Digital Commons Network^™

Turmoil, Derek Kent

HCA Healthcare Journal of Medicine

I painted this picture after tearing up over the phone with her parents. "I think she's passing away," I had told them, "You'd better come up to the hospital." Inexperienced as a brand new physician, I felt like I was drowning in my responsibility over the care of my patients. Real people, with real lives, with real consequences to my decisions. It has gotten easier to feel okay while helping other humans pass away. And it sounds a little dramatic, but I've found ways to help myself cope without being stranded by the waves.

The Heart Of Residency, Julia Fashner, Samantha Gionocchio

HCA Healthcare Journal of Medicine

As part of wellness activities in 2023, our family medicine residents produced individual paintings. Samantha coalesced these 4 x 4 canvases to create this heart. The following quote is also poignant for those of us in family medicine:

Wherever the art of Medicine is loved there is also a love of Humanity. -Hippocrates

Increasing The Efficiency Of Lifestyle Medicine Counseling: A Visual Approach, Kayla A. Hinton, Ryan Smith

HCA Healthcare Journal of Medicine

Too much to counsel on, too little time? We would like to present a unique and innovative perspective on lifestyle medicine counseling through the lens of a homemade flyer, designed to bridge the gap between conventional health care practices and personalized, holistic well-being. In the promising field of health care humanities, the homemade lifestyle medicine flyer serves as a tangible manifestation of individual agency in promoting health and vitality. The flyer encapsulates a diverse range of self-care practices, dietary insights, and mindfulness techniques, emphasizing the inherent connection between mind, body, and spirit in one’s health journey.

This double-sided document highlights …

Well-Being And Leadership Within The Emergency Department, Jacob T. Berg, Thomas Matese, Dennis Anthony Cardriche, David Hotwagner

HCA Healthcare Journal of Medicine

This article looks at well-being and the role of leadership from the perspective of emergency medicine. The importance of leadership within the emergency department (ED), emergency medicine writing at large, and the prevention of burnout and compassion fatigue cannot be overstated. This article looks at the need for more research and measured interventions within the ED. It also highlights some measures that could be taken to help improve well-being from a leadership perspective to improve patient safety and outcomes within the ED.

A Resident Led Newsletter Is A Powerful Communication Tool, Jonathan Brown, Zuhair Ali, An Dao, Mike Wong, Rajeev Raghavan

HCA Healthcare Journal of Medicine

Background

Communication with stakeholders for a graduate medical education (GME) program depends on shared visual and written content. Residency training programs are embracing social media as a communication channel. However, curated information that may only be viewed by subscribers or followers is difficult to archive and may appear overwhelming to novice users. An electronic, printable newsletter may be a unique communication tool for training programs to share information among residents, faculty, and hospital administration.

Methods

We published a monthly electronic newsletter sent to all residents, teaching faculty, and additional stakeholders in our internal medicine residency program. We conducted an electronic …

Burnout And Health Scores Among Residency Programs As An Indicator Of Wellness, Hannah Manzi, Jon Halling, Nayda Parisio Poldiak, Suzanne Perkins

HCA Healthcare Journal of Medicine

Background

With long hours, significant responsibilities, and a heavy workload, residency can be an incredibly stressful experience. The aim of our study was to assess the impact of residency on mental health and wellness. A secondary aim was to determine if the post-graduate year (PGY) of the different residents impacted their mental health or ability to cope with the stressors of residency.

Methods

Residents in anesthesiology, family medicine, internal medicine, and surgery were invited to complete a survey. The first portion of the survey had residents rank their mental health on a scale from 1 to 5. There was also …

The Impact Of A 4-Domain Wellness-Initiative Curriculum On Internal Medicine Resident Physicians, Esha Vallabhaneni, Luigi Cubeddu, Ryan Petit, Fernando Poli, Premal Patel, Cynthia Rivera

HCA Healthcare Journal of Medicine

Background

There is a trend toward fostering well-being, or the state of being happy and healthy, within the medical community. Historically, resident physicians have faced high rates of distress during training. A structured well-being curriculum in residency programs may shift residents' mindsets from survival and resilience to one centered on purpose, engagement, and joy.

