Resident and Fellow Burnout | Professional Well-being | AMA STEPS Forward | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Resident and Fellow BurnoutCreate a Holistic, Supportive Culture of Wellness

Learning Objectives
1. Describe elements needed to create a wellness framework
2. Discover the steps needed to develop a wellness program
3. List key aspects of personal well-being
4. Recognize the importance of personal empowerment and a sustainable culture of wellness
0.5 Credit CME
How will this module help me?

  1. Describes the importance of wellness.

  2. Provides information about successful wellness programs.

  3. Identifies ways to create a sustainable culture of wellness.

Introduction

The increasing number of residents and fellows who describe experiencing burnout highlights a growing crisis within the medical workforce. Among physicians, rates of suicides, depression, and burnout are higher than the rest of the population, while personal and professional satisfaction are low. It is becoming more important to identify ways to create a wellness program within graduate medical education (GME) programs. Resident burnout is also impacted by concern of career choice regret. Physician burnout is a long-term stress reaction characterized by depersonalization, including cynical or negative attitudes toward patients, emotional exhaustion, a feeling of decreased personal achievement, and a lack of empathy for patients. Conversely, wellness consists of multi-dimensional variables that interact to positively impact levels of health and emotional and social functioning. Residents and fellows who attend programs that emphasize wellness and resiliency are more likely to transform into physicians that are less stressed and better able to engage with patients to provide quality care.

Five STEPS to Create a Wellness Culture

  1. Create a Framework.

  2. Gather a Team.

  3. Develop a Wellness Program.

  4. Foster Individual Wellness.

  5. Confront Burnout and Create a Culture of Wellness.

Step 1 Create a Wellness Framework.

To create a sustainable and engaging wellness program, you need to develop the framework first. This requires the time and dedication of key people, especially residents and fellows who can lead their program and organization to make a commitment to the wellness of fellow trainees and potentially the entire medical staff.

Enlist trainees and faculty to serve as wellness advocates and champions. Many programs involve chief residents, the program director, faculty members, social workers, and psychiatrists—all who have a particular interest in wellness.

After you have identified wellness champions, schedule a meeting with the program director to gain leadership support. An organizational commitment to wellness leads to better chances of achieving a healthy workforce; the responsibility of wellness must be shared within the program. The meeting with leadership should be used to discuss how your organization defines wellness, the benefits of a wellness program, and the accomplishments of other successful initiatives.

Defining wellness should be a team effort. Prompt discussions by asking questions that include:

  • What does it mean to be well?

  • What aspects of wellness should be addressed as part of the wellness program's scope?

After developing a definition for wellness, it is important to understand the program's current state of wellness. At the beginning of the year, administer a survey to assess wellness within your program. Encourage trainees to respond to the survey honestly and reflectively, emphasizing that individual responses will remain confidential. Plan to reassess wellness as interventions are introduced to determine whether the changes are making a positive impact.

After the surveys are completed, the wellness team should analyze the results and develop action plans to address any concerning themes. Many programs find this as opportunity to decide if more wellness activities are needed. You may want to display wellness scores on the department dashboard or scorecard, so everyone is reminded to think about wellness as a quality indicator.

Box Section Ref ID

Q&A

  • Why is wellness important?

    Employers have found that happy, engaged workers are more productive. Years ago, companies such as Goldman Sachs and Google made an organizational commitment to create wellness programs for their employees. Since then, the cultural shift has been dramatic, resulting in a more productive and satisfied workforce with happier clients and better outcomes. The story of Goldman Sachs' resilience program's success can be found here. The same programs implemented by Goldman Sachs and Google can be used to impact the field of medicine.

  • What can we do to help our leaders better understand the value of wellness?

    The more data you can show leaders, the better. Some useful information to present to leadership includes:

    • Integrating wellness within a program enhances trainees' ability to fulfill the six core competencies as described by the Accreditation Council for Graduate Medical Education (ACGME).

      • Practice-Based Learning and Improvement.

      • Patient Care and Procedural Skills.

      • Systems-Based Practice.

      • Medical Knowledge.

      • Interpersonal and Communication Skills.

      • Professionalism.

    • Work-related exhaustion is one of the many variables contributing to increased medical errors; a physician whose health is compromised is more likely to provide suboptimal care

  • What if we have concerns about the time and energy required for regular wellness assessments?

