Physical activity, quality of life, and burnout among physician trainees: the effect of a team-based, incentivized exercise program.
ABSTRACT To prospectively study the effects of an incentivized exercise program on physical activity (PA), quality of life (QOL), and burnout among residents and fellows (RFs) in a large academic medical center.
In January 2011, all RFs at Mayo Clinic in Rochester, Minnesota (N=1060), were invited to participate in an elective, team-based, 12-week, incentivized exercise program. Both participants and nonparticipants had access to the same institutional exercise facilities. Regardless of participation, all RFs were invited to complete baseline and follow-up (3-month) assessments of PA, QOL, and burnout.
Of the 628 RFs who completed the baseline survey (59%), only 194 (31%) met the US Department of Health and Human Services recommendations for PA. Median reported QOL was 70 on a scale of 1 to 100, and 182 (29%) reported at least weekly burnout symptoms. A total of 245 individuals (23%) enrolled in the exercise program. No significant differences were found between program participants and nonparticipants with regard to baseline demographic characteristics, medical training level, PA, QOL, or burnout. At study completion, program participants were more likely than nonparticipants to meet the Department of Health and Human Services recommendations for exercise (48% vs 23%; P<.001). Quality of life was higher in program participants than in nonparticipants (median, 75 vs 68; P<.001). Burnout was lower in participants than in nonparticipants, although the difference was not statistically significant (24% vs 29%; P=.17).
A team-based, incentivized exercise program engaged 23% of RFs at our institution. After the program, participants had higher PA and QOL than nonparticipants who had equal exercise facility access. Residents and fellows may be much more sedentary than previously reported.
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ABSTRACT: Two common formats for grading quality of life parameters are descriptive choices (mild, moderate, severe) and visual analogue scales. However the quantitative relationship between descriptive terminology and visual analogue scale scores has not been determined. A content neutral questionnaire was administered to 213 evaluable subjects who were asked to place the descriptors 'mildly', 'moderately', and 'severely' (presented in random order) on 100mm visual analogue scales. Visual analogue scales were presented without and then with hashmarks at 25mm, 50mm, and 75mm. Median visual analogue scale values for the descriptive terms differed significantly without hashmarks ('mildly' = 24mm', moderately' = 43mm, 'severely' = 84mm; p < 0.001) and also with hashmarks ('mildly' = 31mm, 'moderately' = 49mm, 'severely' = 85mm; p < 0.001). Comparison of interquartile range values (25th-75th percentile) revealed a distinct meaning for 'severely' (68-93mm) but marked overlap between 'mildly' (10-45mm) and 'moderately' (22-53mm). Errors of order (order other than 'mildly' < 'moderately' < 'severely') were made by 91 subjects. The discrepancy 'moderately' < 'mildly' accounted for most of these errors (72 subjects). Median values for 'mildly', 'moderately', and 'severely' are distinct and approximately linear on a visual analogue scale for large populations. However there is significant confusion between the terms 'mildly' and 'moderately' for individual subjects. Visual analogue scales can reveal finer quantitative differences than descriptive terms but require a significant time commitment for instruction and administration. Descriptive terms on a word-graphic scale or descriptive terms with numerical values to reenforce order of severity (0 = absent, 1 = 'mildly', 2 = 'moderately', 3 = 'severely') may be reasonable alternatives.Quality of Life Research 02/1996; 5(1):65-72. · 2.41 Impact Factor
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ABSTRACT: In the clinical and economic evaluation of health care, the value of benefit gained should be determined from a public perspective. The objective of this study was to establish relative valuations attached to different health states to form the basis for a 'social tariff' for use in quantifying patient benefit from health care. Three thousand three hundred and ninety-five interviews were conducted with a representative sample of the adult British population. Using the EuroQol health state classification and a visual analogue scale (VAS), each respondent valued 15 health states producing, in total, direct valuations for 45 states. Two hundred and twenty-one re-interviews were conducted approximately 10 weeks later. A near complete, and logically consistent, VAS data set was generated with good test-retest reliability (mean ICC = 0.78). Both social class and education had a significant effect, where higher median valuations were given by respondents in social classes III-V and by those with intermediate or no educational qualifications. These effects were particularly noticeable for more severe states. The use of such valuations in a social tariff raises important issues regarding the use of the VAS method itself to elicit valuations for hypothetical health states, the production of separate tariffs according to social class and/or education and the appropriate measure of central tendency.Quality of Life Research 01/1997; 5(6):521-31. · 2.41 Impact Factor
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ABSTRACT: Resident burnout continues to be a major problem despite work hours restrictions. The authors conducted a longitudinal study to determine whether burnout in internal medicine residents is persistent and what factors predispose residents to persistent burnout. The authors mailed a survey to internal medicine residents at the University of Colorado Denver Health Science Center each May, from 2003 through 2008. The survey measures included the Maslach Burnout Inventory organized into three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment. The authors defined burned-out residents as having a high EE or DP score and persistent burnout as being burned out during all three years of residency. Of the 179 eligible residents, 86 (48%) responded to the survey during all three years of their residency. Sixty-seven residents (78%) were burned out at least once: 58 residents (67%) were burned out during their internship, 58 (67%) during their second year, and 50 (58%) during their third year (P < .08). Of the 58 burned-out interns, 42 (72%) continued to be burned out through their three years of training. Persistent burnout was more likely to occur in men (OR = 3.31, P < .01) and was associated with screening positive for depression as an intern (OR = 4.4, P < .002). Once present, burnout tends to persist through residency. Men and residents who screened positive for depression as interns are at the highest risk for persistent burnout. Interventions to prevent burnout during internship may significantly decrease burnout throughout residency.Academic medicine: journal of the Association of American Medical Colleges 10/2010; 85(10):1630-4. · 2.34 Impact Factor