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INTRODUCTION The rate of burnout among residents has reached an alarming level and negatively impacts learning, attrition, and patient care. We implemented a comprehensive Surgery Resident Wellness Program in a large academic program and aimed to assess the degree this initiative improved resident burnout based on validated burnout and well-being models utilizing voluntary surveys. Materials and Methods A voluntary survey was sent to surgical residents and included the Maslach Burnout Inventory and The Psychological General Well-Being Index. These were graded according to the respective validated scale for each test. The survey was administered prior to establishing a wellness program, and at 6 month- and 24 month-intervals following its establishment. These data were analyzed using univariate analysis based on survey data from each of the time points. RESULTS The survey had a 51% response rate. The baseline, 6-month, and 24-month mean scores for MBI personal accomplishment were 32.80, 32.91, and 35.57, emotional exhaustion was 23.48, 23.0, and 24.42, and depersonalization were 10.94, 9.54, and 11.11. Resident burnout was present in 16 of 31 (51.61%), 14 of 33 (42.42%), and 12 of 27 (44.44%) residents at each time point. The rate of change in resident burnout was –17.8% at 6 months and -13.9% at 24 months. The averaged PGWBI global scores were 66, 73, and 83 among the participants who took the survey at each time interval. CONCLUSIONS Conclusion Implementation of a structured wellness program was associated with a decrease in resident burnout and an increase in overall resident wellness.

User-chosen passwords reflecting common strategies and patterns ease memorization but offer uncertain and often weak security, while system-assigned passwords provide higher security guarantee but suffer from poor memorability. We thus examine the technique to enhance password memorability that incorporates a scientific understanding of long-term memory. In particular, we examine the efficacy of providing users with verbal cues—real-life facts corresponding to system-assigned keywords. We also explore the usability gain of including images related to the keywords along with verbal cues. In our multi-session lab study with 52 participants, textual recognition-based scheme offering verbal cues had a significantly higher login success rate (94.23%) compared to the control condition, i.e., textual recognition without verbal cues (61.54%). We found that when users were provided with verbal cues, adding images contributed to faster recognition of the assigned keywords, and thus had an overall improvement in usability. So, we conducted a field study with 54 participants to further examine the usability of graphical recognition-based scheme offering verbal cues, which showed an average login success rate of 98% in a real-life setting and an overall improvement in login performance with more login sessions. These findings show a promising research direction to gain high memorability for system-assigned passwords.

Palliative care specialists (PCS) and burn surgeons (BS) were surveyed regarding: 1) importance of goals of care (GoC) conversations for burned seniors; 2) confidence in their own specialty's ability to conduct these conversations; and 3) confidence in the ability of the other specialty to do so. A 13-item survey was developed by the steering committee of a multicenter consortium dedicated to palliative care in the injured geriatric patient and beta-tested by BS and PCS unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Burn Association and American Academy for Hospice and Palliative Medicine. Forty-five BS (7.3%) and 244 PCS (5.7%) responded. Palliative physicians rated being more familiar with GoC, were more comfortable having a discussion with laypeople, were more likely to have reported high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to BS. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so. BS favored leading team discussions, whereas palliative specialists preferred jointly led discussions. Both groups agreed that discussions should occur within 72 hours of admission. Both groups believe themselves to conduct GoC discussions for burned seniors better than the other specialty perceived them to do so, which led to disparate views on perceptions for the optimal leadership of these discussions.

Background Despite focus on increasing the quality of ambulatory education training, few studies have examined residents' perceptions of learning during case discussions with their preceptors (i.e., "check-out"). The objective of this study was to assess the difference between residents' and preceptors' perceptions of behaviors that should occur during check-out discussions. Methods We conducted a cross-sectional survey of categorical internal medicine and family medicine residents and preceptors. The survey was distributed electronically and assessed 20 components of the check-out discussion. Results Of 38 preceptors, 22 (61%) completed the survey. Of 172 residents, 82 (48%) completed the survey. For residents, we identified discrepancies in desired and perceived check-out behaviors. Specifically, utilizing a dependent sample t-test, residents felt that all 20 areas needed additional teaching during check-out (P < 0.05). Preceptors believed that demonstrating physical examination skills in the patient room during check-out was significantly more important than did residents (P = 0.01). Increasing years of preceptor experience did not statistically relate to their valuation of components important to residents. Discussion Our research highlighted a major deficiency in training in the check-out process, with residents desiring more patient management education in all components. Moreover, faculty and residents do not necessarily agree with what is an important focus in the "teachable moment." Our results serve as a training needs assessment for future faculty development seminars and highlight the need to consider resident learning needs in general.