    Data is important when developing a framework for a wellness program. Regular surveys emphasize your program's commitment to wellness concerns. Additionally, confidential surveys may offer an opportunity for trainees to identify colleagues that may need help.

  • What if we think a member of our training program is burned out or in distress?

    It is important to rely on other sources to determine if burnout exists. Trainees should be aware of the available resources to address burnout including the support of wellness leaders within the training program. If a trainee reaches out for help, leaders should find resources that the individual can use to seek confidential help.

Step 2 Gather Your Team.

In order for your program to succeed you must create a team with representation of all of those who are invested in its success. These include residency leadership, GME office, one or more residents, residency coordinator, and social work/psychiatry backup. If you are not the program director (PD), you must have the cooperation of either the PD or the associate PD. Both will be integral to your wellness program, as some resources will be required, and will impact resident time commitments and scheduling. Your graduate medical education office and director will be important to both support your program, and to provide resources in the form of counseling or organization wide house staff activities. You will need a resident champion, preferably a senior resident who has credibility with their peers. In order to increase their buy in and that of their peers, create a job description and a title, perhaps “Wellness Lead”. By creating a leadership position for a resident or fellow, they will be more likely to perceive the program as being internally driven and representing the needs and interests of the current group of residents.

Box Section Ref ID

Q&A

  • How do we convince the residents that it's safe to ask for help?

    You will need to normalize the opportunity to seek counseling and/or psychiatric help. At the beginning of each academic year, and periodically, residents should be informed as a group of the procedure to request confidential counseling, with assurance that a provider will be identified whom they will not encounter during their clinical work. They will need to be reassured that regardless of the rotation they are on, opportunities will be ensured for release from clinical duties in order to receive counseling.

  • What resources should I request from the GME office?

    Your organization needs to be invested in the wellness of all residents & fellows in the organization. Providing confidential counseling & psychiatric services for all house staff may already be available, and if not should be requested. Some organizations with multiple training programs have leadership programs for house staff participation, such as those provided by residencies managed by the Council on Interns and Residents (CIR). Providing additional leadership opportunities for residents is one opportunity to reduce burnout.

Step 3 Develop a Wellness Program.

Innovate and design custom interventions that meet the needs of both individual trainees and the training program. You can begin this process by assessing the results from the initial wellness survey. Consider holding a brainstorming session with the wellness team to determine which interventions or activities could increase wellness among trainees. Based on the survey results, you may want to consider some of the following interventions:

  • If trainees are not transitioning well into their new roles, offer peer support with a “buddy” program where they can be paired with a resident or fellow that is a year ahead. The more advanced resident or fellow may be able to offer actionable advice as they recently experienced the same transition.

  • If the threats to wellness involve working too many hours, the wellness team can work with program leaders to manage the amount of time trainees work over the different clinical rotations, or rearrange clinical schedules to alternate more demanding schedules with electives or consult services.

  • If trainees express that the program lacks a strong team culture, schedule group wellness events. These are an opportunity for everyone to have fun and connect with one another outside of the workplace. Plan activities such as:

    • Movie nights or dinners.

    • Holiday potlucks.

    • Ballroom dancing classes including spouses and significant others.

    • Local charity work (e.g., volunteer at a soup kitchen).

    • Lunchtime exercise or yoga classes.

    • Participation in a local 5k or color run.

    • Sporting events (e.g., playing in a recreational league, watching a televised match or attending a university game).

    • Watching popular shows as a team.

    • Painting or pottery classes.

    • Exploring the local environment.

  • A yearly or biyearly resident retreat may be an important way for the residents to feel empowered to focus on their team building and comradery. This will need the support of the PD, with some financial support, and can be an opportunity for the faculty to show their appreciation of the residents by covering some clinical services.

After you establish interventions, educate trainees, staff, and faculty on what wellness is and how you plan to achieve it. Incorporate wellness into the fabric of the training program by offering wellness learning sessions, interactive workshops, or implement it into grand rounds. The wellness team should strive to develop a holistic, engaging curriculum that exposes all trainees to important wellness practices to improve each trainee's life as a physician.

