Harvard Macy Community Blog

Fostering the ongoing connectedness of health professions educators committed to transforming health care delivery and education.

Burnout: Addressing the epidemic in Medical Trainees

Burnout is a serious epidemic affecting medical students, residents, and practicing physicians. This past January, Mohammad Zaher authored an insightful blog discussing the current state of well-being in health care. This current blog will build on these ideas with a focus on medical trainees. In addition, I will discuss practical solutions that can be implemented at your institution to improve trainee well-being.

Burnout is defined as a work related syndrome of depersonalization, emotional exhaustion, and decreased sense of personal accomplishment. Studies have shown that burnout begins in medical school, and intensifies during residency. Furthermore, approximately 50% of practicing physicians meet criteria for burnout. Burnout has grave personal consequences for medical trainees, including decreased quality of life, higher rates of depression, and suicidal ideation. Professionally, burnout affects patient safety, physician turnover, and patient satisfaction. Given these undesirable outcomes, increasing efforts to target burnout and improve physician well-being are an important focus at many training programs. Experts and evidence have suggested a combination of individual and organizational approaches to target burnout. Read on to explore the problem of burnout in medical trainees and get ideas about interventions you can implement at your own institution.

Continue reading
1583 Hits
0 Comments

Exploration of Program Director Perspectives on Core EPAs for Entering Residency

This blog was co-authored by Gary L. Beck Dallaghan, Ph.D. and Michael Ashley, B.S.

In 2014, the Association of American Medical Colleges issued recommendations for essential activities every graduating medical student should be able to perform unsupervised. The guiding principles underscoring the development of these skills included patient safety and enhancing confidence of stakeholders regarding new residents' abilities. These activities are meant to be a foundational core and should complement specialty-specific competencies.

Englander and colleagues mirrored their conceptual framework of the core entrustable professional activities for medical students on that being used by residency training programs. This entailed systematically reviewing published graduation requirements, program director expectations for entering residents, and tasks residents perform without supervision. This helped them develop 21 distinct entrustable professional activities (EPAs) that are considered observable and measurable units of work that represent a variety of competencies expected of medical professionals. More than 100 unique educators representing the continuum of medical education settled on the 13 current EPAs.

Continue reading
1139 Hits
0 Comments

#MedEdPearls March 2018 - "Frame-Based" Feedback

A main learning component of skills and competencies is feedback.   As instructors, when a learner makes a mistake, we jump to the conclusion we know why the learner erred without inquiring about the learner’s thought-processes. “Frame-based” feedback is a strategy to avoid this feedback error and to teach more effectively and efficiently. In an excellent article* about frame-based feedback the authors suggests three quick steps to provide effective feedback while avoiding our own cognitive biases: 1) Provide initial and specific feedback on what you observed; 2) Inquire as to what the learner’s ‘frame of mind’ was; 3) match teaching points with the learner’s frames.

While no one wants to make a mistake and no one wants their mistake pointed out to them, without constructive feedback the learner loses opportunities to improve. As we continue to move toward milestones and competencies in assessment for medical education, we should focus on providing formative feedback to our learners.  

 
Reference:

Rudolph J, Raemer D, Shapiro J. We know what they did wrong, but not why: the case for 'frame-based' feedback. Clin Teach. 2013 Jun;10(3):186-9. doi: 10.1111/j.1743-498X.2012.00636.x

 

...
Continue reading
1740 Hits
0 Comments

Teaching about Health Equity and Advocacy? Consider the Hidden Curriculum

Our best intentions and goals as health professions educators can be easily undone or reinforced by the hidden curriculum.

As the intern completed her presentation on rounds, she said, “Dr. Campbell, this is Ms. Williams’* third admission in three weeks. She is clinically stable and can be discharged today but I’m worried she will soon be back in the hospital.” Imagine with me two possible scenarios: the first where the team discounts the intern’s fears and pushes for a quick discharge; the second where the team stops to explore what non-medical issues might be contributing to the patient’s readmissions, and works with the social worker to connect the patient with resources that help address those issues. What lesson does the intern learn from scenario one versus scenario two? Which hidden curriculum is at play in each scenario?

Recent comment in this post
Atipong Pathanasethpong, MD, MS

Address SDoH and fix the hidde...

I'm a firm believer in addressing the SDoH, and we certainly have a lot to improve on this issue. We say we should care for the pe... Read More
Wednesday, 07 March 2018 4:04 AM
Continue reading
1276 Hits
1 Comment

#HMIchat February 2018 – Let’s talk about trust - of the educator

#HMIchat February 2018 co-authors: Leslie Sheu (@lesliesheu), John Mahan (@MedEdMahan), Larry Hurtubise (@hur2buzy)

"I think to be an entrusted educator means that learners respect you, but also are not afraid to be themselves and be honest to you about their questions and needs." - Lindsey Smith (@DrLindseyMSmith)

We were thrilled that trust was the topic of this month’s #HMIchat, and were astounded to learn that this chat brought together 118 medical educators from around the world (including physicians, physician assistants, nurses, and researchers) across multiple specialties (including medicine, surgery, emergency medicine, ICU, physiatry, and pathology, to name a few).

We came out of the chat reinvigorated with thoughts on how to improve our own work and entrustability as educators, ideas on how to study or think about trust in a broader context, and ways to challenge our current framework. We thought we would frame our key take-aways around the 5 factors of trust (watch this video by Justin Kreuter (@kreuterMD) for a great summary!):

Continue reading
993 Hits
0 Comments