Key Articles
1. Fatigue
  1. Asken M, Raham D. Resident performance and sleep deprivation: a review. J Med Ed. 1983;58:382-8.
  2. Ayas NT, Barger LK, Cade BE, et al. Extended work duration and the risk of self-reported percutaneous injuries in interns. JAMA. 2006 Sep 6;296(9):1055-62. Available at: http://jama.ama-assn.org/cgi/content/full/296/9/1055
  3. Barone JE, Ivy ME. Work hours: Five stages of grief. Acad Med 2004;79:379-380.
  4. Buysse DJ, Barzansky D, Dinges et al. Sleep fatigue and medical training: setting an agenda for optimal learning and patient care. Sleep 2003;26:218-25.
  5. Defoe DM, Power ML, Carpentieri A. Long hours and little sleep: work schedules of residents in obstetrics and gynecology. Obstet Gynecol. 2001;97:1015-1018.
  6. Fischer JE. Continuity of care: A casualty of the 80-hour work week. Acad Med 2004;79:381-383.
  7. Gautam, Mamta. Before Burnout: How Physicians Can Defuse Stress. 2003, September (Volume 5, Number 9).
    http://www.ama-assn.org/ama/pub/category/10971.html
  8. Green MJ. What (if anything) is wrong with residency overwork? Ann Intern Med 1995;123:512-517.
  9. Griner PF. Residency overwork and changing paradigms of service. [Letter] Ann Intern Med 1995;123:547-548.
  10. Howard SK, Gaba DM, Rosekind MR, Zarcone VP. The risks and implications of excessive daytime sleepiness in resident physicians. Acad Medicine 2002;77:1019-25.
  11. Jacques CHM, Lynch JC, Samkoff JS. The effects of sleep loss on cognitive performance of resident physicians. J of Fam Prac 1990;30:223-227.
  12. Lamberg L. Long hours, little sleep: Bad medicine for physicians-in-training? JAMA 2002;287:303-306.
  13. Landrigan CP, Rothschild JM, et al. Effect of Reducing Interns Work Hours on Serious Medical Errors in Intensive Care Units. N Engl J Med 2004. 351;18:1838-1848.
  14. Lockley SW, Cronin JW, et al. Effect of Reducing Interns’Weekly Work Hours on Sleep and Attention Failures. N Engl J Med October 28, 2004. 351;18:1829-37.
  15. Lyznicki JM et al. Sleepiness, Driving and Motor Vehicle Accidents. JAMA 279(23):1908-1913.
  16. Mayo Clinical Staff. Effective time management: Build your organizational abilities. http://www.mayoclinic.com/invoke.cfm?objectid=0AB2CF58-EFC3-4298-ACF3B09ECE9F5946
  17. Mayo Clinical Staff. Tips for shift workers: How to eat, sleep and stay fit when you work unusual hours. http://www.mayoclinic.com/invoke.cfm?objectid=D7C38544-6BD7-4908-9C0E42CB2D0FCAC7
  18. Mayo Clinical Staff. Sleepy at work? How you can stay awake.
  19. Mukherjee S. A Precarious Exchange. N Engl J Med 2004. 351;18:1822-1824.
  20. NAPS IMPORTANT TO DECREASE FATIGUE: Residents on a nap schedule were less fatigued and slept
    41 minutes longer per night than those on a regular schedule, notes a study published in the June 6 Annals
    of Internal Medicine; abstract at: http://enews.ama-assn.org/UM/T.asp?A40.574.3468.18.263231
  21. Papp KK, Stoller EP, Sage P, et al. The effects of sleep loss and fatigue on resident physicians: a multi-institutional,mixed-method study. Acad Med 2004;79:394-406.
  22. Richardson GS, Wyatt JK, Sullivan JP et al. Objective assessment of sleep and alertness in medical housestaff staff and the impact of protected time for sleep. Sleep 1996;19:718-26.
  23. Smith-Coggins R, Rosekind MR, Buccino KR,Dinges DF,Moser RP. Rotating shiftwork schedules: can we enhance physician adaptation to night shifts? Acad Emerg Med 1997;4:951-61.
  24. Veasey S, Rosen R, Barzansk B, Ilene R, Owens, J. Sleep loss and fatigue in residency training. JAMA 2002;288:1116-1124.
  25. Whitcomb ME. More on resident duty hour limits. Acad Med 2004;377-78.
  26. DINGES BIBLIOGRAPHY (from Fatigue)
  27. Chugh DK,Weaver TE, Dinges DF. Neurobehavioral consequences of arousals. Sleep 1996;19:S198-201.
  28. Dinges DF. Critical research issues in development of biomathematical models of fatigue and performance. Aviat Space Environ Med 2004;75(3 Suppl):A181-91.
  29. Dinges DF. An overview of sleepiness and accidents. J Sleep Res. 1995;4:4-14.
  30. Dinges DF. Differential effects of prior wakefulness and circadian phase on nap sleep. Electroencephalogr Clin Neurophysiol 1986;64:224-7.
  31. Dinges DF. The nature and timing of sleep. Trans Stud Coll Physicians Phila 1984;6:177-206.
  32. Dinges DF, Pack F, Williams K, et al. Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night. Sleep 1997;20:267-7.
  33. Jewett ME, Dijk DJ, Kronauer RE, Dinges DF. Dose-response relationship between sleep duration and human psychomotor vigilance and subjective alertness. Sleep 1999;22:171-9.
  34. Kelly SM, Rosekind MR, Dinges DF, et al. Flight controller alertness and performance during spaceflight shiftwork operations. Hum Perf Extrem Environ 1998;3:100-6.
  35. Landrigan C. Sliding Down the Bell Curve: Effects of 24-hour Work Shifts on Physicians’ Cognition and
    Performance. Sleep 2005;28:1351-1353.
  36. Landrigan CP, Barger LK, Cade BE, et al. Interns' compliance with accreditation council for graduate medical education work-hour limits. JAMA. 2006 Sep 6;296(9):1063-70. Available at: http://jama.ama-assn.org/cgi/content/full/296/9/1063
