Spring 2018 GEMS Diversity Presentations

Good afternoon everyone. My name is Alisha Ghosh, I am the program manager at the Office of Diversity and Inclusion and I just want to welcome you to this year’s final Health Equity Forum. As you know, our office hosts Health Equity Forums monthly to discuss healthcare and healthcare disparities. The goal is really to promote the conversation and the awareness around health and inequalities between populations and the progress made towards addressing health inequalities. Each year, our Georgetown Experimental Medical Studies program, otherwise known as GEMS, students are tasked with presenting on healthcare disparities and matters that affect the medical professions in their health exploration course. Student presentations are then evaluated and reviewed by a special committee. Students’ presentations are then selected based on the needs of our school of Medicine. Today, we are delighted to feature two of our GEMS students, Alynna and Brendon. [applause] Mr. Peterson’s topic is focused on physician burnout and healing the healer and Ms. Wiley’s topic is titled “Social Justice and Medicine Beyond Access.” I will not pass it along to Sabrina, another one of our GEMS students, who will introduce our first speaker today. [applause] Good morning everyone, thank you for being here today. I have the honor of introducing our first speaker, Alynna. Prior to her acceptance to the GEMS program here at Georgetown, Alynna earned her degree in Biological Sciences from the Oklahoma State University. She is passionate about the representation of minorities and also mitigating the disparities that are faced in underserved communities. I can think of no one better to, uh, speak to us today about social justice than my friend, Alynna Wiley. [applause] Hello? Hello? Hi everyone! Uh, thank you Sabrina for that wonderful introduction. I’d like to thank you all for joining me in the discussion of my topic that is “Social Justice in Medicine Beyond Access” So, Audre Lorde states that “your silence will not protect you.” What this says to me is that we will be put in circumstances deemed uncomfortable, where neutrality and complicity will be our means and hiding and to keep safe. I would answer that social justice is the answer to that. So throughout this presentation, I want you guys to think how social justice has affected you, your families. And if you haven’t had a conversation about social justice, let’s think about why So, social justice is a large concept, as we see here with this word cloud but what is social justice? What is social justice to you? [inaudible] …I like that Social justice to you [inaudible] I agree So, for the purposes of this discussion, social justice will be aimed in the context of medicine, where it’s defined as the equitable distribution of health services and helping relationships. It’s important to note the beyond access component of this conversation because we’re going beyond the realm of the clinic We’re going beyond the realm of what we traditionally think of the white coat, whether it be stethoscopes, prescriptions, clinical sciences, we’re now looking at physician advocacy. So, the perception of social justice is quite large. As we saw, we had two beautiful examples of what social justice meant to two different individuals but it changes among a different among individuals, whether that be people within this room or the con the confines of Georgetown University. So despite it being a core value, it’s not easily defined in medicine because it’s deemed too political People don’t want to talk about social justice because it kind of makes us a little uncomfortable So to make this a little easier to describe and to define for everyone, we’ll be looking at social justice through the lens of oppression, where oppression is defined as an opposing force or a prolonged cruel treatment of a person, community, or population. Under this umbrella of oppression there are four subdomains where you have the four Is of oppression: ideological, institutional, interpersonal, and internalized where internalization of oppression is the ultimate goal of oppression because the majority population no longer has to exert that force. So, let’s look at how the four

Is of oppression interact, how they intersect, and ultimately impact social justice and advocacy “oppression, it’s a word that’s often used as a blanket term but there’s actually” sorry “a whole lot more to it. There are four interlocking aspects of oppression: ideological, institutional, interpersonal, and internalized And it might seem like a small difference, but it’s very important to be able to distinguish between each kind because understanding oppression is the first step to fighting it Let’s start with the core part of every form of oppression, ideology. Every form of oppression comes from the idea that one group is somehow better than another. Ideological oppression starts when the dominant group associates positive qualities with itself and negative qualities with the marginalized or othered group. Ideological oppression describes the deeply ingrained social root of inequality. It’s the larger overarching idea that leads to the -isms. For example, the idea that black people are dangerous is ideological racism. The idea that poor people are lazy is ideological classism. Ideological oppression leads to institutional oppression. Institutional oppression is the way that systems and institutions manifest the dominant ideology. Institutions control access, who is able to get to what and how. This includes legal rights, police practice, access to medical care and education, public policy, political power, and media representation. For example, when