Medical Student Burnout as Impacted by Trait Emotional Intelligence - Moderated by Three-Year and Four-Year Medical Degree Programs and Gender.

INTRODUCTION: Medical student burnout has received increasing attention in recent years due to greater acceptance of psychological and emotional vulnerability in the health care profession. Given the significant investment of personal and financial resources in this demanding profession, continued evaluation of factors contributing to burnout in medical training is necessary. A midwestern medical college with a longstanding 4-year medical degree program created 2 regional campuses that utilize a calendar-efficient 3-year medical degree program. The objective in this study is to examine if medical student burnout scores are higher for students on the 3-year campuses and how that is affected by emotional intelligence. METHODS: First- and second-year medical students voluntarily completed the Maslach Burnout Inventory for Students (scale: 1 = never, 7 = every day) and the Trait Emotional Intelligence Questionnaire (scale: 1 = completely disagree, 7 = completely agree). Multifactor analysis of variance assessed mean differences in burnout between campus and gender. Multivariate linear regressions were used for predicting burnout from emotional intelligence. RESULTS: Three-year campus students reported significantly (P<0.010) higher mean [SD] scores (8.3 [2.0]) than the 4-year campus students (7.4 [2.4]), and female students reported significantly (P<0.049) higher scores (8.2 [2.0]) than male students (7.6 [2.4]). Five emotional intelligence facets were independently associated with increased burnout scores (R² = 0.26, P<0.001) but significantly varied with campus and gender. CONCLUSIONS: There were higher burnout scores in students studying on the two 3-year campuses compared to students on the traditional 4-year campus and higher scores for female students than male students. Different facets of emotional intelligence mitigated student burnout by campus and gender.

Student Leadership Development Initiative: Benefits of a Unique Medical Student Organization.

BACKGROUND: The Student Leadership Development Initiative was founded at the Medical College of Wisconsin to unite local physician leaders with Medical College of Wisconsin students to develop leadership skills and prepare for careers expanding beyond clinical practice. METHODS: An anonymous survey was distributed to 246 current and past Student Leadership Development Initiative participants, probing confidence in leadership skills, professional goals, and the perceived importance of leadership training. Feedback interviews were also conducted. RESULTS: Respondents reported improvement in areas such as compassion, leadership, and development of career goals. The perceived benefit for developing professional goals and compassion are positively related (P < 0.01) to the number of sessions attended. DISCUSSION: Survey results highlight the importance of leadership training in medical education and suggest an integration strategy for a successful leadership training platform.

Medical Education with 3-Year Regional Campuses: Do They Attract a Different Type of Applicant?

BACKGROUND: In response to calls to increase class sizes, the Medical College of Wisconsin (MCW) opened two new 3-year community-based regional campuses in 2016 and 2017. The goal of this study was to analyze whether the applicants and accepted student pools differed for the school's 3-year and 4-year campuses. METHODS: Deidentified data from Wisconsin applicants to MCW for the class enrolling in 2017 were categorized based on their preference for the Milwaukee or a regional campus. Applicants and admitted student data were compared on Medical College Admissions Test (MCAT) score, undergraduate school grade point average (GPA), sex, age, research intensity of their undergraduate school (Carnegie 1 classification vs all others) and Wisconsin county of residency. RESULTS: Regional campus applicants were significantly older (24.6 vs 23.7, P = 0.023), more likely to reside in nonurban counties (33% vs 13%, < 0.001), attend nonresearch-intense undergraduate schools (65% vs 44%, P < 0.001) and had lower mean MCAT scores (d=0.77, P < .001) than applicants to the Milwaukee campus. Regression models indicated 4 applicant qualities were associated with a preference for 4-year (values > 1.0) or 3-year (values < 1.0) campus: graduation from a Carnegie 1 undergraduate school (OR = 1.626; 95% CI, 1.01 - 2.62), a higher age at the time of application (OR = 1.092; 95% CI, 1.01 - 1.18), total MCAT score (OR = 0.916; 95% CI, 0.89 - 0.95), and permanent residence in a rural Wisconsin county (OR = 0.349; 95% CI, 0.21 - 0.59). When we examined students who were accepted and matriculated as opposed to just applicants, regression models showed that students with higher ages were more likely to attend the 4-year campus (OR = 1.42; 95% CI, 1.15 - 1.76), while a higher total MCAT score (OR = 0.83; 95% CI, 0.76 - 0.91) and rural county residency (OR = 0.27; 95% CI, .1 - 0.73) were associated with atriculation to the 3-year regional campuses. CONCLUSIONS: These results indicate that the regional 3-year campus model is attracting and selecting students with some differences from those at MCW's 4-year campus. After adjusting for other characteristics, students matriculating to the regional 3-year campuses are nearly 4 times more likely to come from a rural county and have slightly higher MCAT scores.

