Occupational Engagement Research Articles

'Normality in all the abnormality'-Older adults' experiences of holidays and celebrations from the COVID-19 pandemic.

The importance of holidays, traditions, and family celebrations to human culture and occupational engagement has been neglected. The aim of this study was to explore how older adults experienced holidays and celebrations with social and physical distancing during the COVID-19 pandemic. A secondary analysis was made on data from the At-Risk Study. Seventeen community-living adults (11 women and 6 men) aged 71-87 years, from Sweden participated. They were interviewed remotely four times during the first year of the pandemic. Data were analysed with qualitative content analysis. No consumer/community involvement occurred. Three categories on how the participants hoped for, planned, decided, adapted, avoided, and experienced holidays and celebrations with social and physical distancing included expectations and preparations in unpredictable times; the constant need for re-evaluation; and almost everything turned out differently. The desire to celebrate despite pandemic restrictions shows the importance and meaning holidays hold for older adults. Celebrations can be disrupted for many reasons, not only as extreme as the ongoing pandemic. For wellbeing in later life health care, social care, and society need to understand the inherent components and acknowledge ways of supporting participation in occasional events such as holidays, traditions, and family celebrations.

Research on sustainable green building space design model integrating IoT technology.

"How can the integration of Internet of Things (IoT) technology enhance the sustainability and efficiency of green building (G.B.) design?" is the central research question that this study attempts to answer. This investigation is important because it examines how green building and IoT technology can work together. It also provides important information about how to use contemporary technologies for environmental sustainability in the building sector. The paper examines a range of IoT applications in green buildings, focusing on this intersection. These applications include energy monitoring, occupant engagement, smart building automation, predictive maintenance, renewable energy integration, and data analytics for energy efficiency enhancements. The objective is to create a thorough and sustainable model for designing green building spaces that successfully incorporates IoT, offering industry professionals cutting-edge solutions and practical advice. The study uses a mixed-methods approach, integrating quantitative data analysis with qualitative case studies and literature reviews. It evaluates how IoT can improve energy management, indoor environmental quality, and resource optimization in diverse geographic contexts. The findings show that there has been a noticeable improvement in waste reduction, energy and water efficiency, and the upkeep of high-quality indoor environments after IoT integration. This study fills a major gap in the literature by offering a comprehensive model for IoT integration in green building design, which indicates its impact. This model positions IoT as a critical element in advancing sustainable urban development and offers a ground-breaking framework for the practical application of IoT in sustainable building practices. It also emphasizes the need for customized IoT solutions in green buildings. The paper identifies future research directions, including the investigation of advanced IoT applications in renewable energy and the evaluation of IoT's impact on occupant behavior and well-being, along with addressing cybersecurity concerns. It acknowledges the challenges associated with IoT implementation, such as the initial costs and specialized skills needed.

Review Paper on Study and Analysis on Low-Cost Housing

Studying and analyzing low-cost housing involves examining various aspects such as design, construction materials, location, affordability, sustainability, and social impact. Here's a breakdown of some key considerations: 1. Design: Low-cost housing often requires innovative designs that maximize space utilization while minimizing costs. This may include modular construction, tiny homes, or efficient layouts that reduce the need for excessive materials. 2. Construction Materials: The choice of materials significantly impacts the cost of housing. Analyzing alternative, locally-sourced materials that are both affordable and durable is essential. This might involve using materials like bamboo, recycled materials, or compressed earth blocks. 3. Location: The location of low-cost housing projects is crucial for accessibility to job opportunities, transportation, and essential services. Analyzing the availability of land and infrastructure in suitable locations can influence the feasibility of such projects. 4. Affordability: True low-cost housing must be affordable not only in terms of initial construction but also in terms of ongoing maintenance and utilities. Analyzing the total cost of ownership over time is essential to ensure that housing remains accessible to its intended occupants. 5. Sustainability: Sustainable practices should be integrated into low-cost housing projects to minimize environmental impact and reduce ongoing costs. This may involve energy-efficient design, renewable energy sources, water conservation, and waste management strategies. 6. Social Impact: Low-cost housing projects should consider the social impact on communities, including issues like inclusivity, community engagement, and empowerment of residents. Analyzing the social dynamics and potential benefits Key Words: Affordability, Construction material , House technique , Urbon Planning

