Elaine M. Zibrowski

Measuring Resident Well-Being: Impostorism and Burnout Syndrome in Residency

BackgroundAssessing resident well-being is becoming increasingly important from a programmatic standpoint. Two measures that have been used to assess this are the Clance Impostor Scale (CIS) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). However, little is known about the relationship between the two phenomena.ObjectivesTo explore the prevalence and association between impostorism and burnout syndrome in a sample of internal medicine residents.DesignAnonymous, cross-sectional postal survey.ParticipantsForty-eight internal medicine residents (postgraduate year [PGY] 1–3) at the Schulich School of Medicine & Dentistry (62.3% response rate).Measurements and Main ResultsShort demographic questionnaire, CIS and MBI-HSS. Impostorism and burnout syndrome were identified in 43.8% and 12.5% of residents, respectively. With the exception of a negative correlation between CIS scores and the MBI’s personal accomplishment subscale (r = −.30; 95% CI −.54 to −.02), no other significant relations were identified. Foreign-trained residents were more likely to score as impostors (odds ratio [OR] 10.7; 95% CI 1.2 to 98.2) while senior residents were more likely to experience burnout syndrome (OR 16.5 95% CI 1.6 to 168.5).ConclusionsBoth impostorism and burnout syndrome appear to be threats to resident well-being in our program. The lack of relationship between the two would suggest that programs and researchers wishing to address the issue of resident distress should consider using both measures. The finding that foreign-trained residents appear to be more susceptible to impostorism warrants further study.Assessing resident well-being is becoming increasingly important from a programmatic standpoint. Two measures that have been used to assess this are the Clance Impostor Scale (CIS) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). However, little is known about the relationship between the two phenomena. To explore the prevalence and association between impostorism and burnout syndrome in a sample of internal medicine residents. Anonymous, cross-sectional postal survey. Forty-eight internal medicine residents (postgraduate year [PGY] 1–3) at the Schulich School of Medicine & Dentistry (62.3% response rate). Short demographic questionnaire, CIS and MBI-HSS. Impostorism and burnout syndrome were identified in 43.8% and 12.5% of residents, respectively. With the exception of a negative correlation between CIS scores and the MBI’s personal accomplishment subscale (r = −.30; 95% CI −.54 to −.02), no other significant relations were identified. Foreign-trained residents were more likely to score as impostors (odds ratio [OR] 10.7; 95% CI 1.2 to 98.2) while senior residents were more likely to experience burnout syndrome (OR 16.5 95% CI 1.6 to 168.5). Both impostorism and burnout syndrome appear to be threats to resident well-being in our program. The lack of relationship between the two would suggest that programs and researchers wishing to address the issue of resident distress should consider using both measures. The finding that foreign-trained residents appear to be more susceptible to impostorism warrants further study.

Oscillatory fast wave activity in the rat pyriform cortex: relations to olfaction and behavior.

Bursts of rhythmical fast waves (> 1 mV, peak frequency approximately 16 Hz; mean frequency approximately 20 Hz) are elicited in the olfactory bulb and pyriform cortex in waking or urethane-anesthetized rats (1.25 g/kg, i.p.) by olfactory stimulation with organic solvents (xylene, toluene, methyl methacrylate, oil of turpentine) or components of anal gland secretions of rat predators (2-propylthietane, weasel; trimethyl thiazoline, red fox). These waves are specifically related to olfaction since they: (a) are blocked when the nares are sealed; (b) are not elicited by non-olfactory stimuli; (c) are unrelated to concurrent motor activity; and (d) can only be elicited in anesthetized-tracheotomized rats when an odorous airstream is drawn through the nasal passages. Pyriform fast waves appear to be somewhat specific to the odors of organic solvents and predators as other strong odors (ammonia, caproic and butyric acids, cadaverine) are ineffective. During natural sleep or after treatment with scopolamine hydrobromide, low voltage pyriform background activity is replaced by larger amplitude, irregular 1-20 Hz waves. The scopolamine-induced waves are not blocked by spontaneous motor activity. We suggest that the pyriform cortex, like the archicortex and the neocortex, receives a cholinergic activating input.

Rules of engagement: residents' perceptions of the in-training evaluation process.

