Author Archives: Barrie Maylott

Navigating Uncharted Waters: A Pandemic Voyage Back to the Basics of Caring for Self, Family and Community

Catherine Florio Pipas, MD, MPH
April 2020

Across the globe, new scenes of struggles and successes are playing out. Navigating unchartered waters while managing elevated levels of stress means processing the paradoxes of grief and gratitude, duty and danger, isolation and risk, trust and fear.  Social distancing equates to limited contact with multiple people but increasing time with a few- often family.  Quarantining alone or together can be challenging but this slower pace of life presents opportunities to prioritize core values and enhance wellbeing skills. Being homebound and providing home daycare, home schooling, home work and home making test our flexibility and creativity, particularly for those juggling all simultaneously. New living conditions, such as grown and college children returning home, multigenerational families coming together, house guests spending day, weeks or even months in tight quarters demand that we give attention to ourselves and have increased compassion for others.  I am reminded of Maslow’s hierarchy of needs when considering the basic principles currently driving our world.

  1. Safety and Health first– Never have I been so appreciative of the necessities of life, or the link of my own wellbeing to the entire world. Water, food, clothing, sleep, shelter and health – all bind us together. The need to safeguard society demands waving to neighbors from across the road and allowing only the guests to our home who can prove 2-week prior isolation. A tank of gas can last a month, a dust covered can of beans or box of strawberry jello are viewed as treasures and neighbors swap wine for the highly prized roll of toilet paper. Handwashing is choreographed worldwide to twenty seconds of the most popular song ever.  And this prioritizing of physical health and safety is being followed by an outpouring of human generosity. The message of connection and caring is once again ringing true in our nation. 

  2. Love and belonging are like food and water for those who have the latter.  Spirited community initiatives (even if virtual) counter isolation and overcome looming fear. Building time in our secluded community to replenish together acknowledges communal stresses and provides all permission to step away from work and worry. Creative activities; cooking, crafts, dance, games, art and music have the potential to refill our tanks.  Amid our new culture simple activities provide the gift of sharing together and apart and re-watching Harry Potter becomes a silver lining in the COVID storm.  Double dipping on social and physical health occurs with a return to  long-lost habits of jogging with a spouse or hosting an on-line coffee break or “wellbeing” check-ins with colleagues. Whether working at home or in the office, prioritizing time together can slip through the cracks of the 24-hour block. Checking in with team and preserving family and meal time allow for much needed replenishing together and alone, personally and professionally.

  3. Purposeful Self Reflection is critical in the swirl of a new routine.  Loss of purpose, self-esteem and sense of contribution can accompany extreme change.  As a newcomer to teleworking I found it difficult and underestimated the need for “me time”.  Routines dissolve; some days working longer hours without breaks to compensate for not being in the office, other days working less hours being distracted by home activities and lack of boundaries. Scheduling “start and end” to core items in the day allow for  precious “me time” Setting limits to screen time also keeps self-awareness in the forefront and social media from becoming the default. The more flexible the schedule the more discipline  needed in caring for me and for others. NO guilt in taking breaks.  Filling our own tanks is key to sustaining wellbeing.

While I count the days that our universal ship continues to sail across choppy waters, I also count my blessings.  On this 31st day of social isolation it may seem like the pandemic will go on forever, but I am reminded by history that “this too” shall pass.  Until the new normal arrives, I will cherish this time spent caring for myself, my family and my community.


Tips for Transitioning to Teaching Online

By Nicky Beaudoin, M.Ed., Research and Learning Director at CaseNetwork

Background: We know this rapid timeline to online teaching is not ideal. The first step is accepting that our lives are being turned upside down and transitioning your face-to-face class to online delivery is now the path forward. It is important to recognize that you will not be an online teaching expert overnight, and that is okay. You are an expert in your craft and have years of experience to offer (that experience didn’t happen overnight). Teaching online is a skill, and skills require practice, and feedback, to get better. Everyone is going through this transition together. Be kind to yourself, be patient as a new learner, and leverage your communities in sharing best practices and challenges. We are all trying our best, while literally seeing into each other’s homes right now, showing our vulnerabilities. Share a laugh and embrace the awkward moments!

