Burnout and Educational Debt Affect Medical Knowledge Among IM Residents (measured by exam scores)

Doctors are not impervious to stresses of daily life. Physician distress is common and has been associated with negative effects on patient care.

This JAMA study of internal medicine residents used data collected during 2008-2009 Internal Medicine In-Training Examination (IM-ITE). Participants were 16,000 IM residents, representing 74% of all eligible US internal medicine residents - approximately 7700 US medical graduates and 8500 international medical graduates (IMGs).

Quality of life was rated “as bad as it can be” or “somewhat bad” by 15% of residents.

Burnout, emotional exhaustion and depersonalization were reported by 51%, 46%, and 29% of residents, respectively.

Burnout was less common among international medical graduates than among US medical graduates (45% vs 59%),

Greater educational debt was associated with the presence of at least 1 symptom of burnout (61% vs 44%; for debt greater than $200 000 relative to no debt).

Residents reporting QOL “as bad as it can be” and emotional exhaustion daily had exam scores 2.7 points and 4.2 points lower than those with QOL “as good as it can be” and no emotional exhaustion, respectively.

Residents reporting debt greater than $200,000 had exam scores 5 points lower than those with no debt.

Suboptimal QOL and burnout were common among IM residents. Burnout was associated with higher debt and was jess frequent among international medical graduates (IMGs).

Low QOL, emotional exhaustion, and educational debt were associated with lower IM-ITE scores.

References:

Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents. JAMA, 2011;306(9):952-960. doi: 10.1001/jama.2011.1247
Stress overdose for doctors. Star Tribune.
Image source: OpenClipArt.org, public domain.

Internal medicine residents spent little time reading, and prefer electronic resources, specifically UpToDate

This study from the Mayo Clinic assessed residents' reading habits and preferred educational resources at 5 internal medicine training programs via a survey.

78% of residents reported reading less than 7 hours a week.

81% of residents read in response to patient care encounters.

The preferred educational format was electronic, and UpToDate was the big winner among the surveyed group:

- 95% of residents cited UpToDate as the most effective resource for knowledge acquisition
- 89% of residents reported that UpToDate was their first choice for answering clinical questions

The study authors concluded that residents spent little time reading and sought knowledge primarily from electronic resources. Most residents read in the context of patient care.

The abstract does not mention anything about social media sources such as Wikipedia, blogs, and Twitter, but the residents encounter a lot of those through Google searches.

References:

A multi-institutional survey of internal medicine residents' learning habits. Edson RS, Beckman TJ, West CP, Aronowitz PB, Badgett RG, Feldstein DA, Henderson MC, Kolars JC, McDonald FS. Med Teach. 2010;32(9):773-5. Image source: UpToDate.

Turning medical residents away from copy-and-paste culture facilitated by EMR

From MedCityNews:

Cleveland VA is trying to cut out the burgeoning subculture of “copy-and-paste”: A phenomenon made possible by electronic medical records in which physicians copy old information about a patient and paste it into a new section of the chart.

The practice is seen by medical residents as a time-saver but the attendings consider it an “egregious problem” because the practice has the potential to perpetuate mistakes. For example, someone might copy and paste information from a patient’s medical history without verifying that the information is correct. Any errors that might exist will be repeated.

EMR can’t just disable the copy-and-paste function, since such a move would impact other programs.

References:

Turning medical residents away from copy-and-paste culture. MedCityNews.

Medical Malpractice Liability in the Age of Electronic Health Records - NEJM, 2010 http://goo.gl/cGZG9
"The iPatient is getting wonderful care across America. The real patient wonders, "Where is everybody?" NYTimes, 2011.

iPad use by medical residents gets rave reviews, increases productivity

View more videos at: http://www.nbcchicago.com.

The Internal Medicine Residents at the University of Chicago Medical Center are now equipped with iPads as their primary device for clinical use.

In the summer of 2010, the Internal Medicine Residency (IMR) program began piloting a project to study the use of iPads on the inpatient wards. Initiated by the Chairman's Office, the project was intended to enhance efficiency of patient care activities on the wards with the goals of improved patient care and more robust conference attendance.

The pilot was overwhelmingly positive and has led to broader use of the devices for all IMR residents. The DOM Internal Medicine Residency program is the first training program in the country to utilize the device.

As an Assistant Professor at University of Chicago, I work with the residents on a daily basis and I can confirm that they love their iPads.

References:

University of Chicago Medical Center
iPads Helping Doctors. NBC.

Tablet computers in the hospital - ACP Hospitalist, August 2011 http://goo.gl/a9OND

Comments from Twitter:

@DrVes: Why are some doctors and nurses giving back their iPads? http://j.mp/Hq15aD - Easy: iPad works great for pt education, NOT for data entry. Only 10% of doctors currently use an iPad at work http://j.mp/Hq15aD - I use iPad daily to discuss these diagrams: http://j.mp/Hq1k5v

iPad is a great teaching tool @CraigCCRNCEN was able to explain to Vietnamese family AFib and clots by showing them animation from YouTube.

Brian S. McGowan PhD @BrianSMcGowan: so is the best option for docs still a touch screen laptop? teach w/ touch screen, work w/ full keyboard? #hcsm

@DrVes: iPad works well for discussing DDx, Tx options with pts. Much more portable than laptop. Full-keyboard COWs best for typing.

Jeff Bray @jeffkbray: I have been scanning all my medical reference books and store them on my iPad for quick use and no weight - great tool and mobile

Polish Your Online Image, AAMC Advises Medical Students and Residents

How can you make sure future program directors find only the best “you” online? Follow these suggestions when using social media services such as Facebook, Twitter and blogs:

- Consider carefully what you’re posting
- Avoid posting patient stories
- Periodically search yourself
- Check the photos in which you’re “tagged”
- Define funny - Humor can be hard to interpret
- Choose your friends carefully
- Restrict your privacy settings

References:

Careers in Medicine. AAMC, 2010 (PDF).

Image source: OpenClipArt.org, public domain.