Clinician Well-being during a Pandemic: Practices to Boost Resilience and Life Satisfaction.

The role of the sports medicine physician has been challenged in several ways during the COVID-19 pandemic, potentially eroding a sense of well-being. Four universal human needs related to flourishing and a sense of life satisfaction are the framework we use to examine the effects of a pandemic on sports medicine clinicians. We offer two evidence-based practices to promote well-being and resilience within each of the four universal needs.

Association Between a Physical Activity Vital Sign and Cardiometabolic Disease in High-Risk Patients.

OBJECTIVE: To determine the association between the physical activity vital sign (PAVS) and markers of cardiometabolic disease. DESIGN: Patients were assessed through the PAVS, a validated tool self-reporting the frequency and duration of physical activity. Patients were categorized into 3 groups: inactive (0 minutes per week), underactive (1-149 minutes per week), and active (>150 minutes per week). Associations were tested between the PAVS and the cardiometabolic disease biomarkers of body mass index, hemoglobin A1c (A1c), blood pressure, and low-density lipoprotein (LDL) using one-way analyses of variance. SETTING: High-risk family medicine residency clinic. PARTICIPANTS: Two thousand three hundred twenty-one adult patients (age ≥ 18 years). RESULTS: Participants reported a mean of 97.87 (SD = 149.35) minutes per week of exercise. Overall, 50.1% reported physical inactivity, 25.7% were underactive, and 24.3% were active. Younger individuals (P < 0.001) and men (P < 0.05) reported more physical activity than older individuals and women. Patients who reported being active were significantly less likely to be overweight (P < 0.05), obese (P < 0.05), or hypertensive (P < 0.05), but there was no association with A1c or LDL levels. CONCLUSIONS: This is the first investigation to examine the PAVS in a high-risk population. In these patients, reported levels of physical inactivity are 150% higher than other clinical settings, and the PAVS is only associated with improvements in 2 of 4 major cardiometabolic risk factors. For this group, self-reported levels of physical activity may need to be higher for cardiovascular benefits to be realized in all 4 cardiometabolic domains. The PAVS offers health professionals an opportunity to encourage lifestyle-based interventions to reduce cardiovascular risk, but refinements may be necessary to address this population.

U.S. medical school curricula on working with medical interpreters and/or patients with limited English proficiency.

PURPOSE: The United States has an increasing population of individuals with limited English proficiency (LEP). Language access is a right for individuals with LEP in the health care system. As such, it is important for medical providers to be appropriately trained to work with individuals with LEP. Therefore, the purpose of this study was to describe curricula offered by United States medical schools to teach medical students to work with medical interpreters and/or patients with LEP. METHODS: An electronic survey was sent in March 2017 to administration at the 147 Liaison Committee on Medical Education® accredited medical schools as of November 7, 2016. The survey consisted of the following question: "As part of your medical school's curriculum, are students provided specific instruction addressing how to work with medical interpreters and/or patients with limited English proficiency (LEP)?" with different follow-up questions for schools that responded "Yes" vs "No". RESULTS: Responses were received from 26% (38/147) of medical schools. Among schools responding to the survey, 76% (29/38) offered a curriculum that provides instruction of how to work with medical interpreters and/or patients with LEP. Of schools that provide instruction, teaching methods included didactic sessions (34% [10/29]) and standardized patient experiences (34% [10/29]). In addition, 76% (22/29) offer training in the first 2 years of medical school and 28% (8/29) offer training in the third and fourth years of the curriculum. Sixty-two percent (18/29) of respondents that offered a formal curriculum have been administering a formal curriculum for ≤10 years. CONCLUSION: The majority of the responding medical schools offer formal instruction of how to work with medical interpreters and/or patients with LEP. Most schools started this type of instruction in the last 10 years with most instruction occurring in the first 2 years of an undergraduate medical curriculum.

Faculty development effects on clerkship grades.

BACKGROUND: Faculty member assessment of clerkship students' clinical performance has been noted as a consistently problematic issue within most medical student clerkships, and thus a worthy target of faculty development. One of the primary challenges in such faculty development is creating a change that improves the clinical assessment of students in a meaningful way. METHOD: In the current study we evaluated the effects of a pair of brief interventions designed to facilitate greater use of the 'Not observed' option in faculty member assessments of clerkship students (as opposed to use of 'Meets expectations' for skills actually not observed by the rater) within a psychiatry rotation for third-year medical students in the USA. RESULTS: The intervention demonstrated statistically significant effects, both intentional and unintentional. Specifically, faculty members rated themselves as having increased their own understanding and confidence regarding the use of the assessment forms after the intervention. With regard to actual ratings of clerkship students, faculty members were less likely to use the 'Not observed' option after the intervention. Also, the mean rating increased slightly, and to a greater degree than could be explained entirely by the shift away from using 'Meets expectations' when 'Not observed' was more appropriate. Faculty member assessment of … students' clinical performance [is] a consistently problematic issue DISCUSSION: Results are discussed with regards to suggestions for implementation of the intervention in other programmes, specifically with regard to proposed improvements and issues to consider and monitor.

