The Feasibility and Impact of an Asynchronous Interprofessional Well-Being Course on Burnout in Health Care Professionals.

Background: Well-being initiatives are essential components in fostering an engaged workforce and creating an effective health care ecosystem. Health care professional (HCP) burnout is widespread and has worsened since the COVID-19 pandemic. In 2014, with Health Resources and Services Administration funding support, the Andrew Weil Center for Integrative Medicine created an online course for HCP well-being. It was subsequently studied in medical residents and revised in 2020. In this study, we explore the impact of the course across larger systems, as well as the long-term impact on HCPs. Methods: The Health Care Professional Well-Being course is 4.5 hours of interactive online education that explores personal well-being, promoters and detractors of well-being, and systemic factors that influence the overall impact of well-being in health care systems. Participants were recruited through institutional members of the Academic Consortium for Integrative Medicine and Health and were randomized to either active or waitlist control groups. Assessments were taken pre-course, 1-month post-course, and 6-months post-course in the areas of burnout, compassion, resiliency, and lifestyle behaviors. Results: Burnout measures of depersonalization and emotional exhaustion showed a significant improvement amongst active participants, sustained for 6 months after the course. However, no significant improvement in either the resiliency or the compassion measurements was noted for the active group. Initially, the active group showed improvement in personal accomplishment; however, both groups showed a decline overall. Most noteworthy, a large number of active participants demonstrated adoption of new health-promoting behavior; 95% incorporated at least 1 new lifestyle behavior learned from the course. Conclusion: This study of a brief, asynchronous, online well-being course with interprofessional HCPs, demonstrates that the course is associated with improvement in individual burnout measures and can educate HCPs about healthy behaviors and a framework for professional engagement.

Correction: Assessing social needs among patients with cardiovascular and psychiatric comorbidities in free community health clinics.

[This corrects the article DOI: 10.1371/journal.pone.0291682.].

Assessment of immigration law enforcement presence in a teaching hospital along the US/Mexico border.

BACKGROUND: Over the past decade, the United States (US) has seen a spike in migration across the US-Mexico border with an increase in hospital admissions of migrants and asylum-seekers under the custody of immigration law enforcement (ILE). This study aimed to determine how the presence of ILE officials affects patient care and provider experience in a teaching hospital setting. METHODS: This cross-sectional online survey solicited quantitative and qualitative feedback from medical students, residents, and attending physicians (n = 1364) at a teaching hospital system with two campuses in Arizona. The survey included participant demographics and addressed participants' experience caring for patients in ILE custody, including the perception of respect, violations of patients' privacy and autonomy, and the comfort level with understanding hospital policies and patient rights. Thematic analyses were also performed based on respondent comments. RESULTS: 332 individuals (24%) responded to the survey. Quantitative analyses revealed that 14% of participants described disrespectful behaviors of ILE officials, mainly toward detained patients. Qualitative thematic analyses of respondent comments revealed details on such disrespectful encounters including ILE officers violating the Health Insurance Portability and Accountability Act (HIPAA) and using intimidation tactics with patients. Nearly half of the respondents did not have knowledge of policies about ILE detainees' medical care, detainees' privacy rights, or ILE's authority in patient care. CONCLUSIONS: This study points out the complexities, challenges, and ethical considerations of caring for patients in ILE custody in the hospital setting and the need to educate healthcare professionals on both patient and provider rights. It describes the lived experiences and difficulties that providers on the border face in trying to achieve equity in the care they provide to detained migrant patients.

Assessing social needs among patients with cardiovascular and psychiatric comorbidities in free community health clinics.

