ABSTRACT
BACKGROUND: Burnout is a complex phenomenon and a major concern in graduate medical education as it directly impacts trainee well-being. Identifying modifiable lifestyle factors over which trainees have immediate control could support timely, actionable, individual and programme-level interventions to combat it. OBJECTIVE: The objective of this pilot study is to describe modifiable lifestyle factors that may limit the development of burnout in medical residents and fellows. METHODS: We performed a cross-sectional survey of residents and fellows at academic medical centre from September 2017 to October 2017. Participants completed the Maslach Burnout Inventory and a questionnaire designed to identify factors hypothesised to be protective against burnout. FINDINGS: A total of 205/805 (25%) trainees completed the survey with a mean (SD) age of 29.7 (2.6) years. 52% (n = 107) were female. Averaging at least 7 h of sleep per night was found to have a significant association with lower scores for the emotional exhaustion (24.8 [11, p = 0.04]) and depersonalisation (11.1 [6.4, p = 0.02]) dimensions of burnout. Additionally, self-identifying as a healthy eater was found to have a significant association with lower scores for emotional exhaustion (25 [11.5, p = 0.03]) and depersonalisation (11.5 [6.6, p = 0.04]) as well. Workouts, hobbies, identifying with organised religion, praying, meditation and mindfulness activities were not associated with a difference. CONCLUSIONS: Adequate sleep (7 or more hours per night) and healthy eating are modifiable individual-level lifestyle factors associated with lower burnout scores in trainees. These items could be a target for trainee education and programme level support initiatives.
ABSTRACT
BACKGROUND: Guidelines for the management of febrile infants emphasize patient-centered communication. Although patient-centeredness is central to high-quality health care, biases may impact physicians' patient-centeredness. We aimed to 1) identify physicians' assumptions that inform their communication with parents of febrile infants and 2) examine physicians' perceptions of bias. METHODS: We recruited physicians from 3 academic pediatric emergency departments (EDs) for semistructured interviews. We applied a constant comparative method approach to conduct a thematic analysis of interview transcripts. Two coders followed several analytical steps: 1) discovery of concepts and code assignment, 2) identification of themes by grouping concepts, 3) axial coding to identify thematic properties, and 4) identifying exemplar excerpts for rich description. Thematic saturation was based on repetition, recurrence, and forcefulness. RESULTS: Fourteen physicians participated. Participants described making assumptions regarding 3 areas: 1) the parent's affect, 2) the parent's social capacity, and 3) the physician's own role in the parent-physician interaction. Thematic properties highlighted the importance of the physician's assumptions in guiding communication and decision-making. Participants acknowledged an awareness of bias and specifically noted that language bias influenced the assumptions that informed their communication. CONCLUSIONS: ED physicians described subjective assumptions about parents that informed their approach to communication when caring for febrile infants. Given the emphasis on patient-centered communication in febrile infant guidelines, future efforts are necessary to understand how assumptions are influenced by biases, the effect of such behaviors on health inequities, and how to combat this.
ABSTRACT
Background: Trauma team leadership is a core skill for the practice of emergency medicine (EM). In this study our goal was to explore EM residents' perception of their trauma leadership skill development through formal and informal processes and to understand factors that may impact the development and implementation of trauma leadership skills. Methods: Using qualitative semi-structured interviews, we explored the leadership experiences of 10 EM residents ranging from second to fourth postgraduate year. Interviews were conducted between July 26-October 31, 2019 and were audio-recorded, transcribed, and de-identified. We analyzed data using qualitative content analysis. Results: Residents discussed three main themes: 1) sources of leadership development; 2) challenges with simultaneously assuming a dual leader-learner role; and 3) contextual factors that impact their ability to assume the leadership role, including the professional hierarchy in the clinical environment, limitations in the physical environment, and gender bias. Conclusion: This study describes the complex factors and experiences that contribute to the development and implementation of trauma team leadership skills in EM residents. This includes three primary sources of leadership development, the dual role of leader and learner, and various contextual factors. Research is needed to understand how these factors and experiences can be leveraged or mitigated to improve resident leadership training outcomes.
Subject(s)
Emergency Medicine , Leadership , Male , Humans , Female , Sexism , Qualitative Research , EnvironmentABSTRACT
INTRODUCTION: The management of low-risk febrile infants presents a model population for exploring how implicit racial bias promotes inequitable emergency care for children who belong to racial, ethnic and language minority groups. Although widely used clinical standards guide the clinical care of febrile infants, there remains substantial variability in management strategies. Deviations from recommended care may be informed by the physician's assessment of the family's values, risk tolerance and access to supportive resources. However, in the fast-paced emergency setting, such assessments may be influenced by implicit racial bias. Despite significant research to inform the clinical care of febrile infants, there is a dearth of knowledge regarding health disparities and clinical guideline implementation. The proposed mixed methods approach will (1) quantify the extent of disparities by race, ethnicity and language proficiency and (2) explore the role of implicit bias in physician-patient communication when caring for this population. METHODS AND ANALYSIS: With 42 participating sites from the Pediatric Emergency Medicine Collaborative Research Committee, we will conduct a multicenter, cross-sectional study of low-risk febrile infants treated in the emergency department (ED) and apply multivariable logistic regression to assess the association between (1) race and ethnicity and (2) limited English proficiency with the primary outcome, discharge to home without lumbar puncture or antibiotics. We will concurrently perform an interpretive study using purposive sampling to conduct individual semistructured interviews with (1) minority parents of febrile infants and (2) paediatric ED physicians. We will triangulate or compare perspectives to better elucidate disparities and bias in communication and medical decision-making. ETHICS AND DISSEMINATION: This study has been approved by the University of Florida Institutional Review Board. All participating sites in the multicenter analysis will obtain local institutional review board approval. The results of this study will be presented at academic conferences and in peer-reviewed publications.
