Jeffrey Silver Humanism in Healthcare Research Roundup – December 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

Everyday resilience: Practical tools to promote resilience among medical students.     Gheihman G, Cooper C, Simpkin A. J Gen Intern Med. 2018 Dec 10.
Dr. Arabella Simpkin is a Mapping the Landscape grantee.
How can medical students learn to be resilient? A 90-minute student-led workshop was designed for first-year medical students to define and discuss resilience and learn two tools (“Breaking Down ‘Easy’” and “My Resilience Practice”) to help prevent burnout. Seventeen students answered pre- and post-session surveys. 94% of the students felt the workshop was valuable. Most reported little or no exposure to burnout and resilience training before the workshop, and also felt that more training was needed. Moreover, the students felt the resiliency tools were easy to use and served as a good resource. The authors found this proof-of-concept pilot shows that resiliency tools can be easy to use and teach, and that students can serve as facilitators in introducing resiliency.

Internal medicine residency program director burnout and program director turnover: Results of a national survey     O’Connor AB, Halvorsen AJ, Cmar JM, Finn KM, Fletcher KE, Kearns L, McDonald FS, Swenson SL, Wahi-Gururaj S, West CP, Willett LL. Am J Med. 2018 Oct 30.
Dr. Colin West is a Mapping the Landscape grantee.
The position of residency program director is demanding and complex, and turnover has been a concern. Program directors’ characteristics were collected from the Association of Program Directors in Internal Medicine (APDIM) national survey, along with data related to whether the program director was considering resigning, burnout, and turnover rates. This study examined results from 2012 to 2016, with 217 to 255 responses each year. About one-third of respondents each year met the criteria for burnout and about half of respondents had considered resigning. The prevalence of burnout remained the same over time. Interventions to identify and then prevent burnout among program directors may help with resignation and turnover rates.

The correlation between neonatal intensive care unit safety culture and quality of care. Free full text    Profit J, Sharek PJ, Cui X, Nisbet CC, Thomas EJ, Tawfik DS, Lee HC, Draper D, Sexton JB. J Patient Saf. 2018 Nov 7.
Dr. Eric Thomas is a Mapping the Landscape grantee.
Does performance of a neonatal intensive care unit (NICU) correlate with caregiver perceptions of a culture of safety? In a cross-sectional study, clinical quality was measured via the Baby-MONITOR (a quality of care tool). Ratings were collected from 2,073 professional caregivers of safety and teamwork climate using the Safety Attitudes Questionnaire. NICU teamwork and safety climate ratings were correlated with decreased healthcare-associated infection only. All other measures of clinical outcomes were not correlated, which was a surprising finding of the study. The authors recommend caution in the expectation that cultivating a culture of safety will translate into broad quality improvements.

Variability of burnout and stress measures in pediatric residents: An exploratory single-center study from the pediatric resident burnout-resilience study consortium.     Reed S, Kemper KJ, Schwartz A, Batra M, Staples BB, Serwint JR, McClafferty H, Schubert CJ, Wilson PM, Rakowsky A, Chase M, Mahan JD. J Evid Based Integr Med. 2018 Jan-Dec.
Dr. Alan Schwartz is a Mapping the Landscape grantee.
What personal and professional factors contribute to physician burnout during the residency period? A physician wellness questionnaire was utilized twice to examine variable influences and predictors of burnout and compassionate care. 108 residents completed both surveys. Over 3 months, burnout increased, empathy decreased, and stress led to emotional exhaustion. Resilience predicted increased compassionate care and decreased burnout, and mindfulness also predicted decreased burnout. Consequently, among pediatric residents, interventions related to lowering stress and fostering mindfulness and resilience may be important considerations in decreasing burnout.

Development and pilot testing of a simulation to study how physicians facilitate surrogate decision-making based on critically ill patients’ values and preferences.     Scheunemann LP, Khalil R, Rajagopal PS, Arnold RM. J Pain Symptom Manage. 2018 Nov 5.
Dr. Robert Arnold is a Mapping the Landscape grantee.
Simulation has been used to gain skill acquisition in healthcare, but little research has been conducted on the affective domain of learning. A simulation scenario involving an elderly patient on mechanical ventilation was created using the expertise of an advisory board. A standardized patient played the role of the patient’s daughter. Physicians rated the scenario as real and acceptable in order to gain skills in surrogate decision-making based on an incapacitated ICU patient’s and family member’s values and preferences. The authors concluded that simulation can be a valuable tool to help physicians practice and learn the difficult clinical skill of shared decision-making.

