While the burnout woes of residency are familiar to many physicians in training, concrete strategies to combat the problem can be more elusive. That’s why experts in the field put resident wellness top-of-mind during a panel discussion at the 2015 AMA Annual Meeting, sharing some innovative solutions.
Here are a few creative ways medical communities in the United States and abroad have developed to empower residents to better care for themselves and colleagues:
Making wellness an accreditation requirement for residency programs
Jeff Blackmer, MD, an associate professor of medicine at University of Ottawa and executive director of the office of ethics, professionalism and international affairs at the Canadian Medical Association, spoke about how physician health, wellness and sustainability are recognized as critical components of medical education and training in Canada.
The Royal College of Physicians and Surgeons of Canada, the country’s governing accreditation association, has made resident wellness a key part of “professionalism,” Dr. Blackmer said. Professionalism is a required competency on the CanMEDS system, a national competency-based framework that describes the core knowledge, skills and abilities Canadian residents must fulfill in training.
“This is a pretty big step for an organization like the Royal College to take since all residency programs will actually have to help residents meet this standard in order to gain accreditation,” Dr. Blackmer said.
“At the University of Ottawa, we have a very innovative program in mindfulness that our university staff developed along with a corresponding book,” he said. “So every student who goes through the University of Ottawa has to take a mindfulness course and do reflective journaling as part of the curriculum, which has already proven beneficial.”
Researching wellness solutions of the future
“There has been a considerable amount of data documenting fatigue and stress as significant issues among residents, but interventions to combat these slowly lag behind,” said Olufunso W. Odunukan, MD, a cardiovascular disease fellow at the Mayo Clinic in Jacksonville, Fla.
To address this issue, Dr. Olufunso and his colleagues created the Fellows and Residents’ Health and Wellness Initiative, which consists of developing evidence-based research and wellness strategies for programs to implement.
In 2014, the initiative launched a pilot study of 45 residents who were asked to replace an hour in their day with art therapy or meditation over a three-month period.
“We found that the art therapy and meditation intervention group reported significant reductions in stress and fatigue levels compared to their cohort of colleagues,” Dr. Olufunso said.
During a second phase of the study in 2015, he also found that rates of stress and fatigue didn’t vary greatly based on activity. Both the art therapy and meditation activities fostered positive behaviors in residents, including team bonding and improved communication.
While he acknowledges the limitations of a pilot study, Dr. Olufunso said he plans to expand his research and hopes it will incite other residency programs to explore wellness solutions.
“We wanted to pass the message on to residents and fellows that their well-being is just as important as caring for patients,” he said. “And that it’s not always physical. In surveys I’ve done of residents, 80 percent of them can exercise and still report levels of fatigue, so just going to the gym isn’t going to solve it. We have to explore other solutions that also address our spiritual and mental health.”
Prioritizing small changes for long-term improvements
Jane Shersher, a medical social worker and occupational therapist, consults practicing physicians and hospitals about burnout prevention.
While organizations have to address infrastructural problems that augment physician burnout—such as unorganized clinical rotations or inefficient electronic health records—Shersher said residents still have control over lifestyle factors that can improve resiliency in training.
“Studies show that making small behavior changes can really impact how you look at your day and treat your patients,” she said.
For instance, Shersher said that doing something as simple as journaling for five minutes a day or taking deep breaths has proven to keep stress at bay. She also advises residents to incorporate vegetables and natural energizing supplements into their diets.
“My passion is specifically for young physicians in the early stages of their careers because if you learn self-care early on, you will not only be more productive for your patients, you will be a much better asset to your employer,” she said.
Taking wellness around the globe
The Junior Doctors Network (JDN), which was founded in 2010 as a platform for young physicians within the World Medical Association (WMA), hosts annual conferences to discuss public health, advocacy, human rights and health system issues that impact physicians around the world.
“[The network] now includes hundreds of junior doctors from more than 70 countries and not surprisingly, physician well-being, specifically the well-being of junior [physicians], was identified early on within the organization as an issue that all of us grapple with,” said Elizabeth Wiley, MD, socio-medical affairs officer for the JDN.
Dr. Wiley said the JDN hosted a wellness meeting in Durham, South Africa, a few years ago. From that meeting, several themes emerged around common issues that impact physician well-being worldwide, which included:
- Excessive working hours
- Poor working environments and conditions
- Insufficient facilities, which span from a lack of adequate supplies to a lack of electricity in practice facilities
- A culture of harassment and bullying in medicine, including verbal and physician abuse, gender discrimination, and inadequate supervision during rotations
“This resulted in the formation of an expert working group, chaired by AMA [Immediate-Past] President Dr. Wah, and has ultimately produced a final policy statement on physician well-being that will establish a global norm and expectation around wellness,” Dr. Wiley said.