Areas of work-life that contribute to burnout among higher education health science faculty and perception of institutional support.

BACKGROUND: COVID-19 added responsibilities to faculty in health-related fields. Educators in these areas have experienced pandemic-related role strain in both the clinical and academic settings. PURPOSE: This investigation sought to identify how health science faculty at one institution perceived challenges related to the COVID-19 pandemic in their role and to glean opportunities for institutions to increase the degree of support for faculty. METHODS: An analysis of narrative comments was conducted on a survey assessing burnout and well-being. The survey was distributed to full-time faculty within the College of Health Sciences at a four-year institution. Using the areas of work-life model as a guide, two free-text questions within the survey were analysed to identify major themes. RESULTS: 39 participants contributed narrative responses to the qualitative, open-ended questions. Three themes emerged related to the areas of work-life categories: work-life imbalance, stress and unwellness, and unmet support needs. Strategies for enhanced well-being were noted to be workload management, administrative support, and wellness opportunities. CONCLUSIONS: This analysis provides insight into why health science faculty may be experiencing feelings of disengagement and exhaustion in their work. Enhanced workload and lack of community during the pandemic were major drivers of this phenomenon. Flexibility in workload, genuine concern and appreciation expressed by institutional leaders, and accessible wellness opportunities may help to offset these negative feelings.

Hypersensitivity Pneumonitis: An Updated Diagnostic Guide for Internists.

This summary highlights updated definitions, terminology, and classification systems proposed in the diagnosis of hypersensitivity pneumonitis. Clinical presentation, epidemiology, and pathophysiology are reviewed from the most recent data. Radiographic and histopathologic diagnostic criteria are presented in a manner relevant to the practice of general medicine internists, including new guideline recommendations. The role of adjunctive tests, such as serum IgG testing, bronchoalveolar lavage lymphocyte analysis, and pulmonary function testing is discussed in the context of supporting diagnostic confidence for hypersensitivity pneumonitis diagnosis. Finally, new diagnostic algorithms are synthesized and applied to the general internal medicine setting.

Nodule net: A centralized prospective lung nodule tracking and safety-net program.

BACKGROUND: Inadequate follow-up of suspicious lung nodules can result in diagnostic delays and potential progression to advanced lung cancer. In 2015, a multidisciplinary lung nodule management program, Nodule Net, was implemented to increase the timely follow-up rate. In this study, we sought to evaluate the effectiveness of the program. METHODS: 2398 chest CT reports were reviewed for the presence of a lung nodule. Baseline demographics, nodule characteristics, and follow-up recommendations were collected. For reports that did not include structured recommendations, Fleischner Society guidelines were applied if appropriate. The rate of follow-up imaging was recorded and compared with historical rates. RESULTS: Lung nodules were reported on 1367 (57%) of scans. Of the 632 participants with recommendations for follow-up, the Nodule Net nurse navigator was notified on 523 (83%). Of these, 408 (78%) completed follow-up, compared to 57/109 (52%) in those who were not reported to Nodule Net tracking system (risk ratio: 1.49, 95% CI: 1.24-1.79, p-value < 0.05). Out of these 408, nodule net outreach was required to prompt the follow-up in 116 (28%). Of these, a lung malignancy was diagnosed in 4 (4%). CONCLUSIONS: Management of lung nodules is a complex process. Implementation of a lung nodule tracking program led to a significant increase in the completion of recommended follow-up imaging compared with usual care. Developing a comprehensive lung nodule program using an automated software system rather than manual processes to refer and track incidental findings may further reduce barriers to completion of follow-up.

Navigate the Challenges of Simulation for Assessment: A Faculty Development Workshop.

Introduction: Given barriers to learner assessment in the authentic clinical environment, simulated patient encounters are gaining attention as a valuable opportunity for competency assessment across the health professions. Simulation-based assessments offer advantages over traditional methods by providing realistic clinical scenarios through which a range of technical, analytical, and communication skills can be demonstrated. However, simulation for the purpose of assessment represents a paradigm shift with unique challenges, including preservation of a safe learning environment, standardization across learners, and application of valid assessment tools. Our goal was to create an interactive workshop to equip educators with the knowledge and skills needed to conduct assessments in a simulated environment. Methods: Participants engaged in a 90-minute workshop with large-group facilitated discussions and small-group activities for practical skill development. Facilitators guided attendees through a simulated grading exercise followed by in-depth analysis of three types of assessment tools. Participants designed a comprehensive simulation-based assessment encounter, including selection or creation of an assessment tool. Results: We have led two iterations of this workshop, including an in-person format at an international conference and a virtual format at our institution during the COVID-19 pandemic, with a total of 93 participants. Survey responses indicated strong overall ratings and impactfulness of the workshop. Discussion: Our workshop provides a practical, evidence-based framework to guide educators in the development of a simulation-based assessment program, including optimization of the environment, design of the simulated case, and utilization of meaningful, valid assessment tools.

