On Staying Human A Multi-Modal Exercise in Wellness for Doctors in Training Gaetan Sgro, MD, Deb Messer BS, MS, Tom Koloc M.Ed., LPC, NCC, Julie B. McCausland, MD, MS

Physician Burnout Syndrome Emotional Exhaustion Losing enthusiasm for work Depersonalization Treating people as if they are objects Reduced Personal Accomplishment Having a sense that work is no longer meaningful ** The highest burnout rates were in CCM (53%) and EM (52%), with half of all FPs, IM, and GS reporting burnout. Medscape 2015

Causes of Burnout

Burnout may; erode professionalism influence quality of care Increase risk of medical errors promote early retirement Burnout also seems to contribute to; broken relationships problematic alcohol use suicidal ideation T. Shanafelt, 2012

Burnout and Suicide Burnout has been shown to negatively affect patient care. Shanafelt T, Dyrbye L. Oncologist burnout: causes, consequences, and responses. J Clin Oncol. 2012;30: Physician suicide rates are higher than in the general population Hampton T. Experts address risk of physician suicide. JAMA. 2005;294: Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. Gen Hosp Psychiatry. 2013;35: A study of medical students suggested an association between burnout and suicidal ideation. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal Ideation among U.S. Medical Students. Ann Intern Med. 2008;149:

Why This Retreat?

Physicians and Suicide 3 interns this year - even one is too many Risk of physicians committing suicide increases with time completed physician suicides per year Males - 1.7X their professional cohorts female physicians 2.4X the risk of their cohorts Across the continuum med students have lower rate of depression and burnout than their peers Residents and fellows have higher rate of burnout than their peers Rubin R. Recent suicides highlight need to address depression in medical students and residents. JAMA Nov 5;312(17):

Reducing Burnout in Physicians The practice of mindfulness appears to be a helpful approach in reducing burnout Mindfulness for PCP’s was described as "mental training that enables one to attend to aspects of experience in a nonjudgmental, nonreactive way, which in turn helps cultivate clear thinking, equanimity, compassion, and open-heartedness.” Physicians reported that learning to set limits improved their sense of well-being and productivity Resilience training helped balance and prioritize work and personal life Cochrane Review 2014

Burnout Intervention Krasner et al – Effect of mindfulness and self- awareness on Primary care physician burnout, empathy and mood Physician training Incorporated elements of mindfulness, reflection, shared experience, and small-group learning Results: Improved meaning and engagement in work Reduced depersonalization, with sustained results

Training physicians in the art of mindful practice has the potential to promote physician health through work. Physicians continue to control the most sacred and meaningful aspect of medical practice—the encounter with the patient and the reward that comes from restoring health and relieving suffering.

Supporting Data – What Works? Few interventions have been tested Promoting self-awareness and meaning seem promising Individual interventions have mostly been centered on stress reduction training rather than organizational intervention “ The fact that almost 1 in 2 US physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals “ T. Shanafelt, 2012

Why is Wellness important in Academic Medicine? It is a critical time in identity development Role models play a key part Faculty teach the ideal and the practical Faculty set the standard Faculty attitudes affect Resident attitudes Wellness for faculty important Assess wellness for faculty

Staying Human: Retreat Outline I.Opening Remarks Gaetan Sgro I.“A Crisis of Meaning” for physicians II.Connections between meaning, burnout, and perspective III.Q: Why did you want to be a physician? II.What does it mean to stay human? Tom Koloc I.Q: What attitudes and habits keep you human? II.The five characteristics of highly humanistic physicians

Staying Human: Retreat Outline I.Introduction to Mindfulness Deb Messer I.What is mindfulness practice and why does it matter? II.Mindfulness Meditation Practice: Human Beings instead of Human Doings. II.Narrative Exercise Gaetan I.Two ten-minute writing exercises with prompts (perspective taking) II.Appreciative Inquiry in pairs III.Group discussion III.Closing I.Dyad question: What do you never want to lose?

Feedback from the TY Residents

Staying Human: Feedback I.Facilitator Feedback I.Overall, impressed with attendance and engagement II.Pleasantly surprised by cohesiveness of the retreat III.Consider tailoring to specialty (IM vs. radiology vs. surgery) II.Participant Feedback I.Mostly “excellent” rating for overall presentation, relevance and instructor ratings (Fair, Good, VG, Excellent). II.Everyone felt the workshop offered practical strategies that they could use and all would recommend to colleagues III.Comments I.“Good to [know]…[I’m] not the only one.” II.Highlights were mindfulness, writing and discussion at the end. III.Really enjoyed discussion at the end (following writing exercise) IV.“mindfulness excercises will help me day to day.”

Next Steps… Open the floor... “Resiliency” as opposed to “Humanness” and “Frailty” or “Burnout” How to study this? Tools/techniques? Physician wellness inventory|| Maslach’s BI|| Subjective happiness scale|| Patient care scale Curriculum considerations? What are other residencies, Fellowships and GME training sites doing?