My Wellness Coach: evaluation of a mobile app designed to promote integrative health among underserved populations.

Underserved populations, including those from racial and ethnic groups and with low socioeconomic status, often lack access to mobile apps aimed at reducing health risk factors. This study evaluated the feasibility, acceptability, and preliminary effectiveness of the mobile app, My Wellness Coach (MWC), designed to promote behavior change in seven core areas of integrative health among underserved populations. Patients and staff were recruited from clinic and other settings. Some participants used MWC in a weekly group setting (n = 5); others on their own with support from a coordinator (n = 36). Health outcomes were assessed at baseline and 3 months. Mobile app ratings were collected at 5 weeks and 3 months. Goal setting data were analyzed at 3 months. Most participants (76%) set at least one goal, 71% created action steps for goals, and 29% completed a goal. Patients in the group setting had the highest rate of goal completion (60%) compared to patients (20%) and staff (27%) using the app on their own. Significant (p < .05) changes in pre- and post-test scores were documented for overall wellbeing, global physical health, BMI, vigorous physical activity, and eHealth literacy. Most participants (75%-91%) gave MWC high ratings for impact on behavior change, help seeking, intent to change, attitudes, knowledge, and awareness. This study documented preliminary evidence of the potential benefits of MWC among underserved communities. Future evaluations of Spanish and Android versions and comparisons between group and individual administration will inform implementation strategies for scaling MWC-based interventions to reach underserved communities nationally.

Many underserved populations, including those from diverse racial and ethnic groups and with low income, do not have access to mobile apps to improve health. This study examined whether using the My Wellness Coach (MWC) app was feasible, acceptable, and effective. MWC was designed to promote behavior change in integrative health (Movement, Nutrition, Spirituality, Resilience, Relationships, Sleep, and Environment) among underserved populations. Five participants used MWC in a group setting and 36 participants used MWC on their own with assistance from a coordinator. Participants completed surveys at the beginning of the study and 3 months later. Most participants (76%) set at least one health goal, 71% created action steps for goals, and 29% completed a goal. Participants who used MWC with the weekly group had the highest rate of goal completion (60%). Participants reported significant changes in wellbeing, physical health, body mass index, physical activity, and ability to find and understand electronic health information. Most participants (75%­91%) gave MWC positive ratings. This study provided evidence of the potential benefits of MWC among underserved communities. Future studies with Spanish and Android versions and comparisons between group and individual administration will inform strategies for expanding the reach of MWC-based interventions to underserved communities.

A Longitudinal Study of Burnout and Well-being in Family Medicine Resident Physicians.

BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) core competencies for residency learning and work environment standards acknowledge high levels of burnout and depression in resident physicians and the critical importance of physician well-being to patient care and effective education. The objective of this study was to follow family medicine resident physicians' well-being throughout residency. METHODS: Family medicine resident physicians from 12 programs completed validated assessments (burnout, depression, perceived stress, satisfaction with life, positive and negative affect, emotional intelligence, mindfulness, gratitude) at residency start, second year start, and graduation. Resident physicians were from the 2011, 2012, and 2013 graduating classes (N=158). RESULTS: Two indicators of burnout (emotional exhaustion, depersonalization) increased between the start of residency and the start of the second year, remaining elevated at graduation. Emotional intelligence was lower at graduation than at the start of residency. In contrast, other measures of well-being (stress, life satisfaction, affect) improved during the second and third years. Depression, mindfulness, and gratitude remained stable. Increased levels of burnout risk at graduation were negatively associated with emotional intelligence, mindfulness, and gratitude. CONCLUSIONS: While the stressful impact of residency is transitory for some measures of well-being, that is not the case for burnout or emotional intelligence. Burnout levels peak after the first year of residency and remain high through graduation. Targeted interventions to identify and address burnout in residency need to be evaluated in future studies.

Integrative Medicine in Residency: Feasibility and Effectiveness of an Online Program.

