Early Attrition Research Articles

Beginning Teachers Navigating Identity Development Transitions: Identity Motives and Commitment to Teaching

Beginning teachers (preservice and novice) must develop a resilient professional identity, yet high early attrition rates indicate the need for additional support in this process. Many attrition studies focus on external factors; few address teacher identity. According to developmental psychologists, identity commitments are concretized in a stepwise process, first by tentatively making them, and then by evaluating them. Most preservice and novice teachers are in a transitional stage, as they explore whether tentative commitments fit their sense of self. Our research tests the proposition that such exploration is often focused on determining whether a teaching career will satisfy their identity motives. We interviewed and collected self-reported written stories from 154 interns and novice teachers. Participants discussed their career choice in an initial interview and in a questionnaire focusing on recent, identity-relevant significant events administered at three points in time over a year. These career choice and written, field-based significant event stories underwent content analysis for the presence of identity motives, guided by a codebook developed for this research. This paper describes two central and innovative findings. First, identity motives are, indeed, present and highly salient in teachers’ career deliberations. Secondly, we found that beginning teachers express motives differentially, vary in the salience they accord the motives, and explore motives differently according to situational context. This differentiation in focus may indicate important shifting priorities and challenges as participants navigate the transition to the field. Taken together, these findings suggest that understanding and addressing identity motives in teacher development may enable more personalized and responsive tools that support teacher retention.

Not all types of depressed patients who persist with their antidepressant treatment improve in side effect complaints: A comparison of treatment completers and dropouts in the STAR*D trial.

There is a "traditional belief" that antidepressant side effect complaints improve with medication persistence; however, support for this theory has remained inconclusive. We aimed to examine if side effect complaints improved over time by modeling the relationship between side effect complaints and time at dropout for patients receiving citalopram during the first level of acute treatment in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. We categorized the 2833 patients into five patterns by week of dropout. We used pattern-mixture modeling to model change in side effect complaints (frequency, intensity, and burden) over the 12-week course of treatment, while accounting for attrition and depressive severity. Using post-hoc linear contrasts, we compared the attrition patterns with the completers' pattern for severity of side effect complaints at each respective last visit prior to dropout as well as averaged side effect complaints across the duration of treatment. We also reported frequencies and tolerability of side effects for nine organ/function systems over the course of treatment. Patients who dropped out early exhibited worsening side effect burden and patients who dropped out later showed improvements in side effect frequency and intensity. Treatment completers improved in all side effect complaints over the course of treatment. Early attrition patterns had more severe side effect complaints for both tests of post-hoc linear contrasts than later attrition patterns and completers. Side effect complaints from antidepressant treatment improve over time, but only for some types of patients. As a precaution for early dropout, clinicians should monitor patients who exhibit worsening and more severe side effect complaints-especially in the first 6 weeks of antidepressant treatment. In addition, clinicians may want to consider changing the type of treatment early on for these patients, rather than encouraging them to persist with their current medication.

BARRIERS OF PROFESSIONAL IDENTITY FORMATION: THE JUSTIFICATION FOR INCREASED TEACHER ATTRITION RATE

This study delves into the barriers to forming teacher identity in Kazakhstan after a year of study and development. Early career teacher attrition is often seen as a problem related to personal or contextual factors. This research examined attrition as a process involving both individual and contextual elements. Based on semi-structured interviews with 38 school English teachers about their first professional career path, experiences, and expectations, the thematic analysis revealed 15 themes, which were then categorized into four main themes: higher salary expectations, status, lack of pre-teaching training, and bureaucracy. This article offers practical recommendations, including the development of programs for preserving cultural heritage and professional development, to contribute to the successful formation of teacher identity. Overall, this study discusses critical aspects of modern education in Kazakhstan, outlines the main conclusions, and explores prospects for improving the education system and supporting the development of professional identity among teachers, considering the peculiarities of national culture.

The effect of multiple types of workplace violence on burnout risk, sleep quality, and leaving intention among nurses.

