Assessment of a Recognition Program in an Academic Family Medicine Department.

BACKGROUND AND OBJECTIVES: Burnout is prevalent among clinicians and faculty. We sought to understand the impact of a recognition program designed to reduce burnout and affect engagement and job satisfaction in a large academic family medicine department. METHODS: A recognition program was created in which three clinicians and faculty from the department were randomly selected each month to be recognized ("awardees"). Each awardee was asked to honor a person who had supported them (a "hidden hero" [HH]). Clinicians and faculty not recognized or selected as an HH were considered "bystanders." Interviews were completed with 12 awardees, 12 HHs, and 12 bystanders for a total of 36 interviews. We used content analysis to qualitatively evaluate the program. RESULTS: Assessment of the "We Are" Recognition Program resulted in the categories of impact (subcategories: process positives, process negatives, and fairness of program) and HHs (subcategories: teamwork and awareness of the program). We conducted interviews on a rolling basis and made iterative changes to the program based on feedback. CONCLUSIONS: This recognition program helped create a sense of value for clinicians and faculty in a large, geographically dispersed department. It represents a model that would be easy to replicate, requires no special training or significant financial investment, and can be implemented in a virtual format.

Assessment of Agenda Setting With ACGME Milestones in Family Medicine Residents.

BACKGROUND AND OBJECTIVES: Family medicine residents are scored via milestones created by the Accreditation Council for Graduate Medical Education (ACGME) on various clinical domains, including communication. Communication involves a resident's ability to set an agenda, but this is rarely taught in formal education. Our study aimed to examine the relationship between ACGME Milestone achievement and ability to set a visit agenda, as measured by direct observation (DO) forms. METHODS: We examined biannual (December, June) ACGME scores for family medicine residents at an academic institution from 2015-2020. Using faculty DO scores, we rated residents on six items corresponding to agenda setting. We used Spearman and Pearson correlations and two-sample paired t tests to analyze results. RESULTS: We analyzed a total of 246 ACGME scores and 215 DO forms. For first-year residents, we found significant, positive associations between agenda-setting and the total Milestone score (r[190]=.15, P=.034) in December, and in individual (r[190]=.17, P=.020) and total communication scores (r[186]=.16, P=.031), in June. However, for first-year residents, we found no significant correlations with communication scores in December or in the total milestone scores in June. We found significant progression for consecutive years in both communication milestones (t=-15.06, P<0.001) and agenda setting (t=-12.26, P<.001). CONCLUSIONS: The significant associations found in agenda setting with both ACGME total communication and Milestone scores for first-year residents only, suggests that agenda setting may be fundamental in early resident education.

Challenges in Effective Faculty and Provider Recognition to Enhance Engagement.

BACKGROUND AND OBJECTIVES: Burnout is associated with reduction in patient care time and leaving academic medicine, and is prevalent among faculty, residents, and advanced practice providers. Recognition may positively impact workplace well-being and reduce attrition. The objective of this study was to understand needs and preferences regarding recognition among faculty and providers in a large academic department. METHODS: A survey including quantitative and qualitative elements was sent to faculty and providers to identify whether additional recognition was needed and, if so, to seek potential opportunities to improve recognition, with mixed-methods assessment of results. RESULTS: Fifty-two participants completed the survey (35.9% response rate; 53.8% female, 59.6% faculty); 26.9% reported performing duties at work that are not being recognized, and 19.2% reported seriously considering leaving the institution because they did not feel appreciated. Females were more likely to want tangible goods as a source of recognition (P=.008). While providers preferred to have recommendations for recognition made by office staff (P=.007), associate professors did not (P=.005). Qualitative responses to the survey also revealed concerns regarding favoritism and risk of feeling unappreciated if a recognition system is perceived as unfair. CONCLUSIONS: This survey demonstrated a deficit of recognition and a lack of consensus regarding how or when faculty and providers should be recognized. There were concerns regarding fairness of recognition. Efforts to enhance recognition should avoid assumptions about faculty and provider preferences, and should be attuned to fairness and inclusion.

Borderline Personality Disorder.

Borderline personality disorder is a psychological disorder characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image. Borderline personality disorder may be present in up to 6.4% of adult primary care visits, which is fourfold higher than in the general population. Borderline personality disorder is underdiagnosed and most patients who have it also have additional psychiatric conditions. Individuals with borderline personality disorder have an underlying vulnerability to emotional hyperarousal states and social and interpersonal stressors. Clinically these patients may have high health care utilization, health-sabotaging behaviors, chronic or vague somatic concerns, aggressive outbursts, high-risk sexual behaviors, and substance use. Obesity and binge-eating disorders are common comorbidities in those diagnosed with borderline personality disorder. There is an established correlation between borderline personality disorder and increased suicide risk. Structured interview assessments that are designed specifically for borderline personality disorder include the Revised Diagnostic Interview for Borderlines and the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders. As general guidelines for practice, family physicians should avoid excessive familiarity, schedule regular visits, set appropriate limits, and maintain awareness of personal feelings. Use of effective communication strategies such as motivational interviewing and problem-solving techniques can help navigate addressing problematic behaviors in patients who have borderline personality disorder. Multiple behavior treatments are useful, the most effective of which are dialectical behavior therapy and mentalization-based therapy. No medications have been approved by the U.S. Food and Drug Administration specifically for the treatment of borderline personality disorder.

