Tackling the Problem Head-on

Resident Confronts Burnout by Launching Wellness Program

July 05, 2017 10:00 am Chris Crawford

As the AAFP takes on the challenge of combating professional burnout and cultivating physician wellness, Kristina Dakis, M.D., a second-year resident in the University of Illinois at Chicago (UIC) Family Medicine Residency Program, recently gave AAFP News an inside look at her own experience with burnout early in her medical training and explains how it drove her to help create a medical student wellness program to combat it.

[Second-year family medicine resident Kristina Dakis, M.D. in classroom]

Second-year resident Kristina Dakis, M.D., presents a workshop as part of a medical student wellness program she helped create after her own battle with burnout. Although she acknowledges the mountains of paperwork and other administrative burdens that lead to burnout in practicing physicians, she says it's essential to realize that burnout plagues physicians-in-training long before they enter practice.

Q: Can you start by explaining the wellness program you worked to create at your medical school and your goal in doing so?

A: I was the co-founder of our medical student wellness program during my third year of medical school at the UIC College of Medicine. The program consisted of a medical student-led wellness committee with representatives from each medical school class, and we worked closely with the office of student affairs and medical school faculty from different departments who were committed to student well-being. Our program consisted of four main components.

First, we initiated an extracurricular series of wellness events that included a physician panel to talk about their personal experiences dealing with burnout in medical school and ways they overcame their burnout, a panel of psychologists who discussed ways to overcome test anxiety, massage chairs, therapy dogs, yoga sessions led by students, etc.

Second, we started a monthly support group for medical students. This was hosted by our faculty adviser Memoona Hasnain, M.D., M.H.P.E., Ph.D., who invited us into her home and served us chai tea. We called them "Chai Chats," and we discussed common challenges in medical training, in addition to ways we find joy in our work.

The third component was meeting with faculty to discuss ways to potentially incorporate wellness into the medical school curriculum. We hosted one of our school's first-ever mandatory wellness events during the M1 orientation -- a panel of upperclassmen who discussed their own experiences with burnout as M1s. This not only normalized burnout for students, but gave them an opportunity to hear ways to prevent burnout during their first year of medical school.

Finally, the fourth component was research to evaluate the effectiveness of our programming.

Q: What progress has the medical school made since incorporating the wellness program?

A: I am proud to say UIC has started implementing a four-year wellness curriculum that includes interactive presentations by medical school faculty on test anxiety, burnout prevention and available mental health resources. One of our deans is currently piloting online, on-demand "wellness modules" for medical students that teach the basics of cognitive behavioral therapy.

The wellness committee that we started remains strong. I am in touch with the current student leaders, and they host monthly wellness events for students, continue to get together at Dr. Hasnain's home for chai tea and remain invested in the development of the medical school wellness curriculum.

Q: I understand you've been involved with Family Medicine for America's Health (FMAHealth)(fmahealth.org). How did that come about?

A: Recently, I was a part of the FMAHealth Workforce Education and Development Team. I worked with Joseph Brodine, who is a recent graduate of Georgetown University School of Medicine and our student leader, as well as with Natasha Bhuyan, M.D., of Phoenix, and Christina Kelly, M.D., of Fort Hood, Texas, who were our project advisers.

When our project began, the medical community was talking a lot about physician burnout, but not necessarily medical student and resident burnout. Our goals were to raise awareness about burnout specifically in medical training and to normalize discussion of mental health issues in the medical profession.

Much of our project(13 page PDF) involved hosting "wellness workshops" at different family medicine conferences during the year. We hosted three workshops at last year's National Conference of Family Medicine Residents and Medical Students, where Joe and I shared our own experiences with burnout in medical training, discussed national data, and then encouraged students and residents to open up and discuss their own experiences with one another. It was extremely well-received. Students and residents were eager to share and to support one another.

At the conclusion of the workshop, we asked participants to discuss what they liked about their institution's wellness programs (if they had one), what could be improved, and what they could personally do to improve wellness at their medical schools and residencies.

During the rest of the year, we presented outcomes from the student and resident workshop to faculty at other family medicine conferences, including the AAFP's Program Directors Workshop and the Society of Teachers of Family Medicine Annual Meeting.

