A Longitudinal Survey on Canadian Emergency Physician Burnout.

STUDY OBJECTIVE: Since Canada eased pandemic restrictions, emergency departments have experienced record levels of patient attendance, wait times, bed blocking, and crowding. The aim of this study was to report Canadian emergency physician burnout rates compared with the same physicians in 2020 and to describe how emergency medicine work has affected emergency physician well-being. METHODS: This longitudinal study on Canadian emergency physician wellness enrolled participants in April 2020. In September 2022, participants were invited to a follow-up survey consisting of the Maslach Burnout Inventory and an optional free-text explanation of their experience. The primary outcomes were emotional exhaustion and depersonalization levels, which were compared with the Maslach Burnout Inventory survey conducted at the end of 2020. A thematic analysis identified common stressors, challenges, emotions, and responses among participants. RESULTS: The response rate to the 2022 survey was 381 (62%) of 615 between September 28 and October 28, 2022, representing all provinces or territories in Canada (except Yukon). The median participant age was 42 years. In total, 49% were men, and 93% were staff physicians with a median of 12 years of work experience. 59% of respondents reported high emotional exhaustion, and 64% reported high depersonalization. Burnout levels in 2022 were significantly higher compared with 2020. Prevalent themes included a broken health care system, a lack of societal support, and systemic workplace challenges leading to physician distress and loss of physicians from the emergency workforce. CONCLUSION: We found very high burnout levels in emergency physician respondents that have increased since 2020.

Ketamine sedation in the intensive care unit: a survey of Canadian intensivists.

PURPOSE: We sought to understand the beliefs and practices of Canadian intensivists regarding their use of ketamine as a sedative in critically ill patients and to gauge their interest in a randomized controlled trial (RCT) examining its use in the intensive care unit (ICU). METHODS: We designed and validated an electronic self-administered survey examining the use of ketamine as a sedative infusion for ICU patients. We surveyed 400 physician members of the Canadian Critical Care Society (CCCS) via email between February and April 2022 and sent three reminders at two-week intervals. The survey was redistributed in January 2023 to improve the response rate. RESULTS: We received 87/400 (22%) completed questionnaires. Most respondents reported they rarely use ketamine as a continuous infusion for sedation or analgesia in the ICU (52/87, 58%). Physicians reported the following conditions would make them more likely to use ketamine: asthma exacerbation (73/87, 82%), tolerance to opioids (68/87, 77%), status epilepticus (44/87, 50%), and severe acute respiratory distress syndrome (33/87, 38%). Concern for side-effects that limited respondents' use of ketamine include adverse psychotropic effects (61/87, 69%) and delirium (47/87, 53%). The majority of respondents agreed there is need for an RCT to evaluate ketamine as a sedative infusion in the ICU (62/87, 71%). CONCLUSION: This survey of Canadian intensivists illustrates that use of ketamine as a continuous infusion for sedation is limited, and is at least partly driven by concerns of adverse psychotropic effects. Canadian physicians endorse the need for a trial investigating the safety and efficacy of ketamine as a sedative for critically ill patients.