BACKGROUND: Community-related health assessments have been shown to improve several outcomes in socioeconomically disadvantaged populations with comorbid chronic health conditions. However, while it is recognized that modifiable social determinant of health (SDH) factors might be responsible for up to 60% of preventable deaths, it is not yet standard of care to routinely screen and address these at preventive health appointments. The objective of this study was to identify the social needs of socioeconomically disadvantaged patients. METHODS: We performed a retrospective review of the socioeconomic screening questionnaires distributed to under- and uninsured patients seen at a medical student-run free primary care-based community clinic. This study included participants of all ages (0 and up), genders, languages, and ethnicities who filled out the social screening questionnaire. Socioeconomic screening questionnaires assessed the need for critical resources such as food, housing, utilities, finances, transportation, childcare, employment, education, legal support, companionship, health literacy, and community assistance. The primary study outcome was to identify unmet social needs of our medical student-run free clinic patients. We secondarily sought to identify associations between these needs and chronic health conditions. We hypothesized that patients with multiple chronic health problems and financial stressors would have the highest requests for resources. RESULTS: Our retrospective review identified 264 uninsured participants who were evaluated for social needs using a screening questionnaire. Participants who reported unmet social needs had significantly more cardiovascular risk factors than those who did not. Cardiovascular comorbidities and a history of psychiatric illness were the two most common medical problems significantly associated with several unmet social needs. CONCLUSION: This study provides support for the preemptive identification and appropriate management of physical, mental, and social care to improve disproportionate disparities in long-term health outcomes.

Well-being in Residency: Impact of an Online Physician Well-being Course on Resiliency and Burnout in Incoming Residents.

BACKGROUND AND OBJECTIVES: Wellness in residency has come to the forefront of national graduate medical education initiatives. Exponential growth in knowledge and skill development occurs under immense pressures, with physical, mental, and emotional stressors putting residents at burnout risk. The Accreditation Council for Graduate Medical Education requires programs to attend to resident wellness, providing the structure, environment, and resources to address burnout. This study's purpose was to evaluate the Andrew Weil Center for Integrative Medicine online Physician Well-being Course (PWC) with incoming postgraduate year-1 (PGY-1) residents in multiple residencies across a single health care system. The PWC teaches the learner strategies for building resilience, managing stress, identifying signs of burnout, and mindfulness practices including a self-selected daily 10-minute resiliency activity (meditation, gratitude journaling, and finding meaning journaling) for 14 days. METHODS: Incoming PGY-1 residents were enrolled in PWC 1 month prior to 2018 orientation. Validated measures of resiliency, burnout and gratitude were completed pre- and postcourse. We assessed pre/postcourse changes with paired t tests. We asked participants whether they incorporated any wellness behavior changes postcourse. RESULTS: Almost two-thirds of the incoming trainees completed the course (n=53/87, 61%). We found significant improvements (P<.05) for resiliency and burnout (emotional exhaustion, depersonalization). Gratitude did not change. The personal accomplishment burnout scale declined. The most frequently reported wellness behaviors were in the area of sleep, exercise, and diet. CONCLUSIONS: Resiliency, emotional exhaustion, and depersonalization improved, personal accomplishment declined, while gratitude remained the same. This project demonstrates an accessible and scalable approach to teaching well-being to incoming residents.

Professional development in integrative health through an interprofessional online course in clinical settings.

BACKGROUND: Although there is mounting clinical and cost-effectiveness evidence supporting integrative healthcare (IH), a significant knowledge gap hinders widespread adoption by health professionals. INTERVENTION: Foundations in Integrative Health (FIH), a 32-h online competency-based interprofessional course to address this knowledge gap. METHODS: The course was pilot-tested by an interprofessional sample of providers in various clinical settings as professional and staff development. OUTCOME MEASURES: Prior to and following the course, participants completed an IH knowledge test, an IH self-efficacy self-assessment, and validated measures of burnout, wellness behaviors, and attitudes toward IH, interprofessional teams, and patient involvement. Evaluation surveys were administered following each unit and the course. RESULTS: Thirty-one percent of the participants (n = 214/690) completed the course. Pre/post course improvements were found in IH knowledge, IH self-efficacy, attitudes towards IH and interprofessional teams, and several wellness behaviors. The course was positively evaluated with 81% of the participants indicating interest in applying IH principles in their practice and 92% reported that the course enhanced their clinical experience. CONCLUSION: This study demonstrates the outcomes of a multi-site, online IH curriculum offered to a diverse group of health professionals in various clinical settings. This course may allow clinical settings to offer an interprofessional, IH curriculum even with limited on-site faculty expertise.

