Advertisement

Wellbeing pp 185-195 | Cite as

Wellbeing Consideration for Residents

  • Christina CelliniEmail author
  • Lauren Decaporale-Ryan
Chapter
  • 25 Downloads
Part of the Success in Academic Surgery book series (SIAS)

Abstract

Resident wellness is a topic of increasing discussion and study. The life of a surgery resident lends itself to unique challenges that threaten a trainee’s wellbeing. This issue is at the forefront of graduate medical education in terms of optimizing the clinical learning environment and mitigating the risk of burnout for residents. However, residency programs struggle to identify and implement actionable items for their trainees. In this chapter the authors review the scope of the problem as studied in the literature, describe the current stance of the Accreditation Council of Graduate Medical Education (ACGME) and provide examples of surgical programs that have embraced and implemented organizational and personal components to address resident wellbeing within their surgical training programs.

Keywords

Burnout Wellbeing Graduate medical education Residency Surgical Curriculum 

References

  1. 1.
    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(7):914–7.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Salles A, Liebert CA, Greco RS. Promoting balance in the lives of resident physicians: a call to action. JAMA Surg. 2015;150(7):607–8.CrossRefGoogle Scholar
  3. 3.
    Jennings ML, Slavin SJ. Resident wellness matters: optimizing resident education and wellness through the learning environment. Acad Med. 2015;90(9):1246–50.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373–83.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Lin DT, Liebert CA, Esquivel MM, Tran J, Lau JN, Greco RS, et al. Prevalence and predictors of depression among general surgery residents. Am J Surg. 2017;213(2):313–7.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Elmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IR. National survey of burnout among US general surgery residents. J Am Coll Surg. 2016;223(3):440–51.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443–51.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463–71.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Pulcrano M, Evans SR, Sosin M. Quality of life and burnout rates across surgical specialties: a systematic review. JAMA Surg. 2016;151(10):970–8.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Dyrbye LN, Burke SE, Hardeman RR, Herrin J, Wittlin NM, Yeazel M, et al. Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians. JAMA. 2018;320(11):1114–30.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Dewa CS, Loong D, Bonato S, Trojanowski L, Rea M. The relationship between resident burnout and safety-related and acceptability-related quality of healthcare: a systematic literature review. BMC Med Educ. 2017;17(1):195.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Yaghmour NA, Brigham TP, Richter T, Miller RS, Philibert I, Baldwin DC Jr, et al. Causes of death of residents in ACGME-accredited programs 2000 through 2014: implications for the learning environment. Acad Med. 2017;92(7):976–83.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004;161(12):2295–302.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Maslach C, Leiter MP. The truth about burnout: how organizations cause personal stress and what to do about it. New York: Wiley; 2008.Google Scholar
  16. 16.
    Sargent MC, Sotile W, Sotile MO, Rubash H, Barrack RL. Quality of life during orthopaedic training and academic practice: part 2: spouses and significant others. J Bone Joint Surg Am. 2012;94(19):e145(1-6).CrossRefGoogle Scholar
  17. 17.
    Koo K. Student narratives and the hidden curriculum in the surgery clerkship. J Surg Educ. 2013;70(1):1.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Cleland J, Johnston PW, French FH, Needham G. Associations between medical school and career preferences in year 1 medical students in Scotland. Med Educ. 2012;46(5):473–84.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Hill E, Bowman K, Stalmeijer R, Hart J. You’ve got to know the rules to play the game: how medical students negotiate the hidden curriculum of surgical careers. Med Educ. 2014;48(9):884–94.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Sanfey HA, Saalwachter-Schulman AR, Nyhof-Young JM, Eidelson B, Mann BD. Influences on medical student career choice: gender or generation? Arch Surg. 2006;141(11):1086–94; discussion 94PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Hill EJR, Bowman KA, Stalmeijer RE, Solomon Y, Dornan T. Can I cut it? Medical students’ perceptions of surgeons and surgical careers. Am J Surg. 2014;208(5):860–7.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    J. W. Millennium Generation poses new implications for surgical resident education. Secondary Millennium Generation poses new implications for surgical resident education 2012. https://www.facs.org/education/division-of-education/publications/rise/articles/rap-archive/millennium-generation-poses-new-implications-for-surgical-resident-education.
