Women Physicians in Transition Learning to Navigate the Pipeline from Early to Mid-Career: Protocol for a Qualitative Study.

BACKGROUND: Women physicians face unique obstacles while progressing through their careers, navigating career advancement and seeking balance between professional and personal responsibilities. Systemic changes, along with individual and institutional changes, are needed to overcome obstacles perpetuating physician gender inequities. Developing a deeper understanding of women physicians' experiences during important transition points could reveal both barriers and opportunities for recruitment, retention, and promotion, and inform best practices developed based on these experiences. OBJECTIVE: The aim is to learn from the experiences and perspectives of women physicians as they transition from early to mid-career, then develop best practices that can serve to support women physicians as they advance through their careers. METHODS: Semistructured interviews were conducted with women physicians in the United States in 2020 and 2021. Eligibility criteria included self-identification as a woman who is in the process of transitioning or who recently transitioned from early to mid-career stage. Purposeful sampling facilitated identification of participants who represented diversity in career pathway, practice setting, specialty, and race/ethnicity. Each participant was offered compensation for their participation. Interviews were audio-recorded and professionally transcribed. Interview questions were open-ended, exploring participants' perceptions of this transition. Qualitative thematic analysis will be performed. We will use an open coding and grounded theory approach on interview transcripts. RESULTS: The Ethics Review Committee of the Faculty of Health, Medicine, and Life Sciences at Maastricht University approved the study; Stanford University expedited review approved the study; and the University of California, San Diego certified the study as exempt from review. Twelve in-depth interviews of 50-100 minutes in duration were completed. Preliminary analyses indicate one key theme is a tension resulting from finite time divided between demands from a physician career and demands from family needs. In turn, this results in constant boundary control between these life domains that are inextricable and seemingly competing against each other within a finite space; family needs impinge on planned career goals, if the boundary between them is not carefully managed. To remedy this, women sought resources to help them redistribute home responsibilities, freeing themselves to have more time, especially for children. Women similarly sought resources to help with career advancement, although not with regard to time directly, but to first address foundational knowledge gaps about career milestones and how to achieve them. CONCLUSIONS: Preliminary results provide initial insights about how women identify or activate a career shift and how they marshaled resources and support to navigate barriers they faced. Further analyses are continuing as of March 2022 and are expected to be completed by June 2022. The dissemination plan includes peer-reviewed open-access journal publication of the results and presentation at the annual meeting of the American Medical Association's Women Physicians Section.

A Survey to Assess the Need for a National Registry to Track Physician Suicide.

Physician suicide is a growing public health crisis that affects the medical community and patients. Literature on physician suicide has been published since 1903. However, the epidemiology of physician suicide including incidence is unclear due to a lack of accurate data. Lack of reliable data can lead to barriers in developing effective physician suicide prevention programs and creating policies to address the issue. Data are often collected from multiple data sources that each have limitations resulting in crude estimates of incidence and persistent barriers to surveillance. The aim of this study was to survey the medical community to determine the perceived usefulness of a physician suicide registry, with an accompanying data warehouse, to collect and store information about suicides reported from the community. Physicians at all stages of their training and careers would be key stakeholders contributing information to the registry and therefore their perception of such a tool to track physician suicides is important. Results show that 70.0% of respondents expressed that they somewhat to strongly agree with the approach; and 74.2% agreed with a statement that more research is needed on physician suicide. The proposed registry to better track physician suicide is a possible solution to better address physician suicide that has garnered initial support from the medical community as reflected by the survey results.

AHA telemetry guidelines improve telemetry utilization in the inpatient setting.

