jgme aliem residency wellness journal clubThis year’s JGME-ALiEM Hot Topics in Medical Education journal club features the systematic review on residency wellness recently published in the Journal of Graduate Medical Education (JGME).  This week, share your thoughts about this timely topic and paper on the blog, on Twitter (follow #JGMEscholar) and during a live Google Hangout with author Kristin Raj, MD (@KristinRajMD), Christopher Doty, MD (@PoppasPearls), and Jonathan Sherbino, MD (@Sherbino). Ultimately, a curated summary of our discussions will be published in the JGME. Some of your best tweets and blog comments will be featured.

Background on Wellness

Residency can be difficult, daunting and arduous. It is a time when you are sometimes forced to prioritize between clinical and academic responsibilities and adequate sleep, exercise, or quality time with your family. The increased workload, stress on personal relationships, and predilection for self-neglect during training create the perfect storm for the degeneration of a resident’s sense of health and well-being. Burnout in physicians has broad implications for the field of Emergency Medicine (EM). Studies indicate that physician burnout influences the quality care, impacts patient safety and satisfaction, and leads to early physician retirement.1,2

EM was ranked highly in rates of burnout among physicians and one study even has EM ranked highest. Rates of depression amongst physicians in training is approximately 22-35%.3 This is startling when compared to the rates of depression in the general population, which is approximately 17%.4 What is even more tragic is that due to a multitude of factors, nearly 400 physicians commit suicide every year in the U.S.5 This is roughly equivalent to losing an entire medical school (all four years) annually!

To tackle this immense and tragic issue, some residency programs have started to develop and expand formal wellness programs at their institution. One of the earliest programs in the U.S. came from Stanford. Their wellness program was developed in 2010 after the death of one of their residents.6 The AMA Steps Forward program has published a comprehensive module called “Physician wellness: preventing resident and fellow burnout” that lays out key steps to start a wellness program at your institution.

The conversation around wellness initially focused on the endpoint of burnout, such as how to recognize, treat, and prevent it. Recently there has been a call for a shift from a focus on burnout to a focus on preventative strategies and the promotion of wellness right from the start in training.7,8 There has been an urge to teach individuals the skills needed for resilience and positivity. There has also been a call challenging executive leadership and institutions to tackle the systems-based problems that contribute to physician burnout and disruption in wellness.1

Featured JGME Paper

Raj KS. Well-Being in Residency: A Systematic Review. J Grad Med Educ. 2016 Dec;8(5):674-684. doi: 10.4300/JGME-D-15-00764.1. PMID: 28018531. [Open access PDF]

ABSTRACT

Article Focus

Raj reviews the literature on resident well-being to identify factors associated with wellness. In addition, this paper aims to identify interventions that may promote wellness and suggests a framework for future research.

Overall, this systematic review identified numerous studies that showed that resident well-being was lower than that of the general population. Furthermore, residents suffered from higher rates of emotional exhaustion, work-life balance challenges, and depersonalization than their faculty counterparts.

The paper identified numerous POSITIVE factors that improved well being including:

  • Autonomy
  • Competence
  • Social relatedness
  • Accomplishment of goals
  • Opportunities for learning
  • Positive feedback
  • Positive colleague relationships
  • Engagement in spiritual practices
  • Increasing physical activity
  • Exposure to nature

The paper also identified factors with a NEGATIVE impact on resident well-being and included:

  • Sleep deprivation
  • Strained relationships with family and significant others
  • Drug and alcohol use

Finally, as residency programs develop wellness initiatives, this review suggests that utilization rates may be suboptimal for the following reasons:

  • Stigmatization of mental health within residency education and clinical medicine
  • Resident concern about helpfulness of initiatives
  • Resident time constraints

Watch the Google Hangout video or the podcast version

Hot Topics Questions

Post your answer to any question below or discuss via Twitter using #JGMEscholar.

Q1 – This systematic review identified factors (e.g. basic physical needs, social relationships, autonomy, development of competence) that correlate with wellness. What does the construct – “wellness” – mean?

Q2 – Only a single investigator was part of this study? Why? Does this threaten the reliability of the articles selected and the abstraction of relevant data?

Q3 – What can we do to decrease the stigma associated with participating in mental wellness programs or seeking mental health resources?

Q4 – Do you have a wellness program in your residency program? If yes, what does it include? How does it work? What are the benefits?If no, what type of program would you like to see implemented? Why?


Previous JGME-ALiEM Hot Topics journal clubs


Disclaimer: We reserve the right to use any and all tweets to #JGMEscholar and comments below in a curated, commentary for the Journal of Graduate Medical Education Your comments will be attributed. Many thanks in advance for your thoughts and contributions.

1.
Shanafelt T, Noseworthy J. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. 2017;92(1):129-146. [PubMed]
2.
Lu D, Dresden S, McCloskey C, Branzetti J, Gisondi M. Impact of Burnout on Self-Reported Patient Care Among Emergency Physicians. WestJEM. 2015;16(7):996-1001. doi: 10.5811/westjem.2015.9.27945
3.
Shanafelt T, Hasan O, Dyrbye L, et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613. [PubMed]
4.
Daskivich TJ, Jardine DA, Tseng J, et al. Promotion of Wellness and Mental Health Awareness Among Physicians in Training: Perspective of a National, Multispecialty Panel of Residents and Fellows. Journal of Graduate Medical Education. 2015;7(1):143-147. doi: 10.4300/jgme-07-01-42
5.
Sargent DA. Preventing Physician Suicide. JAMA. 1977;237(2):143. doi: 10.1001/jama.1977.03270290043024
6.
Salles A, Liebert CA, Greco RS. Promoting Balance in the Lives of Resident Physicians. JAMA Surg. 2015;150(7):607. doi: 10.1001/jamasurg.2015.0257
7.
Schmitz G, Heron S, Kuhn G, et al. Strategies for coping with stress in emergency medicine: Early education is vital. J Emerg Trauma Shock. 2012;5(1):64. doi: 10.4103/0974-2700.93117
8.
Eckleberry-Hunt J, Van Dyke A, Lick D, Tucciarone J. Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs. Journal of Graduate Medical Education. 2009;1(2):225-230. doi: 10.4300/jgme-d-09-00026.1
Nicole Battaglioli, MD

Nicole Battaglioli, MD

Champion, 2016-17 ALiEM Chief Resident Incubator
Chief Operating Officer, 2016-17 ALiEM Wellness Think Tank
Clinical Associate
Mayo Clinic Health System;
Arlene Chung, MD

Arlene Chung, MD

Chief Strategy Officer,
2016-17 ALiEM Wellness Think Tank
Assistant Professor of Emergency Medicine
Assistant Program Director
Mount Sinai Emergency Medicine Residency
Editor, AKOSMED (EM wellness blog)
Michelle Lin, MD
ALiEM Editor-in-Chief
Academy Endowed Chair of EM Education
Professor of Clinical Emergency Medicine
University of California, San Francisco
Michelle Lin, MD
Michelle Lin, MD

Latest posts by Michelle Lin, MD (see all)

Jonathan Sherbino, MD, MEd
Associate Professor, McMaster University
Clinician Educator,
Royal College of Physicians & Surgeons of Canada