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      What Educators Can Learn from the Biopsychosocial-Spiritual Model of Patient Care: Time for Holistic Medical Education

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          Abstract

          Medical students and residents experience burnout at a high rate and encounter threats to their well-being throughout training. It may be helpful to consider a holistic model of education to create educational environments in which trainees flourish. As clinician educators, the biopsychosocial-spiritual model of patient care has helped shape the way we care for patients. Using the biopsychosocial-spiritual model of patient care as a framework, we examine the ways in which clinician educators can support the physical, psychological, social, and spiritual needs of their trainees. The current state of trainee well-being in each of these areas is reviewed. We discuss potential interventions and opportunities for further research to help clinician educators develop a contextualized, holistic approach to the formation of their trainees.

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          Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

          Paul Nathan, Elizabeth Barrett, John M. Lachin … (2002)
          Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
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            The need for a new medical model: a challenge for biomedicine

            G. Engel (1977)
            The dominant model of disease today is biomedical, and it leaves no room within tis framework for the social, psychological, and behavioral dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care.
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              Prevalence of Burnout Among Physicians

              Lisa Rotenstein, Matthew Torre, Marco A. Ramos … (2018)
              Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown.
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                Author and article information

                Contributors
                David Vermette:
                ORCID: http://orcid.org/0000-0003-0150-2064
                David.Vermette@yale.edu
                Journal
                Journal ID (nlm-ta): J Gen Intern Med
                Journal ID (iso-abbrev): J Gen Intern Med
                Title: Journal of General Internal Medicine
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 0884-8734
                ISSN (Electronic): 1525-1497
                Publication date (Electronic): 31 March 2022
                Pages: 1-5
                Affiliations
                [1 ]GRID grid.47100.32, ISNI 0000000419368710, Section of General Internal Medicine, , Yale University School of Medicine, ; New Haven, CT USA
                [2 ]GRID grid.47100.32, ISNI 0000000419368710, Section of Pediatric Hospital Medicine, , Yale University School of Medicine, ; New Haven, CT USA
                [3 ]GRID grid.47100.32, ISNI 0000000419368710, Combined Internal Medicine and Pediatrics Residency Program, , Yale University School of Medicine, ; New Haven, CT USA
                Author information
                http://orcid.org/0000-0003-0150-2064
                Article
                Publisher ID: 7491
                DOI: 10.1007/s11606-022-07491-8
                PMC ID: 8969815
                PubMed ID: 35357678
                SO-VID: 6d9f7bcc-1745-4b09-ac2d-5885a8f540aa
                Copyright © © The Author(s) under exclusive licence to Society of General Internal Medicine 2022
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 29 July 2021
                Date accepted : 22 March 2022
                Categories
                Subject: Perspective

                ScienceOpen disciplines: Internal medicine
                Keywords: well-being,biopsychosocial,burnout,medical education,residency,holistic
                Data availability:
                ScienceOpen disciplines: Internal medicine
                Keywords: well-being, biopsychosocial, burnout, medical education, residency, holistic

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