Write Medicine

Addressing Clinician Burnout Through Mindfully Designed Education

July 05, 2021 Alexandra Howson PhD
Write Medicine
Addressing Clinician Burnout Through Mindfully Designed Education
Show Notes Transcript Chapter Markers

As a yoga teacher who loves to share tools like mindful movement, breath awareness, and stillness to help people cultivate rest and resilience in their lives, I’m beyond delighted to share episode 12 of Write Medicine with you. 

My guest is Donna Gabriel, the Senior Director of Global Education at Med-IQ. Donna is currently pursuing doctorate in Mindful Leadership in Healthcare and is an advocate for mental health in general and reducing clinician burnout in particular. Donna talks about why so many clinicians are exhausted and discusses the importance of mindfully-designed education that not only supports clinician wellbeing but also boosts learning. 

Transcript

Alexandra Howson  05:18 

And we'll launch right in. Hello, and welcome to Write Medicine. I'm your host, Alex Howson. And today we're focusing on mindfulness and clinician education with Donna Gabriel, who is Senior Director of US and Global Education at Med IQ. Welcome, Donna.  

Donna Gabriel 05:39 

Thank you, Alex. 

Alexandra Howson 05:44 

So I like to start our conversations with asking guests just to talk a little bit about who you are, and how you find your way into education and clinical education, in particular, education for health professionals. 

Donna Gabriel 05:59 

So, actually, I started off my career as an event planner, a meeting planner, I worked for a contact lens company, for several years planning their national sales meetings, advisory boards, things like that, for the internal sales team. And then a mutual friend at a continuing medical education company, an oncology focused one here in Atlanta, let me know about an opening to do project management. So to actually organize these continuing medical education conferences it was done all over the world. So it was an opportunity for me to see the world in my 20s. Learn a lot more about conferences. And then there was a point in CME, where you couldn't just go and ask for funding from someone at a pharma company, as we all know that rules sort of changed, and you had to get your funding through formal education grants. And so our company needed someone to manage that process, bring all the pieces together and sort of drive the bus. And they asked if I would take on that role. So I moved from the director of project management into this more educational strategy grant development role. And then that turned into more of a straight business development role, which then led me to Med IQ nine and a half years ago, and where I've been ever since. 

Alexandra Howson 07:31 

And I should say that you're also pursuing a PhD in Mindful Leadership and Healthcare at Saybrook University, what's your research focus? 

 Donna Gabriel 07:41 

The PhD is in mind/body medicine, specializing in mindful leadership and healthcare. And my research interest is on mindfully designed education as a tool to address clinician burnout, clinician wellbeing. 

Alexandra Howson 08:02 

So let's unpack those two concepts. Okay, burnout, and wellbeing. How do you define both of those ideas? 

Donna Gabriel 08:18 

I mean, it's interesting, I'm sure everyone listening to this right now, has heard the term burnout a lot. And originally, it's used to describe many professions, not just clinician burnout. But the reason burnout has such a big focus in the clinician community is because it is such an exponentially higher problem than in other professions. And a lot of research has been done over the past decade, even more so probably in the past five years. Just because this continues to grow and grow and has been labeled an epidemic in recent years. So a lot of healthcare systems have looked at ways to support clinician wellness while being through development of individual strategies for these clinicians, mental health services, maybe yoga, relaxation techniques, meditation. The problem is now after a lot of research and talking about this for a long time, clinicians really aren't resonating very well with the term burnout. It's not received very well because clinicians are viewing this as an individual issue, meaning burnout has this label of it's an individual issue, something that clinicians need to address on their own. If they were more resilient, if they just practiced yoga or meditation, if they were stronger. Maybe they could work this out. I was reading a paper, there was a great quote by Dr. Simon Talbot. He said clinicians are the most resourceful and resilient people out there. And if they could have, he called it, MacGyver their way out of this situation by now, they would have done it. But that hasn't happened. So my colleagues and I have had a lot of discussions and there's research out there about moving this topic more from burnout, the label to moral injury, which seems to us to be more of a clear description of what is going on with clinicians, because moral injury, it was a term that was coined veterans returning from Vietnam and PTSD. And basically, it describes the continued, continued situation where clinicians are forced to deal with decisions or actions that go against their moral code or their oath that they took as clinicians and it's a systemic problem. So it's not an individual problem. So it takes that onus off the clinicians and makes and frames it more as a system level problem. 