대학생의 계획된 우연기술과 기본심리욕구 진로관여행동과, 진로결정자기효능감의 구조적 관계

Objectives The purpose of this study is to select variables that affect university students' career decision-making self-efficacy and to confirm the structural relationship among them.
 Methods A related survey was conducted on 302 university students located in Seoul and Gyeonggi-do. The collected data were subjected to correlation analysis, normality verification, structural model analysis, path analysis, and bootstrapping using SPSS21 and AMOS21 programs.
 Results First, there was a significant positive correlation between the variables of college students' Planned Happenstance Skills, Basic Psychological Needs, Occupational Engagement, and Career Decision Self-efficacy. Second, it was found that Basic Psychological Needs and Occupational Engagement completely mediated the relationship between college students' Planned Happenstance Skills and Career Decision Self-efficacy.
 Conclusions It was confirmed that it was possible to satisfy Basic Psychological Needs and increase Occupational Engagement through the reinforcement of Planned Happenstance Skills for university students in the period of career decision, which has a positive effect on self-efficacy in career decision-making.

Post-stroke depression, activities of daily living, and occupational therapy intervention: An observational survey

Introduction: Post-stroke depression is a frequent but under-diagnosed condition. Nevertheless, it impacts participation in activities of daily living (ADLs) and the rehabilitation process. The aim of this study is to analyze the influence of post-stroke depression on participation in ADLs and on occupational therapy (OT) intervention in adults. Methods: An observational study was conducted through a survey. The questionnaire covered OTs view about the influence of post-stroke depression on ADLs and occupational therapy treatment. Data collected by online questionnaire were analyzed through STATA®, using a mixed method. Quantitative data were analyzed through descriptive statistics. Qualitative data were analyzed by thematic analysis. Results: Sixty-three surveys were valid. Stroke adults manifest hopelessness toward the future, crying and nervousness (“often” / “always” >50%). They have often worse occupational performance than patients with stable mood (55.56%), especially in self-care activities (35.92%). The performance limiting factors are low volition (41%), reduced motor skills (30%), and reduced cognitive skills (19%). OT intervention with these patients aims to increase volition (21.30%), recover roles (16.61%), and improve self-care activities (14.08%). Conclusion: Mood disorders negatively affect participation in ADLs and OT intervention. This study highlights the importance of volitional factors in promoting occupational engagement and provides guidance for OT treatment. Further investigation through specific studies appears necessary.

The impact of a residential fire on occupational engagement and performance: A reflexive narrative approach

Residential fires are a devastating and stressful life event. The high number of residential fires per year and significant associated stressors impacts all aspects of daily life. This reflexive narrative approach highlights gaps in inpatient and outpatient burn care for those who have suffered a residential fire from an occupational therapy perspective. The findings show that healthcare professionals need to consider social support systems, use therapeutic listening, provide stress management techniques and be advocates throughout the recovery process.

Unmet occupational needs of first responders transitioning to retirement

ABSTRACT First responders have high-stress jobs, identify with their professions’ crisis management actions, and yet are highly communal in their work life. They are often unprepared for retirement and transition to civilian life. As a result, their occupational needs are mostly unsatisfied. We employed a hermeneutic phenomenological approach to understand the lived experience of retirement transition among first responders. Data were collected in four focus groups with 15 first responders. A hermeneutical spiral guided the exploration of the data in a back-and-forth and parts-to-whole-text approach to search for new insights via a three-step thematic analysis process. Four themes and nine subthemes emerged from data analysis. Supersuit painted a picture of self-identity tied to the first responder role. Civilian detailed first responders’ transition from public safety to civilian life. The Door Shuts described accounts of a fast work exit without proper retirement preparation and post-retirement care. Staying Busy explained the importance of occupational engagement in retirement. The research findings pointed to unmet occupational, human needs of doing, being, becoming, and belonging, and struggles in retirement transition among retired first responders. Occupational engagement and social participation in retirement appeared to be crucial in meeting those needs and alleviating substantial challenges of retirement transition. We conclude with recommendations for future research and program development to assist first responders to an occupationally rich retirement.