Parenting While in Training: A Comprehensive Needs Assessment of Residents and Fellows.

BACKGROUND: Parenting issues can affect physicians' choice of specialty or subspecialty, as well as their selection of individual training programs, because of the distinctive challenges facing residents and fellows with children. Specific information about how residents perceive these challenges is limited. OBJECTIVE: We sought to better understand the challenges associated with parenting during residency and fellowship training in order to inform policy and research. METHODS: In 2017, a voluntary online questionnaire was distributed to all 2214 Partners HealthCare graduate medical education trainees across 285 training programs. The survey queried attitudes of and about trainees with children and assessed needs and experiences related to parental leave, lactation, and childcare. Responses were compared between subgroups, including gender, surgical versus nonsurgical specialty, parental status, and whether the respondent was planning to become a parent. RESULTS: A total of 578 trainees (26%) responded to the questionnaire. Of these, 195 (34%) became parents during training. An additional 298 (52%) planned to become parents during training. Respondents overwhelmingly agreed that their institution should support trainees with children (95%) and that doing so is important for trainee wellness (98%). However, 25% felt that trainees with children burden trainees without children. Childcare access, affordability, and availability for sufficient hours were identified as key challenges, along with issues related to parental leave, lactation facilities, and effect on peers. CONCLUSIONS: This survey highlights trainees' perspectives about parenting during their clinical training, signaling parental leave, lactation facilities, and childcare access and affordability as particular challenges and potential targets for future interventions.

Clinical management of pressure control ventilation: An algorithmic method of patient ventilatory management to address "forgotten but important variables".

Pressure controlled ventilation is a common mode of ventilation used to manage both adult and pediatric populations. However, there is very little evidence that distinguishes the efficacy of pressure controlled ventilation over that of volume controlled ventilation in the adult population. This gap in the literature may be due to the absence of a consistent and systematic algorithm for managing pressure controlled ventilation. This article provides a brief overview of the applications of both pressure controlled ventilation and volume controlled ventilation and proposes an algorithmic approach to the management of patients receiving pressure controlled ventilation. This algorithmic approach highlights the need for clinicians to have a comprehensive conceptual understanding of mechanical ventilation, pulmonary physiology, and interpretation of ventilator graphics in order to best care for patients receiving pressure controlled ventilation. The objective of identifying a systematic approach to managing pressure controlled ventilation is to provide a more generalizable and equitable approach to management of the ICU patient. Ideally, a consistent approach to managing pressure controlled ventilation in the adult population will glean more reliable information regarding actual patient outcomes, as well as the efficacy of pressure controlled ventilation when compared to volume controlled ventilation.

Integration of systematic clinical interprofessional training in a student-faculty collaborative primary care practice.

The changing healthcare environment and movement toward team-based care are contemporary challenges confronting health professional education. The primary care workforce must be prepared with recent national interprofessional competencies to practice and lead in this changing environment. From 2012 to 2014, the weekly Beth Israel Deaconess Crimson Care Collaborative Student-Faculty Practice collaborated with Northeastern University to develop, implement and evaluate an innovative model that incorporated interprofessional education into primary care practice with the goal of improving student understanding of, and ability to deliver quality, team-based care. In the monthly interprofessional clinic, an educational curriculum empowered students with evidence-based, team-based care principles. Integration of nursing, pharmacy, medicine, and masters of public health students and faculty into direct patient care, provided the opportunity to practice skills. The TeamSTEPPS® Teamwork Attitudes Questionnaire was administered pre- and post-intervention to assess its perceived impact. Seventeen students completed the post-intervention survey. Survey data indicated very positive attitudes towards team-based care at baseline. Significant improvements were reported in attitudes towards situation monitoring, limiting personal conflict, administration support and communication. However, small, but statistically significant declines were seen on one team structure and two communication items. Our program provides further evidence for the use of interprofessional training in primary care.