A Longitudinal Study of Burnout and Well-being in Family Medicine Resident Physicians.

BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) core competencies for residency learning and work environment standards acknowledge high levels of burnout and depression in resident physicians and the critical importance of physician well-being to patient care and effective education. The objective of this study was to follow family medicine resident physicians' well-being throughout residency. METHODS: Family medicine resident physicians from 12 programs completed validated assessments (burnout, depression, perceived stress, satisfaction with life, positive and negative affect, emotional intelligence, mindfulness, gratitude) at residency start, second year start, and graduation. Resident physicians were from the 2011, 2012, and 2013 graduating classes (N=158). RESULTS: Two indicators of burnout (emotional exhaustion, depersonalization) increased between the start of residency and the start of the second year, remaining elevated at graduation. Emotional intelligence was lower at graduation than at the start of residency. In contrast, other measures of well-being (stress, life satisfaction, affect) improved during the second and third years. Depression, mindfulness, and gratitude remained stable. Increased levels of burnout risk at graduation were negatively associated with emotional intelligence, mindfulness, and gratitude. CONCLUSIONS: While the stressful impact of residency is transitory for some measures of well-being, that is not the case for burnout or emotional intelligence. Burnout levels peak after the first year of residency and remain high through graduation. Targeted interventions to identify and address burnout in residency need to be evaluated in future studies.

Educating Physicians in Family Medicine Residencies About Nonpharmacologic Approaches to Pain: Results of an Online Integrative Course.

BACKGROUND AND OBJECTIVES: Opioid misuse is at an all-time crisis level, and nationally enhanced resident and clinician education on chronic pain management is in demand. To date, broad-reaching, scalable, integrative pain management educational interventions have not been evaluated for effectiveness on learner knowledge or attitudes toward chronic pain management. METHODS: An 11-hour integrative pain management (IPM) online course was evaluated for effect on resident and faculty attitudes toward and knowledge about chronic pain. Participants were recruited from family medicine residencies participating in the integrative medicine in residency program. Twenty-two residencies participated, with 11 receiving the course and 11 serving as a control group. Evaluation included pre/post medical knowledge and validated measures of attitude toward pain patients, self-efficacy for nondrug therapies, burnout, and compassion. RESULTS: Forty-three participants (34.4%) completed the course. The intervention group (n=50), who received the course, improved significantly (P<.05) in medical knowledge, attitude toward pain patients, and self-efficacy to prescribe nondrug therapies while the control group (n=54) showed no improvement. There was no effect on burnout or compassion for either group. The course was positively evaluated, with 83%-94% rating the course content and delivery very high. All participants responded that they would incorporate course information into practice, and almost all thought what they learned in the course would improve patient care (98%). CONCLUSIONS: Our findings demonstrate the feasibility of an online IPM course as an effective and scalable intervention for residents and primary care providers in response to the current opioid crisis and need for better management of chronic pain. Future directions include testing scalability in formats that lead to improved completion rates, implementation in nonacademic settings, and evaluation of clinical outcomes such as decreased opioid prescribing.

Introducing integrative primary health care to an interprofessional audience: Feasibility and impact of an asynchronous online course.

