Running on empty: a review of nutrition and physicians' well-being

Disordered eating behaviours, self-compassion, and psychological distress in Canadian general surgery residents

BACKGROUND

Surgical residents experience higher levels of negative stress and helplessness compared to the general population. Studies have linked stress to negative eating habits. Despite the high stress and burnout among surgical residents, studies on their disordered eating behaviors remain limited. Understanding the factors contributing to these findings will help optimize mental health during residency training.

METHODS

This study is a mixed-methods cross-sectional survey of all general surgery residents in Canada. The survey assessed disordered eating, quality of life, and self-compassion using the Eating Attitudes Test (EAT-26), Kessler Psychological Distress Scale (KPDS), and Self-Compassion short-form scale (SCSF). A qualitative component examined factors influencing eating habits in residency. Logistic regression was performed to identify factors associated with at-risk disordered eating behaviors.

RESULTS

Out of 450 surgical residents, 128 residents completed the survey (28 ​%). Respondents were 23 ​% male and split evenly across all postgraduate levels. There were 68 ​% of respondents who identified as having psychological distress and 34 ​% exhibited high risk behaviors for disordered eating. High levels of psychological distress (OR 3.29; 95 ​% CI [1.39-7.76]) and elevated BMI (OR 3.99; 95 ​% CI [1.63-9.77]) were significantly associated with exhibiting at-risk disordered eating behaviors Positive factors influencing eating were having a partner at home and having non-residency related extracurriculars. Negative factors were overnight call shift frequency, call shift length, and volume of pages.

CONCLUSION

This is the first nationwide survey examining eating behaviors among general surgery residents. This population was found to have elevated rates of high-risk behavior for disordered eating.

The Surgeon Athlete? Analysis of the Nutritional Habits of Orthopaedic Surgery Residents

INTRODUCTION

Orthopaedic surgery residency requires physical stamina and mental acuity. Residents work long hours in demanding conditions like those faced by professional athletes. However, surgical residents often neglect their nutritional needs. This investigates dietary habits of orthopaedic surgery residents and explores strategies to improve nutritional status and performance of residents.

METHODS

A prospective survey created by a dietitian focused on performance nutrition was conducted among orthopaedic surgery residents at a large, tertiary, academic surgery residency program. Data were collected on demographics, nutritional habits, and perceptions of dietary practices.

RESULTS

The survey was completed by 30 orthopaedic surgery residents (19 M and 11 F; 29.8 ± 2.5 years). This cohort had inconsistent nutritional habits, characterized by irregular meal patterns, and frequently skipped meals. The most common barrier revolved around time constraints. Other barriers included stress/emotional eating and undesired weight changes. Male and female residents had similar demographics and outcomes, except that female residents more frequently reported having the highest energy level. Those who skipped meals had lower reported levels of nutritional knowledge and cited limited time to prepare or eat food compared with those who did not.

CONCLUSION

This study underscores the paradox of the "surgeon athlete," where despite facing physical demands like athletes, orthopaedic surgeons fail to prioritize their nutrition. This neglect can impair both performance and long-term health and may trickle down to worse patient care and outcomes. Addressing these issues requires a multifaceted approach. Institutional support is essential to improve access to healthy foods, nutrition education, and fostering a culture that values physician well being.

Workforce Concerns: Professional Self Care, Personal Readiness, Impact of the Pandemic, and Other Factors that Impact the Workforce

Physician burnout is pervasive and takes a heavy toll on individuals and the healthcare system. Post-coronavirus disease 2019 the negative impact of organizational culture on physician burnout has been highlighted. Substantial research has accrued identifying steps organizations can take to pivot and develop leaders committed to physician well-being. Physicians can also proactively explore research in sleep, nutrition, physical activity, stress management, and social connections. Positive mindset has a powerful protective effect in medicine, especially in the emerging areas of self-valuation, self-compassion, and positive psychology. Physician coaching can accelerate positive behavior change. Committed physician leaders are needed for sustained culture change to occur.

