Moral Injury during the COVID-19 pandemic: A delphi model survey of family medicine residents

2021 ◽  
pp. 009121742110543
Author(s):  
Sean B Ngo ◽  
Payson J Clark ◽  
Sarah E Parr ◽  
Abel R Thomas ◽  
Akshat Dayal ◽  
...  
Keyword(s):  
Family Medicine ◽  
Family Relationships ◽  
The United States ◽  
Moral Injury ◽  
Professional Relationships ◽  
Major Barrier ◽  
Model Study ◽  
Seeking Help ◽  
Patient Relationships ◽  
Family Medicine Residents

Objectives The objective is to investigate the primary factors that created experiences leading to moral injury in family medicine residents during the COVID-19 pandemic and also to identify any barriers keeping these residents from seeking or receiving help when they experienced moral injury. Method A DELPHI model study utilizing three rounds of surveys was conducted at four family medicine residency programs in the United States. Resident responses to Survey 1 generated factors perceived to be causing them moral injury or constituting barriers to their seeking help. Thematic analysis identified common themes which were presented to residents in Survey 2 for rating and justification. Results and feedback from Survey 2 were shared with residents in Survey 3, where residents were prompted to reevaluate their ratings for factors and barriers for the purpose of generating consensus among themselves. A ranked list of factors and barriers was thereby created for the participating sites. Results Residents shared several stories about the factors that most pressured them to violate their moral values. The most severe and frequent factors contributing to moral injury involved disruptions to doctor–patient relationships, patient–family relationships, and relationships with other healthcare professionals. Time was the major barrier to residents seeking help. Conclusion During times of crisis, moral injury among residents may be minimized by protecting and promoting important clinical and professional relationships with patients, colleagues, and other medical professionals. While residents report that lack of time was the most significant barrier to seeking help, it is unclear how this complicated and ubiquitous problem would be resolved or mitigated.

scholarly journals Institute of Medicine 2009 Gestational Weight Gain Guideline Knowledge: Survey of Obstetrics/Gynecology and Family Medicine Residents of the United States

Birth ◽  
2013 ◽  
Vol 40 (4) ◽  
pp. 237-246 ◽  
Author(s):  
Tiffany A Moore Simas ◽  
Molly E Waring ◽  
Gina M T Sullivan ◽  
Xun Liao ◽  
Milagros C Rosal ◽  
...  
Keyword(s):  
United States ◽  
Weight Gain ◽  
Family Medicine ◽  
Gestational Weight Gain ◽  
The United States ◽  
Institute Of Medicine ◽  
Gestational Weight ◽  
Knowledge Survey ◽  
Family Medicine Residents

scholarly journals Family Medicine Residents' Debt and Certification Examination Performance

PRiMER ◽  
2019 ◽  
Vol 3 ◽  
Author(s):  
Julie P. Phillips ◽  
Lars E. Peterson ◽  
Iris Kovar-Gough ◽  
Thomas R. O'Neill ◽  
Michael R. Peabody ◽  
...  
Keyword(s):  
Family Medicine ◽  
The United States ◽  
Cross Sectional ◽  
Certification Examination ◽  
Debt Level ◽  
Examination Performance ◽  
Educational Debt ◽  
The Relationship ◽  
High Educational ◽  
Family Medicine Residents

Introduction: Previous studies have found that medical students and internal medicine residents with high educational debt perform less well on examinations. The purpose of this study was to examine the relationship between educational debt and family medicine residents’ performance on initial in-training and board certification examinations. Methods: Our study was a cross-sectional secondary analysis of American Board of Family Medicine (ABFM) data collected from residents (N=5,828) who registered for the Family Medicine Certification Examination (FMCE) in 2014 and 2015, representing 85.8% of graduating family medicine residents in the United States in those years. Multivariable linear and logistic regression modeling was used to examine the relationship between debt level and examination scores, and also to explore the relationship between debt level and passing the initial FMCE. Results: After controlling for demographic variables, residents with high debt ($150,000 to $249,999) and very high debt (more than $250,000) performed significantly worse than those with no debt on the initial in-training examination (score differences of 14.2 [CI 8.6, 19.8] and 15.8 [CI 10.3, 21.4] points, respectively) and FMCE (score differences of 19.3 points [CI 13.4, 25.3] and 30.4 points [CI 24.6, 36.3], respectively). Additionally, those with debt above $250,000 had half the odds of passing their initial FMCE (OR 0.45; CI 0.27-0.75). Conclusions: High educational debt is associated with lower examination performance among family medicine residents. This may be because residents with more debt have more stress or fewer day-to-day financial resources. However, confounding factors may also contribute to this association.

