1
|
Kazemi F, Chakravarti S, Stephens R, Ahmed AK, Mukherjee D. Promoting durable well-being among healthcare professionals via an interactive, online, wellness initiative. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:236. [PMID: 39297121 PMCID: PMC11410282 DOI: 10.4103/jehp.jehp_124_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/20/2024] [Indexed: 09/21/2024]
Abstract
Burnout is recognized as a negative contributor to well-being within healthcare. The purpose of this study was to evaluate whether participation in the Peace Education Program (PEP), a 10-week wellness course, promoted durable improvement of burnout and wellness in a large academic medical center. We deployed PEP virtually through a series of free, interactive, online wellness sessions focusing on 10 domains: peace, appreciation, inner strength, self-awareness, clarity, understanding, dignity, choice, hope, and contentment. Two weeks before and six months following the sessions, we distributed de-identified surveys based upon the validated Schwartz Outcome Scale-10 (SOS-10) with Likert scale scores 0-6 to assess participant wellness. The Mann-Whitney U test was used to analyze statistical differences between post- and pre-course data. Sixty-nine faculty, trainees, and staff registered to participate, 21 participants completed the pre-course survey and 10 completed the post-course survey. The pre-course mean + standard error (SE) SOS-10 score was 43.2 ± 0.8, which improved to 51.0 ± 0.7 post-course (P < 0.001). Overall, all 10 domains demonstrated improved mean scores over time, with the five domains of "inner strength" (P = 0.008), "understanding" (P = 0.030), "peace" (P = 0.048), "choice" (P = 0.026), and "hope" (P = 0.020) demonstrating statistically significant score improvements six months after course completion. Participants completing ≥7 sessions benefited more than their counterparts and achieved statistically significant improvement in SOS-10 wellness scores (8.77 points) six months after course completion. Our findings demonstrate improved wellness in participants following peace education course completion. This free, interactive, online course may be utilized at other medical centers to improve wellness.
Collapse
Affiliation(s)
- Foad Kazemi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sachiv Chakravarti
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan Stephens
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
Sinha A, Slater CS, Lee A, Sridhar H, Gowda D. "The forest and the trees": a narrative medicine curriculum by residents for residents. Pediatr Res 2024; 96:313-318. [PMID: 38519792 PMCID: PMC11343708 DOI: 10.1038/s41390-024-03142-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
A 7-session narrative medicine (NM) curriculum was designed and facilitated by pediatrics residents for pediatrics residents in order to unpack challenging experiences during clinical training and strengthen relationships with colleagues and patients. The primary facilitator, a resident with a master's degree in NM, provided facilitator training to her co-residents with whom she co-led the workshops in the curriculum. We conducted, transcribed, and analyzed individual interviews of 15 residents, with three resultant themes: reflection on personal and professional identity; connection to others and community building; and reconceptualization of medical practice. Residents shared that they experienced greater solidarity, professional fulfillment, appreciation for multiple facets of their identities, recognition of holding space for vulnerability, and advocacy for marginalized populations. Our study highlights the feasibility and effectiveness of peer-led NM workshops to enhance clinical training through self-reflection, inclusion of persons from underrecognized backgrounds, and promotion of values consistent with humanistic care. IMPACT: A novel narrative medicine curriculum was designed and facilitated by pediatrics residents for pediatrics residents. The curriculum was feasible and acceptable to pediatrics residents and required a facilitator with content and methodology expertise in narrative medicine to train additional facilitators. Three themes emerged from resident interviews: reflection on personal and professional identity; connection to others and community building; and reconceptualization of medical practice on individual and global levels.
Collapse
Affiliation(s)
- Anoushka Sinha
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Carly S Slater
- Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Alyson Lee
- The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Harini Sridhar
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Deepthiman Gowda
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| |
Collapse
|
3
|
Guldner G. Creating and Supporting Well-Being in Graduate Medical Education. HCA HEALTHCARE JOURNAL OF MEDICINE 2024; 5:183-186. [PMID: 39015592 PMCID: PMC11249172 DOI: 10.36518/2689-0216.1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Description Graduate medical education strives to create the next generation of skillful and compassionate physicians for our nation. Yet, research shows a high degree of depression, anxiety, workplace burnout, lack of engagement, and general dissatisfaction with the work and learning environment for many of these dedicated individuals. We present this special issue related to creating and supporting well-being in the graduate medical education community.