Methods

An original well-being curriculum was administered to residents in person at a single institution every 5 weeks for approximately 10 well-being workshops, totaling around 20 hours of curriculum exposure during every academic year. The well-being curriculum was divided into 4 domains: cognitive distortions and problematic …

The Feasibility And Impact Of An Asynchronous Interprofessional Well-Being Course On Burnout In Health Care Professionals, Mari Ricker, Audrey J. Brooks, Mei-Kuang Chen, Joy Weydert, Amy Locke, E Kyle Meehan, Paula Cook, Patricia Lebensohn, Victoria Maizes

HCA Healthcare Journal of Medicine

Background

Well-being initiatives are essential components in fostering an engaged workforce and creating an effective health care ecosystem. Health care professional (HCP) burnout is widespread and has worsened since the COVID-19 pandemic. In 2014, with Health Resources and Services Administration funding support, the Andrew Weil Center for Integrative Medicine created an online course for HCP well-being. It was subsequently studied in medical residents and revised in 2020. In this study, we explore the impact of the course across larger systems, as well as the long-term impact on HCPs.

Methods

The Health Care Professional Well-Being course is 4.5 hours of interactive …

Resident Feedback On Incorporating Reflection Rounds Into A Family Medicine Residency Wellness Curriculum: A Brief Report, Stacy Ogbeide, Jasmin Aldridge Hamlett, Inez Isabel Cruz

HCA Healthcare Journal of Medicine

Background

We sought to understand well-being from the perspectives of residents in a family medicine residency program and to assess the residents’ opinions on implementing “Reflection Rounds” (RR) to promote wellness and combat burnout through self-reflection. These aims were achieved through descriptive qualitative analysis of a focus group of family medicine residents.

Methods

Participation was voluntary and open to all 45 residents in the program. The final participant sample consisted of 14 residents who shared similar characteristics, including level of training and being exposed to similar training stressors. Both a priori and open coding were used for this analysis.

Results …

A Multi-Wave Study Of Factors Associated With Resident Engagement, Depression, Burnout, And Stay Intent, Anne M. Brafford, Brendon Ellis, Greg Guldner, Gabrielle Riazi, Xitao Liu, Jessica C. Wells, Jason T. Siegel

HCA Healthcare Journal of Medicine

Background

Many studies have documented the epidemic of mental ill-being among resident physicians, but fewer have focused on mental well-being or on guiding intervention design to make progress toward positive change in residency programs to support resident thriving. Informed by the job demands-resources model (JD-R) and positive psychology, the current study examines 4 potential predictors of residents’ ill-being (burnout, depression) and well-being (engagement, stay intent) that are malleable and thus capable of change through intervention: psychological capital (PsyCap), supervising physicians’ autonomy-supportive leadership style (ASL), social support, and meaningful work.

Methods

Three waves of data were collected between November 2017 and …

Perceived Disruption Of Covid-19 On Medical Education In Incoming Psychiatric Residents, Steven Sprenger, Ashley Mahajan, Jeffrey Anderson, Napatkamon Ayutyanont, Jessica C. Wells, Gregory Guldner

HCA Healthcare Journal of Medicine

Background

In 2020, the global COVID-19 pandemic caused educational disruptions to many medical students nationally. Societal and hospital guidelines, including social distancing protocols, resulted in the cancellation or postponement of many elective procedures. A shortage in personal protective equipment also contributed to restrictions in clinical experiences for trainees. The purpose of this study was to determine resident-perceived preparedness in core clinical competencies and evaluate the disruptions to core clerkships.

Methods

A survey was developed to assess self-perceptions of clinical competencies and disruptions to core clerkship experiences. It was distributed to 63 incoming psychiatric residents who were matched to training programs …

The Effects Of The Covid-19 Pandemic On Resident Education And Burnout, Timbre Backen, Oliwier Dziadkowiec, Jeffery S. Durbin, Gregory Guldner, Glenda Quan

HCA Healthcare Journal of Medicine

Background

The COVID-19 pandemic has impacted the residency experience for physicians across all specialties. There have been studies examining resident perspectives on changes in curriculum and clinical experiences due to the pandemic; however, little research has been conducted on how residents in different specialties interpreted their educational experience and rates of burnout during the pandemic.

