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Resident Wellness and Well-being: Lessons Learned from the Integrative Medicine in Residency Program Patricia Lebensohn, M.D., Sally Dodds, Ph.D., Mary.

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Presentation on theme: "Resident Wellness and Well-being: Lessons Learned from the Integrative Medicine in Residency Program Patricia Lebensohn, M.D., Sally Dodds, Ph.D., Mary."— Presentation transcript:

1 Resident Wellness and Well-being: Lessons Learned from the Integrative Medicine in Residency Program Patricia Lebensohn, M.D., Sally Dodds, Ph.D., Mary Guerrera, M.D., Dael Waxman, M.D., & Craig Schneider, M.D.

2 Presentation Objectives ▫Describe the importance of teaching about wellness and well-being during residency. ▫Discuss the definitions of wellness and well-being used in the IMR. ▫Describe the tools used to assess resident wellness and well-being. ▫Review the preliminary findings about IMR resident wellness and well-being. ▫Discuss teaching strategies to promote IMR resident wellness & well- being.

3 Integrative Medicine in Residency (IMR) is… Competency-based, online, 200-hour, curriculum. In-depth training in Integrative Medicine. Incorporated through all 3 years of Family Medicine residency. Piloted at 8 residencies nationwide. Seamless, online evaluation of the curriculum and the residents. Responds to ACGME competency requirements. Evaluation developed simultaneously with the curriculum.

4 University of Arizona University of Texas Medical Branch Hennepin County Carolinas Medical Center Beth Israel Maine-Dartmouth Maine Medical Center University of Connecticut IMR Program Locations Moses H. Cone Alaska Family Medicine Univ. of Minn A. Einstein Montefiore Control sites

5 Importance of Teaching About Wellness & Well-being  Residency is a powerful, formative experience in adulthood.  Establishing physician identity, schema of patient relationships, work habits, and self care.  Physician Burnout  Estimates of physician burnout: 25% - 70%.  Onset linked to residency training.  Distress in Residency  Dramatic increases in depression, anxiety, and drug use.  Increased cynicism, decreased empathy, poorer overall performance.  Consequences  Psychological problems under diagnosed and under treated.  Physician stress and burnout linked to lower-quality patient care.  Habit of ignoring self care perpetuated in life after residency.

6 IMR and Wellness & Well-being  IMR uniquely positioned to shift graduate medical education toward physician wellness.  Prevention and wellness are central in course content.  Opportunity to explore and describe resident wellness & well-being longitudinally.

7 IMR Wellness & Well-being Definitions  Wellness behaviors: Specific behaviors and lifestyles that promote optimal physical, psychological, and spiritual health (Carlson et al., 1997).  Sense of Well-being (multiple dimensions):  Satisfaction with Life: Global judgment of quality of life (Diener et al., 1985).  Sense of Happiness: Pleasant affects (Pavot & Diener, 2008).  Psychological well-being: Absence of psychological distress (Ryff et al., 1995; Keyes et al., 2002).  Positive Personal Characteristics: Qualities of mindfulness, a grateful disposition, and emotional intelligence in the context of interpersonal relationships.

8 Wellness Behaviors Assessed in the IMR Behavior Moderate physical activity (30 min/da) Fruits & vegetables (5/da) Vitamins/other dietary supplements Meditation Prayer PMR/other relaxation Yoga Tai Chi or Qi Gong Behavior Massage Outdoors in nature Nurturing relationships Restful sleep Alcoholic drinks per week Smoking (y/n) Rx for mood, anxiety, stress, sleep (y/n)

