The traditional model of training focused on the hamster wheel of running trainees to the brink of exhaustion, fatigue, and burn-out with a culture of not showing weakness. Not an uncommon saying was “pain is weakness leaving the body”. Some sobering statistics provided by Dr. Riall are as follows:
- 50% of surgeons have symptoms of burnout
- 69% of surgical residents are burned out
- 44% of residents consider leaving residency
- 33% of medical students experience burnout even before they start their residency training
- Suicide affects 300 physicians per year in the United States, which is the second-leading cause of death for residents and is the leading cause for male residents
The experience of burnout includes emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Dr. Riall notes that physician wellbeing is essential for providing high-quality patient care and extends beyond the absence of burnout, including maintaining one’s physical health, emotional health, and social support. As follows are the domains of physician wellbeing:
At the University of Arizona, Dr. Riall sought to instill a culture of wellbeing, highlighting that culture sets the tone for what’s acceptable. Furthermore, culture drives surgeon, faculty, resident and staff behavior. Her resident wellbeing and resiliency program included monthly experiential and interactive sessions focusing on energy leadership, team building, communication, work-life integration, goal setting, empathy, strategic diet and exercise, posture for surgeon/ergonomics, and stress reduction techniques/mindfulness/meditation. In data from her institution, the average resonating level before and after the institution of the wellbeing and resiliency program showed improvement:
Additionally, in just one year, her program’s ACGME annual resident survey showed an increase from 80% of residents rating the program as positive or very positive up to 96% after instilling the wellbeing and resiliency program. More recent (three-year) data shows that these improving trends have continued:
Dr. Riall notes that the key components for success are as follows:
- Occurrence during protected resident education time
- Gathering of all postgraduate year residents together
- Creation of a psychologically safe, low-stress environment that promotes trust and a sense of community
- A breadth of topics responsive to resident’s specific needs
- Commitment and enthusiasm of the leaders of the wellbeing program
- A departmental culture that is receptive to the shift in traditional surgical training
- Engaging, interactive, and continually reinforced throughout the year
Dr. Riall states that personal resiliency is the core of wellbeing and the ability to respond to whatever challenges arise in one’s life is at the core of wellbeing. It is important to recognize that priorities change over time and to continually reevaluate and realign time and energy with those priorities. It is important to ask yourself if a task or event is a priority, considering you can do all things that you want to do, you just can’t do them all right now. Furthermore, it is important to choose how you show up. Dr. Riall quotes Viktor Frankl in that “Between stimulus and response, there is a space. In that space lies our freedom and power to choose our response. In our response lies our growth and freedom.” We must define what success looks like for ourselves, maintain our empathy, assume good intent, and know that everything we want is on the other side of fear. Additionally, we must step out of our comfort zone:
Furthermore, we can’t push happiness over the cognitive horizon and can’t allow success to drive us to work harder while depriving ourselves of happiness:
Dr. Riall concluded by noting that we need to scan our lives for the positive, not wish life away, and we must enjoy the journey because sometimes we get so focused on the finish line that we forget to enjoy it.
Presented by: Taylor Riall, MD, PhD, FACS, Interim Chair, Department of Surgery, Professor, Surgery, Leader, Clinical Discipline / Surgical Oncology - Arizona Cancer Center, University of Arizona, Tucson, Arizona
Written by: Zachary Klaassen, MD, MSc, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Augusta, Georgia, Twitter: @zklaassen_md at the 2020 Society of Urologic Oncology Annual Meeting – December 2-5, 2020 – Washington, DC