Collapse
|
4
|
Ehmann MR, Murano T, Sullivan C, Egan DJ, Nazario S, Regan L. Remediation Methods 2.0 for Professionalism and Interpersonal and Communication Skills Milestones: An Update. J Grad Med Educ 2024; 16:128-132. [PMID: 38993300 PMCID: PMC11234317 DOI: 10.4300/jgme-d-23-00536.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Affiliation(s)
- Michael R Ehmann
- is Assistant Professor and Residency Program Director, Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tiffany Murano
- is Professor and Vice Chair of Education, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Christine Sullivan
- is Professor and Associate Dean for Professional Development, Department of Emergency Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Daniel J Egan
- is Program Director, Harvard Affiliated Emergency Medicine Residency, and Associate Professor and Vice Chair of Education, Massachusetts General Brigham Emergency Medicine, Boston, Massachusetts, USA
| | - Steven Nazario
- is Program Director, AdventHealth Emergency Medicine Residency, Orlando, Florida, USA; and
| | - Linda Regan
- is Associate Professor and Vice Chair for Education, Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
5
|
Wang MK, Geen O, Mach ZH, Khalid Z. Resident Burnout on the Internal Medicine Ward. J Gen Intern Med 2024; 39:366-372. [PMID: 37946021 PMCID: PMC10897070 DOI: 10.1007/s11606-023-08505-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Burnout is common among medical trainees. Whether brief periods of training on the internal medicine ward leads to resident burnout is unknown. METHODS A survey-based study was conducted at a single academic institution. Medical residents undertaking four-week rotations on the internal medicine ward were included. Burnout was measured at the beginning and end of each rotation using the Maslach Burnout Inventory - Human Services Survey. Burnout was defined as either an emotional exhaustion score of ≥ 27 or a depersonalization score of ≥ 10. Self-reported workplace conditions, behaviors and attitudes were recorded. RESULTS The survey response rate was 71% and included 148 participants. The overall prevalence of burnout was 17% higher at the end of the rotation compared to the beginning of the rotation (71% vs. 54%; P < 0.001). Forty-three percent of residents without pre-rotation burnout developed post-rotation burnout. Residents with post-rotation burnout were more likely to report at least one suboptimal behavior or attitude related to patient care or professionalism (84% vs. 35%; P < 0.001). Respondents with new onset burnout were less likely to report being appreciated for their work, having their role as a learner emphasized, and receiving satisfactory support from allied healthcare professionals. New onset burnout was inversely associated with completing a second consecutive internal medicine ward rotation (adjusted OR 0.19; 95% CI, 0.04-0.90; P = 0.04). CONCLUSION Seven in ten residents are in a state of burnout after completing internal medicine ward rotations. Interventions to mitigate burnout development during periods of high intensity clinical training are needed.
Collapse
Affiliation(s)
- Michael Ke Wang
- Department of Medicine, McMaster University, Hamilton, Canada.
| | - Olivia Geen
- Department of Medicine, Trillium Health Partners, Mississauga, Canada
| | - Zi Hymn Mach
- Department of Medicine, Trillium Health Partners, Mississauga, Canada
| | - Zahira Khalid
- Department of Medicine, McMaster University, Hamilton, Canada
| |
Collapse
|
6
|
Maragha T, Garcia AP, Shuler C, von Bergmann H. The six-domain well-being framework in oral health sciences: A pathway from theory to practice. J Dent Educ 2024; 88:157-168. [PMID: 37904583 DOI: 10.1002/jdd.13401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/01/2023] [Accepted: 10/20/2023] [Indexed: 11/01/2023]
Abstract
OBJECTIVES Well-being is a complex and multifaceted construct that has gained popularity in oral health sciences education. Maintaining students' well-being is essential for their academic performance and quality of life. While many definitions and frameworks of well-being exist, their applicability to oral health sciences education remains unknown. This study aimed to evaluate the applicability of the Feeney and Collins's framework of well-being to oral health sciences education by exploring students' perceptions and experiences in the University of British Columbia METHODS: An Interpretive Description approach was used to conduct semi-structured interviews with dental and dental hygiene students. Interviews were transcribed, and transcripts were coded and analyzed with guidance from Feeney and Collins's well-being and thriving framework using content analysis. Domains were inductively developed within and beyond the organizing categories of the chosen framework. RESULTS Thirty-one oral health sciences students participated in the study. Study data can largely be explained by the five well-being domains suggested by Feeney and Collins: physical, psychological, eudaimonic, subjective, and social. Spirituality and gratitude emerged as an additional domain that contributes to students' well-being. Interdomain relationships were observed. The social domain seemed to contribute to all other well-being domains; while the subjective domain seemed to be shaped by all other domains CONCLUSIONS: Feeney and Collins's framework seemed to be useful to understand and conceptualize well-being in oral health sciences education but needed to be expanded to include spirituality and gratitude. Further evidence is needed to explore the applicability of this framework in other health professional education disciplines.
