Module 4

Summary

Recognize that the physician-family member is both alike and different from all other family members. S/he is likely to have intense = and complex emotions to their loved one's illness. Physician-family members need= to be treated like all other family members; they will = benefit from your expertise, guidance, and emotional support. On the other ha= nd, physician family members are highly informed and = active consumers. They are likely to want more control = and = information than other family members.

References

Stone D, Patton B, Heen S. Difficult conversations : how to discuss what matters most. New York Cit= y: Penguin Group; 1999.

Klein M. Too close for comfort. CMAJ. 1997;156(1):= 53-55.

Chen R, Rhodes L, Green L. Family physicians' personal experience of their fathers' health care.= J Fam Pract. 2001;50(9):7= 62-766. Chen R, C F, Rhodes L, Gre= en L. Role conflicts of physician and their family members: rules but no rulebook. Wes= t J Med. 2001;174(4):236-244.

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ACGME Competencies: Medical Knowledge, Patient Care, System-based Practice

Keyword(s): Personal reflection, Professional burnou= t

Confronting Personal Mortality

Most of us f= ear our own death; it is part of the human experience. Various <= span style=3D'position:absolute;top:35.0%;left:9.36%;width:100.18%;height:4.0%'= >authors suggest that the desire to deny mortality is pa= rt of every physician's decision to enter the field of Medicine. When learning about taking care of = the dying, we are often told to "confront our own mortality".

However, asking people to suddenly confront their own mortality is a bit naïve. Young physicians may have no real context for this (unless they = have had a near death experience).

Confronting one's mortality typically means different things to different people and different things to the same person at various stages of life.

Rather than making blanket statements about confronting mortality, it may be helpful to break it down into individual episodes, times when we feel <= span style=3D'position:absolute;top:87.0%;left:9.36%;width:84.08%;height:4.0%'>= particularly vulnerable, as windows to self-exploration= .

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I recently t= old the following story at the end of a Grand Rounds presentation. A 49-year-old patient of mine with severe emphysema was in the hospi= tal for the third time in a year for pneumonia. Each admission <= span style=3D'position:absolute;top:18.25%;left:10.11%;width:82.39%;height:4.0%= '>was worse than the last.

One afternoon as I came to see him, I pause= d at his door. Through the window I saw a cachectic man with pursed lip breathing hunched over a tray table. He was = breathless and suffering.

At that moment I could not get myself to open the door;= it was too difficult for me. I walked around the hospital doing other things for an hour before I finally made it into his room. He said he felt terrible. I said I= was sorry, and that I was giving him all the medicine I could think = of.

The conversation was brief and difficult—it was the same conversation we had the last time he was sick and it went no further than sympt= oms or treatments. Neither he nor I felt better after talking.

Four mont= hs later I received an early morning call from the emergency department. My patient had presented in respiratory failure, was intubated, had three chest tubes placed for ruptured bullae, and died. In the words of the ER <= /span>physician, 'it was ugly'.

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Other than the housestaff asking if he wanted 'everythi= ng done' (he said yes),

I h= ad no discussion about end-of-life care/hopes/wishes with my = pa= tient. Two aspects of personal vulnerability hindered me.

First, I have asthma, and my identification with this patients' dyspnea was painful for me. Second, every time I met w= ith this patient I felt bad about the encounter, as = though I had nothing to offer as his physician. I felt = as if I had failed him because I ha= d no cure.

To avoid the feeling of failure, I avoided discussing issues surrounding his imminent dea= th, and thus, failed him in another way.

Had I been more self-aware of my own issues, I would ha= ve been able to identify the reasons I couldn't enter the room.

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Since then, I have learned to listen to my feelings-when I am avoiding = something unpleasant, it usually means I am feeling vulnerable.

My guess is that adding up these individual episodes wh= en we feel vulnerable, becoming increasingly aware of self, is what is meant by the = term confronting your own mortality.

At the en= d of the Grand Rounds where I presented my story, I asked everyone to turn to the person next to him or her and t= ell their own story, the one that cam= e to their mind as I was telling mine. The room boiled over with = = conversation.

Reference

Bu= ckman, Robert. Communication in palliative care: a practical guide. In Oxford Textbook of Palliative Care 2nd ed. Oxford University Press. 1998, pp.141-156.

