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1.
Curr Probl Pediatr Adolesc Health Care. 2019 Oct 4:100664. doi: 10.1016/j.cppeds.2019.100664. [Epub ahead of print]

Organizational strategies to reduce physician burnout and improve professional fulfillment.

Author information

1
Yale School of Medicine, Yale New Haven Health, 20 York Street, New Haven, CT 06510, United States. Electronic address: kristine.olson@yale.edu.
2
Medstar Health, Georgetown University School of Medicine, Washington, DC, United States.
3
Christiana Care Health System, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, United States.
4
University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
5
University of New Mexico School of Medicine, Albuquerque, NM, United States.
6
Department of Psychiatry and Behavioral Sciences, Stanford Medicine WellMD Center, Stanford University, Stanford, CA, United States.
7
Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
8
The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
9
Wake Forest Baptist Health, Winston-Salem, NC, United States.

Abstract

Burnout is highly prevalent among physicians and has been associated with negative outcomes for physicians, patients, staff, and health-care organizations. Reducing physician burnout and increasing physician well-being is a priority. Systematic reviews suggest that organization-based interventions are more effective in reducing physician burnout than interventions targeted at individual physicians. This consensus review by leaders in the field across multiple institutions presents emerging trends and exemplary evidence-based strategies to improve professional fulfillment and reduce physician burnout using Stanford's tripartite model of physician professional fulfillment as an organizing framework: practice efficiency, culture, and personal resilience to support physician well-being. These strategies include leadership traits, latitude of control and autonomy, collegiality, diversity, teamwork, top-of-license workflows, electronic health record (EHR) usability, peer support, confidential mental health services, work-life integration and reducing barriers to practicing a healthy lifestyle. The review concludes with evidence-based recommendations on establishing an effective physician wellness program.

2.
Pediatr Emerg Care. 2019 Aug;35(8):585-588. doi: 10.1097/PEC.0000000000001896.

A Call to Restore Your Calling: Self-Care of the Emergency Physician in the Face of Life-Changing Stress-Part 3 of 6: Physician Illness and Impairment.

Author information

1
From the Division of Emergency Medicine.
2
Division of General Pediatrics, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Sidney Kimmel Medical College, Thomas Jefferson University.
3
Employee Assistance Program, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE.

Abstract

Physicians suffer from most medical conditions at the same rate as their lay peers. However, physicians' self-care is often sacrificed for patient care. This third article in our series examines physician and trainee illness and impairment. Presenteeism, physician impairment, and substance use disorder (SUD) are defined. We call attention to the potential for harm of dated cultural norms, which often fuel physicians' neglect of their own health and development of ill-advised coping skills.Although any medical condition may become a functional impairment, the primary cause of physician impairment is SUD. Alcohol and prescription opioids top the list of substances used in excess by physicians. Although SUD is less prevalent in residency, we focus on the rise of marijuana and alcohol use in emergency medicine trainees. A nonpunitive model for the prevention and treatment of SUD in residency is described.Physicians are ethically and legally mandated to report any concern for impairment to either a state physician health program or a state medical board. However, recognizing physician SUD is challenging. We describe its clinical presentation, voluntary and mandated treatment tracks, provisions for protecting reporters from civil liability, prognosis for return to practice, and prevention efforts. We underscore the need to model healthy coping strategies and assist trainees in adopting them.In closing, we offer our colleagues and trainees today's to-do list for beginning the journey of reclaiming your health. We also provide resources focused on the practical support of ill and/or impaired physicians.

4.
Anaesthesia. 2019 Oct;74(10):1240-1251. doi: 10.1111/anae.14694. Epub 2019 May 15.

Stress, burnout, depression and work satisfaction among UK anaesthetic trainees: a qualitative analysis of in-depth participant interviews in the Satisfaction and Wellbeing in Anaesthetic Training study.

