Jeffrey Silver Humanism in Healthcare Research Roundup – May-June 2023

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.

Anti-oppressive pedagogy in medical education: A qualitative study of trainees and faculty Punchhi G, Shum K, Sukhera J. Med Educ. 2023 Jun;57(6):566-573. doi: 10.1111/medu.15016. Epub 2023 Jan 19. PMID: 36581567. Dr. Javeed Sukhera has been a Gold Foundation grantee Both Dr. Sukhera and Dr. Jasmine R. Marcelin have been Gold Humanism Scholars at the Harvard Macy Institute.
Anti-Oppressive Pedagogy (AOP) is a framework that centers on challenging inequalities and encompasses principles such as understanding social differences and context, the interaction between personal and political realms and the role of power, and the importance of reflexivity to understand interactions. Despite greater interest in health equity and justice in medical education little is known about how AOP can be applied. Gopika Punchhi and colleagues explored the implementation and impact of anti-oppressive pedagogy (AOP) through a qualitative study June-August 2021 involving 19 medical trainees and faculty, aiming to understand their experiences with AOP and its integration into medical curricula. Through constructivist grounded theory, the authors determined that AOP was often delivered through online modules or singular curricular interventions, which participants felt oversimplified the complexities of oppression. Participants also noted that existing curricula lacked a focus on systemic factors influencing health disparities. The study concluded that AOP was sparsely taught, poorly integrated, and fragmented throughout existing curricula, suggesting a need for more comprehensive and systemic approaches to incorporating AOP in medical education.

Assessing Disparities in Video-Telehealth Use and eHealth Literacy Among Hospitalized Patients: Cross-sectional Observational Study Cheng J, Arora VM, Kappel N, Vollbrecht H, Meltzer DO, Press V. JMIR Form Res. 2023 May 12;7:e44501. doi: 10.2196/44501. PMID: 37171854; PMCID: PMC10221502. Free full text Dr. Vineet M. Arora and Dr. Valerie Press have been Gold Foundation grantees
Telehealth use soared during the COVID-19 pandemic, but along with greater adoption of telehealth, disparities in skills, access, and use have become more apparent. Jessica Cheng and colleagues conducted a study to understand the role of eHealth literacy (eHL) in telehealth usage among a diverse group of adults. The study involved 297 adults, the majority of whom identified as Black (62%), with a median age of 58 years. The participants’ eHL was assessed using the eHealth literacy scale (eHEALS), and their telehealth usage, willingness to use video visits, and technology access were evaluated. The researchers found that participants with low eHL were less likely to have had a video telehealth appointment compared to those with adequate eHL (34% vs 61%). In a multivariable binary logistic regression analysis, unwillingness to use video technology for telehealth visits was significantly associated with older age, low eHL, lack of video capability, and lack of home internet access. Interestingly, health literacy was not a significant predictor for unwillingness to use video technology. The authors conclude that eHL plays a significant role in telehealth usage, particularly for video visits. They conclude that interventions to improve eHL could potentially increase the use of video telehealth services, thereby improving access to healthcare, especially among populations with low eHL.

At-Risk Work Hours Among U.S. Physicians and Other U.S. Workers Shanafelt TD, West CP, Sinsky CA, Trockel MT, Tutty MA, Wang H, Carlasare LE, Dyrbye LN. Am J Prev Med. 2023 May 5:S0749-3797(23)00166-6. doi: 10.1016/j.amepre.2023.03.020. Epub ahead of print. PMID: 37178097. Free full text Dr. Tait D. Shanafelt, Dr. Colin P. West, and Dr. Liselotte Dyrbye have been Gold Foundation grantees
Physicians work long hours, with multiple studies suggesting that they spend at least 10 more hours per week than workers in other fields. Systematic reviews have shown that chronically working more than 55 hours per week is associated with an increased risk of ischemic heart disease and stroke. But little is known about the implications of long work hours on physician health specifically. Dr. Tait D. Shanafelt and colleagues examined the work hours of U.S. physicians compared to other U.S. workers, as well as the potential health and professional implications of these hours. They conducted a national survey in fall 2020, which included 1,162 U.S. physicians, and compared it to a sample of 2,508 employed individuals aged 29-65 years from the general U.S. population. The survey asked participants to provide demographic information and indicate how many hours they worked in a typical week. Differences in weekly work hours by age, gender, and specialty were explored. They found that the mean weekly work hours for U.S. physicians was 50.8, compared to 40.7 in the general population. Fewer than 10% of U.S. workers in other fields surpassed 55 hours a week, compared with 40% of U.S. physicians. The study also found a strong relationship between average weekly work hours and mean emotional exhaustion and depersonalization scores and the risk of physician burnout. Based on these results, the authors concluded that the high work hours of physicians may undermine multiple aspects of the healthcare delivery system, including patient satisfaction, turnover, reductions in clinical work effort, quality of care, and costs.

