LIFE Curriculum

The LIFE curriculum (Learning to Address Impairment and Fatigue to Enhance Patient Safety), sponsored by the Duke University School of Medicine, is a case-based educational program designed to help graduate medical education programs, their residents, and faculty to prevent, identify and manage resident fatigue and impairment. The project is funded in part by a grant from the Josiah Macy, Jr. Foundation. (c.2005)

Boundary Violations

Objectives: (1) Outline strategies for prevention, detection, and intervention for boundary violations, (2) Contrast sexual violation and sexual impropriety, (3) Describe the inherent power differences that constitute the primary factor in boundary violations, (4) Analyze the role that the perceptions of both participants play in boundary violations, (5) Identify cultural diversity issues as they relate to the potential for misunderstanding in the physician/patient encounter, (6) Assist residents in understanding the difference between health demonstrations of empathy and actions that might be construed as boundary violations.

• Learning objectives
• Transference and counter-transference
• Policy regarding gifts
• Cultural aspects of care
• Sex and power
• Sexual violation versus sexual impropriety
• Proposed causes of boundary violations in physicians
• Consequences to patients of boundary violations
• The slippery slope
• Example of a professional expectations form for residents
• Additional references of interest

Disruptive Behavior

Objectives: (1) Define disruptive behavior, (2) describe the impact of disruptive behavior on the medical environment and the health care team, (3) Recognize the signs and symptoms of disruptive behavior, (4) Outline strategies to identify, intervene and manage disruptive behavior, and (5) Access resources to develop effective tools and responses.

• Learning objectives
• Signs and symptoms of disruptive behavior in physicians
• Policy statement
• Example statement of harassment
• Additional references of interest

Fatigue

Objectives: (1) Identify strategies that may prevent fatigue, (2) Identify an impaired resident, (3) Manage an impaired resident effectively, (4) Access appropriate referral resources.

• Objectives
• Work-hour restrictions
• Sleep cycle
• Fatigue and impairment
• Fatigue and resident health
• Fatigue and resident well-being
• Night floats, fatigue, handoffs
• ACGME standards
• ACGME’s approach to resident duty hours
• ACGME misperceptions on duty hour standards
• Milestones in the history of the problem
• Additional references of interest
• David Dinges, PhD: bibliography
• Web resources

Substance Abuse

Objectives: (1) List the five substances most commonly abused by physicians, (2) Recognize common indicators, signs, and symptoms of substance abuse in residents, (3) Describe the medico-cultural factors relative to substance abuse in physicians, (4) Anticipate the favorable treatment outcomes of substance abuse in physicians.

• Objectives
• DSM-IV criteria for substance abuse and substance dependence
• Signs and symptoms indicative of substance abuse
• Principles of intervention
• Common issues involving residents suspected of substance
• Reporting to the National Practitioner Data Bank
• Steps programs can take to help combat substance abuse
• Additional references of interest