Background In-training evaluation reports (ITERs) often fall short of their goals of promoting resident learning and development. Efforts to address this problem through faculty development and assessment-instrument modification have been disappointing. The authors explored residents’ experiences and perceptions of the ITER process to gain insight into why the process succeeds or fails. Method Using a grounded theory approach, semistructured interviews were conducted with 20 residents. Constant comparative analysis for emergent themes was conducted. Results All residents identified aspects of “engagement” in the ITER process as the dominant influence on the success of ITERs. Both external (evaluator-driven, such as evaluator credibility) and internal (resident-driven, such as self-assessment) influences on engagement were elaborated. When engagement was lacking, residents viewed the ITER process as inauthentic. Conclusions Engagement is a critical factor to consider when seeking to improve ITER use. Our articulation of external and internal influences on engagement provides a starting point for targeted interventions.

Pyriform cortex β-waves: odor-specific sensitization following repeated olfactory stimulation

The first exposure to the odors of carbon tetrachloride, isopentenyl methyl sulfide, methyl ethyl ketone, 2-propylthietane, salicylaldehyde, toluene, 2,4,5-trimethyl thiazoline, or xylene elicits a weakly developed 20 Hz wave response (beta-waves) in central olfactory structures in the rat. Repeated presentations of these odors produces a gradual enhancement or sensitization of olfactory beta-waves over 5-10 trials given in 1-3 min. The odors of 2-aminoacetophenone and 2-hydroxyacetophenone produce sensitization after an average of 15-17 presentations. The sensitized beta-wave response to the odors of 2-propylthietane and xylene persists for at least 5 days and probably much longer. Sensitization to one odor transfers partially or not at all to other novel odors even though repeated presentation of the new odor also produces sensitization. Since the initial negative response of the olfactory mucosa (presumably due to receptor depolarization) is not enhanced by repeated olfactory stimulation, it is presumed that the altered responsivity is due to synaptic changes in central olfactory structures such as the olfactory bulb or pyriform cortex. Finally, data are presented to show that behavioral antifeedant activity by an odorant does not invariably mean that the odorant has the ability to elicit an olfactory beta-wave response.

‘I don’t have time’: issues of fragmentation, prioritisation and motivation for education scholarship among medical faculty

Objectives  Although lack of time has been frequently cited as a barrier to scholarship, there has been little inquiry into what specific factors medical faculty staff perceive as contributing to this dilemma. The purpose of the present study was to explore, in greater detail, lack of time as a barrier for faculty interested in pursuing education scholarship.

Fast wave activity in the rat rhinencephalon: elicitation by the odors of phytochemicals, organic solvents, and a rodent predator

Recent research has shown that bursts of approximately 20 Hz fast waves are elicited in rhinencephalic cortex in rats by the odors of a number of different organic solvents and of components of the secretions of predators such as the weasel and the fox. We now show that a number of phytochemicals (benzyl alcohol, carvacrol, eucalyptol, and salicylaldehyde) will elicit fast wave bursts of about 20 Hz in the rat pyriform cortex. Additional organic solvents (carbon tetrachloride, chloroform, diethyl ether, 1, 2-dimethoxyethane, n-heptane, mesitylene, methylcyclohexane, and commercial gasoline and kerosene, but not N,N-dimethylformamide or dimethyl sulfoxide) and another component of fox secretions (isopentenylmethyl sulfide) were also effective. Many of these compounds will also elicit fast wave bursts of about 20 Hz in the dentate gyrus. The effectiveness of benzyl alcohol, camphor, carvacrol, eucalyptol, isopentenylmethyl sulfide, 2-propylthietane, salicylaldehyde, toluene, and trimethylthiazoline (all of which elicit rhinencephalic fast waves in rats) in suppressing feeding in various small herbivores suggests that the recording of odor-induced rhinencephalic fast waves may provide an easy means of identifying new antifeedants. We found no evidence that the bursts of 20-Hz activity seen in the rat rhinencephalon were kindling-induced seizure-like reactions of the olfactory brain to the vapors of toxic chemicals.

