Assessment of a Recognition Program in an Academic Family Medicine Department.

BACKGROUND AND OBJECTIVES: Burnout is prevalent among clinicians and faculty. We sought to understand the impact of a recognition program designed to reduce burnout and affect engagement and job satisfaction in a large academic family medicine department. METHODS: A recognition program was created in which three clinicians and faculty from the department were randomly selected each month to be recognized ("awardees"). Each awardee was asked to honor a person who had supported them (a "hidden hero" [HH]). Clinicians and faculty not recognized or selected as an HH were considered "bystanders." Interviews were completed with 12 awardees, 12 HHs, and 12 bystanders for a total of 36 interviews. We used content analysis to qualitatively evaluate the program. RESULTS: Assessment of the "We Are" Recognition Program resulted in the categories of impact (subcategories: process positives, process negatives, and fairness of program) and HHs (subcategories: teamwork and awareness of the program). We conducted interviews on a rolling basis and made iterative changes to the program based on feedback. CONCLUSIONS: This recognition program helped create a sense of value for clinicians and faculty in a large, geographically dispersed department. It represents a model that would be easy to replicate, requires no special training or significant financial investment, and can be implemented in a virtual format.

Assessment of Agenda Setting With ACGME Milestones in Family Medicine Residents.

BACKGROUND AND OBJECTIVES: Family medicine residents are scored via milestones created by the Accreditation Council for Graduate Medical Education (ACGME) on various clinical domains, including communication. Communication involves a resident's ability to set an agenda, but this is rarely taught in formal education. Our study aimed to examine the relationship between ACGME Milestone achievement and ability to set a visit agenda, as measured by direct observation (DO) forms. METHODS: We examined biannual (December, June) ACGME scores for family medicine residents at an academic institution from 2015-2020. Using faculty DO scores, we rated residents on six items corresponding to agenda setting. We used Spearman and Pearson correlations and two-sample paired t tests to analyze results. RESULTS: We analyzed a total of 246 ACGME scores and 215 DO forms. For first-year residents, we found significant, positive associations between agenda-setting and the total Milestone score (r[190]=.15, P=.034) in December, and in individual (r[190]=.17, P=.020) and total communication scores (r[186]=.16, P=.031), in June. However, for first-year residents, we found no significant correlations with communication scores in December or in the total milestone scores in June. We found significant progression for consecutive years in both communication milestones (t=-15.06, P<0.001) and agenda setting (t=-12.26, P<.001). CONCLUSIONS: The significant associations found in agenda setting with both ACGME total communication and Milestone scores for first-year residents only, suggests that agenda setting may be fundamental in early resident education.

Challenges in Effective Faculty and Provider Recognition to Enhance Engagement.

BACKGROUND AND OBJECTIVES: Burnout is associated with reduction in patient care time and leaving academic medicine, and is prevalent among faculty, residents, and advanced practice providers. Recognition may positively impact workplace well-being and reduce attrition. The objective of this study was to understand needs and preferences regarding recognition among faculty and providers in a large academic department. METHODS: A survey including quantitative and qualitative elements was sent to faculty and providers to identify whether additional recognition was needed and, if so, to seek potential opportunities to improve recognition, with mixed-methods assessment of results. RESULTS: Fifty-two participants completed the survey (35.9% response rate; 53.8% female, 59.6% faculty); 26.9% reported performing duties at work that are not being recognized, and 19.2% reported seriously considering leaving the institution because they did not feel appreciated. Females were more likely to want tangible goods as a source of recognition (P=.008). While providers preferred to have recommendations for recognition made by office staff (P=.007), associate professors did not (P=.005). Qualitative responses to the survey also revealed concerns regarding favoritism and risk of feeling unappreciated if a recognition system is perceived as unfair. CONCLUSIONS: This survey demonstrated a deficit of recognition and a lack of consensus regarding how or when faculty and providers should be recognized. There were concerns regarding fairness of recognition. Efforts to enhance recognition should avoid assumptions about faculty and provider preferences, and should be attuned to fairness and inclusion.

Borderline Personality Disorder.

Borderline personality disorder is a psychological disorder characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image. Borderline personality disorder may be present in up to 6.4% of adult primary care visits, which is fourfold higher than in the general population. Borderline personality disorder is underdiagnosed and most patients who have it also have additional psychiatric conditions. Individuals with borderline personality disorder have an underlying vulnerability to emotional hyperarousal states and social and interpersonal stressors. Clinically these patients may have high health care utilization, health-sabotaging behaviors, chronic or vague somatic concerns, aggressive outbursts, high-risk sexual behaviors, and substance use. Obesity and binge-eating disorders are common comorbidities in those diagnosed with borderline personality disorder. There is an established correlation between borderline personality disorder and increased suicide risk. Structured interview assessments that are designed specifically for borderline personality disorder include the Revised Diagnostic Interview for Borderlines and the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders. As general guidelines for practice, family physicians should avoid excessive familiarity, schedule regular visits, set appropriate limits, and maintain awareness of personal feelings. Use of effective communication strategies such as motivational interviewing and problem-solving techniques can help navigate addressing problematic behaviors in patients who have borderline personality disorder. Multiple behavior treatments are useful, the most effective of which are dialectical behavior therapy and mentalization-based therapy. No medications have been approved by the U.S. Food and Drug Administration specifically for the treatment of borderline personality disorder.