Using Google Hangout ZOOM to bring rural clerkship students together to reduce burnout loss of idealism, a MSEDI project. Cinthia Elkins MD PhD STFM 2015 Annual Meeting Work in Process 4/27/15

Disclosures No personal or family financial or other links to any software or other products mentioned. Faculty at SUNY Upstate Dept. of Family Medicine.

Changed Platform Google Hangout = Free, works with all operating systems, up to 10 participants at a time, But – everyone has to have a Google account and data stored on their secure server or Utube private site. Zoom = Dept. pays $100/year for unlimited use, private, any operating system, any , international calls, audio and video files saved to local host’s desktop.

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Zoom Meeting

Rural Medical Education Program Upstate Medical University – SUNY COM 5-9 months of 3 rd year clerkship training in rural communities, working with board- certified physicians Family Medicine, Emergency, Surgery, Radiology and other elective rotations Scholarships/housing from host communities More hands-on experiences, continuity care

RMED Growing – 23 students at rural sites this year Previous years’ students spoke of feeling detached from their peers and alma mater Wondered how their experiences compared to colleagues, missing advice on schedue, Match Goal is to decrease isolation, maintain idealism, teach burnout prevention Groups alternating between Balint and Clinical Jazz discussion formats

Zoom Meetings 23 RMED students broken into 3 groups – scheduled for noon meeting once a month with either: Clinical Jazz format (Present a case, discussion on applicable evidence-based medicine that applies to case and art of making it work for patient) with Clinical faculty Balint Group (Psychodynamic Psychoanalysis of professional self, sharing troubling cases, discussing how to handle/cope/process) with Psychology Faculty and Clinical Faculty

Topics of Discussion Personal site logistics, career planning How to not cross lines, provide pt info that doc need to give, personal privacy in small town Losing patients, child and elder abuse Patient that try to “test” you based on their google knowledge.

Topics of Discussion Managing patients with addiction/seeking Managing patients who can’t afford care /understanding current health insurance Managing aggressive/abusive patients in the office Breaking bad news/diagnosis in various settings (ER/hospital/office)

Technical difficulties/successes 23 students participating in new virtual groups 18 different rural sites 15 with good connections, 8 strugging with bad wifi Public wifi unstable, cell data bad lag Iphone5/mac/ipad better, windows ok Can call in via phone – don’t have to video

Technical difficulties/successes Timing is difficult. Due to surgery and clinical schedules, evening better than lunch time. Due to bad hospital wifi, those with home internet rather connect at home Finding a quiet spot to meet can be challenging – trying to mute background noise affects a connection, especially on iphone

Meeting challenges Lag time can make conversation awkward – this word appears in majority of surveys. Trying to teach balint over computer is challenging Some students unnerved by record button – despite explanations – hesitate to participate Some desire more structure, others desire less structure Encouraging participation difficult

Next steps Change time to evening meetings Consider not recording audio Offer unmoderated group chat sessions for students to connect with each other Using monthly reflection assignment to drive topic of discussion Consider more frequent meetings, requiring case presentation from each student. Analyze student body survey data.

Impact? Just started new curriculum with RMED rotation in January Goal is to help connect students at rural sites to home base more? – will measure by surveys, compare to previous years. Goal to help prevent burnout? - have added PHQ-2 and Modified Maslach Burnout Score to annual student body survey, will compare to previous year but also RMED to non- RMED

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