Background: The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties’ attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty’s ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so. Methods: A 13-item survey was developed by the steering committee of a multicenter, palliative care-focused consortium and beta-tested by trauma surgeons and palliative care specialists unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Association for the Surgery of Trauma and American Academy for Hospice and Palliative Medicine. Results: Respondents included 118 trauma surgeons (8.8%) and 244 palliative care specialists (5.7%). Palliative physicians rated being more familiar with GoC, were more likely to report high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to trauma surgeons. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so and favored their own specialty leading team discussions. Conclusions: Both groups believe themselves to conduct GoC discussions for injured seniors better than the other specialty perceived them to do so, which led to disparate views on the optimal leadership of these discussions.

Background To optimize resident learning, programs need to readily assess resident well-being. There is a lack of easy-to-use, acceptable instruments for this task. Objective We created a well-being “fuel gauge,” and assessed the acceptability and feasibility of this weekly electronic communication pipeline for residents to report and discuss their well-being. Methods A well-being fuel gauge assessment was administered weekly over the course of 1 academic year (July 2016 to June 2017) in a large internal medicine residency program. The well-being gauge asked residents to report their fuel levels using a 1 to 5 Likert-type scale (1, empty; 3, half tank; and 5, full tank). Residents who provided low scores (1 or 2) were contacted by program leadership, and the program director sent weekly e-mail updates that addressed residents' comments on their well-being fuel gauge. Results Of 163 residents, 149 (91%) provided data on their well-being fuel gauge, with a 53% average weekly response rate. Fifty-four percent of residents (80 of 149) reported a low score over the course of the year, and 4 residents only used the assessment to report a low score. Comments on average consisted of 280 characters (SD = 357) and were lengthier and more prevalent with lower fuel gauge scores. We analyzed the relationship between scores and comments. Conclusions The well-being fuel gauge was well accepted by most residents and was easy to administer and to oversee by program directors. It facilitated ongoing monitoring of well-being and follow-up to address factors contributing to low well-being.

In this study, we propose a hierarchy of password importance, and we use an experiment to examine the degree of similarity between passwords for lower-level (e.g. news portal) and higher-level (e.g. banking) websites in this hierarchy. We asked subjects to construct passwords for websites at both levels. Leveraging the lower-level passwords along with a dictionary attack, we successfully cracked almost one-third of the subjects׳ higher-level passwords. In a survey, subjects reported frequently reusing higher-level passwords, with or without modifications, as well as using a similar process to construct both levels of passwords. We thus conclude that unsafely shared or leaked lower-level passwords can be used by attackers to crack higher-level passwords.

This update presents and discusses 8 important studies in rheumatology that were published in 2016 and are potentially relevant to general internists.

3605 Background: Ethnic disparities can impact clinical outcomes of young-onset colorectal cancer (CRC) patients. We aimed to determine if differences in outcomes based on ethnicity exist in young–onset CRC treated at an NCI-designated comprehensive cancer center program. Methods: A retrospective chart review for stage II – IV young-onset CRC patients ≤45 years old diagnosed between 04/2011 and 11/2015. Patients had to undergo treatment at safety-net Parkland Hospital (PH) or at the Simmons Comprehensive Cancer Center (SCCC) in Dallas, TX. Demographic data, dates of surgery, adjuvant chemotherapy, recurrence or death were obtained. Results: Of 123 patients that met inclusion criteria, 15 were excluded due to incomplete information. Of the remaining 108 patients, 36 (33%) and 72 patients (67%) were treated at SCCC and PH, respectively. Sixty (55%) were non-Hispanic vs 48 (44.4%) Hispanic. There were more Stage IV patients at SCCC vs Parkland (58.3% vs 30.6%, p < 0.01) but there was no difference regarding ethnicity. Also, no significant difference was seen between non-Hispanic White (NHW), Hispanic, and Black patients in median days to colectomy (1 vs 13 vs 0; p = .402) or adjuvant chemotherapy (55.5 vs 53.0 vs 64.0 days, p = .820). Hispanic patients had significantly better overall survival (OS) than Black or NHW patients (p = 0.025). The OS benefit was driven by improved 5-year OS in stage II/III Hispanic vs NHW vs Black patients (95% vs 62% vs 60%; p = 0.06). Multivariate Cox Regression analysis showed stage II/III (p < 0.001) and Hispanic ethnicity (p < 0.001) were independently associated with improved outcomes. Conclusions: In young-onset CRC treated at an NCI-designated comprehensive cancer center, Hispanic ethnicity had better OS than other ethnicities and this was largely due to better outcomes in stage II and III CRC. The causes for these ethnic differences in young-onset CRC patients needs further exploration. [Table: see text]

