Identifying Gaps and Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit

ABSTRACT Background Wellness initiatives implemented by graduate medical education programs can help mitigate burnout in resident physicians. Objective This systematic review seeks to identify factors that impact the effectiveness of resident wellness interventions and to provide a conceptual framework to guide future interventions. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 6 electronic databases were searched in November 2019 using variations of the keywords “resident physicians,” “wellness,” and “intervention.” Peer-reviewed full-text English-language articles on controlled studies were considered for inclusion. The quality of the studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. Results The initial search disclosed 1196 articles, of which 18 studies enrolling 666 resident physicians met inclusion criteria for qualitative review. Interventions using peer support and individual meditation enhanced well-being. Effective wellness interventions also used educational theory to guide program development, surveyed participants to guide intervention design, incorporated programming into existing didactic curricula, and recruited voluntary participants. The quality of most of the included studies was poor (13 of 18, 72%) and could be improved by using standardized wellness assessments supported by validity evidence. Conclusions This systematic review suggests that future resident wellness initiatives should focus on grounding interventions in educational theory, forging consensus on wellness instruments with validity evidence, and examining the impact of initiatives on patient outcomes. A logic model can provide a framework for designing and implementing effective wellness interventions.

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Six Steps to Achieve Meaning, Wellness, and Avoid Burnout in a Residency Program

Journal of Medical Education and Curricular Development ◽

10.1177/2382120520978238 ◽

2020 ◽

Vol 7 ◽

pp. 238212052097823

Author(s):

Brian Stamm ◽

Margaret Yu ◽

Christina M Lineback ◽

Danny Bega

Keyword(s):

Training Program ◽

Team Building ◽

Future Directions ◽

Resident Wellness ◽

Wellness Curriculum ◽

Community Team ◽

The Impact ◽

Wellness Initiatives ◽

Higher Medical Education

Burnout has become an increasingly recognized problem in higher medical education and is particularly prevalent within the field of Neurology and its training programs. Many previously reported wellness initiatives in other residencies focused mainly on community/team building. We developed a comprehensive Wellness Curriculum (WC) and established a new role of Resident Wellness Liaison in order to facilitate wellness across the department and training program. Here we present a 6-step outline of our WC which can easily be adapted to the needs of other programs. The steps include creating a Wellness Committee with a Resident Wellness Liaison, identification and optimization of institutional resources, identifying and troubleshooting barriers to wellness, providing education and reflection on wellness, showing appreciation to each other, and assessing the impact of the implemented strategies. In order to measure the impact of our WC and to perform a needs assessment for future directions, we posed questions—grounded in the theory of drivers of burnout and engagement—to our residents (N = 24) at a noon conference in the summer of 2020. Interventions implemented at our institution have been very well received by residents, as evidenced by their comments and feedback. Themes that were highlighted by residents include enjoying flexibility, having a welcoming social support system at work, and being able to find meaning in the day-to-day work. The creation of a comprehensive WC is a feasible and meaningful intervention for addressing resident wellness in a Neurology training program and could be adapted to other programs.

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Targeted Wellness Initiatives Are Most Effective for Reducing Otolaryngology Resident Burnout

Ear Nose & Throat Journal ◽

10.1177/01455613211009139 ◽

2021 ◽

pp. 014556132110091

Author(s):

Joseph R. Acevedo ◽

Jamie A. Schlacter ◽

Tamara N. Chambers ◽

Lia K. Jacobson ◽

Ronica Yalamanchili ◽

...

Keyword(s):

Program Implementation ◽

Positive Culture ◽

Maslach Burnout Inventory ◽

Hospital Environment ◽

Easy Access ◽

Wellness Program ◽

Resident Wellness ◽

Resident Burnout ◽

Personal Resilience ◽

Wellness Initiatives

Objective: Investigate the effect of a targeted wellness program on burnout in Otolaryngology residents. Methods: Residents and faculty collaboratively developed a program aimed at improving resident wellness. Program implementation began in July of 2018 and after 1 year, residents evaluated the program’s effects on burnout. We used the Maslach Burnout Inventory (MBI) and a Likert scale to evaluate the effects of the program. Results: After 1 year of the resident wellness program, the MBI results showed an increase in the number of residents in the “engaged” category and a decrease in those rated as “burnout.” Residents rated favorably initiatives grouped into the following themes: time away from work, faculty engaging with residents outside of the hospital environment, efforts to enhance residents’ self-efficacy, fostering a positive culture among residents, and providing easy access to physical activity. The majority of initiatives were targeted to the “culture of wellness” domain, as defined by the Stanford Well MD framework. Our program targeted to a lesser extent the other 2 domains, “efficiency of practice” and “personal resilience.” Conclusion: After 1 year, the wellness program resulted in a trend toward improving burnout. Future efforts should be focused on targeting the multidimensional drivers of burnout as defined by established wellness frameworks. Realizing new stressors brought on by the COVID-19 pandemic will also be an area of active effort and research.

