1. Mastering Complexity Without Burning Out: Role-modeling and teaching self-care and burnout prevention to medical students 35 th Annual Predoctoral Education Conferenec Chantal Brazeau, MD Robin Schroeder, MD Steven E. Keller, PhD UMDNJ-New Jersey Medical School Newark, NJ

2. Goals Demonstrate a new approach to role-model and teach self-care and burnout prevention to medical students

3. Objectives 1.Describe a three-pronged approach to self- care and burnout prevention 2.Describe a change that faculty can make in their own work environment to prevent burnout 3.Develop a seminar on self-care and burnout prevention for medical students

4. Relevance to Medical Education Burnout is a work-related syndrome Affects physicians, residents and students Negatively affects quality of care, dr-pt relationship, increases medical errors… 50% of medical students develop burnout (Annals of IM, Dyrbye, 2008) Increased cynicism

5. Relevance to Medical Education Particular concern for Family Medicine: Decreased selection of specialties that care for chronically ill or elderly Self-care practices in physicians and medical students= more preventive counseling

6. Relevance: The Hidden Curriculum Burnout in attending physicians and residents leads them to role-model cynical attitudes and poor self-care practices to students; Propagates the problem further

7. Relevance to Medical Education Since burnout is work-related and affects medical students and physicians …and significantly impacts quality of care Needs to be consciously taught (IN THE CURRICULUM) just like any other important patient care issue Need to role-model and teach self-care Distinct from student mental health services, academic/administrative support services

8. Our approach Stress prevention techniques are often presented as a list of “things to do” and do not always address all components of burnout Our third-year family medicine clerkship seminar addresses the various aspects of burnout using a metaphor that can be easily remembered (3 legged stool)

9. Our Seminar Maslach Burnout Inventory completion Suicide Prevention film, American Foundation for Suicide Prevention www.afsp.orgwww.afsp.org PowerPoint presentation by Dr. Brazeau – Personal – Present concepts of Burnout and Burnout Prevention and the three-legged stool Discussion

10. Struggling in Silence

11. Our Seminar Maslach Burnout Inventory completion Suicide Prevention film, American Foundation for Suicide Prevention www.afsp.orgwww.afsp.org PowerPoint presentation by Dr. Brazeau – Personal – Present concepts of Burnout and Burnout Prevention and the three-legged stool Discussion

12. Risky Coping Method…

13. Risky Coping Method Just Work Harder and Harder…

14. “I Feel Like I’m at the End of my Rope”

15. Burnout: A Work-Related Syndrome Emotional exhaustion: tired, nothing left to give, no pleasure Depersonalization: cynicism, going through the motions, like a robot, automatic pilot Decreased sense of accomplishment: never good enough, not worthwhile Maslach C, Jackson S. Journal of Occupational Behaviour. 1981.

16. Burnout Impacts Quality of Care Riskier prescribing profiles, dissatisfied and less compliant patients, negative effect on the doctor- patient relationship Williams E, Skinner A. Health Care Management Review. 2003 Self-reports: Suboptimal patient care Shanafelt et al, Ann Int Med. 2002 Increased medical errors Williams E et al Health Care Management Review. 2007

17. Burnout Impacts Quality of Care Lowered productivity, increased healthcare costs, conflicts and difficulty making decisions Felton J.S. Occupational Medicine. 1998. Johnson J.V. et al. Journal of Occupational Medicine.37:1151-1158. Self-care practices in physicians and medical students= more preventive counseling Frank E, JAMA 2004

18. Balance to Prevent Burnout 3 Elements (Legs) Stressors

19. Don’t always see it coming

20. Physiologic Stress Response

21. Change What You Can Change Perceived lack of control: schedule, work environment ( Keeton et al, Obst. And Gyn. 2007, Freeborn et al, Western J Med, 2001)

22. Triad of Compulsivity Personality Factors/Self-Awareness Exaggerated sense of responsibility responsible for others, taking on too much Guilt: Self-sacrifice don’t know needs/feelings Guilty if say no Doubt: Double-check, Go the extra mile Critical self-talk The “Go to” person, the “Rock” Difficulty asking for help Postponing gratification Burnout Awareness

23. Exercising less: Not counteracting the stress response Perceived lack of control: schedule Lack of awareness of the impact of personality traits: “the rock” “over-responsible to partners” Why I burned-out: No leg to stand on Long hours hospital meeting/no day off losing an associate

24. The Medical Culture Molds Us Remen: Repress parts of ourselves to fit in Medicine rewards: Intellect, controlling feelings to remain objective, problem-solving, people who can “take it”, don’t complain Predisposes us to and propagates burnout Beyond Self-Awareness

25. What do students see/hear? 98% witnessed derogatory words, 67% unethical behavior 50-85% students feel taken advantaged of or report verbal abuse Institutional abuse: exams, on-call…is that the price? Affects student confidence, patient care AAMC: “Nurturing Learning Environment” Dyrbye et al. Mayo Clin. Proc. 2005

26. How can we get out of this riptide?

27. Our Medical Riptide Stresses of our profession Personality traits valued in medicine Demands of the medical culture Work harder to stay afloat We need to think of self-care explicitly Self-care is counter-intuitive but is the skill we need to escape the riptide

28. Counteract the physiological stress response Change what you can change Self-awareness: what matters to you, know personality traits, address feelings Achieving Balance and Self-Care The Stressors (weights) demands of medicine/academia compulsive personality traits culture of medicine hidden curriculum

29. What can I change as a third year student (even when it feels like I don’t have any control)? They are still better at identifying the stressors…this is a start. Start out asking about stressors during first two years…

31. Student Evaluation of Burnout Seminar 42.Was well presented Total responses=98 Avg: 4.31 on 5 pt. Likert scale 43. Was valuable for my preceptorship experience Total responses: 98 Avg: 3.76 on 5 pt. Likert scale Dr. Brazeau’s burnout lecture was really awesome, very well- presented. I really enjoyed it, despite the sad topic.” “ Dr. Brazeau’s burnout lecture was really awesome, very well- presented. I really enjoyed it, despite the sad topic.”

32. Discussion Administer Maslach Burnout Inventory (MBI)

33. Discussion-Faculty What can you do as a faculty member to decrease your risk for burnout? (and role-model for students) – Physiologic stress – Change what you can change – Self-awareness

34. Discussion-Students What sorts or things have you seen/heard from students that are their stresses(weight on their stool) or are reflective of some level of burnout? Specialty choice because of hours …

35. Thank you!