Lower Frequency of Call Shifts Leads to Higher Attendance, Higher Academic Performance, and Less Burnout Syndrome in Surgical Clerkships

Hinojosa-González, David Eugenio; Farias, Juan; Tellez-Giron, Valeria Cecilia; Aguirre-Villarreal, David; Brenes‐Castro, David; Flores‐Villalba, Eduardo

doi:10.1016/j.jsurg.2020.07.043

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…; regardless of call schedule, students with > 90% attendance scored higher in both midterms and final exams (p = 0.002; p = 0.001) [27]. Although call shift seemed not to dramatically lessen performance of the most resilient / dedicated students, less call was associated with overall higher lecture attendance, generally improved academic performance and lower burnout [27].…”

Section: Interventionsmentioning

confidence: 97%

Wellness Review 2020, Part 2

Ferguson¹,

Huecker²

2020

JWellness

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Introduction: This article comprises Part 2 of the Journal of Wellness review of 2020 wellness literature (July – December). In this review, JWellness editors continue the goal of offering a cohesive summary of recent publications within the wellness domain. We summarize new science and resilience initiatives published outside of JWellness that seek understanding of either burnout and its prevention or thriving in the medical community. Methods: From the interval of 01 July – 31 Dec 2020, PubMed was queried for empirical research studies, review articles, and editorials in accordance with the following algorithm: an article was required to have two delineating keywords, each from a separate grouping. The first identified medical professionals in either the title or the abstract: (“clinical professionals,” “physicians,” or “caregivers”), and the other identified a wellness-related keyword in the title: (“wellness,” “burnout,” “resilience,” or “resiliency”). Literature in Review: A total of 234 articles resulted. The list for inclusion was then narrowed to sixty-three articles plus one that was hand-picked. Recent literature into physician wellness, burnout and resilience continues to focus heavily on COVID-19. Well-researched topics include burnout surveillance, proposals for and small investigations into resilience, multiple studies attempting to differentiate characteristics that predispose to burnout, and the impact of the pandemic. Less has been written on leadership, financial wellness, and sustainable resilience-building initiatives. We note relatively few control-measured interventional studies—the majority of which remain small in endeavor and short in duration, limiting generalizability. Conclusion: Recent literature into physician wellness, burnout and resilience focuses heavily on COVID-19. Many workplace / organizational factors negatively influence wellness: cumbersome EHRs, cultures not focused on socialization and self-compassion, and high physician task load. We express optimism regarding future interventional studies of burnout mitigation and resilience enhancement.

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Section: Interventionsmentioning

confidence: 97%

Wellness Review 2020, Part 2

Ferguson¹,

Huecker²

2020

JWellness

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“…Traditional methods of assessing and grading medical students have come under close scrutiny in recent years, through the lenses of validity evidence, impacts on trainee well-being and equity. This is especially true within the core surgical clerkship (CSC), with its perceptions of increased clinical time demands [1], call requirements [2][3][4][5], variations in teaching modalities [2,6] and differing experiences among surgical subspecialties [7]. The equity lens is a very compelling challenge to the status quo, with growing evidence that under-represented in medicine groups experience inequity at multiple levels including Data from this manuscript were presented at the Association for Surgical Education 2022 Annual Meeting on May 3, 2022. clerkship grading, resulting in significant barriers to successfully matching into competitive residencies [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Measuring what matters: identifying assessments that reflect learning on the core surgical clerkship