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ACGME Competencies: Medical Knowledge, Patient Care, System-based Practice

Keyword(s): Personal reflection, Professional burnou= t

13 Signs of Burnout <= /span>

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü<= span style=3D'font-family:Arial;font-size:67%;text-shadow:auto;color:white; mso-color-index:0'>Chronic fatigue - exhaustion, tiredness, a sense of being physically

run down

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü Anger = at those making demands

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü Self-criticism for putting up with= the demands

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü Cynici= sm, negativity, and irritability

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü A sens= e of being besieged

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü Explod= ing easily at seemingly inconsequential things

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü Freque= nt headaches and gastrointestinal disturbances

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü Weight= loss or gain

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü Sleeplessness and depression =

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü Shortn= ess of breath

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü Suspiciousness

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü Feelin= gs of helplessness

<= span style=3D'font-family:Arial;font-size:67%;color:white;mso-color-index:0; text-shadow:auto'>ü Increa= sed degree of risk taking

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What Is Burnout?

The term "burnout" is credited to Herbert Freudenberger, a psychologist= who used the analogy of a building that has burned out. Where there = was once a vital structure there only remains the crumbling reminders of energy, leaving a sense of desolation.

Freudenberger worked alongside volunteers in the free-clinic movement that served Vietnam veterans. He observed that the = most dedicated and committed professional caregivers se= emed especially at risk of burnout, and suggested that once they lost their idealism, th= ey would exhibit signs of mourning that loss.

Freudenberge= r H. Staff burn-out. J Soc Issues. 1974;30:159-165.

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Current descriptions of burnout include the following characteristics: fa= tigue,

lo= ss of idealism and energy,

emotional numbness, and

dis= satisfaction with one's personal accomplishments.

Some include in the definition

an inability to concentrate, irritability, insomnia, anxiety, and depression. It can be distinguished from an endogenous depression in that it is situational and may respon= d to interventions affecting the culture of the workplace or the nature of the work itself.

It is important to remember that, while physicians and nurses may occasionally experience on= e or more of these symptoms of burnout, the frequency and intensity differentiates cases of true burnout from = temporary distress or overwork.

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From Stress To Burnout

Burnout results from overwhelming stress th= at creates an imbalance between the professional's needs and the rewards derived from the job itself. For example, highly motivated professionals can either achieve peak performance wo= rking within a positive environment, or manifest sym= ptoms of burnout if they find no support or challenge in the workplace.

Awareness of stress in oneself and one's colleagues is = the first step towards recognizing the potential for professional burnout.

Early intervention can interrupt the progression from stress to burnout. Sensitivity = to a team member's distress may go a long way toward = relieving his or her tension or stress. An expression of concern or solidarity can be offered without intruding in another's private life.

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Who Is At Risk For Burnout?

Research on the personality traits of professional caregivers has identified that individuals who are committed, enjoy the challenge of t= heir work, and feel in control of t= heir professional lives are least likely to succumb to burnout.

These traits have been collectively described as resili= ence in the literature.

However, the research defining what we need to do to prevent burnout conflicts wi= th the realistic culture of medical training. Medical school conditions us to learn to postpone instant gratification in favor = of long-term gain, show an almost superhuman commitment to our work, overvalue technology, and undervalue our own needs as well as the power of human relationships.

However, in analyzing the studies in this a= rea, one must bear in mind that an indivi= dual's personality trait and not the nature of the work itself may influence the risk and rate of burnout.

It is important to note that as personality traits affect why someone chooses one specialty over another, this may indicate why some specialists are prone <= /span>to burnout.

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The culture of medicine

In the United States has changed radically, especially = in the past 10 years.

Managed care influences clinical decisions and creates = even more pressure on providers to contain the cost of care at the expense of = spending time with patients. Managed care has also transformed the status a= nd self-image of physicians.

Many feel disgusted about the intrusion of business into the practice of medicine, and = are keenly aware of the divided loyalties between serving patients and conforming to regulatory pressures.

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Enhance Communication Skills, Decrease Stress

Studies have shown that a lack of formal training in communication skills heigh= tens daily stress.

It is considered part of the clinician's role to discuss difficult situations with entire families, and to negotiate and communicate with high levels = = of precision and skill.

Good communication along the disease trajec= tory helps to clarify the patients' and doctors' goals and serves to align their expectations.

