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Background and Objectives: The prevalence of COVID-19 significantly affected different aspects of the quality of life (QoL) in people, especially the medical staff, who are at the forefront of battle against the disease. This study aims to investigate the QoL of medical residents of hospitals affiliated to Kashan University of Medical Sciences (KUMS) during the COVID-19 pandemic. Methods: This cross-sectional study was conducted on 140 medical residents of hospitals affiliated to KUMS in 2021. Their QoL was assessed using World Health Organization quality of life (WHOQOL). The collected data were analyzed in SPSS software, version 22 using Chi-square, Mann-Whitney U test, t-test, one-way analysis of variance, Kolmogorov-Smirnov test, Pearson and Spearman correlation tests. Results: The physical health dimension had a statistically significant relationship with age, marital status, underlying disease, sports/arts activities, and year of residency (P

Background: Early medical residents are expected to have a higher prevalence of burnout due to physical and psychological stressors. However psychological distress associated with burnout has not been adequately investigated in a longitudinal manner. We therefore examined the longitudinal trajectory of depression and its associated factors among early medical residents. Methods: In this cohort study, medical residents (n = 215) who started rotation at the University of Yamanashi Hospital during 2012 to 2018 were recruited and asked to complete the Brief Job Stress Questionnaire (BJSQ), Center for Epidemiologic Studies Depression Scale (CESD), Brief Scale for Coping Profile (BSCP) and Athens Insomnia Scale (AIS) at the time of exit from each clinical department for up to two years over seven years. Factors associated with the CES-D scores were statistically explored, with a cutoff score of 16 to denote depression. Results: The CES-D was completed by 205 residents. The average CES-D score was 10.3 ± 8.0 and the scores were lower in the 2nd versus 1st year of residency (11.3 ± 6.7 versus 9.2 ± 7.0). Multiple regression analysis of BJSQ/BSCP/AIS on CES-D revealed that insomnia had a significant impact on the CES-D scores. Apart from insomnia, avoidance and suppression and peer support had significant effects. Resilient residents, who showed the maximum CES-D score of under 16 consistently throughout the residency, was better in terms of changing a point of view, active solution and changing mood. Women were more likely to express emotions to others, while they reported more job control in the first year. Conclusions: Our results have high clinical relevance to challenge psychological burnout among early medical residents, offering some possible clues for prevention such as reduced burden, more flexibility during the first year and strengthening coworker support. Insomnia exerted moderate to strong effects on depression and monitoring of sleep appears indispensable in this specific population.

Background: Different stages of a physician's career may be associated with different types of mental health impairment. Aims: This study aimed to compare symptoms of anxiety, depression, and stress and their associated factors among medical students, medical residents, and physicians. Methods: A cross-sectional study was conducted. Data collection included sociodemographic data, religiosity (Duke University Religion Index), and mental health (21-item Depression, Anxiety and Stress Scale – DASS-21) data. The comparison between the groups was performed using ANOVA, and the associated factors were evaluated via linear regression models. Results: The sample consisted of 1,417 participants: 778 medical students, 190 medical residents, and 468 established physicians. Medical students had significantly higher depression, anxiety, and stress scores as compared to medical residents and established physicians. However, regarding DASS 21 scores, no significant differences were found between established physicians and medical residents. The factors associated with mental health in the different groups showed that being married and male were associated with better mental health among physicians and medical residents, while the factors of male gender, being in later years of the course, and lower religious attendance were associated with better mental health in students. Conclusion: Medical students had worse mental health outcomes when compared to residents and established physicians. Interventions are needed to minimize suffering during medical education and career. [ABSTRACT FROM AUTHOR]

Background: A death certificate is an official certificate signed by a doctor that states the cause of a person’s death. In most teaching hospitals, resident physicians complete the filling out of death certificates. Materials and Methods: In this research study, we conducted a cross-sectional study on 300 resident physicians from subspecialties, such as internal medicine, emergency medicine, and surgery, at King Khalid University Hospital, Riyadh, Saudi Arabia. The residents responded to a self-administered questionnaire. Both male and female physicians voluntarily participated in the study upon providing electronic consent. The Statistical Package for the Social Sciences(SPSS) version 25 was used to measure the statistical significance of the retrieved responses. Results: The study conveys that in the last 12 months, 8% of the study participants had not filled out any death certificates. Moreover, in the last 3 years, 74.6% of the resident doctor participants had filled out a significant number of death certificates, while only 4.3% had not dealt with this document. Only 16% of the doctors filled out a death certificate for patients for whom they were the primary caregivers in most of the cases. Conclusion: The data generated through this study indicated the reasons why some inaccuracies occur in the process of filling out death certificates, which are based on the reasons accepted by the system, the language barrier, and the training received by the residents on the matter. Given these study results, we have made various recommendations for a training program based on the documented challenges and inaccuracies in filling out death certificates, irrespective of any prior training in the subject. [ABSTRACT FROM AUTHOR]

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Background and Objective: Job burnout is one of the challenges of the health system and medical residents are among the most important pillars of service delivery, especially in epidemic conditions, and spiritual intelligence can be proposed as a way to relieve job burnout. The purpose of this study is to investigate the correlation between spiritual intelligence and job burnout in clinical teaching residents of Mazandaran University of Medical Sciences during the COVID-19 pandemic. Methods: This study is a questionnaire-based survey (cross-sectional study) that was conducted in 1400 with the participation of 36 residents from 3 educational groups of Mazandaran University of Medical Sciences. Maslach job burnout and King spiritual intelligence questionnaires were used for primary data collection and correlation analysis was done by calculating Pearson's coefficient (r) and statistical description and analysis was done using IBM SPSS version 25 software. Findings: The average burden of job burnout was 84.44 and the average burden of spiritual intelligence was 47.69. The production of personal meaning had a direct and significant correlation with job burnout, which was also observed in infectious residents. In emergency medicine residents; Job burnout has had a direct and significant correlation with spiritual intelligence and the subscales of critical existential thinking and the production of personal meaning and transcendental consciousness. Conclusion: According to the findings of the research, there is a need for more studies to examine the correlation between spiritual intelligence and burnout. [ABSTRACT FROM AUTHOR]

Unhealthy behaviors (UBs) can affect mental health. The most impactful of these are alcohol abuse, sedentary behavior, and sleep disturbances. Since these UBs are not well explored in medical residents, this study aims to overcome this gap, focusing on outcomes such as depression and anxiety. The Public Health Residents’ Anonymous Survey in Italy (PHRASI) is a nationwide cross-sectional study based on an 88-item questionnaire. UBs were explored through validated questionnaires: the Alcohol Use Disorders Identification Test-c (AUDIT-C), the International Physical Activity Questionnaire (IPAQ), and the Insomnia Severity Index (ISI). Depressive symptoms and anxiety were detected by Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Hierarchical cluster analysis described clusters using responses from the AUDIT-C, IPAQ, and ISI. A total of 375 participants were included in this study. Three distinct clusters (CL) were identified: CL1 was characterized by a moderate risk for alcohol abuse and high insomnia dissatisfaction, with a significantly higher frequency of depressive symptoms (46%, p < 0.001) and anxiety (53%, p < 0.001); CL2 had no risk for alcohol abuse, high sleep satisfaction, and better mental health profile, with the lowest prevalence of depressive symptoms (15%, p < 0.001); CL3 had the highest risk of alcohol abuse, the highest rate of physical activity (40%, p = 0.013), and the lowest prevalence of anxiety (27%, p < 0.001). Subjects belonging to CL1 required much more attention to prevent the worsening of mental outcomes. Interventions for promoting mental health should be addressed in all Public Health schools to create more sustainable working conditions.

Background: Burnout in medical profession can reduce the work output and affect the clinical decision making. Objectives: To estimate the proportion of medical residents experiencing burnout. Methodology: In this cross-sectional study, 172 medical residents working in the hospitals affiliated with Kasturba Medical College, Mangalore were assessed for presence of burnout. Permission was obtained from the Institutional Ethics Committee before the commencement of the study. Copenhagen Burnout Inventory scale was used to determine the presence of burnout syndrome among the participants. Results: The mean age of the participants was 27.6 years and a high proportion (n=93, 53.8%) of the participants were males. Forty-eight percent (n=83) of the participants in our study had burnout. A high proportion (n=35, 42.2%) of the participants with burnout were from first year of residency. Burnout was observed in the majority of unmarried males. Burnout was also seen to be highest in younger residents, and those who lacked adequate sleep. Conclusion: The proportion of occupational burnout among medical residents in our study was found to be very high. Early identification of the presence of burnout in the healthcare profession and initiating steps to reduce it can help them to provide uncompromised quality care to the patients.

