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Maksutova M, Kemp MT, Sharma SB, Shen M, Leininger L, Singer AA, Krueger M, Kim GJ, Kwakye G, Alam HB, Sandhu G. "You've Got Gratitude!"- A Multispecialty and Multi-institution Program Encouraging Expressions of Gratitude. JOURNAL OF SURGICAL EDUCATION 2023; 80:1741-1744. [PMID: 37723013 DOI: 10.1016/j.jsurg.2023.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE Efforts to improve physician well-being have focused on gratitude, which predicts health and happiness. Despite reported benefits, expressions of gratitude in healthcare can seem infrequent. Here, we describe Gratitude-Grams, an intervention to cultivate expressions of gratitude throughout a department. METHODS/APPROACH Piloted in our Department of Surgery and adopted by others, Gratitude-Grams employs a web-based platform (Qualtrics). Program feedback was solicited during teaching conferences using an anonymous department survey. RESULTS Gratitude-Grams streamlines and encourages expressions of gratitude while minimizing maintenance, cost, and time. The platform has been highly utilized and well-received in our Department of Surgery. CONCLUSION Expressing and receiving gratitude has been shown to be critical for well-being. Gratitude-Grams is a highly utilized, simple, and attainable system to support expressions of gratitude and is ready for rapid implementation.
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Affiliation(s)
- Mariam Maksutova
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Mary Shen
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lisa Leininger
- Department of Surgery, Graduate Medical Education Program Administrator, University of Michigan, Ann Arbor, Michigan
| | - Andrew A Singer
- Department of Surgery, Surgical Education Administrative Manager, Northwestern University, Chicago, Illinois
| | - Mackenzie Krueger
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Grace J Kim
- Department of Surgery, Section of Minimally Invasive Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gifty Kwakye
- Department of Surgery, Section of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hasan B Alam
- Department of Surgery, Northwestern University, Chicago, Illinois
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Latessa RA, Galvin SL, Swendiman RA, Onyango J, Ostrach B, Edmondson AC, Davis SA, Hirsh DA. Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study. BMC MEDICAL EDUCATION 2023; 23:760. [PMID: 37828469 PMCID: PMC10571297 DOI: 10.1186/s12909-023-04622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals. Psychological safety and accountability are supported by relational trust. Relational continuity is the educational construct underpinning longitudinal integrated clerkships. The workplace constructs of psychological safety and accountability may offer lenses to understand students' educational experiences in longitudinal integrated clerkships. METHODS We performed a qualitative study of 9 years of longitudinal integrated clerkship graduates from two regionally diverse programs-at Harvard Medical School and the University of North Carolina School of Medicine. We used deductive content analysis to characterize psychological safety and accountability from semi-structured interviews of longitudinal integrated clerkship graduates. RESULTS Analysis of 20 graduates' interview transcripts reached saturation. We identified 109 discrete excerpts describing psychological safety, accountability, or both. Excerpts with high psychological safety described trusting relationships and safe learning spaces. Low psychological safety included fear and frustration and perceptions of stressful learning environments. Excerpts characterizing high accountability involved increased learning and responsibility toward patients. Low accountability included students not feeling challenged. Graduates' descriptions with both high psychological safety and high accountability characterized optimized learning and performance. CONCLUSIONS This study used the workplace-based frameworks of psychological safety and accountability to explore qualitatively longitudinal integrated clerkship graduates' experiences as students. Graduates described high and low psychological safety and accountability. Graduates' descriptions of high psychological safety and accountability involved positive learning experiences and responsibility toward patients. The relational lenses of psychological safety and accountability may inform faculty development and future educational research in clinical medical education.
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Affiliation(s)
- Robyn A Latessa
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
| | - Shelley L Galvin
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC, USA
| | - Robert A Swendiman
- Department of Pediatric General Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joshua Onyango
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bayla Ostrach
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
- Departments of Family Medicine and Medical Anthropology, Boston University School of Medicine, Boston, MA, USA
| | | | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville, NC, USA
| | - David A Hirsh
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, 02139, USA.