Personalized Machine Learning-Based Prediction of Wellbeing and Empathy in Healthcare Professionals

Healthcare professionals are known to suffer from workplace stress and burnout, which can negatively affect their empathy for patients and quality of care. While existing research has identified factors associated with wellbeing and empathy in healthcare professionals, these efforts are typically focused on the group level, ignoring potentially important individual differences and implications for individualized intervention approaches. In the current study, we implemented N-of-1 personalized machine learning (PML) to predict wellbeing and empathy in healthcare professionals at the individual level, leveraging ecological momentary assessments (EMAs) and smartwatch wearable data. A total of 47 mood and lifestyle feature variables (relating to sleep, diet, exercise, and social connections) were collected daily for up to three months followed by applying eight supervised machine learning (ML) models in a PML pipeline to predict wellbeing and empathy separately. Predictive insight into the model architecture was obtained using Shapley statistics for each of the best-fit personalized models, ranking the importance of each feature for each participant. The best-fit model and top features varied across participants, with anxious mood (13/19) and depressed mood (10/19) being the top predictors in most models. Social connection was a top predictor for wellbeing in 9/12 participants but not for empathy models (1/7). Additionally, empathy and wellbeing were the top predictors of each other in 64% of cases. These findings highlight shared and individual features of wellbeing and empathy in healthcare professionals and suggest that a one-size-fits-all approach to addressing modifiable factors to improve wellbeing and empathy will likely be suboptimal. In the future, such personalized models may serve as actionable insights for healthcare professionals that lead to increased wellness and quality of patient care.

Over 50% of self-reported burnout among Latin American orthopaedic surgeons: A cross-sectional survey on prevalence and risk factors

OBJECTIVE

Assess the prevalence of self-reported burnout and identify risk and protective factors based on demographic and life quality aspects, among Latin American orthopaedic surgeons.

METHODS

This study employed a cross-sectional analytical design. An original design survey was developed using multiple-choice and Likert-scale questions to gather self-reported burnout, demographic, work-related, social, personal, and mood-related data. The survey was electronically distributed to the Chilean Orthopaedic Surgery Society and the Latin American Society of Arthroscopy, Knee Surgery, and Sports Medicine members. Statistical analysis included Chi-square and Fisher's exact tests to determine associations between self-reported burnout and other variables. Subsequently, a multivariate logistic regression was carried out to identify key risk and protective factors (p ​< ​0.05).

RESULTS

The survey's response rate was 20 ​% (n ​= ​358) out of the 1779 invitations that were sent. The most representative age range was 41-60 years (50 ​%) and 94 ​% were men. Of those surveyed, 50 ​% reported a burnout episode more than once per year, 60 ​% depersonalization when treating patients at least yearly, 13 ​% anhedonia, 11 ​% a depressive mood more than half of the month or almost every day, and 61 ​% weariness at the end of a working day. Burnout was statistically associated with age under 40 years old (p ​= ​0.012), fewer years as a specialist (p ​= ​0.037), fear of lawsuits (p ​< ​0.001), a non-healthy diet (p ​= ​0.003), non-doing recreational activities (p ​= ​0.004), depersonalization when treating their patients (p ​< ​0.001), weariness (p ​< ​0.001), anhedonia (p ​< ​0.001), depressive mood (p ​< ​0.001), and career dissatisfaction (p ​< ​0.001). The logistic regression demonstrated that fear of lawsuits (p ​< ​0.001), weariness at the end of a workday (p ​= ​0.016), and anhedonia (p ​= ​0.019) were those variables with stronger direct associations with self-reported burnout. A healthy diet was the strongest protective variable (p ​< ​0.001).

CONCLUSION

Over 50 ​% of the Latin American orthopaedic surgeons who participated in the survey reported experiencing burnout episodes more than once a year, along with depersonalization when treating their patients at least once a year. Additionally, nearly 10 ​% of respondents experienced weekly depressive symptoms. Among the noteworthy risk factors for self-reported burnout were fear of lawsuits, weariness at the end of the workday, and anhedonia. Conversely, maintaining a healthy diet emerged as the most potent protective factor.

LEVEL OF EVIDENCE

Level III.

Evaluating the Impact of the COVID-19 Pandemic on First-Year Medical Student Nutrition

BACKGROUND

Medical school students in high-stress environments have been shown to make poor personal health decisions ranging from less healthy selections of food to lower rates of exercise. With the emergence of the COVID-19 pandemic adding a major social and health challenge, it is important to examine the effect this new stressor has on the health habits of medical school students.

