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This site in undergoing  EXTENSIVE SYSTEMATIC REORGANIZATION which will  be completed by early January 2015.   

FOR THOSE  WHO ARE VISITING FOR FIRST TIME PLEASE REVISIT  IN  at least by EARLY NOVEMBER 2015.   IF you would like an email when the reorganization is complete please email:   ann.davis@dartmouth.edu

IT WILL BE CHALLENGING  TO FIND RESOURCES EASILY DURING THIS REORGANIZATION!!!!   The NEW site will be easier to navigate and will include comment section so others with resources can share them in a comment and they will be added to the website.

We ask that any schools utilizing curricular suggestions also share their experiences including  assessments of curricular sessions in the  comment/blog sections of this website which will be  operational in 2015.

The primary goal of this site is to provide resources that may be useful in the development of a resilience curriculum/programs for use in  UME, GME, CME, and physician organizations.   A goal of the   potential Dartmouth Geisel School of Medicine resilience curriculum is to develop a curriculum that will  promote a life-long energized engagement in medicine and to minimize factors stifling personal growth and active learning through life, all of which are intrinsic to professionalism.

Resources are aimed at a curricular content that will  have a skill emphasis  on practical acquisition and enhancement of evidenced based resilience skills (“tools”) to improve student/physician performance, patient outcomes, self-care, career satisfaction,  altruism/humanism, and lifelong engagement with learning and medicine. The goal is to provide “tools”  that  reduce the impact of stress that is inevitable in life- long medical practice, and  “tools” that also  address the stressors that are amendable to change.

The menu topics in the black dashboard link to articles, documents, videos, and websites on  resilience. Hover over the  menu item ” Strategies for Resilience in Medicine”  in the black dashboard  to bring up a sub-menu that links to specific  strategies/“tools”  to facilitate resilience in medicine.   This Strategies  pages are  often called the “core  of this website”.

The  resources  on our website address  frequently asked questions such as: Does Resilience education work? , What are evidenced based resilience factors?, How can resilience be assessed? , Are there examples of resilience curriculum from other academic settings and organizations?, What is incremental self –theory? , How is metacognition related to resilience?   How does resilience affect patient care , safety, and professionalism in medicine?.

Ongoing Aspirations: 1. Collaboration with Dartmouth College undergraduate education and clinical faculty/ house staff at DHMC through the Physician Wellbeing Task Force and 2. Contribution to the academic literature and national professional organizations through research, sharing of resources,   and publications on resilience in medicine  including the AAMC Council of Faculty and  Academic Societies  ( CFAS) wellbeing task force.

Contacts: Craig Donnelly MD, Professor of Psychiatry (Craig.L.Donnelly@hitchcock.org) or Ann Davis MD, Professor of Obstetrics and Gynecology and Pediatrics (ann.davis@dartmouth.edu): Multiple other  Geisel specific documents and papers are available through the Geisel Resilience Curricular team.

 

Aspirations of the Geisel Dartmouth School of Medicine Resilience Curriculum

The primary goal of the resilience curriculum is to promote a life-long energized engagement in medicine and to minimize factors stifling personal growth and active learning through life, all of which are intrinsic to professionalism.

The  proposed ideal resilience curriculum  would include integrated  and “stand alone” longitudinal content over all 4 years of medical school.   Much of the content can be integrated into biomedical course work. Integration facilitates  utilization of the curriculum as an experiential laboratory. For example the bio statistics/ epidemiology course could  utilize  the student generated data from student  spit cortisol for statistical analysis and analyze for relationship to various valid assesment surveys such as the Connor Davis Resilience scale

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Curricular content should have a  Skill Emphasis: Emphasis will be on practical acquisition and enhancement of evidenced based resilience skills (“tools”) to improve student performance, patient outcomes, self-care, career satisfaction, physician altruism/humanism, and lifelong engagement with learning and medicine. The goal is to provide skills to reduce the impact of stress that is inevitable in life- long medical practice and to address the stressors that are amendable to change.

