Push for Family-friendly Residencies; Burnout May Begin In Residency; Sharps Injuries on the Rise

Wanted: Family-Friendly Residencies

Growing numbers of physicians are becoming parents during their residency, but no formal ways to support such parenting residents exist beyond the immediate birth of their children.

A University of Missouri School of Medicine researcher suggests residency programs should offer certain services to help ease this load and explore the possibility of offering paid parental leave for male and female residents or on-site day care, as well as creating ways for residents to share parenting information and resources with each other.

“Residency is a time of competing demands as trainees attempt to balance work roles as learners and clinicians with personal roles as parents and partners. These conflicts can cause both positive and negative outcomes on their families and residency experiences,” says Laura Morris, MD, a primary care physician at MU Health Care’s Family Medicine-Callaway Clinic in Fulton, MO, and assistant professor of clinical family and community medicine at the MU School of Medicine Columbia, MO.

Researchers conducted focus groups with residents who also were parents. She asked the residents to discuss how parenting during residency had affected their well-being and how they perceived their roles as parents and physicians. Participants described both positive and negative outcomes from their decisions to become parents during residency, yet overwhelmingly supported greater scheduling flexibility at work.

“Participants described negative residency experiences, such as being required to bounce back and forth between working days and nights, and the uncertainty of when and how to access sick leave,” Dr. Morris says. “Participants also described feeling guilty for multiple reasons during their residencies, including not being able to offer more support to their spouse.”

The study is published in Family Medicine.

Sharps Injuries Affect More Than Three-Quarters of Derm Residents

Seventy-six percent of dermatology residents experience a sharps injury, according to a letter to the editor published in the April 2016 issue of the Journal of the American Academy of Dermatology.

Most respondents received formal sharps safety education, but 70 percent had no hands-on safety training.

That needs to change—and fast, says study author Vinod E. Nambudiri, MD, a dermatologist at Brigham and Women’s Hospital in Boston. “Greater emphasis during dermatology training on best practices for physician safety is needed,” he tells Practical Dermatology®. “Dermatologists come into contact with a wide range of potentially hazardous sharps—including but not limited to solid bore suturing needles, hollow needles, straight and curved biopsy blades, curettes—across the medical, surgical, and cosmetic domains of our practices.”

He continues: “Ensuring trainees have the opportunity to gain hands-on practice with these instruments eliminates unfamiliarity and should allow for the safer practice of dermatology and higher quality patient care.”

In the study, Dr. Nambudiri and colleagues conducted an anonymous 14-question survey among 351 residents across 81 dermatology residencies to better characterize the features of needlestick and other sharps injuries. They identified 645 reported sharps injuries, 444 of which were sustained during residency training. During residency, 76 percent of trainees reported sustaining a sharps injury, with cumulative frequency increasing by postgraduate year (PGY).

Specifically, the mean number of sharps injuries was 2.4 per resident by PGY 4, the study found. Overall, 77 percent of injuries occurred during surgical procedures, with 51 percent occurring outside of procedural or operating rooms. Suturing was the most frequently reported cause of a sharps injury (42 percent), and most were self-induced. Rushing contributed to 53 percent of sharps injuries; 34 and 38 percent were not reported to occupational health services and the resident’s attending physician, respectively.

Do the Roots of Doctor Burnout Take Hold in Residency?

Physician burnout is at an all time high, according to multiple media reports, and some new research out of the Mayo Clinic suggests the cycle may start during residency.

Medical students are more prone to alcohol abuse than their non-doctor peers, especially if they are young, single and under a high debt load, the study found.

The findings appear in the journal Academic Medicine.

“We recommend institutions pursue a multifaceted solution to address related issues with burnout, the cost of medical education and alcohol abuse,” says Liselotte Dyrbye, MD, Mayo Clinic internist and senior author of the paper.

Mayo researchers surveyed 12,500 medical students, and one-third responded. Approximately 1,400 experienced clinical alcohol abuse or dependence. Nationally, that translates to about one-third of those responding, compared to only 16 percent of peers not in medical school, and double the rate of alcohol abuse or dependence of surgeons, US physicians, or the general public based on earlier research by this team.

Burnout factors such as emotional exhaustion or feelings of depersonalization were all highly associated with alcohol abuse or dependence among the medical students, the study showed. Three other factors associated with alcohol abuse or dependence among med students include a younger age than most peers in medical school, being unmarried, and the amount of educational debt.

“We recommend wellness curricula for medical schools, identifying and remediating factors within the learning environment contributing to stress, and removal of barriers to mental health services,” adds first author and Mayo Medical School student Eric Jackson.

Five factors Linked to Alcohol Abuse in Med Students

• Emotional exhaustion
• Feelings of depersonalization
• Younger age
• Being Single
• Amount of student loan debt n