scholarly journals P129: The impact of high performance physician training on resident wellness and clinical performance

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S121-S121
Author(s):  
P. Sytnik ◽  
A. Hussain ◽  
J. Brooks
Keyword(s):  
Emergency Medicine ◽  
High Performance ◽  
Situational Awareness ◽  
Performance Enhancement ◽  
Clinical Performance ◽  
Maslach Burnout Inventory ◽  
Significant Difference ◽  
Resident Wellness ◽  
The Impact ◽  
Domain Scores

Introduction / Innovation Concept: There are numerous research studies in the medical literature, which demonstrate how the experience of a medical residency can contribute towards burnout. The escalating performance pressures and expectations during residency training have the potential to negatively impact upon physician health and clinical performance. The purpose of this prospective cohort study was to test the effectiveness of the High Performance Physician (HPP) program among General Surgery residents at the University of Manitoba with regard to burnout and clinical performance. Methods: This program was delivered over a 9-week period. All 26 residents were asked to complete the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). Each resident then participated as the team leader for a 15-minute trauma resuscitation simulation. Three attending physicians from Surgery & Emergency Medicine assessed resident performance and ability to manage work-based stressors. Following the simulation, each resident received a debrief interview. Once the HPP curriculum had been completed, residents took part in a second high fidelity simulation session and again completed the MBI-HSS. Curriculum, Tool, or Material: The HPP program offered through the Department of Emergency Medicine (EM), is a performance enhancement based curriculum. It is designed to equip physicians with mental skills to help optimize focus, arousal control, stress management, communication, and teamwork. Further, to utilize these skills to cope and respond more effectively to the inherent performance pressures that may present within one’s area of specialization. Conclusion: The Emotional Exhaustion domain of the MBI-HSS demonstrated a statistically significant decrease. The other domain scores were not statistically significant. Simulation domain scores did not demonstrate a statistically significant difference in performance between the pre- and post-HPP curriculum simulation sessions. A summative content analysis of the interview data demonstrated that residents believed internal barriers to situational awareness were the most significant impact on performance. Further study is required to determine if differences are seen in long-term follow-up.

scholarly journals MP002: Beyond rater cognition: the impact of supervisor continuity on the quality of documented work-based assessments

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S66-S67
Author(s):  
W. Cheung ◽  
N. Dudek ◽  
T.J. Wood ◽  
J.R. Frank
Keyword(s):  
Repeated Measures ◽  
Clinical Teaching ◽  
Clinical Performance ◽  
Pairwise Comparison ◽  
Clinical Supervisors ◽  
Significant Difference ◽  
Group 2 ◽  
Resident Group ◽  
The Impact

Introduction: Barriers to completing high quality work-based assessments (WBAs) include relational factors such as the episodic and fragmented interaction that often exists between clinical supervisors and trainees. In an effort to increase supervisor-trainee continuity, the Department of Emergency Medicine at the University of Ottawa created Clinical Teaching Teams (CTT) in which a resident and clinical supervisor work matched shifts together throughout the year. The aim of this study was to determine the impact of supervisor-trainee continuity on the quality of assessments documented on Daily Encounter Cards (DECs). Methods: DECs completed by 20 clinical supervisors were collected and sorted into three groups representing differing degrees of supervisor-trainee continuity (Group 1: CTT emergency resident; Group 2: non-CTT emergency resident; Group 3: non-CTT off-service resident). DECs were scored using the Completed Clinical Evaluation Report Rating (CCERR), a 9-item instrument that has been shown to have reliable ratings and the ability to discriminate the quality of completed DECs. Scores were analyzed using a univariate ANOVA with “mean CCERR score” as the dependent variable and “continuity group” and “supervisor” as between-subject variables. The relationship between CCERR scores and number of CTT encounters over time was examined using a repeated measures ANOVA with “encounter number” as the within-subject factor. Results: Mean CCERR scores for the CTT (21.0, SD=5.8), non-CTT (21.9, SD=4.2), and off-service (20.7, SD=4.0) groups differed (p=0.019). A subsequent pairwise comparison demonstrated a statistically significant difference in means between the non-CTT and off-service groups (p=0.04); however, this 1.2 difference on the 45-point CCERR scale is unlikely to be of any educational significance. The number of repeated encounters did not have a statistically significant effect on CCERR scores (p=0.43) indicating that DEC quality did not improve with greater supervisor-trainee interaction. Conclusion: DEC quality as scored by the CCERR was low for all three groups. Increasing supervisor continuity alone did not result in higher quality assessments of clinical performance. Additional research focusing on the educational alliance that develops between supervisor and trainee may hold greater promise.