Collapse
Affiliation(s)
- Tala Maragha
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arnaldo Perez Garcia
- Educational Research and Scholarship Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, British Columbia, Canada
| | - Charles Shuler
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - HsingChi von Bergmann
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
7
|
Underdahl L, Ditri M, Duthely LM. Physician Burnout: Evidence-Based Roadmaps to Prioritizing and Supporting Personal Wellbeing. J Healthc Leadersh 2024; 16:15-27. [PMID: 38192639 PMCID: PMC10773242 DOI: 10.2147/jhl.s389245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
Current literature validates the magnitude of physician burnout as a complex challenge affecting physicians, patients, and healthcare delivery that mandates science-informed intervention. Physician burnout affects both individual practitioners and patient care delivery. Interventions, defined as roadmaps, to prioritizing and supporting personal wellbeing encompass organizational, individual, and moral injury, with virtually no consensus on optimal approaches. The purpose of this conceptual review is to present evidence-based innovative insights on contributing factors, mitigation, and designing adaptive systems to combat and prevent burnout. Science-informed policy initiatives that support long-term organizational changes endorsed by both leadership and institutional stakeholders are keys to sustaining personal wellbeing and ending burnout.
Collapse
Affiliation(s)
- Louise Underdahl
- College of Doctoral Studies, University of Phoenix, Phoenix, AZ, USA
| | - Mary Ditri
- Community Health, New Jersey Hospital Association, Princeton, NJ, USA
| | - Lunthita M Duthely
- Obstetrics, Gynecology and Reproductive Sciences and the Department of Public Health Sciences, University of Miami Health System, Miami, FL, USA
| |
Collapse
|
8
|
Huang WD, Loid V, Sung JS. Reflecting on gamified learning in medical education: a systematic literature review grounded in the Structure of Observed Learning Outcomes (SOLO) taxonomy 2012-2022. BMC MEDICAL EDUCATION 2024; 24:20. [PMID: 38172852 PMCID: PMC10765768 DOI: 10.1186/s12909-023-04955-1] [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: 10/11/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The acquisition of in-depth medical knowledge, skills, and competencies is of utmost importance when training future medical professionals. This systematic literature review delves into the empirical connection between gamified learning in medical education and the Structure of Observed Learning Outcomes (SOLO) taxonomy. METHODS Following PRISMA guidelines, a systematic literature review was conducted in seven databases to identify empirical studies related to gamification and medical education. The literature search was limited to peer-reviewed articles published between January 2012 and December 2022. Articles focusing on games or learning technologies in a broader sense as well as research focusing on nursing or pharmacy education were excluded. RESULTS Upon reviewing 23 qualified empirical studies that applied gamified learning strategies in medical education, 18 (78%) studies are associated with the second lowest level (uni-structural) of the SOLO taxonomy. The mid-level (multi-structural) learning outcomes are associated with three (13%) of the reviewed studies. There are five (22%) studies focusing on the second highest (relational) level of the SOLO. Only one study (4%) is associated with the highest SOLO level (extended-abstract). Finally, three (13%) studies were identified with multiple levels of the SOLO. In addition to the SOLO levels, the review found six (26%) studies emphasizing motivational and engagement support of gamified learning strategies in facilitating intended learning outcome attainment. A total of three (13%) studies, across three SOLO levels, suggested that gamified learning strategies can improve students' soft skills in medical education programs. CONCLUSION These findings collectively emphasize the need for future research and development to design gamified learning experiences capable of fostering higher SOLO taxonomy attainment in medical education. Moreover, there is potential to extend the SOLO framework to encompass motivational and affective learning outcomes, providing a comprehensive understanding of the impact of gamified learning on medical students.
Collapse
Affiliation(s)
- Wenhao David Huang
- Biomedical and Translational Science, Carle-Illinois College of Medicine; Education Policy, Organization, and Leadership, College of Education, University of Illinois Urbana-Champaign, Champaign, IL, USA.
| | - Viktoria Loid
- Education Policy, Organization, and Leadership College of Education, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Jung Sun Sung
- Education Policy, Organization, and Leadership College of Education, University of Illinois Urbana-Champaign, Champaign, IL, USA
| |
Collapse
|
9
|
Stewart RE, Wislocki K, Wolk CB, Bellini L, Livesey C, Kugler K, Kwon N, Cardamone NC, Becker-Haimes EM. Implementing a resilience coach program to support first year housestaff during the COVID-19 pandemic: early pilot results and comparison with non-housestaff sessions. BMC Health Serv Res 2023; 23:915. [PMID: 37644597 PMCID: PMC10463571 DOI: 10.1186/s12913-023-09951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND In response to the COVID-19 pandemic, we launched the Penn Medicine Coping First Aid program to provide psychosocial supports to our health system community. Our approach leveraged lay health worker volunteers trained in principles of Psychological First Aid to deliver coaching services through a centralized virtual platform. METHODS We emailed all (n = 408) first year housestaff (i.e., residents and fellows) with an invitation to schedule a session with a resilience coach. We compared the mental health concerns, symptoms, and Psychological First Aid techniques recorded in (n = 67) first year housestaff sessions with (n = 91) sessions of other employees in the health system. RESULTS Between June and November 2020, forty-six first year housestaff attended at least one resilience coaching session. First year housestaff most commonly presented with feelings of anxiety and sadness and shared concerns related to the availability of social support. Resilience coaches most frequently provided practical assistance and ensured safety and comfort to first year housestaff. First year housestaff reported fewer physical or mental health symptoms and held shorter sessions with resilience coaches than non-housestaff. CONCLUSIONS This work offers insights on how to address psychosocial functioning through low-intensity interventions delivered by lay personnel. More research is needed to understand the efficacy of this program and how best to engage housestaff in wellness and resilience programs throughout training, both during and beyond COVID-19.