The aim of our study is to explore the associations between multiple types of workplace violence (WPV) and burnout risk, sleep problems, and leaving intention among nurses. This cross-sectional survey recruited 1,742 nurses, and data on WPV experiences were collected through self-administered questionnaires. Work conditions, burnout risk scales, sleep quality, and leaving intentions were also evaluated. Multivariate logistic regression analyses were performed to examine the associations of WPV with burnout risk, sleep quality, and leaving intentions, adjusting for demographic characteristics and work conditions. The study found that 66.7% of nurses reported experience of WPV, with 26.9% experiencing both physical and nonphysical forms. Those who experienced multiple types of WPV reported worse work conditions, higher burnout risk, poorer sleep quality, and a stronger leaving intention compared to those without such experiences. Adjusting for working conditions, logistic regression analysis showed that nurses who experienced multiple types of WPV had 2.12-fold higher odds of high personal burnout risk, 2.36-fold higher odds of high client-related burnout risk, 1.95-fold higher odds of poor sleep quality, and 1.80-fold higher odds of high leaving intention, compared to those without WPV experiences. Strategies by hospital managers and policymakers to monitor and reduce workplace violence are vital for sustaining nurses' mental health, well-being, and preventing early attrition from the profession.

Predictors of adherence to follow-up and treatment success in childhood obesity

IntroductionManagement of childhood obesity, based upon behavioural, physical activity and dietary guidance, usually achieves limited success and is hindered by a high attrition rate. The identification of potential predictors of either weight loss or early weight management attrition could help develop personalised management plans in order to improve patient outcomes. Patients and methodsWe conducted a retrospective study in a cohort of 1300 patients with obesity managed in speciality clinics for up to 5 years with outpatient conservative treatment. We studied the family background and personal characteristics (demographic, behavioural, psychosocial, anthropometric and metabolic) of patients who dropped out before completing the first year of the programme and patients who achieved significant weight loss, with a separate analysis of patients who achieved substantial reductions in weight compared to the rest of the cohort. ResultsThe mean age of the patients in the cohort was 10.46 years (SD, 3.48) the mean BMI z-score 4.01 (SD, 1.49); 52.8% of the patients were male, 53.3% were prepubertal, 75.8% were Caucasian and 19% Latin. We found a higher proportion of Latinla ethnicity and compulsive eating in the group of patients with early attrition from the weight management follow-up. In the group of patients with substantial weight loss, a greater proportion were male, there was a higher frequency of dietary intake control at home and obesity was more severe, and the latter factor was consistently observed in patients who achieved substantial weight loss at any point of the follow-up. ConclusionsSome family and personal characteristics in childhood obesity are associated with an increased risk of early withdrawal from follow-up or a greater probability of successful outcomes; however, the predictive value of these variables is limited.

Maternal executive function and stress and children's behavior problem treatment outcomes.

This prospective, observational study was designed to investigate the relationship of mothers' executive function capacities and parenting stress to early dropout, appointment attendance, and outcomes of in-clinic delivery of parent management training to address children's behavior problems. We hypothesized that mothers' executive functions (EFs) would be prospectively and positively associated with adherence to children's behavioral treatment appointments and reduction in children's behavior problems and that mothers' stress levels would be inversely related to these outcomes. Mothers (n = 288) completed the Behavior Rating Inventory of Executive Function for Adults (EF) and Parenting Stress Index at the beginning of treatment. Children were 2-12 years old. Regression models evaluated the extent to which deficits in maternal EF and clinical levels of parenting stress contributed to the three outcomes. The 11% of mothers with clinically significant deficits in executive functioning were significantly (3 times) more likely to drop out early compared to mothers in the normal range. Almost one third of mothers reported clinically significant parenting stress. Their children were half as likely to achieve a positive behavior outcome, although stress was not significantly associated with attendance. Remaining in treatment is fundamental to being able to learn and practice the parenting skills necessary to manage young children's age-inappropriate behavior in positive ways. Clinical consideration of mothers' EF challenges may help prevent early treatment attrition and clinical management of parenting stress may further help improve children's treatment outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Innovative multimodal Open Distance e-Learning (ODeL) supervision practices for master’s and doctoral candidates