  37. Leach DC, Philibert I.High-quality learning for high-quality health care: getting it right. JAMA. 2006 Sep 6;296(9):1132-4. Available at: jama.ama-assn.org/cgi/content/short/296/9/1132
  38. Mallis MM, Mejdal S, Nguyen TT, Dinges DF. Summary of the key features of seven biomathematical models of human fatigue and performance. Aviat Space Environ Med 2004;75(3 Suppl):A4-14.
  39. Meier-Ewert HK, Ridker PM, Rifai N, et al. Mullington JM. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 2004;43:678-83.
  40. Mitler MM, Carskadon MA, Czeisler CA , Dement WC, Dinges DF, Graeber RC. Catastrophes, sleep, and public policy: consensus report. Sleep 1988;11:100-9.
  41. NASA-supported sleep researchers are learning new and surprising things about naps. http://science.nasa.gov/headlines/y2005/03jun_naps.htm?friend
  42. Neri DF, Oyung RL, Colletti LM, Mallis MM, Tam PY, Dinges DF. Controlled breaks as a fatigue countermeasure on the flight deck. Aviat Space Environ Med 2002;73:654-64.
  43. Pack AI, Pack AM, Rodgman E, Cucchiara A, Dinges DF, Schwab CW. Characteristics of crashes attributed to the driver having fallen asleep. Accid Anal Prev 1995;27:769-75.
  44. Ingrid Philibert, I. Sleep Loss and Performance in Residents and Nonphysicians: A Meta-Analytic Examination. Sleep 2005;28:1392-1402.
  45. Rogers NL, Dinges DF. Subjective surrogates of performance during night work. Sleep 2003;26:790-1.
  46. Saxena A, George C. Sleep and Motor Performance in On-call Internal Medicine Residents. Sleep 2005;28:1386-1391.
  47. Smith-Coggins R, Rosekind MR, Buccino KR, Dinges DF, Moser RP. Rotating shiftwork schedules: can we enhance physician adaptation to night shifts? Acad Emerg Med 1997;4:951-61.
  48. Van Dongen HP, Baynard MD, Maislin G, Dinges DF. Systematic interindividual differences in neurobehavioral impairment from sleep loss: evidence of trait-like differential vulnerability. Sleep 2004;27:423-33.
  49. Van Dongen HP, Dinges DF. Investigating the interaction between the homeostatic and circadian processes of sleep-wake regulation for the prediction of waking neurobehavioural performance. J Sleep Res 2003;12:181-7.
  50. Van Dongen HP, Maislin G, Dinges DF. Dealing with inter-individual differences in the temporal dynamics of fatigue and performance: importance and techniques. Aviat Space Environ Med 2004;75(3 Suppl):A147-54.
  51. Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 2003;26:117-26.
  52. Van Dongen HP, Price NJ, Mullington JM, Szuba MP, Kapoor SC, Dinges DF. Caffeine eliminates psychomotor vigilance deficits from sleep inertia. Sleep 2001;24:813-9.
  53. The 80-hour experience: What happens when residents have to leave.
  54. http://jama.ama-assn.org/cgi/content/full/294/9/1025
  55. According to a confidential ACGME survey of more than 50,000 residents, almost all residency programs are complying with the common duty hour standards. Two years after the standards took effect, programs are using innovative approaches to restructure duty hour schedules for residents: http://enews.ama-assn.org/UM/T.asp?A40.574.2827.16.263231
  56. "Residency Work-Hours Reform: A Cost Analysis Including Preventable Adverse Events". Journal of General Internal Medicine, October 2005. http://enews.ama-assn.org/UM/T.asp?A40.574.2827.22.263231
  57. "Chicago hospital wins lawsuit over resident crash". AMNews, Oct. 24/31. http://enews.ama-assn.org/UM/T.asp?A40.574.2827.24.263231
  58. Sleep and Motor Performance in On-call Internal Medicine Residents. http://enews.ama-assn.org/UM/T.asp?A40.574.2901.4.262728
  59. Sleep Loss and Performance in Residents and Nonphysicians: A Meta-Analytic Examination. http://enews.ama-assn.org/UM/T.asp?A40.574.2901.5.262728
  60. Sliding Down the Bell Curve: Effects of 24-hour Work Shifts on Physicians’ Cognition and Performance. http://enews.ama-assn.org/UM/T.asp?A40.574.2901.6.262728
  61. http://www.hourswatch.org/index.htm
  62. http://www.nhlbi.nih.gov/health/public/sleep/
  63. http://www.sleepfoundation.org/quiz/quiz.php?id=2]
  64. Study: Long hospital shifts, sleep deprivation can kill
  65. Work Rules fail to end Danger from Tired Doctors
  66. Barger LK Ayas NT Cade BE Cronin JW Rosner B Speizer FE Czeisler CA. Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attentional Failures http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0030487
  67. Szklo-Coxe M. Are Residents' Extended Shifts Associated With Adverse Events? http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0030497
  68. CAFFEINE QUIZ - http://www.sleepfoundation.org/site/c.jvKRL5MWIyG/b.2450865/k.8D19/Caffeine_Quiz.htm
  69. SLEEP IQ QUIZ - http://www.sleepfoundation.org/site/c.jvKRL5MWIyG/b.2460101/k.9EF6/Sleep_IQ_Quiz.htm
  70. SLEEP MYTHS - http://www.sleepfoundation.org/site/c.jvKRL5MWIyG/b.2461173/k.E7B5/Sleep_Myths__Fact_or_Fiction.htm
  71. Volpp KG Rosen AM Rosenbaum PR Romano PS Even-Shoshan O Canamucio A Bellini L Behringer T Silber J.Mortality Among Patietns in VA Hospitals int he First 2 Years following ACGME Resident Duty Hour Reform JAMA 2007;298:964-992