Co-creating solutions with social housing users: a Living lab case

ABSTRACT Social housing (SH) upgrade processes have the potential to reduce social costs, improve living conditions, and increase the satisfaction of dwellers. All stakeholders, especially end-users, should participate in such processes to identify needs and problems and evaluate proposals. The Living Lab (LL) approach is recommended to develop solutions in a real-life context, and collaboration among participants. Our study explores this to involve residents of SH in enhancing their neighbourhood, positively influencing their satisfaction with their living environment, and improving their quality of life. We pursued this objective by exploring participatory tools. We present co-creation activities to develop upgrade proposals for communal areas. From our analysis of these co-creation activities, important lessons are learned on resident engagement in social housing upgrade processes. Our contributions include a set of practical advice for conducting co-creation activities in Living Labs for social housing upgrades and a demonstration of how research organisations can utilise Living Labs to empower users in creating their social innovation projects.

Coping with Age-Related Vision Loss to Maintain Occupational Engagement: A Narrative Account

Introduction This narrative inquiry study aimed to explore older adults’ stories about how they have coped to maintain occupational engagement, despite living with age-related vision loss (ARVL). Methods Six older adults, ≥ 60 years of age with ARVL participated in three interviews each, which were analyzed using thematic analysis. Results Coping was grouped into three overarching themes namely psychological, social, and behavioral coping strategies. Conclusion Results from this study have identified how older adults with ARVL cope to maintain participation in occupations. Findings highlight the need for increased healthcare support, including occupational therapists, to help older adults aging with vision loss identify and integrate adaptive coping strategies to enhance their occupational lives.

The role of occupational therapy serving LGBTQIA+ people: Retrospective perceptions of an occupational therapist

Introduction and aim: LGBTQIA+ people constitute a minority group that navigate their occupational engagement within a historically entrenched system of oppression. This opinion piece addresses a subject matter that is increasingly garnering attention from the international health science community, yet it remains insufficiently explored in South African occupational therapy dialogues. The aim of this paper is to stimulate critical reflection among occupational therapists on the discourses that underpin our daily practice. By utilising the person- environment-occupation model, we seek to demonstrate the unique and essential role of occupational therapy in serving LGBTQIA+ people within the South African context.
 Conclusion: Although occupational therapists are trained to consider all aspects of a person, discussions around gender are rarely emphasised in undergraduate training or clinical practice. This opinion piece demonstrates the roles that occupational therapists may play when working with LGBTQIA+ people to provide services that are holistic and relevant to their needs and contexts. Recognizing the impact of everyday occupational therapy practices on LGBTQIA+ individuals is crucial, requiring a commitment to inclusivity and continuous reflection within the field of occupational therapy.
 Implications for practice
 Occupational therapists can play an important role in serving LGBTQIA+ individuals when they are committed to recognizing how dominant discourses about this group can be sustained through the everyday practices of delivering occupational therapy.

427 Optimization of Morbidity and Mortality Conference: Results of a Multi-center Pilot at Neurosurgical Training Programs

INTRODUCTION: Neurosurgical morbidity and mortality (M&M) conference is essential to resident education and to quality control. Training programs use different methods for executing the conference, with variability in presentation format, case inclusion criteria, adjudication of findings, and follow-up strategy. Optimal format for this conference is debated. METHODS: Ten ACGME-accredited neurosurgical training programs participated in a 3-month pilot to optimize M&M conference. A standardized format was implemented, using a broadly inclusive strategy for case selection, with morbidities selected by residents. Each neurosurgical complication was defined, in group discussion, according to type of error: indication; technique; procedure; judgment; nature of disease. Follow-up intervention was drafted for each case. Surveys were distributed to trainees and attending neurosurgeons before and after the pilot to assess the new format compared to historical standard. RESULTS: A total of 302 surveys were returned from attending and resident physicians. Seventy-four % of respondents found the new format to be an improvement (“slightly improved” or “much improved”) and Eight-five % expressed preference for the new standardized format. Fifty-two % of resident respondents believed engagement at the conference was increased. Twenty-six % responded that significant process improvements resulted from the standardized format. CONCLUSIONS: This 3-month pilot to optimize neurosurgical M&M conference, undertaken at ten neurosurgery training programs, received favorable reviews by survey. Respondents endorsed high levels of faculty & resident engagement. Case categorization by error was favorably reviewed. Significant process improvements were only noted by a minority of respondents, however, perhaps related to the short duration of the pilot. Overall these results suggest that future amplification of a standardized M&M format across neurosurgical training programs could yield high satisfaction and enhanced resident engagement. Additional attention focused on process improvement will be critical.

