The Difference a Wellness Program Can Make

Across the country, increasing demands on medical residents are leading to more burnout.

Published in Aequanimitas - Fall 2017

One morning last fall, first-year Osler resident Travis D’Souza arrived on his unit to discover a resident with her head in her hands. “She was crying and couldn’t stop,” he recalls. D’Souza and two other trainees whisked her to a quiet area. Between sobs, she told them she’d had a horrible night, with several admissions. Nothing had gone smoothly.

The colleagues got permission to take responsibility for the distraught resident’s patients so she could leave early. “We’ve all been there,” says D’Souza. Onerous tasks, lack of sleep, skipping meals, missing out on family time and feeling demoralized can exact a heavy toll—aka burnout. Recognizing these factors and intervening when necessary can prevent it.

A recent National Academy of Medicine study found that more than half of U.S. physicians working in the front lines of care suffer from burnout. Yet many trainees never seek help or find outlets for their stress, says Sanjay Desai, director of the Osler Medical Training Program. Now, he and his colleagues are redoubling efforts to build morale through the Resident Wellness Program, which debuted in 2013.

That year, Desai assembled a committee of senior residents to interview residents, faculty and alumni and brainstorm about how to make a meaningful difference in trainees’ lives.

Their findings led to free memberships to the Cooley Center gym and a regular supply of snacks and beverages on the units. In addition, the committee crafted an online wellness toolkit that offers interventions to reduce burnout. A “war stories” page invites senior staff to share their vulnerabilities, like feeling overwhelmed. And events such as lunch and dinner get-togethers and faculty-resident basketball games aim to build camaraderie.

“The biggest surprise is that it doesn’t take much money to do all this,” says Desai. “It takes cultural change.”

Providing psycho-spiritual support, however, required more expertise. Desai turned to palliative care expert and hospitalist Rab Razzak, who counsels hospital staff members through the Armstrong Institute’s Resilience in Stressful Events (RISE) program. Razzak witnessed the effects of burnout among palliative care providers while he was at Cedars-Sinai Medical Center in Los Angeles and benefited personally from supportive intervention led by their palliative care chaplain. Now he’s duplicating those efforts at monthly mindfulness sessions for residents and other caregivers.

“It’s all about taking the time to figure out who we are as people and who we want to be,” says Razzak. Depending on the time slot, as many as a dozen residents show up. They begin with a poem. Then they discuss memorable moments on their units—good and bad—and ways to cope with stress.

One resident told the group he felt like he never had enough time to meet all the requirements, and his senior resident didn’t seem sympathetic. “We try to find ways to present his point of view, says Razzak, like, ‘I’ll get to that after X, Y and Z.’ Or, he could say, ‘I’m overwhelmed. Can you give me five minutes to collect myself?’”

 “It’s comforting to hear someone else feels the same way I do,” says second-year resident Trisha Pasricha. The breathing exercises Razzak practices with them have also proved helpful, she says.

Desai concedes that more efforts and studies are needed to combat burnout. “It will take time,” he says. But he sees progress. “Five years ago, I don’t think residents were talking about their stress in the same way. There’s more openness, and the program has been helpful to many residents. They need to know they’re not alone.”