Identification and Accommodation of ADHD in Family Medicine Residencies: A CERA Study.

BACKGROUND: An increasing number of medical students applying to residency programs request accommodations for attention deficit hyperactivity disorder (ADHD). Early implementation of accommodations for individuals with ADHD during family medicine (FM) residency could help learners and programs, but the number of programs prepared to invite learners to disclose ADHD and to implement accommodations is unclear. OBJECTIVES: The purpose of this study was to describe practices employed by FM residency programs to identify residents who need accommodations for ADHD. We also chose to examine the frequency with which basic categories of ADHD accommodations are used and whether review of technical standards (ie, resident job description) is associated with timing of accommodations. METHODS: We analyzed responses from the 2022 Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of FM residency program directors, which was distributed via email invitation to all US programs accredited by the Accreditation Council for Graduate Medical Education. A total of 298 program directors (44.3%) responded. RESULTS: Approximately one in six FM residency programs are proactive in their identification of learners with ADHD, typically recognizing the need for accommodations during the interview process or orientation. Once the need is identified, most programs implement accommodations within 1 month, and many employ multiple types of accommodations. CONCLUSIONS: While a small subset of programs has developed processes to identify and accommodate ADHD proactively, results suggested that the majority of programs approach accommodation processes on an ad hoc basis. In turn, ad hoc identification precludes a proactive approach, given use of poor performance to identify the need for supports.

The relationship between a single-item measure of burnout and the Copenhagen Burnout Inventory in family medicine residents.

OBJECTIVE: Burnout during residency education is a phenomenon which requires careful study. A single item for measuring burnout shows promise for its brevity and concordance with the most commonly used measure of burnout, the Maslach Burnout Inventory, but has not been compared to the Copenhagen Burnout Inventory. We compared the single-item measure of burnout question to the Copenhagen Burnout Inventory to assess the convergence between these two measures of burnout. METHOD: Family Medicine residents (n = 32) from three residency programs completed the single-item measure of burnout question and the Copenhagen Burnout Inventory. We compared the single-item measure of burnout measure to the three scales of the Copenhagen Burnout Inventory. RESULTS: Our analyses indicated that the single item measure is highly correlated with personal burnout (r = .76), moderately correlated with patient burnout (r = .58), and not correlated with work burnout (r = .18). CONCLUSIONS: Because the single-item measure of burnout is particularly useful for identifying personal burnout, it may help to identify early signs of burnout amount physicians in training.

Emotion Regulation and Burnout in Family Medicine Residents.

BACKGROUND AND OBJECTIVES: Although burnout in medicine-particularly medical education-represents an ongoing problem, relatively few studies have established longitudinal connections between burnout and risk factors. Establishment of specific causal links and risk factors will determine important curriculum changes to reduce the risk of burnout in medical learners. Our study aimed to explore links between emotion regulation skill (strategies individuals use to regulate emotional experiences and responses to stress) and vulnerability to burnout using a longitudinal design in one family medicine residency program. METHODS: Family medicine residents completed the Difficulties with Emotion Regulation Scale (DERS) and the Copenhagen Burnout Inventory (CBI) at the beginning of each year (July/August). The residency program collected data over the course of 5 years. All residents consented to participate. We used linear regression analyses to examine postgraduate year-1 DERS scores as a predictor of postgraduate year-2 burnout and postgraduate year-3 burnout. RESULTS: In this sample of residents, higher scores on the DERS at the first year of residency predicted personal and work-related burnout on the Copenhagen Burnout Inventory (CBI) at the beginning of the second and third years. CONCLUSIONS: Difficulties with emotion regulation predicted personal burnout in this small sample. This finding dovetails with cross-sectional data in the literature. Although further mechanisms contributing to burnout should be explored, this finding suggests that direct instruction in adaptive emotion regulation strategies delivered early in medical education could provide significant downstream benefits for family medicine residents.

Comparative effectiveness of exercise with patterned sensory enhanced music and background music for long-term care residents.

The current study compared exercise performance and participant satisfaction for 2 conditions: Patterned Sensory Enhanced music (PSE) and big band background music. Residents of long-term care facilities in the Midwest (N = 45) attended a minimum of 3 sessions per condition and reported levels of satisfaction after each session. Observers blind to condition coded videotapes for number of repetitions, adherence to modeled movements, range of motion, and form. Significant differences were found for only 3/19 exercises and satisfaction levels did not differ between the 2 conditions. The results indicate that PSE may not be more effective than big band background music but that both types of music enhance exercise performance and participant enjoyment. PSE also provides consistency in number of repetitions led.

