58 research outputs found
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#MeToo in EM: A Multicenter Survey of Academic Emergency Medicine Faculty on Their Experiences with Gender Discrimination and Sexual Harassment
Introduction: Gender-based discrimination and sexual harassment of female physicians are well documented. The #MeToo movement has brought renewed attention to these problems. This study examined academic emergency physiciansâ experiences with workplace gender discrimination and sexual harassment.Methods: We conducted a cross-sectional survey of a convenience sample of emergency medicine (EM) faculty across six programs. Survey items included the following: the Overt Gender Discrimination at Work (OGDW) Scale; the frequency and source of experienced and observed discrimination; and whether subjects had encountered unwanted sexual behaviors by a work superior or colleague in their careers. For the latter question, we asked subjects to characterize the behaviors and whether those experiences had a negative effect on their self-confidence and career advancement. We made group comparisons using t-tests or chi-square analyses, and evaluated relationships between gender and physiciansâ experiences using correlation analyses.Results: A total of 141 out of 352 (40.1%) subjects completed at least a portion of the survey. Women reported higher mean OGDW scores than men (15.4 vs 10.2; 95% confidence interval [CI], 3.6â6.8). Female faculty were also more likely to report having experienced gender-based discriminatory treatment than male faculty (62.7% vs 12.5%; 95% CI, 35.1%-65.4%), although male and female faculty were equally likely to report having observed gender-based discriminatory treatment of another physician (64.7% vs 56.3%; 95% CI, 8.6%-25.5%). The three most frequent sources of experienced or observed gender-based discriminatory treatment were patients, consulting or admitting physicians, and nursing staff. The majority of women reported having encountered unwanted sexual behaviors in their careers, with a significantly greater proportion of women reporting them compared to men (52.9% vs 26.2%, 95% CI, 9.9%-43.4%). The majority of unwanted behaviors were sexist remarks and sexual advances. Of those respondents who encountered these unwanted behaviors, 22.9% and 12.5% reported at least somewhat negative effects on their self-confidence and career advancement.Conclusion: Female EM faculty perceived more gender-based discrimination in their workplaces than their male counterparts. The majority of female and approximately a quarter of male EM faculty encountered unwanted sexual behaviors in their careers.
Ideas to Action: Using Curriculum Design to Develop a âRoadmap to Wellnessâ Curriculum
Introduction: Physician burnout, well-being, and professional fulfillment are deeply intertwined topics that are increasingly recognized as affecting the lives of physicians, health care workers, and patients alike. The Accreditation Council for Graduate Medical Education (ACGME) mandates that all residencies address wellness within the context of residency training without providing much guidance on how to do so. Emergency Medicine organizations such as the American College of Emergency Physicians, the American Academy of Emergency Physicians, the Society for Academic Emergency Medicine, and the Council of Residency Directors of Emergency Medicine (CORD) suggest that one method to address wellness is in the form of a curriculum. Successfully developing or modifying a curriculum to work for individual residency programs can be a difficult task.
Methods: The CORD Resilience Committee Wellness Curriculum Subcommittee comprised of experts in physician wellness and medical education started by conducted literature searches on terms related to burnout and wellness and searching the internet for documented wellness curricula, models and resources. Using this information and a standard curriculum development process, they created a roadmap for developing (or modifying), initiating, and evaluating a wellness curriculum.
Conclusion: Wellness curricula are not a one-size-fits-all situation. Using the checklist and guidelines in this white paper, readers can individualize existing wellness curricula to help foster physician well-being
A Resident Retreat with Emergency Medicine Specific Mindfulness Training Significantly Reduces Burnout and Perceived Stress
Introduction: We hypothesize that a resident retreat with mindfulness training tailored for Emergency Medicine (EM) physicians can significantly reduce levels of burnout and perceived stress in EM residents.
Methods: We conducted an intervention study of 60 EM residents undergoing an annual resident retreat with a 2.5-hour mindfulness training. The retreat was a department-funded 2-day off-site experience with a wellness theme. The training was developed and delivered by an EM physician (JO\u27S) who is a Mindfulness-Based Stress Reduction (MBSR) teacher trainee, and a certified MBSR teacher (MD). The training focused on techniques that can be used on shift, such as mindful breathing, handwashing, eating/drinking, walking, and anchoring before resuscitations. The cohort contained an equal distribution of 1st, 2nd and 3rd year residents who received a financial incentive. The subjects completed the Maslach Burnout Inventory, Perceived Stress Scale and Mindful Attention and Awareness Scale at three time points: Time 1 - one month prior, Time 2 â one week post, Time 3 â one month post.
