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Gohar AA, Knauert M, Kalot MA, Khan A, Sider D, Javed MA, Wooldridge D, Eck L, Buckhold F, Colaco B, Bhat A, Castillo DM, Newman R, Mustafa RA. Influence of medical trainee sleep pattern (chronotype) on burn-out and satisfaction with work schedules: a multicentre observational study. Postgrad Med J 2022; 98:936-941. [PMID: 37062998 PMCID: PMC10074556 DOI: 10.1136/postgradmedj-2021-140975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/25/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Medical trainees' work schedule is designed to cover duties without consideration of differences in circadian rhythms during a 24-hour period (chronotype). OBJECTIVE To explore chronotype variation among medical trainees and understand its association with burn-out and schedule satisfaction. METHODS In a multicentre observational study, we conducted two surveys between 1 October 2018 and 1 April 2019. Trainees from nine centres across the USA participated. We measured burn-out using Maslach Burnout Inventory (MBI), and trainee chronotype using the Morningness-Eveningness Questionnaire (MEQ). RESULTS 324 (32%) out of 1012 responded to our survey. Participants were 51% female and had a mean age of 30.8 years. Most participants had an intermediate MEQ type (65%). A large proportion of participants had burn-out on at least one of three tested MBI scales (62%); 5% of participants had burn-out on all three MBI scales. More participants with evening MEQ type had burn-out (66%) compared with morning MEQ type (55%), however, the results were not statically significant (p=0.294). Overall satisfaction with work shifts was 6.5 (95% CI 6.3 to 6.7), with higher satisfaction with day shift 7.7 (95% CI 7.5 to 7.9) and lowest satisfaction with overnight 24-hour call 3.5 (95% CI 3.2 to 3.9). Satisfaction was lower in trainees with burn-out 6.0 (95% CI 5.7 to 6.4), (p<0.001). In the follow-up survey, burn-out was present in at least one scale in 64% compared with 60% of respondents in the initial survey. CONCLUSION Burn-out is prevalent among medical trainees. Improving alignment between trainee preferences may improve performance, reduce human errors and burn-out.
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Affiliation(s)
- Ashraf A Gohar
- Department of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Melissa Knauert
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mohamad A Kalot
- Department of Medicine, State University of New York, Buffalo, New York, USA
| | - Akram Khan
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Darby Sider
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida, USA
| | - Muhammad Ali Javed
- Department of Critical Care Medicine, Mercy Hospital St Louis Area, Saint Louis, Missouri, USA
| | - David Wooldridge
- Department of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Leigh Eck
- Department of Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Fred Buckhold
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Brendon Colaco
- Department of pulmonary, Mayo Clinic, Jacksonville, Florida, USA
| | - Abid Bhat
- Department of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Dubier Matos Castillo
- Division of Pulmonary Critical Care, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Ross Newman
- Department of Pediatrics, Children's Mercy, Kansas City, Missouri, USA
| | - Reem A Mustafa
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Nwankwo EC, Hendrix C, Pollard K, Kallal C, Cruschiel T, Buckhold F, Hachem C. Epidemiologic disparities in colon cancer screening and adherence during the COVID-19 pandemic: a retrospective cohort analysis. Int J Colorectal Dis 2022; 37:849-854. [PMID: 35275279 PMCID: PMC8914442 DOI: 10.1007/s00384-022-04118-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second-leading cause of death in the USA. CRC screening remains underutilized, especially in underinsured populations. Screening has been heavily disrupted during the COVID-19 pandemic. PURPOSE The goal is to explore the impact of the pandemic on ethnic and gender disparities in CRC screening. METHODS Patients were identified 1 year before and after COVID-19 precautions began, using March 1, 2020, as the inflection point. The primary inclusion criterion was an ordered colonoscopy. The outcome of interest was a colonoscopy performed. Differences by year and race were assessed using chi-square analysis. A cohort of 1549 patients (899 in pre-COVID; 650 in post-COVID) between age 45 and 75 for whom a colonoscopy was ordered was selected from EHR at a large institution. RESULTS There was a 51% reduction in screening colonoscopies performed. White patients had a decrease of 49%, and African Americans had a 55% reduction. Stool testing increased from 47% prior to the pandemic to 94% during the pandemic representing a greater than 100% increase in stool testing uptake. CONCLUSION The true impact of COVID-19 on colorectal cancer is yet to be uncovered as future mortality estimates from CRC are ongoing. Due to the widespread closure of endoscopy centers and delay in screening, we believe that the pandemic worsened the screening disparities most prevalent among minority populations. Our study points to the drastic reduction of screening for all races, especially for African Americans.
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Affiliation(s)
- Eugene C. Nwankwo
- grid.262962.b0000 0004 1936 9342Department of Internal Medicine, Saint Louis University School of Medicine, 1008 S. Spring Avenue, Saint Louis, MO 63110 USA
| | - Christian Hendrix
- grid.262962.b0000 0004 1936 9342Department of Internal Medicine, Saint Louis University School of Medicine, 1008 S. Spring Avenue, Saint Louis, MO 63110 USA
| | - Kelvin Pollard
- grid.262962.b0000 0004 1936 9342Department of Internal Medicine, Saint Louis University School of Medicine, 1008 S. Spring Avenue, Saint Louis, MO 63110 USA
| | - Chad Kallal
- grid.262962.b0000 0004 1936 9342The Advanced HEAlth Data (AHEAD) Research Institute at Saint Louis University, Saint Louis, USA
| | - Tim Cruschiel
- grid.262962.b0000 0004 1936 9342The Advanced HEAlth Data (AHEAD) Research Institute at Saint Louis University, Saint Louis, USA
| | - Fred Buckhold
- grid.262962.b0000 0004 1936 9342Department of Internal Medicine, Saint Louis University School of Medicine, 1008 S. Spring Avenue, Saint Louis, MO 63110 USA
| | - Christine Hachem
- grid.262962.b0000 0004 1936 9342Division of Gastroenterology & Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, USA
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Hempel S, Miake-Lye I, Brega AG, Buckhold F, Hassell S, Nowalk MP, Rubenstein L, Schreiber K, Spector WD, Kilbourne AM, Ganz DA. Quality Improvement Toolkits: Recommendations for Development. Am J Med Qual 2019; 34:538-544. [PMID: 30675797 DOI: 10.1177/1062860618822102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A burgeoning number of toolkits dedicated to improving health care exist but development guidance is lacking. The authors convened a panel of health care stakeholders, including developers, purchasers, users, funders, and disseminators of toolkits. The panel was informed by a literature review that analyzed 44 publications and 27 toolkits. A modified Delphi process established recommendations and suggestions to guide toolkit development. The panel established 12 recommendations for content and 1 recommendation for toolkit development methods. The recommendations are accompanied by 11 suggestions for toolkit content, 9 suggestions for development methods, and 6 suggestions for toolkit evaluation methods. The authors established a set of key recommendations and suggestions addressing the content, development, and evaluation methods of quality improvement toolkits, together with a ready-to use checklist. The guidance aims to advance the value of toolkits as an emerging method to effectively disseminate interventions to improve the quality of care.
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Affiliation(s)
| | | | | | - Fred Buckhold
- Saint Louis University School of Medicine, St. Louis, MO
| | | | | | | | - Kathryn Schreiber
- Veterans Health Administration, San Diego Healthcare System, San Diego, CA
| | | | - Amy M Kilbourne
- US Department of Veterans Affairs Quality Enhancement Research Initiative, Ann Arbor, MI.,University of Michigan, Ann Arbor, MI
| | - David A Ganz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA.,University of California Los Angeles, Los Angeles, CA
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