Jeffrey Silver Humanism in Healthcare Research Roundup – May-June 2024

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.

Physician perspectives on internet-informed patients: systematic review Lu Q, Schulz PJ. J Med Internet Res. 2024 Jun 6;26:e47620. doi: 10.2196/47620. PMID: 38842920. Free full text
The internet serves as a pivotal source of health information, significantly influencing patient behavior and interaction dynamics within the healthcare setting. To explore these dynamics further, Qianfeng Lu and Dr. Peter Johannes Schulz conducted a systematic review to explore physicians’ perceptions of patients’ internet health information-seeking behavior, their communication strategies, and the challenges they face with internet-informed patients. They identified 22 articles that seem to indicate that physicians have mixed views on patient internet use, ranging from positive to negative. Physicians tended to adopt one of two communicative strategies, either (1) participative — engaging with internet-informed patients constructively and (2) defensive — discouraging reliance on potentially unreliable online information. Challenges found in the literature included time constraints in consultations and a lack of training on guiding patients toward credible online health resources. The authors concluded by advocating for “a medical teaching curriculum that introduces reliable internet sites to physicians for patient reference” to better prepare physicians for handling internet-informed patients.

Impact of heartfulness meditation practice compared to the gratitude practices on wellbeing and work engagement among healthcare professionals: Randomized trial Desai K, O’Malley P, Van Culin E. PLoS One. 2024 Jun 7;19(6):e0304093. doi: 10.1371/journal.pone.0304093. PMID: 38848338. Free full text
Stress, burnout, and compassion fatigue remain significant issues among healthcare team members. Mindfulness-based interventions, including meditation, have shown some promise in helping to address this problem, yet there is little data comparing different approaches and their effects on well-being, job satisfaction, teamwork, absenteeism, and collaboration. To help answer this, Dr. Kunal Desai and colleagues conducted a randomized controlled trial comparing the effects of a form of meditation termed Heartfulness meditation with gratitude practice on mental well-being among healthcare team members. The study utilized the Professional Quality of Life Scale-5 to measure Compassion Satisfaction, Burnout, and Secondary Traumatic Stress, and the Utrecht Work Engagement Scale to assess work-related vigor, dedication, and absorption. The trial involved 81 participants; half were nurses. They were randomly assigned to either a six-week trainer-guided virtual Heartfulness meditation program (n=55) or self-guided gratitude practice via podcasts (n=26). Results indicated a significant improvement in burnout and secondary traumatic stress among participants in the Heartfulness group, with a notable increase in vigor. Additionally, qualitative feedback highlighted enhanced sleep and reduced stress reactivity in the Heartfulness group, while those in the gratitude group reported uplifted moods and positive family interactions. The authors concluded by recommending further research through larger randomized trials to better characterize the efficacy of these practices in enhancing the well-being of healthcare team members.

‘Role model moments’ and ‘troll model moments’ in surgical residency: How do they influence professional identity formation? Bransen J, Poeze M, Mak-van der Vossen MC, Könings KD, van Mook WNKA. Perspect Med Educ. 2024 May 20;13(1):313-323. doi: 10.5334/pme.1262. PMID: 38800716; PMCID: PMC11122703. Free full text
Professional identity formation (PIF) in medical residency is a crucial learning process in which resident physicians internalize the professional standards and values of their community. To explore how role modeling influences PIF among surgical residents, Dr. Jeroen Bransen and colleagues conducted a qualitative study of 14 surgical residents and analyzed the data using a grounded theory approach. They found that role model behavior significantly impacts residents through specific, context-dependent “role model moments.” These moments are characterized by residents feeling inspired, involved, and a strong identification with the role model, leading to positive emulation. Conversely, negative “troll model moments,” dominated by adverse reactions to role model behaviors, prompt residents to reject certain behaviors. Through these experiences, residents learn to negotiate their values, strengthen desired attributes, and make individual choices critical to their professional development. The authors advocate for a shift in perspective, from simply “learning from role models” to “learning from role model moments.” This nuanced approach emphasizes the importance of recognizing both positive and negative modeling influences, facilitating better professional identity development by aligning these experiences with residents’ contextual factors and individual needs.