BACKGROUND AND OBJECTIVES: Online curricular interventions in residency have been proposed to address challenges of time, cost, and curriculum consistency. This study is designed to determine the feasibility and effectiveness of a longitudinal, multisite online curriculum in integrative medicine (IMR) for residents. METHODS: Residents from eight family medicine programs undertook the 200-hour online IMR curriculum. Their medical knowledge (MK) scores at completion were compared to a control group from four similar residency programs. Study and control groups were comparable in baseline demographics, and MK scores. Course completion, MK scores, and course evaluations were assessed. RESULTS: Of 186 IMR residents, 76.9% met completion requirements. The IMR group showed statistically significant higher MK scores at residency completion, the control group did not (IMR: 79.2% vs. CONTROL: 53.2% mean correct). Over three-fourths of IMR participants (range 79-92%) chose the top two rating categories for each course evaluation item. In an exit survey, ability to access the curriculum for 1 additional year and intention to utilize IM approaches after residency were the highest ranked items. CONCLUSIONS: The demonstrated feasibility, effectiveness, and positive evaluations of the IMR curriculum indicate that a multisite, online curricular intervention is a potentially viable approach to offering new curriculum with limited on-site faculty expertise for other family medicine residencies.

Increasing resident recruitment into family medicine: effect of a unique curriculum in integrative medicine.

INTRODUCTION: Healthcare reform is highlighting the need for more family practice and other primary care physicians. The Integrative Medicine in Residency (IMR) curriculum project helped family medicine residencies pilot a new, online curriculum promoting prevention, patient-centered care competencies, use of complementary and alternative medicine along with conventional medicine for management of chronic illness. A major potential benefit of the IMR program is enhanced recruitment into participating residencies, which is reported here. METHODS: Using an online questionnaire, accepted applicants to the eight IMR pilot programs (n = 152) and four control programs (n = 50) were asked about their interests in learning integrative medicine (IM) and in the pilot sites how the presence of the IMR curriculum affected their ranking decisions. RESULTS: Of residents at the IMR sites, 46.7% reported that the presence of the IMR was very important or important in their ranking decision. The IMR also ranked fourth overall in importance of ranking after geography, quality of faculty, and academic reputation of the residency. The majority of IMR residents (87.5%) had high to moderate interest in learning IM during their residency; control residents also had a high interest in learning IM (61.2%). CONCLUSIONS: The presence of the IMR curriculum was seen as a strong positive by applicants in ranking residencies. Increasing the adoption of innovative IM curricula, such as the IMR, by residency programs may be helpful in increasing applications of competitive medical students into primary care residencies as well as in responding to the expressed interest in learning the IM approach to patient care.

The effect of live spontaneous harp music on patients in the intensive care unit.

This study was performed to investigate the effect of live, spontaneous harp music on individual patients in an intensive care unit (ICU), either pre- or postoperatively. The purpose was to determine whether this intervention would serve as a relaxation or healing modality, as evidenced by the effect on patient's pain, heart rate, respiratory rate, blood pressure, oxygen saturation, and heart rate variability. Each consenting patient was randomly assigned to receive either a live 10-minute concert of spontaneous music played by an expert harpist or a 10-minute rest period. Spontaneous harp music significantly decreased patient perception of pain by 27% but did not significantly affect heart rate, respiratory rate, oxygen saturation, blood pressure, or heart rate variability. Trends emerged, although being not statistically significant, that systolic blood pressure increased while heart rate variability decreased. These findings may invoke patient engagement, as opposed to relaxation, as the underlying mechanism of the decrease in the patients' pain and of the healing benefit that arises from the relationship between healer, healing modality, and patient.

Resident wellness behaviors: relationship to stress, depression, and burnout.

BACKGROUND AND OBJECTIVES: Stress in medical education has been well documented, often with the primary focus on negative factors such as depression and burnout. Few studies have attempted to assess well-being mediating behaviors. This study describes the relationship between wellness behaviors and measures of well-being at the start of family medicine residency. METHODS: Using an online questionnaire, first-year family medicine residents (n=168) completed standardized measures exploring perceived stress, depression, satisfaction with life, and burnout. A lifestyle wellness behavior measure was developed for the study. RESULTS: Average reported perceived stress levels were consistent with ranges found for medical students and residents. Twenty-three percent of residents scored in a range consistent with depression risk. In terms of burnout risk, 13.7% scored in the high emotional exhaustion range and 23.8% in the high depersonalization range. Two thirds reported high life satisfaction. Higher depersonalization and less time in nurturing relationships were associated with greater likelihood of medication use for sleep, mood, and anxiety in females. Higher alcohol use was associated with increased levels of perceived stress, burnout, and depression. The two wellness behaviors most associated with higher well-being were restful sleep and exercise. CONCLUSIONS: At the start of residency, well-being measures are consistent with findings in medical school. Restful sleep and exercise were associated with more positive well-being. Future longitudinal data analysis will help clarify the effect of residency training in well-being and lifestyle behaviors. Identification of protective factors and coping mechanisms could guide residencies in incorporating support services for residents.

