Karina Atwell, MD, MPH – UW Department of Family Medicine and Community Health Balint Group Leadership Training and Program Implementation

The Balint group process is an experiential model that has been used in residency teaching, and by practicing physicians, for decades. Balint groups meet regularly to examine the doctor-patient relationship through case discussions, focusing on the emotions of the clinician and patient that arise from the clinical encounter, rather than the medical aspects of the case. Balint groups are a unique way to examine difficult situations in a non-threatening way. As a result of working in a peer group over a period of time, physicians can recognize their habitual patterns of behavior with various types of patients and situations, and they have a safe space to process these experiences. Balint work encourages self-awareness and self-reflection while simultaneously reinforcing that all clinical relationships occur with reciprocal emotional influence, a key principle in Relationship-Centered Care.

We propose a project to implement Balint groups in residency education and faculty development, with the intent to expand opportunities to explore the patient-physician relationship and foster physician wellness for both resident and faculty physicians within the DFMCH. In order to promote continuity within the groups we intend to create separate resident and faculty groups both founded on the same Balint philosophies. This project fills a current gap in our curriculum by directly addressing the importance of the patient-physician relationship in maintaining empathy in clinical encounters. It further provides concrete tools for strengthening communication skills while proactively valuing and empowering provider wellness and resiliency as a means to lessen burnout.

Jared Dubey, DO – OMT for the MD

The philosophies of osteopathic medicine and family medicine are inherently harmonious. Both seek to treat the whole person (body, mind, and spirit) while respecting the self-healing capacity of each individual. Osteopathic theory and practice is based on the core concept that alterations in physical structure      affect physiologic functioning, and vice-versa. By addressing these physical alterations (ie somatic dysfunctions) OMT aims to correct aberrant physiology. MT is indicated in many common primary care clinical scenarios. This elective is designed for allopathic residents who desire an in depth training in osteopathic manipulative diagnosis and treatment.

A modular, non-linear curriculum allows residents to jump in and out, as schedules necessitate. Modules can be completed in any order; with the exception that module 1 is foundational and should be completed first. In person lab time will heavily prioritize hands-on learning, while significant didactic curriculum will be accomplished via readings and online lectures.

Ellen Goldstein, PhD – A Motivation-Based Intervention to Improve Health Risk Coping Among Urban Black Primary Care Patients

Adverse childhood experiences (ACEs) characterized by abuse, neglect and household dysfunction prior to age 18 underlie many of the most pervasive societal problems and are a root cause of the leading causes of morbidity and mortality in the United States. ACEs affect health at each life stage, are cumulative and can detrimentally impact health and social advantage of subsequent generations. The stressful impact of a traumatic event on an individual can have lasting consequences on health by influencing downstream determinants such as health-risk behaviors. Early life stress is an important risk factor for mental health disorders and chronic diseases. Reducing toxic stress burden on the body may be preventive of a multitude of chronic mental and physical health conditions. Research shows that childhood trauma is especially prevalent in low-income, disadvantaged, minority primary care populations, and is associated with high-risk health behaviors. This study addresses an important gap given that Blacks face greater inequities and persistent health disparities associated with poverty, discrimination, maltreatment and higher than average trauma exposures and health risk behaviors to cope with stressors. Urban Blacks are disproportionately exposed to traumatic events and, therefore, are at a greater risk for PTSD than the General Population. Primary care is often the first point of contact for trauma-exposed individuals and can be a gateway for individuals who have both primary care and behavioral health needs.

To our knowledge, this study offers a novel approach that can assist providers with an actionable step to utilize ACE screen results to improve health and to address the root cause of many health and social disparities among African-Americans.  We propose pilot research using a one-group pre-and-posttest design to assess for feasibility, acceptability and preliminary efficacy of a 2-session motivation-based intervention to reduce perceived (psychological) stress and unhealthy behaviors and to improve patient acceptance of behavioral health referrals among medically underserved, African-American primary care patients.  This study incorporates patient-accepted trauma screening tools as eligibility criteria to participate in an intervention that helps to address the common provider question of what to do after identifying a patient who has endorsed ACEs or PTSD symptoms.

Vincent Minichiello, MD – The effect of a novel adapted Mindfulness Based Stress Reduction program on family medicine resident physician burnout, stress, resiliency, and mindful awareness

It is well documented that resident physicians experience a high level of burnout during their training. (1) In May 2016, 42 out of a total of 47 residents in the Madison Residency Program were surveyed internally about their level of burnout using the Maslach Burnout Inventory. Ninety-eight percent of respondents said that they had experienced some degree of burnout during their training. This project needs support – both financial and administrative – to assess and address resident well-being in the Department of Family Medicine and Community Health.

The purpose of the project is to determine the effect of an adapted, resident-specific Mindfulness Based Stress Reduction (MBSR) program on resident physician well-being. The goals of the project are to: 1) assess program efficacy based on quantitative measures of mindful awareness, burnout, perceived stress, and resiliency, 2) document qualitative experiences of the curriculum through confidential resident interviews, 3) provide a foundation from which future research in resident physician wellness through mindfulness education may evolve.