Resident Wellness and Well-being: Lessons Learned from the Integrative Medicine in Residency Progra PowerPoint Presentation

Resident Wellness and Well-being: Lessons Learned from the Integrative Medicine in Residency Progra PowerPoint Presentation

2018-09-18 18K 18 0 0

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Patricia Lebensohn, M.D., Sally Dodds, Ph.D., Mary Guerrera, M.D., Dael Waxman, M.D., & Craig Schneider, M.D.. Presentation Objectives. Describe the importance of teaching about wellness and well-being during residency. ID: 669248

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Presentations text content in Resident Wellness and Well-being: Lessons Learned from the Integrative Medicine in Residency Progra

Slide1

Resident Wellness and Well-being: Lessons Learned from the Integrative Medicine in Residency Program

Patricia Lebensohn, M.D., Sally Dodds, Ph.D., Mary Guerrera, M.D., Dael Waxman, M.D., & Craig Schneider, M.D.

Slide2

Presentation Objectives

Describe the importance of teaching about wellness and well-being during residency

.Discuss the definitions of wellness and well-being used in the IMR. Describe the tools used to assess resident wellness and well-being.

Review the preliminary findings about IMR resident wellness and well-being.

Discuss teaching strategies to promote IMR resident wellness & well-being.

Slide3

Integrative Medicine in Residency (IMR) is…

Competency-based

, online, 200-hour, curriculum.

In-depth training in

Integrative Medicine

.

Incorporated

through all 3 years of Family Medicine residency.

Piloted at 8 residencies nationwide.Seamless, online evaluation of the curriculum and the residents.Responds to ACGME competency requirements.Evaluation developed simultaneously with the curriculum.

Slide4

University of Arizona

University of Texas Medical Branch

Hennepin County

Carolinas Medical Center

Beth Israel

Maine-Dartmouth

Maine Medical Center

University of Connecticut

IMR Program Locations

Moses H. Cone

Alaska Family Medicine

Univ. of Minn

A. Einstein Montefiore

Control sites

Slide5

Importance of Teaching About Wellness & Well-being

Residency is a powerful, formative experience in adulthood.

Establishing physician identity, schema of patient relationships, work habits, and self care.

Physician Burnout

Estimates of physician burnout: 25% - 70%.

Onset linked to residency training.

Distress in Residency

Dramatic increases in depression, anxiety, and drug use.

Increased cynicism, decreased empathy, poorer overall performance.ConsequencesPsychological problems under diagnosed and under treated.

Physician stress and burnout linked to lower-quality patient care.

Habit of ignoring self care perpetuated in life after residency.

Slide6

IMR and Wellness & Well-being

IMR uniquely positioned to shift graduate medical education toward physician wellness.

Prevention and wellness are central in course content.

Opportunity to explore and describe resident wellness & well-being longitudinally.

Slide7

IMR Wellness & Well-being Definitions

Wellness behaviors: Specific behaviors and lifestyles that promote optimal physical, psychological, and spiritual health

(Carlson et al., 1997).Sense of Well-being (multiple dimensions):

Satisfaction with Life:

Global judgment of quality of life

(Diener et al., 1985).

Sense of Happiness:

Pleasant affects

(Pavot & Diener, 2008). Psychological well-being: Absence of psychological distress (Ryff et al., 1995; Keyes et al., 2002).Positive Personal Characteristics: Qualities of mindfulness, a grateful disposition, and emotional intelligence in the context of interpersonal relationships.

Slide8

Wellness Behaviors Assessed in the IMR

Behavior

Moderate physical activity (30 min/da)

Fruits & vegetables (5/

da

)Vitamins/other dietary supplements

Meditation

Prayer

PMR/other relaxationYogaTai Chi or Qi GongBehavior

Massage

Outdoors in nature

Nurturing relationships

Restful sleep

Alcoholic drinks per week

Smoking (y/n)

Rx for mood, anxiety, stress, sleep (y/n)

Slide9

Resident Wellness Behaviors (All groups combined)

Protective

Slide10

Resident Wellness Behaviors

(All groups combined)Risk

Slide11

Well-being Measures

Dimension

MeasureGlobal life satisfaction

Satisfaction with Life Scale (SWLS;

Dierner

, 1985)

Affective traits

Positive & Negative Affect Schedule (PANAS; Watson, 1988)

Psychological health Perceived stress Mood state distress Depression Burnout

Perceived Stress Scale (Cohen et

al.

