Moral distress and burnout in internal medicine residents

Background: Residents frequently encounter situations in their workplace that may induce moral distress or burnout. The objective of this study was to measure overall and rotation-specific moral distress and burnout in medical residents, and the relationship between demographics and moral distress and burnout.Methods: The revised Moral Distress Scale and the Maslach Burnout Inventory (Human Service version) were administered to Internal Medicine residents in the 2013-2014 academic year at the University of British Columbia.Results: Of the 88 residents, 45 completed the surveys. Participants (mean age 30+/-3; 46% male) reported a median moral distress score (interquartile range) of 77 (50-96). Twenty-six percent of residents had considered quitting because of moral distress, 21% had a high level of burnout, and only 5% had a low level of burnout. Moral distress scores were highest during Intensive Care Unit (ICU) and Clinical Teaching Unit (CTU) rotations, and lowest during elective rotations (p<0.0001). Women reported higher emotional exhaustion. Moral distress was associated with depersonalization (p=0.01), and both moral distress and burnout were associated with intention to leave the job.Conclusion: Internal Medicine residents report moral distress that is greatest during ICU and CTU rotations, and is associated with burnout and intention to leave the job

Utility of the CORD ECG Database in Evaluating ECG Interpretation by Emergency Medicine Residents

OBJECTIVES: Electrocardiograph (ECG) interpretation is a vital component of Emergency Medicine (EM) resident education, but few studies have formally examined ECG teaching methods used in residency training. Recently, the Council of EM Residency Directors (CORD) developed an Internet database of 395 ECGs that have been extensively peer-reviewed to incorporate all findings and abnormalities. We examined the efficacy of this database in assessing EM residents' skills in ECG interpretation. METHODS: We used the CORD ECG database to evaluate residents at our academic three-year EM residency. Thirteen residents participated, including four first-year, four second-year, and five third-year residents. Twenty ECGs were selected using 14 search criteria representing a broad range of abnormalities, including infarction, rhythm, and conduction abnormalities. Exams were scored based on all abnormalities and findings listed in the teaching points accompanying each ECG. We assigned points to each abnormal finding based on clinical relevance. RESULTS: Out of a total of 183 points in our clinically weighted scoring system, first-year residents scored an average of 99 points (54.1%) [9 1- 1191, second-year residents 11 1 points (60.4%) [97-1261, and third-year residents 130 points (7 1.0%) [94- 1501, p = 0.12. Clinically relevant abnormalities, including anterior and inferior myocardial infarctions, were most frequently diagnosed correctly, while posterior infarction was more frequently missed. Rhythm abnormalities including ventricular and supraventricular tachycardias were most frequently diagnosed correctly, while conduction abnormalities including left bundle branch block and atrioventricular (AV) block were more frequently missed. CONCLUSION: The CORD database represents a valuable resource in the assessment and teaching of ECG skills, allowing more precise identification of areas upon which instruction should be further focused or individually tailored. Our experience suggests that more focused teaching of conduction abnormalities and posterior infarctions may be beneficial. The CORD database should be considered for incorporation into an ECG curriculum during residency training

Comparison of clinical and biochemical markers of dehydration with the clinical dehydration scale in children: A case comparison trial

Background: The clinical dehydration scale (CDS) is a quick, easy-to-use tool with 4 clinical items and a score of 1-8 that serves to classify dehydration in children with gastroenteritis as no, some or moderate/severe dehydration. Studies validating the CDS (Friedman JN) with a comparison group remain elusive. We hypothesized that the CDS correlates with a wide spectrum of established markers of dehydration, making it an appropriate and easy-to-use clinical tool.Methods: This study was designed as a prospective double-cohort trial in a single tertiary care center. Children with diarrhea and vomiting, who clinically required intravenous fluids for rehydration, were compared with minor trauma patients who required intravenous needling for conscious sedation. We compared the CDS with clinical and urinary markers (urinary electrolytes, proteins, ratios and fractional excretions) for dehydration in both groups using receiver operating characteristic (ROC) curves to determine the area under the curve (AUC).Results: We enrolled 73 children (male = 36) in the dehydration group and 143 (male = 105) in the comparison group. Median age was 32 months (range 3-214) in the dehydration and 96 months (range 2.6-214 months, p \u3c 0.0001) in the trauma group. Median CDS was 3 (range 0-8) within the dehydration group and 0 in the comparison group (p \u3c 0.0001). The following parameters were statistically significant (p \u3c 0.05) between the comparison group and the dehydrated group: difference in heart rate, diastolic blood pressure, urine sodium/potassium ratio, urine sodium, fractional sodium excretion, serum bicarbonate, and creatinine measurements. The best markers for dehydration were urine Na and serum bicarbonate (ROC AUC = 0.798 and 0.821, respectively). CDS was most closely correlated with serum bicarbonate (Pearson r = -0.3696, p = 0.002).Conclusion: Although serum bicarbonate is not the gold standard for dehydration, this study provides further evidence for the usefulness of the CDS as a dehydration marker in children.Trial registration: Registered at ClinicalTrials.gov (NCT00462527) on April 18, 2007. © 2014 Tam et al.; licensee BioMed Central Ltd

Enhancement of Aviation Fuel Thermal Stability Characterization Through Application of Ellipsometry

ASTM D3241/Jet Fuel Thermal Oxidation Tester (JFTOT) procedure, the standard method for testing thermal stability of conventional aviation turbine fuels is inherently limited due to the subjectivity in the color standard for tube deposit rating. Quantitative assessment of the physical characteristics of oxidative fuel deposits provides a more powerful method for comparing the thermal oxidation stability characteristics of fuels, especially in a research setting. We propose employing a Spectroscopic Ellipsometer to determine the film thickness and profile of oxidative fuel deposits on JFTOT heater tubes. Using JP-8 aviation fuel and following a modified ASTM D3241 testing procedure, the capabilities of the Ellipsometer will be demonstrated by measuring oxidative fuel deposit profiles for a range of different deposit characteristics. The testing completed in this report was supported by the NASA Fundamental Aeronautics Subsonics Fixed Wing Projec

Development of Consolidated Sarawak Geotechnical Site Investigation for Sarawak Soil

The development of spatial or non-spatial digitized Consolidated Sarawak Geotechnical Site Investigation (CoGSI) database aims to enable information to be stored in a digital form with the efficient search and fast retrieving data. The CoGSI database for Sarawak Soil is a function of a database management system, which consists of the site information; includes the project name, locations coordinates (division), borehole logs, field and laboratory test results. The main objectives of the project are to collect, store & digitized all verified & approved Geotechnical SI data and the input gathered from the local authority, consultants and contractors. The digitized database would be enormous value for future planning of infrastructure developments; making preliminary design estimates for earthwork/foundation assessment; and future decision making with early identification of potential areas for construction purposes, which will produce an economic and safe design. The SI databases are important resources where the insufficient ground conditions information, will cause either a significantly over-designed or an under-designed solution, which lead to potential failures. In addition, the project is also intended to realize a web-based application to allow users to search borehole, view bore-logs and provides digital downloadable boreholes data of the available ground information in a standard format for analysis. At present most of the SI data are available in the form of hardcopy reports, which is time consuming and often frustrating, especially when the required report or data cannot be found. In summary, the Consolidated Sarawak Geotechnical Site Investigation (CoGSI) database system, which stored in a digital format are deployed as a web-based system. This platform provides exploration of the digital databases, which then can be accessed anywhere and anytime through the desktop & portable computer and smart phones with internet access facility