Results: The subjects were 60 EM residents (54% Male, 46% Female) with an average age of 29. Completion rates at the three time points were 70% (n = 42), 60% (n = 36) and 50% (n = 30) respectively. We found that Perceived Stress (Ï2 = 0.15, p \u3c 0.01) and Emotional Exhaustion (Ï2 = 0.21, p \u3c 0.01) decreased significantly over time in a linear progression across the three sampling periods. Though mindfulness as a trait did not change significantly during the study period, in the month after the retreat, 64% of resident respondents at Time 3 (n = 32) reported using the mindfulness techniques learned from the training at least 2 or 3 times a week on shift and 52% (n = 31) reported using them at least 2 or 3 times a week at home.
Conclusions: An EM resident retreat that included an EM specific mindfulness training significantly reduced perceived stress and emotional exhaustion. The learned mindfulness skills were readily adopted for use on shift. Further studies should investigate effectiveness of mindfulness training outside of the retreat format. Other wellness / academic activities that occur within the socially supportive milieu of a retreat could lead to the same significant reduction in burnout and perceived stress seen in the current study
Utilization of Wellness Practices For Burnout and Stress During COVID-19 Among an Interdisciplinary Cohort of Emergency Healthcare Workers
Introduction: The Coronavirus Disease (COVID-19) introduced additional stress to the baseline occupational stressors of emergency care workers. The objectives of this study were to evaluate perceived stress and burnout and the utilization and perceived benefit of wellness practices among emergency healthcare workers (EHCWs), including: emergency physicians, advanced practice providers (APPs), nurses, and departmental administrative staff during the COVID-19 pandemic.
Methods: A cross-sectional 28-item electronic survey of EHCWs at three hospitals in a major United States city was used to measure participantsâ utilization and perceived benefit of wellness practices, burnout (2-item measure), overall stress (perceived stress scale), and stress related to COVID-19.
Results: The sample consisted of 260 respondents (response rate 44.6%, 583 eligible). Over one-half (56.5%) reported burnout from their job and a majority (58.5%) reported moderate to high stress. Wellness activities including regular exercise and engaging in hobbies were associated with lower reports of burnout. Higher stress levels were reported by participants who had tested positive for COVID-19. Nurses reported the highest rates of burnout overall (80.6%). Females reported higher rates of burnout than males across the cohort (64.5 vs 41.9%, p = 0.001), and female APPs reported significantly higher burnout than did male APPs (69.2 vs 38.5%, p = 0.048). Participants reported donated personal protective equipment (PPE) and meals on shift were extremely helpful.
Conclusion: The COVID-19 pandemic was a significant contributor to the stress of EHCWs. Regular engagement in wellness activities was associated with lower rates of burnout. The benefit of engagement in wellness practices, both individual practices and organizational interventions are paramount to mitigate stress and burnout in EHCWs
A Comprehensive Residency Wellness Curriculum
Introduction: Resident physician burnout is an epidemic in medical education. There are several wellness curricula published, but few describe a comprehensive program to address wellness. Our objectives were to develop and pilot a longitudinal resident wellness curriculum and assess for feasibility and sustainability.
Methods: We surveyed emergency medicine (EM) residents from two residency programs in the United States to assess a baseline level of burnout using the Maslach Burnout Inventory. We developed a comprehensive and longitudinal wellness curriculum for EM residents that incorporated all domains identified by the American College of Emergency Physicians Wellness Wheel. Mindfulness practice was incorporated throughout the curriculum.
Results: A convenience sample of 106 EM residents were sent the baseline survey. A response rate of 69% was achieved, the median age of the respondents was 29 years, and 44.5% were female. Overall, 67.5% (95% CI: 50.5; 80.8%) reported burnout in at least one of the three domains of the Maslach Burnout inventory. 34.8% reported burnout in the personal accomplishment domain, 40.8% reported depersonalization, and 44.3% reported emotional exhaustion. The wellness curriculum was successfully implemented at the Georgia-based residency program. The curriculum has proven to be sustainable since it began in 2016. Quantitative statistical testing for the post-intervention survey was not possible due to a low response rate. However, subjective receivability was high, with participants describing these sessions as high-yield, informative and practical.
