- Email: [email protected]
Resident Focused Wellness Series
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ABSTRACTS
OBJECTIVE: To evaluate a national blended clinical teaching skills curriculum for pediatric hospitalists. DESIGN/METHODS: The 12-month AAP and APA sponsored curriculum consists of program-specific and elective workshops, asynchronous interactive web-based assignments, reflections, facilitated discussions, and observations of clinical teaching by local/regional mentors. Half-day courses at two consecutive Pediatric Hospital Medicine annual meetings focus on the learning environment, teaching strategies, feedback, and learners in difficulty. Program evaluation included satisfaction, knowledge, and self-efficacy data. Participants evaluated individual workshops and program as a whole. Learning and self-efficacy were measured through retrospective pre/post content area knowledge and efficacy self-assessments. Results were analyzed using t-tests and descriptive statistics. RESULTS: 14/16 participants graduated from the APEX program in the first year. 14/14 graduates completed the program assessment. In aggregate, the cohort shows statistically significant growth across all self-reported knowledge and self-efficacy domains. Participants rate the curriculum highly (with overall module ratings of 4.2-4.7, on a 5 point Likert scale). Unexpected benefits of the program were noted to include the networking/ cohort development and recognition as an educator by their institutions and others. 93% (13/14) graduates said they would make the decision to do it again (1 was unsure). Three workshops are being developed by the 2015 Cohort for submission to PAS and PHM. CONCLUSIONS: The APEX Teaching Program is an innovative multimodal curriculum to enhance the clinical teaching skills of a national cohort of clinical educators. APEX not only shows promise for developing individual clinician educators, but also those they teach through leading faculty development locally and nationally. 96. MENTORING RESEARCH AS A PATHWAY TO INCREASING ACADEMIC PRODUCTIVITY: A UNIQUE THEME FOR A FACULTY DEVELOPMENT PROGRAM Dana I. Williams, MD, Phoenix Children’s Hospital, Burt Feuerstein, MD, PhD, University of Arizona, Vasudha L. Bhavaraju, MD, Grace L. Caputo, MD, MPH, Phoenix Children’s Hospital, Phoenix, AZ BACKGROUND: Lack of time is a barrier to research productivity per faculty in academic residency centers. Residents and fellows help overcome this barrier, but require faculty mentoring skills in research methodology. We used the forum of Faculty Learning Community (FLC) to provide faculty development on mentoring research aimed at increasing faculty academic productivity. METHODS: Educational leaders at Phoenix Childrens Hospital partnered with the Office of Research at University of Arizona College of Medicine - Phoenix, to create a curriculum for a monthly, 1-hour session over 2 years. The formal curriculum was organized into the framework of: Prepare (question, literature, mentoring plan), Perform (study design, IRB submission, data analysis) and Present (abstract, manuscript preparation/review). Sessions included faculty career development, statistical support, grant writing, and funding by internal and external guests. Faculty-learner dyads presented research projects in various stages from preliminary concepts, designs, to data analysis and manuscript drafts, followed by interactive peer review with experienced researchers. RESULTS: About 15 faculty attended each session. 95% of participants ranked FLC as relevant and an opportunity to
ACADEMIC PEDIATRICS improve current practice (learning how to mentor). 92% of responders felt that FLC provided opportunities to create/revise protocols, policies and procedures. Eleven presentations by faculty and their learners, focused on nascent projects and actively discussed strengths, weaknesses and process improvement. All eleven completed scientific and regulatory review by institutional committees, nine were accepted at national meetings as posters and six have been submitted to peer review journals. 100% faculty felt satisfaction, mentoring and collegiality within a motivating FLC environment. Participants identified structured peer mentorship of faculty/learner research studies as most valuable. CONCLUSION: FLC on mentoring research was well-received with significant future potential to enhance faculty and learner academic accomplishments. 