Problem Identification: Burnout

We have adopted the following common definition of Resilience: “Resilience is the capacity to adapt successfully in the presence of risk and adversity” and accepted burnout as the antonym of resilience. Burnout can be measured by the measured by the validated Maslach Burnout Inventory (MBI) which measures three domains: 1) Emotional “exhaustion” and feelings of being emotionally overextended and exhausted, 2) Cynicism: Depersonalization; an impersonal response toward recipients of one’s work and 3) Self efficacy: feelings of competence and achievement.
A longitudinal study Geisel students, like similar medical student studies, demonstrated marked early and prolonged unfavorable changes in all subscales of the Maslach Burnout Inventory. These studies, at both Geisel School of Medicine and other medical schools, have documented burnout rates of ~ 50%.

In addition to the individual effect on the medical professional a variety of undesirable outcomes for  patient care  are associated with burnout: Professionalism declines: Students with burnout are 11 times more likely to say they ordered a test on a patient when they had not and over 2 times more likely to cheat on an exam. Empathy and altruism decline: Students with burnout are half as likely to agree with the following statement compared to peers: “Medical student should be concerned with the problems facing the underserved”. Burnout threatens regional and national efforts to recruit and produce a work force that will provide care to underserved populations. “Learned behaviors” from medical school affect the lives of practicing physicians. These patterns directly affect patient safety as well as patient and physician satisfaction. Practicing physicians with Burnout have: High rates of job dissatisfaction, Elevated rates of suicide, missed work time, and substance abuse. Declines in empathy and professionalism result in profound negative effects on the doctor-patient relationship, poor patient satisfaction ratings, and increased medical error rates. Practicing physicians with Resilience have: Increased career satisfaction, higher personal life satisfaction, and enhanced performance.

Curricular content: We propose  that a  medical school  resilience curriculum be built on foundation  of faculty development in resilience.  Some have called this a “two-fer” approach . Students gain respect when faculty  share their struggles and support the learning resilience skills.   To accomplish student ‘Buy in” , the  strong applications in clinical medicine must be highlighted and reinforced by teaching faculty. The content can be divided into 5 interrelated   groupings:  Buy in, Basic Science/Neurobiology, Engagement with Learning, Life Strategies  ( eg Sleep, time management) ,  and ” Tools ” to cope with/prevent stress ( eg  as biofeedback, MBSR, CBT )

buckets

 

Student Video:

The Science of Woo Woo? Medical School Resilience Curriculum. [Dartmouthy Geisel Students]. Dartmouth College.
Performance improvement; Life strategies; Engagement in learning; Tools: CBT; Tools: biofeedback; Neurobiology: fMRI; Tools: mindfulness


A group 4th year medical students at  Dartmouth  Geisel School of Medicine as part of an evidenced based  capstone course  extensively evaluated the literature  to  to assess “Is  resilience education  a  evidenced based approach to meet  the unavoidable and avoidable stressors of medicine?” . They unanimously concluded,  although many  in the group were initially  skeptical that this was a “Woo Woo” non evidenced based approach, that the literature and current physician/student data  strongly supported resilience education.

Data  that students  quote in the video include  increased anxiety and depression, leading to increased rates of suicide in physicians (~2 times greater than general population). They also  reviewed neuro-imaging and salivary cortisol studies  that showed  improvement  in performance and mood ,compassion  in  professionals  after they employed   resilience strategies ( ie  CBT, biofeedback, and mindfulness/awareness)..

This video  illustrates in a  humorous fashion, sometimes oversimplified,  the plight of a medical student  who primary motivation was test performance and how and why resilience education has great potential to improve self wellbeing  and patient care.

http://www.dhslides2.org/geisel-feb2013/default.asp   ( please note go back to pages from 2013 and look for the “woo woo” title)