Alexandra Howson   11:16 

So, we've been talking about clinicians, one of the things that struck me when you're talking is, as I recall, you know, I trained as a nurse, a lot of the early research on burnout was actually conducted within the nursing profession. And one of the things I remember strongly when I was practicing as a nurse is you don't talk about when you're feeling stressed. There is a code of silence around, you know, any kind of acknowledgement of burnout or any of the steps on the road to burnout. And I'm pretty sure it's the same amongst physicians. But what my question is, do you think that this research has been around for a while? Do you find differences in how different specialties or our disciplines within healthcare, such as medicine, nursing, pharmacy, talk about burnout, and their willingness to kind of open up that black box?  Okay, so the question was, you know, do you see differences in the research that you're looking at, in how, you know, different disciplines within healthcare, look at burnout, or their willingness to kind of, you know, expose, expose it to the light?  

Donna Gabriel 13:43 

It's a great question. And it's interesting that you brought up nurses because nurses are experiencing unprecedented levels of exhaustion and stress, especially right now during COVID. Because there's an amazing nurse shortage, it--nurse shortage right now. A drain on resources. There's a lot required of nurses at this time and then especially in physicians the challenge is based on the research and in discussions that our team has had with physicians is that part of being a physician, there's sort of this badge of honor in your resilience level. Many physicians pride themselves on their ability to handle stress and to handle the pressures of what they're doing. But there's only so much that any human being can manage and there's this stigma of seeking mental health services or saying that you need help, and then a lot of clinicians depending on that state's requirements have to report that they sought mental health services on their licensure application. So, you know, that's another barrier. If you're talking about COVID too there's been this well intentioned proclamation of physicians and nurses being heroes. And while that's all wonderful and good, and meant to be celebratory of these professions, it also creates another problem for these clinicians that they can't, they can't kind of break that facade, I guess, or they need to appear that they are superhuman, or that they've got this. And it doesn't allow them to be vulnerable, and to express the fact that they are also suffering and need help. 

Alexandra Howson 15:59 

And I'm wondering, too, thank you for that. Are you seeing gender differences and differences in ethnicity in the research that you're looking at in terms of mindfulness are burnouts among clinicians? 

Donna Gabriel 16:19 

It's a great question. And I'm going to be very transparent that I haven't been able to dig deeply into the research on burnout, and sort of ethnic, ethnic or cultural components related to burnout. So that is something that I would love to dig into more deeply. But I don't have hard data on that at this time. Um, female versus male. I'm sure it's no surprise, though, that females are more willing to talk about it, and express it than men. And there is data showing that a lot of female clinicians are experiencing burnout at higher levels simply not simply, but one of the factors is, women are often the caretakers in the home. And so they're often responsible for family responsibilities. Many, you know, the majority of nurses are female. So if you correlate that with the high levels of nurse exhaustion, and burnout, that all makes sense as well. So there is a big difference between male and female, though, I believe that women just express it more. I don't know if they're experiencing it more. I don't have data either way, to show that it's only because there may be more people to express that more than then. 

Alexandra Howson 17:54 

Such an interesting distinction. And what about, I know we're kind of sticking with, you know, clinicians of burnout differences in different medical specialties. Last year, in 2020, at the annual meeting, for instance, of the American College of Cardiology, which of course was online, like everything else. I can't remember the clinicians name, and I'll make sure to pull it out for the link in the show notes. But there's a couple of cardiologists who've been working on burnout within the specialty, the specialist, yeah, specialty of cardiology. And I was struck when you were talking about moving away from this idea of burnout as an individual problem, because that was one of the things that she was arguing that, you know, we have to see burnout in cardiology, as, as a, you know, it's a it's a very widespread issue, a couple rounds of, you know, downward dog and so on, aren't really going to cut it. So I'll make sure to send a link to that.  

