Helping Those Who Help Others: Building a Medical Resident...
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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
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Faculty Disclosure
The presenters of this session have NOT had any relevant financial relationships
during the past 12 months.
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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.
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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:
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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.
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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
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Learning Assessment
A learning assessment is required for CE credit.
A question and answer period will be conducted at the
end of this presentation.
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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)
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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)
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Medscape Lifestyle Report 2017: Factors Which Promote Burnout
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A Snapshot of Burnout
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A Snapshot of Burnout
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A Snapshot of Burnout
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A Snapshot of Burnout
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Day 1: New rotation
First day
“Overextended”
Night shifts
After a 28 hour shift
The Realities of Burnout
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When you make a mistake
When you nail a diagnosisWhen you do everything right and
they still die
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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
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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.
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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)
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Our Resident Wellness Program
Retreat
Wellness Lecture Series
Health Half Days
Resident-to-Resident Mentorship
Evaluation
Resident Wellness Board
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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
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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
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Learning AssessmentAudience Question & Answer
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Session Evaluation
Please complete and return theevaluation form to the classroom monitor before leaving this
session.
Thank you!