Methods

We extended surveys to 281 residents across 15 separate residency programs between November 17, 2020, and December 20, 2020. The questions pertained to burnout and the effects of the pandemic on their careers. Differences between general and specialty medicine resident responses were analyzed using …

Learning From Health Care Counselors’ Perspectives On Health Care Worker Distress: A Qualitative Analysis, Nancy Downs, Judy Davidson, Angela Haddad, Sidney Zisook

HCA Healthcare Journal of Medicine

Background

Health care provider stress and emotional distress were well documented long before the COVID-19 pandemic, and there is growing data suggesting these have increased in response to the pandemic. The goal of this study was to take advantage of the unique experiences of licensed mental health (MH) clinicians working with health care trainees and clinicians before and during the pandemic to identify how this crisis affected both ongoing as well as new sources of stress. The Healer Education, Assessment and Referral Program (HEAR) provides MH screening, support, and MH referrals to ~19 000 health care students, trainees, staff, and …

A Qualitative Follow-Up To A Survey Of Program Directors On Wellness Programming At A Large Healthcare Organization: Interviews Of High- And Low-Exemplar Programs, Sabrina Menezes, Kelsey M. Carpenter, Alexander W. Marshburn, Stephanie Ramirez, Gregory Guldner, Jessica C. Wells, Jason T. Siegel

HCA Healthcare Journal of Medicine

Background

The current research used a qualitative approach to understand which factors facilitate and hinder wellness programming in residency programs.

Methods

Program directors identified from a previous quantitative study as having residency programs with notably more or less resident wellness programming than others (ie, high- and low-exemplars, respectively) were contacted. In total, semi-structured interviews were conducted over Zoom with 7 low-exemplars and 9 high-exemplars.

Results

The results of this qualitative examination suggest common themes across the 2 exemplar groups, such as wanting more resources for resident wellness with fewer barriers to implementation, viewing wellness as purpose-driven, and seeing wellness as …

A Nation-Wide Survey Of Program Directors At A Large Health Care Organization: Prevalence And Perceptions Of Resident Wellness Activities, Alexander W. Marshburn, Gabrielle Riazi, Sabrina Menezes, Stephanie Ramirez, Gregory Guldner, Jessica C. Wells, Jason T. Siegel

HCA Healthcare Journal of Medicine

Background

This study evaluated wellness programs in a large hospital network to determine residency program directors’ (PDs) perspectives on their wellness programs' state, including wellness prioritization, frequency of wellness activities, and wellness’ influence on decision-making across organizational levels.

Methods

In 2021, 211 PDs were sent surveys on program policies, program implementation frequency, perceptions of the administration’s ability to prioritize wellness, funding sources, and perceptions of resident wellness’ impact on decision-making.

Results

Among 211 contacted programs, 148 surveys were completed (70.1%). The majority reported having wellness programs, committees, and funding. Fewer than 25% reported having a chief wellness officer. PDs perceived …

Burnout In Graduate Medical Education: Uncovering Resident Burnout Profiles Using Cluster Analysis, Nicholas A. Yaghmour, Nastassia M. Savage, Paul H. Rockey, Sally A. Santen, Kristen E. Decarlo, Grace Hickam, Joanne G. Schwartzberg, Dewitt C. Baldwin Jr., Robert A. Perera

HCA Healthcare Journal of Medicine

Background

Burnout is common among residents and negatively impacts patient care and professional development. Residents vary in terms of their experience of burnout. Our objective was to employ cluster analysis, a statistical method of separating participants into discrete groups based on response patterns, to uncover resident burnout profiles using the exhaustion and engagement sub-scales of the Oldenburg Burnout Inventory (OLBI) in a cross-sectional, multispecialty survey of United States medical residents.

Methods

The 2017 ACGME resident survey provided residents with an optional, anonymous addendum containing 3 engagement and 3 exhaustion items from the OBLI, a 2-item depression screen (PHQ-2), general queries …

Exercise Is A Vital Sign, Megan Dannemiller, Anthony Shadiack, Marvin Sineath Jr, Andrew Baird, Marc Poirier, Kevin Thomas, Michael G. Flynn

HCA Healthcare Journal of Medicine

In this review, we argue that exercise (physical activity) be monitored as a vital sign since no other basic sign or symptom provides as much information about a patient's health status. The influence of regular exercise on patient health is indisputable, with strong evidence to show the power of exercise to mitigate chronic disease and improve overall health. Several simple tools, such as Physical Activity as a Vital Sign and Exercise as a Vital Sign are available to assess patient physical activity. When properly applied, there is evidence to support the efficacy of these tools, but there are barriers that …

Mitigating Workplace Burnout Through Transformational Leadership And Employee Participation In Recovery Experiences, John Pladdys

HCA Healthcare Journal of Medicine

Burnout is a complex organizational phenomenon that diminishes employee well-being and overall organizational productivity. Researchers propose that leadership style contributes to employees’ well-being, which impacts employee productivity. Organizations and leaders must address the causes of burnout and promote techniques employees can use to mitigate burnout, such as employee participation in recovery experiences. Recovery experiences are non-work activities that create positive outlooks and restore the energy needed to focus on one’s work.

