Reducing clinician inefficiency and restoring meaning in practice: A professional coaching approach for family medicine residents.

Burnout is widespread among primary care physicians (PCPs). Several key drivers of burnout in this specialty that have been increasingly recognized are the growing complexity and work demands placed on PCPs by outpatient clinical work environments. These high demands, from the perspective of the physician, detract from other valued tasks which provide meaning in daily work such as relationship-building and fellowship with the medical team. Given these trends, we believe that a viable means to address burnout can be found in utilizing a performance coaching approach to equip resident physicians for the practical and emotional demands of the primary care work environment into which they are entering. Specifically, we recommend a focus on clinical efficiency as an area for coaching development due to its potential impact on resident physician well-being. In this brief review article, we provide a summary of evidence for coaching interventions, along with evidence supporting an expansion to these approaches in clinical efficiency in outpatient settings based on the connection between workflow and engagement in meaningful medical practice. Lastly, we outline a prospective coaching approach which targets common sources of clinic inefficiency for resident practitioners.

Psychological Attributes of Ultramarathoners.

INTRODUCTION: As the popularity of ultramarathon participation increases, there still exists a lack of understanding of the unique psychological characteristics of ultramarathon runners. The current study sought to investigate some of the psychological and behavioral factors that are involved in ultramarathon running. METHODS: We obtained information from participants of the Bear Chase Trail Race via an online survey. This race is a single-day, multidistance race consisting of a 10 k, half marathon, 50 k, 50 mi, and 100 k run in Lakewood, Colorado, at a base altitude of 1680 m with total altitude in climbs ranging from 663 to 2591 m. We correlated information from the Exercise Addiction Inventory and the Patient Health Questionnaire-2 and demographic information with race finish times. RESULTS: Out of 200 runners who started the race, 98 (48%) completed the survey. Over half of the runners were men (61.2%), and the average age was 39.0 years (SD±8.9; range 21-64 years). A number of respondents (20%) screened positive for exercise addiction concerns. Approximately 20% of our sample screened positive for depressive symptoms (Patient Health Questionnaire-2 score >3). The majority of participants reported receiving strong social support from current partners with regard to their ultramarathon running training time and goals. CONCLUSIONS: Although only a screening, the number of positive screens on the Exercise Addiction Inventory suggests use of screening measures with an ultramarathon running population. Athletes with positive screening tests should be fully evaluated for depression and exercise addiction because this would enable appropriate athlete support and treatment referral.

From Survivor to Thriver: A Pilot Study of an Online Program for Rape Victims.

Approximately 15% to 20% of women have been victims of rape and close to a third report current rape-related PTSD or clinically significant depression or anxiety. Unfortunately, very few distressed rape victims seek formal help. This suggests a need to develop alternative ways to assist the many distressed victims of sexual violence. Online treatment programs represent a potentially important alternative strategy for reaching such individuals. The current paper describes a pilot evaluation of an online, therapist-facilitated, self-paced cognitive behavioral program for rape victims. Five college women with current rape-related PTSD were recruited to complete the From Survivor to Thriver (S to T) program in a lab setting over the course of 7 weeks. After completing the program, 4 participants reported clinically significant reductions in PTSD symptoms and no longer met criteria for PTSD. All participants reported clinically significant reductions in vulnerability fears and 4 reported significant reductions in negative trauma-related cognitions. Implications of the results for further development of the S to T program and how clinicians could utilize this program in treating rape-related PTSD are discussed.

An FP's guide to identifying-and treating-postpartum depression.

Certain risk factors and this screening tool can help you identify patients at risk. Cognitive behavioral therapy and SSRIs can provide relief.

Evaluating Changes in Family Medicine Applicant Characteristics Following the Onset of Virtual Interviewing.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic obliged the field of graduate medical education to pivot from in-person to virtual residency interviews in 2020. The decreased travel and financial barriers of this format could potentially lead to greater diversity and equity in the primary care workforce. We aimed to evaluate changes in applicant pools from in-person to virtual interviewing cycles. METHODS: We conducted a retrospective review of Electronic Residency Application Services (ERAS) from five US family medicine residencies across five interview cycles (three in-person and two virtual; 2017/2018 through 2021/2022). We compared geographic and demographic data about applicants as well as administrative program data. RESULTS: The study included 25,271 applicants. The average distance between applicants and programs was 768 miles during in-person interview years and 772 miles during virtual interview years (P=.27). Applicants who interviewed with programs were 446 and 459 miles away, respectively (P=.06). During in-person application years, applicants with backgrounds historically underrepresented in medicine (URM) submitted an average of 21% of applications; this increased approximately 1% during virtual interviewing years (OR, 1.08; P=.03). There were no other differences between in-person and virtual application years in rates of URM applicants. Residency programs received more applications from US medical schools (OR, 1.46; P<.0001) and were more likely to interview a US medical school applicant (OR, 2.26; P<.0001) in virtual years. Program fill rates appeared to be lower during virtual years. CONCLUSIONS: The virtual interviewing format did not appear to substantially increase the geographic, racial, or ethnic diversity of applicants, and was associated with increased applications from US medical schools.

