RESUMEN
Introduction: Residency training is associated with stress and burnout that can contribute to poor mental health. However, residents are less likely to utilize mental health services due to perceived barriers such as lack of time and concerns about confidentiality, among others.1 There is a need to promote help-seeking behavior and improve access to mental health services during residency training. Methods: In order to decrease barriers to seeking mental health care and promote well-being among residents, the University of California Irvine Family Medicine Residency Program (UCI FMRP) implemented a program that included confidential, regular, mental health check-ins between residents and a psychiatrist. We gathered data on help-seeking behavior from an internally conducted electronic survey of 29 residents regarding perceived barriers to seeking mental health care in June, 2020. Results: The internal survey results from 24 respondents out of 29 residents demonstrated that the program supported help-seeking behavior among the residents, with 33% of the residents requesting additional sessions with the psychiatrist and another 13% seeking external mental health resources. Conclusion: Providing additional, confidential, on-site support may be one method of decreasing stigma, increasing access to care, and normalizing conversations around mental health in residency.
RESUMEN
Pincer femoroacetabular impingement occurs in focal or global forms, the latter having more generalized and typically more extreme acetabular overcoverage. Severe global deformities are often treated with open surgical dislocation of the hip. Arthroscopic technical challenges relate to difficulties with hip distraction; central-compartment access; and instrument navigation, acetabuloplasty, and chondrolabral surgery of the posterior acetabulum. Techniques addressing these challenges are introduced permitting dual-portal hip arthroscopy with central-compartment access, subtotal acetabuloplasty, and circumferential chondrolabral surgery. The modified midanterior portal in combination with a zone-specific sequence of acetabular rim reduction monitored with fluoroscopic templating enables precision subtotal acetabuloplasty. Guidelines for acetabular rim reduction include the following suggested radiographic endpoints: postoperative center-edge angle of 35°, a neutral posterior wall sign, and an anterior margin ratio of 0.5. Arthroscopic zone-specific chondrophobic rim preparation and circumferential labral reparative and reconstructive techniques and tools permit the arthroscopic treatment of these challenging deformities.
RESUMEN
Since the classic description of cam femoroacetabular impingement occurring in the anterolateral quadrant of the proximal femur, there has been growing evidence of cam impingement extending outside of this region. Although anteromedial cam decompression may be performed, posterior cam decompression is at higher theoretic risk of vascular embarrassment with osteonecrosis and/or tensile failure with fracture, leading some investigators to believe that these major deformities require open surgical correction. We present a less invasive method of arthroscopic posterior cam decompression using the modified midanterior portal while avoiding the posterolateral vasculature of the proximal femur.