The cyclical nature of residency and fellowship training programs requires constant innovation. Continuously re-evaluate these initiatives to ensure that they are aligned with the wellness program's priorities. The preliminary assessment can serve as a benchmark. Keep track of the activities that the wellness program hosts or sponsors and how well trainees respond to them at the event and on post-event surveys. Use this feedback to establish which events should be continued. To learn more about the impact the interventions have had on wellness, use open-ended survey questions asking whether the interventions have made an impact and request information on other activities that they would be interested in. The wellness team will likely need to tailor the program every year to meet the needs of the current residents and fellows.

“The most important patient we have to take care of is the one in the mirror.”

—Robert Wah, MD, Former AMA president, Reproductive Endocrinology, National Institutes of Health (NIH) and Walter Reed National Military Medical Center, Bethesda MD

Step 4 Foster Individual Wellness.

Quiz Ref IDIn addition to providing residents and fellows with a supportive environment that is committed to wellness, it is important to ensure that they have the tools and resources to develop individual wellness as well. To ensure individual wellness is established, you may consider incorporating the following components to shape the wellness program's curriculum:

  • Nutrition (e.g., healthy food options and scheduled time to eat)—The wellness team can sponsor department meetings to ensure that healthy food is available.

  • Fitness—Make sure residents have free access to a gym that is located in or near the medical center.

  • Emotional health—Relax, renew and re-energize through hosted events (e.g., retreats with team-building and self-awareness exercises, stress management approaches).

  • Preventive care (e.g., dental care and provisions to see a primary care physician)—Program leadership can commit to giving trainees an occasional weekday afternoon off for personal meetings or doctor appointments.

  • Financial health (e.g., debt management, retirement planning and emergency fund support)—Bring in a financial counselor to have informal discussions with interested residents.

  • Mindset and behavior adaptability—Assign “wellness partners” of faculty and trainees who will engage in goal-oriented discussions on emotional, spiritual, physical and social aspects of wellness, to help trainees develop a personal wellness approach.

Box Section Ref ID

Q&A

  • What are some effective individual strategies to achieve wellness?

    Quiz Ref IDThere are many strategies that residents and fellows can use to take wellness into their own hands.2 They can engage with other trainees and leaders in the program to create an environment where the wellness tactics can be applied on an individual level.

    Balance personal and professional goals.

    • Clarify what is most important in your personal and professional life.

    • Identify conflicts.

    • Learn techniques to adapt your daily routine around factors that are out of your control (e.g., your work schedule).

    Shape your career and identify stressors.

    • Determine whether you need to make career changes.

    • Identify what energizes you and what drains you.

    • Decide how stressors can be modified.

    Nurture wellness strategies.

    • Relationships.

    • Self-care.

      • Eat.

      • Sleep.

      • Exercise.

      • Take Vacations.

    • Mindfulness.

    • Personal interests.

  • Our physicians and staff are overwhelmed. How can we find time to implement wellness initiatives?

    The fact that faculty members are overwhelmed is itself justification for taking the time to engage in wellness activities. With strong leadership support of wellness initiatives, time can be found for wellness. Whether it is through annual faculty retreats or at one of the many faculty meetings held each month, wellness activities and discussions can be integrated into existing training program events. Helping trainees find time for self-care should be an institutional priority. Prioritizing self-care is often natural after wellness is discussed in grand rounds or highlighted at a department meeting.

Step 5 Confront Burnout and Create a Sustainable Culture of Wellness.

Quiz Ref IDMaintain a strong wellness program through agility and leadership involvement. Be open to adapting strategies to fit the needs of the trainees and strive to survey residents and fellows on a regular basis, often every 4-6 months as residents and fellows change annually with new entering and those graduating. Provide opportunities for all team members to become involved in the wellness program. Continue to include faculty advisors and enable them to collaborate often. The hierarchy of the medical profession can make residents and fellows feel uncomfortable approaching a more senior member of the medical staff about wellness issues. While creating an anonymous reporting system can be helpful, trainees should be encouraged to seek and offer help as needed. Most importantly, create a community that is empowered to identify and act on signs of burnout. The combined agility and leadership involvement will help to ensure the longevity and success of the wellness program.

Box Section Ref ID

Q&A

  • What is the long-term goal of the wellness program?

    In time, residents and fellows will have built a community where everyone prioritizes wellness. New trainees will be welcomed into a robust framework where physicians are resilient, engage in wellness activities, and are in tune with their level of wellness throughout their training. This increased self- and environmental-awareness will become an important part of learning during crucial developmental years for young physicians. These lessons will help keep the residents and fellows well enough to care for themselves and their patients as they continue to prepare for a successful career in medicine. In the future, physicians should experience longer, more fulfilling careers due to their ability to remain resilient and combat physician burnout.

