W3 Workshop Resident health and well-being: Building resilience Ramezay, Saturday, October 27, 2012 (11 am-12:30 pm)
Resident Health and Wellbeing: Building Resilience A drienne Gaudet, MD Sophie C ollins, MD Suzanne C ummings, MD P h y s i c i a n Ad vi s o r s Q u e b e c P h y s i c i a n H e a l t h P r o g r a m International C onference on Phys ician Health M o n t r é a l, O c t o b e r 2 7, 2 0 1 2
Potential conflict of interest WE HAVE NO POTENTIAL CONFLICT OF INTEREST TO DECLARE
Learning objectives Recognize physician health issues, factors associated with stress in physicians and burnout in residents Practice and integrate reflection as a tool to build resilience Specify steps towards building resilience.
Recognize physician health issues, factors associated with stress in physicians and burnout in residents
How physicians compare to the general population Mental Health Issues Suicide
How physicians compare to the general population Mental Health Issues Suicide Similar rates of : Depression Anxiety disorders Alcohol and Substance use disorders Higher rates of : Suicide Physicians Men: 26% higher risk Women: 146% higher risk
Barriers to consultation Personal barriers Denial Rationalization Minimization Systemic barriers Stigma in the house of medicine
External stress factors Working night shifts/ being on call Dealing with suffering and death Adverse events, mistakes, complications Emergencies Challenging ethical issues High level of professional responsibilities
The Medical Personality
The up side Advantages of Perfectionism
The down side The Compulsive Triad Chronic self-doubt Guilt feelings Exaggerated sense of responsibility
When you become staff... The Beat Goes On Desire to establish and maintain reputation Feeling the need to cover up with a veneer of competence and the illusion of control Sense of personal failure when confronted with difficult patients, bad outcomes, adverse events and patient death
Education and training 4 Dysfunctional beliefs : Altruism, even to the point of self-denial is good Professionalism means keeping feelings, emotions and uncertainty to oneself Ultimate responsibility for patients is the physician s alone Lack of knowledge is a personal failure
Perils of perfectionism The desire to excel must be differentiated from the desire to be perfect Myers M and Gabbard G
Definition of burnout A deteriorating or unsuccessful response to repeated and prolonged occupational stress 3 dimensions: Emotional exhaustion (loss of enthusiasm for work) Depersonalization (cynicism) Low sense of personal accomplishment
Prevalence of burnout in residents Rates are high Residents from various specialties, internationally, experience burnout No relation to gender Associated with intensity of workday and extent of interference with resident home-life First year of residency worse?
Work characteristics Time demands Heavy work load Lack of control Inherently difficult job situations Interpersonal relationship conflict Autonomy Uncertainty about future Feeling personal needs to be unimportant Increasing work hours Anxiety about clinical competence Work/home life conflict Financial burden
Impact on performance Higher self perceived medical error Unprofessional conduct Less altruistic professional values Effect on empathy
Impact on personal life Burnout is associated with: Major depression, anxiety Alcohol and substance abuse Damaged personal relationships Physical symptoms and poor health outcomes
Practice and integrate reflection as a tool to build resilience
The Physician Health Program of British Columbia www.physicianhealth.com Taking care of ourselves: Reflection What worked for you in this module? What would you have done differently?
Specify steps towards building resilience
Building resilience What is resilience? Resilience is a dynamic capability which can allow people to thrive on challenges given appropriate social and personal contexts Howe A, Smajdor A, and Stockl, A
Dimensions of resilience Self-efficacy Self-control Ability to engage support and help Learning from difficulties Persistence despite blocks to progress
Individual resilience Self-care Regular exercise Adequate sleep Adopt a healthy lifestyle Have your own personal physician
Individual resilience Self-awareness Take time to pause and reflect
Individual resilience Finding balance Put aside time for family and friends Avoid the psychology of postponement Influence your own happiness through honouring your personal values
Community resilience Healthy community Mentoring Regular retreats Team building activities Resident wellness programs
Community resilience Healthy community Recognize and accept imperfection and fallibility in oneself, others and medicine Develop an important skill set: Empathic communication Giving and receiving feedback Setting healthy boundaries Learning to say I do not know
Conclusion Resilience is about adaptability rather than hardiness Healthy self-interest is not to be confused with selfishness Resilience is both an individual and community property
Conclusion The real voyage of discovery consists not of seeking new landscapes, but in having new eyes Marcel Proust
Resident Health and Wellbeing: Building Resilience What worked for you in this workshop? What would you have done differently?