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McMichael B, Kemp M, Engler T, Bamdad M, Perrone E, Kwakye G, Mohr D, Palazzolo W, Sonnenday C, Sandhu G. The Michigan Action Progress System (MAPS): Enhancing a Culture of Professionalism, Accountability, and Psychological Safety. JOURNAL OF SURGICAL EDUCATION 2023; 80:7-10. [PMID: 36216770 DOI: 10.1016/j.jsurg.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/22/2022] [Accepted: 08/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To prioritize trainee well-being, promote professionalism, and allow individuals to raise concerns without fear of retribution, one surgical department created an innovative process by which individuals can raise concerns and obtain subsequent support. DESIGN AND SETTING The University of Michigan Department of Surgery implemented the Michigan Action Progress System (MAPS) in February 2021. PARTICIPANTS General Surgery residents, faculty, and staff voluntarily participate in MAPS. RESULTS Since implementation, there have been 26 entries into MAPS. Petitioners included students (10, 38%), residents and fellows (7, 27%), staff (1, 4%), faculty (1, 4%), and anonymous petitioners (7, 27%). Concerns regarding racism (1, 4%), bullying (11, 52%), gender discrimination (1, 4%), and other incidents (8, 38%) were addressed though MAPS. CONCLUSIONS We have successfully implemented an innovative system that focuses on the needs of the user, consolidates handling of concerns, and emphasizes transparency, documentation, education, and improvement to promote a culture of professionalism and accountability.
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Affiliation(s)
| | - Michael Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Tedi Engler
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michaela Bamdad
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Erin Perrone
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gifty Kwakye
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - David Mohr
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Chris Sonnenday
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Aurrecoechea A, Kadakia N, Pandya JV, Murphy MJ, Smith TY. Emergency Medicine Residents' Perceptions of Working and Training in a Pandemic Epicenter: A Qualitative Analysis. West J Emerg Med 2022; 24:269-278. [PMID: 36602489 PMCID: PMC10047728 DOI: 10.5811/westjem.2022.9.57298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/20/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION We sought to describe the range of emergency medicine (EM) resident physicians' perceptions and experiences of working and training during the initial coronavirus 2019 (COVID-19) pandemic surge at two, large-volume, urban training hospitals in Brooklyn, New York. METHODS A total of 25 EM resident physicians who worked at either of two large emergency departments (ED) from March 15-April 11, 2020 participated in semi-structured interviews conducted in July and August 2020. Interviews were conducted by the authors who were also emergency medicine resident physicians working in the ED during this time. We asked open-ended questions to residents about their experiences and emotions at work and outside of work, including their relationship with co-workers, patients, and their community. The interviews were audio-recorded and transcribed. We then conducted a thematic analysis to identify, classify, and define themes from interview transcripts. Iterative commonalities and differences between interview response themes were grouped to create a broadly applicable narrative of the residents' perceptions and experiences of working and training during this initial wave of a novel pandemic. Interviewees also responded to a demographics survey. RESULTS Study participants described four major aspects of their perceptions and experiences of working and training during the stated time, including emotional challenges such as anxiety and feeling underappreciated; protective thoughts, including camaraderie, and sense of duty; workplace challenges such as limited knowledge surrounding COVID-19 and a higher volume of acute patients; and adaptive strategies including increased communication with ED administrators. CONCLUSION Emergency medicine residents have a unique perspective and were key frontline hospital responders during a prolonged disaster and mass triage event within a local health system. Considering the chronic case and mortality fluctuations and new variants of COVID-19, as well as the anticipation of future infectious disease pandemics, we believe it is important for key decision-makers in resident education, hospital administration, and all levels of public health management to inform themselves about residents' emotional and workplace challenges when establishing hospital and residency program disaster protocols.