The COVID-19 vaccination campaign in Italy started in December 2020, and, due to the Omicron variant’s emergence, a second booster dose was recommended for high-risk individuals and healthcare workers from July 2022. The aim of the study was to evaluate the vaccination coverages for the COVID-19 second booster dose and to identify predictors of its acceptance within the population of medical residents (MRs) of the Fondazione Policlinico Universitario “A. Gemelli” IRCCS (FPG) University Hospital. The study was conducted at FPG from October 4th to December 21st, 2022, and COVID-19 second booster dose and influenza vaccines were administered. The study analyzed collected data and conducted multivariate logistic regressions to explore potential predictors of vaccination adherence. The analyses performed were compared with the sample enrolled in FPG residency programs at the start of the COVID-19 vaccination campaign. 1968 MRs were involved in the 2022–2023 vaccination campaign (mean age 28.97, SD 3.44), and the second booster dose of COVID-19 vaccination coverage was low (18.80%). Almost all participants opted for co-administration of COVID-19 and influenza vaccinations, leading to a similar rate of influenza vaccination coverage (16.26%). Being a frontline resident, meaning a direct involvement in managing COVID-19 patients and vaccination campaigns, was the main predictor of vaccination adherence (OR 1.72, 95% CI 1.25–2.17). The dropping in influenza vaccination coverage in 2022–2023 and the low adherence to COVID-19 second booster dose among young physicians is concerning, calling for tailored vaccination campaigns and interventions.

Accurate prediction of SARS-CoV-2 infection based on symptoms can be a cost-efficient tool for remote screening in healthcare settings with limited SARS-CoV-2 testing capacity. We used a machine learning approach to determine self-reported symptoms that best predict a positive SARS-CoV-2 test result in physician trainees from a large healthcare system in New York. We used survey data on symptoms history and SARS-CoV-2 testing results collected retrospectively from 328 physician trainees in the Mount Sinai Health System, over the period 1 February 2020 to 31 July 2020. Prospective data on symptoms reported prior to SARS-CoV-2 test results were available from the employee health service COVID-19 registry for 186 trainees and analyzed to confirm absence of recall bias. We estimated the associations between symptoms and IgG antibody and/or reverse transcriptase polymerase chain reaction test results using Bayesian generalized linear mixed effect regression models adjusted for confounders. We identified symptoms predicting a positive SARS-CoV-2 test result using extreme gradient boosting (XGBoost). Cough, chills, fever, fatigue, myalgia, headache, shortness of breath, diarrhea, nausea/vomiting, loss of smell, loss of taste, malaise and runny nose were associated with a positive SARS-CoV-2 test result. Loss of taste, myalgia, loss of smell, cough and fever were identified as key predictors for a positive SARS-CoV-2 test result in the XGBoost model. Inclusion of sociodemographic and occupational risk factors in the model improved prediction only slightly (from AUC = 0.822 to AUC = 0.838). Loss of taste, myalgia, loss of smell, cough and fever are key predictors for symptom-based screening of SARS-CoV-2 infection in healthcare settings with remote screening and/or limited testing capacity. [ABSTRACT FROM AUTHOR]

Abstract Introduction The optimal treatment plan for patients with cancer is discussed in multidisciplinary team meetings (MDTMs). Effective meetings require all participants to have collaboration and communication competences. Participating residents (defined as qualified doctors in training to become a specialist) are expected to develop these competences by observing their supervisors. However, the current generation of medical specialists is not trained to work in multidisciplinary teams; currently, training mainly focuses on medical competences. This study aims to identify barriers and facilitators among residents with respect to learning how to participate competently in MDTMs, and to identify additional training needs regarding their future role in MDTMs, as perceived by residents and specialists. Methods Semi-structured interviews were conducted with Dutch residents and medical specialists participating in oncological MDTMs. Purposive sampling was used to maximise variation in participants’ demographic and professional characteristics (e.g. sex, specialty, training duration, type and location of affiliated hospital). Interview data were systematically analysed according to the principles of thematic content analysis. Results Nineteen residents and 16 specialists were interviewed. Three themes emerged: 1) awareness of the educational function of MDTMs among specialists and residents; 2) characteristics of MDTMs (e.g. time constraints, MDTM regulations) and 3) team dynamics and behaviour. Learning to participate in MDTMs is facilitated by: specialists and residents acknowledging the educational function of MDTMs beyond their medical content, and supervisors fulfilling their teaching role and setting conditions that enable residents to take a participative role (e.g. being well prepared, sitting in the inner circle, having assigned responsibilities). Barriers to residents’ MDTM participation were insufficient guidance by their supervisors, time constraints, regulations hindering their active participation, a hierarchical structure of relations, unfamiliarity with the team and personal characteristics of residents (e.g. lack of confidence and shyness). Interviewees indicated a need for additional training (e.g. simulations) for residents, especially to enhance behavioural and communication skills. Conclusion Current practice with regard to preparing residents for their future role in MDTMs is hampered by a variety of factors. Most importantly, more awareness of the educational purposes of MDTMs among both residents and medical specialists would allow residents to participate in and learn from oncological MDTMs. Future studies should focus on collaboration competences.

Abstract Background This study was carried out to identify and explore the difference in coping strategies for dealing with stress; adopted by medical residents in surgical and nonsurgical specialties. Methods A mixed methods approach, was chosen for this study. In phase one (quantitative); data were collected by a web-based survey, using a structured questionnaire. This survey was carried out in five major teaching hospitals of Rawalpindi & Muzaffarabad in 2020. Purposive sampling was done and data were analysed using SPSS, recording frequencies and major trends. In phase two (qualitative); six focus group discussions were carried out with 24 participants, using semi-structured questions and prompts. Convenient sampling was done from the cohort of phase 1. These focus group discussions, explored the various coping strategies adopted by medical residents. Later, the data were analysed manually for development of codes, sub-themes and themes. Results Out of 250 (100%) participants, 146 (58%) participants responded to the online survey. Surgical residents had a higher response rate (60%, n = 87) than nonsurgical residents. Moreover, female participation (54%, n = 79) was greater than male participation (46%, n = 67). The Mann-Whitney U test was statistically significant only for seeking medical advice to cope with stress (P = .029). There was no statistically significant difference found between the coping strategies, employed by medical residents. In focus group discussions, female involvement was more (58% n = 14) than their counterparts. Four main themes were developed after data analysis: self-regulation, tailor-made strategies, educational focus and support system. Finally, minor differences were obtained qualitatively; like, socializing is preferred by surgical residents whereas, spiritualism is chosen by nonsurgical residents. Conclusion Quantitatively, no significant differences were found between the coping strategies of medical residents, against work-related stress. However, minor differences were obtained qualitatively due to difference in job demands and level of burnout between these two specialities.

Abstract Background Sleep disturbances among medical staff are common serious entities with devastating consequences. Numerous studies have analyzed the effects of residency on the quality of sleep of the medical trainees in various specialties, but only few studies were conducted in Egypt. Results One hundred fifty medical residents from various medical and surgical specialties who work in the hospitals of Ain Shams University, Egypt, agreed to participate in our study. Sociodemographic and work-related data were collected by a semi-structured sheet. Sleep quality was assessed by self-administered questionnaire—Pittsburgh Sleep Quality Index (PSQI). According to the PSQI, 96.7% of the residents had poor sleep quality with mean PSQI score of 10.4 ± 2.5. No statistically significant difference was detected among the different specialties. Poorer sleep quality was more frequent among senior residents who spent longer duration in residency. The number of hours of sleep before residency and the number of days off during residency were the main predictors of total PSQI score and determinants of sleep quality Conclusions Poor sleep quality is highly prevalent among medical residents and is associated with work-related factors. It is necessary to consider residents’ sleep estate and conduct more analyses to diagnose, treat, and improve their sleep quality.

