Developing Emotional Intelligence in the Clinical Learning Environment: A Case Study in Cultural Transformation

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Abstract

<div class="section"> <a class="named-anchor" id="st1">  </a> <h5 class="section-title" id="d2224588e160">Background </h5> <p id="d2224588e162">Burnout continues to erode the physician workforce, and there are few effective intervention studies to guide educators. </p> </div><div class="section"> <a class="named-anchor" id="st2">  </a> <h5 class="section-title" id="d2224588e165">Objective </h5> <p id="d2224588e167">We explored residents' experience in a model environment emphasizing resident wellness, safety, and interpersonal skills. </p> </div><div class="section"> <a class="named-anchor" id="st3">  </a> <h5 class="section-title" id="d2224588e170">Methods </h5> <p id="d2224588e172">As 1 of 14 participants in the national Preparing the Personal Physician for Practice (P <sup>4</sup>) project, the family medicine residency at Lehigh Valley Health Network implemented a series of curricular changes designed to transform the culture of education. This mixed-methods case study utilizes the results from 3 quantitative self-report instruments for well-being, along with content analysis of transcripts from 20 focus groups and 33 resident advising sessions to describe experiences of the residents enrolled between July 2007 and June 2012. </p> </div><div class="section"> <a class="named-anchor" id="st4">  </a> <h5 class="section-title" id="d2224588e178">Results </h5> <p id="d2224588e180">In the intervention, we found no statistically significant quantitative differences in the well-being of residents compared with the family medicine faculty and staff. Deductive (a priori and template) analysis and inductive thematic analysis of the residents' articulations of their experiences revealed 6 recurrent themes: naming/articulation of emotions, relationships, attitudes about self-care, self-reflection, delivery of learning experiences, and availability of resources. </p> </div><div class="section"> <a class="named-anchor" id="st5">  </a> <h5 class="section-title" id="d2224588e183">Conclusions </h5> <p id="d2224588e185">Quantitative measures of well-being did not capture the experiential value of the curricular innovations implemented by the residency program, while qualitative analysis highlighted themes important to residents. While not all residents in the intervention expressed support for the changes, repeated references to the nurturing educational environment indicate recognition of, and favorable responses to, the creation of an emotionally intelligent learning community. </p> </div>

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A conceptual model of medical student well-being: promoting resilience and preventing burnout.

Laura B Dunn, Alana Iglewicz, Christine Moutier (2015)

This article proposes and illustrates a conceptual model of medical student well-being. The authors reviewed the literature on medical student stress, coping, and well-being and developed a model of medical student coping termed the "coping reservoir." The reservoir can be replenished or drained by various aspects of medical students' experiences. The reservoir itself has an internal structure, conceptualized as consisting of the individual's personal traits, temperament, and coping style. The coping reservoir metaphor is used to highlight the dynamic nature of students' experiences, with potential outcomes including enhanced resilience and mental health versus distress and burnout. Medical student well-being is affected by multiple stressors as well as positive aspects of medical training. Attention to individual students' coping reservoirs can help promote well-being and minimize burnout; formal and informal offerings within medical schools can help fill the reservoir. Helping students cultivate the skills to sustain their well-being throughout their careers has important payoffs for the overall medical education enterprise, for promotion of physician resilience and personal fulfillment, and for enhancement of professionalism and patient care. This and other models of coping should be empirically validated.

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Perspective: a culture of respect, part 2: creating a culture of respect.

Lucian L Leape, Miles Shore, Jules Dienstag … (2012)

Creating a culture of respect is the essential first step in a health care organization's journey to becoming a safe, high-reliability organization that provides a supportive and nurturing environment and a workplace that enables staff to engage wholeheartedly in their work. A culture of respect requires that the institution develop effective methods for responding to episodes of disrespectful behavior while also initiating the cultural changes needed to prevent such episodes from occurring. Both responding to and preventing disrespect are major challenges for the organization's leader, who must create the preconditions for change, lead in establishing and enforcing policies, enable frontline worker engagement, and facilitate the creation of a safe learning environment.When disrespectful behavior occurs, it must be addressed consistently and transparently. Central to an effective response is a code of conduct that establishes unequivocally the expectation that everyone is entitled to be treated with courtesy, honesty, respect, and dignity. The code must be enforced fairly through a clear and explicit process and applied consistently regardless of rank or station.Creating a culture of respect requires action on many fronts: modeling respectful conduct; educating students, physicians, and nonphysicians on appropriate behavior; conducting performance evaluations to identify those in need of help; providing counseling and training when needed; and supporting frontline changes that increase the sense of fairness, transparency, collaboration, and individual responsibility.