Residency Program Wellness

By  Rebecca Kate Miller-Kuhlmann, MD

Briefly describe the wellness program your residency program implemented.

Participants include residents, fellows, and volunteer attending mentors who are divided into vertically integrated teams. There is monthly lunch wellbeing programming, which includes a 15-minute team check-in, then a 35-minute workshop led by local experts on a variety of topics including self-compassion, gratitude practice, sleep optimization, and nutrition for cognition.  We hold off-site events every 1-2 months. Some events have included: BBQ; Secret -Santa, bowling, happy hour, swimming/picnic, and cookie decorating.

What were the intended outcomes of the program? Were there unintended outcomes as a result of the program?

Decrease burnout, create a culture of wellness, and increase community and interpersonal connectedness. We are analyzing the final survey data for the year, the preliminary data is promising.

Who were the key players that made this program successful?

We were supported whenever needed by program directors, department chair, support from AAN Live Well/Lead Well program, and support from Stanford WellMD; a core group of resident leaders that collaborated with us. The program started by myself and my co-fellow Tresa McGranahan last year.   

By Joy Snider, MD, PhD

The Adult Neurology Residency Program at Washington University/Barnes Jewish Hospital places a high priority on resident wellness as it is critical to our missions of educating outstanding neurologists during residency and preparing them for a long and personally satisfying career.  We view wellness as a broad construct, including social and resident recognition activities, also workflow and workspace issues that make life challenging, personal life challenges and work-life balance, quality of education, and challenges of providing compassionate care to very sick people.  As with most things in medicine and medical education, this is a work in progress, with constant cycles of innovation, assessment, and revision, with some efforts successful and others not so much.

We have tried several social/resident appreciation activities.  Things that have been appreciated and will continue include resident “perks” such as a yearly book fund, lunch provided at conferences 2-3 times per week, an annual welcome party for all residents and faculty, and end of residency senior dinner for graduating residents.   We also support a dinner out for each PGY class as a group at least once a year,   an annual “roast” where junior residents roast their seniors, and a resident holiday party.  We make a small additional fund available to our chief residents to use for “burnout prevention” events as needed several times per year. 

Since we are a large program (100+ faculty, 11 residents per year), we have several efforts to develop the relationships between residents and faculty.  We started a “neurology family” program several years ago.  Each family includes 8-10 residents and 3-4 faculty members.  The families gather for social outings – families have gathered for meals at restaurants or faculty member’s homes, for bowling, bocce ball, etc.  Another popular event is our quarterly “Waffle Wednesday,” where the program director and coordinator make waffles for residents during the morning report on our inpatient service.  We have established a formal mentoring program, so each resident has an assigned mentor and is reminded to meet with them at least twice per year.  We also hold “Meet the Mentors” informal gatherings 4-6 times per year with dinner and several mentors to discuss both professional and personal career challenges.

We are working to make improvements in the learning environment that impact resident wellness.  These include large efforts, like finding additional workspace for research/scholarly activity and clinical duties, and some small things, such as purchasing two comfortable reclining desk chairs in the hospital workroom so the on-call resident has a comfortable spot to sit, or making a link on our website more prominent so tired residents can find the tired resident transport service. 

We are trying some new things for the 2018-19 academic year, most notably adding a “Wellness chief” resident.  We have 11 residents per year and now have 5 senior residents (PGY4) who serve in chief leadership roles (2 admin chiefs, and chiefs for education, PSQI and now wellness).  These residents receive a modest additional stipend for their efforts. The Wellness chief will help coordinate wellness efforts and serve as a touchpoint for residents to communicate about wellness concerns.  Our new wellness chief has started a monthly “kudos” program to recognize residents who go above and beyond. This includes a monthly email noting the kudos nominees and the winner gets a gift card to the campus coffee shop.  The wellness chief is starting a wellness didactic curriculum, with the first invited speaker slated to lead a course on meditation and compassion.

We have tried some things that didn’t work.  A noontime resident yoga group had only one resident show up.  In a more general sense, adding wellness “activities” is challenging as these may be just one more demand on resident time. The second big challenge is that wellness is a moving target; residents initially appreciate improvements but after a year or so, the new activities become the expected baseline.    We are working to engage the residents to report both problems and proposed solutions and as a program, we aim to be more transparent as to the changes and improvements we are making, so residents know that these issues are being addressed.

Briefly describe the wellness program your residency program implemented.

We aim to create a supportive and nurturing environment for our residents with a focus on resident well-being. We look to provide the support and tools for managing the challenges of physician training with special attention to physician burnout and depression. Some activities we do are listed below.

• Bi-monthly didactics:
  • One didactic per month with a focus on a talk by an expert in the field. Upcoming topics were given by various individuals in our institution:
    • Thriving in your role as a resident - given by our DIO. Managing the challenges of residency and knowing your resources - given by our resident psychologist
    • Recognizing the resident who might be struggling – given by psychiatrist on the well-being committee
    • Professionalism – given by our Program Director
    • Having a difficult conversation with patients and families - given by psychiatrist who is in the palliative care services
  • One didactic with a focus on a wellness topic such as art, exercise, or mindfulness
• Quarterly resident retreats, some examples include: Parrot Planet and pizza, scavenger hunt and bouncy house, laser tag, Escape Room, Playdate with Puppies
• Quarterly faculty/resident retreats, recent events include: End of year BBQ at our clerkship directors house, Our annual welcome dinner at the Programs Directors house for faculty/residents/staff and families.
• Wellness Program Page on our resident website providing information and resources. Resources found through searching wellness information and from institutional resources.
• Facebook Page for social networking, program updates, and opportunities provided. We post pictures of our events and residents achievements. We post interesting articles or challenging cases.
• Quarterly Neurology Residency Newsletter which was created to keep all members of the department up on the goings on of the program and with the residents such as scholarly activities, fun events, and personal achievements.
• Integrated conferences: Schwartz rounds and IM ethics conferences
• Access to institutional resources

What were the intended outcomes of the program? Were there unintended outcomes as a result of the program?

Residency is challenging intellectually, physically, and emotionally. In order to be the most successful during this journey, you are required to develop lifelong skills to manage the ongoing challenges of training and being a physician. This is done best in an environment that fosters this growth, and feeds the soul as well as the mind while providing you with the skills to be successful.  

Our program has been well received by the residents and faculty. Our residents are a remarkable group of individuals and the wellness program has further fostered that comradery. 

Who were the key players that made this program successful?

• Program Director
• Education Programs Manager
• Trainees providing ideas and feedback
• Guest speakers