1. Wellness Scott M. Rodgers, MD Associate Dean for Students
Vanderbilt School of Medicine
February 9, 2007

2. The Stress of Residency
Inordinate hours
Sleep deprivation
Excessive workload
Overbearing clerical and administrative responsibilities
Inadequate support
Difficult patients
Family
Finances
Isolation

3. Internship Year What to Expect
Anticipation/Excitement
Self doubt and awareness of limitations
Depression sometimes
Recognition of new skills
Gratification and anticipation of new experiences

4. House-officer Stress Syndrome
Four occur in most residents
Episodic cognitive impairment
Chronic anger
Pervasive cynicism
Family discord
Three others suggest serious impairment
Depression
Suicidal ideation and suicidal behavior
Substance abuse

5. Burnout Emotional exhaustion Depersonalization
Reduced sense of personal accomplishment
All of the above leads to a drop in level of patient care

6. Common Sources of Stress
Gender
Women report higher levels of stress reaction to residency than do men
Anxiety related to role stress
Loneliness/depression
Problems balancing family and career
Lack of relationship development in residency
Prejudice from patients, nurses
Fewer role models

7. Stress Sources Continued
Pregnancy
Fatigue
Too little time for partner
Too much physical activity
First year is most stressful time to be pregnant

8. Stress Sources Continued
Family
Partner is most influential person in the choice of residency
Females more likely to sacrifice their needs for their partners
Physicians have a lower divorce rate but higher rates of conflict, instability, and dissatisfaction.
Certain specialties have higher divorce rates (i.e. orthopedic surgery, psychiatry)

9. Roy Menninger To paraphrase:
Physicians work hard to prove their self-worth and take care of others, but have never learned how to have intimacy and receive support from others for themselves
Marriages are subsequently particularly troubled

10. Financial Student debt burdens continue to rise
Physician salaries are falling
Residents feel compelled to moonlight

11. Empathy
Relationship exists between enhanced resident well-being and empathy-one aspect of resident competency.

12. The Halstead Method
William Halstead – deeply influenced by the German method of training in surgery in late 19th century
Rigorous surgical training requiring exacting discipline and total dedication to the art and science of surgical care. Family not a priority. Young surgeons not allowed to leave the hospital (hence the term residents).
Basic principles remained unchanged until recently
What stimulated change?

13. The Libby Zion Case
1984 – an 18 year old woman in a New York hospital whose care was provided by residents who were on duty for more than 18 hours. Led to state legislation limiting resident working hours…in New York only
June, 2002 – ACGME set new standards on resident work hours which have been strictly implemented since July, 2003

14. Medical Student Values Shift
Controllable lifestyle, amount of work, and level of stress in future specialty have replaced altruism and self-sacrifice
(one study only)

15. Protection from Stress
High levels of job satisfaction
Being a parent
Having a physician parent
Speaking about concerns with colleagues, friends, and family
Support from training director and faculty
Counseling services (psychological, financial, career)
Reduced work hours – depends on the study you read
Exercise/nutrition – no data

16. References
The Effect of the 80 hour Work Week on Resident Burnout, Archives of Surgery, September, 2004.
Relationship Between Increased Personal Well-Being and Enhanced Empathy Among Internal Medicine Residents, Journal of General Internal Medicine, January, 2005.
Sources of Stress for Residents and Recommendations for Programs to Assist Them, Academic Medicine, February, 2001.
Stress and Coping Among Orthopedic Surgery Residents and Faculty, The Journal of Bone and Joint Surgery, 2004.
Burnout and Internal Medicine Resident Work-Hour Restrictions, Archives of Internal Medicine, December, 2005.