To Disclose or Not: Residency Application and Psychiatric Illness

Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study

BACKGROUND

A high workload may negatively impact the surgical team's performance and jeopardize patient safety. The aim of this study was to measure the workload of the surgical team across different surgical roles, specialties, and techniques in several hospitals.

METHODS

This cross-sectional multicenter study was performed in the operating rooms of eight teaching hospitals affiliated with Isfahan University of Medical Sciences, Iran. At the conclusion of each surgical procedure, all members of the surgical team completed the Surgery Task Load Index (SURG-TLX) questionnaire to assess workload levels. Descriptive statistics, analysis of variance (ANOVA), and Pearson correlations, were performed to compare surgical roles, specialties, techniques, and surgical time on workload overall and by subscale.

RESULTS

A total of 409 workload questionnaires were obtained from 76 surgical teams or cases, involving 346 surgical team members. The total workload among all participants was 32.41 ± 17.21. Surgical complexity, physical demands, and mental demands were the highest workload subscales and distraction was the lowest workload subscale. Cardiovascular specialty had a higher workload compared to other specialties. Open techniques resulted in a higher workload compared to minimally invasive techniques. Surgical technologists who act in both the role of circulating and scrub nurse (C&Ss) experienced the highest workload, followed by surgical residents and surgeons.

CONCLUSIONS

The results of the study showed that the workload for some members of the surgical team is disproportionately high and is influenced by factors such as specialty, technique, role, and surgical duration. By knowing the distribution of workload among the members of the surgical team, efforts can be made to optimize the team members' workload.

Should I write about mental health on my med school app? Examining medical school admissions committee members' biases regarding mental health conditions

Mental health conditions can impact college students' academic achievements and experiences. As such, students may choose to disclose mental illnesses on medical school applications. Yet, no recent studies have investigated to what extent disclosure of a mental health condition may impact whether an applicant is accepted to medical school. We conducted an audit study to address this gap and surveyed 99 potential medical school admissions committee members from over 40 M.D.-granting schools in the United States. Participants rated a fictitious portion of a single medical school application on acceptability, competence, and likeability. They were randomly assigned to a condition: an application that explained a low semester grade-point average due to 1) a mental health condition, 2) a physical health condition, or 3) offered no explanation. After rating their respective application, all committee members were asked about when revealing a mental health condition would be beneficial and when it would be detrimental. Using ANOVAs, multinomial regression, and open coding, we found that medical school admissions committee members do not rate applications lower when a mental health condition is revealed. Committee members highlighted that revealing a mental health condition to demonstrate resiliency could be beneficial, but if the reference is vague or the condition is not being managed, it could be detrimental to a student's application. This work indicates that medical school admissions committee members do not exhibit a bias against mental health conditions and provides recommendations on how to discuss mental illness on medical school applications.

Perfectionism, Power, and Process: What We Must Address to Dismantle Mental Health Stigma in Medical Education

In this commentary, the authors draw on 2 personal accounts of mental illness published by Kirk J. Brower, MD, and Darrell G. Kirch, MD, in this issue to consider how and why mental health stigma is maintained in medical education. In particular, they explore how perfectionism, power differentials, and structural forces drive mental illness stigma in medical education. They argue that mental health stigma in medical education, while deeply embedded in the physician archetype and medical culture, is not inevitable and that dismantling it will require individual courage, interpersonal acceptance, and institutional action.