women make two-thirds of what men make, that’s institutional sexism When a building is constructed without wheelchair ramps, that’s institutional ableism All of this leads to interpersonal oppression. Interpersonal oppression is probably the easiest to recognize because it happens all around us. Interpersonal oppression is the way that people play out discrimination and violence on each other It can take the form of microagressions, jokes, stereotypes, and harrasment. For example, when a student is bullied for being gay, it’s interpersonal homophobia. When a Muslim person is told that they are a terrorist, it’s interpersonal Islamophobia and all of those forces, ideological, institutional and interpersonal lead to internalized oppression. Internalized oppression is the way that people with marginalized identities internalize narratives of their own inferiority. It’s what leads people to feel less than. This is the end goal of oppression. The oppressive party doesn’t need to exert force anymore because the marginalized group is enacting oppression on itself to maintain the status quo. It’s important to remember that it’s never a marginalized person’s fault that they feel internalized oppression. It’s simply what happens when someone faces negative stereotypes, low expectations and ongoing discrimination. So, for example an immigrant feeling embarrassed about having an accent is internalized xenophobia When a trans woman feels that they can never be a real woman, so, to review the four Is of oppression are ideological, institutional, interpersonal, and internalized Each of these types are interconnected and completely supported by the others They can never exist on their own and can even be seen as a cycle. Now that you understand the different kinds of oppression, you’re even more equipped to fight it. Don’t forget that any effort to dismantle oppression should aim to address it at all four of these levels. Thanks for watching So some points that need to be reiterated, the four Is of oppression. It begins with an idea, an idea that stems into legislation, policies that are enacted on this marginalized community, that is internalized. Right? That, then is spoken. It is made into jokes, those jokes are internalized and now the marginalized community is enacting this oppression within each other So, it’s important- let’s be a little more practical in how we look at oppression by looking at two different examples of these contexts, where we see the four Is working together to ultimately build this oppression on communities. So imagine your child is taken after you send her to the hospital Where you believe she is safest. This would happen to the family of 10 year old Rosemary Hernandez. It’s important to note that she has cerebral palsy. Some key details of her detainment were that she was in the middle of a transfer to a larger hospital in Laredo, Texas. In the middle of a transfer, she had to stop at a checkpoint Border patrol would learn of her status, follow her to her new hospital transfer

wait outside of the recovery room, and once she was cleared to leave, instead of going home, she was to be sent 150 miles away from her family This brings up a larger context of sanctuary where we have communities, cities, states that limit the amount of disclosure when it comes to the immigration status of either undocumented immigrants or citizens when it comes to police services or health services Would Rosa Maria Hernandez be safer in a sanctuary city? I would believe so. Now how many- how many people have water bottles in here? Who has a water bottle? So imagine that is your only means It’s the only way you can cook your food, this is still happening in Flint, Michigan It has been over 1300 days since Flint, Michigan has had clean water. It’s April. April marks the four year anniversary since Flint, Michigan has had clean water. The story would begin in April of 2014 after the local government of Flint, Michigan would reroute water from Detroit, pulling water from the Flint river. Residents immediately noticed the discolorization of the water, the taste, the smell They also noted their health issues: seizures, rashes, hair loss. Some staggering statistics of Flint, Michigan is that in 2015, all of Flint had about a 2x difference, increase, in lead levels in their blood after the water was rerouted Those communities that have larger amounts of lead within their water would have at least a 5x difference of an increase after the water was rerouted So, let’s think about the four Is of oppression again. Umm, can someone raise their hand and tell me which of the four Is they think these two examples are… Institutionalized. Anybody else? That’s correct. These are two examples of an institutionalized oppression but it’s very important to remember that we said that the four Is of oppression are interlinked and connected, so institutionalized context will combine with the interpersonal and the internalized and create an even larger scale, um, concern where now, we’re worried about whether or not Rosa Maria Hernandez will ever return to a hospital. Will she seek those health services again after being traumatized? After being taken from her family 150 miles away. Another context of health equity and health equality, was it equal in terms of the distribution of water and the water sources to Flint, Michigan? Was it equitable in terms of the resources availed to Flint, Michigan or the management of Flint, Michigan after their water was rerouted? I would say no for both contexts. So, How do we act on oppression at these four different levels? What- what are some solutions that we can come up with when it comes to addressing oppression at ideology, at