1. Enhancing Wellness Education to Help Residents Prevent Burnout
Chris Ebberwein, Ph.D.
Ashley Borniger, M.Ed.
Stephanie Murray, M.D.
Wesley Family Medicine Residency, Wichita

2. No Disclosures

3. Participants will be able to:
Goals and Objectives
Participants will be able to:
Define three elements that lead to burnout
Describe risks of failing to promote wellness in medical education
Consider pitfalls in trying to recognize burnout
Use tools for identifying and responding to signs of burnout before they progress

4. What is burnout? Emotional Exhaustion Depersonalization / Cynicism
Reduced Accomplishment / Inefficacy

5. Emotional Exhaustion
Unable to recharge batteries with time off or rest
Energy level begins to follow downward spiral
Fatigue is interfering with patient care or judgment
Resident Story
How is your energy level?
How would you rate your fatigue lately?
How many close calls have you had lately because of fatigue?

6. Depersonalization / Cynicism
Blame patients for stress
Patients are generally a problem
Sometimes don’t talk about patients (or staff) as people
Resident Story
What’s it like for you heading into clinic?
What patients do you look forward to taking care of?
How do you describe your patient panel to others?

7. Reduced Accomplishment
Self-criticism
Doubt the quality of performance
Doubt the difference their work makes in patients’ lives
Resident Story
How would you rate yourself these days as a doctor? 0 = unhelpful; 10 = very effective.
How are you doing in patient care these days? Any success stories? Any close calls? What happened? (Listen for balance/imbalance in the answer)

8. Burnout in Medicine One third to ½ of physicians meet burnout criteria
Female physicians are 1.6 x more likely to report burnout
lack of work control as strong predictor
Mayo Study: 53% of medical students have burnout symptoms
physicians commit suicide each year

9. Previous Wellness Efforts
July Adventure Course – Team building for interns, faculty, chiefs
Lectures on fatigue and burnout annually
Team Meeting (Fall residency retreat)
Behavior Block (lighter than other rotations)
Spring “get-togethers” by class
Social time (Recruiting events +/-)
Advisor check-ins
Public recognition of standout efforts/performance
Optional: Couples group, Bible Study
Conversations about the need to enhance wellness and identify burnout were ongoing, but no significant change in what we were doing (above) moved to the top of the list of program priorities

10. Burnout Reality Check It can’t happen to me! It can’t happen to me
3rd year resident, great support system
I would know what to do
Perfect storm
Pediatric ICU rotation
35 weeks pregnant
Pneumonia
3 hours of uninterrupted sleep at a time
Patient care
Cried midnight to 3am and decided, might as well go in if I can’t sleep
half as efficient
Safe/Competent?
Hindsight
If it happened to me, has it happened to others?
Action
Meeting arranged by resident with program director, program coordinator (AB) and psychologist (CE)
Resident Escape plan
Additional wellness prevention planning

11. Burnout Reality Check It can’t happen to me
3rd year resident, great support system
I would know what to do
Perfect storm
Pediatric ICU rotation
35 weeks pregnant
Pneumonia
3 hours of uninterrupted sleep at a time
Patient care
Cried midnight to 3am and decided, might as well go in if I can’t sleep
half as efficient
Safe/Competent?
Hindsight
If it happened to me, has it happened to others?
Action
Meeting arranged by resident with program director, program coordinator (AB) and psychologist (CE)
Resident Escape plan
Additional wellness prevention planning

12. Burnout Reality Check It can’t happen to me
3rd year resident, great support system
I would know what to do
Perfect storm
Pediatric ICU rotation
35 weeks pregnant
Pneumonia
3 hours of uninterrupted sleep at a time
Patient care
Cried midnight to 3am and decided, might as well go in if I can’t sleep
half as efficient
Safe/Competent?
Hindsight
If it happened to me, has it happened to others?
Action
Meeting arranged by resident with program director, program coordinator (AB) and psychologist (CE)
Resident Escape plan
Additional wellness prevention planning

13. Resident Catalyst How do we prevent this from happening again?
What should I have done?
Wanted to be part of the solution.
Arranged meeting to discuss options.
Meeting arranged by resident with program director, program coordinator (AB) and psychologist (CE)
Resident Escape plan
Additional wellness prevention planning

14. QI Project What’s the status of support in the program?
Results of initial survey: Residents
“I was sick and a faculty asked if there was anything she could do for me.”
“Just saying ‘How’s it going?’ and indicating they meant outside of residency.”
“Program director took a walk with me to discuss my family concerns.”
21% residents surveyed stated faculty never showed concern towards personal wellness/residents didn’t feel comfortable going to faculty with wellness concerns
“I feel if I go to faculty, nothing changes to help.”

15. QI Project What’s the status of support in the program?
Results of initial survey: Faculty
“When I know there is an issue, I check in, offer support, and follow-up (most of the time).”
25% faculty surveyed stated they did not pay attention to resident wellness
63% faculty surveyed stated they did not have adequate resources to help residents deal with wellness concerns
“How do I recognize unwell residents when they are not verbal with their feelings/concerns?”
“What am I allowed to initiate regarding recovery plans?”
“What is the right ‘amount’ of response?”