RéSUMé: OBJECTIF: Nous avons cherché à comprendre les croyances et les pratiques des intensivistes pratiquant au Canada concernant leur utilisation de la kétamine comme sédatif chez la patientèle gravement malade et à évaluer leur intérêt pour une étude randomisée contrôlée (ERC) examinant son utilisation à l'unité de soins intensifs (USI). MéTHODE: Nous avons mis au point et validé un sondage électronique auto-administré examinant l'utilisation de la kétamine comme perfusion sédative pour les patient·es aux soins intensifs. Nous avons envoyé le sondage à 400 médecins membres de la Société canadienne de soins intensifs (SCCC) par courriel entre février et avril 2022 et envoyé trois rappels à intervalles de deux semaines. Le sondage a été redistribué en janvier 2023 afin d'améliorer le taux de réponse. RéSULTATS: Nous avons reçu 87 questionnaires remplis sur 400 (22 %). La plupart des personnes répondantes ont déclaré qu'elles utilisaient rarement la kétamine en perfusion continue pour la sédation ou l'analgésie à l'USI (52/87, 58 %). Les médecins ont déclaré que les conditions suivantes les rendraient plus susceptibles d'utiliser de la kétamine : une exacerbation de l'asthme (73/87, 82 %), une tolérance aux opioïdes (68/87, 77 %), un état de mal épileptique (44/87, 50 %) et un syndrome de détresse respiratoire aigu (33/87, 38 %). Les inquiétudes quant aux effets secondaires qui ont limité l'utilisation de la kétamine par les répondant·es comprennent les effets psychotropes indésirables (61/87, 69 %) et le delirium (47/87, 53 %). La majorité des personnes répondantes étaient d'accord qu'une ERC est nécessaire pour évaluer la kétamine en tant que perfusion sédative à l'USI (62/87, 71 %). CONCLUSION: Cette enquête menée auprès d'intensivistes au Canada montre que l'utilisation de la kétamine comme perfusion continue pour la sédation est limitée, au moins en partie en raison d'inquiétudes liées aux effets psychotropes indésirables. Les médecins pratiquant au Canada reconnaissent la nécessité d'une étude sur l'innocuité et l'efficacité de la kétamine comme sédatif pour la patientèle gravement malade.

Are we talking about practice? A randomized study comparing simulation-based deliberate practice and mastery learning to self-guided practice.

OBJECTIVES: Simulation-based technical skills training is now ubiquitous in medicine, particularly for high acuity, low occurrence (HALO) procedures. Mastery learning and deliberate practice (ML + DP) are potentially valuable educational methods, however, they are resource intensive. We sought to compare the effect of deliberate practice and mastery learning versus self-guided practice on skill performance of the rare, life-saving procedure, a bougie-assisted cricothyroidotomy (BAC). METHODS: We conducted a multi-center, randomized study at five North American emergency medicine (EM) residency programs. We randomly assigned 176 EM residents to either the ML + DP or self-guided practice groups. Three blinded airway experts independently evaluated BAC skill performance by video review before (pre-test), after (post-test) and 6-12 months (retention) after the training session. The primary outcome was post-test skill performance using a global rating score (GRS). Secondary outcomes included performance time and skill performance at the retention test. RESULTS: Immediately following training, GRS scores were significantly higher as mean performance improved from pre-test, (22, 95% CI = 21-23) to post-test (27, 95% CI = 26-28), (p < 0.001) for all participants. However, there was no difference between the groups on GRS scores (p = 0.2) at the post-test or at the retention test (p = 0.2). At the retention test, participants in the ML + DP group had faster performance times (66 s, 95% CI = 57-74) compared to the self-guided group (77 s, 95% CI = 67-86), (p < 0.01). CONCLUSIONS: There was no significant difference in skill performance between groups. Residents who received deliberate practice and mastery learning demonstrated an improvement in skill performance time.

ABSTRAIT: OBJECTIFS: La formation aux compétences techniques fondée sur la simulation est maintenant omniprésente en médecine, en particulier pour les procédures de grande acuité et de faible occurrence (HALO). L'apprentissage de la maîtrise et la pratique délibérée (ML+DP) sont des méthodes éducatives potentiellement précieuses, mais elles exigent beaucoup de ressources. Nous avons cherché à comparer l'effet de la pratique délibérée et de l'apprentissage de la maîtrise par rapport à la pratique autoguidée sur le rendement des compétences de la rare intervention de sauvetage, une cricothyroïdotomie à la bougie. MéTHODES: Nous avons mené une étude multicentrique randomisée dans le cadre de cinq programmes nord-américains de résidence en médecine d'urgence. Nous avons affecté au hasard 176 résidents en SE aux groupes de ML+DP ou de pratique autoguidée. Trois experts des voies respiratoires aveuglés ont évalué de façon indépendante la performance des compétences en BAC par examen vidéo avant (pré-test), après (post-test) et 6 à 12 mois (rétention) après la séance de formation. Le principal résultat a été le rendement des compétences après le test au moyen d'une cote globale (SRC). Les résultats secondaires comprenaient le temps consacré au rendement et le rendement des compétences au test de rétention. RéSULTATS: Immédiatement après la formation, les résultats des SRC étaient beaucoup plus élevés, car le rendement moyen s'est amélioré entre le prétest (22, IC à 95 % = 21 à 23) et le post-test (27, IC à 95 % = 26 à 28), (p < 0,001) pour tous les participants. Cependant, il n'y avait aucune différence entre les groupes sur les scores GRS (p = 0,2) au post-test ou au test de rétention (p = 0,2). Au test de rétention, les participants du groupe ML+DP avaient des temps de performance plus rapides (66 secondes, IC à 95 % = 57 à 74) que ceux du groupe autoguidé (77 secondes, IC à 95 % = 67 à 86) (p < 0,01). CONCLUSIONS: Il n'y avait pas de différence significative dans le rendement des compétences entre les groupes. Les résidents qui ont bénéficié d'une pratique délibérée et d'un apprentissage de la maîtrise ont démontré une amélioration du temps consacré aux compétences.

