Background The PERMA Model, as a positive psychology conceptual framework, has increased our understanding of the role of Positive emotion, Engagement, Relationships, Meaning, and Achievements in enhancing human potentials, performance and wellbeing. We aimed to assess the utility of PERMA as a multidimensional model of positive psychology in reducing physician burnout and improving their well-being. Methods Eligible studies include peer-reviewed English language studies of randomized control trials and non-randomized design. Attending physicians, residents, and fellows of any specialty in the primary, secondary, or intensive care setting comprised the study population. Eligible studies also involved positive psychology interventions designed to enhance physician well-being or reduce physician burnout. Using free text and the medical subject headings we searched CINAHL, Ovid PsychINFO, MEDLINE, and Google Scholar (GS) electronic bibliographic databases from 2000 until March 2020. We use keywords for a combination of three general or block of terms (Health Personnel OR Health Professionals OR Physician OR Internship and Residency OR Medical Staff Or Fellow) AND (Burnout) AND (Positive Psychology OR PERMA OR Wellbeing Intervention OR Well-being Model OR Wellbeing Theory). Results Our search retrieved 1886 results (1804 through CINAHL, Ovid PsychINFO, MEDLINE, and 82 through GS) before duplicates were removed and 1723 after duplicates were removed. The final review included 21 studies. Studies represented eight countries, with the majority conducted in Spain (n = 3), followed by the US (n = 8), and Australia (n = 3). Except for one study that used a bio-psychosocial approach to guide the intervention, none of the other interventions in this review were based on a conceptual model, including PERMA. However, retrospectively, ten studies used strategies that resonate with the PERMA components. Conclusion Consideration of the utility of PERMA as a multidimensional model of positive psychology to guide interventions to reduce burnout and enhance well-being among physicians is missing in the literature. Nevertheless, the majority of the studies reported some level of positive outcome regarding reducing burnout or improving well-being by using a physician or a system-directed intervention. Albeit, we found more favorable outcomes in the system-directed intervention. Future studies are needed to evaluate if PERMA as a framework can be used to guide system-directed interventions in reducing physician burnout and improving their well-being.

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Licensing Examination (USMLE) cosponsors announced the adoption of reporting Step 1 pass/fail and the discontinuation of Step 2 Clinical Skills (CS), respectively. These changes were met with mixed reviews from program directors and medical students applying to residency. 1,2 In the National Resident Matching Program's (NRMP) 2018 survey, 78% of program directors (PD) reported that they cite Step 1/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 when reviewing applications, compared with 70% of PDs for Step 2 Clinical Knowledge (CK)/COMLEX 2 Performance Evaluation (PE) and 51% for Step 2 CS/COMLEX 2 Cognitive Evaluation (CE).Conversely, Step 2 CS was rated as slightly more important than Step 1 and Step 2 CK, supporting the discontinued examination's value when ranking applicants. However, with Step 1 now reported as pass/fail and Step 2 CS discontinued, there remains uncertainty regarding how PDs will tailor their review of applications. Understanding PDs' perspectives on these consequential changes can guide educators reshaping their curricula and students aiming to strengthen their candidacy for residency. MethodsThe authors (A.W., J.D.S., K.L.K.) manually queried a subset (1600 of more than 5000, outreach >50% for every medical specialty except internal medicine and family medicine) of valid PD emails through the Accreditation Council for Graduate Medical Education's public 2019 to 2020 List of Specialty Programs (n = 31) across all medical specialties. In rounds, PDs were allotted 3 months (January to April 2021) to respond to the survey, with a reminder email sent after the first week. The University of California at Los Angeles institutional review board deemed this study exempt from review and waived informed consent because it used deidentified data. This study followed the American Association for Public Opinion Research (AAPOR) reporting guideline.We created a 14-item anonymous online survey using the ExpertReview validation tool (Qualtrics XM operating system version X4 [Qualtrics International Inc]) (eTable 1 in the Supplement).The survey (using Qualtrics and Google Forms) included questions on PD demographics including age, gender, tenure, and residency program specialty. PD race and ethnicity data were not collected to preserve anonymity. PDs were prompted for their general perceptions regarding the impact of residency selection in the context of changes to USMLE Step 1 and Step 2 CS. Responses were recorded as binary (yes or no) or on 3-point Likert scales (disagree, neutral, or agree) or 5-point Likert scales (strongly disagree, disagree, neutral, agree, or strongly agree).Categorical variables were reported as counts and percentages. Derived 95% CIs were from the margin of errors of total sample (±3.1%) and subgroups (±4.3%) defined by AAPOR (eTable 1 in the Supplement). Subgroup analyses between regions and between Association of American Medical Colleges (AAMC)-defined primary care (internal medicine, family medicine, pediatrics, internal medicine/pediatrics) and nonpr...

Although socioeconomic disparities persist both pre‐ and post‐transplantation, the impact of payer status has not been studied at the national level. We examined the association between public insurance coverage and waitlist outcomes among candidates listed for liver transplantation (LT) in the United States. All adults (age ≥18 years) listed for LT between 2002 and 2018 in the United Network for Organ Sharing database were included. The primary outcome was waitlist removal because of death or clinical deterioration. Continuous and categorical variables were compared using the Kruskal‐Wallis and chi‐square tests, respectively. Fine and Gray competing‐risks regression was used to estimate the subdistribution hazard ratios (HRs) for risk factors associated with delisting. Of 131,839 patients listed for LT, 61.2% were covered by private insurance, 22.9% by Medicare, and 15.9% by Medicaid. The 1‐year cumulative incidence of delisting was 9.0% (95% confidence interval [CI], 8.3%‐9.8%) for patients with private insurance, 10.7% (95% CI, 9.9%‐11.6%) for Medicare, and 10.7% (95% CI, 9.8%‐11.6%) for Medicaid. In multivariable competing‐risks analysis, Medicare (HR, 1.20; 95% CI, 1.17‐1.24; P < 0.001) and Medicaid (HR, 1.20; 95% CI, 1.16‐1.24; P < 0.001) were independently associated with an increased hazard of death or deterioration compared with private insurance. Additional predictors of delisting included Black race and Hispanic ethnicity, whereas college education and employment were associated with a decreased hazard of delisting. In this study, LT candidates with Medicare or Medicaid had a 20% increased risk of delisting because of death or clinical deterioration compared with those with private insurance. As more patients use public insurance to cover the cost of LT, targeted waitlist management protocols may mitigate the increased risk of delisting in this population.