Background: Methylphenidate (MPH) and other stimulants may be misused, mainly as cognitive enhancers and recreational drugs. Data regarding misuse among medical residents are scarce. This study aimed to evaluate the prevalence of and main reasons for methylphenidate (MPH) use and misuse among Israeli medical residents. Methods: In this cross-sectional study, we sent an online questionnaire to medical residents who had completed their first residency exam and specialists with up to 2 years of experience. We asked about the use of MPH before and during residency and attitudes toward the use of MPH as a cognitive enhancer. We also added the Adult ADHD Self-Report Scale (ASRS) questionnaire, a validated tool used to screen for the presence of attention deficit hyperactivity disorder (ADHD). Users and misusers were classified based on self-report of use and formal ADHD diagnosis. Logistic regression analysis was used to evaluate factors associated with MPH misuse. Results: From March 2021 to August 2021, 370 physicians responded to our questionnaire (response rate 26.4%). Twenty-eight met the exclusion criteria and were not included. The respondents' average age was 36.5 years. Women comprised 63.5% of the respondents. Of the participants, 16.4% were classified as users and 35.1% as misusers. The prevalence of misusers was 45.6% among surgery and OB/GYN physicians, 39.4% among pediatricians and internists, and 24% among family physicians (P < 0.001). Misusers had a more liberal approach than others to MPH use as a cognitive enhancer. Factors associated with misuse of MPH included not being a native-born Israeli (OR-1.99, 95% CI 1.08, 3.67) and type of residency (OR-2.33, 95% CI 1.22, 4.44 and OR-4.08, 95% CI 2.06, 8.07 for pediatrics and internal medicine and surgery, respectively). Conclusion: Very high levels of MPH misuse during residency may be related to stress, long working hours, night shifts, and the academic burden of the residency period. We believe that our findings should be considered by healthcare policymakers as they make decisions regarding the conditions of medical residencies. The use of MPH as a cognitive enhancer should be further studied and discussed. [ABSTRACT FROM AUTHOR]

Shift work disorder (SWD) may affect medical residents because their workload, academic demands and extended work hours. This condition set residents at risk of more sleep disorders. The study compared parasomnias among residents with and without shift work disorder (SWD) and weighed their relative risk (RR) for each parasomnia. One hundred twenty-six residents participated in the study. The Munich Parasomnia Screening questionnaire and the Barger Questionnaire for SWD were used for the screening of parasomnias and SWD, respectively. Means and percentages of studied variables were compared between groups. Relative risk (RR) was calculated for each type of parasomnia. The more frequent parasomnias in residents with SWD the RR (and 95% confidence intervals) were: sleep terrors, 5.60 (1.84–17.01); confusional arousals, 3.73 (1.84–7.56); sleep paralysis, 3.27 (1.53–6.93); hypnagogic/hypnopompic hallucinations, 2.55 (1.03–6.28); somniloquies, 2.45 (1.21–4.92); and nightmares, 2.01 (1.54–2.62). Our data suggest that residents who experience SWD may be at risk of having lower threshold for the occurrence of rapid eye movement (REM) and non-REM (NREM) sleep parasomnias. Additional research is needed to confirm these results, and to further identify the contribution to this association. [ABSTRACT FROM AUTHOR]

Background: As telemedicine plays an increasing role in health care delivery, providers are expected to receive adequate training to effectively communicate with patients during telemedicine encounters. Teach-back is an approach that verifies patients' understanding of the health care information provided by health care professionals. Including patients in the design and development of teach-back training content for providers can result in more relevant training content. However, only a limited number of studies embrace patient engagement in this capacity, and none for remote care settings. Objective: We aimed to design and evaluate the feasibility of patient-centered, telehealth-focused teach-back training for family medicine residents to promote the use of teach-back during remote visits. Methods: We codeveloped the POTENTIAL (Platform to Enhance Teach-Back Methods in Virtual Care Visits) curriculum for medical residents to promote teach-back during remote visits. A patient participated in the development of the workshop's videos and in a patient-provider panel about teach-back. We conducted a pilot, 2-arm cluster, nonrandomized controlled trial. Family medicine residents at the intervention site (n=12) received didactic and simulation-based training in addition to weekly cues-to-action. Assessment included pre- and postsurveys, observations of residents, and interviews with patients and providers. To assess differences between pre- and postintervention scores among the intervention group, chi-square and 1-tailed t tests were used. A total of 4 difference-in-difference models were constructed to evaluate prepost differences between intervention and control groups for each of the following outcomes: familiarity with teach-back, importance of teach-back, confidence in teach-back ability, and ease of use of teach-back. Results: Medical residents highly rated their experience of the teach-back training sessions (mean 8.6/10). Most residents (9/12, 75%) used plain language during training simulations, and over half asked the role-playing patient to use their own words to explain what they were told during the encounter. Postintervention, there was an increase in residents' confidence in their ability to use teach-back (mean 7.33 vs 7.83; P =.04), but there was no statistically significant difference in familiarity with, perception of importance, or ease of use of teach-back. None of the difference-in-difference models were statistically significant. The main barrier to practicing teach-back was time constraints. Conclusions: This study highlights ways to effectively integrate best-practice training in telehealth teach-back skills into a medical residency program. At the same time, this pilot study points to important opportunities for improvement for similar interventions in future larger-scale implementation efforts, as well as ways to mitigate providers' concerns or barriers to incorporating teach-back in their practice. Teach-back can impact remote practice by increasing providers' ability to actively engage and empower patients by using the features (whiteboards, chat rooms, and mini-views) of their remote platform. [ABSTRACT FROM AUTHOR]

A nationwide survey in the USA reported that healthcare workers had the highest prevalence of short sleep duration compared with other professions. Moreover, several studies have reported poor sleep quality among healthcare professionals and described insufficient sleep as a potential driver of reduced physician well-being. This study aims to explore sleep quality and mental health issues among Syrian medical residents, with the goal of informing targeted interventions to enhance their well-being and professional performance. This cross-sectional study in Syria involved 2071 residents from 22 major hospitals. Conducted between 27 October 2023 and 4 April 2024, it used face-to-face interviews with validated questionnaires following STROBE guidelines. Hospitals were categorized for comparative analysis. Measures included demographics, Pittsburgh Sleep Quality Index, Patient Health Questionnaire for depression, and Generalized Anxiety Disorder 7-item. In a study involving 2071 hospital residents across Syria's major hospitals, significant findings reveal a high prevalence of poor sleep quality (67.7%), depressive symptoms (46%) and anxiety symptoms (42.2%). Analysis by hospital categories highlighted varied rates, with Damascus and Hama General Hospitals showing notably higher incidences. Females exhibited higher rates of depressive and anxiety symptoms compared with males, with predictors including gender, age and marital status. The relatively high prevalence of poor sleep quality, depressive symptoms and anxiety symptoms among Syrian medical residents necessitates proper action, which will probably include limits on work hours, to enhance mental health outcomes and ensure proper patient care., (© 2025 European Sleep Research Society.)

Abstract Background Although shared decision making is championed as the preferred model for patient care by patient organizations, researchers and medical professionals, its application in daily practice remains limited. We previously showed that residents more often prefer paternalistic decision making than their supervisors. Because both the views of residents on the decision-making process in medical consultations and the reasons for their ‘paternalism preference’ are unknown, this study explored residents’ views on the decision-making process in medical encounters and the factors affecting it. Methods We interviewed 12 residents from various specialties at a large Dutch teaching hospital in 2019–2020, exploring how they involved patients in decisions. All participating residents provided written informed consent. Data analysis occurred concurrently with data collection in an iterative process informing adaptations to the interview topic guide when deemed necessary. Constant comparative analysis was used to develop themes. We ceased data collection when information sufficiency was achieved. Results Participants described how active engagement of patients in discussing options and decision making was influenced by contextual factors (patient characteristics, logistical factors such as available time, and supervisors’ recommendations) and by limitations in their medical and shared decision-making knowledge. The residents’ decision-making behavior appeared strongly affected by their conviction that they are responsible for arriving at the correct diagnosis and providing the best evidence-based treatment. They described shared decision making as the process of patients consenting with physician-recommended treatment or patients choosing their preferred option when no best evidence-based option was available. Conclusions Residents’ decision making appears to be affected by contextual factors, their medical knowledge, their knowledge about SDM, and by their beliefs and convictions about their professional responsibilities as a doctor, ensuring that patients receive the best possible evidence-based treatment. They confuse SDM with acquiring informed consent with the physician’s treatment recommendations and with letting patients decide which treatment they prefer in case no evidence based guideline recommendation is available. Teaching SDM to residents should not only include skills training, but also target residents’ perceptions and convictions regarding their role in the decision-making process in consultations.

