Appendix D

Forum-Sponsored Products

Convening Activity Publication: Interprofessional Education for Collaboration: Learning How to Improve Health from Interprofessional Models Across the Continuum of Education to Practice: Workshop Summary (2013)

In 2012, the Global Forum on Innovation in Health Professional Education held its first two workshops, focusing on linkages between interprofessional education (IPE) and collaborative practice. The workshops set the stage for defining and understanding IPE and provided living histories of speakers from around the world who shared experiences working in and between IPE and interprofessional or collaborative practice. This publication summarizes the workshops.

Convening Activity Publication: Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary (2013)

This publication looks at professionalism among the different health professions and considers whether it might be possible for all the health professions to share a common understanding of professionalism with each other (in a transdisciplinary fashion) and with society (through a social contract), and have that understanding be practiced and promoted in the education of all health professionals.

Convening Activity Publication: Assessing Health Professional Education: Workshop Summary (2013)

The content covered at the workshop and captured in this publication involves assessing core competencies particularly within interprofessional ed-

ucation and health professional collaborations that include patient-centered health care teams. Discussions at the workshop helped describe these competencies and explored the challenges, opportunities, and innovations in assessment across the education-to-practice continuum.

Convening Activity Publication: Building Health Workforce Capacity Through Community-Based Health Professional Education: Workshop Summary (2014)

In setting the stage for the workshop that is summarized in this publication, the first speaker reminded participants of the importance of learning from and with communities for understanding the values and challenges faced by the community they serve. It was later remarked that health systems are of the community thus reinforcing the importance of bi-directional learning. Innovative examples of community-based learning that followed this idea were presented and discussed.

Convening Activity Publication: Empowering Women and Strengthening Health Systems and Services Through Investing in Nursing and Midwifery Enterprise: Lessons from Lower-Income Countries: Workshop Summary (2015)

Experts in women’s empowerment, development, health systems’ capacity building, social enterprise and finance, and nursing and midwifery explored the intersections between and among these domains. Innovative and promising models for more sustainable health care delivery that embed women’s empowerment in their missions were examined. This publication highlights examples and explores broad frameworks for existing and potential intersections of different sectors that could lead to better health and well-being of women around the world, and how lessons learned from these examples might be applied in the United States.

Consensus Study Report: Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes (2015)

Whereas considerable research has focused on student learning in interprofessional education (IPE), only recently have researchers begun to look beyond the classroom and beyond learning outcomes for the effect of IPE on such issues as patient safety, patient and provider satisfaction, quality of care, health promotion, population health, and the cost of care. The forum members wanted to know what data and metrics are needed to evaluate the effect of IPE on individual, population, and system outcomes. To answer this question, the individual sponsors of the forum sponsored an Institute of Medicine study to examine the existing evidence on this complex issue and consider the potential design of future studies that could expand this evidence base.

Convening Activity Publication: Envisioning the Future of Health Professional Education: Workshop Summary (2015)

This publication summarizes a workshop where forum members focused on envisioning the future of health professional education in light of the Lancet Commission Report. The workshop aimed to explore the implications that shifts in health, policy, and the health care industry could have on health professional education and workforce learning; identify learning platforms that could facilitate effective knowledge transfer with improved quality and efficiency; and discuss opportunities for building a global health workforce that understands the role of culture and health literacy in perceptions and approaches to health and disease.

Consensus Study Report: A Framework for Educating Health Professionals to Address the Social Determinants of Health (2016)

The World Health Organization defines the social determinants of health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” These forces and systems include economic policies, development agendas, cultural and social norms, social policies, and political systems. Educating health professionals in and with communities negatively affected by the social determinants of health can generate awareness among those professionals about the potential root causes of ill health, contributing to more effective strategies for improving health and health care for underserved individuals, communities, and populations. This is the context in which the expert committee of the National Academies of Sciences, Engineering, and Medicine developed a high-level framework for educating health professionals to address social determinants of health. The committee’s framework aligns education, health, and other sectors to better meet local needs in partnership with communities. The individual sponsors of the forum sponsored this study.

National Academy of Medicine (NAM) Perspective Paper: Breaking the Culture of Silence on Physician Suicide (2016)

Every year an estimated 400 U.S. physicians take their lives. Numerous global studies involving every medical and surgical specialty indicate that approximately one in three physicians is experiencing burnout at any given time. Medical students appear to be at an equal or higher risk of burnout, depression, substance abuse, and suicide. Because of the perceived and real risks associated with seeking help for such problems, many students, trainees, and doctors, and health care organizations fail to recognize, report, discuss, or pursue treatment for these conditions. The purpose of this paper is to shine a spotlight on this culture of silence, to understand the scope and complexity of the underlying issues, and to drive changes to deliver indi-

vidual, organizational, and societal interventions that preserve and promote the physical and emotional health of caregivers.

