Survey of the incidence and effect of major life events on graduate medical education trainees

When Illness and Loss Hit Close to Home-Do Health Care Providers Learn How to Cope?

INTRODUCTION

Up to 85% of newly qualified physicians report loss or illness in themselves or a loved one. These experiences can intensify feelings of grief in the professional setting, but the range of formal training that addresses personal illness or loss is unknown. This study aimed to explore interventions that teach health care providers and trainees about personal illness experience.

METHODS

A scoping review was conducted by searching three bibliographic databases using the terms "illness," "personal," "education," and synonyms. Article screening was performed in duplicate to identify studies that described an intervention that included teaching or learning on personal experiences with illness or loss for health care providers and trainees.

RESULTS

The search yielded 4168 studies, of which 13 were included. Education most often targeted medical students (54%), resident or attending physicians (31%), and nurses (31%). Other participants included social workers and psychologists. Personal illness was most frequently taught for reflection in the context of palliative care curricula (54%). Only two studies' primary purpose was to teach about coping with grief related to personal experiences. No studies within the scope of our defined methodology described training on how to support colleagues or trainees facing personal illness or loss. Reported outcomes included improved coping skills, decreased stress, and better ability to support bereaving patients.

DISCUSSION

Specific training on personal illness experience is limited, with gaps in continuity of learning, particularly for continuing medical education. Future curricula can equip providers with coping strategies while enabling improved resilience and patient care.

Internal Medicine-Paediatrics residents' application of life design principles to career decisions

BACKGROUND

Residency is an important time for career planning. Little is known about how trainees make career decisions during this formative period.

OBJECTIVE

The objective of this study was to understand whether 'design thinking' activities help to inform Internal Medicine-Paediatrics (Med-Peds) residents' career decisions.

METHODS

We performed a cross-sectional survey of a national sample of fourth-year Med-Peds residents in May-July 2019 covering intended career, helpfulness of 'life design' strategies used to inform career decision and confidence with intended career plans. Bivariate analyses were performed to evaluate associations between used strategies and confidence with career plans.

RESULTS

A total of 86/145 (59%) of residents responded to the survey. The most helpful activities for clarifying career decisions were immersive exposure to the career during residency, and reflecting on compatibility of careers with their views of life and work. Finding the right mentor was associated with higher confidence in one's intended career path (p<0.05). There were no significant differences with confidence in intended career plan by gender or career path. Career decisions made during the first 2 years of residency were associated with higher confidence than those made prior to or in the second half of residency (p=0.01 and p=0.004).

CONCLUSION

This national survey of graduating Med-Peds residents reveals that proactive life design strategies were helpful in bringing clarity to their decision and were associated with higher confidence in intended career plans. These data should be of interest to residency training programmes in their efforts to support trainees with their career decisions.

Survey on Specialty Preference and Work-Life Balance among Residents of Japanese Red Cross Hospitals

Introduction

The paucity and maldistribution of physicians among various specialties are key issues facing the Japanese health care system. Studies have shown that young physicians place more emphasis on work-life balance while selecting their specialty and that they prefer controllable lifestyle (CL) specialties over noncontrollable lifestyle (NCL) specialties. As this may be a cause of maldistribution, we investigated the relationship between views on work-life balance and specialty selection among young physicians in Japan.

Methods

An online questionnaire was sent to 1451 residents (postgraduate years 1-5) at 60 Japanese Red Cross hospitals across Japan.

Results

In all, 226 physicians responded (response rate: 15%), with 21% in CL and 74% in NCL specialties. When compared with NCL specialties, CL specialties had less overtime (43% vs. 16%, p = 0.001), considered life to be more important than work (26% vs. 15%, p = 0.018), and were more likely to give precedence to work-life balance over medical interest while choosing their specialty (49% vs. 30%, p < 0.001). Furthermore, physicians were more likely to change their choice of specialty, contrary to their professional interest, because of social reasons (49% vs. 26%, p = 0.007).

Conclusions

Our study suggests that young physicians in CL specialties have better working hours and place more emphasis on work-life balance while choosing their specialty compared with those in NCL specialties. The increase in the number of physicians in CL specialties is likely attributable to the growing preference for an optimal work-life balance among young physicians; this seems to have increased the maldistribution of physicians among various specialties. Institutional mechanisms to support the lifestyle of physicians (especially in NCL specialties) are required to provide a balanced medical service in Japan.

Work-Life Integration and Time Management Strategies

When choosing a career as a surgeon, we knowingly dedicate ourselves to a lifetime of service and education. Our commitment as physicians is but one of many commitments in the larger scheme of life where we function as family members, friends, athletes, and numerous other roles. Work and life are often described as two separate entities diametrically opposed to each other. In reality, personal and professional goals are part of a continuum where work is a major part of our lives and who we are as people and is not necessarily separate from the others. The goal-directed nature with which we approach our responsibilities as surgeons should be applied to all domains of life. As we progress along the training paradigm from intern to attending, control over time allocation increases. Understanding oneself, determining priorities, applying realistic expectations, cultivating a supportive environment, setting personal and professional goals, and being held accountable for progress and completion of these goals will allow us to utilize limited time efficiently to achieve what we individually desire from life.

Wellness and Work: Mixed Messages in Residency Training

Resident physicians are at higher risk for depression, anxiety, and burnout when compared with same-age peers, resulting in substantive personal and professional consequences. Training programs across the country have acknowledged the gravity of this situation and many have implemented programs and curricula that address wellness and resilience, yet the benefits of such initiatives are still largely unknown. While the development of wellness programming is well intentioned, it is often incongruent with the residency training environment. The mixed messaging that occurs when wellness programs are implemented in environments that do not support self-care may unintentionally cause resident distress. Indeed, outside of the time dedicated to wellness curricula, residents are often rewarded for self-sacrifice. In this commentary, we describe how the complexities of the medical system and culture contribute to mixed messaging and we explore the potential impact on residents. We offer recommendations to strengthen wellness programs through efforts to promote structural change in the training environment.