Hunderfund, Andrea N. Leep

Importance Little is known about how factors external to the workplace, such as spousal support, influence physician attrition. Objectives To explore associations of spousal support among married/partnered physicians with both ‘hard’ attrition ((HA), considering leaving academic medicine within 2 years) and ‘soft’ attrition ((SA), having ever considered part-time work), before and after adjusting for demographic variables, burnout and satisfaction with work-life integration (WLI). Design This cross-sectional survey study was conducted among faculty physicians employed at Mayo Clinic. Outcomes and measures Survey items measured demographics, spousal support (five items), HA, SA, satisfaction with WLI (single-item measure) and burnout (two-item measure). Check-all-that-apply questions explored reasons for considering attrition. We investigated associations of spousal career support with attrition consideration using logistic regression analyses, adjusting for demographic variables then for WLI satisfaction and burnout. Results 739/2103 physicians responded (response rate 35.1%); 666 (90.1%) were married or partnered and responded to the HA question. 42.5% (283/666) reported considering HA and 60.9% of full-time employees (288/473) had ever considered SA. 65.5% (437/666) considered any attrition (AA). Respondents reporting more frequent spousal career support had lower odds of HA (OR 0.80, 95% CI 0.68 to 0.94, p=0.006), though this was not significant when considering AA (OR 0.85, 95% CI 0.71 to 1.01, p=0.07). Neither association was significant after adjusting for WLI satisfaction and burnout (OR 1.01, 95% CI 0.80 to 1.29, p=0.91 (HA), OR 1.10, 95% CI 0.86 to 1.37, p=0.45 (any attrition)). Conclusions While spousal support was no longer significantly associated with attrition after adjusting for WLI satisfaction and burnout, it may mitigate attrition.

ABSTRACT Introduction/Aims Neuromuscular ultrasound (NMUS) is becoming increasingly incorporated as a complementary tool in electrodiagnostic (EDX) medicine. Competency assessment is critical to ensure adequate quality, appropriate application, and accurate interpretation. The primary objective was to develop a competency‐based assessment tool of foundational NMUS skills among postgraduate medical trainees in a single center. Methods The assessment included written (28 multiple‐choice, short answer, or yes/no) questions and practical skills (15 prompts) sections recommended by a published consensus‐based survey to include the knowledge and skills necessary to achieve minimal competency for unsupervised practice of NMUS for common conditions. The written portion included interpretation of basic pathology. Core practical content focused on the most evaluated structures in the Mayo EDX laboratory: the median and ulnar nerves and diaphragm muscle. The practical portion was administered by a single examiner and scored with a five‐point competency‐based rating. Four experienced educators used the Angoff standard setting method to set passing scores for each section. Results Subjects included three EMG‐track clinical neurophysiology fellows who completed a NMUS lecture series with supervised hands‐on scanning and a 2‐week intra‐lab NMUS elective during fellowship. Composite scores ranged from 89% to 97%. All subjects met minimum passing scores for each section (77% and 88% for the knowledge and skills sections, respectively). Discussion This NMUS competency assessment was successfully implemented and may be incorporated into postgraduate medical trainee evaluation to ensure minimal competency in evaluation of carpal tunnel syndrome, ulnar neuropathy at the elbow, and diaphragm function. This effort integrates quality NMUS evaluations into clinical practice.

Abstract Purpose This study explores how new residents experienced the transition to residency, examines factors that made the transition process more or less difficult, and identifies potentially modifiable program features that enhanced or would have enhanced transition experiences. Method The authors conducted a qualitative interview study of postgraduate year (PGY) 1 residents in emergency medicine, family medicine, general surgery, internal medicine, obstetrics and gynecology, pediatric and adolescent medicine, and psychiatry at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin between December 2020 and March 2021. Open-ended questions explored residents’ transition experiences. Interviews were audio-recorded, transcribed, coded inductively, and analyzed iteratively using general thematic analysis from an epistemologically constructivist perspective. Results Forty-five residents (25 women, 20 men) from 12 programs, 7 specialties, and 4 states participated. PGY-1 residents experienced the transition to residency as a confluence of overlapping and interconnected transitions that unfolded over time, spanned multiple life domains, and generated numerous personal and professional demands. Residents appraised demands based on their effects on patient care, professional growth, and personal well-being and struggled when coincident demands forced tradeoffs among these concerns. Residents who experienced many difficulties during the transition to residency reported high demands (eg, due to transition-related discontinuities, depleted resources from prior transitions or a difficult match experience, structural and systemic barriers, coincident personal or situational stressors) and/or fewer resources (eg, insufficient residency or life skills, limited social support, financial strain). Preparedness and supportive relationships eased the transition process. Residency program features that enhanced or would have enhanced the transition experience included monitoring and limiting overall demands, minimizing unhelpful and harmful demands, calibrating constructive demands, and increasing holistic support. Conclusions Study findings illuminate transition experiences of PGY-1 residents, reveal person-centered considerations to inform ongoing improvement efforts, and identify potentially actionable steps programs can take to improve resident transition experiences.