Journal Clubs in Sports Medicine Fellowship Programs: Results From a National Survey and Recommendations for Quality Improvement.

BACKGROUND: Journal club is a pervasive component of graduate medical education, yet there is no gold standard as to format and logistics. METHODS: Survey of primary care sports medicine fellowship directors in the United States. RESULTS: Sixty-nine program directors completed the online questionnaire (40% response rate). There were some common aspects to journal club exhibited by a majority of programs, including the general format, required attendance by fellows and expected or required attendance by faculty, the expectation that participants had at least read the article before the meeting, and that meetings occurred during the workday in the work setting without provision of food. There was considerable variation on other aspects, including the objectives of journal club, who had primary responsibility for organizing the session, the criteria for selection of articles, who was invited to attend, and the perceived problems with journal club. CONCLUSIONS: This is the first survey investigating the current state of journal club in primary care sports medicine fellowship programs. Several opportunities for educational enhancements exist within journal clubs in primary care sports medicine, including the use of structured tools to guide discussion, providing mechanisms to evaluate the journal club experience as a whole, inviting multidisciplinary team members (eg, statisticians) to discussions, and ensuring that objectives are explicitly stated to participants.

The self-harm inventory: A meta-analysis of its relationship to the personality diagnostic questionnaire-4 as a measure of borderline personality disorder.

OBJECTIVE: The purpose of the present study was to further examine the efficacy of the Self-Harm Inventory (SHI) as a proxy measure in diagnosing borderline personality disorder, with the comparison measure being the Personality Diagnostic Questionnaire-4 (PDQ-4). METHODS: We undertook a meta-analysis of data from our previous studies of psychiatric inpatients (N = 270) and internal medicine outpatients (N = 2587), all of whom completed both the SHI and the PDQ-4. RESULTS: Scores on the SHI and PDQ-4 were strongly correlated, especially after correcting for attenuation due to measurement unreliability (0.78 in the compiled inpatient psychiatry sample and 0.83 in the compiled internal medicine sample). Moreover, the SHI demonstrated statistically significantly greater reliability coefficients relative to the PDQ-4. CONCLUSIONS: Based upon comparison with the PDQ-4, the SHI appears to be an efficacious proxy measure of borderline personality symptomatology in both psychiatric inpatient samples and primary care outpatient samples.

The self-harm inventory: A meta-analysis of its relationship to the personality diagnostic questionnaire-4 as a measure of borderline personality disorder.

OBJECTIVE: The purpose of the present study was to further examine the efficacy of the Self-Harm Inventory (SHI) as a proxy measure in diagnosing borderline personality disorder, with the comparison measure being the Personality Diagnostic Questionnaire-4 (PDQ-4). METHODS: We undertook a meta-analysis of data from our previous studies of psychiatric inpatients (N = 270) and internal medicine outpatients (N = 2587), all of whom completed both the SHI and the PDQ-4. RESULTS: Scores on the SHI and PDQ-4 were strongly correlated, especially after correcting for attenuation due to measurement unreliability (0.78 in the compiled inpatient psychiatry sample and 0.83 in the compiled internal medicine sample). Moreover, the SHI demonstrated statistically significantly greater reliability coefficients relative to the PDQ-4. CONCLUSIONS: Based upon comparison with the PDQ-4, the SHI appears to be an efficacious proxy measure of borderline personality symptomatology in both psychiatric inpatient samples and primary care outpatient samples.

Effective Research Strategies for Trainees in Internal Medicine Residency Programs.

For most training programs, the development of research endeavors among trainees is an ongoing challenge. In this article, we review various considerations when attempting to undertake research activities within an internal medicine residency training program, including availability of institutional resources (eg, dedicated research time for trainees and faculty, available faculty mentors, accessible adjunctive personnel), engagement of residents into research, classic project quagmires in training programs, the institutional review board, publication options (eg, letters to the editor, case reports, literature reviews, original research reports), and journal submission strategies. Given that research entails multiple components and distinct skills, the overall program goal should be to make research an educationally understandable process for trainees. Research can be a rewarding activity when nurtured in a facilitating educational environment.

Religiosity/spirituality: Relationships with non-suicidal self-harm behaviors and attempted suicide.