METHODS

All first-year students at Albany Medical College completed a self-recorded three-day log of food intake and exercise modality and duration. Reported data included calories, carbohydrates, protein, lipids, sodium, calcium, and other micronutrients. The data was divided between pre-pandemic (2018-19) and mid-pandemic (2020-21) entries. T-tests and ANOVA tests were used to compare for significance.

RESULTS

Students consumed significantly fewer calories during the pandemic compared to before. This reduction was primarily driven by the female cohort of students. Specifically, this reduction in calories appears to be driven by a decrease in carbohydrate consumption, rather than lipids or protein, which did not change. Additionally, there were significant decreases in sodium, calcium, and vitamin D intake. The mid-pandemic time span (2020-21) appears to be correlated with decreased caloric intake, as well as other important nutrients such as vitamin D and calcium.

CONCLUSIONS

This study demonstrated a decrease in calories, carbohydrates, sodium, and alcohol consumption when comparing pre- and mid-pandemic dietary habits of first-year medical students. It also indicated less than the recommended amount of calcium and Vitamin D consumption. Such changes may indicate restrictive eating habits in times of stress.

Comorbidity, Eating Behaviors and Smartphone Addiction in Italian Nurses' Characteristics

BACKGROUND

Evidence suggested how nurses experienced worse lifestyles than the general population by recording deterioration rates in healthy conditions.

AIM

To assess differences between comorbidity, eating behavior, and smartphone addiction according to sex, Body Mass Index (BMI), age, work experience, shift, alcohol assumption, and physical activity in Italian nurses.

METHODS

An online questionnaire was spread through some professional internet pages. Data included demographic characteristics, the Charlson Comorbidity Index (CCI), the Italian Version of the Dutch Eating Behavior Questionnaire, and the Smartphone Addiction Scale (SAS-SV).

RESULTS

A total of 456 nurses were recruited. Significant differences were registered in the smartphone addiction score (p=0.030) and BMI scores and work experience (p=0.001), as underweight participants reported higher scores in the smartphone addiction attitude (2.4714 ± 1.25812) than the other subjects and also participants with the highest number of years in work experience also reported higher smartphone addiction scores (2.8074 ± 1.2022). Significant difference was reported in the CCI scores according to age (p<0.001): subjects aged over 61 years recorded higher scores in the CCI (1.67 ± 1.528) and also according to work experience and CCI scores (p<0.001), as participants employed between 21 and 30 years reported higher scores in the CCI (1.27 ± 1.382) and also to night shift (p=0.037), as participants who worked during the night shift also reported higher scores in the CCI. A significant difference was reported only for restrained eating attitude (p=0.034), as participants who declared to assume alcohol 2-3 times per month recorded higher levels in this eating attitude aspect (32.32 ± 7.181).

CONCLUSION

Female nurses, overweight and obese nurses with low physical activity practice, seemed to spend more time with their smartphones. Healthcare organizations should consider findings to prevent unhealthy lifestyles among nurses, which could negatively influence the whole healthcare system.

Investigation of Health Behavior on Burnout Scores in Women Physicians who Self-Identify as Runners: A Cross-Sectional Survey Study

As the proportion of women in the physician workforce increases, burnout in this population warrants further investigation. Exercise is an often-proposed strategy to combat burnout. Evaluating physical activity across a cohort of women physicians can assess associations of health behaviors with burnout. Cross-sectional study of women attending physicians in the United States who are actively engaged in a social media group for runners. An electronic survey comprised of 60 questions covering demographics, health behaviors, and burnout was administered. A healthy lifestyle subgroup (HLS) was defined based on American Heart Association physical activity and nutrition recommendations. We determine the prevalence of burnout and investigate associations between health behavior factors and burnout. Of the 369 included surveys, most respondents were at least six years out from medical training (85.9%) and White (74.5%). Forty-two percent experienced burnout symptoms. Time exercising was significantly associated with fruit/vegetable consumption (P=.00002). There was no significant difference in burnout between the HLS compared to others (P = .37). This group of self-reported physically active women physicians was found to have a lower prevalence of burnout when compared to other women physicians. Exercise and nutrition may be protective against burnout in women physicians but deserve further investigation.