Author information

1
Bath Spa University, Bath, UK.
2
University of Bath, Bath, UK.
3
Bristol School of Anaesthesia, Bristol, UK.
4
North Bristol NHS Trust, Bristol, UK.
5
Severn Postgraduate Medical Education, Bristol, UK.
6
Swindon and Marlborough NHS Trust, Swindon, UK.
7
University of Exeter, UK.
8
Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
9
Bristol Medical School, University of Bristol, UK.

Abstract

Anaesthetists experience unique stressors, and recent evidence suggests a high prevalence of stress and burnout in trainee anaesthetists. There has been no in-depth qualitative analysis to explore this further. We conducted semi-structured interviews to explore contributory and potentially protective factors in the development of perceived stress, burnout, depression and low work satisfaction. We sampled purposively among participants in the Satisfaction and Wellbeing in Anaesthetic Training study, reaching data saturation at 12 interviews. Thematic analysis identified three overarching themes: factors enabling work satisfaction; stressors of being an anaesthetic trainee; and suggestions for improving working conditions. Factors enabling work satisfaction were patient contact; the privilege of enabling good patient outcomes; and strong support at home and work. Stressors were demanding non-clinical work-loads; exhaustion from multiple commitments; a 'love/hate' relationship, as trainees value clinical work but find the training burden immense; feeling 'on edge', even unsafe at work; and the changing way society sees doctors. Nearly all trainees discussed feeling some levels of burnout (which were high and distressing for some) and also high levels of perceived stress. However, trainees also experienced distinct elements of work satisfaction and support. Suggested recommendations for improvement included: allowing contracted hours for non-clinical work; individuals taking responsibility for self-care in and out of work; cultural acceptance that doctors can struggle; and embedding wellbeing support more deeply in organisations and the specialty. Our study provides a foundation for further work to inform organisational and cultural changes, to help translate anaesthetic trainees' passion for their work into a manageable and satisfactory career.

KEYWORDS:

anaesthetic training; burnout; wellbeing; work satisfaction; work stress

Comment in

PMID:
31090927
DOI:
10.1111/anae.14694
[Indexed for MEDLINE]
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5.
Aktuelle Urol. 2019 Apr;50(2):195-202. doi: 10.1055/a-0854-5049. Epub 2019 Mar 21.

[Physician health: What makes us ill? What keeps us healthy?]

[Article in German; Abstract available in German from the publisher]

Author information

1
Park-Klinik Manhagen, Innere Medizin, Großhansdorf.
2
Coaching Prof. Jocham, Lübeck.

Abstract

The medical profession is a particular health risk. Internal reasons for this are the common practice of self-diagnosis and self-therapy, presenteeism (work despite illness), and increased risks of addiction and suicide. External reasons include infectious diseases, violence against health professionals, the increasingly difficult working conditions - due to economisation, among other things - and the posttraumatic stress syndrome. Therefore, it is increasingly important to proactively take care of one`s own health. Science has shown that the underlying mechanisms leading to this problem are the high self-demand and lack of self-care observed in medical professionals. These starting points and available programs (cognitive-emotional reflection, stress management, relaxation techniques, conflict resolution techniques, mindfulness, priming, framing, meditation, embodiment, etc.) to strengthen resilience offer instruments to optimise the salutogenesis of health professionals. This review article presents interdependencies and concepts aiming to strengthen the resilience of health professionals.

PMID:
30897640
DOI:
10.1055/a-0854-5049
[Indexed for MEDLINE]
Icon for Georg Thieme Verlag Stuttgart, New York
6.
Drug Alcohol Rev. 2019 Feb;38(2):169-176. doi: 10.1111/dar.12894. Epub 2019 Jan 29.

Emergency department physicians' and pharmacists' perspectives on take-home naloxone.

Author information

1
The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia.
2
Royal Prince Alfred Hospital, Sydney, Australia.

Abstract

INTRODUCTION AND AIMS:

Opioid overdose is an increasing burden world-wide and is a major cause of death in Australia. To reduce the number of opioid-related deaths, access to take-home naloxone has expanded in Australia and is now accessible without prescription. Emergency departments (ED) could be ideal settings for the distribution of take-home naloxone, due to regular encounters with patients who experience opioid overdoses. The aim of this study was to gain insight into ED physicians' and pharmacists' perspectives on take-home naloxone in the ED setting.