BACKGROUND: Although there is mounting clinical and cost-effectiveness evidence supporting integrative healthcare (IH), a significant knowledge gap hinders widespread adoption by primary care professionals. INTERVENTION: Based on IH competencies developed by an interprofessional team and a needs assessment, a 32-h online interprofessional IH course, Foundations in Integrative Health, was developed. Trainees learn to conduct an IH assessment and how patients are assessed and treated from the diverse professions in integrative primary care. METHODS: The course was pilot-tested with educational program trainees, faculty and clinical staff at graduate level primary care training programs (primary care residencies, nursing, pharmacy, public health, behavioral health, and licensed complementary and IH programs). OUTCOME MEASURES: Prior to and following the course, participants completed an IH knowledge test, an IH efficacy self-assessment, and validated measures of IH attitudes, interprofessional learning, provider empathy, patient involvement, resiliency, self-care, wellness behaviors, and wellbeing. Evaluation surveys were administered following each unit and the course. RESULTS: Almost one-half (n = 461/982, 47%) completed the course. Pre/post course improvements in IH knowledge, IH self-efficacy, IH attitudes, interprofessional learning, provider empathy, resiliency, self-care, several wellness behaviors, and wellbeing were observed. The course was positively evaluated with most (93%) indicating interest in applying IH principles and that the course enhanced their educational experience (92%). CONCLUSION: This study demonstrates the feasibility and effectiveness of a multi-site, online curriculum for introducing IH to a diverse group of primary care professionals. Primary care training programs have the ability to offer an interprofessional, IH curriculum with limited on-site faculty expertise.

Assessing Integrative Psychiatry Curriculum Needs.

BACKGROUND: Research on incorporating integrative medicine (IM) into medical training is increasing. Programs and organizations around IM have been established, but there has not previously been a needs assessment focused on integrating IM into psychiatry training. OBJECTIVES: The results of a needs assessment of training directors and faculty, focused on interest and priorities for developing an IM curriculum for psychiatry training programs, are described. METHODS: Psychiatry Training Directors and faculty were invited to participate in a detailed electronic survey. Areas of inquiry included (a) IM content areas to include in training; (b) IM approaches to specific medical conditions; (c) existing IM content; (d) importance, interest, and strategies for IM training; and (e) availability of wellness programs for trainees. RESULTS: Thirty-six respondents from psychiatry training programs completed the survey. Of the training programs represented by the respondents, 50% indicated that they currently had IM content in their curriculum; only 11.8% of them rated their programs' existing IM content as sufficient. Content areas rated most highly for inclusion in a psychiatry IM curriculum included sleep health, motivational interviewing, and self-care. Respondents indicated incorporating IM into the psychiatry training curriculum (47%) or as an elective (44%) as the desired implementation strategy, with experiential onsite activities demonstrating IM topics (67%) and online modules supplemented by local faculty (58%) as the 2 most desirable learning formats. Significant barriers identified were time constraints, lack of faculty expertise in IM, current lack of curricular requirements for IM competencies, and budgetary limitations. CONCLUSION: Responses to the survey suggest that faculty need support and additional education in implementing IM training. A standardized, online curriculum could help meet that need. Our results also indicate that wellness programs for residents are currently inadequate; bolstering them could help address burnout and increase the knowledge psychiatrists have of IM modalities. The types of institutions represented by faculty interested in further developing IM offerings vary considerably, as do their current efforts to integrate IM into training programs.

Pharmacy Competencies for Interprofessional Integrative Health Care Education.

Objective. To address the gap in evidence-based knowledge among pharmacy students and practicing pharmacists regarding complementary and integrative health approaches due to insufficient education and a lack of standardized training. Methods. The National Center for Integrative Primary Healthcare (NCIPH) developed 22 pharmacy competencies linked to a set of 10 interprofessional "metacompetencies" in integrative health care. Results. The NCIPH pharmacy competencies are well-aligned with the current educational standards and Center for the Advancement of Pharmacy Education (CAPE) outcomes for pharmacy programs. Therefore, the NCIPH competencies may provide a foundation for the incorporation of interprofessional integrative health care education into pharmacy curricula. Conclusion. The NCIPH pharmacy competencies in integrative health care, linked to the interprofessional "metacompetencies," are aligned with educational standards and outcomes, and may serve as a basis for pharmacy curriculum.

Integrative Medicine in Residency: Feasibility and Effectiveness of an Online Program.

