"Flourish in the Clerkship Year": a Curriculum to Promote Wellbeing in Medical Students.

Unlabelled: The stresses of medical training can lead to burnout and other adverse outcomes. The Flourish curriculum was designed to mitigate negative effects of stress among clerkship students through debriefing and skills-building activities that foster practical wisdom: mindfulness, appreciative practice, story-telling/listening, and reflection. Students rated the curriculum highly, felt it addressed common concerns about clerkships, and were able to apply techniques from the curriculum to their clinical work.

Acting Wisely: Eliminating Negative Bias in Medical Education-Part 2: How Can We Do Better?

In Part 1 of this 2-article series, the authors reviewed the problem of unmitigated bias in medical education and proposed a wisdom-based framework for a different way of educating medical students. In this article, Part 2, the authors answer a key question: How can medical educators do better? Is a bias-free environment possible? The answer to the latter question likely is "no." In fact, having a zero-bias goal in mind may blind educators and students to the implicit biases that affect physicians' decisions and actions.

Acting Wisely: Eliminating Negative Bias in Medical Education-Part 1: The Fundamentals.

Bias is a ubiquitous problem in human functioning. It has plagued medical decision making, making physicians prone to errors of perception and judgment. Racial, gender, ethnic, and religious negative biases infest physicians' perception and cognition, causing errors of judgment and behavior that are damaging.

You can have both: Coaching to promote clinical competency and professional identity formation.

Coaching is a critical tool to guide student development of clinical competency and formation of professional identity in medicine, two inextricably linked concepts. Because progress toward clinical competence is linked to thinking, acting and feeling like a physician, a coach's knowledge about a learner's development of clinical skills is essential to promoting the learner's professional identity formation. A longitudinal coaching program provides a foundation for the formation of coach-learner relationships built on trust.

Views of institutional leaders on maintaining humanism in today's practice.

Objective: To explore leadership perspectives on how to maintain high quality efficient care that is also person-centered and humanistic.

Methods: The authors interviewed and collected narrative transcripts from a convenience sample of 32 institutional healthcare leaders at seven U.S.

Healthcare at the Crossroads: The Need to Shape an Organizational Culture of Humanistic Teaching and Practice.

Background: Changes in the organization of medical practice have impeded humanistic practice and resulted in widespread physician burnout and dissatisfaction.

Objective: To identify organizational factors that promote or inhibit humanistic practice of medicine by faculty physicians.

Design: From January 1, 2015, through December 31, 2016, faculty from eight US medical schools were asked to write reflectively on two open-ended questions regarding institutional-level motivators and impediments to humanistic practice and teaching within their organizations.

A Multi-Institutional Longitudinal Faculty Development Program in Humanism Supports the Professional Development of Faculty Teachers.

The authors describe the first 11 academic years (2005-2006 through 2016-2017) of a longitudinal, small-group faculty development program for strengthening humanistic teaching and role modeling at 30 U.S. and Canadian medical schools that continues today.

How physicians draw satisfaction and overcome barriers in their practices: "It sustains me".

Objective: Major reorganizations of medical practice today challenge physicians' ability to deliver compassionate care. We sought to understand how physicians who completed an intensive faculty development program in medical humanism sustain their humanistic practices.

Methods: Program completers from 8 U.

Stories of Growth and Wisdom: A Mixed-Methods Study of People Living Well With Pain.

Chronic pain remains a daunting clinical challenge, affecting 30% of people in the United States and 20% of the global population. People meeting this challenge by achieving wellbeing while living with pain are a virtually untapped source of wisdom about this persistent problem. Employing a concurrent mixed-methods design, we studied 80 people living with chronic pain with "positive stories to tell" using semi-structured interviews and standardized questionnaires.

Wisdom in Medicine: What Helps Physicians After a Medical Error?

Purpose: Confronting medical error openly is critical to organizational learning, but less is known about what helps individual clinicians learn and adapt positively after making a harmful mistake. Understanding what factors help doctors gain wisdom can inform educational and peer support programs, and may facilitate the development of specific tools to assist doctors after harmful errors occur.