DESIGN AND METHODS:

Semi-structured interviews were carried out with ED physicians and pharmacists about their perceptions of take-home naloxone. Participants were recruited through their involvement with professional bodies and through 'snowball' recruitment. Interviews were audio recorded and transcribed verbatim to be analysed using an inductive thematic approach.

RESULTS:

Twenty-five interviews were conducted with 13 pharmacists and 12 physicians. Responses were categorised into three main themes: (i) Attitudes-the majority of participants supported take-home naloxone in principle, but had numerous concerns; (ii) Clinical Application-where challenges in terms of its patient use, implementation and pharmacological actions were raised; and (iii) Logistical Considerations-where many hindrances in relation to the distribution of take-home naloxone from the ED such as time considerations, education and resourcing were discussed.

DISCUSSION AND CONCLUSIONS:

Despite the majority supporting take-home naloxone, participants identified barriers to take-home naloxone in the ED. In the future, emphasis should be placed on educating and training staff in the ED about take-home naloxone and implementing standardised protocols.

KEYWORDS:

emergency department; opioid; overdose; take-home naloxone

PMID:
30697852
DOI:
10.1111/dar.12894
[Indexed for MEDLINE]
Icon for Wiley
9.
Aust J Gen Pract. 2018 Aug;47(8):571-575. doi: 10.31128/AJGP-01-18-4475.

Junior doctors, burnout and wellbeing: Understanding the experience of burnout in general practice registrars and hospital equivalents.

Author information

1
BSci (OT), MBBS, MPH, MSurg (Ortho), MSpMed, GDAAD, DCH, Academic Registrar, University of Wollongong, NSW; General Practice Registrar (GP Synergy), NSW. rhoffman@uow.edu.au.
2
MBBS, MFM (Clin), PhD, DRANZCOG, FRACGP, Roberta Williams Chair of General Practice, University of Wollongong, NSW.

Abstract

BACKGROUND AND OBJECTIVES:

Australian junior doctors are stressed and report high rates of burnout. The aim of this study was to understand the experience of burnout in general practice registrars and hospital equivalents.

METHOD:

Qualitative, semi-structured interviews were completed until saturation and thematically analysed.

RESULTS:

Stress was common among the interviewees, and the causes of stress were multifactorial. The junior doctors were aware of burnout prevention strategies but were not always effectively undertaking them. They were more likely to be feeling stressed when their expectations regarding workplace support were not met and when they believed they were practising beyond the level of their own abilities.

DISCUSSION:

On the basis of our findings, we propose a multifactorial model of junior doctor burnout. This model warrants further investigation to inform policies to reduce burnout in junior doctors and ensure a research-based solution is found to the progressive concerns regarding junior doctor burnout and suicides.

PMID:
30114893
DOI:
10.31128/AJGP-01-18-4475
[Indexed for MEDLINE]
Free full text
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10.
Adv Pediatr. 2018 Aug;65(1):1-17. doi: 10.1016/j.yapd.2018.03.001. Epub 2018 May 7.

Battling Burnout: Strategies for Promoting Physician Wellness.

Author information

1
Department of Pediatrics, Harbor-UCLA Medical Center, UCLA David Geffen School of Medicine, 1000 West Carson Street, Box 460, Torrance, CA 90502, USA. Electronic address: klcallahan@ucla.edu.
2
Department of Pediatrics, Children's Hospital Los Angeles, USC Keck School of Medicine, 4650 Sunset Boulevard #94, Los Angeles, CA 90027, USA.
3
Department of Pediatrics, Harbor-UCLA Medical Center, UCLA David Geffen School of Medicine, 1000 West Carson Street, Box 460, Torrance, CA 90502, USA.

KEYWORDS:

Burnout; Mindfulness meditation; Physician wellness; Resilience; Self-care

PMID:
30053918
DOI:
10.1016/j.yapd.2018.03.001
[Indexed for MEDLINE]
Icon for Elsevier Science
11.
BMJ Open. 2018 Jun 30;8(6):e021027. doi: 10.1136/bmjopen-2017-021027.