the institutionalized context, interpersonal, and the even more frightening internalization of oppression? Well, one way we can do that is by fostering cultural competency. One way we do this is by establishing curriculums that intertwines the cultural competency aspect which is important and mixing that with the basic sciences and the clinical applications that come with medical school curriculum. A study done by Weir saw that the Ferguson syllabus is a great way to intertwine those two contexts within each other where we have two subdomains: the anti-racist pedagogy and the structural competency Anti racist pedagogy first aims to dismantle neutrality. What that means is that we are no longer able to take that stance where we don’t do anything, where it’s easier to hide and it’s easier not to say anything at all Another important component of the anti-racist pedagogy is that it brings reflection, critical thinking outside of the sciences that you normally think of in a medical school context. We know medical students are brilliant they got into medical school, now it’s about physician advocacy. Now it’s about thinking about how oppressive forces not only affects one’s self, but affects the people around us. So, another important context for this is that if that oppressive force does not affect you, you must know that that oppressive force may affect people around you. Very important. Another context of the Ferguson syllabus is the structural competency component where that is an emph- emphasized focus of

the different socioeconomic and environmental factors that affect patient health. So this could be food deserts, can my patient get these- the vegetables and the fruits that I am suggesting to them? Pollution, is that affecting them? Water sources, let’s think about Flint, Michigan. So in combining these two different, uh domains under the Ferguson syllabus, we can work to intertwine this longitudinal track that is cultural competency within medical curriculum. So you ask what is Georgetown doing? Georgetown has the Health Justice Scholars Program which aims to early expose medical students to the different contexts of the community around them They are learning about advocacy and policies that are enacted on the community within themselves. A very important component of Health Justice Scholars track is the Health Justice Alliance. The Health Justice Alliance is an interprofessional, uh, relationship whereas the there is work done in conjunction with the Georgetown School of Law and that of the School of Medicine. This is a legal advocacy and a medical domain where we are now, uh it is, it is enacted at the Hoya Clinic which is strictly volunteer-based There’s about a, it was established about 11 years ago where it now serves to help the homeless and it is important to note that it’s free for all who comes in and it functions as safe haven for patients who are worried about either documentation status or other different contexts that come with those socioeconomic factors that may affect their health So, another way we can foster cultural competency is through examples. This is found at maybe an attending physician’s level. I had the distinct honor of discussing this with Dr. Michelle Roett which discussed how advocacy works for her, how advocacy how she sees advocacy work within her clinic and how she expects that of the people she oversees. She stated that she takes judgment out of the room, which allows her to really hear what suffering is happening and, and a more important context of this is that she was willing to be an example for both her residents and the medical students that she sees. So with both taking judgment out of the room, and the willingness to be an example, this allows for consistency at all tiers of the clinic where it’s not, compassion is, um, expected of everyone that enters the clinic and who will oversee a patient So, I think in combining a medical school curriculum that interweaves cultural competency within its, uh within its studies and by setting examples at an attending physician level, even residency, even seeing an early exposure that comes with medical students, we can create a great environment that truly fosters social justice beyond access Thank you for your attention, I’m now opening the floor for questions. [applause] [inaudible] So I think there are a lot of required maybe discussions about implicit bias. Like there’s seminars done here at Georgetown but first, I talked about this with Dean Cheng once, um, and I told her that I think we have to begin making medical students, or students in general more uncomfortable when it comes to these contexts. Oppression isn’t comfortable, and so when it comes to talking about social justice it, we have, we come with some sort of privilege that, that comes with just discussing social justice. Some people don’t have the privilege of talking about social justice, it’s just, it oppression is acting on them and so by deeming oppression uncomfortable because it is, um, so by deeming oppression uncomfortable discussions of social justice should be a little easier because there’s a privilege that comes with just having a conversation about it… yes [inaudible] …as a form of institutional oppression, basically with the Flint example

