Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Is professionalism in medicine just another bureaucratic imposition on our practice or a fundamental concept for physicians at all stages in their career? In this review, the historical perspectives of professionalism are explored as well as the what, why, and how questions concerning this topic. ⋯ Considerable evidence exists to suggest that professionalism must be treated seriously, particularly in these times of social accountability and budgetary pressures.
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The purpose of this article is to review current evidence for the identification and management of substance use disorders in anesthesiologists and to describe an approach to return to practice. ⋯ The treatment of substance use disorders in anesthesiologists is effective, and a safe return to practice is possible in a majority of cases. National guidelines are needed to ensure equitable access to high-quality treatment and recovery monitoring for all Canadian physicians.
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Anesthesiology Resident Wellness Program at the University of Saskatchewan: concept and development.
We describe the need for an anesthesiology resident wellness program (ARWP) and the challenges associated with its development and implementation. We also present the results of a preliminary program evaluation. ⋯ After identifying the need for a formal ARWP in Canada, we implemented one at the University of Saskatchewan. We found high levels of overall resident satisfaction with the program.
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Resident and physician health are increasingly recognized by the Royal College of Physicians and Surgeons of Canada and its CanMEDS framework as integral to residency training in Canada. Resident stress, burnout, and depression also have implications for patient care. Although curricula have been advocated to promote resident wellness and resilience, no such published curricula exist to guide programs in addressing these needs. ⋯ The described ARWP is a novel innovation in Canadian postgraduate medical education. We believe this ARWP is the first comprehensive, formalized, actualized program in Canada. It also provides a guide and a helpful resource for further development of resident wellness programs by other disciplines in Canada and internationally.
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In this narrative review, the neurobiological mechanisms underlying substance abuse and addiction are discussed with a particular emphasis on the mechanisms that promote ongoing use and relapse. Addiction is estimated to affect 10-15% or more of the adult population, including physicians. Genetic predisposition, psychological and environmental risk factors, the timing of exposure to the substance, the type of substance used, and the frequency of use influence the individual's susceptibility to addiction. ⋯ Repetitive exposure to substances leads to persistent, altered genetic expression and accumulation of ΔFos-B and corticotropin-releasing factor. High levels of these substances suppress the reward circuit and activate the endogenous stress response, resulting in a generalized state of discord. These changes are enduring and can trigger substance use relapse even after long periods of abstinence.