Integrative medicine in residency education: developing competency through online curriculum training.

INTRODUCTION: The Integrative Medicine in Residency (IMR) program, a 200-hour Internet-based, collaborative educational initiative was implemented in 8 family medicine residency programs and has shown a potential to serve as a national model for incorporating training in integrative/complementary/alternative medicine in graduate medical education. INTERVENTION: The curriculum content was designed based on a needs assessment and a set of competencies for graduate medical education developed following the Accreditation Council for Graduate Medical Education outcome project guidelines. The content was delivered through distributed online learning and included onsite activities. A modular format allowed for a flexible implementation in different residency settings. EVALUATION: TO ASSESS THE FEASIBILITY OF IMPLEMENTING THE CURRICULUM, A MULTIMODAL EVALUATION WAS UTILIZED, INCLUDING: (1) residents' evaluation of the curriculum; (2) residents' competencies evaluation through medical knowledge testing, self-assessment, direct observations, and reflections; and (3) residents' wellness and well-being through behavioral assessments. RESULTS: The class of 2011 (n  =  61) had a high rate of curriculum completion in the first and second year (98.7% and 84.2%) and course evaluations on meeting objectives, clinical utility, and functioning of the technology were highly rated. There was a statistically significant improvement in medical knowledge test scores for questions aligned with content for both the PGY-1 and PGY-2 courses. CONCLUSIONS: The IMR program is an advance in the national effort to make training in integrative medicine available to physicians on a broad scale and is a success in terms of online education. Evaluation suggests that this program is feasible for implementation and acceptable to residents despite the many pressures of residency.

Integrative medicine in residency: assessing curricular needs in eight programs.

BACKGROUND AND OBJECTIVES: Integrative medicine in residency (IMR) is a competency-based online program designed to incorporate a core curriculum in integrative medicine (IM) into established residency training in family medicine. Results of a needs assessment survey developed to guide this curriculum design are presented and discussed. METHODS: Faculty and residents from eight self-selected family medicine programs that agreed to pilot the IMR were invited to complete an online needs assessment survey. The survey included a mix of structured and open-ended questions. RESULTS: A total of 222 respondents completed the survey, yielding a 60% response rate. Sixty-seven percent of faculty and residents preferred that IM be woven throughout all curriculum areas. The highest rated content topics were nutrition and supplements and physician wellness. Chronic illness, behavioral health, and outpatient medicine were the three top curricular areas seen to need enhancement with IM. Qualitative analysis revealed that 84% of respondents viewed IM as central to family medicine training, the care of patients, and the field of family medicine. Top challenges to implementation included limitations in time, resources, and acceptance. CONCLUSIONS: The findings from the needs assessment serve as a resource for addressing curriculum design and potential challenges in implementation.

Measuring the "whole system" outcomes of an educational innovation: experience from the integrative family medicine program.

BACKGROUND AND OBJECTIVES: Six family medicine residency programs in the United States collaborated on the development and implementation of an integrative family medicine (IFM) program, which is a postgraduate training model that combines family medicine residency training with an integrative medicine fellowship. This paper reports on effects of IFM on residency programs and clinical systems in which it was implemented. METHODS: We used the Integrative Medicine Attitudes Questionnaire (IMAQ) to assess participants' attitudes toward integrative medicine before and after the program was implemented. We assessed residency program recruitment success before and after the program was implemented. We conducted interviews with key informants at each program to evaluate the effects of the IFM on the six participating residency programs. RESULTS: IMAQ scores demonstrated a significant increase in the acceptance of integrative medicine after implementation of IFM. Recruiting data showed that participating programs filled at a rate consistently above the national average both before and after implementation. Analysis of interview data showed that programs became more open to an integrative medicine (IM) approach and offered a wider range of clinical services to patients. CONCLUSIONS: Our mixed-methods strategy for evaluation of IFM showed that implementing the program increased acceptance of IM, did not affect residency fill rates, and increased use of IM in clinical practice. The combination of quantitative and qualitative methods was an effective strategy for documenting the "systems level" effects of a new educational program.