Purpose Currently there are a limited number of comprehensive studies exploring in more depth the relationship between burnout and quality of life (QoL) of medical residents during residency training. This study aims to examine the correlation between burnout and residents’ QoL and explore the factors associated with burnout in residency training.
Methods This was a mixed-method study. The first stage was a quantitative study using cross-sectional design to administer the Maslach Burnout Inventory Human Service Survey and World Health Organization Quality of Life-BREF instruments to 86 medical residents, followed with the qualitative study through 10 in-depth interviews.
Results Twenty-seven residents (31.4%) experienced severe emotional exhaustion (EE), 22 (25.6%) experienced severe depersonalization (DP), and 40 (46,5%) experienced low personal accomplishment (PA). Factors increasing the likelihood of experiencing burnout were being surgical residents for EE (2.65 times), dealing with difficult/rare cases for DP (1.14 points), and working hours for PA (1.03 points). The QoL was influenced by the three burnout domains, marital status, education level, gender, age, type of residency, night shift, difficult/rare cases, working hours, and number of emergency cases. Factors influencing burnout, both intrinsic and extrinsic, were identified and divided into causative and protective factors.
Conclusion The current study has examined the relationship between burnout and QoL and identified factors affecting residents’ burnout. Both intrinsic factors, such as spirituality, and extrinsic factors which include duration of shift, work facilities, and teacher-senior-junior relationships, affect burnout. Supervision and academic regulation are some of the solutions expected by the residents to minimize burnout.
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Korean J Med Educ 2021;33(4):419-430. Published online November 30, 2021
Since coronavirus disease 2019 was declared a global pandemic by the World Health Organization, it has become a challenging situation to continue medical education, including in Indonesia. The situation prohibited face-to-face (direct) educational activities in clinical settings, therefore also postponing examinations involving especially procedural skills. Adaptations were urgently needed to maintain the delivery of high-stake examinations to sustain the number of ophthalmology graduates and the continuation of eye health service. Objective structured clinical examination (OSCE) has been one of our widely used method to assess clinical competencies for ophthalmology residents, and is the one method that involves gatherings, close contact of examiners, examinees and patients, therefore the most difficult to adjust. Pandemic challenges brought technical changes in our delivering the OSCE to online, maximizing digital platforms of meetings, while still concerned to guarding the safety of candidates, patients and staffs. OSCE scenarios were also made as timely efficient as possible by changing continuous station models to a cascade one. The purpose of this article is to document our experience in conducting a feasible and reproducible OSCE in this pandemic era filled with limitations.
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Purpose This study investigated the perceptions of medical residents and faculty members before the implementation of the duty hour regulation in December 2017.
Methods A survey was administered to 263 residents and 358 faculty members in the Chonnam National University Hospital. The subjects were given a self-administered structured questionnaire designed to measure their perspectives on duty hour regulation. They were also asked to answer an open-ended question regarding their expectations or concerns regarding duty hour regulation. The response rates were 50.2% for residents and 24.0% for faculty members.
Results Residents and faculty members regarded the improvement of junior residents’ well-being favorably, but had conflicting views regarding senior residents. Residents expressed difficulty in completing unchanged workloads within the limited time, while faculty members were more concerned about worsening patient safety due to the discontinuity of care and insufficient resident education.
Conclusion Medical residents and faculty members had differing concerns regarding duty hour regulation. Further studies and the development of future policies should be considered to improve resident education and patient safety within the limited duty hour regulation.
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Purpose This study was aimed to evaluate the factors affecting the results of comprehensive pre-internship exam (CPIE) among medicals students of Kermanshah University of Medical Sciences.
Methods In this descriptive-analytical study, all students (n=240) participating in CPIE over a 3-year period (2012–2014) were selected. Data were gathered by a questionnaire, including the CPIE results and educational and demographic data. Spearman correlation coefficient, Mann-Whitney U-test, and analysis of variance were used to analyze the association of students’ success with study variables. Also, regression analysis was applied to determine the role of independent variables in students’ success.
Results The frequency of the failed units in apprenticeship course was one of the most important risk factors associated with failure in CPIE. Average scores of pre-internship course were the most important factors of success in CPIE. The CPIE score had the highest direct relationship with grade point average (GPA) of apprenticeship course, total GPA of all three courses, GPAs of physiopathology and basic sciences courses, and score of comprehensive basic sciences examination, respectively.