As a learning community, you may find it helpful to revise your current expectations of yourself, your learners, and each other. As teachers, your objective has not changed, your environment, tools, and resources have. You are being asked to build the plane while flying it. I’m confident each of you have the resilience necessary to make it through this online transition. My name is Nicky Beaudoin, I’m an instructional designer, and I’m here to help get you up and running! 

These tips are written for anyone who is struggling to transition their face-to-face teaching to the online space. 

Start small. Prioritize what matters.

Transitioning your course to fully online means some-to-much of your curriculum will need to be rethought, adapted, and maybe tossed. You have a limited amount of time and resources to get this done, so you will need to prioritize what matters and what you can accomplish. This is the time to triage your content. Spend some time thinking through your course (or what is left of it) and identify the most important pieces for you to teach, and students to learn within the remaining weeks. Think of this exercise as a recipe: What are your students going to make? This is the deliverable. What ingredients do students need to make it? This is how you plan your instruction. Next, focus your time and attention on building your priority list (ingredients).

Solicit all voices, leverage asynchronous activities and wisdom of the class. 

Consider asynchronous learning (where students access and engage in the same course materials at different times) to be the gold standard. If you know your community has the ability to hold synchronous (in real time) sessions, then do these too! There are no guarantees students will be in the same time zone with access to reliable internet, thus, setting up your course in a way that allows students to complet tasks on their individual schedule will yield larger participation. 

An asynchronous approach also can deliver several positive outcomes: students can manage their time to complete coursework while juggling their new responsibilities (homeschool teacher, caregiver, online teaching expert, etc.). They can check their knowledge when working through problems to solidify or expose content gaps that they can discuss with peers in a larger forum.  When designed purposefully, this approach is a great equalizer for introverts who now have time to gather their thoughts and participate confidently with their peers. This peer-to-peer learning and problem solving is leveraged more online than in the classroom, which allows faculty the opportunity to take a step back, like a coach, and assess students’ understandings as discussions unfold. 

Another bright spot with teaching online is the amount of new data you will have at your fingertips. If you are someone who likes to encourage your students to participate in activities such as “think-pair-share”, then you will love the transition to online learning because now you can see what students are thinking and sharing with each other. Leveraging your Learning Management System, you can provide your learners opportunities to engage in peer-peer learning and higher order thinking by crafting thought-provoking discussion questions. If you build this environment purposefully, you won’t hear crickets, you’ll hear the percussive clicks of students typing away.

Be okay with Good-enough.

When I was a film student, I was taught projects can be Good, Fast, Cheap, but you can only have two. With this short timeline (fast) and little to no resources (cheap), lets focus on how to make a good-enough version 1. 

After you have dissected your previous curriculum plans and sutured your new priority pieces into a makeshift syllabus, you are ready to start. Whether you choose backwards design (remember the recipe planning example where you start with the outcomes that students will be submitting for review), or a “let’s get some recorded lectures, articles, and discussion board conversation starters posted and we will do the best we can for this round because I just need to get this done before the internet cuts off again…”, you just need to aim for good-enough. Are your instructions clear? Are your assignments meaningful and not busy-work? Are you providing students an opportunity to practice and receive feedback? Let good-enough be enough for right now.

Recording 101… Is this thing on?

Recording a video lecture on your own may seem a bit daunting at first. Be kind to yourself. Chances are you already have most of the skills and technology needed to achieve this feat. Start where you are and don’t try to learn a handful of new technologies. Creating an Oscar winning video lecture is not the goal. Think of the technology you use for creating lectures or attending video conferences (something you are now, or soon will be, well-versed in), and with a few deliberate clicks, you can turn your Zoom call into an “off-label” recording application. Make sure you always do a test- you don’t want to give the lecture of your life and find out you were muted. If you can’t record your lecture slides with audio, provide slides and detailed notes for your students to follow. The goal is to give your students the right information so they can start applying the content.  Also, less is more. Think of your lecture as a Ted-Talk, short, thoughtful, and be yourself!

Communication is more important in an Online environment.
We are all juggling multiple jobs and can use some semblance of predictable schedules and clear instructions. While we are all a lot of great things, sadly, we are not mind readers. Taking the time to write what can seem like painfully clear instructions will serve you and your students well in the end. You want students to spend their time wrestling with the meat of your assignments, not spending their time deciphering what they think you want them to do. Save yourself from having to answer panicked emails at all hours of the night- if you want a discussion post to be no more than 500 words with citations, then put that in writing. Even better, provide a rubric.