The benefits of good communication translate into a sen= se of a job well done and also serve to increase patients' and families' satisfaction = with the medical care they receive. Communication train= ing allows physicians to be more rela= xed in dealing with patients' concerns and emotions, and to respond in sensitive ways to a wide ra= nge of situations. =

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Wellness and Self-Care

Self-care is typically low on the list of physicians' priorities. Doctors are conditioned = to deny their own needs during their training, and this behavior is later reinforced in the culture of the workplace. Many do not have a doctor themselves, and are not in the habit of sharing their worries or seeking support.

Self-care begins with the recognition of self-worth. Th= ere are many different ways of finding one's spiritual or emotional center and restoring a sense of balance to one's life.

Advice and self-improvement materials are easy to find = on supermarket shelves and medical librar= ies! Reflect on your personal goals, needs, and responsibilities, and protect the time and space requir= ed to meet those challenges. Allow some time for rest and leisure.

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Understan= ding common stressors is essential for self-care. It is also = useful to reflect on the characteristics that have b= een associated with job satisfaction, such as:

      having a = sense of mastery and control
<= /span>=      dealing well wi= th patients and families
<= /span>=      learning to det= ach from suffering
<= /span>      enjoying a stro= ng self-esteem
<= /span>

attaining a professional status

<= /b>

     having adequate resources
<= /span>=      intellectual stimulation, learning new skills
<= /span>      adapting to the= work environment
<= /span>
     developing mult= iple roles, such as clinician, teacher,
     researcher, administrator
<= /span>
     leaving work &#= 13;

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Reference= s
For additional information on these referen= ces, please visit the selected research section. Vachon MLS. Stress and Burnout in Oncology. In: Berger = A, Portenoy RK, eds. Principles and Practice of Supportive Oncology. Philadelphia, Pa: Lipincott Williams & Wilkins; 1998.

Freudenberger H. Staff burn-out. J Soc Issues. 1974;30:159-165.

Mount BM. Dealing with our losses. J Clin Oncol. 1986;4(7):1127-1134.

Remen RN. Recapturing the soul of medicine. West J Med. 2001;174:4-5.

Conversations in Care™. Healthcare Professional Survey. Available at: http://www.conversationsincare.org. Accessed March 1= 2, 2002.
Whippen DA, Canellos GP. Burnout syndrome in the practi= ce of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol= . 1991;9:1916-1920.

Ramirez AJ, Graham J, Richards MA, et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer. 1995;71:1263-12= 69.

Einhorn LH. ASCO 2001 Presidential address. J Clin Onco= l. 2001;19(suppl 18):1S-5S.

Meier DE, Back AL, Morrison S. The inner life of physic= ians and care of the seriously ill. JAMA. 2001;286(23):3007-3014. <= /div>

Maguire P, Booth K, Elliot C, Jones B. Helping health professionals involved in cancer care acquire key interviewing skills - the impact of workshops. Eur J Cancer. 1996;32A(9):1486-1489.

Maguire P, Faulkner A. How to do it: improve the counselling skills of doctors and nurses in cancer care. BMJ. 1988;297:847-849.
Fallowfield LJ, Lipkin M, Hall A. Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom. J Clin Oncol. 1998;16(5):1961-1968.

Roter D, Fallowfield L. Principles of Train= ing Medical Staff in Psychosocial Communication Skills. In: Holland JC, Breitb= art W, eds. Psycho-Oncology. Oxford, England: Oxford University Press; 1999:1074-1082.

Jenkins V, Fallowfield L. Can communication skills training alter physicians' beliefs and behavior in the Clinics? J C= lin Oncol. 2002;20(3):765-769.
Gundersen L. Physician burnout. Ann Intern Med. 2001;135(2):145-148.

McPhee SJ. Letter from the Abbey. West J Med. 2001;174:73-75.

Rabow MW, McPhee SJ. Doctoring to heal. West J Med. 2001;174:66-69.

Puddester D. The Canadian Medical Association's policy = on physician health and well-being. West J Med. 2001;174:5-7

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http://www.med-ed-online.org= /pdf/res00124.pdf

