Association of part-time clinical work with well-being and mental health in General Internal Medicine: A survey among Swiss hospitalists.

INTRODUCTION: Burnout and low job satisfaction are increasing among the General Internal Medicine (GIM) workforce. Whether part-time compared to full-time clinical employment is associated with better wellbeing, job satisfaction and health among hospitalists remains unclear. MATERIALS AND METHODS: We conducted an anonymized cross-sectional survey among board-certified general internists (i.e. hospitalists) from GIM departments in 14 Swiss hospitals. Part-time clinical work was defined as employment of <100% as a clinician. The primary outcome was well-being, as measured by the extended Physician Well-Being Index (ePWBI), an ePWBI ≥3 indicating poor wellbeing. Secondary outcomes included depressive symptoms, mental and physical health, and job satisfaction. We compared outcomes in part-time and full time workers using propensity score-adjusted multivariate regression models. RESULTS: Of 199 hospitalists invited, 137 (69%) responded to the survey, and 124 were eligible for analysis (57 full-time and 67 part-time clinicians). Full-time clinicians were more likely to have poor wellbeing compared to part-time clinicians (ePWBI ≥3 54% vs. 31%, p = 0.012). Part-time compared to full-time clinical work was associated with a lower risk of poor well-being in adjusted analyses (odds ratio 0.20, 95% confidence interval 0.07-0.59, p = 0.004). Compared to full-time clinicians, there were fewer depressive symptoms (3% vs. 18%, p = 0.006), and mental health was better (mean SF-8 Mental Component Summary score 47.2 vs. 43.2, p = 0.028) in part-time clinicians, without significant differences in physical health and job satisfaction. CONCLUSIONS: Full-time clinical hospitalists in GIM have a high risk of poor well-being. Part-time compared to full-time clinical work is associated with better well-being and mental health, and fewer depressive symptoms.

Challenges in the transition from resident to attending physician in general internal medicine: a multicenter qualitative study.

BACKGROUND: The attending physician in general internal medicine (GIM) guarantees comprehensive care for persons with complex and/or multiple diseases. Attendings from other medical specialties often report that transitioning from resident to attending is burdensome and stressful. We set out to identify the specific challenges of newly appointed attendings in GIM and identify measures that help residents better prepare to meet these challenges. METHODS: We explored the perceptions of 35 residents, attendings, and department heads in GIM through focus group discussions and semi-structured interviews. We took a thematic approach to qualitatively analyze this data. RESULTS: Our analysis revealed four key challenges: 1) Embracing a holistic, patient centered perspective in a multidisciplinary environment; 2) Decision making under conditions of uncertainty; 3) Balancing the need for patient safety with the need to foster a learning environment for residents; and 4) Taking on a leader's role and orchestrating an interprofessional team of health care professionals. Newly appointed attendings required extensive practical experience to adapt to their new roles. Most attendings did not receive regular, structured, professional coaching during their transition, but those who did found it very helpful. CONCLUSIONS: Newly appointed attending physician in GIM face a number of critical challenges that are in part specific to the field of GIM. Further studies should investigate whether the availability of a mentor as well as conscious assignment of a series of increasingly complex tasks during residency by clinical supervisors will facilitate the transition from resident to attending.

Does multifaceted nutritional education improve malnutrition management?

OBJECTIVES: Malnutrition is a challenging issue in hospitals, but mostly reversible. However, despite being associated with increased morbidity and mortality risk, malnutrition is hardly recognized and treated. There is a strong need to raise awareness of treating residents to improve patients' nutritional management. This study aimed to investigate the impact of an educational intervention on residents' nutritional knowledge, perception, and prescribed nutritional therapies. METHODS: This prospective intervention study was conducted at the Department of General Internal Medicine of the Bern University Hospital. Nutritional risk was evaluated in consecutive patients admitted to the wards using the Nutritional Risk Screening 2002 and the number of prescribed nutritional therapies were assessed. The educational intervention included an interactive case discussion headed by nutritional medicine consultants. A pocket card with basic nutritional information was handed out. Each resident's nutritional knowledge was checked with a multiple choice test before the intervention, immediately after, and after 2 months. RESULTS: In total, 609 patients were included (121 preintervention, 161 postintervention phase I, 327 postintervention phase II). Overall prevalence of malnutrition was 35%. The percentage of prescribed nutritional therapies was 36%. There was no significant difference between the phases (46% preintervention, 52% postintervention phase I, 27% postintervention phase II) or between the test results (mean percentage of correct answers 61 ± 15%; 57 ± 12%, and 60 ± 10%). CONCLUSIONS: The multimodal intervention failed to achieve both objectives, as neither residents' knowledge and awareness nor the number of prescribed therapies could be increased. Nutritional risk remains highly prevalent; thus, innovative and more effective teaching strategies are needed to increase knowledge, abilities, and skills to fight malnutrition.