Learning Environment


​Physician Health & Wellness

Learning Environment 

Introduction 


The learning environment is often when work-life 
integration obscures and burnout beginsMedical
students and residents often experience higher rates of burnout and depression compared 
to their similar age peers. (JAMA 2016) These increased rates can be seen as soon as 3 months into internship. (Arch Gen Psychiatry 2010) 

The learning environment can be a major contributor to resident and intern experiences and how well they are able to manage work-life integration, combat burnout, and maintain mental health. Explore the strategies and resources below for opportunities to bolster the learning environment and create a culture of wellness in residency.  

    Policies and Procedures to Support Wellness

    There are many ways a residency program can support physician well-being. Ensuring wellness is integrated into the foundation of the residency program can shape many resident and intern experiences as well as bolster other wellness supports. The following are only some suggested areas of focus when examining policies and procedures.  

    Orientation 

    Are residents offered wellness resources during orientation? Is work-life integration explicitly addressed? Are residents offered a wellness plan during orientation? Do you address stressors or supports?

    Family leave 

    Do you offer family leave? Does it extend the residency?  

    Sick or personal time 

    What is your policy regarding sick or personal time? Are you encouraging physicians to work while ill?   

    Wellness curriculum 

    Have you identified institutional resources that support well-being and mental health? Do you share these resources with residents and interns? Does your organization wellness committee include efforts to support wellness to residents? Are the organizational wellness activities open to residents and are residents offered time to attend? 

    Crisis management plan 

    Do you have a plan for managing crises such as the death of a trainee? Have you identified a Crisis Response Team? Do you have a communication plan? Does it include an opportunity for resident grief? 

    *Adapted from ACGME Inventory of Elements of Your Institutional Well-Being Plan 

    Physical environment and wellness 

    Access to healthy foods and beverages: 

    • Improve resident meals. 

    • Snack breaks: Consider stations of healthy snacks for residents to grab and go healthy options.  

    • Offer water stations at easy to access resident locations such as paperwork stations. Offer water bottles to residents. 

    • Offer quick exercise opportunities – 20 minutes. Bare-essentials gym (or resistance bands in meeting spaces); walking treadmills or desk cycles for administration stations; movement rituals before meetings, walking meetings, etc . 

    • Post wellness reminders throughout the physical space.

    Space to recharge: reorganize existing space such as call rooms into retreat areas for residents can recharge after adverse events, long shifts, etc. 

    Communal spaces: Create a sense of community with the resident for example, host monthly/quarterly dinners. 
    Train Faculty

    Mentorship in faculty 

    Faculty mentors serve a pivotal resource for residents and interns. However, they often struggle with mentor fatigue, demand burden, and lack of training. This can lead to dissatisfaction and burnout of both mentor and mentee. Effective mentors need to be supported and offered regular professional development by their institutions.  

    Learn more: 

    The Secret Sauce to Successful Mentorships, AAP Mentorship Program Webinar 2019 

    Optimizing your Mentoring Relationship: A Toolkit for Mentors and Mentees, MedEdPortal 2016 

    Wellness coaching 

    Wellness coaching focuses on health care provider performance challenges and can help pediatricians recapture meaning, joy, and satisfaction through self-awareness, problem solving, and skills. Coaches may use mindfulness and resilience training as well as stress management techniques.  

    Learn more: 

    Coaching to Enhance Individual Well-Being, Foster Teamwork, and Improve the Health Care System, NEJM Catalyst 2017 

    Support mental health 

    It is important to identify and understand that all trainees have emotions of sadness, guilt and anger.  

    About one third of medical students are depressed. One in 10 report suicidal thoughts. (JAMA 2016) 

    Faculty can create a culture that supports the mental health and wellness of training physicians. Allow physicians to feel, make errors, and offer opportunities for residents to talk about their own current and past struggles. Programs can offer: 

    • Faculty panels to share stories of struggles and mental health needs 

    • Peer support groups  

    • Resident-only gatherings 

    • Second year residents to shepherd interns 

    • Dedicated wellness coaches with office hours

    Train Residents

    ​EMR training in medical school 

    Medical school and residency programs are encouraged to offer training regarding the electronic health record to prepare the new generation of physicians. It can also be a strategy to combat professional dissatisfaction in practice. EHR training can decrease time spent documenting patient visits and increase physician satisfaction. Individually tailored EHR training has been shown to improve physician confidence and efficiency. (J Oncology Practice 2018) Find more resources on our practice environment page.  

    Mentorship and coaching 

    Mentorship produces value beyond the creation of good leaders. It contributes to recruitment, retention, and development of the next generation of health care leaders. Effective mentorship has been shown to have many benefits for mentees, mentors, and their institutions. Mentorship can improve job satisfaction and productivity, facilitate personal growth and career satisfaction, and lessen risk of compassion fatigue and burnout. (Hosp Pediatr 2016;  Fam Med 2014.) Nearly half of medical students and residents do not have a mentor. Residency programs can offer mentors to interns and residents. The AAP offers an online mentorship and networking program that enables members across the country to connect on common interests across the country.  
     
