Jeffrey Silver Humanism in Healthcare Research Roundup – September-October 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.

Ethical aspects of physician decision-making for deprescribing among older adults with dementia Norton JD, Zeng C, Bayliss EA, Shetterly SM, Williams N, Reeve E, Wynia MK, Green AR, Drace ML, Gleason KS, Sheehan OC, Boyd CM. JAMA Netw Open. 2023 Oct 2;6(10):e2336728. doi: 10.1001/jamanetworkopen.2023.36728. PMID: 37787993; PMCID: PMC10548310   Free full text Dr. Matthew Wynia has been a Gold Foundation grantee.
Deprescribing — that is, the physician-directed cessation of a medication that’s redundant or unnecessary — is an important aspect of patient-centric care that carries with it a variety of ethical dilemmas, especially for patients with dementia. Deprescribing may be seen as discontinuing treatment. Despite its importance, there is little information on how physicians navigate this situation. To explore this, Jonathan Norton and colleagues conducted a survey to examine the influences on physician decisions regarding deprescribing for elderly patients with cognitive impairments. A comprehensive 24-question survey was mailed to a random selection of 3,000 U.S. physicians specializing in family medicine, general, internal, or geriatric medicine, as listed in the American Medical Association’s Physician Masterfile for 2020-2021. 890 returned the surveys, of which 689 were sufficiently complete to analyze. Key findings revealed that physicians often prioritize patient symptoms, indicating a tilt toward autonomy in their ethical considerations. They also exhibited hesitancy in altering prescriptions initiated by other colleagues, suggesting a prioritization of autonomy and non-maleficence. Financial implications of continuing or discontinuing a medication was the least influential factor in proposed scenarios of deprescribing, reflecting the ethical principle of justice. The study’s insights underscore the need for guidelines rooted in ethical principles to guide complex deprescribing decisions, especially given the intricate tapestry of competing concerns in dementia care.

Using visual arts education and reflective practice to increase empathy and perspective taking in medical students Rezaei S, Childress A, Kaul B, Rosales KM, Newell A, Rose S. MedEdPORTAL. 2023 Sep 22;19:11346. doi: 10.15766/mep_2374-8265.11346. PMID: 37745278; PMCID: PMC10514245   Free full text
Empathy is vital for healthcare professionals, yet paradoxically, studies have shown that empathy levels in medical trainees tend to decline throughout their medical education. To address this, an art education elective was developed and offered to first-year medical students from 2017 to 2022, focusing on observation, reflective practice, and the influence of bias and perspective in art interpretation. Over the 5-year period, 128 students participated, with 89 completing the assessments. The effectiveness of this curriculum was gauged using the Interpersonal Reactivity Index (IRI) and self-assessments. The results revealed that the course significantly enhanced perspective taking, a cognitive component of empathy, with IRI scores rising from 19.0 to 20.2 (p < .0125). Furthermore, students reported better empathic communication, a heightened awareness of bias, and improved observational skills. Such findings suggest that integrating arts education and reflective practice can promote the development of empathy in medical students. This underscores the potential for arts-based pedagogies in fostering essential skills in healthcare training.

A pilot study of art museum-based small group learning for pre-health students Kelly-Hedrick M, Stouffer KM, Benskin E, Wolffe S, Wilson N, Chisolm MS. Adv Med Educ Pract. 2023 Sep 5;14:957-960. doi: 10.2147/AMEP.S403723. PMID: 37693300; PMCID: PMC10492539   Free full text Dr. Margaret S. Chisolm has been a Gold Foundation grantee and a Gold Humanism Scholar at the Harvard Macy Institute.
Pre-health professional students, in the process of developing their professional identity formation (PIF), can benefit from exposure to the arts and humanities. To explore this idea, a multidisciplinary team at Johns Hopkins University developed a series of art museum-based sessions specifically designed for these students. Over four unique sessions, lasting 2.5 hours each, a total of 23 students were introduced to various activities at the Baltimore Museum of Art. Six weeks post-session, 10 out of the 23 participants responded to an online survey. The results revealed that 90% of the respondents had not previously engaged in a similar museum-based experience. All respondents supported integrating such experiences into the pre-health curriculum, with 90% agreeing that it would enhance their future patient care. Thematic analysis of the open-ended responses identified three main insights gained: cultivation of the health professional, personal growth, and an increased awareness and appreciation of multiple perspectives. Despite the limited sample size and potential for bias due to self-selection, this pilot study indicates that integrating arts and humanities into the curriculum of pre-health students can be beneficial for their professional and personal development.

