Factors Associated With Physician Empowerment and Well-being at an Academic Medical Center.

OBJECTIVE: This study reports an institutional approach to rapidly measure burnout and gather physicians' opinions on workplace factors that empower well-being. METHODS: In July 2017, physicians at Vanderbilt University Medical Center were invited to participate in a two-question survey measuring self-reported burnout and providing an opportunity to describe structures that empower well-being. Free-text responses were analyzed and a linear regression model assessed factors associated with well-being. RESULTS: A total of 1135 physicians responded (43.3% response rate) with a mean well-being score of 56 (scale 0 to 100). Higher scores were associated with clinical fellow status (P = 0.002), male sex (P = 0.008), less allocation of time to clinical care (P < 0.001), and not commenting on "leadership" and "autonomy" in the free-text response. CONCLUSIONS: Brief surveys collecting perspectives on well-being can help employers identify high-risk groups and provide a roadmap for institutional change.

Embedding Ethics Education in Clinical Clerkships by Identifying Clinical Ethics Competencies: The Vanderbilt Experience.

The clinical clerkships in medical school are the first formal opportunity for trainees to apply bioethics concepts to clinical encounters. These clerkships are also typically trainees' first sustained exposure to the "reality" of working in clinical teams and the full force of the challenges and ethical tensions of clinical care. We have developed a specialized, embedded ethics curriculum for Vanderbilt University medical students during their second (clerkship) year to address the unique experience of trainees' first exposure to clinical care. Our embedded curriculum is centered around core "ethics competencies" specific to the clerkship: for Medicine, advanced planning and end-of-life discussions; for Surgery, informed consent; for Pediatrics, the patient-family-provider triad; for Obstetrics and Gynecology, women's autonomy, unborn child's interests, and partner's rights; and for Neurology/Psychiatry, decision-making capacity. In this paper, we present the rationale for these competencies, how we integrated them into the clerkships, and how we assessed these competencies. We also review the additional ethical issues that have been identified by rotating students in each clerkship and discuss our strategies for continued evolution of our ethics curriculum.

Framing Medicine as a Moral Practice: An Introductory Medical School Course.

PROBLEM: The transition into medical school represents a time of profound professional development for medical students. Many medical schools manage this transition with brief orientations followed by abrupt moves into the anatomy laboratory. Recognizing that early introduction of key humanistic concepts could have a lasting impact on students' attitudes, faculty at the Vanderbilt University School of Medicine created the Foundations of the Profession (FoP) course to frame medicine as a moral practice. APPROACH: The FoP course, offered annually since 2012, occurs during the first week of medical school. Using coronary artery disease with a chief complaint of angina as a core example, teams of students create variations of five hypothetical patients and walk them through potential care episodes. This allows students to compare the impact of many factors on a provider's ability to uphold fundamental professional obligations. Students engage in readings, lectures, small-group discussions, clinic visits, and research on insurance plans. Faculty engage with students in small groups and establish a safe environment for discussion of challenging moral dilemmas. OUTCOMES: From 2013 to 2016, 356 (97%) of the 368 first-year medical students who took the course submitted summative course evaluations. Of the respondents, 349 (98%) indicated they believed the course contributed to their professional development and supported their learning. NEXT STEPS: Future iterations of this course may include increased exposure to key educational faculty to solidify the formation of a moral scaffold on which to build subsequent knowledge.