Conclusion CPIE showed the highest inverse correlation with the number of failed units in apprenticeship course. The most important factors influencing this exam were failure in apprenticeship course and GPA of previous educational stages.
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Purpose The core curriculum in graduate medical education (GME) is an educational program that covers the minimum body of knowledge and skills that is required of all residents, regardless of their specialty. This study examined the opinions of stakeholders in GME regarding the core curriculum. Methods: A questionnaire was administered at three tertiary hospitals that were affiliated with one university; 192 residents and 61 faculty members and attending physicians participated in the survey. The questionnaire comprised six items on physician competency and the needs for a core curriculum. Questions on subjects or topics and adequate training years for each topics were asked only to residents. Results: Most residents (78.6%) and faculty members (86.9%) chose “medical expertise” as the “doctor’s role in the 21st century.” In contrast, communicator, manager, and collaborator were recognized by less than 30% of all participants. Most residents (74.1%) responded that a core curriculum is “necessary but not feasible,” whereas 68.3% of faculty members answered that it is “absolutely needed.” Regarding subjects that should be included in the core curriculum, residents and faculty members had disparate preferences— residents preferred more “management of a private clinic” and “financial management,” whereas faculty members desired “medical ethics” and “communication skills.” Conclusion: Residents and faculty members agree that residents should develop a wide range of competencies in their training. However, the perception of the feasibility and opinions on the contents of the core curriculum differed between groups. Further studies with larger samples should be conducted to define the roles and professional competencies of physicians and the needs for a core curriculum in GME.
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PURPOSE This study was conducted to investigate medical residents' job satisfaction and their related factors to improve the quality of residency program.
METHODS The study subjects were 159 medical residents being trained at Chonnam National University Hospital, South Korea, in 2011. The participants were asked to complete a short form Minnesota satisfaction questionnaire (MSQ).
RESULTS The mean score for 20 items on the short form MSQ varied between 2.91 and 3.64 on a 5-point Likert scale. The assessment of related factors with job satisfaction revealed that medical residents had higher levels for job satisfaction, particularly those who were women (beta=0.200, p=0.022), and those who had mentorship experience (beta=0.219, p=0.008).
CONCLUSION This study results indicate that we should expand and support the mentorship program during medical residency to promote job satisfaction.
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PURPOSE The purpose of this study was to compare attitudes toward disclosing medical errors between medical students and interns.
METHODS The questionnaires were administrated to 164 medical students and interns. The questionnaires consist of 3 major concepts: knowledge, attitudes toward disclosure of medical error, barriers to the disclosure of medical error.
RESULTS Interns (56.1%) took medical errors less seriously than medical students (74.8%). Medical students (75.6%) believed that patients would want to be informed of any kind of medical errors while Interns (46.3%) thought so. Medical students (83.1%) considered that serious medical errors should be disclosed to patients. On the contrary, only 46.3% of interns believed so. Medical students (16.3%) and interns (19.5%) believed disclosing medical error would increase patients trust in doctors. Both medical students and interns pointed out worries about malpractice suits as the biggest barrier to disclosing medical error.
CONCLUSION The attitudes toward disclosing medical error between medical students and interns were significantly different in many aspects. Interns show more negative attitudes about disclosing medical errors than medical students. And they also take medical errors less seriously than medical students. In particular, the attitudes of the subjects in this study were greatly different from the results of a previous patients' attitudes study. These perspectives differences could work against achieving patient-centered care which is the upmost priority in the current trends in health care. The efforts to bridge these perspective gaps between patients and doctors should start from medical school by teaching medical students the importance of the disclosing medical errors.
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PURPOSE This study aims to explore the perceived effectiveness, benefits, and learning experiences of interns with regard to their participation in a communication skills workshop program, which can have implications for the development and implementation of future communication skills training.
METHODS One hundred twenty one interns and 12 senior residents and fellows participated in the workshop program as learners and tutors. The participating interns encountered three difficult communication situations, represented by trained standardized patients. During each encounter, each participant had an individual encounter, group discussion, and feedback on his performance. A self-assessment survey, composed of five itemized questions and seven open-ended questions, was administered after the workshop. A mixed methods approach was used to analyze the quantitative and qualitative data.
