Create a holistic, supportive culture of wellness

Physician Wellness: Preventing Resident and Fellow Burnout

  • Toyin Okanlawon, MD, MPH Harvard Business School
CME Credits: 0.5
Physician Wellness: Preventing Resident and Fellow Burnout

How will this module help me successfully create a wellness program?

  1. Understand the importance of wellness for the trainee and the program as a whole
  2. Identify ways to create a sustainable culture of wellness and mental resiliency among trainees and clinical educators
  3. Learn about successful wellness programs across the country in case studies

CME accreditation information 

Increasing administrative responsibilities—due to regulatory pressures and evolving payment and care delivery models—reduce the amount of time physicians spend delivering direct patient care. Physicians in residency and fellowship training often experience depression, lack of mental resiliency and symptoms of burnout caused by demanding workloads, nights on call and other common stressors. Residency programs that create a sustainable culture of wellness and provide trainees with tools and resources to manage stress and burnout will produce more engaged physicians who can provide high-quality care to their patients.

Preventing resident and fellow burnout
Release Date: October 2015
End Date: October 2019

Objectives

At the end of this activity, participants will be able to:

  1. Describe how to develop or establish a wellness framework.
  2. Encourage a culture of wellness and resiliency among trainees and clinical educators.
  3. Administer a survey to assess wellness among residents and fellows.
  4. Develop activities to increase wellness and personal awareness.

Target Audience

This activity is designed to meet the educational needs of practicing physicians.

Statement of Need

Residency and fellowship training is a challenging period in a physician’s career, with many personal and professional stressors that can lead to burnout. Physicians in training are at increased risk for depression compared to their peers. Wellness programs implemented as part of the training program can help guide trainees on what they can personally do in their lives to help avoid burnout. By providing opportunities for residents and fellows to experience a supportive program environment that is committed to wellness, physicians will become engaged in wellness activities that will become integrated into their lives as they continue in their careers.

Statement of Competency

This activity is designed to address the following ABMS/ACGME competencies: practice-based learning and improvement, interpersonal and communications skills, professionalism, systems-based practice and also address interdisciplinary teamwork and quality improvement.

Accreditation Statement

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

The American Medical Association designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claiming Your CME Credit

To claim AMA PRA Category 1 Credit™, you must 1) view the module content in its entirety, 2) successfully complete the quiz answering 4 out of 5 questions correctly and 3) complete the evaluation.

Planning Committee

  • Alejandro Aparicio, MD, Director, Medical Education Programs, AMA
  • Rita LePard, CME Program Committee, AMA
  • Ellie Rajcevich, MPA, Practice Development Advisor, Professional Satisfaction and Practice Sustainability, AMA
  • Sam Reynolds, MBA, Director, Professional Satisfaction and Practice Sustainability, AMA
  • Christine Sinsky, MD, Vice President, Professional Satisfaction, American Medical Association and Internist, Medical Associates Clinic and Health Plans, Dubuque, IA
  • Krystal White, MBA, Program Administrator, Professional Satisfaction and Practice Sustainability, AMA

Author(s)

  • Toyin Okanlawon, MD, MPH, Senior Health Care Research Associate, Harvard Business School

Faculty

  • Ralph S. Greco, MD, Distinguished Professor of Surgery, Johnson and Johnson and Director, Balance in Life Program, Stanford University School of Medicine
  • Frank M. Reed, MD, Family Physician, Senior Clinical Professor, University of Montana, Family Medicine Residency of Western Montana
  • Tina Shah, MD, MPH, 2014 - 2015 National Chair of the AMA Resident and Fellow Section
  • Chris Sudduth, MD, MPH, Internal Medicine-Pediatrics Resident Physician, University of Oklahoma School of Community Medicine
  • Rosa Karbowiak, MBA, Director, Resident and Fellow Section, AMA
  • Emilie Y. Prot, DO, Preventive Medicine Residency, Austin TX
  • Jane E. Shersher, MSW, Founder of Ava Today
  • Ellie Rajcevich, MPA, Practice Development Advisor, Professional Satisfaction and Practice Sustainability, AMA
  • Sam Reynolds, MBA, Director, Professional Satisfaction and Practice Sustainability, AMA
  • Christine Sinsky, MD, Vice President, Professional Satisfaction, American Medical Association and Internist, Medical Associates Clinic and Health Plans, Dubuque, IA

About the Professional Satisfaction, Practice Sustainability Group

The AMA Professional Satisfaction and Practice Sustainability group has been tasked with developing and promoting innovative strategies that create sustainable practices. Leveraging findings from the 2013 AMA/RAND Health study, “Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy,” and other research sources, the group developed a series of practice transformation strategies. Each has the potential to reduce or eliminate inefficiency in broader office-based physician practices and improve health outcomes, increase operational productivity and reduce health care costs.