Wellness in the Time of COVID: A CERA Follow-up Survey of Program Directors.

BACKGROUND AND OBJECTIVES: Residency program directors (PDs) are tasked with supporting resident well-being, and a 2018-2019 CERA survey found PDs to be generally satisfied with residency wellness curricula. However, less is known about graduate medical education wellness programming following the unprecedented social and public health stressors of 2020. This study aimed to evaluate PDs' satisfaction with wellness programming and perceived changes in wellness program implementation in the context of these factors. METHODS: An online survey was administered by CERA to the program directors of all ACGME-accredited, US-based family medicine residencies. The survey replicated a 2018 CERA survey and assessed PDs' satisfaction with the wellness curriculum and which wellness curricular elements were currently implemented in the residency. RESULTS: The survey was completed by 263 PDs (42% response rate). There was no difference in total number of wellness curricular elements reported in programs in 2021 (M=9.85) vs 2018 (M=9.57; P=.377). Compared to the 2018 survey, PDs reported increased assessment of resident burnout (P=.02), increased scheduled time for personal needs (P=.002), but decreased scheduled time for interpersonal connection (P=.017). Most PDs reported increased emphasis on wellness and the same or increased access to wellness resources compared to 2018 χ2 indicated no significant difference in PD satisfaction with wellness programming between the two years (P=.84). CONCLUSIONS: Despite significant social and public health challenges to curriculum delivery, family medicine PDs did not perceive significant reductions in wellness programming, and in fact reported increases in some specific curricular elements and an overall increased emphasis on well-being. Future studies should explore the factors that facilitate and impede the implementation of wellness programming.

Comfort With Uncertainty in Medical Students and Their Residency Choice: A Residency Research Network of Texas Study.

BACKGROUND AND OBJECTIVES: Little is known about how comfort with uncertainty (CwU) influences career choice in medical students. The authors of this study examined the correlation between CwU and primary care career choice. METHODS: In academic years 2017-2018 and 2018-2019, the authors distributed surveys to third-year medical students from eight US medical schools, seven in Texas. The survey tool included two CwU scales and one comfort with ambiguity scale. Other questions covered career plans, family and personal background, and student debt. In the subjects' fourth year of medical school, authors obtained match data from the medical schools and the authors further communicated with the students where indicated. The primary outcome was the composite score of the three scales correlated to career choice, with a focus on primary care and family medicine. RESULTS: Among 642 participants, there was no difference in CwU scores between students who matched into primary care versus specialty fields (3.39 vs 3.37 average of three scales, P=.65, each individual scale NS) or family medicine (FM) vs all other fields (3.39 vs 3.37 average of three scales, P=.81). Other bivariate predictors of FM choice were more similar than different to previous studies, such as osteopathic more likely than allopathic, lower family income, planning to care for underserved populations, and had a primary care role model. Logistic regression found the two biggest predictors of FM were osteopathic training and the importance of educating patients about health promotion and disease prevention. CONCLUSIONS: We found no correlation between CwU and medical student career choice for primary care or FM. We discuss confounding factors that may impact results, as well as recommendations for medication education and public policy.

Erectile dysfunction: How to help patients and partners.

This guide and helpful list of key questions can provide a therapeutic framework for addressing the relationship side of ED.

Family Medicine Faculty Time Allocation and Burnout: A Residency Research Network of Texas Study.