Impact of implementing the pain best practice guideline in a long-term care home using the knowledge-to-action framework

Introduction. Assessment and management of pain in older adults can be challenging, with persistent pain prevalence ranging from 25% to 80%, especially in long term care homes (LTCH), where most seniors are unable to verbalize their pain. This article describes the implementation of the Registered Nurses’ Association of Ontario (RNAO) Assessment and Management of Pain (Third Edition) best practice guideline (BPG) in a LTCH in Toronto, Canada. Methodology. Using mixed descriptive study methodology, this 391-bed home housing older adults over 80 years implemented the Pain guideline using the knowledge-to-action framework and audit procedures to evaluate the impact of implementing this guideline. Key implementation activities included educating residents, families, and staff about pain while integrating validated pain screening and assessment tools into practice. A mixed methods approach of qualitative and quantitative data was utilized to monitor improvements in clinical and organizational outcomes. Results. The impact of implementing Pain BPG is: improved utilization of pain assessment and management tools, reduced incidence of worsening pain, improved pain scores and improved resident quality of life. The structured and integrated, evidence-based approaches to pain assessment and management reflected that long-term care residents don’t have to live with pain regularly, which leads to a better quality of life and resident/family satisfaction. Discussion. In conjunction with the structured approach of the knowledge-to-action framework and the Pain BPG, the LTCH utilized tailored approaches to meet the needs of their resident population. Recognizing the unique needs of seniors in a residential setting, organizational structural facilitators, and barriers and cultural needs, the LTCH developed multi modal approaches based on a person and family centred approach. This evidence-based and resident focused approach was the key to the successful implementation and subsequent outcomes that were resultant. Conclusion. The systematic implementation of the RNAO pain BPG and the utilization of the knowledge-to-action framework was shown to improve resident outcomes, improve organizational processes and generate staff satisfaction. Participation and engagement of residents, their families and health professionals in the process was one of the greatest facilitators.

The Relationship Between Children’s Screen Time and the Time They Spend Engaging in Play: An Exploratory Study

ABSTRACT Introduction Play is a critical daily occupation that facilitates children’s learning of essential life skills. However, with the growing use of, and accessibility to, online-linked devices, children are engaging more and more in screen-time linked activities and less time in non-technology play. Therefore, it is crucial to understand the influence of children’s screen-time use on their play patterns. This study aims to explore the relationship between school-age children’s screen time and their engagement and participation in play occupations. Methods Twenty-six pairs of parents and children were recruited to complete the Children’s Play Scale (CPS), parent and child versions of the Children’s Screen Time Use Report (CSTUR), and the Children’s Perceptions of Their Play (CPTP). Data were analyzed using Spearman’s rho correlations and linear regressions with bootstrapping. Results Two regression models found that weekday social screen time accounted for 30.7% of the total variance (p = .002) of social play while weekend educational screen time, weekday interactive screen time, and weekday passive screen time together accounted for 55.6% of the total variance (p < .001) of active play. Conclusion The study findings provide evidence that a relationship exists between school-aged children’s screen time and play engagement and participation. Further research is recommended on this topic.

The role of Occupational Therapy in community development to combat social isolation and loneliness

Background: Social participation activities, an important area of occupation, have been effective in reducing social isolation and loneliness. However, most attendees are women, warranting the need to explore older men’s social participation needs. Methods: Qualitative methods, including interviews and a collaborative workshop, were used to explore the research aim. Public involvement included establishing partnerships with six staff from four community organisations and twelve older men. The project was informed by a steering committee. The steering group offered insight into all aspects of the research except analysis, which was performed thematically. Findings: Intergenerational engagements and the appropriate environment to establish connections with their communities were highlighted as beneficial to men. However, there is a lack of appropriate local spaces to connect communities through social participation. This suggests the need for occupational therapists to diversify their roles, moving beyond the individual and into community development. Conclusions: Occupational therapists’ unique and varied skill set, including the understanding of the profound impact of the environment on occupational engagement and, thus, well-being would offer valuable contributions to community development roles, including the built environment to ensure all communities have places for connection where individuals of all ages can thrive.

Occupation-based practice in hand therapy - perspectives from a South African occupational therapy survey.

