Letters to the Editor
To the Editor:
Creating a culture of wellness in residency is a major challenge facing academic medicine. I want to congratulate Edmondson and colleagues1 for not only shedding light on this topic by powerfully quoting the heartache and pain of a resident at the Hospital of the University of Pennsylvania (HUP) but also for rethinking wellness programs. The authors describe the internal medicine residency program at HUP as having an innovative, resident-run Wellness Committee that engages in an open dialogue about mental illness and resilience. Encouraging the residents to identify situations out of their control and helping them learn to let these matters go is as important a skill as placing an arterial line in the ICU.
The epidemic of depression within society has gripped medicine, as evidenced by the increasing number of physicians who commit suicide every year.2 However, through the Wellness Committee, resident peers teach each other resilience and identify modifiable barriers to wellness, a lifelong skill. Resilience is recognized as an important skill for all professions, but it is particularly useful in medicine given the demanding responsibilities and challenges we face.3 Factors contributing to resident well-being are autonomy, competence, strong social relatedness, sleep, and time away from work.4 Perseverance has been shown to be predictive of well-being, so resilience and perseverance are crucial behavior competencies to overcoming obstacles and should be learned in residency.
Since residents must take care of themselves prior to being able to help their peers, physicians might adopt advice from the airlines: “Put on your own oxygen mask before helping those around you.” However, trainee involvement with improving the well-being of their future physician peers not only impacts their own mental health but also impacts the patients they serve. Academic medicine institutions must encourage leadership and organizational commitment to foster a holistic and supportive culture of wellness. They must also empower faculty to recognize the signs of residents and medical students who are in distress or may need intervention. The first National Physician Suicide Awareness Day was on September 17, 2018. May that day serve as a battle cry for our fellow brothers and sisters in medicine.
National Suicide Prevention Lifeline: 1-800-273-TALK
Jennifer A. D’Abreau, DO
Senior university physician, Kent State University, Kent, Ohio, fellow in academic medicine, clinical assistant professor in family medicine, Northeast Ohio Medical University, Rootstown, Ohio, clinical associate professor/adjunct faculty, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, and adjunct clinical faculty, Kent State University College of Nursing, Kent, Ohio; firstname.lastname@example.org; ORCID: https://orcid.org/0000-0002-3488-8373.
1. Edmondson EK, Kumar AA, Smith SM. Creating a culture of wellness in residency. Acad Med. 2018;93:966–968.
3. Ele D, Wilkinson D, Cloninger CR. Physician understand thyself, and develop your resilience. BMJ. 2013;346:f1299
4. Raj KS. Well-being in residency: A systematic review. J Grad Med Educ. 2016;8:674–684.