Mind and Body: Residency Programs Tackle Burnout

Integrative Programs Strive to Bring Balance to Stressful Lives

Nancy A. Melville


August 20, 2015

In This Article

Integrative Approach Tackles Burnout at UCSD

At the University of California, San Diego (UCSD), the issue of burnout is being addressed with a similarly integrative approach called the Healer Education Assessment and Referral (HEAR) Program. The programs works with several departments in arranging wellness workshops on such topics as yoga, nutrition counseling, and life coaching, with an emphasis on interactive discussion.

"Giving residents a voice as much as possible has been effective in sustaining motivation and trying to curb apathy," Sidney Zisook, MD, director of the UCSD Residency Training Program and distinguished professor of psychiatry, told Medscape Medical News. In addition to providing outreach to residents by having experts speak at resident seminars and in grand rounds presentations, an annual forum is provided for incoming and outgoing chief residents to meet with one another to share lessons on life and work balance.

"Information about burnout and self-care is discussed," Dr Zisook said. "We believe that increasing awareness about how burnout relates to residents specifically, normalizing help-seeking, and providing information about available resources has been effective in reducing burnout.'

The UCSD program also uses the American Foundation for Suicide Prevention anonymous survey to better identify residents who may be at a higher risk for burnout, Dr Zisook added. "This has had the spill-over effect of referrals to mental health professionals for housestaff who might not always be at risk for serious depression or suicide, but who are feeling 'stressed' or 'burned out.'"

Reflection a Focus From the Start at Loyola University

At Loyola University's Stritch School of Medicine in Maywood, Illinois, reflection and self-awareness are key aspects of the formal curriculum and co-curricular programs in all 4 years of medical school, preparing students for the ethical and emotional challenges that can lie ahead in their careers in medicine.

In a paper published in Narrative Inquiry in Bioethics that describes the program, its focus is summed up as "Physician, know thyself." The authors underscore the role of reflection in enabling students to adhere to their ideals and become the physician they intended to be.

"...Students can be stripped of their ideals by the toxicity of the clinical training environment," the authors wrote. "We intended to use reflection to enable students to transition from being passive victims of such an environment to proactively guiding their development as physicians."

First-year students are divided into groups of eight who remain their core group for the remainder of their tenure. With the leadership of two faculty members, the groups meet every week during the first year and are encouraged to reflect on their experiences; they meet again during their third-year clinical rotations.

Reflective writing is an important part of the program, and students are encouraged to carry a small notebook that can fit into their lab coat and write answers to reflective questions, such as, "What surprised you?" "What inspired you?" and "Do you feel you are becoming the physician you want to be?"

The school's Bioethics and Professionalism Honors Program delves deeper into the development of character in medicine, encouraging communal rather than competitive activity among medical students. Although the program focuses on medical students, Kayhan Parsi, JD, PhD, the Graduate Program Director at Loyola's Neiswanger Institute for Bioethics and coauthor on the paper describing the program, said the benefits probably extend well into residencies. "By and large, I think if you talk to people who come through Stritch, they feel better prepared to face some of the rigors of residency training and some of the aspects that are out of their control," he told Medscape Medical News.

In underscoring the important role that reflective writing has played in medicine, Dr Parsi pointed out that a simple search for the term "reflective writing" in PubMed brings up more than 380 results. "One thing is clear: Reflective writing has definitely taken a hold in medical schools," he said.


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