Humans not heroes: Canadian emergency physician experiences during the early COVID-19 pandemic.

BACKGROUND: The pandemic has upended much clinical care, irrevocably changing our health systems and thrusting emergency physicians into a time of great uncertainty and change. This study is a follow-up to a survey that examined the early pandemic experience among Canadian emergency physicians and aimed to qualitatively describe the experiences of these physicians during the global pandemic. The study was conducted at a time when Canadian COVID-19 case numbers were low. METHODS: The investigators engaged in an interview-based study that used an interpretive description analytic technique, sensitised by the principles of phenomenology. One-to-one interviews were conducted, transcribed and then analysed to establish a codebook, which was subsequently grouped into key themes. Results underwent source triangulation (with survey data from a similar period) and investigator-driven audit trail analysis. RESULTS: A total of 16 interviews (11 female, 5 male) were conducted between May and September 2020. The isolated themes on emergency physicians' experiences during the early pandemic included: (1) disruption and loss of emergency department shift work; (2) stress of COVID-19 uncertainty and information bombardment; (3) increased team bonding; (4) greater personal life stress; (5) concern for patients' isolation, miscommunication and disconnection from care; (6) emotional distress. CONCLUSIONS: Canadian emergency physicians experienced emotional and psychological distress during the early COVID-19 pandemic, at a time when COVID-19 prevalence was low. This study's findings could guide future interventions to protect emergency physicians against pandemic-related distress.

Canadian emergency medicine physician burnout: a survey of Canadian emergency physicians during the second wave of the COVID-19 pandemic.

OBJECTIVES: A previous survey of Canadian emergency medicine (EM) physicians during the first wave of the COVID-19 pandemic documented less than 20% experienced high levels of burnout. This study examined the experience of a similar group of physicians during the second pandemic wave. We reported the associations between burnout and physician age, gender, having children at home and training route. METHODS: This study utilized a national survey of Canadian emergency physicians. We collected data on demographics and measured burnout using the Maslach Burnout Inventory (MBI). Multiple logistic regression models identified associations between the emotional exhaustion and depersonalization domains of the MBI and EM physician demographics (age, gender, children living at home, and training route). RESULTS: Between November 25, 2020, and February 4, 2021, 416 emergency physicians completed the survey, representing all Provinces or Territories in Canada (except Nunavut). The mean participant age was 44, 53% were male, 64% had children living at home and 41% were FRCPC and 41% CCFP-EM trained. Sixty percent reported high burnout (either high emotional exhaustion and/or high depersonalization). Increasing age was associated with lower emotional exhaustion and depersonalization; female or nonbinary gender was associated with an increase in emotional exhaustion; and having children living at home was associated with lower depersonalization. CONCLUSIONS: Most Canadian emergency physicians participating in our study during the COVID-19 pandemic reported high burnout levels. Younger physicians and female physicians were more likely than their coworkers to report high burnout levels. Hospitals should address emergency physician burnout during the pandemic because it is a threat to quality of patient care and retention of the workforce for the future.

