"I need to have a fulfilling job": A qualitative study of surgeon well-being and professional fulfillment.

BACKGROUND: Burnout, often regarded as an individual failing, rather than a systemic one, negatively impacts quality of care, patient safety and healthcare costs. Focusing on improving well-being can help mitigate burnout. This study examined protective factors that promote well-being and professional fulfillment in surgeons. METHODS: Using a purposive sample, 32 semi-structured 30-60-min interviews were conducted with surgeons of varying sub-specialties and rank. Abductive exploratory analysis was used to code and interpret interview transcripts and to build a conceptual model of surgeon well-being. RESULTS: Emergent protective factors were placed into one of three levels of implementation: individual, team-level, and institutional (figure). Individual factors for well-being included autonomy and adequate time to pursue non-clinical endeavors. Team-level factors consisted of adaptability, boundaries, and cohesion. Institutional factors related to diversifying performance evaluations and celebrating and recognizing individual value and contributions. CONCLUSIONS: The conceptual model developed from the results of this study highlights factors important to surgeons' professional well-being. This model can be used to guide quality improvement efforts.

Extended-release triamcinolone provides prolonged relief for patients who failed standard corticosteroid injection for knee osteoarthritis; a pragmatic retrospective study.

Objective: Identify if extended-release triamcinolone has a longer duration of action in a cohort of patients who have had limited duration of relief from prior corticosteroid injection. Design: Retrospective analysis of patients with knee osteoarthritis. Setting: Academic outpatient musculoskeletal practice. Subjects: One hundred and fifty patients (age 67.5 â€‹± â€‹13.7, 68.2% female) with knee osteoarthritis who had subjectively insufficient relief from a standard corticosteroid injection. Methods: Ultrasound-guided knee injections of extended-release triamcinolone were administered to all patients by experienced practitioners. The primary outcome measure was comparative duration of subjective relief from extended-release triamcinolone, compared to the patients' duration from their prior standard corticosteroid injection. The secondary outcome was the duration of relief from extended-release triamcinolone. Results: Patients reported 7.1 â€‹± â€‹8.7 additional weeks of relief from extended-release triamcinolone (t â€‹= â€‹6.50, p â€‹< â€‹0.001), with lower Kellgren-Lawrence score being the only factor associated with increased comparative duration of relief (B â€‹= â€‹-2.39, p â€‹= â€‹0.042). No factors were associated with duration of pain relief from extended-release triamcinolone. Conclusions: This retrospective study suggests that injection of extended-release triamcinolone is associated with prolonged pain relief in patients who have had insufficient duration of pain relief from a standard corticosteroid injection. Those with lower Kellgren-Lawrence grades were more likely to have an increased comparative duration of relief.