Attitudes and Habits of Highly Humanistic Surgeons: A Single-Institution, Mixed-Methods Study.

PURPOSE: Humanism in medicine is associated with increased patient satisfaction, trust of patients in their doctors, and better outcomes. The authors sought to identify attitudes, habits, and other factors that sustain humanism in academic surgical faculty, and compare these with attributes determined from a previous study of internal medicine faculty. METHOD: A mixed-methods study design at University of Pennsylvania Health System was employed from 2016 to 2018 using a survey instrument and semistructured interviews. Surgical residents nominated faculty who exemplified humanism. In-depth interviews were then conducted with surgeons receiving the most nominations. The interviews were transcribed, and common themes were identified using the grounded theory method. These were compared with findings from a previous internal medicine study. RESULTS: Ten faculty described three strongly shared attitudes: humility, responsibility, and a desire to live up to a high standard of professional behavior. Five habits were found important to sustaining these attitudes and their practice: self-reflection, finding deep connections with patients, maintaining personal and professional relationships, "having fun" at work, and paying it forward to surgical trainees. Surgeons also cited the importance of past role models in developing humanistic attitudes and sustaining practice. Responses were compared with previously documented attitudes and habits of humanistic internal medicine faculty at the institution. CONCLUSIONS: This study identified recurring attitudes and habits that characterize humanistic behaviors in a cohort of academic surgeons. Learning from these exemplary humanistic surgeons may inform the development of future educational programs for residents and faculty in sustaining humanism.

Qualities and Methods of Highly Effective Surgical Educators: A Grounded Theory Model.

OBJECTIVE: To identify personal qualities and teaching methods of highly effective surgical educators using a novel research design. DESIGN: In this qualitative study, surgical residents were sent an electronic survey soliciting nominations for faculty perceived as highly effective surgical educators. In-depth, semistructured interviews were conducted with surgeons receiving the most nominations. Grounded theory methodology identified themes for analysis. SETTING: General, vascular, and plastic surgery residents and faculty at the University of Pennsylvania Health System. PARTICIPANTS: A total of 77 surgical residents were surveyed. Data saturation occurred after 12 semistructured interviews with attending surgeons, corresponding to the top 15% of faculty. RESULTS: Interviewees described both personal characteristics and specific teaching approaches that facilitated successful learning. These included providing exceptional surgical education as a mission, a strong influence from past mentors and role models, a love for the profession, and a low rate of self-professed burnout. Desirable teaching methods included promoting a culture of psychological safety (the perceived ability to take interpersonal risks within one's environment), progressive autonomy, accountability of trainees, and individualized teaching for the learner. Interviewees saw education as inseparable from clinical duties, and all surgeons believed providing exceptional patient care was the foundation of effective surgical teaching. The derived themes suggested that educators prefer "cognitive-based" approaches, focusing on learning processes rather than specific outcomes. CONCLUSIONS: This study identified characteristics and educational styles of highly effective educators in a cohort of academic surgeons. This framework may inform the development of educational programs for residents and faculty in effective teaching methods.

Early Indication of Noise-Induced Hearing Loss in Young Adult Users of Personal Listening Devices.

OBJECTIVES: The recent integration of portable music players into cell phones has further increased the use of personal listening devices (PLD) among young adults, raising concerns about potentially hazardous effects on hearing. METHODS: Assessment of young adults' hearing ability and listening preferences by subjective and objective measurement. Young adult users of PLDs (n = 50; 30 females, 20 males; mean age = 24.1 ± 4.2 years; average PLD use = 6.1 ± 2.1 years) were included. Subjective assessment of listening preferences was performed via a questionnaire as well as objective assessment of preferred volume levels in different background noise environments and hearing tests. RESULTS: Preferred volume levels were significantly correlated with hearing thresholds. Most participants exhibited safe listening behavior according to National Institute for Occupational Safety and Health criteria. We identified a substantial high-risk subgroup of PLD users (22% of participants, daily use ⩾2 h at ⩾91 dB) in which pure tone audiometry showed increased hearing thresholds at 4000 and 6000 Hz, potentially indicating an early manifestation of noise-induced hearing loss (NIHL). CONCLUSIONS: These findings suggest that preventive measures may be warranted to prevent a future increase of clinically relevant NIHL among heavy users of PLDs.

Attitudes and habits of highly humanistic physicians.

PURPOSE: Humanism is fundamental to excellent patient care and is therefore an essential concept for physicians to teach to learners. However, the factors that help attending physicians to maintain their own humanistic attitudes over time are not well understood. The authors attempted to identify attitudes and habits that highly humanistic physicians perceive allow them to sustain their humanistic approach to patient care. METHOD: In 2011, the authors polled internal medicine residents at the University of Pennsylvania to identify attending physicians who exemplified humanistic patient care. In this cross-sectional, qualitative study, the authors used a semistructured script to interview the identified attending physicians to determine attitudes and habits that they believed contribute to their sustenance of humanistic patient care. RESULTS: Attitudes for sustaining humanism in this cohort of humanistic physicians included humility, curiosity, and a desire to live up to a standard of behavior. Many of the physicians deliberately worked at maintaining their humanistic attitudes. Habits that humanistic physicians engaged in to sustain their humanism included self-reflection, connecting with patients, teaching and role modeling, and achieving work-life balance. Physicians believed that treating their patients humanistically serves to prevent burnout in themselves. CONCLUSIONS: Identification of factors that highly humanistic attending physicians perceive help them to sustain a humanistic outlook over time may inform the design of programs to develop and sustain humanism in teaching faculty.