 Donna Gabriel 19:07 

Yeah exactly right. If you are meditating or doing yoga, but then you go, do your job and the system that you're working for the organization that you're that you're working for, just has no mechanism to support anything you're doing and support your well being or nurture your well being. I mean, there's not enough yoga and meditation in the world for you to overcome that. Even though those are great practices, I love them. I mean, you just have to be realistic and a lot of these health care systems, these leaders, they, I want to I do want to mention that in the research that I've done and discussions I've had healthcare organization leaders do see that they understand that but there's this they don't quite Know how to address it in a holistic way, because this is they want to support these, you know, most, I can't speak for all of them. But many organizations want to support their clinicians, but they also have these competing demands that they have to address or there's a lack of understanding of what engagement or well being means to them and what it means to these clinicians, which is another issue. So it's important moving forward, that we look at ways that we can provide these health care organizations with frameworks and tools and you know, just resources that they need to bridge this gap in collaboration with their clinicians. 

Alexandra Howson  20:49 

Now, that's really interesting. Because I think some healthcare organizations do use a version of the burnout inventory to kind of track employee satisfaction and engagement in those kinds of things, don't they, I was talking to a group of oncologists and oncology clinicians, actually three focus groups just before the end of 2020. And actually, one of the first focus group participants was a psychologist within the healthcare system. And he was saying that, you know, they've been, they've been trying to provide buddy systems and those kinds of things to support. They're not just oncologists, actually, all their, their staff throughout the health system, he was saying, like, take ups really slow and take ups really low. And so there's this kind of puzzle about what as you're saying, what do we do to support clinicians? So that's the question, then what, what do we do? 

 Donna Gabriel 21:51 

Right? I mean, there's a lot of, there's a lot of things that are outside of my realm and education that are being done. And if anyone is interested in looking at more systemic stuff, Tait Shanafelt. He's well known in mindfulness. He's at Stanford now, but he was at the Mayo Clinic. And there's a lot of articles and research he published about doing a lot of mindful engagement at the Mayo Clinic. And there's these frameworks. And they're just really interesting and beautifully done. And I've seen great results. And I, I know, they're being looked at in many other organizations that are employed in other organizations, but obviously, there's a lot more work to be done. But in our space and education, I started to look at what we were doing with my organization and the industry as a whole, and what were we doing to either make this problem worse or not make it better? And what we could do, what was our role here moving forward? Because we do have a role. We have a role in perpetuating the problem, and we have a role in making it better. 

Alexandra Howson 23:12 

And is your focus--I know that you touched on COVID--does your focus on on mindfulness, predate COVID? 

Donna Gabriel 23:24 

I entered my PhD--well, I've always practiced mindfulness for many, many years. I've always had an interest in mind/body medicine as a health coach, and in my master's. But the deep research and mindfulness started in 2018 when I entered Saybrook, and really dug deep into this topic, so COVID was just an interesting, an interesting addition to it. But I have to say, as horrible as COVID is, and the problems that it has brought, I think it is allowing a lot of things to come to the surface that are positive. There's a bigger focus I've seen in looking at mindfulness. Mindfulness is a big topic out there right now. It's always sort of been there, but I think it's really come to the you know, to the light more in 2020. And I think that's a great thing. So for better or for worse with COVID. I think it's making us step back and look at things that are important and look at things differently and create a new path forward. 

 Alexandra Howson 24:47 

It's been an accelerator in lots of ways. And you did talk we have, you know, kind of touched on covered a few times here. 2020 is just going to be known as not 2020 just COVID, isn't it? 

