To the Editor:
Dr. Ripp and colleagues’ recent call to action on well-being in graduate medical education emphasizes the importance of multilevel interventions in addressing well-being.1 We concur with these recommendations, but want to emphasize the importance of considering residents’ voices when addressing wellness.
The University of Utah Family Medicine Residency Program has incorporated wellness longitudinally into the curriculum through a variety of mechanisms including protected support groups, structured wellness check-ins, and mindfulness training. Even with these changes, residents continue to report burnout and depression symptoms at higher rates than program leaders would like, leading to the question, What do residents want for burnout prevention?
During a recent resident meeting, we authors asked, “What else could our residency program do to support wellness?” Using a nominal group technique, residents shared their ideas, without filtering, then weighted their top eight priorities.
What emerged was that residents overwhelmingly prioritize time. Almost half (n = 35; 42%) of all resident votes supported increasing time for personal and professional needs. Residents want more time for self-care (i.e., going to the dentist, exercising, and getting adequate sleep), as well as for patient care (i.e., completing notes, managing patient panels, and reading about challenging cases). While residents endorsed other aspects of wellness (e.g., mindfulness training, expanding support groups, and receiving snacks or meals) as important, they indicated—through both the number of raters selecting time and how highly they rated it—that having adequate time was most critical.
While we conducted this survey to improve our own residency program, we suspect that the theme of more time runs across residencies and settings. Wellness interventions designed, for example, to improve mindfulness skills or provide a sense of meaning cannot correct work schedules and responsibilities that allow little time for anything else. When baseline needs of adequate sleep and self-care are not met, the capacity for self-actualization is limited. The strained, moment-to-moment mentality many residents experience does not permit introspection, processing of emotions, or learning from challenging patient encounters and may be a leading factor in dissatisfaction with medical careers. The U.S. system of training normalizes overcommitment. Now is the time to open a conversation about redesigning medical training to reflect what we physicians and physicians-in-training—all of us, as people—really need: time for work, and time for life.
Katherine Fortenberry, PhD
Clinical assistant professor and Behavioral Sciences Education director, University of Utah Family Medicine Residency Program, Division of Family Medicine, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah; e-mail: Katie.firstname.lastname@example.org.
Jordan Knox, MD
Third-year family medicine resident, University of Utah Family Medicine Residency Program, Division of Family Medicine, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah.
Sonja Van Hala, MD, MPH
Clinical associate professor and program director, University of Utah Family Medicine Residency Program, Division of Family Medicine, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah.
1. Ripp JA, Privitera MR, West CP, et al. Well-being in graduate medical education: A call for action. Acad Med. 2017;92:914–917.