The generation and gender shifts in medicine: an exploratory survey of internal medicine physicians

BACKGROUND: Two striking demographic shifts evident in today's workforce are also apparent in the medical profession. One is the entry of a new generation of physicians, Gen Xers, and the other is the influx of women. Both shifts are argued to have significant implications for recruitment and retention because of assumptions regarding the younger generation's and women's attitudes towards work and patient care. This paper explores two questions regarding the generations: (1) How do Baby Boomer and Generation X physicians perceive the generation shift in work attitudes and behaviours? and (2) Do Baby Boomer and Generation X physicians differ significantly in their work hours and work attitudes regarding patient care and life balance? Gen Xers include those born between 1965 and 1980; Baby Boomers are those born between 1945 and 1964. We also ask: Do female and male Generation X physicians differ significantly in their work hours and work attitudes regarding patient care and life balance? METHODS: We conducted exploratory interviews with 54 physicians and residents from the Department of Medicine (response rate 91%) and asked about their perceptions regarding the generation and gender shifts in medicine. We limit the analyses to interview responses of 34 Baby Boomers and 18 Generation Xers. We also sent questionnaires to Department members (response rate 66%), and this analysis is limited to 87 Baby Boomers' and 65 Generation Xers' responses. RESULTS: The qualitative interview data suggest significant generation and gender shifts in physicians' attitudes. Baby Boomers generally view Gen Xer physicians as less committed to their medical careers. The quantitative questionnaire data suggest that there are few significant differences in the generations' and genders' reports of work-life balance, work hours and attitudes towards patient care. CONCLUSION: A combined qualitative and quantitative approach to the generation shift and gender shift in medicine is helpful in revealing that the widely held assumptions are not necessarily reflective of any significant differences in actual work attitudes or behaviours of Boomer and Gen X physicians or of the younger generation of women entering medicine

Physician nutrition and cognition during work hours: effect of a nutrition based intervention

<p>Abstract</p> <p>Background</p> <p>Physicians are often unable to eat and drink properly during their work day. Nutrition has been linked to cognition. We aimed to examine the effect of a nutrition based intervention, that of scheduled nutrition breaks during the work day, upon physician cognition, glucose, and hypoglycemic symptoms.</p> <p>Methods</p> <p>A volunteer sample of twenty staff physicians from a large urban teaching hospital were recruited from the doctors' lounge. During both the baseline and the intervention day, we measured subjects' cognitive function, capillary blood glucose, "hypoglycemic" nutrition-related symptoms, fluid and nutrient intake, level of physical activity, weight, and urinary output.</p> <p>Results</p> <p>Cognition scores as measured by a composite score of speed and accuracy (Tput statistic) were superior on the intervention day on simple (220 vs. 209, p = 0.01) and complex (92 vs. 85, p < 0.001) reaction time tests. Group mean glucose was 0.3 mmol/L lower (p = 0.03) and less variable (coefficient of variation 12.2% vs. 18.0%) on the intervention day. Although not statistically significant, there was also a trend toward the reporting of fewer hypoglycemic type symptoms. There was higher nutrient intake on intervention versus baseline days as measured by mean caloric intake (1345 vs. 935 kilocalories, p = 0.008), and improved hydration as measured by mean change in body mass (+352 vs. -364 grams, p < 0.001).</p> <p>Conclusions</p> <p>Our study provides evidence in support of adequate workplace nutrition as a contributor to improved physician cognition, adding to the body of research suggesting that physician wellness may ultimately benefit not only the physicians themselves but also their patients and the health care systems in which they work.</p

Consequences of telomere dysfunction in fibroblasts, club and basal cells for lung fibrosis development.

