In case you missed last week’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Peer Support: Mitigating the Emotional Toll of Medical Errors
Presenter: Jo Shapiro, MD, FACS
April 5, 12 PM ET

• There is an abundance of research that makes the case for a peer support program for those who make medical errors by showing the financial and moral costs for what happens after medical errors are committed.
• Culture has a huge effect on how medical errors are viewed and how they are dealt with. Creating a safety culture with a learning and growing mindset is essential to the success of any peer support program.
• The mission for the Center for Professionalism and Peer Support is to encourage a culture that values and promotes mutual respect, trust and teamwork.
• It is important to understand and be respectful of how others might react to a medical error in which someone has been harmed instead of only interpreting the situation from one’s own perspective
• Medicine acculturates its members to “be perfect.” As a result, committing medical errors is discordant with perfection and creates feelings of upset and isolation.
• Shame and blame is the predominant model for dealing with medical errors. It is always somebody’s fault vs. how do we learn from this?
• Following a medical error, 30% of clinicians experience a negative impact on work performance, personal life and/or colleague relationships.
• Research shows that those committing medical errors are at an increased risk for depression and burnout.
• Burnout and depression are independent predictors of reporting a major medical error. It is not simply the emotional toll for committing errors, but burnout and depression lead to further medical errors.
• Commonly felt emotions by clinicians who have made medical errors are: Sadness, Shame, Self-Doubt, Fear, Anger, Isolation.
• Feeling these negative emotions is a natural reaction, but the problem is that sometimes recovery from these negative emotions never occurs.
• One cannot expect people who are feeling unsupported and isolated to deliver high quality patient care or to sustain joy in their work.
• Many people are impacted by medical errors, most significantly, patients and families. Errors also impact physicians, team members and the institution. Everyone should have access to support.
• Factors associated with resilience after adverse events include: talking about it with colleagues, dealing with imperfection, disclosure and apology, learning from the error, sharing that learning with colleagues and trainees, forgiveness.
• Barriers to clinicians seeking support include: lack of time, stigma, lack of confidentiality, access.
• The Center for Professionalism and Peer Support uses a first responder model. There is 1:1 peer support and group peer support. Peer support is available to everyone who works in the program.
• Training is crucial for peer support volunteers; they must be well-trained.
• Disclosure coaching supports physicians in having transparent and empathic conversations with patients after errors.
• Peer support is a powerful tool for culture change.
  Shame and Blame > Promotion of a “just” culture
  Personal invulnerability > We are all humans who are influenced by human emotions and other human factors
  Expectation of emotional denial > Normalizing emotional reactions
  Isolation > Community solidarity
  Self Care is selfish > Gets you back to what you do well
  Helps clinicians to show up with compassion for patients.

• Informal peer support is valuable. As a colleague, it is important to acknowledge the adverse event to let your colleague know that “I see you and I care about you.” E.g. “Sorry you had to go through this.” It is also helpful to ask a colleague if he/she has adequate support and if you can help him/her obtain support.
• For informal peer support it is not useful to do the following;
  • Minimize a colleague’s pain. E.g. “It will be OK.”
  • Try to “fix” the situation.

• Because this type of peer support program has so much face validity and it is not resource intensive, it is not exceptionally difficult to advocate for peer support at one’s institution.
• The worst thing we can do is not to be there for one another when an adverse event occurs.

The Fall web seminar series is set to begin in September. Be sure to keep an eye on your email for more information!

In case you missed last week’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Project on the Good Physician: Using Life Stories to Study Medical Student Wellness
Presenters: Tania M. Jenkins, PhD and John D. Yoon, MD
March 29, 12 PM ET

• The Project on the Good Physician is a longitudinal study of the moral and professional formation of the US physician.
• How does one become and remain a good physician?
• Researchers found high rates of reported burnout for medical students.
• The life-story approach is unique because it examines the dynamic nature of stressors and resilience-building factors before and throughout the duration of medical school.
• The study design included questionnaires and follow-up phone interviews. Secondary analyses were conducted on the qualitative data from the phone interviews which produced the following findings:
  • Stressors: Negative role models, difficult rotations, USMLE Step 1
  • Double-edged swords: (stressor and/or motivator) Financial concerns, personal life events
  • Stress-attenuating factors: Positive role models, support networks, faith and spirituality, passion (These strategies helped students reframe stressors as temporary.)

