Taking up space : exploring clinical social workers\u27 attitudes and practice experiences with their overweight and obese clients

This qualitative study provides in an-depth exploration of clinical social workers\u27 experiences with their overweight and obese clients. As the War on Obesity rages on, clinical social workers have come to occupy a unique position in understanding and addressing the needs of this population. This study seeks to add to the growing clinical literature on size bias in psychotherapy and intends to explicate the clinician\u27s experience in both establishing and maintaining therapeutic relationships with these clients. Nine licensed clinical social workers were interviewed about their attitudes towards their overweight and obese clients and their experiences as they worked with them. The findings demonstrated that clinicians\u27 relationships with their clients were marked with great challenge and complexity. Clinicians felt overweight and obesity could be highly problematic to clients psychologically, physically and socially. At the same time, implicit anti-fat attitudes were frequently revealed in clinicians\u27 narratives and may have been unintentionally communicated to clients. An overarching theme was the strong negative countertransference reactions that clinicians experienced in their work with these clients, primarily around weight-related discussions. This research suggests that social work clinicians may benefit from cultural competence training in their work with overweight and obese clients and could benefit from examining their own relationships to their bodies and the ways this relationship enters the therapeutic space

Medical student perspectives on conducting patient experience debrief interviews with hospitalized children and their families

Purpose: To explore how medical students completing a pediatric clerkship viewed the benefits and barriers of debrief interviews with hospitalized patients and families. Methods: In this study, focus groups were conducted with pediatric clerkship students after completion of a debrief interview. The constant comparative method was used with Mezirow’s transformative learning theory as a lens to explore perceptions of the benefits and challenges of performing the interview. Results: Focus groups revealed five benefits and two challenges. The benefits were that the debrief interviews helped students (1) humanize patients and appreciate social and environmental influences on patient health, (2) assess caregiver/patient understanding about care to correct misunderstandings, (3) actively involve caregivers/patients in treatment plan development, (4) engage patients in active expression of questions/concerns, and (5) recognize the value of their own role on the healthcare team. The challenges were that students felt (1) a lack of knowledge to answer caregivers’/patients’ questions about diagnoses and (2) discomfort responding to caregiver/patient frustration, anxiety, or sadness. Student feedback on feasibility and implementation led to guidelines for selecting patients and conducting small group discussions after the debrief interviews. Conclusions: Debrief interviews offer a unique approach for learners to explore patient perspectives during hospitalization through direct patient engagement and dialogue, contributing to professional development, empathy, and potentially more positive patient care experiences

The Patient Experience Debrief Interview: How Conversations With Hospitalized Families Influence Medical Student Learning and Reflection

PURPOSE: To determine the effect of patient debrief interviews on pediatric clerkship student depth of reflection and learning. METHOD: The authors conducted a multi-institutional, mixed-methods, cluster randomized trial among pediatric clerkship students from May 2016 to February 2017. Intervention students completed a debrief interview with a patient-caregiver, followed by a written reflection on the experience. Control students completed a written reflection on a memorable patient encounter. Three blinded authors scored written reflections according to the 4-level REFLECT rubric to determine depth of reflection. Interrater reliability was examined using kappa. REFLECT scores were analyzed using a chi-square test; essays were analyzed using content analysis. RESULTS: Eighty percent of eligible students participated. One hundred eighty-nine essays (89 control, 100 intervention) were scored. Thirty-seven percent of the control group attained reflection and critical reflection, the 2 highest levels of reflection, compared with 71% of the intervention group; 2% of the control group attained critical reflection, the highest level, compared with 31% of the intervention group (χ(3, N = 189) = 33.9, P \u3c .001). Seven themes were seen across both groups, 3 focused on physician practice and 4 focused on patients. Patient-centered themes were more common in the intervention group, whereas physician-focused themes were more common in the control group. CONCLUSIONS: Patient debrief interviews offer a unique approach to deepen self-reflection through direct dialogue and exploration of patient-caregiver experiences during hospitalization

The Prevalence of Social and Behavioral Topics and Related Educational Opportunities During Attending Rounds

PurposeTo quantify the prevalence of social and behavioral sciences (SBS) topics during patient care and to rate team response to these topics once introduced.MethodThis cross-sectional study used five independent raters to observe 80 inpatient ward teams on internal medicine and pediatric services during attending rounds at two academic hospitals over a five-month period. Patient-level primary outcomes-prevalence of SBS topic discussions and rate of positive responses to discussions-were captured using an observational tool and summarized at the team level using hierarchical models. Teams were scored on patient- and learner-centered behaviors.ResultsObservations were made of 80 attendings, 83 residents, 75 interns, 78 medical students, and 113 allied health providers. Teams saw a median of 8.0 patients per round (collectively, 622 patients), and 97.1% had at least one SBS topic arise (mean = 5.3 topics per patient). Common topics were pain (62%), nutrition (53%), social support (52%), and resources (39%). After adjusting for team characteristics, the number of discussion topics raised varied significantly among the four services and was associated with greater patient-centeredness. When topics were raised, 38% of teams' responses were positive. Services varied with respect to learner- and patient-centeredness, with most services above average for learner-centered, and below average for patient-centered behaviors.ConclusionsOf 30 SBS topics tracked, some were addressed commonly and others rarely. Multivariable analyses suggest that medium-sized teams can address SBS concerns by increasing time per patient and consistently adopting patient-centered behaviors