Clinical Assistant Professor, Medicine - Primary Care and Population Health
Early Outcomes of SARS-CoV-2 Infection in a Multisite Prospective Cohort of Inpatient Veterans.
Open forum infectious diseases
2023; 10 (7): ofad330
Over 870 000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have occurred among Veterans Health Administration users, and 24 000 have resulted in death. We examined early outcomes of SARS-CoV-2 infection in hospitalized veterans.In an ongoing, prospective cohort study, we enrolled veterans age ≥18 tested for SARS-CoV-2 and hospitalized at 15 Department of Veterans Affairs medical centers between February 2021 and June 2022. We estimated adjusted odds ratios (aORs), adjusted incidence rate ratios (aIRRs), and adjusted hazard ratios (aHRs) for maximum illness severity within 30 days of study entry (defined using the 4-category VA Severity Index for coronavirus disease 2019 [COVID-19]), as well as length of hospitalization and rehospitalization within 60 days, in relationship with demographic characteristics, Charlson comorbidity index (CCI), COVID-19 vaccination, and calendar period of enrollment.The 542 participants included 329 (61%) who completed a primary vaccine series (with or without booster; "vaccinated"), 292 (54%) enrolled as SARS-CoV-2-positive, and 503 (93%) men, with a mean age of 64.4 years. High CCI scores (≥5) occurred in 61 (44%) vaccinated and 29 (19%) unvaccinated SARS-CoV-2-positive participants. Severe illness or death occurred in 29 (21%; 6% died) vaccinated and 31 (20%; 2% died) unvaccinated SARS-CoV-2-positive participants. SARS-CoV-2-positive inpatients per unit increase in CCI had greater multivariable-adjusted odds of severe illness (aOR, 1.21; 95% CI, 1.01-1.45), more hospitalization days (aIRR, 1.06; 95% CI, 1.03-1.10), and rehospitalization (aHR, 1.07; 95% CI, 1.01-1.12).In a cohort of hospitalized US veterans with SARS-CoV-2 infection, those with a higher CCI had more severe COVID-19 illness, more hospital days, and rehospitalization, after adjusting for vaccination status, age, sex, and calendar period.
View details for DOI 10.1093/ofid/ofad330
View details for PubMedID 37484899
View details for PubMedCentralID PMC10358428
When it's needed most: a blueprint for resident creative writing workshops during inpatient rotations.
BMC medical education
2021; 21 (1): 535
BACKGROUND: Narrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. However, Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents.OBJECTIVE: To evaluate programmatic and learner outcomes of a novel narrative medicine curriculum implementation during inpatient medicine rotations for medical residents. Programmatic outcomes included implementation lessons. Learner outcomes included preliminary understanding of impact on feelings ofburnout. Additionally, we developed a generalizable narrative medicine framework for program implementation across institutions.METHODS: We developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford's busiest and emotionally-demanding inpatient rotation (medical oncology). Using the Physician Wellbeing Inventory (PWBI, range 1-7; 3-4=high burnout risk; ≥4, high burnout), we anonymously assessed resident burnout during pre-implementation control year (2017-2018, weeks 1and 4), and implementation year (2018-2019, weeks 1 and 4). We interviewed program directors and facilitators regarding curriculum implementation challenges/facilitators.RESULTS: Residents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years. We identified success factors for programmatic success including time neutrality, control of session, learning climate, building trust, staff partnership, and facilitators training. During control year, resident burnout was initially high (n=16; mean PBWI=3.0, SD: 1.1) and increased by the final week (n=15; PBWI=3.4, SD: 1.6). During implementation year, resident burnout was initially similar (n=13; PBWI=3.1, SD: 1.9) but did not rise as much by rotation end (n=24; PBWI=3.3, SD: 1.6). Implementation was underpowered to detect small effect sizes. Based on our our experience and literature review, we propose an educational competency framework potentially helpful to facilitate inpatient narrative medicine workshops, as a blueprint for other institutions.CONCLUSIONS: Inpatient Narrative Medicine is feasible to implement during a challenging inpatient rotation and may have important short-term effects in mitigating burnout rise, with more study needed. We share teaching tools and propose a competency framework which may be useful to support development of inpatient narrative medicine curricula across institutions.
View details for DOI 10.1186/s12909-021-02935-x
View details for PubMedID 34670565
ADDRESSING UNMET NEEDS IN WOMEN'S HEALTH EDUCATION FOR VA CONTINUITY CLINIC RESIDENTS: A HANDS-ON, RESIDENT-TAILORED CURRICULAR INNOVATION
SPRINGER. 2020: S706
View details for Web of Science ID 000567143602236
NARRATIVE ONCOLOGY: AN INTERVENTION TO PROMOTE RESIDENT WELLBEING AND PATIENT-CENTERED CARE ON AN EMOTIONALLY EXHAUSTING INPATIENT ROTATION
SPRINGER. 2020: S754
View details for Web of Science ID 000567143602345
YES WE CAN: A PATIENT-CENTERED, RESIDENT-LED GOALS OF CARE INTERVENTION FOR HIGH-RISK PRIMARY CARE PATIENTS
SPRINGER. 2018: S840
View details for Web of Science ID 000442641404253