Identification of surgeon burnout via a single-item measure

Background Burnout is endemic in surgeons in the UK and linked with poor patient safety and quality of care, mental health problems, and workforce sustainability. Mechanisms are required to facilitate the efficient identification of burnout in this population. Multi-item measures of burnout may be unsuitable for this purpose owing to assessment burden, expertise required for analysis, and cost. Aims To determine whether surgeons in the UK reporting burnout on the 22-item Maslach Burnout Inventory (MBI) can be reliably identified by a single-item measure of burnout. Methods Consultant (n = 333) and trainee (n = 217) surgeons completed the MBI and a single-item measure of burnout. We applied tests of discriminatory power to assess whether a report of high burnout on the single-item measure correctly classified MBI cases and non-cases. Results The single-item measure demonstrated high discriminatory power on the emotional exhaustion burnout domain: the area under the curve was excellent for consultants and trainees (0.86 and 0.80), indicating high sensitivity and specificity. On the depersonalisation domain, discrimination was acceptable for consultants (0.76) and poor for trainees (0.69). In contrast, discrimination was acceptable for trainees (0.71) and poor for consultants (0.62) on the personal accomplishment domain. Conclusions A single-item measure of burnout is suitable for the efficient assessment of emotional exhaustion in consultant and trainee surgeons in the UK. Administered regularly, such a measure would facilitate the early identification of at-risk surgeons and swift intervention, as well as the monitoring of group-level temporal trends to inform resource allocation to coincide with peak periods

Polymeric and monomeric IgA response in serum and milk after parenteral cholera and oral typhoid vaccination

The effect of vaccinating lactating Pakistani mothers with a combination of live oral typhoid vaccine and parenteral inactivated cholera vaccine on specific milk and serum IgA antibodies in both monomeric (m) and polymeric (p) forms was analysed. IgA antibody titres peaked for both antigenic specificities 2 weeks after the first dose of vaccine. 82±7% of anti-Vibrio cholerae and 72±17% of anti-Salmonella typhi IgA were in the polymeric form. These serum pIgA antibodies were mainly dimeric IgA, not complexed with the secretory component. They disappeared more rapidly from serum than mIgA antibodies. Anti-V. cholerae IgA responses were parallel in serum and milk samples, whereas anti-S. typhi responses were dissociated. In milk, IgA antibodies were secretory IgA for both antigenic specificities, being probably of local origin in the mammary gland. Our results indicate that both oral and parenteral vaccinations can induce pIgA antibodies in serum and secretions, confirming that the presence of pIgA in serum does not necessarily reflect an immune stimulation only at the mucosal level.SCOPUS: ar.jFLWNAinfo:eu-repo/semantics/publishe

What do effective teachers of literacy do? Subject knowledge and pedagogical choices for literacy

This article explores the fine detail of practice by three teachers, recognised as effective teachers of literacy. All three were observed during nine literacy lessons, working with Year 2 (6/7 year olds) classes of successful inner-city primary schools in the South of England. Data collection took place in 2003, just as their schools were moving away from the early prescription of the National Literacy Strategy (NLS), and follow up visits were made in 2005. My initial interest had been in what these three teachers did with the NLS in order to motivate pupils and ensure high pupil attainment. Following observations, interviews and coding of teacher-pupil interaction, it became clear that The NLS Framework for Teaching (DfES, 2001) was not the driver of their success but a valuable vehicle for subtle and intuitive teacher behaviours that grew from a detailed understanding of how children develop as readers and writers. Implications for training student teachers to marry theoretical understanding with the expectations of a prescribed curriculum for literacy are discussed