Correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns at Yale University, New Haven, USA

Purpose: This study aimed to determine the correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns in internal medicine, primary care, and internal medicine/pediatrics residency programs at two institutions. Methods: Intern physicians completed anonymous voluntary surveys prior to starting the internship in June 2009 and in the middle of the internship in February 2010. Three validated survey instruments were used to explore burnout, coping, and spiritual attitudes: the Maslach Burnout Inventory, the COPE Inventory, and the Hatch Spiritual Involvement and Beliefs Scale. The interns were in programs at the Yale University School of Medicine and a Yale-affiliated community hospital, New Haven, Connecticut, USA. Results: The prevalence of self-identified burnout prior to starting the internship was 1/66 (1.5%) in June 2009, increasing to 10/53 (18.9%) in February 2010 (P<0.0001). From June 2009 to February 2010, the prevalence of high emotional exhaustion increased from 30/66 (45.5%) to 45/53 (84.9%) (P<0.0001), and that of high depersonalization increased from 42/66 (63.6%) to 45/53 (84.9%) (P=0.01). Interns who employed the strategies of acceptance and active coping were less likely to experience emotional exhaustion and depersonalization (P<0.05). Perceptions of high personal accomplishment was 75.5% and was positively correlated with total scores on the Hatch Spiritual Involvement and Beliefs Scale, as well as the internal/fluid and existential/meditative domains of that instrument. Specific behaviors did not impact burnout. Conclusion: Burnout increased during the intern year. Acceptance, active coping, and spirituality were correlated with less burnout. Specific behaviors were not correlated with burnout domains

A clinician-educator’s roadmap to choosing and interpreting statistical tests

As educators seek confirmation of successful trainee achievement, medical education must move toward a more evidence-based approach to teaching and evaluation. Although medical training often provides physicians with a general background in biostatistics, many are not prepared to apply these skills. This can hinder clinician educators as they wish to develop, analyze and disseminate their scholarly work. This paper is intended to be a concise educational tool and guide for choosing and interpreting statistical tests aimed toward medical education assessment. It includes guidelines and examples that clinician-educators can use when analyzing and interpreting studies and when writing methods and results sections of reports

Teaching Medical Students the Important Connection between Communication and Clinical Reasoning

BACKGROUND: Medical students are rarely taught how to integrate communication and clinical reasoning. Not understanding the relation between these skills may lead students to undervalue the connection between psychosocial and biomedical aspects of patient care. OBJECTIVE: To improve medical students' communication and clinical reasoning and their appreciation of how these skills interrelate in medical practice. DESIGN: In 2003, we conducted a randomized trial of a curricular intervention at Johns Hopkins University School of Medicine. In a 6-week course, participants learned communication and clinical reasoning skills in an integrative fashion using small group exercises with role-play, reflection and feedback through a structured iterative reflective process. PARTICIPANTS: Second-year medical students. MEASUREMENTS: All students interviewed standardized patients who evaluated their communication skills in establishing rapport, data gathering and patient education/counseling on a 5-point scale (1=poor; 5=excellent). We assessed clinical reasoning through the number of correct problems listed and differential diagnoses generated and the Diagnostic Thinking Inventory. Students rated the importance of learning these skills in an integrated fashion. RESULTS: Standardized patients rated curricular students more favorably in establishing rapport (4.1 vs 3.9; P=.05). Curricular participants listed more psychosocial history items on their problem lists (65% of curricular students listing ≥1 item vs 44% of controls; P=.008). Groups did not differ significantly in other communication or clinical reasoning measures. Ninety-five percent of participants rated the integration of these skills as important. CONCLUSIONS: Intervention students performed better in certain communication and clinical reasoning skills. These students recognized the importance of biomedical and psychosocial issues in patient care. Educators may wish to teach the integration of these skills early in medical training