Barriers and opportunities for implementation of a brief psychological intervention for post-ICU mental distress in the primary care setting – results from a qualitative sub-study of the PICTURE trial Sanftenberg L, Beutel A, Friemel CM, Kosilek RP, Schauer M, Elbert T, Reips UD, Gehrke-Beck S, Schubert T, Schmidt K, Gensichen J; PICTURE-study team. BMC Prim Care. 2023 May 6;24(1):113. doi: 10.1186/s12875-023-02046-0. PMID: 37149603; PMCID: PMC10163700. Free full text
Post-Intensive Care Unit (ICU) mental distress is a significant issue that can lead to lasting physical and psychological impairments. Psychological interventions have been proposed to help mitigate these long-term effects. However, there is limited understanding about how brief psychological interventions can be implemented in primary care settings to address this problem. Dr. Linda Sanftenberg and colleagues explored this issue through a qualitative exploratory sub-study of the PICTURE (“PTSD after ICU Survival”) trial, involving eight patients in Germany who received a brief intervention based on the Narrative Exposure Therapy (NET) from their General Practitioner (GP). The study identified four factors that strongly influenced the acceptance and perceived effectiveness of the intervention: 1) long-term trusting relationship between patient and the GP team, 2) intervention applied by a medical doctor, rather than a psychotherapist 3) professionalism of the GP team, with whom patients can share openly without fear of negative reactions, and 4) length of the intervention; two patients mentioned the limit of two sessions as a barrier. Despite the small sample size, the authors concluded that the primary care setting offers good opportunities for implementing brief psychological interventions for post-ICU impairments. The authors also cautioned that severely affected patients should be referred to specialized settings. Regardless, these results may help to empower the development of a stepped care approach for those experiencing post-ICU mental distress.

Barriers to Disclosure of Disability and Request for Accommodations Among First-Year Resident Physicians in the US Pereira-Lima K, Meeks LM, Ross KET, Marcelin JR, Smeltz L, Frank E, Sen S. JAMA Netw Open. 2023 May 1;6(5):e239981. doi: 10.1001/jamanetworkopen.2023.9981. PMID: 37166801; PMCID: PMC10176117. Free full text  Dr. Karina Pereira-Lima and Dr. Srijan Sen have been Gold Foundation grantees
The Accreditation Council for Graduate Medical Education (ACGME) has recently introduced disability-focused regulations, emphasizing disability as a key component of diversity, equity, and inclusion efforts in medical training. However, compliance with these requirements remains low, and stigmatizing attitudes toward disability persist in the medical field. To understand the barriers to disability disclosure and accommodation requests among resident physicians, Dr. Karina Pereira-Lima and colleagues conducted a cross-sectional survey. In June 2022, they surveyed 1,162 first-year resident physicians across the United States, assessing the frequency of disability reporting and requests for accommodations. The authors found that a significant number of residents did not request accommodations when needed, often due to fear of stigma or bias, lack of a clear institutional process for requesting accommodations, or lack of documentation to support the accommodation request. According to the authors, these findings underscore the urgent need for medical programs to commit to ACGME compliance and design policies that include clear processes for requesting accommodations.