Convening Activity Publication: Exploring the Role of Accreditation in Enhancing Quality and Innovation in Health Professions Education (2016)

The purpose of accreditation is to build a competent health workforce by ensuring the quality of training taking place within those institutions that have met certain criteria. It is the combination of institution or program accreditation with individual licensure—for confirming practitioner competence—that governments and professions use to reassure the public of the capability of its health workforce. This workshop explored global shifts in society, health, health care, and education, and their potential effects on general principles of program accreditation across the continuum of health professional education. This publication summarizes the workshop.

NAM Perspective Paper: I Felt Alone But I Wasn’t: Depression Is Rampant Among Doctors in Training (2016)

Dr. Elisabeth Poorman, a primary care doctor and a former resident at Cambridge Health Alliance, answered the call and agreed to reprint her entry in WBUR’s CommonHealth blog, published in August 2016. This piece is Dr. Poorman’s personal reflection on the rampant depression experienced by doctors and doctors in training. As with any challenge, the first step is to identify the problem so solutions can be formed jointly by those most affected.

NAM Perspective Paper: Defining Community-Engaged Health Professional Education: A Step Toward Building the Evidence (2017)

The Global Strategy for Health Workforce 2030 outlines a set of milestones and strategies to expand and strengthen the health workforce that could better position countries to achieve universal health coverage and relevant Sustainable Development Goals (SDGs). The strategy underscores a need to counter the global shortage of health workers (expected to be 17 million by 2030) and ensure the workforce is appropriately trained to address the evolving health needs of the population. This training would ideally produce health professionals who are responsive to the population, socially accountable, both person- and population-centered, and supportive of empowered and engaged communities. Community-engaged health professional education is a mechanism for learning how to work in and with communities while obtaining the attributes just listed. Developing socially accountable individuals and institutions within a health system is key to improving the health and well-being of present and future societies.

NAM Perspective Paper: 100 Days of Rain: A Reflection on the Limits of Physician Resilience (2017)

By January 1999, it rained, they say, for more than 100 days in a row. Seattle has a reputation for precipitation, which I have to believe could lead to higher rates of seasonal affective disorder and the need for strong coffee. It was during this month that I can say I may have reached my low point. I was a young, insecure, and nervous intern in the Harborview Medical Center intensive care unit that month—one in which our attending physician later admitted was the busiest of his long career. Myself and my senior resident, Phil, came to expect the admission of more than 10 critically ill patients every fourth night.

The idea of caps on resident duty hours has been studied and discussed since the early 1970s, and even in 1999 the 80-hour workweek was implemented, if not necessarily followed. But caps were not a term we used on-call—they were what our surgical colleagues wore in the operating room, and what I wore on the rare off day I could attend a Mariners game. Despite a deep-seated feeling that I was an imposter in such a well-regarded training program, I was always a relatively happy-go-lucky guy, who tended to be a shoulder to cry on rather than the one who might suffer from burnout.

NAM Perspective Paper: A Multifaceted Systems Approach to Addressing Stress in Health Professions Education and Beyond (2017)

There are unique stressors faced by health professionals that begin during the educational process and continue throughout training and into practice. While stress is expected owing to the intense nature of the work in health care, the systems in which faculty and health professionals work often intensifies this already stressful environment and can lead to negative mental and physical effects. Stress takes a major toll on individuals and has been reported to increase absenteeism, errors, burnout, and substance use, and it can even lead to individuals quitting the health professions altogether. While it is indisputable that the nature of the work in health care causes stress, organizations also bear responsibility for accepting and even creating an institutional culture where stress can be worsened by outdated or negative policies and behavioral patterns. Moral distress can be experienced when there is difficulty obtaining appropriate interventions or care to support patients and families.

Convening Activity Publication: Future Financial Economics of Health Professional Education: Proceedings of a Workshop (2017)

Health workforce shortages affect people’s access to quality health care around the globe, and can result in untreated sickness, disability, and adverse economic consequences. Chronic underinvestment in health workforce education and training creates a mismatch between strategies to educate

the right number and mix of health professionals and meeting the needs of the population particularly within remote and underserved communities. Addressing this mismatch while considering how supply and demand drive decisions within education and health was the topic of the workshop summarized in this document. The workshop sought to explore resources for financing health professional education in high-, middle-, and low-income countries, and to examine innovative methods for financially supporting investments in health professional education within and across professions.

NAM Perspective Paper: Addressing Burnout, Depression, and Suicidal Ideation in the Osteopathic Profession: An Approach That Spans the Physician Life Cycle (2017)

Burnout, depression, and suicidal ideation are key areas of concern because of the consequences they can have on physicians as well as the patients for whom they care. The level of burnout in the medical profession has increased at an alarming rate in the past decade. Statistics reveal that about 54 percent of all physicians are burnt out (30–40 percent of employed physicians and 55–60 percent of self-employed physicians). Students, interns, and residents also factor into the equation as reports indicate they experience burnout at a rate of 20–40 percent. According to the International Classification of Diseases, Tenth Edition (ICD-10), burnout is defined as “a state of vital exhaustion.” It manifests as emotional exhaustion that affects a person’s passion for work; ability to relate to others; sense of accomplishment or purpose; judgment; productivity; emotions; and overall health.