BACKGROUND: The relationships between religiosity/spirituality (RS) and self-harm behavior, including non-suicidal self-harm behavior (NS-SHB) and suicide attempts/completions, remain of keen interest. Whereas the majority of studies strongly suggest that RS protects against suicide attempts/completions, relationships between RS and NS-SHB have been rarely studied. AIM: In this study, we examined RS in relationship to both NS-SHB (six explicit behaviors) and past history of suicide attempts. METHOD: In a cross-sectional sample of 306 consecutive primary care outpatients, we administered four self-report assessments for RS (extent participant considered self a religious person, extent participant considered self a spiritual person, extent religion is involved in understanding/dealing with stressful situations, Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12)) as well as examined seven items on the Self-Harm Inventory: six items reflecting NS-SHB and one item reflecting a past suicide attempt. RESULTS: While two RS items yielded no significant findings (extent participant considered self a spiritual person, extent religion is involved in understanding/dealing with stressful situations), the remaining two items were associated with a lowered risk of self-harm behavior, particularly the FACIT-Sp-12. CONCLUSIONS: Some but not all aspects of RS are associated with lowered risk for self-harm. In this study, considering oneself a religious person and reporting a general sense of RS well-being offered the most protective effect to participants, particularly the latter.

Body mass index and self-reported compliance with general health care.

OBJECTIVES: The relation between elevated body mass index (BMI)/overweight-obesity and compliance with health care remains unclear; some studies have demonstrated a relation whereas others have not. To add to the confusion, a number of studies have examined specialized populations (eg, patients with diabetes mellitus) and/or only one parameter of compliance (eg, taking medication). In the present study, we examined primary care outpatients for relations between BMI and multiple parameters of healthcare adherence/compliance. METHODS: Using a cross-sectional approach and a self-report survey methodology, we examined 250 primary care outpatients using three measures of healthcare compliance: conscientiousness in following through with medical treatment; a 5-item questionnaire examining compliance with general healthcare behaviors such as regular dental checkups and arrival to doctors' appointments on time; and the Medical Outcomes Study General Adherence Items, a general measure of compliance with physician directives. RESULTS: With the exceptions of regular dental checkups, on-time arrival for doctors' appointments, and timely completion of laboratory work, the remaining variables demonstrated statistical significance at minimally the P & 0.05 level. CONCLUSIONS: Patients with higher BMIs self-report less willingness to adhere to general healthcare requests/recommendations than patients with lower BMIs.

Childhood bullying and healthcare adherence in adulthood.

BACKGROUND: The relationship between childhood bullying and healthcare adherence in adulthood has been rarely studied, but one published study suggests that being bullied in childhood is related to lower healthcare adherence among adolescents. This previous study examined few adherence variables and was limited to youths. AIMS: In this study, we assessed five variables for childhood bullying as related to seven measures of healthcare adherence among a cohort of adult primary care outpatients. METHOD: Using a cross-sectional, self-report survey methodology in a sample of 263 consecutive internal medicine outpatients, we examined five aspects of bullying and seven aspects of adherence with general healthcare. RESULTS: Being a victim of bullying, type of bullying (emotional, physical), number of years bullied and number of bullies each evidenced no statistical relationships with healthcare adherence. However, being a bully demonstrated several statistical relationships with healthcare adherence, indicating less adherence to instructions provided by healthcare professionals. CONCLUSIONS: Despite all of the deleterious psychological and physical effects of being bullied in childhood, there was no evidence that non-adherence with healthcare in adulthood is one of them. In contrast, bullies evidenced several areas of reduced healthcare adherence.

Borderline personality symptomatology and compliance with general health care among internal medicine outpatients.

OBJECTIVES: The extant literature on borderline personality disorder (BPD) and compliance with mental health treatment contains conflicting findings. However, among those individuals with this type of personality dysfunction, reduced compliance with mental health treatment appears to be the predominant theme. To our knowledge, the relationship between BPD and compliance with general health care has not been studied. In addition, there is no prior study in this area examining a primary care population. METHODS: Using a cross-sectional survey methodology among a sample of internal medicine outpatients (N = 261), we assessed borderline personality symptoms with two self-report measures and general health care compliance or adherence with four self-report measures. RESULTS: With the exception of on-time arrival for doctor appointments, the remaining compliance variables demonstrated statistically significant relationships at the p < 0.01-0.001 levels, with borderline personality symptoms predicting reduced compliance (i.e., conscientiousness with medical treatment, regular dental check-ups, timely completion of laboratory work, following doctor's exercise and nutrition instructions, remembering to take medications, and Medical Outcomes Study General Adherence Score). CONCLUSIONS: Compared with participants without borderline personality symptoms, those participants with such symptoms in this study evidenced lower general health care compliance.