Statement of partnership and humility: A structural intervention to improve equity and justice in medical education Benoit LJ, Alves-Bradford JM, Amiel J, Gordon RJ, Lypson ML, Pohl DJ, Cunningham H. Acad Med. 2024 May 20. doi: 10.1097/ACM.0000000000005770. Epub ahead of print. PMID: 38768295. Dr. Jonathan Amiel has been a Gold Humanism Scholar at the Harvard Macy Institute, a member of the Gold Humanism Honor Society Advisory Council, and a National Humanism in Medicine Medalist.
Medical education innovations are essential to counteract the perpetuation of racial and other biases that contribute to significant health disparities. Dr. Laura J. Benoit and colleagues have responded to this urgent need with a “systematic, resource-negligible approach” aimed at improving anti-bias education in medical schools. Recognizing that systemic racism and biases are often unknowingly passed down through medical education, Dr. Benoit and her team developed and implemented a Statement of Partnership and Humility (SPH) disclosure slide. This slide is presented at the beginning of each preclinical lecture, encouraging faculty to acknowledge potential biases in their teaching materials and to openly invite student feedback. The SPH slide initiative is part of a broader effort to create a safe, inclusive, and nonjudgmental educational environment where both students and faculty can engage in meaningful discussions about biases without fear of retaliation. Initial results indicate that the SPH slide not only raises faculty awareness about biases but also significantly reduces faculty anxiety regarding student feedback, thereby increasing student involvement and fostering a healthier learning atmosphere. The authors concluded by emphasizing the importance of continuing to evaluate the impact of the SPH slide through both qualitative and quantitative research to assess its effectiveness in promoting psychological safety and openness to feedback.

Impact of a virtual coaching program for women physicians on burnout, fulfillment, and self-valuation Smith S, Goldhaber N, Maysent K, Lang U, Daniel M, Longhurst C. BMC Psychol. 2024 Jun 5;12(1):331. doi: 10.1186/s40359-024-01763-0. PMID: 38840137; PMCID: PMC11155151. Free full text
Burnout among physicians remains a major workforce challenge and has been associated with medical errors, self-reported suboptimal patient care, reduced professional work effort, self-reported unprofessional behaviors, and lower productivity. Coaching has been posited as an intervention to help with burnout but most programs have been institutional with coaches not being physicians. To evaluate how a virtual coaching program tailored for female physicians impacts burnout, Dr. Sunny Smith and colleagues conducted a retrospective cohort study of a coaching program that included a combination of individual, small group, and large group sessions over eight weeks. They found that there were significant improvements in the well-being of the 201 participants: Burnout rates decreased from 77.1% to 33.3%, professional fulfillment increased from 27.4% to 68.2%, and self-valuation, which measures self-compassion, improved markedly. The changes observed had large to very large effect sizes, indicating substantial clinical relevance. The authors concluded by emphasizing the potential of virtual coaching programs led by physician coaches to significantly alleviate burnout, enhance professional fulfillment, and foster self-compassion among physicians. Such non-institution-based coaching, accessible to physicians irrespective of geographic or workplace boundaries, offers a scalable and impactful strategy for addressing critical wellness issues in the medical profession.

Physicians’ attention to patients’ communication cues can improve patient satisfaction with care and perception of physicians’ empathy Campos CFC, Olivo CR, Martins MA, Tempski PZ. Clinics (Sao Paulo). 2024 May 3;79:100377. doi: 10.1016/j.clinsp.2024.100377. PMID: 38703716; PMCID: PMC11087704. Free full text
High-quality physician-patient communication is crucial for achieving patient satisfaction and enhancing perceptions of physician empathy, which in turn can lead to stronger relationships, more accurate diagnoses, and increased patient adherence. Yet the relationship between patient satisfaction and perceived empathy is not well characterized. To identify which specific communication skills influence patient satisfaction and perceived empathy in medical interactions, Dr. Carlos Frederico Confort Camposa and colleagues conducted an explorative, cross-sectional survey-based study using video recordings of 10 consultations between second-year internal medicine residents and their patients. The research team classified observed behaviors into 23 verbal and 6 nonverbal communications, and correlated them with patient ratings of care satisfaction and perceived empathy. Results indicated that negative communication behaviors such as expressions of disapproval, interruptions, and content questions from patients were inversely related to patient satisfaction and perceived empathy. In contrast, positive behaviors like patient affective expressions and physician advice or suggestions correlated positively with these outcomes. While small and observational in nature, the authors concluded by emphasizing that training physicians to recognize and respond appropriately to patient communication cues could foster more satisfactory and empathetic therapeutic relationships.

