Paediatric cardiology training: burnout, fulfilment, and fears.

BACKGROUND: Burnout is well characterised in physicians and residents but not in paediatric cardiology fellows, and few studies follow burnout longitudinally. Training-specific fears have been described in paediatric cardiology fellows but also have not been studied at multiple time points. This study aimed to measure burnout, training-specific fears, and professional fulfilment in paediatric cardiology fellows with the attention to time of year and year-of-training. METHODS: This survey-based study included the Professional Fulfillment Index and the Impact of Events Scale as well as an investigator-designed Fellow Fears Questionnaire. Surveys were distributed at three-time points during the academic year to paediatric cardiology fellows at a large Midwestern training programme. Fellow self-reported gender and year-of-training were collected. Descriptive analyses were performed. RESULTS: 10/17 (59%) of fellows completed all surveys; 60% were female, 40% in the first-year class, 40% in the second-year class, and 20% in the third-year class. At least half of the fellows reported burnout at each survey time point, with lower mean professional fulfilment scores. The second-year class, who rotate primarily in the cardiac ICU, had higher proportions of burnout than the other two classes. At least half of fellows reported that they "often" or "always" worried about not having enough clinical knowledge or skills and about work-life balance. CONCLUSIONS: Paediatric cardiology fellows exhibit high proportions of burnout and training-specific fears. Interventions to mitigate burnout should be targeted specifically to training needs, including during high-acuity rotations.

Assessment of Employee Susceptibility to Phishing Attacks at US Health Care Institutions.

Importance: Cybersecurity is an increasingly important threat to health care delivery, and email phishing is a major attack vector against hospital employees. Objective: To describe the practice of phishing simulation and the extent to which health care employees are vulnerable to phishing simulations. Design, Setting, and Participants: Retrospective, multicenter quality improvement study of a convenience sample of 6 geographically dispersed US health care institutions that ran phishing simulations from August 1, 2011, through April 10, 2018. The specific institutions are anonymized herein for security and privacy concerns. Exposures: Simulated phishing emails received by employees at US health care institutions. Main Outcomes and Measures: Date of phishing campaign, campaign number, number of emails sent, number of emails clicked, and email content. Emails were classified into 3 categories (office related, personal, or information technology related). Results: The final study sample included 6 anonymized US health care institutions, 95 simulated phishing campaigns, and 2 971 945 emails, 422 062 of which were clicked (14.2%). The median institutional click rates for campaigns ranged from 7.4% (interquartile range [IQR], 5.8%-9.6%) to 30.7% (IQR, 25.2%-34.4%), with an overall median click rate of 16.7% (IQR, 8.3%-24.2%) across all campaigns and institutions. In the regression model, repeated phishing campaigns were associated with decreased odds of clicking on a subsequent phishing email (adjusted OR, 0.511; 95% CI, 0.382-0.685 for 6-10 campaigns; adjusted OR, 0.335; 95% CI, 0.282-0.398 for >10 campaigns). Conclusions and Relevance: Among a sample of US health care institutions that sent phishing simulations, almost 1 in 7 simulated emails sent were clicked on by employees. Increasing campaigns were associated with decreased odds of clicking on a phishing email, suggesting a potential benefit of phishing simulation and awareness. With cyberattacks increasing against US health care systems, these click rates represent a major cybersecurity risk for hospitals.

Survival through staged palliation: fate of infants supported by extracorporeal membrane oxygenation after the Norwood operation.

BACKGROUND: Infants supported by extracorporeal membrane oxygenation (ECMO) after a Norwood operation face in-hospital mortality rates of 60% to 70%. There are limited data on completion of staged palliation for the subset of patients who survive to hospital discharge. METHODS: We performed a retrospective case-control study of 64 sequential patients at a single institution supported by ECMO after a Norwood operation. Primary endpoints were survival to hospital discharge, stage II palliation, and stage III palliation. Predictors of non-survival to each endpoint were identified with logistic regression. Survival was compared with a 3:1 era-matched group of control patients who underwent a Norwood operation but did not require ECMO. RESULTS: Survival to hospital discharge, stage II palliation, and stage III palliation was 43.8%, 35.9%, and 25.4%, respectively for ECMO cases. Factors independently associated with non-survival to hospital discharge included female gender, ECMO 7 days or greater, and need for renal replacement therapy on ECMO. Non-Caucasian race and ECMO 7 days or greater were independently associated with non-survival to stage II, while non-Caucasian race, lower birth weight, and ECMO 7 days or greater were independently associated with non-survival to stage III. Extracorporeal membrane oxygenation was associated with decreased survival at each endpoint. Patients who survived ECMO had increased interstage mortality between hospital discharge and stage II palliation. CONCLUSIONS: Extracorporeal membrane oxygenation after a Norwood operation can be life-saving but ultimate survival through staged palliation remains suboptimal. The elevated mortality risk for patients supported by ECMO persists after hospital discharge. Both socioeconomic factors and ECMO-related morbidity may contribute to midterm mortality.