Michael H. Gendel

Can admissions interviews predict performance in residency

ObjectiveThe authors aim to determine whether admission interviews predict performance in residency.MethodsThe authors determined whether interview and other admission data were correlated with performance during postgraduate years 2–4 and with remaining in the residency in 544 residents enrolled in a single psychiatry residency program between 1963 and 2004.ResultsConsidered together, admissions data predicted 13% of the variance in performance ratings in postgraduate year 2 (PGY-2) and 5% in PGY-4. Interview scores were moderately correlated with performance ratings in PGY-2, modestly correlated with performance in PGY-3, and not correlated with performance ratings in PGY-4. Letters of reference were moderately correlated with performance ratings in PGY-2 and modestly correlated with performance in PGY-3 and PGY-4. In PGY-2, interview scores differentiated between the top quartile of performance and the other three quartiles, while letters of reference differentiated performance in the top and bottom quartiles from the middle quartiles. Numerical differences among groups were not great enough to be practically useful, and no variables predicted which residents would leave the program before completing it.ConclusionAs they are currently conducted, application interviews do not have sufficient power to predict performance during residency. Letters of reference may be useful to the extent that they reflect personal experience with the applicant, but differences in ratings of these letters are not great enough to base admission decisions on them. As it is currently performed, the interview process may be more useful as a means of interesting applicants in the program than of evaluating their potential for success in the residency.

Self-prescribed and other informal care provided by physicians: scope, correlations and implications

Background While it is generally acknowledged that self-prescribing among physicians poses some risk, research finds such behaviour to be common and in certain cases accepted by the medical community. Largely absent from the literature is knowledge about other activities doctors perform for their own medical care or for the informal treatment of family and friends. This study examined the variety, frequency and association of behaviours doctors report providing informally. Informal care included prescriptions, as well as any other type of personal medical treatment (eg, monitoring chronic or serious conditions). Method A survey was sent to 2500 randomly-selected physicians in Colorado, 600 individuals returned questionnaires with usable data. The authors hypothesised: (1) physicians would prescribe the same types of treatment at home as they prescribed professionally; and (2) physicians who informally prescribed addictive medications would be more likely to engage in other types of informal medical care. Results Physicians who wrote prescriptions for antibiotics, psychotropics and opioids at work were more likely to prescribe these medications at home. Those prescribing addictive drugs outside of the office treated more serious illnesses in emergency situations, more chronic conditions and more major medical/surgical conditions informally than did those not routinely prescribing addictive medications. Physicians reported a variety of informal care behaviour and high frequency of informal care to family and friends. Discussion The frequency and variety of informal care reported in this study strongly argues for profession-wide discussion about ethical and guideline considerations for such behaviour. These areas are discussed in the paper.

Tobacco Use by Physicians in a Physician Health Program, Implications for Treatment and Monitoring

The use of tobacco by physicians with substance abuse histories is drastically understudied. A chart review of 1319 physicians enrolled in a physician health program found tobacco use highest for those referred for substance abuse problems (58.1%). Among a subset of currently monitored substance abusers, all those who relapsed during monitoring were using tobacco and had more difficulty maintaining sobriety following initial treatment (p = 0.0137) than non tobacco users. Because tobacco was a risk factor for relapse, reasons why physician health programs should address its use and treatment facilities should establish tobacco-free environments to provide optimum learning and recovery are explored.

Challenging cognitive cases among physician populations: case vignettes and recommendations

BACKGROUND Physicians are not immune to cognitive impairment. Because of the risks created by practising doctors with these issues, some have suggested developing objective, population-specific measures of evaluation and screening guidelines to assess dysfunction. However, there is very little published information from which to construct such resources. AIMS To highlight the presentation characteristics and provide evaluation recommendations specific to the needs of physicians with actual or presumed cognitive impairment. METHODS A retrospective database and chart review of cognitively impaired doctors who presented to a physician health programme (PHP). Complex cases were highlighted using simple descriptives and clinical vignettes. RESULTS A total of 124 cases were included. Clients presented with a variety of issues other than cognitive concerns. We identified four principal domains of impairment: (i) diseases of (or in) the brain (48%); (ii) mood/ anxiety disorders or treatment side effects (28%); (iii) substance use (9%) and (iv) traumatic brain injury (7%). Age was not a good predictor of impairment and brief screening using the Montreal Cognitive Assessment demonstrated a ceiling effect with this cohort. Although many clients underwent some type of professional or personal transition, impairment did not necessarily indicate worse functioning after care. CONCLUSIONS Physician cognitive evaluations should consider a variety of secondary sources of information, particularly vocational performance reports. It may take time before cognitive impairment can be diagnosed or ruled-out in this population. Prior assumptions, especially for non-cognitive referrals, can lead to inaccurate diagnosis and referrals. PHPs must manage cognitive cases carefully, not only in their clinical complexity but also in their psychosocial aspects.

When Doctors Struggle: Current Stressors and Evaluation Recommendations for Physicians Contemplating Suicide

The objective of this study was to document current risk factors associated with physicians’ suicide ideation among a group of doctors enrolled in a Physician Health Program. A retrospective cohort study was drawn from administrative data. The study compared intake information between doctors who reported recent thoughts of suicide (n = 70) and those who did not (n = 1,572) using adjusted regression analysis. Current stressors included personal, financial, health, and occupational problems; ideation was more likely with multiple stressors. Physicians endorsing suicidal ideation lacked personal supports and scored differently on Short Form-36 measures. Evaluators treating physicians should assess enduring risks and current stressors, particularly multiple stressors, to help detect suicidal patients. Current stressors should not be viewed as transitory and it is critical to bring in collateral information.