We then gathered data from faculty regarding what they had tried to prevent burnout in their trainees, barriers they have faced to achieving learner wellness and possible solutions.

It's been eye-opening to be a part of these discussions with students, residents and faculty from around the country. Everyone is clearly committed to improving well-being in medical education, but there are still systemic barriers at play that we need to overcome before we can improve the medical school and residency experience.

[Kristina Dakis, M.D., playing clarinet in a jazz band ]

For Kristina Dakis, M.D., who considered a career in music education before deciding to pursue family medicine, playing clarinet in a jazz band offers respite from the rigorous demands of medical training.

Q: Why is it important to address burnout at the medical school level?

A: In the practicing physician community, everyone talks a lot about the electronic medical record, the mountains of paperwork and other administrative burdens that lead to burnout. While I agree that these things are a significant problem and need to be fixed, it's important to realize that burnout is a huge problem in physicians-in-training long before they ever enter an exam room.

Based on recent studies, 50 percent of medical students will burn out at some point during their medical training; 25 percent will become depressed; and 10 percent will experience suicidal ideation. Clearly, the problem isn't only the electronic medical record -- something is wrong with the way we train physicians, and we should be talking more about it.

In addition, some preliminary studies suggest that medical students who burn out during the process are more likely to choose fields with more flexible schedules -- that is, not primary care.

Personally, I believe burnout in medical school leads to a loss of empathy and therefore deters medical students from choosing careers in primary care. This is potentially a significant workforce recruitment problem.

The medical education community needs to be working together to train physicians who are mentally healthy and excited for their future careers. This involves decreasing stigma of mental illness, creating a culture that is collaborative and not competitive, and ultimately changing the culture of medical education.

The AAFP has made medical student and resident wellness a priority, and I am very grateful for the work AAFP leaders are doing to address this important issue.

Q: Can you give examples of burnout that you experienced and discuss how you dealt with it?

A: One month into my residency, my father was diagnosed with colon cancer, and suddenly my life was a lot different than I'd imagined it would be.

Toward the end of my intern year, I was having a difficult time empathizing with patients and found myself getting easily frustrated with them. I was emotionally exhausted all the time. I had forgotten a lot of the reasons I'd fallen in love with family medicine in the first place. In fact, I found myself resenting medicine for keeping me away from my family. But there were three main things that helped me get through this.

The first was stepping away from work and focusing on family. When my dad was getting really sick, I turned to my support network (family, friends, co-residents/colleagues). My residency program let me take as much time off as I needed. Because of this, my husband and I were able to have a last-minute wedding ceremony so my father could be there. I was also able to surround myself with people who cared about us and who reminded me of who I was outside of medicine -- which I hadn't thought about in a while. That was really important.

Another thing that helped me was reflecting on why being a family medicine physician makes me so happy. A very powerful experience I had as an intern was delivering my very first continuity OB patient. I followed her through her entire pregnancy. I really loved her. And I remember rushing to the hospital at 11 p.m. and having the entire family cheer when I showed up in the room. It's still amazing to me that I was the one to hand her child to her right after he was born, and that he is now my patient. It's just really beautiful ... and it made me realize all the potential patients out there who I might get to help one day, people I haven't even met yet. And that really makes everything worth it.

Finally, I dived into my FMAHealth project. Because it's sometimes way too difficult to stay human while in medical training, and I wanted to help raise awareness and do something about it. Trying to make a difference in my own small way was therapeutic for me.

Q: In closing, if burnout is seriously addressed at the medical school level, what does that mean for future generations of students?

A: Medical students would be encouraged to seek help for mental health conditions when needed -- in fact, they would be praised for taking extra time to care for themselves in order to be mentally fit to serve their patients.

Medical students would find more joy in their work, make self-care a priority and -- in my opinion -- would be more likely to choose careers in primary care.

This kind of learning environment would foster a happy, resilient physician workforce prepared to address the health care needs of our country.

I am encouraged by the tremendous progress we have made over the past few years to address this issue, and I cannot wait to see what other positive changes we can make in medical education.