9 Resident Wellness Behaviors (All groups combined) Protective

10 Resident Wellness Behaviors (All groups combined) Risk

11 Well-being Measures DimensionMeasure Global life satisfactionSatisfaction with Life Scale (SWLS; Dierner, 1985) Affective traitsPositive & Negative Affect Schedule (PANAS; Watson, 1988) Psychological health Perceived stress Mood state distress Depression Burnout Perceived Stress Scale (Cohen et al., 1983) CES-D (Radloff, 1977) PHQ-9; (Kroneke et al., 2001) Maslach Burnout Inventory (Maslach et al. 1996) Personal characteristics Mindfulness Gratitude Emotional intelligence Freiburg Mindfulness Inventory (Walach, et al., 2006) Gratitude Questionnaire-6 (McCullough, 2002) Trait Meta Mood Scale (Salovey & Mayer, 1995) Interpersonal Reactivity Index (Davis, 1980)

12 Perceived Stress Scale (e.g., “How often you felt you were on top of things?”) Mean scores at baseline – 2011, 2012, Controls ns Range 1-33 Range 5-27Range 9-30 Possible scores range from 0 – 40.

13 Perceived Stress Scale Frequency of stress in the past month (at baseline) * *p =.03

14 Perceived Stress Scale Baseline and 1 st repeated measure 2011 Class (mean scores) n=44; ns * p =.002; ** p =.001 Stress Frequency past 30 days * **

15 CES-D (Depression screener) – Mean scores PGY1 – All groups (baseline) ns Range 0-34 Range 0-32Range 1-34 Cutpoint =/> 16

16 CES-D Severity scores in the past month (at baseline)

17 Range 0-34 Range 0-32 n=46; ns Severity scores2011 Class means *p= <.001 * CES-D Baseline and 1 st repeated measure

18 PHQ-9 (Depression diagnostic screener) Mean scores at baseline ns Range 0-13 Range 0-14 Range 0-16

19 PHQ-9 Severity scores at baseline ns

20 CES-D and PHQ-9 Compared 2011 PGY2

21 Maslach Burnout Inventory 1 Emotional Exhaustion Subscale (e.g., “I feel emotionally drained from my work”) Mean scores at baseline – 2011, 2012, Controls ns Range 1-33 Range 5-27Range 9-30 Possible scores range from 0 – 54.

22 Maslach Burnout Inventory 2 EE category scores at baseline *p =.02 *

23 Mean group scores at baselineSeverity scores t1 – t2 Maslach Burnout Inventory 3 EE Baseline and 1 st repeated measure ns *p=.032; **p=<.001 ** * * *p=<.001

24 Maslach Burnout Inventory 4 Depersonalization (e.g., “I really don’t care what happens to some patients”) Mean scores at baseline – 2011, 2012, Controls ns Range 0-23 Range 0-18Range 1-20 Possible scores range from 0 – 30.

25 Maslach Burnout Inventory 5 Dp Score Categories – 2011, 2012, Controls

26 BaselineSeverity scores t1 – t2 Maslach Burnout Inventory 3 Depersonalization (Baseline &1 st F/U) p = <.001 * ** *** *p = <.001; **p=..001; ***p= <.001

27 References De Matteo, MR, Sherbourne, CD, Hays, RD, Ordway, L, Kravitz, RL, McGlynn, EA, et al. (1993). Physicians’ characteristics influence patients’ adherence to medical treatment: Results from the Medical Outcomes Study. Health Psychology, 12, 2, Eckleberry-Hunt, J, Lick, D, Boura, J, Hunt, R, Balasubramaniam, M, Mulhem, E, & Fisher, C. (2009). An exploratory study of resident burnout and wellness. Academic Medicine, 84, 2, Eckleberry-Hunt, J, Van Dyke, A, Lick, D, & Tucciarone, J. (2009). Changing the conversation from burnout to wellness: Physician well-being in residency training programs. Journal of Graduate Medical Education, DOI: /JGME-D Gunderson, L. (2001). Physician burnout. Annals of Internal Medicine, 135, 2, Wallace, JE & Lemaire, J. (2009). Physician well being and quality of patient care: An exploratory study of the missing link. Psychology, Health & Medicine, 14, 5,

28 Discussion


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