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Katherine Buck, PhD
Reducing clinician inefficiency and restoring meaning in practice: A professional coaching approach for family medicine residents
Int J Psychiatry Med. 2021 Jul 29:912174211034624. doi: 10.1177/00912174211034624. Online ahead of print.
Burnout is widespread among primary care physicians (PCPs). Several key drivers of burnout in this specialty that have been increasingly recognized are the growing complexity and work demands placed on PCPs by outpatient clinical work environments. These high demands, from the perspective of the physician, detract from other valued tasks which provide meaning in daily work such as relationship-building and fellowship with the medical team. Given these trends, we believe that a viable means to address burnout can be found in utilizing a performance coaching approach to equip resident physicians for the practical and emotional demands of the primary care work environment into which they are entering. Specifically, we recommend a focus on clinical efficiency as an area for coaching development due to its potential impact on resident physician well-being. In this brief review article, we provide a summary of evidence for coaching interventions, along with evidence supporting an expansion to these approaches in clinical efficiency in outpatient settings based on the connection between workflow and engagement in meaningful medical practice. Lastly, we outline a prospective coaching approach which targets common sources of clinic inefficiency for resident practitioners.
Erectile dysfunction: How to help patients and partners.
J Fam Pract. 2020 Jun;69(5):251-254
Authors: Buck K, Stratton J, Hodgson J
This guide and helpful list of key questions can provide a therapeutic framework for addressing the relationship side of ED.
PMID: 32555756 [PubMed - in process]
Getting It Off the Ground: Key Factors Associated With Implementation of Wellness Programs.
Fam Med. 2020 Mar;52(3):182-188
Authors: Penwell-Waines L, Cronholm PF, Brennan J, Romain A, Runyan C, Buck K, Fazio L, Grace A, Ricker M, Ross V, Schneiderhan J, Talen M
BACKGROUND AND OBJECTIVES: Many residency programs are developing resident wellness curricula to improve resident well-being and to meet Accreditation Council for Graduate Medical Education guidelines. However, there is limited guidance on preferred curricular components and implementation. We sought to identify how specific driving factors (eg, having an identified wellness champion with a budget and protected time to develop wellness programs) impact implementation of essential elements of a resident wellness curriculum.
METHODS: We surveyed 608 family medicine residency program directors (PDs) in 2018-2019 on available resources for wellness programs, essential wellness elements being implemented, and satisfaction with wellness programming; 251 PDs provided complete responses (42.5% response rate). Linear and logistic regressions were conducted for main analyses.
RESULTS: Having an identified wellness champion, protected time, and dedicated budget for wellness were associated with greater implementation of wellness programs and PD satisfaction with wellness programming; of these, funding had the strongest association. Larger programs were implementing more wellness program components. Program setting had no association with implementation.
CONCLUSIONS: PDs in programs allocating money and/or faculty time can expect more wellness programming and greater satisfaction with how resident well-being is addressed.
PMID: 32159829 [PubMed - in process]
Authors' Reply to "Working Together to Heal Our Physician Well-Being Crisis".
Fam Med. 2020 Feb;52(2):153-154
Authors: Penwell-Waines L, Schneiderhan J, Ross V, Grace A, Buck K, Brennan J
PMID: 32050277 [PubMed - in process]
Cognitive Behavior Therapy for Postpartum Depression.
Am Fam Physician. 2019 Aug 15;100(4):244-245
Authors: Buck K, Zekri S, Nguyen L, Ogar UJ
PMID: 31414780 [PubMed - in process]
Making Sense of Family Medicine Resident Wellness Curricula: A Delphi Study of Content Experts.
Fam Med. 2019 Jul 02;:
Authors: Penwell-Waines L, Runyan C, Kolobova I, Grace A, Brennan J, Buck K, Ross V, Schneiderhan J
BACKGROUND AND OBJECTIVES: The Association of Family Medicine Residency Directors (AFMRD) Physician Wellness Task Force released a comprehensive Well-Being Action Plan as a guide to help programs create a culture of wellness. The plan, however, does not offer a recommendation as to which elements may be most important, least resource intensive, or most feasible. This study sought to identify the most essential components of the AFMRD's Well-Being Action Plan, as rated by expert panelists using a modified Delphi technique.
METHODS: Sixty-eight selected experts were asked to participate; after three rounds of surveys, the final sample included 27 participants (7% residents, 38% MD faculty, 54% behavioral science faculty).
RESULTS: Fourteen elements were rated as essential by at least 80% of the participants. These components included interventions at both the system and individual level. Of those elements ranked in the top five by a majority of the panel, all but one do not mention specific curricular content, but rather discusses the nature of a wellness curriculum.
CONCLUSIONS: The expert consensus was that an essential curriculum should begin early, be longitudinal, identify a champion, and provide support for self-disclosure of struggles.
PMID: 31269221 [PubMed - as supplied by publisher]
Family Physician Burnout and Resilience: A Cross-Sectional Analysis.
