Impact of a Mentorship Program on Medical Student Burnout.

BACKGROUND: Burnout can have negative consequences for providers' health and patient care. Mentorship has positive effects including stress mitigation. We sought to evaluate the impact of a mentorship program on burnout in fourth-year medical students during their 4-week emergency medicine subinternship. METHODS: This was a prospective, quasi-experimental, mixed-methods study at two institutions. We assessed burnout using the Maslach Burnout Inventory, comprising three subscales: Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA). We compared changes in burnout scores before and after implementation of a resident-student mentorship program. We compared categorical variables using risk ratios and continuous variables using Wilcoxon rank-sum test. To account for potential confounders, we performed multivariable analysis. Students and mentors completed an evaluative survey. We reported descriptive statistics and performed thematic qualitative analysis on free-response data. RESULTS: A total of 135 students (intervention = 51; control = 84) and 59 mentors participated. Intervention students demonstrated decreased EE and DP and increased PA scores, medians of -2 (-4 to 4), -1 (-3 to 2), and 1 (-1 to 4), respectively, compared to controls, median difference of 0 for all subscales. After adjusting for potential confounders, there was no significant difference in EE (mean difference = -0.2 [-0.5 to 0.2], p = 0.4) or DP scores (mean difference = -0.2 [-1.8 to 1.5], p = 0.9). There was a significant difference in PA scores (mean difference = 2.2 [0.1 to 4.3], p = 0.04). Most students felt the program positively impacted their rotation (39/48) and decreased stress (28/48). Students felt that the program provided career guidance and positively impacted their personal and professional development. The majority (34/37) of mentors enjoyed participating. Qualitative analysis revealed five major themes: relationship building, different perspective, knowledge sharing, personal fulfillment, and self-reflection. CONCLUSION: We found an increased sense of personal accomplishment after implementation of a mentorship program. Both mentors and mentees viewed the program positively and perceived multiple benefits.

Teaching Endotracheal Intubation Using a Cadaver Versus a Manikin-based Model: a Randomized Controlled Trial.

INTRODUCTION: The optimal method to train novice learners to perform endotracheal intubation (ETI) is unknown. The study objective was to compare two models: unembalmed cadaver vs simulation manikin. METHODS: Fourth-year medical students, stratified by baseline ETI experience, were randomized 1:1 to train on a cadaver or simulation manikin. Students were tested and video recorded on a separate cadaver; two reviewers, blinded to the intervention, assessed the videos. Primary outcome was time to successful ETI, analyzed with a Cox proportional hazards model. Authors also compared percentage of glottic opening (POGO), number of ETI attempts, learner confidence, and satisfaction. RESULTS: Of 97 students randomized, 78 were included in the final analysis. Median time to ETI did not differ significantly (hazard ratio [HR] 1.1; 95% CI [confidence interval], 0.7-1.8): cadaver group = 34.5 seconds (interquartile ratio [IQR]: 23.3-55.8) vs manikin group = 35.5 seconds (IQR: 23.8-80.5), with no difference in first-pass success (odds ratio [OR] = 1; 95% CI, 0.1-7.5) or median POGO: 80% cadaver vs 90% manikin (95% CI, -14-34%). Satisfaction was higher for cadavers (median difference = 0.5; p = 0.002; 95% CI, 0-1) as was change in student confidence (median difference = 0.5; p = 0.03; 95% CI, 0-1). Students rating their confidence a 5 ("extremely confident") demonstrated decreased time to ETI (HR = 4.2; 95% CI, 1.0-17.2). CONCLUSION: Manikin and cadaver training models for ETI produced similar time to ETI, POGO, and first-pass success. Cadaver training was associated with increased student satisfaction and confidence; subjects with the highest confidence level demonstrated decreased time to ETI.

Sofosbuvir-based treatment regimens for chronic, genotype 1 hepatitis C virus infection in U.S. incarcerated populations: a cost-effectiveness analysis.

BACKGROUND: Prevalence of chronic hepatitis C virus (HCV) infection is high among incarcerated persons in the United States. New, short-duration, high-efficacy therapies may expand treatment eligibility in this population. OBJECTIVE: To assess the cost-effectiveness of sofosbuvir for HCV treatment in incarcerated populations. DESIGN: Markov model. DATA SOURCES: Published literature and expert opinion. TARGET POPULATION: Treatment-naive men with chronic, genotype 1 HCV monoinfection. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTION: No treatment, 2-drug therapy (pegylated interferon and ribavirin), or 3-drug therapy with either boceprevir or sofosbuvir. For inmates with short remaining sentences (<1.5 years), only no treatment or sofosbuvir 3-drug therapy was feasible; for those with long sentences (≥1.5 years; mean, 10 years), all strategies were considered. After release, eligible persons could receive sofosbuvir 3-drug therapy. OUTCOME MEASURES: Discounted costs (in 2013 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS: The strategies yielded 13.12, 13.57, 14.43, and 15.18 QALYs, respectively, for persons with long sentences. Sofosbuvir produced the largest absolute reductions in decompensated cirrhosis (16%) and hepatocellular carcinoma (9%), resulting in 2.1 additional QALYs at an added cost exceeding $54,000 compared with no treatment. For persons with short sentences, sofosbuvir cost $25,700 per QALY gained compared with no treatment; for those with long sentences, it dominated other treatments, costing $28,800 per QALY gained compared with no treatment. RESULTS OF SENSITIVITY ANALYSIS: High reinfection rates in prison attenuated cost-effectiveness for persons with long sentences. LIMITATIONS: Data on sofosbuvir's long-term effectiveness and price are limited. The analysis did not consider women, Hispanic persons, or patients co-infected with HIV or hepatitis B virus. CONCLUSION: Sofosbuvir-based treatment is cost-effective for incarcerated persons, but affordability is an important consideration. PRIMARY FUNDING SOURCE: National Institutes of Health.