Open Distance e-Learning (ODeL) is on the rise to cater to non-traditional students. However, the surge in master's and doctoral students opting for ODeL raises concerns about the quality and timely completion of degrees. Existing literature on student attrition in higher education indicates that both student-related factors and institutional variables significantly impact completion rates. Factors such as students' sense of connection or isolation, as well as institutional aspects like supervisor responsiveness to feedback and feedforward, contribute to student persistence. To address this early attrition and extended stays in postgraduate studies, a community of practice (CoP), comprising lecturers and master’s and doctoral students was formed. The CoP employed the Social Learning Theory (SLT) approach to initiate collaborative partnerships designed to promote a research culture and explore alternative approaches to curb master’s and doctoral late completion and attrition. This paper reports on a study undertaken to explore the experiences, perceptions and insights of master’s and doctoral candidates regarding the implementation of innovative multimodal Open Distance e-Learning supervision practices. Grounded in SLT, the exploratory case study employed an open-ended questionnaire to gather data from the students participating in the support programme. The findings revealed the positive impact of innovative practices on candidates' academic development and overall research experience. The findings further demonstrated that virtual communication tools have significantly enhanced collaboration between candidates and supervisors, breaking down geographical barriers and facilitating real-time feedback and guidance. The innovative multimodal OdeL supervision practices gave master’s and doctoral candidates flexibility and increased their learning engagement.

Reported pain at work is a risk factor for vascular surgery trainee burnout

BackgroundWork-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. MethodsA confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Service Examination to trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs. Burnout was measured by a modified, abbreviated Maslach Burnout Inventory; pain after a full day of work was measured using a 10-point Likert scale and then dichotomized as “no to mild pain” (0-2) vs “moderate to severe pain” (3-9). Univariable analyses and multivariable regression assessed associations of pain with well-being indicators (eg, burnout, thoughts of attrition, and thoughts of career change). Pain management strategies were included as additional covariables in our study. ResultsWe included 527 trainees who completed the survey (82.2% response rate); 38% reported moderate to severe pain after a full day of work, of whom 73.6% reported using ergonomic adjustments and 67.0% used over-the-counter medications. Significantly more women reported moderate to severe pain than men (44.3% vs 34.5%; P < .01). After adjusting for gender, training level, race/ethnicity, mistreatment, and dissatisfaction with operative autonomy, moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change after adjustment. ConclusionsPhysical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should consider mitigating this occupational hazard by offering ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.

It’s Complicated: Examining Connections Between Emotions and Career Stages Among Physical Educators

Background: Physical education (PE) is a marginalized profession that is socially and emotionally demanding. PE teachers are prone to early career attrition, isolation, and burnout as a result of negative emotional experiences. While these outcomes are customary, little is known about how teachers’ emotions change across their careers. The purpose of this study was to explore the relationship between PE Teacher Career Stages and their emotional experiences. Methods: Participants included 31 in-service PE teachers (Mage = 44.70 years, SD = 9.48; M = 15.87 years of teaching) from the United States. Inductive and deductive analyses were used to evaluate the interview data. Results: Themes included: (a) teachers identify within multiple stages/emotions, (b) stakeholder agendas cultivate negative emotions, and (c) the aftermath of the pandemic as a catalyst for frustration. Conclusion: Teachers’ emotions are complex and multidimensional. Exploring teachers’ emotions within different career stages may help prevent early career attrition and increase job satisfaction.

Early Student Attrition from Medical Schools: A Scoping Review

Early Student Attrition from Medical Schools: A Scoping Review

Students' perspectives on their early dropout of medical school.

