RESUMEN
BACKGROUND AND OBJECTIVES: Burnout is common among resident physicians. Studies show that those who engage in stress management and mindful practice have improved empathy and lower rates of mood disturbance. This study piloted a program entitled Stress Management and Resiliency Training for Residents (SMART-R) with Family Medicine (FM) and Ob-Gyn residents at an academic medical center. METHODS: The 6-hour SMART-R program, which teaches relaxation strategies, stress awareness, and adaptive coping, was mandatory for all years of residency and delivered in three 2-hour sessions during protected didactic time. Interested residents received a weekly phone text message with mindfulness and resiliency reminders to enhance practice between sessions. We measured burnout, empathy, perceived stress, mindful attention awareness, mind body practices, and program satisfaction. RESULTS: There were 14 matched pre/post surveys (six FM, eight Ob-Gyn), of which 10 (five FM; five Ob-Gyn) opted to receive weekly texts. Empathy, stress, and burnout remained stable over time. Those who received the weekly texts showed a significant increase in mindful attention awareness and trended toward lower perceived stress compared to those who did not receive texts. Half of those surveyed felt the training should be mandatory and 71% would recommend it to colleagues. While 93% thought it was important to know the current research on mind-body medicine to guide patients, only 29% felt they knew much about this. CONCLUSIONS: This study demonstrated the positive impact a 6-hour stress management and resiliency intervention can have on resident physicians. Unlike other studies that have shown decreased empathy and increased stress and burnout over time, these features remained stable over the academic year. Weekly text reminders supported the training and suggest potential benefit to enhance stress management training for medical professionals.
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Agotamiento Profesional , Internado y Residencia , Atención Plena , Médicos , Envío de Mensajes de Texto , Agotamiento Profesional/prevención & control , Humanos , Proyectos PilotoRESUMEN
PURPOSE OF REVIEW: We reviewed research on computer-assisted cognitive-behavior therapy (CCBT) performed in medical settings with the goals of assessing the effectiveness of this newer method of treatment delivery, evaluating the need for clinician support of therapeutic computer programs, and making suggestions for future research and clinical implementation. RECENT FINDINGS: The overall results of randomized, controlled trials suggest that CCBT can be an effective treatment for depression in primary care patients and health care anxiety. Also, it can be a useful component of treatment for somatic conditions including irritable bowel syndrome, diabetes, fibromyalgia, and chronic pain. The amount and type of clinician support needed for maximizing effectiveness remains unclear. CCBT offers promise for overcoming barriers to delivering effective psychotherapy in medical settings. We recommend that next steps for researchers include more definitive studies of the influence of clinician support, investigations focused on implementation in clinical practices, cost-benefit analyses, and use of technological advances.
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Ansiedad/terapia , Terapia Cognitivo-Conductual , Depresión/terapia , Trastorno Depresivo/terapia , Atención Primaria de Salud , Terapia Asistida por Computador , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
OBJECTIVE: To examine evidence for the effectiveness of computer-assisted cognitive-behavior therapy (CCBT) for depression in primary care and assess the impact of therapist-supported CCBT versus self-guided CCBT. METHODS: A search for randomized studies of CCBT compared to control groups for treating depression in primary care settings was conducted using Ovid MEDLINE, PsycINFO, PubMed, and Scopus. We extracted the following information from the studies that met inclusion criteria: mean depression rating scale scores before and after treatment, number of patients, type of control group and CCBT program, therapist support time and method of support, and treatment completion rate. Meta-analyses compared differences between posttreatment mean scores in each condition, as well as mean scores at follow-up. Study quality and possible bias also were assessed. RESULTS: Eight studies of CCBT for depression in primary care met inclusion criteria. The overall effect size was g = 0.258, indicating a small but significant advantage for CCBT over control conditions. Therapist support was provided in 4 of the 8 studies. The effect size for therapist-supported CCBT was g = 0.372-a moderate effect. However, the effect size for self-guided CCBT was g = 0.038, indicating little effect. CONCLUSIONS: Implementation of therapist-supported CCBT in primary care settings could enhance treatment efficiency, reduce cost, and improve access to effective treatment for depression. However, evidence to date suggests that self-guided CCBT offers no benefits over usual primary care.
