A biopsychosocial-spiritual wellness check program for internal medicine residents: A brief report.

INTRODUCTION: The pandemic has significantly impacted medical residents. We created and implemented a biannual biopsychosocial-spiritual Wellness Check Program (WCP) to help internal medicine residents self-assess for burnout, enhance resilience, and to promote early identification and referral to mental health services. We report the preliminary findings from our quality improvement pilot effort at Loma Linda University Health (LLUH). METHOD: Residents participated in biannual sessions with licensed therapists employed by Loma Linda University, Office of Physician Vitality (OPV). Visits consisted of an evidence-guided discussion about general wellbeing, relationships, family life, coping strategies, and referrals. Archived, confidential WCP session notes between July 1, 2019 and December 31, 2019 were reviewed and a simple tally system was used to record coping strategies, concerns, and referrals made. RESULTS: Partner and family issues were the most prevalent concern, followed by mental health issues, and relationships with colleagues, faculty, or staff. Most residents described several coping strategies: 66.36% listed two to three, and 26.36% listed four or more. Referrals were offered to community or employee assistance program therapists, follow-up with the OPV, psychiatry, couple counseling, given Web based psychoeducational links, or referred to their program director. Nine other residencies requested the WCP providing anecdotal evidence of its feasibility and usefulness. DISCUSSION: As the pandemic surged, these visits normalized reflections about wellbeing, intentional coping strategies, and resilience practices. We continue to gather data to refine and further structure this program and help residents monitor and address their resilience needs and wellness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Intimate Partner Violence Experienced by Physicians.

PURPOSE: World Health Organization (WHO) defines intimate partner violence (IPV) as physical, sexual or psychological harm caused by an intimate partner or ex-partner. There are few studies describing interpersonal violence (IPV) among physicians. Our study describes IPV experienced by U.S. physicians. METHODS: This was a multicenter survey administered to 4 physician groups in 2015 to 2016. In total 400 respondents returned survey results. Measures included current IPV, childhood abuse, mental health, professional role, and demographics. RESULTS: IPV was reported by 24% of respondents. The most frequent abuses reported were: verbal (15%), physical (8%) followed by sexual abuse (4%) and stalking (4%). Logistic regression model found that IPV was more likely to be reported by older participants (aged 66-89), those who experienced childhood abuse, working less than full time, and had been diagnosed with a personality disorder. Women and Asian Americans reported slightly higher IPV rates. CONCLUSIONS: Our study has implications for both medical education and intervention development. Universal screening and education that addresses clinical implications when treating peers who experience IPV are needed. Workplace interventions that consider unique physician characteristics and experiences are needed, as well as programs that support sustained recovery. This is the first survey to our knowledge that confirms that physicians experience IPV at a rate consistent or higher than the national level. We developed a standardized instrument to assess IPV in male and female physicians at various career stages. We also identified significant predictors that should be included in IPV screening of potential physician victims.

Consistencies and Discrepancies Between the Expectations of Urology Trainees and the Experience of Practicing Urologists.

OBJECTIVE: To compare the expectations of urology trainees with the experience of practicing urologists. METHODS: Residents, fellows, and practicing urologists were surveyed in 2018 regarding weekly work hours, number of hospitals covered, call nights per week, administrative workload relative to residency, annual net income, and time to pursue personal interests and hobbies. Urology trainees, defined as residents and fellows, were also surveyed regarding their expectations for clinical practice. The expectations of trainees were compared with the reported experience of practicing urologists using 1-tailed t test and chi-square analysis. Trainee expectations were also stratified by age, gender, training level, relationship status, and whether trainees had dependent children. RESULTS: The expectations of 99 trainees were compared with the reported experience of 377 practicing urologists. Trainees expect to work more hours but less call nights per week than reported by practicing urologists while annual net income was either consistent or underestimated. Compared to practicing urologists, however, trainees appear to underestimate the administrative workload relative to residency and overestimate time to pursue personal interests and hobbies. Junior residents were more likely to underestimate administrative workload than senior residents and fellows. CONCLUSION: While the expectations of urology trainees for work hours and annual net income were fairly consistent with those reported by practicing urologists, trainees may underestimate administrative workload and overestimate time to pursue personal interests and hobbies.

Fostering self-awareness in collaborative reflective training: Commentary response.