Humility is one of the most powerful and sometimes least understood virtues we can possess. It is often misinterpreted as a sign of weakness, especially today, where self-promotion is encouraged and celebrated. Many people view humility as “thinking less of ourselves.” In truth, humility is not thinking less of oneself; rather it is appropriately thinking less about oneself. Our ability as caregivers in putting the needs of the patient at the center of all we do is enhanced through our humility. A steady focus on the needs of the patient helps us gain an honest assessment of both our strengths and limitations. Studies have shown that patient outcomes and experiences are strongly associated with provider humility. This article aims to shine a light on the power of humility and its impact on patient experience, psychological and cultural safety, and the provider-patient relationship.

A 10-year-old girl with a past medical history significant for prematurity at 29 weeks, short bowel syndrome secondary to necrotizing enterocolitis, prior episodes of small intestinal bacterial overgrowth complicated by D-lactic acidosis, and gastric tube dependence presented to an emergency department with emesis, slurred speech, somnolence, and unsteady gait. Workup was initiated, and she was started on broad-spectrum antibiotics and transferred to our pediatric intensive care unit for further evaluation and treatment. Differential diagnosis on admission was broad, and, through thorough laboratory evaluation, imaging, and multiple subspecialty inputs, an unusual diagnosis was confirmed.

Importance Few studies have assessed whether factors outside the workplace, such as support from a spouse or partner, are associated with work-life integration (WLI) satisfaction and burnout among physicians. Evaluating such an association may help with developing novel strategies to address burnout and improve WLI satisfaction among this group. Objectives To compare spousal support among female and male physicians and explore associations of spousal support with WLI satisfaction and burnout. Design, Setting, and Participants This cross-sectional, multispecialty survey study was conducted among 661 faculty physicians employed at an academic medical center from March 26 to May 22, 2024. Main Outcomes and Measures Survey items measured spousal support (5 items), WLI satisfaction (1 item), and burnout (2 Maslach Burnout Inventory items). Associations of spousal support and gender with WLI and burnout were assessed using logistic regression analyses adjusting for age, race and ethnicity, weekly work hours, and weekly hours spent on household or childcare duties. Results Overall, 739 of 2103 faculty physicians (response rate, 35.1%) completed the survey, of whom 661 (89.4%) were currently married or partnered (359 of 661 men [54.3%]). In this subset, 322 of 351 male physicians (91.7%) and 276 of 298 of female physicians (92.6%) reported frequent career support (defined as often, most of the time, or always) over the last year from their spouse or partner. Physicians reporting high levels of career support from their spouse or partner had higher odds of WLI satisfaction (odds ratio [OR], 1.50 [95% CI, 1.22-1.86]; P < .001) and lower odds of burnout (OR, 0.73 [95% CI, 0.61-0.87]; P < .001), independent of gender and adjusted for age, race and ethnicity, weekly work hours, and weekly hours spent on household or childcare duties. Male physicians had higher odds of WLI satisfaction than female physicians (OR, 1.95 [95% CI, 1.32-2.90]; P < .001), even after adjusting for spousal career support and other covariates listed, whereas odds of burnout did not significantly differ by gender (OR, 0.84 [95% CI, 0.57-1.23]; P = .37). Conclusions and Relevance This study suggests that the level of career support from a spouse or partner is associated with WLI satisfaction and burnout among physicians, independent of gender. Future studies should explore whether interventions designed to enhance career support can improve WLI and well-being among physicians.

Abstract Purpose This study examines sense of belonging (belongingness) in a large population of medical students, residents, and fellows and associations with learner burnout, organizational recruitment retention indicators, and potentially modifiable learning environment factors. Method All medical students, residents, and fellows at Mayo Clinic sites were surveyed between October and November 2020 with items measuring sense of belonging in 3 contexts (school or program, organization, surrounding community), burnout (2 Maslach Burnout Inventory items), recruitment retention indicators (likelihood of recommending the organization and accepting a job offer), potentially modifiable learning environment factors, and demographics (age, gender, race and ethnicity, LGBTQ+ identification, disability, socioeconomic background). Results Of 2,257 learners surveyed, 1,261 (56%) responded. The percentage of learners reporting a somewhat or very strong sense of belonging was highest in the school or program (994 of 1,227 [81%]) followed by the organization (957 of 1,222 [78%]) and surrounding community (728 of 1,203 [61%]). In adjusted analyses, learners with very strong organization belongingness had lower odds of burnout (odds ratio [OR], 0.05; 95% CI, 0.02–0.12) and higher odds of being likely to recommend the organization (OR, 505.23; 95% CI, 121.54–2,100.18) and accept a job offer (OR, 38.68; 95% CI, 15.72–95.15; all P < .001). School or program and community belongingness also correlated strongly with these outcomes. In multivariable analyses, social support remained associated with higher odds of belongingness in all 3 contexts; favorable ratings of faculty relationships and leadership representation remained associated with higher odds of belongingness in 2 contexts (school or program and organization); and favorable ratings of diversity, equity, and inclusion learning climate remained associated with belongingness in 1 context (community). Conclusions Sense of belonging among medical students, residents, and fellows varies across contexts, correlates strongly with burnout and organizational recruitment retention indicators, and is associated with multiple potentially modifiable learning environment factors.