97. PEDIATRIC AND MED-PEDS RESIDENTS EMOTIONAL INTELLIGENCE SUB-SCORES VARY BY TRAINING YEAR Ramzan Shahid, MD, Jerold Stirling, MD, Loyola University, Maywood, IL PURPOSE: A physicians level of emotional intelligence (EI) positively correlates with patients’ trust, better patient followup, better doctor-patient relationships and increased patient satisfaction. Recent studies have begun assessing the level of EI demonstrated by resident physicians in various specialties. While most of these studies have focused on surgical specialties, fewer studies have included Pediatric and MedicinePediatric residents. The purpose of this study was (1) to determine the baseline EI scores of Pediatric and Med-Peds residents and (2) to compare EI scores between Pediatric and Med-Peds residents. METHODS: Residents from Pediatrics and Med-Peds residency programs at a university-based training program volunteered to complete an online self-report EI survey (EQ-i 2.0) in May 2015. A summary EI score report was generated for each resident by a consulting firm. De-identified score reports were compared between programs and by year of training. RESULTS: All pediatric and med-peds residents completed the survey (N¼47). The median score for the group as a whole for overall emotional intelligence was higher than the national average and considered to be in the high range (110). The highest median subcomponent scores were in Impulse Control (114) and Empathy (113) and the lowest subcomponent scores were in Independence (101) and Assertiveness (102). No difference was seen between pediatric residents and medicine-pediatric residents in their total EI scores or the various components. Residents in their early years of training (PGY 1-2) compared to later years of training (PGY 3-4) showed significant differences in the component of Assertiveness (100 vs 109, p¼0.002) and Empathy (115.5 vs 110, p¼0.03). CONCLUSION: As a group, Pediatric and Med-Peds residents scored lowest in areas of independence and assertiveness. While assertiveness scores did go up with added years of training, empathy scores decreased. Educational interventions to improve resident EI scores should focus on the areas of independence, assertiveness, and empathy. 98. RESIDENT FOCUSED WELLNESS SERIES Lorna Fitzpatrick, Karishma Kalwani, Justine Parmele, MD, Thomas Black, Buffalo, NY
ACADEMIC PEDIATRICS BACKGROUND: Resident Physician health and wellness are critical components of postgraduate education and training. Residency training can evoke a variety of challenges including physical and emotional burnout, lowered mood, feelings of inefficacy and social disconnection. As residents spend a majority of their time in the clinical setting, residency naturally creates a community which can be a major sponsor of wellness. METHODS: We surveyed the residents to obtain a baseline understanding of resident wellness behaviors including their physical, mental, spiritual, and emotional wellness. We used the standardized Perceived Stress Scale from the American Sociological Association to measure the residents perception of their own stress. Based on resident interest and response, we plan on offering wellness activities including walking groups, guided mediation, yoga, group volunteering, joint resident and faculty events, art therapy, and reading groups among others. Workshops will be offered to discuss trainee depression recognition and available counselling services, sleep behaviors, time management, as well as financial guidance and counselling. A post-survey will be given to the residents later in the academic year to measure changes in their wellness habits and stress level. RESULTS: 41 out of our 62 Pediatric and Combined Internal Medicine-Pediatric Residents returned the full survey. On average, they estimate that they participate in the daily wellness behaviors surveyed as follows: physical activity 2 days/week, eat at least 5 servings of fruits and vegetable 2.7d/wk, prayer 2.4d/wk, wake feeling rested 1.5d/wk, and get at least 7 hours of sleep 2.5d/wk. They feel fatigued 3d/wk, irritable or angry 1.9d/wk, lack interest/motivation 1.7d/wk, and skip a meal 3d/ wk. They had an average Perceived Stress Score of 16.4, above a standardized average of 14.2 in a national poll of respondents age 18-29. CONCLUSIONS: Pending results of post-survey. 