Promoting wellness is a team sport. It takes more than one individual to champion it at any institution. In medicine, when a team is formed to effect change, it is called a committee. Dr. Dan Lakoff was one of the founding leaders of the council of residency wellness committee, and has also helped lead wellness efforts at his own institution. Here he shares his thoughts, his inspiration, and practical ideas that helped improve wellness at his program.
|Daniel Lakoff, MD, FACEP
|Icahn School of Medicine at Mount Sinai, New York, NY
|Attending Physician, Associate Residency Director
How did you become interested in wellness and resilience?
I became interested in the topic of wellness and resilience by witnessing and experiencing the paradox of medicine: where physicians are being held to high standards charged with the care of patients, but are not caring for themselves. For centuries a physician’s skill has been measured in lives saved, suffering eased, human kindness, and prowess in teaching. Now we are simply and bluntly being measured by metrics and profitability. This transformation of values has led to profound discontent, as we’ve been asked to play a game treating numbers and not people. My goal is to work with like-minded individuals to help effect culture change so that we include physician satisfaction in the equation of what makes a department and hospital work well.
What resilience and wellness initiative have you started? What is your role?
I have been fortunate to have be surrounded by great colleagues who have provided support and helped nurture ideas. I have part of the team that has helped transform our Wellness program at Mount Sinai from one based on social events to one with a meaningful educational structure and support network. I am also co-chair of a newly formed GME Wellness subcommittee at my institution and a co-chair of the CORD (Council of Residency Directors) Resilience Committee where we are aiming to find ways to share ideas to improve residency wellness nationally. Specific changes implemented include the following:
Lecture series: The overarching plan is to have a 24 month curriculum and lecture series. This year our Wellness Committee residents took on the task of being the lecturers for near-peer teaching. In lectures we discussed topics such as impostor syndrome, sleep, and debriefing. We have also tried round table discussions and free writes, and have plans to do more small group discussions and resilience training next year.
Surveys on Wellness and Resilience: Just as we are taught that the plural of anecdote does not equal data, we were faced with the reality that no institutional change can occur without data. In light of this, we have implemented the use of the Maslach Burnout Inventory (MBI) as a means to measure residency wellness. Though we are still considering alternative tools, the MBI has definitely proven useful to shed light on the current mood of our residency and support our wellness movement.
Wellness month: After one attempt at a wellness week, it was obvious that we not able to include all our residents in the events due to the complexity of our academic schedules, so we morphed our wellness week into a wellness month. We scheduled it right after the winter holidays during the dreaded “Block 8” when the cold and dark of a Northeastern winter hits the hardest. During that month, we hosted a set of 4 bolstered “Tuesday Night Fun” or “TNF” events, and also scheduled events on Wednesdays post-conference. Examples of “TNF” events from the past year included: attending a movie as a group, an excursion to a trendy bar with some activities (shuffleboard), a “whine and cheese”. Examples of post-Wednesday conference events were: a spa trip, a yoga session, spending time with puppies, and a ski trip. Our conferences themselves had a few wellness-related lectures and small group sessions as well.
Sports Series: One other highlight for our program is our resident-vs-attending sports series in which we have organized three games over the course of the year with softball, basketball, and touch football. It has been a great way to get faculty and residents together outside of our typical confines and has lead to some great stories and camaraderie.
What has been the outcome or result of your initiatives?
At the departmental level, I think our residents see that we care about their wellbeing as well as their education. At the GME level, we have been able to move our agenda forward of making residency more “live-able”, not just a time of life that needs to be survived. Nationally at CORD, we have made great progress on a few fronts, but I think as a specialty and physicians, the efforts to fight burnout are about to catch fire (no pun intended)!
What hurdles have you had to overcome?
With the current tidal wave of interest in the subject and mounting discourse right now, I have been fortunate in that I have not run into any major hurdles.
Where have you found support?
At the program-level, we have obtained support from all important and involved parties in the equation, from our graduate medical education (GME) office, chairman, and program director. Nationally, the council of residency directors (CORD) leadership and membership has been extraordinarily supportive of our endeavors on the resilience committee.
What do you see as most important for promoting wellness in your program?
The first and most important step is that we had to re-brand, broaden, and reframe the meaning of “wellness” at our program. It went from simply meaning social gatherings (usually involving alcohol) to a legitimate academic focus. The next few critical steps that added legitimacy to our wellness committee were to build a solid team, define what “wellness” meant to us and our program, and finally put pen to paper to create the wellness curriculum and academic calendar.
What would you recommend as important, practical steps that individuals at other institutions could take?
- Build enthusiasm for your wellness program by building an awesome team of like-minded attendings and residents.
- Identify all current practices that are wellness-related and claim them as wellness initiatives, with plans to bolster or infuse them with some educational concepts and integrate them with the wellness curriculum as a whole.
- Start developing a strategy for a longitudinal curriculum to ensure spaced-repetition of wellness education
- Try to change the climate at your institution as a whole by engaging the GME with the concept of resident wellness
- Ensure your team is rewarded for their hard work with positivity and opportunities for career growth.