Conclusion

A commitment to wellness will help ensure that residents and fellows are involved and engaged in their training program as well as in their care of patients. Equipping trainees with skills to foster their own wellness will serve them, their families, and their patients throughout their careers. The strategies, tools, and resources in this module can assist you in creating a wellness culture that fits your training program's needs.

Box Section Ref ID
Graphic Jump Location
AMA Pearls

AMA Pearls

Even small changes can make a big difference.

There is no change too small when it comes to addressing burnout and improving the wellness and resilience of residents and fellows. Programs that prioritize their trainees' wellness will produce more engaged physicians who can provide quality care to their patients. If your training program is hesitant to commit to developing a wellness program, align with others who are interested in wellness and create a special interest group or club. Host a grand rounds speaker and invite your colleagues and faculty to wellness events. Your involvement may make a big difference to someone who needs it, and in time your activities will gain support to create a larger program.

Sign in to take quiz and track your certificates

STEPS Forward™ presents actionable, practical toolkits and customizable resources that you can use to successfully implement meaningful and transformative change in your practice or organization. See How it Works

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

0.5 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;

0.5 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;

0.5 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program; and

0.5 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program;

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Article Information

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this enduring material activity for a maximum of .50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

ABMS MOC Statement: Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Maintenance of Certification (“MOC”) Activities, this activity has met the requirements as an MOC Part II CME Activity. Please review the ABMS Continuing Certification Directory to see what ABMS Member Boards have accepted this activity.