Enrolling in medical school launches a more demanding and stressful way of life for newly admitted students. Some students will struggle academically and will ultimately drop out from medical school. The study aims to understand the perspectives that dropped-out students have and their opinion regarding possible preventative solutions. This study uses a mixed-method approach. The results of students' examinations in the first 2 years of admission (within four academic years from 2016 until 2020) were collected from the medical school records. A questionnaire was developed to investigate the causes of early attrition during the study period. All dropped-out students who were admitted were included in this study. The study included 479 admitted students, 349 (72.9%) were females; 152 (31.7%) students dropped out in the premedical program (first two years); 104 (68.4%) of the dropped-out students were females. Thirty-five (23%) students responded to the questionnaire. Twenty-eight (80%) respondents believed that their low academic performance and leaving medical school was primarily related to psychological problems, 19 (54%) of respondents reported leaving for social reasons, and lack of self-organization in 13 (37.1%) respondents. Human anatomy was recorded as the most difficult course in the first year by 21 (63.6%) students. The cause of attrition is often multifactorial and complex. Psychological problems are one of the important factors in students with low academic performance and dropping out of the students. Some difficult courses in the curriculum may affect the students' academic performance leading to their attrition.

Generation and screening of mouse models of ADRD with multiple genetic manipulations to model dementia with mixed brain pathologies

AbstractBackgroundAlzheimer’s disease‐related dementias (ADRD) encompass a wide range of neurodegenerative diseases including Alzheimer’s disease, vascular dementia, frontotemporal dementia (FTD), Lewy body dementia (LBD), and mixed dementia [1‐4]. ADRDs are distinguished by the presence of pathologies including amyloid, tau, TDP‐43 inclusions, alpha‐synuclein aggregates, cerebral amyloid angiopathy, and/or hippocampal sclerosis [4‐9]. Consequently, the heterogeneity of ADRDs presents challenges for animal modeling of disease mechanisms. Our laboratory has demonstrated that genetic diversity in disease modeling is critical to recapitulate the molecular and cognitive features of AD [1,9, 10]. Here, we introduce multiple genetic manipulations to develop novel translational models of ADRD.MethodPrecision models of ADRD on multiple genetic backgrounds were generated via combinatorial CRISPR editing to knock‐in human disease‐causing mutations onto the C57BL/6J (B6) strain and crossed to either B6, DBA/2J (D2), FVB, or WSB to generate a set of 20 unique ADRD models (Fig.1). The effect of homozygous mutations were evaluated on the B6 background. Each model was assessed using a high‐capacity multi‐domain go/no‐go screen to prioritize candidate strains for future ADRD modeling of drug discovery, preclinical testing, and disease pathology.ResultAssays included frailty, open field, y‐maze, rotarod, and contextual fear conditioning. Models with one or more late‐onset behavioral deficits (12 mo) were a “go”; whereas, early behavioral deficits (6 and 9 mo), aggression, high attrition, and low fecundity and additional factors were considered unsuitable (“no‐go”). We identified several promising models of ADRD that exhibited late‐onset frailty and motor deficits as function of mutation burden and genetic background (e.g., App/Psen1/Tardbp/Mapt on the D2 background). The FVB background strain exhibited early frailty deficits (6 mo), and thus considered unsuitable (“no‐go”). The WSB background strain exhibited reserve across multiple frailty and behavioral assays up to 12 mo.ConclusionOur results demonstrate that combining ADRD mutations in genetically distinct backgrounds is a promising strategy to generate new mouse models that better model the human mid and late‐life onset of deficits associated with ADRD. The resulting model(s) will be translationally relevant and provide important insight into disease mechanisms for the future of ADRD research and drug discoveries.

Predicting Early Exercise Attrition With The Physical Activity Skill-sets For Identification And Training (Passfit) Profile

Predicting Early Exercise Attrition With The Physical Activity Skill-sets For Identification And Training (Passfit) Profile

Correlates of early attrition from school sports clubs in male senior high school students: a 2.4-year follow-up study.