Abstract Background Palliative medicine is a newly developing field in the United Arab Emirates (UAE). The purpose of this study was to gain a deeper understanding of the experiences of internal medicine residents providing end-of-life care to patients and their families, and how those experiences shape their learning needs. Method Nine focus groups were conducted with internal medicine residents and recent graduates from two large academic health centers in the UAE between 2019 and 2020. Through an iterative process, data were collected and examined using constant comparison to identify themes and explore their relationships. Results Fifty-two residents and graduates participated. Residents frequently care for terminally ill patients and their families, but lack confidence in their skills and request more structured education and training. Cultural and system related factors also impact palliative care education and patient care. Five main themes and associated subthemes were identified: (1) clinical management of palliative patients, (2) patient and family communication skills, (3) religion, (4) barriers to end-of-life education, and (5) emotional impact of managing dying patients. Conclusion Our findings can help guide program development and curricular changes for internal medicine residents in the region. Structured education in end-of-life care, with a focus on fostering culturally sensitive communication skills and spirituality, can improve resident education and patient care. Clear and transparent policies at the institution level are necessary. Programs are also needed to assist residents in developing effective coping strategies and emotionally navigating experiences with patient death.

Background: During the Novel Coronavirus disease (COVID-19) pandemic, medical residents were deployed to help with managing patients in a wide range of settings. Unlike other COVID-19-related topics, the psychological impact of the pandemic on medical residents has received little attention. Objective: This study aims to assess the impact of the COVID-19 pandemic on medical residents' well-being, depression, and stress levels. Methods: A cross-sectional study was conducted in the Emirate of Abu Dhabi. A total of 597 medical residents were identified and with the aim of a sample size of 300 participants; 242 responses were collected during the period between November 2020 to February 2021. Data were collected through an online survey utilizing Patient Health Questionnaire and Perceived Stress Scale. SPSS software was used for data analysis. Results: Most of the residents in our study were females (73.6%) and single (60.7%). Around 66.5% were depressed, 87.2% were under low-moderate stress, and 12.8% were under high stress. Majority (73.5%) of the single residents were depressed (P = 0.016). Being male has been found to lower the risk of developing depression (P = 0.042). The need to relocate for family protection increased the risk of developing depression (P = 0.022).Residents who were living with their friends/roommates were found to be under a high level of stress (P = 0.001). Surgical specialties' residents were found to be the most under high stress (P = 0.044). Conclusion: Female gender, single status, and changing housing were risk factors for depression. Conversely, living with friends/roommates and working in surgical specialties were contributing to high-stress levels.

ObjectivesThere is little evidence on the impact of the COVID-19 pandemic on Public Health Residents' (PHR) mental health (MH). This study aims at assessing prevalence and risk factors for depression, anxiety and stress in European PHR during the COVID-19 pandemic.MethodsBetween March and April 2021, an online survey was administered to PHR from France, Italy, Portugal and Spain. The survey assessed COVID-19 related changes in working conditions, training opportunities and evaluated MH outcomes using the Depression Anxiety Stress Scales-21. Multivariable logistic regressions were applied to identify risk factors.ResultsAmong the 443 respondents, many showed symptoms of depression (60.5%), anxiety (43.1%) and stress (61.2%). The main outcome predictors were: female gender for depression (adjOR = 1.59, 95%CI [1.05–2.42]), anxiety (adjOR = 2.03, 95%CI [1.33–3.08]), and stress (adjOR = 2.35, 95%CI [1.53–3.61]); loss of research opportunities for anxiety (adjOR = 1.94, 95%CI [1.28–2.93]) and stress (adjOR = 1.98, 95%CI [1.26–3.11]); and COVID-19 impact on training (adjOR = 1.78, 95%CI [1.12–2.80]) for depression.ConclusionsThe pandemic had a significant impact on PHR in terms of depression, anxiety and stress, especially for women and who lost work-related opportunities. Training programs should offer PHR appropriate MH support and training opportunities.

Introduction: Distance learning (DL) is a promising educational approach for teaching medical courses. Our Pathology College was faced with the difficulty of a complete online transition of the classes because of the public health measures implemented during the COVID-19 pandemic. The objective is to evaluate this teaching method of the Pathology College with reference to the learner's point of view. Methods: After attending DL sessions in the Pathology College, pathology residents completed the questionnaire using Google Forms. Twenty-six out of 33 initially enrolled in the pathology course returned fully filled out, valid questionnaires. Results: Twenty-four residents (92.3%) had already an E-learning experience. Almost 70% of participants were satisfied with their DL experience. Thirty percent of the participants thought that DL should replace face-to-face courses. Technical difficulties were encountered in 42% of cases with the most common one related to internet connection (66.7%). Interaction with teachers during DL courses was considered more difficult than face-to-face courses by 61.5% of participants. Participants found that learning via the virtual slide websites was better than learning in the histology workshop in 53.8% of cases. The main weaknesses of DL were the dependence on technical means (42.3%), the lack of interactivity with colleagues (26.9%) and teachers (26.9%). Conclusion: Pathology lessons were successfully taught via DL, which was highly embraced by the students. Our findings shed light on a variety of areas of the students' DL experiences, and we strongly urge the faculty to take the students' opinions into account when formulating guidelines for higher-quality medical education. Resumen: Introducción: el aprendizaje a distancia (AD) es un enfoque educativo prometedor para la enseñanza de cursos de Medicina. Nuestra Facultad de Patología se enfrentó a la dificultad de una transición completa de las clases en línea debido a las medidas de salud pública aplicadas durante la pandemia de COVID-19. El objetivo es evaluar este método de enseñanza de la Facultad de Patología con referencia al punto de vista del alumno. Métodos: después de asistir a las sesiones del AD en el Colegio de Patología, los residentes de patología completaron el cuestionario utilizando Google Forms. Veintiséis de los 33 matriculados inicialmente en el curso de patología devolvieron los cuestionarios válidos y totalmente cumplimentados. Resultados: Veinticuatro residentes (92,3%) ya habían tenido una experiencia de E-learning. Casi el 70% de los participantes estaban satisfechos con su experiencia de AD. El 30% de los participantes pensaba que el AD debería sustituir a los cursos presenciales. Se encontraron dificultades técnicas en el 42% de los casos, siendo la más común la relacionada con la conexión a Internet (66,7%). La interacción con los profesores durante los cursos del AD fue considerada más difícil que los cursos presenciales por el 61,5% de los participantes. Los participantes consideraron que el aprendizaje a través de los sitios web de diapositivas virtuales era mejor que el aprendizaje en el taller de histología en el 53,8% de los casos. Los principales puntos débiles del AD fueron la dependencia de los medios técnicos (42,3%), la falta de interactividad con los colegas (26,9%) y los profesores (26,9%). Conclusión: las clases de patología se impartieron con éxito a través del AD, que fue muy aceptado por los estudiantes. Nuestros hallazgos arrojan luz sobre una variedad de áreas de las experiencias del AD de los estudiantes, e instamos encarecidamente al profesorado a tener en cuenta las opiniones de los estudiantes a la hora de formular directrices para una educación médica de mayor calidad.

