Implementation of a "Best Self" Exercise to Decrease Imposter Phenomenon in Residents.

Background Imposter phenomenon (IP) is common in medicine. An intervention from the business world, the Reflected Best Self Exercise (RBSE), in which an individual elicits stories of themselves at their best, has not been studied in medical residents. Objective To determine the feasibility of implementing the RBSE and its potential for reducing IP in residents. Methods All incoming internal medicine and medicine-pediatrics interns in the 2022-2023 academic year at a single institution were invited to complete the RBSE. Participants elicited stories from contacts prior to beginning residency and received their stories during intern orientation in a 1-hour session led by one author with no prior training. Cost and time requirements were assessed. IP was measured via the Clance Impostor Phenomenon Scale (CIPS) at baseline, 1 month, and 6 months following the RBSE. Informal feedback on the RBSE was collected via surveys at 1 month and 6 months. Results Nineteen of 35 interns (54.3%) completed the RBSE. It cost $75 per participant, for a total cost of $1,425. Twenty-eight of 35 (80%) completed the baseline CIPS, with scores similar between participants and nonparticipants (64.9 vs 68.9). CIPS scores were lower in participants at 1 month (57.6 vs 69.6) and 6 months (55.6 vs 64.5) but did not meet statistical significance. Survey feedback from participants suggested the intervention was beneficial. Conclusions Implementing the RBSE in residents was feasible with reasonable cost and time commitment. It appeared highly acceptable to residents, with some promise of effects on an IP scale.

Reducing the Incidence of Retained Double-J Ureteral Stents: A Multidisciplinary Approach.

INTRODUCTION: Double-J® ureteral stents are temporary tubes used for ureteral patency that can cause serious complications if left beyond the allotted time. We developed a streamlined framework that allows for Double-J stent tracking to alert patients to the need for removal. METHODS: By creating a multidisciplinary committee we developed a database of patients with Double-J stents who presented to our facility between 2012 and 2014. The database was populated by a query of the billing system, generating HIPAA compliant stent removal reminder letters. Three queries (A, B and C) were developed using a combination of billing codes and each query was compared to a gold standard list. RESULTS: The ICD-9 ureteral catheterization code used to perform query A was only 28% sensitive. Query B (using CPT or HCPCS codes) was 98% sensitive. However, it incorrectly captured many patients with nonureteral stents. Our final query method, query C, rectified this issue by using the ICD-9 code with CPT or HCPCS codes, resulting in the highest sensitivity (78%) while minimizing undesired stent capture. CONCLUSIONS: We developed an automated and reproducible program that correctly identifies and alerts a high percentage of patients to the need to remove their stent. Repeated audits of our query methods combined with regular meetings of a multidisciplinary Double-J stent committee were integral to developing and maintaining this system. By promoting proactive awareness for patients as well as physicians, we are working to minimize the incidence of retained Double-J stents and associated complications.

Active surveillance of very-low-risk prostate cancer in the setting of active treatment of benign prostatic hyperplasia with 5α-reductase inhibitors.

OBJECTIVE: To review the efficacy of treating benign prostatic hyperplasia and very-low-risk prostate cancer (PCa) in patients receiving active surveillance and 5α-reductase inhibitor (5-ARI; finasteride or dutasteride) treatment. MATERIALS AND METHODS: Eighty-two men with very-low-risk PCa (clinical stage T1c, Gleason score ≤ 6, <3 biopsy cores positive with ≤ 50% involvement, and prostate-specific antigen density ≤ 0.15 ng/mL/g) and benign prostatic hyperplasia (≥ 30 cm(3)) received active surveillance and were treated with a 5-ARI. RESULTS: All 82 men completed 1 year of 5-ARI therapy (n = 79) or underwent early biopsy for cause (n = 3). Restaging biopsies were performed for 76 men (22 underwent a second restaging biopsy and 1 a third restaging biopsy), 4 patients were awaiting biopsy, and 2 were lost to follow-up before the first restaging biopsy. At the first restaging biopsy, of the 76 men, 41 (54%) had no PCa, 16 (21%) continued to have very-low-risk PCa, 15 (20%) had progressed to low-risk PCa (>2 cores positive and Gleason score ≤ 6), and 4 (5%) had progressed to intermediate-risk PCa (Gleason score 7). Of the 76 biopsies, 20 were performed early for cause, with 11 (55%) showing PCa progression. Of the 82 patients, 22 (27%) underwent treatment of PCa. CONCLUSION: Active surveillance of very-low-risk PCa in the setting of 5-ARI therapy for benign prostatic hyperplasia appears to be a safe therapeutic option, because most (57 of 82; 70%) patients maintained very-low-risk PCa or had negative follow-up biopsies during a 3-year follow-up period. Complementary to the Prostate Cancer Prevention Trial, our results indicate that 5-ARI therapy increases prostate-specific antigen sensitivity and can aid the clinician in appropriately targeting biopsies.