The correlation between early attrition and school sports clubs has been underexplored. This study aims to clarify the correlates of early attrition from school sports clubs at a private male senior high school in Fukuoka Prefecture, Japan. Of the 928 first-year students, 331 belonging to the school's sports clubs were included in this study. A baseline survey was conducted in May 2017 and a follow-up survey was conducted in October 2019. This study defined early attrition as a student who quit a sports club earlier than April in their third year. Examined correlates for early attrition consisted of biological, intrapersonal, interpersonal, and institutional factors. We used univariate logistic regression analysis, in which early attrition was the response variable and the examined correlates were the explanatory variables, and calculated the odds ratios (OR) and 95% confidence intervals (CI). Overall, 232 students (85.0%) continued to participate in sports clubs after April of their third year, and 41 students (15.0%) experienced early attrition. Statistically significant correlates for early attrition were weight (OR = 0.94, 95% CI = 0.90-0.98), body mass index (OR = 0.84, 95% CI = 0.74-0.97), experience of injury or disability (OR = 0.40, 95% CI = 0.19-0.87), athletic achievement (OR = 0.29, 95% CI = 0.13-0.62), and duration of experience of the sport (OR = 0.99, 95% CI = 0.98-1.00). Our findings suggest that the school officers or family members of students should recognize the possibility of early attrition and provide appropriate support if a student experiences early attrition. The athletic level or norms of school sports club activities may differ among other schools and sports clubs; therefore, it is necessary to examine whether our findings are applicable to other schools and sports clubs.

Early Attrition Prediction for Web-Based Interpretation Bias Modification to Reduce Anxious Thinking: Machine Learning Study (Preprint)

Early Attrition Prediction for Web-Based Interpretation Bias Modification to Reduce Anxious Thinking: Machine Learning Study (Preprint)

Teacher leadership and teachers’ learning: actualizing the connection from day one

ABSTRACTThis article offers a review of research and scholarly work about why it matters that new teachers have early opportunities to engage in leadership activities despite their beginner status. It builds on a continuing strand of literature grappling with leadership work as an organisational quality, manifest in activity and practice which need not be restricted to those with formal leadership roles. If capacity building for leadership is left until later in a teacher’s career, this can mean those with potential to lead may have already left the profession in search of new challenges. That early career teacher attrition continues to be a worldwide concern, suggests more could be done to address this unfortunate trend. This article takes on that challenge through a deepening of insights about essential on-the-job practice for early career teachers. The literature is presented through three themes: teachers’ need for learning, teacher leadership as collective work for improved student learning, and trusting relationships, colleagues’ pedagogical expertise and modelling with coaches and mentors. These themes recognise teachers’ professional learning as the pathway to leadership influence which can begin on entry to teaching. The article concludes with questions to be addressed by schools in dialogue with early career teachers.

Canadian (CAN) real-world outcomes for relapsed/recurrent (R/R) metastatic triple-negative breast cancer (mTNBC) in the first-line or later (1L+) setting by early or late recurrence status.

