Cultivating a way of being and doing: Individual strategies for physician well-being and resilience

Insights into values and emotional wellbeing of medical students in the United Arab Emirates: a cross-sectional study

Objective

To describe the difference in values among medical students from a first-year student' and final year student' perspective. In addition, it is designed to report associations and trends between personal values and overall emotional states.

Methods

This is an analytical cross-sectional study that involved disseminating an online survey via email to first and final year students at the College of Medicine in Mohammed Bin Rashid University (MBRU) in Dubai, United Arab Emirates in December of 2023. The survey encompassed queries on demographics, the Life Values Inventory (LVI) and the Positive and Negative Affect Schedule (PANAS).

Results

The survey was completed by 84 students. About half of the participants were final year medical students (45/84; 53.6%) with the majority being females (70/84; 83.3%). Positive emotions were positively correlated to various life values, including belonging, scientific understanding, responsibility, and achievement (p < 0.05). When comparing academic years, the scores of the life value of Achievement showed a significant correlation (p = 0.04), with first-year students' mean (SD) of 12 (2) out of 15 compared to 11 (3) out of 15 for final-year students. Positive Emotions also exhibited a significant correlation (p = 0.006), with first-year students' mean (SD) 40 (5) out of 50 compared to 36 (7) out of 50 for final-year students.

Conclusion

This study adds to medical education research by exploring values and emotions, shedding light on factors shaping students' professional identities. Understanding these dynamics can aid in supporting future healthcare providers and by extension the patients for whom they care.

Workforce Concerns: Professional Self Care, Personal Readiness, Impact of the Pandemic, and Other Factors that Impact the Workforce

Physician burnout is pervasive and takes a heavy toll on individuals and the healthcare system. Post-coronavirus disease 2019 the negative impact of organizational culture on physician burnout has been highlighted. Substantial research has accrued identifying steps organizations can take to pivot and develop leaders committed to physician well-being. Physicians can also proactively explore research in sleep, nutrition, physical activity, stress management, and social connections. Positive mindset has a powerful protective effect in medicine, especially in the emerging areas of self-valuation, self-compassion, and positive psychology. Physician coaching can accelerate positive behavior change. Committed physician leaders are needed for sustained culture change to occur.

Professional Coaching as a Continuing Professional Development Intervention to Address the Physician Distress Epidemic

ABSTRACT

Physician distress and burnout are reaching epidemic proportions, threatening physicians' capacities to develop and maintain competencies in the face of the increasingly demanding and complex realities of medical practice in today's world. In this article, we suggest that coaching should be considered both a continuing professional development intervention as well as an integral part of a balanced and proactive solution to physician distress and burnout. Unlike other interventions, coaching is intended to help individuals gain clarity in their life, rather than to treat a mental health condition or to provide advice, support, guidance, or knowledge/skills. Certified coaches are trained to help individuals discover solutions to complex problems and facilitate decision-making about what is needed to build and maintain capacity and take action. Across many sectors, coaching has been shown to enhance performance and reduce vulnerability to distress and burnout, but it has yet to be systematically implemented in medicine. By empowering physicians to discover and implement solutions to challenges, regain control over their lives, and act according to their own values, coaching can position physicians to become leaders and advocates for system-level change, while simultaneously prioritizing their own well-being.

Piloting an Interprofessional Narrative-Based Interactive Workshop for End-of-Life Conversations: Implications for Learning and Practice

BACKGROUND

Based on the principles of Narrative Medicine, this study explored a narrative-based workshop for multi-level interdisciplinary clinicians who have EOL conversations.

METHODS

Fifty-two clinicians participated in narrative-based interactive workshops. Participants engaged narrative in three forms: viewing narratives, writing/sharing narratives, and co-constructing narratives. Post workshop interviews were conducted and thematically analyzed.

RESULTS

Five themes characterized how the workshop shaped learning and subsequent care experiences: (1) learning to enter/respond to the patient stories, (2) communicating across professions and disciplines, (3) practicing self-care. Additional themes emphasized (4) barriers to narrative learning and (5) obstacles to applying narrative to practice.

DISCUSSION

Results highlight the function/utility of narrative forms such as the value of processing emotions via reflective writing, feeling vulnerable while sharing narratives, and appreciating colleagues' obstacles while observing patient-clinician simulations. Challenges associated with narrative such as writing anxiety and barriers to implementation such as time constraints are detailed to inform future initiatives.

Physician Health and Wellness

Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.