RéSUMé: OBJECTIFS: Une enquête précédente sur les médecins d'urgence canadiens pendant la première vague de la pandémie de COVID-19 a montré que moins de 20 % d'entre eux souffraient de niveaux élevés d'épuisement professionnel. Cette étude a examiné l'expérience d'un groupe similaire de médecins au cours de la deuxième vague et a rapporté les associations entre l'épuisement professionnel et l'âge du médecin, son sexe, le fait d'avoir des enfants à la maison et le parcours de formation. MéTHODES: Cette étude s'est appuyée sur une enquête nationale auprès des médecins d'urgence canadiens. Nous avons recueilli des données démographiques et mesuré le burnout à l'aide du Maslach Burnout Inventory (MBI). De multiples modèles de régression logistique ont identifié des associations entre les domaines de l'épuisement émotionnel et de la dépersonnalisation du MBI et les données démographiques des médecins de la médecine d'urgence (âge, sexe, enfants vivant à la maison et parcours de formation). RéSULTATS: Entre le 25 novembre 2020 et le 4 février 2021, 416 médecins urgentistes ont répondu au sondage, représentant toutes les provinces ou territoires du Canada (sauf le Nunavut). L'âge moyen des participants était de 44 ans, 53% étaient des hommes, 64% avaient des enfants vivant à la maison et 41% étaient formés FRCPC et 41% CMFC-MU. Soixante pour cent ont signalé un épuisement professionnel élevé (soit un épuisement émotionnel élevé et/ou une dépersonnalisation élevée). L'augmentation de l'âge était associée à une diminution de l'épuisement émotionnel et de la dépersonnalisation ; le sexe féminin ou non binaire était associé à une augmentation de l'épuisement émotionnel ; et le fait d'avoir des enfants vivant à la maison était associé à une diminution de la dépersonnalisation. CONCLUSIONS: La plupart des médecins urgentistes canadiens ayant participé à notre étude pendant la pandémie de COVID-19 ont signalé des niveaux élevés d'épuisement professionnel. Les médecins plus jeunes et les femmes médecins étaient plus susceptibles que leurs collègues de déclarer des niveaux élevés d'épuisement professionnel. Les hôpitaux doivent s'attaquer au problème de l'épuisement professionnel des médecins urgentistes pendant la pandémie, car il constitue une menace pour la qualité des soins aux patients et la rétention de la main-d'œuvre pour l'avenir.

Phenobarbital for the management of severe acute alcohol withdrawal (the PHENOMANAL trial): a pilot randomized controlled trial.

BACKGROUND: Benzodiazepines are considered first-line treatment for patients experiencing severe acute alcohol withdrawal syndrome (sAAWS). Although several medications have been evaluated as potential adjuvant treatments for sAAWS, barbiturates show particular promise. OBJECTIVE: In the PHENOMANAL trial, we will assess the feasibility of conducting an allocation-concealed, quadruple-blinded, randomized controlled trial (RCT) comparing symptom-triggered benzodiazepine therapy with either a single dose of adjuvant intravenous (IV) phenobarbital (7.5 mg/kg of ideal body weight) or a single dose of matching IV placebo for patients with sAAWS. METHODS: We will recruit adult patients from the Emergency Department, Intensive Care Unit, or hospital wards with a Clinical Institute of Withdrawal - Adult revised (CIWA-Ar) score of 16 or more after receipt of at least 60 mg of diazepam or equivalent within 16 h of diagnosis of sAAWS, and an anticipated need for hospitalization. We will randomize participants (n=39) in a 2:1 manner to treatment and placebo groups, respectively. The primary objective of the PHENOMANAL pilot trial will be to demonstrate our ability to recruit the desired population over the trial period. As secondary objectives, we will evaluate clinician compliance with the treatment protocols, assess crossover rates from the placebo arm to the treatment arm, and obtain preliminary estimates of treatment effect. All trial participants will be followed for 7 days or until hospital discharge. RELEVANCE: The PHENOMANAL trial is novel in investigating a new treatment for a common and understudied condition, repurposing an existing medication for a novel indication, and addressing an important evidence gap. Through conduct of the multidisciplinary pilot trial, we aim to advance methodology in acute care research through the use of a hybrid consent model and inform the design of a large-scale trial. TRIAL REGISTRATION: ClinicalTrials.gov Registration NCT03586089 ; first registered July 13, 2018.