  72. Arora VM Georgitis E Woodruff JN Humphrey HJ Meltzer D. Improving Sleep Hygiene of Medical interns: Can the sleep, alertness and fatigue education in residency program help? Arch Int Med 2007;167(16):1738-44
  73. Choby B Passmore C. Faculty perceptions of the ACGME resident duty hour regulations in familiy medicine. Family Medicine 2007;39(6);392-8
  74. Horwitz LI Kosiborod M Lin Z Krumholz HM Changes in Outcomes for Internal Medicine Inpatients After Work-Hour Regulations. Annals of Internal Medicine 2007;147:97-103
  75. Kusuma SK Mehta S Sirkin M Yates AJ Templeton MT Friedlaender F Measuring the attitudes and impact of the eighty hour workweek rules on orthopaedic surgery residents. J Bone & Joint Surgery 2007’89(3):679-85
  76. Mitchell CC Ashley SW Zinner MJ Moore FD Jr. Predicting future staffing needs at teaching hospitals: use of an analytical program with multiple variables Arch Surgery 2007;142(4):329-34
  77. Owens JA Sleep loss and fatigue in healthcare professionals. J Perinatal & Neonatal Nursing 2007:21(2):92-100 and 101-2
  78. Reed DA Levine RB Miller RG Ashar BH Bass EB Rice TN Cofrancesco J Effect of Residency Duty -Hours Limits: Views of Key Clinical Faculty Arch Intern Med 2007;167(14):1487-1492
  79. Salim A Teixeira PGR Chan L Oncel D Inaba K Brown C Rhee P Verne T. Impact of the 80-Hour Workweek on Patient Care at a Level 1 Trauma Center Arch Surg 2007;142(8):708-714
  80. Shetty KD Bhattacharya J Changes in Hospital Mortality Associated with Residency Work-Hour Regulations. Annals of Internal Medicine 2007;147:73-80
  81. Surani S Subramanian S Aguillar R Maqsood A Varon J. Sleepiness in medical residents: Impact of mandated reduction in work hours. Sleep Medicine 2007;8:90-93
  82. Whalen TV Duty Hours Restrictions: How will this affect the surgeonof the Future? American Surgeon 2007;73(2):140-2
  83. Vanderveen K Chen M Scherer L. Effects of residenty duty-hours restrictions on surgical and nonsurgical teaching faculty. Arch Surgery 2007;142(8):759-64
  84. Veasey SC ACGME housestaff duty hours: enforced, yet not delivering rested physicians in training. Sleep Medicine 2007;8(1):10-1
  85. Vidyarthi AR Auerbach AD Wachter RM Katz PP The impact of duty hours on resident self reports of errors. J Gen Int Medicine 2007;22(2):205-9
  86. Veasey SC ACGME housestaff duty hours: enforced, yet not delivering rested physicians in training. Sleep Medicine 2007;8(1):10-1
  87. Volpp KG Rosen AK Rosenbaum PR Romano PS Even-Shoshan O Wang Y Bellini L Behringer T Silber JH Mortailaty Among Hospitalized Medicare Beneficiaries in the First 2 Years following ACGME resident Duty Hour Reform JAMA 2007;298(9):975-983
  88. Volpp KG Rosen AK Rosenbaum PR Romano PS Even-Shoshan O Canamucio A Bellini L Behringer T Silber JH Mortailaty Among Patients in VA Hospitals in the First 2 Years following ACGME resident Duty Hour Reform JAMA 2007;298(9):984-992
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2. Disruptive Behavior
  1. Knox GE. Doctors behaving badly and the people who let them. Trustee 1999;52(4):18–19.
  2. Linney BJ. Confronting the disruptive physician. Physician Exec 1997; 23:55–58.
  3. Pfifferling JH. The disruptive physician: a quality of professional life factor. Physician Exec 1999;25:56–61.
  4. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med 2003;114:513–519.
  5. Sotile WM, Sotile MO. Managing yourself while managing others. Physician Exec 1996; 22:39–42.
  6. Spath P. Don't let impairments jeopardize patient safety: separate health matters from discipline. Hospital Peer Review 2003;28(i8):113-6.
  7. Spath P. Don't let impairments jeopardize patient safety: separate health matters from discipline. Hosp Peer Rev 2003;28:113–116.
  8. AMA guidelines on disruptive behavior
  9. Irons, Richard. 1994. The Behaviorally Disruptive Physician. Metamorphosis. North Carolina Physicians Health Program, 3,6.
  10. Pfifferling, John-Henry. 1997. Managing the Unmanageable: The Disruptive Physician. Family Practice Management, November/December: 77-92.
  11. Linney BJ. Confronting the disruptive physician. Physician Exec.1997;23:55-8.
  12. Pfifferling JH. The disruptive physician: a quality of professional life factor. Physician Exec.1999;25:56-61.
  13. Knox GE. Doctors behaving badly and the people who let them. Trustee. 1999;April:18-19.
  14. http://www.mc.vanderbilt.edu/root/vumc.php?site=cph&doc=742
  15. treatment resources for physicians with disruptive behaviors http://www.mc.vanderbilt.edu/root/vumc.php?site=cph&doc=4255
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3. Stress and Depression
  1. A monthly lunch time program to help first-year medicine residents think about their relationships with patients and how to humanize the hospital experience was described on National Public Radio last week: http://enews.ama-assn.org/UM/T.asp?A40.574.3468.3.263231
  2. American College of Physicians: Clinical depression: more than just residency blues
  3. American College of Physicians: Steps residents can take to recognize and get help with depression
