Healthcare organizations offer numerous clinical and academic leadership pathways for physicians, among which the position of program director (PD) is considered to be a prominent educational ...leadership role. As PDs are instrumental in the recruitment and training of the next generations of physicians, PD gender distribution can affect the present and future of a medical specialty. This study offers a dialectical perspective in understanding how international PDs negotiate gendered understanding of their work/role by using the framework of Relational Dialectics Theory 2.0. Thirty-three interviews of PDs from Qatar, Singapore, and the United Arab Emirates were conducted and, using contrapuntal analysis, the competing discourses of meanings of gender in the PD work/role were examined. Competing discourses where structural, cultural, and professional meanings of gender were interrogated revealed inherent multiple meanings of how gender is understood in PD work/roles. In making sense of these meanings of gender, PDs express dilemmas of traditional gender binaries of masculine/feminine work/role meanings to explain the term in different ways in their everyday organizational and cultural struggles. The findings have implications for PD recruitment and retention in teaching hospitals.
Background
Gender inequities are documented in academic medicine. Within General Internal Medicine (GIM), there are fewer female division directors and first and last authors on publications. With ...gender parity in US medical school graduates and with Academic Hospital (AH) medicine being a relatively newer discipline, one might postulate that AH would have less gender inequity.
Design
A national survey of AH programs was developed via literature review and expert recommendations. Domains included program and faculty information. Gender of the leader was determined via website or telephone call.
Participants
Leaders of AH programs associated with the American Association of Medical Colleges (AAMC). Programs without a primary teaching hospital or hospitalist program and those not staffed by university-affiliated physicians were excluded.
Main Measures
Description and characteristics of leaders and programs including a multivariable analysis of gender of hospitalist leaders and the portion of female faculty.
Key Results
59% response rate (80 of 135); there were no differences between responders/non-responders in NIH funding (
p
= 0.12), type of institution (
p
= 0.09), geographic region (
p
= 0.15), or year established (
p
= 0.86). Reported number of female and male faculty were approximately equal. 80% of hospitalist leaders were male; 37% of male hospitalist leaders were professors, no female leaders were professors. In univariate and multivariate analysis only the number of hospitals staffed was a significant predictor of having a female hospitalist leader. There were no significant predictors of having fewer female faculty.
Conclusion
This study demonstrated gender inequality in academic hospital medicine regarding leadership and rank. Though there was equal gender distribution of faculty, among leaders most were men and all “full professors” were men. As diversity benefits the tripartite mission research on methods, initiatives and programs that achieve gender equity in leadership are needed.
Background
This is the first randomized controlled trial evaluating the impact of note template design on note quality using a simulated patient encounter and a validated assessment tool.
Objective
...To compare note quality between two different templates using a novel randomized clinical simulation process.
Design
A randomized non-blinded controlled trial of a standard note template versus redesigned template.
Participants
PGY 1-3 IM residents.
Interventions
Residents documented the simulated patient encounter using one of two templates. The standard template was modeled after the usual outpatient progress note. The new template placed the assessment and plan section in the beginning, grouped subjective data into the assessment, and deemphasized less useful elements.
Main Measures
Note length; time to note completion; note template evaluation by resident authors; note evaluation by faculty reviewers.
Key Results
36 residents participated, 19 randomized to standard template, 17 to new. New template generated shorter notes (103 vs 285 lines,
p
< 0.001) that took the same time to complete (19.8 vs 21.6 min,
p
= 0.654). Using a 5-point Likert scale, residents considered new notes to have increased visual appeal (4 vs 3,
p
= 0.05) and less redundancy and clutter (4 vs 3,
p
= 0.006). Overall template satisfaction was not statistically different. Faculty reviewers rated the standard note more up-to-date (4.3 vs 2.7,
p
= 0.001), accurate (3.9 vs 2.6,
p
= 0.003), and useful (4 vs 2.8,
p
= 0.002), but less organized (3.3 vs 4.5,
p
< 0.001). Total quality was not statistically different.
Conclusions
Residents rated the new note template more visually appealing, shorter, and less cluttered. Faculty reviewers rated both note types equivalent in the overall quality but rated new notes inferior in terms of accuracy and usefulness though better organized. This study demonstrates a novel method of a simulated clinical encounter to evaluate note templates before the introduction into practice.
Trial Registration
ClinicalTrials.gov
ID: NCT04333238
Background
Depressive symptoms and burnout are common among medical students. However, few studies have investigated their trajectory over the course of medical school.