TRF1 is an essential component of the telomeric protective complex or shelterin. We previously showed that dysfunctional telomeres in alveolar type II (ATII) cells lead to interstitial lung fibrosis. Here, we study the lung pathologies upon telomere dysfunction in fibroblasts, club and basal cells. TRF1 deficiency in lung fibroblasts, club and basal cells induced telomeric damage, proliferative defects, cell cycle arrest and apoptosis. While Trf1 deletion in fibroblasts does not spontaneously lead to lung pathologies, upon bleomycin challenge exacerbates lung fibrosis. Unlike in females, Trf1 deletion in club and basal cells from male mice resulted in lung inflammation and airway remodeling. Here, we show that depletion of TRF1 in fibroblasts, Club and basal cells does not lead to interstitial lung fibrosis, underscoring ATII cells as the relevant cell type for the origin of interstitial fibrosis. Our findings contribute to a better understanding of proper telomere protection in lung tissue homeostasis.We are grateful to Dr. J. Xu from the Baylor College of Medicine for providing p63-CreERT2 mouse sperm for the generation of the p63 mutant mouse line. Research in the Blasco Lab is funded by AstraZeneca; Fundacion Botin and Banco Santander (Spain); Agencia Estatal de Investigacion (AEI/MCI/10.13039/501100011033) with the project RETOS SAF2017-82623-R, cofunded by European Regional Development Fund (ERDF), "A way of making Europe"; Comunidad de Madrid with the Synergy Project COVIDPREclinicalMODels-CM and the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement No 882385) through the project ERC-AvG SHELTERINS. The CNIO, certified since 2011 as Severo Ochoa Centre of Excellence by AEI/MCI/10.13039/501100011033, is supported by the Spanish Government through the Instituto de Salud Carlos III (ISCIII).S

The \u3cem\u3eChlamydomonas\u3c/em\u3e Genome Reveals the Evolution of Key Animal and Plant Functions

Chlamydomonas reinhardtii is a unicellular green alga whose lineage diverged from land plants over 1 billion years ago. It is a model system for studying chloroplast-based photosynthesis, as well as the structure, assembly, and function of eukaryotic flagella (cilia), which were inherited from the common ancestor of plants and animals, but lost in land plants. We sequenced the ∼120-megabase nuclear genome of Chlamydomonas and performed comparative phylogenomic analyses, identifying genes encoding uncharacterized proteins that are likely associated with the function and biogenesis of chloroplasts or eukaryotic flagella. Analyses of the Chlamydomonas genome advance our understanding of the ancestral eukaryotic cell, reveal previously unknown genes associated with photosynthetic and flagellar functions, and establish links between ciliopathy and the composition and function of flagella

Not all coping strategies are created equal: a mixed methods study exploring physicians' self reported coping strategies

<p>Abstract</p> <p>Background</p> <p>Physicians experience workplace stress and draw on different coping strategies. The primary goal of this paper is to use interview data to explore physicians' self reported coping strategies. In addition, questionnaire data is utilized to explore the degree to which the coping strategies are used and are associated with feelings of emotional exhaustion, a key symptom of burnout.</p> <p>Methods</p> <p>This mixed methods study explores factors related to physician wellness within a large health region in Western Canada. This paper focuses on the coping strategies that physicians use in response to work-related stress. The qualitative component explores physicians' self reported coping strategies through open ended interviews of 42 physicians representing diverse medical specialties and settings (91% response rate). The major themes extracted from the qualitative interviews were used to construct 12 survey items that were included in the comprehensive quantitative questionnaire. Questionnaires were sent to all eligible physicians in the health region with 1178 completed surveys (40% response rate.) Questionnaire items were used to measure how often physicians draw on the various coping strategies. Feelings of burnout were also measured in the survey by 5 items from the Emotional Exhaustion subscale of the revised Maslach Burnout Inventory.</p> <p>Results</p> <p>Major themes identified from the interviews include coping strategies used at work (e.g., working through stress, talking with co-workers, taking a time out, using humor) and after work (e.g., exercise, quiet time, spending time with family). Analysis of the questionnaire data showed three often used workplace coping strategies were positively correlated with feeling emotionally exhausted (i.e., keeping stress to oneself (r = .23), concentrating on what to do next (r = .16), and going on as if nothing happened (r = .07)). Some less often used workplace coping strategies (e.g., taking a time out) and all those used after work were negatively correlated with frequency of emotional exhaustion.</p> <p>Conclusions</p> <p>Physicians' self reported coping strategies are not all created equal in terms of frequency of use and correlation with feeling emotionally exhausted from one's work. This knowledge may be integrated into practical physician stress reduction interventions.</p