Survey of Physician Well-Being and Health Behaviors

at an Academic Medical Center

Abstract: Purpose: The study aims were to ascertain, among attending and house staff at a single = ac= ademic medical center, the prevalence of and risk factors for psychiatric symptoms and disorders and for personal health behaviors. Methods: A self-administered, anonymous 72-item survey of physicians was conducted in February 20= 03. Results: Response rate was 37.6%. The prevalence of current depressive symptoms was 29%. AUDIT scores consistent with high likelihoo= d of harmful alcohol consumption were prevalent in 6%. Al= most 5% acknowledged use of sedatives or hypnotics without a prescription in the prior 12 months. Characteristics independently associated with current depressive symptoms included: living al= one, full time salaried faculty status, not having a primary care physician, fe= male sex, and age < 50 years. Factors associated with high risk of harmful alcohol consumption included: male sex, house = st= aff status, and not being exclusively heterosexual. Conclusions<= /span>: T= he prevalence of recent depressive symptoms among responding physicians was <= /span>ne= arly 30%. Interventions to engage physicians in primary care relationships and social support to confidentially disclose potentially stigmatizing characteristics may facilitate earlier case findi= ng of those at risk for depression, suicide, and substance abuse

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http://www.ama-assn.org/ama/= pub/category/10971.html

Before Burnout: How Physic= ians Can Defuse Stress

The facto= rs that lead to stress among physicians are many and varied. They can be largely divided into&nb= sp;2 categories: personal factors unique to the physician, and workplace factors.

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Common Personality Traits of Physicians

•Conscientious, Perfectionist

•Great sense of responsibility

•Guilt

•Need for control

•People pleasing

•Discomfort with approval

•Self-doubts

•Ability to delay gratification

•

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Stages of Burnout

•Emotional exhaustion &= #13;

•Depersonalization = ;

<= span style=3D'font-weight:normal'>•Reduced sense of accomplishment

•<= span style=3D'mso-special-format:lastCR;display:none'>

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Conseq= uences of Burnout

•Complaints, Litigation

•Anxiety disorders = ;

•Eating disorders =

•Addictions

•Depression

•Suicide

•<= span style=3D'mso-special-format:lastCR;display:none'>

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General Stress Solutions

•The Number One Cause of Stress: Feeling Lack of Control, Choice = = •The Number One Solutio= n; Challenge this perception.

•<= span style=3D'mso-special-format:lastCR;display:none'>

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Specific strategies

• Anti= cipate and prepare for situations.

• Set realistic expectations

• Don'= t take your work home

• Laug= h more often

• Seek= and use supports

• Get a mentor

• Let = go of the guilt

•

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‹header›

‹date/time&= #8250;