    “I was so burned out that I was actually praying for appendicitis on my way to work just to have some time off. I loved my job and colleagues, but the hassles of insurance companies, documentation for billing and coding and malpractice prophylaxis, arguing with parents who felt Dr. Google knew better really took its toll. I took a month off, made a huge career change, worked with a physician coach and a therapist, and am now enjoying my job and my life more than I have in years. I'm mid-career, 9 years out of neonatology fellowship. I'm starting to say "no", and doing things I'm passionate about. I'm no longer sacrificing the care of myself to impress others, trying to let go of perfectionism. It's been quite a journey. I'm here and anxious to help anyone who is struggling. It can get better! Don't be afraid to make a change, you are not trapped like a caged bird with it's wings cut, you have a choice in your happiness! Also, don't let your career as a physician be your identify. Don't forget to have fun!” 

    Learn more: 

    The Secret Sauce to Successful Mentorships, AAP Mentorship Program Webinar 2019 
Skill development 


Recognizing burnout:

Knowing the signs and symptoms of burnout can help prevent burnout. Be aware of the following signs or symptoms: 

  • Changes in mood or personality 

  • Frustration or cynicism: Are you or a colleague feeling like what you do doesn’t matter? Have you become disillusioned by medicine? 

  • Professional exhaustion 

  • Lack of motivation 

  • Trouble concentrating or becoming more forgetful 

  • Declining job performance 

  • Intrapersonal conflicts: Are you or a colleague having more arguments at home? Is someone withdrawing from social interactions? 

Talking to colleagues about burnout: 

“We absolutely need to look at and address the drivers of the problem, but meanwhile, we have to take care of each other.” – Michael Munger, MD, former president of the AAFP.

Identifying burnout in ourselves is important to our own wellness. But we also need to support each other. We should be able to recognize the signs of burnout in our friends and colleagues. If you feel someone might be experiencing burnout, your first step could be to reach out and give them an opportunity to talk about it. Remember to initiate empathic, open, non-judgmental dialogue.  

“This has been a rough rotation for me. How have you been holding up?” 

“It seems you have a lot on your plate right now. How are you feeling?”

The medical community has struggled with accepting our own infallibility. We can change this culture by not judging each other for perceived weakness and understanding that wellness is an integral part to becoming a successful physician.  

Do you feel your friend or colleague is struggling with more than just burnout, such as suicidal ideation? It is important to get them help from a trained professional immediately.  

Hear more: 

Stop Physician Burnout – How to Reach Out to a Colleague, Dike Drummond The Happy MD 

Residency programs should: 

  • Talk about the warning signs for suicide 

  • Normalize seeking care and ensure regular access to counseling, peer support groups, and community resources 

  • Build a community of support with the resident and interns 

Building wellness plans:

Residency programs can support wellness by encouraging interns and residents to build their own wellness plan.  

This year, I developed a very simple mini-personal strategic plan. I thought about my goals, thoughts and plans for 2019. I took about 15-20 minutes of quiet time and came up with 4 domains - work life, AAP life, personal (me) life, and family life. I divided a piece of paper into 4 parts and came up with 1-3 goals in each of those areas. Now, I will do my best to keep myself accountable to these goals, knowing that they may and probably will change or look a little different come the end of 2019. However, it gives me a sounding board to come back to and bounce off future ideas, projects or asks. Does this bring me toward my goals? Will it distract from my goals? Will this augment an important area of my life? Is it worth my time? – Pediatrician 

Read more: 

Johns Hopkins Medicine Resident Wellness Toolkit 

Medical errors and delivering bad news: 

A common cause of resident stress is related to the fear of making medical errors or delivering bad news. The culture of medicine needs to address the human physician by creating a training atmosphere that turns errors into a positive learning event rather than an event to cope or survive.  

Talk about medical errors: Physicians often report speaking about their error with colleagues as a helpful learning and processing tool. It is important for colleagues to avoid minimizing the seriousness of the error, dismiss emotions, or offer solutions. Programs can offer opportunities for faculty to share past medical errors and build a peer support group to discuss errors and focus on building teamwork improvement strategies.  

Practice and process delivering bad news: Sharing bad news with patients is an unfortunate part of practicing medicine. Not all patients will recover or have positive outcomes. This can be especially challenging for pediatricians to share poor outcomes with families and children. Residency can be a supportive environment to build skills delivering bad news and processing emotions afterwards. Strategies can include: 

  • Role-playing 

  • Peer group discussion of events or case studies 

  • Journaling 

Learn more: 

Managing Emotions after Challenging Patient Care Experiences, Resilience in the Face of Grief and Loss AAP Curriculum 

Wisdom in Medicine: What Helps Physicians After a Medical Error? Acad Med 2016    

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