Maslach Burnout Inventory Manual

Few industries match the scale of health care. In the United States alone, an estimated 85% of the population has at least 1 health care encounter annually and at least one quarter of these people experience 4 to 9 encounters annually. A single visit requires collaboration among a multidisciplinary group of clinicians, administrative staff, patients, and their loved ones. Multiple visits often occur across different clinicians working in different organizations. Ineffective care coordination and the underlying suboptimal teamwork processes are a public health issue. Health care delivery systems exemplify complex organizations operating under high stakes in dynamic policy and regulatory environments. The coordination and delivery of safe, high-quality care demands reliable teamwork and collaboration within, as well as across, organizational, disciplinary, technical, and cultural boundaries. In this review, we synthesize the evidence examining teams and teamwork in health care delivery settings in order to characterize the current state of the science and to highlight gaps in which studies can further illuminate our evidence-based understanding of teamwork and collaboration. Specifically, we highlight evidence concerning (a) the relationship between teamwork and multilevel outcomes, (b) effective teamwork behaviors, (c) competencies (i.e., knowledge, skills, and attitudes) underlying effective teamwork in the health professions, (d) teamwork interventions, (e) team performance measurement strategies, and (f) the critical role context plays in shaping teamwork and collaboration in practice. We also distill potential avenues for future research and highlight opportunities to understand the translation, dissemination, and implementation of evidence-based teamwork principles into practice. (PsycINFO Database Record

Teamwork in healthcare: Key discoveries enabling safer, high-quality care.

Thrombosis has long been recognized as a potentially life-threatening complication in children with congenital heart disease (CHD), children with acquired heart disease, and in adults with CHD. High-risk groups include patients with shunt- dependent single ventricles (shunt thrombosis, 8%–12%; 4%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease A Scientific Statement From the American Heart Association

Mentorship is a catalyst capable of unleashing one's potential for discovery, curiosity, and participation in STEMM and subsequently improving the training environment in which that STEMM potential is fostered. Mentoring relationships provide developmental spaces in which students' STEMM skills are honed and pathways into STEMM fields can be discovered. Because mentorship can be so influential in shaping the future STEMM workforce, its occurrence should not be left to chance or idiosyncratic implementation. There is a gap between what we know about effective mentoring and how it is practiced in higher education. The Science of Effective Mentorship in STEMM studies mentoring programs and practices at the undergraduate and graduate levels. It explores the importance of mentorship, the science of mentoring relationships, mentorship of underrepresented students in STEMM, mentorship structures and behaviors, and institutional cultures that support mentorship. This report and its complementary interactive guide present insights on effective programs and practices that can be adopted and adapted by institutions, departments, and individual faculty members.

The Science of Effective Mentorship in STEMM

Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database.

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 negativity bias drives people to attend to and be more greatly affected by the negative aspects of experience. Some common teaching methods such as simulations, pimping, and instruction in clinical reasoning inadvertently reinforce the negativity bias and thereby enhance physicians' focus on the negative. Here, the authors examine the concept of negativity bias in the context of academic medicine, arguing that culture is affected by serially emphasizing the inherent bias to recognize and remember the negative. They explore the potential role of practices rooted in positive psychology as powerful tools to counteract the negativity bias and aid in achieving desired culture change.

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

This study tested the hypothesis that pediatric patients who develop chylothorax (CTX) after surgery for congenital heart disease (CHD) have an elevated incidence and risk profile for central venous thrombosis (CVT). We evaluated 30 patients who developed CTX after surgery for CHD. All but one CTX patient were surgery-, anatomy-, and age-matched with two controls (NON-CTX) to compare their relative risk and incidence of CVT. Using conditional logistic regression analyses, CTX development was associated with significantly longer ventilator dependence (14.8 +/- 10.9 vs. 6.1 +/- 5.9 days, p = 0.003) and a non-significant trend towards more days of central venous catheters (CVC) (19.1 +/- 16.6 vs. 12.2 +/- 10.0 days; p = 0.16) when comparing the period prior to CTX development with the entire hospitalization in NON-CTX patients. CTX development was associated with a significantly elevated mortality risk (Odds Ratio 6.2, 95% CI 1.3-30.9). Minimum and mean daily central venous pressures were significantly higher in the CTX group. Post operative need for extracorporeal membrane oxygenation conferred an increased risk of CTX development in this sample of patients (Odds Ratio 9.9, 95% CI 2.2-44.8). Incidence of documented CVT was 26.7% in the CTX group versus 5.1% in the NON-CTX group. Prospective screening for CVT risk and formation, combined with early removal of CVC may help reduce the incidence of CTX.