RESULTS The participants had positive perceptions of the implementation and effects of the workshop, and they responded higher than 4.0 to all itemized questions on their perception of the effectiveness and benefits of the workshop. The analysis of open-ended questions demonstrated specific learning experiences of the participants, such as the hardship of solving ill-structured communication problems and reflection on their current knowledge, skills, attitudes, and practice as physicians. The participants reported that the workshop provided opportunities of improving diverse communication skills and problem-solving skills and identifying further learning needs.
CONCLUSION The results suggest that communication skills training for interns facilitates their reflection and development of communication skills, as well as their competency of situated problem solving. Consequently, communication skills development should be regarded as an important subject of continuing medical education. Several implications of this study can contribute to the design and development of communication skills-related programs.
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PURPOSE A growing number of residents bear children during residency training. This study was conducted to examine the pregnancy and maternity leave experiences of women who delivered infants during their residency training.
METHODS From March 2007 through June 2007, we surveyed 94 women who had given birth during their residency training during the past 5 years from the survey date. Participants were recruited using snowball sampling.
RESULTS Most of the respondents (70.2%) delivered in the 3rd and 4th year of residency. The average length of leave was 68.9 days, and more than half (54.3%) of the women expressed that a maternity leave policy was not formally established in the department. In general, participants believed that having a child during residency was difficult (mean=4.18 in 5-point Likert scale), and this perception was inversely related with systematic departmental support.
CONCLUSION Pregnancy is a special challenge for residents, with regard to not only physical overexertion but also psychosocial impacts on pregnant residents and their colleagues. However, most current residency programs do not have written policies on pregnancy. A formal policy and more flexible curriculum can help both the training program and the pregnant resident.
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PURPOSE The purpose of this study is to analyze the development and implementation of the Objective Structured Clinical Examination (OSCE) for the residency applicant examination at Daegu-Catholic Hospital. METHODS: Fifty-four Daegu-Catholic residency applicants were evaluated by written examination, internship scores, and OSCE. The correlation between written examination scores, internship scores, and OSCE scores was assessed. RESULTS: The correlation between OSCE and internship scores showed a tendency to be more significant than that between the written test and internship scores, but OSCE-internship correlation coefficients and written test and internship correlation coefficients was not statistically significant.
The distribution of OSCE and internship scores on a graph corroborated this relationship between the two variables.
CONCLUSION The OSCE presents more objective criteria for residency application tests.
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BACKGROUND There has been widespread use of in-training examination for the evaluation of clinical competence of residents. The result of in-training examination seems to be helpful for improving the quality of residency programs using feedback system, further. We evaluated the relationship between residency program and the result of in-training examination.
METHODS Reports on the contents of residency program(82 programs) which were submitted in 1999 and in-training examination scores of 516 family medicine residents in 1998 were linked each other through the name of resident.
Correlation analysis, t test, ANOVA analysis, and the multiple linear regression analysis were used.
RESULTS Mean score acquired by residents of tertiary hospital residency program(59.4+/-7.79) was significantly higher than that of secondary hospital(56.4+/-8.45) among all three residency years. Residents who have seen their own patients in ambulatory care clinic(58.5+/-8.14) and were given feedback by peer review of teaching faculty(60.2+/-7.71) acquired significantly better results compared to those who have not(56.1+/-8.35, 57.5+/-8.27).
Residents in programs with moderate ratio of the number of residents to teaching faculty acquired significantly better results compared to those with smaller or larger ratio; the score were 56.2+/-6.90, 59.2+/-8.64, 58.7+/-7.90, 57.1+/-8.82 for the ratio of < or =3, 4-6, 7-9, and 9 <, respectively. Statistically significant but low correlation coefficients(less than 0.25) were observed between in-training examination score and the period of rotation to learn family medicine, general medicine, dermatology, musculo- skeletal problem, and the neuro-sensory problem.
After controlling probable confounders, third year of residency, residency program in tertiary hospital, and the moderate ratio of residents to teaching faculty were significantly associated with the better result of in-training examination.
CONCLUSION For improving clinical competence of residents in family practice, limiting the ratio between residents and teaching faculty in residency program to appropriate level and substantiality in contents of hospital teaching rotation program should be needed.
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