Gender and inconsistent evaluations: A mixed-methods analysis of feedback for emergency medicine residents Brewer A, Nelson L, Mueller AS, Ewert R, O’Connor DM, Dayal A, Arora VM. West J Emerg Med. 2023 Sep;24(5):847-854. doi: 10.5811/westjem.58153. PMID: 37788024; PMCID: PMC10527837   Free full text Dr. Vineet Arora has been a Gold Foundation grantee.
Emergency medicine is among the most male-dominated medical specialties, so ensuring that women in emergency medicine residency programs are treated equitably is an important priority. One area that may point to equitable or biased treatment is the content of evaluations. To investigate this, Dr. Alexandra Brewer and colleagues examined whether evaluations of emergency medicine (EM) residents contained disparities by gender. Conducted across four diverse academic EM training programs in the U.S. between July 1, 2013, and July 1, 2015, the research examined 11,845 numerical and textual evaluations made by 151 attending physicians observing 202 residents. The findings revealed that women EM residents received more inconsistent evaluations compared to men. This inconsistency was evident in two ways: 1) a discrepancy between numerical scores and the sentiment of textual comments, and 2) a deviation from the expected career progression of continuous improvement. Specifically, while male residents’ feedback aligned more closely with their numerical scores, female residents were more likely to receive positive comments with lower scores or negative comments with higher scores. Additionally, as residency progressed, male residents received increasingly positive feedback, whereas female feedback remained more mixed. The study underscores the gender inequality in resident evaluations, suggesting a need for training programs to ensure clear and consistent feedback for all residents irrespective of gender.

Health equity: A concept analysis Lewis CL, Yan A, Williams MY, Apen LV, Crawford CL, Morse L, Valdez AM, Alexander GR, Grant E, Valderama-Wallace C, Beatty D. Nurs Outlook. 2023 Sep 6;71(5):102032. doi: 10.1016/j.outlook.2023.102032. Epub ahead of print. PMID: 37683597   Free full text Dr. Cecelia L. Crawford has been a Gold Foundation grantee.
As health equity is gaining momentum as a cornerstone of public health, there is a pressing need to thoroughly understand its nuances and implications. To explore this further, Dr. Chrystal Lewis and colleagues conducted a comprehensive analysis of the entire concept of health equity. The study utilized a methodological concept analysis approach, ultimately identifying key attributes, antecedents (events that must be in place before the concept can occur), and consequences (incidents or events that happen as a result of the occurrence of a concept). To do so, they first conducted two systematic searches of literature, identifying 127 articles across a spectrum of health disciplines. Through their analysis, health equity was dissected into three key attributes: (1) ethical principles of beneficence, autonomy, and justice, (2) absence of unfair and avoidable differences, and (3) every person has a fair and just opportunity to attain full health potential. Six antecedents were also identified, including (1) environmental, (2) financial and economic, (3) law, political, and policy, (4) societal and structural, (5) research, and (6) digital divide and technology. Four consequences of health equity were also categorized: (1) increased multi-sector collaborations, (2) maximum physical, cognitive, and psychological abilities, (3) enhanced cost-saving in U.S. healthcare expenditure, and (4) visibly prominent health equity-focused research. The findings underscore that achieving health equity means more than just addressing disparities — it requires a holistic approach that considers societal structures, resources, and opportunities. The study serves as a foundational piece for future research and policy discussions, emphasizing that true health equity reflects a just and fair society where everyone has the opportunity to attain their highest level of health.