OBJECTIVES: Overuse of telemetry among hospitalized patients results in poor patient care and wasted health care dollars. Guidelines addressing telemetry use have been developed by the American Heart Association (AHA) and are effective when applied to specific clinical practices and high-value care. The purpose of our intervention was to facilitate more effective utilization of telemetry in our hospital. We aimed to reduce patient days on telemetry through use of AHA guideline criteria for telemetry. STUDY DESIGN: We used Plan-Do-Study-Act cycles with chart review for pre- and postintervention measurement collection. METHODS: We included patients hospitalized at The Brooklyn Hospital Center on inpatient general medical wards from January 1, 2017, through July 31, 2018. The intervention consisted of a standard process of reviewing patients on telemetry based on AHA guidelines, educating teams on the guidelines, and changes to telemetry order sets. The primary outcome measured was the total number of days that patients remained on telemetry. Secondary measures included the daily number of telemetry downgrades and total number of patients on telemetry. Diagnosis-related group and case mix index were also noted. RESULTS: Patient average days on telemetry changed from 7.20 days preintervention to 3.51 days post intervention (P < .0001). The number of patients on telemetry with a diagnosis meeting AHA guidelines for telemetry increased. CONCLUSIONS: The stated intervention resulted in more effective use of telemetry, evidenced by fewer patient days on telemetry and increased numbers of patients on telemetry meeting AHA guidelines for telemetry.

Trends in Epidemiology: Analysis of Risk Factors and Outcomes of Infective Endocarditis: A Retrospective Study (2009-2015).

Background Despite advanced diagnosis and treatment, infective endocarditis (IE) is a potentially life-threatening condition. Although recent studies have provided evidence of changing trends in IE epidemiology, few studies examine patterns within urban minority populations. Here we present the epidemiology, risk factors, and outcomes of IE among an underserved African American population in Brooklyn, New York, compared to the general population. Methods This is a retrospective study which included 67 patients with IE diagnosed at The Brooklyn Hospital Center from 2009 to 2015. Patients were selected according to the modified Duke Criteria for definite IE. Various epidemiological parameters were examined via chi-square and Fisher's exact test using SPSS 24 software (IBM Corp., Armonk, NY). Results The mean age of the 67 patients was 63 years and 46.3% of the patients were men. The majority of patients (70.1%) were African American while Hispanics and Caucasians were 17.9% and 7.5%, respectively. Healthcare-associated IE (58.2%, n=39) outnumbered community-acquired IE (41.8%, n=28). The sites of vegetation were the mitral valve (62.7%, n=42), tricuspid valve (22.4%, n=15), aortic valve (11.9%, n=8), and intravenous catheter (3%, n=2). In valves, 13.4% of the cases were found in prosthetic valves while the majority occurred in native valves. The most common pathogens of IE were the Staphylococcus (50.8%, n=34) species, followed by Streptococcus species (32.8%, n=22). Overall, the in-hospital mortality was 38.8% (n=26) with higher mortality observed for healthcare-associated IE than community-acquired IE (P = .049). Embolic complications were associated with significant mortality (P < .001). Conclusion Our study demonstrated that the common causative pathogens for IE among African Americans trends towards Staphylococcus species followed by Streptococcus species, similar to the contemporary epidemiology of IE. Healthcare-associated IE outnumbered community-acquired IE and was associated with higher mortality. Embolic complications were significantly associated with high mortality. Therefore, efforts made to control healthcare-associated infections are expected to decrease the trend of IE.

Anti-signal Recognition Particle Necrotizing Autoimmune Myopathy: An Atypical Presentation.

Necrotizing autoimmune myopathy (NAM), also known as necrotizing autoimmune myositis, is a heterogeneous group of diseases characterized by the presence of necrotic muscle fibers on biopsy, elevated creatine kinase (CK) levels, an abnormal electromyogram (EMG) result, and the associated antibodies. The anti-signal recognition particle (anti-SRP) and the anti-3-hydroxyl-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies are the two most prevalent antibodies identified with NAM. NAM is a rare disease that typically affects middle-aged Caucasian women. In this case report, we present the diagnosis of anti-SRP NAM in a middle-aged African American male. This case report displays the atypical presentation of NAM outside of the typical patient population as well as the need for additional research to determine the pathogenesis and the precise role of anti-SRP antibodies in NAM.