e18798 Background: Little epidemiological data characterizing the mTNBC population in Canada exist, limiting the understanding of treatment patterns, attrition rates, and unmet need for CAN patients (pts) with R/R mTNBC. This study examined real-world outcomes and palliative treatment patterns for CAN pts with 1L+ R/R mTNBC, stratified by early vs late recurrence. Methods: This retrospective study used real-world, population-based data from the Oncology Outcomes database in Alberta to identify pts diagnosed with early stage (I to III) TNBC between 2010-2019 who progressed to mTNBC. Algorithms reliably identified recurrent pts as those who received 2+ cycles of systemic therapy &gt; 240 days from the initiation of adjuvant treatment or surgery. Clinical outcomes from 1L+ treatment of mTNBC, including time to next treatment (TTNT) or death and overall survival (OS), were ascertained. Diagnosis, demographics, treatment patterns, and attrition rates were stratified by treatment-free interval (TFI), early (8-12 mo TFI) or late ( &gt; 12 mo TFI). Results: Data from 181 CAN pts with R/R mTNBC (recurred early, n = 59; recurred late, n = 122) were analyzed. Baseline characteristics were generally comparable between groups. Pts who recurred late were on average older at recurrence (59 y vs 55 y, P= 0.03) and less likely to be stage III (21% vs 51%, P&lt; 0.001) at initial diagnosis. The median time to recurrence was 17 mo. The most common 1L therapies were capecitabine monotherapy (35%), other chemotherapy combinations (16%), and taxane monotherapy (12%), with a median duration of therapy (DOT) of 4.9 mo, 3.5 mo, and 4.5 mo, respectively. Rates of attrition between lines of therapy (LOT) were relatively high, with 96 pts (53%) initiating 2L therapy (among the 85 pts who did not start 2L treatment, 63 had died). Median DOT was 3.6 mo for 1L, 3.0 mo for 2L, and 3.0 mo for 3L. Stratifying by early or late recurrence did not show differences in TTNT (4 mo vs 4 mo; HR, 0.94; 95% CI, 0.64-1.38; P= 0.75) or OS (10 mo vs 11 mo; HR, 0.96; 95% CI, 0.64-1.44; P= 0.84). Exploratory analyses showed improved OS (23 mo vs 10 mo; HR, 0.60; 95% CI, 0.40-0.92; P= 0.02) in pts with TFI ≥24 mo (n = 61) but not in pts with TFI 12-24 mo (11 vs 10 mo; HR: 0.96; 95% CI: 0.64-1.44; P= 0.84) vs pts with TFI of 8-12 mo. Conclusions: This retrospective study showed higher than expected rates of early recurrence and high attrition between LOT in a CAN breast cancer population that progressed to mTNBC. The short DOT across lines was similar and consistent with CAN practice. OS for 1L+ R/R mTNBC were similar for individuals who recurred between 8-12 vs 12-24 mo. These findings confirmed the poor prognosis of pts with R/R mTNBC and the need for improved therapies especially in 1L, where the most common treatments, including capecitabine, may not deliver the most meaningful impact.

