Mind and Body: Residency Programs Tackle Burnout

Integrative Programs Strive to Bring Balance to Stressful Lives

Nancy A. Melville

Disclosures

August 20, 2015

In This Article

With the high prevalence of burnout among medical residents well documented and linked to consequences that range from medical errors to suicide, the pressure is on residency programs to come up with meaningful interventions to tackle the problem. These new efforts come in the wake of disappointing and inconsistent results from perhaps the most sweeping previous measures to date: duty-hour restrictions mandated by the Accreditation Council for Graduate Medical Education in 2003 and 2011.

"The first cohort of surgical interns to train under the new regulations report decreased continuity with patients, coordination of patient care, and time spent in the operating room," concluded one study surgery programs that was published in JAMA Surgery. "Furthermore, suboptimal quality of life, burnout, and thoughts of giving up surgery were common, even under the new paradigm of reduced work hours."

This conclusion was echoed in similar studies that evaluated the impact of duty-hour restrictions on residents in various specialties, including internal medicine and the intensive care unit.

In looking to develop more effective approaches to resident burnout, numerous programs are finding success with measures that, instead of imposing mandatory restrictions, focus more on the time-honored proverb of "Physician, heal thyself." Their emphasis is on promoting core values, such as physical activity, nutrition, social engagement, and self-reflection—all basic elements that one need not attend medical school to understand are important to healthy living. Paradoxically, however, these elements are often lost or at least neglected by medical residents as they plunge into the stressful training of providing healthcare to others.

'Resiliency' Program Focuses on Mind, Body Wellness

In a program designed to develop resiliency in medical residents under such stresses, the University of Toledo's Department of Family Medicine is working to helping residents stay grounded with a balance of healthy living programs.

As detailed in a study published in the International Journal of Psychiatry in Medicine, the program has shown encouraging success in improving resident burnout and the ability to "bounce back from stress." "Results to date show excellent acceptance of the program by trainees, increased consumption of nutritious foods, more personal exercise, and self-reported decreased overreactions to stress," the authors write.

The program was developed with input from residents combined with evidence-based techniques from the literature, as well as with elements from the model of mindful practice, developed at the University of Rochester by physicians Michael S. Krasner, MD, and Ronald M. Epstein, MD. Aspects include interactive sessions with residents to develop self-awareness and coping skills while finding strength and meaning in work. Sessions also focus on time management, self-care, and social connections in and outside of medicine.

In addition, improvements in physical and nutritional health are encouraged and supported, with investment in an elliptical trainer that was installed in the residents' call room; provision of improved dietary choices, such as fruits and vegetables; and even an mp3 player to facilitate the practice of 1-minute mindfulness meditation among residents.

According to Julie Brennan, PhD, director of behavioral health at the university's Family Medicine Residency Program, feedback from residents in evaluations has been overwhelmingly positive. "In evaluations, residents could not say enough good about the program and how they wanted it to continue," she told Medscape Medical News. "Residents rated the program as a '9' on a 1-10 scale (not satisfied to very satisfied) and would recommend it, on average, '9' on a 1 (not likely) to 10 (very likely) scale."

An important factor in implementing such a program is getting all staff members on board, Dr Brennan said. "The willingness of the other faculty to support the system changes, including resiliency topics in meetings, meditation, allowing time in the curriculum, offering healthier choices for food, and allowing the elliptical in the call room, was essential to the program's success," she said. "There needs to be a cultural shift in the way the program

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