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: firstname.lastname@example.org
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 (email@example.com): 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
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 )
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)