Mindful Self-Care and Resiliency (MSCR): protocol for a pilot trial of a brief mindfulness intervention to promote occupational resilience in rural general practitioners.

Author information

1
School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia.
2
School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia.
3
Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
4
School of Psychology, Murdoch University, Perth, Australia.
5
Research Division, Central Queensland University, Brisbane, Australia.
6
School of Applied Psychology, Griffith University, Nathan, Queensland, Australia.

Abstract

INTRODUCTION:

The Mindful Self-Care and Resiliency (MSCR) programme is a brief psychosocial intervention designed to promote resilience among various occupational groups. The intervention is based on the principles of mindfulness and also incorporates an educational self-care component. The current paper presents the protocol for a pilot study that will evaluate the effectiveness of this programme among general practitioners working in rural Queensland, Australia.

METHODS AND ANALYSIS:

We will measure the impact of the MSCR programme on levels of employee resilience (Connor-Davidson Resilience Scale; State-Trait Assessment of Resilience STARS), compassion satisfaction and compassion fatigue (Professional Quality of Life Scale), self-compassion (Self-Compassion Scale) and mood (Positive and Negative Affect Scale). We will also assess the impact of the programme on job satisfaction (The Abridged Job in General Scale), absenteeism/presenteeism (The WHO Health and Work Performance Questionnaire) and general well-being (WHO Five Well-being Index). Repeated measures analysis of variance will be used to analyse the impact of the intervention on the outcome measures taken at pre, post, 1-month, 3-month and 6-month follow-ups. We will conduct individual interviews with participants to gather data on the feasibility and acceptability of the programme. Finally, we will conduct an initial cost-effectiveness analysis of the programme.

ETHICS AND DISSEMINATION:

Approval for this study was obtained from the Curtin University Human Research ethics committee and the study has been registered with the Australian Clinical Trials Registry. Results will be published and presented at national and international congresses.

TRIAL REGISTRATION NUMBER:

ACTRN12617001479392p; Pre-results.

KEYWORDS:

burnout; general practice; resilience; rural practice; stress

PMID:
29961022
PMCID:
PMC6042610
DOI:
10.1136/bmjopen-2017-021027
[Indexed for MEDLINE]
Free PMC Article
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12.
PLoS One. 2018 Jun 4;13(6):e0197375. doi: 10.1371/journal.pone.0197375. eCollection 2018.

Associations between psychosocial work factors and provider mental well-being in emergency departments: A systematic review.

Author information

1
Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany.

Abstract

BACKGROUND:

Emergency departments (ED) are complex and dynamic work environments with various psychosocial work stressors that increase risks for providers' well-being. Yet, no systematic review is available which synthesizes the current research base as well as quantitatively aggregates data on associations between ED work factors and provider well-being outcomes.

OBJECTIVE:

We aimed at synthesizing the current research base on quantitative associations between psychosocial work factors (classified into patient-/ task-related, organizational, and social factors) and mental well-being of ED providers (classified into positive well-being outcomes, affective symptoms and negative psychological functioning, cognitive-behavioural outcomes, and psychosomatic health complaints).

METHODS:

A systematic literature search in eight databases was conducted in December 2017. Original studies were extracted following a stepwise procedure and predefined inclusion criteria. A standardized assessment of methodological quality and risk of bias was conducted for each study with the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. In addition to a systematic compilation of included studies, frequency and strength of quantitative associations were synthesized by means of harvest plots. Subgroup analyses for ED physicians and nurses were conducted.

RESULTS:

N = 1956 records were retrieved. After removal of duplicates, 1473 records were screened for titles and abstracts. 199 studies were eligible for full-text review. Finally, 39 original studies were included whereof 37 reported cross-sectional surveys. Concerning the methodological quality of included studies, the majority was evaluated as weak to moderate with considerable risk of bias. Most frequently surveyed provider outcomes were affective symptoms (e.g., burnout) and positive well-being outcomes (e.g., job satisfaction). 367 univariate associations and 370 multivariate associations were extracted with the majority being weak to moderate. Strong associations were mostly reported for social and organizational work factors.