Disclosure Statement

The content of this activity does not relate to any product of a commercial interest as defined by the ACCME; therefore, neither the planners nor the faculty have relevant financial relationships to disclose.

Media Types

This activity is available to learners through Internet and Print.

Hardware/software Requirements

Adobe Flash 9.0.115 or above
Audio speakers or headphones
Screen resolution of 800X600 or higher
MS Internet Explorer 8.0 or higher, Firefox, Opera, Safari, etc.
Adobe Reader 5.0 or higher

References

  1. Shersher J. Six key aspects of personal well-being. Telephone interview by Okanlawon T. July 25, 2015.
  2. Shanafelt TD, Kaups KL, Nelson H, et al. An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons. Ann Surg. 2014;259(1):82-88.
  3. Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well-being: assessment of an innovative program. J Gen Intern Med. 2007;22(11):1544-1552.
  4. Eckleberry-Hunt J, Van Dyke A, Lick D, Tucciarone J. Changing the conversation from burnout to wellness: physician well-being in residency training programs. J Grad Med Educ. 2009;1(2):225-230.
  5. Lefebvre, DC. Perspective: Resident physician wellness: a new hope. Acad Med. 2012;87(5):598-602.
  6. Ahmed N, Devitt KS, Keshet I, Spicer J, Imrie K, Feldman L, Rutka J. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg. 2014;259(6):1041-1053.
  7. Rubin R. Recent suicides highlight need to address depression in medical students and residents. JAMA. 2014;312(17):1725-1727.
  8. Milling TJ. Drug and alcohol use in emergency medicine residency: an impaired resident's perspective. Ann Emerg Med. 2005;46(2):148-151.
  9. Cedfeldt AS, Bower E, Flores C, Brunett P, Choi D, Girard DE. Promoting resident wellness: evaluation of a time-off policy to increase residents’ utilization of health care services. Acad Med. 2015;90(5):678-683.
  10. Shapiro J. Perspective: Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training. Acad Med. 2011;86(3):326-332.
  11. Perry MY, Osborne WE. Health and wellness in residents who matriculate into physician training programs. Am J Obstet Gynecol. 2003;189(3):679-683.
  12. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med. 2006;81(1):82-85.
  13. Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among patients in VA hospitals in the first 2 years following ACGME resident duty hour reform. JAMA. 2007;298(9):984-992.
  14. Drolet BC, Rodgers S. A comprehensive medical student wellness program—design and implementation at Vanderbilt School of Medicine. Acad Med. 2010;85(1):103-110.
  15. Koran LM, Litt IF. House staff well-being. West J Med. 1988;148(1):97-101.
  16. Parshuram CS, Dhanani S, Kirsh JA, Cox PN. Fellowship training, workload, fatigue and physical stress: a prospective observational study. CMAJ. 2004;170(6):965-970.
  17. Landrigan CP, Fahrenkopf AM, Lewin D, et al. Effects of the Accreditation Council for Graduate Medical Education duty hour limits on sleep, work hours, and safety. Pediatrics. 2008;122(2):250-258.
  18. Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336(7642):488-491.
  19. Prins JT, van der Heijden FMMA, Hoeksrta-Weebers JE, et al. Burnout, engagement and resident physicians’ self-reported errors. Psychol Health Med. 2009;14(66):654-666.
  20. Moonesinghe SR, Lowery J, Shahi N, Millen A, Beard JD. Impact of reduction in working hours for doctors in training on postgraduate medical education and patient’s outcomes: systematic review. BMJ. 2011;342:d1580
  21. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714-1721.
  22. Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual, 3rd ed. Consulting Psychologists: Palo Alto, CA; 1996.
  23. Chen PW. A Medical School More Like Hogwarts. The New York Times. http://well.blogs.nytimes.com/2011/12/22/a-medical-school-more-like-hogwarts/?_r=0. Published December 22, 2011. Accessed July 23, 2015.
  24. Hobson K. New Medical School Programs Help Students Battle Burnout. U.S. News & World Report. http://www.usnews.com/education/best-graduate-schools/top-medical-schools/articles/2013/03/21/new-medical-school-programs-help-students-battle-burnout. Published March 21, 2013. Accessed July 23, 2015.
  25. 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. J Grad Med Educ. 2015;7(1):143-147.
  26. AMA Wire. How one program achieved resident wellness, work-life balance. http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance. Accessed August 24, 2015.
  27. Mayo Clinic Florida. Accessed August 24, 2015
  28. Mata DA, Ramos MA, Narinder B et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373-2383.
  29. Sklar, DP. Fostering Student, Resident, and Faculty Wellness to Produce Healthy Doctors and a Healthy Population. Academic Medicine. 2016;91(9):1185-1188 doi: 10.1097/ACM.0000000000001298