The study aimed to quantify and compare rate of parental postpartum depression (PPD) among medical residents to that of the general population and identify potential areas of further support for resident parents. Our team, University of Nebraska Medical Center (UNMC) OB/GYN and Creighton Psychiatry departments, developed and disseminated 22 item anonymous survey distributed via email link to targeted specialties as well as the "Physician Mom's Group" on Facebook. The survey included both quantitative and qualitative measures on medical resident and resident partner mental health, demographics, specialty, year in residency, support from residency program, parental leave, and an open comment section. Seventy-two resident parents, 64% of whom were female, completed the survey. 42% of female respondents reported feeling they suffered from PPD symptoms, representing more than four times the rate of PPD within the general population (11%). Only 12% of these women reported having sought treatment or were diagnosed with PPD. Male residents did not report an increased rate of depressive symptoms; however, 19% of respondents believed their partner's symptoms were consistent with PPD. Responses from the survey and open-ended questions emphasized need for emotional support, transparency in programmatic leave policy, breastfeeding accommodations, and additional parental leave time. This is the first study of its kind to examine PPD among both male and female medical resident parents. Limitations of the study included small sample size, which impacted statistical significance. The data and commentary are nonetheless useful in highlighting risk of PPD amongst medical residents and indicate further study is warranted. [ABSTRACT FROM AUTHOR]

Dyspnea is a frightening and debilitating experience. It attracts less attention than pain ('dyspnea invisibility'), possibly because of its non-universal nature. We tested the impact of self-induced experimental dyspnea on medical residents. During a teaching session following the principles of experiential learning, emergency medicine residents were taught about dyspnea theoretically, observed experimental dyspnea in their teacher, and personally experienced self-induced dyspnea. The corresponding psychophysiological reactions were described. Immediate and 1-year evaluations were conducted to assess course satisfaction (overall 0–20 grade) and the effect on the understanding of what dyspnea represents for patients. Overall, 55 emergency medicine residents participated in the study (26 men, median age 26 years). They were moderately satisfied with previous dyspnea teaching (6 [5–7] on a 0–10 numerical rating scale [NRS]) and expressed a desire for an improvement in the teaching (8 [7–9]). Immediately after the course they reported improved understanding of patients' experience (7 [6–8]), which persisted at 1 year (8 [7–9], 28 respondents). Overall course grade was 17/20 [15–18], and there were significant correlations with experimental dyspnea ratings (intensity: r = 0.318 [0.001–0.576], p = 0.043; unpleasantness: r = 0.492 [0.208–0.699], p = 0.001). In multivariate analysis, the only factor independently associated with the overall course grade was 'experiential understanding' (the experimental dyspnea-related improvement in the understanding of dyspneic patients' experience). A separate similar experiment conducted in 50 respiratory medicine residents yielded identical results. This study suggests that, in advanced medical residents, the personal discovery of dyspnea can have a positive impact on the understanding of what dyspnea represents for patients. This could help fight dyspnea invisibility. [ABSTRACT FROM AUTHOR]

Background: The important central theme in the career is one’s professional self-concept based on attributes, beliefs, values, motives, and experiences regarding the professional identity. Recently, there has been a growing interest in how a physician’s professional identity is shaped by education and experience. Objectives: This study aimed to illuminate the role of experience in shaping the professional identity of Tehran University of Medical Sciences medical residents. Methods: Eighteen 26 - 40 years old residents (male and female) in four Major specialty groups, including obstetrics and gynecology, surgery, and internal medicine, participated in this qualitative content analysis study. Sampling was done in four specialty hospitals of Tehran University of Medical Sciences. Data were gathered through semi-structured in-depth interviews and analyzed by conventional content analysis. Results: Results showed four main categories of effective experiences in Shaping of residents’ professional identity formation, including interpersonal communication experiences, independent professional work, general medical education course, knowledge, and educational background.in this study also, sub-categories extracted from the findings were: (1) forced scheme; (2) symbolic events; (3) learnt competencies of GP; (4) beneficial reforms and integration in general medical education; (5) the education quality level among families; and (6) the education quality level among schools and institutes. Conclusions: This study demonstrated that the previous unique constructive experiences of assistants are one of the most important underlying factors in shaping their professional identity. Interpersonal communication experiences, independent professional work, general medicine training courses, and knowledge and educational background are the unique experiences of any assistant. By creating constructive experiences, it is possible to positively affect the formation of the professional identity of the assistants so that they can be accountable to society. [ABSTRACT FROM AUTHOR]

Background: During the Novel Coronavirus disease (COVID-19) pandemic, medical residents were deployed to help with managing patients in a wide range of settings. Unlike other COVID-19-related topics, the psychological impact of the pandemic on medical residents has received little attention. Objective: This study aims to assess the impact of the COVID-19 pandemic on medical residents' well-being, depression, and stress levels. Methods: A cross-sectional study was conducted in the Emirate of Abu Dhabi. A total of 597 medical residents were identified and with the aim of a sample size of 300 participants; 242 responses were collected during the period between November 2020 to February 2021. Data were collected through an online survey utilizing Patient Health Questionnaire and Perceived Stress Scale. SPSS software was used for data analysis. Results: Most of the residents in our study were females (73.6%) and single (60.7%). Around 66.5% were depressed, 87.2% were under low-moderate stress, and 12.8% were under high stress. Majority (73.5%) of the single residents were depressed (P = 0.016). Being male has been found to lower the risk of developing depression (P = 0.042). The need to relocate for family protection increased the risk of developing depression (P = 0.022).Residents who were living with their friends/roommates were found to be under a high level of stress (P = 0.001). Surgical specialties' residents were found to be the most under high stress (P = 0.044). Conclusion: Female gender, single status, and changing housing were risk factors for depression. Conversely, living with friends/roommates and working in surgical specialties were contributing to high-stress levels. [ABSTRACT FROM AUTHOR]

Background: Although shared decision making is championed as the preferred model for patient care by patient organizations, researchers and medical professionals, its application in daily practice remains limited. We previously showed that residents more often prefer paternalistic decision making than their supervisors. Because both the views of residents on the decision-making process in medical consultations and the reasons for their 'paternalism preference' are unknown, this study explored residents' views on the decision-making process in medical encounters and the factors affecting it. Methods: We interviewed 12 residents from various specialties at a large Dutch teaching hospital in 2019–2020, exploring how they involved patients in decisions. All participating residents provided written informed consent. Data analysis occurred concurrently with data collection in an iterative process informing adaptations to the interview topic guide when deemed necessary. Constant comparative analysis was used to develop themes. We ceased data collection when information sufficiency was achieved. Results: Participants described how active engagement of patients in discussing options and decision making was influenced by contextual factors (patient characteristics, logistical factors such as available time, and supervisors' recommendations) and by limitations in their medical and shared decision-making knowledge. The residents' decision-making behavior appeared strongly affected by their conviction that they are responsible for arriving at the correct diagnosis and providing the best evidence-based treatment. They described shared decision making as the process of patients consenting with physician-recommended treatment or patients choosing their preferred option when no best evidence-based option was available. Conclusions: Residents' decision making appears to be affected by contextual factors, their medical knowledge, their knowledge about SDM, and by their beliefs and convictions about their professional responsibilities as a doctor, ensuring that patients receive the best possible evidence-based treatment. They confuse SDM with acquiring informed consent with the physician's treatment recommendations and with letting patients decide which treatment they prefer in case no evidence based guideline recommendation is available. Teaching SDM to residents should not only include skills training, but also target residents' perceptions and convictions regarding their role in the decision-making process in consultations. [ABSTRACT FROM AUTHOR]

Background: Dealing with death and dying is one of the most common sources of work-related stress for medical trainees. Research suggests that the degree of psychological distress that students and residents feel around providing care for terminally ill patients generally decreases as training progresses. However, there is a dearth of literature that directly addresses how trainees learn to manage emotions and process grief when patients die.Objective: To gain insight into medical resident experiences in caring for the dying, including the role of training level and use of support networks and coping strategies to manage personal reactions to patient death.Design: A thematic analysis of focus group interviews was conducted, and patterns that reflected resident coping and managing experiences with patient death were identified.Participants: Internal medicine residents from all year levels and recent graduates from two large academic medical centers in the United Arab Emirates.Approach: Qualitative study using a phenomenologic approach.Results: Residents undergo transformational learning and growth in their experiences with death and dying. Five major themes emerged: emotions, support, education and experience, coping strategies, and finding meaning. As residents progress through their training, they seek and receive support from others, improve their end-of-life patient care and communication skills, and develop effective coping strategies. This transformational growth can enable them to find meaning and purpose in providing effective care to dying patients and their families. Positive role modeling, faith and spirituality, and certain innate personality traits can further facilitate this process.Conclusion: Understanding the complex emotions inherent in caring for dying patients from the perspective of medical residents is a critical step in creating evidence-based educational innovations and policies that support trainees. Residency programs should work to foster reflective practice and self-care in their trainees and teaching faculty. [ABSTRACT FROM AUTHOR]

