Abstract
Objective
This study aimed to determine the feasibility of a resident-led resiliency curriculum developed by residents, for residents.
Methods
The Stress Management and Resiliency Training Program for Residents (SMART-R) is a 6-h group-based curriculum that teaches meditation, behavioral skills, and positive perspective-taking strategies. SMART-R was implemented for all medicine and psychiatry interns at a large US teaching hospital during the first 6 months of internship. Risk and resilience factors for burnout were assessed before and after the curriculum. A wearable health-tracking device was used to assess feasibility of wearables for studying resident health behaviors.
Results
All 73 medicine and 17 psychiatry interns participated in the SMART-R curriculum. Seventy-five of 85 interns (88%) consented to be in the study. Thirty-one of 75 (41%) completed both baseline and post surveys of risk and resilience factors for burnout. Preliminary curriculum feedback was enthusiastic. Twenty-five of 62 (40%) wore the health tracker more than half the time in the first 3 months of the study.
Conclusions
Implementation of a resident-led resiliency curriculum for internal medicine and psychiatry interns at an academic medical center during the most challenging first months of internship is feasible. Future controlled studies are needed to determine efficacy of SMART-R on risk and resilience factors. Over the first 6 months of internship, we observed an expected increase in burnout, fatigue, and depression, though other key risk and resilience factors were unchanged.
References
Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout among US medical students, residents, and early career physicians relative to the general US population. Acad Med J Assoc Am Med Coll. 2014;89:443–51.
West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296:1071–8.
Tarantino B, Earley M, Audia D, D’Adamo C, Berman B. Qualitative and quantitative evaluation of a pilot integrative coping and resiliency program for healthcare professionals. Explore N Y N. 2013;9:44–7.
Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302:1284–93.
Horowitz CR, Suchman AL, Branch J, William T, Frankel RM. What do doctors find meaningful about their work? Ann Intern Med. 2003;138:772–5.
Beach MC, Roter D, Korthuis PT, Epstein RM, Sharp V, Ratanawongsa N, et al. A multicenter study of physician mindfulness and health care quality. Ann Fam Med. 2013;11:421–8.
Finkelstein C, Brownstein A, Scott C, Lan Y-L. Anxiety and stress reduction in medical education: an intervention. Med Educ. 2007;41:258–64.
Warnecke E, Quinn S, Ogden K, Towle N, Nelson MR. A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Med Educ. 2011;45:381–8.
Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M. Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med. 2003;15:88–92.
Louie AK, Trockel MT, Balon R, et al. “Physician Wellness” as Published in Academic Psychiatry. Acad Psychiatry. February 2017. https://doi.org/10.1007/s40596-017-0677-5.
Rosdahl J, Goldhagen B, Kingsolver K, Stinnett S. Stress and burnout in residents: impact of mindfulness-based resilience training. Adv Med Educ Pract 2015;525.
Ripp JA, Fallar R, Korenstein D. A randomized controlled trial to decrease job burnout in first-year internal medicine residents using a facilitated discussion group intervention. J Grad Med Educ. 2016;8:256–9.
Epstein RM, Krasner MS. Physician resilience: what it means, why it matters, and how to promote it. Acad Med. 2013;88:301–3.
Alley S, Schoeppe S, Guertler D, Jennings C, Duncan MJ, Vandelanotte C. Interest and preferences for using advanced physical activity tracking devices: results of a national cross-sectional survey. BMJ Open. 2016;6:e011243.
Park ER, Traeger L, Vranceanu A-M, Scult M, Lerner JA, Benson H, et al. The development of a patient-centered program based on the relaxation response: the Relaxation Response Resiliency Program (3RP). Psychosomatics. 2013;54:165–74.
Samuelson M, Foret M, Baim M, Lerner J, Fricchione G, Benson H, et al. Exploring the effectiveness of a comprehensive mind-body intervention for medical symptom relief. J Altern Complement Med N Y N. 2010;16:187–92.
Perez GK, Haime V, Jackson V, Chittenden E, Mehta DH, Park ER. Promoting resiliency among palliative care clinicians: stressors, coping strategies, and training needs. J Palliat Med. 2015;18:332–7.
Foret MM, Scult M, Wilcher M, Chudnofsky R, Malloy L, Hasheminejad N, et al. Integrating a relaxation response-based curriculum into a public high school in Massachusetts. J Adolesc. 2012;35:325–32.
Chaukos D, Cromartie D et al. “Stress management and resiliency training program for residents implementation toolkit”. Adopted as a peer-reviewed model curriculum by the American Association of Psychiatry Residency Training Directors Curriculum Committee, March 7 2017. Accessed at www.AADPRT.org.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.
Chaukos D, Chad-Friedman E, Mehta DH, Byerly L, Celik A, McCoy TH, et al. Risk and resilience factors associated with resident burnout. Acad Psychiatry. 2017;41:189–94.
Willcock SM, Daly MG, Tennant CC, Allard BJ. Burnout and psychiatric morbidity in new medical graduates. Med J Aust. 2004;181:357–60.
Jennings ML, Slavin SJ. Resident wellness matters: optimizing resident education and wellness through the learning environment. Acad Med. 2015;90:1246–50.
Slavin SJ. Medical student mental health: culture, environment, and the need for change. JAMA. 2016;316:2195.
Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being. Mayo Clin Proc. 2017;92:129–46.
Shanafelt TD, Gorringe G, Menaker R, Storz KA, Reeves D, Buskirk SJ, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015;90:432–40.
Ripp JA, Privitera MR, West CP, Leiter R, Logio L, Shapiro J, et al. Well-being in graduate medical education: a call for action. Acad Med. 2017;92:914–7.
Acknowledgements
The authors would like to thank Dr. Hasan Bazari and Dr. Felicia Smith for their support of this research within the residency training programs in the departments of Medicine and Psychiatry, respectively, at Massachusetts General Hospital.
Funding
This pilot project was supported by an APIRE Janssen Resident Award (award recipient is corresponding author). Basis Inc. provided health-tracking devices for this investigator-initiated study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This study was approved by the Partners HealthCare Human Research Committee/IRB review. All participants signed written, informed consent.
Disclosures
Dr. Denninger receives support for unrelated investigator-initiated studies from Onyx Pharmaceuticals. Dr. Denninger receives support from Basis Inc. for materials related to investigator-initiated studies. This does not alter the author’s adherence to Academic Psychiatry policies on sharing data and materials. On behalf of all authors, the corresponding author states that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
Chaukos, D., Chad-Friedman, E., Mehta, D.H. et al. SMART-R: A Prospective Cohort Study of a Resilience Curriculum for Residents by Residents. Acad Psychiatry 42, 78–83 (2018). https://doi.org/10.1007/s40596-017-0808-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40596-017-0808-z