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Learn how the Johns Hopkins School of Medicine created a 6-pronged approach to address resident and fellow burnout.
More than 1200 resident physicians and clinical fellows work in the clinical sites of the Johns Hopkins School of Medicine. Johns Hopkins undertakes a regular system-wide safety culture survey, and these data showed that approximately half of the trainees experience symptoms of burnout. Leaders of the Office of Graduate Medical Education (GME) recognized that a multi-pronged initiative was crucial to improving well-being and reducing burnout. A needs assessment of residency and fellowship program directors and program coordinators found they needed more wellness programming.
The first step was to review the literature and perform an internet search to identify current GME well-being programs. The article “Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout” was instrumental in determining what strategies to include in a multi-pronged wellness initiative.1 The planning also incorporated input from residents, fellows, and faculty physicians from multiple training programs—the initiative launched to reduce resident and clinical fellow burnout.
The Johns Hopkins Resident & Fellow Wellness Initiative (the Wellness Initiative) is composed of:
A GME-specific Wellness website that serves as a central repository of information
Wellness programming including weekly “Wellness Wednesdays” events. Events cover pet therapy, yoga, massage therapy, healthy snacks, and reflective writing. There have also been opportunities to attend optional seminars in financial planning for physicians or training on providing peer support and psychological first aid.
Weekly emails titled “Wellness Matters” sent to all trainees and program directors to raise awareness of activities and resources
A GME-wide Wellness Committee
Promotion of faculty role modeling and coaching to foster resilience and thriving in medicine
Outreach to clinical and educational leaders to emphasize the importance of identifying trainees at risk for depression or suicide
The Wellness Initiative reached all residents and clinical fellows over the web and email at launch. The highest-profile part of the initiative has been the weekly Wellness Matters email. This email alerts residents regarding activities going on that week and serves as a prompt to remind them of the resources available. An important finding was that the professional email software to format and distribute the email did not impact how many people opened the email. In fact, more residents and fellows read the normal email format rather than one that is professionally formatted.
This email is an example of how the Wellness Initiative shares important news, upcoming programming, wellness tips, and campus wellness resources with residents and fellows.
Early Wellness Wednesdays were well attended and the events continue to be a valuable part of the Wellness Initiative. Most trainees are located at Johns Hopkins Hospital, so Wellness Wednesdays are held weekly at that location. Wellness Wednesday events are held monthly at the Johns Hopkins Bayview Medical Center because there are substantially fewer trainees at that location. Attendance ranges from 50 to 100 participants weekly at the main site, and up to about 25 participants at the monthly Bayview sessions. The most popular events are those with food or pet therapy; a “make your own” yogurt parfait bar was stand out success. Some events were suspended or adjusted during the height of the COVID-19 pandemic. For example, pet therapy and yoga sessions were temporarily put on hold. Food options were changed from buffet style to individually-packaged portions. Wellness Wednesday continued despite these changes and some of the programs are beginning to return as the burden of COVID-19 eases.
The Wellness Committee
The Wellness Committee existed for about 2 years and worked on several systems-level projects, including creating a GME-wide well-being resource guide and recommendations for integrating well-being into individual training programs. The Wellness Committee eventually disbanded because the work of the committee was being done as effectively by other groups—particularly trainee-led groups—such as the Housestaff Council and Clinical Fellows Council. Members of the Wellness Committee joined other standing groups to continue work on systems-level well-being related needs.
Residents and clinical fellows find this program raises awareness of burnout and depression and may encourage trainees to talk more about these issues. A formal survey conducted 1 year after the program launch found residents and fellows appreciated how the program met their basic needs. For example, they enjoyed the availability of healthy snacks and that a coffee machine dispensing free coffee was installed in the resident lounge. A smaller subset of participants really appreciated having free, unbiased financial planning seminars available. Another subset welcomed how the Wellness Initiative negotiated free gym membership for resident physicians at the campus gym. After introducing programs that were enjoyable for all—particularly those with free food—the Wellness Initiative targeted the needs of smaller but still substantial size subsets of the trainee population.
Challenges of the initiative included:
Timing of activities, for example, what works for non-surgical trainees may not work for surgical or operating room-based trainees. As a result, some programming shifted to the residents in the spaces where they work. The time of weekly Wellness Wednesday programming is flexible and alternates between morning, mid day, and afternoon to try to allow different groups to attend. Some programming moved online during the COVID-19 pandemic because of necessity—be it yoga, meditation, online resiliency skills training—and in some ways that helped with attendance. Some groups, such as emergency department and anesthesia residents, remain difficult to reach simply because the hospital is large and they may not have enough time on their breaks to walk to events.
How to best plan a GME-wide initiative with a diverse group of training programs, some of which have an extensive focus on well-being and others with less. The Wellness Initiative is meant to complement, not replace, efforts that some individual training programs have launched in this area.
Reaching trainees in small programs.
Interfacing with other groups focused on well-being and wellness for employees, faculty, and students.
With the pandemic, the Resident & Fellow Wellness Initiative collaborated closely with the other groups working on well-being, and in fact the Johns Hopkins Medicine Office of Well-Being has taken the lead in assembling and promoting well-being resources for all staff and faculty. Interfacing with other groups worked better over the last year as the organization took a much larger scale approach to these issues.
Journal Articles and Other Publications
Hanyok LA. Johns Hopkins wellness initiatives promote happy, healthy residents. Journeys in Medicine, an ECFMG blog. November 16, 2018. Accessed April 30, 2021. https://www.ecfmg.org/journeysinmedicine/johns-hopkins-wellness-initiatives-promote-happy-healthy-residents/
Berg S. How Johns Hopkins helps ease the stresses of residency. American Medical Association. March 20, 2018. Accessed April 30, 2021. https://www.ama-assn.org/residents-students/resident-student-health/how-johns-hopkins-helps-ease-stresses-residency
Johns Hopkins Medicine Graduate Medical Education. Wellness at Johns Hopkins for Residents and ACGME Fellows. Accessed April 30, 2021. https://www.hopkinsmedicine.org/som/gme/wellness/
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About the AMA Professional Satisfaction and Practice Sustainability Group
The AMA Professional Satisfaction and Practice Sustainability group has been tasked with developing and promoting innovative strategies that create sustainable practices. Leveraging findings from the 2013 AMA/RAND Health study, “Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy,” and other research sources, the group developed a series of practice transformation strategies. Each has the potential to reduce or eliminate inefficiency in broader office-based physician practices and improve health outcomes, increase operational productivity, and reduce health care costs.
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