Renewal Date: December 10, 2016; October 03, 2019

References
1.
Shersher  J.  Six key aspects of personal well-being.  Telephone interview by Okanlawon T. July 25 , 2015.Google Scholar
2.
Shanafelt  TD, Kaups  KL, Nelson  H,  et al.  An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons.  Ann Surg. 2014;259(1):82–88.Google ScholarCrossref
3.
Dunn  PM, Arnetz  BB, Christensen  JF, Homer  L.  Meeting the imperative to improve physician well-being: assessment of an innovative program.  J Gen Intern Med. 2007;22(11):1544–1552.Google ScholarCrossref
4.
Eckleberry-Hunt  J, Van Dyke  A, Lick  D, Tucciarone  J.  Changing the conversation from burnout to wellness: physician well-being in residency training programs.  J Grad Med Educ. 2009;1(2):225–230.Google ScholarCrossref
5.
Lefebvre  DC.,  Perspective: Resident physician wellness: a new hope.  Acad Med. 2012;87(5):598–602.Google ScholarCrossref
6.
Ahmed  N, Devitt  KS, Keshet  I, Spicer  J, Imrie  K, Feldman  L, Rutka  J.  A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes.  Ann Surg. 2014;259(6):1041–1053.Google ScholarCrossref
7.
Rubin  R.  Recent suicides highlight need to address depression in medical students and residents.  JAMA. 2014;312(17):1725–1727.Google ScholarCrossref
8.
Milling  TJ.  Drug and alcohol use in emergency medicine residency: an impaired resident's perspective.  Ann Emerg Med. 2005;46(2):148–151.Google ScholarCrossref
9.
Cedfeldt  AS, Bower  E, Flores  C, Brunett  P, Choi  D, Girard  DE.  Promoting resident wellness: evaluation of a time-off policy to increase residents' utilization of health care services.  Acad Med. 2015;90(5):678–683.Google ScholarCrossref
10.
Shapiro  J.  Perspective: Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training.  Acad Med. 2011;86(3):326–332.Google ScholarCrossref
11.
Perry  MY, Osborne  WE.  Health and wellness in residents who matriculate into physician training programs.  Am J Obstet Gynecol. 2003;189(3):679–683.Google ScholarCrossref
12.
Rosen  IM, Gimotty  PA, Shea  JA, Bellini  LM.  Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns.  Acad Med. 2006;81(1):82–85.Google ScholarCrossref
13.
Volpp  KG, Rosen  AK, Rosenbaum  PR,  et al.  Mortality among patients in VA hospitals in the first 2 years following ACGME resident duty hour reform.  JAMA. 2007;298(9):984–992.Google ScholarCrossref
14.
Drolet  BC, Rodgers  S.  A comprehensive medical student wellness program—design and implementation at Vanderbilt School of Medicine.  Acad Med. 2010;85(1):103–110.Google ScholarCrossref
15.
Koran  LM, Litt  IF.  House staff well-being.  West J Med. 1988;148(1):97–101.Google Scholar
16.
Parshuram  CS, Dhanani  S, Kirsh  JA, Cox  PN.  Fellowship training, workload, fatigue and physical stress: a prospective observational study.  CMAJ. 2004;170(6):965–970.Google ScholarCrossref
17.
Landrigan  CP, Fahrenkopf  AM, Lewin  D,  et al.  Effects of the Accreditation Council for Graduate Medical Education duty hour limits on sleep, work hours, and safety.  Pediatrics. 2008;122(2):250–258.Google ScholarCrossref
18.
Fahrenkopf  AM, Sectish  TC, Barger  LK,  et al.  Rates of medication errors among depressed and burnt out residents: prospective cohort study.  BMJ. 2008;336(7642):488–491.Google ScholarCrossref
19.
Prins  JT, van der Heijden  FMMA, Hoeksrta-Weebers  JE,  et al.  Burnout, engagement and resident physicians' self-reported errors.  Psychol Health Med. 2009;14(66):654–666.Google ScholarCrossref
20.
Moonesinghe  SR, Lowery  J, Shahi  N, Millen  A, Beard  JD.  Impact of reduction in working hours for doctors in training on postgraduate medical education and patient's outcomes: systematic review.  BMJ. 2011;342:d1580.Google ScholarCrossref
21.
Wallace  JE, Lemaire  JB, Ghali  WA.  Physician wellness: a missing quality indicator.  Lancet. 2009;374(9702):1714–1721.Google ScholarCrossref
22.
Maslach  C, Jackson  S, Leiter  M.  Maslach Burnout Inventory Manual, 3rd ed.  Consulting Psychologists: Palo Alto, CA; 1996.
23.
Chen  PW.  A Medical School More Like Hogwarts.  The New York Times. http://well.blogs.nytimes.com/2011/12/22/a-medical-school-more-like-hogwarts/?_r=0. Published December 22 , 2011. Accessed July 23, 2015.Google Scholar
24.
Hobson  K.  New Medical School Programs Help Students Battle Burnout.  U.S. News & World Report. http://www.usnews.com/education/best-graduate-schools/top-medical-schools/articles/2013/03/21/new-medical-school-programs-help-students-battle-burnout. Published March 21 , 2013. Accessed July 23, 2015.Google Scholar
25.
Daskivich  TJ, Jardine  DA, Tseng  J,  et al.  Promotion of wellness and mental health awareness among physicians in training: perspective of a national, multispecialty panel of residents and fellows.  J Grad Med Educ. 2015;7(1):143–147.Google ScholarCrossref
26.
AMA Wire.  How one program achieved resident wellness, work-life balance. http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance. Accessed August 24, 2015.
27.
Mayo Clinic Florida. Accessed August 24, 2015.
28.
Mata  DA, Ramos  MA, Narinder  B,  et al.  Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis.  JAMA. 2015;314(22):2373–2383.Google ScholarCrossref
29.
Sklar  DP.,  Fostering Student, Resident, and Faculty Wellness to Produce Healthy Doctors and a Healthy Population.  Academic Medicine. 2016;91(9): 1185–1188. doi: 10.1097/ACM.0000000000001298.Google ScholarCrossref
30.
Dyrbye, Liselotte  N.,  Burnout among U.S. medical students, residents, and early career physicians relative the general U.S. population.  Academic Medicine. March 2014 - Volume 89 - Issue 3 - p 443–451 doi: 10.1097/ACM.0000000000000134Google ScholarCrossref
31.
Dyrbye, Liselotte  N.,  Association of clinical specialty with symptoms of burnout and career choice regret among U.S. resident physicians.  JAMA. 2018;320(11):1114–1130. 10.1001/jama.2018.12615Google ScholarCrossref
32.
Tawfik, Daniel  S,  et al.  Physician Burnout, well-being, and work unit safety grades in relationship to reported medical errors.  Mayo Clinic Proceedings, Volume 93, Issue 11, 1571 - 1580Google ScholarCrossref
Close
Close
Close

Name Your Search

Save Search
Close
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
Close