This literature review examines current research in employee recovery experiences, conservation of resource theory (COR), burnout, and transformational leadership theory. Studying burnout through the lens of COR shows how …

Autonomy Versus Independence: Implications For Resident And Faculty Engagement, Performance, And Well-Being, Adam P. Neufeld, C. Scott Rigby

HCA Healthcare Journal of Medicine

Research shows that when educational leaders support their learners’ autonomy, it positively impacts both parties. This is particularly important in graduate medical education (GME), given that there is a strong emphasis on resident performance, evaluation, and development. Unfortunately, GME faculty often misunderstand autonomy as the resident’s desire for independence or “freedom,” when in fact it refers to the core psychological need to feel volitional and agentic. The distinction is important because volition is not synonymous with independence, and providing freedom can be at odds with strategies that provide true autonomy support. This, in turn, can contribute to the stress, maladjustment, …

What Motivates You?, Mohamad S. Saad

HCA Healthcare Journal of Medicine

For over 100 years, we have tried to understand how human motivation works. Although various theories have been developed and different experiments have been conducted to explain motivational drive, we have realized that extrinsic motivation factors, such as rewards and punishment, and financial incentives are not the answers. More important and central to motivation is nourishing our innate human need to be autonomous, competent, and to relate to our organizational culture. All of us need to understand the story of motivation because, as dire as our need for high-quality motivation is, high-quality motivation remains an asymptote.

Addressing Burnout And Enhancing Well-Being Among Academic Physicians: A Call For Future Research And Organizational Support, Kelly D. Holder, Sharon Y. Lee, Fatima Zehra Raza, Laura R. Stroud

HCA Healthcare Journal of Medicine

Burnout among academic physicians, who navigate multiple roles beyond the clinical environment, is a pressing issue. However, the factors driving burnout among academic physicians are not fully understood. Prior research has revealed differences in burnout dimensions between clinical and basic science faculty, but the impact of balancing research, education, and clinical demands on academic physicians is still unclear. This knowledge gap negatively affects the clinical, translational science, research, and medical education workforces and has particular implications for minoritized and marginalized groups working in academic medical centers. Creating a culture of well-being has been vital in addressing burnout. Further research is …

Lifestyle Medicine For The Health Care Worker, Workplace, And Community Well-Being: A Butterfly Effect, Karina Doucet, Nicholas D'Angelo

HCA Healthcare Journal of Medicine

Burnout is a prevalent and expensive problem in the US, and the National Plan For Health Workforce Well-Being included a goal to institutionalize well-being as a long-term value. Lifestyle Medicine (LM), an evidence-based practice using behavioral interventions to treat, prevent, and reverse certain chronic conditions, can achieve this goal. Implementing small changes in the workplace that support lifestyle medicine has a butterfly effect on both workplace and community well-being. Furthermore, the health of health care workers (HCWs) and patients improves, and health care costs decrease. This can be done with LM wellness programs or LM training for HCWs. LM wellness …

Empowering Voices: Cultivating A Supportive Network From The Women In Medicine And Health Care Symposium, Rutuja D. Bhalerao, Kyle Mefferd, Jocelyn A. Limas

HCA Healthcare Journal of Medicine

There are many studies, some discussed in this article, that recognize the numerous issues faced by women in medicine and the health care field. In response to the prevalence of these challenges, Riverside Community Hospital’s General Medical Education department organized the second Women in Medicine & Healthcare Symposium on November 17, 2023. The symposium featured a panel of women leaders addressing challenges, such as work-life balance, maternity leave, fertility concerns, and family planning. Personal stories and studies on gender bias and infertility shed light on the shared experiences of women physicians. The positive response prompted Riverside Community Hospital to view …

Creating And Supporting Well-Being In Graduate Medical Education, Gregory Guldner

HCA Healthcare Journal of Medicine

Graduate medical education strives to create the next generation of skillful and compassionate physicians for our nation. Yet, research shows a high degree of depression, anxiety, workplace burnout, lack of engagement, and general dissatisfaction with the work and learning environment for many of these dedicated individuals. We present this special issue related to creating and supporting well-being in the graduate medical education community.