Objective
Evaluate ...year-by-year changes in depressive and burnout symptoms over the course of medical school training.
Design
Prospective study.
Participants
Medical students who matriculated at a private medical school in Maryland from 2010 to 2016 (
n
=758).
Main Measures
Clinically significant depressive symptoms were defined as a score of ≥10 on the 9-item Patient Health Questionnaire (PHQ-9), and burnout was measured using the Maslach Burnout Inventory (MBI). High emotional exhaustion, high depersonalization, and low personal accomplishment were defined as scores of ≥ 27, ≥10, and ≤33 on the respective MBI subscales.
Key Results
At matriculation, the prevalences of significant depressive symptoms, high emotional exhaustion, high depersonalization, and low personal accomplishment were 4.3%, 9.4%, 8.6%, and 37.7%, respectively. After adjustment for age, sex, race/ethnicity, marital status, and cohort, compared with year 1, the odds of significant depressive symptoms was significantly higher at the beginning of the 2nd, 3rd, and 4th years of study (ORs=2.63, 2.85, and 3.77, respectively; all
p
s<0.001). Compared with the 1st year, the odds of high emotional exhaustion also increased during the 2nd, 3rd, and 4th years of study, (ORs=3.46, 4.79, 8.20, respectively; all
p
s<0.001), as did the odds of high depersonalization (ORs=3.55, 6.14, 12.53, respectively; all
p
s<0.001). The odds of low personal accomplishment did not significantly differ across years of study.
Conclusions
The results of this study suggest that symptoms of depression and burnout may increase during medical school. Because of the high prevalence of depressive symptoms and burnout in medical students, interventions earlier in the medical career pathway that aim to prevent, detect, and treat these symptoms may be of benefit to the physician community.
CONTEXT Many patients infected with human immunodeficiency virus type 1 (HIV-1)
and receiving highly active antiretroviral therapy experience intermittent
episodes of detectable viremia (“blips”), ...which may raise concerns
about drug resistance, lead to costly repeat measurements of viral RNA, and
sometimes trigger alterations in therapy. OBJECTIVE To test the hypothesis that blips represent random biological and statistical
variation around mean steady-state HIV-1 RNA levels slightly below 50 copies/mL
rather than biologically significant elevations in viremia. DESIGN, SETTING, AND PATIENTS Between June 19, 2003, and February 9, 2004, patients receiving therapy
underwent intensive sampling (every 2-3 days) over 3 to 4 months to define
the frequency, magnitude, and duration of blips and their association with
drug levels and other clinical variables. Blips were defined as HIV-1 RNA
measurements greater than or equal to 50 copies/mL preceded and followed by
measurements less than 50 copies/mL without a change in treatment. To determine
whether blips result from or lead to drug resistance, an ultrasensitive genotyping
assay was used to detect drug resistance mutations before, during, and after
blips. Patients were 10 HIV-1–infected asymptomatic adults recruited
by clinicians and followed up in the Moore Clinic at the Johns Hopkins Hospital.
Patients had suppression of viremia to below 50 copies/mL while receiving
a stable antiretroviral regimen for 6 months or longer. MAIN OUTCOME MEASURES At each time point, plasma HIV-1 RNA levels were measured in 2 independent
laboratories and drug resistance mutations were analyzed by clonal sequencing. RESULTS With the intensive sampling, blips were detected in 9 of 10 patients.
Statistical analysis was consistent with random assay variation around a mean
viral load below 50 copies/mL. Blips were not concordant on independent testing
and had a short duration (median, <3 days) and low magnitude (median, 79
copies/mL). Blip frequency was not associated with demographic, clinical,
or treatment variables. Blips did not occur in relation to illness, vaccination,
or directly measured antiretroviral drug concentrations. Blips were marginally
associated (P = .08) with reported episodes
of nonadherence. Most importantly, in approximately 1000 independent clones
sequenced for both protease and reverse transcriptase, no new resistance mutations
were seen before, during, or shortly after blips. CONCLUSION Most blips in this population appear to represent random biological
and statistical variation around mean HIV-1 levels below 50 copies/mL rather
than clinically significant elevations in viremia.