708 Background: Colorectal cancer is the fourth most common cancer diagnosed in the United States and accounts for > 50,000 deaths nationwide annually. With data showing that oncologic treatment at National Cancer Institute (NCI) designated comprehensive cancer centers improves outcomes in a variety of malignancies, understanding the drivers behind this is vital to help bring the world-class care being administered at comprehensive cancer centers to underserved populations across the U.S. One component of colorectal cancer care that has a paucity of data afforded to it is the effect of increased time from diagnosis to surgery on survival. Methods: Patients diagnosed with AJCC stage II or stage III colorectal cancer between 4/2011 and 11/2015 and either underwent surgery or adjuvant chemotherapy within the University of Texas Southwestern system were selected. Several pertinent data points were abstracted via the EMR including date of diagnosis, surgery, adjuvant chemotherapy, progression, and death. A retrospective analysis was performed on the abstracted data to determine if the number of days between diagnosis and surgery was correlated with increased survival. Spearman coefficients were calculated to determine correlations between the data. All tests were two-sided. Results: Out of 203 patients identified, 113 patients had complete data available and were included in the study. The average age at diagnosis was 62.6 and average follow-up time was 41.4 months. Median time to surgery was 21 days (25th percentile-75th percentile: 4 – 53 days). There was a significant negative correlation between days from diagnosis to surgery and mortality (Spearman’s r = -.392, p < .001). Survivors had a mean of 42.7 days from diagnosis to surgery (SD = 56.4) and nonsurvivors had a mean of 61.7 days (SD = 46.9). Conclusions: There was a significant negative correlation seen in days between diagnosis and surgery and survival during the study period, which indicates that early surgical intervention may be an underappreciated indicator of quality colorectal cancer care. Further research should be conducted to better understand the relationship between early surgical intervention and prognosis in limited-stage colorectal cancer.

710 Background: Oncologic treatment at National Cancer Institute (NCI) designated comprehensive cancer centers improves outcomes in a variety of malignancies. Racial disparity plays an important role in cancer outcomes and prognosis. Racial outcomes were compared in early stage colorectal cancer patients that presented to a comprehensive cancer center. Methods: This is a retrospective analysis on patients diagnosed with AJCC stage II or stage III colorectal cancer and underwent surgery or adjuvant chemotherapy within the University of Texas Southwestern and Simmons Comprehensive Cancer Center. Pertinent data points were abstracted from EMR including demographic data and dates of initial diagnosis, surgery, adjuvant chemotherapy, progression, and death. Results: Between 4/2011 and 11/2015, 203 patients were identified and 167 patients had complete follow up data available. Median age of cohort was 62 (range 21-90) and most of the patients were men (52.7%). Stage II comprised 44.3% of patients while 55.7% were diagnosed at stage III. One hundred and twenty patients (71.9%) were white, while 34 patients (20.4%) identified as black and the rest belonged to other races. Hispanic ethnicity was identified in 10.4% of patients. There was no significant difference between white and black cohorts between variables age (median 62 vs. 64.5 years; p = 0.44), gender (p = 0.43), and stage (p = 0.99) of colorectal cancer. Similarly there was no significant difference between white and black race in regards to days to surgery (median 17 vs 32 days; p = 0.53), first medical oncology appointment (30 vs. 34 days; p = 0.23) and days to adjuvant chemotherapy (42 vs 52 days; p = 0.24). The rate of recurrence (10.9% vs. 26%; p = 0.09), rate of death (14.1% vs 14.7%; p = 1.0), median relapse free survival (41.7 vs. 36.2 months; p = 0.173) and median overall survival (42 vs. 38.5 months; p = 0.491) from colorectal cancer were also not significantly different between white and black races. Conclusions: Oncologic treatment at NCI designated comprehensive cancer centers may lead to racial parity in colorectal cancer outcomes. Further research should be completed to compare these results to those seen at safety net hospitals.

In the current study, we sought to further our understanding of the relations between various types of protégé-reported mentoring functions (psychosocial and career support and role modeling [RM]) by conducting a meta-analysis. We examined the relationships among these functions and investigated their relationships with expected mentorship outcomes. There is still a great deal left for us to understand regarding how these functions relate to outcomes and what these relationships mean. We expanded upon previous meta-analyses in the following ways: We included RM functions in addition to psychosocial and career support functions, corrected for unreliability of the function scales in addition to sampling error, and examined the relations of these functions with one another. Results show that all the mentoring functions were related to outcomes, with RM being the strongest predictor. Finally, we identified and conceptually analyzed numerous moderators of these relations.

