The Positive Impact of a Novel Air Purification Technology on Environmental and Clinical Outcomes

Reducing sources of illness improves resident care. An advanced air purification technology (AAPT) was designed to destroy the DNA and RNA of all bacteria, fungi and viruses, rendering them non-infectious and to remediate volatile organic compounds (VOCs). This study compares the biological, fungal and VOC loading using the AAPT to standard high efficiency particulate air (HEPA) filtration. It was hypothesized that the AAPT would be associated with reductions in airborne and surface pathogens, VOCs and improved clinical metrics. A control floor with HEPA filtration and study floor with AAPT remediation were studied. Measurements of total VOCs and airborne and surface bacteria and fungi were measured in five locations on each floor. The facility acquired infection (FAI) rate, the number of infections divided by total patient days, showed a 57% difference between the control floor (2.33 FAIs/month) and the study floor (1.00 FAIs/month) and a decrease of 39.75% pre-installation (1.66 FAIs/month) to post-installation (1.00 FAIs/month). The viable pathogen loading measured on the study floor was reduced from an average of 483.8 colony forming units (CFU)/m3 pre-installation to an average of 56 CFU/m3 post-installation. VOCs were reduced from an average of 641.66 parts per billion (PPB) to 64.96 PPB and viable surface bacteria from an average of 110.6 CFU/m3 to 97.2 CFU/m3. The AAPT significantly reduced levels of infectious airborne and surface pathogens and VOC levels. As a result, residents on the AAPT floor demonstrated significant improvements in FAI rates. The findings support the hypothesis that environmental factors impact resident wellness.

For the People and the Profession

In 1982 Dean Warren delivered the presidential address “Not for the Profession… For the People” in which he identified substandard surgical residency programs graduating residents who were unable to pass American Board of Surgery exams. Drs. Warren and Shires as members of the independent ACGME began to close the substandard programs in order to improve surgical care for average Americans i.e. “for the people”. By 2003 these changes dramatically reduced the failure rate for the ABS exams and trained good surgeons who could operate independently however the residents were on duty for every other or every third night. In 2003 the ACGME mandated duty hour restrictions in order improve resident wellness and improve the training environment for the profession. However, work hour restrictions reduced the time surgical residents spent in the hospital environment primarily when residents had more autonomy and had exposure to emergency cases which degraded readiness for independent practice. Surgical educators in the 2 decades after the work hour restrictions have improved techniques of training so graduates could not only pass the board exams but also be prepared for independent practice. Surgical residency training has improved by both the changes implemented by the independent ACGME in 1981 and by the work hour restrictions mandated in 2003. Five recommendations are made to ensure that Dr Warren's culture of excellence in surgical training continues in an environment that enhances wellbeing of the trainee i.e. “For the People and the Profession”.

Improving physician wellness through electronic health record education

Objective Our goal is to improve the wellness of our Family Medicine residents now and in the future by educating them on more efficient use of our electronic health record (EHR). Resident physician burnout is a significant problem and is correlated with time spent using an EHR after work hours. Family physicians have the highest rate of burnout of all specialties, and the EHR is a significant contributor to this burnout. Studies have shown that increased EHR education can improve job satisfaction. Method Over 5 months, we provided weekly brief (15 minute) educational sessions covering 6 topics twice and a one-hour individualized meeting of each resident physician with an EHR trainer. We evaluated our intervention with wellness surveys and objective measures of EHR efficiency both pre and post intervention. We further evaluated efficiency by comparing pre and post-intervention values of the following: average keystrokes, mouseclicks, accelerator use, minutes per encounter and percent closed encounters at month’s end. Results Resident questionnaires showed lessons increased knowledge and intention to use EHR accelerators, but this was not statistically significant. Analysis of objective data showed most efficiency metrics worsened, though most not to a degree that was statistically significant. Residents reported subjective increases in efficiency, and paired data from wellness surveys showed an overall decrease in burnout post-intervention vs. baseline. Conclusions Much of the data in this pilot study does not reach statistical significance, but is highly suggestive that increased EHR training can improve at least perceived efficiency and thereby resident wellness.

Job Satisfaction Among Plastic Surgery Residents in Canada: A National Survey

Objective: Resident wellness is a focus of medical training and is prioritized in both Canadian and American accreditation processes. Job satisfaction is an important component of wellness that is not examined in the literature. The purpose of this study was to analyze job satisfaction in a national sample of plastic surgery residents, and identify factors that influence satisfaction. Methods: We designed a cross-sectional survey adapted from existing instruments, with attention to thorough item generation and reduction as well as pilot and clinical sensibility testing. All plastic surgery residents at Canadian institutions were surveyed regarding overall job satisfaction as well as personal- and program-specific factors that may affect satisfaction. Predictors of satisfaction were identified using multivariable regression models. Results: The response rate was 40%. Median overall job satisfaction was 4.0 on a 5-point Likert scale. Operative experience was considered both the most important element of a training program, and the area in most need of improvement. Senior training year ( P < .01), shorter commute time ( P = .04), fewer duty hours ( P = .02), fewer residents ( P < .01), and more fellows ( P < .01) were associated with significantly greater job satisfaction. Conclusions: This is the first study to gather cross-sectional data on job satisfaction from a national sample of plastic surgery residents. The results from this study can inform programs in making tangible changes tailored to their trainees’ needs. Moreover, our findings may be used to inform a prospectively studied targeted intervention to increase job satisfaction and resident wellness to address North American accreditation standards.

Targeted Wellness Initiatives Are Most Effective for Reducing Otolaryngology Resident Burnout

Objective: Investigate the effect of a targeted wellness program on burnout in Otolaryngology residents. Methods: Residents and faculty collaboratively developed a program aimed at improving resident wellness. Program implementation began in July of 2018 and after 1 year, residents evaluated the program’s effects on burnout. We used the Maslach Burnout Inventory (MBI) and a Likert scale to evaluate the effects of the program. Results: After 1 year of the resident wellness program, the MBI results showed an increase in the number of residents in the “engaged” category and a decrease in those rated as “burnout.” Residents rated favorably initiatives grouped into the following themes: time away from work, faculty engaging with residents outside of the hospital environment, efforts to enhance residents’ self-efficacy, fostering a positive culture among residents, and providing easy access to physical activity. The majority of initiatives were targeted to the “culture of wellness” domain, as defined by the Stanford Well MD framework. Our program targeted to a lesser extent the other 2 domains, “efficiency of practice” and “personal resilience.” Conclusion: After 1 year, the wellness program resulted in a trend toward improving burnout. Future efforts should be focused on targeting the multidimensional drivers of burnout as defined by established wellness frameworks. Realizing new stressors brought on by the COVID-19 pandemic will also be an area of active effort and research.