Resident Wellness Intro: In August 2014, 2 interns committed suicide within 2 weeks of each other in New York City. These tragic events unfortunately are one of many stories of physicians suffering from mental health issues. Recently, national organizations like the AMA, ACGME are taking action to increase awareness and provide support. GRMEP recognizes the importance of Resident Wellness and is establishing a program to support our residents.

Objectives Define physician burnout & recognize risks leading to burnout Describe & apply techniques to promote physician resilience Provide a time for self reflection & assessment

Dimensions of Wellness Emotional Spiritual Social Physical Career Financial

Many physicians are not well Physicians have higher suicide rates when compared to general population1 Male physicians 40% increased risk Female physicians 130% increased risk 400 physicians per year die by suicide Rate of depression among physicians in training is approximately 22% to 35%, compared with 17% in the general population2 46% of interns meet depression criteria at some point in their first year 400 physicians per year = The size of 2-3 graduating medical school classes

What is Burnout? State of emotional, mental and physical exhaustion Feel overwhelmed and unable to meet demands Loss of motivation, interest, and energy Causes physicians to feel cynical, helpless, hopeless, resentful Caused by prolonged excessive stress

Stress vs. Burnout STRESS: Too much (work, tasks, appointments, pressure, etc.) VS BURNOUT: Not enough (feeling empty, lacking motivation, not caring) Can be stressed without being burned out. In fact, stress can often motivate and engage us in improvement. Burnout is often a results of too much stress for too long.

Why does Burnout happen? Increasing demands Lack of control Lack of recognition for good work Chaotic/high pressure environment Misalignment between personal values and that of the healthcare system Some qualities that lead to success can be risk factors for burnout Culture of medicine can value performance and competitiveness above collaboration5

Consequences of Burnout Depression Substance abuse Higher divorce rate Job turnover Lower patient satisfaction More medical mistakes

So what do we do about it? 1.) ASSESS your overall wellness 2.) IDENTIFY areas in which change is necessary in your life and environment 3.) APPLY realistic strategies 4.) ASK for help 5.) Be an ADVOCATE for change in your healthcare system and in medical education

3 Good Things- Bryan Sexton, Duke University A stress management technique Before bedtime for 14 days, write down 3 good things that happened that day & what your role was in each Proven benefits: Happiness Sleep quality Mindfulness Depression Better Relationships https://www.youtube.com/watch?v=57ru- P7EuMw (Link on Wellness Webpage) Bite-Sized Resilience: Three Good Things is a stress management technique with proven benefits for addressing emotional exhaustion and burn-out. Effectiveness has been demonstrated by clinical research at the Patient Safety Center of Duke University Health Center. We’re hard-wired to remember negative things- this technique utilizes sleep to short circuit us to remember good things Clinical research has shown this technique has resulted in the benefits listed on slide and has had better effects than Prozac Link on Resident Wellness page- with that video it provides more detailed information and instruction

ASSESS Maslach Burnout Inventory 8 Dimensions of Wellness Thank you for completing it! Results: 8 Dimensions of Wellness High (8-10) Moderate (4-7) Low (1-3) 2014 Shanafelt et al. found physicians ability to reliably determine their level of distress was very poor. In fact, among those with the lowest levels of well being, most believed their well be was at or above average…lack of awareness lead to ignoring burnout *Complete the 8 dimension of wellness scale

Self Reflection Eight dimensions of wellness

References 1. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta- analysis). Am J Psychiatry.2004;161(12):2295–2302. 2. Collier VU, McCue JD, Markus A, Smith L. Stress in medical residency: status quo after a decade of reform? Ann Intern Med. 2002;136(5):384–390 3. Ahola, Kirsi, et al. "Contribution of burnout to the association between job strain and depression: the health 2000 study." Journal of occupational and environmental medicine 48.10 (2006): 1023-1030. 4. University of Colorado Anschutz Medical Campus School of Medicine. Behavioral Health and Wellness Program Packet 5. Montgomery, A. The inevitability of physician burnout: Implications for interventions. Burnout Research 1(2014). 50- 56.