“I just want you to hear that term”: Characterizing language used in fetal cardiology consultations Schweiberger K, Harris KW, Kavanaugh-McHugh A, Soudi A, Arnold RM, Merlin JS, Kasparian NA, Chang JC. J Cardiovasc Dev Dis. 2023 Sep 13;10(9):394. doi: 10.3390/jcdd10090394. PMID: 37754823; PMCID: PMC10531623   Free full text Dr. Robert M. Arnold has been a Gold Foundation grantee.
Healthcare team members play a crucial role in clearly imparting diagnostic information to expectant parents. To understand the nature and impact of the language used in communicating with parents-to-be about complex congenital heart disease, Dr. Kelsey Schweiberger and colleagues embarked on an in-depth analysis of fetal cardiology consultations when the results were abnormal. Employing a qualitative study design, the researchers reviewed transcripts of 30 consultations between fetal cardiologists and parents-to-be at a single tertiary care center over a six-month period. Their analysis revealed that cardiologists frequently used “optimistic framing,” a type of language characterized by positivity and hope, especially when discussing potential outcomes or treatment options. While such framing might be intended to offer comfort and reassurance, it may inadvertently lead parents to develop unrealistic expectations or misunderstand the gravity of a diagnosis. Furthermore, the study identified that cardiologists often avoided or deferred discussions about potential complications, mortality, or termination of pregnancy. This study highlights the delicate balance healthcare professionals must strike between offering hope and ensuring clear, transparent communication. It underscores the need for clinicians to be acutely aware of their language choices and the potential implications these might have on parental understanding and decision-making.

Analysis of race and ethnicity among United States medical board leadership Jacobs JW, Fleming TK, Jagsi R, Stanford FC, Spector ND, Booth GS, Silver JK. J Womens Health (Larchmt). 2023 Sep;32(9):921-926. doi: 10.1089/jwh.2023.0088. Epub 2023 Jul 26. PMID: 37498526; PMCID: PMC10510691   Free full text Dr. Julie K. Silver has been a Gold Foundation grantee.
Diversity in medical board leadership is crucial for ensuring representation and addressing health disparities. To assess the representation of racial and ethnic groups in leadership positions within United States medical boards, Dr. Jeremy W. Jacobs and colleagues conducted a comprehensive analysis of Board director positions within the American Board of American Specialties (ABMS). In this cross-sectional study, the researchers examined the racial and ethnic composition of physicians within the 449 director positions across 24 boards in 2022. Two independent coders used online biographies and photographs to code directors by race and ethnicity. They found that, among the 415 physicians, there were 41 who were coded as Asian (12.3%), 34 as Black (8.2%), and 14 as Hispanic (3.4%). White physicians were overrepresented in 14 of these boards. When accounting for women, their analysis revealed that women who are members of minoritized groups were even more underrepresented. More than 60% of boards lacked women coded as either Black or Asian. This study underscores the pressing need for initiatives aimed at improving racial and ethnic diversity in medical board leadership, ensuring that these crucial decision-making bodies better reflect the diverse populations they serve.

Association of interview and holistic review metrics with resident performance-related difficulties in an internal medicine residency program Hemrajani R, Vettese T, Law K, Turbow S. J Grad Med Educ. 2023 Oct;15(5):564-571. doi: 10.4300/JGME-D-22-00726.1. PMID: 37781425; PMCID: PMC10539138   Free full text
The process of selecting medical residents often relies on metrics from interviews and holistic reviews, but the effectiveness of these metrics in predicting resident performance remains uncertain. To delve into this issue, Dr. Reena Hemrajani and colleagues investigated the association between interview and holistic review metrics and subsequent resident performance-related difficulties at Emory University’s Internal Medicine Residency Program. In this retrospective cohort study, data from 117 residents who matriculated between 2018 and 2020 was analyzed. The results indicated that seven interview and holistic review metrics were correlated with performance-related difficulties during residency. Factors linked to a lower risk of difficulties included (1) Gold Humanism Honor Society membership, (2) Alpha Omega Alpha membership, and higher scores on (3) United States Medical Licensing Examination Step 2 Clinical Knowledge, (4) general faculty overall interview, (5) leadership competency, and (6) leadership overall. The seventh metric, interview or file review “flags,” was correlated with a higher risk of difficulties. The study emphasizes the potential value of emphasizing holistic review of residency applications, as these results may be predictive of future performance.

