Jeffrey Silver Humanism in Healthcare Research Roundup – November 2017

The Jeffrey Silver Humanism in Healthcare Research Roundup features summaries of recently published studies on humanism in healthcare. To receive email notification of new studies once per month, enter your information here and select “Jeffrey Silver Research Roundup” from the checkboxes at the bottom. See previous posts in this series.

Publications from Gold Foundation-Affiliated Authors

Electronic-clinical evaluation exercise (e-CEX): A new patient-centered EHR use tool
Alkureishi MA, Lee WW, Lyons M, Wroblewski K, Farnan JM, Arora VM.    Patient Educ Couns. 2017 Oct 10. pii: S0738-3991(17)30560-8.

This tool was created as a result of a Mapping the Landscape literature review grant.
Researchers developed a 10-item tool called Electronic-Clinical Evaluation Exercise (e-CEX) to assess EHR (electronic health record) communication skills. Second-year medical students participated in an EHR-use lecture and structured Clinical Examination (OSCE). Untrained third-year medical students participated in the same OSCE. The trained second-year students scored higher than untrained third-year students, providing evidence of discriminant validity. The study’s conclusion: e-CEX is a reliable, valid tool to assess medical student patient-centered EHR communication skills.

A multi-institutional longitudinal faculty development program in humanism supports the professional development of faculty teachers (free full text)
Branch WT Jr, Frankel RM, Hafler JP, Weil AB, Gilligan MC, Litzelman DK, et al.    Acad Med. 2017 Oct 3.

This study was funded by a grant from the Arnold P. Gold Foundation Research Institute.
The authors describe the first 11 academic years of a longitudinal, small-group faculty development program for strengthening humanistic teaching and role modeling at 30 U.S. and Canadian medical schools that continues today. Strong engagement and attendance by faculty participants as well as the multimodal evaluation suggest that the program may serve as a model for others.  The authors discuss the program’s learning theory, outline its curriculum, and reflect on the program’s accomplishments and future plans.

Medical licensure questions and physician reluctance to seek care for mental health conditions
Dyrbye LN, West CP, Sinsky CA, Goeders LE, Satele DV, Shanafelt TD.    Mayo Clin Proc. 2017 Oct;92(10):1486-1493.

Drs. Dyrbye, West and Shanafelt are Mapping the Landscape grantees.
Authors examined whether state medical licensure application questions (MLAQs) about mental health were related to physicians’ reluctance to seek help for a mental health condition because of concerns about repercussions to their medical licensure. Using information from 5,829 physicians, authors found that nearly 40% of physicians would be reluctant to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure.

‘Oh my God, I can’t handle this!’: Trainees’ emotional responses to complex situations
Helmich E, Diachun L, Joseph R, LaDonna K, Noeverman-Poel N, Lingard L, Cristancho S.    Med Educ. 2017 Oct 16.

Dr. Lingard is a Mapping the Landscape grantee.
Researchers asked 29 trainees to draw two rich pictures of complex clinical situations, one exciting and one frustrating. They used these pictures to guide semi-structured, individual interviews. Participants’ drawings depicted a range of personal emotions in response to complexity, and disclosed unsettling feelings and behaviors that might be considered unprofessional. The authors recommend helping students understand that feeling out of control is an inherent property of participating in complex clinical situations, and, by extension, that it is not something they will “grow out of” with expertise.

A critical appraisal of guidelines for electronic communication between patients and clinicians: The need to modernize current recommendations
Lee JL, Matthias MS, Menachemi N, Frankel RM, Weiner M. J Am Med Inform Assoc. 2017 Aug 25.
Dr. Frankel is a Mapping the Landscape grantee.
Researchers performed a narrative review of provider-targeted guidelines for electronic communication between patients and providers. Across 11 identified guidelines, the primary focus was on technical and administrative concerns. Guidelines appear to be based on minimal evidence and offer little guidance on how best to use electronic tools to communicate effectively.

Associations of physician empathy with patient anxiety and ratings of communication in hospital admission encounters
Weiss R, Vittinghoff E, Fang MC, Cimino JEW, Chasteen KA, Arnold RM, Auerbach AD, Anderson WG.  J Hosp Med. 2017 Oct;12(10):805-810.

Dr. Arnold is a Mapping the Landscape grantee.
Researchers recorded interactions between 76 patients and their physicians across two academic hospitals. They found that when physicians responding empathically to their patients’ negative emotions, patient anxiety was reduced. Physicians who responded empathically did not spend longer on their appointments than physicians who did not respond empathically.

The business case for investing in physician well-being (free full text)
Shanafelt T, Goh J, Sinsky C.  JAMA Intern Med. 2017 Sep 25.
Dr. Shanafelt is a Mapping the Landscape grantee.
Financial costs associated with burnout include turnover, decreased productivity, as well as financial risk and threats to longterm viability due to lower quality of care, decreased patient satisfaction, and problems with patient safety. In this paper, the authors provide conservative formulas to determine the financial return on organizational investments to reduce physician burnout; a model outlining the steps of the typical organization’s journey to address this issue; and critical ingredients to making progress.

Other Publications

Examining patient-provider relationship (PPR) quality and patient activation in the Medicare population
Mattingly TJ 2nd, Tom SE, Stuart B, Onukwugha E. Aging Clin Exp Res. 2017 Jun;29(3):543-548.
 Researchers surveyed over 15,000 patients to learn about their relationships with their healthcare providers and their willingness and ability to take actions to independently manage their health.  They found that patients with stronger relationships with their providers are also more active in healthcare decisions.

Beyond the chief complaint: Our patients’ worries
Chau VM, Engeln JT, Axelrath S, Khatter SJ, Kwon R, Melton MA, et al. J Med Humanit. 2017 Oct 4.
Fourth-year medical students who were Gold Humanism Honor Society members distributed cards to patients in the emergency department asking “What Worries You Most?” The students returned to collect the cards and discuss patients’ answers with them, often talking for a half hour or more. They found that patients’ responses were often unrelated to their chief complaints. This activity provided them with a way to meaningfully engage with their patients.

Personality traits are associated with academic achievement in medical school: A nationally representative study
Sobowale K, Ham SA, Curlin FA, Yoon JD.  Acad Psychiatry. 2017 Aug 4.

Authors surveyed over 400 medical students during their third and fourth years to learn more about which personality traits were associated with receiving honors/highest grade in clinical clerkships, failing a course or rotation, and being selected for the Alpha Omega Alpha or Gold Humanism Honor Society. They found that students with higher conscientiousness were more likely to be inducted into the Alpha Omega Alpha Honor Society, while students high in openness or agreeableness traits were more likely to be inducted into the Gold Humanism Honor Society.

Brandy King, MLIS

Head of Information Services

Provides research services for staff; creates resources on humanism and medicine; and maintains the Foundation’s website, blog and social media presence.