Collapse
Affiliation(s)
- Rebecca E Stewart
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Room 3103, Philadelphia, PA, 19104, USA.
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA.
| | - Katherine Wislocki
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Room 3103, Philadelphia, PA, 19104, USA
| | - Courtney B Wolk
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Room 3103, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Lisa Bellini
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Cecilia Livesey
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Room 3103, Philadelphia, PA, 19104, USA
| | - Kelley Kugler
- The Acceleration Lab, Center for Health Care Innovation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nayoung Kwon
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Room 3103, Philadelphia, PA, 19104, USA
| | - Nicholas C Cardamone
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Room 3103, Philadelphia, PA, 19104, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Room 3103, Philadelphia, PA, 19104, USA
| |
Collapse
|
10
|
Schwill S, Bugaj TJ, Rentschler A, Nikendei C, Szecsenyi J, Krug K. Effects of an educational compact intervention in self-care - a mixed methods study with postgraduate trainees in primary care. BMC PRIMARY CARE 2023; 24:124. [PMID: 37328816 PMCID: PMC10273587 DOI: 10.1186/s12875-023-02074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Multiple studies indicate that residents in family medicine (FM) are exposed to considerable stress and are particularly affected by burnout syndrome. Aim of the study was to specify the effects of a so-called "compact intervention" (i.e., a short intervention) in self-care on FM residents. METHODS The authors performed a concurrent and independent mixed-methods study with FM residents on the KWBW VerbundweiterbildungPLUS© program. FM residents could voluntarily take part in a two-day seminar including 270 min on self-care, which can be regarded as a compact intervention. Study participants completed a questionnaire before (T1) and ten to twelve weeks after the course (T2), with subsequent recruitment to interview. The main outcomes of the quantitative part were to evaluate (I) self-rated change of cognition and (II) change in behavior. The qualitative outcomes were all possible effects of the compact intervention on participants´ competencies as well as all sorts of induced behavioral changes. RESULTS From a total of n = 307 residents, n = 287 FM residents (intervention group: n = 212; control group: n = 75) participated in the study. At T2, 111 post-intervention questionnaires were completed. 56% rated the intervention to be helpful for their well-being (n = 63/111). At T2, there was a significant increase in those willing to act in comparison to T1 (p = .01): 36% (n = 40/111) had changed their behavior and half of the study participants had passed on competencies to others (n = 56/111). From the intervention group, n = 17 participants additionally gave an interview. FM residents favored a trustful learning atmosphere, an interactive teaching concept and practical exercises. They described an encouraging stimulus to act and specified behavioral changes. CONCLUSIONS A compact intervention in self-care could increase well-being, foster competencies and induce behavioral changes, if implemented into a training program with sufficient group cohesiveness. Further studies are required to specify long-term-results.
Collapse
Affiliation(s)
- Simon Schwill
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Till Johannes Bugaj
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Annalena Rentschler
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
11
|
Ellwood S, Weathers J, DeMello J, Graves L, Antoun J, Soares N. Personal Financial Well-being of Family Medicine Residents and Residency Curricula: A CERA Study. PRIMER (LEAWOOD, KAN.) 2023; 7:415901. [PMID: 36845848 PMCID: PMC9957455 DOI: 10.22454/primer.2023.415901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction Personal financial wellness is a milestone in graduate medical education. Prior surveys addressing financial wellness have not included family medicine (FM) residents and to date, no literature has explored the relationship between perceived financial well-being and personal finance curriculum in residency. Our study aimed to measure the financial well-being of residents and its association with the delivery of financial curricula in residency and other demographics. Methods Our survey was included in the Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey sent to 5,000 FM residents. We use the Consumer Financial Protection Bureau (CFPB) financial well-being guide and scale to measure financial well-being and categorize into low, medium, and high ranges. Results Two hundred sixty-six residents (response rate of 5.32%) responded with a mean financial well-being score of 55.7 (SD 12.1), in the medium score range. Financial well-being was positively associated with any form of personal financial curricula in residency, year in residency, income and citizenship. Most residents 204 (79.1%) agreed/strongly agreed that personal financial curricula are important to their education, and 53 (20.7%) never received personal financial curricula. Conclusions Personal financial well-being scores of family medicine residents are considered medium per the CFPB ranges we assigned. We find a positive and significant association with the presence of personal financial curricula in residency. Future studies should evaluate the effectiveness of different formats of personal finance curriculum in residency on financial well-being.