An Active Shooter in Your Hospital: A Novel Method to Develop a Response Policy Using In Situ Simulation and Video Framework Analysis.

Hospital shootings (Code Silver) are events that pose extreme risk to staff, patients, and visitors. Hospitals are faced with unique challenges to train staff and develop protocols to manage these high-risk events. In situ simulation is an innovative technique that can evaluate institutional responses to emergent situations. This study highlights the design of an active shooter in situ simulation conducted at a Canadian level-1 trauma center to test a Code Silver active shooter protocol response. We further apply a modified framework analysis to extract latent safety threats (LSTs) from the simulation using ethnographic observation of the response by law enforcement, hospital security, logistics, and medical personnel.The video-based framework analysis identified 110 LSTs, which were assigned hazard scores, highlighting 3 high-risk LSTs that did not have effective control measures or were not easily discoverable. These included lack of security during patient transport, inadequate situational awareness outside the clinical area, and poor coordination of critical tasks among interprofessional team members. In situ simulation is a novel approach to support the design and implementation of similar events at other institutions. Findings from ethnographic observations and a video-based analysis form a structured framework to address safety, logistical, and medical response considerations.

Macrocirculatory and Microcirculatory Endpoints in Sepsis Resuscitation.

Sepsis is a common disease process encountered by physicians. Sepsis can lead to septic shock, which carries a hospital mortality rate in excess of 40%. Although the Surviving Sepsis Guidelines recommend targeting a mean arterial pressure (MAP) of 65 mmHg and normalization of lactate, these endpoints do not necessarily result in tissue perfusion in states of shock. While MAP and lactate are commonly used markers in resuscitation, clinicians may be able to improve their resuscitation by broadening their assessment of the microcirculation, which more adequately reflects tissue perfusion. As such, in order to achieve a successful resuscitation, clinicians must optimize both macrocirculatory (MAP, cardiac output) and microcirculatory (proportion of perfused vessels, lactate, mottling, capillary refill time) endpoints. This review will summarize various macrocirculatory and microcirculatory markers of perfusion that can be used to guide the initial resuscitation of patients with sepsis.

Gender-Based Differences in Outcomes Among Resuscitated Patients With Out-of-Hospital Cardiac Arrest.

BACKGROUND: Studies examining gender-based differences in outcomes of patients experiencing out-of-hospital cardiac arrest have demonstrated that, despite a higher likelihood of return of spontaneous circulation, women do not have higher survival. METHODS: Patients successfully resuscitated from out-of-hospital cardiac arrest enrolled in the CCC trial (Trial of Continuous or Interrupted Chest Compressions during CPR) were included. Hierarchical multivariable logistic regression models were constructed to evaluate the association between gender and survival after adjustment for age, gender, cardiac arrest rhythm, witnessed status, bystander cardiopulmonary resuscitation, episode location, epinephrine dose, emergency medical services response time, and duration of resuscitation. Do not resuscitate (DNR) and withdrawal of life-sustaining therapy (WLST) order status were used to assess whether differences in postresuscitation outcomes were modified by baseline prognosis. The analysis was replicated among ALPS trial (Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest) participants. RESULTS: Among 4875 successfully resuscitated patients, 1825 (37.4%) were women and 3050 (62.6%) were men. Women were older (67.5 versus 65.3 years), received less bystander cardiopulmonary resuscitation (49.1% versus 54.9%), and had a lower proportion of cardiac arrests that were witnessed (55.1% versus 64.5%) or had shockable rhythm (24.3% versus 44.6%, P<0.001 for all). A significantly higher proportion of women received DNR orders (35.7% versus 32.1%, P=0.009) and had WLST (32.8% versus 29.8%, P=0.03). Discharge survival was significantly lower in women (22.5% versus 36.3%, P<0.001; adjusted odds ratio, 0.78 [95% CI, 0.66-0.93]; P=0.005). The association between gender and survival to discharge was modified by DNR and WLST order status such that women had significantly reduced survival to discharge among patients who were not designated DNR (31.3% versus 49.9%, P=0.005; adjusted odds ratio, 0.74 [95% CI, 0.60-0.91]) or did not have WLST (32.3% versus 50.7%, P=0.002; adjusted odds ratio, 0.73 [95% CI, 0.60-0.89]). In contrast, no gender difference in survival was noted among patients receiving a DNR order (6.7% versus 7.4%, P=0.90) or had WLST (2.8% versus 2.4%, P=0.93). Consistent patterns of association between gender and postresuscitation outcomes were observed in the secondary cohort. CONCLUSIONS: Among patients resuscitated after experiencing out-of-hospital cardiac arrest, discharge survival was significantly lower in women than in men, especially among patients considered to have a favorable prognosis.