CONCLUSIONS:

To the best of our knowledge, this review is the first to provide a quantitative summary of the research base on associations of psychosocial ED work factors and provider well-being. Conclusive results reveal that peer support, well-designed organizational structures, and employee reward systems balance the negative impact of adverse work factors on ED providers' well-being. This review identifies avenues for future research in this field including methodological advances by using quasi-experimental and prospective designs, representative samples, and adequate confounder control.

TRIAL REGISTRATION:

Protocol registration number: PROSPERO 2016 CRD42016037220.

PMID:
29864128
PMCID:
PMC5986127
DOI:
10.1371/journal.pone.0197375
[Indexed for MEDLINE]
Free PMC Article
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13.
Am J Prev Med. 2018 Jun;54(6 Suppl 3):S230-S242. doi: 10.1016/j.amepre.2017.12.022.

Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment.

Author information

1
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan. Electronic address: haffajee@umich.edu.
2
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, Michigan.
3
Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, Michigan; Division of General Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.

Abstract

At least 2.3 million people in the U.S. have an opioid use disorder, less than 40% of whom receive evidence-based treatment. Buprenorphine used as part of medication-assisted treatment has high potential to address this gap because of its approval for use in non-specialty outpatient settings, effectiveness at promoting abstinence, and cost effectiveness. However, less than 4% of licensed physicians are approved to prescribe buprenorphine for opioid use disorder, and approximately 47% of counties lack a buprenorphine-waivered physician. Existing policies contribute to workforce barriers to buprenorphine provision and access. Providers are reticent to prescribe buprenorphine because of workforce barriers, such as (1) insufficient training and education on opioid use disorder treatment, (2) lack of institutional and clinician peer support, (3) poor care coordination, (4) provider stigma, (5) inadequate reimbursement from private and public insurers, and (6) regulatory hurdles to obtain the waiver needed to prescribe buprenorphine in non-addiction specialty treatment settings. Policy pathways to addressing these provider workforce barriers going forward include providing free and easy-to-access education for providers about opioid use disorders and medication-assisted treatment, eliminating buprenorphine waiver requirements for those licensed to prescribe controlled substances, enforcing insurance parity requirements, requiring coverage of evidence-based medication-assisted treatment as essential health benefits, and providing financial incentives for care coordination across healthcare professional types-including behavioral health counselors and other non-physicians in specialty and non-specialty settings.

SUPPLEMENT INFORMATION:

This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

PMID:
29779547
PMCID:
PMC6330240
DOI:
10.1016/j.amepre.2017.12.022
[Indexed for MEDLINE]
Free PMC Article
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14.
Circ Res. 2018 May 11;122(10):1330-1333. doi: 10.1161/CIRCRESAHA.118.312999.

Career Development of Young Physician-Scientists in the Cardiovascular Sciences: Perspective and Advice From the Early Career Committee of the Cardiopulmonary, Critical Care, and Resuscitation Council of the American Heart Association.

Author information

1
From the Neurocritical Care, Columbia University, New York (S.A.).
2
Pulmonary and Critical Care Medicine, Stanford University, CA (E.S., V.d.J.P.).
3
Department of Pediatrics, Vanderbilt University, Nashville, TN (E.D.A.).
4
Department of Critical Care Medicine, University of Pittsburgh, PA (C.D.).
5
Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (B.A.M., P.B.Y.).
6
Department of Cardiovascular Medicine, University of Utah, Salt Lake City (J.J.R.).
7
Department of Cardiovascular Medicine, Duke University, Durham, NC (M.A.S.).
8
Department of Medicine, Laval University, Quebec, Canada (S.B.).
9
Department of Emergency Medicine, University of Colorado, Denver (S.M.P.). sarah.perman@ucdenver.edu.

