Program Director’s Corner – May 2019
The Importance of Trainees Well-being and Example of an Effective Program
Ricardo Correa, MD, Es.D
Program Director, Endocrine Fellowship Program
University of Arizona College of Medicine Phoenix
Karyne Vinales, MD
Associate Program Director, Endocrine Fellowship Program
University of Arizona College of Medicine Phoenix
Medicine is a demanding profession. Physicians, especially physicians-in-training, experience high levels of work-related stress, burnout, and mental health disorders. This is concerning, not only because physician wellness affects individual physicians, but because physician health and wellness is central to the quality and safety of the care patients receive. Physician well-being has even been suggested as a potential missing quality indicator (1). During the training stages, fellows and residents are more susceptible to developing dehumanizing traits and stigmatizing attitudes (1). This is very important because it translates to poor patient care and/or patient safety. These early years of training and practice often shape a physician’s future, especially with respect to Well-being; during this period coping strategies are established and implemented, parameters of lifestyle are set, and preventive health behaviors are acquired (1). Physician well-being is defined as the presence of positive emotions and moods, the absence of negative emotions, satisfaction with life, fulfillment and positive functioning” in the context of “physical wellness.” (2).
Physician well-being can be divided into two dimensions: 1. Stress, Burnout and Sleep Deprivation (SBSD); and 2. Substance Abuse Disorder (SAD). SBSD is not a new phenomenon, but its prevalence has been increasing in the last years (3). It is defined as a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that can affect the quality of care and productivity with dire consequences for health systems (4). Besides this statement, sleep deprivation has been linked to a higher risk of surgical complications, medical errors, increased rate of needle-stick injuries and post-shift car accidents (5). SAD might be more common than one would imagine. The most commonly abused substance is alcohol, but sedatives, stimulants or opiates, and psychedelics are also used by physicians (6).
Over the past years, physician well-being has become a hot topic among patients, providers and national and international medical organizations. Several systematic reviews and meta-analyses have consistently found higher suicide rates among medical professionals (7). Some of them found that the suicide rate ratio for male physicians, compared to the general population, was 1.41; for female physicians, the ratio was 2.27 (8). Every year several resident or fellows commit suicide and endocrinology is not the exception. These are not isolated events but more the tip of the iceberg of a bigger problem that involves graduate medical education, humans, and medicine as an organization.
The title VII CPR released by the ACGME in 2017 (9) introduces a new section, that we had the privilege to work for, related to well-being. The notion of keeping our fellows away from burn out and improving their wellness at work is stated in every of the core or detail program requirements.
How to implement helpful strategies for improving well-being depends on the institution’s resources, and other variables. Programs that stimulate diversity and inclusion have been shown to improve trainee wellness (we will talk about this in a future article).
We would like to present a simple project that has improved physician-in-training wellness. This strategy is based on peer support.
The program name is Big Brother. The methodology is straightforward as we explain below.
Each Junior fellow would be assigned to a senior fellow as their “Big Brother” or mentor two weeks before the start of the fellowship. These “Big Brothers” would guide the fellows through their first year of fellowship with, at minimum, monthly one-on-one meetings to discuss progression through one’s milestones and guiding through any challenges the junior fellow have. Each session should emphasize stress coping mechanisms and prioritization of self-care. Junior Fellows could be also be introduced to the Employee Assistance Plan or any other program that the institution offers. Every three months, the “Big Brothers” and mentees should collectively meet in small groups to review a pertinent topic about self-care and mental health issues in the medical community. At this time, all participants would also complete a survey to evaluate the program. The survey should contain a depression screening scale and a rubric to determine if this program was helpful. The program would end after 12 months.
If you want to implement this program in your fellowship or want to learn about other program to improve wellness, please contact us for more details on it at riccorrea20@hotmail.com and karclima@hotmail.com
References
1. Institute of Medicine, To Err is Human: Building a Safer Health System. 2000. Available at http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx
2. Centers for Disease Control & Prevention. Health-related Quality of Life: Well-being Concepts. 2013. Available at http://www.cdc.gov/hrqol/well-being.htm
3. Burnout During Residency: A Literature Review. J Grad Med Educ. Dec. 2009.
4. Dewa C et al. How does burnout affect physician productivity? A systematic literature review. BMC Health Services Res 2014; 14:325.
5. Olson E et al. Sleep Deprivation, Physician Performance, and Patient Safety. Chest 2009; 136(5):1389-96.
6. Oreskovich M et al. The prevalence of substance use disorders in American physicians. Am J on Addictions 2014; doi: 10.111/j.1521-0391.2014.12173.x
7. Schernhammer E & Colditz G. Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Anay, Am J Psychiatry 2004; 161(12):2295-2302
8. Gong, Y. et al. Prevalence of anxiety and depressive symptoms and related risk factors among physicians in China: a cross-sectional study. PLoS One, 2014; 9(7).
9. Ahn Y, Bach P, Berry T, Correa R, et al. Physician well-being. Junior Doctor Network. World Medical Association 2017. Personal communication with senior author Elizabeth Wiley.
10. Burchiel KJ, Zetterman RK, Ludmerer KM, Philibert I, Correa R, et al. The 2017 ACGME Common Work Hour Standards: Promoting Physician Learning and Professional Development in a Safe, Humane Environment. J Grad Med Educ. 2017 Dec;9(6):692-696