Jeffrey Silver Humanism in Healthcare Research Roundup – May 2018

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

Awareness of bullying in residency: Results of a national survey of internal medicine program directors
Ayyala MS, Chaudhry S, Windish D, Dupras D, Reddy ST, Wright SM.    J Grad Med Educ. 2018 Apr;10(2):209-213.
Dr. Wright is one of our Gold Professors.
Researchers conducted a survey of internal medicine program directors (PDs).  Sixty-two percent of the 368 PDs responded to the survey. Less than one-third reported being aware of bullying in their residency programs during the previous year. There were no significant differences in program or PD characteristics between respondents who reported bullying in their programs and those who did not. Those who acknowledged bullying in their program were more likely to agree it had a significant negative impact on the learning environment (P < .0001).

Training surgical residents to use a framework to promote shared decision-making for patients with poor prognosis experiencing surgical emergencies Free full text
Chesney T, Devon K.    Can J Surg. 2018 Apr;61(2):114-120.
Dr. Devon is a Gold Foundation grantee.
Patients with poor underlying prognosis experiencing surgical emergencies face challenging treatment decisions, but the Best Case/Worst Case (BC/WC) framework has improved shared decision-making by surgeons. It is unclear whether residents can be similarly trained. Senior residents found the BC/WC tool to be acceptable and useful, and are amenable to training in this type of communication. After training, self-reported actions scores increased, and observed performance was accurate.

Physician burnout: Contributors, consequences and solutions Free full text
West CP, Dyrbye LN, Shanafelt TD.    J Intern Med. 2018 Mar 5.
All three authors are  Mapping the Landscape grantees.
This article provides an overview of the importance of studying physician burnout as well as rates, causes and effects of burnout. The authors provide insight into solutions, stating that the problem of physician burnout is best addressed when viewed as a shared responsibility of both healthcare systems and individual physicians. They also describe the gaps in knowledge, pointing out that longitudinal studies  of burnout’s effects and the impact of interventions on both burnout and its effects are needed, as are studies of effective solutions implemented in combination.

Other Publications

Effect of emergency physician burnout on patient waiting times
De Stefano C, Philippon AL, Krastinova E, Hausfater P, et al.    Intern Emerg Med. 2018 Apr;13(3):421-428.
Researchers conducted a study of all patients who visited an emergency department (ED) during a 4-month period. All emergency physicians had their level of burnout assessed using the Maslach Burnout Inventory. Researchers defined the level of burnout of the day in the ED as the mean burnout level of the physicians working that day. A logistic regression model was performed and researchers found that burnout of emergency physicians was independently associated with a prolonged waiting time.

Keystrokes, mouse clicks, and gazing at the computer: How physician interaction with the EHR affects patient participation
Street RL Jr, Liu L, Farber NJ, Chen Y, et al.    J Gen Intern Med. 2018 Apr;33(4):423-428.
Researchers conducted a cross-sectional, observational study of 217 patient visits with 32 physicians. They found that when physicians engaged in more keyboard activity, patients were less active participants. More physician gaze at the computer was associated with more silence in the encounter. Authors suggest that conversational flow can be better maintained if physicians ask about a patient’s thoughts and concerns or make social conversation while using the computer.

Qualities, teaching, and measurement of compassion in nursing: A systematic review
Durkin M, Gurbutt R, Carson J.    Nurse Educ Today. 2018 Apr;63:50-58.
Researchers conducted a systematic literature review of studies on compassionate nursing. Of the 21 studies that met their criteria, 14 identified characteristics of a compassionate nurse, three investigated teaching compassion to nursing students, and four reported on instruments used to measure compassion in nursing. They conclude that more research is needed to develop a teaching approach and psychometric measure for nurses’ compassion.

Burnout and self-reported suboptimal patient care amongst health care workers providing HIV care in Malawi Free full text
Kim MH, Mazenga AC, Simon K, Yu X, et al. PLoS One. 2018 Feb 21;13(2):e0192983.
Researchers conducted a cross-sectional study of 520 health care workers (HCWs) providing HIV care in 89 facilities in Malawi. Burnout was measured using the Maslach Burnout Inventory and nine questions adapted for this study assessed self-reported suboptimal patient care. Researchers found that 62% of the HCWs met criteria for burnout. The majority (89%) reported engaging in suboptimal patient care/attitudes including making mistakes in treatment not due to lack of knowledge/experience (52%), shouting at patients (45%), and not performing diagnostic tests due to a desire to finish quickly (35%).

What are healthcare providers’ understandings and experiences of compassion? The healthcare compassion model: A grounded theory study of healthcare providers in Canada Free full text
Sinclair S, Hack TF, Raffin-Bouchal S, McClement S, et al.    BMJ Open. 2018 Mar 14;8(3):e019701.
Researchers conducted a combination of focus groups and interviews of 57 individuals who were frontline healthcare providers or peer-nominated exemplary compassionate healthcare providers. Data was analyzed using Straussian grounded theory. Five categories and 13 associated themes emerged that depicted the dimensions of compassion and their relationship to one another. Compassion was conceptualized as-a virtuous and intentional response to know a person, to discern their needs and ameliorate their suffering through relational understanding and action.

Estimating time physicians and other healthcare workers spend with patients in an intensive care unit using a sensor network
Butler R, Monsalve M, Thomas GW, Herman T, et al. Am J Med. 2018 Apr 9. pii: S0002-9343(18)30296-1. Researchers used a network of stationary and wearable sensors to electronically record location and contacts among healthcare workers and patients under their care in a 20-bed intensive care unit for a 10-day period. Data analysis showed that day shift physicians spent 14% of their time in patient rooms and day shift nurses spent 32% of their time in patient rooms. Data was similar for night shift workers. They also found that physicians spend more than twice as much time in the physician work room (where electronic medical record review and documentation occurs) as they do with patients.

Brandy King, MLIS

Head of Information Services

Provides research services for staff, maintains resources on humanism and healthcare and works closely with Research Institute grantees.