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Helping Those Who Help Others: Building a Medical Resident Wellness Program
Tyler J. Lawrence, M.A.
Jennifer S. Harsh, Ph.D.
Jill K. Wagoner, M.D.
Session # B6
Friday, October 20, 2017
CFHA 19th Annual ConferenceOctober 19-21, 2017 • Houston, Texas
Faculty Disclosure
The presenters of this session have NOT had any relevant financial relationships
during the past 12 months.
Conference ResourcesSlides and handouts shared in advance by our Conference Presenters are available on the
CFHA website at http://www.cfha.net/?page=Resources_2017
Slides and handouts are also available on the mobile app.
Learning Objectives
• Describe the resident perspective of burnout and factors that increase the risk of developing burnout.
• List and describe evidence-based components of a resident wellness program.
• Discuss strategies for beginning or enhancing a resident wellness program.
At the conclusion of this session, the participant will be able to:
References1.Anagnostopoulos, F., Liolios, E., Persefonis, G., Slater, J., Kafetsios, K., & Niakas, D. (2012).
Physician burnout and patient satisfaction with consultation in primary health care settings: evidence of
relationships from a one-with-many design. Journal of Clinical Psychology in Medical Settings, 19(4),
401-410.
2.Bragard, I., Etienne, A. M., Merckaert, I., Libert, Y., & Razavi, D. (2010). Efficacy of a communication
and stress management training on medical residents' self-efficacy, stress to communicate and
burnout: a randomized controlled study. Journal of Health Psychology, 15(7), 1075-1081.
3.Dyrbye, L. N., Varkey, P., Boone, S. L., Satele, D. V., Sloan, J. A., & Shanafelt, T. D. (2013). Physician
satisfaction and burnout at different career stages. Mayo Clinic Proceedings, 88(12), 1358-1367.
4.Ghetti, C., Chang, J., & Gosman, G. (2009). Burnout, psychological skills, and empathy: balint
training in obstetrics and gynecology residents. Journal of Graduate Medical Education, 1(2), 231-235.
5.Gunasingam, N., Burns, K., Edwards, J., Dinh, M., & Walton, M. (2015). Reducing stress and burnout
in junior doctors: the impact of debriefing sessions. Postgraduate Medicine Journal, 91(1074), 182-187.
6.Martins, A. E., Davenport, M. C., Del Valle, M. P., Di Lalla, S., Dominguez, P., Ormando, L., . . .
Ferrero, F. (2011). Impact of a brief intervention on the burnout levels of pediatric residents. Jornal de
Pediatria, 87(6), 493-498.
References1.Maslach, C., Jackson, S. E., & Leiter, M. P. (1997). Maslach burnout inventory. Evaluating stress: A
book of resources, 3, 191-218.
2.McCue, J. D., & Sachs, C. L. (1991). A stress management workshop improves residents' coping
skills. Archives of Internal Medicine, 151(11), 2273-2277.
3.Ospina-Kammerer, V., & Figley, C. R. (2003). An evaluation of the Respiratory One Method (ROM) in
reducing emotional exhaustion among family physician residents. International Journal of Emergency
Mental Health and Human Resilience, 5(1), 29-32.
4.Ripp, J., Fallar, R., Babyatsky, M., David, R., Reich, L., & Korenstein, D. (2010). Prevalence of
resident burnout at the start of training. Teaching and Learning in Medicine, 22(3), 172-175.
5.Ripp, J. A., Fallar, R., & Korenstein, D. (2016). A randomized controlled trial to decrease job burnout
in first-year internal medicine residents using a facilitated discussion group intervention. Journal of
Graduate Medical Education, 8(2), 256-259.
6.Shanafelt, T. D., Bradley, K. A., Wipf, J. E., & Back, A. L. (2002). Burnout and self-reported patient
care in an internal medicine residency program. Annals of Internal Medicine, 136(5), 358-367.
7.http://www.medscape.com/features/slideshow/lifestyle/2017/overview
Learning Assessment
A learning assessment is required for CE credit.
A question and answer period will be conducted at the
end of this presentation.