Location of residence associated with the likelihood of patient visit to the preoperative assessment clinic

BACKGROUND: Outpatient preoperative assessment clinics were developed to provide an efficient assessment of surgical patients prior to surgery, and have demonstrated benefits to patients and the health care system. However, the centralization of preoperative assessment clinics may introduce geographical barriers to utilization that are dependent on where a patient lives with respect to the location of the preoperative assessment clinic. METHODS: The association between geographical distance from a patient's place of residence to the preoperative assessment clinic, and the likelihood of a patient visit to the clinic prior to surgery, was assessed for all patients undergoing surgery at a tertiary health care centre in a major Canadian city. The odds of attending the preoperative clinic were adjusted for patient characteristics and clinical factors. RESULTS: Patients were less likely to visit the preoperative assessment clinic prior to surgery as distance from the patient's place of residence to the clinic increased (adjusted OR = 0.52, 95% CI 0.44–0.63 for distances between 50–100 km, and OR = 0.26, 95% CI 0.21–0.31 for distances greater than 250 km). This 'distance decay' effect was remarkable for all surgical specialties. CONCLUSION: The present study demonstrates that the likelihood of a patient visiting the preoperative assessment clinic appears to depend on the geographical location of patients' residences. Patients who live closest to the clinic tend to be seen more often than patients who live in rural and remote areas. This observation may have implications for achieving the goals of equitable access, and optimal patient care and resource utilization in a single universal insurer health care system

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Physician Coping Styles and Emotional Exhaustion

