The Prevalence of Faculty Physician Burnout in Military Graduate Medical Education Training Programs: A Cross-Sectional Study of Academic Physicians in the United States Department of Defense.

INTRODUCTION: In military populations, physician burnout has potential to adversely affect medical readiness to deploy in support of joint operations. Burnout among Graduate Medical Education (GME) faculty may further threaten the welfare of the medical force given the central role these officers have in training and developing junior physicians. The primary aim of this investigation was to estimate the prevalence of burnout among faculty physicians in United States (US) Army, Navy, and Air Force GME programs. MATERIALS AND METHODS: We conducted a cross-sectional study of faculty physicians at US military GME training programs between January 2018 and July 2018. Through direct coordination with Designated Institutional Officials, we administered the Maslach Burnout Inventory Health Services Survey (MBI-HSS) via online web link to faculty physicians listed in Accreditation Data System at each sponsoring institution. In addition to the MBI-HSS, we collected demographic data and queried physicians about common occupational stressors in order to assist institutional leaders with identifying at-risk physicians and developing future interventions to address burnout. RESULTS: Sixteen of 21 institutions that currently sponsor military GME programs agreed to distribute the MBI-HSS survey to core faculty. We received completed assessments from 622 of the 1,769 (35.1%) reported physician core faculty at these institutions. Of the 622 physician respondents, 162 demonstrated high levels of emotional exhaustion and depersonalization for an estimated 26% prevalence of burnout. We identified only one independent risk factor for burnout: increasing numbers of deployments (OR 1.38, 95% CI 1.07-1.77). Physicians in our cohort who reported a desire to stay beyond their initial active duty service obligation were less likely to be classified with burnout (OR 0.45, 95% CI 0.26-0.77). The most common drivers of occupational distress were cumbersome bureaucratic tasks, insufficient administrative support, and overemphasis on productivity metrics. CONCLUSIONS: We estimate that 26% of physician faculty in military GME programs are experiencing burnout. No specialty, branch of service, or specific demographic was immune to burnout in our sample. Institutional leaders in the MHS should take action to address physician burnout and consider using our prevalence estimate to assess effectiveness of future interventions.

Humanitarian Surgical Missions: Guidelines for Successful Anesthesia Support.

Many anesthesiologists and CRNAs are provided little training in preparing for a humanitarian surgical mission. Furthermore, there is very little published literature that outlines how to plan and prepare for anesthesia support of a humanitarian surgical mission. This article attempts to serve as an in-depth planning guide for anesthesia support of humanitarian surgical missions. Recommendations are provided on planning requirements that most anesthesiologists and CRNAs do not have to consider on routinely, such as key questions to be answered before agreeing to support a mission, ordering and shipping supplies and medications, travel and lodging arrangements, and coordinating translators in a host nation. Detailed considerations are included for all the phases of mission planning: advanced, mission-specific, final, mission-execution, and postmission follow-up planning, as well as a timeline in which to complete each phase. With the proper planning and execution, the anesthetic support of humanitarian surgical missions is a very manageable task that can result in an extremely satisfying sense of accomplishment and a rewarding experience. The authors suggest this article should be used as a reference document by any anesthesia professional tasked with planning and supporting a humanitarian surgical mission.

Introducing a Novel Applicant Ranking Tool to Predict Future Resident Performance: A Pilot Study.