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Affiliation(s)
- Adrian Aurrecoechea
- SUNY Downstate Health Sciences University, Department of Emergency Medicine Brooklyn, New York. NYC H+H Kings County Hospital, Department of Emergency Medicine, Brooklyn, New York
| | - Nidhi Kadakia
- SUNY Downstate Health Sciences University, Department of Emergency Medicine Brooklyn, New York. NYC H+H Kings County Hospital, Department of Emergency Medicine, Brooklyn, New York
| | - Jay V Pandya
- SUNY Downstate Health Sciences University, Department of Emergency Medicine Brooklyn, New York. NYC H+H Kings County Hospital, Department of Emergency Medicine, Brooklyn, New York
| | - Marie J Murphy
- SUNY Downstate Health Sciences University, Department of Emergency Medicine Brooklyn, New York. NYC H+H Kings County Hospital, Department of Emergency Medicine, Brooklyn, New York
| | - Teresa Y Smith
- SUNY Downstate Health Sciences University, Department of Emergency Medicine Brooklyn, New York. NYC H+H Kings County Hospital, Department of Emergency Medicine, Brooklyn, New York
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Nguyen MA, Castelo M, Greene B, Lu J, Brar S, Reel E, Cil TD. Profiles of Burnout and Response to the COVID-19 Pandemic Among General Surgery Residents at a Large Academic Training Program. Surg Innov 2022:15533506221120145. [PMID: 35971874 PMCID: PMC9382580 DOI: 10.1177/15533506221120145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background COVID-19 has placed demands on General Surgery residents, who are already at high risk of burnout. This study examined the pandemic’s impact on burnout and wellness among General Surgery residents at a large training program. Methods General Surgery residents at our institution completed a survey focused on self-reported burnout, mental health, perceptions of wellness resources, and changes in activities during the pandemic. Burnout was measured using the Maslach Burnout Inventory (MBI). Unsupervised machine learning (k-means clustering) was used to identify profiles of burnout and comparisons between profiles were made. Results Of 82 eligible residents, 51 completed the survey (62% response rate). During COVID-19, 63% of residents had self-described burnout, 43% had depression, 18% acknowledged binge drinking/drug use, and 8% had anxiety. There were no significant differences from pre-pandemic levels (p all >.05). Few residents perceived available wellness resources as effective (6%). Based on MBI scores, the clustering analysis identified three clusters, characterized as “overextended”, “engaged”, and “ineffective”. Engaged residents had the least concerning MBI scores and were significantly more likely to exercise, retain social contact during the pandemic, and had less self-reported anxiety or depression. Research residents were overrepresented in the ineffective cluster (46%), which had high rates of self-reported burnout (77%) and was characterized by the lowest personal accomplishment scores. Rates of self-reported burnout for overextended and engaged residents were 73% and 48%, respectively. Conclusion Surgical residents have high rates of self-reported burnout and depression during the COVID-19 pandemic. Clusters of burnout may offer targets for individualized intervention.
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Affiliation(s)
- May-Anh Nguyen
- Division of General Surgery, Department of Surgery, 7938University of Toronto, Toronto, Ontario, Canada
| | - Matthew Castelo
- Division of General Surgery, Department of Surgery, 7938University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, 7938University of Toronto, Toronto, Ontario, Canada
| | - Brittany Greene
- Division of General Surgery, Department of Surgery, 7938University of Toronto, Toronto, Ontario, Canada
| | - Justin Lu
- Temerty Faculty of Medicine, 7938University of Toronto, Toronto, Ontario, Canada
| | - Savtaj Brar
- Division of General Surgery, Department of Surgery, 7938University of Toronto, Toronto, Ontario, Canada
| | - Emma Reel
- Division of General Surgery, Department of Surgery, 7938University of Toronto, Toronto, Ontario, Canada
| | - Tulin D Cil
- Division of General Surgery, Department of Surgery, 7938University of Toronto, Toronto, Ontario, Canada
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Bartholomew A, Sanatkar S, Counson I, Harvey SB. Junior doctors' mental health and coronavirus disease safety concerns. Aust N Z J Public Health 2022; 46:307-313. [PMID: 35238447 PMCID: PMC9968570 DOI: 10.1111/1753-6405.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/01/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This article aims to assess whether caring for COVID-19 patients impacted junior doctors' COVID-19-related anxieties, general anxiety and depression, and the relative impact of depression, general anxiety and specific COVID-19 anxiety on work and social functioning during the COVID-19 pandemic in 2020. METHODS Recruitment occurred between June and August 2020 in New South Wales, Australia. Demographic information, symptoms of depression (PHQ-9), generalised anxiety (GAD-7), and COVID-19-related anxieties around infections, help-seeking behaviours, and work and social functioning (WSAS) were collected. RESULTS About one third (n=73, 33%) had cared for a patient with overt or covert COVID-19 in the previous month. However, the extent of COVID-19-related anxiety symptoms was largely unrelated to caring for COVID-19 patients. Instead, the presence of other COVID-19 concerns and gender predicted variations in COVID-19 concerns for one's own safety and the safety of loved ones. CONCLUSION COVID-19 anxiety symptoms were largely unrelated to caring for COVID-19 patients, while COVID-19-related anxiety around the safety of family and friends added to impaired functioning in addition to the established impact of depression and general anxiety. IMPLICATIONS FOR PUBLIC HEALTH Provided the replicability of these findings, this research highlights the importance of addressing pandemic-related anxieties in junior doctor populations.
