Promoting Student Wellness and Self-Care During COVID 19: The Role of Institutional Wellness

Stress and burnout are serious and growing threats to the mental health of medical trainees. Recent estimates of burnout in medical students and residents are quite high, with more than half displaying signs of stress, anxiety and depression. The COVID-19 pandemic has only heightened the state of poor mental health in these student populations. It is the position of LSU Health Shreveport Office of Institutional Wellness that a critical need exists for academic institutions to evaluate challenges to self-care and wellbeing in medical trainees. Such evaluations may pave the way for the development of effective institutional wellness initiatives and strategies, with the goal of reducing barriers to self-care to promote better mental and physical health, and facilitate improved quality of life in medical students and residents.

Influence of medical trainee sleep pattern (chronotype) on burn-out and satisfaction with work schedules: a multicentre observational study

BackgroundMedical trainees’ work schedule is designed to cover duties without consideration of differences in circadian rhythms during a 24-hour period (chronotype).ObjectiveTo explore chronotype variation among medical trainees and understand its association with burn-out and schedule satisfaction.MethodsIn a multicentre observational study, we conducted two surveys between 1 October 2018 and 1 April 2019. Trainees from nine centres across the USA participated. We measured burn-out using Maslach Burnout Inventory (MBI), and trainee chronotype using the Morningness-Eveningness Questionnaire (MEQ).Results324 (32%) out of 1012 responded to our survey. Participants were 51% female and had a mean age of 30.8 years. Most participants had an intermediate MEQ type (65%). A large proportion of participants had burn-out on at least one of three tested MBI scales (62%); 5% of participants had burn-out on all three MBI scales. More participants with evening MEQ type had burn-out (66%) compared with morning MEQ type (55%), however, the results were not statically significant (p=0.294). Overall satisfaction with work shifts was 6.5 (95% CI 6.3 to 6.7), with higher satisfaction with day shift 7.7 (95% CI 7.5 to 7.9) and lowest satisfaction with overnight 24-hour call 3.5 (95% CI 3.2 to 3.9). Satisfaction was lower in trainees with burn-out 6.0 (95% CI 5.7 to 6.4), (p<0.001). In the follow-up survey, burn-out was present in at least one scale in 64% compared with 60% of respondents in the initial survey.ConclusionBurn-out is prevalent among medical trainees. Improving alignment between trainee preferences may improve performance, reduce human errors and burn-out.

Portrayal of Sickle Cell Disease Complications By Commercial Question Banks

BACKGROUND Sickle cell disease (SCD) affects ~100,000 people in the US and is associated with multi-system acute and chronic complications that shorten lifespan. While most pediatric patients in the US survive beyond age 18, the risk of death increases dramatically during late adolescence and young adulthood. This surge is due partly to insufficient access to comprehensive sickle cell and subspecialty care. As a result, patients with episodic SCD care have high rates of ED use and hospitalization, incurring substantial cost. Emergency physicians, hospitalists, and primary care physicians are frequently responsible for these highly complex patients and studies suggest that they lack necessary SCD knowledge and training. Question banks have emerged as the most widely used educational resource among medical students and residents studying for licensing exams. Medical trainees favor question banks over all other learning platforms, including lecture, to learn new material and for review. Question banks feature "highest-yield" topics and may be viewed as the most important clinical knowledge to carry into practice. Our study aims to examine SCD-related content in the most popular commercial question bank to determine how this important teaching platform serves to educate medical trainees about the complex pathophysiology and scope of SCD. METHODS We obtained access to three question banks used by trainees to prepare for the current USMLE Step 1, Step 2, and Step 3 exams. The keyword "sickle cell" was entered into a search feature. Inclusion criteria consisted of question vignettes that included a patient with SCD. Exclusion criteria comprised questions featuring patients with sickle cell trait or other hemoglobinopathy and non-SCD questions with SCD-related answer choices. Resulting questions were analyzed for disease-related topic and patient age. Questions were assigned to one of the following categories, selected due to high incidence of clinically significant complications per NHLBI guidelines: vasooclusive crisis (VOC)/pain, fever/infection, stroke, acute chest syndrome (ACS), spleen, renal, priapism, or hepatobiliary. Questions outside of these categories were designated "other." Patient age was categorized by group: birth to 5 years, 6-10 years, 11-15 years, 16-20 years, and 20 years or older. For clinical vignettes with multiple questions in series, questions were categorized individually while the patient was counted once (ex: 5-year-old with VOC in first question, develops ACS in second question: one "VOC/pain," one "ACS," and one patient 0-5 years). Test questions that were unrelated to the clinical vignette were categorized by the patient's clinical history (ex: 12-year-old frequently hospitalized for pain and observed sickle-shaped RBCs on peripheral smear most likely has what sequence in the beta-globin gene? Categorized as "VOC/pain" and patient 11-15 years). RESULTS There were 9041 questions total in the three banks. "Hematology & Oncology" questions comprised 5.3% (478/9041) of content and less than 1% were tagged "sickle cell" (0.55%, 50/9041). However, SCD rarely formed the question content (0.24%, 22/9041). A total of 20 patients with SCD were presented in questions. Pediatric patients were featured in almost every question (90.0%, 18/20) and the median patient age was 7.5 years. Two questions involved adult patients (M, F; age 23) and both presented to the ER with pain. Acute VOC pain, including dactylitis, was the most common complaint (36.4%, 8/22), followed by patients with fever or infection (27.3%, 6/22). Acute chest syndrome and splenic dysfunction (from fibrosis) were each tested once and acute stroke was tested twice (Table 1). There were no questions about renal failure, priapism, hepatobiliary complications, or splenic sequestration. CONCLUSIONS Our study found a significant proportion of questions focused on acute SCD pain in pediatric patients. Adult SCD patients were largely omitted from this question bank's content. Given that medical trainees favor question banks over all other learning platforms, this finding may suggest a limited scope of understanding of this disease. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

