RESUMO
Background: With long hours, significant responsibilities, and a heavy workload, residency can be an incredibly stressful experience. The aim of our study was to assess the impact of residency on mental health and wellness. A secondary aim was to determine if the post-graduate year (PGY) of the different residents impacted their mental health or ability to cope with the stressors of residency. Methods: Residents in anesthesiology, family medicine, internal medicine, and surgery were invited to complete a survey. The first portion of the survey had residents rank their mental health on a scale from 1 to 5. There was also a short-form answer portion, which collected suggestions on how to improve wellness. An analysis of variance was used to compare the means of 2 continuous outcome variables-Patient Health Questionnaire (PHQ) and burnout scores compared across specialties and post-graduate years. Burnout scores were measured using the Oldenburg Burnout Inventory. This survey was created and validated by psychology researchers to assess burnout based on the strongest indicators of burnout-emotional exhaustion and disengagement from work. The PHQ9 survey was chosen as it has a specificity of 91-94% and is a reliable method to screen for depression, a common companion to burnout. Results: PHQ9 scores were highest among surgery residents (7.2 ± 7.07), followed by anesthesia (6.59 ± 6.64), emergency medicine (5.57 ± 4.09), and internal medicine (4.82 ± 3.68). Scoring was also higher among PGY4-6 residents. Burnout scores were highest among surgery (37.8 ± 8.69) and anesthesia (38.17 ± 7.09) residents and among PGY4-6 residents. PGY4-6 residents had a mean burnout score of 38.55 ± 7.67 compared to 36.17 ± 8.69 among first-year residents. Similarly, the P value noted no significant difference among burnout scores across either specialty or year: .5930 and .8061. Conclusion: There was no significant difference among specialties or years in training among their subjective ratings of depression.
RESUMO
Description Chiari malformations (CMs) are congenital defects of the brain and skull that result in inferior displacement of the cerebellum. There are four types of CMs distinguished by the severity of the anatomic defects and parts of the brain that protrude beyond the foramen magnum. Of these types, CM Type I (CMI) is the least severe. It is characterized by the downward displacement of the cerebellar tonsils beyond the foramen magnum by more than 5 millimeters and goes into the cervical spinal canal. CMI is the most common type with an incidence of 0.1-0.5% in the general population and a predominance in females. Given its relatively benign nature, CMI is often found incidentally or in adulthood when symptoms such as a headache or neck pain are present. It can be associated with syringomyelia or, less commonly, hydrocephalus. Although surgical decompression can be performed, most patients do not require surgical treatment. CMs present a unique challenge for anesthesiologists providing care to parturients. Since a majority of patients do not have a history of surgical decompression or ventriculoperitoneal shunting, it is difficult to evaluate for hydrocephalus when the patient is in labor. Therefore, many patients with diagnosed CMI are scheduled for an elective cesarean section. Numerous case reports and literature reviews have documented the successful use of spinals, epidurals and combined spinal-epidurals (CSEs) in these patients without neurologic sequelae. The patient in this case presented with CMI, which was diagnosed one year prior to our encounter, without any treatment. At the time of labor, she was asymptomatic. Although she had two prior vaginal deliveries under epidural anesthesia, she was scheduled for an elective cesarean section this time given the new diagnosis. This case report demonstrates the safe and successful use of epidural anesthesia for a parturient with CMI.