Curricular reform in serious illness communication and palliative care: Using medical students’ voices to guide change Reidy JA, Brizzi K, Chan SH, Day H, Epstein SK, Fischer M, Garg PS, Gosline A, Jaramillo C, Livne E, Mitchell S, Morgan S, Olmsted MW, Stebbins P, Stumpf I, Vesel T, Yeh IM, Young ME, Goldman RE. Acad Med. 2024 May 1;99(5):550-557. doi: 10.1097/ACM.0000000000005647. Epub 2024 Jan 29. PMID: 38277443.  Dr. Jennifer A. Reidy has been a Gold Humanism Scholar at the Harvard Macy Institute, and Molly W. Olmsted was formerly an intern of the Gold Foundation.
The integration of palliative care into U.S. medical school curricula has been increasing, but the content and timing vary widely, often leaving students feeling unprepared to manage serious illnesses effectively. Dr. Jennifer Reidy and colleagues explored this issue through a multicenter, qualitative study using a phenomenological approach and an immersion/crystallization qualitative data analysis to gather students’ views at two medical schools with strong palliative care programs. Their method involved conducting eight focus groups with a total of 50 medical students across four schools to understand their educational experiences and perspectives on serious illness communication (SIC) and palliative care. The results highlighted six key themes: (1) acquiring skills in SIC and palliative care collaboration is essential for all physicians, (2) training in SIC skills and palliative care should be required in medical school, (3) learning SIC skills by practicing with frameworks is preferred, (4) palliative care specialists are experts but a scarce resource, (5) luck plays a role in observing good role models and participating in family meetings, and (6) regular practice in debriefing difficult, emotional situations is desired. Based on this feedback from students, the authors concluded by recommending significant curricular reforms to ensure all medical students receive comprehensive training in palliative care and serious illness communication and suggest that these reforms could serve as a national model for other medical schools.

New insights into physician burnout and turnover intent: a validated measure of physician fortitude Weinzimmer L, Hippler S. BMC Health Serv Res. 2024 Jun 18;24(1):748. doi: 10.1186/s12913-024-11186-7. PMID: 38890733; PMCID: PMC11186125. Free full text
Physician burnout continues to be a critical issue, exacerbated by increasing demands in healthcare and resulting in significant professional and financial consequences, including turnover.  Yet there is little understanding of how burnout contributes to turnover. To help explore this further, Dr. Laurence Weinzimmer and Dr. Stephen Hippler introduced and validated the concept of physician fortitude, “an interpersonal attitudinal attribute that enables one to succeed under repeated pressure and stress.” To investigate and validate this concept, they conducted a survey and employed exploratory factor analysis on a sample of 909 physicians, Advanced Practice Providers (APPs), and healthcare leaders to create a 12-item fortitude scale. A second sample of 212 participants further tested the scale for reliability and validity by comparing this scale to other scales for turnover intent, grit, hardiness, resilience, and mental toughness, as well as the three subdimensions of burnout (emotional exhaustion, depersonalization, and lack of personal achievement).  Through complex psychometric and statistical analysis, they demonstrated that fortitude significantly correlates with reduced levels of all three subdimensions of burnout as well as lower turnover intent. Notably, the fortitude measure explained more variance in these outcomes than other common measures, such as grit, hardiness, mental toughness, and resilience, indicating its unique contribution to understanding physician burnout and retention. The authors concluded by highlighting the effectiveness of the newly developed fortitude scale in capturing a broader range of adaptive responses to stress than previous measures. This opens new avenues for developing targeted interventions to enhance physician resilience and reduce burnout and suggests the potential for broad application across various healthcare settings.

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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.