With more than 1,200 residents and fellows, the John Hopkins School of Medicine has a large body of physicians in training whose well-being required a dedicated plan.

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“Within our own institution, we had issues with burnout—both for our residents and clinical fellows, but also for other clinicians, and we knew that the needs of our residents and fellows might be a little bit different than the needs of nurses or attending physicians or others,” said Laura Ann Hanyok, MD, Johns Hopkins’ assistant dean for graduate medical education and associate professor of medicine, in an episode of the AMA STEPS Forward® podcast. “So, we really thought it was important to develop a strategy that would meet their needs.”

Dr. Hanyok walked through the strategy that went into creating Hopkins’ multipronged well-being initiative and some key factors to know about addressing well-being in a broader sense.

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Knowing what residents and fellows needed meant understanding the scope of the burnout, which was measured through a regular systemwide safety culture survey. Those results showed that half of Hopkins’ resident-and-fellow survey respondents were experiencing symptoms of burnout. 

After conversations on a formal level with groups such as resident wellness committees and less formal level—simply speaking with individual residents—Dr. Hanyok and her team realized that the institution’s well-being initiative needed to be designed around the residents and fellows.

“Most residents and fellows work more hours than even a lot of attendings do,” she said. “They may be in new places and therefore have not the same social connections, if you will, that others may have who have been in the same place for a period of time. They are getting used to their new professional roles as physicians, and still developing as physicians. And we knew that some of those things impacted what they needed and what, frankly, we were able to offer.

“Something that might make sense for a medical student to come to—a yoga session at 2 o’clock in the afternoon—wouldn’t necessarily make sense if you were a surgery resident,” Dr. Hanyok said. “We had to think creatively about how to meet residents and fellows where they were, knowing their schedules were busy.”

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Wellness activities shouldn’t feel like another to-do for busy residents and fellows, Dr. Hanyok said.

“This is supposed to make people’s lives easier, and just adding more stuff isn’t necessarily going to make people well,” she said. “We’ve tried to be mindful of finding things that will help their well-being but are feasible in the time they have as a resident or fellow, and not make them feel that this is just some other self-care thing I need to check off, and that it really will be impactful.”

The key activities in Hopkins’ well-being initiative included weekly “wellness Wednesdays,” with events such as pet therapy, yoga, massage therapy and reflective writing.

Discover four ways that residency programs can help medical residents beat burnout.

The role of the training institution in creating or changing policies that allow for increased resident-and-fellow wellness is a key one.

“The other piece of the initiative that is important, but less tangible, is all of the advocacy that our office has done with our housestaff counsel and our clinical fellows counsel to advance wellness needs on an institution or school of medicine level,” Dr. Hanyok said.

“For instance, having free gym memberships for our residents that are subsidized by the hospital, focusing on improving parental need,” she added. “Those sorts of positive changes that really an individual residency program couldn’t do on its own that it really needs the larger wellness initiative that our GME office can help spearhead.”

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