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Postoperative Chylothorax Development Is Associated with Increased Incidence and Risk Profile for Central Venous Thromboses

Interprofessional education (IPE) and interprofessional collaborative practice (ICP) are essential to achieving high-quality patient care. Leading IPE/ICP requires training in new knowledge and skills that most health professions faculty and clinicians lack. To guide this training, the Interprofessional Education Collaborative (IPEC) defined interprofessional collaboration through four core competencies: (a) Values/Ethics for Interprofessional Practice, (b) Roles/Responsibilities, (c) Interprofessional Communication, and (d) Teams and Teamwork. For IPE/ICP training to be effective, it is necessary to identify new educational models that provide an operational framework for these competencies. The University of Virginia (UVA) ASPIRE Model is a new paradigm for developing IPE/ICP educational experiences. It was created by mapping the IPEC competencies to three overlapping curricular content areas: (a) Practical Tools, (b) Leadership, and (c) Relational Factors. This model shows the relationship among the four IPEC core competencies and corresponding sub-competency statements and their inclusion in one or more of these three curricular content areas. The UVA ASPIRE Model was empirically tested as an approach to provide IPE/ICP training through "real-world" application for clinicians and faculty participating in an intensive team development program. Positive evaluations and improved capabilities of learners to apply their new knowledge and skills to solving real-world clinical challenges revealed that the UVA ASPIRE Model is an effective approach to embed the IPEC competencies in the design of IPE/ICP educational activities.

The ASPIRE Model: Grounding the IPEC core competencies for interprofessional collaborative practice within a foundational framework.

Burnout incurs significant costs to health care organizations and professionals. Mattering, moral distress, and secondary traumatic stress are personal experiences linked to burnout and are byproducts of the organizations in which we work. This article conceptualizes health care organizations as moral communities-groups of people united by a common moral purpose to promote the well-being of others. We argue that health care organizations have a fundamental obligation to mitigate and prevent the costs of caring (eg, moral distress, secondary traumatic stress) and to foster a sense of mattering. Well-functioning moral communities have strong support systems, inclusivity, fairness, open communication, and collaboration and are able to protect their members. In this article, we address mattering, moral distress, and secondary traumatic stress as they relate to burnout. We conclude that leaders of moral communities are responsible for implementing systemic changes that foster mattering among its members and attend to the problems that cause moral distress and burnout.

Moral Distress, Mattering, and Secondary Traumatic Stress in Provider Burnout: A Call for Moral Community

The complexity of implementing interprofessional education and practice (IPEP) strategies that extend across the learning continuum requires that institutions create a structure to support effective and organized coordination among interested administrators, faculty and staff. The University of Virginia Center for Academic Strategic Partnerships for Interprofessional Research and Education (UVA Center for ASPIRE) was formally established in 2013 following five years of dramatic growth in interprofessional education at the School of Nursing, School of Medicine and the UVA Health System. This guide briefly describes the steps that led to the creation of the Center and the key lessons learned that can guide other institutions toward establishing their own IPE centers.

Julie Haizlip

Papers

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

Postoperative Chylothorax Development Is Associated with Increased Incidence and Risk Profile for Central Venous Thromboses

The ASPIRE Model: Grounding the IPEC core competencies for interprofessional collaborative practice within a foundational framework.

Moral Distress, Mattering, and Secondary Traumatic Stress in Provider Burnout: A Call for Moral Community

Interprofessional education and practice guide no. 2: developing and implementing a center for interprofessional education.