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Miyawaki Y, Sada KE, Shidahara K, Nawachi S, Asano Y, Katayama Y, Hayashi K, Katsuyama E, Katsuyama T, Takano-Narazaki M, Matsumoto Y, Oguro N, Yajima N, Ishikawa Y, Sakurai N, Hidekawa C, Yoshimi R, Ichikawa T, Kishida D, Shimojima Y, Wada J, Kurita N. The Association of Grit With Burnout Components (Professional Efficacy, Exhaustion, and Cynicism) Among Academic Rheumatologists: The TRUMP 2 -SLE Study. J Clin Rheumatol 2023; 29:268-274. [PMID: 37226300 DOI: 10.1097/rhu.0000000000001989] [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: 05/26/2023]
Abstract
OBJECTIVES There is a high prevalence of burnout among rheumatologists. Grit, which is defined as possessing perseverance and a passion to achieve long-term goals, is predictive of success in many professions; however, whether grit is associated with burnout remains unclear, especially among academic rheumatologists, who have multiple simultaneous responsibilities. Thus, the purpose of this study was to examine the associations between grit and self-reported burnout components-professional efficacy, exhaustion, and cynicism-in academic rheumatologists. METHODS This cross-sectional study involved 51 rheumatologists from 5 university hospitals. The exposure was grit, measured using mean scores for the 8-item Short Grit Scale (range, 1-5 [5 = extremely high grit]). The outcome measures were mean scores for 3 burnout domains (exhaustion, professional efficacy, and cynicism; range, 1-6; measured using the 16-item Maslach Burnout Inventory-General Survey). General linear models were fitted with covariates (age, sex, job title [assistant professor or higher vs lower], marital status, and having children). RESULTS Overall, 51 physicians (median age, 45 years; interquartile range, 36-57; 76% men) were included. Burnout positivity was found in 68.6% of participants (n = 35/51; 95% confidence interval [CI], 54.1, 80.9). Higher grit was associated with higher professional efficacy (per 1-point increase; 0.51 point; 95% CI, 0.18, 0.84) but not with exhaustion or cynicism. Being male and having children were associated with lower exhaustion (-0.69; 95% CI, -1.28, -0.10; p = 0.02; and -0.85; 95% CI, -1.46, -0.24; p = 0.006). Lower job title (fellow or part-time lecturer) was associated with higher cynicism (0.90; 95% CI, 0.04, 1.75; p = 0.04). CONCLUSIONS Grit is associated with higher professional efficacy among academic rheumatologists. To prevent burnout among staff, supervisors who manage academic rheumatologists should assess their staff's individual grit.
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Affiliation(s)
| | | | - Kenta Shidahara
- From the Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Shoichi Nawachi
- From the Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Yosuke Asano
- From the Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Yu Katayama
- From the Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Keigo Hayashi
- From the Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Eri Katsuyama
- From the Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Takayuki Katsuyama
- From the Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Mariko Takano-Narazaki
- From the Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Yoshinori Matsumoto
- From the Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Nao Oguro
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo
| | | | - Yuichi Ishikawa
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu
| | - Natsuki Sakurai
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama
| | - Chiharu Hidekawa
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama
| | - Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
| | - Jun Wada
- From the Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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Alnahhal KI, Lyden SP, Caputo FJ, Sorour AA, Rowe VL, Colglazier JJ, Smith BK, Shames ML, Kirksey L. The USMLE® STEP 1 Pass or Fail Era of the Vascular Surgery Residency Application Process: Implications for Structural Bias and Recommendations. Ann Vasc Surg 2023:S0890-5096(23)00239-X. [PMID: 37120072 DOI: 10.1016/j.avsg.2023.04.018] [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: 03/14/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023]
Abstract
MOTIVES BEHIND THE SHIFT USMLE® STEP 1 score reporting has been changed to a binary pass/fail format since January 26, 2022. The motives behind this change were (1) the questionable validity of using USMLE® STEP 1 as a screening tool during the candidate selection process and (2) the negative impact of using standardized examination scores as an initial gatekeeping threshold for the underrepresented in medicine (URiM) candidates applying to GME programs, given their generally lower mean standardized exams scores compared to non-URiM students. The USMLE® administrators justified this change as a tactic to enhance the overall educational experience for all students and to increase the representation of URiM groups. Moreover, they advised the program directors (PDs) to give more attention to other important qualities and components such as the applicant's personality traits, leadership roles and other extracurricular accomplishments, as part of a holistic evaluation strategy. IMPACT OF USMLE® STEP 1 PASS/FAIL: At this early stage, it is unclear how this change will impact Vascular Surgery Integrated residency (VSIR) programs. Several questions are outstanding, most importantly, how VSIR PDs will evaluate applicants absent the variable which heretofore was the primary screening tool. Our previously published survey showed that VSIR PDs will move their attention to other measures such as USMLE® STEP 2CK and letters of recommendation during the VSIR selection process. Furthermore, more emphasis on subjective measures such as the applicant's medical school rank and extracurricular student activities is expected. Given the expected higher weight of USMLE® STEP 2CK in the selection process than ever, many anticipate that medical students will dedicate more of their limited time to its preparation at the expense of both clinical and non-clinical activities. Potentially leaving less time to explore specialty pathways and to determine whether VS is the appropriate career for them. A FRAMEWORK FOR CANDIDATE EVALUATION The critical juncture in the VSIR candidate evaluation paradigm presents an opportunity to thoughtfully transform the process via current (Standardized Letter of Recommendation, USMLE® STEP 2CK, and clinical research) and future (Emotional Intelligence, Structure Interview and Personality Assessment) measures which constitute a framework to follow in the USMLE® STEP 1 pass/fail era.