99. AN INNOVATIVE APPROACH TO TEACHING PERSONAL AND PROFESSIONAL DEVELOPMENT AND RESILIENCY DURING PEDIATRICS RESIDENCY Amy E. Sass, MD, MPH, Adam A. Rosenberg, MD, University of Colorado, J. Lindsey Lane, BM BCh, Janice L. Hanson, PhD, Eds, University of Colorado, Aurora, CO BACKGROUND: The Pediatric Milestone Projects Personal and Professional Development (PPD) competency encompasses milestones that are integral to individual professional formation and resiliency. Clinical training during residency is largely experiential and PPD milestones are often not addressed explicitly. Reflection and deliberate practice can be used to promote development in these areas. OBJECTIVES: To develop, implement and evaluate a curriculum utilizing self-reflection and deliberate practice to promote PPD and resiliency during residency. METHODS: A longitudinal curriculum for the 2014-15 academic year was developed with five 3 hour, protected sessions focused on topics pertaining to the PPD milestones. Each session included a large group (LG) activity followed by a small group (SG) discussion. 84 residents were divided into 8 SGs composed of PL1s, PL2s and PL3s and 2 faculty facilitators. The LG topics were used in the SGs as triggers for reflection and discussion of issues pertaining to their practice, PPD and resiliency. Residents completed worksheets summarizing meaningful points from the session and described application strategies to improve their
ABSTRACTS
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practice and resiliency. Residents reported back and described their efforts and outcomes at subsequent SGs. Residents provided verbal feedback and completed written evaluations at the end of each session. RESULTS: Residents agreed that the topics were relevant to their experience as trainees. They enjoyed the LGs but favored the SG setting, describing it as a safe environment that was conducive to reflection and sharing and fostered inter-class collegiality and peer mentoring. They described sharing their experiences as normalizing and validating and although their efforts at deliberate practice were variable, they expressed learning from each others reports of application strategies and outcomes. CONCLUSIONS: This curriculum provided a learning environment that built collegiality, fostered peer mentoring and facilitated direct application of personal strategies to improve PPD and resiliency. 100. WELLNESS WEDNESDAYS Amanda D. Lee, MD, Jennie E. Lee, MD, Nuzhat Shaikh, MD, Kaiser Permanente Medical Group (Northern California), Oakland, CA, Rebecca Chasnovitz, MD, Kaiser Permanente Medical Group (Northern California), Oakalnd, CA BACKGROUND: The ACGME acknowledges that the demanding nature of residency can lead to fatigue, emotional exhaustion, and burnout. In our program, residents took initiative to create a wellness curriculum in order to help one another personally thrive as well as to benefit patient care. VISION: We aim to promote the physical, social, emotional, and spiritual health of all residents by reflecting on the challenges we all face, by fostering resiliency, and by harnessing our inner child through creativity, movement, and play. LEARNING ACTIVITIES: Wellness Wednesdays take place weekly during our 30-minute afternoon report. Each session focuses on rotating themes of Creativity, Patient Bonding, Movement, and Humanism. Residents or faculty facilitate each session, and all residents attend. Each session begins and ends with a one-minute meditation. Sessions are all activity-based and interactive. Creativity sessions have included creating a My Life Wheel and coloring. Movement has included Tahitian, Bollywood dancing, and Yoga. During Patient Bonding, residents spend time with one of their patients focused on an activity unrelated to medicine, such as reading, doing crafts, or walking the hallways. Humanism sessions are case discussions designed to spark conversation on common challenges residents face. ASSESSMENT: We collected baseline Maslach scores and conducted a needs assessment. Ongoing assessment at 3 and 6 months includes focus groups, Maslach scores, and formal course evaluations. Preliminary data from the 3 month Maslach inventory show a decrease in emotional exhaustion scores, stable depersonalization scores, and a slight decrease in personal accomplishment scores. 92% of residents felt that dedicating 30 minutes weekly toward wellness is an appropriate amount of time. The majority appreciate Creativity, Movement, Humanism, and one-minute meditation sessions. Challenges of Patient Bonding sessions include bonding with patients who have short stays and patient availability. CONCLUSION: Residents find dedicated time for wellness to be helpful in improving their overall well-being and were able to identify strengths of the curriculum and areas for improvement.