16. Re-energized Wellness Efforts
Continue previous efforts
Resident wellness survey (every 2 blocks)
Designed to be easy to complete and actionable
Resident database
Pass around the table at each faculty meeting
Dr. E follows up after each faculty meeting with resident advisor
Faculty training on recognizing burnout
Vital Sign Questions added to advisor check-ins
Downsides: Resident wellness survey can be anonymous, so more of a program snapshot than an individualized tool to respond to.

17. Re-energized Wellness Efforts
Emphasize advanced planning with advent of advanced scheduling
Intern resource guide
Effort to coach interns before arriving
Residents choose and keep advisors
Effort to enhance relationships
Planning quarterly team building events with different groups

18. Impact QI Results (six months later): Residents
“Our faculty genuinely care very much about our wellbeing.”
“By ing, texting, stopping in hallway concerning job search.”
“Asked how I was handling residency and how things are going.”
29% residents surveyed stated faculty never showed concern towards personal wellness and 15% didn’t feel comfortable going to faculty with wellness concerns
“Have the impression to suck it up.”

19. Impact QI Results (six months later): Faculty
“I listen to updates at faculty meeting and follow-up as appropriate.”
“I check in on residents when I see or hear they’re struggling.”
100% faculty surveyed stated they did pay attention to resident wellness
67% faculty surveyed stated they did not have adequate resources to help residents deal with wellness concerns
“Time is the major resource residents need to recharge. This is self-limited by residents. Resources are much improved, though.”
“There will always be improvement here.”

20. Block 3 Survey Responses
“New to job, too much information, too many unimportant s, meetings, no downtime.”
“Unexpected life events, getting pulled in multiple directions. Faculty could follow up, provide encouragement/support- that goes a long way!”
In reference to the open-ended survey question, “What is happening in your work life this block that makes it hard to manage stress?”

21. Block 3 Survey Responses
“Time for exercise. Spending time with family and friends. Enjoying the beautiful weather.”
“Great team work, had great seniors who were very supportive in making sure I wasn't overwhelmed.”
In reference to the open-ended survey question, “What is happening in your work life this block that helps you manage stress?”

22. Resident Comments on Wellness Efforts
“One of the nice chances is the advanced scheduling—residents will know months in advance, so can actually plan vacations and family events.”
“Certainly many more opportunities and outlets if something does come up. Getting assistance is much easier now.”
“Have noticed that everyone has been great about checking in on my home life. I also like how everyone has been very flexible and making sure I get to take my pump breaks.”
Responses to a question added to the most recent resident survey, requesting their impressions of how wellness efforts have chanced in the last year.

23. Burnout “Vital Signs” Emotional Exhaustion How is your energy level?
How would you rate your fatigue lately?
How many “close calls” have you had lately because of fatigue?
As a faculty member, I wanted prompts for how to engage residents in this conversation. I also knew my faculty colleagues were in the same boat. We devised these prompts as conversation starters that align with the three elements of burnout.

24. Burnout “Vital Signs” Depersonalization
What’s it like for you heading into clinic?
What patients do you look forward to seeing?
How do you describe your patient panel to others?

25. Burnout “Vital Signs” Reduced Accomplishment
How would you rate yourself these days as a doctor?
0 = unhelpful; 10 = very effective
How are you doing in patient care these days? Any success stories? Any close calls? What happened? (Listen for balance/imbalance in the answer)

26. Possible Suggestions
Have to tailor these to the individual (personality, generational factors, values)
Talk it out (advisor, mentor, friend, counselor)
Connect with others (don’t isolate)
Coping / Stress management (what has worked in the past?)
Prioritize self-care
Nutrition
Physical Activity
Rest
Personal interests / hobby / fun
What we’re calling the vital signs questions, is just one effort to help faculty connect with advisees in regard to wellness, but we also wanted to offer ideas for what to suggest to residents in regard to avoiding burnout.

27. Future Direction Reassess vital sign questions in January
Compile ongoing results of the wellness surveys; Compare times of the year
Follow-up faculty training
Focus on Prevention
Mindfulness practice
Relaxation practice
Resilience training
Emotional regulation practice
Physical activity
Faculty wellness?

28. Q&A / Discussion

29. References
AMA Wire. Ways residents have found to conquer burnout. Published Oct 15, Accessed Sept 15, 2015.
AMA Wire. How to beat burnout: Seven signs physicians should know. Published March 4, Accessed Sept 15, 2015.
Maslach C, Leiter M. Early predictors of job burnout and engagement. J Appl Psychol 2008;93:

30. References
Meltzer-Brody S. Five tips to prevent or mitigate physician burnout. Published July, Accessed Sept 15, 2015.
Nedrow A, Steckler NA, Hardman, Physician resilience and burnout. Family Practice Management 2013 Jan-Feb;20(1):25-30.

31. References
Studer Group. Physician burnout: Preparing for a “Perfect Storm.” Straight A Review: A Bulletin for the C-Suite. Published Feb Accessed Sept 15, 2015.
Sinha P. Why do doctors commit suicide? The New York Times. Published Sept 4, Accessed Sept 15, 2015.
Tobar A. Tips to fight depression during medical residency. Published Apr 15, Accessed 9/15/15.