The last piece about communication is related to communicating your communication expectations. Are we having fun yet? Let students know when you will be available to answer emails, hold office hours, respond to discussion posts, grading, etc. Let them know how you prefer they get a hold of you, and how you will be communicating with them (email, announcements, carrier pigeon). 

There is so much uncertainty with transitioning to virtual instruction, you can ease much of this anxiety by explicitly over-communicating your expectations about participation, assignment instructions, deadlines, etc. That is, unless you are teaching a mind reading class, then disregard everything you just read.

It’s called a learning process for a reason.

Remember that learning new things can be mentally exhausting, so be kind to yourself and to others. With practice, you will be able to convert these new cognitively draining tasks into more automated habits. Think of your 1st video call and how overloaded you were trying to figure out how to share your screen and unmute yourself. How many calls did it take before you became the expert in teaching others how to unmute their phones?! It’s all a process.

After you have made it through to the other side and have come up for air, you can ask for feedback and begin making changes and improvements for Version 2. Version 2 is going to be even better. 

I hope my “Version 1 tips” gave you some ideas for how you can start your own Version 1. Remember to find the humor, be good to each other, and embrace the awkward!

In Search of a Silver Lining; Harnessing Fear

By Catherine Florio Pipas, Chief Wellness Officer, CaseNetwork(for other blogs by Dr. Pipas, please visit her website at https://www.catherinefloriopipas.com/blog)

The power of pandemic fear can generate chaos like a hurricane spiraling out of control; this same power can be channeled like a turbine to create positive energy and outcomes. The escalating COVID-19 pandemic is justifiably generating fear in all. Fear stemming from uncertainty is particularly heightened when negative outcomes occur, and no clear solution or end is in sight. Fear breeds more fear and panic cycles can ensue. This innate process of fear also drives behavior change, which can be healthy or not. When fear is harnessed to instill healthy behaviors, new opportunities arise and individual’s and societies flourish. 

Harvesting advantages from fear requires understanding its origin and impact. The word “fear” derives from the Old English “fær” meaning calamity or danger. The New Oxford American Dictionary defines fear as “an unpleasant emotion caused by the belief that someone or something is dangerous, likely to cause pain, or a threat.” Fear is much older than the English language and looking beyond the “unpleasant” description. Neurophysiologists and psychologists recognize innate fear as protective. Fear of foe large or small, beast to microbe, serves as an internal warning that sets into motion the fight or flight response. Fear generates the power to conquer and destroy, this same emotion has the power to build and create. Evolutionarily those who harnessed their fear survived and thrived. Heightened awareness of true danger motivates individuals to perform protective behaviors; students prepare for test to avoid failure, health care workers meticulously wash their hands to minimize viral contamination, scientists work 24/7 to discover vaccines to avert pandemics. 

Fear of imminent danger keeps us alive, but fear that is out of proportion to an actual danger can activate unhealthy behaviors and undue anxiety. Assessing situations utilizes feelings and thoughts, but these can be in conflict. Feelings can battle thoughts within our brain – a war between the amygdala and the frontal cortex – the emotional epicenter firing against critical cognitive powers. When in check, fear is our friend, but when the amygdala highjacks the brain, fear itself becomes our foe. 

Our effectiveness is dependent on our capacity for equilibrium. When fear exceeds the analytical thinking processes; cognitive thinking is distorted, performance paralyzed and outcomes reduced. Students can’t focus, health care workers don’t sleep, neighbors hoard food, society pulls apart believing “we are all going to die”. A trip to the zoo or a walk on Halloween are simple examples of our ability to balance feelings and thoughts. Observing wild animals or costumed monster – the amygdala fires, a rush of fear continues winning the battle until the hippocampus stands up and reminds us of logic, likelihood, context and facts. Our minds play the “what if” game. “What if” the cage opened, “What if” I fell in, “What if” the costumed maniac was an actual killer? Logical thinking and focus on positive experiences dampen the amygdala’s power and we walk away unscathed. 

So how in the context of a REAL Pandemic can we harness this silver lining of fear to function at our greatest potential? The key to cultivating positive energy from challenges is to 1) embrace emotions, 2) refocus distorted beliefs and 3) accentuate what is going well. These strategies diminished fear and anxiety and enhance productivity and wellbeing. 