I know that early on there was a lot of coverage during this issue and during the election as far as campaigns talking about it, yes but it’s largely disappeared from conversation I believe that that’s tied to the demographics of the community in some way and so how do you think we as students can bring these issues to the foreground of media attention and when people sort of forget because things happen constantly because this is an ongoing issue [inaudible] …that’s a great question, I really love it actually, um, so one way we can we can keep these different, um these different events uh concurrent, current sorry is that 1) we have to keep talking about it. That sounds really simple and it sounds really hard, it’s really easy to uh be to jump on an issue especially when it’s very widespread it’s also important to note that the Flint residents noticed quite early about, um, with their water and no one was listening. So the very fact that it got to media was a very big deal because it was a town that was 57% black and it was getting news coverage about water, um the water quality there so I think by doing things like maybe a Health Equity Forum and doing that once a month where you can’t forget these injustices that have happened weekly [inaudible], something happened um and bringing those contexts and making the conversation less, um, less uncomfortable and being willing to have conversations about it helps keep those events current and it helps keep us up to date because now, we’re more empathetic, we’re thinking about what’s happening in the communities around us because we’re always talking about it.. yes? not more so of a question but more so of a comment we talk about the Flint, Michigan situation more so than our kind of institutional problem but if we do a good cost analysis with the problem that the water system, so the question of asking or we should think about what was the ideological situation that caused them to reroute the the water, do they see ok Flint, Michigan is mostly minority populated thus they are less likely to realize that the water they are using is contaminated? Or is there an ideological standpoint where minorities deserved or should have a lesser quality of life thus they can reroute the water source so that they can save whatever money whatever the the point so even though we’re looking at the situation as an institutional problem, there is often a soft ideological component to it that leads to the institutional, um, issues so ideology then minorities they suppress then there’s the something to save us money leading to an institutional bias. So a question that I would ask now, and maybe to Dean Mitchell or anyone who is in the administration standpoint we implement changes so that we can see a result but for us to see the results we have to have kind of a structure that will allow us to measure what we’re doing and whether or not it’s working, it’s great to have the conversation about social justice etc and trying to change our own curriculum to address the the issues. How are we measuring the changes that we’re implementing to know that they are actually having the intended effects? It’s a great question, the, and the challenge for us is it’s even presumptuous for us to take on ideology like cura personalis is the cure of the whole person but my favorite read recently is the Book of Joy and it’s Dalai Lama and Desmond Tutu and Dalai Lama says When I reach out, when I meet anyone it’s not that they’re groups of people they’re all people, they’re all one, we are all one so you’re right. When the ideology gets in the way, if we live up to it we need to make sure we’re teaching how to take care of everyone and it shouldn’t be an issue, unfortunately I don’t think we always live up to cura personalis, uh, and sometimes you’ll come to my office and say if you believe in cura personalis you need to make the curriculum pass/fail so we can go out and do more or

we need to, uh, it’s the work that we do on the Hill um is, what are the priorities we should tackle? um, what what do we do? Is it our responsibility about immigration and about DACA? It is our responsibility so sometimes the charge is so vile it’s hard to measure, it doesn’t mean we shouldn’t do it, uh, and I think curriculum um, there are pieces of or optional things in there about cultural competence and there have been off and on though we don’t measure everyone probably, um but empowering this is you know, that’s there’s not always more room and sometimes it means you have to set priorities and take some things out and that, that are your priorities driven unconsciously by your ideology so, uh it’s a big challenge, so help us, stay after us I guess just as a follow-up I’m a little bit more practical because, um, the biases that we see has been has been kind of part of our history, it’s been there for a while so there has been prior this group or the conversation about how can we be less biased so then if we try to really implement changes, we have to be able to measure, ok if we do this then this is what we expect so then that allows us to say, ok then the changes that we have done in the curriculum are not really working then let’s do something else, so I guess in the future we have to create ways to measure what we’re doing to measure if it’s actually working or having the intended consequences Any last questions… yes? Um so you mentioned mostly like dialoguing within you know, our internal system but as far as, it seems like the outcome is more so even what is the community feeling, perceiving, experiencing? Are they valued as a whole person so are there kind of consistent opportunities to engage with the community in that way to understand what they’re taking back besides just you know maybe like quick patient surveys after they’ve seen a doctor but something that’s um a little bit more engaging and maybe even like outside of the campus directly in the communities where are being affected and in on campus, um well Georgetown specifically has the Hoya Clinic, which is the first student created clinic here in DC and I, I set that a little high because it’s volunteer based and