Barbara Kiersz, DO; Stacy Obeigde, PsyD, MS; Mark Nadeau, MD, MBA, FAAFP, The University of Texas Health Science Center at San Antonio

Sixty percent of practicing physicians report symptoms of burnout, and recent studies show family physicians are some of the most burned out of all specialties.¹ Encouraging healthy habit formation and teaching skills to build resilience during medical training is crucial for helping combat this serious issue. Resilience is the ability of an individual to respond to stress in a healthy, adaptive way such that personal goals are achieved at minimal psychological and physical cost. Resilient individuals not only bounce back rapidly after challenges but also grow stronger in the process. To encourage wellness and build resilience, the University of Texas Health Science Center at San Antonio (UTHSCSA) Family Medicine Residency Program has developed a Wellness Curriculum for physicians in training.

The goal of the Wellness Curriculum is to help trainees take care of their overall well-being so they can be better physicians. The curriculum focuses on six elements of wellness: Physical, Professional, Financial, Social, Emotional, and Spiritual. The Wellness curriculum has multiple components including didactic sessions every 2 months covering wellness topics, quarterly social activities, fall and spring faculty-resident retreats, a Wellness Newsletter, and a chief resident of Wellness.

Bi-monthly didactics sessions are led by different specialists on select wellness topics in an interactive lecture-discussion format. These sessions are typically 60 minutes in length with core residency faculty and residents comprising the audience. Examples of topics covered include mindfulness, gratitude, time management, nutrition, and cultivating interpersonal and intrapersonal skills. Following the sessions, residents are able to access all materials and tools covered to apply what they have learned to their lives and medical practice.

Quarterly social activities help cultivate social, emotional, and physical wellness. Residents complete surveys to identify activities they would like to participate in. The activity that receives the most interest is chosen as the social activity for that quarter. Residents and faculty are invited and encouraged to attend these activities to build camaraderie. Examples of social activities include participating in obstacle courses, attending carnivals and picnics, playing Topgolf, and going bowling. Debriefing sessions following these events are used to guide planning of future activities. Additionally, every fall and spring, residents and faculty have a retreat to promote team building. This year, a barbeque and trail hike around a river at a local park is scheduled. Prior retreats have included participating in a Team Building Ropes Course² and having faculty and residents complete a Myers-Briggs Type Indicator³ to identify personality types to build strong diverse intra-residency working groups.

The Wellness Newsletter is another component of the wellness curriculum. This quarterly newsletter is edited by the chief resident of Wellness and is sent electronically to residents and faculty. Topics include “Nutrient of the Quarter,” “How to Get Healthy,” authored by the clinic’s dietician, “Sitting Exercises,” “Parks and Recreation,” and mandalas to print and color for relaxation. The goal of the newsletter is provide readers information on a variety of topics that promote the different aspects of wellness to help themselves and patients they serve. The newsletter follows a standard format with topics in the above mentioned areas. Plans are in place for future newsletters to also include a section authored by a different resident each quarter on “What does wellness mean to me?” The thought behind this section is to help the residents reflect on what they do in their own lives to promote wellness, and so the group can learn more about each other.

Finally, the chief resident of Wellness oversees and directs all components of the Wellness curriculum. This leadership positon was created by the residency program director in AY 2016-2017 to emphasize the importance of resident wellness. Included in the charter for the first Wellness chief is to help define the role of this position for the future. The residency program’s behavioral health counselor also helps collaborate with the Wellness chief to develop the aforementioned activities.

In closing, the pressure and anxiety internally and externally placed on physicians makes it difficult to relax, causes inefficiency and deceased work satisfaction, and ultimately can lead to burnout. Residency presents an opportune time for physicians in training to cultivate and preserve qualities and skills that can help them become more effective and satisfied practicing physicians. Instilling a Wellness Curriculum that deliberately teaches resilience and promotes the six elements of wellness is one strategy to help residents find gratification in their daily work and develop life skills they will use to solve problems and overcome obstacles throughout their medical careers. The wellness curriculum described here offers several components and many examples of activities that can be incorporated into training programs across the country to promote resident wellness.

References

1. Johnson A, Caragol J. University of Colorado. A toolkit for physician wellness in medical education. Leawood, KS: Society of Teachers of Family Medicine, 2012.
2. http://www.adventuresinsa.com/what-we-do/team-building/
3. https://www.mbtionline.com/