Anesthesiologists Become ICU Attending Physicians During the Delta Variant Surge

Abstract Background More and more female residents enter postgraduate medical training (PGMT). Meanwhile, women are still underrepresented in academic medicine, in leadership positions and in most surgical specialties. This suggests that female residents’ career development may still be negatively impacted by subtle, often unconscious stereotype associations regarding gender and career-ambition, called implicit gender-career bias. This study explored the existence and strength of implicit gender-career bias in doctors who currently work in PGMT, i.e. in attending physicians who act as clinical trainers and in their residents. Methods We tested implicit gender-career bias in doctors working in PGMT by means of an online questionnaire and an online Implicit Association Test (IAT). We used standard IAT analysis to calculate participants’ IAT D scores, which indicate the direction and strength of bias. Linear regression analyses were used to test whether the strength of bias was related to gender, position (resident or clinical trainer) or specialty (non-surgical or surgical specialty). Results The mean IAT D score among 403 participants significantly differed from zero (D-score = 0.36 (SD = 0.39), indicating bias associating male with career and female with family. Stronger gender-career bias was found in women (βfemale =0 .11; CI 0.02; 0.19; p = 0.01) and in residents (βresident 0.12; CI 0.01; 0.23; p = 0.03). Conclusions This study may provide a solid basis for explicitly addressing implicit gender-career bias in PGMT. The general understanding in the medical field is that gender bias is strongest among male doctors’ in male-dominated surgical specialties. Contrary to this view, this study demonstrated that the strongest bias is held by females themselves and by residents, independently of their specialty. Apparently, the influx of female doctors in the medical field has not yet reduced implicit gender-career bias in the next generation of doctors, i.e. in today’s residents, and in females.

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Empathy Can Be Taught, and Patients Teach it Best

Journal of Medical Education and Curricular Development ◽

10.1177/23821205211000346 ◽

2021 ◽

Vol 8 ◽

pp. 238212052110003

Author(s):

Sudhagar Thangarasu ◽

Gowri Renganathan ◽

Piruthiviraj Natarajan

Keyword(s):

Medical Education ◽

Graduate Medical Education ◽

Core Competencies ◽

Core Competency ◽

Role Modeling ◽

Residency Programs ◽

Graduate Medical ◽

Mixed Messages ◽

Attending Physicians ◽

Medical Education Curriculum

Empathy toward patients is an essential skill for a physician to deliver the best care for any patient. Empathy also protects the physician from moral injury and decreases the chances for malpractice litigations. The current graduate medical education curriculum allows trainees to graduate without getting focused training to develop empathy as a core competency domain. The tools to measure empathy inherently lack validity. The accurate measure of the provider’s empathy comes from the patient’s perspectives of their experience and their feedback, which is rarely reaching the trainee. The hidden curriculum in residency programs gives mixed messages to trainees due to inadequate role modeling by attending physicians. This narrative style manuscript portrays a teachable moment at the bedside vividly. The teaching team together reflected upon the lack of empathy, took steps to resolve the issue. The attending demonstrated role modeling as an authentic and impactful technique to teach empathy. The conclusion includes a proposal to include the patient’s real-time feedback to trainees as an essential domain under Graduate Medical Education core competencies of professionalism and patient care.

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A qualitative assessment of the diagnosis and management of ventilator-associated pneumonia among critical care clinicians exploring opportunities for diagnostic stewardship

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.130 ◽

2021 ◽

pp. 1-7

Author(s):

Blaine Kenaa ◽

Lyndsay M. O’Hara ◽

Mary Elizabeth Richert ◽

Jessica P. Brown ◽

Carl Shanholtz ◽

...

Keyword(s):

Tertiary Care ◽

Qualitative Assessment ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Sample Collection ◽

