Lomholthatcher0401

The ISR group had significantly higher FAR level compared with the no-ISR group (73.26 ± 17.68 vs. 64.90 ± 15.88, P less then 0.05). Furthermore, the ISR group had significantly lower albumin level and higher prevalence of diabetes mellitus compared to no-ISR (P less then 0.05). In a multivariate analysis, FAR (odds ratio [OR] = 1.039, 95% confidence interval (CI) = 1.024-1.054), albumin (OR = 0.923, 95% CI = 0.389-0.977) and diabetes mellitus (OR = 2.663, 95% CI = 1.587-4.468) were significantly associated with ISR. CONCLUSION FAR is significantly associated with the development of ISR in CAD patients undergoing PCI with DES implantation.PURPOSE Postgraduate medical trainees experience high rates of burnout, however inconsistencies in definitions of burnout characterize this literature. The authors conducted a systematic review and meta-analysis examining burnout levels and patterns in postgraduate medical trainees, using a continuous conceptualization of burnout, consistent with the Maslach Burnout Inventory (MBI) framework. METHOD The authors searched 5 electronic databases (Cochrane Library, Embase, ERIC, Ovid MEDLINE, Ovid PsycINFO) between January 1981 and July 2019 for studies reporting postgraduate medical trainees' burnout levels using the MBI-Human Services Survey. They examined study reporting quality using the QualSyst quality appraisal tool and calculated standardized mean differences (Hedges' g), comparing trainees' data with MBI norms for medicine and the overall population using a random effects model. They explored between-study heterogeneity using subgroup analyses (i.e., by training level and specialty). Finally, they studiepulation using a multidimensional approach. Standardizing the definition of burnout in accordance with the MBI framework will facilitate progression of this work.Attempting to effect change in modern medicine, particularly as trainees or junior faculty, is often an overwhelming undertaking. While early-career physicians are in close contact with patients, they often lack the credibility or access to resources that are necessary to implement new ideas at large institutions. Although there may be scientific evidence to support new models of care, existing cultural patterns of practice can foster resistance to these interventions.The authors describe their own experience as residents reforming the management of endocarditis patients at an academic medical center, emphasizing the important role that residents can plain in changing medical practice. learn more Starting with a devastating patient case, the authors share their story of creating a multidisciplinary endocarditis team while navigating the many obstacles, some unseen, that can derail innovative ideas. Ultimately, through a combination of new perspectives, data-driven analysis, determination, and-most importantly-hope, the authors were able to dramatically improve outcomes for patients. Moving forward, their experience can serve as a model for young physicians and inspire them to effect change in their own institutions.PURPOSE A fundamental goal of medical education is supporting learners in forming a professional identity. While it is known that learners perceive clinical teachers to be critically important in this process, the latter's perspective is unknown. This study sought to understand how clinical teachers perceive their influence on the professional identity formation of learners. METHOD In 2017, a research assistant conducted 16 semistructured interviews of clinical teachers from 8 specialties at McGill University. The research assistant audiorecorded and subsequently transcribed interviews for analysis. Following principles of qualitative description, the research team developed a coding scheme using both inductive codes (from the words of the participants) and deductive codes (based on the literature and the theory of communities of practice). Through a cross-case analysis, the team then identified salient themes. RESULTS Participants struggled to describe their influence on learners' professional identity without first being prompted to focus on their own identity and its formation. Once prompted, clinical teachers reported viewing their personal and professional identities as integrated and believed that caring for patients was integral to forming their professional identity. They identified explicit role modeling, engaging in difficult conversations, and providing graded autonomy as ways in which they could influence the identity development of learners. However, they had difficulty discerning the magnitude of their influence. CONCLUSIONS This study was the first to explore professional identity formation from the perspective of clinical teachers. The 2010 Carnegie Foundation report called for an increased focus on professional identity formation. Giving clinical teachers the space and guidance to reflect on this process, helping them make the implicit explicit, and supporting them in using their own experiences as learners to inform their teaching, appear to be critical steps in achieving this goal.PURPOSE To examine common themes and synthesize data surrounding pregnancy and parenthood during surgical residency training. METHOD The authors conducted a systematic search of the literature in March 2019. They searched MEDLINE, EMBASE, and Scopus, seeking articles published from 2003-2018 that focused on pregnancy, parenthood, and the experience of surgical residents. They excluded articles that examined non-surgical programs, as well as editorials, abstracts, and commentaries. Two investigators independently reviewed all citations, selected articles for full-text review, and extracted data from the selected articles. RESULTS Of 523 titles and abstracts screened, 27 were included. Overall, female surgical residents had fewer children during residency training than their male counterparts (18-28% vs 32-54%). As compared to the general population, surgical residents had their first child later in life (30-34 vs 25 years old), and had fewer children overall (0.6-2.1 vs 2.7). Infertility rates were higher among female surgeons than in the general population (30-32% vs 11%), as were assisted reproductive technology rates (8-13% vs 1.7%). Pregnant surgical residents experienced a high rate of obstetrical complications; working more than 6 calls shifts per month or 60 hours per week were predictors of increased complication rates. The authors noted no differences in attrition, caseload, or exam pass rates amongst female surgical residents who had become pregnant as compared to other residents. Despite these similar academic outcomes, negative attitudes and perceptions towards pregnancy during residency were consistently identified. CONCLUSIONS Female surgical residents experience high rates of infertility and obstetrical complications, contend with negative attitudes and stigma during their pregnancies, and voluntarily delay childbearing. Formal maternity policies, a shift in surgical culture, and ongoing discussion with all stakeholders are needed to attract and retain female surgical residents.