Bibliography Frank E, Segura C. Health practices of Canadian physicians. Canadian Family Physician. Vol. 55: August 2009 Lefebvre DC. Perspective: Resident physician Wellness: A new hope. Academic Medicine, Vol. 87. No. 5/May 2012 CMA Board Working Group on Mental Health, CMA Physician Mental Health Strategy Working Group. Physician Health Matters: A mental health strategy for physicians in Canada. CMA February 2010 Elliot L, Tan J, Norris S. The Mental Health of Doctors : A Systematic Literature Review August 2010 Myers M, Gabbard G. The Physician as Patient: A Clinical Handbook for Mental Health Professionals. American Psychiatric Publishing, Arlington, VA, 2008 McLeod ME. The Caring Physician: A Journey in Self-Exploration and Self-Care. The American Journal of Gastroenterology. Vol. 98, No.10 2003 Shanafelt TD, Boone S, Tan L et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Archives of Internal Medicine August 2012
Bibliography Thomas NK. Resident Burnout. JAMA December 15, 2004- Vol. 292, No 23 Eckleberry-Hunt J, Lick D, Boura J et al. An Exploratory Study of Resident Burnout and Wellness. Academic Medicine, Vol. 84, No. 2 /February 2009 Martini S, Arfken CL, Churchill A et al. Burnout Comparison among Residents in Different Medical Specialties. Academic Psychiatry, 28:3, Fall 2004 Campbell J, Prochazka AV, Yamashita T et al. Predictors of Persistent Burnout in Internal Medicine Residents: A Prospective Cohort Study. Academic Medicine, Vol. 85, No 10 / October 2010 Woodside JR, Miller MN, Flloyd MR et al. Observations on Burnout in Family Medicine and Psychiatry Residents. Academic Psychiatry, 32;1, January- February, 2008 Cohen JS, Leung Y, Fahey M et al. The happy docs study: a Canadian Association of Internes and Residents well-being survey examining resident physician health and satisfaction within and outside of residency training in Canada. BMC Research Notes 2008, 1:105, 29 October 2008
Bibliography West CP, Tan AD, Habermann TM et al. Association of Resident Fatigue and Distress with Perceived Medical Errors. JAMA September 23/30, 2009- Vol. 302, No. 12 Dyrbye LN, Massie FS Jr, Eacker A et al. Relationship between Burnout and Professional Conduct and Attitudes Among US Medical Students. JAMA September 15, 2010-Vol 304, No.11 Shanafelt, TD, West C, Zhao X. et al. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med, 2005 Jul; 20(7) Spickard A, Gabbe SG, Christensen JF. Mid-Career Burnout in Generalist and Specialist Physicians. JAMA 2002 Vol. 288. No 12 Howe A, Smajdor A, Stöckl A. Towards an understanding of resilience and its relevance to medical training. Medical Education 2012; 46: 349-356
Bibliography Longenecker R, Zink T, Florence J. Teaching and Learning Resilience: Building Adaptive Capacity for Rural Practice. A Report and Subsequent Analysis of a Workshop Conducted at the Rural Medical Educators Conference, Savannah, Georgia, May 18, 2012. The Journal of Rural Health, 28 (2012) 122-127 Gautam, M, Iron Doc: Practical Stress Management Tools for Physicians, Book Coach Press, Ottawa, ON Canada, 2004 Kearney MK, Weininger RB, Vachon ML. Self-care of Physicians Caring for Patients at the End of Life : Being Connected A Key to My Survival". JAMA March 18, 2009, Vol. 301, No.11 Eckleberry-Hunt J, Dyke AV, Lick D. Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs. Journal of Graduate Medical Education December 2009
Reference books
Reference books
Changing the Conversation from Burnout to Wellness... Develop a shared definition of physician wellness Determine interventional strategies to bolster physician wellness The Wellness Toolbox Benefits of cultural change Providing a more positive educational environment for residents and faculty Raising awareness about burnout and it s symptoms Decreasing stigma associated with admitting burnout symptoms Enabling the development of prevention strategies Eckleberry-Hunt J, Dyke AV, Lick D. Changing the Conversation form Burnout to Wellness: Physician Well-being in Residency Training Programs Journal of Graduate Medical Education, Dec. 2009