Method: Using "posttraumatic growth" as a model, the authors conducted semistructured interviews (2009-2011) with 61 physicians who had made a serious medical error.

Addressing the nation's physician workforce needs: The Society of General Internal Medicine (SGIM) recommendations on graduate medical education reform.

The Graduate Medical Education (GME) system in the United States (US) has garnered worldwide respect, graduating over 25,000 new physicians from over 8,000 residency and fellowship programs annually. GME is the portal of entry to medical practice and licensure in the US, and the pathway through which resident physicians develop the competence to practice independently and further develop their career plans. The number and specialty distribution of available GME positions shapes the overall composition of our national workforce; however, GME is failing to provide appropriate programs that support the delivery of our society's system of healthcare.

Wisdom through adversity: learning and growing in the wake of an error.

Objective: Medical errors are a nearly universal experience for physicians. An error that harms a patient is one of the most difficult experiences that physicians face. Difficult experiences can result in growth.

Forgive me: medical error and the poetics of forgiveness.

Alexander Pope, in his Essay on Criticism, proposes that "To err is human; to forgive divine." This essay considers the latter half of that proposition and includes quotes from doctors who participated in a study of learning and growing through adversity. Doctors, like poets, find it necessary to put their moral and psychological dilemma into words.

Perspective: the negativity bias, medical education, and the culture of academic medicine: why culture change is hard.

Despite ongoing efforts to improve working conditions, address well-being of faculty and students, and promote professionalism, many still feel the culture of academic medicine is problematic. Depression and burnout persist among physicians and trainees. The authors propose that culture change is so challenging in part because of an evolutionary construct known as the negativity bias that is reinforced serially in medical education.

The role of talking (and keeping silent) in physician coping with medical error: a qualitative study.

Objective: The aim was to examine the role of talking (or remaining silent) in the physician's experience of coping with medical error.

Methods: Sixty-one physicians participated in in-depth interviews about their experience of coping with a serious medical error. We analyzed verbatim transcripts to develop a taxonomic analysis of talking domains to capture the physician experience of talking and coping with error.

Achieving transformational change: using appreciative inquiry for strategic planning in a school of nursing.

To achieve transformational change, a transformational approach is needed. The Appreciative Inquiry (AI) summit is a method that has been used to achieve transformational change in business for at least 20 years, but this innovative alternative approach is unknown to nursing. At the University of Virginia School of Nursing, an AI Summit was designed to bring all staff, faculty, student representatives, and members of the community together to rewrite the school's strategic plan.

Use of an appreciative inquiry approach to improve resident sign-out in an era of multiple shift changes.

Background: Resident duty hour restrictions have resulted in more frequent patient care handoffs, increasing the need for improved quality of residents' sign-out process.

Objective: To characterize resident sign-out process and identify effective strategies for quality improvement.

Design: Mixed methods analysis of resident sign-out, including a survey of resident views, prospective observation and characterization of 64 consecutive sign-out sessions, and an appreciative-inquiry approach for quality improvement.

The association of health literacy and socio-demographic factors with medication knowledge.

Objective: To compare patient demographics and Rapid Estimate of Adult Literacy in Medicine (REALM) scores with respect to their ability to predict medication comprehension.

Methods: A survey was conducted of 100 patients presenting for follow-up at an academic primary care clinic serving a low socio-economic status population. The Medication Knowledge Score (MKS) consisted of knowledge of drug name, dose, indication, and a potential side effect for each of their medications and then averaged.

Changing conversations: teaching safety and quality in residency training.

Improving patient safety and quality in health care is one of medicine's most pressing challenges. Residency training programs have a unique opportunity to meet this challenge by training physicians in the science and methods of patient safety and quality improvement (QI).With support from the Health Resources and Services Administration, the authors developed an innovative, longitudinal, experiential curriculum in patient safety and QI for internal medicine residents at the University of Virginia.