Physician health and well-being is a topic of much concern not just at the AAFP, but in hospitals, clinics, medical schools and physician training programs all across the nation. The sheer scope of the issue makes positive inroads made by an innovative wellness project at an Indianapolis-based internal medicine residency program all the more compelling.
Findings from the first year of the project are reported in a research article(www.mededpublish.org) titled "Improving Overall Resident and Faculty Wellbeing Through Program-Sponsored Innovations" published recently in MedEdPublish.
"Our innovation attempted to create a culture of physician well-being within one year (October 2016-Octobert 2017) after discovering high levels of burnout among our internal medicine residents and faculty," wrote the authors.
The authors pointed out that during that time frame, their well-being program demonstrated improvements in all 10 aspects of wellness that they measured: social, occupational, spiritual, physical, intellectual, emotional, environmental, financial, mental and medical wellness.
Additionally, they wrote, "A large decrease (from 15% at baseline to 4% after one year) in the rate of self-reported 'thoughts of self-harm' was noted."
- A recent research report describes an internal medicine residency program in Indiana that has developed a winning formula to improve physician well-being and diminish burnout.
- The first year after the program launched the well-being initiative, resident and faculty physicians reported improvements in all 10 aspects of wellness that were measured.
- The study authors also reported a large decrease (from 15% at baseline to 4% after one year) in the incidence of self-reported thoughts of self-harm.
Although that decline was not statistically significant, the authors clarified, it represented a positive trend.
"Our post-intervention results indicate that 91% of respondents felt that the culture of wellness at work has at least some influence on their personal wellness," the authors wrote. In fact, they noted, the success of the well-being program has led to continuing support by the institution's leadership team.
In written correspondence with AAFP News, lead author Laurel Fick, M.D., discussed the critical importance of the topic.
"Physician burnout affects nearly half of U.S. physicians -- including physicians in training," she said. "By instilling personal well-being and self-care into residency training, we are hoping to prevent burnout before it happens to ensure a healthy and engaged physician workforce for the future."
Fick serves as director of the Transitional Year Residency program and is an associate director of the Internal Medicine Residency program at Ascension St. Vincent Hospital in Indianapolis.
"I am married to a physician, and we are in a continuous dance between our two demanding jobs and two spunky kids ages 5 and 7, " said Fick. "As an educator, I realize the opportunity to positively influence hundreds of thousands of future patients under the care of my learners; creating an environment where they can thrive is my passion."
Beginning the Work
In January 2016, as part of a quality improvement study, each faculty member and resident in the internal medicine department at Fick's academic institution completed a modified Maslach Burnout Inventory-Health Services Survey.
The results were eye-opening. Nearly 44% of inpatient teaching faculty and 43% of residents showed high levels of distress in the areas of emotional exhaustion, depersonalization or low sense of personal accomplishment.
Fast forward to October 2016, when project leaders oversaw the electronic distribution of an internally developed survey to assess participants' wellness needs. The survey garnered an 80% response rate: 53 residents and 66 core faculty completed the questionnaire.
"Less than half of respondents rated their overall level of wellness as high or very high," wrote the authors. Physical, emotional and spiritual wellness were the three most poorly rated areas.
Most alarming was the finding that nearly 15% of survey respondents "had thoughts of self-harm in the previous year, higher than averages reported in national surveys," noted the authors.
Leaders set to work creating low-cost, high-impact strategies to target loneliness -- a condition that past research has shown correlates with physician burnout in a dose-dependent fashion.
Specifically, the physician well-being committee developed a broad program and introduced it throughout a 12-month period. Innovations included
- improving the work environment by adding perks such as ergonomic workstations, a photo contest with winning pictures displayed for all to enjoy and an office fitness circuit;
- distributing a monthly wellness bulletin highlighting birthdays, recipes, physician spotlights and more;
- scheduling monthly social events, such as bowling and art therapy; and
- holding fitness challenges and biannual wellness weeks that included visits by adoptable animals.
Program promoters also oversaw the creation of "safe zones" where faculty and coordinators were available to provide confidential, judgment-free support to physicians.
But that's not all.
"Improving physician connectedness by developing a robust social media presence was a cornerstone of our well-being initiative," wrote the authors. The effort involved faculty and resident "well-being champions" who were given access to the program's social media accounts.
"We sprinkled in wellness, thereby promoting 24/7 connectedness to our physician followers who may otherwise be separated by rotation/practice site or shift," they said.
Frequent and varied Instagram posts featuring photos of residents at work, social activities and more were a big hit. "This free initiative to improve connectedness was, and continues to be, our most important and effective strategy to date," wrote the authors.
Fick added that even though social connectedness is a key component of resident well-being, "it can be one of the hardest to achieve due to staggered schedules, clinical responsibilities and geographical separation due to multiple training sites."
More From Lead Author
Fick covered other aspects of her residency's well-being program with AAFP News and portions of that discussion are reflected in the following Q&A.
Q. What's the most important takeaway for family physicians?
A. Improving personal physician well-being can be accomplished without tons of money or time; it just takes a creative and inspired leader to focus on high-yield, low-resource interventions. And it's important to include the faculty because they need to prioritize wellness, too.
Q. Were you surprised by any of the outcomes?
A. To our knowledge, this is the first study of resident physicians demonstrating improvements in personal well-being based off of a department-sponsored program. We were pleased to see benefits extending beyond the hospital and clinic door. We want healthy physicians in both their personal and professional lives.
Q. Has your work generated any feedback or interest from other programs?
A. To date, our biggest impact has been via our social media reach.(www.instagram.com) Since we publicly post our well-being work, we have had several other programs follow us and state that they have modeled some of their own wellness work after ours. We are so glad to learn and share from each other!
Q. What are your program's next steps?
A. We will continue what we are doing but will tweak the program so it evolves alongside the changing culture and health care landscape. We are shifting some attention toward getting physicians to know themselves better by taking a deep dive into their personal well-being needs and then learning how to incorporate those into residency.
We also have some fun things planned, like hosting a parents' night out that will feature faculty babysitting residents' kids so the parents can have a free night out.
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