The association between objectively-measured activity, sleep, call responsibilities, and burnout in a resident cohort.

BACKGROUND: When compared to the general US working population, physicians are more likely to experience burnout and dissatisfaction with work-life balance. Our aim was to examine the association of objectively-measured sleep, activity, call load, and gender with reported resident burnout and wellness factors. METHODS: Residents were recruited to wear activity tracker bands and complete interval blinded surveys. RESULTS: Of the 30 residents recruited, 28 (93%) completed the study. Based on survey results, residents who reported high amounts of call reported equivalent levels of wellness factors to those who reported low call loads. There was no association between amount of call on training satisfaction, emotional exhaustion, self-reported burnout, or sleep quality. Analysis of sleep tracker data showed that there was no significant association with time in bed, time asleep, times awakened or sleep latency and call load or self-reported burnout. Female gender, however, was found to be associated with self-reported burnout. No significant associations were found between objectively-measured activity and burnout. CONCLUSIONS: Based on the results of our study, there was no association with burnout and objectively-measured sleep, call volume, or activity. Increased call demands had no negative association with training satisfaction or professional fulfillment. This would suggest that more hours worked does not necessarily equate to increased burnout.

General Surgery Resident Case Logs: Do They Accurately Reflect Resident Experience?

INTRODUCTION: Operative experience during residency lays the foundation for independent practice and additional specialty training following general surgery residency. The aim of this study was to examine operative experience of general surgery residents and detail the results of an intervention aimed at improving resident record keeping in the Accreditation Council for Graduate Medical Education (ACGME) case log system to better reflect their experience. METHODS: Residents were asked to characterize variances in recorded operative experience identified through an audit of operative logs. Based on the results of the audit, an intervention was designed to prompt timely record keeping by residents. The intervention included education and discussion of survey audit results, weekly presentation of graphs detailing operative experience, and possible missed cases in the ACGME logs and addition of a first assistant column in morbidity and mortality (M&M) logs. RESULTS: The audit of case logs identified discrepancies in 24.2% of the 636 cases examined. Chief residents were significantly more accurate (95.9%) in recording operative experience in ACGME case logs, whereas 50.3% of junior resident case logs contained variances. Residents characterized discrepancies as "forgot to log" (9.6%), "staff did the case" (5.2%), "another resident did more of the case" (3.6%), "other" (3.6%), a "more advanced resident was present for the case" (1.6%), "not present for case" (0.6%), and "left for consult" (0.3%). Over the 4-week intervention period, residents logged between 72.7% and 94.0% of cases. A month following the intervention period, we observed a 13.3% increase in recorded cases compared with the intervention period. Review of first assistant case logging following inclusion of a "first assistant" column in M&M logs demonstrated a 70.5% increase in first assistant cases logged into the ACGME system compared with the same time period a year ago. CONCLUSIONS: Based on our results, we found that weekly displays of cases improved resident record keeping in the ACGME case log system, especially by junior residents. We believe that the addition of first assistant column on M&M lists, periodic audits reviewed at conferences, and semiannual evaluations will help junior residents more accurately report their experience during training.

Impact of personality, sex, and generation on resident operative role.

BACKGROUND: The aim of this study was to determine if gender, generation, or personality traits influence resident perception of their operative role. MATERIALS AND METHODS: Over a 4-wk period, daily surveys were sent to residents and staff to assess the Accreditation Council for Graduate Medical Education (ACGME) role of residents on operative cases. Personality was assessed on completion of the survey period using the big five inventory (BFI). RESULTS: In 184 paired responses, resident perception of their operative role and staff reported resident role coincided in 82.1% surveys. In instances when resident perception differed from staff assessment, neither gender nor generation correlated with discrepancy between resident and staff assessment. High BFI agreeableness of staff was associated with more disparity, and high BFI neuroticism scores of staff translated to less disparity between resident-perceived and staff-assessed operative roles (odds ratio 2.63, P = 0.003 and odds ratio 0.44, P = 0.002, respectively). CONCLUSIONS: This study demonstrates agreement between resident and staff reports of ACGME resident operative role in most cases; however, staff personality traits influenced resident's perception of their operative role. Perceived underparticipation in operative cases may influence a resident's experience during training, which may impact their reporting of operative experience to the ACGME.