Changes in Patient Perceptions of the Provider Most Involved in Care During COVID-19 and Corresponding Effects on Patient Trust Ren M, Zhang H, Meltzer D, Arora VM, Prochaska M. J Patient Exp. 2023 Apr 3;10:23743735231166501. doi: 10.1177/23743735231166501. PMID: 37035096; PMCID: PMC10074613. Free full text Dr. Vineet Arora has been a Gold Foundation grantee
The COVID-19 pandemic has disrupted routine clinical operations, including limits on the types of healthcare professionals allowed to perform in-person care and the frequency of times they could enter a patient’s room. Yet the impact of these changes on patients’ trust in the care they received during hospitalization is unknown. Megan Ren and colleagues aimed to determine whether patients’ perceptions of who was most involved in their hospital care changed from pre-pandemic to during the pandemic, and whether any were associated with changes in patients’ trust in their inpatient clinicians. They conducted follow-up interviews with 2,058 hospitalized patients on the general medicine service 30 days after discharge (1,626 before the pandemic and 432 during the pandemic). As part of the interviews, they asked participants to identify who was most involved in their inpatient care and how much trust they had in the physician caring for them. The study found that during the pandemic, patients were more likely to report attending physicians and nurses, and less likely to report residents/interns, medical students, or “don’t know” as most involved in their care. Patients who reported their attending physician was the most involved in their care were more likely to report trusting their doctor. The authors concluded that policies in medical education during the pandemic that limited trainees’ time in direct patient care may also have affected the development of clinical and interpersonal skills necessary to establish patient trust.

Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum Ayers JW, Poliak A, Dredze M, Leas EC, Zhu Z, Kelley JB, Faix DJ, Goodman AM, Longhurst CA, Hogarth M, Smith DM. JAMA Intern Med. 2023 Jun 1;183(6):589-596. doi: 10.1001/jamainternmed.2023.1838. PMID: 37115527; PMCID: PMC10148230.
The rapid adoption of virtual healthcare during the COVID-19 pandemic has led to an increase in electronic patient messages, adding to the workload of healthcare professionals and potentially contributing to burnout. In this context, the use of artificial intelligence (AI) assistants, such as ChatGPT, is being explored as a potential solution. Dr. John Ayers and colleagues compared the responses of ChatGPT and physicians to patient questions posted on a public social media forum, Reddit’s r/AskDocs. The cross-sectional study involved analyzing responses to 195 patient questions. Responses were evaluated by a team of licensed healthcare professionals, who evaluated both the quality of the information provided and the empathy or bedside manner. Compared to physicians who had answered in the online forum, ChatGPT was able to provide 3.6 times as many “good” or “very good” quality responses, and 9.8 times as many “empathic” or “very empathic” responses. These results suggest that AI assistants could be a helpful resource in managing the increasing volume of patient messages. However, the authors caution that further research is still needed to fully understand how AI assistants may improve responses, lower clinician burnout, and improve patient outcomes.

Connective and Tactfully Tactical: Connective Tactics and Professional Authority in Doctor-Patient Relationships Larsen LT, Cecchini M. Soc Sci Med. 2023 Jun;326:115924. doi: 10.1016/j.socscimed.2023.115924. Epub 2023 Apr 28. PMID: 37141679. Free full text
The doctor-patient relationship has always been a complex dynamic. Greater access to information through the internet has shifted the knowledge of patients and possibly the relationship itself. Dr. Lars Thorup Larsen and colleagues asked: “Medical authority is often thought to be threatened by lay access to information, but how does professional authority work when citizens have more knowledge and choices?” They explored this changing relationship through the lens of “connective tactics,” tools used by both doctors and patients to navigate their mutual authority. The researchers conducted qualitative in-person interviews with 20 doctors and 17 patients in Denmark before the pandemic, focusing on how physicians understood their roles, potential challenges to medical authority, and how they handle such situations. The authors found that doctors use tactics such as being understanding and sympathetic, making deals with patients, deflecting blame by drawing on rules and regulations, and using personal anecdotes. Patients, on the other hand, employ tactics such as complete acceptance and compliance, asking questions, and sometimes hiding non-compliance to maintain a good relationship without damaging the ongoing authority relationship with the doctor. The authors mention certain limitations, such as whether results can be generalized beyond the Danish cultural setting and into the COVID-19 era. Regardless, the study concludes that these connective tactics are crucial in building a relationship and maintaining a balance of authority in the doctor-patient relationship.