Introduction

What is wellness?

Increasing rates of suicides, depression and burnout and decreasing personal and professional satisfaction among physicians emphasize the importance of creating a wellness culture within graduate medical education (GME) programs. In fact, the increasing number of residents and fellows who describe experiencing burnout highlights a growing crisis within the medical workforce. Physician burnout is a long-term stress reaction characterized by depersonalization, including cynical or negative attitudes toward patients, emotional exhaustion, a feeling of decreased personal achievement and a lack of empathy for patients. Conversely, wellness consists of multi-dimensional aspects that in combination lead to optimal levels of health and emotional and social functioning. A concerted effort to increase wellness and resiliency during medical training will produce physicians who are less stressed and better able to engage with their patients and provide higher quality care.

Resident and physician wellness introduction
Robert Wah, MD

The most important patient we have to take care of is the one in the mirror.

Robert Wah, MD
Former AMA president, Reproductive Endocrinology, National Institutes of Health (NIH)
and Walter Reed National Military Medical Center, Bethesda MD

Five steps to create a wellness culture

  1. Create a framework
  2. Develop a program
  3. Foster at individual level
  4. Empower faculty and trainees to confront burnout
  5. Create a sustainable culture of wellness and resiliency
  1. 1

    Create a wellness framework

    To create a sustainable, engaging wellness program, a framework must first be built. This will require the time and dedication of key people, especially residents who can lead their program and organization to make a commitment to the wellness of fellow trainees and potentially the entire medical staff.

    1. A
      Identify a group or team of trainees and faculty members who can serve as wellness advocates or champions

    Many programs have enlisted the support of chief residents, the program director and others who have a particular interest in wellness. Others have hired new faculty members who, in addition to their clinical expertise, have expressed an interest in wellness. Start a special interest group to involve those who have an interest in wellness from the very beginning. The wellness team may want to consider including a social worker or psychiatrist as an advisor as well.

    1. B
      Secure leadership support

    Set up a meeting with your program director, involving the wellness champions who have been identified. Bring examples of what other programs have done (see case studies) and examples of the benefits of a wellness program. An organizational commitment to wellness leads to a healthy workforce and better patient care. The responsibility of wellness must be shared within the program.

  • Why is wellness important?

    Employers have found that happy, engaged workers are more productive. Years ago, companies such as Goldman Sachs and Google made an organizational commitment to create wellness programs for their employees. The cultural shift has been dramatic, resulting in a more productive, satisfied workforce with happier clients and better outcomes. The story of Goldman Sachs’ resiliency program’s success can be found here. The same impact can be made in the field of medicine.

  • What can we do to help our leaders understand the value of wellness?

    The more data you can show leaders, the better. The stressful, high-stakes work of taking care of patients, combined with an intense medical training period can compromise residents’ and fellows’ wellness. As training programs continue to prioritize clinical competency and knowledge, educating trainees on how to better care for themselves is becoming increasingly important. Further, integrating wellness within a program enhances trainees’ ability to fulfill the six core competencies as described by the Accreditation Council for Graduate Medical Education (ACGME).

    Work-related exhaustion is one of the many variables contributing to increased medical errors; a physician whose health is compromised is more likely to provide suboptimal care. Lastly, there is an undeniable link between physician well-being and physician satisfaction. To learn more about this topic among trainees, stay tuned for the results of the national 2015 survey on the determinants of resident satisfaction, which was conducted by the AMA Resident and Fellow Section.