Collapse
Affiliation(s)
- Stephanie Ellwood
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
| | - Jamie Weathers
- University of Cincinnati Lindner College of Business, Cincinnati, OH
| | - Jim DeMello
- Western Michigan University Haworth College of Business, Kalamazoo, MI
| | - Lisa Graves
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
| | | | - Neelkamal Soares
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
| |
Collapse
|
12
|
Buscail E, Muscari F, Hostalrich A, Bolzinger M, Malavaud S, Minville V, Martin C, Delhoste M, Houze-Cerfon CH, Buscail S, Bastiani B, Roumiguié M, Weyl A, Carrère N, Abbo O. Boot camp approach to surgical residency preparation: feedback from a French university hospital. BMC MEDICAL EDUCATION 2022; 22:678. [PMID: 36104703 PMCID: PMC9473737 DOI: 10.1186/s12909-022-03745-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The transition from medical student to surgical resident is not a simple one. The aim of this study was to report the experience of a university hospital in the organization of the induction course for future surgical residents and the contribution of a video support in the learning of the suture. MATERIAL AND METHOD We were able to study two consecutive years of students (October 2020 and 2021). Concerning the practical and technical workshops (learning suture) we carried out a comparative study between two groups of students. A group that had video support for learning suture (video group) and a group without video (control group). The evaluation of the suture was performed in a blinded manner by two supervising surgeons. The other practical workshop was drain fixation; the students did not have a video for this workshop. A comparative study was also performed for the drain fixation workshop between the two groups (video group and control group). A program of theoretical courses was also set up. This program is established according to the different future functions of the residents by integrating medico-legal notions and teamwork. Satisfaction questionnaires were given to the students and the answers were given two months after taking up their duties in the hospital (6 questions with Likert scale and 4 free questions). RESULTS The cohort consisted of 58 students (29 each in 2020 and 29 in 2021). Comparative analyses of the evaluation of the suture workshops showed better performance in the video group compared with the group without video. The comparison of these two groups did not show significant differences in the drain fixation workshop. The theoretical teaching was broken down according to the students' future tasks and each speaker was a specialist in his or her field of expertise. The results of the questionnaires showed a desire on the part of the students to increase the time spent on practical workshops and theoretical forensic teaching. CONCLUSION We were able to show through these two years of a program that we were able to offer a surgical resident preparation course. In addition, we have highlighted the contribution of a video support in the learning curve of the suture.
Collapse
Affiliation(s)
- Etienne Buscail
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France.
- INSERM, U1220, University of Toulouse, Digestive Health Research Institute (IRSD), Toulouse, France.
- Department of Digestive Surgery, Colo-Rectal Surgery Unit, CHU Rangueil, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France.