 Donna Gabriel 25:00 

Yeah, it was funny. I was at Chick-fil-a yesterday getting food for my children. And the guy said, okay, that'll be 2020. That was our total. 

Alexandra Howson 25:16 

That's good. I like that. I just want to forget 2020. Yeah. So what? What kind of things were you seeing? Are you still seeing in your work in relation to the impact of COVID on clinician well being?  

Donna Gabriel 25:33 

That's a great question. And I stepped back and looked at education as a whole. And then how it translated to continuing medical education and the education we were putting forth, and that I was putting out there as someone who is responsible for designing education. And I noticed that while in continuing, we call continuing professional development, outcomes, methodologies or technologies had changed or some platforms, the basic process of delivering education, to practicing clinicians has largely remained unchanged the way as I see it, and the problem areas, when you when you sort of create education in a bubble, instead of looking at where clinicians are understanding with what they're going through, right now, if you try to take a framework that is worked, quote, unquote, worked for many years, and then don't look at what is happening now what these clinicians need, what they are facing and pivot, then you're if you're not going to see the practice, change, the knowledge change. That is expected with continuing medical education. And there's also a lot of research showing that when learners are learning under stress, learning under anxiety, it affects their ability to learn to sustain attention. And there's data out there connecting burnout with clinicians, professional efficacy. So one of the goals of CPD is to improve professional efficacy, help people practice or treat patients more effectively. But a nice thought, Well, if these conditions are burnt out, how can we expect them to improve their professional efficacy, if we don't give them tools, mindfully support their ability to do that. And so those are the conversations I started having and the things I've started to look at. Based on examples in other medical and other educational settings, because mindfully designed education in CPD has not been done. I've scoured the research. So if it's been done, I can't find it. I did find two articles. They were both outside the US; they were small sample sizes. And so I just said this is what I thought this is something that we need to do. Because in other educational settings, early childhood graduate education, even medical residency training, mindfully designed education is being done, and it's working. And so we need to take a pause and look at how we can do it in our space.  

Alexandra Howson  28:41 

So, so much good stuff, there are a couple of things that I want to unpack just a little bit. One is what you mean when you're talking about mindfully designed education. But before we get to that, you talked about, you know, looking at where clinicians are in order to kind of meet their needs, can you talk a little bit about some of the strategies that you find most effective to really take that deep dive into where learners are because you're not just talking about, you know, a kind of knowledge pretest you're talking about something else? So what is that something else? 

 Donna Gabriel  29:21 

Sure, um, I'll look at it more from a systems based approach. So say you're doing an educational program where you want to address practice gaps or competency gaps within a specific healthcare system. And say, you've noticed these gaps in the treatment of lung cancer, for example, and you're trying to understand exactly what's going on and we pull chart data and we do some surveys and case questions and knowledge questions. And then we say oh, well This is what they're not doing, or this is what they don't know, or what sort of put this together and put these educational interventions together and and move the needle and it works. It has worked. Med IQ does these often. And we've seen a lot of positive changes, but one piece that is missing is going a little bit deeper down. We don't need to, and we've started to do this more to understand, okay, what are the clinicians? What is what is not being shown in a patient record? We need to dig deeper and say, Okay, what, what is the process in place for this multidisciplinary collaboration? What resources are they lacking? Or maybe what resources do they have that play into this? What are they feeling? What level? What are they dealing with? What about staffing shortages. So there's this just a bigger picture here that we need to make sure that we capture to get a really a better understanding of what these clinicians need from us at that time to do their jobs in a way they do their jobs better, but to be more effective, is maybe what I'm trying to say. 

Alexandra Howson  31:29 

And so to me, that sounds like there's an interesting blurring of boundaries between education and change management. We're looking at processes and systems and that kind of thing. So and, and come back to me on that if, if that's a mischaracterization. But I did want to dig into a little bit what you mean because in January, when the Alliance for Continuing Education in the Health Professions had its annual virtual meeting, our annual meeting, which was virtual in 2021, you and Alison Gardner presented material on mindfulness and clinician education. And one of the distinctions you made and you've been kind of I think this has been implicit in what you've been saying, is between creating content about mindfulness and designing education in a mindful way. So can you talk a little bit about what you mean by mindfully designed education? In CPD in particular? 