    If wellness is considered a vital quality indicator, then a training program without a wellness focus could prove catastrophic for the individual, patients and the organization. Physicians who are mentally and emotionally detached from their work are unlikely to provide quality care or positive patient/physician interactions. To ensure a healthy physician workforce, prioritizing wellness is a must and requires concerted efforts by both the individual and the training program leadership.

    1. C
      Identify your program’s and/or institution’s definition of wellness

    It is important to focus on a specific definition that is agreed upon by the wellness team members. What does it mean to be well? What aspects of wellness should be included as part of the wellness program’s scope? Completing this exercise will unite the team around what is most important.

    1. D
      Evaluate the current state of wellness and burnout

    As the group begins its work, understanding the current state of wellness will help the team focus efforts and initiatives in addressing burnout as experienced by residents and fellows in your training program. Administer a survey to assess wellness at the beginning of the year. Plan to reassess wellness periodically throughout the course of the year as interventions are introduced to see if your changes are making a positive impact. Encourage trainees to respond to the survey honestly and reflectively with the understanding that individual responses will remain confidential.

    1. E
      Schedule times for the wellness team to regularly discuss wellness survey results

    The team may decide to include the program’s wellness score on the department dashboard or scorecard, so everyone becomes accustomed to thinking about wellness as a quality indicator. Based on survey findings, the team can develop action plans to address themes or take recommendations into consideration, such as scheduling more wellness activities for trainees.

  • What if we have concerns about the time and energy required for regular wellness assessments?

    Data is important for developing a framework upon which to build a wellness program. Regular surveys and reviews of survey data also show a commitment to measuring and responding to wellness concerns and recommendations that have been shared by trainees. In addition, people who are committed to wellness can often make a big impact by simply being active listeners and good observers of their colleagues and identifying when someone needs help. When someone does need help, he or she may not be comfortable indicating it on a formal survey or at a staff meeting.

  • What if we think a member of our training program is burned out or in distress?

    Someone may not indicate on a survey that they need help, so do not rely on the survey as the sole source of information. Trainees should be made aware that they can speak in confidence about personal wellness concerns or issues with a wellness champion or leader in their training program. Leaders should make resources available confidentially for people who seek help. This is an integral aspect of wellness program development.

  1. 2

    Develop a wellness program

    1. A
      Innovate and design custom interventions that meet the needs of both individual trainees and the training program

    Use results from the initial wellness survey to understand where to start. Consider holding an initial brainstorming session with the wellness team to determine which interventions or activities could increase wellness among trainees.

    • If trainees are having a hard time transitioning into their new roles, provide peer support or a “buddy” program where new trainees can be paired with someone in postgraduate year (PGY) 2, who was in their shoes the previous year.
    • If the threats to wellness involve working too many hours, the wellness group can work with program leaders to manage the amount of time trainees work to mitigate burnout.
    • If trainees feel like the program is “all work and no play,” schedule group wellness events. These are an opportunity for everyone to have fun and connect with one another outside of the workplace (not to identify who seems stressed or down). Plan activities such as:
      • Movie nights or dinners
      • Holiday potlucks
      • Ballroom dancing classes including spouses and significant others
      • Local charity work (e.g., volunteer at a soup kitchen)
      • Lunchtime exercise or yoga classes
      • Participation in a local 5k or color run
      • Sporting events (e.g., playing in a recreational league, watching a televised match or attending a university game)
      • Watching popular shows as a team
      • Painting or pottery classes
      • Exploring the local environment (e.g., experience a local jazz club in New Orleans, a hike in Colorado or a bus tour in New York City)
    1. B
      Educate trainees, staff and faculty on what wellness is and how to achieve it

    Incorporate wellness into the fabric of the training program. This may include relevant sessions, workshops, lectures or grand rounds. Ideally, these activities would be incorporated into the curriculum and would not require significant amounts of time outside of regular responsibilities. The wellness team should strive to develop a holistic, engaging wellness curriculum that exposes all trainees to important wellness practices that will make an impact on each trainee’s life as a doctor.

    1. C
      Re-evaluate and redesign

    Continue to ensure that wellness initiatives and programs are aligned with achieving the program’s wellness priorities. Use the same measurement instruments throughout the year, and compare results. The preliminary assessment can serve as a benchmark that clarifies the needs of the trainees and informs the direction of the wellness program. On subsequent monthly or quarterly wellness assessments, monitor how the culture is changing. Open-ended survey questions that require written answers are a great way to learn more about the state of wellness in the training program and about what interventions or activities would lead to meaningful improvements in wellness. For example, ask trainees to rate the wellness activities from the previous three months, and ask them to recommend new activities for the upcoming months.

