Author Archives: Melissa Young

Wellness Can’t Wait

Wellness Can’t Wait

Burnout syndrome (BOS) is a serious epidemic that is adversely affecting between 40 to 75% of our healthcare trainees and professionals. Up to 12% of doctors with BOS express thoughts of suicide, and the rate of completed suicide in medical trainees is double that of the general population. In fact, we are losing almost 400 healthcare providers a year to suicide. This is comparable to losing the number of students in an average size medical school every year. We must address the issues of BOS now, before we lose anymore healthcare providers to suicide.

BOS is defined as the prolonged, psychological response to job-related, interpersonal stressors. BOS occurs when occupational demands exceed one’s ability to cope, and is characterized by three measurable domains:

  1. Emotional Exhaustion: feelings of emotional and physical depletion.
  2. Depersonalization: a sense of indifference, detachment, or negative, cynical feelings toward patients and/or co-workers.
  3. Lack of Personal Efficacy: a decreased sense of personal accomplishment.

Occupational stressors leading to BOS accumulate during the preclinical training years, finally reaching a critical point during the later years of medical school or shortly after starting residency. Without improved coping ability during the first months of internship, as the workday becomes longer and patient responsibility increases, those more susceptible to BOS struggle to put present-day challenges in perspective. They may lose sight of the greater goal of graduating residency and going into practice.

Burnout may seem to be a purely personal issue, but in medicine that is not the case. The enormous burden that residents and medical students on rotation undertake to maintain patient quality-of-care could result in BOS with detrimental effects on the trainees’ personal lives and professional development. However, burnout also leads to negative ramifications for patients.

Professional Consequences

  • gaps in professionalism, including callous attitudes or overt hostility toward patients and co-workers
  • lack of career satisfaction
  • early retirement or leaving the profession

Personal Consequences

  • strained relationships, marital separation, or divorce
  • depression and anxiety
  • suicidal ideation/completed suicides

Patient Consequences

  • increased medical errors
  • less patient satisfaction with quality of care

I am presently at the AAIM meeting in Philadelphia and have had the opportunity to meet with dozens of residency program directors and discuss their departmental wellness initiatives. During those discussions five program directors confided in me that their programs have been devastated by recent resident suicides. Three out of five stated they did not see it coming. In contrast, other program directors told me that their residents were doing just fine and did not really need a wellness initiative. But how do they know? How do they be assured that they won’t be the next program director devastated by a resident suicide and dealing with the guilt that they did not do enough?

So when I say, “Wellness can’t wait!” –  I mean it literally.

Jeffrey Levy, MD
CEO, CaseNetwork
Author of CoreWellness: A Physician Wellness program

About CaseNetwork

CaseNetwork is a technology enhanced medical education company and the developer of CoreWellness: A Physician Wellness program – a 24 module online program that provides the tools needed for residents and medical students to overcome adversities, build resilience, improve wellness, and thrive. CaseNetwork also delivers competency-focused, case-based education that enables learners to improve their knowledge and comprehension of critical patient situations and disease states. CaseNetwork’s simulated patient encounters integrate evidence-based clinical information with required proficiencies and skills. CaseNetwork’s proprietary platforms include interactive decision making and peer-to-peer problem solving that is conveniently delivered in a browser or on a mobile device for anytime, anywhere learning. The CaseNetwork solution helps healthcare professionals advance their skills and improve competency with the ultimate goal of enhancing patient outcomes. For more information, visit www.casenetwork.com.

Education Philosophy: Part 2

After 30 years of innovations in medical education and training and conducting hundreds of live and online programs, I have gained some important insights into effective strategies that make educational programs more successful. I would like to share a few of these with you.

Blended Education Solutions
Medicine requires more complex education and training strategies than other disciplines due to the need to integrate cognitive (knowledge), technical (psychomotor/procedural), and nontechnical (e.g., communication, collaboration, professionalism, and management) skills within limited work hours. All learners, independent of learning styles and background knowledge and experiences must meet or exceed high level standards determined by government, medical societies, and regulatory/credentialing boards.

In my experience this is best accomplished by providing a blended solution education model that promotes interactivity and limits traditional lecturing. The blended solution model builds pre-knowledge through e-learning, so the adult learner comes to live meetings with a higher level of understanding and knowledge. Live meetings are reserved for “flipped classrooms” (facilitated discussions rather than teacher-directed lectures) and the training of technical and non-technical skills.

Contextualized Learning
Providing precise and directed information in the moment the learner needs it to build context around the present learning experience. This technique also ties information to past learnings and experiences to build “scaffolding” or “schema”.

Formative Feedback
Providing immediate feedback regarding decisions or actions within an education and training program. An emphasis on the avoidance, recognition, and management of errors fosters more efficient and effective implementation of learnings into clinical/surgical practice.

Information Reinforcement
Providing multiple “educational touch points” improves retention and provides opportunities for continued knowledge growth as experience increases.

Proficiency-based Progression
The process starts with deconstruction of a procedure into its component parts (task deconstruction). The learner can then undergo deliberate practice to perform a single task to a high-level benchmark set by experts. Once a single task is mastered (proficiency), other tasks increasing in difficulty and complexity (progression) are practiced and mastered. These tasks can be conducted in dry labs, wet labs, or simulation settings.

Procedure Practice
Once all of the component tasks from a particular procedure are mastered, they are reintegrated so the entire procedures can be practiced, mastered, and assessed. Such teaching should focus on the correct execution of the procedure, forward planning, decision making and error detection. This method improves safety and outcomes for full procedures. Procedures should be accomplished in a laboratory setting first (animal, synthetic, cadaver, or simulator models) before attempting them on a live patient. Appropriate mentoring/coaching should be included for the first several live cases to ensure successful procedure completion and patient outcomes before granting privileges for independent practice.

Team Training
Communication, collaboration, and professionalism are important components of any clinical, procedural, or surgical interaction and should be a critical part of any education and training program.

Social networking
Incorporate social networking using a peer-to-peer style of education into educational programs to improve learner engagement, retention, personalization, and application of materials.

Train-the-Trainer
Trainers should receive standardized training including learning theory, communication skills, and debriefing methodologies before being allowed to serve as a trainer. It is expected that the trainer is an expert in the subject matter, tasks, and procedures being trained. It is optimal to create opportunities for trainers to become ongoing mentors (or develop an additional long-term mentoring system possibly through telementoring) to continue to provide support to the trainee as his or her practice increases in complexity over time.

Metrics and Assessments
Create unambiguous metrics to assess a learner’s knowledge and skills in the most objective and reproducible manner. Binary metrics are preferred over more subject Likert scales.

Ongoing Tracking of Performance and Outcomes
The value of the education and training programs can only be evaluated and improved if data is collected regarding long-term clinical performance and patient outcomes. These measurements are for quality improvement opportunities and training remediation and should not be collected/analyzed for punitive purposes.

Jeffrey Levy, MD
CEO, CaseNetwork