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We created a curriculum addressing physician resiliency and well-being, designed for an Internal Medicine Residency Program. This curriculum utilized episodes from a medical television series, Scrubs, to facilitate a monthly, 1-h faculty guided discussion group. We collected informal feedback and abbreviated Maslach Burnout Inventories (aMBI) monthly and conducted a formal focus group after 6 months to gauge its effectiveness.
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Given the documented learner satisfaction with the use of popular media, we elected to create a longitudinal monthly curriculum combining the viewing of selected media with group discussions related to topics on PBO. The primary goal of our investigation was to determine the feasibility of a regular facilitated discussion session utilizing themes and events in a fictional comedic medical television program in our internal medicine training program. Our secondary goal was (if the intervention demonstrated feasibility) to elicit and record the qualitative response to the intervention in our trainees. Thirdly we sought to measure the quantitative impact of the intervention on the self-report of burnout using a standardized reporting instrument.,
Scrubs is a popular medical drama anecdotally felt to most accurately depict the stress and emotions common within a Medicine residency. As such, we pre-selected certain episodes to address topics associated with PBO such as physician cynicism, dealing with death, and work-life balance. The episodes last on average 23 min, allowing for 37 min for discussion during and after the episode. An episode guide (Fig. 1 and Additional file 1) was developed for each monthly session that describes the session goals, provides an episode introduction, and designates pre-set stopping points with open-ended questions to help the faculty facilitate conversation. However, the residents were encouraged to stop the episode themselves if they had something to discuss and the facilitators had complete flexibility in how they conducted the session based on the flow of conversation. The guides covered a multitude of issues within the episode, and when feasible, they were organized in two parallel formats: the complete 23-min episode, or a focused sub-plot guide. The sub plot guide has start and stop times for select DVD scenes to allow focus on a particular topic or conversely compress the presentation and allow more discussion time.
The sessions were conducted in the residency conference room during lunch prior to an already protected academic half day. To mitigate the additional hour of required time, food was provided for each session and the inpatient pagers were held by the team attending physicians. The protected time is essential as it allowed the residents to relax and prevented frequent disruptions of the discussion. Logistical requirements include a room big enough to fit the group, a DVD player and projector/screen to view the episode, and the Scrubs DVD for the episode.
Qualitative feedback was obtained in three different manners. First, the session leader asked directly after the sessions for any feedback on their conduct, perceived utility, and trainee reactions. The session leader also emphasized resources available for any trainee struggling with PBO or mental health issues. Second the program director utilized an end of week residency sync session following morning report to ask for feedback about the session during the weeks they occurred, which allowed some time for the trainees to reflect. Third, after 6 sessions were complete, the Chief Resident utilized part of a monthly house-staff meeting to conduct a focus group to solicit detailed feedback and assess the longer-term curriculum impact. This meeting consisted of 11 trainees and consisted of the following questions with accompanied informal discussion: what is your opinion of the new curriculum? how does it compare to prior curricula on PBO that you have experienced? does it have a positive or negative effect on your work day? what are the strengths/weaknesses of the curriculum? do you feel it has improved your awareness of PBO in yourself/your peers? do you think we should continue this curriculum?
To our knowledge, this longitudinal utilization of a humorous television program with a guided open discussion about resiliency and provider well-being is the first of its kind. It was not only well-liked but also anecdotally successful in sparking candid communication about difficult topics both during the sessions and afterwards as well.
However, this pilot demonstrated the feasibility of this curriculum and has laid the groundwork for widespread implementation and more rigorous study. This curriculum is easy to implement and popular among residents with the only cost being 1 h per month and the cost of the Scrubs DVD. The ready-made episode guide concept allows for multiple faculty perspectives to be utilized in the teaching sessions, is editable and customizable for specific program needs, and allows multiple focus areas for physician resilience. The subject matter itself is widely varied in topic and includes end of life care, dealing with death, diversity issues, as well as physician burnout and resilience, which are applicable along the physician career spectrum. Additionally, the open discussion nature of this curriculum helps normalize the discussion of these topics as well as showing that we all struggle at times in our careers. Dyrbye reports that students were more likely to seek help if they saw others reveal their own personal struggles . Although not studied in this pilot, this witnessing of the struggles of peers could help reduce the stigma of admitting to PBO and improve the rates of trainees with PBO seeking help if needed. Furthermore, the concept is not unique to Scrubs and can easily expanded to use of other media and is worth further evaluation.
Group Discussion or GD Round is conducted as one of the recruitment rounds and it is also held in MBA admissions. In a GD round, participants are required to share their views and opinions on a given group discussion topic. Normally a group discussion round is about 20 minutes.
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Seventy students participated in an experiment to measure the effects of either providing explanations or listening during small group discussions on recall of related subject-matter studied after the discussion. They watched a video of a small group discussing a problem. In the first experimental condition, the video was stopped at various points in time, enabling the participants to verbally respond to the discussion. In the second condition, they listened to the same discussion, without contributing. In the control condition, they listened to a discussion that was not related to the subject-matter subsequently studied. After the discussion, all participants studied a text and answered questions that tested their recall of information from this text. No immediate differences in recall were found. One month later, participants who had actively engaged in explaining remembered more from the text. The conclusion appears justified that actively providing explanations during a discussion positively affects long-term memory.
The participants were 70 students at the Faculties of Health, Medicine and Life Sciences, Psychology, Cultural Sciences, and Economics and Business Administration, Maastricht University, The Netherlands. They were recruited with advertisements and received a financial compensation for their participation. At Maastricht University, group discussions are the main educational format, so all participants in this study were used to taking part in such discussions. Their average age was 21.04 years (SD = 2.21). None of the participants reported having taken their final secondary school examination in physics. This implied that they had not studied physics in school after the third grade of secondary education, so approximately after the age of 15 years.
Before the actual experiment started, two group discussions were digitally recorded in a studio: one about the radar problem and one about the alcohol problem. Four students, all members of a drama club, participated in both discussions. In several rehearsal sessions, they first familiarized themselves with the contents of the text for the pre-experiment instruction and they then discussed the radar problem based on their prior knowledge. They also discussed the alcohol problem during these sessions. Based on the videotaped rehearsal sessions two written scripts were produced, one for the radar problem and one for the alcohol problem. In a studio, these scripts were performed by the same student actors and recorded.
In both simulated discussions one actor did most of the explaining. The other actors asked him for explanations, for he was obviously the most knowledgeable student of the group. Of the radar discussion, two versions were prepared: an unedited version showing the integral discussion and an edited version from which the part of the actor who did most of the explaining was removed. The unedited version was used for the listening condition and the edited version for the explanation condition. For the control condition the integral recording of the alcohol discussion was used. Figure 1 shows a screen shot of the radar discussion.
When the simulated group discussion about radar was finished, the participants were given 20 min to read the text about radar, which answered the questions that had been raised during the discussion. Immediately after that, they answered 13 open-ended questions. One month later they returned and answered the same sequence of 13 open-ended questions.
The procedure for the participants in the listening condition was identical, except that they watched the integral group discussion, in which the questions were answered by one of the actors. They were instructed to listen carefully and keep in mind what they had learned during the pre-experimental session. The participants in the control condition read the alcohol problem and watched the simulated discussion about this problem. They were only instructed to listen carefully.