Burnout in Academic Medicine: A Peripandemic Assessment

The impact of burnout on academic medicine has affected its 3 major missions-education, patient care, and research-in ways both similar to and dissimilar from the community practice of medicine. The authors have assessed major themes in the literature regarding burnout in health care professionals in academic medicine in the peripandemic periods-pre-, intra-, and postpandemic-to gain information on the impact of the pandemic on these perspectives. Additionally, burnout in military physicians, particularly in the military medicine academic community, was assessed to provide comparative perspectives on the factors of military training, personal resiliency, and unit cohesiveness on the development of, or resistance to, professional burnout. Overall, there are data to indicate an aggravation of burnout during the pandemic, but currently no long-term data to indicate a persistence of its effects over time on health care professionals beyond baseline prevalence identified prepandemic. Based on the assessments, recommendations are provided for future research, including clarification and standardization of the concepts of burnout, developing longitudinal studies on health care practitioner burnout status with preventive and/or mitigating interventions, and the special protection of certain professionals, including female physicians, physicians in training, and early-career faculty, including nonclinical researchers.

Medical Ethics in Extreme and Austere Environments

American society has a history of turning to physicians during times of extreme need, from plagues in the past to recent outbreaks of communicable diseases. This public instinct comes from a deep seated trust in physician duty that has been earned over the centuries through dedicated and selfless care, often in the face of personal risks. As dangers facing our communities include terroristic events physicians must be adequately prepared to respond, both medically and ethically. While the ethical principles that govern physician behavior—beneficence, nonmaleficence, autonomy, and social justice—are unchanging, fundamental doctrines must change with the new risks inherent to terroristic events. Responding to mass casualty disasters caused by terrorists, natural calamities, and combat continue to be challenging frontiers in medicine. Preparing physicians to deal with the consequences of a terroristic disease must include understanding the ethical challenges that can occur.

Contemporary ethical considerations in clinical otolaryngology

The practice of otolaryngology has been significantly challenged by the constraints of the novel virus pandemic, but the specialty has continued to provide clinical care for patients in a manner consistent with ethical principles and moral leadership. Continued attention to maintaining the ethical foundations for appropriate informed consent, provision of remote health care through telemedicine, and strengthening the patient-physician relationship while role modeling the highest level of professionalism will continue to be challenging for the specialty throughout and beyond the pandemic temporal boundaries. These contemporary elements of ethical clinical care, examined in the context of disruption of the traditional practice of otolaryngology, are foundational to the duties and responsibilities inherent to the profession of medicine.

LEVEL OF EVIDENCE

5.

The Pandemic Effect: Raising the Bar for Ethics, Empathy, and Professional Collegiality

The widespread, tragic loss of life and the dedication of health care professionals have characterized the severe acute respiratory syndrome coronavirus 2 pandemic. While we mourn the loss of so many Americans to this novel virus, we also much acknowledge the positive effects to our profession, which are not insignificant. We have witnessed our larger community of otolaryngologist-head and neck surgeons pulling together in a manner not heretofore observed by this author. From the local level of practitioners to our national societies, there has been an amazing effort of collegial unity to develop the most clinically relevant guidelines for providing patient care with maximal safety, in the face of little scientific knowledge or experience with this virus. In addition, we as a specialty and individual otolaryngologists have, through our shared experiences, raised the bar for empathy, ethics, and professional interaction during these difficult times. We must reflect upon our professional growth and capture this renewal of altruism that lives at the heart of our calling.

Management of High-Velocity Injuries of the Head and Neck

Trauma centers must prepare to manage high-velocity injuries resulting from a mass casualty incidents as global terrorism becomes a greater concern and an increasing risk. The most recent conflicts in Iraq and Afghanistan have significantly improved understanding of battlefield trauma and how to appropriately address these injures. This article applies combat surgery experience to civilian situations, outlines the physiology and kinetics of high-velocity injuries, and reviews applicable triage and management strategies.

Vestibular Dysfunction in Gulf War Syndrome

METHODS: Vestibular complaints of Gulf War veterans were characterized by a nested case-control study of 23 veterans with 3 different Gulf War syndromes and 20 matched control subjects. All subjects completed a standardized symptom questionnaire and underwent standard audiovestibular tests administered by audiologists blinded to group identities.

RESULTS: The prevalence of reported dizzy spells was higher in veterans with Gulf War syndromes 1 (100%), 2 (85%), and 3 (100%) than in controls (25%, P < 0.0001). Dizzy spells were more frequent, lasted longer, and involved a wider variety of accompanying symptoms in veterans with syndrome 2 than in those with syndromes 1 and 3. Audiovestibular testing showed greater interocular asymmetry of nystagmic velocity on sinusoidal harmonic acceleration in syndromes 1 ( P = 0.015) and 2 ( P = 0.002), greater asymmetry of saccadic velocity in syndrome 2 ( P = 0.4), diminished nystagmic velocity after caloric stimulation bilaterally in syndrome 3 (P = 0.02 to 0.04), more subjects with pathologic nystagmus ( P = 0.09), and greater interside asymmetry of wave I to III interpeak latency on auditory brain stem response in syndromes 1 ( P = 0.005) and 2 ( P = 0.07). Asymmetry of gain on sinusoidal harmonic acceleration and pathologic nystagmus were most strongly associated with symptoms of paroxysmal vertigo (P = 0.002 and 0.07, respectively); asymmetry of saccadic velocity, with the severity of vertigo (P = 0.004); and abnormal caloric response, with chronic dysequilibrium ( P = 0.006).

CONCLUSIONS: The findings are compatible with a subtle neurologic injury from organophosphate-induced delayed neurotoxicity.