Background: Respect for patient autonomy has become the guiding biomedical ethical tenet in the West; yet, moral values are contextual and culturally relevant. In the collectivist society of the Middle East, families and physicians have historically believed that concealing truth about a terminal illness is more ethical and compassionate. Recent studies reveal a trend toward truth disclosure. Objective: To gain insight into resident experiences with, and barriers to, truth disclosure in terminally ill patients in the United Arab Emirates (UAE). Methods: Focus group interviews were conducted with first through fourth year internal medicine residents and recent graduates at two large academic medical centers in the UAE. Qualitative thematic content analysis was used to identify themes related to communication and truth telling in end-of-life care. Results: Residents revealed that non-disclosure of medical information in serious illness is a common practice in UAE hospitals. Barriers to truth telling include family objection, deficits in medical training, and inconsistently implemented institutional guidelines. Conclusion: Educational and policy interventions are needed to improve physician-patient communication, decrease patient-family-physician tension, and alleviate trainee moral distress. [ABSTRACT FROM AUTHOR]

BackgroundNurses, social workers, and medical residents are ethically mandated to engage in policy advocacy to promote the health and well-being of patients and increase access to care. Yet, no instrument exists to measure their level of engagement in policy advocacy.Research objectiveTo describe the development and validation of the Policy Advocacy Engagement Scale, designed to measure frontline healthcare professionals' engagement in policy advocacy with respect to a broad range of issues, including patients' ethical rights, quality of care, culturally competent care, preventive care, affordability/accessibility of care, mental healthcare, and community-based care.Research designCross-sectional data were gathered to estimate the content and construct validity, internal consistency, and test-retest reliability of the Policy Advocacy Engagement Scale. Participants and context: In all, 97 nurses, 94 social workers, and 104 medical residents (N = 295) were recruited from eight acute-care hospitals in Los Angeles County. Ethical considerations: Informed consent was obtained via Qualtrics and covered purposes, risks and benefits; voluntary participation; confidentiality; and compensation. Institutional Review Board approval was obtained from the University of Southern California and all hospitals.FindingsResults supported the validity of the concept and the instrument. In confirmatory factor analysis, seven items loaded onto one component with indices indicating adequate model fit. A Pearson correlation coefficient of .36 supported the scale's test-retest stability. Cronbach's α of .93 indicated strong internal consistency.DiscussionThe Policy Advocacy Engagement Scale demonstrated satisfactory psychometric properties in this initial test. Findings should be considered within the context of the study's limitations, which include a low response rate and limited geographic scope.ConclusionThe Policy Advocacy Engagement Scale appears to be the first validated scale to measure frontline healthcare professionals' engagement in policy advocacy. With it, researchers can analyze variations in professionals' levels of policy advocacy engagement, understand what factors are associated with it, and remedy barriers that might exist to their provision of it.

Abstract Background Little data exists regarding depression and its associated factors in medical residents and doctors in Sub-Saharan Africa. Residents are at high risk of developing depression owing to the stressful nature of their medical practice and academic training. Depression in medical residents leads to decreased clinical efficiency, and poor academic performance; it can also lead to substance abuse and suicide. Our primary aim was to measure depression prevalence among medical residents in Kenya’s largest national teaching and referral hospital. Secondary aims were to describe how depression was associated with perceived stress, perceived social support, substance use, and educational environment. Methods We sampled 338 residents belonging to 8 different specialties using self administered questionnaires in this cross-sectional survey between October 2019 and February 2020. Questionnaires included: sociodemographics, the Centres for Epidemiology Depression Scale - Revised, Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, Alcohol, Smoking and Substance Involvement Screening Test, and Postgraduate Hospital Educational Environment Measure. Bivariate and multivariate linear regression were used to assess for risk factors for depression. Results Mean participant age was 31.8 years and 53.4% were males. Most residents (70.4%) reported no to mild depressive symptoms, 12.7% had moderate, and 16.9% had severe depressive symptoms. Most residents had high social support (71.8%) and moderate stress (61.6%). The educational environment was rated as more positive than negative by 46.3% of residents. Bivariate analyses revealed significant correlations between depressive symptoms, perceived stress, substance use, perceived social support, and educational environment. Multivariate analysis showed that depression was strongly associated with: fewer hours of sleep (β = − 0.683, p = 0.002), high perceived stress (β = 0.709, p

Background and Objective: Job burnout is one of the challenges of the health system and medical residents are among the most important pillars of service delivery, especially in epidemic conditions, and spiritual intelligence can be proposed as a way to relieve job burnout. The purpose of this study is to investigate the correlation between spiritual intelligence and job burnout in clinical teaching residents of Mazandaran University of Medical Sciences during the COVID-19 pandemic. Methods: This study is a questionnaire-based survey (cross-sectional study) that was conducted in 1400 with the participation of 36 residents from 3 educational groups of Mazandaran University of Medical Sciences. Maslach job burnout and King spiritual intelligence questionnaires were used for primary data collection and correlation analysis was done by calculating Pearson's coefficient (r) and statistical description and analysis was done using IBM SPSS version 25 software. Findings: The average burden of job burnout was 84.44 and the average burden of spiritual intelligence was 47.69. The production of personal meaning had a direct and significant correlation with job burnout, which was also observed in infectious residents. In emergency medicine residents; Job burnout has had a direct and significant correlation with spiritual intelligence and the subscales of critical existential thinking and the production of personal meaning and transcendental consciousness. Conclusion: According to the findings of the research, there is a need for more studies to examine the correlation between spiritual intelligence and burnout.

OBJECTIVE: To identify the burnout syndrome in medical residents of a second level care hospital in Mexico City. MATERIALS AND METHODS: A descriptive, cross-sectional study, done in November 2020, including medical residents. Measurement instrument was Maslach-Burnout Inventory questionnaire. RESULTS: One hundred and one resident physicians were studied, average age: 29 years; 12.9% met criteria for burnout syndrome, the most affected specialty was family medicine (53.8%), followed by emergency medicine (38.5%). The most affected axis was that of professional burnout in second-year residents with 38.4%. CONCLUSIONS: Burnout syndrome is a health problem among residents that worsens as they advance in their hierarchical grade. Family medicine and emergency specialties are the most affected. Second year residents show the highest level of burnout. It is convenient to initiate preventive and educational measures that reduce this syndrome. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to determine sleep quality and related factors including restless leg syndrome in the 6th year medical students and medical residents in Pamukkale University, Faculty of Medicine, Denizli, Turkey. Methods: The data collection phase of this cross-sectional study was completed between November 1st and December 31st, 2019, with a questionnaire including 59 items. Three hundred forty-one medical students and residents participated in the study. The Pittsburgh Sleep Quality Index was used to determine the participants' sleep quality. The International Restless Legs Syndrome Study Group Diagnostic Criteria and the Restless Leg Syndrome Rating Scale were used for the diagnosis and for determining the seriousness of restless leg syndrome, respectively. Results: The mean age (SD ±) was 26.6 ± 3.2. Men (50%) and medical residents (59%) constituted the majority. Most of the participants (70%) had poor sleep quality, and 9% had restless leg syndrome. Despite losing their significance in multivariable analysis, a relationship existed between restless leg syndrome and sleep quality in bivariate comparisons (p = 0.04). According to the multiple variable analysis, age (p = 0.008), female gender (p = 0.04), insufficient income (p = 0.009), being on-medication (p = 0.007), being a current smoker (p = 0.01), not sleeping at the usual time (p = 0.04), and listening to music before sleeping (p = 0.03) were identified as independent risk factors for poor sleep quality. Conclusions: The prevalence of poor sleep quality and restless leg syndrome are high in the 6th year medical students and residents. Necessary measures should be taken to reduce the effect of negative conditions on these vulnerable groups. [ABSTRACT FROM AUTHOR]

Objectives. Human resource management is the most important function in the management of organizations and significantly affects the quality of work-life (QWL). Recently, the health sector started to be interested in the QWL among doctors. The study aim was to assess the QWL among Polish medical residents. Methods. The questionnaire for the medical residents was prepared using data acquired from a review of the international literature. In October 2017, the questionnaires were completed twice by 10 residents with a 2-week interval to assess the inter-rater reliability. The online questionnaire was distributed between April and May 2018. Results. A total of 243 doctors responded, over one-third of whom were men. The QWL was very high for 2.06% of the participants, high for 23.87%, moderate for 27.16%, low for 38.27% and very low for 8.64%. Among the factors that significantly relate to the QWL are the number of working hours per week (p = 0.007) and the general quality of life (p = 0.000). Conclusion. Low QWL is the result of inadequate management in Polish hospitals and residents' QWL still needs to be improved. We propose to conduct such a survey periodically among all young medical doctors to systematically improve their QWL. [ABSTRACT FROM AUTHOR]

