Pamela A. Saunders

Stress Biomarkers in Medical Students Participating in a Mind Body Medicine Skills Program

Georgetown University School of Medicine offers an elective Mind-Body Medicine Skills (MBMS) course to medical students to promote self-care and self-awareness. Participating medical students reported better management of academic stress and well-being than non-participants. In this study, we sought to assess the stress-reducing effects of MBMS by measuring physiological changes in first-year medical students. Saliva samples were collected before (January, time 1 (T1)-pre-intervention) and upon completion of the course (May, time 2 (T2p)-post-intervention), as well as from non-participating medical students (May, time 2 (T2c)-control). The T2p and T2c collections coincided with the period of final examinations. Cortisol, dehydroepiandrosterone-sulfate (DHEA-S), testosterone and secretory immunoglobulin A (sIgA) were measured. The mean morning salivary cortisol at T2p was 97% of the mean at baseline T1 which was significantly lower than for T2c (2.4) (95% confidence interval (CI) 0.57–1.60, P =  .001); DHEA-S showed similar pattern as cortisol where the T2p levels were significantly lower than T2c (P <  .001) in both morning and evening collections. Testosterone ratio at T2p (0.85) was also lower than T2c (1.6) (95% CI 0.53–1.3, P =  .01). sIgA levels were not statistically different. On direct comparison, the T2c and T2p means were significantly different for all cortisol, DHEA-S and testosterone values. Participants maintained their hormonal balance within the normal range throughout the academic semester while the control group showed significantly increased levels, probably exacerbated by the end of the semester exam stress. To our knowledge, this is the first study to assess the physiologic benefits of a MBMS program in medical students.

Friendships among people with dementia in long-term care

Despite the growing literature on social interactions in dementia settings, few studies have investigated ‘friendships’ in people with dementia living in long-term care. ‘Social interactions’ describe communicating, verbally and/or non-verbally, at least once with another person while ‘friendship’ suggests a deeper, more meaningful connection that may include reciprocity, intimacy, and shared trust. During a 6-month, mixed-methods study, we investigated friendships among 31 assisted living residents with moderate to advanced dementia. Results revealed no correlation between test scores or demographic characteristics (except gender) and friendship dyads identified by staff. Staffs’ perceptions of residents’ friendships were not supported through our observations. We did observe friendships among residents characterized by voluntary participation and accommodation in conversation, and recognition of the uniqueness of the other. Findings suggest staff perceptions of residents’ friendships are not sufficient and that more research on this topic is needed.

‘Oh he was forgettable’: Construction of self identity through use of communicative coping behaviors in the discourse of persons with cognitive impairment

Communication involving persons with cognitive impairment (CI) associated memory issues requires particular attention in the clinical setting due to the sensitive and often difficult institutional work that must take place between the patient and his or her physician. An individual with CI is often tested for memory issues during the office visit, generating a potentially face-threatening situation. Said individual may attempt to preserve positive identity or ‘save face’ (Gumperz, 1982) by using communicative coping behaviors (CCBs). This study characterizes the use of CCBs (e.g., accounts and humor) by persons with CI in clinical interviews and provides important insight on how to improve doctor—patient communication involving people with CI. In order to describe and compare CCBs used by persons with cognitive impairment, and those used by cognitively normal individuals, verbatim, in-office transcripts from both groups were analyzed. Results showed that participants with CI used more memory accounts than cognitively normal individuals and similar amounts of humor in order to save face and construct a normal identity. These data help to inform doctors and caregivers regarding the ways in which persons with CI construct and preserve a positive sense of self-identity through communication.

The discourse of friendship: Mediators of communication among dementia residents in long-term care

One the most difficult challenges experienced by people with dementia and their caregivers is their communication. The ability to communicate is essential to creating and maintaining social relationships. Many individuals who suffer from dementia experience increased agitation and diminished social interaction in the long-term care living setting. This paper demonstrates how, through language, they construct social relationships. As part of The Friendship Study, which is an ethnographic observation of persons with dementia living in a long-term care setting, we analyzed transcripts from video- and audio-taped data and performed a discourse analysis of conversations to show how persons with dementia who live in a long-term care setting use language to create friendships. These analyses show that friendships are constructed using concepts such as conversational objects, discourse deixis, indexicality, and alignment among speakers.