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Affiliation(s)
- Alexandra Bartholomew
- Black Dog Institute, UNSW Sydney, New South Wales,Correspondence to: Ms Alexandra Bartholomew, Black Dog Institute, Hospital Road, Sydney 2031
| | - Samineh Sanatkar
- Black Dog Institute, UNSW Sydney, New South Wales,School of Psychiatry, UNSW Sydney, New South Wales
| | - Isabelle Counson
- Black Dog Institute, UNSW Sydney, New South Wales,School of Psychiatry, UNSW Sydney, New South Wales
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Cox JS, Wehrle CJ, Mejias C, Devarakonda AK, McKenzie JA, Arora TK. General Surgery Twitter during COVID-19: Tweets, Trends, and Implications for Recruitment Strategies. Am Surg 2021:31348211060414. [PMID: 34937400 DOI: 10.1177/00031348211060414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted traditional resident recruitment practices, requiring virtual interviews and new forms of outreach. Social media, such as Twitter, is one tool programs can use to connect with applicants. This study sought to assess changes in Twitter use during the COVID-19 pandemic among general surgery programs. METHODS Twitter and residency program websites were queried for public Twitter accounts related to general surgery residency programs. Publicly available tweets for available accounts were reviewed for all posts for the period March 15, 2019-November 25, 2020. Thematic analysis of each tweet was performed, and engagement was determined by likes and retweets on each tweet. RESULTS The number of programs with active Twitter accounts increased after the onset of COVID-19 pandemic, as did the number of tweets, likes-, and retweets-per-tweet. There was a significant increase in the number of tweets regarding resident promotion, program promotion, and virtual event promotion. Tweets received more likes-per-tweet if the subject was program promotion and resident promotion than tweets regarding virtual events. All results were statistically significant (P < .05). DISCUSSION Twitter use and engagement with residency programs have increased significantly since pandemic onset. Engagement is highest for tweets regarding program and resident promotion as measured by likes-per-tweet and highest for program promotion and virtual events as measured by retweets-per-tweet. Given the nearly nationwide increase in Twitter engagement after pandemic onset, programs should consider the impact of Twitter as a means of communication with applicants and program branding.
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Affiliation(s)
- James Shell Cox
- 1421Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Chase J Wehrle
- 1421Medical College of Georgia at Augusta University, Augusta, GA, USA
| | | | | | | | - Tania K Arora
- Department of Surgical Oncology, 1421Medical College of Georgia at Augusta University, Augusta GA, USA
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Scott L, Lim R, Foxcroft L, Lum PA. How can surgical programs use peer support programs in times of crisis? Can Urol Assoc J 2021; 15:S36-S39. [PMID: 34406930 DOI: 10.5489/cuaj.7302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Leslie Scott
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rodrick Lim
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Laura Foxcroft
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - P Andrea Lum
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Anderson SH, Moe JS, Abramowicz S. Work-Life Balance for Oral and Maxillofacial Surgeons. Oral Maxillofac Surg Clin North Am 2021; 33:467-473. [PMID: 34364748 DOI: 10.1016/j.coms.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Oral and maxillofacial surgeons experience high levels of stress and work-home conflict, which predispose them to burnout. There is emerging evidence in support of work-life integration to prevent burnout; interventional strategies exist on an individual and organizational level. This article explores the current evidence on promoting work-life integration for improved surgeon satisfaction, performance, and efficiency. Work-life integration initiatives can help promote the recruitment and retention of a diverse surgical workforce in oral and maxillofacial surgery.
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Affiliation(s)
- Sara Hinds Anderson
- Department of Oral and Maxillofacial Surgery, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Justine Sherylyn Moe
- Department of Oral and Maxillofacial Surgery, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, Building B, Suite 2300, Atlanta, GA 30322, USA.
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