 Donna Gabriel  32:40 

Yeah, absolutely. So in 2020, we gave a presentation at the Alliance, sort of just just dipping our toe into this topic. And we talked about mindfulness. And it was very clear to us that we needed to make this distinction because during the presentation, a lot of people kept saying, kept misunderstanding what we were saying, with mindfulness that we were wanting to teach meditation and yoga, and incorporate meditation into CME, which, I mean, of course, we could do but that wasn't where we were going. So it was very important to us in January. So to make us make it very clear, we're not to we're not talking about teaching mindfulness to clinicians, there's many resources out there for that we are teaching is how we can mindfully design education, to support clinician while being to meet them where they are, to make them feel seen, to make them feel understood, and to make them feel supported. So when I say mindfully designed education when learners that like I said, when they are learning under stress, or they're just, you know, hammered with a bunch of data, and they're already experiencing these levels of burnout or moral injury, it's just not going to be as effective. data shows that in other educational settings, but when you take moments to connect emotionally, with your learners, through reflective moments through storytelling, storytelling is a huge benefit to learning. When you make things more community focused, where people can share vulnerabilities, share experiences, it's not the expert talking to the non experts or the more the expert talking to the inferior person. Or you make education that's fun, where it's just a moment to exhale to breathe out to just relax. That's what I'm talking about. 

And it's probably important in our discussion here, at some point that we clarify what we mean by mindfulness and what it means to be mindful okay? Because there's mindfulness. Like I said before, it's a big buzzword out there, people hear it all the time. And I think a lot of people assume it's something, but it's not. And so it's important, it was important for us in January. And it's important anytime I talk about it to clarify what I mean, and mindfulness is simply the act of paying attention to what is happening inside you around you in a non judgmental way. So in other words, you are aware of what is happening around you, or inside you, but you don't get carried away by it. So it's not a religion. So another reason people may back away from this, when we start to talk about it is they think we're talking about a religion. And these people get a little funny about that, but it's not secular. It is rooted in Buddhism, but it's not Buddhist. Also, mindfulness is not--o when you say, mindfulness, people think, oh, you're meditating to kind of check out now or go off into this space and meditate. And that's not it. There's hundreds of forms of meditation, right? Mindfulness actually enhances your awareness and heightens your present moment awareness. And it can be done through mindfulness meditation, but it can be done when you are driving in your car, or, you know, you're playing with your children when you're eating a meal, and then when you're learning. So simply put, mindfulness, that moment that you realize your mind is wandering. That is mindfulness. Because you are aware of what is happening at that moment. So if you translate that to education, if we create moments in education for a learner, to recognize that their mind is wandering, and all of our minds wander during learning; the moment that they recognize that and bring their attention back, a change in the brain immediately occurs, and your ability to sustain attention is enhanced. And then learning is enhanced, and on and on. So that's why I'm so passionate about creating these moments in education. 

 Alexandra Howson  37:54 

That's a wonderful definition. My mind wandered. Because the slight irony of this conversation is, this is our second go around. For listeners, because the first conversation that Donna and I had was about mindfulness, I forgot to hit the record button. Because I was not present at the moment and very distracted by a lot of different things. And so I love that. I love that definition. And I think we're gonna have to include some little practice at the end of our show notes or something for people to practice mindfulness. 

 Donna Gabriel  39:06 

Sure, sure. And it's just interesting. You say that the errors are because you're reading a paper recently about the EHR and the high use of the EHR, and this copy and paste means when you're kind of mindlessly copy and pasting, sometimes they've found that a lot of patient errors have occurred from that paper copy and how many times have you done some writing an email or puts a document together? Even grant requests that are templated and you just sort of are going through the motions and then you look back and you realize, oh my gosh, I missed this or that because I wasn't paying attention. 