Nested social groups within the social environment of a dementia care assisted living setting

The social environments of people with dementia are complex and still not fully understood. Investigating how residents in a dementia care setting navigate and participate within social groups is critical as the therapeutic benefits of social engagement are unequivocal. An ethnographic study of social environments within a dementia care residence revealed that there is active socialization and even strong and lasting friendships formed between people with dementia. Many of these relationships were observed to be a part of groups, ‘nested’ within the larger social environment. These ‘nested social groups’ had unique dynamics and their structuring was often influenced by outside factors (e.g. physical environment and staff preferences). The existence of these groups has implications for the experiences and quality of life of the residents in long-term care. Nested social groups will be defined and their function within the social environment will be discussed.

Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

ABSTRACT Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.

OA05.03. Impact of a mind-body medicine skills course on medical students’ perceived stress, mindfulness and elements of emotional intelligence

Purpose Most medical schools list self-awareness, self-care and personal growth as key educational competencies. Yet, studies have reported that traits such as altruism and empathy tend to decline throughout medical school training. To foster medical student self-awareness and mindfulness, which may improve their emotional intelligence (EI), Georgetown University School of Medicine (GUSOM) offers an experiential course to medical students in mind-body medicine skills. The purpose is to expose students to a variety of mind-body approaches (e.g., mindfulness meditation, autogenic training, guided imageries, movement, and writing exercises), as well as group sharing that involves listening generously and without judgment.

A qualitative analysis of beginning mindfulness experiences for women with post-traumatic stress disorder and a history of intimate partner violence

This article presents the beginning mindfulness experiences of low income, minority women with a history of intimate partner violence. Ten women participated in a Mindfulness-Based Stress Reduction group, three interviews and a focus group over 15 months. Using an interpretive phenomenological analysis approach, we derived the following themes: struggles to practice meditation; a vision of growing and helping; personal improvements, and interpersonal improvements. We share recommendations for clinical practice.

Friendships and the social environments of people with dementia: Introduction to the Special Issue:

Despite decades of work on friendships across the lifespan, only a limited body of work is focused on friendships among people with dementia, especially in advanced stages and in long-term care settings. The research and experiences presented in this Special Issue address this gap in the literature and comprise a collection of empirical and theoretical papers which focus on various elements of social interaction, friendships, and the social environments of people with dementia. The benefits of friendships and social contacts, including improved overall health and wellbeing, have been well described (Antonucci, Akiyama, & Adelmann, 1990; Berkman, Glass, Brissette, & Seeman, 2000; Berkman & Syme, 1979; Crohan & Antonnuci, 1989; Giles, Glonek, Luszcz, & Andrews, 2005; Kutner, Brown, Stavisky, Clark, & Green, 2000; Williams & Roberts, 1995) as have the consequences of social isolation, such as anxiety, depression, and anger and poorer physical health (Hawthorne, 2006; House, Robbins, & Metzner, 1982; Metzner & Fellner, 2010). Such compelling support for the importance of friendship leads to the question: Why have friendships among people with dementia been so understudied? Friendships, like many other aspects of dementia-related care and research, are not easily linked to long-term measurable cognitive, physical or psychological improvement. As Hopper (2003) argued in her paper advocating for language rehabilitation therapy for dementia residents in long-term care, the response is often, ‘They’re just going to get worse anyway’. The continuation of cognitive and physical decline associated with most

Validation of a Standardized Patient Checklist for Patient-Centered Communication: the G-PACER

This study sought to validate the Georgetown PAtient-CEnteredness Rating Scale (G-PACER) standardized patient (SP) checklist as a measure of patient-centered communication in patient-provider interactions. Patient centeredness is associated with improved doctor-patient communication and better health outcomes. Simulated medical encounters using SPs are an important way to teach and evaluate provider communication skills, yet validated SP scales that focus on patient-centered communication are limited. Two versions of an SP checklist of provider interaction behaviors, the G-PACER, were developed as part of a training designed to improve relationships between providers and patients who have experienced trauma. Concurrent validity of the G-PACER was assessed with Roter Interaction Analysis System (RIAS) summary scores, particularly the patient centeredness summary score. Item-total correlations were conducted to determine which items should be retained for future versions of the scale. Scores on the G-PACER were significantly correlated with the RIAS patient centeredness score. Correlation analysis also revealed significant associations between G-PACER total score and RIAS global affect ratings. The 12-item version of the G-PACER was performed at a commensurate level with the longer version; thus, its use is recommended in future research. This study represents an important step in the development of reliable, valid, and efficient tools to add to those available for evaluating patient-provider interactions from the SP perspective.