Abstract
Background
Physician distress is common and related to numerous factors involving physicians’ personal and professional lives. The present study was designed to assess the effect of a Stress Management and Resiliency Training (SMART) program for increasing resiliency and quality of life, and decreasing stress and anxiety among Department of Medicine (DOM) physicians at a tertiary care medical center.
Participants
Forty DOM physicians were randomized in a wait-list controlled clinical trial to either the SMART intervention or a wait-list control group for 8 weeks. The intervention involved a single 90 min one-on-one training in the SMART program. Primary outcome measures assessed at baseline and week 8 included the Connor Davidson Resilience Scale (CDRS), Perceived Stress Scale (PSS), Smith Anxiety Scale (SAS) and Linear Analog Self Assessment Scale (LASA).
Results
Thirty-two physicians completed the study. A statistically significant improvement in resiliency, perceived stress, anxiety, and overall quality of life at 8 weeks was observed in the study arm compared to the wait-list control arm: CDRS: mean ± SD change from baseline +9.8 ± 9.6 vs. -0.8 ± 8.2, t(30) = 3.18, p = 0.003; PSS: -5.4 ± 8.1 vs. +2.2 ± 6.1, t(30) = -2.76, p = 0.010; SAS: -11.8 ± 12.3 vs.+ 2.9 ± 8.9, t(30) = -3.62, p = 0.001; and LASA: +0.4 ± 1.4 vs. -0.6 ± 1.0, t(30) = 2.29, p = 0.029.
Conclusions
A brief training to enhance resilience and decrease stress among physicians using the SMART program was feasible. Further, the intervention provided statistically significant improvement in resilience, stress, anxiety, and overall quality of life. In the future, larger clinical trials with longer follow-up and possibly wider dissemination of this intervention are warranted.
References
Campbell DA Jr, Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surgery. 2001;130(4):696–702. discussion 702-5.
Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet. 1996;347(9003):724–728.
Pathman DE, Konrad TR, Williams ES, Scheckler WE, Linzer M, Douglas J. Physician job satisfaction, dissatisfaction, and turnover. J Fam Pract. 2002;51(7):593.
Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114(6):513–519.
Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136(5):358–367.
Spickard A Jr, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA. 2002;288(12):1447–1450.
West CP, Huschka MM, Novotny PJ, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296(9):1071–1078.
Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169(10):990–995.
Beckman TJ, Reed DA, Shanafelt TD, West CP. Impact of resident well-being and empathy on assessments of faculty physicians. J Gen Intern Med. 2009;25(1):52–56.
Kuerer HM, Eberlein TJ, Pollock RE, et al. Career satisfaction, practice patterns and burnout among surgical oncologists: report on the quality of life of members of the Society of Surgical Oncology. Ann Surg Oncol. 2007;14(11):3043–3053. Epub 2007 Sep 9.
Varkey P, Karlapudi S, Hensrud D. The impact of a quality improvement program on employee satisfaction in an academic setting. Am J Med Qual. 2008;23(3):215–221.
Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82.
Ford IW, Eklund RC, Gordon S. An examination of psychosocial variables moderating the relationship between life stress and injury time-loss among athletes of a high standard. J Sports Sci. 2000;18(5):301–312.
Farber EW, Schwartz JA, Schaper PE, Moonen DJ, McDaniel JS. Resilience factors associated with adaptation to HIV disease. Psychosomatics. 2000;41(2):140–146.
Waite PJ, Richardson GE. Determining the efficacy of resiliency training in the work site. J Allied Health. 2004;33(3):178–183.
Judge TA, Jackson CL, Shaw JC, Scott BA, Rich BL. Self-efficacy and work-related performance: the integral role of individual differences. J Appl Psychol. 2007;92(1):107–127.
Wilmshurst L, Peele M, Wilmshurst L. Resilience and well-being in college students with and without a diagnosis of ADHD. J Atten Disord. 2009;18:18.
Bradshaw BG, Richardson GE, Kumpfer K, et al. Determining the efficacy of a resiliency training approach in adults with type 2 diabetes. Diabetes Educ. 2007;33(4):650–659.
Ahern NR, Kiehl EM, Sole ML, Byers J. A review of instruments measuring resilience. Issues Compr Pediatr Nurs. 2006;29(2):103–125.
Cohen S, Williamson GM. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, eds. The Social Psychology of Health. Newbury Park: CA; 1988:31–67.
Smith C, Hancock H, Blake-Mortimer J, Eckert K. A randomised comparative trial of yoga and relaxation to reduce stress and anxiety. Complement Ther Med. 2007;15(2):77–83.
Locke DE, Decker PA, Sloan JA, et al. Validation of single-item linear analog scale assessment of quality of life in neuro-oncology patients. J Pain Symptom Manage. 2007;34(6):628–638. Epub 2007 Aug 20.
Wolfe F. Fatigue assessments in rheumatoid arthritis: comparative performance of visual analog scales and longer fatigue questionnaires in 7760 patients. J Rheumatol. 2004;31(10):1896–1902.
Bishop SJ. Neural mechanisms underlying selective attention to threat. Ann NY Acad Sci. 2008;1129:141–152.
Ellenbogen MA, Schwartzman AE. Selective attention and avoidance on a pictorial cueing task during stress in clinically anxious and depressed participants. Behav Res Ther. 2009;47(2):128–138. Epub 2008 Nov 8.
Houston BK, Holmes DS. Effect of avoidant thinking and reappraisal for coping with threat involving temporal uncertainty. J Pers Soc Psychol. 1974;30(3):382–388.
Abramowitz JS, Tolin DF, Street GP. Paradoxical effects of thought suppression: a meta-analysis of controlled studies. Clin Psychol Rev. 2001;21(5):683–703.
Marcks BA, Woods DW. A comparison of thought suppression to an acceptance-based technique in the management of personal intrusive thoughts: a controlled evaluation. Behav Res Ther. 2005;43(4):433–445.
Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284–1293.
Burton NW, Pakenham KI, Brown WJ. Feasibility and effectiveness of psychosocial resilience training: a pilot study of the READY program. Psychol Health Med;15(3):266-77
Steinhardt M, Dolbier C. Evaluation of a resilience intervention to enhance coping strategies and protective factors and decrease symptomatology. J Am Coll Health. 2008;56(4):445–453.
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Department of Medicine, Mayo Clinic, Rochester, MN
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Sood, A., Prasad, K., Schroeder, D. et al. Stress Management and Resilience Training Among Department of Medicine Faculty: A Pilot Randomized Clinical Trial. J GEN INTERN MED 26, 858–861 (2011). https://doi.org/10.1007/s11606-011-1640-x
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DOI: https://doi.org/10.1007/s11606-011-1640-x