Consider applying these strategies to the COVID-19 pandemic and current policies for social distancing and “working from home”. Mandated “lock downs,” suspended non-essential services, restricted access and self-quarantines are all unprecedented messages in the 21st century. All are critical to diminishing individuals’ risk of COVID and flattening the curve of global spread but induce fear. 

Embracing emotions means acknowledging the fear that drove us home We’re experiencing fear every day. Fear of being close to an infected individual, fear of acquiring the virus, fear of getting sick, fear of transmitting it to our loved ones and for some, fear of dying. Fear has many faces, fear of the unknown, fear of what are we missing, fear of what won’t happen “out there” if we are “in here”. Fear that continues to escalate lends itself to a “we are all going to die” mentality, it permeates surfaces and when not addressed can zap our mental and physical power. 

Fear that is shared, however, is stripped of its power. Like Clorox to a virus, acknowledgement disrupts the cycle of fear. Try sharing how you feel, say it out loud, write it down in a journal, tell a friend or family member. With sharing, knowledge can be shared, healthy behaviors practiced and fear eradicating. Hand washing to the tune of happy birthday for that 20 second rule puts the threat back in perspective and the power back in our clean hands. Even in a changing environment embracing feelings and sharing up to date knowledge reduces unfounded and escalating fears. A list of FAQs exist on the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/about/index.html 

Refocusing distorted beliefs requires new lens Imagine the swirl of a storm and try to harness a silver lining by visualizing the sun behind the clouds. Often our own thoughts and beliefs are what limit our ability to perform effectively. We can’t control our experiences, but we can control how we interpret those experiences. Excessive fear can drive distorted thoughts and refocusing thoughts can reduce the worry to enhance daily function. 

Refocusing thoughts means changing perspectives, taking off your current glasses and finding new lens. There are many angles to every situation, we can take a historic perspective, a mirror image, wide angle, a long lens, a broad look, and even a sunny day view. In the case of COVID and our “stay at home” mandates, consider the following alternative perspectives that focus on benefits to the environment, the healthcare system and the future community. New perspectives have the potential to safeguard our health and drive positive outcomes. 

• Environmental lens- By lessening high traffic commutes across the country, emissions will be down in the US as seen recently in China. Less travel limits the use of natural resources like gasoline and allows essential workers shorter commutes and lower rates of accidents. 

• Infectious lens- Fear of corona virus has changed the practice of hand hygiene. Many who previously rarely washed their hands are now singing happy birthday dozens of times a day, holding doors open for others with their feet and touching surfaces with paper towels and gloves. This rampant hygienic shift in culture will not only flatten the curve of coronavirus but should reduce the spread of many infectious diseases. 

• Healthcare lens- Telehealth has received unprecedented attention with a fast track to most primary care offices as a result of the pandemic. Long standing barriers are crumbling allowing opportunity to institute a lower cost, more convenient method of delivering healthcare. Policies for billing are moving forward and research studies will follow. 

• The community lens- Learning from history, we saw the 1918 Influenza Pandemic infect 500 million people worldwide. This H1N1 viral pandemic was associated with crowded hospitals and military camps across Europe and the US following WWI. This Spanish Flu, named for causing the death of Alfonso XIII , King of Spain also killed over 50 million worldwide. A century later, flu vaccines continue to be responsible for saving lives. 

Accentuate what is Going Well 

Mandates arising from fear activated a mass exodus of children and parents back to home towns, back to their families of origin. Experiencing life from within the constructs of our homes has generated a growing list of advantages personally and professionally. If we can tune out the frenzy, shut down the “do more” culture and turn off the news, it is possible to capture a moment of stillness amongst loved ones. Embracing this gift of time and space permits us ability to reunite, replenish, rebalance and redirect our energies. Fear driven changes are triggers for exploring what is going well: 

• Family time – Focus on family connections and home cooking replaces eating out and fosters a shared experience. “a coming home for thanksgiving without the turkey” 

• Shared Learning- Remote working and distance online curriculum allows parents and children to now learn side by side. Seeing one another’s routines generates a shared experience of lessons learned. 