Hand injuries affect occupational engagement and participation, yet anecdotal evidence reports a focus on body structures and functions within hand therapy. Failing to address occupational challenges may result in sub-optimal patient outcomes. In line with the growing body of evidence of positive outcomes relating to occupation-based practice (OBP), this article aimed to describe the knowledge, attitudes and practices towards OBP of occupational therapists treating hand-related conditions in South Africa. In this quantitative, cross-sectional study, South African occupational therapists treating hand conditions were recruited. Data were collected via an emailed survey developed for the study. Data were analysed descriptively. Sixty-seven responses met the inclusion criteria, a response rate of 62%. Most respondents worked in the private sector (73%) with many holding postgraduate qualifications (54%). Lack of access to evidence and a preference for biomedical literature impacted on acquiring knowledge on OBP. Attitudes towards OBP were mostly positive. Barriers were contextual, patient-related and therapist-related. Practice focussed predominantly on performance components and aimed to reduce impairment rather than promoting occupational engagement. Current hand therapy services in South Africa reflect a biomechanically-focused practice that is mis-aligned with occupational therapy philosophy. In line with existing research, OBP should be adopted more routinely in hand therapy in South Africa.

Just transitions and sociotechnical innovation in the social housing sector: An assemblage analysis of residents’ perspectives

Creating low-carbon pathways for domestic electricity and heating is a core aspect of the UK Government's housing strategy. Understanding issues of energy justice and the socio-technical dynamics of low-carbon innovation are vital for successfully implementing new technologies and retrofit measures across diverse communities and different housing types. The social housing sector is particularly important in the study of just domestic low-carbon transitions due to the challenges faced by residents concerning energy affordability and insecurity during the ongoing cost of living crisis in the UK. This qualitative study, conducted in the Northeast of England, adopts an assemblage thinking approach to examine the experiences of social housing residents. Through thematic analysis of interviewee responses, we identify themes related to cost and affordability; decision-making dynamics and energy justice; disruption, retrofit and ‘fabric first’; energy autonomy and the practicalities of technology choice; and environmental values and collective climate action. We find that justice in the low-carbon home requires social housing organisations to strengthen mechanisms for resident engagement and interconnectedness before retrofit roll-out, to identify independent sources and arbiters of information on upfront and long-term energy costs, to ensure effective mechanisms for the social control of energy use, and to provide a platform to encourage nascent energy citizenship through which residents link pro-environmental behaviours in the home to broader networks of social action on climate change.

Exploring occupational therapy practice in Australian residential aged care facilities: A cross-sectional survey.

Occupational therapy in residential aged care facilities (RACFs) can enhance residents' occupational engagement and wellbeing. However, industry reports suggest that occupational therapists in Australian RACFs have mostly provided physical therapies such as pain management via massage and not addressed residents' occupations. There is limited literature on what constitutes occupational therapists' practice in RACFs to inform policy and practice. The aim of this cross-sectional survey was to explore practice patterns of occupational therapists working in Australian RACFs and influences on their practice. Occupational therapists working in Australian RACFs were invited from July 2019 to March 2020 to complete a self-report online questionnaire via email and advertisements on industry websites, newsletters, and social media. The questionnaire asked therapists about their caseload, referrals, assessments, and interventions. Data were analysed descriptively and presented as frequencies and percentages. A total of 214 occupational therapists completed the survey. Occupational therapists' daily practice largely focussed on pain management; other areas of practice included falls prevention, pressure care, and mobility. The Aged Care Funding Instrument in place at the time of the survey was identified as the leading factor influencing therapists' choice of assessments and interventions. Organisational policies and procedures were also perceived as key factors influencing occupational therapy practice. This paper highlights the influence of government funding and organisational policies in limiting occupational therapists' scope of practice and their ability to fully address the occupational needs of residents. Occupational therapists and the profession in general should be aware of factors in aged care funding models, and their application, that restrict occupational therapy practice and inhibit residents' function and advocate for change where needed. With the introduction of the Australian National Aged Care Classification funding model replacing Aged Care Funding Instrument, future research should explore potential changes to therapists practice following the implementation of the new funding model.

The engagement of Polish residents with their home space in single-family houses and flats in multi-family blocks of flats

The engagement of Polish residents with their home space in single-family houses and flats in multi-family blocks of flats

"You're Someone Different Now": An Autoethnography on Identity and Occupational Identity Disruption After Traumatic Brain Injury.

