Resident Well-being: Meeting the ACGME Professionalism Sub-Competency Requirements through Resiliency Training Patricia Lebensohn, MD, Laura Micek- Galinat, MD, & Mari Ricker, MD

Introductions  Patricia Lebensohn, MD  Director of Integrative Medicine in Residency (IMR), Arizona Center for Integrative Medicine (AZCIM)  Site Director, IMR, University of Arizona, Family Medicine Residency  Laura Micek-Galinat, MD  Site Director, IMR, RWJ-Somerset in Somerville NJ  Mari Ricker, MD,  Associate Program Director, University of Arizona Family Medicine Residency  Associate Director of IMR, AZCIM

Learning Objectives  Identify elements of an evidence- based approach to resident well- being.  List three activities that can be implemented in the residency setting to build resiliency skills.  Formulate a plan to implement resident well-being activities in your own residency training programs.

Integrative Medicine in Residency  The Integrative Medicine in Residency program (IMR) was developed to implement and evaluate Integrative Medicine in a way which would provide standardized and high quality training in Integrative Medicine.  Distributed education through interactive online 200-hour core Integrative Medicine curriculum  Currently we have 59 IMR sites and 11 Pediatric IMR sites around the country (and the world)

Integrative Medicine Core Competencies for Residents in FM  Wellbeing was high-lighted in IMR competencies  Practices self-care  Demonstrates self-awareness.  Our intention was to address these through learning the content  However in the pilot, these did not have an impact on burnout or wellbeing  Uses patient-centered care techniques.  Uses communication skills that enhance the physician/patient relationship.  Facilitates lifestyle changes in patients.

Burnout Amongst Physicians Depression in Residents  Burnout among Practicing Physicians National Data (Shanafelt et al., Arch Intern Med 2012 )  Burnout:45.8%  Emotional exhaustion:37.9%  Depersonalization: 29.4%  Prevalence of depression in residents is % (Mata et al. JAMA 2015)

PollEverywhere  In order to participate:  Use the PollEverywhere App or website  Respond at PollEv.com/mariricker203  Text message  Text mariricker203 to to join  May be charged, depending on your plan

 Mindfulness, Reflection, and Shared Experience can improve elements of wellbeing, including meaning, empowerment, and engagement in work, reducing distress, including depersonalization. West et al. JAMA Intern Med, 2015

Physician Wellbeing Module  Core content and training in the Online Interactive Module used for IMR  Self Assessment  Introduction to Wellness  Wellness Inventory (activity)  Burnout  Resiliency  Mind and Spirit  Resiliency Practice (activity)  Personal and Professional “time-out” (activity)  Personal Development Plan (activity)  Self Assessment

Contributors

Self Assessments  At the beginning and end of the Module we include three Self Assessments for reflection  Connor Davidson Resiliency Scale  Dispositional Resiliency Scale  Gratitude Scale  The scores are reported back to the resident on a continuum with suggestions of areas to focus on during the module.  Post Module the resident is shown their pre and post Self Assessment scores

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Online Interactive Content  Introduction to Wellness  Wellness Inventory  Burnout  Resiliency  Mind and Spirit Mindfulness Meditation Defining Purpose Stress Self Care Resiliency Getting into Nature Cluttered Life Reducing burnout risk The stress response The relaxation response Integrative Self care Physical activity Sleep Optimism Resilience Grit Wellbeing and Happiness Humor

Resiliency Activity

Empathy Activity

Mindfulness Activity

Reflection Activity  In thinking about your experience here at STFM 2016:  What surprised you?  What inspired you?  What moved you?

 Turn to the person next to you and share your reflections

Activities to Foster Resiliency

Nutrition Series Anti-Inflammatory Diet Making Kale Salad

Mind-Body Skills Qi gong

Summary PDF document provided to the CCC  The resident has completed 7 hours of evidence-based on line curriculum regarding Well-being and Self Care.  This report summarizes the reflections and participation the resident.

Participation in the Wellbeing Course may show evidence that the resident has met the following milestone levels: PROF-1 Completes a process of professionalization  Level 3 Recognizes that physicians have an obligation to self-discipline and to self-regulate. Engages in self-initiated pursuit of excellence. PROF-2 Demonstrates professional conduct and accountability  Level 4 Exhibits self-awareness, self-management, social awareness, and relationship management. PROF-4 Maintains emotional, physical, and mental health: and pursues continual personal and professional growth  Level 1 Demonstrates awareness of the importance of maintenance of emotional, physical, and mental health.  Level 2 Applies basic principles of physician wellness and balance in life to adequately manage personal emotional, physical, and mental health.

Future  We will be offering in our IMR program  We also will offer this module for residents with IMR at their program even if they are not participating in the IMR track  We are piloting at our home institution Banner University Medical Center, with all residencies this year.  We hope to soon offer to institutions or residencies as a stand alone module

Questions?