Area- and Individual-Level Correlates of Self-Rated Health: Implications for Geographic Health Disparities.

BACKGROUND: Self-rated health (SRH) is a common measure of overall health. However, little is known about multilevel correlates of physical and mental SRH. METHODS: Patients attending primary care clinics completed a survey before their appointment, which we linked to community data from American Community Survey and other sources (n = 455). We conducted multilevel logistic regression to assess correlates of excellent/very good versus good/fair/poor physical and mental SRH. RESULTS: 43.9% of participants had excellent/very good physical SRH, and 55.2% had excellent/very good mental SRH. Physical SRH was associated with age (odds ratio[OR] = 0.82 per 10 years; 95% confidence interval[CI] = 0.72-0.93) and community correlates, including retail establishment density (OR = 0.94, 95% CI = 0.90-0.99) and percent of students eligible for free/reduced lunch (OR = 1.60, 95% CI = 1.08-2.38) (all P < .05). Mental SRH was not associated with any characteristics. CONCLUSIONS: Practitioners in public health, social work, and medicine could use zip codes to intervene in patients and communities to improve physical SRH.

Loneliness in Primary Care Patients: Relationships With Body Mass Index and Health Care Utilization.

PURPOSE: Rates of loneliness and obesity have increased in recent decades. Loneliness and obesity independently have been found to be risk factors for negative physical and mental health outcomes. This study examined the rates and interrelationships of loneliness, body mass index (BMI), and health care utilization in a primary care setting. METHODS: A cross-sectional survey of adult patients presenting for outpatient care at 7 family medicine clinical practices in Pennsylvania was conducted. Survey questions included self-reported measures of loneliness, height/weight, number of health care visits, and potential confounders (eg, sociodemographic variables, health status). Bivariate and multivariable linear regression models were used to analyze associations among loneliness, BMI, and health care utilization. RESULTS: In all, 464 eligible patients returned surveys for an overall response rate of 26%. Mean (standard deviation) loneliness score was 4.2 (1.7), mean BMI was 30.4 (7.6), and mean number of visits in year prior was 2.7 (3.6). On bivariate analysis, BMI was positively associated with loneliness (effect estimate: 0.50; P=0.03). On multivariable analysis, BMI was negatively associated with attending religious services and self-reported physical health and positively associated with self-reported mental health (P<0.05 for all), but not associated with loneliness. While not associated with loneliness, health care utilization was negatively associated with Hispanic ethnicity, marital status, and self-reported physical health (P<0.05 for all). CONCLUSIONS: Given the detrimental effects loneliness and obesity have on health outcomes, it might be prudent for health care providers to prioritize health concerns for their patients by assessing loneliness and counseling regarding associated risks, particularly in patients with obesity.

Factors that Influence Work Family Conflict for Women Faculty.

This article was migrated. The article was marked as recommended. Purpose: This study examined the interaction between work role overload, work-to-family conflict, and departmental/division culture conducive to women's academic success. Methods: All women assistant and associate professors eligible for promotion from the Departments of Family Medicine, Internal Medicine, and Pediatrics were invited to complete a validated web-based survey that measured work-to-family conflict, work hours, work role overload, and culture conducive to women's academic success ( Westring et al., 2012). Results: With 88 survey respondents, high work role overload was associated with increased levels of work-to-family conflict while those who reported a higher culture conducive to women's academic success reported less work-to-family conflict. Culture conducive to women's academic success did not moderate the impact of work demand on work-to-family conflict. Conclusions: While departmental/division culture was important, it was not sufficient to completely mitigate work-to-family conflict. Work demand appears to impact work-to-family conflict related to strain, in which women report being too stressed by work to focus on their family and their own health and wellness. Employers can greatly impact work culture by reducing the strain of work demands that interfere with women pursuing promotion, increase burnout, and contribute to women faculty deciding to work part-time.

Using Social Media to Broaden Understanding of the Barriers and Facilitators to Exercise in Adults With Type 1 Diabetes.

BACKGROUND: Many people with type 1 diabetes (T1D) do not achieve levels of exercise recommended by the American Diabetes Association, often due to unique barriers, including fear of hypoglycemia. This study aimed to broaden the understanding of barriers and facilitators to exercise among adults with T1D by exploring social media-specifically T1D-themed blogs-in addition to more traditional interviews and journals. METHODS: Data sources included exercise-focused T1D blog posts (n = 67) and associated comments (n = 717), as well as interviews of and journals kept by adults with T1D (n = 10). Data were analyzed using a qualitative inductive thematic approach. Shared and unique themes were identified among the three data sources. Content mapping illustrates these relationships and interplay. RESULTS: Three metathemes were identified: (1) exercise with T1D requires significant planning, (2) hypoglycemia often interrupts or causes alteration to exercise, and (3) "ordinary" activities can cause greater insulin sensitivity and hypoglycemia, much like planned exercise, but are often unrecognized as exercise. Unique themes found only in the blogs, only in interviews, or only in journals are also reported. CONCLUSIONS: Social media such as blogs can be a valuable addition to qualitative research, especially when combined with other sources of data. This study suggests a need for providing adults with T1D with more instruction on preventing hypoglycemia during exercise, as well as links to organized or online activities that can provide support and education. Health care providers may wish to consider strategies to help adults with T1D recognize glycemic impact from daily activities not typically recognized as exercise.