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ObjectiveBurnout syndrome, characterised by emotional exhaustion, depersonalisation and decreased personal accomplishment, is well documented in the medical workforce. This study aimed to investigate the prevalence of burnout in New Zealand resident doctors (doctors who have yet to complete their specialty training).DesignCross-sectional survey study of resident doctors in New Zealand.SettingDistributed by email.Participants509 resident doctors currently working in New Zealand. Doctors not currently working or those who have completed their specialty training (consultants) were excluded.Primary and secondary outcome measuresParticipants were asked about a number of demographic and work-related factors and to complete the Maslach Burnout Inventory, which measures the three dimensions of burnout: ‘Emotional Exhaustion’, ‘Depersonalisation’ and low ‘Personal Accomplishment’.Results409/509 (80%) of respondents had scores indicating high burnout on at least one dimension. 163 (32%) had high burnout on one dimension, 111 (22%) on two dimensions and 135 (26%) on all three dimensions. Feeling well supported protected against burnout in all three dimensions: emotional exhaustion (OR 0.34, CI 0.19 to 0.60), depersonalisation (OR 0.52, CI 0.31 to 0.86) and decreased personal accomplishment (OR 0.51, CI 0.29 to 0.78). Having a manageable workload protected against emotional exhaustion (OR 0.23, CI 0.13 to 0.37) and depersonalisation (OR 0.39, CI 0.24 to 0.61). Increasing weekly exercise was protective for personal accomplishment (OR 0.846, CI 0.73 to 0.98). Having children was protective for depersonalisation (OR 0.7, CI 0.53 to 0.90). A personal history of depression or anxiety was associated with burnout on all three dimensions: emotional exhaustion (OR 2.86, CI 1.67 to 5.00), depersonalisation (OR 1.66, CI 1.01 to 2.73) and decreased personal accomplishment (OR 1.71, CI 1.05 to 2.80). Alcohol misuse was associated with an increased risk of depersonalisation (OR 1.68, CI 1.08 to 2.62), and feeling inadequately remunerated was associated with emotional exhaustion (OR 2.27, CI 1.28 to 4.17). Qualitative data revealed concerns about poor staffing, inadequate remuneration, a focus on service provision over education, slow career progression and difficulty balancing work and specialty examinations.ConclusionsBurnout has a high prevalence in New Zealand’s resident doctor workforce. Several associations and qualitative themes were identified. These findings may aid in the development of interventions to mitigate burnout in the medical workforce.

Purpose. To review the records of 50 children who underwent open joint washout for septic arthritis with (n=25) or without (n=25) preoperative antibiotics. Methods. Records of 50 children who underwent open joint washout for presumed septic arthritis with (n=25) or without (n=25) preoperative antibiotics were reviewed. 17 boys and 8 girls aged 3 weeks to 16 years (median, 1.5 years) who were prescribed preoperative antibiotics before joint washout were compared with 12 boys and 13 girls aged one month to 14 years (median, 2 years) who were not. Following arthrotomy and washout, all patients were commenced on high-dose intravenous antibiotics. Patients were followed up for 6 to 18 months until asymptomatic. Results. Patients who were referred from places other than our emergency department were twice as likely to have been prescribed preoperative antibiotics (p=0.0032). Patients prescribed preoperative antibiotics had a longer median (range) time from symptom onset to joint washout (8 [2–23] vs. 4 [1–29] days, p=0.05) and a higher mean erythrocyte sedimentation rate (93.1 vs. 54.3 mm/h, p=0.023) at presentation. Nonetheless, the 2 groups were comparable for weight bearing status, fever, and positive culture, as well as the mean (range) duration of antibiotic treatment (4.9 [4–7] vs. 4.7 [1–8] weeks, p=0.586). Conclusion. Preoperative antibiotics should be avoided in the management of septic arthritis in children. Their prescription delays diagnosis and definitive surgery, and leads to additional washouts and complications. A high index of suspicion and expedite referral to a specialist paediatric orthopaedic unit is needed if septic arthritis is suspected.

Management of Complications in Common Hand and Wrist Procedures: FESSH Instructional Course Book 2021 Operative complications can have a major impact on patients and surgeons. While most textbooks list them, few provide in-depth discussion on prevention, repercussions, and methods to resolve them. Management of Complications in Common Hand and Wrist Procedures: FESSH Instructional Course Book 2021, edited by renowned hand surgeons Brigitte van der Heijden, Jan-Ragnar Haugstvedt, and Henk Coert, features contributions from an impressive group of international hand surgery experts. This book provides in-depth, illustrated coverage on the prevention and management of complications that can occur during common hand and wrist approaches. It also provides insights on how meticulously performed hand therapy can help alleviate postsurgical problems, on the complex regional pain syndrome (CRPS), and on critical social issues. Key Highlights * Firsthand clinical pearls, evidence-based interventions, and expert opinion for preventing and resolving complications from distinguished hand surgery experts * The history of the catch-all term CRPS, why continued use of this term is a disservice to patients and medical progress, and an evidence-based argument on why it should be removed from the armamentarium and eventually the literature * Managing expectations of patients with factitious disorders, the role of informed consent in preventing medicolegal issues, and the impact of complications on surgeons and patients This unique and insightful resource will be invaluable in the practice of plastic, orthopaedic, and trauma surgeons specializing in hand and wrist surgery.