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:
- Physical – recognizing the need for physical activity, healthy foods, and sleep.
- Emotional – coping effectively with life and creating satisfying relationships.
- Spiritual – expanding a sense of purpose and meaning in life.
- Social – developing a sense of connection, belonging, and a support system.
- Intellectual – recognizing creative abilities and finding ways to expand knowledge and skills.
- Occupational – personal satisfaction and enrichment from one’s work.
- Environmental – good health by occupying pleasant, stimulating environments that support well-being.
- 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 firstname.lastname@example.org 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.
Jeffrey Levy, MD
Developer of CoreWellness Online for Residents
Author of CoreWellness: A Physician Wellness Program
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.
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/