Support opportunities for second victims lessons learned: a qualitative study of the top 20 US News and World Report Honor Roll Hospitals

Background Second Victim Programs (SVPs) provide support for healthcare providers involved in a near-miss, medical error, or adverse patient outcomes. Little is known about existence and structure of SVPs in top performing US hospitals. Methods We performed a prospective study and interviewed individuals representing SVPs from 20 US News and World Report (USNWR) Honor Roll Hospitals. Telephone interviews were recorded, transcribed, and de-identified. To allow identification of both quantitative and qualitative themes that unified or distinguished programs with SVPs from each other, a content analysis approach was used. Results Of the Top 20 UNSWR hospitals, nineteen individuals with knowledge of or involvement in SVPs were identified. One individual represented two hospital systems for the same institution. Thirteen representatives agreed to participate, 12 declined, and 5 did not respond. One individual who initially agreed to participate did not attend the interview. Among twelve representatives interviewed, 10 reported establishment of SVPs at their hospitals between 2011 and 2016. Most program representatives reported that participants sought support voluntarily. Four domains were identified in the qualitative analysis: (a) identification of need for Second Victim Program (SVP); (b) challenges to program viability; (c) structural changes following SVP creation, and (d) insights for success. Driving SVP creation was the need support medical providers following a traumatic patient event. Poor physician participation due to the stigma associated with seeking support was commonly reported as a challenge. However, acceptance of the mission of SVPs, growing recognition of the value of the program across hospital departments, and systematic safety enhancements were cited as key advantages. To ensure success, participants suggested training a variety of volunteers and incorporating SVPs within quality improvement processes. Conclusions In this convenience sample, programs for healthcare providers that experience psychosocial or emotional trauma from clinical care were uncommon. Variation in structure, performance, and measures of success among SVPs was observed. A systematic approach to evaluating SVPs is needed to help inform institutions of how to best serve their second victims.

Proprioceptive Coherence: An Expanded View of the Mechanics Behind the Indirect Method and the Introduction of an Innovative Variation

Proprioceptive coherence is proposed as a novel osteopathic treatment technique whereby the desired technique response is rapid, resulting from the sensory integration of multiple diverse proprioceptive, somatosensory, nociceptive, neuroendocrine elements contributing to focal somatic dysfunction. Volitional components involving the cerebral cortex, emotional contributions from the limbic system as well as prioritization of the motor responses to dysfunction contribute to mechanisms putatively involved with the technique. The technique has a unique obligatory focus on a temporal element. To better comprehend this treatment approach, diverse determinants of somatic dysfunction such as altered proprioceptive input, muscular influences, nociception, spinal cord processing and higher level central processing are discussed including muscular, aspects of mechanical transduction and tensegrity, nociception, spinal cord, and central processing. The diagnostic component of this technique involves identification of primarily interoceptive, proprioceptive and somatosensory related tissue alterations and considers a secondary exteroceptive contribution. The treatment phase is dictated by perception of precise balancing of localized forces on the area of dysfunction. A mandatory physician participation is dictated by the feed forward unique chronoception component. At the completion of the technique, rapid therapeutic effects are perceived by both the physician and the patient. This paper is intended to appeal to the scientist in all of us; the lover of osteopathic manipulative techniques, and the healer we embrace as practicing osteopathic physicians. To help establish proprioceptive coherence as a novel technique, a comparison to common forms of osteopathic treatment based upon the indirect method is presented. It is proposed that proprioceptive coherence is a novel technique with unique mechanisms however others may consider the technique as a refinement of existing indirect methods.

Fertility education: what’s trending on Instagram

Objective To determine the prevalence, authorship, and types of fertility-related information shared on Instagram targeted toward a new patient interested in fertility options using hashtag and content analysis. Secondary outcomes included comparison of post content stratified by author type (physicians versus patients). Methods A list of ten hashtags consisting of fertility terms for the new patient was derived. Content analysis was performed in April 2019 on the top 50 and most recent 50 posts for each hashtag to determine authorship and content type. The distribution of fertility terms in posts made by physicians was compared to that of patients and differences in use of terms were analyzed. Results Our search yielded 3,393,636 posts. The two most popular hashtags were IVF (N = 912,049), and Infertility (N = 852,939). Authorship of the top posts for each hashtag (N = 1000) were as follows: patients (67 %), physicians (10 %), for-profit commercial groups (6.0 %), allied health professional (4.5 %), professional societies (1 %), and other (11 %). Of these posts, 60 % related to patient experiences, 10 % advertisements, 10 % outreach, and 8 % educational. Physicians were more likely to author posts related to oocyte cryopreservation compared to IVF, while patients were more likely to author posts about IVF (p < 0.0001). Conclusions Over 3 million posts related to fertility were authored on Instagram. A majority of fertility posts are being mobilized by patients to publicly display and share their personal experiences. Concurrent with the rising utilization of planned oocyte cryopreservation, there is a trend toward physicians educating their patients about the process using social media as a platform. Physician participation on social media may offer a low-cost platform for networking and connecting with patients. Future studies examining the educational quality of posts by author type should be explored.