KEYWORDS:

budgets; mentors; research personnel; time management; work-life balance

PMID:
29748361
PMCID:
PMC5972553
DOI:
10.1161/CIRCRESAHA.118.312999
[Indexed for MEDLINE]
Free PMC Article
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16.
Am J Emerg Med. 2018 Nov;36(11):2110-2112. doi: 10.1016/j.ajem.2018.03.036. Epub 2018 Mar 17.

Emergency physician resistance to a take-home naloxone program led by community harm reductionists.

Author information

1
University of California, Irvine, Department of Emergency Medicine, 101 the City Drive, Route 128-01, Orange, CA 92868, United States; Orange County Needle Exchange Program (OCNEP), c/o the LGBT Center OC, 1605 N Spurgeon St, Santa Ana, CA 92701, United States. Electronic address: kyle.barbour@uci.edu.
2
University of California, Irvine, Department of Emergency Medicine, 101 the City Drive, Route 128-01, Orange, CA 92868, United States; Orange County Needle Exchange Program (OCNEP), c/o the LGBT Center OC, 1605 N Spurgeon St, Santa Ana, CA 92701, United States. Electronic address: mcquadem@uci.edu.
3
University of California, Irvine, Department of Emergency Medicine, 101 the City Drive, Route 128-01, Orange, CA 92868, United States. Electronic address: ssomasun@uci.edu.
4
University of California, Irvine, Department of Emergency Medicine, 101 the City Drive, Route 128-01, Orange, CA 92868, United States. Electronic address: bchakrav@uci.edu.

KEYWORDS:

Community outreach; Harm reduction; Injection drug use; Overdose prevention and naloxone distribution; Social stigma; Take-home naloxone

PMID:
29588147
DOI:
10.1016/j.ajem.2018.03.036
[Indexed for MEDLINE]
Icon for Elsevier Science
17.
Reprod Health. 2018 Mar 27;15(1):53. doi: 10.1186/s12978-018-0489-4.

Thriving in scrubs: a qualitative study of resident resilience.

Author information

1
New York University Langone Health, Department of Obstetrics & Gynecology, New York, NY, USA. abigail.winkel@nyumc.org.
2
New York University Langone Health, Department of Obstetrics & Gynecology, New York, NY, USA.
3
New York University Rory Meyers College of Nursing, New York, NY, USA.

Abstract

BACKGROUND:

Physician well-being impacts both doctors and patients. In light of high rates of physician burnout, enhancing resilience is a priority. To inform effective interventions, educators need to understand how resilience develops during residency.

METHODS:

A qualitative study using grounded theory examined the lived experience of resilience in residents. A cohort of obstetrics and gynecology residents were selected as a purposive, intensity sample.. Eighteen residents in all years of training participated in semi-structured interviews. A three-phase process of open coding, analytic coding and thematic analysis generated a conceptual model for resilience among residents.

RESULTS:

Resilience among residents emerged as rooted in the resident's calling to the work of medicine. Drive to overcome obstacles arose from personal identity and aspiration to professional ideals. Adversity caused residents to examine and cultivate coping mechanisms. Personal connections to peers and mentors as well as to patients and the work helped buffer the stress and conflicts that present. Resilience in this context is a developmental phenomenon that grows through engagement with uncertainty and adversity.

CONCLUSION:

Resilience in residents is rooted in personal and professional identity, and requires engagement with adversity to develop. Connections within the medical community, finding personal fulfillment in the work, and developing self-care practices enhance resilience.

PMID:
29587793
PMCID:
PMC5869777
DOI:
10.1186/s12978-018-0489-4
[Indexed for MEDLINE]
Free PMC Article
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18.
West J Emerg Med. 2018 Mar;19(2):337-341. doi: 10.5811/westjem.2017.12.36244. Epub 2018 Feb 26.

An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit.

Author information

1
Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Hood, Texas.
2
Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California.
3
Sinai-Grace Hospital, Department of Emergency Medicine, Detroit, Michigan.
4
University of Missouri Hospital, Department of Emergency Medicine, Columbia, Missouri.
5
Detroit Receiving Hospital, Department of Emergency Medicine, Detroit, Michigan.
6
University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada.