Student Leadership Development Initiative: A Pilot for a Sustainable, Replicable Model for Incorporating Leadership into Medical Education.

INTRODUCTION: Today's medical students are tomorrow's leaders. As leadership training becomes incorporated into undergraduate medical education, there is a need for validated educational models that are both effective and replicable. METHODS: Between April 2017 and October 2017, groups of 15 to 20 medical students participated in sessions with an exemplary physician leader incorporating a guided interview format and discussion about her or his career. Prepared questions ensured leadership domains were covered. The program was evaluated using a post-session survey. RESULTS: One hundred percent of survey respondents (N = 58) reported that the session was a good use of time. Seventy-eight percent felt more prepared to lead a team; 93% learned specific ways to improve their leadership skills. DISCUSSION: This leadership program is a unique model to provide leadership education to medical students that is both effective and replicable.

Medical Student Mock Interviews to Improve Residency Interviewing and Match Success.

PURPOSE: Using a quasi-experimental approach, we examined student and faculty satisfaction with a mock residency interview program. We also examined whether self-selected participants had match rates that differed from nonparticipants. METHODS: Interviews were arranged on a specified evening between students and a physician in the specialty to which the student wished to apply. Interviews were structured as similarly to residency interviews as possible, but included 10 minutes of verbal feedback and subsequent written feedback to all students. Students completed surveys indicating their satisfaction with the mock interview immediately following the interview and 5 months later (after their actual resident interviews). Faculty feedback to students and their satisfaction with the program also was collected. Out of 189 (55%) students in the senior class, 104 volunteered to participate. RESULTS: Immediately following the mock interview, over 90% of students who participated either strongly agreed or agreed that the interview feedback was helpful, seemed realistic, and helped them identify strengths and weaknesses. Responses collected 5 months later were still favorable, but less positive. Faculty identified 7 students who they believed had poor interview techniques and an additional 13 who interviewers believed would be unlikely to match in their specialty. Final match results for the group participating in the mock interview showed a primary match rate of 99%, which was higher than students who did not participate (94%, P < .001). CONCLUSION: In a self-selected group of students who chose to participate, mock interviews were useful in improving student match success compared to students who did not participate in the mock interview program. Because all students were not required to participate, it is unclear whether this tactic would be successful for all students.

The Merits and Challenges of Three-Year Medical School Curricula: Time for an Evidence-Based Discussion.

The debate about three-year medical school curricula has resurfaced recently, driven by rising education debt burden and a predicted physician shortage. In this Perspective, the authors call for an evidence-based discussion of the merits and challenges of three-year curricula. They examine published evidence that suggests that three-year curricula are viable, including studies on three-year curricula in (1) U.S. medical schools in the 1970s and 1980s, (2) two Canadian medical schools with more than four decades of experience with such curricula, and (3) accelerated family medicine and internal medicine programs. They also briefly describe the new three-year programs that are being implemented at eight U.S. medical schools, including their own. Finally, they offer suggestions regarding how to enhance the discussion between the proponents of and those with concerns about three-year curricula.

Cost and Utilization: Hospitalized Patients on a Family Medicine Service.

