I'm on the treadmill at the local YMCA, watching a “family” movie that breaks to the following commercials:

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“3 games for the price of 1!” —an ultraviolent video game maker;
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“Get a large pie for the price of a small pie!” —a pizza restaurant;
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“In just 60 seconds you've got snack-defying, satisfying pizza roll!”;
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“Once you've seen her story, you have 7 days to live!” —a trailer for a violent movie;
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“I've got the hots for what's in the box with dominos!” —more pizza; and
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“Talcum powder alert! If

ABSTRACT

Background

Studies report high burnout prevalence among resident physicians, with little consensus on methods to effectively reduce it.

Objective

This systematic literature review explores the efficacy of interventions in reducing resident burnout.

Methods

PubMed, Embase, and Web of Science were searched using these key words: burnout and resident, intern, or residency. We excluded review articles, editorials, letters, and non–English-language articles. We abstracted data on study characteristics, population, interventions, and outcomes. When appropriate, data were pooled using random effects meta-analysis to account for between-study heterogeneity. Study quality was assessed using Newcastle-Ottawa Scale (cohort studies) and Jadad scale (randomized control trials [RCTs]).

Results

Of 1294 retrieved articles, 19 (6 RCTs, 13 cohort studies) enrolling 2030 residents and examining 12 interventions met criteria, with 9 studying the 2003 and 2011 Accreditation Council for Graduate Medical Education (ACGME) duty hour restrictions. Work hour reductions were associated with score decrease (mean difference, −2.73; 95% confidence interval (CI) −4.12 to −1.34; P < .001) and lower odds ratio (OR) for residents reporting emotional exhaustion (42%; OR = 0.58; 95% CI 0.43–0.77; P < .001); a small, significant decrease in depersonalization score (−1.73; 95% CI −3.00 to −0.46; P = .008); and no effect on mean personal accomplishment score (0.93; 95% CI −0.19–2.06; P = .10) or for residents with high levels of personal accomplishment (OR = 1.01; 95% CI 0.67–1.54; P = .95). Among interventions, self-care workshops showed decreases in depersonalization scores, and a meditation intervention reduced emotional exhaustion.

Conclusions

The ACGME work hour limits were associated with improvement in emotional exhaustion and burnout.

ABSTRACT

Background

The Accreditation Council for Graduate Medical Education Milestone Project was implemented in 2014 to standardize assessments and progression of residents. While it is recommended that milestones not be used as tools for direct assessments of resident competency, many programs have used or adapted milestone tools for this purpose.

Objective

We sought to explore use of the most frequent milestone level at which a resident was evaluated (ie, the mode), and compared this to the standard practice of using the arithmetic mean for summarizing performance.

Methods

We reviewed all Family Medicine Milestone evaluations from 1 program for the first 2 academic years of milestone implementation. Mean and mode scores were calculated across 24 unique residents, 841 evaluation forms, and 5897 measurements. The proportion of overestimation errors (where the mean is at least 0.5 larger than the mode) and underestimation errors (where the mean is at least 0.5 less than the mode) were then compared across resident training year and subcompetency.

Results

For the 24 residents, an estimation error occurred in 175 of 792 of the comparisons (22%). Of these errors, 118 (67%) were overestimation errors. First-year residents accounted for 55% (96 of 175) of all estimation errors. All subcompetencies had some estimation errors, with 6 having greater than 5%.

Conclusions

If the trend for using the milestones as stand-alone assessment tools is to continue, aggregating data by using frequency distributions and mode would be a more stable and appropriate approach given their nominal or, at best, ordinal nature.

ABSTRACT

Background

The I-PASS Handoff Study found that introduction of a handoff bundle (handoff and teamwork training for residents, a mnemonic, a handoff tool, a faculty development program, and a sustainability campaign) at 9 pediatrics residency programs was associated with improved communication and patient safety.

Objective

This parallel qualitative study aimed to understand resident experiences with I-PASS and to inform future implementation and sustainability strategies.

Methods

Resident experiences with I-PASS were explored in focus groups (N = 50 residents) at 8 hospitals throughout 2012–2013. A content analysis of transcripts was conducted following the principles of grounded theory.

Results

Residents generally accepted I-PASS as an ideal format for handoffs, and valued learning a structured approach. Across all sites, residents reported full adherence to I-PASS when observed, but selective adherence in usual practice. Residents adhered more closely when patients were complex, teams were unfamiliar, and during evening handoff. Residents reported using elements of the I-PASS mnemonic variably, with Illness Severity and Action Items most consistently used, but Synthesis by Receiver least used, except when observed. Most residents were receptive to the electronic handoff tool, but perceptions about usability varied across sites. Experiences with observation and feedback were mixed. Concern about efficiency commonly influenced attitudes about I-PASS.

Conclusions

Residents generally supported I-PASS implementation, but adherence was influenced by patient type, context, and individual and team factors. Our findings could inform future implementation, particularly around the areas of resident engagement in change, sensitivity to resident level, perceived efficiency, and faculty observation.

Setting and Problem

The Accreditation Council for Graduate Medical Education (ACGME) requires sponsoring institutions to provide protected administrative time for program directors (PDs) and program coordinators (PCs). Some specialty requirements state the full-time equivalents (FTEs) required for PD and PC support, while others do not. This has led to inequitable budgetary support for our institution's ACGME-accredited programs. To address this inconsistency, our Graduate Medical Education Committee (GMEC) appointed a task force in 2014 to develop a solution for transparent, equitable institutional support of ACGME-accredited programs.

Intervention

The task force consisted of graduate medical education (GME) administration and PDs representing medical,