Fam Med. 2019 Jul 02;:
Authors: Buck K, Williamson M, Ogbeide S, Norberg B
BACKGROUND AND OBJECTIVES: Current physician burnout levels are at historically high levels, especially in family medicine, with many factors playing a role. The goal of this study was to understand demographic, psychological, environmental, behavioral, and workplace characteristics that impact physician wellness and burnout, focusing on family medicine physicians and residents.
METHODS: Survey respondents were 295 family medicine residents and faculty members across 11 residency programs within the Residency Research Network of Texas (RRNeT). Subjects completed multiple measures to assess resilience, burnout, psychological flexibility, and workplace stress. Respondents also reported personal wellness practices and demographic information. The primary outcome variables were burnout (depersonalization, emotional exhaustion, and personal achievement) and resilience.
RESULTS: The predictor variables contributed significant variance (depersonalization=27.1%, emotional exhaustion=39%, accomplishment=37.7%, resilience=37%) and resulted in large effect sizes (depersonalization f²=.371, emotional exhaustion f²=.639, accomplishment f²=.605, resilience f²=.587) among the three burnout models and the resilience model for the sample. Similar variance and effect sizes were present for independent resident and program faculty samples, with resilience being the only outcome variable with significant differences in variance between the samples.
CONCLUSIONS: This study demonstrates the roles of both individual and organization change needed to impact provider wellness, with special attention to resilience across faculty and residents. The results of this study may inform workplace policies (ie, organizational practice change) and wellness programming and curricula (ie, individual level) for family medicine residents and program faculty.
PMID: 31269220 [PubMed - as supplied by publisher]
Addressing Mental Health Needs among Physicians.
South Med J. 2019 Feb;112(2):67-69
Authors: Buck K, Grace A, Runyan T, Brown-Berchtold L
PMID: 30708367 [PubMed - in process]
Psychological Attributes of Ultramarathoners.
Wilderness Environ Med. 2018 03;29(1):66-71
Authors: Buck K, Spittler J, Reed A, Khodaee M
INTRODUCTION: As the popularity of ultramarathon participation increases, there still exists a lack of understanding of the unique psychological characteristics of ultramarathon runners. The current study sought to investigate some of the psychological and behavioral factors that are involved in ultramarathon running.
METHODS: We obtained information from participants of the Bear Chase Trail Race via an online survey. This race is a single-day, multidistance race consisting of a 10 k, half marathon, 50 k, 50 mi, and 100 k run in Lakewood, Colorado, at a base altitude of 1680 m with total altitude in climbs ranging from 663 to 2591 m. We correlated information from the Exercise Addiction Inventory and the Patient Health Questionnaire-2 and demographic information with race finish times.
RESULTS: Out of 200 runners who started the race, 98 (48%) completed the survey. Over half of the runners were men (61.2%), and the average age was 39.0 years (SD±8.9; range 21-64 years). A number of respondents (20%) screened positive for exercise addiction concerns. Approximately 20% of our sample screened positive for depressive symptoms (Patient Health Questionnaire-2 score >3). The majority of participants reported receiving strong social support from current partners with regard to their ultramarathon running training time and goals.
CONCLUSIONS: Although only a screening, the number of positive screens on the Exercise Addiction Inventory suggests use of screening measures with an ultramarathon running population. Athletes with positive screening tests should be fully evaluated for depression and exercise addiction because this would enable appropriate athlete support and treatment referral.
PMID: 29336959 [PubMed - indexed for MEDLINE]
J Psychosom Obstet Gynaecol. 2016 Sep;37(3):84-90. doi: 10.3109/0167482X.2016.1167181. Epub 2016 Apr 19.
INTRODUCTION: Although training in obstetrics and gynecology is a key part of medical education, male students receive less extensive experience, due in part to patient refusals. However, there is limited work seeking to reduce patient refusal rates of male students. The current study examined the efficacy of two messages at increasing male medical student acceptance into a well-woman visit.
METHODS: A total of 656 college women participated in a simulation study where they viewed a video of a nurse asking for permission to have a male medical student participate in their well-woman visit. The 30.5% of women who refused student participation (n = 181) were randomly assigned to view a video of the nurse either describing students' medical knowledge and technical skills training (e.g. training in performing pelvic exams) or empathic skills training (e.g. training in communication about sensitive issues). They were again asked if they would be willing to have the student participate.
RESULTS: Both messages similarly increased student acceptance with 44.8% of those receiving the empathic skills training message and 48.9% of those who received the medical/technical skills training message accepting student participation, χ(2) (1, N = 181) = 0.3, p = 0.58.
DISCUSSION: Educational messages about medical student training delivered in an engaging fashion by a credible source are a potentially effective tool to increase male student acceptance into sensitive patient encounters. Future work should test these messages in real-world settings as part of a focus on patient education to increase comfort with student participation.