No More Discussions of Wellness! In Search of Direction in truly Assisting Residents in Flourishing and Being inoculated to Burnout Thomas W. Bishop, PsyD University of Michigan Jill Schneiderhan, MD TB

Only that We are Trying to Do Better Disclosures Only that We are Trying to Do Better TB

Goals and Objectives Articulate the most common negative themes that emerge in the developing of wellness curriculum in residency education. Define the commonly used terms of wellness, well-being, burnout, and resilience. Articulate strategies to align expectations of the residents with the faculty in regard to curriculum designed to promote well-being. TB

What Do We Know? The effects of resident burnout has found its way into headlines. The intersection of the Quadruple Aim’s addition of provider wellness and the ACGME inclusion of trainee wellness to requirements has led to more inclusion of wellness in resident curriculum. Even with the shift to system factors for burnout, there has been little guidance for training programs. Since program have little control over the “larger systemic drivers” of burnout, they are left focusing on what they can control, and with little direction. TB

So, What Has Been Tried? Our Program had 3 guiding principles: TB Allocation of Resources Evidence-Based Interventions Iterative Developmental Feedback Our Program had 3 guiding principles: TB

Our Program Factors that Drove Change Resource Allocation Curricular elements Resident Involvement JS

Initial Curriculum Design Session Timing Topic Content 1 - Interns July – During Orientation Mindfulness Introduction Mindfulness exercises (meditation, walking, mindful movement) 2 - Interns November Mindfulness Review and addition of self- compassion Mindfulness exercises (meditation, walking, mindful movement) and Self-Compassion exercises 3 - Interns February Mindfulness Based Cognitive Therapy Incorporating an overview of MBCT 4 - Interns May Acceptance and Commitment Therapy Principles Incorporating emotional regulation, acceptance and value centered living 5 Hourly All Resident Sessions Variety of Topics Time management and Efficiency Flower arranging Mindful walks Scavenger Hunts Team building Self-compassion leading to thriving JS

Current Curriculum Design Session Timing Topic Content 1 - Interns July – During Orientation Skill Focus: CBT 101 and how emotional awareness can be helpful Reflection Focus: fears/hopes on what they are envisioning over this year. Opening: group mingle time, eat, get settled Mindfulness Exercise: Body Scan Nature Walk: personal values statements, Stone Cutter story, self-reflection, group discussion CBT 101 Group exercise – lizard puzzle 2 - Interns November Skill Focus: Self-awareness, boundary setting, expression/getting needs met, sense of control Reflection Focus: Meaningful patient interactions Opening: same Nature Walk: think/pair share Group Discussion: TED talk, Group exercise 3 - Interns February Skill Focus: Self - Compassion Reflection Focus: Burnout/depression awareness/prevention Mindfulness Exercise – self compassion focus Skill session: Cognitive reframe of medical errors/Awareness of burnout in colleagues and what to do Nature Walk: scavenger hunt indoor terrarium 4 - Interns May Skill Focus: Review Reflection Focus: mastery and how far they have come over the year Mindfulness Exercise Skill session: Think/Pair/Share – stories of mastery, Group Conversation, reminder of values statements Nature Walk: Collect an object that typifies who they are now 5 Hourly All Resident Sessions Variety of Topics Similar Constantly Adjusting Content JS

What Have You Tried? JS - Limit to 2-3 examples

The push back and most common negative themes What have you all noticed? JS : Run discussion TB: Write Items on paper Dreamstime.com

Tensions Multiple concepts Faculty use of wellness time: Structured Didactic vs Experiential Skills Unstructured processing time Connection & Processing vs Going to Deep Resident use of time: what is the definition of well-being Lack of time to implement wellness. Locus of control: Resident vs faculty directed JS to describe what our tensions are TB to comment on what the group came up with and overlaps

Definitions Happy all the time Well-being Increased leisure time No work from home Being present to patients and family – “able to be ON all the time” Meals with colleagues Well-being Wellness Resilience Burnout Flourishing Thriving TB – conflicting understanding of definitions

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Approaching “Push Back” by Building Scaffolding Group Activity: Defining Wellness We have done this two years running Has worked well Tom to introduce activity – goal is to come to shared understanding around definitions and curriculum content Jill to run it: Four pieces of paper Buckets: Skills/processing Relationship and connection/team building Leisure and self care Structural/systemic components components

What Would Work in Your Program? Think – what’s the biggest tension you face Pairs – share an idea how you would address that tension Share – large group discussion of ideas generated Write down an action you could take on returning from what you have heard TB – introduce and run discussion JS – write ideas on white paper Both to walk around and listen to discussions

Brainstorming Share – large group discussion of ideas generated Write down an action you could take on returning from what you have heard

Summary & What’s Next Identified tension around resident wellness Many opportunities for scholarly endeavors in this area Great ideas generated here today Tom to share next steps for the curriculum Jill to share next steps on broader national stage for understanding scope