Education scholarship: it's not just a question of ‘degree’

Background: Although medical faculty are frequently encouraged to participate in education scholarship, there is a paucity of literature addressing how to support those who wish to do so. Aims: The purpose of this study was to explore faculty involvement in and support needs for pursuing education scholarship. Methods: A purposive sample of 108 medical faculty with an interest in medical education were invited to participate in a two-phase, mixed-methods study (survey and focus groups). Results: Seventy-three faculty (67.6%) completed the questionnaire with 16 subsequently participating in focus group sessions. Nearly 40% had enrolled in or completed formal education training. Although the majority had been involved in at least one education project during the past five years, few had received funding or published their work. Three support-related themes emerged: education research support; enhancing colleague interactions; and ongoing development activities. Three related barriers were identified: time, access to support staff, and knowledge of research methodology. No significant differences were identified between those with and without additional education training. Conclusions: Assisting faculty to participate in education scholarship is a complicated endeavor. Institutional supports should not be limited to those with advanced degrees nor rely on Master-level degree programs to provide all the necessary training.

The ability of various chemicals to elicit olfactory β-waves in the pyriform cortex of meadow voles (Microtus pennsylvanicus) and laboratory rats (Rattus norvegicus)

Previous research has shown that, in freely moving laboratory rats, the odors of benzyl alcohol, camphor, carvacrol, isopentenyl methyl sulfide, 2-propylthietane, salicylaldehyde, trimethylthiazoline, and xylene (plus other compounds) elicit high amplitude bursts of roughly 20-Hz waves (beta-waves) in the olfactory bulb and pyriform cortex. Since all these compounds are effective antifeedants in a variety of small herbivores, a more extensive test of the effect of the odor of a variety of antifeedants on pyriform cortex activity in meadow voles (Microtus pennsylvanicus) was undertaken. A beta-wave response was reliably elicited in the vole pyriform cortex by the odors of isopentenyl methyl sulfide (a component of fox odor), 2-propyl thietane (a component of stoat odor), and xylene but not by the odors of 29 other compounds. The results indicate: (a) that there are clear interspecific differences in the olfactory reactions of the pyriform cortex and (b) that not all antifeedants elicit beta-waves in the pyriform cortex.

Relying on others' reliability: challenges in clinical teaching assessment.

Background: The quality of the data generated from internally created faculty teaching instruments often draws skepticism. Strategies aimed at improving the reliability and validity of faculty teaching assessments tend to revolve around literature searches for a replacement instrument(s). Purpose: The purpose was to test this “search-and-apply” method and discuss our experiences with it within the context of observational assessment practice. Method: In a naturalistic pilot test, two previously validated faculty assessment instruments were paired with a global question. The reliability of both metrics was estimated. Results: Generalizability analyses indicated that for both pilot tested faculty teaching instruments, the global question was a more reliable measure of perceived clinical teaching effectiveness than a multiple-item inventory. Item analysis with Cronbachs coefficient alpha suggested redundant instrument content. Rater error accounted for the greatest proportion of the variance and straight-line responses occurred in approximately 28% of residents’ appraisals. Conclusions: The results of the present study draw attention to one of the common fallacies surrounding instrument-based assessment in medical education; the solution to improving ones assessment practice primarily involves identifying a previously published instrument from the literature. Academic centers need to invest in ongoing quality control efforts including the pilot testing of any proposed instruments.

Engaged at the extremes: residents' perspectives on clinical teaching assessment.

Purpose Although academic centers rely on assessments from medical trainees regarding the effectiveness of their faculty as teachers, little is known about how trainees conceptualize and approach their role as assessors of their clinical supervisors. Method In 2010, using a constructivist grounded theory approach, five focus group interviews were conducted with 19 residents from an internal medicine residency program. A constant comparative analysis of emergent themes was conducted. Results Residents viewed clinical teaching assessment (CTA) as a time-consuming task with little reward. They reported struggling throughout the academic year to meet their CTA obligations and described several shortcut strategies they used to reduce their burden. Rather than conceptualizing their assessments as a conduit for both formative and summative feedback, residents perceived CTA as useful for the surveillance of clinical supervisors at the extremes of the spectrum of teaching effectiveness. They put the most effort, including the crafting of written comments, into the CTAs of these outliers. Trainees desired greater transparency in the CTA process and were skeptical regarding the anonymity and perceived validity of their faculty appraisals. Conclusions Individual and system-based factors conspire to influence postgraduate medical trainees’ motivation for generating high-quality appraisals of clinical teaching. Academic centers need to address these factors if they want to maximize the usefulness of these assessments.