  4. American College of Physicians: Keeping Personal Relationships Intact During Times of Stress
  5. Bellini LM, Abbuhl S, Grisso JA, Lavizzo-Mourey R, Shea JA. Stresses and workplace resources for academic junior faculty: track and gender comparisons. Acad Med . 2001;76(10 Suppl):S62-4.
  6. Center C, Davis M, Detre T, Ford DE, Hansbrough W, Hendin H, Laszlo J, Litts DA, Mann J, Mansky PA, Michels R, Miles SH, Proujansky R, Reynolds CF 3rd, Silverman MM. Confronting depression and suicide in physicians: a consensus statement.JAMA. 2003;289:3161-6.
  7. Cohen JJ. Heeding the plea to deal with resident stress. Ann Intern Med. 2002;136:394-5.
  8. Collier VU, McCue JD, Markus A, Smith L. Stress in medical residency: status quo after a decade of reform?Ann Intern Med. 2002;136:384-90.
  9. Epstein RM. Mindful Practice. JAMA. 1999;282:833-9.
  10. Firth-Cozens J. Doctors, their well-being and their stress. BMJ. 2003;326:671-72.
  11. Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med. 1997;44:1017-22.
  12. Frank E, Breyan J, Elon L. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med. 2000;9:287-90.
  13. Frank E, Biola H, Burnett CA. Mortality rates and causes among US physicians. Am J Prev Med. 2000;19:155-159.
  14. Frank E, Dingle AD. Self-reported depression an dsuicide attempts among US women physicians. Am J Psychiatry. 1999;156:1887-1894.
  15. Givens JL, Tija J. Depressed medical students' use of mental health services and barriers to use. Acad Med. 2002;77:918-921.
  16. Glass RM. Awareness about depression: important for all physicians. JAMA. 2003;289:3169-70.
  17. Horiguchi T, Kaga M, Inagaki M, Uno A, Lasky R, Hecos K. An assessment of the mental health of physicians specializing in the field of child neurology. J Pediatr Nurs. 2003;18:70-4.
  18. Kivimaki M, Sutinen R, Elovainio M, Vahtera J, Rasanen K, Toyry S, Ferrie JE, Firth-Cozens J. Sickness absence in hospital physicians: 2 year follow up study on determinants.Occup Environ Med. 2001;58:361-6.
  19. Live for Life at DukE. Success Over Stress. http://www.hr.duke.edu/sos/
  20. Duke Human Resources. Stress Management. http://www.hr.duke.edu/eohs/livelife/stress.html#STRESS
  21. Mayo Clinical Staff. Getting along with your coworkers: How to build a peaceful work environment. http://www.mayoclinic.com/findinformation/conditioncenters/centers.cfm?objectid=09BB3738-5E3B-4242-8A552250AB1CB1D6
  22. Mayo Clinical Staff. Stretches you can do in your office. http://www.mayoclinic.com/invoke.cfm?objectid=766A709C-9FB9-4907-82603345573D47CC&ref=0AB2CF58-EFC3-4298-ACF3B09ECE9F5946
  23. Meier DE, Back AL , Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286:3007-14.
  24. Petersen-Crair P, Marangell L, Flack J, Harper R, Soety E, Gabbard GO. An impaired physician with complex comorbidity. Am J Psychiatry. 2003;160:850-4.
  25. Personal Growth During Internship: A Qualitative Analysis of Interns' Responses to Key Questions Abstract at: http://enews.ama-assn.org/UM/T.asp?A40.574.3468.2.263231 http://enews.ama-assn.org/UM/T.asp?A40.574.3468.2.263231
  26. Rahe RH, Taylor CB, Tolles RL, Newhall LM, Veach TL, Bryson S. A novel stress and coping workplace program reduces illness and healthcare utilization. Psychosom Med. 2002;64:278-86.
  27. Robinson GE. Stresses on Women Physicians: Consequences and coping techniques. Depression and Anxiety. 2003;17:180-89.
  28. Schemhammer ES, Colditz GA. Suicide rates among physicians: A quantitative and gender assessment (meta analysis). AM J Psychiatry. 2004;161:2295-2302.
  29. Smith R. Why are doctors so unhappy? There are probably many causes, some of them deep. BMJ. 2001;322:1073-4.
  30. Torre D, Wang NY, Mead LA, et al. Mortality in a prospective study of physicians. J Gen Intern Med. 2000;15:150.
  31. University of Pittsburgh Medical Center. Healthy Lifestyle Program. http://healthylifestyle.upmc.com/
  32. Yao DC, Wright SM. National survey of internal medicine residency program directors regarding problem residents. JAMA. 2000;284:1099-104.
  33. Zare´ SM, Galanko J, Behrns KE, et al. Psychological well-being of surgery residents before the 80-hour work week: a multiinstitutional study. J Am Coll Surg 2004;198:633–640.
  34. Levey RE. Sources of stress for residents and recommendations for programs to assist them. Acad Med 2001;76:142–150.
  35. Southern Medical Association: Resident Resources: http://www.sma.org/residents/index.cfm
  36. The Painful Truth: Physicians Are Not Invincible. Miller MN Mcgowen K R Quillen JH South Med J 2000; 93(10):966-972
  37. The average debt of graduating medical students increased in 2006 by 8.5 percent over the previous year, according to data recently released by the AAMC. The average educational debt of indebted graduates of the class of 2006
    (including pre-med borrowing) was about $130,500. The data, which come from student responses to the AAMC Graduation Questionnaire, also indicate that almost 72 percent of graduates have debt of at least $100,000. This
    information is published in the "Medical Student Education: Cost, Debt and Resident Stipend Facts Card."