• Self-care – working from home permits a scale of efficiency. By not commuting, time is freed up daily and opportunities can be woven throughout the day for exercise, arts, personal hobbies and family activities. Will this opportunity to exclusively be with our family come again in the 21st century? One hopes not. The good news is our successful efforts will reduce the transmission of coronavirus, the bad news is home mandates won’t last, and before we know it, we will all be back to the grind, commuting on busy highways, working and studying long hours and spending most of our waking time away from our families. Taking advantage of the situation now is the right thing to do to safeguard society. Practicing these strategies, we can harness our fears and discover silver linings together and apart.

Amor: The Most Valuable Currency Worldwide

By Catherine Florio Pipas, Chief Wellness Officer, CaseNetwork
(for other blogs by Dr. Pipas, please visit her website at https://www.catherinefloriopipas.com/blog)

“Love” is universally valued. It has no boundaries and rings true in all languages. It is a gift, a virtue and a quality that no law can destroy. We cannot purchase it, order it online, tax, or import it.  But all across the world  love is present. One only has to observe people to see its magic. 






The words of George Sands, “There is only one happiness in this life, to love and be loved,” rang true for me in Spanish and English on a recent educational trip to Cuba.  I was struck by the absence of material goods contrasted by a profound joy overflowing among the people.  Gaps in monetary belongings appeared offset by an excess of time and devotion to a culture of love. Music, dance, singing and art displayed day and night by individuals, families, neighborhoods and communities encompassed my Cuban experience. “What the Cuban people lack in “stuff” and freedom,  they make up for  in love of each other and of life.

Although very little monetary currency is exchanged by the average person in Havana, there is a palpable richness among the people – young and old.  There are also health outcomes more closely associated with first world countries.  Money can certainly buy some happiness, but my observations within this northern Caribbean island of 11 million suggests love (in addition to a strong primary care health system) is priceless and no form of government or limitations in freedom or purchasing power can take that away. 

Questions come to mind as I return to the Miami airport among the luxuries of duty-free shopping and the plethora of food options. Is there a link between a simpler life and more love and happiness? Does capitalism focus us too much on achievement and affluence? Does the human spirit have a potential to grow love in the absence of  stuff?  Is there an alternative balance of  “things”  with “relationships “than that which I have grown up believing in?  Perhaps there is a healthier way I could invest my time or energy that would bring more love and happiness to my life. While I would never give up my freedom, are there other items I could part with, in exchange for more time with those I love?     

Perhaps a change is in my control?

Permission to Be Well

Resilience is associated with overall wellbeing and lower rates of burnout. Predictors of resilience include cognitive flexibility and attention to personal health habits. But despite possessing the knowledge and skills to promote self-care, we, as health professionals often, for complex reasons, deny ourselves the time and permission to prioritize our own wellbeing. In staying with my New Year’s tradition of selecting a “word of the year,” I have chosen permission for 2020.

Permission, defined as the go-ahead, green light or blessing to move forward. This carte blanche resolves one of guilt, doubt or fear that may otherwise accompany a decision not sanctioned or approved. Additionally, permission provides reassurance and clearance to not only advance on a journey or task but to also enjoy the process and the outcome.

In 2020, I Grant Myself Permission to…
• Go for walk …every day!
• Read a novel, paint a picture, listen to Bruce Springsteen
• Write
• Make a mistake and learn from it
• Accept my own and other’s limitations
• Live my values daily and publicly
• Embrace fears and talk about stressors
• Say “yes” to help
• Be done at the end of the work day
• Speak honestly, even if it displeases others
• Not be judged by self or others
• Rethink my thoughts, no matter how right I thought I was
• Challenge status quo, but also be willing to accept status quo
• Provide a clean slate- tabula rasa to myself and others
• View the glass half full
• Say “NO” to perfection!
• Be ME; do what I love and what I am good at
• Enjoy life, let me be happy!
• Feel no guilt for any of the above.

What will you give yourself permission to do?

Permission Granted – Cheers to our Health!

Resilience Training is the Key to Wellness Initiatives

Over the last six months, I have had the opportunity to interact with over 300 residency programs and medical schools about wellness of their trainees. A vast majority of program directors and faculty expressed how over half of their residents and over a third of their medical students had at least one component of burnout syndrome. More than a dozen residency program directors confided in me that they had a recent resident suicide in their institutions.