Experimental procedure for determination of the energy dissipation capacity of ultra-high-performance fibre-reinforced concrete under localized impact loading

2019 ◽  
Vol 10 (2) ◽  
pp. 251-265 ◽  
Author(s):  
Petr Konrád ◽  
Radoslav Sovják
Keyword(s):  
Reinforced Concrete ◽  
Impact Loading ◽  
High Performance ◽  
Volume Fraction ◽  
Concrete Specimen ◽  
Basic Material ◽  
Fibre Reinforced Concrete ◽  
Significant Difference ◽  
The Impact ◽  
High Performance Fibre

Research presented in this article is aimed to investigate the ability of ultra-high-performance fibre-reinforced concrete to absorb and dissipate mechanical energy at elevated strain rate loading. Specimens made of ultra-high-performance fibre-reinforced concrete were subjected to the low-velocity impact using the new testing procedure where no fixed supports that hold the sample during the impact were applied. The fibre volume fraction of the ultra-high-performance fibre-reinforced concrete was set as the main test variable in the framework of this study and the volumetric fraction of fibres was ranging from 0.125% to 2%. A high-speed camera was used to measure velocities of the impactor and the ultra-high-performance fibre-reinforced concrete specimen before and after the impact. Consequently, the energy dissipated by the ultra-high-performance fibre-reinforced concrete specimen during the impact was calculated using a simple energy balance equation. To determine the basic material properties of ultra-high-performance fibre-reinforced concrete, quasi-static loading rate was applied and conventional methods were used. A significant difference between the values of dissipated energies for different loading rates and various fibre volumetric fractions was observed. It can be noted that the new procedure shows a reasonable approach for testing the fibre-reinforced cementitious composites under localized impact loading and is worthy of further optimization.

scholarly journals What affects medical students’ applications to five-year FRCPC emergency medicine programs?

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ravi Datar ◽  
Harrish Gangatharan ◽  
Fraser Kegel
Keyword(s):  
Emergency Medicine ◽  
Medical Schools ◽  
Study Data ◽  
Home School ◽  
Epidemiologic Factors ◽  
Medical Graduates ◽  
Application Rates ◽  
Significant Difference ◽  
Core Rotation ◽  
The Impact

Purpose: To compare the impact of institutional and epidemiologic factors on differences in application trends of Canadian medical graduates (CMGs) from different medical schools to FRCPC emergency medicine (EM) residency programs. Methods: This was a retrospective cohort study. Data from 2013-2018 were obtained from the Canadian Resident Matching Service (CaRMS) database and standardized questionnaires sent to Canadian medical schools. Results: CaRMS data were available for all schools and survey data was available for 76% schools. Five schools yielded significantly higher rates of applications to FRCPC-EM programs (8.8-13.1%, p<0.05), and 5 schools had significantly lower rates compared to the national mean (2.9-5.1%, p<0.05). Increased exposure to EM (a core rotation and/or elective rotation in EM in the third year of medical school at home-school) yielded 28-55% higher application rates (p<0.001). The presence of an FRCPC-EM residency program at the applicant's home school, and a home school program with 5 or more CMG residency positions at a CMG’s increased the application rates by 39 and 17%, respectively (p<0.05). Conclusion: These data demonstrate a significant difference in application rates of CMGs graduating from Canadian medical schools and certain factors may affect application rates. This information could be used by medical schools to modify curricula, increase exposure to EM, and contribute towards addressing the forecasted national shortage of EM physicians.