    The AAMC offers several programs to assist students and residents in managing their educational debt, including: Monetary Decisions for Medical Doctors, online financial planning and debt management information; Financial
    Education and Wellness, a five-part curriculum for medical students on personal financial philosophy; Careers in Medicine, a career-planning program that also supplies basic financial aid and debt management information;
    MEDLOANS, debt management materials and workshops; and a database of state loan repayment/forgiveness and scholarship programs.

    http://www.aamc.org/students/medloans/

    http://www.aamc.org/students/medloans/debtmanagement/

    http://www.aamc.org/students/financing/debthelp/start.htm

    http://www.aamc.org/students/financing/md2/phase3/start.htm

    http://www.aamc.org/studentdebt/

    http://www.aamc.org/students/financing/repayment/
  38. Financial Aid Resource Guide
  39. Ins and Outs of Student Loan Consolidation
  40. Economic Hardship Deferment
  41. Education Financing Web sites
  42. Gautam M. Women in medicine: stresses and solutions. West J Med. January 2001; Vol 174: 37-41.
  43. Miller LH et al. The Stress Solution: An Action Plan to Manage the Stress in Your Life. Pocket Star, 1993.
  44. Financial aid and loan management: http://www.ama-assn.org/ama/pub/category/17472.html
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4. Substance Abuse
  1. Ahmad T, Wallace J, Peterman J, Desbiens NA. Doctors’ perceptions of drinking alcohol while on call: Questionnaire survey. Student BMJ 2002;10:421–422.
  2. Boisaubin EV, Levine RE. Identifying and assisting the impaired physician. Am J Med Sci 2001;332:31–36.
  3. Carlson HB, Dilts SL, Radcliff S. Physicians with substance abuse problems and their recovery environment: a survey. J Subs Abuse Treatment 1994;11:113–119.
  4. Centrella M. Physician addiction and impairment—current thinking: a review. J Addic Dis 1994;13:91–105.
  5. Collins GB. New hope for impaired physicians: helping the physician while protecting patients. Cleve Clin J Med 1998;65:101–106.
  6. Herrington RE, Benzer DG, Jacobson GR, Hawkins MK. Treating substance abuse disorders among physicians. JAMA 1982;247:2253–2257.
  7. Jex SM, Hughes P, Storr C, Conard S, Baldwin DC Jr, Sheehan DV. Relations among stressors, strains, and substance use among resident physicians. Int J Addic 1992;27:979–994.
  8. Khantzian EJ. The injured self, addiction, and our call to medicine. Understanding and managing addicted physicians. JAMA 1985;254:249–253.
  9. Lohr KM, Engbring NH. Institution-wide program for impaired residents at a major teaching hospital. J Med Ed 1988;63:182–188.
  10. Petersen-Crair P, Marangell L, Flack J, Harper R, Soety E, Gabbard GO. An impaired physician with complex comorbidity. Am J Psychiatry 2003;160:850–854.
  11. Sansone RA, Wiederman MW, Sansone LA. Physician mental health and substance abuse. What are state medical licensure applications asking? Arch Fam Med 1999;8:448–451.
  12. Winter RO, Birnberg B. Working with impaired residents: trials, tribulations, and successes. Fam Med 2002;34:190–196.
  13. McGovern MP, Angres DH, Shaw M, Rawal P. Gender of physicians with Substance Use Disorders: Clinical Characteristics, Treatmetn Utilization and post treatment functioning. Substance Use and Misuse 2003;38:993-1001.
  14. Gastfriend DR. Physician Substance Abuse and Recovery What Does it Mean For Physicians—and Everyone Else? JAMA 2005;293(12)1513-1515.
  15. Domino KB, Hornbein TF, Polissar NL, Renner G, Johnson J, Alberti S, Hankes L. Risk Factors for Relapse in Health CAre Professioals with Substance Use Disorders JAMA 2005;293:1453-1460.
  16. Beneett J, O'DonovanD. Substance misuse by doctors, nurses and other health care workers. Cur Opin Psych 2001;14:195-199.
  17. Shwa MF, McGovern MP, Angres DH, Rowal P. Physicians and nurses with substance use disorders. J Advnced Nursing 2004;47:561-571.
  18. Skipper GE, Fletcher C, Roch-Judd R, Brase D. Tramadol use and dependence among physicians. JAMA 2004;292:1818-1819.
  19. Ward CF, Knight JR, Melcher M. Physicians with opiod dependence JAMA 2005;293:294.
  20. Bennett J, O'Donovan D. Substance misuse by doctors, nurses and other health care workers. Curr Opin Psych 2001;14:195–199.
  21. Booth JV, Grossman D, Moore J, Lineberger C, Reynolds JD, Reves JG, et al. Substance abuse among physicians: a survey of academic anesthesiology programs. Anesth Analg 2002;95:1024–1030.
  22. Domino KB, Hornbein TF, Polissar NL, Renner G, Johnson J, Alberti S, et al. Risk factors for relapse in health care professionals with substance use disorders. JAMA 2005;293:1453-1460.
  23. Gastfriend DR. Physician substance abuse and recovery: what does it mean for physicians—and everyone else? JAMA 2005;293:1513–1515.
  24. Knight JR. Physicians with opiod dependence. [Letter] JAMA 2005;293:294.
  25. McGovern MP, Angres DH, Shaw M, Rawal P. Gender of physicians with substance use disorders: clinical characteristics, treatment utilization, and post-treatment functioning. Subst Use Misuse 2003;38:993–1001.
  26. Melcher M. Physicians with opiod dependence. [Letter] JAMA 2005;293:294.
  27. Shaw MF, McGovern MP, Angres DH, Rowal P. Physicians and nurses with substance use disorders. J Adv Nurs 2004;47:561–571.
  28. Skipper GE, Fletcher C, Rocha-Judd R, Brase D. Tramadol use and dependence among physicians. JAMA 2004;292:1818–1819.
  29. Ward CF. Physicians with opiod dependence. [Letter] JAMA 2005;293:294.
  30. Mallin KM. Me? A substance abuser. Medical Economics 2006;83(7):70-74
  31. http://www.mc.vanderbilt.edu/root/vumc.php?site=cph&doc=1088
  32. Medical Education Online.