This paper examines how different coping styles that physicians use relate to emotional exhaustion, the key defining dimension of burnout. Specifically, we examine the extent to which they use active problem solving techniques, seek support, disengage from the situation or use denial as a coping strategy. In addition, we also explore whether the coping styles are more or less effective depending on certain dispositional and/or situational factors. Two individual predispositions are examined in this study in terms of positive and negative affectivity, as optimism and pessimism are stable personality traits that have implications for how individuals view situations and respond to them. Four different sources of physician work stress are examined to reflect the situational factors: work overload, patient interactions, average weekly work hours at work, and average weekly work hours at home. We analyze survey data from 1,110 practising physicians in a single health region in Western Canada.The overall pattern of results suggests that physicians’ individual dispositions are relevant to understanding the coping styles that they adopt. Physicians appear to use denial as a coping strategy when they experience work overload and difficult patient interactions. Furthermore, it is used by those with high negative affectivity. However, having a highly positive outlook appears to neutralize the harmful relationship between denial and emotional exhaustion. This supports the literature that argues that the effects of different coping styles may depend on the personality traits of who uses them. In addition, the harmful experiences related to stressful patient interactions are weakened for doctors who disengage or take a time out from the situation. This supports the literature that suggests that certain coping strategies may be more effective depending on the situation or type/source of stressor. Our findings suggest that certain coping strategies may be more effective depending on personality type and the type or source of stress encountered.Cet article examine comment différents modes d’adaptation utilisés par les médecins sont reliés à l’épuisement émotif, la dimension-clé de l’épuisement professionnel. Plus particulièrement, nous examinons dans quelle mesure ils ou elles font appel à une forme active de résolution de problème, cherchent à obtenir du support, se dissocient de la situation ou utilisent le déni comme stratégies d’adaptation. De plus nous explorons également dans quelle mesure les modes d’adaptation sont plus ou moins efficaces selon certains facteurs situationnels ou liés aux prédispositions des personnes. Deux prédispositions personnelles sont examinées dans cette étude en termes d’affectivité positive ou négative, étant donné que l’optimisme et le pessimisme sont des traits de personnalité stables qui ont des implications sur la manière dont les personnes perçoivent les situations et y répondent. Quatre sources différentes de stress chez les médecins sont examinées afin de refléter les facteurs situationnels : des situations de surcharge de travail, les interactions avec les patients, le nombre hebdomadaire moyen d’heures passées au travail et le nombre hebdomadaire moyen d’heures passées à la maison. Nous analysons les données d’une enquête menée auprès de 1 110 médecins pratiquant dans une même région de l’Ouest canadien.Une vue d’ensemble des résultats suggèrent que les prédispositions personnelles des médecins sont pertinentes dans la compréhension des modes d’adaptation auxquels ils recourent. Les médecins semblent recourir au déni comme stratégie lorsqu’ils sont en situation de surcharge de travail et lors d’interactions difficiles avec des patients, particulièrement chez ceux et celles qui affichent une affectivité négative. Toutefois, le fait d’afficher une affectivité positive semble neutraliser les relations pernicieuses entre le déni et l’épuisement émotif. Cela vient en appui à la littérature suggérant que les effets des divers modes d’adaptation dépendent des traits de personnalité de ceux qui y ont recourt. De plus les expériences douloureuses liées aux interactions stressantes avec des patients sont moins présentes chez les médecins qui s’en dissocient ou qui prennent un temps d’arrêt face à la situation. Cela vient aussi en appui à la littérature suggérant que certaines stratégies d’adaptation peuvent s’avérer plus efficaces selon la situation ou le type des facteurs de stress ou leur source. Nos résultats suggèrent donc que certaines stratégies d’adaptation sont plus efficaces selon le type de personnalité et selon le type de facteurs de stress rencontrés ou leur source.Este artículo examina cómo los diferentes estilos de afrontar el estrés que usan los médicos son asociados al agotamiento emocional, dimensión clave de la definición del surmenaje. En concreto, se analiza en qué medida los médicos utilizan de manera activa ciertas técnicas de resolución de problemas, buscan a obtener apoyo, se retiran de la situación o usan la negación como estrategia de afrontamiento. Exploramos también si los estilos de afrontamiento son más o menos eficaces en función de ciertos factores situacionales o vinculados a predisposiciones personales. En este estudio se examinan dos predisposiciones individuales en términos de afectividad positiva o negativa, dado que el optimismo y el pesimismo son rasgos estables de la personalidad que tienen implicaciones en la manera cómo las personas perciben las situaciones y cómo las enfrentan. A fin de reflejar los factores situacionales, se examinan cuatro diferentes fuentes de estrés en el trabajo médico: sobrecarga de trabajo, interacciones con los pacientes, promedio semanal de horas de trabajo, y promedio semanal de horas de trabajo en casa. Los datos analizados provienen de una encuesta con 1110 médicos que ejercen en una región sanitaria del Oeste Canadiense.El patrón general de los resultados sugiere que las características temperamentales individuales de los médicos son pertinentes para comprender los estilos de afrontamiento que ellos adoptan. Los médicos parecen utilizar la negación como estrategia de afrontamiento cuando experimentan sobrecarga de trabajo e interacciones difíciles con el paciente. Más aún, esto es utilizado sobre todo por las personas con alta afectividad negativa. Sin embargo, tener una actitud muy positiva parece neutralizar la relación perjudicial entre la negación y el agotamiento emocional. Esto apoya la literatura que sostiene que los efectos de los diferentes estilos de afrontamiento pueden depender de las características de personalidad de quienes los usan. Además, las experiencias perjudiciales asociadas a las interacciones estresantes con el paciente son menos presentes en los médicos que se desvinculan o se alejan temporalmente de la situación. Esto apoya la literatura que sugiere que ciertas estrategias de afrontamiento pueden ser más eficaces en función de la situación o el tipo/fuente de estrés. Nuestros resultados sugieren que ciertas estrategias pueden ser más eficaces en función del tipo de personalidad y del tipo o fuente de estrés encontrado