Since 2006, the University of Tennessee's Preston Medical Library has collected survey feedback from exiting residents through targeted emails or at the required exit process in the library. Questions ask residents which types of articles or sources they use to find information and address the resident's use of the library's physical space. Survey results from 2006 to 2021 were examined for trends and changes in resident utilization of resources to better inform future library decisions on instruction and marketing. Resident resource usage varied over time and demonstrated an encouraging increase in attention to evidence-based tools. UpToDate's consistent popularity shows the durability of the product. A reported increase in use of reviews, randomized controlled trials, case reports, and practice guidelines reflects greater employment of more in-depth resources than merely expert opinion. At the same time, residents clearly valued the library's physical space. Survey results will inform future outreach focus. [ABSTRACT FROM AUTHOR]

Background: Identifying the magnitude and the determinants of stress-related disorders will help to improve the work environment besides minimizing its drawback on residents' medical care performance. Aim: This study aims to assess the prevalence of depression and anxiety and their associated factors among Ministry of Health (MOH) programs residents. Methodology: This cross-sectional survey targeted all MOH residents from different specialties in Abha city. The questionnaire included resident's sociodemographic information, specialty, duration, seniority, workload, shifts, and number of cared patients per shift. Resident's depression was assessed using Depression Patient Health Questionnaire-9 and anxiety was assessed using the anxiety Generalized Anxiety Disorder-7 Scale. The data were analyzed using SPSS version 21. Results: A total of 370 residents were included. Residents' age ranged from 20 to 35 years, with a mean age of 27.6 ± 6.7 years. Nearly 61.1% of residents were males and 58.6% were married. About 66.2% of the residents were normal (no depression), while 15.1% experienced minimal depression, 13% had mild depression, and 4.3% had severe depression. Considering anxiety, 85.9% of the residents showed no/minimal anxiety levels, while 7.8% had mild, 4.9% had moderate, and 1.4% showed severe anxiety levels. Conclusions: The study showed that psychological health, including depression and anxiety, was satisfactory among the study residents, where the majority of them were free of both issues. Further nationwide studies are required to assess additional factors such as work environment and autonomy. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND: New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE: To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING: Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS: All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS: The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS: The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.

Background: Evidence suggests empathy, an essential component of holistic patientcare, may be declining amongst medical students and residents. Yet there are only a few qualitative studies, mostly from West, exploring this phenomenon. Objective: This is a qualitative study of the learning environments of a tertiary care hospital of Pakistan, aimed to understand how junior doctors perceive and develop empathy and articulate the challenges faced by them. Methods: This case study adopted constructivist theoretical perspectives and was conducted from January 2019 to June 2019. Data was gathered from three focus group discussions and analyzed by thematic analysis. Patterns were identified and reported to generate codes, basic and organizing themes. Results: The participants were cognizant of empathy and its significance in patient management. Seniors as role models, first-hand knowledge of patients’ plights, active involvement in patient care and witnessing illnesses in dear ones were facets positively influencing empathy. Salient hindrances included enormous work load, gender bias, past negative experiences, language and literacy barriers. Some participants felt like devising their own strategies to cope with workload and providing empathetic care. There is pivotal role of workplace based learning; enabling junior doctors to handle multi-dimensional doctor-patient relationship. Conclusion: Clinical environments are significant for junior doctors’ grooming in attainment of empathetic patient care. Exhibiting empathy may be different in eastern and western diaspora. Faculty development could promote refined understanding of empathy and strategies to convey empathetic patientcare ensuring safe medical practice.

Introduction: The optimal treatment plan for patients with cancer is discussed in multidisciplinary team meetings (MDTMs). Effective meetings require all participants to have collaboration and communication competences. Participating residents (defined as qualified doctors in training to become a specialist) are expected to develop these competences by observing their supervisors. However, the current generation of medical specialists is not trained to work in multidisciplinary teams; currently, training mainly focuses on medical competences. This study aims to identify barriers and facilitators among residents with respect to learning how to participate competently in MDTMs, and to identify additional training needs regarding their future role in MDTMs, as perceived by residents and specialists. Methods: Semi-structured interviews were conducted with Dutch residents and medical specialists participating in oncological MDTMs. Purposive sampling was used to maximise variation in participants' demographic and professional characteristics (e.g. sex, specialty, training duration, type and location of affiliated hospital). Interview data were systematically analysed according to the principles of thematic content analysis. Results: Nineteen residents and 16 specialists were interviewed. Three themes emerged: 1) awareness of the educational function of MDTMs among specialists and residents; 2) characteristics of MDTMs (e.g. time constraints, MDTM regulations) and 3) team dynamics and behaviour. Learning to participate in MDTMs is facilitated by: specialists and residents acknowledging the educational function of MDTMs beyond their medical content, and supervisors fulfilling their teaching role and setting conditions that enable residents to take a participative role (e.g. being well prepared, sitting in the inner circle, having assigned responsibilities). Barriers to residents' MDTM participation were insufficient guidance by their supervisors, time constraints, regulations hindering their active participation, a hierarchical structure of relations, unfamiliarity with the team and personal characteristics of residents (e.g. lack of confidence and shyness). Interviewees indicated a need for additional training (e.g. simulations) for residents, especially to enhance behavioural and communication skills. Conclusion: Current practice with regard to preparing residents for their future role in MDTMs is hampered by a variety of factors. Most importantly, more awareness of the educational purposes of MDTMs among both residents and medical specialists would allow residents to participate in and learn from oncological MDTMs. Future studies should focus on collaboration competences. [ABSTRACT FROM AUTHOR]

Background: This study was carried out to identify and explore the difference in coping strategies for dealing with stress; adopted by medical residents in surgical and nonsurgical specialties. Methods: A mixed methods approach, was chosen for this study. In phase one (quantitative); data were collected by a web-based survey, using a structured questionnaire. This survey was carried out in five major teaching hospitals of Rawalpindi & Muzaffarabad in 2020. Purposive sampling was done and data were analysed using SPSS, recording frequencies and major trends. In phase two (qualitative); six focus group discussions were carried out with 24 participants, using semi-structured questions and prompts. Convenient sampling was done from the cohort of phase 1. These focus group discussions, explored the various coping strategies adopted by medical residents. Later, the data were analysed manually for development of codes, sub-themes and themes. Results: Out of 250 (100%) participants, 146 (58%) participants responded to the online survey. Surgical residents had a higher response rate (60%, n = 87) than nonsurgical residents. Moreover, female participation (54%, n = 79) was greater than male participation (46%, n = 67). The Mann-Whitney U test was statistically significant only for seeking medical advice to cope with stress (P =.029). There was no statistically significant difference found between the coping strategies, employed by medical residents. In focus group discussions, female involvement was more (58% n = 14) than their counterparts. Four main themes were developed after data analysis: self-regulation, tailor-made strategies, educational focus and support system. Finally, minor differences were obtained qualitatively; like, socializing is preferred by surgical residents whereas, spiritualism is chosen by nonsurgical residents. Conclusion: Quantitatively, no significant differences were found between the coping strategies of medical residents, against work-related stress. However, minor differences were obtained qualitatively due to difference in job demands and level of burnout between these two specialities. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbances among medical staff are common serious entities with devastating consequences. Numerous studies have analyzed the effects of residency on the quality of sleep of the medical trainees in various specialties, but only few studies were conducted in Egypt. Results: One hundred fifty medical residents from various medical and surgical specialties who work in the hospitals of Ain Shams University, Egypt, agreed to participate in our study. Sociodemographic and work-related data were collected by a semi-structured sheet. Sleep quality was assessed by self-administered questionnaire—Pittsburgh Sleep Quality Index (PSQI). According to the PSQI, 96.7% of the residents had poor sleep quality with mean PSQI score of 10.4 ± 2.5. No statistically significant difference was detected among the different specialties. Poorer sleep quality was more frequent among senior residents who spent longer duration in residency. The number of hours of sleep before residency and the number of days off during residency were the main predictors of total PSQI score and determinants of sleep quality Conclusions: Poor sleep quality is highly prevalent among medical residents and is associated with work-related factors. It is necessary to consider residents' sleep estate and conduct more analyses to diagnose, treat, and improve their sleep quality. [ABSTRACT FROM AUTHOR]

