Burnout: exploring the differences between U.S. and international medical graduates.

Background: International medical graduates (IMGs) have less burnout than U. S. medical school graduates (USMGs) during residency training. This study evaluates possible correlates of differences in burnout rates between USMGs and IMGs. Methods: We surveyed 375 first-year residents at orientation in June/July 2017. We assessed burnout using the Copenhagen Burnout Inventory (CBI) and used validated scales to measure stress, quality of life (QoL), mastery, and spirituality. We collected data on gender, place of graduation, language fluency, and specialty. We compared CBI scores between USMGs and IMGs, performed a multivariate linear regression analysis of relationships between covariates and CBI subscales, and logistic regression analysis for our categorical definition of burnout. Results: Two hundred twenty-two residents responded for a response rate of 59%. Personal, work or patient- related burnout was common among residents, particularly among USMGs. The most common form of burnout was work-related. Forty nine percent of USMGs have work burnout compared to 26% of IMGs (p \u3c 0.01). In multivariate analysis, being an IMG reduced odds of work-related and of total burnout by 50% (OR 0.5 C.I 0.25-0.99). Perceived mastery was associated with reductions in all subscales of burnout (p \u3c 0.05). Stress and low QoL related to personal and work burnout scores (p \u3c 0.01). Conclusion: Work-related burnout is more common among USMGs than in IMGs. Although mastery, QoL and stress were correlates of burnout among all residents, these factors did not explain the difference. Future studies should evaluate the role of medical school structure and curriculum on differences in burnout rates between the two groups

Isolated virtualised clusters: testbeds for high-risk security experimentation and training

International audienceAdequate testbeds for conducting security experiments and test under controlled, safe, repeatable and asrealistic- as-possible conditions, are a key element for the research and development of adequate security solutions and the training of security personnel and researchers. In this paper, we report on the construction and operations of isolated virtualised testbeds used in two separate security research labs in Canada and France, as part of a joint collaborative effort. The main idea was to use mid- to large-scale isolated computing clusters to obtain high levels of scale, manageability and safety by heavily leveraging virtualisation technology, open-source cluster management tools and a network architecture separating experiment and control traffic. Both facilities have been used for conducting different types of security research experiments, including in-lab reconstructions of botnets, denial-of-service attacks, and virus detection experimentation. They have also been used for teaching and training students in experimental security methods. We describe these facilities and the criteria that we used to design them, the research and training activities that were conducted, and close by discussing the lessons learned and the pros and cons of this approach

The case for in-the-lab botnet experimentation: creating and taking down a 3000-node botnet

International audienceBotnets constitute a serious security problem. A lot of effort has been invested towards understanding them better, while developing and learning how to deploy effective counter-measures against them. Their study via various analysis, modelling and experimental methods are integral parts of the development cycle of any such botnet mitigation schemes. It also constitutes a vital part of the process of understanding present threats and predicting future ones. Currently, the most popular of these techniques are “in-the-wild” botnet studies, where researchers interact directly with real-world botnets. This approach is less than ideal, for many reasons that we discuss in this paper, including scientific validity, ethical and legal issues. Consequently, we present an alternative approach employing “in the lab” experiments involving at-scale emulated botnets. We discuss the advantages of such an approach over reverse engineering, analytical modelling, simulation and in-the-wild studies. Moreover, we discuss the requirements that facilities supporting them must have. We then describe an experiment in which we emulated a close to 3000-node, fully-featured version of the Waledac botnet, complete with a reproduced command and control (C&C) infrastructure. By observing the load characteristics and yield (rate of spamming) of such a botnet, we can draw interesting conclusions about its real-world operations and design decisions made by its creators. Furthermore, we conducted experiments where we launched sybil attacks against the botnet. We were able to verify that such an attack is, in the case of Waledac, viable. However, we were able to determine that mounting such an attack is not so simple: high resource consumption can cause havoc and partially neutralise the attack. Finally, we were able to repeat the attack with varying parameters, in an attempt to optimise it. The merits of this experimental approach is underlined by the fact that it is very difficult to obtain these results by employing other methods

Integration of Public Health in LCME Accredited Medical Schools in Florida: A Survey Based Study

