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!