| | - Fabrice Muscari
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - Aurélien Hostalrich
- Department of Vascular Surgery, Toulouse University Hospital, Toulouse, France
| | - Manon Bolzinger
- Department of Pediatric Surgery, Toulouse University Hospital, Toulouse, France
| | - Sandra Malavaud
- Department of Infection Control, Toulouse University Hospital, Toulouse, France
| | - Vincent Minville
- Department of Anesthesiology and Intensive Care, Toulouse University Hospital, Toulouse, France
| | - Charlotte Martin
- Department of Anesthesiology and Intensive Care, Toulouse University Hospital, Toulouse, France
| | - Magali Delhoste
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | | | | | - Bruno Bastiani
- Toulouse Institute for Health Stimulation, Toulouse, France
| | - Mathieu Roumiguié
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | - Ariane Weyl
- Department of Gynecologic Surgery, Toulouse University Hospital, Toulouse, France
| | - Nicolas Carrère
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - Olivier Abbo
- Department of Pediatric Surgery, Toulouse University Hospital, Toulouse, France
| |
Collapse
|
13
|
Sharp EA, Nicholson KJ, Taft M, Glaser DH, Gibson B, Kazmerski TM. Parent-in-training: Resident and fellow experiences from pregnancy to parenthood. J Hosp Med 2022; 17:609-623. [PMID: 35855539 DOI: 10.1002/jhm.12914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Residents and fellows with children face distinct challenges; however, knowledge of factors associated with increased parental stress is limited. OBJECTIVE This study aimed to investigate experiences and concerns of physician trainees and identify factors associated with higher parental stress. METHODS An anonymous survey was distributed to all resident and fellow trainees in June 2021 to assess experiences regarding parental leave, breastfeeding, and childcare. We used the Parental Stress Scale (PSS) to identify the factors associated with stress and analyzed the results using descriptive statistics, linear regression, and thematic analysis. RESULTS Of 1719 trainees, 509 participated (62% women, 30% response rate); half were parents. One-third of the respondents (152/470) said that childcare costs affected the number of children they plan to have; One-third of respondents (152/470) said that childcare costs affected the number of children they plan to have; 45% (210/470) said childcare costs affected when they plan to have children. Among parents, the mean PSS score was 44.3 ± 12.3, with no significant gender differences. More women identified as primary or coprimary caregivers (97% [113/117] vs. 79% [60/76], p < .001) and anticipated training extensions due to parental leave (36% vs. 13% men, p = .009). Breastfeeding was associated with significantly higher PSS scores (p = .017). Twenty-four percent of breastfeeding parents (22/93) felt that their program/institution did not support their breastfeeding goals; lack of perceived support was associated with significantly higher PSS scores (63.6 ± 13.1 vs. 38.6 ± 8.7, p < .001). Trainees experiencing unreliable childcare had significantly higher PSS scores (p = .005). Forty percent (64/159) changed their career plans after becoming parents. CONCLUSIONS Physician trainee parents experience high stress, with women bearing disproportionate burdens in the domains of parental leave and breastfeeding. These results should inform policies promoting trainee wellness and gender equity.
Collapse
Affiliation(s)
- Eleanor A Sharp
- Department of Pediatrics, Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Maia Taft
- Department of Pediatrics, Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel H Glaser
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Blake Gibson
- UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Traci M Kazmerski
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
14
|
Wolfe AHJ, Hinds PS, du Plessis AJ, Gordish-Dressman H, Arnold RM, Soghier L. Defining Objective Measures of Physician Stress in Simulated Critical Communication Encounters. Crit Care Explor 2022; 4:e0721. [PMID: 35795402 PMCID: PMC9249269 DOI: 10.1097/cce.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study had three aims: 1) quantify the difference in stress levels between low and high stress roles during simulated critical communication encounters using objective physiologic data (heart rate variability [HRV]) and subjective measures (State-Trait Anxiety Inventory [STAI]), 2) define the relationship between subjective and objective measures of stress, and 3) define the impact of trainee preparedness and reported self-efficacy on stress levels.
Collapse
|
15
|
Buzzelli L, Krawiec C. To the Editor: Children of Residents: What About Their Well-Being. J Grad Med Educ 2022; 14:241-242. [PMID: 35463160 PMCID: PMC9017253 DOI: 10.4300/jgme-d-22-00074.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Lindsay Buzzelli
- Fourth-Year Medical Student, Penn State College of Medicine-University Park
| | - Conrad Krawiec
- Associate Professor, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital
| |
Collapse
|
16
|
Sedney CL, Dekeseredy P, Elmo R, Sofka S. Exploring Resident Physician Wellness at an Allopathic Medical School in West Virginia: A Qualitative Study. THE WEST VIRGINIA MEDICAL JOURNAL 2022; 118:18-24. [PMID: 35600669 PMCID: PMC9119293 DOI: 10.21885/wvmj.2022.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Social support is key to wellness, especially during times of stress and uncertainty. The working climate, including the multidisciplinary medical community provides opportunities for both positive and negative wellness experiences. The purpose of this study is to explore residents' concepts of wellness and the influence of programs, faculty, peers, and nursing and ancillary staff. METHODS An email with a link to the REDCap survey was sent to each resident (n=450) in the school of medicine at West Virginia University asking them to give examples of ways their wellness has been supported (or not) by faculty members, their program, co-residents, and nursing and ancillary staff. The residents returned 51 completed surveys (11% response rate). Seven residents participated in a face to face interview. A content analysis using Hale's adaptation of resident wellness (based upon Maslow's Hierarchy of Needs) as the theoretical framework was conducted on the data. RESULTS Positive wellness elements frequently focused on time, supportive actions, and social connection. Negative examples impacting wellness included feeling disrespected, not being included in decision making, conflicts, and feeling unappreciated. Suggestions from the residents often described low cost interventions such as being" included" and feeling part of the team. CONCLUSION The participants described how all members of the healthcare team can support resident wellness in a variety of domains. Peers, support staff in the hospital environment, faculty supervisors, and the program overall can contribute to the basic physiologic needs, safety, belonging, esteem, and self-actualization of resident learners through social support.
