(154) Evaluating and expanding knowledge of demoralization amongst resident physicians

Abstract: Background/significance
Demoralization, a dysphoric state characterized by helplessness and hopelessness, is common amongst patients with both serious medical and psychiatric illnesses. While medical professionals in many specialties engage with patients with demoralization, medical trainees receive little formal and informal education on demoralization. We aimed to assess and expand knowledge of demoralization amongst internal medicine residents at a tertiary care teaching hospital in Chicago, IL.

Methods
Via a longitudinal, cross-sectional study design, we evaluated internal medicine residents’ knowledge and perceptions of demoralization before and after a 1-hour, interactive, case-based didactic session on demoralization. Pre-intervention surveys occurred prior to the didactic session, and post-interventions surveys occurred on the day of the session and 8 weeks later to assess for retention over time. Survey participants were self-selected. Surveys assessed residents’ knowledge of demoralization, ability to distinguish demoralization from major depression in clinical vignettes, and perceived comfort identifying and addressing demoralization in their patients. Composite knowledge scores were calculated for each participant based on their answers to 8 knowledge questions. Mean knowledge and perception scores were calculated at each time point and were compared using unpaired t-tests or Mann-Whitney U tests. This project was IRB exempt.

Results
Of the 28 pre-intervention survey participants, 46.4% had heard of demoralization and only 10.7% had received formal or informal education on demoralization previously. 11 internal medicine residents participated in the didactic session and day 0 post-intervention survey. Results from the week 8 post-intervention survey are not yet available but will be prior to the ACLP conference. Day 0 post-intervention knowledge scores (7.82±0.40) were significantly higher than pre-intervention knowledge scores (5.86±1.28), p value< 0.001. Both pre- and day 0 post-intervention participants indicated that they sometimes or often feel disheartened, burned out, and unable to help when caring for patients with demoralization. Post-intervention participants indicated feeling more comfortable identifying and addressing demoralization in their patients (3.73±0.47 for identifying, 3.09±0.94 for addressing) than pre-intervention participants (2.27±0.88 for identifying, 2.00±0.62 for addressing), p-value< 0.001 and =0.0002 respectively. Post-intervention participants also reported high satisfaction with the didactic session.

Discussion
Results suggest the 1-hour didactic session increased knowledge of and perceived comfort identifying and addressing demoralization amongst internal medicine residents. Previous groups that have created educational experiences on demoralization for medical professionals and trainees similarly demonstrated that participants benefit from such interventions (Frank, 2013, Garrison, 2011, and Brewer, 2018).

Conclusion/implications
As improved ability to communicate with patients regarding emotional or existential distress may combat feelings of burnout in providers, more widespread medical education on demoralization may promote both patient and provider wellness.

References
Frank, JB. Teaching medical students to recognize demoralization. Eur J Psychiat. 2013;27(1). 

Garrison, D, Lyness, JM, Frank, JB, Epstein, RM. Qualitative analysis of medical student impressions of a narrative exercise in the third-year psychiatry clerkship. Acad Med. 2011;86(1):85-89.     

Brewer, BW, Caspari, JM, Youngwerth, J, Nathan, L, Ripoll, I, and Heru, A. Demoralization in medical illness: Feasibility and acceptability of a pilot educational intervention for inpatient oncology nurses. Palliat Support Care. 2018;16(5):503-510. 


Presentation Eligibility: Not previously published or presented. Prior to the ACLP conference, curriculum design and preliminary data will have been presented as a poster at the ADMSEP conference in June 2024. However, the complete project including 8 week follow-up data will not be presented or published prior to the ACLP conference.

Diversity, Equity, and Inclusion: Enhancing provider communication regarding patients' emotional or existential distress may be particularly impactful for patients from marginalized background, as the medical field has historically undervalued and under appreciated marginalized patients' experiences and perspectives.