    Prescribing of Controlled Substances for Non-Patients in the Educational Setting: Review of the Ethical, Legal, and Moral Dilemma for Residents Ari Halldorsson, M.D. Department of Surgery Texas Tech University Health Sciences CenterLubbock, Texas, USA

    Abstract: Prescription drug abuse is an enormous problem in modern society. Studies have shown that it results in more injuries and deaths to Americans than all illegal drugs combined.In this review, the author discusses the prescribing of controlled substances by residents as it relates to intercollegial and other non-patient workplace encounters. Physician drug abuse, medical/legal issues regarding controlled substance prescriptions, and ethical conflicts will be discussed. These issues will be specifically addressed as they relate to the academic institutions where residents can potentially be placed in a moral, ethical and legal dilemma by supervisors and co-workers. Finally, a recommendation for an institutional policy will be suggested to help residents and other physicians recognize and deal with drug seeking behavior by coworkers. Also, a recommendation regarding strict institutional regulation of resident prescription practices regarding controlled substances will be presented.

    http://www.med-ed-online.org/volume12.php#F0000116
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5. Burnout
  1. Abrass CK, Ballweg R, Gilshannon M, Coombs JB. A process for reducing workload and enhancing residents' education at an academic medical center. Acad Med 2001;76:798–805.
  2. Anonymous. Burnished or burnt out: the delights and dangers of working in health. [Editorial] Lancet 1994;344:1583–1585.
  3. Chopra SS, Sotile WM, Sotile MO. Physician burnout. JAMA 2004;291:633.
  4. Clever LH. Who is sicker: patients—or residents? Residents’ distress and the care of patients. [Editorial] Ann Intern Med 2002;136:391–393.
  5. Frey JJ 3rd. A piece of my mind. Time to myself. JAMA 2003;289:2185–2186.
  6. Gabbe SG, Melville J, Mandel L, Walker E. Burnout in chairs of obstetrics and gynecology: diagnosis, treatment, and prevention. Am J Obstet Gynecol 2002;186:601–612.
  7. Gundersen L. Physician burnout.Ann Intern Med 2001;135:145–148.
  8. Lim JK, Golub RM. Graduate medical education research in the 21st century and JAMA on call. JAMA 2004;292:2913–2915.
  9. Linzer M, Visser MRM, Oort FJ, et al. Predicting and preventing physician burnout: results from the UnitedStates and the Netherlands . Am J Med. 2001;111:170–175.
  10. Mayo Clinical Staff. Work-life balance: Establish priorities. http://www.mayoclinic.com/invoke.cfm?objectid=E76D4912-66D9-40A0-950F4DD018E94838
  11. Parshuram CS, Dhanani S, Kirsh JA, Cox PN. Fellowship training, workload, fatigue and physical stress: a prospective observational study. CMAJ 2004;170:965–970.
  12. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358–367.
  13. Spickard A Jr, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA 2002;288:1447–1450.
  14. Thomas NK. Resident burnout. JAMA 2004;292:2880–2889.
  15. Wright SM, Beasley BW. Motivating factors for academic physicians within departments of medicine. Mayo Clin Proc2004;79:1145–1150.
  16. Careers in Medicine Login Page. http://services.aamc.org/careersinmedicine
  17. Southern Medical Association: Resident Resources: http://www.sma.org/residents/index.cfm
  18. http://www.mc.vanderbilt.edu/root/vumc.php?site=cph&doc=739
  19. Betts WC.NCPH Program. Burnout: Overwork Syndrome. Spring, 1993.
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6. Boundry Violations
  1. Danner C. Boundaries and the patient-physician relationship. Behavioral medicine briefs. University of Minnesota. Department of Family Practice and Community Health. 2002;24 (September) http://www.med.umn.edu/fammed/bmb/bmb24.pdf
  2. Glass L. The gray areas of boundary crossings and violations. Am J Psychother 2003;57:429–444.
  3. Nadelson C, Notman MT. Boundaries in the doctor-patient relationship. Theor Med 2002;23:191–201.
  4. Walker R, Clark JJ. Heading off boundary problems: clinical supervision as risk management. Psychiatr Serv 1999;50:1435–1439.
  5. White GE. Medical students’ learning needs about setting and maintaining social and sexual boundaries: a report. Med Educ 2003;37:1017–1019.
  6. AMERICAN ACADEMY OF PEDIATRICS Committee on Bioethics Appropriate Boundaries in the Pediatrician-Family-Patient Relationship PEDIATRICS Vol. 104 No. 2 August 1999, pp. 334-336. http://pediatrics.aappublications.org/cgi/content/full/104/2/334