Physician engagement in regularly scheduled rounds

Background: Physician participation in regularly scheduled series (RSS), also known as grand rounds, was explored with a particular focus on physician perceptions about the elements that affected their engagement in RSS and the unanticipated benefits to RSS. Methods: A qualitative study using semi-structured interviews and thematic analysis examined physicians’ perception of their knowledge and educational needs and the factors that contributed to engagement in their local hospital RSS. Results: Physician engagement in RSS was affected by four major themes: Features that Affect the RSS’ Quality; Collegial Interactions; Perceived Outcomes of RSS; and Barriers to participation in RSS. Features that Affect RSS’ Quality were specific modifiable features that impacted the perceived quality of the RSS. Collegial Interactions were interactions that occurred between colleagues directly or indirectly as a result of attending RSS. Outcomes of RSS were specific outcome measures used in RSS sessions. Barriers were seen as reasons why physicians were unwilling or unable to participate in RSS. All of the elements identified within the four themes contributed to the development of physician engagement. Physicians also identified changes directly and indirectly due to RSS. Discussion: Specific features of RSS result in enhanced physician engagement. There are benefits that may not be accounted for in continuing medical education (CME) outcome study designs

Fitness habits and barriers to exercise during residency training

While physicians advise patients on healthy lifestyle habits, physicians may struggle to abide by their own recommendations. We sought to characterize resident physician participation in exercise, their barriers to exercise, and the effect of exercise on their overall wellness. We hypothesized that residents who exercised would have less depression and greater wellbeing. Trainees at a university-based institution were surveyed. Data regarding exercise habits, hours worked, barriers to exercise, and mental health were acquired. Mental health was assessed via the Patient Health Questionnaire-2. Inter-group differences were analyzed using chi-squared testing; statistical significance was set at P<0.05. 129 trainees responded to the survey. 84 trainees reported exercising while 45 denied. 63 exercisers reported “living a healthy lifestyle” compared to 18 nonexercisers (P<0.001). Exercisers were more likely to report “Time” as their greatest barrier to exercise (P<0.001). Fifty-five exercisers answered “Not at all” when asked about how often they experience anhedonia compared to 23 non-exercisers. Trainees who exercise are more likely to report living a healthy lifestyle and less likely to experience anhedonia than non-exercisers, demonstrating the importance of exercise during residency.

Characterizing Physician Practice in Nursing Homes Using Claims-Based Measures: Correlation With Nursing Home Administrators’ Perceptions

Heterogeneity in physician practice within nursing homes (NHs) may explain variations in quality. However, data on physician practice organization in NHs are hard to obtain. We characterized NH physician practice using two claims-based measures: (a) concentration of NH care among physicians (measured by Herfindahl–Hirschman index of visits); and (b) physician NH practice specialization (measured by the proportion of a physician’s visits to NHs). We examined the relationship between the measures and NH administrator perceptions of physician practice reported in the Shaping Long-Term Care in America (SLTCA) Survey. All 2011 Part B claims from 13,718 physicians who treated Medicare fee-for-service patients in 2,095 NHs in the SLTCA survey were analyzed. The median Herfindahl–Hirschman index was 0.44 (interquartile range [IQR] 0.28-0.70), and the median specialization was 38.1% (IQR 19.9% to 60.9%). NHs with higher physician specialization reported more frequent physician participation in care coordination activities. Claims-based measures could inform the study of NH physician practice.

Tumor Genomic Profiling Practices and Perceptions: A Survey of Physicians Participating in the NCI-MATCH Trial

PURPOSE To identify factors that may influence physician participation in tumor profiling studies and to assess the routine use of tumor profiling in clinical practice. METHODS Physicians in the National Cancer Institute–Molecular Analysis for Therapy Choice (NCI-MATCH) were invited to participate in an electronic survey consisting of 73 questions related to participation in genomic profiling studies, tumor profiling practices and education during usual patient care, and physician background and practice characteristics. RESULTS The survey response rate was 8.9% (171 surveys returned of 1,931 sent). A majority of respondents practiced in academic medical centers (AMCs). Participation in NCI-MATCH increased workload and cost but resulted in increased professional satisfaction, confidence in treatment recommendation, and subsequent use of tumor profiling. Barriers to patient participation included length of wait time for results and lack of a therapeutic option from the testing. Physicians who worked in AMCs reported a higher use of tumor profiling than did those who worked in non-AMC settings (43% v 18%; P = .0009). Access to a molecular tumor board was perceived as valuable by 56%. The study identified a need for educational materials to guide both physicians and patients in the field of genomic profiling. CONCLUSION Physicians who participate in NCI-MATCH perceive value to patient treatment that outweighs the additional effort required; survey results help identify barriers that may limit participation. The current findings have implications for the design of future genomic and other profiling studies.

Merging the Traditional with the New CME-accredited Twitter Journal Clubs

Twitter journal clubs are increasingly popular amongst healthcare providers. Most journal clubs rely on voluntary physician participation. Offering continuing medical education credit may incentivize and improve these journal clubs.In this investigation a series of 5 consecutive publication-sponsored Twitter journal clubs were analyzed in calendar year 2016, in which the latter 3 journal clubs offered CME credit. Various quality metrics were measured and analyzed to identify sustainable improvements in those journal clubs that offered CME credit.Overall, Twitter journal clubs that offered CME credit performed better in certain quality metrics, to wit activity, originality, and evidence-based tweeting, but fared poorly in number of and type of participant interactions.Twitter journal clubs are in their infancy and physician participation remains steady. Offering CME credit improves certain quality metrics within these journal clubs. This investigation should encourage more publications to sponsor CME-accredited Twitter journal clubs.