    The cyclical nature of residency and fellowship training programs requires constant innovation. The best programs are structured and proactive, effectively establishing and then sustaining a supportive culture of learning and wellness. Keep track of the activities that the wellness program hosts or sponsors, and how well trainees respond to them at the event and on post-event surveys. Use this feedback to establish which events should be held annually (e.g., a holiday potluck and wellness grand rounds) or even quarterly. The wellness team will likely need to tailor aspects of the program every year to meet the needs of the current residents and fellows.

  1. 3

    Foster individual wellness

    In addition to providing opportunities for residents and fellows to experience a supportive program environment that is committed to wellness, it is important to give trainees the tools to develop individual wellness. Through a supportive environment, trainees will become engaged in wellness activities and will make them a part of their life. The wellness program can help foster individual wellness in many ways, including these tactics to increase engagement:

    • Creating “buzz” around wellness events and activities
      • Visible recognition (e.g., name a wellness champion for each PGY)
      • Social events (e.g., field day, softball tournament, dance-off)
      • Engage spouses and significant others
    • Send notifications about wellness activities and events from someone whose endorsement matters (e.g., program director or wellness champion)
    • Assign “wellness partners” of faculty and trainees who will engage in goal-oriented discussions on emotional, spiritual, physical and social aspects of wellness, to help trainees develop a personal wellness approach
    • Develop a physician support group for trainees and faculty members
    • Relax, renew and re-energize through hosted events (e.g., retreats with team-building and self-awareness exercises, stress management approaches)

    For residents, there are six key aspects1 of personal well-being. Incorporate lessons on each of these aspects into your wellness program, and as much as possible, build them into the existing training program framework:

    1. Nutrition (e.g., healthful food options and scheduled time to eat)
    2. Fitness
    3. Emotional health
    4. Preventive care (e.g., dental care and provisions to see a primary care physician)
    5. Financial health (e.g., debt management, retirement planning and emergency fund support)
    6. Mindset and behavior adaptability

    Use these six keys to personal well-being to shape the wellness program’s activities. Bring in a financial counselor to have informal discussions with interested residents. Make sure residents have free access to a gym that is located in or near the medical center. The wellness team can sponsor department meetings to ensure that healthful food is available. Program leadership can commit to giving trainees an occasional weekday afternoon off for personal meetings or doctor appointments.

Avoid burnout by taking a proactive approach to your own wellness #STEPSforward

  • What are some effective personal strategies to achieve wellness?

    There are many strategies that residents and fellows can use to take wellness into their own hands.2 Work with other trainees and leaders in your program to create an environment where these wellness tactics can be applied on an individual level.

    Balance personal and professional goals

    • Clarify what is most important in your personal and professional life
    • Identify conflicts
    • Learn techniques to adapt your daily routine around factors that are out of your control (e.g., your work schedule)

    Shape your career and identify stressors

    • Determine whether you need to make career changes
    • Identify what energizes you and what drains you
    • Decide how stressors can be modified

    Nurture wellness strategies

    • Relationships
    • Self-care
      • Eat and sleep
      • Exercise
      • Vacation
    • Mindfulness-based stress reduction
    • Personal interests
  • Our physicians and staff are overwhelmed. How can we find time to implement wellness initiatives?

    The fact that faculty members are overwhelmed is itself justification for taking the time to engage in wellness activities. With strong leadership support for wellness initiatives, time can be found for wellness. Whether it is through annual faculty retreats or at one of the many faculty meetings held each month, wellness activities and discussions can be integrated into existing training program events. Helping trainees find time for self-care should be an institutional priority. Prioritizing self-care is often natural after wellness is discussed in grand rounds or highlighted at a department meeting.

  1. 4

    Empower faculty and trainees to confront burnout

    The hierarchy of the medical profession can make residents and fellows feel uncomfortable approaching a more senior member of the medical staff about wellness issues. While creating an anonymous reporting system can be helpful, trainees should be encouraged and empowered to seek and offer help as needed. The wellness team’s role in accepting feedback and acting on it is crucial to the wellness program’s success. Empowering all trainees and members of the medical staff to identify signs of burnout and act on them engages everyone in the issue of wellness and can create a sense of community around a topic that impacts all physicians—and all of their patients.

