Strengthening Resident Resiliency for Rewarding, Sustainable Careers. Dr. Jonathan Dean August 24, 2016

Transcription

1 Strengthening Resident Resiliency for Rewarding, Sustainable Careers Dr. Jonathan Dean August 24, 2016

2 Objectives u Understand the need for resident doctor resiliency u Examine prevalence of resident burnout u Describe the impact of poor resident well-being u Discuss approaches to resident resiliency training u Discuss how organizations can promote resiliency

3 Disclosures u I am a resident doctor

4 Why does resiliency matter? 27-75% of residents experience burnout [10,12]

5 Resident burnout by specialty 80% 70% Residents (%) 60% 50% 40% 30% 20% 10% 0% Overall Obstetrics and Gynecology Internal Medicine Neurology Specialty General Surgery Psychiatry Family Medicine [10,12]

6 Contributors to resident burnout Patient care Supervision of learners Information overload Career planning Professional Burnout Personal Family obligations Finances Limited time for self-care Inadequate coping skills Sleep deprivation Heavy workload Poor learning environment Situational [1,2,3,4,8]

7 Impact of work-related fatigue [16]

8 Resident mental health [8]

9 Implications of burnout u Decreased career satisfaction u Decreased professionalism u Suboptimal patient care u Physical illness u Substance abuse u Depression u Suicidal ideation [1,3,6,7,9,10,13]

10 Role of resiliency [5]

11 Examples of resiliency techniques in medicine u Mindfulness-based stress reduction and relaxation u Reduction in psychological distress, anxiety u Increased empathy u Stress management training u Better performance u Increased use of coping mechanisms [11,14,15]

12 Resiliency training The Working Mind

13 RDoC s Resiliency Curriculum u The Mental Health Continuum u The Big Four+ u Practical skills to optimize mental health u Helps to cope with stress, improve mental well-being, and improve performance u When to seek support and how to approach colleagues in distress

14 Long term goals with stakeholders u Commitment to formalize national resiliency training in medical education. u Evaluation of resiliency training programs as part of accreditation standards. u Full support for stakeholder physician health initiatives and internal development of policies and resources to promote physician health and well-being throughout the career lifecycle.

15 References 1. Becker JL, Milad MP, Klock SC. Burnout, depression, and career satisfaction: Cross-sectional study of obstetrics and gynecology residents. American Journal of Obstetrics and Gynecology 2006;195(5): Castelo-Branco C, Figueras F, Eixarch E, et al. Stress symptoms and burnout in obstetric and gynaecology residents. BJOG: An International Journal of Obstetrics & Gynaecology 2006;114(1): Cohen JS, Patten S. Well-being in residency training: A survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Medical Education 2005;5(1). 4. Collier VU. Stress in medical residency: Status quo after a decade of reform? Annals of Internal Medicine 2002;136(5): Diamond DM, Campbell AM, Park CR, Halonen J, Zoladz PR. The temporal dynamics model of emotional memory processing: A synthesis on the neurobiological basis of stress-induced amnesia, flashbulb and traumatic memories, and the erkes-dodson Law. Neural Plasticity. 2007; 2007: Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. Medical students, residents, and early career physicians relative to the general U.S. Population. Academic Medicine 2014;89(3): Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: Prospective cohort study. BMJ 2008;336(7642): Goebert D, Thompson D, Takeshita J, et al. Depressive symptoms in medical students and residents: A Multischool study. Academic Medicine 2009;84(2): Halbesleben JRB, Rathert C. Linking physician burnout and patient outcomes. Health Care Management Review 2008;33(1): IsHak WW, Lederer S, Mandili C, et al. Burnout during residency training: A literature review. Journal of Graduate Medical Education 2009;1(2): Maher Z, Milner R, Cripe J, Gaughan J, Fish J, Goldberg AJ. Stress training for the surgical resident. Am J Surg Feb; 205(2): Martini S. Burnout comparison among residents in different medical specialties. Academic Psychiatry 2004;28(3): Shanafelt TD. Burnout and self-reported patient care in an internal medicine residency program. Annals of Internal Medicine 2002;136(5): Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med 1998; 2:6, pp Wetzel CM, George A, Hanna GB, Athanasiou T, Black SA, Kneebone RL, Nestel D, Woloshynowych M. Stress management training for surgeons: a randomized, controlled, intervention study. Ann Surg Mar; 253(3): Resident Doctors of Canada 2015: National Resident Survey.

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