Supporting home-based meal preparation improves lunchtime habits and self-assessed work performance of interns at a tertiary hospital

There is ample evidence that doctors frequently miss meals at work, which negatively impacts concentration, decision-making and overall patient care. Junior doctors are particularly vulnerable given their heavy workload. We report on the impact of a pilot programme supporting home-based meal preparation on the dietary habits and energy levels of interns at a tertiary hospital and demonstrate this is one strategy healthcare organisations can adopt to promote a healthier workforce.

Do emergency medicine residents have access to healthy food options during work hours?

Background

Relatively little data describe how diet and food choices impact trainee well-being despite evidence that diet impacts both physical and mental health. The objective was to describe food options available to emergency medicine (EM) residents when on duty.

Methods

A survey utilizing closed-ended, binary, rank-order responses was developed by experts in graduate medical education and wellness; it was piloted, revised, and then electronically distributed to 211 EM residency programs over 2 weeks in 2021. The program director (PD) or associate PD was invited to participate.

Results

A total of 114 EM programs participated (54%). The primary teaching site included 43 community hospitals, 23 county hospitals, and 48 university hospitals. Resident access to an onsite hospital cafeteria was most common (97%); other onsite options were vending machines (87%), fresh food fridges (34%), national chains (32%), local restaurants (25%), food trucks (30%), and farmer's markets (11%). More than one-third (38%) reported that onsite options did not include healthy food, 26% reported being dissatisfied with onsite food, and 35% rarely or never purchased food onsite. Most programs (89%) do not have a dedicated "meal break" for residents while on duty. Few residency programs include diet or nutrition classes or counseling. When programs sponsor meals during residency events, nutritional value and dietary considerations were ranked less important than cost of food and convenience.

Conclusions

Access to healthy food options is not always available during scheduled resident work hours, and dedicated meal breaks are infrequent. These data should inform institutional initiatives to improve the health and well-being of resident physicians.

Hydration and meal habits of physicians and medical learners: a literature review

PURPOSE

Nutrition and hydration are important components of physician and medical learner well-being; meal-skipping and insufficient hydration are known to negatively impact cognition. Existing data on these phenomena are sparse and rarely considered together; furthermore, there is a lack of literature on interventions to address these problems. We therefore aimed to characterize existing literature on this topic.

METHODS

We conducted a literature review of existing literature on the prevalence of and reasons for meal-skipping and insufficient hydration in physicians and medical learners.

RESULTS

Reported prevalences varied widely, as did the ways in which the data were collected. Reasons for meal-skipping and insufficient hydration are less studied, but a lack of time is the most commonly reported reason, among a variety of other barriers.

CONCLUSION

Further research is required to better characterize the prevalences and reasons for meal-skipping in physicians and medical learners. By consolidating the state of current knowledge on this topic in this work, we establish the groundwork for future studies and allow intervention studies to be based on a broader data set.

Well-Being in Anesthesiology Graduate Medical Education: Reconciling the Ideal with Reality

Addressing burnout through well-being initiatives in anesthesiology residency training has been well described. Our intervention of in-person mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) as a means of addressing burnout among anesthesiology trainees proved unfeasible given attitudinal and logistic variables. We subsequently found success with a "confessions session" model structured as a modification of the Delphi method; this led to organizational changes associated with reduced resident burnout and well-being measured through internal (GME) and external (the Accreditation Council for Graduate Medical Education (ACGME)) annual anonymous surveys.

Nutritional Wellness for the Busy Health Care Provider: Small Everyday Wins

When describing health care provider wellness, diet and nutrition are typically not addressed. This, in combination with the lack of decent food and diet resources typically available to the typically busy health care provider, exposes a significant gap in the road to advancing clinician wellness. This article aims to describe the relationship between nutrition and well-being, and potential barriers to optimal nutrition encountered by health care providers in the workplace. Readily available and practical strategies to improve physician diet and nutrition include: mindful eating practices, home meal preparation, food journaling, and mobile applications. From an organizational level, once physicians are making more informed food choices it is the hospital's responsibility to make nutritional options available in the workplace.

Work site food purchases among healthcare staff: Relationship with healthy eating and opportunities for intervention

Aim

The current study describes food‐purchasing behaviours of healthcare staff, determines whether purchasing food at work is associated with overall indicators of healthy eating, and explores opportunities for improving the hospital food environment.