ABSTRACTS
OBJECTIVE: To evaluate a national blended clinical teaching skills curriculum for pediatric hospitalists. DESIGN/METHODS: The 12-month AAP and APA sponsored curriculum consists of program-specific and elective workshops, asynchronous interactive web-based assignments, reflections, facilitated discussions, and observations of clinical teaching by local/regional mentors. Half-day courses at two consecutive Pediatric Hospital Medicine annual meetings focus on the learning environment, teaching strategies, feedback, and learners in difficulty. Program evaluation included satisfaction, knowledge, and self-efficacy data. Participants evaluated individual workshops and program as a whole. Learning and self-efficacy were measured through retrospective pre/post content area knowledge and efficacy self-assessments. Results were analyzed using t-tests and descriptive statistics. RESULTS: 14/16 participants graduated from the APEX program in the first year. 14/14 graduates completed the program assessment. In aggregate, the cohort shows statistically significant growth across all self-reported knowledge and self-efficacy domains. Participants rate the curriculum highly (with overall module ratings of 4.2-4.7, on a 5 point Likert scale). Unexpected benefits of the program were noted to include the networking/ cohort development and recognition as an educator by their institutions and others. 93% (13/14) graduates said they would make the decision to do it again (1 was unsure). Three workshops are being developed by the 2015 Cohort for submission to PAS and PHM. CONCLUSIONS: The APEX Teaching Program is an innovative multimodal curriculum to enhance the clinical teaching skills of a national cohort of clinical educators. APEX not only shows promise for developing individual clinician educators, but also those they teach through leading faculty development locally and nationally. 96. MENTORING RESEARCH AS A PATHWAY TO INCREASING ACADEMIC PRODUCTIVITY: A UNIQUE THEME FOR A FACULTY DEVELOPMENT PROGRAM Dana I. Williams, MD, Phoenix Children’s Hospital, Burt Feuerstein, MD, PhD, University of Arizona, Vasudha L. Bhavaraju, MD, Grace L. Caputo, MD, MPH, Phoenix Children’s Hospital, Phoenix, AZ BACKGROUND: Lack of time is a barrier to research productivity per faculty in academic residency centers. Residents and fellows help overcome this barrier, but require faculty mentoring skills in research methodology. We used the forum of Faculty Learning Community (FLC) to provide faculty development on mentoring research aimed at increasing faculty academic productivity. METHODS: Educational leaders at Phoenix Childrens Hospital partnered with the Office of Research at University of Arizona College of Medicine - Phoenix, to create a curriculum for a monthly, 1-hour session over 2 years. The formal curriculum was organized into the framework of: Prepare (question, literature, mentoring plan), Perform (study design, IRB submission, data analysis) and Present (abstract, manuscript preparation/review). Sessions included faculty career development, statistical support, grant writing, and funding by internal and external guests. Faculty-learner dyads presented research projects in various stages from preliminary concepts, designs, to data analysis and manuscript drafts, followed by interactive peer review with experienced researchers. RESULTS: About 15 faculty attended each session. 95% of participants ranked FLC as relevant and an opportunity to
ACADEMIC PEDIATRICS improve current practice (learning how to mentor). 92% of responders felt that FLC provided opportunities to create/revise protocols, policies and procedures. Eleven presentations by faculty and their learners, focused on nascent projects and actively discussed strengths, weaknesses and process improvement. All eleven completed scientific and regulatory review by institutional committees, nine were accepted at national meetings as posters and six have been submitted to peer review journals. 100% faculty felt satisfaction, mentoring and collegiality within a motivating FLC environment. Participants identified structured peer mentorship of faculty/learner research studies as most valuable. CONCLUSION: FLC on mentoring research was well-received with significant future potential to enhance faculty and learner academic accomplishments. 