Burnout: Definition and PrevalenceBurnout is a combination of:
Emotional Exhaustion
– No longer able to give yourself at a psychological level because of depleted emotional energy
Depersonalization
– Cynical or negative feelings toward patients
Reduced Personal Accomplishment
– Inclination toward negative self-evaluation
Medscape Lifestyle Report 2017
1. (Maslach, Jackson, & Leiter, 1997)
Effects of Burnout • Suboptimal patient care1
• Medical negligence or malpractice litigation2
• Increased odds of suicidal ideation3
• Reductions in work effort4
• Reduced viability of healthcare systems5
• Suffering
1. (Shanafelt, Bradley, Wipf, & Back, 2002)
2. (Anagnostopoulos, Liolios, Persefonis, Slater, Kafetsios, & Niakas, 2012)
3. (Dyrbye et al., 2008)
4. (Dyrbye & Shanafelt, 2011)
5. (West, Dyrbye, Erwin, & Shanafelt, 2016)
Medscape Lifestyle Report 2017: Factors Which Promote Burnout
A Snapshot of Burnout
A Snapshot of Burnout
A Snapshot of Burnout
A Snapshot of Burnout
Day 1: New rotation
First day
“Overextended”
Night shifts
After a 28 hour shift
The Realities of Burnout
When you make a mistake
When you nail a diagnosisWhen you do everything right and
they still die
Factors of Burnout Constant vigilance
Persistent, high stress decision making
Inability to ‘leave it at work’
Social impasses that detract from the
healing high
Difficult patient situations/outcomes
60-80 hour weeks, constantly
”You can do anything for a week”
becomes the norm.
Communal defeatism
Group support, group suffering
Curriculum Creep (outside of 80hr
weeks)
Monthly Journal club
Learning modules
Computer training for multi-hospital
programs
Further boards studying
Research emphasis
QI projects
Typical Day6-8:30am
– Pre-round on patients, read charts, visit patient, put in orders, make 10-20 treatment decisions before 830.
8:30-12
– Discuss and defend those decisions on rounds, walking rounds with patients until 12.
12-1pm
– Straight to lecture. Step out for 3-4 pages.1-5pm
– Finish orders, return pages, family meetings, discuss with consults and Social Work. Occasional afternoon rounds. Up to 40 pages throughout the day, constant re-interpretation of data and decision making (not always supervised). Small break for more coffee/snack if able.
5-7pm
– Prepare for night coverage team, with instructions and anticipated needs for patients overnight. Checkout to coworkers on night shift.
7-?
– Home for dinner, socializing, family time.
Evidence-based resident wellness programs
Communication skills and stress management
training1
Wellness lecture2
Self-care workshops3
Facilitated discussion
groups4
Balintgroups5
Stress management
workshop6
Respiratory One
Method7
BATHE technique8
1. (Bragard, Etienne,
Merckaert, Libert,
& Razavi, 2010
2. (Gunasingam,
Burns, Edwards,
Dinh, & Walton,
2015)
3. (Martins et al.,
2011)
4. (Ripp, Fallar, &
Korenstein, 2016)
5. (Ghetti, Chang, &
Gosman, 2009)
6. (McCue & Sachs,
1991)
7. (Ospina-
Kammerer &
Figley, 2003)
8. (Milstein,
Raingruber,
Bennett, Kon,
Winn, & Paterniti,
2009)
Our Resident Wellness Program
Retreat
Wellness Lecture Series
Health Half Days
Resident-to-Resident Mentorship
Evaluation
Resident Wellness Board
Wellness Lecture Series Topics
Introduction to Wellness and Biopsychosocial Goal Setting
Resident Wellness Resources
Physical Wellbeing
Emotional Health, Burnout, and Resilience
Relational Wellbeing
Managing Second Victim Difficulties
Wellness in Your Work SettingWhat is one (or one more) wellness intervention you could incorporate into your work setting?
Consider the following
• Who are the stakeholders?
• Are there other “wellness champions” who can assist you?
• Feasibility
• Combined individual and organizational strategies
Learning AssessmentAudience Question & Answer
Session Evaluation
Please complete and return theevaluation form to the classroom monitor before leaving this
session.
Thank you!