Substance Use Disorder Among Anesthesiology Residents, 1975-2009

Warner, David O.; Berge, Keith H.; Sun, Huaping; Harman, Ann E.; Hanson, Andrew C.; Schroeder, Darrell R.

doi:10.1001/jama.2013.281954

Cited by 127 publications

(73 citation statements)

References 24 publications

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“…Finally, we collected data on each individual's age at the time of primary certification, sex, medical school country (United States vs international), years between completion of an Accreditation Council for Graduate Medical Education-accredited residency program and board certification, year in the diplomate's MOCA cycle that the examination was first attempted, history of substance use disorder, and history of a Disciplinary Action Notification Service (DANS) alert. The DANS alert is a service of the Federation of State Medical Boards that provides information on any actions regarding the diplomate's medical license to all American Board of Medical Specialties® (ABMS®) member boards [10].…”

Section: Data Sourcementioning

confidence: 99%

Predictors of performance on the Maintenance of Certification in Anesthesiology Program® (MOCA®) examination

Sun

Culley

Lien

et al. 2015

Journal of Clinical Anesthesia

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Section: Data Sourcementioning

confidence: 99%

Predictors of performance on the Maintenance of Certification in Anesthesiology Program® (MOCA®) examination

Sun

Culley

Lien

et al. 2015

Journal of Clinical Anesthesia

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“…In a large study that focused on substance abuse the graduation and certification rates were significantly decreased, and similar to the respective rates of residents with Essential Attribute deficiencies in this study. 22 …”

Section: Discussionmentioning

confidence: 99%

“…1–22 The prevalence of residents with performance deficiencies has been reported between 6% and 26% across specialties including psychiatry, family medicine, internal medicine, and general surgery. 1,9,10,17 These residents have been referred to variously as “problem residents,” “residents in difficulty,” “troublesome residents,” “problem learners,” and “residents in trouble.” 1 We have chosen the term “residents in trouble,” since it conveys the attitude of concern for the performance and improvement of trainees, as we might say when our patients are “in trouble.”…”

Section: Introductionmentioning

confidence: 99%

Effect of Performance Deficiencies on Graduation and Board Certification Rates

et al. 2016

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Background This multicenter, retrospective study was conducted to determine how resident performance deficiencies affect graduation and board certification. Methods Primary documents pertaining to resident performance were examined over a 10-yr period at four academic anesthesiology residencies. Residents entering training between 2000 and 2009 were included, with follow-up through February 2016. Residents receiving actions by the programs’ Clinical Competency Committee were categorized by the area of deficiency and compared to peers without deficiencies. Results A total of 865 residents were studied (range: 127 to 275 per program). Of these, 215 residents received a total of 405 actions from their respective Clinical Competency Committee. Among those who received an action compared to those who did not, the proportion graduating differed (93 vs. 99%, respectively, P < 0.001), as did the proportion achieving board certification (89 vs. 99%, respectively, P < 0.001). When a single deficiency in an Essential Attribute (e.g., ethical, honest, respectful behavior; absence of impairment) was identified, the proportion graduating dropped to 55%. When more than three Accreditation Council for Graduate Medical Education Core Competencies were deficient, the proportion graduating also dropped significantly. Conclusions Overall graduation and board certification rates were consistently high in residents with no, or isolated, deficiencies. Residents deficient in an Essential Attribute, or multiple competencies, are at high risk of not graduating or achieving board certification. More research is needed on the effectiveness and selective deployment of remediation efforts, particularly for high-risk groups.

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“…6 To summarize, the primary data sources for this ascertainment process included the training records of the American Board of Anesthesiology (ABA), the National Death Index, and the Disciplinary Action Notification Service (DANS) of the Federation of State Medical Boards (more information regarding the latter two sources is provided in subsequent sections). A staged procedure was used to determine whether there was definite evidence of SUD during primary residency training as previously described in detail.…”

Section: Methodsmentioning

confidence: 99%

“…2–5 In prior work we utilized an extensive array of data resources to describe the incidence and selected outcomes of SUD in anesthesiology residents in the United States from 1975–2009. 6 This initial analysis demonstrated that the incidence of SUD in this population continues to increase and that adverse outcomes such as death are not uncommon. However, comparisons were not made with residents who did not develop SUD, precluding direct quantification of how much SUD may increase the risk of adverse outcomes, such as failure to complete residency and achieve board certification, and the exploration of risk factors associated with SUD.…”

Section: Introductionmentioning

confidence: 99%

Risk and Outcomes of Substance Use Disorder among Anesthesiology Residents

et al. 2015

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Background The goal of this work was to evaluate selected risk factors and outcomes for substance use disorder (SUD) in physicians enrolled in anesthesiology residencies approved by the Accreditation Council for Graduate Medical Education. Methods For each of 384 individuals with evidence of SUD while in primary residency training in anesthesiology from 1975–2009, two controls (n=768) who did not develop SUD were identified and matched for gender, age, primary residency program, and program start date. Risk factors evaluated included location of medical school training (United States vs other) and anesthesia knowledge as assessed by In-Training Examination performance. Outcomes (assessed to December 31, 2013, with a median follow-up time of 12.2 years and 15.1 years for cases and controls, respectively) included mortality and profession-related outcomes. Results Receiving medical education within the United States, but not performance on the first in-training examination, was associated with an increased risk of developing SUD as a resident. Cases demonstrated a marked increase in the risk of death after training (hazard ratio 7.9 [95% CI, 3.1–20.5]), adverse training outcomes (including failure to complete residency (odds ratio 14.9 [9.0–24.6]) or become board certified (odds ratio 10.4 [7.0–15.5]), and adverse medical licensure actions subsequent to residency (hazard ratio 6.8 [3.8–12.2]). As of the end of follow-up, 54 (14.1%) cases were deceased compared with 10 (1.3%) controls; 28 cases and no controls died during residency. Conclusions The attributable risk of SUD to several adverse outcomes during and after residency training, including death and adverse medical license actions, is substantial.

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Substance Use Disorder Among Anesthesiology Residents, 1975-2009

Cited by 127 publications

References 24 publications

Predictors of performance on the Maintenance of Certification in Anesthesiology Program® (MOCA®) examination

Predictors of performance on the Maintenance of Certification in Anesthesiology Program® (MOCA®) examination

Effect of Performance Deficiencies on Graduation and Board Certification Rates

Risk and Outcomes of Substance Use Disorder among Anesthesiology Residents

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