scholarly journals Demographics, Activities, and Environmental Factors Impact Burnout in a National Survey of Emergency Medicine Residents

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Nicole Battaglioli ◽  
Keyword(s):  
Emergency Medicine ◽  
Environmental Factors ◽  
Medical School ◽  
National Survey ◽  
Emotional Exhaustion ◽  
Maslach Burnout Inventory ◽  
Well Being ◽  
Individual Characteristics ◽  
System Level ◽  
The Impact

Introduction: Burnout in emergency medicine and in residency training has been well-described. The impact of demographic, individual, and programmatic factors on burnout have not previously been determined in a national survey of emergency medicine residents. This study aimed to identify personal and environmental factors impacting resident burnout in a national sample of emergency medicine residents. Methods: A prospective Emergency Medicine Resident Wellness Survey was administered in 2017. We surveyed Respondents on demographic, personal, and environmental factors; each Respondent also completed the Maslach Burnout Inventory - Human Services Survey. Linear regressions were used to identify variables associated with the Maslach Burnout Inventory’s subscales of burnout (depersonalization, emotional exhaustion, and personal achievement). Results: The survey was completed by 1,522 of 7,186 (21.2%) eligible EM residents. Respondents represented 193 of 247 (78.1%) Emergency Medicine residency programs. Increased levels of depersonalization were associated with graduation from a US medical school, female gender, and increase in respondent age. Trainees who were parents and who graduated from an osteopathic (vs. allopathic) medical school were found to have decreased levels of depersonalization. Emotional exhaustion was decreased in respondents who took breaks while on shift and who engaged in regular studying. Conclusion: While some individual characteristics impact burnout, environmental factors also play a significant role, and should be a target of system-level interventions to improve trainee well-being.

Feasibility of EEG to monitor cognitive performance during venous cannulation: EEG Distracted Intravenous Access (E-DIVA)

2016 ◽  
Vol 2 (3) ◽  
pp. 68-72 ◽  
Author(s):  
David J Lowe ◽  
Scott A James ◽  
Adam Lloyd ◽  
Gareth R Clegg
Keyword(s):  
Cognitive Load ◽  
Clinical Performance ◽  
Educational Interventions ◽  
Task Completion ◽  
Cognitive Workload ◽  
Simple Arithmetic ◽  
Arithmetic Task ◽  
Significant Difference ◽  
Set Up ◽  
The Impact

BackgroundThe feasibility study aims to evaluate the use of EEG in measuring workload during a simulated intravenous cannulation task. Cognitive workload is strongly linked to performance, but current methods to assess workload are unreliable. The paper presents the use of EEG to compare the cognitive workload between an expert and novice group completing a simple clinical task.Methods2 groups of volunteers (10 final year medical students and 10 emergency medicine consultants) were invited to take part in the study. Each participant was asked to perform 3 components of the simulation protocol: intravenous cannulation, a simple arithmetic test and finally these tasks combined. Error rate, speed of task completion and an EEG-based measure of cognitive workload were recorded for each element.ResultsEEG cognitive workload during the combined cannulation and arithmetic task is significantly greater in novice participants when compared with expert operators performing the same task combination. EEG workload mean measured for novice and experts was 0.62 and 0.54, respectively (p=0.001, 95% CI 0.09 to 0.30). There was no significant difference between novice and expert EEG workload when the tasks were performed individually.ConclusionsEEG provides the opportunity to monitor and analyse the impact of cognitive load on clinical performance. Despite the significant challenges in set up and protocol design, there is a potential to develop educational interventions to optimise clinician's awareness of cognitive load. In addition, it may enable the use of metrics to monitor the impact of different interventions and select those that optimise clinical performance.

