The learning environment is often when work-life integration obscures and burnout begins. Medical 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.
- Physician Wellness: Preventing Resident and Fellow Burnout, AMA STEPS Forward CME bearing module
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.
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
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:
- Peer group discussion of events or case studies
Managing Emotions after Challenging Patient Care Experiences, Resilience in the Face of Grief and Loss AAP Curriculum
American Academy of Pediatrics