NAM Perspective Paper: Burnout, Stress, and Compassion Fatigue in Occupational Therapy Practice and Education: A Call for Mindful, Self-Care Protocols (2017)

Now more than ever is the time for occupational therapy educators, students, and practitioners to invest in strategies to combat burnout and stress. Current health care practice requires occupational therapy practitioners to manage many dimensions of patient care. Combining professional and educational duties with the emotional energy required for patient encounters and managing one’s personal life can create the potential for burnout and compassion fatigue and an imbalanced professional quality of life. Yuen (1990) called on occupational therapy fieldwork educators to put more time in their formal training toward teaching experiences with their students, and to recognize potential for burnout by increasing self-awareness.

NAM Perspective Paper: Promoting Well-Being in Psychology Graduate Students at the Individual and Systems Level (2017)

More than 70 percent of psychology doctoral students report experiencing stressors that can affect their ability to fully function. Common stressors

include academic responsibilities, debt, anxiety, and poor work–life balance. Lack of support from faculty, poor relationships with faculty, and cohort tension are sources of stress and negatively affect both personal and professional functioning while serving as barriers to effective coping. This can result in trainees who have difficulty developing and exhibiting the proper degree of professional competence (termed as problems with professional competence). These problems with professional competence can be manifested in difficulties attaining identity as a psychologist, self-awareness, and reliable clinical judgment and reflection skills, as well as developing the ability to have effective interpersonal interactions. Once competency problems emerge, they demand immediate attention in order to ensure patient safety and effective care. A proactive and preventive strategy involves implementing both individual- and systems-level approaches designed to increase self-care.

NAM Perspective Paper: Stress-Induced Eating Behaviors of Health Professionals: A Registered Dietitian Nutritionist Perspective (2017)

For health professionals, stress and eating often combine in unhealthy ways. The stress comes early in their training and lingers throughout their careers. Anyone who has worked or trained in a hospital knows all too well the cycle of workplace stress leading some individuals to overeat and gain excess weight, which in turn leads to physical and mental stress owing to the weight gain itself. Others react to stress by eating less and losing weight, which can similarly have negative consequences. Often stress comes with unhealthy food choices such as skipping meals, reliance on fast food, restricting fluid intake, or choosing foods high in sugars and fats and low in nutrients. Skipping meals and drinking too little fluid have not been shown to increase medical errors, but they do contribute to burnout and jeopardize weight and nutritional status.

NAM Perspective Paper: Breaking Silence, Breaking Stigma (2017)

In a late March issue of the New England Journal of Medicine, the dean of my medical school published a beautiful essay on the tragic death of one of my classmates. Kathryn had committed suicide last August. Earnest and humble, Dr. Muller’s piece demonstrates his ongoing commitment to promoting wellness among medical trainees in a way that is not reactionary but rather proactive and sustained. With student input, he and his colleagues are studying ways to enhance work–life balance, relieving the pressure to perform according to unforgiving metrics, and expanding access to mental health resources. As I read his thoughtful words, a gnawing question formed in my mind: Why has a medical school community with deeply compassionate leadership seen two trainee suicides in 1 year? More broadly, if Hippocrates’s words are true that those who love medicine also love

humanity, how does profound suffering pass unnoticed among our own? Perhaps we residents can play a role in bringing that suffering out into the open. While continuing to expect confidential mental health services, we should at the same time foster a culture that embraces open conversation about experiences with depression and other mental illnesses.

NAM Perspective Paper: Breaking the Culture of Silence: The Role of State Medical Boards (2017)

The NAM Perspectives paper Breaking the Culture of Silence on Physician Suicide brought together four unique voices from surgery, nursing, medical training, and the clergy to consider what led Kaitlyn, a young medical student, to take her own life on April 11, 2013. Drawing from personal experiences, the authors exposed what they thought was a culture of silence under intense pressure that pushes physicians, health professionals, and trainees to experience depression and in some cases to tragically end their lives. But these are just four opinions based on four experiences. The authors hope to bring more voices into the conversation by asking others who are comfortable doing so to share their own reactions to situations they have been forced to navigate throughout their education and careers as health care providers.

NAM Perspective Paper: The Role of Accreditation in Achieving the Quadruple Aim (2017)

Interprofessional education (IPE) and collaborative practice continue to gain momentum within the health sector. Recently, accreditors from multiple health professions have joined together to discuss their role and to set continuing education standards for IPE and guidance for interprofessional foundational education. And although models for IPE exist to guide the learning process from education to practice, there are few guides for the historic work of accreditors to promote interprofessional collaboration across education and practice.

Convening Activity Publication: Exploring a Business Case for High-Value Continuing Professional Development: Proceedings of a Workshop (2018)

Continuing education, continuing professional development, and high-value continuing professional development (CPD) exist along a continuum. The Global Forum on Innovation in Health Professional Education hosted a workshop on April 6–7, 2017, to explore the value proposition for CPD. Forum members and workshop participants gathered in Washington, DC, to learn about innovative CPD programs around the world, to consider the perspectives of those who invest in CPD, and to discuss the businesses case for CPD. The workshop rapporteurs prepared this proceedings as a factual summation of the session discussions.