Understanding the value of art prompts in an online narrative medicine workshop: an exploratory-descriptive focus group study

Narrative medicine is an interdisciplinary field that complements and expands on conventional healthcare training by supporting narrative competence skills and creativity derived from the arts and humanities domains to address the needs of healthcare providers and receivers. With the COVID-19 pandemic having had a profound impact on the healthcare workforce with an already high burn-out rate, multimodal arts interventions may help address the holistic dimensions of well-being. While empirical evidence supports the use of arts-based interventions in promoting healthcare workers' well-being and personal growth, art prompts are underexplored and underused in narrative medicine. Moreover, protocols and frameworks adopted in extant research on this topic are inconsistent, resulting in replication and validation challenges. These issues have motivated this exploratory-descriptive study with 11 narrative medicine practitioners to examine the use of short art prompts in an online narrative medicine workshop.The art prompts leveraged art therapy's Expressive Therapies Continuum (ETC) model, which uses the inherent properties of art materials, media and methods to elicit specific levels of information processing and creative experiences. The study aimed to understand how art prompts differ from writing prompts and explore the value art prompts could add to narrative medicine if any. Qualitative analyses revealed that art prompts in narrative medicine increase positive feelings and promote creativity and insight. Specifically, art prompts allowed participants to use sensorimotor functions, enter a flow-like state, be challenged and inspired by novelty and uncertainty, and experience a sense of play and personal discovery.

When it's needed most: a blueprint for resident creative writing workshops during inpatient rotations

BACKGROUND

Narrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. However, Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents.

OBJECTIVE

To evaluate programmatic and learner outcomes of a novel narrative medicine curriculum implementation during inpatient medicine rotations for medical residents. Programmatic outcomes included implementation lessons. Learner outcomes included preliminary understanding of impact on feelings of burnout. Additionally, we developed a generalizable narrative medicine framework for program implementation across institutions.

METHODS

We developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford's busiest and emotionally-demanding inpatient rotation (medical oncology). Using the Physician Wellbeing Inventory (PWBI, range 1-7; 3-4 = high burnout risk; ≥4, high burnout), we anonymously assessed resident burnout during pre-implementation control year (2017-2018, weeks 1 and 4), and implementation year (2018-2019, weeks 1 and 4). We interviewed program directors and facilitators regarding curriculum implementation challenges/facilitators.

RESULTS

Residents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years. We identified success factors for programmatic success including time neutrality, control of session, learning climate, building trust, staff partnership, and facilitators training. During control year, resident burnout was initially high (n = 16; mean PBWI = 3.0, SD: 1.1) and increased by the final week (n = 15; PBWI = 3.4, SD: 1.6). During implementation year, resident burnout was initially similar (n = 13; PBWI = 3.1, SD: 1.9) but did not rise as much by rotation end (n = 24; PBWI = 3.3, SD: 1.6). Implementation was underpowered to detect small effect sizes. Based on our our experience and literature review, we propose an educational competency framework potentially helpful to facilitate inpatient narrative medicine workshops, as a blueprint for other institutions.

CONCLUSIONS

Inpatient Narrative Medicine is feasible to implement during a challenging inpatient rotation and may have important short-term effects in mitigating burnout rise, with more study needed. We share teaching tools and propose a competency framework which may be useful to support development of inpatient narrative medicine curricula across institutions.

Positive Health and the happy professional: a qualitative case study

BACKGROUND

Primary care professionals (PCPs) face mounting pressures associated with their work, which has resulted in high burn-out numbers. Increasing PCPs' job satisfaction is proposed as a solution in this regard. Positive Health (PH) is an upcoming, comprehensive health concept. Among others, this concept promises to promote PCPs' job satisfaction. However, there is limited research into PH's effects on this topic. This study, therefore, aims to provide insight into how adopting PH in a general practice affects PCPs' job satisfaction.

METHODS

An ethnographic case study was conducted in a Dutch general practice that is currently implementing PH. Data collected included 11 semi-structured interviews and archival sources. All data were analyzed thematically.

RESULTS

Thematic analysis identified three themes regarding PCPs' adoption of PH and job satisfaction, namely [1] adopting and adapting Positive Health, [2] giving substance to Positive Health in practice, and [3] changing financial and organizational structures. Firstly, the adoption of PH was the result of a match between the practice and the malleable and multi-interpretable concept. Secondly, PH supported PCPs to express, legitimize, and promote their distinctive approach to care work and its value. This strengthened them to further their holistic approach to health and stimulate autonomy in practice, with respect to both patients and professionals. Thirdly, the concept enabled PCPs to change their financial and organizational structures, notably freeing time to spend on patients and on their own well-being. This allowed them to enact their values. The changes made by the practice increased the job satisfaction of the PCPs.

CONCLUSIONS

PH contributed to the job satisfaction of the PCPs of the general practice by functioning as an adaptable frame for change. This frame helped them to legitimize and give substance to their vision, thereby increasing job satisfaction. PH's malleability allows for the frame's customization and the creation of the match. Simultaneously, malleability introduces ambiguity on what the concept entails. In that regard, PH is not a readily implementable intervention. We recommend that other organizations seeking to adopt PH consider whether they are willing and able to make the match and explore how PH can help substantiate their vision.