The Development and Evaluation of Online Podcast Modules as a Toolkit for Teaching Genetics and Genomics Competencies in Post-Graduate Medical Education

Background: The lack of comfort with core genetic and genomic competencies among medical trainees and physicians is a barrier to the implementation of precision medicine. To address this, we developed short online modules to promote genetic competencies for use post-graduate medical education. Methods: The educational toolkit was delivered as short online podcasts accompanied by slides. Each core module is approximately 15-20 minutes, and covered basic genetics, genetic testing, counselling and consenting, and interpreting and delivering results. These were supplemented by case-based modules on cancer genetics, prenatal genetics and cardiogenetics. The modules had pre- and post-test multiple choice questions pertaining to genetic and genomic competencies, attitudes towards precision medicine, and perceived competence. Results: Based on the pre- and post-test data, residents reported a discordance between how often they cared for patients with genetic disorders and their level of confidence with core genetic competencies. Post-module evaluations demonstrated a significant increase in confidence in interpreting a microarray, and basic genetics knowledge.Conclusions: Our study demonstrates that podcast modules are an innovative method to promote genetic and genomic competencies to postgraduate medical trainees. Limitations to our study included a small sample size, and further work is needed identify and address barriers to implementation. We suggest that integration at the post-graduate medical education level will be crucial to further promoting the development of precision medicine competencies in medical trainees and physicians.

Don’t Throw Your Heart Away: Increased Transparency of Donor Utilization Practices in Transplant Center Report Cards Alters How Center Performance Is Evaluated

Background Publicly available report cards for transplant centers emphasize posttransplant survival and obscure the fact that some centers reject many of the donor organs they are offered (reflecting a conservative donor acceptance strategy), while others accept a broader range of donor offers (reflecting an open donor acceptance strategy). Objective We assessed how the provision of salient information about donor acceptance practices and waitlist survival rates affected evaluation judgments of hospital report cards given by laypeople and medical trainees. Methods We tested 5 different report card formats across 4 online randomized experiments ( n1 = 1,003, n2 = 105, n3 = 123, n4 = 807) in the same hypothetical decision. The primary outcome variable was a binary choice between transplant hospitals (one with an open donor acceptance strategy and the other with a conservative donor acceptance strategy). Results Report cards featuring salient information about donor organ utilization rates (transplant outcomes categorized by quality of donor offers accepted) or overall survival rates (outcomes from both waitlist and transplanted patients) led lay participants (studies 1, 3, and 4) and medical trainees (study 2) to evaluate transplant centers with open donor acceptance strategies more favorably than centers with conservative strategies. Limitations Due to the nature of the decision, a hypothetical scenario was necessary for both ethical and practical reasons. Results may not generalize to transplant clinicians or patients faced with the decision of where to join the transplant waitlist. Conclusions These findings suggest that performance evaluations for transplant centers may vary significantly based not only on what outcome information is presented in report cards but also how the information is displayed.