Daniel Z. Fang

Depression in Asian–American and Caucasian undergraduate students

BACKGROUND Depression is a serious and often under-diagnosed and undertreated mental health problem in college students which may have fatal consequences. Little is known about ethnic differences in prevalence of depression in US college campuses. This study compares depression severity in Asian-American and Caucasian undergraduate students at the University of California San Diego (UCSD). METHODS Participants completed the nine item Patient Health Questionnaire and key demographic information via an anonymous online questionnaire. RESULTS Compared to Caucasians, Asian-Americans exhibited significantly elevated levels of depression. Furthermore, Korean-American students were significantly more depressed than Chinese-American, other minority Asian-American, and Caucasian students. In general, females were significantly more depressed than males. Results were upheld when level of acculturation was considered. LIMITATIONS The demographic breakdown of the student population at UCSD is not representative to that of the nation. CONCLUSIONS These findings suggest that outreach to female and Asian-American undergraduate students is important and attention to Korean-American undergraduates may be especially worthwhile.

Burnout in Premedical Undergraduate Students

BackgroundThere has been growing recognition that medical students, interns, residents and practicing physicians across many specialties are prone to burnout, with recent studies linking high rates of burnout to adverse mental health issues. Little is known about the trajectory and origins of burnout or whether its roots may be traced to earlier in medical training, specifically, during undergraduate studies. Here, the authors surveyed undergraduates at UC San Diego (UCSD) to assess the relationship of burnout to premedical status while controlling for depression severity.MethodsUndergraduate students at UCSD were invited to participate in a web-based survey, consisting of demographic questions; the Maslach Burnout Inventory Student Survey (MBI-SS), which gauged the three dimensions of burnout; and the nine-item Patient Health Questionnaire (PHQ-9), to assess depression severity.ResultsA total of 618 premedical students and 1,441 non-premedical students completed the questionnaire. Premedical students had greater depression severity and emotional exhaustion than non-premedical students, but they also exhibited a greater sense of personal efficacy. The burnout differences were persistent even after adjusting for depression. Also, premedical women and Hispanic students had especially high levels of burnout, although differences between groups became nonsignificant after accounting for depression.ConclusionDespite the limitations of using a burnout questionnaire not specifically normed for undergraduates, the unique ethnic characteristics of the sample, and the uncertain response rate, the findings highlight the importance of recognizing the unique strains and mental health disturbances that may be more common among premedical students than non-premedical students. Results also underscore the close relationship between depression and burnout, and point the way for subsequent longitudinal, multi-institutional studies that could help identify opportunities for prevention and intervention.

Cost and turn-around time display decreases inpatient ordering of reference laboratory tests: a time series

Objective Reference tests, also known as send-out tests, are commonly ordered laboratory tests with variable costs and turn-around times. We aim to examine the effects of displaying reference laboratory costs and turn-around times during computerised physician order entry (CPOE) on inpatient physician ordering behaviour. Design We conducted a prospective observational study at a tertiary care hospital involving inpatient attending physicians and residents. Physician ordering behaviour was prospectively observed between September 2010 and December 2012. An intervention was implemented to display cost and turn-around time for reference tests within our CPOE. We examined changes in the mean number of monthly physician orders per inpatient day at risk, the mean cost per order, and the average turn-around time per order. Results After our intervention, the mean number of monthly physician orders per inpatient day at risk decreased by 26% (51 vs 38, p<0.0001) with a decrease in mean cost per order (US

Depression in Premedical Undergraduates: A Cross-Sectional Survey

146.50 vs US

Erratum to Burnout in Premedical Undergraduate Students.

134.20, p=0.0004). There were no significant differences in mean turn-around time per order (5.6 vs 5.7 days, p=0.057). A stratified analysis of both cost and turn-around time showed significant decreases in physician ordering. The intervention projected a mean annual savings of US

Quality improvement in academic medical centres: a resident perspective

330 439. Reference test cost and turn-around time variables were poorly correlated (r=0.2). These findings occurred in the setting of non-significant change to physician ordering in a control cohort of non-reference laboratory tests. Conclusions Display of reference laboratory cost and turn-around time data during real-time ordering may result in significant decreases in ordering of reference laboratory tests with subsequent cost savings.