Alexandra Howson  40:02 

Yeah, that is definitely the worst. And so thinking about and I think you did offer some strategies at the Alliance presentation. And you've you've, you've hinted at them here as well, in terms of reducing hierarchical educational formats, fostering community integrating opportunities for to exchange and reflective questions that make learners pause. I mean, I kind of feel like I've known Med IQ for a long time. I kind of feel like this is something that Med IQ has actually done for quite a long time, which is kind of interesting to me. But you did talk about storytelling. And so let's focus on that a little bit. Because, for me, I hear a lot of people talk about storytelling. And I'm, I'm a writer, so I'm, I'm invested in storytelling and what that means. It does also, for me, kind of point to some of the work of Paolo Freire, the Brazilian educator who was very much focused on the power of curiosity. Yeah, and storytelling as part of that. Power, to me, that feels exciting. And it's a little bit radical as well. I wonder, I wonder if you could talk a little bit about what you mean by storytelling, and how you see that kind of fitting into mindfully designed education for continuing in continuing professional development. 

 Donna Gabriel  41:38 

Sure. And storytelling can be used in many different ways. And there is documented research that when content is presented in the form of a narrative that people can emotionally connect to, they remember it more. So it's just I keep thinking like, I'm going to be kind of maybe a little nerdy for a second, but I watched a documentary on the Bee Gees the other day. 

Alexandra Howson 42:09 

Oh, my gosh, it's so wonderful, isn't it? 

 Donna Gabriel 42:14 

Yes. All right. So I was hooked from beginning to end, if someone had given me a paper talking about and then they did this album, and then this happened, and then they married and then they got divorced, I wouldn't have remembered any of it. But the way of presenting it as a story, presenting it as a narrative telling, talking about, you know, gauging all of the senses in this delivery of information, helps you to soak that information up more. And so an example I gave an education is, trust me, I am constantly reading learning materials, for better or worse. And I think about those times when I'm in a textbook, or I'm in an article, and I'm just reading, reading this data, and I don't even know what is in front of me at a certain point. And then you notice times where there's a pause. And then they give you an example of a story or a person or something to connect this data, they're giving you this information to a real life situation, or an example of a story. And when that happens if you're reading this data, there's a pause, there's a movement to a story, and then you connect the material and you say, Okay, I get this, yes, or you feel something. And then you're ready, your attention is on that moment, your attention is on that feeling that you feel and your attention, your ability to kind of learn and continue reading is enhanced, you kind of reset. So that's what I'm talking about with storytelling. curiosity. So interesting. Curiosity is an innate human trait. And it's very, very prevalent in clinicians, very prevalent in many clinicians who enter the field of medicine because of their curiosity about the way our bodies function. And so and they're out there scientists, and they're curious about data and new ways of doing things. And so any moment that you can tap into that curiosity makes clinical breakthroughs exciting. Why does it have to like and then this study came out and this study, attach emotion to it, because think of all the education that's out there, there are so many educational choices for clinicians. But just like with any choice that anyone has out in the world, people are going to choose the things that they emotionally connect with or that they find important to them. So if you're someone who's designing education, You want people to choose your education more often or in or engaging in a more deeply meant and deep manner, make it something that they choose because it makes them feel a certain way, it makes them want to learn more, it makes them curious. And will, you'll start to see a lot of differences in what your education can do. 

Alexandra Howson  45:24 

So I am on board with that 100%. As you know, I teach yoga and my goal in teaching is experiential. I want people to feel a particular way. But I'm also conscious that there are going to be listeners there probably, you know, practitioners in the CME/CPD community, who as soon as you start to talk about emotion and feeling in a particular way, are going to take a big step to the back of the room. So, you know, I'd be interested in your response to that. And then the other part of that is, you know, it raises different questions, if you're talking about emotional engagement, and that as part of the, the design and the delivery of the content, what are the implications for assessment and evaluation? 