The purposes of this study are to (1) introduce our novel Applicant Ranking Tool that aligns with the Accreditation Council for Graduate Medical Education competencies and (2) share our preliminary results comparing applicant rank to current performance. After a thorough literature review and multiple roundtable discussions, an Applicant Ranking Tool was created. Feasibility, satisfaction, and critiques were discussed via open feedback session. Inter-rater reliability was assessed using weighted kappa statistic (κ) and Kendall coefficient of concordance (W). Fisher's exact tests evaluated the ability of the tool to stratify performance into the top or bottom half of their class. Internal medicine and anesthesiology residents served as the pilot cohorts. The tool was considered user-friendly for both data input and analysis. Inter-rater reliability was strongest with intradisciplinary evaluation (W = 0.8-0.975). Resident performance was successfully stratified into those functioning in the upper vs. lower half of their class within the Clinical Anesthesia-3 grouping (p = 0.008). This novel Applicant Ranking Tool lends support for the use of both cognitive and noncognitive traits in predicting resident performance. While the ability of this instrument to accurately predict future resident performance will take years to answer, this pilot study suggests the instrument is worthy of ongoing investigation.

Milestone-specific, Observed data points for evaluating levels of performance (MODEL) assessment strategy for anesthesiology residency programs.

BACKGROUND: Anesthesiology residency programs will be expected to have Milestones-based evaluation systems in place by July 2014 as part of the Next Accreditation System. METHODS: The San Antonio Uniformed Services Health Education Consortium (SAUSHEC) anesthesiology residency program developed and implemented a Milestones-based feedback and evaluation system a year ahead of schedule. It has been named the Milestone-specific, Observed Data points for Evaluating Levels of performance (MODEL) assessment strategy. RESULTS: The "MODEL Menu" and the "MODEL Blueprint" are tools that other anesthesiology residency programs can use in developing their own Milestones-based feedback and evaluation systems prior to ACGME-required implementation. Data from our early experience with the streamlined MODEL blueprint assessment strategy showed substantially improved faculty compliance with reporting requirements. CONCLUSIONS: The MODEL assessment strategy provides programs with a workable assessment method for residents, and important Milestones data points to programs for ACGME reporting.

Predicting Success: Does Performance on the Anesthesia Knowledge Test - 6 (AKT-6) correlate with the American Board of Anesthesiology (ABA) Licensing Exam first-time pass rate?

BACKGROUND: We sought to determine the relationship between residents' Anesthesia Knowledge Test 6 (AKT-6) scores and their first-time success/failure on the American Board of Anesthesiology written licensing examination. Reliable early identification of residents at risk for failing the ABA exam would be an invaluable screening tool for program leadership and facilitate timely remediation for struggling residents. METHODS: Program directors were invited to submit anonymous data regarding their residents' performance on the AKT-6 and their subsequent first-time success/failure on the American Board of Anesthesiology written licensing examination. RESULTS: Eight residency programs responded with AKT6 percentile scores and ABA part 1 first-time pass/fail status from 306 residents spanning 2004-2011. Of these, 292 also included AKT6% correct scores. AKT-6 performance was significantly better for trainees who went on to pass the ABA exam on their first attempt compared to those who failed. Trainees who scored at or below the 4(th) percentile (or answered ≤42% of questions correctly) failed the ABA exam while all those scoring above the 84(th) percentile (or answered >68% of questions correctly) passed. A Mantel-Haenszel common odds ratio estimate revealed significantly increased odds of failure below the thresholds of AKT-6 scores ≤ 36(th) percentile (≤56% correct). CONCLUSIONS: Observations from this work help to validate educators' use of AKT-6 exam performance as a marker for likelihood of success/failure on the ABA written licensing exam. Our analysis, based on data from eight training programs, yielded definitive cut points for ABA exam failure and passing. ROC analysis of our data supports a recommendation for educators to intervene with trainees scoring at or below the 36(th) percentile or 56% correct on AKT-6 testing. Our results likely require confirmation in a larger subset of anesthesiology residency programs.

The importance of a military-unique curriculum in active duty graduate medical education.

Military residency training programs are unique in a number of ways, none more significant than the fact that our graduates become our colleagues and future teammates on lengthy deployments. We have a fundamental responsibility to make sure that they are up to the task. Although certainly not a panacea, a well-crafted military-unique curriculum goes a long way toward creating the kind of institutional culture and training mindset that enables a successful transition from active duty resident to deployable physician.