Conclusions: Burnout is highly prevalent among EM residents. We provide a curriculum developed for an EM residency program that is multifaceted and comprehensive, including basic wellness topics, mindfulness, financial and medicolegal issues, as well as topics that address the stresses specific to clinical emergency medicine. The curriculum has been in place in its current form since 2016 and has proven to be sustainable
Optimizing Wellness in Academic Emergency Medicine
Introduction
Academic Emergency Physicians (EPs) face additional unique challenges in optimizing wellness compared to community EPs.
Objective
Our objective was to explore specific individual and systems challenges that academic EPs encounter that affect their wellbeing and professional fulfillment in emergency medicine (EM).
Methods
An expert group of academic EPs convened in 2019 at the annual meeting of the Society of Academic Emergency Medicine to investigate the overall causes of burnout in healthcare providers, the effects of burnout on the healthcare system, specific causes of burnout in EM, and the distinct challenges facing academic emergency physicians.
Results
We outline specific causes of burnout in EM and the effects of burnout on the healthcare system. Scholarly productivity pressures, variable reimbursement gaps, time allotment, and work-life balance are challenges facing academic EPs.
Conclusion
Understanding the unique challenges of academic EPs in optimizing wellness is vital to inform future research and effective interventions
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This Article Corrects: âAssessment of Physician Well-being, Part Two: Beyond Burnoutâ
Part One of this two-article series reviews assessment tools to measure burnout and other negative states. Physician well-being goes beyond merely the absence of burnout. Transient episodes of burnout are to be expected. Measuring burnout alone is shortsighted. Well-being includes being challenged, thriving, and achieving success in various aspects of personal and professional life. In this second part of the series, we identify and describe assessment tools related to wellness, quality of life, resilience, coping skills, and other positive states
Unconditional care in academic emergency departments
Recent news stories have explicitly stated that patients with symptoms of COVID-19 were "turned away" from emergency departments. This commentary addresses these serious allegations, with an attempt to provide the perspective of academic emergency departments (EDs) around the Nation. The overarching point we wish to make is that academic EDs never deny emergency care to any person
Promising anticancer activity of batumin : a natural polyene antibiotic produced by Pseudomonas batumici
AIM : To determine the computer-predicted anticancer activity of antibiotic batumin. MATERIALS AND METHODS : Cytotoxicity assays, cell morphology microscopy and cell cycle progression were studied in cancer and nontumorigenic cell lines. An in vivo experiment on Lewis lung carcinoma (3LL)-transplanted mice was conducted to evaluate potential antimetastatic. RESULTS AND CONCLUSION : Cytotoxicity against melanoma and lung carcinoma cells (IC50 â 5 ÎŒg/ml) was detected. Hypercondensed chromatin and apoptotic body formation in batumin-treated cells suggested the induction of apoptosis supported also by an observed increase in the quantity of cells occupying the sub-G1 cell cycle phase. Twofold reduction in the number and volume of lung metastases in Lewis lung carcinoma (3LL)-bearing batumin-treated mice was demonstrated. Highly specific cytotoxicity of batumin against cancer cell lines potentiates further studies.https://www.future-science.com/loi/fmc2019-09-01hj2018BiochemistryGeneticsMicrobiology and Plant PathologyPhysiologyPlant Production and Soil Scienc
Route of drug administration in out-of-hospital cardiac arrest: A protocol for a randomised controlled trial (PARAMEDIC-3)
© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).AIMS: The PARAMEDIC-3 trial evaluates the clinical and cost-effectiveness of an intraosseous first strategy, compared with an intravenous first strategy, for drug administration in adults who have sustained an out-of-hospital cardiac arrest. METHODS: PARAMEDIC-3 is a pragmatic, allocation concealed, open-label, multi-centre, superiority randomised controlled trial. It will recruit 15,000 patients across English and Welsh ambulance services. Adults who have sustained an out-of-hospital cardiac arrest are individually randomised to an intraosseous access first strategy or intravenous access first strategy in a 1:1 ratio through an opaque, sealed envelope system. The randomised allocation determines the route used for the first two attempts at vascular access. Participants are initially enrolled under a deferred consent model.The primary clinical-effectiveness outcome is survival at 30-days. Secondary outcomes include return of spontaneous circulation, neurological functional outcome, and health-related quality of life. Participants are followed-up to six-months following cardiac arrest. The primary health economic outcome is incremental cost per quality-adjusted life year gained. CONCLUSION: The PARAMEDIC-3 trial will provide key information on the clinical and cost-effectiveness of drug route in out-of-hospital cardiac arrest.Trial registration: ISRCTN14223494, registered 16/08/2021, prospectively registered.Peer reviewe
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