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Preventing burnout in residency programs: Mayo Clinic's unique approach

A cardiology fellow at the Mayo School of Graduate Medical Education at Mayo Clinic in Jacksonville, Fla., launched a program-wide wellness initiative that helps physicians in training reduce stress and prevent burnout through activities not usually associated with medicine.

It started with one fellow’s idea

When cardiology fellow Olufunso Odunukan, MBBS, took a year off between residency and fellowship, he signed up for ballroom dancing classes once a week while working as a hospitalist. He found it was a great way to reduce stress.

When he jumped back into the learning environment for his fellowship at the Mayo School of Graduate Medical Education at Mayo Clinic in Jacksonville, Fla., Dr. Odunukan looked at the medical literature to find ways to combat burnout during training. While he found plenty of research on the extent of burnout, there was frustratingly little written about how to intervene and prevent burnout.

“Then an epiphany came when I volunteered with a heart failure support group,” Dr. Odunukan said. “It wasn’t all lectures. … They had an instructor who taught people how to paint or make origami boxes. I had no background in either, but in 10 minutes I made the most beautiful box, and I had a sense of accomplishment.”

It left Dr. Odunukan wondering if this approach would help physicians in training lower their stress as well. So he tested his theory.

Can arts and meditation reduce stress?

Dr. Odunukan created a pilot project that revealed that internal medicine residents who participated in one hour of art class were less fatigued and had improved work-related motivation when compared to their colleagues who participated in the usual noon conference.

He then followed up with a three-month study that included arts and humanities activities every two weeks, which replicated his initial finding. Afterward, he ran a randomized, crossover study that compared the impact of art and meditation on reducing stress and fatigue.

The results showed that group participation in arts led to improved bonding with colleagues, while meditation was more effective for lowering stress and fatigue.

“They were complimentary to each other,” Dr. Odunukan said.

Today, the internal medicine program at Mayo Clinic’s campus in Florida designates one noon conference every month as “Humanities Thursday.” The Fellows’ and Residents’ Health and Wellness Initiative (FERHAWI) humanities program includes discussions of artwork, guided visual imagery and art projects, such as watercolor painting, screen printing and origami.

The initiative has received rave reviews, leading Mayo Clinic to earmark funds for resident wellness programs on all three of their campuses, Dr. Odunukan said. The Mayo Fellows Association also began a quarterly Wellness Fair at the Florida campus, where residents and fellows have a three-hour period to come and go and participate in arts, chair massages, yoga and pilates, among other things. And physicians in training can visit vendors to gather information, such as healthy eating tips.

“It is a strong message that we don’t just care for patients but we have to care for ourselves,” Dr. Odunukan said. “It is just very reassuring to see an institution placing value on the wellness and well-being of residents.”

Improving residents’ well-being

The program, which won the David C. Leach Award of the Accreditation Council for Graduate Medical Education in February, is one that could be replicated in resident programs nationwide. FERHAWI is featured in the AMA’s STEPS Forward™ collection of practice improvement strategies. The collection contains an online module that explains what is needed to prevent burnout among physician trainees, based on lessons learned by successful residency wellness programs.

Studies have shown there are six key factors in fostering residents’ personal wellness, including practicing good nutrition and fitness, meeting emotional needs, and participating in preventive care. Through the AMA STEPS Forward™ collection, the AMA is helping physicians and physicians in training take those steps.

Explore other wellness solutions for residents and fellows