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Resident and Fellow Burnout Case Report: Stanford Department of General Surgery

Background: Four years ago, the Stanford Department of General Surgery was rocked by news that one of their star trainees, who had recently left Stanford to pursue his vascular surgery fellowship training in Chicago, committed suicide. Dr. Greg Feldman, MD, was one of the most accomplished resident physicians the program had ever seen. He was warm, outgoing and seemed happy. He was described by a fellow trainee as “extremely good at balancing his work and non-work life and cared about getting other residents to have fun both at work and outside the hospital.” His death shocked the Stanford surgery department. Faculty, staff and residents alike were stricken with grief. How can someone so amazing, so talented and so “happy” commit suicide? Why? What went wrong? What was missed? These questions remain unanswered.

Action: As the healing process continued at Stanford, the program leadership decided to take action by addressing underlying issues affecting resident physician health. Thomas Krummel, MD, chair of the Department of Surgery, asked Ralph Greco, MD, Program Director of the General Surgery Residency, to develop a wellness program for residents. With a committee comprised of three faculty members and four residents, Balance in Life (BIL) was created. BIL is a holistic, multifaceted program with the primary aim of educating about and facilitating physical and mental health among resident trainees.

Results: Four years since its inception, BIL's active leadership team has created a wellness-focused training environment for surgery residents. They have established a “resident-only” clubhouse where physicians can have a quiet space to discuss and reflect on their days. They have developed a system that provides protected, weekly time when trainees can meet with a therapist alone or as a group in a confidential setting. They have implemented a curriculum that enhances wellness and teamwork. A strong sense of community has emerged since the initiation of yearly retreats, team sports events and other outings. Finally, a “big-sib/little-sib” mentoring program that pairs younger trainees with more experienced ones provides guidance for new members of the program.

BIL remains deeply embedded in the ethos of this world-class training program and creates an environment where asking for help is welcomed, encouraged and supported. In BIL, Dr. Feldman's legacy is a successful program that promotes wellness and balance in the lives of current and future trainees. In helping residents address challenges during the rigorous training years, the BIL program ensures that these physicians will be better prepared to handle the continued stressors they will face in years of practice over long, successful careers.

“We know that we cannot claim that our program will prevent suicide. Our goal was to do everything we could to prevent residents from thinking that suicide is a way to deal with problems and remove the stigma of asking for help.”

—Ralph S. Greco, MD, FACS, Johnson & Johnson Distinguished Professor, Director of the Balance in Life Program, Stanford University, Stanford, CA
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