We are pleased that the authors feel the importance of resident wellness as we do.
Dr. Tabatabai suggests that a national movement is needed to improve resident wellness. We agree. Changing the culture of medicine from one that values self-sacrifice and self-neglect into one that values and embodies self-care will require a revolution. The Accreditation Council for Graduate Medical Education convened a conference in November 2015 on the topic of resident wellness and plans to have annual meetings on this topic in the years to come. These meetings may provide opportunity to build community and raise consciousness for residency program directors and others wishing to spearhead this movement. Those readers interested in intervening further upstream—at the level of the health care system and work environment—might look into joining the Right Care Alliance (www.rightcarealliance.org).
Dr. Chaukos and colleagues point out that wellness programs that are social events do not address the needs of trainees who are already clinically depressed. We agree that programs to promote resiliency should be separate from programs that provide mental health services and that seek to improve the visibility and accessibility of these services.
Overcoming obstacles for residents to seek mental health care is a challenge indeed. In the anecdotal experience of one of us (M.L.J.), depressed residents fall into four categories: (1) those who know they need professional help and seek it, usually off campus; (2) those who prescribe themselves antidepressants; (3) those who are depressed situationally and who rebound without treatment; and (4) those who don’t think they need help. Sadly, individuals in group 4 either “white-knuckle” through or end up leaving the program, sometimes after developing a substance use disorder.
The resiliency programs we espouse, however, are less like social events and more like Jedi warrior training. One of us (S.J.S.) has led such programs with medical students and residents for several years. These programs normalize the experience of distress in residency and teach evidence-based skills from the fields of mindfulness, cognitive therapy, and positive psychology. A critical ingredient is that the physician presenter shares personal examples about how to apply the skills. Residents and medical students appear to absorb these concepts quite well. They have returned after only one session with remarks such as “I think I’m having impostor syndrome” or “I realized my happiness is my responsibility, and I started swimming.” While resiliency programs are not a substitute for mental health care, they do provide participants with a language for reflecting upon and talking about wellness in residency.
The culture of medicine is highly tribal, and standards of behavior are transmitted through modeling. If we wish to change the culture of medicine, we must be willing to begin with ourselves.
M.L. Jennings, MD
Staff psychiatrist, Methodist Hospital System, San Antonio, Texas; [email protected]
Stuart J. Slavin, MD, MEd
Associate dean of curriculum, Saint Louis University School of Medicine, St. Louis, Missouri.