Methods

A secondary analysis of a health and wellbeing survey of healthcare workers (n = 501) in Queensland, Australia. Multiple regression models describe the associations between food purchases and indicators of healthy eating, while controlling for age, gender and work role.

Results

More than 60% of staff purchased food/drinks at work in the past week, and this was inversely associated with indicators of healthy eating. For example, among those purchasing food/drinks at work on most days, only 18% reported their overall diet as excellent or very good, compared to 50% of those who do not purchase food/drink at work (odds ratio [OR] = 0.24; 95% confidence interval [CI] = [0.12,0.48] in adjusted models). Staff feedback prioritised strategies to make healthy meals more accessible and affordable.

Conclusion

Improvements to the retail food environment in hospitals could have a positive impact on the overall nutritional wellbeing of staff.

Performance Nutrition for Physician Trainees Working Overnight Shifts: A Randomized Controlled Trial

PURPOSE

To compare acute effects of 2 dietary interventions with usual dietary habits on physician trainees' alertness during overnight shifts.

METHOD

This registered, controlled, block randomized crossover trial (NCT03698123) was conducted between October 2018 and May 2019 at Stanford Medicine. Physician trainees working at least 3 overnight shifts during a 1-week period were recruited. During the first night, participants followed their usual dietary habits. During the intervention nights (low carbohydrate-to-protein ratio and high carbohydrate-to-protein ratio interventions), participants received healthy dinners, snacks, water, and, upon request, caffeinated beverages, at the beginning of their shifts and were instructed to eat meals before 10 pm. The sequence of interventions on the second and third nights were block randomized across study weeks. Outcome measures (a priori) were overnight changes in validated measures of specific neurobehavioral dimensions: psychomotor vigilance, sensory-motor speed, working memory, and risk decision making, as well as self-reported sleepiness and work exhaustion.

RESULTS

Sixty-one physician trainees participated in this study. Compared with usual dietary habits, overnight changes in psychomotor vigilance scores (scale 0-1,000) improved by 51.02 points (95% CI: 12.08, 89.96) and sleepiness (scale 1-7) improved by 0.69 points (95% CI: 0.33, 1.05) under the low carbohydrate-to-protein ratio intervention. Compared with usual dietary habits, overnight changes in sleepiness (scale 1-7) improved by 0.61 points (95% CI: 0.25, 0.96) under the high carbohydrate-to-protein ratio intervention. Neither intervention had beneficial effects relative to usual dietary habits with respect to sensory-motor speed, working memory, risk decision making, or work exhaustion. There were no differences in outcomes between low carbohydrate-to-protein ratio and high carbohydrate-to-protein ratio interventions.

CONCLUSIONS

Dietary interventions may mitigate negative effects of physician trainee sleep deprivation during overnight shifts. Future studies are warranted to further examine the effectiveness of nutritional strategies on physician alertness during overnight shifts.

Promoting Wellness in Orthopaedic Surgery Residency

The challenges associated with surgical residency have been well documented and described. Despite implementation of work-hour restrictions, residency remains a balancing act between patient care, surgical and clinical education, medical record documentation, and research endeavors. The added challenge of balancing these duties with life outside of the hospital further complicates the situation. Multiple studies have documented the stress associated with residency training, highlighting the prevalence of emotional exhaustion, detachment from people both in and out of the hospital, and a concerning rate of clinical depression among residents. Moreover, this emotional exhaustion has been shown to directly correlate with residents' clinical performance and abilities to carry out academic duties. More recently, feelings of isolation and detachment have been exacerbated by the necessity of COVID-19 precautions and change in clinical duties. The Accreditation for Graduate Medical Education (ACGM) now requires all residencies to include programming that focuses on resident well-being. Programs have implemented various strategies in an effort to help their trainees cope with the stress associated with residency and beyond. Despite the variety in approaches of programs, these initiatives have the similar objective of teaching resilience and the ability to navigate stressors in a healthy and effective manner. The programming can also serve to promote resident interaction and develop camaraderie in an effort to minimize feelings of emotional exhaustion and isolation. In this article, we discuss the importance of sustained physician wellness and describe approaches from various professions that can be implemented into the wellness curriculum for residency programs across the country. By promoting a culture of wellness and incorporating effective wellness programming, our aim is that residents will be able to succeed not only in their training but also in their personal lives and professional endeavors after graduation.