Burnout and neurotic symptoms among medical students

2016 ◽  
Vol 33 (S1) ◽  
pp. S327-S328 ◽  
Author(s):  
A. Tereszko ◽  
K. Drozdowicz ◽  
M. Szymura ◽  
A. Tuleja ◽  
W. Korzeniowski ◽  
...  
Keyword(s):  
Mental Health ◽  
Medical Students ◽  
Medical Profession ◽  
Maslach Burnout Inventory ◽  
Symptom Checklist ◽  
Student Survey ◽  
Medical Studies ◽  
Significant Difference ◽  
Competing Interest ◽  
The Impact

IntroductionMedical studies are considered one of the most stressful majors and the medical profession is one of the most at risk of burnout. Some studies indicate the presence of symptoms of burnout already in the early stages of career, or even before it started, i.e. during studies preparing for the profession. Medical studies may be such a case and it can affect the mental health deterioration and cause the occurrence of both burnout and neurotic symptoms.ObjectivesAssessment of the impact of the course of studies on mental health of students and the risk of rapid burnout.AimEstimation of the prevalence and severity of burnout and neurotic symptoms among medical student depending on the year of study.MethodsSeven hundred and eighty-one medical students participated in the study. We used translated version of Maslach Burnout Inventory-Student Survey and Polish questionnaire – Symptom checklist S-III – for neurotic symptoms assessment.ResultsThere was no significant difference in MBI-SS subscales and symptoms checklist between first and last year of studies. Difference turned out to be significant when 1st and 6th year students with 3rd year – in Symptom checklist (P < 0.01 and P < 0.05, respectively), MBI-SS emotional exhaustion subscale (P < 0.01 for both) and depersonalization subscale (P < 0.01, significant only when compared with 1st year students).ConclusionsStudy revealed interesting pattern of burnout and neurotic symptoms, with theirs greatest severity at the beginning and the end of studies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals P110: Are there differences in student academic and clinical performance after rotations at tertiary or community care Emergency Medicine teaching sites?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S103-S104
Author(s):  
C. Rotenberg ◽  
S. Field
Keyword(s):  
Emergency Medicine ◽  
Student Perceptions ◽  
Clinical Performance ◽  
Tertiary Care ◽  
Pass Rate ◽  
Medical Emergency ◽  
Community Hospitals ◽  
Undergraduate Medical Students ◽  
Clinical Scenarios ◽  
Significant Difference

Introduction: Canadian undergraduate medical Emergency Medicine (EM) rotations are often completed at either tertiary care centres or regional community hospitals. While the latter offer students exposure to different practice settings and population needs, many students perceive that teaching at tertiary care EM departments is superior to that in community hospitals. At our institution, third year undergraduate medical students complete three-week EM rotation at either a tertiary centre or a community hospital. We compared academic and clinical performance between students trained in tertiary care centres and students trained in community hospitals. Methods: Academic and clinical performance in EM was evaluated based on the results of an EM-specific multiple choice examination (MCQE) and an annual Objective Structured Clinical Exam (OSCE) assessing competency in a broad range of clinical scenarios commonly addressed in EM. The 40-question MCQE is administered quarterly and a mix of old and new questions are used to ensure consistency. The OSCE is administered annually and relies on the same principal to remain consistent. OSCE scores are binary: pass or fail. We reviewed MCQE and OSCE scores from three consecutive cohorts of students. Students were pooled into two groups, tertiary and community, based on the site of their EM rotation. Mean MCQE and OSCE performance were compared between the two groups of students using two-tailed unpaired T tests. Chi squared tests were used to identify significant differences in scores between cohorts. Results: MCQE and OSCE scores from 312 students over three consecutive cohorts were analyzed. Cohorts included 104, 100, and 108 students with 61% trained in tertiary centres (N = 191). Students trained in tertiary centres had a mean MCQE score of 77%. Students from community centres had a mean score of 78%. There was no significant difference in MCQE scores between tertiary- and community-trained students (p = 0.6099). The OSCE pass rate was 97% for students trained in tertiary centres and 98% for students trained in community centres. OSCE pass rates were not significantly different between the two groups (p = 0.8145). Conclusion: Despite student perceptions that training in tertiary care EM centres was superior, objective analysis showed that academic and clinical performance were similar regardless of training site.