BACKGROUND: Burnout among graduate medical education (GME) faculty is a well-documented phenomenon, but few studies have explored the relationship between faculty time allocation and burnout. OBJECTIVE: Our objectives were to (1) characterize time allocation of academic family physicians, (2) measure the difference between actual versus preferred time spent on various tasks, and (3) examine this difference in relation to burnout. METHODS: From January to March 2017, family medicine GME faculty across Texas completed anonymous online surveys for burnout (Maslach Burnout Inventory) and occupational stress (Primary Care Provider Stress Checklist). They also reported the percentage of time they actually versus prefer to allocate across 5 categories of tasks: direct patient care, nondirect clinical duties, teaching, administration, and research. Difference scores between actual and preferred time allocation were calculated and correlated with burnout and stress scores. RESULTS: Of the faculty physicians surveyed, 53% provided complete responses (103 of 195). On average they engaged in their preferred amount of time on direct patient care (30% of their time) and administrative duties (15%). Meanwhile, faculty preferred to increase time spent teaching (37% to 41%, P = .002) and conducting research (4% to 7%, P ≤ .001), while reducing time spent on nondirect clinical duties (14% to 7%, P < .001). Those with higher misalignment in their weekly schedules reported higher levels of professional burnout and occupational stress. CONCLUSIONS: Many family medicine GME faculty spent 20% or more of their time in a manner incongruent with their preferences, which may place them at higher risk for burnout and occupational stress.

Getting It Off the Ground: Key Factors Associated With Implementation of Wellness Programs.

BACKGROUND AND OBJECTIVES: Many residency programs are developing resident wellness curricula to improve resident well-being and to meet Accreditation Council for Graduate Medical Education guidelines. However, there is limited guidance on preferred curricular components and implementation. We sought to identify how specific driving factors (eg, having an identified wellness champion with a budget and protected time to develop wellness programs) impact implementation of essential elements of a resident wellness curriculum. METHODS: We surveyed 608 family medicine residency program directors (PDs) in 2018-2019 on available resources for wellness programs, essential wellness elements being implemented, and satisfaction with wellness programming; 251 PDs provided complete responses (42.5% response rate). Linear and logistic regressions were conducted for main analyses. RESULTS: Having an identified wellness champion, protected time, and dedicated budget for wellness were associated with greater implementation of wellness programs and PD satisfaction with wellness programming; of these, funding had the strongest association. Larger programs were implementing more wellness program components. Program setting had no association with implementation. CONCLUSIONS: PDs in programs allocating money and/or faculty time can expect more wellness programming and greater satisfaction with how resident well-being is addressed.

Family Physician Burnout and Resilience: A Cross-Sectional Analysis.

BACKGROUND AND OBJECTIVES: Current physician burnout levels are at historically high levels, especially in family medicine, with many factors playing a role. The goal of this study was to understand demographic, psychological, environmental, behavioral, and workplace characteristics that impact physician wellness and burnout, focusing on family medicine physicians and residents. METHODS: Survey respondents were 295 family medicine residents and faculty members across 11 residency programs within the Residency Research Network of Texas (RRNeT). Subjects completed multiple measures to assess resilience, burnout, psychological flexibility, and workplace stress. Respondents also reported personal wellness practices and demographic information. The primary outcome variables were burnout (depersonalization, emotional exhaustion, and personal achievement) and resilience. RESULTS: The predictor variables contributed significant variance (depersonalization=27.1%, emotional exhaustion=39%, accomplishment=37.7%, resilience=37%) and resulted in large effect sizes (depersonalization f²=.371, emotional exhaustion f²=.639, accomplishment f²=.605, resilience f²=.587) among the three burnout models and the resilience model for the sample. Similar variance and effect sizes were present for independent resident and program faculty samples, with resilience being the only outcome variable with significant differences in variance between the samples. CONCLUSIONS: This study demonstrates the roles of both individual and organization change needed to impact provider wellness, with special attention to resilience across faculty and residents. The results of this study may inform workplace policies (ie, organizational practice change) and wellness programming and curricula (ie, individual level) for family medicine residents and program faculty.

Making Sense of Family Medicine Resident Wellness Curricula: A Delphi Study of Content Experts.

BACKGROUND AND OBJECTIVES: The Association of Family Medicine Residency Directors (AFMRD) Physician Wellness Task Force released a comprehensive Well-Being Action Plan as a guide to help programs create a culture of wellness. The plan, however, does not offer a recommendation as to which elements may be most important, least resource intensive, or most feasible. This study sought to identify the most essential components of the AFMRD's Well-Being Action Plan, as rated by expert panelists using a modified Delphi technique. METHODS: Sixty-eight selected experts were asked to participate; after three rounds of surveys, the final sample included 27 participants (7% residents, 38% MD faculty, 54% behavioral science faculty). RESULTS: Fourteen elements were rated as essential by at least 80% of the participants. These components included interventions at both the system and individual level. Of those elements ranked in the top five by a majority of the panel, all but one do not mention specific curricular content, but rather discusses the nature of a wellness curriculum. CONCLUSIONS: The expert consensus was that an essential curriculum should begin early, be longitudinal, identify a champion, and provide support for self-disclosure of struggles.