Use of a Hands Free, Instantaneous, Closed-Loop Communication Device Improves Perception of Communication and Workflow Integration in an Academic Teaching Hospital: A Pilot Study

BACKGROUND Medical students and residents are known to have high rates of depression, a common stress-related challenge that impairs quality of life and job satisfaction and predisposes those affected to general medical illness. Our primary hypothesis was that premedical students would exhibit greater depressive symptoms than nonpremedical students. A secondary aim was to explore the interactions of premedical student status with gender and ethnicity in the context of depression. METHOD In this cross-sectional study 647 premedical and 1,495 nonpremedical undergraduates at the University of California, San Diego, were surveyed to examine whether seeds of depression can be identified even before formal medical training. Participants completed a series of demographic questions along with the 9-item Patient Health Questionnaire to gauge depression intensity. The survey was made available online for a period of 3 months from March 2009-June 2009. RESULTS Premedical students were more likely to meet screening criteria suggestive of the presence of major depressive disorder and to exhibit more severe depression than nonpremedical students. Female premedical students exhibited greater depression than female nonpremedical students and males in general. Hispanic premedical students, in particular, had a greater prevalence of depression and greater intensity of depressive symptoms than other premedical students and Hispanic nonpremedical students. No differences were found in current, past, or family history between premedical and nonpremedical students. CONCLUSIONS These findings underscore the importance of understanding the unique strains and mental health consequences of a premedical curriculum, especially for women and certain minority ethnic populations. A meaningful next step would be a larger study, conducted by several representative university campuses, to confirm these findings; a follow-up of these cohorts could track longitudinal progress. More research must be done to determine the etiology of these findings with the ultimate intention of identifying opportunities for prevention and early intervention, which may provide significant public health payoffs in the long run.

Impact of problem-based charting on the utilization and accuracy of the electronic problem list

tients. Acad Med 2002; 77:438–445 20. Kerns JW, Krist AH, Woolf SH, et al: Patient perceptions of how physicians communicate during prostate cancer screening discussions: a comparison of residents and faculty. Family Med 2008; 40:181–187 21. Sloan DA, Donnelly MB, Johnson SB, et al: Assessing surgical residents’ and medical students’ interpersonal skills. J Surg Res 1994; 57:613–618 22. Langewitz WA, Eich P, Kiss A, et al: Improving communication skills: a randomized, controlled, behaviorally-oriented intervention study for residents in internal medicine. Psychosom Med 1998; 60:268–276 23. Testerman JK, Morton KR, Loo LK, et al: The natural history of cynicism in physicians. Acad Med 1996; 71:S43–S45 24. Roter D, Larson S: The Roter Interaction Analysis System (RIAS): utility and flexibility for analysis of medical interactions. Patient Educ Couns 2002; 46:243–251 25. Hales DJ, Delanoche N: Resident census: characteristics and distribution of psychiatry residents in the U.S. Washington, D.C., American Psychiatric Association: Office of Education, 2008–2009 26. Roter DL, Hall JA, Katz NR: Patient–physician communication: a descriptive summary of the literature. Patient Educ Couns 1988; 12:99–119 27. Isikawa H, Roter DL, Yamazaki Y, et al: Physician–elderly patient-companion communication and roles of companions in Japanese geriatric encounters. Soc Science Med 2005; 60:2307–2320 28. Bensing JM, Roter DL, Hulsman RL: Communication patterns of primary-care physicians in the United States and The Netherlands. J Gen Intern Med 2003; 18:335–342 29. Mojtabai R, Olfson M: National trends in psychotherapy by office-based psychiatrists. Arch Gen Psychiatry 2008; 65: 962–970 30. Roter DL, Larson S: The relationship between residents’ and attending physicians’ communication during primary-care visits: an illustrative use of the Roter Interaction Analysis System. Health Commun 2001; 13:33–48 31. Roter DL, Stewart M, Putnam SM, et al: Communication patterns of primary-care physicians. JAMA 1997; 277:350– 356 32. Hall J, Roter D, Katz N: Meta-analysis of correlates of provider behavior in medical encounters. Med Care 1988; 26: 657–675 33. Makoul G: Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med 2001; 76:390–393 34. Simpson M, Buckman R, Stewart M, et al: Doctor–patient communication: The Toronto Consensus Statement. BMJ 1991; 303:1385–1387 35. Sanson-Fisher RW, Fairbairn S, Maguire P: Teaching skills in communication to medical students: a critical review of the methodology. Med Educ 1981; 15:33–37