Self-Valuation Challenges in the Culture and Practice of Medicine and Physician Well-being

OBJECTIVE

To compare physicians with workers in other fields on measures of self-valuation (SV) and determine the effect of adjusting for SV on the relationship between being a physician and risk for burnout.

PATIENTS AND METHODS

A random sample of physicians from the American Medical Association Physician Masterfile and a probability sample from the general US population were used. Data were collected for this cross-sectional study between October 12, 2017 and March 15, 2018. Burnout was indicated by a score of 27 or higher on Emotional Exhaustion or 10 or higher on Depersonalization, using the Maslach Burnout Inventory. Self-valuation was measured with Self-valuation Scale items.

RESULTS

Physicians (248/832=29.8%) more than workers in other fields (1036/5182=20.0%) "often" or "always" felt more self-condemnation than self-encouragement to learn from the experience when they made a mistake. Physicians (435/832=52.3%) more than workers in other fields (771/5182=14.9%) "often" or "always" put off taking care of their own health due to time pressure. Physicians had greater odds of burnout before (odds ratio [OR], 1.51; 95% CI, 1.30 to 1.76) but not after adjusting for SV responses (OR, 0.93; 95% CI, 0.78 to 1.11). After adjustment for SV, work hours, sex, and age, physicians had lower odds of burnout than workers in other fields (OR, 0.82; 95% CI, 0.68 to 0.99).

CONCLUSION

Self-valuation is lower in physicians compared with workers in other fields and adjusting for SV eliminated the association between being a physician and higher risk for burnout. Experimental design research is needed to determine whether the association of SV with burnout is causal and the degree to which SV is malleable to intervention at individual, organization, and professional culture levels.

Total Fasting and Dehydration in the Operating Room: How Can Surgeons Survive and Thrive?

OBJECTIVES

Hydration and nutrition are critical to achieving optimal performance. This study aimed to assess the impact of limited oral intake in the operating room environment on surgical resident health, well-being, and performance.

DESIGN

Electronic survey was sent to 94 surgical trainees at our institution in 2020. Chi-square analyses were performed to assess for differences in survey responses by sex.

SETTING

A single tertiary-care institution.

PARTICIPANTS

Surveys were sent to surgical residents and fellows in general surgery, neurosurgery, and orthopedic surgery. Seventy-nine (80%) of the 94 residents and fellows responded.

RESULTS

Of the 79 responses, most trainees (79%) experienced dehydration within 6 hours of operating. Forty-four (56%) reported no fluid intake for greater than 6 hours on average, and 39 (49%) reported that they frequently had difficulty rehydrating in between cases. Most of the respondents (70%) frequently experienced symptoms of dehydration, including orthostasis, headache, and constipation. Fifty-six (71%) believed that dehydration frequently affected their performance. Compared to men, women were more likely to feel dehydrated within 4 hours of operating (58% vs. 25%, p = 0.005). Women were also more likely to have difficulty rehydrating in between cases (75% vs. 38%, p = 0.0026), experience symptoms of dehydration (92% vs. 60%, p = 0.0049), and report that dehydration affects surgical performance (88% vs. 64%, p = 0.0318).

CONCLUSIONS

Prolonged fasting and dehydration are common issues that may negatively impact performance and wellbeing of surgical trainees. Also, dehydration may affect men and women differently.

Physician Well-Being in Practice

Despite a recent surge of interest in physician well-being, the discussion remains diffuse and often scattered. Lingering questions of what wellness entails, how it is personally applicable, and what can be done, remain pervasive. In this review, we focus on policy-level, institutional and personal factors that are both obstacles to wellness and interventions for potential remedy. We outline clear obstacles to physician wellness that include dehumanization in medicine, environments and cultures of negativity, barriers to wellness resources, and the effect of second victim syndrome. This is followed by proven and proposed interventions to support physicians in need and foster cultures of sustained well-being from policy, institutional, and personal levels. These include medical liability and licensure policy, peer support constructs, electronic health record optimization, and personal wellness strategies. Where sufficient data exists, we highlight areas specific to anesthesiology. Overall, we offer a pragmatic framework for addressing this critical concern at every level.

