Oral and Maxillofacial Surgery Resident Perception of Personal Achievement and Anxiety: A Cross-Sectional Analysis.

PURPOSE: Anxiety is prevalent among medical residents and is associated with fatigue, psychological dysfunction, and burnout. A low personal achievement level is a characteristic of burnout, which-if unaddressed-may lead to medical error and decrease the quality of patient care. This study aimed to assess both personal achievement levels and anxiety levels in current oral and maxillofacial surgery (OMS) residents and to discern a relationship between anxiety severity and perceived personal achievement level among residents. MATERIALS AND METHODS: An anonymous 20-question cross-sectional online survey was developed using the anxiety component of the Hospital Anxiety and Depression Scale and the personal Maslach Burnout Inventory. The survey was sent to all the OMS residents enrolled in programs affiliated with the American Association of Oral and Maxillofacial Surgeons in 2017. Univariate and bivariate analyses were conducted to obtain summary measures of the predictor (anxiety) and the outcome (personal achievement) stratified by age, gender, marital status, program type (4- or 6-year program), and year of residency. Multinomial logistic regression models were obtained to evaluate the association between anxiety and personal achievement. A 2-sided P < .05 was considered statistically significant. RESULTS: We received 238 responses (20% response rate); 58% of respondents had moderate or severe levels of anxiety, and nearly half of respondents reported moderate or low levels of personal achievement. Women were more likely to have severe anxiety than men (60% vs 37%, P < .01). Residents with severe anxiety were 91% more likely to report low levels of personal achievement than residents with low anxiety (odds ratio, 0.09; 95% confidence interval, 0.03 to 0.22; P < .0001). The results suggest the presence of an inverse relationship between personal achievement level and anxiety. CONCLUSIONS: More than half of OMS residents in the United States report moderate to severe anxiety. Higher levels of anxiety are associated with lower personal achievement levels. It is important to understand the negative impact anxiety has on trainees, including the unintended consequences.

What a Shame: Increased Rates of OMS Resident Burnout May Be Related to the Frequency of Shamed Events During Training.

PURPOSE: Shame is an ineffective tool in residency education that often results in depression, isolation, and worse patient care. This study aimed to assess burnout, depersonalization, and personal achievement levels in current oral and maxillofacial surgery (OMS) residents, to assess the prevalence of the use of shame in OMS residency training, and to determine whether there is a relation between shame exposure and resident burnout, depersonalization, and personal achievement levels. MATERIALS AND METHODS: An anonymous 20-question cross-sectional survey was developed incorporating the Maslach Burnout Index and a previously validated shame questionnaire and sent to all OMS program directors affiliated with the American Association of Oral and Maxillofacial Surgeons for distribution among their respective residents in 2016. Univariate analyses were used to determine the distribution of the predictor (shame) and outcome (burnout) by gender and by frequency of shaming events. Multivariable logistic regression analysis was used to assess the relation of shame to burnout. A 2-sided P value less than .05 was considered statistically significant. RESULTS: Two hundred seventeen responses were received; 82% of respondents were men (n = 178), 95% were 25 to 34 years old (n = 206), and 58% (n = 126) were enrolled in a 4-year program. Frequently shamed residents were more likely to have depression (58 vs 22%; P < .0001), isolation (55 vs 22%; P < .0001), and poor job performance (50 vs 30%; P < .0001). Residents who were frequently shamed were more likely to experience moderate to severe burnout (odds ratio = 4.6; 95% confidence interval, 2.1-10.0; P < .001) and severe depersonalization (odds ratio = 5.1; 95% confidence interval, 2.1-12.0; P < .0001) than residents who had never or infrequently been shamed. CONCLUSION: There is a clear relation between the number of shame events and burnout and depersonalization levels. It is important to understand the negative impact that the experience of shame has on residents, including its unintended consequences.

Mandibular Destruction Secondary to Invasion by Carcinoma Cuniculatum.

Carcinoma cuniculatum is a rare form of well-differentiated squamous cell carcinoma that is often misdiagnosed. It has a propensity for local invasion and rarely metastasizes. Oral carcinoma cuniculatum is exceedingly rare, with very few reported cases in the English-language literature. Classically, its presentation mimics osteomyelitis or a dental abscess, resulting in misdiagnosis, multiple biopsy examinations, and procedures before a final diagnosis of carcinoma cuniculatum. This case report describes the case of a 71-year-old woman who was referred to the authors' clinic for evaluation of persistent pain and swelling of the mandible. Multiple biopsy examinations were negative for malignancy, and the patient was misdiagnosed with osteomyelitis and dental abscess before obtaining an accurate diagnosis of carcinoma cuniculatum. The aim of this report is to provide a thorough clinical and histopathologic report of carcinoma cuniculatum of the mandible, provide a brief review of the literature, and highlight the difficulties in arriving at this uncommon diagnosis.

Relationship of grit and resilience to dental students' academic success.

OBJECTIVES: This study assesses the levels of grit (the perseverance and passion for long-term goals), and resilience (the ability to bounce back or recover from stress), reported by U.S. dental students, and its possible association with academic achievements. METHODS: An anonymous 27 question cross-sectional online survey with sections on demographics, grit, resilience, and academic achievement was e-mailed to all dental students in the U.S. The Short Grit and Brief Resilience scales were used. Scores for both scales ranged from 1 to 5, and were grouped into low, moderate, and high tertiles based on distribution. Dental school grade point average (GPA), and class rank were used to measure academic achievement, and were similarly grouped. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from multinomial logistic regression models assessing the relationship of grit and resilience to the outcomes adjusting for gender, dental school year, race, geographic origin, and a variable combining education and income. RESULTS: Of the 3292 (17%) respondents, 58% were female. Hispanics reported significantly higher grit and resilience scores while Asian students reported the lowest. 18% of Hispanics were ranked in the top 20 percentile versus 37% of whites. CONCLUSION: Results indicate that dental students with high grit (high vs. low scores: OR [95% CI]: 2.06 [1.57-2.72]) and resilience (high vs. low scores: 1.36 [1.04-1.76]) achieved higher GPA and better class ranks. Therefore, it is crucial for students wanting to achieve academic success to consider the value that these non-cognitive characteristics might have on their overall progress.

Assessment of a novel module for training dental students in child abuse recognition and reporting.

This study assessed the merits of introducing a novel, online interactive training module designed to positively engage dental students and teach them to recognize and report signs of child abuse and neglect. The study aimed to determine if the online training module educated the students equivalently or better than a lecture presentation of the same content. Seventy-two students from Columbia University College of Dental Medicine's class of 2015 (90 percent of the class) agreed to participate and were randomly assigned to either a traditional lecture-based presentation or the online training module. Study participants were given a twenty-question multiple-choice pretest on their knowledge of child abuse recognition and reporting prior to the start of the study. The same instrument was administered as a posttest. At the end of the training, questionnaires were also given to both groups to assess students' perceptions of the two educational methodologies. The results showed that the interactive online training module was more effective than the lecture-based method. Results of the posttest comparison of the two groups were statistically significant (p<0.05) in favor of the online training group. Additionally, the students reported that the interactive online training module was engaging and a helpful resource, but on average they did not prefer it as a total replacement for the lecture-based approach.