Associations between gender, disease features and symptom burden in patients with myeloproliferative neoplasms: an analysis by the MPN QOL International Working Group.

The myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia and myelofibrosis, are distinguished by their debilitating symptom profiles, life-threatening complications and profound impact on quality of life. The role gender plays in the symptomatology of myeloproliferative neoplasms remains under-investigated. In this study we evaluated how gender relates to patients' characteristics, disease complications and overall symptom expression. A total of 2,006 patients (polycythemia vera=711, essential thrombocythemia=830, myelofibrosis=460, unknown=5) were prospectively evaluated, with patients completing the Myeloproliferative Neoplasm-Symptom Assessment Form and Brief Fatigue Inventory Patient Reported Outcome tools. Information on the individual patients' characteristics, disease complications and laboratory data was collected. Consistent with known literature, most female patients were more likely to have essential thrombocythemia (48.6% versus 33.0%; P<0.001) and most male patients were more likely to have polycythemia vera (41.8% versus 30.3%; P<0.001). The rate of thrombocytopenia was higher among males than females (13.9% versus 8.2%; P<0.001) and males also had greater red-blood cell transfusion requirements (7.3% versus 4.9%; P=0.02) with shorter mean disease duration (6.4 versus 7.2 years, P=0.03). Despite there being no statistical differences in risk scores, receipt of most therapies or prior complications (hemorrhage, thrombosis), females had more severe and more frequent symptoms for most individual symptoms, along with overall total symptom score (22.8 versus 20.3; P<0.001). Females had particularly high scores for abdominal-related symptoms (abdominal pain/discomfort) and microvascular symptoms (headache, fatigue, insomnia, concentration difficulties, dizziness; all P<0.01). Despite complaining of more severe symptom burden, females had similar quality of life scores to those of males. The results of this study suggest that gender contributes to the heterogeneity of myeloproliferative neoplasms by influencing phenotypic profiles and symptom expression.

Perceptions of internal medicine residency program candidates on the use of simulation in the selection process.

BACKGROUND: The recruitment of skilled candidates into internal medicine residency programs has relied on traditional interviewing techniques with varying degrees of success. The development of simulated medical technology has provided a new arena in which to assess candidates' clinical skills, knowledge base, situational awareness, and problem-solving dexterities within a standardized environment for educational and assessment purposes. OBJECTIVE: The purpose of this study was to investigate the interest of program candidates in incorporating simulation medicine into the internal medicine residency interview process. METHODS: As a prospective, survey-based analysis, potential candidates who completed an interview between October 2012 and January 2013 with an accredited internal medicine residency program were sent a postmatch survey that incorporated 3 additional questions relating to their prior experience with medical simulation and their views on incorporating the technology into the interview format. RESULTS: Of the 88 candidates who completed an interview, 92% (n  =  81) were scheduled to graduate medical school in 2013 and were graduates of a US medical school. All survey responders described previous experience with medical simulation. Fifty-eight percent (n  =  51) of responders described being "less likely" to interview with or join a residency program if they were required to participate in a 10-minute medical simulation during the interview process. CONCLUSIONS: The results of this study suggest that despite the increasing role of technology in medical education, its role in high-stakes evaluations (such as residency interviews) requires further maturation before general acceptance by residency candidates can be expected.

Burnout in inpatient-based versus outpatient-based physicians: a systematic review and meta-analysis.

BACKGROUND: Burnout is a syndrome affecting the entirety of work life and characterized by cynicism, detachment, and inefficacy. Despite longstanding concerns about burnout in hospital medicine, few data about burnout in hospitalists have been published. PURPOSE: A systematic review of the literature on burnout in inpatient-based and outpatient-based physicians worldwide was undertaken to determine whether inpatient physicians experience more burnout than outpatient physicians. DATA SOURCES: Five medical databases were searched for relevant terms with no language restrictions. Authors were contacted for unpublished data and clarification of the practice location of study subjects. STUDY SELECTION: Two investigators independently reviewed each article. Included studies provided a measure of burnout in inpatient and/or outpatient nontrainee physicians. DATA EXTRACTION: Fifty-four studies met inclusion criteria, 15 of which provided direct comparisons of inpatient and outpatient physicians. Twenty-eight studies used the same burnout measure and therefore were amenable to statistical analysis. DATA SYNTHESIS: Outpatient physicians reported more emotional exhaustion than inpatient physicians. No statistically significant differences in depersonalization or personal accomplishment were found. Further comparisons were limited by the heterogeneity of instruments used to measure burnout and the lack of available information about practice location in many studies. CONCLUSIONS: The existing literature does not support the widely held belief that burnout is more frequent in hospitalists than outpatient physicians. Better comparative studies of hospitalist burnout are needed.