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Affiliation(s)
- Khaled I Alnahhal
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland
| | - Sean P Lyden
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland
| | - Francis J Caputo
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland
| | - Ahmed A Sorour
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland
| | - Vincent L Rowe
- Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester
| | - Brigitte K Smith
- Department of Surgery, Division of Vascular Surgery, University of Utah, Salt Lake City
| | - Murray L Shames
- Division of Vascular Surgery, University of South Florida School of Medicine, Tampa
| | - Lee Kirksey
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland.
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Ricotta DN, Richards JB, Atkins KM, Hayes MM, McOwen K, Soffler MI, Tibbles CD, Whelan AJ, Schwartzstein RM. Self-Directed Learning in Medical Education: Training for a Lifetime of Discovery. TEACHING AND LEARNING IN MEDICINE 2022; 34:530-540. [PMID: 34279167 DOI: 10.1080/10401334.2021.1938074] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
Issue: Life-long learning is a skill that is central to competent health professionals, and medical educators have sought to understand how adult professionals learn, adapt to new information, and independently seek to learn more. Accrediting bodies now mandate that training programs teach in ways that promote self-directed learning (SDL) but do not provide adequate guidance on how to address this requirement. Evidence: The model for the SDL mandate in physician training is based mostly on early childhood and secondary education evidence and literature, and may not capture the unique environment of medical training and clinical education. Furthermore, there is uncertainty about how medical schools and postgraduate training programs should implement and evaluate SDL educational interventions. The Shapiro Institute for Education and Research, in conjunction with the Association of American Medical Colleges, convened teams from eight medical schools from North America to address the challenge of defining, implementing, and evaluating SDL and the structures needed to nurture and support its development in health professional training. Implications: In this commentary, the authors describe SDL in Medical Education, (SDL-ME), which is a construct of learning and pedagogy specific to medical students and physicians in training. SDL-ME builds on the foundations of SDL and self-regulated learning theory, but is specifically contextualized for the unique responsibilities of physicians to patients, inter-professional teams, and society. Through consensus, the authors offer suggestions for training programs to teach and evaluate SDL-ME. To teach self-directed learning requires placing the construct in the context of patient care and of an obligation to society at large. The SDL-ME construct builds upon SDL and SRL frameworks and suggests SDL as foundational to health professional identity formation.KEYWORDSself-directed learning; graduate medical education; undergraduate medical education; theoretical frameworksSupplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1938074 .
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Affiliation(s)
- Daniel N Ricotta
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy B Richards
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - K Meredith Atkins
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret M Hayes
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine McOwen
- Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Morgan I Soffler
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie D Tibbles
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alison J Whelan
- Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Richard M Schwartzstein
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Jiménez-Fernández R, Corral-Liria I, Trevissón-Redondo B, Lopez-Lopez D, Losa-Iglesias M, Becerro-de-Bengoa-Vallejo R. BURNOUT, RESILIENCE AND PSYCHOLOGICAL FLEXIBILITY IN FRONTLINE NURSES DURING THE ACUTE PHASE OF THE COVID-19 PANDEMIC (2020) IN MADRID-SPAIN. J Nurs Manag 2022; 30:2549-2556. [PMID: 36042534 PMCID: PMC9539113 DOI: 10.1111/jonm.13778] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
Background In April 2020, Spain was the country with the highest number of patients infected by COVID‐19 in Europe. The pressure on health care providers has had a direct impact on nurses and their mental health. Aim The aim of this study is to demonstrate the causal relationship between resilience, acceptance, experiential avoidance, psychological inflexibility and burnout syndrome, all of which are measured with validated questionnaires. Methods This was designed as a transversal correlational study with nurses who worked during the acute phase of the pandemic in public hospitals in the Community of Madrid with patients diagnosed with COVID‐19 in COVID‐19 medical hospitalization units, emergency services and intensive care units. Google Forms was used to obtain an informed consent sheet, socio‐demographic variables and the following questionnaires: 10 CD‐Risk, Connor‐Davidson Risk Resilience Scale, Acceptance and Action Questionnaire‐II and the Maslach Burnout Inventory. Results The final sample included 375 nurses with a high number of consecutive days of direct exposure to an infected patient and a very high number of consecutive days without rest; almost 18% suffered from COVID‐19. The nurses presented medium levels of resilience, medium levels of experiential avoidance and medium levels as measured for emotional exhaustion, personal accomplishment and depersonalization. We also found a predictive correlation between all the dimensions of the burnout questionnaire in relation to the data obtained from the resilience questionnaire. Conclusions There is a direct and predictive relationship between the resilience that nurses had during the acute phase of the pandemic and their capacity for acceptance, experiential avoidance, psychological inflexibility and burnout syndrome. Implications for Nursing Management The scores show the necessity to implement preventive measures to avoid fatal psychological consequences for nurses.
