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Daly KA, Segura A, Heyman RE, Aladia S, Slep AMS. Scoping Review of Postvention for Mental Health Providers Following Patient Suicide. Mil Med 2024; 189:e90-e100. [PMID: 36661225 DOI: 10.1093/milmed/usac433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION As suicides among military personnel continue to climb, we sought to determine best practices for supporting military mental health clinicians following patient suicide loss (i.e., postvention). MATERIALS AND METHODS We conducted a scoping review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Our initial search of academic databases generated 2,374 studies, of which 122 were included in our final review. We categorized postvention recommendations based on the socioecological model (i.e., recommendations at the individual provider, supervisory/managerial, organizational, and discipline levels) and analyzed them using a narrative synthesizing approach. RESULTS Extracted recommendations (N = 358) comprised those at the provider (n = 94), supervisory/managerial (n = 90), organization (n = 105), and discipline (n = 69) levels. CONCLUSIONS The literature converges on the need for formal postvention protocols that prioritize (1) training and education and (2) emotional and instrumental support for the clinician. Based on the scoped literature, we propose a simple postvention model for military mental health clinicians and recommend a controlled trial testing of its effectiveness.
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Affiliation(s)
- Kelly A Daly
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Anna Segura
- Family Translational Research Group, New York University, New York, NY 10010, USA
- Faculty of Education, Translation, Sport and Psychology, Universitat de Vic-Universitat Central de Catalunya, Catalunya 08500, Spain
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Salomi Aladia
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Amy M Smith Slep
- Family Translational Research Group, New York University, New York, NY 10010, USA
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Quirk R, Rodin H, Linzer M. Targeting Causes of Burnout in Residency: An Innovative Approach Used at Hennepin Healthcare. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:690-694. [PMID: 33496434 DOI: 10.1097/acm.0000000000003940] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM Rates of burnout are high in physicians in the United States. While others have reported on the success of burnout-reduction strategies on practicing physicians and residents, few strategies have approached the problem longitudinally in residents. APPROACH From 2014 to 2019, the authors used a previously developed survey to assess factors related to resident burnout, including sleep, personal time, professional fulfillment, effects on relationships, program recognition, and peer support. At Hennepin Healthcare, a safety-net hospital in Minneapolis, Minnesota, the authors created a reproducible process for collecting data from internal medicine residents annually, and for using evidence-based conceptual frameworks to develop a continuous improvement method to address worklife across training years. Interventions included jeopardy coverage for essential life events, a newsletter celebrating resident achievements, removal of after-hours consult pager call, an extra day off for senior residents on the wards, and care packages distributed to night teams. OUTCOMES Annually from 2014 to 2019, 40/66 (60.6%) to 62/73 residents (84.9%) completed the survey (average response rate was 72.1% over 6 years). Survey results were shared with residents in multiple formats, and feedback was requested, demonstrating that burnout reduction is a priority for program leadership. High professional fulfillment scores were documented every year. Self-reported rates of burnout were between 25% and 35%. Significant improvements were seen in perception of empathy, sleep impairment, and peer support. NEXT STEPS The authors developed a plan for minimizing burnout, which includes the following evidence-based domains: workload, control, balance in effort and reward, work-life balance, fairness, values, support, gender equity, moral distress, and moral injury. Additional interventions include protected time for didactics, trauma-informed care training, and addressing workplace racism. The authors aspire to achieve an integrated culture of well-being for residents and faculty; foster an efficient, effective, and fair learning environment; and reduce-and ultimately eliminate-burnout.
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Affiliation(s)
- Rosemary Quirk
- R. Quirk is program director, Internal Medicine Residency Program, Hennepin Healthcare, and assistant professor of medicine, University of Minnesota, Minneapolis, Minnesota
- H. Rodin is a scientist, Analytic Center of Excellence, Hennepin Healthcare, Minneapolis, Minnesota
- M. Linzer is professor of medicine, University of Minnesota, and vice chair, Department of Medicine, and director, Institute for Professional Worklife, Hennepin Healthcare, Minneapolis, Minnesota
| | - Holly Rodin
- R. Quirk is program director, Internal Medicine Residency Program, Hennepin Healthcare, and assistant professor of medicine, University of Minnesota, Minneapolis, Minnesota
- H. Rodin is a scientist, Analytic Center of Excellence, Hennepin Healthcare, Minneapolis, Minnesota
- M. Linzer is professor of medicine, University of Minnesota, and vice chair, Department of Medicine, and director, Institute for Professional Worklife, Hennepin Healthcare, Minneapolis, Minnesota
| | - Mark Linzer
- R. Quirk is program director, Internal Medicine Residency Program, Hennepin Healthcare, and assistant professor of medicine, University of Minnesota, Minneapolis, Minnesota
- H. Rodin is a scientist, Analytic Center of Excellence, Hennepin Healthcare, Minneapolis, Minnesota
- M. Linzer is professor of medicine, University of Minnesota, and vice chair, Department of Medicine, and director, Institute for Professional Worklife, Hennepin Healthcare, Minneapolis, Minnesota
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