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Two Novel Approaches to Improve Otolaryngology Resident Wellness: The ACGME Back to Bedside Initiative

Otolaryngology ◽

10.1177/0194599818758272 ◽

2018 ◽

Vol 158 (6) ◽

pp. 979-980 ◽

Cited By ~ 6

Author(s):

Emily C. Ambrose ◽

Jenna Devare ◽

Carl M. Truesdale ◽

Ellen Ricker ◽

Janice Firn ◽

...

Keyword(s):

Mental Illness ◽

Medical Education ◽

Learning Environment ◽

Training Programs ◽

Professional Burnout ◽

Review Committee ◽

Resident Wellness ◽

Resident Burnout ◽

Novel Approaches ◽

Wellness Initiatives

Rates of burnout, mental illness, and suicide are disproportionately elevated among physicians, and surgical specialists, including otolaryngologists, are at even higher risk for professional burnout. These trends have been identified at both the trainee and attending level. To combat resident burnout, the Accreditation Council for Graduate Medical Education (ACGME) Council of Review Committee Residents (CRCR) designed the Back to Bedside Initiative, the goals of which are to foster meaning in the learning environment and to help trainees to engage more deeply with patients. Two funded Back to Bedside proposals involve otolaryngology training programs. Herein, we discuss these 2 approaches in an effort to foster additional novel resident wellness initiatives and awareness thereof across our subspecialty.

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63. Developing a program for resident wellness at the postgraduate medical education office, University of Torontos

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2824 ◽

2007 ◽

Vol 30 (4) ◽

pp. 63 ◽

Cited By ~ 1

Author(s):

S. Edwards ◽

S. Verma ◽

R. Zulla

Keyword(s):

Mental Health ◽

Medical Education ◽

Stress Management ◽

Residency Training ◽

Medical Training ◽

Postgraduate Medical Education ◽

Program Directors ◽

University Of Toronto ◽

Resident Wellness ◽

The University

Prevalence of stress-related mental health problems in residents is equal to, or greater than, the general population. Medical training has been identified as the most significant negative influence on resident mental health. At the same time, residents possess inadequate stress management and general wellness skills and poor help-seeking behaviours. Unique barriers prevent residents from self-identifying and seeking assistance. Stress management programs in medical education have been shown to decrease subjective distress and increase wellness and coping skills. The University of Toronto operates the largest postgraduate medical training program in the country. The Director of Resident Wellness position was created in the Postgraduate Medical Education Office to develop a systemic approach to resident wellness that facilitates early detection and intervention of significant stress related problems and promote professionalism. Phase One of this new initiative has been to highlight its presence to residents and program directors by speaking to resident wellness issues at educational events. Resources on stress management, professional services, mental health, and financial management have been identified and posted on the postgraduate medical education website and circulated to program directors. Partnerships have been established with physician health professionals, the University of Toronto, and the Professional Association of Residents and Internes of Ontario. Research opportunities for determining prevalence and effective management strategies for stress related problems are being identified and ultimately programs/resources will be implemented to ensure that resident have readily accessible resources. The establishment of a Resident Wellness Strategy from its embryonic stags and the challenges faced are presented as a template for implementing similar programs at other medical schools. Earle L, Kelly L. Coping Strategies, Depression and Anxiety among Ontario Family Medicine Residents. Canadian Family Physician 2005; 51:242-3. Cohen J, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Medical Education; 5(21). Levey RE. Sources of stress for residents and recommendations for programs to assist them. Academic Med 2001; 70(2):142-150.

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Improving physician wellness through electronic health record education

The International Journal of Psychiatry in Medicine ◽

10.1177/00912174211034633 ◽

2021 ◽

pp. 009121742110346

Author(s):

Elizabette Johnson ◽

Elizabeth Roth

Keyword(s):

Electronic Health Record ◽

Statistical Significance ◽

Resident Physician ◽

Health Record ◽

Physician Burnout ◽

Paired Data ◽

Post Intervention ◽

Physician Wellness ◽

Resident Wellness ◽

Electronic Health

Objective Our goal is to improve the wellness of our Family Medicine residents now and in the future by educating them on more efficient use of our electronic health record (EHR). Resident physician burnout is a significant problem and is correlated with time spent using an EHR after work hours. Family physicians have the highest rate of burnout of all specialties, and the EHR is a significant contributor to this burnout. Studies have shown that increased EHR education can improve job satisfaction. Method Over 5 months, we provided weekly brief (15 minute) educational sessions covering 6 topics twice and a one-hour individualized meeting of each resident physician with an EHR trainer. We evaluated our intervention with wellness surveys and objective measures of EHR efficiency both pre and post intervention. We further evaluated efficiency by comparing pre and post-intervention values of the following: average keystrokes, mouseclicks, accelerator use, minutes per encounter and percent closed encounters at month’s end. Results Resident questionnaires showed lessons increased knowledge and intention to use EHR accelerators, but this was not statistically significant. Analysis of objective data showed most efficiency metrics worsened, though most not to a degree that was statistically significant. Residents reported subjective increases in efficiency, and paired data from wellness surveys showed an overall decrease in burnout post-intervention vs. baseline. Conclusions Much of the data in this pilot study does not reach statistical significance, but is highly suggestive that increased EHR training can improve at least perceived efficiency and thereby resident wellness.

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