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Affiliation(s)
| | | | | | - Daniel Lopez-Lopez
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
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Lang I, King A, Jenkins G, Boddy K, Khan Z, Liabo K. How common is patient and public involvement (PPI)? Cross-sectional analysis of frequency of PPI reporting in health research papers and associations with methods, funding sources and other factors. BMJ Open 2022; 12:e063356. [PMID: 35613748 PMCID: PMC9131100 DOI: 10.1136/bmjopen-2022-063356] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Patient and public involvement (PPI) in health research is required by some funders and publications but we know little about how common it is. In this study we estimated the frequency of PPI inclusion in health research papers and analysed how it varied in relation to research topics, methods, funding sources and geographical regions. DESIGN Cross-sectional. METHODS Our sample consisted of 3000 research papers published in 2020 in a general health-research journal (BMJ Open) that requires a statement on whether studies included PPI. We classified each paper as 'included PPI' or 'did not include PPI' and analysed the association of this classification with location (country or region of the world), methods used, research topic (journal section) and funding source. We used adjusted regression models to estimate incident rate ratios of PPI inclusion in relation to these differences. RESULTS 618 (20.6%) of the papers in our sample included PPI. The proportion of papers including PPI varied in relation to location (from 44.5% (95% CI 40.8% to 48.5%) in papers from the UK to 3.4% (95% CI 1.5% to 5.3%) in papers from China), method (from 38.6% (95% CI 27.1% to 50.1%) of mixed-methods papers to 5.3% (95% CI -1.9% to 12.5%) of simulation papers), topic (from 36.9% (95% CI 29.1% to 44.7%) of papers on mental health to 3.4% (95% CI -1.3% to 8.2%) of papers on medical education and training, and funding source (from 57.2% (95% CI 51.8% to 62.6%) in papers that received funding from the UK's National Institute for Health Research to 3.4% (95% CI 0.7% to 6.0%) in papers that received funding from a Chinese state funder). CONCLUSIONS Most research papers in our sample did not include PPI and PPI inclusion varied widely in relation to location, methods, topic and funding source.
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Affiliation(s)
- Iain Lang
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Angela King
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Georgia Jenkins
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Kate Boddy
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Zohrah Khan
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - Kristin Liabo
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
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He Y, Wen S, Zhou M, Li X, Gong M, Zhou L. A Pilot Study of Modified Mini-Clinical Evaluation Exercises (Mini-CEX) in Rotation Students in the Department of Endocrinology. Diabetes Metab Syndr Obes 2022; 15:2031-2038. [PMID: 35846182 PMCID: PMC9278438 DOI: 10.2147/dmso.s372253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The mini-clinical evaluation exercise (mini-CEX) is an excellent tool for assessing the clinical abilities of medical students in intense clinical practice. In this study, the Mini-CEX was adapted to professional questionnaires for Diabetes Mellitus (DM), and examined in medical students completing their clerkship rotation in the department of endocrinology. METHODS From January 2021 to January 2022, all rotating medical students at Shanghai Pudong Hospital completed two mini-CEX exams before and following their rotation under the supervision and guidance of six tutors. The mini-CEX form was modified in this study primarily for inpatient management based on our clinical experience and updated DM guidelines of the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the Chinese Diabetes Society (CDS). Each component of the mini-CEX assessment, including medical interviews, physical examination, clinical judgment, clinical management, and overall clinical competence was evaluated using a nine-item questionnaire. RESULTS Our findings revealed that the second-round performance on the assessments significantly improved, as indicated by higher scores on each component. The Pearson association analysis revealed that the feedback time of the first examination was markedly associated with improved overall scores (r= 0.391, p<0.001). However, no correlations were discovered between patient age, gender, disease severity disparity, or the interval between examinations (p>0.05). Additional regression analysis revealed that the feedback time during the initial examination was the most significant contributor to the increased overall scores (β=0.391, p<0.001). CONCLUSION This newly designed mini-CEX form based on current ADA and EASD guidelines may assist trainees in more effectively diagnosing and managing DM in inpatients, particularly those with macrovascular, microvascular, or peripheral nerve neuropathy. This study aims to assess the efficacy of administering a modified mini-CEX form to rotating trainees participating in an endocrine clerkship.
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Affiliation(s)
- Yanju He
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Song Wen
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Mingyue Zhou
- Helen Driller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Xiucai Li
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Min Gong
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Ligang Zhou
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
- Correspondence: Ligang Zhou, Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China, Tel +8613611927616, Email
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