Other Publications

Physician stress and burnout: the impact of health information technology.     Gardner RL, Cooper E, Haskell J, Harris DA, Poplau S, Kroth PJ, Linzer M. J Am Med Inform Assoc. 2018 Dec 5.
How is stress from using health information technology (HIT) related to burnout among physicians? HIT-related stress was defined as difficulties related to documentation with an electronic health record (EHR), EHR use at home for documentation beyond work hours, and frustration with technology. In a survey of 1,792 physicians, 70% of physicians who used EHRs reported HIT stress. The presence of any of the 3 HIT-related stresses independently predicted burnout. Moreover, those with time pressure for documentation who completed documentation at home had 1.9 times the odds of burnout; those reporting low/marginal time for EHR documentation had 2.8 times the odds of burnout; and those who said the EHR added to daily frustrations had 2.4 times the odds of burnout.  Understanding the challenges that physicians are feeling associated with HIT stress can help organizations take steps to address them.

The stress from EHR demands, and how it has affected physicians’ daily mental efforts, was also chronicled recently in a thought-provoking commentary with hand-drawn illustrations by Dr. Elizabeth Toll, a Mapping the Landscape grantee: The other office.     Toll ET. J Am Med Inform Assoc. 2018 Nov 22.

Defining empathy to better teach, measure, and understand its impact     Dohrenwend AM. Acad Med. 2018 Dec;93(12):1754-1756.
The definition of empathy remains ambiguous and difficult to separate from other communication skills. Frequently, instruments used to measure empathy select either a single cognitive or multidimensional emotional focus. The author of this invited commentary proposes defining empathy as a single cognitive process and thus clearly distinguishing empathy from other forms of communication. She defines empathy as a “conscious, strenuous, mental effort to clarify a patient’s muddy expression of her experience using a soft interpretation of her story.” Four aspects are empathy are used to understand the concept: the “as if” condition (putting yourself in the patient’s shoes, “as if you had her feet”), the use of soft interpretation (a careful sensitivity), the primacy of cognition (adding clinical expertise to the expressions), and the relevance of reflection (provider self-reflection on patient encounters). A shared understanding of the definition of empathy will facilitate teaching, measuring, and a better understanding of its impact.

Embodying compassion; a systematic review of the views of nurses and patients.     Durkin J, Usher K, Jackson D. J Clin Nurs. 2018 Nov 28.
How is compassion expressed by nurses and received by patients? A systematic literature review was conducted using a meta-ethnographic approach and followed PRISMA-P reporting guidelines. Definitions of compassion were explored, along with the delivery of compassion by nurses, and the experience of compassion by patients. Themes from the review included virtuous motivation, emotional connection, communication and building an understanding, being present, and taking action to provide individualized care. The articles drew out the role of suffering in compassion.  The authors explained, “Compassion occurs in partnership with nurse as the observer of suffering and patient as the one who suffers.” The expression of compassion by nurses depended greatly on the recognition of and emotional connection to the patient’s suffering.

Nurse practitioner-physician comanagement: A theoretical model to alleviate primary care strain Free full text     Norful AA, de Jacq K, Carlino R, Poghosyan L. Ann Fam Med. 2018 May;16(3):250-256.
Nurse practitioners are increasingly finding roles in primary care. This article proposes a co-management model between a nurse practitioner and a physician. The model emerged out of a literature review of 156 studies, which helped to identify antecedents, attributes, consequences, and effects of co-management, and 26 in-person qualitative interviews with nurse practitioners and physicians. Three critical elements of co-management were identified: effective communication; mutual respect and trust; clinical alignment/shared philosophy of care. The interviews indicated that co-management can lead to improved balance of workload, prevent burnout, improve quality care, and enhance patient access to care.

Tresa Kaur

Research Roundup Editor

Disseminates current issues, trends, and research on humanism and healthcare.