et al. 2022

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Purpose There are various assessments used during the core surgical clerkship (CSC), each of which may be influenced by factors external to the CSC or have inherent biases from an equity lens. In particular, the National Board of Medical Examiners’ Clinical Subject Exams (“Shelf”) is used heavily and may not reflect clerkship curriculum or clinical learning. Methods This is a retrospective review of medical student characteristics and assessments during the CSC from July 2017-June 2021. Assessment methods included: subjective Clinical Performance Assessments (CPA), Shelf, Objective Structured Clinical Examinations, and a short-answer in-house examination (IHE) culminating in a Final Grade (FG) of Honors/Pass/Fail. A Shelf score threshold for Honors was added in academic years 2020–2021. Descriptive, univariate, and multivariable logistic and linear regression statistics were utilized. Results We reviewed records of 192 students. Of these, 107 (55.7%) were female, median age was 24 [IQR: 23–26] years, and most were White/Caucasian ( N = 106, 55.2%). Univariate analysis showed the number of Exceeds Expectations obtained on CPA to be influenced by surgical subspecialty taken ( p = 0.013) and academic year ( p < 0.001). Shelf was influenced by students’ race ( p = 0.009), timing of CSC before or after Internal Medicine (67.9 ± 7.3 vs 72.9 ± 7.1, p < 0.001), and Term taken (increasing from 66.0 ± 8.7 to 73.4 ± 7.5, p < 0.001). IHE scores did not have any external associations. After adjustment with multivariable logistic and linear regressions, CPA and IHE did not have external associations, but higher scores were obtained on Shelf exam in Terms 3, 5, and 6 (by 4.62 [95% CI 0.86–8.37], 4.92 [95% CI 0.53–9.31], and 7.56 [95% CI 2.81–12.31] points, respectively. Odds of FG honors were lower when Shelf threshold was implemented (OR 0.17 [95% CI 0.06–0.50]), and increased as students got older (OR 1.14 [95% CI 1.01–1.30]) or on specific subspecialties, such as vascular surgery (OR 7.06 [95% CI 1.21–41.26]). Conclusions The Shelf is substantially influenced by temporal associations across Terms and timing in relation to other clerkships, such as Internal Medicine. An IHE reflective of a clerkship’s specified curriculum may be a more equitable summative assessment of the learning that occurs from the CSC curriculum, with fewer biases or influences external to the CSC. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-022-00047-8.

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“…9 We believe that the proposed virtual hybrid program can offset to an important degree the loss of clinical exposure, promote critical thinking and retain or increase interest in surgery, thus aiding clerkships around the world in the management of student formation during the pandemic. 11…”

Section: Introductionmentioning

confidence: 99%

Lessons from the Effective Implementation of a Hybrid Virtual Clinical Model for Surgical Clerkships during the Covid Pandemic: Impact on Academic Performance, Burnout and Surgical Interest

Hinojosa-González¹,

Roblesgil‐Medrano²,

Segura‐Ibarra³

et al. 2020

Preprint

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Objective: Determine the academic and psychosocial impact of a hybrid-virtual surgical clerkship in medical students during the Covid Pandemic.Background: The Covid-19 pandemic has forced universities to modify their academic curriculum to adapt and overcome never before seen adversities. Herein we present the implementation of a Hybrid Virtual Clinical Model for Surgical Clerkships and its comparison against traditional face-to-face learning.Methods: We surveyed 47 medical students prior to their first-ever clerkship using Maslach’s Burnout Inventory and a questionnaire regarding their interest in surgery as a career path before and after their clerkship. Burnout rates, clinical exposure, academic performance, and surgical interest were analyzed and compared against results from prior year students on a traditional program.Results: Baseline burnout was significantly lower in the hybrid model (15.4% vs. 2.6%, p=0.048). The same was seen on alternate burnout rates (33.3% vs. 10.3%, p=0.02), differences remained after three months of clerkship (23.1% vs. 5.1%, p=0.023). When comparing different domains such as professional fulfillment, depersonalization, and fatigue, the hybrid model did overall better. Clinical exposure hours were statistically significant between both groups (954.32 vs. 276.33, p=0.001), however, when considering virtual clinical hours, no significant differences were found. Despite the hybrid group having a lower midterm exam score (68 vs. 77.49, p=0.001), final exam scores were similar between groups (74.97 vs. 75.89, p=0.662).Conclusion: We believe our model may be useful for other programs to maximize clinical exposure while minimizing the risk of exposure, maintaining maximum academic performance, and preserving the surgical interest of rotating alumni.ACGME Competencies: Practice-Based Learning and Improvement

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Lower Frequency of Call Shifts Leads to Higher Attendance, Higher Academic Performance, and Less Burnout Syndrome in Surgical Clerkships

Cited by 7 publications

References 28 publications

Wellness Review 2020, Part 2

Wellness Review 2020, Part 2

Measuring what matters: identifying assessments that reflect learning on the core surgical clerkship

Lessons from the Effective Implementation of a Hybrid Virtual Clinical Model for Surgical Clerkships during the Covid Pandemic: Impact on Academic Performance, Burnout and Surgical Interest

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