scholarly journals Dental surgical care in blood dyscrasias patients: an epidemiological study

2021 ◽  
Vol 69 ◽  
Author(s):  
Lorenzzo De Angeli CESCONETTO ◽  
Luiz Henrique Soares TORRES ◽  
Renata Pittella CANÇADO ◽  
André Alberto Camara PUPPIN
Keyword(s):  
Hepatitis C ◽  
Tranexamic Acid ◽  
Clinical Performance ◽  
Surgical Care ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Advantages And Disadvantages ◽  
Retention System ◽  
Significant Difference ◽  
The Impact

ABSTRACT Introduction: In Brazil, about 18.500 people have some kind of hereditary coagulopathy. In combination, the increase in life expectancy has led to an increasingly frequent presence of older people in medical offices. These patients make use of many drugs, including those that produce anticoagulant effects. The dentist should be aware about the impact of bleeding disorders during the approach of their patients, especially if invasive procedures are considered. Objective: To identify the most prevalent blood dyscrasias presented by patients covered by the Program of dental surgical care to patients with blood dyscrasias; to establish the presence of associated diseases and investigate the correlation between pre- and postoperative drug protocols and the occurrence of postoperative complications. Methods: This was an epidemiological retrospective cross-sectional study of medical reports used by the program. After the survey of defined variables, data were tabulated in Microsoft Excel ® software and evaluated using the chi-square and Fisher’s exact tests. Results: One patient was identified as having Human Immunodeficiency Virus and 18 with Hepatitis C virus. There was a statistically significant difference between patients with haemophilia B and Hepatitis C. The administration of tranexamic acid as pre- and post-surgical protocol was the therapy of choice. Of the 11 patients with vWD, 7 of them received tranexamic acid as preoperative medication. Conclusion: The appropriate retention system for the patient depends on several factors, including indication, advantages and disadvantages, retention provided, aesthetics and clinical performance.

scholarly journals P012: Does physician burnout differ between urban and rural emergency medicine physicians? A comparison using the Maslach Burnout Inventory tool

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S68-S69
Author(s):  
R. Leigh ◽  
K. Van Aarsen ◽  
L. Foxcroft ◽  
R. Lim
Keyword(s):  
Emergency Medicine ◽  
Emotional Exhaustion ◽  
Qualitative Interviews ◽  
Maslach Burnout Inventory ◽  
Primary Outcome Measure ◽  
Personal Accomplishment ◽  
Rural Practice ◽  
Physician Burnout ◽  
Survey Tool ◽  
Significant Difference

Introduction: Previous literature suggests that emergency medicine physicians experience high levels of work-related burnout. However, these results are drawn primarily from physicians working in large urban emergency departments. The aim of this study was to compare physician wellness between emergency medicine physicians working in urban versus rural settings. Methods: Emergency medicine physicians were recruited to complete a wellness survey from both urban and rural emergency medicine departments in Southwestern Ontario. The primary outcome measure of interest was physician burnout as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). This survey tool measures physician burnout in the three domains of emotional exhaustion, depersonalization, and personal accomplishment. Descriptive statistics, paired t-tests and Mann-Whitney U tests were used to analyze parametric and non-parametric burnout domain data respectively. Results: Surveys were completed by 67/99 (68%) and 22/66 (33%) of urban and rural emergency medicine physicians, respectively. An emotional exhaustion score ≥27 OR a depersonalization sub-score ≥10 was considered the threshold for burnout and was found in 71.4% (40/56) of urban physicians surveyed and 85.7% (18/21) (P = 0.20) of rural physicians. No statistically significant difference in mean emotional exhaustion, depersonalization, or personal accomplishment was noted between groups. Conclusion: High levels of burnout were noted amongst both urban and rural emergency medicine physicians. No statistically significant differences were noted between groups when compared on the Maslach Burnout Inventory survey tool. Despite many factors differentiating urban from rural practice, rural emergency doctors suffer similar rates of burnout. Thematic qualitative interviews exploring specific burnout factors may offer further insight into the drivers of physician burnout.

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