• Studying life stories provides a window into how medical students make sense of their lived experiences and how they identify stressors and those factors that protect against stress.
• Life stories explore the role of past individual challenges as sources of future resilience by creating an understanding of how lived experiences influence and mitigate stress.
• For more details about this study, please refer to the Good Physician website: https://pmr.uchicago.edu/projects/research/good-physician

For more information on the next session or to register, please click here.

In case you missed yesterday’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Integrating Wellness & Nutrition: Lessons from University of Cincinnati
Presenter: Sian Cotton, PhD
March 22, 12 PM ET

Objectives:

1. Briefly review the crisis of chronic disease and minimal attention to lifestyle education in medical schools and healthcare provider burnout as background
2. Highlight 2 programs at UC that constitute a preventive and educational approach to fostering well-being
3. Provide overview of first program: Turner Farm Student Wellness retreats
4. Provide overview of second program: Mind-Body course, modeled after Georgetown University
5. Present information on development, outcomes, and sustainability plans for both programs as models

Program #1

Teaching Kitchen: idea is to pair the culinary science with the nutritional science.

• To transform Disease Care to Wellness Care, need to educate health providers
• Transformation starts with education of students -traditional curriculum does not emphasize lifestyle modification
• Inter-professional learning grows into inter-professional team-based care
• Turner Farm’s Teaching Kitchen as platform

Have Student Wellness Retreats

• Retreats are 6 hours usually on a Saturday
• Evaluations are over whelming supportive of the Wellness Retreats with regards to presentations, experience and opportunities for both professional and personal changes.

Conclusion/Future Directions

• Student Wellness Retreats at Turner Farm were highly successful
• Sought after –Student Affairs promotes
• Development of personal wellness skills
• Increasing interest in Integrative Health
• Greatest challenge: funding/faculty time to sustain
• Future longitudinal student teaching kitchen sessions for continued healthy behavior change and knowledge

Program #2

Mind-Body Course

• One out of two physicians experience burnout
• This is not just limited to physicians but to all health care professionals
• “Burnout is a response to chronic stressors that wear on a person over time – not acute ones such as a big event or a big change” Christina Maslack, PhD
• According to John Kabat-Zinn Mindfulness is “The awareness that emerges through paying attention, in a particular way, on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment.”

Conclusion 1

• Although the rates of chronic stress and burnout among physicians are rising, practicing mindfulness can reduce burnout and increase empathy
• Student outcomes saw increase in mindfulness, empathy, positive affect, resilience and a decrease in perceived stress and negative affect.

Summary and Final Thoughts

• Wellness, through nutrition, movement, mindfulness and connectivity is critical to expose students to early on
• Experiential versus didactic-only
• What is Required?
  • Faculty modelling
  • Integration, rather than “one-offs”
  • Resources

“Tell me and I forget, teach me and I may remember, involve me and I learn”

For more information on the next session or to register, please click here.

In case you missed the March 15th Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Fat Chance for Obesity Medicine Education in Medical Schools
Presenter: Nicholas Pennings
March 15, 12 PM ET

