Department of Anesthesiology, Perioperative and Pain Medicine Boston Children’s Hospital, a Harvard Medical School Teaching Hospital

Development of a Comprehensive Wellness Curriculum for a 1-year Pediatric Anesthesiology Fellowship Amy Vinson, MD, Laura Downey, MD, Mary Landrigan-Ossar, MD, PhD, Robert Holzman, MD, Yuan-Chi Lin, MD, MPH

Stressor Orientation !

• Goal to address and reframe the major stressors cited anecdotally by prior trainees. !Structure:

• 20 minute lecture and Q&A at orientation for new trainees !Status of implementation

• Implemented in October 2013 • Anecdotal reports by trainees that it was helpful for attenuating the impact of certain stressors.

Monthly Lecture Series !

• Introduce key wellness concepts • Focus on small, achievable goals and lifestyle changes • Pre-lecture online module (increases knowledge

retention) with pre-test • Post-test to follow • Lectures will focus on background, achievable behavior

changes, and a period for self-reflection and questions !Topics:

• What is Burnout? • What is Mindfulness? • What is the Relaxation Response? • Nutrition in a busy life • Ergonomics in practice • Physical fitness • Substance abuse • Sticking to a budget • Organization and efficiency • Getting your first job • Balancing family and work

!Status of implementation

• Pursuing identification as a recognized CME course • Plan to roll out in July 2014

Monthly Small Group !

• Goal to decrease the sense of isolation that can occur with strong emotional responses to clinical experiences

• To encourage self reflection and awareness of these emotional responses !

Structure: • Monthly meeting in fellow’s lounge • Facilitated by junior faculty • Voluntary participation • Vegas rule: What happens there, stays

there! !!Status of implementation

• Implemented in January 2014 with good levels of participation

Resource Awareness !

• Goal to increase awareness of already existing wellness and support resources

• Resources include support services, cultural activities and primary care and psychiatric provider lists. !

Structure: • Resource board in fellow’s lounge • Resource list on internal website !!

Status of implementation • Resource board in place since Spring 2013 • Online resources in phase of formatting!!!!!!!!!! Future Directions

!Complete Implementation

• Roll out monthly morning lectures • Invest in “library” of wellness related

books for fellows • Optimize on-line resource availability • Institute fitness and nutrition initiatives !

Study • Pre and post-test data from lectures • Maslach Burnout Inventory study for

fellows at beginning and end of year • Survey assessments • Eventual long-term followup studies !!

Portability • Assist other programs in

implementation of curriculum • Generalize our program to all

members of the department

Self-care as a Competency

!!!!!!Canada

“Demonstrate a commitment to physician health and sustainable

practice” !!!!!!United Kingdom

“Demonstrate knowledge of responsibility to look after personal

health, including maintaining a suitable balance between work and personal life, and knowing how to deal with personal

illness and protect patients”

Wellness

Education & Awareness

Skills & ResilienceSupport

General Approach !

• Education - wellness topics • Awareness - resources available • Support - informal and formal • Skills - achievable life changes • Resilience - the ultimate goal !!!!!

Background and Scope of the Problem

!As we are restructuring our curriculum for a new milestones based structure, we are including a new wellness curriculum for our fellows to:

• Decrease burnout • Increase resilience • Improve patient care • Improve overall health !!

• Burnout is a problem amongst US physicians, as measured by the Maslach Burnout Inventory1

• Anesthesiologists experience high levels of burnout2

• Younger anesthesiologists are more susceptible3

• Behavior based interventions can decrease levels of burnout4

• Wellness, burnout prevention and resilience training are not taught in every medical school

• A recent study suggest higher degrees of mindfulness improve patient satisfaction5

• Many studies link burnout to various aspects of personal health6

Selected References: 1. Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, CA: Consulting Psychologist Press: 1996 2. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012 Oct 8;172(18):1377-85 3. Nyssen, A.S., et al., Occupational stress and burnout in anaesthesia. Br J Anaesth, 2003. 90(3): p. 333-7. 4. Goodman MJ, Schorling JB. A mindfulness course decreases burnout and improves well-being among healthcare providers. Int J Psychiatry Med. 2012;43(2):119-28. 5. Beach MC, Roter D, Korthuis PT, Epstein RM, Sharp V, Ratanawongsa N, Cohn J, Eggly S, Sankar A, Moore RD, Saha S. A multicenter study of physician mindfulness and health care quality. Ann Fam Med. 2013 Sep-Oct;11(5):421-8. 6. The association between burnout and physical illness in the general population--results from the Finnish Health 2000 Study. Honkonen T, Ahola K, Pertovaara M, Isometsä E, Kalimo R,Nykyri E, Aromaa A, Lönnqvist J. J Psychosom Res. 2006 Jul;61(1):59-66.