OBJECTIVES: The cost of hospitalizations contributes to the rising expense of medical care in the United States. Providing health insurance to uninsured Americans is a strategy to reduce these costs, but only if costs for uninsured patients are disproportionately high. This study examined hospitalization use patterns for uninsured patients compared with those with Medicaid and commercial insurance. METHODS: We performed a retrospective chart review to analyze inpatient admissions to a family medicine teaching service in a 290-bed, for-profit community hospital during a 2-year period based on insurance status of the patient. Outcome variables investigated were length of stay, emergency department visits, and readmission rates to the hospital and/or emergency department. Secondary outcome variables were mean charges. RESULTS: A total of 1102 admissions to a family medicine teaching service were evaluated. Length of stay, readmission rates to the hospital and the emergency department after hospital discharge, and average length of stay compared with diagnosis-related groups were significantly higher in the Medicaid population than for insured and uninsured individuals. Variable costs also were significantly higher. CONCLUSIONS: Insurance status was found to be a significant factor in hospital charges and utilization data, with Medicaid patients having the highest costs. This suggests that moving uninsured patients to Medicaid may not significantly reduce hospitalization costs.

Rhinosinusitis.

Although sinusitis is common, controversy exists regarding terminology, diagnostic criteria, indications for imaging, and treatment guidelines. Patients who are diagnosed with bacterial sinusitis should be started on amoxicillin-clavulanate unless an allergy to penicillin is reported, in which case doxycycline or a respiratory fluoroquinolone is indicated for non-pregnant patients. Patients who fail to respond to antibiotic therapy should be suspected of having chronic sinusitis, which may requirea dditional therapy, including endoscopic surgery. Referral of these patients to an otolaryngologist for further evaluation is recommended. Patients with severe systemic symptoms including altered mental status or severe headaches should be suspected of having fungal sinusitis and to an otolaryngologist acutely because this condition has high mortality if not treated emergently.

Medical school research intensity and academic rank of family medicine faculty.

BACKGROUND: Family medicine research productivity has been reported to be less than that of other academic disciplines. This difference could be reflected in academic success for family medicine faculty at schools where National Institutes of Health (NIH) funding in emphasized. This study sought to determine if academic rank for family medicine faculty was different at schools with higher NIH funding compared to those with less funding. METHODS: From the latest available list of NIH funding by institution, we selected 10 medical schools each from the higher, middle, and lowest tertile of overall funding (30 total schools). Using departmental web sites, we compared the percentage of family medicine faculty at assistant, associate, and professor rankings with those of other generalist divisions and two other sample departments. RESULTS: The distribution of faculty ranks for family medicine faculty does not differ based on the level of NIH funding of the school. When compared to other disciplines, family medicine faculty were less likely to be at advanced ranks compared to some disciplines (neurology) but more likely than in others (general internal medicine). CONCLUSION: The level of NIH funding does not appear to be a predictor of success at achieving higher faculty ranks for family medicine faculty.

Section one. Acute and chronic rhinosinusitis.

Rhinosinusitis is one of the most common conditions seen by family physicians. Most cases are viral in nature and resolve spontaneously. When symptoms persist for 10 days or more or are accompanied by severe pain and fever, bacterial sinusitis may be present. Current guidelines recommend that acute bacterial sinusitis be treated with amoxicillin-clavulanate. Chronic bacterial sinusitis typically involves a change in the sinus ostia and microbiology. This rarely resolves with antibiotic treatment alone and often warrants surgical intervention. Fungal sinusitis is a rare condition seen more often in immunosuppressed individuals and manifests in severe symptoms along with possible neurologic findings.

Section two: otitis media.

With the widespread use of vaccinations against Streptococcus pneumoniae, the frequency of acute otitis media (OM) has decreased significantly in recent years. Current management varies considerably in different countries, but there is consensus that most mild cases in children older than 6 months can be treated with observation and analgesics. When antibiotic therapy is indicated for children younger than 6 months or older children with severe or unrelenting symptoms, initial management with amoxicillin or amoxicillin-clavulanate is recommended. For children with recurrent OM or persistent serous OM, prophylactic antibiotic regimens appear to be effective. Insertion of tympanostomy tubes can be useful to prevent recurrences but confers little benefit on speech acquisition. Tonsillectomy and adenoidectomy yield minimal benefit for children with OM.