  7. Lyckholm LJ Should Physicians Accept Gifts From Patients? JAMA. 1998;280:1944-1946. http://jama.ama-assn.org/cgi/content/full/280/22/1944
  8. Spence SA, Patients bearing gifts: are there strings attached? BMJ 2005;331:1527-1529 (24 December), http://bmj.bmjjournals.com/cgi/content/full/331/7531/1527
  9. JD Rhodes R. Gifts from Patients The Journal of Bone and Joint Surgery 2004; 86:2339-2340 http://www.ejbjs.org/cgi/content/full/86/10/2339?ijkey=28ad373aaedfdad0d574fcc9d52915cf0dcb710b& keytype2=tf_ipsecsha
  10. Principles of Medical Ethics. The AMA House of Delegates. 17 June 2001. American Medical Association. 22 Sep. 2005. www.ama-assn.org
  11. Karen Broquet, MD Professional Boundaries and Physician Patient Relationship SIU School of Medicine AAMC GRA Austin Texas 2006
  12. Web based curriculum on prevention of sexual boundary crossings called Hazardous Affairs. The web site is www.hazardousaffairs.com.
  13. http://www.mc.vanderbilt.edu/root/vumc.php?site=cph&doc=742
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7. Impairments
  1. Boon K, Turner J. Ethical and professional conduct of medical students: review of current assessment measures and controversies. J Med Ethics 2004;2:221 –226.
  2. Centrella M. Physician addiction and impairment—current thinking: a review. J Addict Dis 1994;13:91–105.
  3. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002;287:226 –235.
  4. Kennedy M. Patient Safety. WMJ 2001;100:16 –19.
  5. Petersen-Crair P, Marangell L, Flack J, Harper R, Soety E, Gabbard GO. Am J Psychiatry 2003;160:850–854.
  6. Yee P. Brain cramp: the emergency physician’s worst nightmare. Ann Emerg Med 2002;39:329–330.
  7. Walker YN. Protecting the Public: The impact of the Americans with Disabilities Act on licensure considerations involving mentally impaired medical and legal professionals. J Leg Med 2004;25:441–468.
  8. Maillet M, Ephgrave K. Temporarily impaired surgeons and calling for help. Am J Surg 2004;187:3–5.
  9. Medical Students with Disabilities: A Generation of Practice. http://www.aamc.org/members/gsa/resources.htm
  10. Students with Disabilities: A Generation of Practice (PDF). https://services.aamc.org/Publications/index.cfm?fuseaction=Product.displayForm&prd_id=131&prv_id=150
  11. GSA - Executive Summary: The Disabled Student in Medical School. http://www.aamc.org/members/gsa/ada.htm
  12. Merry N. Miller, MD, K. Ramsey Mcgowen, PhD, Department of Psychiatry and Behavioral Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City. The Painful Truth: Physicians Are Not Invincible. South Med J 93(10):966-972, 2000. © 2000 Southern Medical Association
  13. http://www.mc.vanderbilt.edu/root/vumc.php?site=cph&doc=710
  14. Losh DP, Church L. Provisions of the Americans with Disabilities Act and the development of essential job functions for family practice residents. Fam Med 1999;31:617–621
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8. Instructive Feedback
  1. Boon K, Turner J. Ethical and professional conduct of medical students: review of current assessment measures and controversies. J Med Ethics 2004;30:221–226.
  2. Brinko KT. The practice of giving feedback to improve teaching: what is effective? J Higher Educ 1993;64:574–593.
  3. Ende J. Feedback in clinical medical education. JAMA 1983;250:777–781.
  4. Kaprielian VS, Gradison M. Effective use of feedback. Fam Med 1998;30:406–407.
  5. Kübler-Ross E. On death and dying. New York : Touchstone, 1997.
  6. McKegney CP. Medical education: a neglectful and abusive family system. Fam Med 1989;21:452–457.
  7. Medio, Franklin. The 5-Stage Process for Giving and Receiving Critical Feedback. Leadership in Graduate Medical Education: Challenges for 2005. November 15, 2005
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9. Teachers Guide I and II

  1. Teacher's Guide I
    Click here to download

    Teacher's Guide II
    Click here to download
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10. LIFE Curriculum Questions and Answer Key
  1. USING THE LIFE CURRICULUM AS SELF STUDY OPPORTUNITY FOR RESIDENTS

    Linda Youmans has designed a self study opportunity for residents using the modules as part of required resident orientation.

    Instructions: You are required to review four of the eight modules of the LIFE CURRICULUM - Fatigue, Disruptive Behavior, Substance Abuse and Boundary Violations. After reviewing these, please complete the post test and return with the tests you completed from the Orientation CD. You are welcome to review the remaining modules of the LIFE Curriculum and keep the CD's for future reference."