Identity disruption and occupational identity disruption are common after traumatic brain injury (TBI), but the relationship between these two phenomena is underexplored. Occupational therapy practitioners should be knowledgeable about identity challenges after TBI and ways to reconstruct a sense of self. To sensitize readers to the experience of identity disruption and occupational identity disruption and describe how those two experiences are interrelated and transactional in nature. We completed an autoethnography, because this method privileges the insider perspective of participants as members of the research team. We interviewed Andi's family and friends, with textual and nontextual data being reviewed during team meetings that occurred 3 times per month over 3 yr. Data were analyzed by hand-coding transcripts to organize findings until we identified themes and salient text for constructing a narrative. Setting: Community. TBI survivor. Identity disruption after TBI occurs because of physiological difficulties, psychological changes, and cognitive deficits. Additionally, survivors face interruptions in occupational participation that affect their identity as doers. Andi experienced identity disruption that was exacerbated by being unable to engage in written expression. When he was able to resume writing and regain his occupational identity, Andi was able to reconstruct his sense of self. Identity is created by occupational engagement. Occupational therapy practitioners can better serve their clients by exploring identity disruption and occupational identity disruption after TBI. Plain-Language Summary: This article describes the lived experience of identity disruption and occupational identity disruption with an emphasis on the transformative nature of occupation. Occupational therapists should work collaboratively with clients to identify key occupations that support their sense of identity.

Resident Burnout, Wellness, Professional Development, and Engagement Before and After New Training Schedule Implementation

Burnout is a work-related syndrome of depersonalization (DP), emotional exhaustion (EE), and low personal achievement (PA) that is prevalent among internal medicine resident trainees. Prior interventions have had modest effects on resident burnout. The association of a new 4 + 4 block schedule (4 inpatient weeks plus 4 outpatient weeks) with resident burnout has not previously been evaluated. To evaluate the association of a 4 + 4 block schedule, compared with a 4 + 1 schedule, with burnout, wellness, and self-reported professional engagement and clinical preparedness among resident physicians. This nonrandomized preintervention and postintervention survey study was conducted in a single academic-based internal medicine residency program from June 2019 to June 2021. The study included residents in the categorical, hospitalist, and primary care tracks in postgraduate years 1 and 2 (PGY1 and PGY2). Data analysis was conducted from October to December 2022. In the 4 + 4 structure, resident schedules alternated between 4-week inpatient call-based rotations and 4-week ambulatory non-call-based rotations. The primary outcome was burnout, assessed using the Maslach Burnout Inventory subcategories of EE (range, 0-54), DP (range, 0-30), and PA (range, 0-48), adjusted for sex and PGY. Secondary outcomes included In-Training Examination (ITE) scores and a questionnaire on professional, educational, and health outcomes. Multivariable logistic regression was used to assess the primary outcome, 1-way analysis of variance was used to compare ITE percentiles, and a Bonferroni-adjusted Kruskal Wallis test was used for the remaining secondary outcomes. The findings were reexamined with several sensitivity analyses, and Cohen's D was used to estimate standardized mean differences (SMDs). Of the 313 eligible residents, 216 completed the surveys. A total of 107 respondents (49.5%) were women and 109 (50.5%) were men; 119 (55.1%) were PGY1 residents. The survey response rates were 78.0% (85 of 109) in the preintervention cohort and 60.6% (63 of 104) and 68.0% (68 of 100) in the 2 postintervention cohorts. The PGY1 residents had higher response rates than the PGY2 residents (119 of 152 [78.2%] vs 97 of 161 [60.2%]; P < .001). Adjusted EE scores (mean difference [MD], -6.78 [95% CI, -9.24 to -4.32]) and adjusted DP scores (MD, -3.81 [95% CI, -5.29 to -2.34]) were lower in the combined postintervention cohort. The change in PA scores was not statistically significant (MD, 1.4 [95% CI, -0.49 to 3.29]). Of the 15 items exploring professional, educational, and health outcomes, a large positive association was observed for 11 items (SMDs >1.0). No statistically significant change in ITE percentile ranks was noted. In this survey study of internal medicine resident physicians, a positive association was observed between a 4 + 4 block training schedule and internal medicine resident burnout scores and improved self-reported professional, educational, and health outcomes. These results suggest that specific 4 + 4 block combinations may better improve resident burnout than a 4 + 1 combination used previously.