1
|
Cui CL, Reilly MA, Pillado EB, Li RD, Eng JS, Grafmuller LE, DiLosa KL, Conway AM, Escobar GA, Shaw PM, Hu YY, Bilimoria KY, Sheahan MG, Coleman DM. Burnout is not associated with trainee performance on the Vascular Surgery In-Training Exam. J Vasc Surg 2024:S0741-5214(24)01817-2. [PMID: 39233022 DOI: 10.1016/j.jvs.2024.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/15/2024] [Accepted: 08/25/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVES The Vascular Surgery In-Training Examination (VSITE) is a yearly exam evaluating vascular trainees' knowledge base. While multiple studies have evaluated variables associated with exam outcomes, few have incorporated training program-specific metrics. The purpose of this study is to evaluate the impact of the learning environment and burnout on VSITE performance. METHODS Data was collected from a confidential, voluntary survey administered after the 2020-2022 VSITE as part of the SECOND Trial. VSITE scores were calculated as percent correct then standardized per the American Board of Surgery. Generalized estimating equations with robust standard errors and an independent correlation structure were used to evaluate trainee and program factors associated with exam outcomes. Analyses were further stratified by integrated and independent training paradigms. RESULTS A total of 1385 trainee responses with burnout data were collected over three years (408 in 2020, 459 in 2021, 498 in 2022). On average, 46% of responses reported at least weekly burnout symptoms. On unadjusted analysis, burnout symptoms correlated with a 14 point drop in VSITE score (95% confidence interval (CI) -24- -4, p=0.006). However, burnout was no longer significant after adjusted analysis. Instead, higher PGY level, being in a relationship, identifying as male gender with or without kids, identifying as non-Hispanic white, larger programs, and having a sense of belonging within a program were associated with higher VSITE scores. CONCLUSIONS Despite high rates of burnout, trainees generally demonstrate resilience in gaining the medical knowledge necessary to pass the VSITE. Performance on standardized exams is associated with trainee and program characteristics, including availability of support systems and program belongingness.
Collapse
Affiliation(s)
- Christina L Cui
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Margaret A Reilly
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL
| | - Eric B Pillado
- Division of Vascular Surgery, Department of Surgery, Northwestern University, Chicago, IL
| | - Ruojia Debbie Li
- Division of Vascular Surgery, Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Leanne E Grafmuller
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Kathryn L DiLosa
- Division of Vascular Surgery, Department of Surgery, University of California Davis Health, Sacramento, CA
| | - Allan M Conway
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Guillermo A Escobar
- Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Palma M Shaw
- Division of Vascular Surgery, Department of Surgery, Upstate Medical University, Syracuse, NY
| | - Yue-Yung Hu
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Department of Surgery, Northwestern University, Chicago, IL
| | - Karl Y Bilimoria
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
| |
Collapse
|
2
|
Cui CL, Loanzon RS, West-Livingston LN, Coleman DM, Long CA, Kim Y. The Diversity of Surgical Trainees Index identifies racial and ethnic disparities among surgical specialties. J Vasc Surg 2024; 80:902-908.e1. [PMID: 38631516 DOI: 10.1016/j.jvs.2024.03.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Racial and ethnic disparities have been well-described among surgical specialties; however, variations in underrepresented in medicine (URiM) representation between these specialties have not previously been quantified. METHODS Data collected from Accreditation Council for Graduate Medical Education (ACGME) annual reports were used to derive the Diversity of Surgical Trainee Index (DoSTI), which was calculated as the proportion of URiM residents and fellow physicians within a given surgical specialty, relative to the overall proportion of URiM trainees within all surgical and non-surgical ACGME-accredited programs in the same academic year. RESULTS From 2013 to 2022, a total of 108,193 ACGME-accredited residency programs trained 1,296,204 residents and fellows in the United States. Of these, 14.1% (n = 182,680) of trainees self-identified as URiM over the study period. The mean DoSTI among all surgical specialties was 0.80 (standard error, 0.01) compared with all ACGME-accredited programs. High DoSTI specialties incorporated significantly higher proportions of trainees who identify as Hispanic (8.7% vs 6.3%) and Black or African American (5.2% vs 2.5%) when compared with low DoSTI specialties (P < .0001 each). General surgery (1.06 ± 0.01), plastic surgery (traditional) (1.12 ± 0.06), vascular surgery (integrated) (0.96 ± 0.03), and vascular surgery (traditional) (0.94 ± 0.06) had the highest DoSTI (P < .05 each vs composite). On linear regression analysis, only ophthalmology (+0.01/year; R2 = 0.41; P = .019), orthopedic surgery (+0.01/year; R2 = 0.33; P = .047), otolaryngology (+0.02/year; R2 = 0.86; P < .001), and pediatric surgery (+0.06/year; R2 = 0.33; P = .048) demonstrated an annual increase in DoSTI. CONCLUSIONS The DoSTI is a novel metric used to quantify the degree of URiM representation among surgical specialties. DoSTI has revealed specialty-specific variations in racial/ethnic minority representation among surgical training programs. This metric may be used to improve provider awareness and identify high performing DoSTI specialties to highlight best practices to ultimately recruit a more diverse surgical workforce.