Impact of educational messages on patient acceptance of male medical students in OB-GYN encounters.

INTRODUCTION: Although training in obstetrics and gynecology is a key part of medical education, male students receive less extensive experience, due in part to patient refusals. However, there is limited work seeking to reduce patient refusal rates of male students. The current study examined the efficacy of two messages at increasing male medical student acceptance into a well-woman visit. METHODS: A total of 656 college women participated in a simulation study where they viewed a video of a nurse asking for permission to have a male medical student participate in their well-woman visit. The 30.5% of women who refused student participation (n = 181) were randomly assigned to view a video of the nurse either describing students' medical knowledge and technical skills training (e.g. training in performing pelvic exams) or empathic skills training (e.g. training in communication about sensitive issues). They were again asked if they would be willing to have the student participate. RESULTS: Both messages similarly increased student acceptance with 44.8% of those receiving the empathic skills training message and 48.9% of those who received the medical/technical skills training message accepting student participation, χ(2) (1, N = 181) = 0.3, p = 0.58. DISCUSSION: Educational messages about medical student training delivered in an engaging fashion by a credible source are a potentially effective tool to increase male student acceptance into sensitive patient encounters. Future work should test these messages in real-world settings as part of a focus on patient education to increase comfort with student participation.

Location of care for patients with borderline personality disorder: Challenges and opportunities in finding a home.

Patients with borderline personality disorder (BPD) represent a population with increased care needs and high provider demand, even in the best cases of quality integrated primary care. The current article outlines the complexities of working with patients with BPD in primary care, including when the transition to the specialty mental health sector may be warranted. Core factors around transitions of care (between integrated primary care and the specialty mental health sector) have been identified. These factors included suicidal ideations, psychiatric hospitalizations/conditions, physician consultation availability, behavioral provider availability, supervision availability, finances, and patient preferences. (PsycINFO Database Record

Stereotyped beliefs about male and female OB-GYNS: relationship to provider choice and patient satisfaction.

BACKGROUND: Up to 60% of women prefer a female obstetrician-gynecologist (OB-GYN), perhaps in part due to holding negative stereotypes of male providers. However, provider gender stereotypes have not been directly examined. The purpose of the current studies was to evaluate women's stereotypes of male and female OB-GYN providers and the impact of these stereotypes on provider evaluations. METHODS: First, stereotypes of male and female OB-GYNs were elicited from 96 undergraduate women who described the attributes and behaviors of a typical male or female OB-GYN. Next, 126 undergraduate women were randomized to review recordings depicting male or female OB-GYNs engaging in male or female-stereotype congruent behaviors during a well-woman visit. RESULTS: Participants overall had positive stereotypes of female OB-GYNs (e.g. knowledgeable, easy to talk to) but some negative stereotypes of males (e.g. unable to fully understand women's health issues). However, male and female OB-GYNs who engaged in female stereotype-congruent behaviors were similarly preferred over providers who engaged in male-stereotype congruent behavior. CONCLUSION: Women generally regard female OB-GYNs as highly competent, whereas some believe that being male is a disadvantage in providing OB-GYN care. However, providers who engage in behaviors associated with high quality care are evaluated positively, regardless of the provider's gender.

Health Risk Behavior and Sexual Assault Among Ethnically Diverse Women.

Sexual assault is associated with a number of health risk behaviors in women. It has been hypothesized that these risk behaviors, such as hazardous drinking, may represent women's attempts to cope with psychological distress, such as symptoms of depression and anxiety. However, extant research has failed to evaluate these relationships among ethnic minority samples or identify the mechanisms responsible for this association. The current study examined sexual assault history and two health risk behaviors (hazardous drinking and engaging in sexual behavior to regulate negative affect) in a diverse sample of 1,620 college women. Depression and anxiety were examined as mediators of the relationship between sexual assault and health risk behaviors. There was evidence of moderated mediation, such that for European American women, but not for ethnic minority women, both forms of psychological distress were significant mediators of the sexual assault/hazardous drinking relationship. In contrast, among all ethnic groups, the relationship between sexual assault and both forms of psychological distress was mediated by the use of sexual behavior as an affect regulation strategy. Results support a need to evaluate the assault experiences of ethnically diverse women, as well as the impact of the assault on their postassault experiences including health risk behaviors and psychological adjustment. Additionally, results suggest that practitioners should carefully assess health risk behaviors among victims of sexual assault and be aware that there may be differences in the risk factors and motives for these behaviors among women of various ethnic backgrounds.