Primary care clinician stress and psychological flexibility
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Session # H4a October 18, 2014. Primary Care Clinician Stress and Psychological flexibility. Debra A . Gould MD, MPH Central Washington Family Medicine Residency Program [email protected] Michael J. Aquilino MS Central Washington Family Medicine Residency Program

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Primary Care Clinician Stress and Psychological flexibility

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Primary care clinician stress and psychological flexibility

Session # H4a

October 18, 2014

Primary Care Clinician Stress and Psychological flexibility

Debra A. Gould MD, MPH

Central Washington Family

Medicine Residency Program

[email protected]

Michael J. Aquilino MS

Central Washington Family

Medicine Residency Program

[email protected]

Patricia Robinson PhD

MountainviewConsulting Inc.

[email protected]

Collaborative Family Healthcare Association 16th Annual Conference

October 16-18, 2014 Washington, DC U.S.A.


Faculty disclosure

Faculty Disclosure

We currently have or have had the following relevant financial relationships during the past 12 months:

  • Dr. Gould & Dr. Robinson:

    Book Royalties - New Harbinger Publications, Inc.

  • Dr. Robinson:

    - Mountainview Consulting Group, Inc.

    • Book Royalties - Springer Science + Business Media, LLC - Behavioral Consultation and Primary Care: A Guide to Integrating Services


Learning objectives at the conclusion of this session the participant will be able to

Learning ObjectivesAt the conclusion of this session, the participant will be able to:

  • Use tools to self-assess level of burn-out, sources and magnitude of stress, and level of psychological flexibility

  • Name 6 core psychological processes that support clinician resiliency

  • Describe specific exercises designed to enhance resilience among PCMH team members

  • Develop a personal strategy for building resiliency based on cognitive-behavioral therapy model called Acceptance and Commitment Therapy (ACT)


Primary care clinician stress and psychological flexibility

Bibliography / Reference

Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, ShanafeltTD, Acad Med, 2014 Mar;89(3):443-51. doi:10.1097/ACM.0000000000000134.

Identifying psychological mechanisms underpinning a cognitive behavioural therapy Intervention for emotional burnout. Lloyd, J., Bond, F. W. & Flaxman, P. E. Lloyd, Apr-Jun 2013, Vol. 27 Issue 2, p181-199.

To be or not to be empathic: the combined role of empathic concern and perspective taking in understanding burnout in general practice. LamotheM, Boujut E, Zenasni F, Sultan S. BMC Family Practice 2014, 15:15 doi:10.1186/1471-2296-15-15.http://www.biomedcentral.com/1471-2296/15/15

Not all coping strategies are created equal: a mixed methods study exploring physicians’ self reported coping strategies. LemaireJB, and Wallace JE, BMC Health Services Research 2010, 10:208, http://www.biomedcentral.com/1472-6963/10/208

Real Behavior in Primary Care; Improving Patient Outcomes and Increasing Job Satisfaction. Robinson PJ, Gould DA, Strosahl KD, New Harbinger Press, Inc., 2010, Oakland California.

The Mindful Employee and Effective Employee. Flaxman PE, Bond FW, Livheim F, Hayes SC; New Harbinger Press, Inc., 2013, Oakland California.


Learning assessment

Learning Assessment

  • Describe self-assessment tools and use them to determine a. level of burn-out, b. sources and magnitude of stress, and c. level of psychological flexibility

  • Describe 6 core psychological processes that support clinician resiliency and specific exercises designed to enhance resilience among PCMH team members


Primary care home

Primary Care Home

“Adaptive Reserve”

  • Value their role

  • Self-aware

  • Balance and prioritize

  • Manage a practice

  • Support relationships


Resilience

Resilience

Burnout

ACT

Organizational

Individual

Wellness


Burnout

Burnout

Symptoms:

  • Emotional Exhaustion

  • Depersonalization

  • Personal Accomplishment

  • Unhealthy coping:

  • Over-eat, drink, work

  • Isolation, Depression, Suicide

  • Leave Profession

  • Relationship Problems


Psychological flexibility

Psychological Flexibility

“Learning to be aware and accepting of the pain that comes into our lives and continue to pursue what we value.”


Primary care clinician stress and psychological flexibility

  • Resiliency – Core Processes

Be Present

Connect with

Values

Acceptance

Psychological

flexibility

Act on Values

Defuse

Changing Self

Mindfulness

Values


Tool pcp stress checklist

Tool: PCP Stress Checklist

Domains:

  • Interactions with Patients

  • Practice Management

  • Administrative Issues

  • Education / Learning

  • Relationships with Colleagues

  • Balance between Work and the “Rest of Life”

Scoring: Higher scores indicates more stress (range 0-100)


Tool primary care provider acceptance and action questionnaire pcp aaq

Tool: Primary Care Provider Acceptance and Action Questionnaire (PCP-AAQ)

Measures Psychological Flexibility

  • 20 Items; sum equals total score (range 0-120)

  • Higher indicates greater psychological flexibility.


Tool values clarification

Tool: Values Clarification

If you were at your own retirement party, what would you like to hear other people say about what you stood for:

  • Practicing Medicine

  • Relationships with Colleagues

  • Relationships with Family/Friends

  • Personal Health & Well-being


Primary care clinician stress and psychological flexibility

Tool: Bulls Eye Values Assessment

My work life is totally consistent with my values

Studying/Practicing Medicine

Relationships with colleagues

My work life is totally inconsistentwith my values

x

x

Relationships with Family & Friends

Personal Health & Well Being


Personal action plan

Personal ACTion Plan

Value Statement:

Action Steps:

1. Practice of Acceptance -

2. Practice of Mindfulness -

Practice of Value Consistent Daily Actions -


Primary care clinician stress and psychological flexibility

  • How We’ve Done It!

Be Present

“EHR billing”

Connect with

Values

“Compassionate Self”

Acceptance

“Heavy Hitters”

Psychological

flexibility

Act on Values

“3 at 3PM on Friday”

Defuse

“Drug Seeker”

Changing Self

“A Different Doc”


Act resources

ACT Resources

Association for Contextual Behavioral Science www.contextualpsychology.org/

New Harbinger Publications

www.newharbinger.com


Primary care clinician stress and psychological flexibility

  • Questions?????

Be Present

“EHR billing”

Connect with

Values

“Compassionate Self”

Acceptance

“Heavy Hitters”

Psychological

flexibility

Act on Values

“3 at 3PM on Friday”

Defuse

“Drug Seeker”

Changing Self

“A Different Doc”


Session evaluation

Session Evaluation

Please complete and return theevaluation form to the classroom monitor before leaving this session.

Thank you!


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