Collapse
Affiliation(s)
- Cara L. Sedney
- Cara Sedney MD MA. Associate Professor Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Patricia Dekeseredy
- Patricia Dekeseredy MScN RN. Clinical Research Specialist in the Department of Neurosurgery, WVU Medicine, Morgantown, WV, USA
| | - Rebecca Elmo
- Rebecca Elmo Accreditation Specialist Department of Medical Education, West Virginia University School of Medicine
| | - Sarah Sofka
- Sarah Sofka MD. Associate Professor General Internal Medicine, West Virginia University School of Medicine
| |
Collapse
|
17
|
Wellness in Graduate Surgical Medical Education. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
18
|
Perez AR, Boscardin CK, Pardo M. Residents' Challenges in Transitioning to Residency and Recommended Strategies for Improvement. THE JOURNAL OF EDUCATION IN PERIOPERATIVE MEDICINE : JEPM 2022; 24:E679. [PMID: 35707017 PMCID: PMC9176399 DOI: 10.46374/volxxiv_issue1_boscardin] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The transition from internship to residency can be a particularly stressful time for learners, adversely affecting residents' experience of training. Despite awareness of residents' stress during transitions, there is limited information available regarding how residents perceive these transitions or how they could be improved. We explored residents' accounts of the experience of transitioning from internship to residency to develop a better understanding of their challenges and recommended strategies for interventions. METHODS We conducted semistructured interviews with first-year anesthesia residents at the University of California, San Francisco. We conducted a thematic analysis through a general inductive approach on transcribed interviews. RESULTS Ten residents, evenly split among categorical and noncategorical residents, participated in the interviews. We identified seven challenges faced by residents during the transition, including cognitive load management, self-assessment and eliciting effective feedback, learning resource utilization, preoperative care planning and discussion, forming relationships with peers and faculty, and professional identity formation. Residents also recommended strategies to address these challenges, including early low-stake exposure to complex cases, standardized feedback structure, resource utilization guides, normalization of discussing errors with peers, and protected time for networking events. CONCLUSION Residents face multiple challenges at the personal, social, and structural levels during the transition. Their recommended strategies are actionable, including scaffolded learning opportunities with increasing difficulty, more standardized and structured communications around expectations and effective feedback, enhanced orientation through bootcamp, and integration of more formal and informal social networking opportunities to increase peer and faculty interaction.
Collapse
Affiliation(s)
- Alejandro R. Perez
- Alejandro R. Perez is a PGYA Resident Physician in the Department of Emergency Medicine at Loma Linda University Medical Center, Loma Linda, CA
| | - Christy K. Boscardin
- Manuel Pardo is a Professor; Christy K. Boscardin is a Professor in the Department of Anesthesia and Perioperative Care at the University of California, San Francisco, CA and is also in the Department of Medicine and Department of Anesthesia and Perioperative Care
| | - Manuel Pardo
- Manuel Pardo is a Professor; Christy K. Boscardin is a Professor in the Department of Anesthesia and Perioperative Care at the University of California, San Francisco, CA and is also in the Department of Medicine and Department of Anesthesia and Perioperative Care
| |
Collapse
|
19
|
Kelly PD, Yengo-Kahn AM, Roth SG, Zuckerman SL, Chitale RV, Wellons JC, Chambless LB. Data-Driven Residency Training: A Scoping Review of Educational Interventions for Neurosurgery Residency Programs. Neurosurgery 2021; 89:750-759. [PMID: 34423828 DOI: 10.1093/neuros/nyab322] [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: 03/02/2021] [Accepted: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neurosurgery residency programs are tasked with imparting large volumes of both clinical knowledge and technical skill to trainees in limited time. Many investigators have described local practices, which may offer evidence-based interventions in neurosurgical residency education, but this literature has not been systematically reviewed. OBJECTIVE To perform a scoping review of educational practices in neurosurgery, which are supported by quantitative, peer-reviewed research. METHODS A scoping review of the literature was performed. PubMed, Embase, and Web of Science databases were queried for articles describing educational interventions for neurosurgery residents, which included a quantitative assessment of the effect on resident performance. RESULTS From an initial set of 1785 unique articles, 29 studies were ultimately screened and included. Studies were into the following 6 topics: (1) didactics and curricula (n = 13), (2) nontechnical skills (n = 6), (3) wellness and burnout (n = 4), (4) assessment and feedback (n = 2), (5) mentorship and career development (n = 2), and (6) research (n = 2). Individual study results were described. CONCLUSION Several educational interventions in neurosurgical training are supported by quantitative evidence. Methodological shortcomings are prevalent among studies of education, particularly in the selection of meaningful outcome measures. A summary of evidence-based considerations is provided for current and future program directors.