The Mindset of the Resuscitationist.

Excellent resuscitation requires technical skills and knowledge, but also the right mindset. Expert practitioners must master their internal affective state, and create the environment that leads to optimal team performance. Leaders in resuscitation should use structured approaches to prepare for resuscitation, and psychological skills to enhance their performance including mental rehearsal, positive self-talk, explicit communication strategies, and situational awareness skills. Postevent recovery is equally important. Providers should have explicit plans for recovery after traumatic cases, including developing resilience and self-compassion. Experts in resuscitation can improve their performance (and that of their team) by consciously incorporating psychological skills into their armamentarium.

Public perceptions of federal science advisory boards depend on their composition.

The United States Environmental Protection Agency (EPA) Science Advisory Board (SAB) provides expert advice to inform agency decision-making. Recent regulations have decreased the representation of academic scientists on the EPA SAB and increased the representation of industry scientists. In an experiment, we asked how the US public views the goals and legitimacy of the board as a function of its composition. Respondents perceived SABs with a majority of industry scientists to be more likely to promote business interests than SABs with a majority of academic scientists. Liberals were less likely than conservatives to perceive industry-majority SABs as promoting human health and the environment, and making unbiased and evidence-based decisions. Our findings underscore the potential for politicization of scientific advice to the government.

Canadian emergency physician psychological distress and burnout during the first 10 weeks of COVID-19: A mixed-methods study.

Objectives: The aim of this study was to report burnout time trends and describe the psychological effects of working as a Canadian emergency physician during the first weeks of the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a mixed-methods study. Emergency physicians completed a weekly online survey. The primary outcome was physician burnout as measured by the emotional exhaustion and depersonalization items, from the Maslach Burnout Inventory. We captured data on work patterns, aerosolizing procedures, testing and diagnosis of COVID-19. Each week participants entered free text explaining their experiences and well-being. Results: There were 468 participants who worked in 143 Canadian hospitals. Burnout levels did not significantly change over time (emotional exhaustion P = 0.632, depersonalization P = 0.155). Three participants were diagnosed with COVID-19. Being tested for COVID-19 (odds ratio [OR] 11.5, 95% confidence interval [CI] 3.1-42.5) and the number of shifts worked (OR 1.3, 95% CI 1.1-1.5 per additional shift) were associated with high emotional exhaustion. Having been tested for COVID-19 (OR 4.3, 95% CI 1.1-17.8) was also associated with high depersonalization. Personal safety, academic and educational work, personal protective equipment, the workforce, patient volumes, work patterns, and work environment had an impact on physician well-being. A new financial reality and contrasting negative and positive experiences affected participants' psychological health. Conclusion: Emergency physician burnout levels remained stable during the initial 10 weeks of this pandemic. The impact of COVID-19 on the work environment and personal perceptions and fears about the impact on lifestyle have affected physician well-being.

Relationship between heifer carcass maturity and beef quality characteristics.

