Michael R. Floyd

Observations on Burnout in Family Medicine and Psychiatry Residents

ObjectiveTo investigate the relationship between burnout, work environment, and a variety of personalvariables, including age, gender, marital, parental and acculturation status within a population of family medicine and psychiatry resident physicians.MethodsBetween 2002 and 2005, 155 residents in family medicine and psychiatry at East Tennessee State University College of Medicine were surveyed at intervals using the Maslach Burnout Inventory and Work Environment Scale, form R, to assess their current state of emotional health and job satisfaction.ResultsFemale residents had lower scores on the Depersonalization scale of the Maslach Burnout Inventory (t = 3.37, p = 0.001). Parenting was associated with lower Depersonalization (t = 3.98, p<0.001) and Emotional Exhaustion (t = 2.59, p = 0.011). Residents from the United States culture reported higher Depersonalization and Emotional Exhaustion (t = −3.64, p<0.001; t = −3.85, p<0.001). On the Work Environment Scale, residents from United States culture reported less Task Orientation and Control but higher Work Pressure (t = 2.89, p = 0.005; t = 2.24, p = 0.027; t = −2.79, p = 0.006). Psychiatry residents reported less burnout than family medicine residents on the Depersonalization and Emotional Exhaustion scales (t = 2.49, p = 0.014: t = 2.05, p = 0.042) and higher Physical Comfort on the Work Environment Scale (t = −2.60,p = 0.011); while family medicine residents reported higher Peer Cohesion, Supervisor Support, and Autonomy (t = 3.41, p = 0.001; t = 2.38, p= 0.019; t = 2.27, p = 0.025).ConclusionThis study design, using well established, standard, and valid measures, identified important issues for further exploration: the relationship between acculturation to burnout the potential role of parenting as a protective factor from burnout, and the recognition that women residents may not be as vulnerable to burnout as previously reported.

Patients Prefer the Method of “Tell Back- Collaborative Inquiry” to Assess Understanding of Medical Information

Purpose: The goal of this study was to determine which approach to assessing understanding of medical information patients most prefer and perceive to be most effective. Methods: Two videos were shown to participants: (1) a physician explaining a medical condition and its treatment and (2) a physician inquiring about patient understanding of the medical information the patient had been given using 3 different types of inquiry: Yes-No, Tell Back-Collaborative, and Tell Back-Directive. Results: The Tell Back-Collaborative inquiry was significantly preferred over the other 2 approaches. Conclusions: Patients strongly prefer the Tell Back-Collaborative inquiry when assessing their understanding. We recommend that physicians ask patients to restate what they understand using their own words and that they use a patient-centered approach.

Intention for healthy eating among Southern Appalachian teens.

OBJECTIVE To describe the intention for healthy eating and its correlates among southern Appalachian teens. METHODS Four hundred sixteen adolescents 14- to 16-years-old were surveyed with self-administered questionnaires. RESULTS About 30% of the adolescents surveyed had definite intentions to eat healthfully during the next 2 weeks. The scales for perceived behavior control, attitude, perceived eating habits of significant others, and social support were shown to be fairly reliable (Cronbachs alpha=0.60 to 0.88). Perceived behavior control and attitude were positively associated with the intention for healthy eating. CONCLUSIONS Better behavior control and more positive attitude may lead to a stronger intention for healthy eating.

Insights about Psychotherapy Training and Curricular Sequencing: Portal of Discovery

ObjectiveThe authors discuss the curricular implications of a research project originally designed to evaluate the instructional strategy of using standardized patients in a psychotherapy training seminar.MethodsThe original project included second-year residents enrolled in an introductory psychotherapy seminar that employed sequential meetings with standardized patients. Residents were videotaped at baseline and at 6 week intervals; these sessions were rated by outside raters, standardized patients, and the residents themselves using two rating scales designed to assess psychotherapy skill. Results of the ratings were used to assess whether the instructional strategy was effective in teaching psychotherapy.ResultsData were analyzed for group and individual effects. Results of unpaired t tests revealed that as a group resident performance did not improve. Individual effects were examined using regression analysis of individual learning plots. This analysis revealed that residents differed widely in their individual responses to this instructional technique.ConclusionThese results precipitated a realization about the curriculum. Despite initial disappointment about the apparent limitations of the technique, thoughtful analysis prompted a reinterpretation that led to residency curriculum modification.

Innovative patient-centered skills training addressing challenging issues in cancer communications Using patient’s stories that teach

This workshop demonstrated the utility of a patient-centered web-based/digital Breaking Bad News communication training module designed to educate learners of various levels and disciplines. This training module is designed for independent, self-directed learning as well as group instruction. These interactive educational interventions are based upon video-recorded patient stories. Curriculum development was the result of an interdisciplinary, collaborative effort involving faculty from the East Tennessee State University (ETSU) Graduate Storytelling Program and the departments of Family and Internal Medicine at the James H. Quillen College of Medicine. The specific goals of the BBN training module are to assist learners in: (1) understanding a five-step patient-centered model that is based upon needs, preferences, and expectations of patients with cancer and (2) individualizing communication that is consistent with patient preferences in discussing emotions, informational detail, prognosis and timeline, and whether or not to discuss end-of-life issues. The pedagogical approach to the training module is to cycle through Emotional Engagement, Data, Modeled Practices, Adaptation Opportunities, and Feedback. The communication skills addressed are rooted in concepts found within the Reaching Common Ground communication training. A randomized control study investigating the effectiveness of the Breaking Bad News module found that medical students as well as resident physicians improved their communication skills as measured by an Objective Structured Clinical Examination. Four other similarly designed modules were also created: Living Through Treatment, Transitions: From Curable to Treatable/From Treatable to End-of-Life, Spirituality, and Family.