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Second level

Third level

Fourth level

Fifth level

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application/javascript; charset="us-ascii" function LoadSld() { var sld=3DGetObj("SlideObj") if( !g_supportsPPTHTML ) { =09 sld.style.visibility=3D"visible" return } if( MakeNotesVis() ) return runAnimations =3D _InitAnimations(); =09 if( IsWin("PPTSld") ) parent.SldUpdated(GetSldId()) g_origSz=3DparseInt(SlideObj.style.fontSize) g_origH=3Dsld.style.posHeight g_origW=3Dsld.style.posWidth g_scaleHyperlinks=3D(document.all.tags("AREA").length>0) if( g_scaleHyperlinks ) InitHLinkArray() if( g_scaleInFrame||(IsWin("PPTSld") && parent.IsFullScrMode() ) ) document.body.scroll=3D"no" _RSW() if( IsWin("PPTSld") && parent.IsFullScrMode() ) FullScrInit(); =09 MakeSldVis(); ChkAutoAdv() if( runAnimations ) { if( document.all("NSPlay") ) document.all("NSPlay").autoStart =3D false; if( sld.filters && sld.filters.revealtrans ) setTimeout( "document.body.start()", sld.filters.revealtrans.duration * = 1000 ); else document.body.start(); } } function MakeSldVis()=20 { var fTrans=3Dg_showAnimation && SldHasTrans() if( fTrans )=09 { if( g_bgSound ) { idx=3Dg_bgSound.indexOf(","); pptSound.src=3Dg_bgSound.substr( 0, idx ); pptSound.loop=3D -(parseInt(g_bgSound.substr(idx+1))); } SlideObj.filters.revealtrans.Apply()=09 } SlideObj.style.visibility=3D"visible" if( fTrans ) SlideObj.filters.revealtrans.Play() } function MakeNotesVis()=20 { if( !IsNts() ) return false=20 SlideObj.style.display=3D"none" nObj =3D document.all.item("NotesObj") parent.SetHasNts(0) if( nObj ) {=20 nObj.style.display=3D"" parent.SetHasNts(1) } return 1 } function ChkAutoAdv() { if(SldHasTrans()) SlideObj.onfilterchange=3DAutoAdv else AutoAdv() } function AutoAdv() { if(!IsWin("PPTSld") || !gUseSldTimings )return var sld=3DGetCurSld() if( (sld.mAdvDelay>0) && !parent.IsFramesMode() ) setTimeout("parent.GoToNextSld()",sld.mAdvDelay) } function GetObj(id) { if(g_supportsPPTHTML) return document.all(id); else return document.getElementById(id); } function SldHasTrans() { return SlideObj.style.filter !=3D ""; } function GetSldId() { return sId=3Dlocation.href.substring(location.href.la= stIndexOf('/')+1) } function HideMenu() { if( frames["PPTSld"] && PPTSld.document.all.item("ctx= tmenu") && PPTSld.ctxtmenu.style.display!=3D"none" ) { PPTSld.ctxtmenu.styl= e.display=3D'none'; return true } return false } function IsWin( name ) { return window.name =3D=3D name } function IsNts() { return IsWin("PPTNts") } function IsSldOrNts() { return( IsWin("PPTSld")||IsWin("PPTNts") ) } function SupportsPPTAnimation() { return( navigator.platform =3D=3D "Win32"= && navigator.appVersion.indexOf("Windows")>0 ) } function SupportsPPTHTML() { var appVer=3Dnavigator.appVersion, msie=3DappVer.indexOf("MSIE "), ver=3D0 if( msie >=3D 0 ) ver=3DparseFloat( appVer.substring( msie+5, appVer.indexOf(";",msie) ) ) else ver=3DparseInt(appVer) return( ver >=3D 4 && msie >=3D 0 ) } function _RSW() { if( !g_supportsPPTHTML || IsNts() || ( !g_scaleInFrame && (!IsWin("PPTSld") || !parent.IsFullScrMode()) ) ) return var padding=3D0; if( IsWin("PPTSld") && parent.IsFramesMode() ) padding=3D6 cltWidth=3Ddocument.body.clientWidth-padding cltHeight=3Ddocument.body.clientHeight-padding factor=3D(1.0*cltWidth)/g_origW if( cltHeight < g_origH*factor ) factor=3D(1.0*cltHeight)/g_origH newSize =3D g_origSz * factor if( newSize < 1 ) newSize=3D1 s=3DSlideObj.style s.fontSize=3DnewSize+"px" s.posWidth=3Dg_origW*factor s.posHeight=3Dg_origH*factor s.posLeft=3D(cltWidth-s.posWidth+padding)/2 s.posTop=3D(cltHeight-s.posHeight+padding)/2 if( g_scaleHyperlinks ) ScaleHyperlinks( factor ) } function _InitAnimations() { animRuntimeInstalled =3D ''+document.body.localTime !