    Materials designed and/or adapted by Linda C. Youmans, MA, LPC Programs Educator, Grand Rapids Medical Education & Research Center for Health Professions 1000 Monroe Avenue NW Grand Rapids, MI 49503

    LIFE Curriculum Test Key
    Questions on LIFE Curriculum
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11. Additonal References Added 3/22/05
  1. Smola KW Sutton CD Generational differences: revisiting generaitonal workvalues for the new millenium J Organizational Behaviors 2002;23:363-382.
  2. Brownstein A The next great generation? The Chronicles of HIgerh Education 2000;47(7): A71-A72.
  3. Barney SM. A changing workforce calls for twenty first centrual strategies.J Healthcare Management. 2002;47(2):81-84.
  4. Barger LK, Cade BE, Ayas MT, et al. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med 2005(Jan 13);352(2):125-134.
  5. Duchscher B, Judy E, Corwin L. Multigenerational nurses in the workplace. J Nurs 2004;34:493-401.
  6. Gross CP, Mead LA, Ford DE, Klag MJ. Physician, heal thyself? regular source of care and use of preventive health services among physicians. Arch Intern Med 2000;160:3209-3214.
  7. Ende J. Feedback in Clinical Medical Educaiton JAMA 1983;250(6) 777-81.
  8. Brinko KT. The practice of Giving Feedback to Improve Teacing. What is Effective? Journal of Higher Education 1993; 64(5):574-93.
  9. Kaprielian VS Gradison M. Effective Use of Feedback. Family Medicine 1998;30(6):405-6.
  10. Center C DAvis M Detre T et al Confronting depression and suicide in physicians: a consensus statement. JAMA 2003;289:3161-3166.
  11. Frank E Dingle AD Self reported depression and suicide attempts among US women physicians. Am J Psychiatry 1999;156:1887-1894.
  12. Reinhardt T Chavez E Jackson M Matthews WC Survey of Physician well being and Health Behaviors at an Academic Medical Center Medical Education on line 2005;10 http:www.med-ed-online.org
  13. McNamara RM Physician Wellness http://www.emedicine.com/emerg/topic678.htm
  14. Ganley OH, Pendergast WJ, Wilkerson MW, Mattingly DE. Outcome study of substance impaired physicians and physician assistants under contract with North Carolina Physicians Health Program for the period 1995-2000. J Addict Dis 2005;24:1-12.
  15. http://www.sma.org/residents/index.cfm
  16. http://www.sma.org/education/index.cfm
  17. http://www.sma.org/education/cmecalendar/index.cfm
  18. Many medical education organizations have endorsed the AAMC's newly released "Compact Between Resident Physicians and Their Teachers," a list of the core tenets of graduate medical education. The AAMC initiated the development of the compact to re-focus attention on the primary goal of U.S. residency training-physician education. http://www.aamc.org/newsroom/pressrel/2005/051103.htm
  19. Compact Between Resident Physicians and Their Teachers
  20. "Residents in Trouble" in Family Medicine, April 2006.
  21. AAMC contract between Resident Physicians and their teachers. http://www.aamc.org/meded/residentcompact/">
  22. https://services.aamc.org/Publications/index.cfm?fuseaction=Product.displayForm&prd_id=212&prv_id=256
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12. Legal
  1. http://chronicle.com/weekly/v52/i48/48a02301.htm
  2. Virtual Mentor(April 2007)examines the significance of professionalism in medical education ie "fudging" an answer during rounds, observing boundaries in conversations with patients, self-interest vs friendship in medical school, potential risks of saying "I'm sorry" to patients, origin of unprofessional medical student behavior & the gap between what society wants & what physicians providehttp://enews.ama-assn.org/UM/T.asp?A40.442.4278.26.263231
  3. Medical Errors Involving Trainees: A Study of Closed Malpractice Claims From 5 Insurers http://archinte.ama-assn.org//cgi/content/abstract/167/19/2030?etoc&eaf
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13. Generational
  1. McMurray JE, et al. The work lives of women physicians. J Gen Intern Med 2000; 15:372-80.
  2. International Medical Graduates in the U.S. Workforce A discussion paper. April 2006 http://www.ama-assn.org/ama1/pub/upload/mm/18/workforce2006.pdf
  3. http://www.ama-assn.org/ama1/pub/upload/mm/384/medsoc2_16183.pdf
  4. http://www.ama-assn.org/ama1/pub/upload/mm/377/a06cmereport10.doc
  5. http://www.eeo.nsw.gov.au/diversity/managing.htm
  6. http://www.ama-assn.org/ama/pub/category/15944.html
  7. http://www.ama-assn.org/ama/pub/category/15944.html
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14. Getting The Right Applicants
  1. Roadmap to Residency: From application to the Match and Beyond. https://services.aamc.org/Publications/index.cfm?fuseaction=Product.displayForm&prd_id=146&prv_id=171
  2. Rosenfeld JM, Reiter HI, Trinh K, Eva KW. A Cost Efficiency Comparison Between The Multiple Mini-Interview and Traditional Admissions Interviews. Adv Health Sci Educ Theory Pract. 2006 Sep 29; [Epub ahead of print]
  3. Eva KW, Rosenfeld J, Reiter HI, Norman GR. An admissions OSCE: the multiple mini-interview. Med Educ. 2004 Mar;38(3):314-26.
  4. Eva KW, Reiter HI, Rosenfeld J, Norman GR. The relationship between interviewers' characteristics and ratings assigned during a multiple mini-interview. Acad Med. 2004 Jun;79(6):602-9.
  5. Eva KW, Reiter HI, Rosenfeld J, Norman GR. The ability of the multiple mini-interview to predict preclerkship performance in medical school. Acad Med. 2004 Oct;79(10 Suppl):S40-2.
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15. Staying In Program Director Role
  1. GME Guidebook online: Program directors can download their complimentary copy of the Guidebook for GME Program Directors, available at: http://enews.ama-assn.org/UM/T.asp?A40.574.3468.22.263231
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