1. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Christine N. Runyan, PhD UMass Medical School Department of Family Medicine and Community Health Taking Care of Our Own: Building Resiliency through Residency Wellness

2. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin No Disclosures

3. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Burnout among physicians and impact Physician as Leader and Wellness Curriculum Reflection exercises Small group work and reporting out Meditation

4. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin UMass Worcester Family Medicine Residency Program Founded 1973 12-12-12 University Based Diverse communities

5. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Up to 60% of practicing physicians report symptoms of burnout – Emotional exhaustion, depersonalization and low sense of accomplishment – Linked to poorer quality of care, including patient dissatisfaction, increased medical errors, and decreased ability to express empathy

6. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Men are born soft and supple; Dead, they are stiff and hard. Plants are born tender and pliant; dead, they are brittle and dry. Thus whoever is stiff and inflexible is a disciple of death. Whoever is soft and yielding is a disciple of life. The hard and stiff will be broken. The soft and supple will prevail. From: Tao Te Ching Trans. Stephan Mitchell Harper & Row, NY (1988)

7. RESILIENCE  STEADY  FLEXIBILE  TENSIL  STABLE  ADAPTIVE  SUPPLE  NIMBLE A sense of stability in a situation in which you feel completely out of control The ability to work with or recover rapidly from adversity

8. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Physician as Leader Curriculum Goal: Build skills toward leadership with a focus on IHI Triple Aim working in health center based resident teams.

9. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin PAL 1 PAL 3 PAL 2 Wellness Curriculum Built Into the PAL Rotation

10. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin WFMR Curriculum 12 Block First YearSecond YearThird Year FoundationsFamily Medicine Inpatient Service FMIS Family Medicine Inpatient Service Health Center Chief Family Medicine Inpatient Service Health Center Chief Family Medicine Inpatient ServiceDevelopmental PediatricsHealth Center Chief Maternal Child Health Urgent Care Pediatrics ObstetricsMaternal Child HealthSurgical Subspecialties Ambulatory Women’s HealthAmbulatory PediatricsOrthopedics Surgery Dermatology Newborn Nursery/Neonatal ICUSports MedicineElective Emergency MedicineGeriatricsElective Inpatient PediatricsElective Critical Care Family Medicine Community HealthHC Based Practice Experience

11. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin WFMR REVISED Curriculum 13 Block First YearSecond YearThird Year FoundationsFamily Medicine Inpatient Service Senior Inpatient Selective Family Medicine Inpatient Service Health Center Chief Family Medicine Inpatient Service Health Center Chief Family Medicine Inpatient ServiceDevelopmental PediatricsHealth Center Chief Maternal Child Health Professor Chief ObstetricsMaternal Child HealthSurgical Subspecialties Ambulatory Women’s HealthAmbulatory PediatricsOrthopedics Surgery Dermatology Newborn Nursery/Neonatal ICUSports MedicineUrgent Care Pediatrics Emergency MedicineGeriatricsElective Inpatient PediatricsElective Critical Care Elective Physician as Leader 1 Physician as Leader 2 Physician as Leader 3

12. Skills that cultivate mindfulness, self- awareness and reflection, self- compassion, and self- care Largely experiential 4 Sessions; 4 Residents, 1 Faculty Monthly E-mail reminders Pre/3 Mo Post Assessment

13. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin The Curriculum Mindfulness Mindfulness in Medicine Self-Assessments on Burnout, Stress, Acceptance Creating Balance and Recovery – Videos and Discussion Gratitude and Self-Care Narrative Medicine and Reflection with Sharing Appreciative Inquiry Values Clarification Exercises Burnout Prevention Plan Meditation each Session, Walking Meditation with Reflection Slightly varied for each year

14. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin http://www.ted.com/talks/nigel_marsh_how_to_make_w ork_life_balance_work

15. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin “Found Time”

16. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Centering Meditation

17. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Centering Meditation What percent of time were you in the present moment? When not in the moment, did you tend to be: Reflections of your experience during exercise? Distant Past Recent Past Near Future Distant Future

18. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Measures Maslach Burnout Inventory Jefferson Empathy Scale Perceived Stress Scale Self-Compassion Scale

19. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Maslach Burnout Inventory I feel emotionally drained from my work. I feel used up at the end of the workday. I feel tired when I get up in the morning and have to face another day on the job

20. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin

21. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Jefferson Empathy Scale My understanding of how my patients and their families feel does not influence medical or surgical treatment Patients' illnesses can be cured only by medical or surgical treatment; therefore, emotional ties to my patients do not have a significant influence on medical or surgical outcomes. Asking patients about what is happening in their personal lives is not helpful in understanding their physical complaints Empathy is a therapeutic skill without which success in treatment is limited

22. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin

23. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Small Groups What 5 skills do you want residents to develop and carry with them that will make a difference in their resilience? How can you help them gain these skills?

24. The 35th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Discussion The specific components, duration, frequency, and modality of what constitutes and effective residency wellness curriculum remain unclear What I’ve noticed / What works well? Timing – when to start? Longitudinal? What is a sufficient dose? Opt in vs. Required? Cultural Considerations? Is Measurement Important? Addresses Milestones?