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Terapia Cognitivo-Conductual , Trastorno Depresivo/terapia , Atención Primaria de Salud , Terapia Asistida por Computador , Terapia Cognitivo-Conductual/métodos , Humanos , Atención Primaria de Salud/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Terapia Asistida por Computador/métodosRESUMEN
BACKGROUND: Clinical research is required to develop and evaluate suicide prevention interventions in the elderly. However, there is insufficient information available about how to best recruit suicidal older adults for such research. This study evaluated the success and efficiency of five recruitment strategies for a clinical trial on the efficacy of cognitive therapy for suicidal older men. METHODS: For each strategy, the numbers of individuals approached, screened, and enrolled were calculated, and the expenses and time associated with each enrollment estimated. Men who were 60 years or older and who had a desire for suicide over the past month were eligible for the trial. RESULTS: Of 955 individuals considered for trial, 33 were enrolled. Most enrollments were sourced from the Veterans Affairs Behavioral Health Laboratory. Recruiting form this source was also the most time and cost efficient recruitment strategy in the study. CONCLUSIONS: Recruitment strategies are effective when they are based on collaborative relationships between researchers and providers, and utilize an existing infrastructure for involving patients in ongoing research opportunities.
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Selección de Paciente , Suicidio/psicología , Anciano , Anciano de 80 o más Años , Terapia Cognitivo-Conductual/métodos , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Derivación y ConsultaRESUMEN
BACKGROUND: Prevalent among resident physicians, burnout has been associated with absenteeism, low job satisfaction, and medical errors. Little is known about the number and quality of interventions used to combat burnout. METHODS: We performed a systematic review of the literature using MEDLINE and PubMed databases. We included English-language articles published between 1966 and 2007 identified using combinations of the following medical subject heading terms: burnout, intervention studies, program evaluation, internship and residency, graduate medical education, medical student, health personnel, physician, resident physician, resident work hours, and work hour limitations. Additional articles were also identified from the reference lists of manuscripts. The quality of research was graded with the Strength of Evidence Taxonomy (SORT) from highest (level A) to lowest (level C). RESULTS: Out of 190 identified articles, 129 were reviewed. Nine studies met inclusion criteria, only two of which were randomized, controlled trials. Interventions included workshops, a resident assistance program, a self-care intervention, support groups, didactic sessions, or stress-management/coping training either alone or in various combinations. None of the studied interventions achieved an A-level SORT rating. CONCLUSIONS: Despite the potentially serious personal and professional consequences of burnout, few interventions exist to combat this problem. Prospective, controlled studies are needed to examine the effect of interventions to manage burnout among resident physicians.
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Adaptación Psicológica , Agotamiento Profesional/psicología , Internado y Residencia , Satisfacción en el Trabajo , Agotamiento Profesional/prevención & control , Bases de Datos como Asunto , Humanos , Errores Médicos , Prevalencia , Factores de RiesgoRESUMEN
BACKGROUND: Our aim was to evaluate whether personality factors significantly contribute to the identification of depression in older primary care patients, even after controlling for depressive symptoms. METHODS: We examined the association between personality factors and the identification of depression among 318 older adults who participated in the Spectrum study. RESULTS: High neuroticism (unadjusted Odds Ratio (OR) 2.36, 95% Confidence Interval (CI) [1.42, 3.93]) and low extraversion (adjusted OR 2.24, CI [1.26, 4.00]) were associated with physician identification of depression. Persons with high conscientiousness were less likely to be identified as depressed by the doctor (adjusted OR 0.45, CI [0.22, 0.91]). CONCLUSION: Personality factors influence the identification of depression among older persons in primary care over and above the relationship of depressive symptoms with physician identification. Knowledge of personality may influence the diagnosis and treatment of depression in primary care.