Search

Context: Studies of burnout among allopathic physicians have shown many deleterious effects for both physicians and patients. To our knowledge, no studies have quantified burnout among osteopathic physicians. Objective: To determine the prevalence of burnout, mentoring, and resident training satisfaction among US osteopathic otolaryngology residents compared with previously published data for allopathic otolaryngology residents. Methods: A cross-sectional, questionnaire-based, electronic survey of US osteopathic otolaryngology residents was conducted. Residents were surveyed about demographic information, personal and professional life satisfaction, professional stressors, burnout (assessed with the Maslach Burnout Inventory–Human Services Survey), and mentor-resident interactions. Burnout was measured based on levels of emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (PA). Results were compared with previously published data for allopathic otolaryngology residents. Results: Of the 102 osteopathic residents contacted, 48 (47%) responded and 47 provided complete responses in some categories. Burnout rates were low in 11 respondents (23%), moderate in 31 (66%), and high in 5 (11%), compared with published rates of 14%, 76%, and 10%, respectively, for allopathic residents (P=.18). The rates of EE and DP did not differ significantly from published data, but levels of PA were higher in osteopathic residents (P=.03). Sleep hours per night were significantly higher in osteopathic than in allopathic residents (mean, 6.6 vs 6.2; P=.04), and work hours per week were significantly lower (mean, 62 vs 71; PP=.003). Increased influence from a mentor was associated with decreased levels of burnout for all 3 components (EE: ρ=−0.54, P=.002; DP: ρ=−0.59, PP=.02). Conclusion: To our knowledge, the current study is the first to quantify burnout among osteopathic residents, and our findings suggest that osteopathic residents have lower rates of burnout than allopathic residents. Osteopathic residents reported lower rates of low PA, increased hours of sleep, and decreased overall work hours. Further study of the relationship between mentoring and decreased burnout is needed.

In the academia of cosmetic surgery, multiple specialties contribute to the advancement of knowledge and surgical techniques. To surgeons attempting to learn or review cosmetic surgery, the volume of information can seem overwhelming with different articles and texts emphasizing different ideas. In an attempt to better standardize the education of cosmetic surgeons in an active format, the authors introduce COSMET, or Cosmetic Organized Study Material and Educational Tutorial. In its current form, COSMET is a 25-topic study guide currently under construction and covering the major aspects and procedures of cosmetic surgery. Each topic directs the physician by asking specific board-relevant questions and referring to key authors/articles. This is an ideal tool for fellowship training and may be structured according to a board review course. At a rate of one topic per week, a fellow may complete the tutorial twice over a 1-year term. Experts from around the country may be recruited to contribute to specific topics that they emphasize. COSMET may be reviewed as weekly PowerPoint presentations for fellows and staff, creating a “library” that may be enhanced each year. This tool would also benefit established surgeons seeking a review or recertification. COSMET could be made available in a Portable Document Format for easy web access.

A 43-year-old Asian woman who was initially seen because of hematemesis later had a gastric leiomyosarcoma cliagnosed. Epigastric palpation, computed tomography, and magnetic resonance imaging assisted in determining the size, borders, and location of the tumor while a second esophagogastroduodenoscopy revealed friable gastric mucosa with erosions. Biopsy specimens taken for frozen section during surgical abdominal exploration revealed a malignant gastric stromal tumor. An en bloc excision of the mass then followed, with the final pathologic diagnosis a gastric leiomyosarcoma. Metastases were later found in the liver, peritoneum, and mesentery. Differentiation of gastric leiomyosarcoma from other stromal tumors is difficult and requires standardized nuclear and cellular evaluation of atypia, necrosis, mitosis, and tumor doubling time. The most common symptoms at initial presentation are abdominal pain and gastrointestinal bleeding. Abdominal computed tomography remains more specific in suggesting gastric stromal tumors than esophagogastroduodenoscopy and upper gastrointestinal barium series. Lymph node involvement in gastric leiomyosarcoma is rare and affords the first line therapy of laparoscopic wedge gastrectomy with a good prognosis in tumors less than 6 cm in diameter. The prognostic factors include metastasis, size of the tumor, histologic grade, DNA ploidy of the tumor, and ulceration of overlying gastric mucosa.