so those who come in are accepted and they’re treated and there are patients that continuously come in, um and they are now seeing consistent care, um and, it’s also important to note that everyone of different statuses can come to these clinics, now I would say uh to kind of counter that though I would say I don’t think the student driven clinic should be only volunteer based, that says a lot about the students who volunteer for it um, those who are willing to put their time um their effort into that that’s just outstanding but I think to, to make it a little to make the Hoya Clinic a little more mandatory for everyone, that might negate the true meaning of what the Hoya Clinic is but I think it exposes Georgetown students earlier to what the Hoya Clinic is trying to establish in the population around um DC as we know is regarded as a lot of separation when it comes to income inequality that’s here so I think um I think the Hoya Clinic is it’s a very beautiful thing uh and it says a lot that it’s student driven and volunteer but I think there can be another like establishment that comes with helping like helping the community around them as opposed to just making it just a volunteer sort of thing yes? I don’t want this to sound offensive at all but Dr. and her Dr. Cameron in her office , we had the former Dean of Curriculum who came to me and said You should require every student to do service, yes, and I said three quarters, at that time three quarters of the students did volunteer [inaudible] and he said but if you require it makes a statement about the institution so that’s why and then what we had to say before Dr. Cameron was we want every student at the school to do service and she, she and Dr. [inaudible] found science and [inaudible] so you all do, you’ll all do that and then we threw in

it’s sort of token, but every student has to do 20 hours of volunteer… it’s it’s a token but it says the school requires it um and [inaudible] [inaudible] but it does take an institutional commitment…. Thank you so much [applause] uh good afternoon my name is Jerome Murray, I’m a member of the 2017-2018 uh GEMS class and uh I have the esteemed pleasure of introducing our second speaker for today uh, Brendon Peterson uh Brendon comes to us from Houston Texas by way of Morehouse College where he completed his degree in Biology with an emphasis in the pre medical sciences after completing his undergraduate studies, Brendon began working at a hospital as a emergency medical technician and it is at this time that he was exposed to the role of a physician and the issue of physician burnout. I’ve had a chance to get to know Brendon uh over the past uh however many months GEMS is long um and it is his passion for the subject and his captivating personality uh that makes him the ideal speaker for this incredibly important topic so without further ado um I bring to you my friend my colleague and future doctor Brendon Peterson [applause] I want to thank Jerome for that wonderful introduction and how about another round of applause for Dr. Wiley with a compelling discussion on social justice [applause] Good afternoon colleagues, faculty, staff um before I begin I want everyone to close their eyes As your eyes are closed think about a time you set out to accomplish a goal Think about actualizing that goal, feelings of optimism accomplishment, meaning in that goal. Reminisce in the feelings that were in that moment…. now open your eyes Today we’re going to have an engaging interactive conversation about physician burnout As we observe this junior doctor, please take in all of the notes that are around him Alex, what do you observe about this junior doctor [inaudible] great Dr. Henry, what do you observe about this junior doctor? [inaudible]… [laughter] Well uh as Dean Taylor would so kindly and eloquently put it “very reasonable responses from you all” When I look at this junior doctor I notice uh a couple key points, some things that we need to draw our attention to I notice that he hasn’t slept, I notice that he’s tired and I think this is important to emphasize that it’s very hard to be a physician when you are well rested but imagine being tired, imagine having to have the level and attention to detail to make sure your patients get high quality precision care. I notice that he’s neglecting his self care. We’ve all been in situation where you need to pay attention to a lecture, you’re in the middle of giving a presentation and you need to use the restroom but you can’t It’s not socially, um, equitable right now to go to the restroom but lastly I draw your attention to the patient stickers on the junior doctor’s sleeve I commend the junior doctor for doing the best he can to efficiently and effectively provide care but we all know that we’re breaching some privacy and that it may not be the best way to give the best patient care Here I see a context of a lack of patient care so as we go throughout the presentation, in the background of your minds constantly think about how we got from those feelings of accomplishment, of optimism, of having meaning in what we do to this junior doctor picture

