1.
The Society of Gynecologic Oncology wellness curriculum pilot: A groundbreaking initiative for fellowship training.
Turner, TB, Kushner, DM, Winkel, AF, McGwin, G, Blank, SV, Fowler, JM, Kim, KH, ,
Gynecologic oncology. 2020;(3):710-714
Abstract
OBJECTIVES Trainee well-being is a core component of ACGME program requirements and the SGO has recognized the high incidence of burnout among gynecologic oncologists and its negative impact. To foster a culture of wellness throughout the SGO community we sought to engage current fellows along with fellowship directors in a structured didactic program designed to teach wellness. We evaluated the feasibility of and preliminary responses to a pilot curriculum designed to teach skills that promote wellness and prevent burnout. METHODS The SGO Wellness Taskforce developed a curriculum with topics based on established evidence as well as specialty specific stressors such as end of life discussions. Faculty leaders from 15 pilot-sites attended a full-day training course and then taught four modules over four months. Interactive modules engaged fellows through reflective writing, guided discussion, and multimedia presentations. Fellows completed the Perceived Stress Scale pre- and post-implementation and provided feedback regarding attitudes toward wellness and the individual modules. Faculty curriculum leaders completed surveys regarding their attitudes toward the curriculum as well as their trainees' reactions. RESULTS Among 73 participating gynecologic oncology fellows, 95% (69/73) and 52/73 (71%) completed the pre-and post-surveys, respectively. Only 34/73 (49%) respondents reported that there was wellness programming at their institution prior to the initiation of the SGO curriculum. At institutions where such programming was available, 35% (12/34) reported not utilizing them. Fifty-five (80%) fellows had PSS scores greater than 12 compared to 39 (75%) post-intervention. After the curriculum, the percentage of fellows comfortable discussing wellness topics increased from 63 to 74%. Prior to the curriculum, 75% felt they could identify symptoms of burnout or psychosocial distress. This increased to 90% post-intervention. The modules were well received by fellows, and the time spent addressing wellness was widely appreciated. CONCLUSIONS A structured curriculum to promote wellness among gynecologic oncology fellows is feasible and was associated with observed decreased reported stress among fellows at participating programs. This curriculum addresses ACGME requirements regarding trainee well-being, and showed potential for more programmatic, nationwide implementation. Fellowship culture change was not directly measured, but may have been one of the most significant positive outcomes of the wellness program. Further longitudinal studies will be necessary to understand the natural course of fellow burnout and the impact of structured wellness programming.
2.
The relationship between risk of eating disorders, age, gender and body mass index in medical students: a meta-regression.
Jahrami, H, Saif, Z, Faris, MA, Levine, MP
Eating and weight disorders : EWD. 2019;(2):169-177
Abstract
PURPOSE Age, gender and body mass index (BMI) are commonly described risk factors for the development of eating disorders. However, the magnitude of these factors (individually and together) is still not well-defined in some populations. METHODS A systematic search was performed for studies that reported the prevalence of eating disorder risk among medical students using the Eating Attitudes Test-26 (EAT-26) and age, gender and BMI as risk factors. We included studies published in English peer-reviewed journals between 1982 and 2017. A total of 14 studies were included in the analyses, and the meta-regression analyses were performed using mean age (years), gender (proportion of female subjects), and mean BMI (kg/m2) as moderators with the risk of eating disorders measured using EAT-26 as an outcome variable. Four interaction terms were created (1) age × gender (2) age × BMI (3) gender × BMI and (4) age × gender × BMI to assess if two or more independent variables simultaneously influence the outcome variable. RESULTS Utilizing the EAT-26, the pooled prevalence of at risk for eating disorders among medical students (k = 14, N = 3520) was 10.5% (95% CI 7.3-13.7%). Meta-regression model of age, gender and BMI alone revealed poor predictive capabilities. Meta-regression model of age × gender × BMI interaction revealed statistically significant results with a covariate coefficient of 0.001 and p value of 0.044. CONCLUSION Results from this sample of medical students provided evidence for the role of interactions between risk factors (e.g., age × gender × BMI) in predicting individuals at risk for eating disorders, whereas these variables individually failed to predict eating disorders. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis.
3.
Why do medical graduates choose rural careers?
Henry, JA, Edwards, BJ, Crotty, B
Rural and remote health. 2009;(1):1083
Abstract
INTRODUCTION This study is based on the metaphor of the 'rural pipeline' into medical practice. The four stages of the rural pipeline are: (1) contact between rural secondary schools and the medical profession; (2) selection of rural students into medical programs; (3) rural exposure during medical training; and (4) measures to address retention of the rural medical workforce. METHODS Using the rural pipeline template we conducted a literature review, analysed the selection methods of Australian graduate entry medical schools and interviewed 17 interns about their medical career aspirations. LITERATURE REVIEW The literature was reviewed to assess the effectiveness of selection practices to predict successful gradation and the impact of rural pipeline components on eventual rural practice. Undergraduate academic performance is the strongest predictor of medical course academic performance. The predictive power of interviews is modest. There are limited data on the predictive power of other measures of non-cognitive performance or the content of the undergraduate degree. Prior rural residence is the strongest predictor of choice of a rural career but extended rural exposure during medical training also has a significant impact. The most significant influencing factors are: professional support at national, state and local levels; career pathway opportunities; contentedness of the practitioner's spouse in rural communities; preparedness to adopt a rural lifestyle; educational opportunities for children; and proximity to extended family and social circle. Analysis of selection methods: Staff involved in student selection into 9 Australian graduate entry medical schools were interviewed. Four themes were identified: (1) rurality as a factor in student selection; (2) rurality as a factor in student selection interviews; (3) rural representation on student selection interview panels; (4) rural experience during the medical course. Interns' career intentions: Three themes were identified: (1) the efficacy of the rural pipeline; (2) community connectedness through the rural pipeline; (3) impediments to the effect of the rural pipeline, the most significant being a partner who was not committed to rural life CONCLUSION Based on the literature review and interviews, 11 strategies are suggested to increase the number of graduates choosing a career in rural medicine, and one strategy for maintaining practitioners in rural health settings after graduation.