  23. 23.
    Lebares CC, Guvva EV, Ascher NL, O'Sullivan PS, Harris HW, Epel ES. Burnout and stress among US surgery residents: psychological distress and resilience. J Am Coll Surg. 2018;226(1):80–90.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Lindeman B, Petrusa E, McKinley S, Hashimoto DA, Gee D, Smink DS, Mullen JT, Phitayakorn R. Association of burnout with emotional intelligence and personality in surgical residents: can we predict who is most at risk? J Surg Educ. 2017;74(6):e22–30.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Williford ML, Scarlet S, Meyers MO, Luckett DJ, Fine JP, Goettler CE, et al. Multiple-institution comparison of resident and faculty perceptions of burnout and depression during surgical training. JAMA Surg. 2018;153(8):705–11.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Jackson T, Provencio A, Bentley-Kumar K, Pearcy C, Cook T, McLean K, et al. PTSD and surgical residents: everybody hurts... Sometimes. Am J Surg. 2017;214(6):1118–24.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Dahlke AR, Johnson JK, Greenberg CC, Love R, Kreutzer L, Hewitt DB, et al. Gender differences in utilization of duty-hour regulations, aspects of burnout, and psychological Well-being among general surgery residents in the United States. Ann Surg. 2018;268(2):204–11.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Daskivich TJ, Jardine DA, Tseng J, Correa R, Stagg BC, Jacob KM, et al. Promotion of wellness and mental health awareness among physicians in training: perspective of a national, multispecialty panel of residents and fellows. J Grad Med Educ. 2015;7(1):143–7.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Accreditation Council for Graduate Medical Education 2017. 2019. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRs_2017-07-01.pdf.
  30. 30.
    Weiss KB, Bagian JP, Wagner R. CLER pathways to excellence: expectations for an optimal clinical learning environment (executive summary). J Grad Med Educ. 2014;6(3):610–1.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Education ACfGM. CLER pathways to excellence: expectations for an optimal clinical learning environment to achieve safe and high quality patient care, Version 1.1. https://www.acgme.org/Portals/0/PDFs/CLER/CLER_Pathways_V1.1_Digital_Final.pdf.
  32. 32.
    Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–6.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129–46.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Rothenberger DA. Physician burnout and Well-being: a systematic review and framework for action. Dis Colon Rectum. 2017;60(6):567–76.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144(4):371–6.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Goldman ML, Bernstein CA, Konopasek L, Arbuckle M, Mayer LES. An intervention framework for institutions to meet new ACGME common program requirements for physician well-being. Acad Psychiatry. 2018;42(4):542–7.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Philibert I. What is known: examining the empirical literature in resident work hours using 30 influential articles. J Grad Med Educ. 2016;8(5):795–805.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Bolster L, Rourke L. The effect of restricting residents’ duty hours on patient safety, resident well-being, and resident education: an updated systematic review. J Grad Med Educ. 2015;7(3):349–63.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Bilimoria KY, Chung JW, Hedges LV, Dahlke AR, Love R, Cohen ME, et al. National cluster-randomized trial of duty-hour flexibility in surgical training. N Engl J Med. 2016;374(8):713–27.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Mendelsohn D, Despot I, Gooderham PA, Singhal A, Redekop GJ, Toyota BD. Impact of work hours and sleep on well-being and burnout for physicians-in-training: the resident activity tracker evaluation study. Med Educ. 2019;53(3):306–15.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Winkel AF, Nguyen AT, Morgan HK, Valantsevich D, Woodland MB. Whose problem is it? The priority of physician wellness in residency training. J Surg Educ. 2017;74(3):378–83.