The Cost, Price, and Debt of Medical Education

Asch, David A.; Grischkan, Justin A.; Nicholson, Sean

doi:10.1056/nejmp1916528

Cited by 27 publications

(22 citation statements)

References 2 publications

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“…The increased demand for healthcare services is a challenge for health workers because the virus is highly transmissible so that interactions represent a risk for contamination while the disease may have a severe presentation in 19% of cases ( 1 , 2 ). Moreover, the effectiveness of clinical management protocols is uncertain ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Risk and Protective Factors for the Mental Health of Brazilian Healthcare Workers in the Frontline of COVID-19 Pandemic

et al. 2021

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The objective was to compare the mental health indicators of health workers providing care to individuals with COVID-19 in Brazil, considering sociodemographic and occupational variables and the risk perception of contamination by the Sars-CoV-2 of workers from different professions, identifying risk and protective factors. A sample of 916 health workers was assessed: physicians, nursing workers, and workers from other professions (psychologists, physical therapists, nutritionists, speech therapists, occupational therapists, dentists, pharmacists, and social workers). REDCAP software was used to collect data online, using standardized instruments to assess anxiety, depression, posttraumatic stress, and insomnia, and one questionnaire addressed risk and protective variables. Statistical techniques for comparing groups were used along with logistic regression analysis. The results revealed that all the groups presented indicators of significant mental health problems (>36%), especially the nursing group. A larger percentage of participants, regardless of the profession, presented a high rate of insomnia disorders, while posttraumatic stress was the least expressive. Occupational variables stand out as risk factors for mental health, with specificities among the different groups. A protective factor for all the groups was having positive professional prospects. The protective factors for the physicians group included support provided by co-workers, being older and a man, while being satisfied with physical protective measures implemented by the employing institution was a protective factor for the groups composed of nursing workers and other professionals. These findings are relevant for devising mental health care strategies.

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Section: Introductionmentioning

confidence: 99%

Risk and Protective Factors for the Mental Health of Brazilian Healthcare Workers in the Frontline of COVID-19 Pandemic

et al. 2021

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“…This result suggests that financial strain may contribute to burnout in resident physicians, a possibility that merits further research given the increasing average medical school debt burden for new physicians. 29 While our study's strengths lie in its large sample size and high response rate, it is also subject to limitations. First, our assessment of burnout comes from a one-time metric collected at the end of residency and we cannot determine directionality in the relationship between academic performance and burnout.…”

Section: Discussionmentioning

confidence: 95%

Academic Achievement, Professionalism, and Burnout in Family Medicine Residents

Davis

Krishnasamy

Morgan

et al. 2021

Fam Med

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Background and Objectives: Physician burnout has been shown to have roots in training environments. Whether burnout in residency is associated with the attainment of critical educational milestones has not been studied, and is the subject of this investigation. Methods: We used data from a cohort of graduating family medicine residents registering for the 2019 American Board of Family Medicine initial certification examination with complete data from registration questionnaire, milestone data, in-training examination (ITE) scores, and residency characteristics. We used bivariate and multilevel multivariate analyses to measure the associations between four professionalism milestones ratings and ITE performance with burnout. Results: Our sample included 2,509 residents; 36.8% met the criteria for burnout. Multilevel regression modeling showed a correlation between burnout and failure to meet only one of four professionalism milestones, specifically professional conduct and accountability (OR 1.41, 95% CI 1.07-1.87), while no statistically significant relationship was demonstrated between burnout and being in the lowest quartile of ITE scores. Other factors negatively associated with burnout included international medical education (OR 0.60, 95% CI 0.48-0.76) and higher salary compared to cost of housing (OR 0.62, 95% CI 0.46-0.82). Conclusions: We found significant association between self-reported burnout and failing to meet expectations for professional conduct and accountability, but no relationship between burnout and medical knowledge as measured by lower ITE performance. Further investigation of how this impacts downstream conduct and accountability behaviors is needed, but educators can use this information to examine program-level interventions that can specifically address burnout and development of physician professionalism.

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“…A recent commentary by Asch et al in New England Journal of Medicine cautions against paying attention to price and debt without attending to cost [ 33 ]. There are significant expenses that could be trimmed by colleges, including colleges of medicine.…”

Section: Discussionmentioning

confidence: 99%