97. PEDIATRIC AND MED-PEDS RESIDENTS EMOTIONAL INTELLIGENCE SUB-SCORES VARY BY TRAINING YEAR Ramzan Shahid, MD, Jerold Stirling, MD, Loyola University, Maywood, IL PURPOSE: A physicians level of emotional intelligence (EI) positively correlates with patients’ trust, better patient followup, better doctor-patient relationships and increased patient satisfaction. Recent studies have begun assessing the level of EI demonstrated by resident physicians in various specialties. While most of these studies have focused on surgical specialties, fewer studies have included Pediatric and MedicinePediatric residents. The purpose of this study was (1) to determine the baseline EI scores of Pediatric and Med-Peds residents and (2) to compare EI scores between Pediatric and Med-Peds residents. METHODS: Residents from Pediatrics and Med-Peds residency programs at a university-based training program volunteered to complete an online self-report EI survey (EQ-i 2.0) in May 2015. A summary EI score report was generated for each resident by a consulting firm. De-identified score reports were compared between programs and by year of training. RESULTS: All pediatric and med-peds residents completed the survey (N¼47). The median score for the group as a whole for overall emotional intelligence was higher than the national average and considered to be in the high range (110). The highest median subcomponent scores were in Impulse Control (114) and Empathy (113) and the lowest subcomponent scores were in Independence (101) and Assertiveness (102). No difference was seen between pediatric residents and medicine-pediatric residents in their total EI scores or the various components. Residents in their early years of training (PGY 1-2) compared to later years of training (PGY 3-4) showed significant differences in the component of Assertiveness (100 vs 109, p¼0.002) and Empathy (115.5 vs 110, p¼0.03). CONCLUSION: As a group, Pediatric and Med-Peds residents scored lowest in areas of independence and assertiveness. While assertiveness scores did go up with added years of training, empathy scores decreased. Educational interventions to improve resident EI scores should focus on the areas of independence, assertiveness, and empathy. 98. RESIDENT FOCUSED WELLNESS SERIES Lorna Fitzpatrick, Karishma Kalwani, Justine Parmele, MD, Thomas Black, Buffalo, NY
ACADEMIC PEDIATRICS BACKGROUND: Resident Physician health and wellness are critical components of postgraduate education and training. Residency training can evoke a variety of challenges including physical and emotional burnout, lowered mood, feelings of inefficacy and social disconnection. As residents spend a majority of their time in the clinical setting, residency naturally creates a community which can be a major sponsor of wellness. METHODS: We surveyed the residents to obtain a baseline understanding of resident wellness behaviors including their physical, mental, spiritual, and emotional wellness. We used the standardized Perceived Stress Scale from the American Sociological Association to measure the residents perception of their own stress. Based on resident interest and response, we plan on offering wellness activities including walking groups, guided mediation, yoga, group volunteering, joint resident and faculty events, art therapy, and reading groups among others. Workshops will be offered to discuss trainee depression recognition and available counselling services, sleep behaviors, time management, as well as financial guidance and counselling. A post-survey will be given to the residents later in the academic year to measure changes in their wellness habits and stress level. RESULTS: 41 out of our 62 Pediatric and Combined Internal Medicine-Pediatric Residents returned the full survey. On average, they estimate that they participate in the daily wellness behaviors surveyed as follows: physical activity 2 days/week, eat at least 5 servings of fruits and vegetable 2.7d/wk, prayer 2.4d/wk, wake feeling rested 1.5d/wk, and get at least 7 hours of sleep 2.5d/wk. They feel fatigued 3d/wk, irritable or angry 1.9d/wk, lack interest/motivation 1.7d/wk, and skip a meal 3d/ wk. They had an average Perceived Stress Score of 16.4, above a standardized average of 14.2 in a national poll of respondents age 18-29. CONCLUSIONS: Pending results of post-survey. 