Collapse
Affiliation(s)
- Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rohan V Chitale
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John C Wellons
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
20
|
Li‐Sauerwine S, Rebillot K, Chung AS, Coates WC, Shah S, Yarris LM. Moving beyond personal factors: A national study of wellness interventions in emergency medicine residency programs. AEM EDUCATION AND TRAINING 2021; 5:e10690. [PMID: 34693184 PMCID: PMC8513675 DOI: 10.1002/aet2.10690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/18/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In 2017, the Accreditation Council for Graduate Medical Education (ACGME) revised its Common Program Requirements to support trainees and faculty by mandating programs to provide dedicated wellness resources and education. Emergency medicine may benefit from this change due to high burnout rates within the specialty. However, the current state of wellness interventions in emergency medicine (EM) residency programs has not yet been well described. Understanding current practices is necessary to assess unmet needs and inform the development and evaluation of future interventions that aim to improve trainee wellness. OBJECTIVES The goal of this study was to describe currently implemented wellness interventions in EM residency programs. METHODS This descriptive study surveyed 250 ACGME-accredited EM residency programs between March 1 and June 1, 2020, regarding wellness interventions. The survey included demographic questions; structured multiple-choice questions about cost, frequency, and champions; and free-text response options to briefly describe interventions. Respondents were also asked to classify the interventions according to the seven factors described in the National Academy of Medicine Model of Clinician Well-Being and Resilience. RESULTS Ninety of 250 (36% response rate) residency programs participated, describing 162 unique wellness interventions. Respondents classified the majority of interventions (n = 136) as targeting personal factors according to the National Academy of Medicine model. Qualitative analysis revealed five major themes describing the interventions: program culture, program factors, environmental and clinical factors, wellness activities and practices, and wellness resources. CONCLUSIONS Results of this survey may help to inform a national needs assessment addressing the current state of wellness interventions in EM residency programs. Our results highlight the need for more interventions targeting external factors impacting resident wellness.
Collapse
Affiliation(s)
| | - Katie Rebillot
- Department of Emergency MedicineLAC+USC Medical CenterLos AngelesCaliforniaUSA
| | - Arlene S. Chung
- Department of Emergency MedicineMaimonides Medical CenterBrooklynNew YorkUSA
| | - Wendy C. Coates
- UCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - Sneha Shah
- Department of Emergency MedicineMaimonides Medical CenterBrooklynNew YorkUSA
| | - Lalena M. Yarris
- Department of Emergency MedicineOregon Health & Science UniversityPortlandOregonUSA
| |
Collapse
|
21
|
Vasquez TS, Close J, Bylund CL. Skills-Based Programs Used to Reduce Physician Burnout in Graduate Medical Education: A Systematic Review. J Grad Med Educ 2021; 13:471-489. [PMID: 34434508 PMCID: PMC8370364 DOI: 10.4300/jgme-d-20-01433.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Physician burnout is pervasive within graduate medical education (GME), yet programs designed to reduce it have not been systematically evaluated. Effective approaches to burnout, aimed at addressing the impact of prolonged stress, may differ from those needed to improve wellness. OBJECTIVE We systematically reviewed the literature of existing educational programs aimed to reduce burnout in GME. METHODS Following the PRISMA guidelines, we identified peer-reviewed publications on GME burnout reduction programs through October 2019. Titles and abstracts were reviewed for relevance, and full-text studies were acquired for analysis. Article quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS A total of 3534 articles met the search criteria, and 24 studies were included in the final analysis. Article quality varied, with MERSQI assessment scores varying between 8.5 and 14. Evaluation was based on participant scores on burnout reduction scales. Eleven produced significant results pertaining to burnout, 10 of which yielded a decrease in burnout. Curricula to reduce burnout among GME trainees varies. Content taught most frequently included stress management (n = 8), burnout reduction (n = 7), resilience (n = 7), and general wellness (n = 7). The most frequent pedagogical methods were discussion groups (n = 14), didactic sessions (n = 13), and small groups (n = 11). Most programs occurred during residents' protected education time. CONCLUSIONS There is not a consistent pattern of successful or unsuccessful programs. Further randomized controlled trials within GME are necessary to draw conclusions on which components most effectively reduce burnout.
Collapse
Affiliation(s)
- Taylor S. Vasquez
- All authors are with the University of Florida
- Taylor S. Vasquez, MA, is a Doctoral Student, College of Journalism and Communications
| | - Julia Close
- All authors are with the University of Florida
- Julia Close, MD, is Associate Dean of Graduate Medical Education, College of Medicine
| | - Carma L. Bylund
- All authors are with the University of Florida
- Carma L. Bylund, PhD, FACH, is Professor, College of Journalism and Communications, College of Medicine
| |
Collapse
|