Self-disclosure through weblogs and perceptions of online and "real-life" friendships among female bloggers.

The current study examined female bloggers' perceptions of online and "real-life" same-sex friendships and examined relationships between self-disclosure through blogs and perceptions of the two types of friendships. Three hundred seven female bloggers (M age = 34.56 years) completed an online survey regarding friendship satisfaction and perceptions of intimacy-promoting interaction patterns in friendships. One hundred respondents' weblogs were analyzed for self-disclosure. Self-reported self-disclosure was positively correlated with number of online friendships and satisfaction with online friendships. Although participants reported having close online friends, they perceived real-life friendships as more likely than online friendships to possess intimacy-promoting interaction patterns. These perceptions did not differ as a function of self-disclosure through blogging, although bloggers who were categorized as higher in disclosure were more satisfied with online friendships than were bloggers who were categorized as lower in disclosure. These results suggest a relationship between self-disclosure through blogging and online relationship satisfaction among women in middle adulthood but that these women perceive real-life friendships as more likely to offer interaction patterns that foster intimacy.

Religious identification as a moderator of evolved sexual strategies of men and women.

Buss and Schmitt (1993) found empirical support for their Sexual Strategies Theory hypothesis of evolved sex differences in mating attitudes. This study hypothesized that religiosity would moderate those sex differences. Specifically, it was predicted that men high and low in religiosity would differ in mating attitudes, but it was expected that there would be fewer differences between women high and low in religiosity because of evolved preferences for longer term, more committed relationships. In Study 1, 219 college students completed questionnaires that included a single-item indicator of religiosity and short-term and long-term mating desires. Religiosity moderated sex differences in some mating preferences. In Study 2, 234 college student participants (mean age, 19.1 years) completed measures from Study 1 plus a measure of three types of religiosity: intrinsic (religion as a valuable end in itself), extrinsic (religion as a means to an end), and quest (religion as a means of questioning and doubting; Revised Religious Life Inventory-Hills, Francis, & Robbins, 2005). Intrinsic religiosity, but not extrinsic or quest, moderated sex differences in mating attitudes, especially attitudes regarding number of sexual partners in the short term. These results provide evidence that intrinsic religiosity is an individual difference variable that qualifies the differences in mating strategies hypothesized in Sexual Strategies Theory.

Love, marriage, and divorce: newlyweds' stress hormones foreshadow relationship changes.

Neuroendocrine function, assessed in 90 couples during their first year of marriage (Time 1), was related to marital dissolution and satisfaction 10 years later. Compared to those who remained married, epinephrine levels of divorced couples were 34% higher during a Time 1 conflict discussion, 22% higher throughout the day, and both epinephrine and norepinephrine were 16% higher at night. Among couples who were still married, Time 1 conflict ACTH levels were twice as high among women whose marriages were troubled 10 years later than among women whose marriages were untroubled. Couples whose marriages were troubled at follow-up produced 34% more norepinephrine during conflict, 24% more norepinephrine during the daytime, and 17% more during nighttime hours at Time 1 than the untroubled.

Stress-related modulation of matrix metalloproteinase expression.

Matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs), whose expression can be controlled by cytokines, play a role in extracellular matrix remodeling in physiological and pathological processes. Using a blister chamber wound model on UV-B-exposed human forearm skin, we examined whether stress or mood-associated neuroendocrine alteration is sufficient to modulate MMP and TIMP expression. We did not find evidence that depressive symptoms were reliably associated with modulation of either MMP or TIMP expression. However, we did find that activation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal medullary (SAM) axes can modulate levels of MMPs. A positive association between plasma norepinephrine levels and MMP-2 protein levels, and a negative correlation between plasma cortisol levels and MMP-2 levels were found. The data suggest that activation of the HPA and SAM axes, even in individuals within the normal range of depressive symptoms, could mediate MMP levels and wound healing in blister wounds.

Characteristics of smoking in low-income pregnant Latina and white women.

Smoking during pregnancy is hazardous as it poses numerous risks to both the mother and the unborn child. Formerly, interventions that were successful for White smokers were thought to be equally appropriate for all smokers. It is now acknowledged that there is a need to tailor interventions for distinct ethnic and cultural groups. This study was designed to identify variables that are associated with smoking status in a low-income sample of pregnant Latina and White women. Results indicate that Latinas had lower levels of addiction to cigarettes and were less likely to have partners who smoked than White women. Identifying differences in the characteristics of ethnically diverse pregnant smokers will assist in the development of interventions that are tailored for women who attend prenatal clinics.