So what is physician burnout and better yet, why is it important? Physician burnout is a big term, it’s been popular in the last couple of years within medical education and in the medical community. Simply put, physician burnout is emotional exhaustion This manifests itself as if you are on the worge or you’re doing a round and you’re swamped with work and you have patients of all different levels of care and a patient kindly asks for a pillow or a warm blanket. Now most of us have been in a mode of prioritizing, let me get the most life and death things out of the way first then I can deal with that but we also have to keep in mind that a patient, although we see them as needing medical care, sometimes we need to give in to their emotional needs as well and when you’re exhausted that can be a sign and symptom of physician burnout It’s feelings of cynicism, low sense of personal accomplishment and at its worse it’s suicidal ideations and personal harm. Now these are a lot of things that encompass physician burnout but to operationalize this definition for the rest of this presentation physician burnout is simply the loss of meaning in what you do you lose your why, as students you lose the why to go through the grueling blocks of education that we go through. As a physician, you lose your why to get up when you’re tired to maintain that balance between professional and personal life so these are clips from an infographic of the National Academy of Medicine. I think it’s uh it’s a discussion paper and I think it’s fitting that we put this here to give us a snapshot of physician burnout in the national climate I want to draw your attention to the 9% among physicians. This is taken from a paper done by Shanafelt and the Mayo Clinic, 2011 to 2014 where they looked at physician burnout by specialty and compared it to the US workforce and what they noticed is from 2011 to 2014 physician burnout has increased by 9%. It’s a problem and it’s growing and it needs attention. Now I would take your attention to the burnout is nearly 2x. This is really significant It’s 2x as prevalent among physicians. One out of every two physicians will experience burnout So to make this, to put it in context according to the master physician file, there are 1.4 million physicians in the US currently today. The US population is approximately 325 million so at any given time, 1.4 million physicians are charged with giving accurate high level patient care and making sure that their patients are safe to a population of 325 million context of burnout. Now when we add the 2x as prevalent among physicians or the 50% of physicians having burnout, we now can see what that means of a national context. Of the 1.4, seven hundred thousand physicians are operating optimally. The other seven hundred thousand are trying to cope with physician burnout to make sure their patients are still taken care of and they’re also dealing with personal contexts in their own lives. And lastly, on the opposite end of the spectrum of physician burnout, I draw your attention to the 130% and the 40% Suicide rates among female physicians are 130% and this is compared to the US workforce and likewise in males it’s 40% elevated compared to the normal workforce. I think this is important to note that physician burnout can be considered a syndrome or disease and therefore it needs an intervention. As we go through this presentation, it’s not gonna be all doom and gloom you are not set out and destined to, you know, be a physician and encompass physician burnout, or as a student you’re not destined to have a student or medical student burnout. There are specific interventions by the end of this discussion and this talk that I want to equip and arm you guys with to mitigate burnout and prevent it altogether This graphic is taken out of a paper that looked at burnout and satisfaction of work life balance from 2011 to 2014 It was done by Shanafelt and Mayo Clinic and this first graph, to orient everybody

the x axis is percent burnout. The y axis is by specialty. So physicians in the room please try to find your specialty and medical students, look for a specialty that you’re interested in. Now we might be asking our questions what does the yellow and the blue bars mean? The yellow is physician burnout in 2011, the blue is physician burnout in 2014 Heather what do you notice in comparison of the blue and yellow lines across all specialties? [inaudible] awesome. Did everybody hear that? She said that all instances of burnout have increased since 2011 so irregardless or regardless of specialty there’s a context of physician burnout and not only is it there, it’s growing so now this begs the question, we looked at physicians compared by specialty but what about physicians compared to their US counterparts in the workforce? That’s exactly what Shanafelt did in this study. He wanted to look at physician burnout compared to the US population Again, the x axis is year from 2011 to 2014. The y axis is percent burnout. Now although the colors are the same they have a little bit of a different meaning. The blue represents physicians and the yellow represents population. The population are all other occupations that are not physicians. These are your teachers, these are your bus drivers, these are your, uh any profession or occupation that is not a physician. And this graph here has some telling data does anybody wanna volunteer and tell me what they notice about the yellow line? [inaudible] exactly It’s a flat line. It’s stable in stark comparison to the blue line of physicians In other words, the data suggests that from 2011 to 2014 burnout among the US population is stable, it’s not changing. It has an established point and it’s hovering around that point whereas physicians not only was it higher in 2011, but it’s increased It has a positive slope to 2014. So in 2011 burnout was higher and then during 2011 all the way to the end of 2014 its been increasing So we talk about burnout but rarely do we ever see a physician that is just a physician, we have personal roles we may be mothers, we may be fathers uncles brothers sisters daughters any other personal role that you may wear when the white coat comes off? What does that data mean how can we unpack it? This is