Collapse
Affiliation(s)
- Christina L Cui
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Roberto S Loanzon
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Lauren N West-Livingston
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
| |
Collapse
|
3
|
Giacomelli E, D'Oria M, Speziali S, Dorigo W, Pacciani C, Bassini S, Lepidi S, Pulli R, Fargion AT. Gender-Related Disparities Among Vascular Surgeons in Italy: Results from a Cross-Sectional Survey. Ann Vasc Surg 2024; 105:20-28. [PMID: 38570012 DOI: 10.1016/j.avsg.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND To assess the presence, quality and impact of gender-related discrepancies in academic vascular surgery at a national level. METHODS This was an anonymous national structured nonvalidated cross-sectional survey on gender disparity perceptions, named "I love it when you call me Señorita", distributed to 645 participants from academic Italian vascular centers. Endpoints were related to job-related characteristics, satisfaction, and sexual harassment. RESULTS The survey yielded a 27% response rate (n = 174, 78 males and 96 females). Significant differences between male and female responders were found in terms of job satisfaction (83.3% vs. 53.1%, P < 0.001), perception of career opportunities (91.7% vs. 67.9%, P < 0.001), surgical activity in the operating theater (34.6% vs. 7.3%, P < 0.001), involvement in scientific activities (contribution in peer-reviewed articles: 37.2% vs. 9.4%, P < 0.001; scientific meeting attendance/year: 42.3% vs. 20.8%, P = 0.002), and perception of lower peer support at work (2.6% vs. 22.9%, P < 0.001). In addition, female physicians more frequently suffered sexual harassment from male peers/colleagues (10% vs. 34%, P < 0.001), male health-care workers (7% vs. 26%, P = 0.001), or patients/caregivers independently from their sex (6% vs. 38.5%, P < 0.001 for males and 5% vs. 22%, P = 0.001 for females). CONCLUSIONS A significant number of the female vascular surgeons in Italian academic vascular centers responding to the survey have experienced workplace inequality and sexual harassment. Substantial efforts and ongoing initiatives are still required to address gender disparities, emphasizing the need for the promotion of specific guidelines within scientific societies.
Collapse
Affiliation(s)
- Elena Giacomelli
- Vascular and Endovascular Surgery Unit, Careggi Teaching Hospital, Florence, Italy
| | - Mario D'Oria
- Vascular and Endovascular Surgery Unit, Trieste Integrated University Healthcare, Trieste, Italy
| | - Sara Speziali
- Vascular and Endovascular Surgery Unit, Careggi Teaching Hospital, Florence, Italy
| | - Walter Dorigo
- Vascular and Endovascular Surgery Unit, Careggi Teaching Hospital, Florence, Italy.
| | - Claudia Pacciani
- Vascular and Endovascular Surgery Unit, Careggi Teaching Hospital, Florence, Italy
| | - Silvia Bassini
- Vascular and Endovascular Surgery Unit, Trieste Integrated University Healthcare, Trieste, Italy
| | - Sandro Lepidi
- Vascular and Endovascular Surgery Unit, Trieste Integrated University Healthcare, Trieste, Italy
| | - Raffaele Pulli
- Vascular and Endovascular Surgery Unit, Careggi Teaching Hospital, Florence, Italy
| | - Aaron Thomas Fargion
- Vascular and Endovascular Surgery Unit, Careggi Teaching Hospital, Florence, Italy
| |
Collapse
|
4
|
Pillado E, Li RD, Chia MC, Eng JS, DiLosa K, Grafmuller L, Conway A, Escobar GA, Shaw P, Sheahan MG, Bilimoria KY, Hu YY, Coleman DM. Reported pain at work is a risk factor for vascular surgery trainee burnout. J Vasc Surg 2024; 79:1217-1223. [PMID: 38215953 DOI: 10.1016/j.jvs.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. METHODS A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Service Examination to trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs. Burnout was measured by a modified, abbreviated Maslach Burnout Inventory; pain after a full day of work was measured using a 10-point Likert scale and then dichotomized as "no to mild pain" (0-2) vs "moderate to severe pain" (3-9). Univariable analyses and multivariable regression assessed associations of pain with well-being indicators (eg, burnout, thoughts of attrition, and thoughts of career change). Pain management strategies were included as additional covariables in our study. RESULTS We included 527 trainees who completed the survey (82.2% response rate); 38% reported moderate to severe pain after a full day of work, of whom 73.6% reported using ergonomic adjustments and 67.0% used over-the-counter medications. Significantly more women reported moderate to severe pain than men (44.3% vs 34.5%; P < .01). After adjusting for gender, training level, race/ethnicity, mistreatment, and dissatisfaction with operative autonomy, moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change after adjustment. CONCLUSIONS Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should consider mitigating this occupational hazard by offering ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.