Objective: Occupational burnout occurs more often among doctors than among those working in other sectors. It is an indisputable fact that medics whose work requires almost continuous contact with people are more prone to burnout. It is noticed that the burnout syndrome affects doctors at all stages of their careers - from residents to experienced practitioners. Methods:. This paper performs a literature review on the frequency and causes of professional burnout among resident doctors. Results: The results of numerous large-scale studies are conclusive that the intensive workload of doctors, including night shifts and overtime, and the lack of work-life balance, due to the numerous resident duties, are the most common predisposing factors for the development of burnout syndrome in resident doctors. Another important conclusion from these studies is that a high level of BOS is mainly associated with depression and inadequate patient care. Conclusions: Professional burnout syndrome among resident doctors is an ongoing issue. It is then required that additional subjects, such as building skills to recognize and combat stress and implement strategies to overcome it, should be included in resident doctors training programmers. [ABSTRACT FROM AUTHOR]

Background: Residents receive a numeric performance rating (eg, 1-7 scoring scale) along with a narrative (ie, qualitative) feedback based on their performance in each workplace-based assessment (WBA). Aggregated qualitative data from WBA can be overwhelming to process and fairly adjudicate as part of a global decision about learner competence. Current approaches with qualitative data require a human rater to maintain attention and appropriately weigh various data inputs within the constraints of working memory before rendering a global judgment of performance. Objective: This study explores natural language processing (NLP) and machine learning (ML) applications for identifying trainees at risk using a large WBA narrative comment data set associated with numerical ratings. Methods: NLP was performed retrospectively on a complete data set of narrative comments (ie, text-based feedback to residents based on their performance on a task) derived from WBAs completed by faculty members from multiple hospitals associated with a single, large, residency program at McMaster University, Canada. Narrative comments were vectorized to quantitative ratings using the bag-of-n-grams technique with 3 input types: unigram, bigrams, and trigrams. Supervised ML models using linear regression were trained with the quantitative ratings, performed binary classification, and output a prediction of whether a resident fell into the category of at risk or not at risk. Sensitivity, specificity, and accuracy metrics are reported. Results: The database comprised 7199 unique direct observation assessments, containing both narrative comments and a rating between 3 and 7 in imbalanced distribution (scores 3-5: 726 ratings; and scores 6-7: 4871 ratings). A total of 141 unique raters from 5 different hospitals and 45 unique residents participated over the course of 5 academic years. When comparing the 3 different input types for diagnosing if a trainee would be rated low (ie, 1-5) or high (ie, 6 or 7), our accuracy for trigrams was 87%, bigrams 86%, and unigrams 82%. We also found that all 3 input types had better prediction accuracy when using a bimodal cut (eg, lower or higher) compared with predicting performance along the full 7-point rating scale (50%-52%).Conclusions: The ML models can accurately identify underperforming residents via narrative comments provided for WBAs. The words generated in WBAs can be a worthy data set to augment human decisions for educators tasked with processing large volumes of narrative assessments. [ABSTRACT FROM AUTHOR]

Abstract Background Shared Decision Making (SDM) is as ideal model for resident-patient relationship which may improve medical outcomes. Nevertheless, predictive psychological factors influencing residents’ perspective regarding SDM are unclear. The current study investigated the relationship between two psychological factors, mental health and personality traits, and residents’ views toward SDM. Method In a cross-sectional study, 168 medical residents of the Babol University of Medical Sciences studying in 13 field specialties were recruited. The residents completed three questionnaires including Shared Decision-Making Questionnaire (SDM-Q-Doc, physician version), General Health Questionnaire (GHQ-12), and Big Five Personality (NEO-FFI). Results Residents had an overall agreement of about 88% regarding SDM with patients. There was no significant difference between male and female residents in terms of the degree of agreement for SDM. Concerning SDM, there was no significant relationship either between residents’ views and neuroticism, extraversion, agreeableness, and conscientiousness. In multivariate regression, mental health did not predict the SDM, but openness to experience negatively predicted residents’ views concerning SDM (β = − 0.388, p

Ahmad Al-Azayzih,1,2 Karem H Alzoubi2 1Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; 2Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, JordanCorrespondence: Ahmad Al-AzayzihDepartment of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab EmiratesEmail aazayzih@uaeu.ac.aeBackground: Clinical trials are an important tool to test the efficacy of new treatment modalities for cancer patients. Physicians, including medical residents, should play a major role in carrying out clinical trials to generate a strong body of evidence to determine the best available treatment for their patients. Carrying out clinical trials demands adequate understanding of the research phases and requirements including ethical standards as well as presenting positive attitudes toward the clinical research. Hence, evaluating the knowledge and attitudes of medical residents toward running clinical trials is essential to assess their preparedness and willingness to participate in future studies.Methods: This study was a questionnaire-based observational study. It involved medical residents from various specialties who served cancer patients admitted at King Abdullah University Hospital during the period from June 1 to August 15, 2017.Results: A total number of 83 respondents completed the questionnaire. Of them, 56.7% and 53.0% of the respondents reported either current or previous participation in clinical trials research, respectively. Only 10 residents (12.0%) had previous participation in clinical research where a new investigational cancer treatment was tested. While, 91.6% of respondents believed that physicians should be involved in running clinical cancer research, only 25.3% had previous experience in writing a cancer clinical trial protocol and 28.9% wrote a scientific manuscript on cancer clinical trials for publication. Moreover, 67.5% of residents knew when informed consent should be obtained and 62.7% were aware of the clinical equipoise concept in clinical trials.Conclusion: Much remains to be done to improve knowledge and attitudes of medical residents toward cancer clinical trials and the main ethical principles that should be followed to assure having an ideal research environment, which will pave the way for the generation of high quality clinical cancer research and reliable evidence-based clinical practice for cancer management.Keywords: clinical trials, cancer, Jordan, oncology, medical residents

Introduction Depression and suicide risk are disturbing issues within the medical community. In many countries, physician’s mental health is not a concern, due to the fact that many do not even consider medical staff as potential mental health patients. However, health care providers are an at risk population for phycological affliction due to their heavy workload. Objectives We aim to describe the prevalence of depressive symptoms and suicidal risk among medical residents from health centers of Santiago de los Caballeros, Dominican Republic. Methods A cross-sectional descriptive study was made, between the months of February and May 2021, using the Beck Depression Inventory II (BDI-2) and the Plutchick Suicidal Risk Scale. Results There was a total population of 507 residents, where 231 completed the survey. Of these, 1 recanted his participation, and 14 were excluded according to the study’s criteria, resultingin a total of 217 residents. The overall prevalence of depressive symptoms was 24.9% and suicidal risk was 22.94%. Residents who worked in a private center had 3.83 times more risk of suffering depressive symptoms compared to those who belonged to the public sector. Furthermore, residents from Internal Medicine (39.5%) had a higher prevalence of depressive symptoms, and residents from Anesthesiology (42.2%) suffered a higher suicide risk compared to other medical residences. Conclusions A disturbing percentage of the medical residents suffer from depressive symptoms and suicidal risk. Therefore, residency programs should offer assistance to help prevent and manage mental health disorders. Disclosure No significant relationships.

Introduction Recent studies in the word found an increase of substance use among medical students. Objectives To determine the prevalence of substance use and associated factors among medical residents in Tunisia. Methods It was a descriptive and analytical cross-sectional study among medical residents from the 4 medical faculties of Tunisia. A questionnaire was created from Google Forms and was published on the social network Facebook. We asked about the current consumption of different psychoactive substances. We used the Patient Health Questionnaire (PHQ-9) to identify depressive symptoms. Results The sample included 241 residents. The female sex was predominant (83.4%, n = 201). The average age was 28.18 (± 2.13) years. Among these residents, 27.8% (n = 67) currently consume at least one psychoactive substance and 71% (n = 171) had depressive symptoms. The substances consumed by residents were: tobacco 18.7% (n = 45), alcohol 18.7% (n = 45), cannabis 6.2% (n = 15) , amphetamine 3.3% (n = 8), sleeping pills (without medical prescription) 2.9% (n = 7), hallucinogens 2.9% (n = 7), cocaine 2.1 % (n = 5) and inhaled solvents 0.4% (n = 1). The use of at least one psychoactive substance was significantly associated with male sex (p = 0.01), the presence of financial problems (p = 0.08), lack of religiosity (p