Resident Wellness Program Key Considerations Podcast

Posted by Dike Drummond MD

resident wellness resident resilience program podcastResident Wellness and Resilience Podcast

What are the key components of an effective burnout prevention program for Residency and Fellowship trainees?

Amy Vinson M.D., F.A.A.P from the Boston Children's Pediatric Anesthesia program and I sat down today and recorded this powerful conversation about the stresses of becoming a doctor. This is the master list of causes of burnout we must mitigate against in residency.

The message of the Quadruple Aim is spreading. If you want to take better care of your residents and give them the skills to avoid burnout in the future, this conversation is a superb place to start.

A Must Listen if you are involved in Resident Wellness and Resilience Program design.

(a full list of the topics we covered is below the audio frame) 

Dike Drummond MD, CEO
Amy Vinson M.D., F.A.A.P – Boston Children’s Pediatric Anesthesia Fellowship

Building an effective Resident Wellness and Resilience Program Podcast

Topics Covered:

The differences in specific stressors between the specialties
Specifically primary care vs. anesthesia/pathology/radiology
The support possible in primary care where you are with colleagues frequently
As opposed to anesthesia where you work alone and share war stories later

The hard wiring of medical education to support competition
A gladiator style survival contest
The role of trauma and the lack of support for the traumatized resident that we must mitigate for

Why does the training need to be so hard?
We are not trying to make the training less rigorous
We are trying to make a more resilient physician AND a quality physician
Compare it to military – another area where you must be able to work under pressure and in crisis
We need to perform under crisis conditions … over and over
The training has got to be rigorous, stressful and demanding
Candidate selection
Adequate preparation
Their clinical skills
Protecting their humanity through the training program
And give them habits that will lead to future resilience

The skill of giving the task at hand your “undivided attention”
“Cognitive behavior therapy for executive function”

The difference between healthcare and military training process
Military is TEAM focused
Healthcare is the gladiator style
And we give them habits that ensure burnout down the road

Lifetime incidence of burnout is over 100%
We sow the seeds of burnout in training
Why are we not mitigating for this in training

Is there something inherent in certain specialties that makes them more resilient?
Look at the prevalence data
(the daily burnout rate is 1 in 3 across all specialties!)

The amount of crap that we must complete
That separates us from the patient
Patient satisfaction vs. the truth
Paperwork is squeezing doctors out of their jobs as PA’s/NP’s come in to see patients and do some of the data entry
This outsources the best part of being a doctor … being in contact with the patients
Even as an anesthesiologist you are in direct contact in consenting the patient pre-op
An intimate conversation you would not want to miss
Going back to the basics of medicine
They ask about their deepest fears
It is a therapeutic relationship

The benefit of a physician community and social structure
Where you get together outside of work
As opposed to today’s matrix of gerbil cages
Where we rarely interact with colleagues and rarely outside the workplace
Something is lost in this disconnection
The mutual support and social bonding
You can’t talk about these stresses to patients, administrators or your significant other

So building community is important … and it can begin in residency

Physicians are made not born
The training remakes all of us
You have to do different things for doctors than other people / workers

Malpractice risk always falls to the shoulders of the physician
It is another high risk feature of the job we can prepare residents for in training

When bad things happen how do we create a culture that leans in and support them
Rather than isolate them as if they have ebola
Lawsuit, bad outcome … how can we lean in and support them as we would a friend

It is so helpful for Amy that her office – her “safe place” is shared with a good friend. They care about each other.

This brings up the Gallup 12 questions - from “First Break all the Rules”

If your people – residents/employees/team members can answer yes to these
you have a high performing team. Can your residents answer all these with a “Yes”?

1. Do I know what is expected of me at work?
2. Do I have the materials and equipment I need to do my work right?
3. At work, do I have the opportunity to do what I do best every day?
4. In the last seven days, have I received recognition or praise for doing good work?
5. Does my supervisor, or someone at work, seem to care about me as a person?
6. Is there someone at work who encourages my development?
7. At work, do my opinions count?
8. Does the mission/purpose of my company make me feel my job is important?
9. Are my co-workers committed to doing quality work?
10. Do I have a best friend at work?
11. In the last six months, has someone at work talked to me about my progress?
12. This last year, have I had opportunities at work to learn and grow?

People have a basic drive to do a good job
They are stressed when the work environment obstructs that

How do we create a rigorous training?
Can we simultaneously do two things?
• That we care about you as a resident in a way that you can have faith in this institution
• Can we give you the skills to continue to care about your patients AND COLLEAGUES AND TEAM MEMBERS

Your Residency Support Groups
An attendee who never participated … said this:
“I don’t know that I got anything out of these
And it was really great to know you were there”
THAT IS what he got out of it!

This is a different curriculum
It is not intellectually based
There will be no multiple choice question
And the challenge is can you be
• Technically excellent
• AND a human being with the capability of a human connection

Caring AND Technical Expertise

Without this education in training
The employer organizations on the outside must create this CULTURE OF CARING
For the people in the system
Ideally it is just an extension of the CULTURE established in residency

Wellness / Resilience must compete for time in the curriculum that is maxed out on producing a technically excellent clinician

The future will be TEAM centered
How can you demonstrate you care for the members of your team?
See the Gallup 12 above

The changing general level of respect in society
Due to physicians in survival mode complaining about being doctors
The larger population does not want to hear a “rich doctor” complain at work

Can we create a workplace that feels like home?
Where you get to do what you love to do in a supportive environment

Survival mode and its shut down of awareness and caring
Put your white coat armor on
Keep your head down
And focus on getting out of there ASAP
Survival mode is epidemic in all members of the care team
And it does not have to be that way
All energy to the shields, limit your exposure

There is a much greater AWARENESS these days about these issues
Due to the connection between burnout, quality, satisfaction and safety

As a group we can design and test meaningful interventions
And create best practice candidates

How to teach the choice point of
Do I stay with this patient or stay to finish these charts
Or do I go home to be with my family
How do we fine tune that decision process?
The doctor who always stays for the patient, loses their family/spouse/significant other
How do you decide to let work go and head home?
And deal with the feelings that come up

How do you talk with your spouse about the exception?
The time you stay at work
And how do you make sure it is an exception in your practice
We don’t teach how to have these conversations
How to be a physician and have a life

Tags: resident burnout