Resiliency Strategies Resident/Fellow Wellness Subcommittee 2017

GRMEP Resident/Fellow Wellness Subcommittee established in 2015 Mission To foster a culture of wellness, support, and collaboration in which residents and fellows can thrive Goals Implement a multifaceted approach: To raise awareness of and destigmatize burnout Make residents aware of resources to confidentially identify and treat depression Promote a supportive culture in training Help residents develop resiliency skills

Individual Program Wellness Sessions 2016 sessions focused on introduction to burnout and awareness Most residents described as somewhat Valuable: 37/99 (37.4%) or of great Value: 57/99 (57.6%) Post-test knowledge improved significantly for all three of the educational session objectives (p<0.001) 2017 Objectives: Recognize the prevalence and significance of physician burnout Introduce realistic strategies for strengthening resiliency Assess one’s own state of mindfulness through a period of self- reflection Identify values and meaning in work Determine personal strategies to incorporate into daily life

Burnout in Medical Training Burnout rates in residents range from 27-75%1 Recent study of over 600 General Surgery residents showed burnout rate of 69%2 Levels rise quickly within first few months of residency3 ACGME duty hour restrictions have not improved sleep, depression, burnout or errors4 Resident distress is associated with poorer patient care and increased errors5

What do we do? SYSTEM INDIVIDUAL Culture and Leadership Education and Awareness Workload management EMR efficiency Physician engagement Mentorship Faculty Development INDIVIDUAL Education and Awareness Assessment Mindfulness Resiliency Training Regain Autonomy Time Management Access to mental health services It is very important for physicians to be engaged at the system level to help make changes to the practice environment that lead to burnout. However, there are Individual strategies that we have control over more immediately. We are going to focus on mindfulness and resiliency today. We will focus on two strategies: Mindfulness and resiliency

What is Resiliency? The ability to recover from setbacks, adapt well to change, and keep going in the face of adversity Interaction between a physician's values, level of insight (mindfulness), and dedication to a healthy lifestyle make him or her better able to cope with the challenges of the medical profession.

Ways to Build Resilience Make connections and foster strong relationships with friends and family Avoid seeing crises as insurmountable problems Accept that change is a part of living Develop realistic goals and work towards them Look for opportunities for self discovery Nurture a positive view of yourself and the world Take care of yourself Adapted from the American Psychological Association

Resiliency Tool: Dr. Rachel Remen, an expert in resiliency training, and founder of “The Healer’s Art” curriculum offered at many med schools (including MSU) suggests a daily reflective tool: “Finding greater meaning and satisfaction in your work is often not about doing things differently; it is about seeing familiar things in new ways.” Each day, ask yourself the following questions: What surprised me today? What touched my heart today? What inspired me today? We will be putting this tool to work in our small group discussion

What is Mindfulness? “The awareness that emerges through paying attention, intentionally and non-judgmentally to the unfolding of experience moment by moment” A way of thinking that enhances focus and clarity despite the pressures of a busy day Physicians who are more mindful: Have lower rates of burnout6 Are less stressed6 Have patients who rated the quality of their communication and care more highly7 Better quality sleep8 Enhanced concentration/memory/learning Mindfulness is especially suited to physicians, because it can help counteract the worrying, perfectionism and self-judgment that are so common among doctors.

Mindfulness GOLD STANDARD: Mindfulness Based Stress Reduction (MBSR) – 8 week course RESIDENT VERSIONS: Take 5 method = 5 breaths in, 5 breaths out; each to the count of 5; 5 times per day Mindfulness Apps Mindfulness Daily Headspace Apple Watch We recognize that an 8 week class is not realistic for residents. There are ways to incorporate mindfulness into your daily life

Realistic Resiliency Strategies Real-life examples from our peers and attendings: “Instead of hitting the elevator close door button repeatedly, use those few seconds as an opportunity to take a mindful deep breath” “I take the stairs whenever I can to get exercise and give myself a couple minute break” “I go out of my way to learn something new about a coworker every day. This helps build relationships and makes working with others more enjoyable” “I did Three Good things and it really worked!” “Before I walk into a patients room I take a deep breath and say the patient’s name. This helps bring me back to the present and helps me truly focus on that patient” “Instead of looking at my phone at red lights, now I use the time to do deep breathing exercises”

Assess your own Mindfulness Please complete the Mindful Awareness Attention Scale

Please divide into small groups of 4-6 people and review the discussion questions

THANK YOU!!

References: 1.) Ishak, W et al. Burnout During Residency Training: A Literature Review. JGME. 2009; 236-242 2.) Elmore, L.C., Jeffe, D.B., Jin, L. et al, National survey of burnout among US general surgery residents. J Am Coll Surg. 2016;223:440–451. 3.) Sen S et al Effects of the 2011 Duty Hour Reforms on Interns and Their PatientsA Prospective Longitudinal Cohort Study. JAMA Intern Med. 2013;173(8):657-662 4.) Desai Et Al, Effect of the 2011 vs 2003 Duty Hour Regulation–Compliant Models on Sleep Duration, Trainee Education, and Continuity of Patient Care Among Internal Medicine House Staff. JAMA Intern Med. 2013;173(8):649-655 5.) West, CP et al. Association of Perceived Medical Errors with resident distress and empathy. JAMA. 2006;296(9):1071-1078. doi:10.1001/jama.296.9.1071 6.) Fortney L et al. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med. 2013 Sep-Oct;11(5):412-20. doi: 10.1370/afm.1511. 7.) Beach MC et al. A multicenter study of physician mindfulness and health care quality. Ann Fam Med. 2013 Sep-Oct;11(5):421-8. doi: 10.1370/afm.1507. 8.) Kemper KJ et al. Are Mindfulness and Self-Compassion Associated with Sleep and Resilience in Health Professionals? J Altern Complement Med. 2015 Aug;21(8):496-503. doi: 10.1089/acm.2014.0281. Epub 2015 Jun 2.

Additional Resources Rachel Remen Resiliency tool http://www.rachelremen.com/keeping-a-heart-journal/ Dr. Bryan Sexton -Three good things https://www.youtube.com/watch?v=57ru-P7EuMw Take 5 Method https://vimeo.com/37824379 Stanford WellMD website http://wellmd.stanford.edu/