#KeyLIMEpodcast 146: The Mortality Rate of Residency Education

*Author’s Note: Some KeyLIME podcast followers will find this a tough episode to discuss.*

Issues of the wellness of health care providers are an increasingly discussed in medical education. The stressors and impact of medical practice on physician health have been documented for decades. So perhaps it is time to document the “mortality rate” of medical training… Jason’s selection for this podcast, from Yaghmour et al in Academic Medicine, sets out to study and characterize US resident (postgraduate) trainee deaths from 2000-2014.

Check out the podcast here (or on iTunes!) to hear the conversation.

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KeyLIME Session 146 – Article under review:

Listen to the podcast

View/download the abstract here.

Yaghmour NA, Brigham TP, Richter T, Miller RS, Philibert I, Baldwin DC Jr, Nasca TJ. Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment. Acad Med. 2017 Jul;92(7):976-983

Reviewers: Jason Frank (@drjfrank)

Background

Issues of the wellness of health care providers are an increasingly discussed in medical education. The stressors and impact of medical practice on physician health have been documented for decades. The study by Center et al recently estimated 300-400 MDs died by suicide each year in the US, for example. This generated the hard-hitting, pithy headline that “an entire medical school worth of physicians commit suicide yearly” when this hit the mainstream media. And this is not just a professional practice issue…Research shows that impaired wellness in healthcare providers leads to worse care for patients in every way, from empathy to other quality markers. When we hurt, our patients do too.

Medical education contemplates these issues as we think about the design of the medical training and practice system. Our attention has been increasingly focused on the health and wellbeing of our trainees, highlighted by the duty hours debates [see our previous episodes on this topic – 62, 76, 113 and 115] and the shocking news of trainee deaths covered by public media.

Purpose

So perhaps it is time to document the “mortality rate” of medical training…Yaghmour et al in Academic Medicine set out to study and characterize US resident (postgraduate) trainee deaths from 2000-2014.

Type of Paper

Research: Observational database study

Key Points on Methods

Yaghmour et al used the ACGME’s database of 9,900 accredited programs and their 381,614 residents in training from 2000-2014 to identify names of residents reported as deceased. They then queried the US National Death Index to identify the official causes of death of the residents.

Key Outcomes

The ACGME documented the training of approximately 125,000 residents per year. The team identified 324 residents who died (220 men, 104 women) over 15 years. All rates were stable over time. The leading causes of death were: cancer, suicide, and accidents. The mortality rate in residency was 8.5 per 10,000 training years, a rate below the general age and gender-matched population. Higher death rates occurred early in residency. Suicides were higher early in training and during the 1st and 3rd quarters of the academic year.

Key Conclusions

The authors conclude that while cancer was the leading cause of death of residents, suicide was an important #2 cause that calls for intervention.…

 

Shout out

A shout out to our friends at the ACGME, including Ingrid Philibert, Tom Nasca, and Tim Brigham. We continue to admire the work of the ACGME and their big impact on meded.

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