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Morgan HK, Winkel AF, Nguyen AT, Carson S, Ogburn T, Woodland MB. Obstetrics and gynecology residents’ perspectives on wellness: findings from a National Survey. Obstet Gynecol. 2019;133(3):552–7.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Kolarik RC, O'Neal RL, Ewing JA. Resident preferences for program director role in wellness management. J Gen Intern Med. 2018;33(5):705–9.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Tran EM, Scott IU, Clark MA, Greenberg PB. Resident wellness in US ophthalmic graduate medical education: the resident perspective. JAMA Ophthalmol. 2018;136(6):695–701.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Tran EM, Scott IU, Clark MA, Greenberg PB. Assessing and promoting the wellness of United States ophthalmology residents: a survey of program directors. J Surg Educ. 2018;75(1):95–103.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Holmes EG, Connolly A, Putnam KT, Penaskovic KM, Denniston CR, Clark LH, et al. Taking care of our own: a multispecialty study of resident and program director perspectives on contributors to burnout and potential interventions. Acad Psychiatry. 2017;41(2):159–66.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Sridhar P, Sanchez SE, DiPasco PJ, Novak L, Dechert T, Brahmbhatt TS. Educator and trainee perspectives on the need for a “real world” curriculum in general surgery. J Surg Res. 2019;233:268–75.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Smeds MR, Thrush CR, McDaniel FK, Gill R, Kimbrough MK, Shames BD, et al. Relationships between study habits, burnout, and general surgery resident performance on the American Board of Surgery In-Training Examination. J Surg Res. 2017;217:217–25.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Baer TE, Feraco AM, Tuysuzoglu Sagalowsky S, Williams D, Litman HJ, Vinci RJ. Pediatric resident burnout and attitudes toward patients. Pediatrics. 2017;139(3):e20162163.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    de Oliveira GS Jr, Chang R, Fitzgerald PC, Almeida MD, Castro-Alves LS, Ahmad S, et al. The prevalence of burnout and depression and their association with adherence to safety and practice standards: a survey of United States anesthesiology trainees. Anesth Analg. 2013;117(1):182–93.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Spiotta AM, Fargen KM, Patel S, Larrew T, Turner RD. Impact of a residency-integrated wellness program on resident mental health, sleepiness, and quality of life. Neurosurgery. 2019;84(2):341–6.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Lebares CC, Hershberger AO, Guvva EV, Desai A, Mitchell J, Shen W, et al. Feasibility of formal mindfulness-based stress-resilience training among surgery interns: a randomized clinical trial. JAMA Surg. 2018;153(10):e182734.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Chakravarti A, Raazi M, O’Brien J, Balaton B. Anesthesiology Resident Wellness Program at the University of Saskatchewan: concept and development. Can J Anaesth. 2017;64(2):185–98.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Williamson K, Lank PM, Lovell EO. Development of an emergency medicine wellness curriculum. AEM Educ Training. 2018;2(1):20–5.CrossRefGoogle Scholar
  56. 56.
    Arnold J, Tango J, Walker I, Waranch C, McKamie J, Poonja Z, et al. An evidence-based, longitudinal curriculum for resident physician wellness: the 2017 resident wellness consensus summit. West J Emerg Med. 2018;19(2):337–41.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Aggarwal R, Deutsch JK, Medina J, Kothari N. Resident wellness: an intervention to decrease burnout and increase resiliency and happiness. MedEdPORTAL. 2017;13:10651.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Riall TS, Teiman J, Chang M, Cole D, Leighn T, McClafferty H, et al. Maintaining the fire but avoiding burnout: implementation and evaluation of a resident well-being program. J Am Coll Surg. 2018;226(4):369–79.PubMedCrossRefGoogle Scholar
  59. 59.
    Schneider BD. Energy leadership: transforming your workplace and your life from the Core. New York: Wiley; 2010.Google Scholar
  60. 60.
    Mueller CM, Buckle M, Post L. A facilitated-group approach to wellness in surgical residency. JAMA Surg. 2018;153(11):1043–4.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Dyrbye LN, Satele D, Sloan J, Shanafelt TD. Ability of the physician well-being index to identify residents in distress. J Grad Med Educ. 2014;6(1):78–84.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of RochesterRochesterUSA
  2. 2.Departments of PsychiatryMedicine and Surgery, University of RochesterRochesterUSA

Personalised recommendations