Longitudinal faculty development to improve interprofessional collaboration and practice: a multisite qualitative study at five US academic health centres Rider EA, Chou C, Abraham C, Weissmann P, Litzelman DK, Hatem D, Branch W. BMJ Open. 2023 Apr 18;13(4):e069466. doi: 10.1136/bmjopen-2022-069466. PMID: 37076167; PMCID: PMC10124268. Free full text  Dr. Elizabeth A. Rider and Dr. William Branch have been Gold Foundation grantees
The concept of relational learning in interprofessional education, which involves learning within oneself, with others, and within a system, is gaining traction but has not yet been extensively studied. To explore this, Dr. Elizabeth A. Rider and colleagues created and evaluated a yearlong interprofessional faculty development program involving 26 healthcare professionals from five U.S. academic health centers. The program focused on enhancing leadership and professionalism and used both critical reflection and experiential learning designed to promote teamwork, collegiality, self-knowledge, and communication skills. The participants, who included physicians, nurse practitioners, social workers, pharmacists, physical therapists, and administrators, submitted reflective essays that were analyzed using a constructivist grounded theory approach. The study found relational competencies at each of the three levels: 1) intrapersonal: reflective capacity/self-awareness, becoming aware of biases, empathy for self and mindfulness; 2) interpersonal: listening, understanding others’ perspectives, appreciation and respect for colleagues and empathy for others; and 3) systemic: resilience, conflict engagement, team dynamics, and utilization of colleagues as resources. The authors concluded that the faculty development program did achieve changes in attitude and relational learning, and that participants experienced meaningful change, including “decreased biases, increased-self-reflection, empathy and understanding of others’ perspectives and enhanced IP teamwork.”

Development, Feasibility, and Acceptability of an Oncologist Group Peer Support Program From ASCO’s Clinician Well-Being Task Force Hlubocky FJ, McFarland DC, Back AL, Friese CR, Lyckholm L, Gallagher CM, McGinnis M, Spence R, Lynch L, Tomkins J, Shanafelt T, Srivastava P. JCO Oncol Pract. 2023 Jun 16:OP2300068. doi: 10.1200/OP.23.00068. Epub ahead of print. PMID: 37327462. Dr. Anthony L. Back and Dr. Tait D. Shanafelt have been Gold Foundation grantees
The impact of the COVID-19 pandemic on oncologists’ practice and well-being has been significant, leading to increased burnout, occupational changes, and concerns about COVID-19 infection risk. To address this issue, Dr. Fay J. Hlubocky and colleagues developed a brief, biweekly, 2-hour-per-session oncologist-centered, virtual group peer support program and tested its feasibility, acceptability, and preliminary impact on well-being. The pilot program, conducted from February to May 2022, involved 5-10 members per group, with each group meeting for a total of 4 hours. The study found that the program was feasible and acceptable to participants, with three primary themes emerging from participant feedback: enhanced understanding of oncologist burnout, shared experiences in the practice of oncology, and fostering connections with diverse colleagues. The program yielded a statistically significant improvement in pre- and post-intervention well-being. Participants also suggested improvements, such as restructuring the peer support format and tailoring groups based on the oncologist practice setting. The authors concluded that such a peer support program can improve well-being and should be adopted by cancer organizations to address burnout and promote well-being among oncologists.

Reluctant heroes: New doctors negotiating their identities dialogically on social media Dornan T, Armour D, Bennett D, Gillespie H, Reid H. Med Educ. 2023 May 22. doi: 10.1111/medu.15109. Epub ahead of print. PMID: 37218311. Dr. Timothy Dornan, Dr. Helen Reid, and Dr. Deirdre Bennett have been Gold Foundation grantees
The transition from being a medical student to a practicing doctor is a challenging one, with the COVID-19 pandemic making it even fraught. Dr. Timothy Dornan and colleagues examined this transition process, specifically focusing on how new doctors, institutions, and other clinicians constructed their identities through Twitter posts. The study began in March 2020 and involved monitoring Twitter posts from medical students transitioning to practice, as well as posts from institutions and other clinicians. The researchers found that institutions initially used heroic rhetoric to elevate the status of new doctors, but this was soon contrasted by the posts of new doctors themselves, who expressed feelings of inadequacy, fear, and unpreparedness. The study concluded that the hierarchical nature of medical education and the tensions within it can have detrimental effects on new doctors. Researchers suggested that fostering dialogue between institutions, educators, interns, and medical students about these tensions could be beneficial: “to maintain the vitality of medical education, institutions should seek to reconcile their projected identities with the lived identities of graduates.”

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Bharat Kumar, MD

Humanism in Research Assistant Editor

Updates the staff, databases, and social media about new studies around humanism in healthcare; curates and compiles the monthly Jeffrey Silver Humanism in Healthcare Research Roundup.