Section three: oral cancers.

Oral cancers are uncommon in the United States. Risk factors for oral cancer include tobacco use, alcohol consumption, and high-risk oral human papillomavirus infection. Precancerous lesions, such as leukoplakia, may lead to oral cancers, but the majority of precancerous lesions never undergo malignant transformation. Management and prognosis for oral cancers vary widely depending on the site of the cancer. Lip cancers typically are detected early and have the greatest likelihood for cure and long-term patient survival. Cancers of the pharynx and tonsil have poor survival rates even when diagnosed in early stages. The best approach to preventing oral cancers is to control risk factors.

Section four: laryngitis and dysphonia.

Acute laryngitis is most often caused by viral illnesses through direct inflammation of the vocal cords or from irritation due to postnasal drainage. Bacterial infections, such as acute epiglottitis, also can cause dysphonia but typically have other systemic symptoms as well as respiratory distress. Chronic laryngitis is characterized by symptoms lasting more than 3 weeks. Chronic vocal cord issues can be related to overuse or stress on the vocal cords resulting in nodules or polyps. Individuals in certain occupations, such as singers, school teachers, and chemical workers, are at greater risk of chronic laryngitis. The diagnostic approach to chronic laryngitis should include visualization of the vocal cords to rule out potential malignant lesions. For acute and chronic overuse symptoms, the best treatment is vocal rest. The use of antibiotics or decongestants should be discouraged.

Patients' preference for physician attire: a survey of patients in family medicine training practices.

BACKGROUND: Conflicting evidence exists about how patients would like their doctors to dress. This is complicated by new evidence showing elements of common physician attire (white coat or ties) can be contaminated with pathogens. METHODS: We conducted a survey on a convenience sample of adult patients in three academic primary care offices in South Carolina and Ohio during the summer of 2010. The survey asked about patient preferences for physician attire and how their doctor usually dressed. After a brief statement regarding evidence of microbial contamination of coats and ties, the preferences were reexamined. RESULTS: A total of 432 patients participated in the survey. No clear preference was stated by patients, and patients' initial preference was not closely related to their own physicians' customary attire. After reading the statement about microbial contamination, a significant percentage of patients changed their preference to select categories that did not include a tie or a white coat and tie. This information was associated with a large shift in preference to having physicians wear dress shirts and slacks with no tie (from 16% to 41%). CONCLUSIONS: Patients in these three academic family medicine practices did not show any consistent preference for their physicians' attire. However, providing information about potential microbial contamination of clothing was associated with a shift in patient preferences for physicians not wearing a tie and a white coat.

Trends in hospitalizations with antibiotic-resistant infections: U.S., 1997-2006.

OBJECTIVES: Antibiotic resistance is a significant global problem, but the trends in prevalence and impact of antibiotic resistance in hospitalizations in the United States are unclear. We evaluated the trends in hospitalizations associated with antibiotic-resistant infections in U.S. hospitals from 1997 to 2006. METHODS: We analyzed the National Hospital Discharge Survey (NHDS) during 1997-2006 (unweighted n = 3.3 million hospitalizations; weighted n = 370.3 million hospitalizations) and examined trends in prevalence of hospitalizations with antibiotic-resistant infections, length of stay, and discharge status. RESULTS: The number of infection-related hospitalizations with antibiotic resistance increased 359% during the 10-year period, from 37,005 in 1997 to 169,985 in 2006. The steepest rise was seen among individuals < 18 years of age. The mean age of individuals with infection-related hospitalizations that had antibiotic-resistant infections decreased substantially, from 65.7 years (standard error [SE] = 2.01) in 1997 to 44.2 years (SE = 1.47) in 2006. As the proportion of patients with antibiotic-resistant infections who did not have insurance increased, the length of stay for those hospitalizations had a corresponding decrease (r = 0.91, p < 0.01). CONCLUSIONS: Antibiotic-resistant infections are becoming increasingly commonplace in hospitalizations in the U.S., with a steady upward trend between 1997 and 2006. Antibiotic-resistant infections are increasingly being seen in younger patients and those without health insurance.