Donna Gabriel  46:22 

Right, so let's, let's remove the emotion from it, there might be people listening who say, who just just can't even go there. They have a certain way of thinking, and it's, it's not that, okay, let's look at the science, if you just want science, there have been multiple studies in many educational settings and in just clinical settings on mindfulness and practicing mindfulness showing that physical changes in the brain happen, these are on scans, you can find them in many places, physical changes happen in the brain, when people are being mindful when they are aware of their present moment when they are engaging in something in a mindful way, their attention is enhanced. stress levels go down, heart rate levels go down. But it's that change in the brain that is responsible for learning and attention. So as educators, if you just want to focus on that little piece, to me, that would be enough to make you kind of look at this more deeply. And you know, for lack of a better term, get curious about it. 

Alexandra Howson 47:37 

Oh, that's, that's great. And if, if people were interested in exploring that a little bit more, do you have recommendations for a good starting read? 

Donna Gabriel 47:53 

Well, I have a lot of reading on mindfulness. But um, there's a really great book by Ronald Epstein. He's a physician out of New York. And he has a book called Attending, which is a really great book, talking about clinicians their needs and intrinsic needs and approaching patient care in a mindful way. Mindfulleader.org is another one for helping people understand how to incorporate mindfulness into their organizations. But there's a lot of research out there and I can send you some references to put in the notes to Tait Shanafelt is a great one. He does a lot of work in this space. Everyone knows Jon Kabat-Zinn. So there's just a lot of resources for that. I also want to mention, if someone wants more of a storytelling, there's a Netflix documentary called the Mindfulness Movement, which is just a really, really great presentation of this and a lot of clinical information is given in this in a very entertaining, engaging way. So if people want something like that, that's a great option. 

 Alexandra Howson  49:35 

Yeah, I haven't actually seen that documentary. I'm definitely gonna gonna check that one out. And Ronald Epstein, some of his work I'm familiar with because he did some of the really early research on the importance of actually liking the importance of patients and providers liking each other in that patient provider. Um, communication piece. And I know a lot of his research has been used by people who've looked at disparities in health communication between patients and providers, particularly in relation to race, racial and ethnic concordance. So love his work. mindful of time here, just a couple of questions. If we are thinking about mindfully designing education, does that change how we need to think about evaluating education programs are education activities. And it sounds to me as though that that a lot of what we're talking about here is it's not a one off activity, we're talking about much more substantive initiative, perhaps with a healthcare system or with a team within a particular healthcare vertical or? 

 Donna Gabriel 50:58 

Yeah, I mean,I believe, and I've had many conversations with our outcomes director that pre and post questions have a place. But for the most part, they're not going to tell you much. I don't want to go, I don't want to have the people coming at me. After this, I'm just talking about my personal belief, they tell you things to a point. But you've got to dig a little deeper. And so programs where you can get feedback on a more meaningful way in a more meaningful way to how people are changing their thinking about this, what they're, they're thinking about their patient management approach. Those are the things that you can add to this by creating reflective questions. And sometimes we get into autopilot and creating these outcomes methodologies, just because of lack of time, or it's just part of the moving forward process. So as much as you can take a moment and step back. And don't try and I say this so much, don't try to do it all at once, don't say okay, we've got to throw everything away, and start over. Because I think that gets people into this paralyzed state. And they don't need to do that. An example is a colleague of mine was just creating an evaluation form for a program this week. And she said, I just want to let you know, I added in a question a reflective one saying, think about a patient or a moment, I'm trying to remember what she said, think about a patient you might be treating, and how this might apply to him or her and asking some deeper questions there just to kind of draw a little bit more out. Or if you have activities like echo programs we've done, where we did an ever program on a rare disease and these clinicians who felt so isolated from their colleagues, because they were triggering a disease, we brought them together in this initiative that made them feel so good. And because they told us that not because I thought it that they bonded with one another and they created this community. And that when when they felt vulnerable and safe and able to share it, the the the soft outcomes that we got from that there were things we were able to share with our supporters and each other as they went and took this information that they got from their colleagues, and they did X, Y, and Z. Put those in an outcomes report because I gather that a lot of people were giving these reports to would love to read that information more than Oh, we improved learning by, you know, 20% on this question. 