So, you can imagine I was somewhat surprised that many programs and institutions still don’t incorporate proactive training like resilience exercises in their wellness initiatives. I believe that resilience training should be an integral component of ALL wellness initiatives. As resilience expert and author of The Resilience Factor, Dr. Andrew Shatte said, “More than education, more than experience, more than training, it is RESILIENCE that determines who succeeds and who fails.” Resilience empowers residents and medical students to overcome obstacles and challenges, steer through day-to-day adversities and bounce back from major setbacks. Resilience proactively builds the critically important skills necessary to help prevent burnout and depression. Cognitive behavioral therapy (CBT) research shows that everyone is capable of becoming more resilient if they have willingness to change – a process that begins with self-exploration.

Building resilience takes deliberate practice beginning with learning the “A-B-Cs” of cognitive therapy. Most people think that there is a direct connection from an adversity (A) to a consequence (C) that cannot be controlled. Can an adversity occur that automatically leads to a consequence? The answer is no! There is always a belief (B) or thought process in between the A and C that has a direct impact on the resulting consequence (the feelings, behavior and actions). If an A led directly to a C, everyone would react to an adversity in the exact same way. But that is of course not how it happens. Everyone reacts differently because everyone has unique thinking processes and patterns.

Let me illustrate how different Bs can lead to unique Cs in an example below.

A= Adversity (Stressor)

Example: You are on-call and you are getting paged every few minutes about another patient being admitted to your service. This is turning out to be the busiest call you have ever had.

B= Belief (Thought Process)

Example 1: “I cannot deal with this and I am not confident things will work out; there will be so many patients that I’ll make mistakes. A patient will die and that will be the end of my medical career.”

Example 2: “Yes, there are a lot of patients at once, but I can ask for help and do the best I can. I can learn new organization skills to handle this challenge, because it is not unlike what I have done before. This on-call night will be one I will remember, and it’s going to turn out just fine.”

C = Consequences (Feelings or Behaviors)

C resulting from the belief in example 1: The trainee is highly stressed and takes a disorganized approach to the on-call challenge. This distressful consequence is a result of a type of cognitive distortion known as catastrophizing where one assumes the worst, most catastrophic outcome possible rather than assuming the most likely (a more neutral or positive) outcome.

C resulting from the belief in example 2:  The trainee is more likely to appropriately cope with the situation with an acceptable stress level and creative use of support services for processing patient admissions. Note how the thought content invokes reason and problem solving, unlike the dysfunctional, stress-inducing thought-stream in the first example.

Now you can understand how the A-B-C model can help explain how we react to different types of adversities. As trainees get more in tune with their thinking, they might detect some emerging patterns. They may begin to realize that there are some consistent connections between their B and C as described in the table below.

Beliefs (B) Consequences (C)
Violation of your rights Anger
Real world loss or loss of self-worth Sadness, depression
Violation of another’s rights Guilt
Future threat Anxiety, fear
Negative comparison to others Embarrassment

This understanding leads to insights in their thinking patterns. This creates opportunities for trainees to change their thinking patterns to improve their consequences or outcomes.

Teaching oneself to adopt new ways of thinking is not only possible based on cognitive behavioral methods, but also based on the neurophysiologic model of resilience. Research on post-traumatic stress, depression, and differences in resilience teach us that improved coping is related both to neuroplasticity and to developing new neuropathways and different, more adaptive and helpful ways of viewing stress. The overall objective of resilience skill-building is to harness one’s innate cognitive flexibility, leading to the ability to reappraise negative situations.

As Henry Ford said so clearly and succinctly, “Whether you think you can, or you think you can’t – you are right.”

In the CoreWellness program, there are several proactive resilience skill-building exercises for residents and medical students to help them better deal with adversities and improve their consequences resulting in more realistic and optimistic beliefs. In this way trainees learn to not only survive their training, but to actually grow and flourish both professionally and personally.

Please let me know if there is anything I can do to help you, your department, or your institution build resilience. You can reach me at info@casenetwork.com. I look forward to interacting with you.

 Jeff
 Jeffrey Levy, MD
CEO, CaseNetwork
Developer of CoreWellness Online for Residents
Author of CoreWellness: A Physician Wellness Program

About Consulting Services

Dr. Jeffrey Levy, author of CoreWellness: A Physician Wellness Program and Dr. Catherine Pipas, author of A Doctor’s Dozen lead a team of physician wellness experts to provide consultative services including train-the-trainer programs for faculty development to improve the faculty’s ability to facilitate wellness discussions and create a culture of wellness. Other longer-term consultative engagements include guiding departments and/or institutions through a step-by-step process to design, launch, measure, sustain and improve their wellness initiatives.

