This Neurologist Has Made Fighting Burnout His ‘Mission’
He's Starting with Residents
By Lola Butcher
November 7, 2019
Article In Brief
An AAN member has developed a pilot program focusing on wellness strategies for residents in training.
The term “burnout” wasn't being used much when Prasanna Tadi, MD, did his neurology residency at Warren Alpert Medical School of Brown University or his stroke fellowship at the University of Pittsburgh School of Medicine. But he knew its misery even if he didn't have a name for the symptoms.
“I had nowhere to go, no support system,” he said. “It was such a horrible, horrible time in my life. I really wanted to quit medicine at one point. Nobody should have to go through that.”
Now Dr. Tadi is an assistant professor in neurology at Creighton University's School of Medicine in Omaha, and he calls addressing medicine's burnout epidemic “the mission of my life.”
Dr. Tadi, who serves as director of wellness for Creighton University CHI Health, pursued that mission as a member of the 2019 cohort of the AAN's Live Well Lead Well Program. His anti-burnout concept—which he calls CHEER —is currently being tested with Creighton's internal medicine residents, courtesy of a two-year grant from the Accreditation Council for Graduate Medical Education.
Liza George, MD, was chief resident for the internal medicine residency program when she started working with Dr. Tadi to create the program. Few residency programs make reducing trainee burnout a priority, she said, and his passion for helping others taking action shows what one physician can do.
“It's one thing to say, ‘I'm worried about resident wellness; it's another thing to do something about it,” Dr. George said. “Dr. Tadi is actively trying to make a difference.”
Dr. Tadi was one of only 30 recipients nationally to receive an ACGME Back to Bedside grant, is another example of how the AAN's Live Well, Lead Well program is making an impact, said Neil A. Busis, MD, FAAN, who represents the AAN on the National Academy of Medicine Action Collaborative on Clinician Well-being and Resilience. He cited other examples in which Live Well, Lead Well is getting attention beyond neurology: Live Well, Lead Well Chair Jennifer Rose V. Molano, MD, FAAN, associate professor of neurology at the University of Cincinnati College of Medicine, made two presentations at the recent American Conference on Physician Health, and Rebecca Miller-Kuhlmann, MD, clinical assistant professor of neurology at Stanford University, presented her Live Well, Lead Well project at the International Conference of Physician Health in 2018.
“I think we're punching above our weight for a small organization,” said Dr. Busis, professor of neurology at University of Pittsburgh.
CHEER in Action
The study, which involves internal medicine residents at all levels of training, started in August. The program is built around the acronym:
- C for celebrating successes to avoid getting trapped in negative thinking.
- H for hearing. Residents get to hear about other people's experiences.
- E for expertise. Experts meet with residents to discuss specific wellness topics.
- E for engage. Residents are encouraged to share their own ideas about wellness.
- R for recharge. Residents find ways to implement anti-burnout strategies into their own lives.
Backspace—patient rounds, monthly meetings, and twice-monthly emails—will be built around the CHEER concept, Dr. Tadi said.
Each hospital medicine team will select one patient per month for a half-hour bedside visit to give residents an opportunity to connect more deeply with the patient and his or her family. This intervention is designed to counter the depersonalization that can lead to clinician burnout. “Rounding on patients, beyond the context of just purely medicine, will help residents connect with patients in a totally different way,” Dr. George said.
Residents have a half-day education session built into their schedule each week; once a month, an hour of the meeting will follow the CHEER format, giving residents an opportunity to focus on wellness. Because the education sessions are mandatory, this will ensure that all residents are exposed to the burnout-prevention process without adding anything more to their schedule. “In fact, these CHEER meetings will be kind of a welcome break,” she said.
These will be used to recognize the personal and professional accomplishments of residents, allowing them to know one another better and acknowledging that their hard work is worthwhile, Dr. Tadi said.
As part of the AGCME grant application, Dr. George and her colleagues gathered baseline well-being scores for Creighton residents as assessed by the Mayo Clinic Resident/Fellow Well-Being Index, a nine-item screening tool that evaluates fatigue, depression, burnout, anxiety/stress, and mental/physical quality of life. Survey results showed that its residents were suffering.
“When I talk to my colleagues from medical school who are in other residency programs, I recognize that Creighton has created an environment that is highly nurturing, but there was still a significant amount of burnout and reduced wellness,” she said. “That was eye-opening because it made me realize that no program is immune.”
The survey will be administered several times during the two-year duration of the program to determine its impact on resident well-being.
Fighting Burnout Beyond Residency
Dr. Tadi will serve as a mentor for the resident-led CHEER study while he works to promote anti-burnout programming throughout the medical school and health system.
Elizabeth Hartley and Eric Villanueva—both fourth-year medical students—are spearheading a study of whether CHEER meetings influence student well-being. Most medical students have experienced some burnout symptoms, Hartley said; all are aware of the burnout epidemic in medicine.
“We've seen the statistics,” she said. “It's scary to think that we're investing so much time and making so many sacrifices for our career at this point in our lives and we might not be happy at the end of it.”
The goal of the meetings is to increase a sense of community among medical students and foster an environment in which students can discuss their well-being freely and get support from their colleagues, Hartley said.
Third- and fourth-year students will serve as mentors to first- and second-year students, whose well-being will be assessed before and after each iv—that's the ‘R—by discussing how to take what we have learned in this meeting and apply it in the future,” he said.
Beyond that, Dr. Tadi has piloted an anti-burnout program for physician leaders at a community hospital and is working to develop a program for neurology faculty and residents together.