Reimagining the rheumatology fellowship interview: Using participatory design-thinking process to create a more applicant-centered experience Kumar B, Feng A, Gheriani GA, Iftekhar A, Ni R, Dimachkie M, Gokalp G, Bazigh I, Moy L, Chao C, Lingamaneni A, Patel A, Cepero GS, Iqtidar T, Thoene PB, Knaack A, Swee ML, Suneja M, Davis B. ACR Open Rheumatol. 2023 Sep 19. doi: 10.1002/acr2.11606. Epub ahead of print. PMID: 37724836   Free full text Dr. Bharat Kumar and Dr. Manish Suneja have been Gold Foundation grantees. Dr. Bharat Kumar is also the Humanism-in-Research Associate Editor for the Gold Foundation Research Roundup.
Traditional fellowship interviews have faced criticism for their potential inequities and stress-inducing nature. In response, Dr. Bharat Kumar and colleagues sought to redesign the rheumatology fellowship interview process to prioritize the needs and preferences of applicants. Employing a participatory design-thinking approach, the team gathered insights from 16 stakeholders, including 9 fellowship applicants, 4 current fellows, and 3 faculty physicians, to guide a redesign of the interview experience. Through a 5-step process (empathize, define, ideate, prototype, and test), they redesigned elements of the applicant interview. The finalized prototype prioritized (1) customization of interview experiences, (2) greater facilitation by fellows, (3) better preparation of interviewers, and (4) hybridization of virtual and face-to-face elements. This initiative showcases the power of a participatory design-thinking approach in transforming traditional practices of interviewing into more inclusive and applicant-centered experiences.

Effect of a novel online group-coaching program to reduce burnout in female resident physicians: A randomized clinical trial Fainstad T, Mann A, Suresh K, Shah P, Dieujuste N, Thurmon K, Jones CD. JAMA Netw Open. 2022 May 2;5(5):e2210752. doi: 10.1001/jamanetworkopen.2022.10752. Erratum in: JAMA Netw Open. 2022 Jun 1;5(6):e2220348. PMID: 35522281; PMCID: PMC9077483 Free full text
Burnout among female resident physicians is a recognized issue, impacting their well-being and patient care. Dr. Tyra Fainstad and colleagues explored the efficacy of an online group-coaching program in addressing this challenge. In this randomized clinical trial, 101 female resident physicians at the University of Colorado were divided into two groups: one participated in a 6-month web-based group-coaching program called “Better Together Physician Coaching” (n=50), while the other received standard institutional well-being resources (n=51). The primary outcome measure was the Maslach Burnout Inventory (MBI) score at 6 months. Results showed a significant reduction in burnout symptoms for participants in the group-coaching program compared to those who only received standard resources. Specifically, the group-coaching cohort demonstrated improved emotional exhaustion and depersonalization scores on the MBI. Additionally, those in the professional coaching group also had lower impostor syndrome scores and increased self-compassion scores. This study underscores the potential benefits of an online group-coaching approach as a scalable intervention for reducing burnout among female resident physicians.

When Did the Empathy Die?: Examining the Correlation Between Length of Medical Training and Level of Empathy Dinoff A, Lynch S, Hameed AS, Koestler J, Ferrando SJ, Klepacz L. Med Sci Educ. 2023 Mar 17;33(2):489-497. doi: 10.1007/s40670-023-01768-1. PMID: 37251206; PMCID: PMC10020755 Free full text
Empathy, “broadly defined as the ability to imagine and understand the thoughts, perspective, and emotions of another,” is a complex multi-dimensional concept that has been shown to improve both patient outcomes and patient and clinician satisfaction. Despite its importance, there is concern about the decline in empathy as medical students progress through their training, as prior studies have revealed. Dr. Adam Dinoff and colleagues conducted a cross-sectional study assessing self-reported empathy among 179 medical students at New York Medical College in August 2020. The participants completed the Jefferson Scale of Empathy-Student Version and were asked to indicate their top choice of specialty. The results showed the mean levels of empathy of the fourth-year medical students were lower than first-year students. Students interested in pediatrics reported higher empathy scores compared to those interested in other specialties. Additionally, those identifying as women were also more likely to have higher empathy levels. However, the authors do acknowledge limitations, such as self-selection bias, since only 179 out of 840 total medical students responded. Regardless, the authors conclude that “medical schools must place a greater effort on teaching and enhancing clinical empathy in students to benefit future patients as well as the well-being of the students throughout their professional careers.”

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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.