We used an online academic-advising program to examine the effects of preparatory training designed to elicit high states of learning-goal orientation and low states of avoid goal orientation. Results indicate that training was effective in some cases for manipulating states of goal orientation. The training did not directly affect behaviors as anticipated; however, perceptions of partner behaviors showed effects. Moreover, learning-goal orientation was related to advisee postprogram academic self-efficacy. Thus, individuals working with such mentoring programs should consider implementing goal-oriented preparatory training programs to increase mentoring relationship effectiveness.

The present study compared the relative impact of peer-mentoring that took place either face-to-face or through electronic chat. Proteges were 106 college freshmen randomly assigned to a senior college student mentor and to one of the two communication modes. Fifty-one mentors interacted with one of these proteges face-to-face and one solely through electronic chat. Electronic chat resulted in less psychosocial support, career support, and post-mentoring protege self-efficacy for those with male but not female mentors. Analyses of coded transcripts revealed that males condensed their language to a greater extent than did females in the electronic chat condition relative to the face-to-face condition. Dyads in the electronic chat condition had more interactive dialogue than did those in the face-to-face condition. Finally, dialogue interactivity predicted post-mentoring self-efficacy but only for those who communicated through electronic chat.

Given the choice, users produce passwords reflecting common strategies and patterns that ease recall but offer uncertain and often weak security. System-assigned passwords provide measurable security but suffer from poor memorability. To address this usability-security tension, we argue that systems should assign random passwords but also help with memorization and recall. We investigate the feasibility of this approach with CuedR, a novel cued-recognition authentication scheme that provides users with multiple cues (visual, verbal, and spatial) and lets them choose the cues that best fit their learning process for later recognition of system-assigned keywords. In our lab study, all 37 of our participants could log in within three attempts one week after registration (mean login time: 38.0 seconds). A pilot study on using multiple CuedR passwords also showed 100% recall within three attempts. Based on our results, we suggest appropriate applications for CuedR, such as financial and e-commerce accounts., Will appear at CHI 2015 Conference, to be held at Seoul, Korea

User-chosen passwords fail to provide adequate security. System-assigned random passwords are more secure but suffer from memorability problems. We argue that the system should remove this burden from users by assisting with the memorization of randomly assigned passwords. To meet this need, we aim to apply the scientific understanding of long-term memory. In particular, we examine the efficacy of augmenting a system-assigned password scheme based on textual recognition by providing users with verbal cues—real-life facts corresponding to the assigned keywords. In addition, we explore the usability gain of including images related to the keywords along with the verbal cues. We conducted a multi-session in-lab user study with 52 participants, where each participant was assigned three different passwords, each representing one study condition. Our results show that the textual recognition-based scheme offering verbal cues had a significantly higher login success rate (94 %) as compared to the control condition, i.e., textual recognition without verbal cues (61 %). The comparison between textual and graphical recognition reveals that when users were provided with verbal cues, adding images did not significantly improve the login success rate, but it did lead to faster recognition of the assigned keywords. We believe that our findings make an important contribution to understanding the extent to which different types of cues impact the usability of system-assigned passwords.

Entering a password on a mobile phone requires more effort than entering it on a PC keyboard, especially when using capital letters, digits, and special characters that are considered important for strong passwords. In this study, we examine how these factors affect the construction of passwords on input-constrained devices such as mobile phones. We conducted a between-group experiment with 72 students from the University of Texas at Arlington (UTA), in which we asked the participants to construct new passwords using PC keyboards and mobile phones with different keypad layouts. Passwords constructed by using PC keyboards were stronger than those constructed by touchscreen keypads. Surprisingly, passwords that were constructed by mobile phones with physical keyboards were stronger than those constructed by PC keyboards. We also designed a custom layout for the touchscreen keypad that offers a more convenient method of typing digits and some special characters. Our results show that this custom layout helped the participants to construct stronger passwords on mobile phones. To address an alternative explanation for better performance of the physical keyboard and custom layout groups, we designed a second experiment by removing the potential bias effects of the first experiment. The results of this within-group experiment confirm that if users are presented with a more convenient method of entering digits and special characters on mobile handsets, they take advantage of it to construct stronger passwords. The results also supplement our finding regarding password construction and user engagement from the first experiment and highlight an important design consideration about password construction pages for mobile versions of websites.

This Update summarizes studies published in 2015 that the authors consider highly relevant to the practice of rheumatology.