 

Creating a Culture of Wellness

I just returned from the Society of Teachers in Family Medicine (STFM) meeting in Toronto. There was a strong focus on resident wellness at this meeting. As I had the opportunity to speak with dozens of program directors, it quickly became apparent that every residency program is moving toward creating their own “culture of wellness.” Many are at the beginning stages of the process and are struggling with how to design and implement their wellness initiates.

I believe the first step of the process is to accurately define wellness. According to the World Health Organization wellness is as an “optimal state of physical, mental/emotional and social well-being, and not merely the absence of disease.”

I have adopted and subscribe to a much broader definition of wellness provided by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration, which includes eight dimensions of wellness, including:

  1. Physical – recognizing the need for physical activity, healthy foods, and sleep.
  2. Emotional – coping effectively with life and creating satisfying relationships.
  3. Spiritual – expanding a sense of purpose and meaning in life.
  4. Social – developing a sense of connection, belonging, and a support system.
  5. Intellectual – recognizing creative abilities and finding ways to expand knowledge and skills.
  6. Occupational – personal satisfaction and enrichment from one’s work.
  7. Environmental – good health by occupying pleasant, stimulating environments that support well-being.
  8. Financial – satisfaction with current and future financial situations.

Residents certainly have unique circumstances in a very demanding profession, but also have many similarities to the general population. It probably comes as no surprise that adequate sleep, a nutritious diet and exercise, and social connectedness with community, family and friends are important to residents. Why, then, are these obvious self-care practices set aside, postponed, or frankly ignored during the long road through post-graduate training?

Deficits in these basic human needs become risk factors for burnout – an imbalance between work demands and coping ability, which generally continues to worsen throughout medical training. The high prevalence of burnout among post-graduate trainees is, in part, due to deficits in two other dimensions of well-being that are important to address but challenging to nurture.
The first is autonomy that can be described as having a say in shaping one’s learning environment so that it supports well-being as much as clinical education, providing supervision commensurate with a graduated level of independence and responsibility. The second is competence, which is a sense of self-efficacy that increases through training as one accumulates positive experiences of successful patient care resulting from a resident’s knowledge and skills.

To achieve a culture of wellness, a department must:

  • Support a healthy environment that values self-care as a means of maintaining high-quality patient care.
  • Advocate for the adoption of healthy habits in residents’ professional and personal lives.
  • Embrace a nurturing community where seeking help is not discouraged, but rather encouraged.
  • Create an environment where residents feel safe to engage in ongoing dialogue about their challenges and needs.
  • Develop a Wellness Committee that can addresses residents’ needs as well as national/local mandates or requirements.

Does your program have a culture of wellness? If not, please contact me at info@casenetwork.com and we can discuss a step-by-step approach to designing, implementing, assessing and maintaining a culture of wellness.

I look forward to interacting with you.

Jeff

Jeffrey Levy, MD
CEO, CaseNetwork
Developer of CoreWellness Online for Residents
Author of CoreWellness: A Physician Wellness Program

About CaseNetwork
CaseNetwork is a technology enhanced medical education company that delivers competency-focused, case-based education that enables learners to improve their knowledge and comprehension of critical patient situations and disease states. CaseNetwork’s simulated patient encounters integrate evidence-based clinical information with required proficiencies and skills. CaseNetwork’s proprietary platforms include interactive decision making and peer-to-peer problem solving that is conveniently delivered in a browser or on a mobile device for anytime, anywhere learning. The CaseNetwork solution helps healthcare professionals advance their skills and improve competency with the ultimate goal of enhancing patient outcomes. For more information, visit http://www.casenetwork.com.

About CoreWellness
CoreWellness Online is a breakthrough online program from CaseNetwork with 24 modules that provide your residents with the knowledge and practical skills to manage stress and adversities typical of post-graduate training. Residents will learn about burnout syndrome (BOS), improve resilience, and achieve self-awareness through proactive wellness and self-care measures.  This comprehensive program is the first of its kind, designed to help residents cope with the unique demands of the healthcare profession and to better understand the impact stressors have on their cognitive, emotional, and physical well-being. This program provides information to help them not only survive training, but to actually thrive and flourish. For more information go to http://casenetwork.com/markets/corewellness/