Our objective was to determine the relationship between heifer carcass maturity and beef palatability of the longissimus lumborum (LM) and biceps femoris (BF). Left sides of A (n = 30), B (n = 30), and C (n = 30) maturity heifer carcasses under 30 mo of age by dentition were used. Carcasses were selected to ensure similar marbling scores across maturity groups (Small to Modest). Beef strip loins (LM) and outside rounds (BF) were obtained from these carcasses. Steaks were used to measure color stability, lipid oxidation (thiobarbituric acid reactive substances; TBARS), Warner-Bratzler shear force (WBSF), soluble and insoluble collagen, and consumer sensory perceptions. Heifer carcass maturity did not affect pH, fluid loss, WBSF, or collagen content of LM or BF steaks (P > 0.29). In LM and BF steaks, a maturity × day of retail display interaction occurred for TBARS, in which B maturity steaks had lower levels of lipid oxidation compared with A and C maturity steaks from the fourth day to the end of the retail display (P < 0.01). Nevertheless, LM steaks from B maturity carcasses tended to have lower overall acceptability (P = 0.08) and juiciness (P = 0.09) than steaks from C maturity carcasses, but steaks from B and C maturity carcasses did not differ from LM steaks obtained from A maturity carcasses. No differences in tenderness or flavor were observed due to maturity (P > 0.24). Similarly, maturity had no effect on sensory characteristics of BF steaks (P > 0.30). In conclusion, our results indicate that advanced physiological maturity does not decrease palatability of strip loin or outside round steaks from carcasses of heifers under 30 mo of age.

An environmental scan of wellness initiatives and programs at Canadian academic emergency medicine programs: How far have we come?

OBJECTIVES: We sought to conduct a major objective of the Canadian Association of Emergency Physicians (CAEP) Wellness Committee, an environmental scan of the academic emergency medicine programs across the 17 Canadian medical schools. METHODS: An 89-question questionnaire was distributed to academic heads or wellness leads. The responses were verified by the lead author to ensure that the questions were answered completely and consistently. RESULTS: While formal wellness programs may exist in varying degrees across the 17 universities, most were found to exist only at local, divisional, or departmental levels. A broad variability of established leadership positions exists. Shift practices varied greatly. In day to day practice, availability for food and debriefing were high and childcare, sleep rooms, and follow-up following critical incidents were low. Sabbaticals existed in the majority of centers. Roughly 50% of departments have gender equity program and annual retreats. Centers report programs for the initiation of leaves (82%), onboarding (64%), and reorientation (94%). Support of health benefits (76%) and pensions (76%) depended on type of appointment and relationship to the university. Fiscal transparency was reported in 53% of programs. CONCLUSION: Wellness and burnout are critical issues for emergency medicine in Canada. This comprehensive review of wellness programs identifies areas of strength, but also allows identification of areas of improvement for future work. Individual centers can identify common options when developing or expanding their wellness programs.

Emergency medicine physician burnout and wellness in Canada before COVID19: A national survey.

INTRODUCTION: Emergency medicine (EM) is a high-risk specialty for burnout. COVID-19 has had and will continue to have important consequences on wellness and burnout for EM physicians in Canada. Baseline data are crucial to monitor the health of EM physicians in Canada, and evaluate any interventions designed to help during and after COVID-19. OBJECTIVES: To describe the rates of burnout, depression, and suicidality in practicing EM physicians in Canada, just before the COVID-19 pandemic. METHODS: A modified snowball method was used for survey distribution. Participants completed the Maslach Burnout Inventory - Health Services Tool (MBI-HSS), a screening measure for depression (PHQ-9), and a question regarding if the physician had ever or in the past 12 months contemplated suicide. RESULTS: A total of 384 respondent surveys were included in the final analysis: 86.1% (329/382) met at least one of the criteria for burnout, 58% (217/374) scored minimal to none on the PHQ-9 screening tool for depression, 14.3% (53/371) had contemplated suicide during their staff career in EM, and of those, 5.9% (22/371) had actively considered suicide in the past year. CONCLUSION: Canadian EM physicians just before the COVID-19 pandemic had an alarming number of respondents meet the threshold for burnout, confirming EM as a high-risk specialty. This important baseline information can be used to monitor the physical and mental risks to EM physicians during and after COVID-19, and evaluate support for mental health and wellness, which is urgently needed now and post pandemic.