Empower Faculty
  1. 5

    Create a sustainable culture of wellness and resiliency

    Continue to survey trainees on a regular basis, and give new residents the opportunity to become involved as members of the wellness team. Include people who become interested at any point; if someone becomes interested in their final year of training, welcome them onto the wellness team. Continue to include faculty advisors and enable them to become more involved in wellness work as well. Effective leadership involvement by leaders and impactful recruitment of new members, coupled with a strong framework (e.g., regular survey administration, annual wellness grand rounds and regular wellness activities planned by the wellness team) will ensure the longevity and success of the wellness program.

  • What is the ultimate goal of the wellness program?

    In time, residents and fellows will have built a community where everyone prioritizes wellness. New trainees will be welcomed into a robust framework where physicians are resilient, engage in wellness activities and are in tune with their level of wellness throughout their training. This increased self- and environmental-awareness will become an important part of learning during crucial developmental years for young physicians. These lessons will help keep the residents and fellows well enough to care for themselves and their patients as the training program seeks to prepare them for a successful career in medicine. They will likely experience longer, more fulfilling careers due to their ability to remain resilient and combat physician burnout.

Only by applying robust measures of wellbeing, engaging physicians in reflection and conversation about promoting it in the workplace, tracking it as a meaningful outcome and making changes to enhance its realization, will physicians and their organizations thrive in their service to patients.3


Even small changes can make a big difference

There is no change too small when it comes to addressing burnout and improving the wellness and resiliency of residents and fellows. Programs that prioritize their trainees’ wellness will produce more engaged physicians who can provide quality care to their patients. If your training program is hesitant to commit to developing a wellness program, align with others who are interested in wellness and create a special interest group or club. Host a grand rounds speaker and invite your colleagues and faculty to wellness events. Your involvement may make a big difference to someone who needs it. In time, your activities will gain support to create a more formal program.

+ More

Conclusion

A commitment to wellness will help ensure that residents and fellows are involved and engaged in their training program as well as in their care of patients. Equipping trainees with skills to foster their own wellness will serve them, their families and their patients throughout their careers. The strategies, tools and resources in this module can assist you in creating a wellness culture that fits your training program’s needs.