Comfort Care, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Death does not thrill me anymore. I am a trauma surgeon extraordinaire! The patient had suffered a traumatic brain injury and has struggled for weeks. He is only 16. Today, the family decided to make him “comfort care." I was at the end of my call, exhausted, drained of all energy. I looked out of the ICU window and saw the fading rain and the city lights. It somehow reminded me of a precious life ebbing away, and I burst into a silent scream. I am still human.

Suspected Thiamine Deficiency Secondary To Chronic Gastrointestinal Illness: A Case Report, Abigail L. Meckley, Natalie Lagattuta, Elise Gonzalez, Chamonix Kinimaka, Jessica El-Bahri

HCA Healthcare Journal of Medicine

Introduction

Thiamine deficiency, also known as beriberi, is a nutritional disorder caused by a lack of thiamine (vitamin B₁) in the diet. It can occur in 2 forms: dry beriberi, which affects the nervous system, and wet beriberi, which affects the cardiovascular system. Gastrointestinal beriberi is a subtype that affects the digestive system and can lead to multisystem involvement. In the United States (US), thiamine deficiency often arises from chronic malnutrition secondary to alcoholism, known as Wernicke-Korsakoff Syndrome.

Case Presentation

A 45-year-old female with no known past medical history or alcohol use disorder came to the emergency department …

Dercum’S Disease: The Clinical Presentation, Diagnosis, Radiological Findings, And Treatment Of A Rare, Debilitating Inflammatory Disorder, Obyda Al-Housni, Constantinos Boufeas, Valori Slane

HCA Healthcare Journal of Medicine

Introduction

Dercum’s disease, also known as adiposis dolorosa, is a rare syndrome characterized by the growth of multiple, and painful, subcutaneous adipose tissues that commonly present in the abdomen and extremities. The scientific community hypothesizes that Dercum’s disease is a combination of neurologic and endocrine disorders. Patients commonly describe it as chronic adipose pain, which manifests as sporadic painful flares throughout their history with the disease.

Case Presentation

We share the case of a 32-year-old woman who presented to the emergency department for an acute episode of left lower extremity pain and swelling associated with a previously diagnosed history of …

Actinic Granuloma Complicated By Secondary Syphilis: A Case Report, Kevin H. Nguyen, Christopher M. Wong, Ethan Q. Nguyen

HCA Healthcare Journal of Medicine

Introduction

Actinic granuloma (AG) is a rare skin eruption thought to result from a sun-induced inflammatory response attracting giant cells, which are large, multinucleated, and inflammatory, to form granulomas and degrade surrounding elastic material. Clinically, lesions begin on sun-exposed skin as pink papules and nodules that coalesce into demarcated annular plaques with a hypopigmented center. Histologically, actinic elastosis surrounds the outer annulus ring, with histiocytes and giant cells within the raised border, and the innermost central zone is filled with minimal to absent elastic fibers.

Case Presentation

We present a middle-aged female with a pruritic eruption of diffuse erythematous macules …

A Case Series Of Unusual Iga Vasculitis, Jared Bradley, Ian Whitaker, Brittany Lyons, Amy Mangla

HCA Healthcare Journal of Medicine

Introduction

Immunoglobulin A vasculitis (IgA)is a rare condition characterized by palpable purpura, often involving the skin, gastrointestinal tract, joints, and kidneys. Presentation is usually acute and is more common in children and adolescents of Southeast Asian and European descent. In the adult population, it is less common and therapies are not as well-established.

Case Presentation

Disease prevalence of IgA vasculitis outside Southeast Asian and European populations is not well-documented. In this case series, we present 2 cases of IgA vasculitis in 2 older adult males, one of Native American descent and one of African American descent.

Conclusion

IgA vasculitis must …

Acute Bilateral Pyelonephritis In The Setting Of Newly Diagnosed Diabetes Mellitus: A Case Report, Jessenia Ariana Contreras, Satwinder Singh, Ramesh Alwarappan

HCA Healthcare Journal of Medicine

Introduction

Acute pyelonephritis is a bacterial infection that starts in the bladder and ascends to the kidneys, causing inflammation of the renal parenchyma. Women are more likely to get infected compared to men, with diabetics being at higher risk. The pathophysiology of how diabetics are more prone to getting urinary tract infections/pyelonephritis has been studied, particularly the difference between bilateral pyelonephritis and unilateral pyelonephritis.

Case Presentation

This case presentation follows a 51-year-old Spanish-speaking woman with a past medical history of prediabetes, bilateral tubal ligation, and perimenopause. She presented to the hospital for abdominal and back pain, fevers, and weakness that …