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Ergonomics, physician wellness plays big role in endoscopists’ health
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CHICAGO — A survey intended to delve into the health of women endoscopists revealed a need for greater physician training as a whole to prevent injury and improve physician wellness, according to one presenter at Digestive Disease Week.
“Provider wellness is important. There’s a conflict between productivity, efficiency and vitality of our workforce. Provider wellness is considered the opposite of burnout and, ultimately, ensuring provider wellness allows for ongoing high-quality care,” Katherine S. Garman, MD, assistant professor at Duke University, said during her presentation.
Overall findings
Both men and women in the endoscopy field reported high rates of injury. Prior to entering the field, 46% reported injury, while afterward, 86% reported “some sort of strain or injury.”
Of those surveyed, 36% reported neck injuries, with 3.7% being debilitating. This was predicted by inability to move one’s screen and 15.8% reported a practice alteration to alleviate the injury.
Additionally, 34% reported injury in the left thumb and 21.2% resulted in a practice alteration. Lower back injury was reported in 35%, with 4.4% described as debilitating and 25.7% reporting a practice alteration.
After performing logistic regression analysis, Garman and colleagues linked injury since starting endoscopy to any prior injury (OR 2.5; 95% CI, 1.43-4.33), number of half days scoping (OR 2.45; 95% CI, 1.41-4.28), a request to increase production volume (OR 2.45; 95% CI, 1.41-4.28) and screen height (OR 0.823; 95% CI, 0.68-0.99).
In an effort to respond to their injuries, the following actions were taken: microbreaks were implemented by 15% of women and 13% of men; ergonomic time-out was implemented by 9% of women and 7% of men; 19% of women and 11% of men incorporated special clothing or equipment (P = .006); and 7% of women and 8% of men tried staying seated during endoscopy, though Garman reported this increased the risk of neck strain (50% vs. 34%, P = .026).
“In general, responses to injury reported by survey participants indicated a general lack of awareness of such strategies as taking microbreaks,” which Garman defined as a “small, biologically meaningful movement.”
Overall, 37% of respondents attempted changes to reduce the pain related to endoscopy. Most often, they adjusted the table height (76%), which was rated as the most effective change. Additionally, some adjusted screen height (53%), employed a gel mat (41%), reduced the hours of endoscopy (22%), bought support clothing (20%) and used microbreaks (20%).
Another interesting finding Garman reported was that “Vigorous exercise was associated with a decreased risk of injury after starting endoscopy.”
In those reporting vigorous exercise up to once a week, 15.9% reported no injury. In those working out two to three times per week, 34.1% reported no injury. But in those who reported working out vigorously four to six times per week, 50% reported no injury since beginning their endoscopy career (P = .0007).
Preparing fellows
“On average it took about 11 years to develop some sort of injury or strain,” Garman said. “Fellows, in particular, need to pay heed to these data because starting off with good practice may very well help to prevent injury later.”
Garman showed that ergonomics training in fellowship is very uncommon overall. Only 1% of fellows received that training in the 80s, 90s and 2000s, she said. From 2010 to 2015, that number did rise to 11.1%, but from 2016 to 2018 it fell again to 9.8%.
“Education on best practice and awareness of risks of injury while scoping should be included in training for every fellow,” Garman said.
Fellows should be aware that any prior injury puts them at a higher risk for re-injury when performing endoscopy, she said. Additionally, tables and monitors should be adjustable and placed at the proper height for each individual endoscopist.
Despite knowledge that the monitor should be at or below eye level, 41% of survey respondents reported having their monitor above eye level, which is counter to the guidelines and puts one’s neck at risk for injury, Garman reported.
Findings in women
Garman did report some differences between men and women endoscopists, such as 57% of women were asked to increase their clinical volume as compared to 37% of men
“While overall rates of injury were relatively high in both men and women, rates of upper body injury were more common in women endoscopists than men,” Garman said.
Men and women reported the same overall rate — 85.8% — of injury. Eye strain, left thumb, left wrist, lower back and feet injury rates were similar, but women were significantly more likely to report right thumb (26.2% vs. 18.7%), right wrist (30.6% vs. 17.5%), right shoulder (8.5% vs. 12.3%), left shoulder (17.1% vs. 11.2%) and upper back injury (16.1% vs. 8.7%).
“We did find that women were more likely to have foot problems after starting endoscopy,” Garman said.
Though foot injury was not significantly different between the sexes, Garman showed that after a logistic regression model, women were nearly three times as likely to report foot injury (OR = 2.92; 95% CI, 1.5-5.7). The other factors contributing to foot injury were similar to injury overall.
Sixty-four percent of women who reported trying special clothing reported trying different footwear, she added.
Another interesting point seen in this survey was that women were much more likely to have women as patients; 49.5% of women reported that more than 60% of their patients were women. Only 6% of men reported the same patient make-up. However, there was no association with injury and percent of women patients. – by Katrina Altersitz
Reference: Garman KS. Sp162. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.
Disclosures: Garman reports no relevant financial disclosures.