Wellness Groups Not Going So Well? We Can Help! Lauren Penwell-Waines, PhD Novant Health Family Medicine Residency Sue King, MSW, LCSW Williamsport Family Medicine Residency Valerie Ross, MS University of Washington Family Medicine Residency

The presenters have no conflicts of interest to disclose. Disclosures The presenters have no conflicts of interest to disclose.

Goals and Objectives Compare and contrast different types of groups for family medicine residents and faculty Understand the role behavioral scientists play in facilitating different types of resident and faculty groups Understand the unique challenges to facilitating resident and faculty groups and how those challenges might be addressed

Value of Wellness-Focused Groups Demonstrated outcomes of reflective group practice include improved (i.e., more patient-centered) communication, decreased burnout, and improved job satisfaction (Branch, 2010; West et al., 2014) Balint groups may improve residents’ comfort with psychosocial aspects of medicine; results mixed related to decreasing burnout (Turner & Malm, 2004; Van Roy et al., 2014) AFMRD (2017) includes time for reflection and time to connect with colleagues on their well-being action plan Raj (2016) notes strong social relatedness associated with resident wellness Groups can be integral part of intentional efforts to promote a culture of wellness in residency programs (Fortenberry et al., 2017) Overall, these groups may help to address burnout/promote well-being and social connectedness, as well as improve patient care Not just for residents - Relationships/inclusion (trust, connection, able to express opinions), institutional support (feel like part of supportive communitive, faculty development valued), values alignment (commitment to clinical mission) among top predictors of faculty vitality in AHCs (Pololi et al., 2014) Also not just about individual wellness but program wellness, too

Types of Resident Groups Balint Reflection Support Purpose Promote patient-centered medicine and effective patient-physician relationships; cultivate empathy Promote humanism, compassion, authenticity; develop trustworthy relationships; increase reflective capacity Provide social support, decrease feelings of isolation; enhance culture of wellness; forum to discuss concerns and personal experiences as a physician Structure Small group with defined leader; focus on patient case; question-based Prompt for reflection; question-based Flexible Needs Leader training; ongoing process; confidentiality; respect Open, safe space; confidentiality; willingness to engage in inner work Supportive group members; confidentiality Not an exhaustive list of group types – also incl FMIM, mindfulness, etc Balint – understand “troubling” patient encounters from patient & physician perspective through questions; formal vs. Balint-inspired Reflection group based on Parker Palmer’s groups (from Center for Courage & Renewal) Johnson (2001) reported that many groups framed as Balint groups actually may be functioning more like support groups, often didn’t have a physician facilitator Support group more broad way to address variety of stressors associated with practicing medicine

Challenges to Facilitating Groups Resources (e.g., time, training, space) Buy-in (program and resident) Expectations Voluntary or compulsory Program history Groups in context of larger dysfunction Multiple resident needs May vary by year Overlapping roles (Reitz et al., 2016) Implementing such programs is not without challenges. For example, differences in ethics and culture between medical and mental health traditions can introduce conflict into how topics are approached. Additionally, behavioral science faculty fulfilling multiple roles (e. g. , evaluator, colleague, wellness supporter) must learn how to navigate role conflicts (Reitz et al. , 2016). Must have skilled facilitators; behavioral scientists often leaders by default but may not be trained in process-type groups Match between resident/facilitator/program expectations Groups at times may devolve into venting  breeds negativity, also not intended to be psychotherapeutic

Your Turn

Group Summary of Successes Clarify purpose and expectations Ensure that there are ways to address different resident needs Develop the culture Takes time (maybe 3 years), may need to start over or rename group May help to include other team members or faculty as role models Look for additional opportunities for connection Groups are only one part of a well culture Key recommendations/things to consider for managing barriers and implementing groups successfully may include getting program and group member buy-in, protecting regularly scheduled time for the groups, clarifying the purpose of the groups and the facilitator's role(s), using adequately trained facilitators, creating a safe space for sharing, doing informal check-ins outside of the group time, other opportunities for connection (e.g., social gatherings, buddy system) (Diaz et al. , 2015; Fortenberry et al., 2017; Kumagai & Naidu, 2015). Every gathering is an opportunity for a brief treatment wellness / community building intervention (quality vs. duration) Using my social work skills to meet my group where they are Wellness doesn’t have to be a big annual retreat Self-care is incremental. Baby steps keep us going. Starting or ending meetings with a 2-3 minute personal reflection exercise. Something that went well today High five your neighbor Tell the person next to you a strength you see in them

References American Balint Society. Americanbalintsociety.org AFMRD (2017). Well-Being Action Plan for Family Medicine Residencies: Creating a Culture of Wellness. Branch, W. (2010). The road to professionalism: Reflective practice and reflective learning. Patient Education and Counseling, 80, 327-332. Center for Courage & Renewal. Couragerenewal.org Diaz, V. A. et al. (2015). Balint groups in family medicine residency programs: A follow-up study from 1990-2010. Family Medicine, 47,367-372. Fortenberry et al. (2017). Establishing a culture of intentional wellness: Lessons from a family medicine resident focus group. PRiMER. DOI: 10.22454/PRiMER.2017.597444 Johnson et al. (2001). The current status of Balint groups in US family practice residencies: A 10-year follow-up study, 1990-2000. Family Medicine, 33, 672-677. Kumagai & Naidu. (2015). Reflection, dialogue, and the possibilities of space. Academic Medicine, 90, 283-288. Mahoney et al (2013). Balint groups: the nuts and bolts of making better doctors. IJPM, 45, 401-411. Pololi et al. (2015). Faculty vitality – Surviving the challenges facing academic health centers: A national survey of medical faculty. Academic Medicine, 90, 930-936. Reitz, R. et al. (2016). Balancing the roles of a family medicine residency faculty: A grounded theory study. Family Medicine, 48, 359-365. Turner & Malm (2004). A preliminary investigation of Balint and non-Balint behavioral medicine training. Family Medicine, 36, 114-117. Van Roy et al. (2014). Research on Balint groups: A literature review. Patient Educ and Counseling. doi.org/10.1016/j.pec.2015.01.014 West, C. P. , et al. (2014). Intervention to promote physician well-being, job satisfaction, and professionalism: A randomized controlled trial. JAMA IM, 174, 527-533.