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Bouncing Back

The Quest for the Best Wellness Program for Residents

Stoneking, Lisa MD

doi: 10.1097/01.EEM.0000526104.71814.66
Bouncing Back

Dr. Stonekingis an associate professor of emergency medicine, the residency program director, and chief of staff-elect at Banner University Medical Center South in Tucson, AZ.

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What does physician wellness mean? Wellness, resiliency, positivity, bouncing back? We program leaders can't even agree on a definition, let alone on the best well-being program for future EPs. There lies the problem—wellness is relative to the person experiencing it. How do we ignite a well-being fire in our program for dozens of tired, vulnerable, overworked, and stressed-out residents when wellness may be different for each of them?

The answer is we ask them! We find out what they find meaningful, what helps them find balance, and what they enjoy doing in their free time. This means getting creative for most of us program directors without wellness program funding.

Five years ago, I sat down to write my program's official wellness policy. I thought, “Why reinvent the wheel?” Certainly this has been done before. I borrowed templates and copied excerpts from other policies. Counseling, check. Call rooms, check. Protocols to deal with drug and alcohol problems, check. Cab rides home for exhausted residents, check.

Feeling proud of myself for crossing an important task off my to-do list, I re-read my new program wellness policy. We had a big problem. This was not wellness. This was a manifesto of necessary afterthoughts, not wellness. I wholeheartedly agree that these checks and balances are necessary components of any residency program, but I was saddened to think that these were the only items that I had listed.

So began my quest to integrate a true wellness program into our residency training. I polled my residents about what physician wellness meant to them, and asked them to suggest three things that program leadership could integrate into our program to improve well-being. They gave me four, of course. They asked for a place to work out and do yoga together, a medical literature book club, more social gatherings, and small celebrations (with food).

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Tailored Wellness

Today, our wellness program has grown to encompass the following (I hope you steal as many of these ideas as you can fit into your program): passes to the YMCA to work out, participate in group exercise classes, play basketball, or swim; a fall wellness conference day held outside that includes an hour of physical activity and discussion about topics that lay the foundation for physician wellness; a spring wellness conference held at the YMCA incorporating interval training between lectures and a healthy breakfast; an annual retreat held outside at a state park allowing for camping the night before; monthly organized resident family-friendly social gatherings; monthly birthday breakfast celebrations at didactics; massage chairs during wellness week; asynchronous learning (often from 7-8 a.m.) to allow for an extra hour of sleep for residents on the evening shift and allow the residents to complete the task whenever it's convenient (not necessarily from 7-8); and creation of a narrative medicine curriculum including two novels per year that our group reads and discusses together upon completion.

We also added a working walking treadmill to chart while moving; a mini fridge in our doc box and healthy snack options in our charting room; a constant supply of good coffee; a primary care provider phone number list during intern orientation; integrated wellness lectures to lay some well-being foundation; and assigned faculty mentors and resident big-siblings prior to starting residency with the goal of meeting in September and March (so the residents have someone checking in on them every three months, on top of biannual reviews with the PD).

I just finished The Happiness Advantage, a book by Shawn Achor. The premise that we are more successful when we are happier and more positive is exemplified in the fact that physicians who are put in a positive mood before making a diagnosis show almost three times more intelligence and creativity and make accurate diagnoses 19 percent faster than doctors in a neutral state. Why wouldn't we want to implement a well-being program to foster this? Look at the cutting-edge companies that have foosball tables in their lounge and massage in-house, and encourage their employees to bring their dogs to work. I'm not suggesting that we go to the extreme, but I am suggesting five minutes in the sun, healthy snacks, and a few quiet minutes to breathe after a difficult patient or tough code. I'm suggesting not only that are these things OK to do, but they will also lead to bottom-line results.

I am proud of the attention we are giving to our own well-being and our residents'. Today's group of eager young physicians has different definitions of well-being than those who helped me develop our original wellness curriculum five years ago. Time to ask this group what they find meaningful, what balances them, and what they enjoy doing with their free time.

I encourage each PD to ask incoming interns and current residents what wellness means to them and how we can best support them. I think you'll find that just by asking questions, they will feel heard and will willingly participate in helping your leadership create a tailored wellness program.

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