99. AN INNOVATIVE APPROACH TO TEACHING PERSONAL AND PROFESSIONAL DEVELOPMENT AND RESILIENCY DURING PEDIATRICS RESIDENCY Amy E. Sass, MD, MPH, Adam A. Rosenberg, MD, University of Colorado, J. Lindsey Lane, BM BCh, Janice L. Hanson, PhD, Eds, University of Colorado, Aurora, CO BACKGROUND: The Pediatric Milestone Projects Personal and Professional Development (PPD) competency encompasses milestones that are integral to individual professional formation and resiliency. Clinical training during residency is largely experiential and PPD milestones are often not addressed explicitly. Reflection and deliberate practice can be used to promote development in these areas. OBJECTIVES: To develop, implement and evaluate a curriculum utilizing self-reflection and deliberate practice to promote PPD and resiliency during residency. METHODS: A longitudinal curriculum for the 2014-15 academic year was developed with five 3 hour, protected sessions focused on topics pertaining to the PPD milestones. Each session included a large group (LG) activity followed by a small group (SG) discussion. 84 residents were divided into 8 SGs composed of PL1s, PL2s and PL3s and 2 faculty facilitators. The LG topics were used in the SGs as triggers for reflection and discussion of issues pertaining to their practice, PPD and resiliency. Residents completed worksheets summarizing meaningful points from the session and described application strategies to improve their
ABSTRACTS
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practice and resiliency. Residents reported back and described their efforts and outcomes at subsequent SGs. Residents provided verbal feedback and completed written evaluations at the end of each session. RESULTS: Residents agreed that the topics were relevant to their experience as trainees. They enjoyed the LGs but favored the SG setting, describing it as a safe environment that was conducive to reflection and sharing and fostered inter-class collegiality and peer mentoring. They described sharing their experiences as normalizing and validating and although their efforts at deliberate practice were variable, they expressed learning from each others reports of application strategies and outcomes. CONCLUSIONS: This curriculum provided a learning environment that built collegiality, fostered peer mentoring and facilitated direct application of personal strategies to improve PPD and resiliency. 100. WELLNESS WEDNESDAYS Amanda D. Lee, MD, Jennie E. Lee, MD, Nuzhat Shaikh, MD, Kaiser Permanente Medical Group (Northern California), Oakland, CA, Rebecca Chasnovitz, MD, Kaiser Permanente Medical Group (Northern California), Oakalnd, CA BACKGROUND: The ACGME acknowledges that the demanding nature of residency can lead to fatigue, emotional exhaustion, and burnout. In our program, residents took initiative to create a wellness curriculum in order to help one another personally thrive as well as to benefit patient care. VISION: We aim to promote the physical, social, emotional, and spiritual health of all residents by reflecting on the challenges we all face, by fostering resiliency, and by harnessing our inner child through creativity, movement, and play. LEARNING ACTIVITIES: Wellness Wednesdays take place weekly during our 30-minute afternoon report. Each session focuses on rotating themes of Creativity, Patient Bonding, Movement, and Humanism. Residents or faculty facilitate each session, and all residents attend. Each session begins and ends with a one-minute meditation. Sessions are all activity-based and interactive. Creativity sessions have included creating a My Life Wheel and coloring. Movement has included Tahitian, Bollywood dancing, and Yoga. During Patient Bonding, residents spend time with one of their patients focused on an activity unrelated to medicine, such as reading, doing crafts, or walking the hallways. Humanism sessions are case discussions designed to spark conversation on common challenges residents face. ASSESSMENT: We collected baseline Maslach scores and conducted a needs assessment. Ongoing assessment at 3 and 6 months includes focus groups, Maslach scores, and formal course evaluations. Preliminary data from the 3 month Maslach inventory show a decrease in emotional exhaustion scores, stable depersonalization scores, and a slight decrease in personal accomplishment scores. 92% of residents felt that dedicating 30 minutes weekly toward wellness is an appropriate amount of time. The majority appreciate Creativity, Movement, Humanism, and one-minute meditation sessions. Challenges of Patient Bonding sessions include bonding with patients who have short stays and patient availability. CONCLUSION: Residents find dedicated time for wellness to be helpful in improving their overall well-being and were able to identify strengths of the curriculum and areas for improvement.