Reported Pain at Work Is a Risk Factor for Vascular Surgery Trainee Burnout

Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Training Exam. Trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs were asked to complete a modified, abbreviated Maslach Burnout Inventory. Pain after a full day of work was measured using a 10-point Likert scale and dichotomized into none to mild pain (0-2) vs moderate to severe pain (3-9). Univariable and multivariable regression analyses were used to assess associations of pain with well-being indicators such as burnout, thoughts of attrition, and career change. Pain management strategies were included as covariables in our study. There were 527 who trainees completed the survey (82.2% response rate). After a full day of working, 38% reported moderate to severe discomfort/pain. Among those who reported moderate to severe pain, 73.6% reported using ergonomic adjustments and 67.0% over-the-counter medications. More women tended to report moderate to severe pain than men (44.3% vs 34.5%; P < .01) (Table I). After adjusting for gender, training level, race/ethnicity, mistreatment, and lack of operative autonomy (a proxy for loss of meaning in work), moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change following adjustment (Table II). Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should provide ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.Table IUnivariable associations of vascular surgery trainee characteristics and well-being with moderate to severe painModerate to severe painP valueYes (n = 200, %)No (n = 327, %)Male118 (34.5)224 (65.6)Female82 (44.3)103 (55.7).03Race/ethnicity Non-Hispanic White109 (41.8)152 (58.4) Non-Hispanic Black10 (35.7)18 (64.3) Hispanic/Latinx14 (33.3)28 (66.7) Asian45 (33.8)88 (66.2) Other12 (41.4)17 (58.6) Prefer not to say10 (37.0)17 (63.0).69Postgraduate year 123 (36.5)40(63.5) 2-344 (34.7)83 (65.3) 5-7133 (39.5)204 (60.5).62Did not feel they had appropriate level of OR autonomy16 (59.3)11 (40.7).06Thoughts of attrition29 (54.7)164 (40.4).047Thoughts of career change28 (14.5)21 (7.8).02Burnout125 (54.1)75 (25.3)<.001Mistreatment147 (79.9)132 (54.1)<.001 Open table in a new tab Table IIMultivariable associations of risk factors with burnout, thoughts of attrition, and thoughts of career change in vascular surgery traineesBurnoutAttritionCareer changeOR95% CIP valueOR95% CIP valueOR95% CIP valueModerate to severe pain2.521.48-4.260.0011.690.77-3.700.192.100.92-4.820.08Gender MaleRefRefRef Female0.960.53-2.740.900.540.22-1.320.180.540.22-1.360.19Race NH WhiteRefRefRef NH Black1.040.29-3.740.950.330.02-4.510.411.470.22-9.720.69Hispanic/Latinx0.430.16-1.180.100.850.20-3.650.830.650.12-3.450.62 Asian0.800.43-1.490.491.540.62-3.820.360.910.32-2.610.84 Other0.590.36-4.060.361.640.31-8.570.561.790.33-9.720.50 Prefer not to say1.210.36-4.060.761.140.25-5.110.872.330.56-9.620.24Postgraduate year level 1RefRefRef 2-31.760.70-4.410.230.690.20-2.400.560.810.21-3.110.76 4-71.150.50-2.640.740.670.22-2.040.490.910.27-3.020.88Pain management OTC medications1.270.75-2.170.370.540.24-1.200.130.590.26-1.350.21Orthotics (eg, brace, footware, etc)1.350.72-2.530.350.910.37-2.200.832.200.77-6.320.14 Yoga/Pilates0.790.43-1.450.440.950.39-2.290.910.510.21-1.240.14 Physiotherapy3.061.02-9.140.0453.950.44-35.40.223.650.41-32.700.25Massage/chiropractic/acupuncture0.770.43-1.400.400.540.23-1.270.160.830.35-1.980.67Ergonomic adjustments0.700.40-1.230.211.520.68-3.410.310.980.42-2.310.96Did not feel they had appropriate level of operative autonomy9.892.02-48.40.0111.856.07-35.54<0.0019.993.31-30.11<0.001Any form of mistreatment2.621.42-4.800.0025.201.40-19.310.015.501.21-25.080.03CI, Confidence interval; OR, odds ratio; Ref, reference; OTC, over the counter; NH, non-Hispanic/Latinx. Open table in a new tab

Development and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban Zambia with newly diagnosed HIV infection

BackgroundWomen who are newly diagnosed with HIV infection during pregnancy may not be ready to immediately initiate lifelong antiretroviral therapy (ART; called Option B +) as is recommended. Lack of “readiness” drives early disengagement from care and undermines prevention of HIV transmission to infants. Several studies have shown high early attrition of women initiating ART in pregnancy. Although poor ART uptake and adherence have been attributed to various factors including stigma, disclosure issues and structural issues, there is no standard way of determining which pregnant woman will face challenges and therefore need additional support. We developed and validated a novel ART readiness tool in Lusaka, Zambia.MethodsThe aim of this study was to develop and validate a tool that could be used to assess how ready a newly diagnosed pregnant woman living with HIV would be to initiate ART on the day of diagnosis. Using a mixed method design, we conducted this study in three public-setting health facilities in Lusaka, Zambia. Informed by qualitative research and literature review, we identified 27 candidate items. We assessed content validity using expert and target population judgment approaches. We administered the 27-item questionnaire to 454 newly diagnosed pregnant women living with HIV, who were enrolled into a randomized trial (trials number NCT02459678). We performed item reduction analysis and used Cronbach’s alpha coefficient of 0.70 as threshold for reliability.ResultsA total of 454 pregnant women living with HIV enrolled in the study between March 2017 and December 2017; 452 had complete data for analysis. The correlation coefficient between the 27 items on the completed ART readiness scale ranged from 0.31 to 0.70 while item discrimination index ranged from -0.01 to 2.38. Sixteen items were selected for the final scale, representing three domains, which we classified as “internalized and anticipated HIV stigma”, “partner support” and “anticipated structural barriers”.ConclusionWe developed and validated a tool that could be used to assess readiness of newly diagnosed women living with HIV to initiate ART. This ART readiness tool could allow clinics to tailor limited resources to pregnant women living with HIV needing additional support to initiate and remain on ART.