Abstract

Introduction:

Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS) addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout.

Methods:

A 30-person (27 residents, three attending physicians) Wellness Curriculum Development workgroup developed the curriculum in two phases. In the first phase, the workgroup worked asynchronously in the Wellness Think Tank - an online resident community - conducting a literature review to identify 10 core topics. In the second phase, the workgroup expanded to include residents outside the Wellness Think Tank at the live RWCS event to identify gaps in the curriculum. This resulted in an additional seven core topics.

Results:

Seventeen foundational topics served as the framework for the longitudinal resident wellness curriculum. The curriculum includes a two-module introduction to wellness; a seven-module "Self-Care Series" focusing on the appropriate structure of wellness activities and everyday necessities that promote physician wellness; a two-module section on physician suicide and self-help; a four-module "Clinical Care Series" focusing on delivering bad news, navigating difficult patient encounters, dealing with difficult consultants and staff members, and debriefing traumatic events in the emergency department; wellness in the workplace; and dealing with medical errors and shame.

Conclusion:

The resident wellness curriculum, derived from an evidence-based approach and input of residents from the Wellness Think Tank and the RWCS event, provides a guiding framework for residency programs in emergency medicine and potentially other specialties to improve physician wellness and promote a culture of wellness.

PMID:
29560063
PMCID:
PMC5851508
DOI:
10.5811/westjem.2017.12.36244
[Indexed for MEDLINE]
Free PMC Article
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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

19.
Otolaryngol Head Neck Surg. 2018 Jun;158(6):985-986. doi: 10.1177/0194599818764887. Epub 2018 Mar 20.

We Have Enough Information to Act.

Author information

1
1 Center for Professionalism and Peer Support, Brigham and Women's Hospital, Boston, Massachusetts, USA.
2
2 Harvard Medical School, Boston, Massachusetts, USA.

Abstract

Evidence clearly indicates that physicians are suffering. This is harming our profession, our colleagues, other health care team members, and sometimes our patients. There are efforts nationally and internationally to explore ways of promoting wellness and decreasing the high levels of burnout among physicians. While promoting wellness is a complex challenge, and the solutions will need to be multifactorial, the literature suggests that the most effective interventions are organizational. Instead of putting the burden solely on us as individuals to be able to cope with challenging environments, we should be working toward improving the culture and processes in the workplace. Some technical solutions will be needed, but the challenges will also require adaptive solutions that address issues of trust and support. Our Center for Professionalism and Peer Support offers organizational initiatives designed to foster a culture of trust and respect through professionalism, conflict management, peer support, and disclosure coaching programs.

KEYWORDS:

physician wellbeing; physician wellness; wellbeing; wellness

PMID:
29557303
DOI:
10.1177/0194599818764887
[Indexed for MEDLINE]
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20.
Otolaryngol Head Neck Surg. 2018 Jun;158(6):987-988. doi: 10.1177/0194599818765126. Epub 2018 Mar 20.

Integrative Medicine as a Bridge to Physician Wellness.

Author information

1
1 Ventura County Medical Center, Ventura, California, USA.

Abstract

Burnout is increasingly recognized as an issue of major importance affecting physicians of all ages and disciplines and thereby patients, systems, and health care in general. At the 2017 American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting, the scope of burnout in medicine was addressed, along with systematic issues that remain. While changing the culture of medicine and health systems to address this is needed, what strategies can health care providers use in their everyday lives to lessen the impact of burnout? Integrative medicine with its focus on wholeness of patient care, including the emotional, mental, social, and spiritual domains of health, is uniquely positioned in arming physicians with sets of tools to help them navigate patients to better health and healing. These very same methods are invaluable for personal self-care, as we are all potential patients. Integrative medicine is a pathway to improving one's own self-care and, thereby, improving patient care.

KEYWORDS:

bridge; integrative; medicine; physician; wellness

PMID:
29557285
DOI:
10.1177/0194599818765126
[Indexed for MEDLINE]
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