BACKGROUND AND OBJECTIVES: Online curricular interventions in residency have been proposed to address challenges of time, cost, and curriculum consistency. This study is designed to determine the feasibility and effectiveness of a longitudinal, multisite online curriculum in integrative medicine (IMR) for residents. METHODS: Residents from eight family medicine programs undertook the 200-hour online IMR curriculum. Their medical knowledge (MK) scores at completion were compared to a control group from four similar residency programs. Study and control groups were comparable in baseline demographics, and MK scores. Course completion, MK scores, and course evaluations were assessed. RESULTS: Of 186 IMR residents, 76.9% met completion requirements. The IMR group showed statistically significant higher MK scores at residency completion, the control group did not (IMR: 79.2% vs. CONTROL: 53.2% mean correct). Over three-fourths of IMR participants (range 79-92%) chose the top two rating categories for each course evaluation item. In an exit survey, ability to access the curriculum for 1 additional year and intention to utilize IM approaches after residency were the highest ranked items. CONCLUSIONS: The demonstrated feasibility, effectiveness, and positive evaluations of the IMR curriculum indicate that a multisite, online curricular intervention is a potentially viable approach to offering new curriculum with limited on-site faculty expertise for other family medicine residencies.

The evolution of integrative medical education: the influence of the University of Arizona Center for Integrative Medicine.

The University of Arizona Center for Integrative Medicine (AzCIM) was founded in 1994 with a primary focus of educating physicians in integrative medicine (IM). Twenty years later, IM has become an internationally recognized movement in medicine. With 40% of United States' medical schools having membership in the Academic Consortium for Integrative Medicine and Health it is foreseeable that all medical students and residents will soon receive training in the principles and practices of IM. The AzCIM has the broadest range and depth of IM educational programs and has had a major influence on integrative medical education in the United States. This review describes the fellowship, residency and medical student programs at AzCIM as well as other significant national drivers of IM education; it also points out the challenges faced in developing IM initiatives. The field of IM has matured with new national board certification in IM requiring fellowship training. Allied health professional IM educational courses, as well as integrative health coaching, assure that all members of the health care team can receive training. This review describes the evolution of IM education and will be helpful to academic centers, health care institutions, and countries seeking to introduce IM initiatives.

Interprofessional Competencies in Integrative Primary Healthcare.

In October 2014, the National Center for Integrative Primary Healthcare (NCIPH) was launched as a collaboration between the University of Arizona Center for Integrative Medicine and the Academic Consortium for Integrative Health and Medicine and supported by a grant from the Health Resources and Services Administration. A primary goal of the NCIPH is to develop a core set of integrative healthcare (IH) competencies and educational programs that will span the interprofessional primary care training and practice spectra and ultimately become a required part of primary care education. This article reports on the first phase of the NCIPH effort, which focused on the development of a shared set of competencies in IH for primary care disciplines. The process of development, refinement, and adoption of 10 "meta-competencies" through a collaborative process involving a diverse interprofessional team is described. Team members represent nursing, the primary care medicine professions, pharmacy, public health, acupuncture, naturopathy, chiropractic, nutrition, and behavioral medicine. Examples of the discipline-specific sub-competencies being developed within each of the participating professions are provided, along with initial results of an assessment of potential barriers and facilitators of adoption within each discipline. The competencies presented here will form the basis of a 45-hour online curriculum produced by the NCIPH for use in primary care training programs that will be piloted in a wide range of programs in early 2016 and then revised for wider use over the following year.

