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"One size does not fit all" - lessons learned from a multiple-methods study of a resident wellness curriculum across sites and specialties

Chaukos, Deanna; Zebrowski, Jonathan P; Benson, Nicole M; Celik, Alper; Chad-Friedman, Emma; Teitelbaum, Aviva; Bernstein, Carol; Cook, Rebecca; Genfi, Afia; Denninger, John W
BACKGROUND:There is growing recognition that wellness interventions should occur in context and acknowledge complex contributors to wellbeing, including individual needs, institutional and cultural barriers to wellbeing, as well as systems issues which propagate distress. The authors conducted a multiple-methods study exploring contributors to wellbeing for junior residents in diverse medical environments who participated in a brief resilience and stress-reduction curriculum, the Stress Management and Resiliency Training Program for Residents (SMART-R). METHODS:Using a waitlist-controlled design, the curriculum was implemented for post-graduate year (PGY)-1 or PGY-2 residents in seven residency programs across three sites. Every three months, residents completed surveys, including the Perceived Stress Scale-10, General Self-Efficacy Questionnaire, a mindfulness scale (CAMSR), and a depression screen (PHQ-2). Residents also answered free-text reflection questions about psychological wellbeing and health behaviors. RESULTS:The SMART-R intervention was not significantly associated with decreased perceived stress. Linear regression modeling showed that depression was positively correlated with reported stress levels, while male sex and self-efficacy were negatively correlated with stress. Qualitative analysis elucidated differences in these groups: Residents with lower self-efficacy, those with a positive depression screen, and/or female residents were more likely to describe experiencing lack of control over work. Residents with higher self-efficacy described more positive health behaviors. Residents with a positive depression screen were more self-critical, and more likely to describe negative personal life events. CONCLUSIONS:This curriculum did not significantly modify junior residents' stress. Certain subpopulations experienced greater stress than others (female residents, those with lower self-efficacy, and those with a positive depression screen). Qualitative findings from this study highlight universal stressful experiences early in residency, as well as important differences in experience of the learning environment among subgroups. Tailored wellness interventions that aim to support diverse resident sub-groups may be higher yield than a "one size fits all" approach. TRIAL REGISTRATION/BACKGROUND:NCT02621801 , Registration date: December 4, 2015 - Retrospectively registered.
PMCID:8590124
PMID: 34774057
ISSN: 1472-6920
CID: 5048782

A Key Differential Diagnosis for Physicians-Major Depression or Burnout?

Oquendo, Maria A; Bernstein, Carol A; Mayer, Laurel E S
PMID: 31314066
ISSN: 2168-6238
CID: 3977932

[S.l.] : National Academy of Medicine, 2019

Gender-Based Differences in Burnout: Issues Faced by Women Physicians

Templeton, Kim; Bernstein, Carol A; Sukhera, Javeed; Nora, Lois Margaret; Newman, Connie; Burstin, Helen; Guille, Constance; Lynn, Lorna; Schwartze, Margaret L; Sen, Srijan; Busis, Neil
(Website)
CID: 4372102

On call: Psychiatry

Bernstein, Carol A; Poag, Molly; Rubinstein, Mort; Ahn, Christina; Maloy, Katherine F; Ying, Patrick
Amsterdam, Netherlands : Elsevier, 2019
Extent: xix, 332 p.
ISBN: 9780323531092
CID: 4104642

Potential Risks and Benefits of Mental Health Screening of Physicians

Goldman, Matthew L; Bernstein, Carol A; Summers, Richard F
PMID: 30500057
ISSN: 1538-3598
CID: 3618432

An Intervention Framework for Institutions to Meet New ACGME Common Program Requirements for Physician Well-Being

Goldman, Matthew L; Bernstein, Carol A; Konopasek, Lyuba; Arbuckle, Melissa; Mayer, Laurel E S
PMCID:6070414
PMID: 29470799
ISSN: 1545-7230
CID: 3150362

An Ounce of Prevention: A Public Health Approach to Improving Physician Well-Being

Chaukos, Deanna; Vestal, Heather S; Bernstein, Carol A; Belitsky, Richard; Cohen, Mitchell J; Hutner, Lucy; Penzner, Julie; Scheiber, Stephen; Wrzosek, Marika I; Silberman, Edward K
PMID: 28685352
ISSN: 1545-7230
CID: 2617392

The undiagnosed pandemic: Burnout and depression within the surgical community

DeCaporale-Ryan, Lauren; Sakran, Joseph V; Grant, Scott B; Alseidi, Adnan; Rosenberg, Tziporah; Goldberg, Ross F; Sanfey, Hilary; Dubose, Joseph; Stawicki, Stanislaw; Ricca, Robert; Derrick, Ellen Thomason; Bernstein, Carol A; Jardine, Dinchen A; Stefanou, Amalia J; Aziz, Ben; He, Ellie; Dissanaike, Sharmila; Fortuna, Col Gerald R Jr; Oviedo, Rodolfo J; Shapiro, Jo; Galowitz, Pamela; Moalem, Jacob
PMID: 29073980
ISSN: 1535-6337
CID: 2756452

Required and Elective Experiences During the 4th Year: An Analysis of ACGME Accredited Psychiatry Residency Program Websites

Vestal, Heather S; Belitsky, Richard; Bernstein, Carol A; Chaukos, Deanna; Cohen, Mitchell B; Dickstein, Leah J; Hilty, Donald M; Hutner, Lucy; Sakman, Ferda; Scheiber, Stephen C; Wrzosek, Marika I; Silberman, Edward K
OBJECTIVE: The objective of this study was to assess and describe required and elective components of the 4th post-graduate year (PGY4) in psychiatry residency programs. METHODS: We reviewed the websites of all 193 2014-2015 ACGME accredited psychiatry residency programs for content describing the specific components of the PGY4 year. RESULTS: Nearly all residency programs (99 %) had some form of required experiences during the PGY4 year. Ninety-four percent had clinical requirements for PGY4 residents, with longitudinal outpatient clinic being the most common (77 %). All programs offered some elective time during PGY4, but the amount of time ranged from 2 months to 100 %. CONCLUSION: Virtually all residency programs include some requirements in the 4th year (most commonly didactics and outpatient clinic) in addition to a broad array of elective experiences. Although 3 years may suffice for residents to complete ACGME requirements, a variety of factors may motivate programs to include required 4th year curricula. Future studies should explore the rationales for and possible benefits of programmatic requirements throughout 4 versus only 3 years of psychiatric training.
PMID: 26895930
ISSN: 1545-7230
CID: 1949972

Responding to the Call for Improving Resident Wellness

Chaukos, Deanna; Vestal, Heather S; Bernstein, Carol
PMID: 27218898
ISSN: 1938-808x
CID: 2114542