Impact of an Online Nutrition Course to Address a Gap in Medical Education: A Feasibility Study

BACKGROUND AND OBJECTIVES

Nutrition is a foundation of health, yet there is a deficiency of nutrition training in graduate medical education. The purpose of this feasibility study was to assess the impact of a brief online clinical nutrition course on medical residents' knowledge and attitudes related to the role of nutrition in clinical practice.

METHODS

Medical residents from two institutions took a 3-hour, online, self-paced and interactive clinical nutrition course that reviewed macronutrients, evidence-based dietary patterns, a rapid nutrition assessment, and motivational interviewing. We administered surveys of nutrition knowledge and attitudes at three time points: (1) just prior to taking the online course, (2) immediately following, and (3) 3 months after course completion.

RESULTS

Seventy-six residents enrolled in the study and 47 (62%) completed the online course and postcourse surveys. For residents who completed the study, the summated nutrition knowledge scores assessed both immediately after taking the course and 3 months later showed significant improvement (P<.001). Three months after completing the course, residents were more likely to believe it was their role to personally provide detailed nutrition information to patients (P=.045) and to endorse the view that a healthy diet is important for self-care (P<.001). The estimated time residents spent counseling patients on nutrition did not change after the intervention.

CONCLUSION

This feasibility study demonstrated the potential of a 3-hour, online, self-paced nutrition course administered to medical residents to result in a significant and sustained increase in nutrition knowledge and positive attitudes about the role of nutrition in clinical practice.

The Mismatch of Nutrition and Lifestyle Beliefs and Actions Among Physicians: A Wake-Up Call

Background. There is a notable lack of education on nutrition and physical activity guidelines in medical schools and postgraduate training. The purpose of this study is to assess the nutrition and exercise knowledge and personal health behaviors of physicians in the Department of Medicine at a large academic center. Methods. We conducted a survey study in the Department of Medicine at the University of Florida in 2018. The survey instrument included questions on demographics, medical comorbidities, baseline perception of health and fitness, and knowledge of nutrition concepts. The Duke Activity Status Index assessed activity/functional capacity and the validated 14-point Mediterranean Diet Survey evaluated dietary preferences. Data were analyzed using descriptive statistics and the χ² test was used to perform comparisons between groups. Statistical significance was determined at P < .05. Results. Out of 331 eligible physicians, 303 (92%) participated in the study. While all respondents agreed that eating well is important for health, less than a fourth followed facets of a plant-based Mediterranean diet. Only 25% correctly identified the American Heart Association recommended number of fruit and vegetable servings per day and fewer still (20%) were aware of the recommended daily added sugar limit for adults. Forty-six percent knew the American Heart Association physical activity recommendations and 52% reported more than 3 hours of personal weekly exercise. Reported fruit and vegetable consumption correlated with perceived level of importance of nutrition as well as nutrition knowledge. Forty percent of physicians (102/253) who considered nutrition at least somewhat important reported a minimum of 2 vegetable and 3 fruit servings per day, compared with 7% (3/44) of those who considered nutrition less important ("neutral," "not important," or "important, but I don't have the time to focus on it right now"; P < .0001). Conclusions. This study highlights the need for significant improvement in education of physicians about nutrition and physical activity and need for physicians to focus on good personal health behaviors, which may potentially improve with better education.

Self-valuation: Attending to the Most Important Instrument in the Practice of Medicine

OBJECTIVE

To measure self-valuation, involving constructive prioritization of personal well-being and a growth mindset perspective that seeks to learn and improve as the primary response to errors, in physicians and evaluate its relationship with burnout and sleep-related impairment.

METHODS

We analyzed cross-sectional survey data collected between July 1, 2016, and October 31, 2017, from 5 academic medical centers in the United States. All faculty and medical-staff physicians at participating organizations were invited to participate. The self-valuation scale included 4 items measured on a 5-point (0-4) Likert scale (summative score range, 0-16). The self-valuation scale was developed and pilot tested in a sample of 250 physicians before inclusion in the multisite wellness survey, which also included validated measures of burnout and sleep-related impairment.

