Resident physician burnout: insights from a Canadian multispecialty survey.

BACKGROUND: Burnout results from chronic exposure to stress: comprising emotional exhaustion (EE), depersonalisation (DP) and a reduced sense of personal achievement (PA). Only a few studies have examined burnout in Canadian residents, and no multispecialty studies using the Maslach Burnout Inventory-Health Sciences Survey (MBI-HSS) exist. The purpose of our study is to identify burnout prevalence, contributory factors and solutions. METHODS: A prospective 62-item survey, including the 22-item MBI-HSS, was sent to all Alberta residents, with a resident population of 1745. The association between burnout, EE, DP and PA with items in the survey was performed. Continuous data were evaluated using Student's t-test or analysis of variance. Ordinal data were evaluated using Spearman's correlation coefficient and Mann-Whitney U test. Nominal data were evaluated using χ2 test. RESULTS: Response rate was 41.1% (n=718), with burnout prevalence of 69.4%. 61.6% of residents demonstrated high EE, 47.8% high DP and 29.0% low PA. More hours worked, poor work-life balance, poor service-education balance, poor mental health support, experiencing intimidation/harassment and being unhappy with programme and with career choice were associated with higher burnout (p<0.001). 53.5% of residents experienced intimidation/harassment. Solutions to burnout included improved teaching, improved call/working hours, more wellness days and a change in medicine culture. CONCLUSION: High prevalence of burnout in Canadian residents with contributory factors and solutions identified. We hope programmes across the world can use this information to improve the burden of burnout among residents.

Burnout in Canadian Radiology Residency: A National Assessment of Prevalence and Underlying Contributory Factors.

OBJECTIVE: To determine burnout prevalence in Canadian radiology residency and identify contributing factors. MATERIALS AND METHODS: A prospective 57-item survey, including the 22-item Maslach Burnout Inventory-Health Sciences Survey, was sent to all Canadian radiology residents, with a total resident population of 359. The association between emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA) scores with items in the survey was performed. Continuous data were evaluated using the Student t test for comparing the means between the 2 groups or the analysis of variance test for comparing the means between at least 3 groups. Spearman correlation coefficient was performed when evaluating ordinal categorical data. RESULTS: Response rate is 40.1% (n = 144); 50.7% of residents demonstrate high EE, 48.6% demonstrate high DP, and 35.9% demonstrate low PA. Being unhappy with residency and with radiology as a career is associated with burnout (P < .001). Age, sex, marital status, and children have no impact on burnout. More hours worked is associated with higher EE (P = .025) and DP (P = .004). In all, 47.2% residents experienced intimidation or harassment. Feeling unsupported by staff radiologists is associated with higher EE (P < .001), higher DP (P = .001), and lower PA (P = .008). In all, 45.1% of residents have poor work-life balance, and those residents demonstrate higher EE (P < .001), higher DP (P = .006), and lower PA (P = .01). In all, 25% of residents identify poor education-service balance in their residency, and those residents have higher EE (P < .001), higher DP (P = .042), and lower PA (P = .005). CONCLUSION: This study demonstrates significant burnout in Canadian radiology residents with major contributory factors identified.

Reporting lower extremity CT angiography for treatment planning.

Diagnostic radiologists play an important role in the evaluation of patients presenting with signs and symptoms of lower extremity peripheral vascular disease, including critical limb ischemia in both acute and chronic settings, and intermittent claudication. The complications associated with tissue and/or limb loss related to acute limb ischemia and critical limb ischemia of the lower extremity make rapid diagnosis and early intervention critical in the management of these patients. Computed tomography angiography (CTA) is an effective, widely available, easily reproducible, non-invasive imaging modality that offers a rapid and accurate means to diagnose and grade the extent of vascular disease. However, CTA run-off reports are usually dictated in free text form, and referring and treating physicians may be unsure whether an anatomic structure has been evaluated if it has not been specifically mentioned in the report. In this article, the vascular anatomy and anatomic variants of the lower extremity, the most common lower extremity vascular pathologies are reviewed and clinically important CTA imaging findings are outlined. This provides a framework for radiologists to accurately evaluate lower extremity vascular pathologies and convey clinically relevant imaging findings for management by vascular surgeons or interventional radiologists.

Hippocampal volume and the brain-derived neurotrophic factor Val66Met polymorphism in first episode psychosis.

INTRODUCTION: Small hippocampi and impaired memory are common in patients with psychosis and brain-derived neurotrophic factor (BDNF) plays a critical role in hippocampal neuroplasticity and memory. A common BDNF allele (Val66Met) has been the focus of numerous studies but results from the few BDNF-imaging studies are complex and contradictory. The objective of this study was to determine the association between Val66Met and hippocampal volume in patients with first episode psychosis. Secondary analyses explored age-related associations and the relationship between Val66Met and memory. METHOD: Hippocampal volume and BDNF genotyping were obtained for 58 patients with first-episode psychosis and 39 healthy volunteers. Patients were recruited from an early psychosis program serving a catchment-area population. RESULTS: Hippocampal volume was significantly smaller in patients than controls (F(1,92)=4.03, p<0.05) and there was a significant group-by-allele interaction (F(1,92)=3.99, p<0.05). Hippocampal volume was significantly smaller in patients than controls who were Val-homozygotes but no group differences were found for Met carriers. Findings were not affected by diagnosis, antipsychotic medication, or age, and there was no change in hippocampal volume during a one-year follow-up. Val-homozygous patients had worse immediate and delayed memory than their Met counterparts. CONCLUSIONS: Results suggest the effects of the BDNF Val66Met allele may be different in patients with psychosis than in healthy adults. Hippocampal volume in patient and control Met allele carriers was very similar suggesting that illness-related factors have minimal influence in this group. In contrast, Val homozygosity was related to smaller hippocampi and poorer memory functioning only in patients with psychosis.