, 1983)

CES-D (

Radloff

, 1977)

PHQ-9; (

Kroneke

et al., 2001)

Maslach

Burnout Inventory (

Maslach

et al. 1996)

Personal characteristics

Mindfulness

Gratitude

Emotional intelligence

Freiburg Mindfulness Inventory (Walach

, et al., 2006)

Gratitude Questionnaire-6 (McCullough, 2002)

Trait Meta Mood Scale (Salovey & Mayer, 1995)

Interpersonal Reactivity Index (Davis, 1980)

Slide12

Perceived Stress Scale

(e.g., “How often you felt you were on top of things?”)

Mean scores at baseline – 2011, 2012, Controls

ns

Range

1-33

Range 5-27

Range 9-30

Possible scores range from 0 – 40.

Slide13

Perceived Stress Scale

Frequency of stress in the past month (at baseline)

*

*

p = .

03

Slide14

Perceived Stress Scale

Baseline and 1

st repeated measure

2011 Class (mean scores)

n=44; ns

*

p =

.002; **

p = .001Stress Frequency past 30 days

*

**

Slide15

CES-D (Depression screener) – Mean scores

PGY1 – All groups (baseline)

ns

Range 0-34

Range 0-32

Range 1-34

Cutpoint =/> 16

Slide16

CES-D

Severity scores in the past month (at baseline)

Slide17

Range

0-34

Range 0-32

n=46; ns

Severity scores

2011 Class means

*p

= <.001

*

CES-D

Baseline and 1

st

repeated measure

Slide18

PHQ-9 (Depression diagnostic screener)

Mean scores at baseline

ns

Range 0-13

Range 0-14

Range 0-16

Slide19

PHQ-9

Severity scores at baseline

ns

Slide20

CES-D and PHQ-9 Compared2011 PGY2

Slide21

Maslach

Burnout Inventory

1Emotional Exhaustion Subscale (e.g., “I feel emotionally drained from my work”)

Mean scores at baseline – 2011, 2012, Controls

ns

Range

1-33

Range 5-27

Range 9-30

Possible scores range from 0 – 54.

Slide22

Maslach Burnout Inventory

2

EE category scores at baseline

*

p = .

02

*

Slide23

Mean group scores at baseline

Severity scores t1 – t2

Maslach Burnout Inventory

3

EE Baseline and 1

st

repeated measure

ns

*

p

=.032; **

p

=<.001

**

*

*

*

p

=<.001

Slide24

Maslach

Burnout Inventory

4Depersonalization (e.g., “I really don’t care what happens to some patients”)

Mean scores at baseline – 2011, 2012, Controls

ns

Range

0-23

Range 0-18

Range 1-20

Possible scores range from 0 – 30.

Slide25

Maslach Burnout Inventory

5

Dp Score Categories – 2011, 2012, Controls

Slide26

Baseline

Severity scores t1 – t2

Maslach Burnout Inventory

3

Depersonalization (Baseline &1

st

F/U)

p

= <.001p

= <.001

*

**

***

*p

= <.001; **

p=.

.001; ***

p=

<.001

Slide27

References

De Matteo, MR, Sherbourne, CD, Hays, RD, Ordway, L, Kravitz, RL, McGlynn, EA, et al. (1993). Physicians’ characteristics influence patients’ adherence to medical treatment: Results from the Medical Outcomes Study. Health Psychology,

12, 2, 93-102.Eckleberry-Hunt, J, Lick, D, Boura, J, Hunt, R, Balasubramaniam, M, Mulhem, E, & Fisher, C. (2009). An exploratory study of resident burnout and wellness. Academic Medicine, 84, 2, 269-277.Eckleberry-Hunt, J, Van Dyke, A, Lick, D, & Tucciarone, J. (2009). Changing the conversation from burnout to wellness: Physician well-being in residency training programs.

Journal of Graduate Medical Education,

DOI:10-4300/JGME-D-90-00026.1.

Gunderson, L. (2001). Physician burnout. Annals of Internal Medicine, 135, 2, 145-148.Wallace, JE & Lemaire, J. (2009). Physician well being and quality of patient care: An exploratory study of the missing link.

Psychology, Health & Medicine, 14

, 5, 545-552.

Slide28

Discussion

Acknowledgements

University of Arizona

Pilot

Sites

Emily Sherbrooke

Ben Kligler, M.D., MPH

Paula

Cook

Victor Sierpina, M.D.

Rhonda Hallquist

Selma Sroka, M.D.

Tieraona Low Dog, M.D.

Raymond Teets, M.D.

Victoria Maizes, M.D.

John Woytowicz, M.D.


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