satisfactional work life balance and simply put, or a definition that we can work for rest that will work for the rest of this presentation is do you have enough gas in the tank when you take off the white coat when you put your stethoscope down can you fulfill all the other roles that you may have outside of being a physician again, the x axis is year from 2011 to 2014 the y axis is satisfaction with work life balance Does anybody notice anything about the yellow line in this graph? [inaudible] exactly She said it’s increased and again, in stark comparison to the blue line physicians it’s not only lower but it’s decreasing so the data here suggests that satisfaction work life balance and the population was already higher and it’s getting better, people are leaving their jobs rejuvenated they have enough gas in the tank to fulfill all the other roles that they do whereas physicians they already started with a lower satisfaction work life balance in 2011 but it’s been declining rapidly to 2014. You’re leaving school you’re leaving your job with no energy left to fulfill the, all the other roles dealing with balancing, doing a balancing act between being a physician and wearing the other hats This is some telling data about physician burnout but what is the correlation or does it have any, um does it have any meaning for medical students? This is what Presault set out to find in her study in 2014 and she looked at distress among medical students compared to age similar college graduates. Now the x axis is distress, further subdivided into burnout and depression The y axis is the, a percentage of respondents

Now the red column, the one with the stethoscope are medical students The blue column are age similar college graduates. These are your students that go to law school, students that go to um education, that are pursuing the education all other studies that are not becoming a physician are the age similar college graduates Now one thing to note about this graph is this is entering medical school, you have not began your medical education yet and I think this is important to note that admissions committees are doing a great job at hand selecting students that have an overall better quality of life better qua- uh better phys- um better quality of life, a better physique, better mental um emotional IQ This is one year post medical school education The data here suggests that medical students are entering healthy and during their medical education they’re getting sick and having higher rates of burnout and depression Now I stated earlier in the presentation before it’s not all doom and gloom just because you’re a Georgetown medical student doesn’t mean you’re gonna experience burnout and if you happen to be a practicing physician, it doesn’t mean that you’re going to have a balance uh struggle with balancing between personal and work life it doesn’t mean that you’re giving a lack of patient safety and low quality patient, uh care. It does not mean that So here are some individual interventions. How now can we growing in the practicing physicians and now that was established by Brazeau in 2014 in medical students. What can we do now to make sure that we can prevent or mitigate burnout if it is occurring. As Georgetown professors often say in their lectures “this is a laundry list of things to remember, but you don’t need to know it all” “I’ll tell you exactly what’s gonna be on the test.” [laughter] First, we have to become aware and recognize the symptoms We now know that there is a problem, but how can we solve the problem if we can’t identify it? We have to identify what burnout looks like and how does it manifest for each of us individually? Once we can identify not only in ourselves we can help those and our colleagues around us Now each and every one of these bullet points is important in intervening on an individual level to combat physician burnout but of the most important, meditation and mindfulness has been proven to be the most important in mitigating physician burnout and how does this manifest? If you’re stressed out as many students are during the block or during their education and you’re reading a paragraph four or five times over and you can’t remember a single word or if you’re a practicing physician, swamped with all the bureaucreatic duties that comes along with wearing a white coat. Take a moment, take 5 to 10 minutes to step away, to meditate, to get your mind and to recalibrate all your sensory back to normal so that you can do an efficient, high quality job other things is decompress after work or find me time When I’m stressed out during my medical education or from a long day of being grilled by DT at like 4:00 I take time out to play basketball so whatever your hobby is or whatever that you do that can allow you to decompress and take time away from what you are doing so that you can have that meaning in what you do I encourage you all to do it so here’s, here’s a visual aid that looks at key drivers of burnout and engagement of physicians this is looking at it from an organizational or institutional view what can organizations or institutions like Georgetown School of Medicine do to make sure that we mitigate burnout and that we promote self care? Now I’m gonna ask anybody in the audience today what was our operational definition of burnout when we began this talk? [inaudible] exactly