Collapse
Affiliation(s)
- Eric Pillado
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Ruojia Debbie Li
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Matthew C Chia
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Kathryn DiLosa
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, CA
| | - Leanne Grafmuller
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Allan Conway
- Division of Vascular Surgery Lenox Hill Hospital, Department of Surgery, Northwell Health, New York, NY
| | - Guillermo A Escobar
- Division of Vascular Surgery, Department of Surgery, Emory University, Atlanta, GA
| | - Palma Shaw
- Division of Vascular Surgery, Upstate Medical University, Syracuse, NY
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
| |
Collapse
|
5
|
Møller CM, Clausen T, Aust B, Budtz-Lilly JW, Eiberg JP. Burnout and Its Consequences among Vascular Surgeons and Trainees: A Danish National Survey. J Am Coll Surg 2023; 237:874-883. [PMID: 37694920 DOI: 10.1097/xcs.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Burnout among physicians has widespread negative consequences. Little is known about burnout among European vascular surgeons (VS). A previously published study found that 82% of VS and vascular surgical trainees (VST) in Denmark experience burnout symptoms. The present study aimed to investigate work- and health-related consequences of burnout. STUDY DESIGN An electronic survey was distributed to all VS/VST in Denmark in January 2020. Validated assessment tools were used to measure burnout, mental health, and psychosocial work environment aspects. RESULTS Of 104 invited VS/VST, 82% (n = 85) completed the survey. VS accounted for 72% (n = 61) of the respondents, and 40% (n = 33) were female. Statistically significant associations were found between higher levels of burnout and a range of work- and health-related outcomes, including a sense of meaning at work, workplace commitment, conflicts between work and private life, work stress, sick leave, and depressive symptoms. VS/VST using pain medication daily or weekly had significantly higher burnout scores than respondents who rarely or never use pain medication. A significant association between burnout and job satisfaction and retention was found, with respondents indicating an intention to stay within the specialty having significantly lower burnout scores than those who considered leaving within 5 years. Among those who indicated leaving the specialty, 35% (n = 13) attributed this to their current working conditions. CONCLUSIONS Burnout among VS/VST in Denmark is negatively associated with various work- and health-related outcomes. The work environment seems to play an essential role in these associations, and alterations in workplace organization may remedy this situation.
Collapse
Affiliation(s)
- Cecilie M Møller
- From the Department of Cardiothoracic and Vascular Surgery, University Hospital Aarhus, Aarhus, Denmark (Møller, Budtz-Lilly)
| | - Thomas Clausen
- From the Department of Cardiothoracic and Vascular Surgery, University Hospital Aarhus, Aarhus, Denmark (Møller, Budtz-Lilly)
| | - Birgit Aust
- From the Department of Cardiothoracic and Vascular Surgery, University Hospital Aarhus, Aarhus, Denmark (Møller, Budtz-Lilly)
| | - Jacob W Budtz-Lilly
- From the Department of Cardiothoracic and Vascular Surgery, University Hospital Aarhus, Aarhus, Denmark (Møller, Budtz-Lilly)
| | - Jonas P Eiberg
- From the Department of Cardiothoracic and Vascular Surgery, University Hospital Aarhus, Aarhus, Denmark (Møller, Budtz-Lilly)
| |
Collapse
|
6
|
Maloni K. "Are you my doctor?". J Vasc Surg 2023; 78:805. [PMID: 37599033 DOI: 10.1016/j.jvs.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Krystal Maloni
- MedStar Washington Hospital Center/Georgetown University, Washington, DC
| |
Collapse
|