Replies to comments by DeCaporale-Ryan, Dadiz, and Peyre (see record 2016-27364-002) on the original article by Kim, Hernandez, Lavery, and Denmark (see record 2016-18380-001). The current authors thank DeCaporale-Ryan, Dadiz, and Peyre for presenting a rich theoretical counterpoint to their article and respond to issues they raised regarding their collaborative reflecting team (CRT) model.

Stimulating reflective practice using collaborative reflective training in breaking bad news simulations.

Medical simulation has long been used as a way to immerse trainees in realistic practice scenarios to help them consolidate their formal medical knowledge and develop teamwork, communication, and technical skills. Debriefing is regarded as a critical aspect of simulation training. With a skilled debriefing facilitator, trainees are able to go beyond a rote review of the skills and steps taken to explore their internal process and self-reflect on how their experience during the simulation shaped their decision making and behavior. However, the sense of vulnerability is an aspect of experiential training that can raise a trainee's defensiveness. Anxiety increases when trainees anticipate being evaluated for their performance, or when the simulation scenario pertains to complex interpersonal activities such as learning how to break bad news (BBN), a commonly encountered aspect of medical practice with inadequate training. Thus, collaborative reflective training (CRT), developed out of ideas based in family therapy, was designed as an approach for facilitating open dialogue and greater self-reflection while receiving training in BBN. This article will discuss the conceptual framework of CRT, explain how it was developed, and describe the nature of how it was used with a team of neonatology and pediatric fellows and medical family therapy interns. (PsycINFO Database Record

Intimate Partner Violence Experienced by Physicians: A Review.

BACKGROUND: Physicians play a significant role in screening for domestic violence. However, little information is available about the prevalence of physicians who experience intimate partner violence (IPV) or the implications for their clinical practice. National surveys indicate a potential prevalence of 16% for sexual abuse and 32% for abuse by an intimate partner. This extrapolates to more than 395,000 potential physician victims, the majority of which are women. METHODS: We conducted a systematic review of IPV and physician victims from 1990 to 2014 that included peer-reviewed journals, trade books, and dissertations that referenced physician victims. RESULTS: We identified 17 publications; nine quantitative studies, four first-person accounts, one qualitative study, and a qualitative dissertation that included two physician subjects. Two case studies of victimized physicians were identified in trade books. Quantitative results noted that women reported higher prevalence for all experiences of violence [childhood exposure (6%-32%), adult IPV exposure (7%-24%)] than men (6%-10%). CONCLUSIONS: This review highlights the need for improved understanding of physician experience with IPV, and development of physician-sensitive resources and treatment approaches. Contributions and limitations are provided for each publication. IPV exposure impacts clinical practice, including reticence to consistently screen patients. Lower reported prevalence may be related to extreme stigma among physicians that may prevent their reporting and help seeking, but more research is needed. We provide recommendations for clinical practice, education, and future research.

Marriage and family therapists and psychotropic medications: practice patterns from a national study.

A national sample of marriage and family therapists (MFTs) was used to describe practice patterns of MFTs whose clients use psychotropics and to compare medicated and nonmedicated clients. Marriage and Family Therapists (n=283) reported on 195 medicated and 483 nonmedicated adult clients. Clients (n=375) rated their improvement and satisfaction with treatment. Results showed that 91% of MFTs treat medicated clients, and these clients accounted for 25% of MFT cases. Medicated clients were most often seen in individual therapy, had more serious medical problems, and showed greater cumulative improvement in relational functioning. Therapists from MFT educational backgrounds had fewer medicated clients than MFTs from other educational backgrounds.

The Development of a Physician Vitality Program: A Brief Report.

We describe the development of an innovative program to support physician vitality. We provide the context and process of program delivery which includes a number of experimental support programs. We discuss a model for intervention and methods used to enhance physician resilience, support work-life balance, and change the culture to one that explicitly addresses the physician's biopsychosocial-spiritual needs. Recommendations are given for marriage and family therapists (MFTs) who wish to develop similar support programs for healthcare providers. Video Abstract.

Spouses in mixed-orientation marriage: a 20-year review of empirical studies.

Empirical studies on mixed-orientation marriage in social science journals from 1988 to 2008 were reviewed. Fifteen articles published in eight peer-reviewed journals were identified and discussed in terms of sampling, design, measures, rigor, theoretical framework, and literature review. An overview of each study is provided along with a summary of critical findings. Implications and recommendations for future research and education are offered.