Category Archives: Tips

Best Of AAST #13: Work-Life Balance

Okay, so this abstract is a bit more on the touchy-feely side. But it is extremely important because it speaks to the balancing act we all have to perform in order to achieve a satisfying harmony between work and everything else.

Older generations of surgeons threw nearly all of their energy into work, and ended up with lesser amounts of involvement with their family and everything else outside of work. At the time, , though, people seemed to be (mostly) satisfied. That’s just the way it was.

But now, there is much more emphasis on a healthy lifestyle, and this includes a healthy delineation of work and not-work. An AAST-approved survey was sent to the membership which tried to parse out the various factors involved in work-life balance, happiness, and burnout.

Here are some very interesting factoids:

  • Of more than 1300 questionnaires sent out, only 291 (21%) returned them (wish I had a sad face icon here)
  • Only 43% were satisfied with their work-life balance
  • There was no difference in satisfaction based on age, sex, or practice type
  • Here are the factors that set the satisfied surgeons apart from the dissatisfied:
    • Early (<10 years) or late in career (>20 years)
    • Fewer hours spent at work
    • More hours spent (awake) at home
    • Enjoy their job
    • Enjoy their partners
    • Better at saying no or delegating work tasks
    • Feel they are fairly compensated
    • Engage in hobbies (86% vs 68%)
    • Exercise regularly (49% vs 20%)
    • Eat a healthy diet (74$ vs 48%)
    • Get more sleep (7 hrs vs 6 hrs)
  • Despite getting the same amount of vacation time, the satisfied surgeons actually used it
  • Dissatisfied surgeons reported significantly more feelings of burnout (77% vs 39%)

The authors concluded that trauma programs should concentrate on optimizing the modifiable factors listed above to improve satisfaction and decrease burnout.

Here are my comments: Well, I don’t have many, nor do I have any questions for the authors. This is a purely descriptive study that paints a general picture outlining what seems to be important in enhancing satisfaction with one’s career path. It is an interesting read, and outlines many of the factors that influence this. I’m sure it’s not all of the factors, but they hit the big ones.

All trauma professionals should look at this data and read the final manuscript. It may help you make changes to optimize your own work-life balance and career satisfaction.

Reference: Modifiable factors to improve work-life balance for trauma surgeons. AAST 2020, Oral abstract #50.

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Trauma Education In The COVID Age

Trauma education has gotten significantly more difficult in the face of the Coronavirus. In-person education offerings like ATLS and PALS courses, TNCC courses, and major trauma conferences are routinely being cancelled or delayed. And many of them have decided to move to a virtual format.

Until early this year, I traveled around the country as a speaker for numerous trauma education conferences. The bulk of these have been cancelled for the remainder of the year. A few have opted to try an online format, and I will be giving several online talks in the coming months.

The American Association for the Surgery of Trauma (AAST) has converted their physical meeting in Hawaii to a virtual one (sigh). I will definitely be participating anyway!

Here are two conferences I will be speaking at, using the new virtual format. If you are in need of some quality education, check them out:

Virtual Excellence in Trauma Care Conference
Intermountain Medical Center – Salt Lake City UT
September 17-18, 2020
Presentations:
1. Keynote Address: Massive Bleeding Associated With Pelvic Fractures
2. Trauma Mythbusters
Registration Info: click here
Brochure: click here

Stormont Vail Trauma Symposium
Stormont Vail Hospital – Topeka KS
October 16, 2020
Presentations:
1. New Trends in Trauma
2. Mobility of the Trauma Patient in ICU
Registration and brochure: available soon

And if your hospital or organization is interested in putting your own grand rounds or other educational conference together, I am now focusing on providing presentations via telepresence.

Please check out the FAQ on my speaking engagements by clicking here.

Granted, telepresence is not the same as being there in person. It’s so much nicer to meet people in person, and it’s much more satisfying to make that more personal connection. But in-person conferences won’t be in the cards for a while. In the meantime, I hope to see you all soon via WebEx or Zoom! Please reach out!

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Video: Keeping Up With Your Literature

Every trauma professional at any level of training and expertise knows that it’s so important to keep up with new developments in your field. To that end, I created a video five years ago that described a super-efficient 5-step system for staying abreast.

Well, time passes and technology changes. So I’ve updated this classic with new recommendations and some refinements to the technique. I hope you enjoy! And please leave comments and recommendations on YouTube!

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Whaaat? Stuff You Sterilize Other Stuff With May Not Be Sterile??

When one works in the trauma field, or medicine in general, we deal with the need for sterility all the time. We use equipment and devices that are sterile, and we administer drugs and fluids that are sterile. In surgery, we create sterile fields in which to use this sterile stuff.

In the past few years, we’ve come to the realization that the sterility we take for granted may not always be the case. There have been several cases of contaminated implanted hardware. And a few years ago, supposedly sterile injectable steroids were found to be contaminated with fungus, leading to several fatal cases of meningitis.

An article in the New England Journal of Medicine brings a bizarre problem to light: microbial stowaways in the topical products we use to sterilize things. Most drugs and infused fluids are prepared under sterile conditions. However, due to the antimicrobial activity of topical antiseptics, there is no requirement in the US that they be prepared in this way.

A number of cases of contamination have been reported over the years:

  • Iodophor – contamination with Buckholderia and Pseudomonas occurred during manufacture, leading to dialysis catheter infection and peritonitis
  • Chlorhexidine – contaminated with Serratia, Buckholderia and Ralstonia by end users, leading to wound infections, catheter infections, and death
  • Benzalkonium chloride – contaminated with Buckholderia and Mycobacteria by end users, causing septic arthritis and injection site infections

Bottom line: Nothing is sacred! This problem is scarier than you think, because our most basic assumptions about these products makes it nearly impossible for us to consider them when tracking down infection sources. Furthermore, they are so uncommon that they frequently may go undetected. The one telltale sign is the presence of infection from weird bacteria. If you encounter these bugs, consider this uncommon cause. Regulatory agencies need to get on this and mandate better manufacturing practices for topical antiseptics.

Reference: Microbial stowaways in topical antiseptic products. NEJM 367:2170-2173, Dec 6 2012.

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How To MacGyver A Ventilator From Common Parts

A cardiac anesthesiology fellow, and several engineers from the University of Minnesota and a local device company got together over the past few weeks and cobbled together a ventilator from some spare parts. Here’s a picture to give you an idea of what it looks like:

It uses a metal toolbox tray, an Ambu bag, and some other spare parts lying around one of the medical device labs at the university. Essentially, a servo motor intermittently squeezes the Ambu bag, and there are adjustments for how often (rate) and how deeply (volume) the bag is compressed. There is a pressure limiting device included in the system as well.

This project illustrates how we will need to think outside the (tool)box in the coming weeks, especially as the number of severe Coronavirus cases begins to tax our supply of ventilators. And obviously, this thing will not get FDA approval in your lifetime. But if a choice needs to be made between using something like this in a pinch vs letting someone asphyxiate, the answer is pretty clear.

The group has produced a short YouTube video as well (see below), but it is rather short on details. You get to see some partial views of it as it is being tested on pigs. But so far, the concept is promising.

If you are trying to view this on my Tumblr feed, the video will not show here. Please click here to visit my main blog site to view it.

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