Julie Brennan

DSM-5 PTSD's symptom dimensions and relations with major depression's symptom dimensions in a primary care sample

Existing literature indicates significant comorbidity between posttraumatic stress disorder (PTSD) and major depression. We examined whether PTSDs dysphoria and mood/cognitions factors, conceptualized by the empirically supported four-factor DSM-5 PTSD models, account for PTSDs inherent relationship with depression. We hypothesized that depressions somatic and non-somatic factors would be more related to PTSDs dysphoria and mood/cognitions factors than other PTSD model factors. Further, we hypothesized that PTSDs arousal would significantly mediate relations between PTSDs dysphoria and somatic/non-somatic depression. Using 181 trauma-exposed primary care patients, confirmatory factor analyses (CFA) indicated a well-fitting DSM-5 PTSD dysphoria model, DSM-5 numbing model and two-factor depression model. Both somatic and non-somatic depression factors were more related to PTSDs dysphoria and mood/cognitions factors than to re-experiencing and avoidance factors; non-somatic depression was more related to PTSDs dysphoria than PTSDs arousal factor. PTSDs arousal did not mediate the relationship between PTSDs dysphoria and somatic/non-somatic depression. Implications are discussed.

Designing and implementing a resiliency program for family medicine residents

Family medicine residents are at risk for burnout due to extended work hours, lack of control over their work schedule, and challenging work situations and environments. Building resiliency can prevent burnout and may improve a resident’s quality of life and health behavior. This report describes a program designed to build resiliency, the ability to bounce back from stress, in family medicine residents in a medium sized U.S. residency training program. Interactive sessions emphasized building self-awareness, coping skills, strengths and meaning in work, time management, self-care, and connections in and outside of medicine to support resident well-being. System changes which fostered wellness were also implemented. These changes included increasing the availability of fresh fruits in the conference and call room, purchasing an elliptical exercise machine for the on call room, and offering a few minutes of mindfulness meditation daily to the inpatient residents. Results to date show excellent acceptance of the program by trainees, increased consumption of nutritious foods, more personal exercise, and self-reported decreased overreactions to stress. Resiliency programs can effectively serve to meet accreditation requirements while fostering residents’ abilities to balance personal and professional demands.

Group Visits and Chronic Disease Management in Adults: A Review

Chronic disease management using the traditional 15-minute appointment is exceptionally challenging and arguably inadequate to provide comprehensive, prospective, patient-centered primary care. A model of care designed to promote patient education, patient self-management, and improved access to their physicians and other health care providers is needed. Group visits have been identified as one model that allows physicians to deliver extensive patient education and self-management instruction while enhancing financial productivity. A thorough review of the literature on group visits was performed. Fairly consistent results from level I and II quality of evidence from a revised Strength of Recommendation Taxonomy (SORT) rating system indicate that patients who attended group visits demonstrated improved standards of care, improved quality of life, greater patient and physician satisfaction, lower rates of hospitalization and emergency department utilization, and reduced specialty costs. Discrepancies from the literature review include body mass index, hemoglobin A1C, blood pressure, and lipids. Overall, group visits appear to provide an effective and complementary strategy to traditional primary care in dealing with the complexities of providing chronic disease management in an increasing complex and aging population.

Stress Management Intervention for First Year Medical Students

Numerous studies have demonstrated the deleterious psychological and physical effects medical school has on students. There are, however, only a few intervention studies that have focused on improving medical students’ ability to cope with this intense stress. This article describes an eight-session stress management program that can be implemented with first-year medical students. The program was designed based on a review of the literature regarding typical sources of stress during the first year of medical school. Each session was interactive and focused on improving skills to manage stress. Medical students who agreed to participate filled out a program evaluation upon completion of the program. Overall, 80% of students were satisfied with the program, and 76% percent would recommend it to other students. Our findings show that it is both beneficial and feasible to offer a stress management intervention to first-year medical students.

Emotional Status of Third Year Medical Students and Their Responses to a Brief Intervention

Three classes of entering third-year medical students answered questions regarding emotional and physical stress responses and self care behaviors and were screened for anxious and depressive symptoms. The most common stress response was emotional and the majority of students felt the most tension in their neck and shoulders. Students’ primary self care behavior was exercise. Sixteen percent screened positive for depressive symptoms as assessed by the Patient Health Questionnaire-2 (PHQ-2) and 24% screened positive for anxiety as assessed by the Generalized Anxiety Disorder-2 (GAD-2) scale. A brief relaxation exercise was offered to students and resulted in statistically significant increases in perceived relaxation, lower tension, and increased skin temperature, a physiological indicator of relaxation. While a short relaxation intervention can produce significant improvements in stress-related symptoms, some students may be at risk for emotional disorders during medical school and need further evaluation and treatment.

Curricular integration of social medicine: a prospective for medical educators

In the United States, the health of a community falls on a continuum ranging from healthy to unhealthy and fluctuates based on several variables. Research policy and public health practice literature report substantial disparities in life expectancy, morbidity, risk factors, and quality of life, as well as persistence of these disparities among segments of the population. One such way to close this gap is to streamline medical education to better prepare our future physicians for our patients in underserved communities. Medical schools have the potential to close the gap when training future physicians by providing them with the principles of social medicine that can contribute to the reduction of health disparities. Curriculum reform and systematic formative assessment and evaluative measures can be developed to match social medicine and health disparities curricula for individual medical schools, thus assuring that future physicians are being properly prepared for residency and the workforce to decrease health inequities in the United States. We propose that curriculum reform includes an ongoing social medicine component for medical students. Continued exposure, practice, and education related to social medicine across medical school will enhance the awareness and knowledge for our students. This will result in better preparation for the zero mile stone residency set forth by the Accreditation Council of Graduate Medical Education and will eventually lead to the outcome of higher quality physicians in the United States to treat diverse populations.In the United States, the health of a community falls on a continuum ranging from healthy to unhealthy and fluctuates based on several variables. Research policy and public health practice literature report substantial disparities in life expectancy, morbidity, risk factors, and quality of life, as well as persistence of these disparities among segments of the population. One such way to close this gap is to streamline medical education to better prepare our future physicians for our patients in underserved communities. Medical schools have the potential to close the gap when training future physicians by providing them with the principles of social medicine that can contribute to the reduction of health disparities. Curriculum reform and systematic formative assessment and evaluative measures can be developed to match social medicine and health disparities curricula for individual medical schools, thus assuring that future physicians are being properly prepared for residency and the workforce to decrease health inequities in the United States. We propose that curriculum reform includes an ongoing social medicine component for medical students. Continued exposure, practice, and education related to social medicine across medical school will enhance the awareness and knowledge for our students. This will result in better preparation for the zero mile stone residency set forth by the Accreditation Council of Graduate Medical Education and will eventually lead to the outcome of higher quality physicians in the United States to treat diverse populations.