Because it's about the story. The story, tell people a story and it takes a certain practice. But it's not that complicated at the end of the day.  

Alexandra Howson 54:11 

I love that. That's really helpful. Thank you. And so I guess we're coming up to the top of the hour here. When we’re talking about programs...what kind of programs do you see mindfully designed education as having a kind of key role in is it mostly, you know, health systems, interventions, are there other areas where what you're talking about could be really valuable? 

Donna Gabriel 54:55 

You can do this in any form of education, yet. I would not say it's more effective or less effective. Anywhere, there are ways you can take a simple webcast or 15 minute online publication and make it and design it in a mindful way. And then obviously, systems based activities, you can get maybe a little bit more complex with it. But it's just moments of reflection story, you can tell a story in a 15 minute written publication. Simple or even just the question you asked is a mindfully designed question that you're asking the participants. So I don't believe that there's any activity that could not be designed mindfully. 

 Alexandra Howson 55:48 

And Donna, if listeners want to talk with you, and reach you, how can they do that? 

 Donna Gabriel 55:57 

So I'm always available at med IQ. So you can reach me at D Gabriel at med me d dash IQ COMM And I'm always happy to talk and then for those of you who are part of the Alliance, and hopefully we can connect in July, and I'll be there or virtually, and would love to continue the conversation as well. 

 Alexandra Howson 56:21 

And anything we haven't touched on that you feel is especially important when thinking about mindful education for to support clinician well being. 

 Donna Gabriel 56:32 

The one thing I'll say is, it's important that people don't be don't get overwhelmed with this topic. So it's easy to look at this mountain of clinician burnout or moral injury and look, and get paralyzed and not know what to do or think you have to have everything figured out. And then you can do it. The way you move through that is by small steps that build upon each other over time. So just take a small step, and then another and then another. And eventually, this just becomes part of your process. Like any other thing that you introduced to your organization, a new technology, or a new process, you just have to take it one step at a time. And eventually it just becomes natural. 

 Alexandra Howson 57:23 

Donna Gabriel, thank you so much for talking with us today on right medicine. It's been such a pleasure. 

 Donna Gabriel 57:30 

Thank you, I enjoyed it. 

Resources
Dean W, Talbot S, Dean A. Reframing Clinician Distress: Moral Injury Not Burnout. Fed Pract. 2019;36(9):400-402.

Epstein RM. Attending: Medicine, Mindfulness, and Humanity. Scribner, 2017.

Laxmi S. Mehta, MD, chair of the ACC Membership Committee’s Well-Being Workgroup, director of preventive cardiology and women’s cardiovascular health at Ohio State University

Shanafelt TD, Makowski MS, Wang H, et al. Association of Burnout, Professional Fulfillment, and Self-care Practices of Physician Leaders With Their Independently Rated Leadership Effectiveness. JAMA Netw Open. 2020;3(6):e207961.

Paulo Freire

The Bee Gees: How Can you Mend aBroken Heart? HBO

The Mindfulness Movement. Netflix.

Connect with Donna: [email protected], LinkedIn
Connect with Alex

Podcast Team
Host: Alexandra Howson PhD
Sound Engineer: Suzen Marie
Shownotes: Anna Codina

Who is Donna and how did she find herself in the CME field?
How do you define burnout?
Are there differences in how healthcare disciplines approach burnout?
What can educators do to support clinicians and pre-empt burnout?
What are you seeing in your research in relation to the impact of COVID on clinician well being?
What do you mean by mindfully designed continuing healthcare education?
An example of Alex not practicing presence
The power of storytelling
Emotional engagement, assessment and evaluation
Evaluating mindfully designed education
Key take aways