RESULTS

Of the 6189 physicians invited to participate, 3899 responded (response rate, 63.0%). Each 1-point score increase in self-valuation was associated with -1.10 point lower burnout score (95% CI, -1.16 to -1.05; standardized β=-0.53; P<.001) and 0.81 point lower sleep-related impairment score (95% CI, -0.85 to -0.76; standardized β=-0.47; P<.001), adjusting for sex and medical specialty. Women had lower self-valuation (Cohen d=0.30) and higher burnout (Cohen d=0.22) than men. Lower self-valuation scores in women accounted for most of the sex difference in burnout.

CONCLUSION

Low self-valuation among physicians is associated with burnout and sleep-related impairment. Further research is warranted to develop and test interventions that increase self-valuation as a mechanism to improve physician well-being.

Associations Between Dietary Patterns and Sleep-Related Impairment in a Cohort of Community Physicians: A Cross-sectional Study

There is increasing evidence that diet can mitigate fatigue. The objective of this study was to assess the associations between dietary habits and sleep-related impairment (SRI) in a cohort of community physicians. In this cross-sectional study, we analyzed data from 245 physicians who had completed a wellness survey in March 2016 (98% response rate). Three dietary patterns were derived using principal component analysis: plant based, high protein, and high saturated fat and sugar. In the adjusted analysis, every SD increase in the plant-based dietary pattern score was associated with a 0.71-point decrease (β = -0.72; SE = 0.32; P = .027; 95% CI = -1.35 to -0.08) in the SRI score, and every SD increase in the high saturated fat and sugar dietary pattern score was associated with a 0.77-point increase (β = 0.77; SE = 0.32; P = .015; 95% CI = 0.15 to 1.39) in the SRI score. There were no associations between high protein diets and SRI scores. Physicians adhering to diets that are high in plant-based foods and low in saturated fat and added sugars had less SRI. Physicians currently face significant barriers to maintaining a healthy diet. This study highlights the potential role of workplace nutrition on SRI and work performance of physicians.

A Novel Culinary Medicine Course for Undergraduate Medical Education

Traditional nutrition education in medical school has been inadequate to prepare future physicians to counsel patients on practical dietary changes that can prevent and treat food-related disease. Culinary medicine is being used to address this in a variety of settings, including medical education. The Teaching Kitchen Elective for Medical Students at Stanford University School of Medicine spans 1 academic quarter and combines hands-on cooking of food that is delicious and healthy, correlations with multiple clinical specialties, and role-playing real-life examples of brief dietary counseling with patients to make nutrition education practical and approachable. The course has been run as a quasi-randomized controlled study comparing 3 cohorts of students versus wait-listed controls via precourse and postcourse surveys. Preliminary analysis of the first cohort of students shows significant improvements in attitudes, knowledge, and behaviors around healthy cooking and meal planning for the students compared with controls. Despite these promising preliminary results, more resources are needed to be able to hold the course frequently enough to meet student demand.

Food for Life: evaluation of the impact of the Hospital Food Programme in England using a case study approach

OBJECTIVES

To evaluate the impact and challenges of implementing a Food for Life approach within three pilot NHS sites in 2014/2015 in England. Food for Life is an initiative led by the Soil Association, a non-governmental organisation in the UK that aims to encourage a healthy, sustainable food culture across communities.

DESIGN

A case-study approach was undertaken using semi-structured interviews with staff and key stakeholders together with analysis of relevant documents such as meeting minutes, strategic plans and reports.

SETTING

Three NHS Trusts in England.

PARTICIPANTS

Staff and key stakeholders.

MAIN OUTCOME MEASURES

Synthesis of key findings from semi-structured interviews and analysis of relevant documents.

RESULTS

Key themes included the potential to influence contracting processes; measuring quality; food for staff and visitors; the role of food in hospitals, and longer term sustainability and impact. Participants reported that adopting the Food for Life approach had provided enormous scope to improve the quality of food in hospital settings and had provided levers and external benchmarks for use in contracting to help drive up standards of the food provided by external contractors for patients and staff. This was demonstrated by the achievement of an FFLCM for staff and visitor catering in all three organisations.

CONCLUSIONS

Participants all felt that the importance of food in hospitals is not always recognised. Engagement with Food for Life can produce a significant change in the focus on food within hospitals, and help to improve the quality of food and mealtime experience for staff, visitors and patients.