The role of Balint group training in the professional and personal development of family medicine residents

2017 ◽  
Vol 53 (1-2) ◽  
pp. 24-38 ◽  
Author(s):  
Marty Player ◽  
John R Freedy ◽  
Vanessa Diaz ◽  
Clive Brock ◽  
Alexander Chessman ◽  
...  
Keyword(s):  
Family Medicine ◽  
Personal Development ◽  
Future Research ◽  
Complex Nature ◽  
Individual Interviews ◽  
Balint Groups ◽  
Resident Physicians ◽  
Balint Group ◽  
Patient Relationships ◽  
Family Medicine Residents

This paper presents a study based on the participation of PGY2 and PGY3 family medicine residents in Balint seminars that occurred twice monthly for 24 months. Balint groups were cofacilitated by leader pairs experienced with the Balint method. Prior to residency graduation, 18 of 19 eligible resident physicians (94.5%) completed 30- to 60-min semistructured interviews conducted by a research assistant. Resident physicians were told that these individual interviews concerned “…how we teach communication in residency.” The deidentified transcripts from these interviews formed the raw data that were coded for positive (n = 9) and negative (n = 3) valence themes by four faculty coders utilizing an iterative process based on grounded theory. The consensus positive themes included several elements that have previously been discussed in published literature concerning the nature of Balint groups (e.g., being the doctor that the patient needs, reflection, empathy, blind spots, bonding, venting, acceptance, perspective taking, and developing appreciation for individual experiences). The negative themes pointed to ways of possibly improving future Balint offerings in the residency setting ( repetitive, uneasiness, uncertain impact). These findings appear to have consistency with seminal writings of both Michael and Enid Balint regarding the complex nature of intrapsychic and interpersonal skills required to effectively manage troubling doctor–patient relationships. The implications of findings for medical education (curriculum) development as well as future research efforts are discussed.

scholarly journals Family Medicine Residents’ Attitudes About Training in Ethiopia and the United States

2019 ◽  
Vol 51 (5) ◽  
pp. 424-429 ◽  
Author(s):  
Weyinshet Gossa ◽  
Christine Jones ◽  
Sorana Raiculescu ◽  
Mesfin Melaku ◽  
Elnathan Kebebew ◽  
...  
Keyword(s):  
Family Medicine ◽  
Patient Care ◽  
Family Physicians ◽  
Residency Education ◽  
The United States ◽  
Personal Life ◽  
Women's Issues ◽  
The Impact ◽  
Residents Attitudes ◽  
Family Medicine Residents

Background and Objectives: In Ethiopia, family medicine began in 2013. The objective of this study was to compare family medicine residents’ attitudes about training in Ethiopia with those at a program in the United States. Methods: Family medicine residents at Addis Ababa University in Addis Ababa, Ethiopia and the University of Maryland in Baltimore, Maryland completed a 43-item Likert scale survey in 2017. The survey assessed residents’ attitudes about residency education, patient care, independence as family physicians, finances, impact of residency on personal life, and women’s issues. We calculated descriptive statistics on the demographics data and analyzed survey responses using a two-sample t-test. Results: A total of 18 (75%) Ethiopian residents and 18 (60%) US residents completed the survey (n=36). The Ethiopian residents had a wider age distribution (25-50 years) than the US residents (25-34 years). More US residents were female (72%) compared to the Ethiopian cohort (50%), while more Ethiopian residents were married (72%) compared to the US cohort (47%). There were statistically significant differences in attitudes toward patient care (P=0.005) and finances (P<0.001), differences approaching significance in attitudes toward residency education, and no significant differences in independence as family physicians, the impact of residency on personal life, and women’s issues in family medicine. Conclusions: Across two very different cultures, resident attitudes about independence as family physicians, the impact of residency on personal life and women’s issues, were largely similar, while cross-national differences in attitudes were found relative to residency education, patient care, and finances.