Respiratory Sample ◽

Identification Of Bacteria ◽

Attending Physicians ◽

Work Up ◽

Radiographic Changes

Abstract Background: Prompt diagnosis and intervention for ventilator-associated pneumonia (VAP) is critical but can lead to overdiagnosis and overtreatment. Objectives: We investigated healthcare provider (HCP) perceptions and challenges associated with VAP diagnosis, and we sought to identify opportunities for diagnostic stewardship. Methods: We conducted a qualitative study of 30 HCPs at a tertiary-care hospital. Participants included attending physicians, residents and fellows (trainees), advanced practice providers (APPs), and pharmacists. Interviews were composed of open-ended questions in 4 sections: (1) clinical suspicion and thresholds for respiratory culture ordering, (2) preferences for respiratory sample collection, (3) culture report interpretation, and (4) VAP diagnosis and treatment. Interviews transcripts were analyzed using Nvivo 12 software, and responses were organized into themes. Results: Overall, 10 attending physicians (75%) and 16 trainees (75%) trainees and APPs believed they were overdiagnosing VAP; this response was frequent among HCPs in practice 5–10 years (91%, n = 12). Increased identification of bacteria as a result of frequent respiratory culturing, misinterpretation of culture data, and fear of missing diagnosis were recognized as drivers of overdiagnosis and overtreatment. Although most HCPs rely on clinical and radiographic changes to initiate work-up, the fear of missing a diagnosis leads to sending cultures even in the absence of those changes. Conclusions: HCPs believe that VAP overdiagnosis and overtreatment are common due to fear of missing diagnosis, overculturing, and difficulty distinguishing colonization from infection. Although we identified opportunities for diagnostic stewardship, interventions influencing the ordering of cultures and starting antimicrobials will need to account for strongly held beliefs and ICU practices.

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Perceptions of Antimicrobial Stewardship among Infectious Disease Physicians at Two Affiliated Teaching Hospitals

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.962 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s346-s348

Author(s):

Katharina Rynkiewich ◽

David Schwartz ◽

Sarah Won ◽

Brad Stoner

Keyword(s):

Infectious Disease ◽

Qualitative Analysis ◽

Antimicrobial Stewardship ◽

Ethnographic Study ◽

Teaching Hospitals ◽

Prescribing Behavior ◽

Doctoral Candidate ◽

Stewardship Program ◽

Primary Service ◽

Attending Physicians

Background: Two affiliated teaching hospitals in Chicago, Illinois, participated in an ethnographic study of hospital-based inpatient antimicrobial stewardship programs and interventions between 2017 and 2018. Although antimicrobial stewardship is now a requirement in medical practice, it is not clear how infectious disease physicians perceive and understand antimicrobial stewardship. Over a period of 18 months, we directly observed infectious disease practice to better understand how antimicrobial stewardship is conducted among physicians within the same specialty. Methods: A doctoral candidate medical anthropologist conducted semistructured interviews with infectious disease attending physicians and fellow physicians (N = 18) at 2 affiliated teaching hospitals in Chicago, IL, between July 2017 and March 2018 as part of an ethnographic study involving direct observation of inpatient care. Interview questions focused on 3 key domains: (1) descriptions of antimicrobial use among hospital-based physicians, (2) solicited definitions of antimicrobial stewardship, and (3) experiences practicing as an infectious disease consultant. Physicians who were directly involved with the antimicrobial stewardship program were excluded from this analysis. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Infectious disease physicians have a robust understanding of antimicrobial stewardship (Table 1). Infectious disease physicians described other hospital-based physicians as regularly overusing and misusing antimicrobials, compared with their practice, which they described as “thoughtful.” Definitions in response to the question “What is antimicrobial stewardship?” centered on guiding the prescribing behavior of others. Infectious disease physicians valued stewardship and were concerned with lack of adherence to antimicrobial prescribing recommendations among other hospital-based physicians, behaviors which infectious disease physicians viewed as perpetuating antibiotic resistance. Finally, infectious disease physicians found serving as antimicrobial stewards during their everyday practice to be challenging based on their role as consultants to the primary service. Conclusions: Our qualitative analysis revealed that infectious disease physicians not regularly involved in antimicrobial stewardship are highly motivated stewards who perceive their hospital-based colleagues to be less effective at appropriately prescribing antimicrobials. As consultants, infectious disease physicians are not autonomous decision makers. However, as antimicrobial stewardship programs search for champions, infectious disease physicians could be better utilized as knowledgeable and motivated individuals who can make the case for stewardship.Funding: NoneDisclosures: None

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Artificial Intelligence in Biomedicine: A Legal Insight

BioTech ◽

10.3390/biotech10030015 ◽

2021 ◽

Vol 10 (3) ◽

pp. 15

Author(s):

Takis Vidalis

Keyword(s):

Artificial Intelligence ◽

Personal Data ◽

Health Data ◽

The Self ◽

Data Handling ◽

Direct Control ◽

Eu Legislation ◽

Attending Physicians ◽

Self Learning ◽

The Eu

The involvement of artificial intelligence in biomedicine promises better support for decision-making both in conventional and research medical practice. Yet two important issues emerge in relation to personal data handling, and the influence of AI on patient/doctor relationships. The development of AI algorithms presupposes extensive processing of big data in biobanks, for which procedures of compliance with data protection need to be ensured. This article addresses this problem in the framework of the EU legislation (GDPR) and explains the legal prerequisites pertinent to various categories of health data. Furthermore, the self-learning systems of AI may affect the fulfillment of medical duties, particularly if the attending physicians rely on unsupervised applications operating beyond their direct control. The article argues that the patient informed consent prerequisite plays a key role here, not only in conventional medical acts but also in clinical research procedures.

