MICHELLE BAILEY, MD, FAAP DIRECTOR, MEDICAL EDUCATION DUKE INTEGRATIVE MEDICINE

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1 ANNIE NEDROW, MD, MBA ASSOCIATE DIRECTOR DUKE INTEGRATIVE MEDICINE MICHELLE BAILEY, MD, FAAP DIRECTOR, MEDICAL EDUCATION DUKE INTEGRATIVE MEDICINE EMILY RATNER, MD, FAAMA CLINICAL PROFESSOR STANFORD UNIVERSITY SCHOOL OF MEDICINE

2 RESILIENCY

3 ROI

4 Ineffectiveness Depersonalization Emotional Exhaustion BURNOUT

5 Burnout 46% of surveyed physicians [1] very real human suffering among the physicians and their families [2] Physician job dissatisfaction most powerful predictor of departure [3] [1] Shanafelt TD, et al. Arch Intern Med [2]Saleh KJ, Quick JC, Sime WE, Novicoff WM, Einhorn TA. Recognizing and preventing burnout among orthopaedic leaders. Clin Orthop Relat Res. 2009;467(2): [3]Buchbinder S, Wilson M, Melick C, Powe N. Primary care physician job satisfaction and turnover. Am J Manag Care. 2001;7:702-13

6 Implications Physicians who are stressed fear they are committing more errors [4] Physician s self-reported satisfaction is strongly linked to patient satisfaction [5] Physicians sense of professional fulfillment positively correlated with patients adherence to medication, exercise, and diet regimens [6] [4]Firth-Cozens J, Greenhalgh J. Doctors perceptions of the links between stress and lowered clinical care. Soc Sci Med. 1997;44(7): [5]Haas J, Cook E, Puopolo A, Burstin H, Cleary P, Brennan T. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med. 2000;15: [6]Sundquist J, Johansson S. High demand, low control, and impaired general health: working conditions in a sample of Swedish general practitioners. Scand J Public Health. 2000;28:

7 Gender women physicians 1.6 times as likely as men to report burnout [7] lack of work control being a strong predictor of burnout in women but not men [7] female physicians report having more patients with complex, psychosocial problems than male physicians [7] [7]McMurray JE, Linzer M, Konrad TR et al. The work lives of women physicians: results from the Physician Work Life Study J Gen Intern Med. 2000;15:

8 The qualities of burnout begin in medical school WHAT WE THINK WE KNOW?

9 Our findings show that burnout is present at the beginning of the third year of medical school, prior to the initiation of the clinical years of medical training. Medical Of student the students burnout who is quite responded common, to all and the early MBI efforts items, should be 1354 made of 2566 to empower (52.8%) medical had burnout. students to both Scores build Burnout indicative the knowledge was of associated higher and skills medical with necessary self-reported student to burnout become were capable associated unprofessional physicians, with as lower conduct well medical as withstand less student altruistic the empathy emotional, scores professional mental, and and with values physical lower among professionalism challenges medical inherent students climate to medical at scores 7 US observed in medical students, residents, and faculty. schools. school. Seven US Medical Psychol Schools Health reported Med by Jul Mayo 25. Clinic group JAMA Sep Mt. Sinai, 15;304(11): NY Acad Med Oct;85(10 Suppl):S33-6 (UMDNJ) MEDICAL STUDENTS AND BURNOUT

10 MEDICAL PROFESSIONAL OR MEDICAL PROFESSION? 54% of over 7000 physicians are not experiencing burnout 46% of over 7000 physicians are experiencing burnout

11 RESILIENCY TRIAD Values Resiliency Self- Care Insight

12 OREGON HEALTH & SCIENCES UNIVERSITY INTEGRATIVE SELF-CARE INITIATIVE FOR STUDENTS (ISIS) 8 week elective course for first and second year medical students Mindfulness Guided Imagery Creative Expression Narrative Laughter Appreciative Inquiry Biofeedback Ritual Music Yoga Silence

13 Stanford Anesthesiology Resident Wellness Program Large department 75 residents 150 faculty members 4 hospitals Cornerstone mindfulness practices + Initiated 2010

14 CORE COMPONENTS 1) Mandatory first year resident lecture Scientific lecture stress Biofeedback exercise 2) Voluntary offsite weekend retreat CA-1 s 3) Ongoing sessions for remaining 3 years of residency

15 WELLNESS RETREAT /26 (54%) /26 (69%) /24 (88%) Divide into 2 small groups lead by 2 facilitators Safe, confidential, nonjudgmental environment Meditation, guided imagery, yoga Drawing, journaling exercise Opportunity for self-reflection, check-in, sharing concerns with peers in a supportive environment

16

17 WELLNESS RETREAT 100% - expectations met/exceeded Strong peer support system New coping and communication skills To talk openly about my struggles Our interactions were personal and deeply profound. Unbelievable investment in our well-being. The time spent here has truly changed me. Cathartic.

18 WELLNESS SESSIONS Meet every 8 weeks, 1 ½ - 2 hours Protected didactic time For each class, all 75 residents, mandatory Two groups from retreat maintained, same facilitators Third group formed with residents who did not attend retreat

19 FUTURE FACULTY

20 HISTORY: DUKE PHYSICIAN WELLNESS Integrative Self-Care for Physicians: pilot (Arthur-Vining-Davis Foundation) