With the COVID-19 pandemic came an increased focus on mental health and resiliency of physicians and other health professionals. For Atlantic Health System—a member of the AMA Health System Program—that meant spearheading work to help physicians endure the stress caused by the pandemic through debrief style sessions that embrace peer support and the impact of leadership.

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There was deep concern at Atlantic and across the country "about how all physicians were dealing with the stress of the onslaught of patients," AMA member Peter Bolo, MD, said during an AMA STEPS Forward™ webinar about supporting mental health during times of crisis.

Dr. Bolo is medical director of Atlantic Behavioral Health and chair of psychiatry and behavioral health services at Overlook Medical Center, part of Atlantic Health System in Summit, New Jersey. Atlantic Health System is a nonprofit health system with 4,800 affiliated physicians serving 4.9 million people.

At Atlantic Health System, after administering the AMA Coping with COVID-19 survey, 85% of physicians and other health professionals reported experiencing high or modest stress, while 75% felt anxious or depressed. What was surprising to Dr. Bolo was that 78% of respondents reported an increased sense of purpose and 83% felt valued by the organization. Learn more about the stress and burnout findings from the AMA Coping with COVID-19 survey.

"I decided to take a look at the literature and see what had been helpful during past pandemics and was very intrigued by what I was seeing in the literature from SARS [severe acute respiratory syndrome] in 2003 in Hong Kong, Toronto and South Korea on the use of debrief sessions for team members, physicians, nurses—anybody at the bedside—and positive results that they had" in cutting post-traumatic stress disorder, said Dr. Bolo.

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With support from the administrative team, Dr. Bolo launched what he dubbed reflection sessions. Forty sessions were launched during the initial surge of COVID-19 in May and the effort was extended through November.

Dr. Bolo shared some keys to making these sessions a success.



Dr. Bolo focused first on physicians and other health professionals on the front lines of COVID-19 care. This included the emergency department, intensive care unit and residency programs.

"I organized around work units or teams, including a number of physician teams, nursing units—including the various interdisciplinary staff on the nursing units—and then allied groups such as respiratory therapists and others," he said, adding that "the sessions were requested by the leaders of those particular work groups—they had identified an interest in providing the service to their team members."

Finding time was key. This required setting aside an hour of time in a comfortable room for people to sit in. Each group had an average of 10–15 people while the largest group included 40 individuals.

Physicians and other health professionals "were invited to this by their leaders in advance" and "encouraged to attend," said Dr. Bolo who is a resiliency advocate at Atlantic Health System. He coined the title "resiliency advocate" to emphasize that he is of, with and for the people—rather than of the C-suite.

The sessions "were oftentimes scheduled during or adjacent to regular staff meetings or regular section meetings to make it easier for people to get to since everyone was already extending their work hours.

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"We wanted to stack the deck in our favor to make people be able to access it," he added.

Many "felt most comfortable with their co-workers because it was such a singular experience taking care of the patients that those who they were working with understood it and knew intuitively how to support each other in the moment," explained Dr. Bolo. There was an agreement "by all of the teams that peer support in the moment from your co-workers, those people in the trenches with you, was the most helpful in getting them through the situation."

It was about that uncanny or intuitive ability of fellow physicians, nurses and other health professionals "to be able to recognize when you need a pat on the back or you need a moment to take a breather … before you dive in and get back to your work," he said.

Learn more from the AMA STEPS Forward™ webinar series, which focuses on physician well-being, practice redesign and implementing telehealth during COVID-19.

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