• Obesity trends are rising at alarming rates across the United States.
• 57% of children today are projected to have obesity by age 35 (NEJM, 2107)
• The WHO projects that the worldwide cost of obesity will be $1.2 trillion dollars by 2025.
• Obesity can be framed as a disease process, a chronic condition with pathological consequences, which is responsive to lifestyle changes.
• Obesity is both a physical and psychological condition.
• Obesity education is relevant for all medical specialties as it impacts all body systems.
• Currently, 23% of medical schools in the US cover obesity medicine across their undergraduate curriculum and 66% of US medical schools dedicate 2-6 hours to obesity medicine in the their curriculum.
• Barriers to integrating an adequate obesity curriculum into undergraduate medical education include: not enough time, competing curricular demands and lack of prioritization.
• According to studies, there is a predominant “weight bias” in health care that leads to “weight stigma,” which negatively impacts patients with obesity from seeking health care.
• According to the Gayer study (2018), early introduction of an obesity curriculum for students in health care professions demonstrated a sustained reduction in weight bias over four years.
• A brief synopsis of the 2007 AAMC guiding principles for obesity education in undergraduate medical education includes the following:
  • Vertically and horizontally integrate obesity education into the medical school curriculum.
  • Highlight the universal importance of weight management and the prevention of obesity.
  • Utilize a multidisciplinary team to provide social support and behavioral treatment.
  • Provide self-awareness training about weight bias and weight stigma.
  • Employ population-based/community efforts to better prevent, support, and control obesity.
  • Direct basic science instruction to identify and explore the metabolic, genetic and environmental effects of obesity and the metabolic and immunologic responses to obesity.
  • Provide opportunities for learners to do a history and physical on patients with obesity and assess these patients in terms of nutrition (impact of different diets), physical activity, behavioral interventions and surgery.
• The ongoing expansion of knowledge in the science of obesity has created a growing chasm between knowledge acquisition and knowledge application for practitioners in the real world.
• Northwestern University, Oklahoma State University College of Osteopathic Medicine and Campbell University College of Osteopathic Medicine are three institutions that have longitudinally integrated Obesity Education. For further details about these, please contact Dr. Nicholas Pennings (pennings@Campbell.edu)
• Additional resources for Obesity Education include the following:
  • Obesity Medicine Association (provides free obesity educational materials) www.obesitymedicine.org
  • The Obesity Society www.obesity.org
  • American Society of Metabolic and Bariatric Surgeons www.asmbs.org
  • Obesity Action Coalition (gives voice to patients with obesity)

For more information on the next session or to register, please click here.

In case you missed the March 8th Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

The Importance of Nutrition in Physician Performance and Well-Being
Presenters: Angela M. Cheung and Maryam S. Hamidi
March 8, 12 PM ET

The Importance of Nutrition in Physician Performance and Well-Being

• Improving physician dietary habits and hydration is a novel approach to supporting wellness and preventing burnout.
• According to a 2017 AMA survey, the burnout rate for physicians had increased to 51%, up from 40% in 2013. Conservative estimates show that physician suicide rates in the US are between 300 and 400 per year.
• Physician burnout negatively affects patient care.
• Emergent studies demonstrate a link between nutrition and physician performance.
• Physicians report that inadequate nutrition and hydration impact their work performance.
• Diet is important in brain health.
• High cognitive demands require proper nutrition for optimal performance.
• Physicians identify the following barriers to healthy eating: lack of nutrition breaks, limited healthy food options in the workplace, limited food storage and eating areas in the workplace, prioritization of clinical work over self-care.
• Nutritional strategies for improving short-term cognitive performance include: hydration, meal timing, meal composition, meal size and strategic use of caffeine.
• Hydration enhances the nervous system. Dehydration can impair cognitive function and mood modulation.
• Coordinating meal times with one’s own circadian rhythms optimizes nutritional effectiveness.
• Thoughtfully balanced meal composition and portion control can enhance cognitive and functional performance.
• Nutritional strategies for increased alertness include: eat larger meals before 10 pm, eat light snacks after lunch that contain protein and carbs, hydrate often, drink coffee or tea (caffeine increases core body temperature), chew gum (improves blood flow to the brain).
• Sustainable individual and institutional interventions are needed to support and improve physicians’ nutrition.
• These nutritional strategies can be applied across all health professions.
• Taking care of oneself leads to better patient care.

For more information on the next session or to register, please click here.