=3D 'undefined'; isFullScreen =3D (window.name =3D=3D "PPTSld") && !parent.IsFramesMode(); g_animUseRuntime =3D g_showAnimation && animRuntimeInstalled && !(isFullSc= reen && parent.IsSldVisited()); if( g_animUseRuntime ) { collSeq =3D document.all.tags("seq"); if( collSeq !=3D null ) { for(ii=3D0;ii numSlds ) gSldJumpIdx =3D numSlds; if ( gSldJumpIdx >=3D 0 ) { if ( gSldJumpIdx =3D=3D 0 ) gSldJumpIdx =3D 1; var jumpTo =3D parseInt(gSldJumpIdx); gSldJump =3D 0; gSldJumpIdx =3D ""; win.GoToSld( parent.GetSldList().mList[jumpTo-1].mSldHref ) } } } function _KDH() { if( event.keyCode =3D=3D 8 ) { event.returnValue =3D 0; parent.GoToPrevSld(); } }function DocumentOnClick() { if( IsNts() || parent.HideMenu() ) return; if( ( g_allowAdvOnClick && (window.name=3D=3D"PPTSld") && !parent.IsFrames= Mode() ) || (event && event.keyCode=3D=3D32) ) { =09 if( g_animUseRuntime && g_animMainSequence && g_animMainSequence.cangonex= t ) return; parent.GoToNextSld(); } } var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""= , g_bgSound=3D"", g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser = =3D 0, gLoopCont =3D 0, gUseSldTimings =3D 1; var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w= indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va= r g_animManager =3D null; var g_animUseRuntime =3D false; var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime; var g_animMainSequence =3D null; var ENDSHOW_MESG=3D"End of slide show, click to exit.", SCREEN_MODE=3D"Fram= es", gIsEndShow=3D0, NUM_VIS_SLDS=3D28, SCRIPT_HREF=3D"script.js", FULLSCR_= HREF=3D"fullscreen.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var gMainDoc=3Dnew Array(new hrefList("slide0056.htm",1,-1,1),new hrefList(= "slide0169.htm",1,-1,1),new hrefList("slide0170.htm",1,-1,1),new hrefList("= slide0171.htm",1,-1,1),new hrefList("slide0172.htm",1,-1,1),new hrefList("s= lide0173.htm",1,-1,1),new hrefList("slide0174.htm",1,-1,1),new hrefList("sl= ide0175.htm",1,-1,1),new hrefList("slide0177.htm",1,-1,1),new hrefList("sli= de0178.htm",1,-1,1),new hrefList("slide0176.htm",1,-1,1),new hrefList("slid= e0180.htm",1,-1,1),new hrefList("slide0179.htm",1,-1,1),new hrefList("slide= 0181.htm",1,-1,1),new hrefList("slide0191.htm",1,-1,1),new hrefList("slide0= 190.htm",1,-1,1),new hrefList("slide0189.htm",1,-1,1),new hrefList("slide01= 88.htm",1,-1,1),new hrefList("slide0187.htm",1,-1,1),new hrefList("slide018= 6.htm",1,-1,1),new hrefList("slide0185.htm",1,-1,1),new hrefList("slide0192= .htm",1,-1,1),new hrefList("slide0196.htm",1,-1,1),new hrefList("slide0195.= htm",1,-1,1),new hrefList("slide0194.htm",1,-1,1),new hrefList("slide0193.h= tm",1,-1,1),new hrefList("slide0200.htm",1,-1,1),new hrefList("slide0198.ht= m",1,-1,1)); /********************************************* Frameset functions These functions control slide navigation and state of the frameset. **********************************************/ function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) {=09 var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix();=20 function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') {=20 href=3Dnew String(document.location.href)=20 Start=3Dhref.indexOf('!')+1=20 End=3Dhref.lastIndexOf('/')+1=20 if (End < Start)=20 return href.substring(0, Start)=20 else=20 return href.substring(0, End)=20 } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { // Clear any sounds playing before launching another browser window. Other= wise, // in fullscreen mode, you'll continue to hear the sound in the frames mod= e. if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() {=20 if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; PPTSld.location.replace(MHTMLPrefix+obj.mSldHref) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 PPTSld.location.replace(MHTMLPrefix+href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('

' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. Creating the DIVs using createElement() means we don't have to write out any extra HTML into the slide HTML files. **********************************************/ var sNext=3D"Next",sPrev=3D"Previous",sEnd=3D"End Show",sFont=3D"Arial",sAr= row=3D"Arrow",sFreeform=3D"Freeform",sRect=3D"Rectangle",sOval=3D"Oval" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) =09 CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; s.fontFamily=3DsFont s.fontSize=3D"9pt" s.paddingLeft=3D2 } function CreateSeparator( node ) { var sObj=3DCreateItem( node ) SetCMBorder(sObj,"menu","menu") var s=3DsObj.style s.borderTopColor=3D"threedshadow" s.borderBottomColor=3D"threedhighlight" s.height=3D1 s.fontSize=3D"0px" } function CreateItem( node ) { var elem=3DPPTSld.document.createElement("DIV") node.insertBefore( elem ) return elem } function SetCMBorder( o,ltClr,rbClr ) { var s=3Do.style s.backgroundColor=3D"menu" s.borderStyle=3D"solid" s.borderWidth=3D1 s.borderColor=3DltClr+" "+rbClr+" "+rbClr+" "+ltClr } ------=_NextPart_01C7D841.8C0F8650 Content-Location: file:///C:/50921AF3/Module13ProfessionalselfCare_fastfacts_files/fullscreen.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" ------=_NextPart_01C7D841.8C0F8650 Content-Location: file:///C:/50921AF3/Module13ProfessionalselfCare_fastfacts_files/buttons.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhWAESAPf4AAAAAIAAAACAAICAAAAAgIAAgACAgICAgAQEBISEBASEBISEhAQEhMTExAQE /KTM9Pz8/ERERPz8BAT8/KSkpGRkhMTcxCRkxAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAMDAwP8AAAD/AP//AAAA//8A/wD//////yH5BAEAAPgALAAAAABYARIA QAj/APEJHEiwoMGDCBMqXMiwocOHECNKnEixosWLGCEiQKCRo8YDIEHig2DxAD4LKD1avDDhgUuV GUOGbHBR5QGYFBG4fHAB58EKECJEwCfUYAWPFGAygLCRKQIIUKM6WAohKUGgCikcFWh1INWoYKVS 7SrQ41GbIhGYLAuVQVOoC+IyXUuUAkG1HE3KFDhAwkgJc5/qDZmxsOHDiBMrXsy4sePDGyP7lChT 5MULmDPnlDw5YmW6FTNrfgi0aNGEZPEtbfo2bNTUpYeeRph69dPWrqvCNFuBIGG1A59CYPAVQtwF cw0OxWdTIOiBCQAjaAB17fOFII8voGmRc+eOkilm/z9OvTtnjN4hYk1YoT3H2rnBOphPAB9skgq3 2lcaX/5YnJVt9BloAar12UEIRGCZdQghMABI1Tn32IQUVthYexhmqGGGMBHAgIfEhSiiiATAtOGJ GnYI4ogsEldicAYOGNJGZaml3Y0L3NTZUBz1xlB0PUoUI0jlVWRSVN89xBKSGB1YU1TMoRfVBEle hR9HQs1GEHxQ3RZZbveZthxt/LEmXHyp5XWABSCpaRJwbM13gAACPHVccgJFgF+NEhqUAEkQSCfc ddhVhh5dVTaEAEsTUNlkZUWKN9BNGDE6QU8OrSdbllzpxyVTTrU21Uj3scfhp7nNpyoDaTIEJ3P9 If8J2kbLNYegg9JRBwGhFvbq66+ZUiDssMQWK2yHxiZLrInKNotss8l+B5yBrr5p2UIJvortANoC 6+234IbLla/elRtZjeamh5CC3Sb0YLvixivvYkDFGlZqBNh7r4n6goVvv6/ZlCicN+kL71ALTnpQ dCIZp7CihkLA3UQmoWRBogyxtBPGCTnZncVR1rSTo5nuydC/Eo8kUH+lOoTyyvjoCuZu+PjYIKLD rZybtrM1d10C0QXKEVz48GrQkEeWdFJKlbb0UmEeV0SzyC6RvNB646LWIVjUNeC1zAFb+RDKXksM 9r531bwmpQW9+hQDDsx5pqwDRWBXcFES2hc+gEn/wJGdEEWdE6LoWcoxQweaTNmkhydkKaYMYY2Q p1unbLl/pPKbn3v7EZRvrKvqlja2ONvrtoIw9tn2g32/tQBlhtYkU+MNikZ7QYlPDPuMldpOmuJX nVo5VF3HjI+q89mteX5IDd/fVFClma5kiE4f2XUJhlz09gj2NbTDRifkmu7zXjR++RVJ/lPznuvr QH2iD6S+UewP9Dnon6d2NLwN8n90BB6hC68cFMCHoe+ACASP9c4DowUyEF0OPFcDI0ij/VXPaAKC UfhS95AKGoQ7IBRICI1HwhGaUIQoLGEKT6jCFrLwhSuMoQtlCMMZ2rCGOKShDm+4wxzy8Ic+DGIP B4cIRCKGMCAAOy== ------=_NextPart_01C7D841.8C0F8650 Content-Location: file:///C:/50921AF3/Module13ProfessionalselfCare_fastfacts_files/frame.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Module 4 ------=_NextPart_01C7D841.8C0F8650 Content-Location: file:///C:/50921AF3/Module13ProfessionalselfCare_fastfacts_files/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" ------=_NextPart_01C7D841.8C0F8650 Content-Location: file:///C:/50921AF3/Module13ProfessionalselfCare_fastfacts_files/filelist.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C7D841.8C0F8650--

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24	Common Personal= ity Traits of Physicians Conscientious, Perfectionist Great sense of responsibility Guilt Need for control People pleasing Discomfort with approval Self-doubts Ability to delay gratification
25	Stages of Burno= ut Emotional exhaustion Depersonalization Reduced sense of accomplishment
26	Consequences of= Burnout Complaints, Litigation Anxiety disorders Eating disorders Addictions Depression Suicide
27	General Stress Solutions The Number One Cause of Stress: Feeling Lack of Control, Choice The Number One Solution; Challenge this perception.
28	Specific strate= gies Anticipate and prepare= for situations. Set realistic expectat= ions Don't take your work h= ome Laugh more often Seek and use supports<= /li> Get a mentor Let go of the guilt