IMPORTANCE On July 1, 2011, the Accreditation Council for Graduate Medical Education implemented further restrictions of its 2003 regulations on duty hours and supervision. It remains unclear if the ...2003 regulations improved trainee well-being or patient safety. OBJECTIVE To determine the effects of the 2011 Accreditation Council for Graduate Medical Education duty hour regulations compared with the 2003 regulations concerning sleep duration, trainee education, continuity of patient care, and perceived quality of care among internal medicine trainees. DESIGN AND SETTING Crossover study design in an academic research setting. PARTICIPANTS Medical house staff. INTERVENTION General medical teams were randomly assigned using a sealed-envelope draw to an experimental model or a control model. MAIN OUTCOME MEASURES We randomly assigned 4 medical house staff teams (43 interns) using a 3-month crossover design to a 2003-compliant model of every fourth night overnight call (control) with 30-hour duty limits or to one of two 2011-compliant models of every fifth night overnight call (Q5) or a night float schedule (NF), both with 16-hour duty limits. We measured sleep duration using actigraphy and used admission volumes, educational opportunities, the number of handoffs, and satisfaction surveys to assess trainee education, continuity of patient care, and perceived quality of care. RESULTS The study included 560 control, 420 Q5, and 140 NF days that interns worked and 834 hospital admissions. Compared with controls, interns on NF slept longer during the on call period (mean, 5.1 vs 8.3 hours; P = .003), and interns on Q5 slept longer during the postcall period (mean, 7.5 vs 10.2 hours; P = .05). However, both the Q5 and NF models increased handoffs, decreased availability for teaching conferences, and reduced intern presence during daytime work hours. Residents and nurses in both experimental models perceived reduced quality of care, so much so with NF that it was terminated early. CONCLUSIONS AND RELEVANCE Compared with a 2003-compliant model, two 2011 duty hour regulation–compliant models were associated with increased sleep duration during the on-call period and with deteriorations in educational opportunities, continuity of patient care, and perceived quality of care.
Peripheral fat loss and visceral fat gain have been reported in HIV infection. There are limited data on long-term change in adipose tissue in HIV-infected patients vs. controls. Therefore, we ...determined change in regional adipose tissue from baseline examination to 5 years later among participants in the study of Fat Redistribution and Metabolic Change in HIV Infection.
Regional adipose tissue volume was measured using MRI at both examinations in 477 HIV-infected and 214 control men and women. Lipoatrophy was defined as leg subcutaneous adipose tissue (SAT) below the cutoff point marking the lowest decile (10%) of controls at each examination.
HIV-infected and control participants showed similar adipose tissue gains. In men, all SAT depots and visceral adipose tissue started lower and remained lower on average in HIV-infected vs. controls. In women, leg and arm SAT also started lower and remained lower in HIV-infected vs. controls. Mean leg SAT of HIV-infected men was 67% of control men at baseline and 65% at follow-up; for women 83% and 77%. At baseline, 48% of HIV-infected participants had lipoatrophy; on average those with baseline lipoatrophy gained 0.96L of leg SAT compared with 1.23L gain for controls in the lowest decile (P = 0.16). At follow-up, 53% of HIV-infected participants had lipoatrophy. In multivariable models, discontinuation of stavudine appeared to produce little gain in leg SAT ( approximately 1.1%/year).
HIV-infected participants did not substantially recover SAT compared with controls, although both showed average gains. HIV-associated lipoatrophy persisted after 5 years of follow-up.
In light of a recent report that short-term treatment with valproic acid (VA) might accelerate the decay of the latent reservoir for HIV-1 in patients receiving combination therapy and allow eventual ...eradication of the infection, we studied patients with prolonged suppression of viremia who were receiving combination therapy and who had also been receiving chronic VA therapy for neurological or psychiatric conditions. Latently infected cells were readily detected in all patients at levels comparable to those seen in patients receiving combination therapy alone. We conclude that the clinical use of VA has no ancillary effect on the decay of the latent reservoir.
Gender inequity in academic medicine remains an important issue worldwide, with more female faculty entering academic medicine internationally. Some academic institutions have initiated programs and ...created policies to promote gender equity, but disparities remain in faculty numbers, promotions rates, research productivity and access to funding and resources. We offer 12 tips for best practices in the broad domains of faculty recruitment, retention and scholarship, promotion and leadership that institutions and individual faculty can adopt to promote gender equity. While the 12 tips form a comprehensive approach, each tip can be implemented individually depending on institutional needs and culture. Each tip includes practical advice for implementation supported by a successful example from the literature.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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