Pathways to Legalization: Undocumented Mexican Immigrants in the US/Mexico Borderlands, 1942–1956

2015 ◽  
Vol 2 (2) ◽  
Author(s):  
Ana Elizabeth Rosas
Keyword(s):  
United States ◽  
Family Relationships ◽  
Mexican Immigrants ◽  
Extended Family ◽  
The United States ◽  
Mexican Immigrant ◽  
Agricultural Laborers ◽  
The Us ◽  
Us Government ◽  
Contract Laborers

In the 1940s, curbing undocumented Mexican immigrant entry into the United States became a US government priority because of an alleged immigration surge, which was blamed for the unemployment of an estimated 252,000 US domestic agricultural laborers. Publicly committed to asserting its control of undocumented Mexican immigrant entry, the US government used Operation Wetback, a binational INS border-enforcement operation, to strike a delicate balance between satisfying US growers’ unending demands for surplus Mexican immigrant labor and responding to the jobs lost by US domestic agricultural laborers. Yet Operation Wetback would also unintentionally and unexpectedly fuel a distinctly transnational pathway to legalization, marriage, and extended family formation for some Mexican immigrants.On July 12, 1951, US president Harry S. Truman’s signing of Public Law 78 initiated such a pathway for an estimated 125,000 undocumented Mexican immigrant laborers throughout the United States. This law was an extension the Bracero Program, a labor agreement between the Mexican and US governments that authorized the temporary contracting of braceros (male Mexican contract laborers) for labor in agricultural production and railroad maintenance. It was formative to undocumented Mexican immigrant laborers’ transnational pursuit of decisively personal goals in both Mexico and the United States.Section 501 of this law, which allowed employers to sponsor certain undocumented laborers, became a transnational pathway toward formalizing extended family relationships between braceros and Mexican American women. This article seeks to begin a discussion on how Operation Wetback unwittingly inspired a distinctly transnational approach to personal extended family relationships in Mexico and the United States among individuals of Mexican descent and varying legal statuses, a social matrix that remains relatively unexplored.

scholarly journals Perceived knowledge of psychiatry and family medicine residents regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia: opportunities to refine the residency training

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiangbo Ying ◽  
Jinhui Wan ◽  
Kang Sim ◽  
Ee-Jin Darren Seah ◽  
Mythily Subramaniam
Keyword(s):  
Diabetes Mellitus ◽  
Family Medicine ◽  
Residency Training ◽  
Medical Management ◽  
Demographic Data ◽  
Significant Proportion ◽  
Psychiatry Residents ◽  
Training Curriculum ◽  
Cross Sectional Survey ◽  
Family Medicine Residents

Abstract Background Psychiatry and Family Medicine residents frequently see patients with comorbid mental and physical disorders. Little is known about the difference in knowledge of Psychiatry residents and Family Medicine residents regarding management of common conditions they encounter. This study aimed to assess the knowledge of Psychiatry and Family Medicine residents regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia, as the findings could help to refine the training curriculum for residency training. Methods A cross-sectional survey design was used. Psychiatry and Family Medicine residents pursuing their residency in Singapore were recruited from November 2019 to June 2020. The survey questionnaire consisted of questions which assessed the knowledge regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia. Descriptive statistics were used to describe the demographic data; T-tests or Mann-Whitney U tests to compare the differences between groups; and multiple regression analyses to assess the factors associated with Psychiatry residents’ knowledge of hypertension, diabetes mellitus, and dyslipidemia. Results Fifty-seven out of 70 (81.4%) Psychiatry residents and 58 out of 61 (95.1%) Family Medicine residents participated in the study. The majority of Psychiatry residents encountered patients with hypertension (93.0%), diabetes mellitus (87.7%) and dyslipidemia (91.2%) on a daily to weekly basis. Psychiatry residents had higher scores on questions about schizophrenia versus Family Medicine residents (mean 50.70 versus 43.28, p < 0.001). However, Psychiatry residents scored lower on questions about hypertension (mean 33.86 versus 40.98, p < 0.001), diabetes mellitus (mean 45.68 versus 49.79, p = 0.005) and dyslipidemia (mean 37.04 versus 44.31, p < 0.001). Receiving undergraduate medical education locally, compared to receiving it overseas, was associated with better knowledge of hypertension (beta = 0.515, p = 0.009) and dyslipidemia (beta = 0.559, p = 0.005); while younger age (26–30 versus > 35 and 31–35 versus > 35) was associated with better knowledge of hypertension (beta = 1.361, p = 0.002 and beta = 1.225, p = 0.003). A significant proportion of Psychiatry residents (61.4%) did not agree that the training provided to manage hypertension, diabetes mellitus, and dyslipidemia was adequate. Similarly, majority of Family Medicine residents (62.1%) did not agree that they had adequate training to manage schizophrenia. Conclusions This study raises the awareness of Psychiatry residents’ sense of discomfort in managing hypertension, diabetes mellitus, or dyslipidemia and conversely Family Medicine residents in management of schizophrenia, which can be further addressed during the training postings within the residency programs. Future studies are needed to look at local (such as training curriculum) and systemic factors (such as practice trends and culture) in order to better align residency selection criteria and training foci with real world practice factors over time.

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