Health related quality of life in patients with Charcot arthropathy of the foot and ankle.

BACKGROUND: Clinical observation suggests that Charcot arthropathy of the foot and ankle has major negative consequences on the quality of life of neuropathic patients, particularly those with diabetes. We hypothesized that the quality of life in patients with Charcot arthropathy may be aggravated by Aboriginal ethnicity and rural residence because of limited access to timely specialty healthcare. METHODS: Sixty patients with Charcot arthropathy were interviewed with the Short Form 36 (SF-36) Health Survey. RESULTS: Mean Physical Component Summary (PCS) score was 31+/-8 points and mean Mental Component Summary (MCS) score was 45+/-10 points. Mean PCS and MCS scores were not affected by gender, ethnicity, residence, or Charcot stage. Mean PCS score was significantly lower in non-employed (unemployed or retired) than employed patients and in patients who did not use alcohol than those who used alcohol; MCS score was not affected by employment status or alcohol use. CONCLUSIONS: Charcot arthropathy has a major negative effect on quality of life. The SF-36 survey was sensitive to the physical effects, but not to mental effects, of Charcot arthropathy.

A prospective study of the relationship between medical knowledge and professionalism among internal medicine residents.

PURPOSE: To explore residents' competency in medical knowledge and in empathy, one element of professionalism, and to evaluate the relationship between competencies in these domains. METHOD: In 2003-2004 and 2004-2005, first-year internal medicine residents at the Mayo Clinic College of Medicine in Rochester, Minnesota were invited to participate in a prospective, longitudinal study of resident competency. Participating residents completed the annual Internal Medicine In-Training Examination (ITE) each October and the Interpersonal Reactivity Index (IRI), a standardized tool to measure empathy administered at multiple time points during training. Changes in medical knowledge and empathy between the fall of postgraduate years one and two were evaluated, and associations between medical knowledge and empathy were explored. RESULTS: Residents' medical knowledge as measured by the ITE increased over the first year of training (mean increase 8.7 points, P < .0001), whereas empathy as measured by the empathic concern subscale of the IRI decreased over this same time period (mean decrease 1.6 points, P = .0003). No significant correlation was found between medical knowledge and empathy or between changes in these domains of competency over time. CONCLUSIONS: Resident competency in the domains of medical knowledge and empathy seems to be influenced by separate and independent aspects of training. Training environments may promote competency in one domain while simultaneously eroding competency in another. Residency programs should devise specific curricula to promote each domain of physician competency.

How do distress and well-being relate to medical student empathy? A multicenter study.

OBJECTIVE: To determine whether lower levels of empathy among a sample of medical students in the United States are associated with personal and professional distress and to explore whether a high degree of personal well-being is associated with higher levels of empathy. DESIGN: Multi-institutional, cross-sectional survey. SETTING: All medical schools in Minnesota (a private medical school, a traditional public university, and a public university with a focus in primary care). PARTICIPANTS: A total of 1,098 medical students. MEASUREMENTS: Validated instruments were used to measure empathy, distress (i.e., burnout and symptoms of depression), and well-being (high quality of life). RESULTS: Medical student empathy scores were higher than normative samples of similarly aged individuals and were similar to other medical student samples. Domains of burnout inversely correlated with empathy (depersonalization with empathy independent of gender, all P < .02, and emotional exhaustion with emotive empathy for men, P = .009). Symptoms of depression inversely correlated with empathy for women (all P < or = .01). In contrast, students' sense of personal accomplishment demonstrated a positive correlation with empathy independent of gender (all P < .001). Similarly, achieving a high quality of life in specific domains correlated with higher empathy scores (P < .05). On multivariate analysis evaluating measures of distress and well-being simultaneously, both burnout (negative correlation) and well-being (positive correlation) independently correlated with student empathy scores. CONCLUSIONS: Both distress and well-being are related to medical student empathy. Efforts to reduce student distress should be part of broader efforts to promote student well-being, which may enhance aspects of professionalism. Additional studies of student well-being and its potential influence on professionalism are needed.

Association of optimism-pessimism with quality of life in patients with head and neck and thyroid cancers.

OBJECTIVE: To examine the relationship between optimism-pessimism and quality of life (QOL) in survivors of head and neck and thyroid cancers. PATIENTS AND METHODS: Between 1963 and 2000, 190 patients completed both the Minnesota Multiphasic Personality Inventory (MMPI), used to assess explanatory style (optimism-pessimism), and either the 12-Item or 36-Item Short-Form Health Survey (SF-12 or SF-36), used to assess QOL. The MMPIs were completed an average of 13.4 years before the QOL assessment. The QOL measures were completed an average of 12.5 years after cancer diagnosis. Patients were divided into quartiles based on their MMPI Optimism-Pessimism scale score. Analysis was performed for all patients, those with head and neck cancer, and those with thyroid cancer. Adjustments were made for age, sex, and disease stage. RESULTS: For all 190 patients, optimism was associated with a higher QOL on both the mental and the physical component scales and 6 of 8 subscales of the SF-12 and SF-36. For patients with head and neck cancer, optimism was associated with higher QOL on 3 subscales but neither component scale. For patients with thyroid cancer, optimism was associated with higher QOL on both component scales and 6 subscales. After adjusting for age, sex, and disease stage, optimism was not associated with QOL in the head and neck cancer group. CONCLUSIONS: Optimism was associated with a higher QOL in survivors of thyroid cancer compared with survivors of head and neck cancer. After adjusting for age, sex, and disease stage, optimism was not associated with QOL for survivors of head and neck cancer. Optimism was more associated with the mental rather than physical QOL subscales.

Personal life events and medical student burnout: a multicenter study.

PURPOSE: Burnout, a marker of professional distress prevalent among residents and physicians, has been speculated to originate in medical school. Little is known about burnout in medical students. The authors sought to identify the prevalence of burnout, variation of its prevalence during medical school, and the impact of personal life events on burnout and other types of student distress. METHOD: All medical students (n = 1,098) attending the three medical schools in Minnesota were surveyed in spring 2004 using validated instruments to assess burnout, quality of life, depression, and alcohol use. Students were also asked about the prevalence of positive and negative personal life events in the previous 12 months. RESULTS: A total of 545 medical students (response rate 50%) completed the survey. Burnout was present in 239 (45%) of medical students. While the frequency of a positive depression screen and at-risk alcohol use decreased among more senior students, the frequency of burnout increased (all p < .03). The number of negative personal life events in the last 12 months also correlated with the risk of burnout (p = .0160). Personal life events demonstrated a stronger relationship to burnout than did year in training on multivariate analysis. CONCLUSIONS: Burnout appears common among U.S. medical students and may increase by year of schooling. Despite the notion that burnout is primarily linked to work-related stress, personal life events also demonstrated a strong relationship to professional burnout. The authors' findings suggest both personal and curricular factors are related to burnout among medical students. Efforts to decrease burnout must address both of these elements.