he said a lack of meaning in work. You lose your why, and here in this graph we see that meaning in work is essentially the central piece to this visual aid and there’s different things that institutions or organizations can do to reinforce meaning in work or if they don’t do it, run the risk of medical students and physicians losing the meaning in what they do. Georgetown does a wonderful job at creating an organization and culture of values around physician burnout Georgetown acknowledges that burnout exists and they provide you with many interventions throughout the curriculum to mitigate and prevent burnout one of which is the mind body medicine program by Dr. Hamadi if you uh for students that are in the audience when we got finished with block 3 they scheduled in our um Google Calendar wellness time after our last exam these are a couple of the examples that Georgetown School of Medicine is doing now to help mitigate physician burnout lastly, control and flexibility This is crucial in helping people find meaning in their work So in summary, key strategies to reduce burnout and engagement again this is a laundry list of items, of the most important this is what you need to know whether you’re looking at interventions from an individual organization institution or even some national goals, the key thing that I want you to take away from this is to provide resources to promote resilience and self care When you can promote resilience and self care, you arm yourself against physician burnout You arm yourself against the effects of physician burnout Thank you guys for your attention, I now open up the floor for a Q&A. [applause] [inaudible] …great question the time period from 2011 to 2014 was picked specifically because these were landmark papers. In 2011, Shanafelt and Mayo Clinic originally, if you would diagnosed the problem of physician burnout They got data to quantify what was going on in physician population and then in 2015 when they published the changes in burnout from 2011 to 2014 they not only diagnosed it in 2011 but they showed that it was growing, so I thought that was fitting to give you guys an audience, I mean give the audience a a look a snapshot into what’s going on in the physician burnout climate Now for the result paper looking at distress in medical students Here is numerous paper, more current, that are out now that said distress in medical students However I think Presault established that medical students are entering healthy and they’re getting sick. Current papers now look at interventions stratified across different levels of the medical education and they don’t compare to the national or age similar college graduates. So for the purposes of this presentation, I wanted to give you a look of physician burnout, medical school burnout and I wanted y’all to see the comparison to the workforce as well as age similar college graduates… very good question uh, tamara … um, first of all Dr. Peterson I really enjoyed your presentation um I just wanted to see if you had any specific things that we could do here at Georgetown like your ideas, as you know like with the curriculum being so compressed and all the various responsibilities that a med student has to go through, I don’t know that there’s necessarily time for mindful meditation or that since it’s not a requirement it sort of gets prioritized like at the end of the list So do you have any like uh any ways to make that more of a priority or to kind of build it in so that it comes naturally? Outstanding question. I think being a GEMS student and having the privilege to be a student at Georgetown Medical School or um School of Medicine I think that the Georgetown curriculum does a great job, it offers students meaning in their work, but it also has some setbacks and that sometimes midway through a block students are feeling burned out with not only the volume of the information but all the other duties that come with trying to be , and I think that one intervention that I propose outside of the mind body medicine program that we already offer because you have to register for that I think that maybe

in the beginning of each medical school orientation you have a seminar arming students against physician burnout and for current students that are in the block maybe a week or two before the test or sometime during that block, we offer a longitudinal opportunity for students to participate in mindful meditation This can be ranging from an hour to two hours or it can be an entire day. But I think that these are the types of discussions that we need to have to um get our student body um armed against physician burnout and medical school burnout. Great question um, sure yeah thank you Dr. Peterson, um I just wanted to kind of take you back on your [inaudible] throughout the point that self care as a physician and medical student is also going to affect the level of care you’re giving your patients and you’re also going to you know these are many issues that are caused by a lack of self care [inaudible] another intervention could be emphasizing in the clinical .. the impact that the example that you are .. for your patients and practicing self care on yourself is going to help pass medical care to your patients Amazing um you know Dean Taylor would say you did a great job linking the two presentation today [laughter] Alynna did a wonderful job talking about Dr and her ability to exemplify what it means to bring social justice into the patient clinic and I think that throughout my presentation you can take that same being an example of your patients to promote self care. I think that one thing to note as aspiring physicians and physicians this is an occupation we are still humans and in some cases patients in a different time and setting so just to be able to like you said be able to be that example for your patients not only takes you off of a pedestal but it allows your patients to see that hey, although I am in this highly respected occupation me and you are no different thank you guys. [applause]