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Patients' Understanding of the Roles of Interns, Residents, and Attending Physicians in the Emergency Department

Academic Emergency Medicine ◽

10.1111/j.1553-2712.1999.tb00399.x ◽

1999 ◽

Vol 6 (4) ◽

pp. 339-344 ◽

Cited By ~ 36

Author(s):

Robin R. Hemphill ◽

Sally A. Santen ◽

C. Bart Rountree ◽

Andrew R. Szmit

Keyword(s):

Emergency Department ◽

Attending Physicians

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Teaching humanism on the wards: What patients value in outstanding attending physicians

Journal of Communications In Healthcare ◽

10.1179/175380710x12870623776559 ◽

2010 ◽

Vol 3 (3-4) ◽

pp. 291-299 ◽

Cited By ~ 2

Author(s):

Peter F. Weissmann ◽

Paul Haidet ◽

William T. Branch ◽

Catherine Gracey ◽

Richard Frankel

Keyword(s):

Attending Physicians

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Effects of Varying Inpatient Attending Physician Rotation Length on Medical Students’ and Attending Physicians’ Perceptions of Teaching Quality

Teaching and Learning in Medicine ◽

10.1080/10401334.2011.536889 ◽

2011 ◽

Vol 23 (1) ◽

pp. 37-41 ◽

Cited By ~ 5

Author(s):

D. Michael Elnicki ◽

Amanda Cooper

Keyword(s):

Medical Students ◽

Teaching Quality ◽

Rotation Length ◽

Perceptions Of Teaching ◽

Attending Physician ◽

Attending Physicians

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Comparison of Pterygium Recurrence Rates Between Attending Physicians and Supervised Trainee Residents

Cornea ◽

10.1097/ico.0000000000002721 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

John P. Thompson ◽

Zach Harbin ◽

Hrishikesh Das ◽

Lauren A. Deschner ◽

Stephanie A. Seale ◽

...

Keyword(s):

Recurrence Rates ◽

Attending Physicians

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Abstract 192: Pressure Methods for Primary Hemorrhage Control

Circulation ◽

10.1161/circ.138.suppl_2.192 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Nathan P Charlton ◽

Robert Solberg ◽

Justin Rizer ◽

Eunice Singletary ◽

William Woods

Keyword(s):

Statistical Significance ◽

Medical Personnel ◽

Convenience Sample ◽

Comparable Amount ◽

Right Hand ◽

Manual Pressure ◽

Direct Pressure ◽

Primary Hemorrhage ◽

The Right ◽

Attending Physicians

Introduction: Hemorrhage is the primary cause of death in 35% of traumatic mortalities. However, guidelines give little guidance regarding the best method of applying direct pressure including the mechanics of applying the pressure. Hypothesis: The purpose of this study is to compare the force generated using different techniques of force application. Additionally, we aimed to measure the pressure generated by a pressure wrap using two commonly used types of bandages in comparison to manual pressure. Methods: In this IRB approved study, subjects were recruited as a convenience sample of medical providers during a weekly medical conference. A standardized bleeding simulator (Z-Medica) with a flat force sensitive resistor was used in this study to measure force. Subjects were randomized to application order of each of the following techniques: the finger pads of 3 digits of the right hand, 3 fingers of the right hand with the opposing hand applying counter pressure, or 3 digits of each of two hands on top of the other. The subjects were asked to hold pressure at each application for 10 seconds and all completed each method sequentially. Subjects then applied a compression wrap using either an elastic wrap or self-adhesive wrap. Researchers were not blinded during data collection, but data analysts were blinded to the groups. Results: Thirty-three subjects were enrolled and all had data available for analysis. Twenty-two were residents, 11 attending physicians, 22 were male, and the average age was 34.2 years (range 26-63). Two hand pressure application generated the most amount of force averaging a constant of 3.75 (SD 1.54) lbs. This was statistically different from one hand application which generated an average of 3.00 (SD 1.29) lbs of force (p <0.001). Comparison of opposing hands to single hand and two hands to opposing hands did not reach statistical significance. Neither pressure wrap technique generated a comparable amount of force to that of manual pressure [0.70 (SD 0.49) lbs vs 1 hand with 10 4x4” gauze pads (p <0.001)]. Conclusions: In this model of bleeding, medical personnel generated the most force when two hands were used to apply pressure over the wound. This study also demonstrated direct manual pressure generated much higher pressures than a pressure dressing.

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