Author: Lori Weichenthal, MD (UCSF Fresno, lweichenthal@fresno.ucsf.edu)

Originally Presented at CORD AA 2016

Summary

This didactic session started with a review of the current concerns regarding burn out in emergency physicians (EP) including:  Studies supporting that medical students enter medical students with similar mental health profiles as their peers but by the third year have increased levels of burn out and depression; studies that show that burn out continues to worsen in residency; and the sentinel study by Shanafelt et al. showing that EPs have the highest rate of burn out in comparison to other specialties.

The second part of the lecture focused on what the model core content for EM suggests to be covered during residency regarding wellbeing (fatigue and impairment, time management and organizational skills, work-life balance and work dysphoria), what exists within the literature regarding the key aspects of a residency wellness program, and the results of a CORD survey regarding current practices in emergency medicine (EM) residencies regarding wellness programs was shared.  This survey showed that the majority of EM residencies cover the core content, have assigned faculty mentors, and host yearly retreats.  A little over half of the EM residencies cover other wellness topics, including offerings on effective communication, career development, financial planning, healthy eating, mindfulness practices and mitigation of malpractice stress.

The session concluded with the suggestion for a model wellness program for EM residencies based on the literature and the results of the CORD survey.  Key components include:  Support from program leadership, a faculty champion, resident involvement, faculty mentors, monthly resident meetings and yearly program retreats.  Suggested curriculum topics include:  Fatigue mitigation and recognition, time management, work-life balance, burnout awareness and stress management, developing resiliency, management of compassion fatigue, communication skills, nutrition, career development, managing litigation stress, and mindfulness training.

Future Directions

As part of the CORD meeting, a new committee on resident wellness and resiliency was formed.  This committee has created three task forces to look at:  Providing access to mental health resources, developing a data bank of burnout assessment tools, and creating a repository of wellness and resiliency resources for EM residency programs including lectures, podcasts, online resources, etc.

Resources

• CDC wellbeing concepts: http://www.cdc.gov/hrqol/wellbeing.htm
• Coalition for physician well being: http://forphysicianwellbeing.org
• University of Colorado Behavioral Health and Wellness Program: https://cps.memberclicks.net/assets/work%20and%20wellbeing%20toolkit.pdf
• Wellness book for emergency physicians: http://www.acep.org/workarea/DownloadAsset.aspx?id=8998
• For lectures, exercises, and other content of a wellness curriculum: lweichenthal@fresno.ucsf.edu