Creating a Culture of Wellbeing and Resilience in Academic Medicine
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1 Creating a Culture of Wellbeing and Resilience in Academic Medicine
2 Medical resident burnout reaches epidemic levels Medscape, May 17, 2015 One symptom in new medical codes: Doctor anxiety The New York Times, September 13, 2015 Why the toxic treatment of doctors needs to change Time, August 31, 2015
3 Knowing yourself is the beginning of all wisdom. Aristotle
4 Well-being Definition of Well-being A good or satisfactory condition of existence; a state characterized by health, happiness, and prosperity. Dictionary.com Well-being can be described as judging life positively and feeling good. Centers for Disease Control
5 I never thought burnout applied to me. AAMC constituent
6 Burnout Definition of Burnout Emotional exhaustion, depersonalization and sense of low personal accomplishment. Dyrbye et al, 2008
7 Spending less than 20% of time in the most meaningful activity increased burnout risk by 54%. Shanafelt (2009, 2014)
8 It s not just individuals who burn out companies do, too. The Acceleration Trap (Bruch and Menges) Harvard Business Review
9 Mental Health Definition of Mental Health Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. The positive dimension of mental health is stressed in WHO s definition of health as contained in its constitution: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. World Health Organization
10 These are the duties of a physician: first to heal his mind and to give help to himself before giving it to anyone else. from the epitaph of an Athenian physician, 2 AD
11 Resilience Definition of Resilience Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress such as family and relationship problems, serious health problems or workplace and financial stressors. It means bouncing back from difficult experiences. Research has shown that resilience is ordinary, not extraordinary. People commonly demonstrate resilience. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts and actions that can be learned and developed in anyone. American Psychological Association
12 Resilience Definition of Resilience The mental, physical, emotional and behavioral ability to face and cope with adversity, adapt to change, recover, learn and grown from setbacks. U.S. Army Ready and Resilient Campaign
13 Ten Factors Contributing to Resilience Optimism Role Models Facing Fear Physical Exercise Moral Compass Mental Exercise Religion and Spirituality Flexibility and Acceptance Social Support Meaning and Purpose Southwick, S.M. and D. S. Charney (2012). Resilience: The Science of Mastering Life s Greatest Challenges. Cambridge University Press.
14 Our Workforce s Resilience Is Wavering Emergency medicine General internal medicine Neurology Family medicine Orthopedic surgery Anesthesiology Obstetrics and gynecology Radiology Mean burnout among all physicians General surgery Psychiatry Neurosurgery Radiation oncology Pathology General pediatrics Dermatology Prev., occupational, or environ. med. 45.4% of physicians show symptoms of burnout in Source: Shanafelt T, Boone S, et al. Burnout and satisfaction with work-life balance among U.S. physicians relative to the general U.S. population. Arch Intern Med. 2012;172(18):
15 Figure 1 And The Problem Is Worsening! Physicians Experiencing Symptoms in the Last 12 Months Burnout 45.5% 54.4% Depression 38.2% 39.8% Suicidal Ideation 6.4% 6.4% Source: Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, West CP. Changes in burnout and satisfaction with work-life Mayo Clinic Proceedings , DOI: ( /j.mayocp ) balance in physicians and the general US working population between 2011 and Mayo Clin Proc. December 2015:90(12):
16 [Resilience is] the glue that holds groups together, provides a purpose larger than the solitary self, and allows entire groups to rise in challenges. Martin Seligman, PhD Psychologist and Author of Flourish
17 Physician Health Care 1/3 of physicians: no regular source of health care Physicians: low rates of treatment for depression despite SES advantages JAMA 2006; Evans et al, Headache, 2006; Wachtel et al, JGIM, 1995; Montgomery et al, Occup Med, 2011
18 Depression in Medical Students Medical students (Michigan): almost 15% of students had current moderate to severe depression scores. 15% Schwenk, JAMA, 2010
19 Depression Treatment for Medical Students 1/5 2/5 1/3 1/2 Only 1/5 with positive depression screen sought care Only 2/5 with suicidal ideation sought care In Norway, only 1/3 sought treatment UK survey: only half would seek formal professional advice for mental illness JAMA 2003; Tyson et al, 2004; Hassan et al, Clin Med, 2009
20 Depression in Residents In a meta-analysis of 54 studies, on average, 28% of residents had depression or depressive symptoms. Overall prevalence = 21-43%. Mata, JAMA, 2015
21 Physician Suicide Rate High Recent studies show suicide is twice as likely in physicians vs. the rest of the working population (controlling for marital status, gender, race, And socio-economic status). Stack S, Archives of Suicide Research, 2004 Aasland et al, Social Science & Medicine, 2001
22 Suicidal Ideation 6% 25% 16% 39% 6% of surgeons reported suicidal ideation Only 25% sought help The rate is three-fold higher if physician perceived making recent major medical error (16% suicidal ideation) 39% reluctant to seek help due to repercussions for medical license Shanafelt et al, 2011
23 Female Physicians at Highest Risk for Suicide White female physicians rate higher than working US population (age-adjusted ration: 2.39) 1.5% of US female physicians have attempted suicide Female physicians: fewer attempts; higher completion rate than other females Schernhammer and Colditz, American Journal of Psychology, 2004 Petersen and Burnett, Journal of Occupational Medicine and Toxicology, 2008 Frank and Dingle, American Journal of Psychology, 1999 Center et al, JAMA, 2003
24 There is nothing in the world, I venture to say, that would so effectively help one to survive even the worst conditions as the knowledge that there is a meaning in one s life. There is much wisdom in the words of Nietzsche: He who has a why to live for can bear almost any how. Victor E. Frankl, Man s Search for Meaning
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