Gender and Clinical Status in Burnout in Medicine.

This survey study assesses feelings of satisfaction, stress, and burnout by gender and clinical status among health care workers at a single academic center.

Comparison of nurse and resident physician paging frequency by sex in the emergency department.

Objectives: The role of biological sex in interprofessional relationships is an important factor in collaborative health care settings such as the emergency department (ED) but one that has been sparsely studied. While there is anecdotal evidence on gender-based differences in communication, little research has focused on this topic. The goal of this study was to determine whether there are differences in paging frequency between nurses and male and female residents. Methods: We conducted a retrospective review of patient visits to our urban, tertiary care academic ED between January 1 and April 1, 2021. Only pages from nurses to emergency medicine (EM) residents were included. Outcome variables included number of pages received by sex, number of unique ED visits, and mean number of pages per unique visit. Pearson's chi-square tests were used to analyze differences between observed and expected results. Results: A total of 15,617 pages from nurses to residents over 6843 unique patient visits to the ED were analyzed. This included 187 nurses, 162 (87%) of whom were female and 25 (13%) were male. Of the 39 residents, 12 (31%) were female and 27 (69%) were male. Female residents received 4500 pages over 2228 unique patient ED visits, or a mean of two pages per patient with a mean of 186 unique ED visits per female resident. Male residents received 11,117 pages over 4615 unique patient ED visits, or a mean of 2.4 pages per patient, with a mean of 171 unique ED visits per male resident. This difference in pages per patient was statistically significant (χ2(1) = 369, p < 0.001). Conclusions: We found that male residents received significantly more pages per patient than their female colleagues. Overall, further research is required to understand the factors, such as characteristics of patients or preferred communication methods of providers, that drive this disparity and what the implications are for patient outcomes.

Does the number of pages received per hour affect resident productivity?

Background: Workflow interruptions are common for emergency physicians and are shown to have downstream consequences such as patient dissatisfaction, delay in clinical response, and increase in medical error. However, the impact of passive interruptions on physician productivity is unclear and has not been well studied. We sought to evaluate if the number of pages received per hour significantly affects the number of patients seen per hour. Methods: Retrospective data was collected on resident physician (RP) emergency department shifts from July 1st, 2021 to June 30th, 2022 at an academic medical center with an annual census of 55,000 patients. A total of 2865 RP shifts were collected among the 26 postgraduate year (PGY) 1 and PGY2 residents. For each RP shift, we identified the number of pages received per hour and the number of new patients seen per hour. Pages consist of any transmitted message that was sent to the RP's personal pager, which includes both automatic (eg, bed assignments, abnormal lab values) and personalized pages from other healthcare practicioners (eg, nursing, consultants). Data were analyzed using Poisson regression controlling for clustering at the physician level to determine if the number of patients seen per hour is significantly affected by the number of pages (divided into quartiles) received. Results: We found the number of pages received per hour did not decrease the number of patients seen per hour. Contrary to our hypothesis, there was a strong positive relationship between the number of pages received per hour and the number of patients seen by RPs in that hour and subsequent hours. During the middle of a shift (hours 3, 4, and 5), RPs receiving pages in the third and fourth quartile (top 50% of pages) saw significantly more patients during that same hour and the next hour (p <0.001). Conclusion: The number of pages received by RPs per hour did not decrease the number of patients seen per hour. When RPs receive a higher number of pages, there is a positive association with the number of patients they see in that hour and subsequent hours. Further studies will be needed to determine whether the content of pages affects resident productivity.

Resident Attitudes Toward Performing Pelvic Examinations in the Emergency Department.

Mounting evidence suggests that emergency physicians tend to avoid patients with gynecologic chief complaints, and that avoidance may be higher for male physicians compared to females. One underlying reason could be discomfort with performing pelvic examinations. The goal of this study was to assess whether male residents report greater discomfort with pelvic examinations than females. We performed a cross-sectional, Institutional Review Board-approved survey of residents at 6 academic emergency medicine programs. Of 100 residents who completed the survey, 63 self-identified as male, 36 female, and one selected "prefer not to say" and was excluded. Responses were compared between male and females using chi-square tests. In secondary analysis, t-tests were used to compare preferences for various chief complaints. Self-reported comfort with pelvic examinations did not differ significantly between males and females (p = 0.4249). Barriers for male respondents in performing pelvic examinations included lack of training, general dislike, and concern the patient would prefer female providers. Male residents had a statistically significant higher aversion ranking towards patients with vaginal bleeding than female residents (mean difference = 0.48, confidence interval = 0.11-0.87). Aversion ranking was the same between males and females on other chief complaints. There is a gender disparity among male and female residents in attitudes towards patients with vaginal bleeding. However, the results from this study do not demonstrate a significant difference in self-reported comfort amongst male and female residents in performing pelvic examinations. This disparity may be driven by other barriers, including self-reported lack of training and concern about patients' physician gender preferences.

A longitudinal surgical systems strengthening research program for medical students: the exploration of a model for global health education.

BACKGROUND: In response to the staggering global burden of conditions requiring emergency and essential surgery, the development of international surgical system strengthening (SSS) is fundamental to achieving universal, timely, quality, and affordable surgical care. Opportunity exists in identifying optimal collaborative processes that both promote global surgery research and SSS, and include medical students. This study explores an education model to engage students in academic global surgery and SSS via institutional support for longitudinal research. OBJECTIVES: We set out to design a program to align global health education and longitudinal health systems research by creating an education model to engage medical students in academic global surgery and SSS. PROGRAM DESIGN AND IMPLEMENTATION: In 2015, medical schools in the United States and Colombia initiated a collaborative partnership for academic global surgery research and SSS. This included development of two longitudinal academic tracks in global health medical education and academic global surgery, which we differentiated by level of institutional resourcing. Herein is a retrospective evaluation of the first two years of this program by using commonly recognized academic output metrics. MAIN ACHIEVEMENTS: In the first two years of the program, there were 76 total applicants to the two longitudinal tracks. Six of the 16 (37.5%) accepted students selected global surgery faculty as mentors (Acute Care Surgery faculty participating in SSS with Colombia). These global surgery students subsequently spent 24 total working weeks abroad over the two-year period participating in culminating research experiences in SSS. As a quantitative measure of the program's success, the students collectively produced a total of twenty scholarly pieces in the form of accepted posters, abstracts, podium presentations, and manuscripts in partnership with Colombian research mentors. POLICY IMPLICATIONS: The establishment of scholarly global health education and research tracks has afforded our medical students an active role in international SSS through participation in academic global surgery research. We propose that these complementary programs can serve as a model for disseminated education and training of the future global systems-aware surgeon workforce with bidirectional growth in south and north regions with traditionally under-resourced SSS training programs.

A Case Report of Acute Transverse Myelitis Following Novel Coronavirus Infection.

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, emergency providers are not only seeing an increasing number of patients with COVID-19 infections, but also associated complications and sequelae of this viral illness. CASE REPORT: We present the case of a 28-year-old female patient who presented after a confirmed COVID-19 infection with lower back pain, bilateral symmetric upper and lower extremity numbness, and urinary retention. The patient was diagnosed with acute transverse myelitis. She required intravenous corticosteroids and plasma exchange with significant improvement in symptoms and minimal residual effects. CONCLUSION: This case illustrates the importance of prompt recognition and treatment of sequelae of COVID-19 infections.