Resilience interventions in physicians: A systematic review and meta-analysis

The aim of this review was to evaluate the effectiveness of interventions in promoting resilience among physicians. Previous reviews concerning resilience did not assess effectiveness in a systematic way using meta-analytic methods. PubMed, PsycINFO, and Cochrane Register of Controlled Trials were searched from inception to January 31, 2020. Randomized clinical trials, non-randomized clinical trials, and repeated-measures studies of intervention designs targeting at resilience in physicians were included. Eleven studies were included in the review (n = 580 physicians). Research findings suggest that interventions for resilience in physicians were associated with small but significant benefits. Subgroup analyses suggested small but significantly improved effects for emotional-supportive-coping interventions (Hedges's g = 0.242; 95% CI, 0.082-0.402, p = .003) compared with mindfulness-meditation-relaxation interventions (Hedges's g = 0.208; 95% CI, 0.131-0.285, p = .000). Interventions that were delivered for more than a week indicated higher effect (Hedges's g = 0.262; 95% CI, 0.169-0.355, p = .000) compared with interventions delivered for up to a week (Hedges's g = 0.172; 95% CI, -0.010 to 0.355, p = .064). Results were not influenced by the risk of bias ratings. Findings suggest that physicians can benefit in their personal levels of resilience from attending an intervention specifically designed for that reason for more than a week. Moreover, policy-makers should view current results as a significant source of redesigning healthcare systems and promoting attendance of resilience interventions by physicians. Future research should address the need for more higher-quality studies and improved study designs.

The challenge of change: Resilience traits in Women's Dermatological Society Forum participants by generation

BACKGROUND

Physician burnout is a common problem that can have negative ramifications for both physicians and patients. Lack of effective coping mechanisms decreases resilience, which can lead to burnout, and women may be particularly vulnerable.

OBJECTIVE

We aimed to evaluate resilience by generation among professionals in dermatology. We hope to gain a better understanding of the plasticity of resilience traits to identify modifiable resilience components.

METHODS

Attendees of the 2020 Women's Dermatological Society Forum were asked to complete an 80-item questionnaire evaluating eight characteristics of resilience. Each participant received scores electronically, and attendees were invited to anonymously submit scores, job category (physician or industry), and birth year and/or generation category. Participants who provided scores and were part of the millennial generation (born 1980-1994; ages 26-40 years at the time of survey completion), Generation X (born 1965-1979; ages 41-55 years), or baby boomer generation (born 1944-1964; ages 56-76 years) were included.

RESULTS

Of the 67 participants meeting the inclusion criteria, 96.7% were women and 3.3% were men, 69.4% were physicians and 30.6% were industry representatives. Millennials accounted for 43.3%, Generation X for 35.8%, and baby boomers for 20.9% of the study participants. There was a significant difference among the three generations for mean scores on rumination (p = .0071) and flexibility (p = .0005), with scores becoming more ideal for older generations. There was no significant difference among generations for other resilience or burnout indicators, including emotional inhibition, toxic achieving, avoidance coping, perfect control, detached coping, and sensitivity.

CONCLUSION

Resilience traits such as rumination and flexibility differed by generation, with the most favorable scores occurring in the oldest cohort, suggesting that some resilience traits may be malleable and improve with age or be inherently affected by environment during development. Health care professionals may benefit from engaging in activities that enhance malleable resilience traits and improve the ability to manage work-related stressors.

Clinician Wellness During the COVID-19 Pandemic: Extraordinary Times and Unusual Challenges for the Allergist/Immunologist

The global spread of coronavirus disease 2019 (COVID-19) has caused sudden and dramatic societal changes. The allergy/immunology community has quickly responded by mobilizing practice adjustments and embracing new paradigms of care to protect patients and staff from severe acute respiratory syndrome coronavirus 2 exposure. Social distancing is key to slowing contagion but adds to complexity of care and increases isolation and anxiety. Uncertainty exists across a new COVID-19 reality, and clinician well-being may be an underappreciated priority. Wellness incorporates mental, physical, and spiritual health to protect against burnout, which impairs both coping and caregiving abilities. Understanding the stressors that COVID-19 is placing on clinicians can assist in recognizing what is needed to return to a point of wellness. Clinicians can leverage easily accessible tools, including the Strength-Focused and Meaning-Oriented Approach to Resilience and Transformation approach, wellness apps, mindfulness, and gratitude. Realizing early warning signs of anxiety, depression, substance abuse, and posttraumatic stress disorder is important to access safe and confidential resources. Implementing wellness strategies can improve flexibility, resilience, and outlook. Historical parallels demonstrate that perseverance is as inevitable as pandemics and that we need not navigate this unprecedented time alone.