Introduction: The future physician will face a career challenged by a number of significant changes in healthcare, including changes in demographics and disease, an increasing focus on population health and value-based care, and changes in healthcare funding. National organizations have called for medical schools to better prepare students for these challenges, and to incorporate more public health education in medical school. While many medical schools have responded, the topics covered, the timing in the curriculum, and the importance of these topics for graduation vary widely. Florida has been a site of growth in medical education in the last 10 years. Given that new medical schools were developed during a period of increased emphasis on the need for public health education, a survey was developed to assess the state of public health education in medical schools accredited by the Liaison Committee for Medical Education (LCME) in the state of Florida. Methods: The survey included questions on school location, size of the student body, date of initial LCME accreditation, presence of department or school of public health, and presence of a pathway or track in public health. The survey asked detailed questions about public health content, curricula delivery methods, and timing of the curriculum within the four-year course of study as well as the courses providing public health content. The survey asked about the value of curricular content and the survey itself. The online survey was sent to the associate or senior associate deans for education in the seven LCME accredited schools who had full or provisional accreditation as of December 2017. Data collection occurred between March 14 and March 30, 2018. Results: Six of the seven medical schools responded. Of the eleven competencies included in the survey, schools reported between five and eleven. Three schools cover nine or more of the eleven competencies. The number of competencies covered was not statistically influenced by age of the school, percentage of underrepresented students in medicine, the presence of a school or department of public health, or a special pathway or track in public health. The most common teaching method used was a didactic lecture, and the least was the structured experience with a local health organization. The fourth year of medical school saw the least amount of public health education. Five of the six respondents felt that the competencies presented here are very important to extremely important, and one school feels that they are moderately important. Discussion: Nationally, education in public health is an important component in medical education, but the topics included, educational methods used and the importance of the content varies from school to school. The state of public health education in medical schools in Florida is robust in some schools. The individuals responsible for the curriculum support the importance of these topics. The content is delivered through a diversity of pedagogical methods. The study results demonstrate a number of opportunities for enhancement. Conclusion: Given the importance of public health content in medical schools, survey methodology using established competencies to assess public health curricula could be used in the US to provide an up-to-date assessment of the strengths and opportunities for improvement in this area

Daily self-care and cognitive restructuring: A potentially potent prescription for physician wellness

Burnout among physicians has increased dramatically over the past decade. Recently, the United States Accreditation Council of Graduate Medical Education has prioritised the development of strategies aimed at promoting physician wellness and self-care. This pilot study sought to assess the feasibility of delivering a wellness curriculum in the context of multispecialty learning communities and to determine whether interns would benefit from being taught wellness strategies within these group settings. We examined outcomes of a wellness curriculum for interns from 14 different specialties at a large academic institution. 188 interns were assigned to one of 18 multispecialty learning communities (MSLC). Thirty-seven interns (20%) completed questionnaires at the end of the study. Interns reported an increased awareness of the need to take care of themselves and to practice wellness strategies, particularly cognitive restructuring and daily intentional self-care, as well as an improved ability to practice these wellness techniques. Almost all the interns reported they would be likely to continue to use these strategies throughout the remainder of their residency. Based on these preliminary findings, it appears that teaching wellness in multispecialty learning communities may be feasible and interns may benefit from being taught targeted, evidence-based wellness strategies in these focused group settings

How Does Black History Help Doctors? Addressing Cultural Competency through Cinemeducation at a Diverse Medical School

Racial minorities will account for >50% of the United States population by 2045, yet race and ethnicity persist as leading predictors of morbidity. Although minorities achieve better outcomes when treated by racially concordant providers, the number of minority physicians is disproportionately low compared with the rapidly growing minority population. This imbalance creates a cultural gap between many minority patients and their healthcare providers. Research suggests that educational initiatives addressing health inequity through a historical lens can help providers better understand the root causes of disparities; however, extensive clinical demands severely limit the time providers can dedicate to non-medical learning. To address this gap, the University of Miami/Jackson Memorial Hospital System developed and piloted a short film about the history of Black people in South Florida, highlighting significant events that shaped the health-seeking behaviors of this population. A 20-minute documentary exploring the sociocultural history of Black communities in Miami-Dade County was presented to 188 first-year postgraduate residents in June 2017. Residents completed pre-post surveys to measure changes in knowledge and care delivery intentions. Analyses performed between March and July 2018 revealed moderate improvements in the knowledge and awareness of the socioeconomic history of Miami's Black communities. Before watching the video, a majority indicated that increasing awareness of the sociocultural history of their patient population was a valuable learning activity. These findings suggest that brief videos focused on the history of culturally distinct populations may be a successful pedagogical strategy to introduce physicians to the communities they serve and improve provider knowledge

Acute generalised exanthematous pustulosis associated with shock

A 23-year-old man with a history of end-stage renal disease was admitted to the hospital due to fever and shock, which occurred during his dialysis. One week prior, he developed an erythematous rash on his chest, face and back, associated with generalised eruption of pustules. In hospital, his status did not improve with norepinephrine and empirical broad-spectrum antibiotics. Following this, methylprednisolone was administered with remarkable improvement. Cultures revealed no infectious aetiology. Based on the morphology of the rash and a compatible skin biopsy, the diagnosis of acute generalised exanthematous pustulosis (AGEP) was established and considered the cause of his shock. The causative agent of his AGEP remained unknown. AGEP is a rare condition, most frequently associated with drug exposure. The removal of the offending agent is the treatment of choice. It can be complicated by shock in rare cases. In that scenario, systemic corticosteroids seem to improve outcomes greatly