What Factors Are Associated With Early Career Attrition Among Orthopaedic Surgeons in the United States?

The attrition of medical personnel in the United States healthcare system has been an ongoing concern among physicians and policymakers alike. Prior studies have shown that reasons for leaving clinical practice vary widely and may range from professional dissatisfaction or disability to the pursuit of alternative career opportunities. Whereas attrition among older personnel has often been understood as a natural phenomenon, attrition among early-career surgeons may pose a host of additional challenges from an individual and societal perspective. (1) What percentage of orthopaedic surgeons experience early-career attrition, defined as leaving active clinical practice within the first 10 years after completion of training? (2) What are the surgeon and practice characteristics associated with early-career attrition? In this retrospective analysis drawn from a large database, we used the 2014 Physician Compare National Downloadable File (PC-NDF), a registry of all healthcare professionals in the United States participating in Medicare. A total of 18,107 orthopaedic surgeons were identified, 4853 of whom were within the first 10 years of training completion. The PC-NDF registry was chosen because it has a high degree of granularity, national representativeness, independent validation through the Medicare claims adjudication and enrollment process, and the ability to longitudinally monitor the entry and exit of surgeons from active clinical practice. The primary outcome of early-career attrition was defined by three conditions, all of which had to be simultaneously satisfied ("condition one" AND "condition two" AND "condition three"). The first condition was presence in the Q1 2014 PC-NDF dataset and absence from the same dataset the following year (Q1 2015 PC-NDF). The second condition was consistent absence from the PC-NDF dataset for the following 6 years (Q1 2016, Q1 2017, Q1 2018, Q1 2019, Q1 2020, and Q1 2021), and the third condition was absence from the Centers for Medicare and Medicaid Services Opt-Out registry, which tracks clinicians who have formally discontinued enrollment in the Medicare program. Of the 18,107 orthopaedic surgeons identified in the dataset, 5% (938) were women, 33% (6045) were subspecialty-trained, 77% (13,949) practiced in groups of 10 or more, 24% (4405) practiced in the Midwest, 87% (15,816) practiced in urban areas, and 22% (3887) practiced at academic centers. Surgeons not enrolled in the Medicare program are not represented in this study cohort. A multivariable logistic regression model with adjusted odds ratios and 95% confidence intervals was constructed to investigate characteristics associated with early-career attrition. Among the 4853 early-career orthopaedic surgeons identified in the dataset, 2% (78) were determined to experience attrition between the first quarter 2014 and the same point in 2015. After controlling for potential confounding variables such as years since training completion, practice size, and geographic region, we found that women were more likely than men to experience early-career attrition (adjusted OR 2.8 [95% CI 1.5 to 5.0]; p = 0.006]), as were academic orthopaedic surgeons compared with private practitioners (adjusted OR 1.7 [95% CI 1.02 to 3.0]; p = 0.04), while general orthopaedic surgeons were less likely to experience attrition than subspecialists (adjusted OR 0.5 [95% CI 0.3 to 0.8]; p = 0.01). A small but important proportion of orthopaedic surgeons leave the specialty during the first 10 years of practice. Factors most-strongly associated with this attrition were academic affiliation, being a woman, and clinical subspecialization. Based on these findings, academic orthopaedic practices might consider expanding the role of routine exit interviews to identify instances in which early-career surgeons face illness, disability, burnout, or any other forms of severe personal hardships. If attrition occurs because of such factors, these individuals could benefit from connection to well-vetted coaching or counseling services. Professional societies might be well positioned to conduct detailed surveys to assess the precise reasons for early attrition and characterize any inequities in workforce retention across a diverse range of demographic subgroups. Future studies should also determine whether orthopaedics is an outlier, or whether 2% attrition is similar to the proportion in the overall medical profession.