En octubre de 2014, se inauguró el Centro nacional de atención primaria integral de salud (National Center for Integrative Primary Healthcare, NCIPH) como una colaboración entre el Centro de medicina integral de la Universidad de Arizona y el Consorcio académico de salud y medicina integral, y fue subvencionado con fondos de la Administración de Recursos y Servicios de Salud. El objetivo principal del NCIPH es desarrollar un conjunto básico de competencias de asistencia sanitaria integral (SI) y programas educativos que abarquen los espectros de formación y práctica en atención primaria interprofesional y se integren en última instancia en la educación en atención primaria. Este artículo detalla la primera fase de la iniciativa del NCIPH, que se centra en el desarrollo de un conjunto de competencias compartidas en asistencia sanitaria integral para las disciplinas de atención primaria. Se describe un proceso de desarrollo, perfeccionamiento y adopción de 10 "metacompetencias" a través de un proceso de colaboración en el que participa un equipo interprofesional heterogéneo. Los miembros del equipo representan al personal de enfermería, las profesiones médicas de atención primaria, farmacia, salud pública, acupuntura, naturopatía, quiropráctica, nutrición y medicina de la conducta. Se ofrecen ejemplos de las subcompetencias específicas de cada disciplina en fase de desarrollo en cada una de las profesiones participantes, junto con los resultados iniciales de la evaluación de los posibles obstáculos y los facilitadores de la adopción dentro de cada disciplina. Las competencias que se presentan aquí constituirán la base de un plan de estudios en línea de 45 horas elaborado por el NCIPH para su uso en programas de formación en atención primaria que se pondrán a prueba a principios de 2016 y serán posteriormente revisados para la generalización de su uso el año siguiente.

The incorporation of stress management programming into family medicine residencies-results of a national survey of residency directors: a CERA study.

BACKGROUND AND OBJECTIVES: Residents' stress and burnout is a concern among family medicine residency programs. Our objective is to assess stress management options available to family medicine residents. METHODS: In 2012, the Council of Academic Family Medicine Educational Research Alliance (CERA) e-mailed a survey to US residency directors. Questions were asked on four types of stress management programming (SMP): (1) access to counselors, social workers, or mental health providers, (2) residency support or Balint groups, (3) stress management lectures or workshops, and (4) residency retreats. We assessed how many programs contained all four types of SMP and their relationship to the following topics: stress management techniques for patients, spirituality, mind/body techniques, and self-care for residents. RESULTS: Of the 212 responses, 29% reported having all four types of SMP. Eighty-three percent reported stress management lectures or workshops, and 79% reported residency retreats. Smaller and mid-size residencies (36%) and residencies in the West (36%) were more likely to have all four types of SMP. There was a correlation between having didactics, clinical rotations, and electives on stress management techniques for patient care and having stress management lectures or workshops for residents. There was statistical significance between having resident self-care curriculum and (1) having retreats and (2) stress management lectures or workshops. CONCLUSIONS: It is necessary to evaluate whether residency programs are providing appropriate stress management skills for residents that will improve physician wellness and patient outcomes.

Pediatric Integrative Medicine in Residency (PIMR): Description of a New Online Educational Curriculum.

Use of integrative medicine (IM) is prevalent in children, yet availability of training opportunities is limited. The Pediatric Integrative Medicine in Residency (PIMR) program was designed to address this training gap. The PIMR program is a 100-hour online educational curriculum, modeled on the successful Integrative Medicine in Residency program in family medicine. Preliminary data on site characteristics, resident experience with and interest in IM, and residents' self-assessments of perceived knowledge and skills in IM are presented. The embedded multimodal evaluation is described. Less than one-third of residents had IM coursework in medical school or personal experience with IM. Yet most (66%) were interested in learning IM, and 71% were interested in applying IM after graduation. Less than half of the residents endorsed pre-existing IM knowledge/skills. Average score on IM medical knowledge exam was 51%. Sites endorsed 1-8 of 11 site characteristics, with most (80%) indicating they had an IM practitioner onsite and IM trained faculty. Preliminary results indicate that the PIMR online curriculum targets identified knowledge gaps. Residents had minimal prior IM exposure, yet expressed strong interest in IM education. PIMR training site surveys identified both strengths and areas needing further development to support successful PIMR program implementation.

Increasing resident recruitment into family medicine: effect of a unique curriculum in integrative medicine.