Resident and fellow wellness conclusion

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References

  1. Shersher J. Six key aspects of personal well-being. Telephone interview by Okanlawon T. July 25, 2015.
  2. Shanafelt TD, Kaups KL, Nelson H, et al. An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons. Ann Surg. 2014;259(1):82-88.
  3. Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well-being: assessment of an innovative program. J Gen Intern Med. 2007;22(11):1544-1552.
  4. Eckleberry-Hunt J, Van Dyke A, Lick D, Tucciarone J. Changing the conversation from burnout to wellness: physician well-being in residency training programs. J Grad Med Educ. 2009;1(2):225-230.
  5. Lefebvre, DC. Perspective: Resident physician wellness: a new hope. Acad Med. 2012;87(5):598-602.
  6. Ahmed N, Devitt KS, Keshet I, Spicer J, Imrie K, Feldman L, Rutka J. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg. 2014;259(6):1041-1053.
  7. Rubin R. Recent suicides highlight need to address depression in medical students and residents. JAMA. 2014;312(17):1725-1727.
  8. Milling TJ. Drug and alcohol use in emergency medicine residency: an impaired resident's perspective. Ann Emerg Med. 2005;46(2):148-151.
  9. Cedfeldt AS, Bower E, Flores C, Brunett P, Choi D, Girard DE. Promoting resident wellness: evaluation of a time-off policy to increase residents’ utilization of health care services. Acad Med. 2015;90(5):678-683.
  10. Shapiro J. Perspective: Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training. Acad Med. 2011;86(3):326-332.
  11. Perry MY, Osborne WE. Health and wellness in residents who matriculate into physician training programs. Am J Obstet Gynecol. 2003;189(3):679-683.
  12. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med. 2006;81(1):82-85.
  13. Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among patients in VA hospitals in the first 2 years following ACGME resident duty hour reform. JAMA. 2007;298(9):984-992.
  14. Drolet BC, Rodgers S. A comprehensive medical student wellness program—design and implementation at Vanderbilt School of Medicine. Acad Med. 2010;85(1):103-110.
  15. Koran LM, Litt IF. House staff well-being. West J Med. 1988;148(1):97-101.
  16. Parshuram CS, Dhanani S, Kirsh JA, Cox PN. Fellowship training, workload, fatigue and physical stress: a prospective observational study. CMAJ. 2004;170(6):965-970.
  17. Landrigan CP, Fahrenkopf AM, Lewin D, et al. Effects of the Accreditation Council for Graduate Medical Education duty hour limits on sleep, work hours, and safety. Pediatrics. 2008;122(2):250-258.
  18. Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336(7642):488-491.
  19. Prins JT, van der Heijden FMMA, Hoeksrta-Weebers JE, et al. Burnout, engagement and resident physicians’ self-reported errors. Psychol Health Med. 2009;14(66):654-666.
  20. Moonesinghe SR, Lowery J, Shahi N, Millen A, Beard JD. Impact of reduction in working hours for doctors in training on postgraduate medical education and patient’s outcomes: systematic review. BMJ. 2011;342:d1580
  21. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714-1721.
  22. Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual, 3rd ed. Consulting Psychologists: Palo Alto, CA; 1996.
  23. Chen PW. A Medical School More Like Hogwarts. The New York Times. http://well.blogs.nytimes.com/2011/12/22/a-medical-school-more-like-hogwarts/?_r=0. Published December 22, 2011. Accessed July 23, 2015.
  24. Hobson K. New Medical School Programs Help Students Battle Burnout. U.S. News & World Report. http://www.usnews.com/education/best-graduate-schools/top-medical-schools/articles/2013/03/21/new-medical-school-programs-help-students-battle-burnout. Published March 21, 2013. Accessed July 23, 2015.
  25. 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. J Grad Med Educ. 2015;7(1):143-147.
  26. AMA Wire. How one program achieved resident wellness, work-life balance. http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance. Accessed August 24, 2015.
  27. Mayo Clinic Florida. Accessed August 24, 2015
  28. Mata DA, Ramos MA, Narinder B et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373-2383.
  29. Sklar, DP. Fostering Student, Resident, and Faculty Wellness to Produce Healthy Doctors and a Healthy Population. Academic Medicine. 2016;91(9):1185-1188 doi: 10.1097/ACM.0000000000001298

STEPS in practice

Case 1

How’s it working in Jacksonville, FL?

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Case 2

How is it working in Palo Alto, CA?

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Case 3

How’s it working in Nashville, TN?

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Case 4

How’s it working in Birmingham, AL?

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Downloadable tools

Go to Resource Library

The tools and resources here can offer implementation support for your practice. You can download and modify them to fit your specific needs.

Complete wellness toolkit

Access all tools and resources for this module.

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(ZIP, 1,934 KB)

Module Completion

Individual tools

  • Physician wellness: preventing resident and fellow burnout module

    Download a printable PDF version of this module.

    Download

    PDF, 556 KB

    Preview
  • Physician wellness: preventing resident and fellow burnout PowerPoint

    Use this PowerPoint presentation to review this module with your team.

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    PPT, 1,296 KB

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  • How FERHAWI meets ACGME core competencies

    Learn how one residency program demonstrates that their wellness program meets ACGME competencies.

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    PDF, 214 KB

    Preview
  • Wellness activities and workshop topics

    A list of suggested activities and workshop topics for resident programs and trainees to consider to help establish a culture of wellness.

    Download

    MS WORD, 32 KB

    Preview
  • AMA Wire - Preventing Resident and Fellow Burnout

    Article adapted from the AMA Wire® that summarizes the STEPS Forward module on Preventing Resident and Fellow Burnout.

    Download

    PDF, 143 KB

    Preview

Implementation support

The AMA is committed to helping you implement the solutions presented in this module.

If you would like to learn about available resources for implementing the strategies presented in this module, please call us at (800) 987‑1106 or send us a message.

Implementation Support

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Obtaining CME credits with STEPS Forward

AMA PRA Category 1 Credit™ will be available for the activity. Physicians should claim only the credit commensurate with the extent of their participation in the activity. In order to claim AMA PRA Category 1 Credit™, you must: 1) view the module in its entirety, 2) successfully complete the quiz by answering 4 out of 5 questions correctly and 3) complete the evaluation.

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If you have already completed this module, you can claim AMA PRA Category 1 Credit™ or receive a certificate of participation through the AMA Education Center.

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