A high value care curriculum for interns: a description of curricular design, implementation and housestaff feedback

My pager goes off. It’s the nurse worried about my sick patient in room 143 who spiked another fever overnight and is becoming more tachycardic. I ask my intern to evaluate and consider broadening the antibiotic coverage. Looking over our list, I notice there are still 12 patients to see: 4 potential discharges, 3 overnight admissions and 5 others. My pager beeps again and its the emergency department (ED) calling for another admission. I look at the clock and notice its 8:05. Attending rounds begin in 55 min. Just under 11 h left in the call day. I run to the ED to triage the new admission, passing by our quality improvement board for inpatient medicine. Its packed with information: charts and graphs depicting length of stay, hand washing, patient satisfaction and infection control. Our progress interests me greatly, but I seldom have a moment to look at the board given the time pressures of my daily work. Downstairs in the ED, I interview and examine the patient, diagnosing decompensated heart failure. I enter admission orders quickly, starting a diuretic so we don’t waste time. It has been the new standard work to place orders for an inpatient admission within 1 h of an ED call in an effort to improve the patient experience and expedite movement from the ED to the medicine ward. I know this target well because I was the resident representative during our recent quality improvement workshop on decreasing patient wait times in the ED. During this activity, we were educated in the use of Lean, one of many powerful tools for process improvement.1 Lean starts with understanding the ‘current state’ of a system and outlining an ideal ‘future state’ followed by transitioning towards that ideal through a series of stepwise experiments using the scientific method. Lean has …

Why providers transfuse blood products outside recommended guidelines in spite of integrated electronic best practice alerts.

Efficient and effective communication between providers is critical to quality patient care within a hospital system. Hands free communication devices (HFCD) allow instantaneous, closed-loop communication between physicians and other members of a multidisciplinary team, providing a communication advantage over traditional pager systems. HFCD have been shown to decrease emergency room interruptions, improve nursing communication, improve speed of information flow, and eliminate health care waste. We evaluated the integration of an HFCD with an existing alphanumeric paging system on an acute inpatient medicine service. We conducted a prospective, observational, survey-based study over twenty-four weeks in an academic tertiary care center with attending physicians and residents. Our intervention involved the implementation of an HFCD alongside the existing paging system. Fifty-six pre and post surveys evaluated the perception of improvement in communication and the integration of the HFCD into existing workflow. We saw significant improvements in the ability of an HFCD to help physicians communicate thoughts clearly, communicate thoughts effectively, reach team members, reach ancillary staff, and stay informed about patients. Physicians also reported better workflow integration during admissions, rounds, discharge, and teaching sessions. Qualitative data from post surveys demonstrated that the greatest strengths of the HFCD included the ability to reach colleagues and staff quickly, provide instant access to individuals of the care team, and improve overall communication. Integration of an instantaneous, hands free, closed loop communication system alongside the existing pager system can provide improvements in the perceptions of communication and workflow integration in an academic medicine service. Future studies are needed to correlate these subjective findings with objective measures of quality and safety.