INTRODUCTION: Healthcare reform is highlighting the need for more family practice and other primary care physicians. The Integrative Medicine in Residency (IMR) curriculum project helped family medicine residencies pilot a new, online curriculum promoting prevention, patient-centered care competencies, use of complementary and alternative medicine along with conventional medicine for management of chronic illness. A major potential benefit of the IMR program is enhanced recruitment into participating residencies, which is reported here. METHODS: Using an online questionnaire, accepted applicants to the eight IMR pilot programs (n = 152) and four control programs (n = 50) were asked about their interests in learning integrative medicine (IM) and in the pilot sites how the presence of the IMR curriculum affected their ranking decisions. RESULTS: Of residents at the IMR sites, 46.7% reported that the presence of the IMR was very important or important in their ranking decision. The IMR also ranked fourth overall in importance of ranking after geography, quality of faculty, and academic reputation of the residency. The majority of IMR residents (87.5%) had high to moderate interest in learning IM during their residency; control residents also had a high interest in learning IM (61.2%). CONCLUSIONS: The presence of the IMR curriculum was seen as a strong positive by applicants in ranking residencies. Increasing the adoption of innovative IM curricula, such as the IMR, by residency programs may be helpful in increasing applications of competitive medical students into primary care residencies as well as in responding to the expressed interest in learning the IM approach to patient care.

Resident wellness behaviors: relationship to stress, depression, and burnout.

BACKGROUND AND OBJECTIVES: Stress in medical education has been well documented, often with the primary focus on negative factors such as depression and burnout. Few studies have attempted to assess well-being mediating behaviors. This study describes the relationship between wellness behaviors and measures of well-being at the start of family medicine residency. METHODS: Using an online questionnaire, first-year family medicine residents (n=168) completed standardized measures exploring perceived stress, depression, satisfaction with life, and burnout. A lifestyle wellness behavior measure was developed for the study. RESULTS: Average reported perceived stress levels were consistent with ranges found for medical students and residents. Twenty-three percent of residents scored in a range consistent with depression risk. In terms of burnout risk, 13.7% scored in the high emotional exhaustion range and 23.8% in the high depersonalization range. Two thirds reported high life satisfaction. Higher depersonalization and less time in nurturing relationships were associated with greater likelihood of medication use for sleep, mood, and anxiety in females. Higher alcohol use was associated with increased levels of perceived stress, burnout, and depression. The two wellness behaviors most associated with higher well-being were restful sleep and exercise. CONCLUSIONS: At the start of residency, well-being measures are consistent with findings in medical school. Restful sleep and exercise were associated with more positive well-being. Future longitudinal data analysis will help clarify the effect of residency training in well-being and lifestyle behaviors. Identification of protective factors and coping mechanisms could guide residencies in incorporating support services for residents.

Family medicine residency program directors attitudes and knowledge of family medicine CAM competencies.

CONTEXT: Little is known about the incorporation of integrative medicine (IM) and complementary and alternative medicine (CAM) into family medicine residency programs. OBJECTIVE: The Society for Teachers of Family Medicine (STFM) approved a set of CAM/IM competencies for family medicine residencies. We hope to evaluate whether residency programs are implementing such competencies into their curriculum using an online survey tool. We also hope to assess the knowledge and attitudes of Residency Directors (RDs) on the CAM/IM competencies. DESIGN: A survey was distributed by the Council of Academic Family Medicine (CAFM) Educational Research Alliance to RDs via e-mail. The survey was distributed to 431 RDs. Of those who received it, 212 responded, giving a response rate of 49.1%. Questions assessed the knowledge and attitudes of CAM/IM competencies and incorporation of CAM/IM into the residency curriculum. RESULTS: Forty-five percent of RDs were aware of the competencies. In terms of RD attitudes, 58% reported that CAM/IM is an important component of residents' curriculum; yet, 60% report not having specific learning objectives for CAM/IM in their residency curriculum. Among all programs, barriers to CAM/IM implementation included time in residents' schedules (77%); faculty training (75%); access to CAM experts (43%); lack of reimbursement (43%); and financial resources (29%). CONCLUSIONS: While many RDs are aware of the STFM CAM/IM competencies and acknowledge their role in residence education, there are many barriers that prevent residencies from implementing the STFM CAM/IM competencies.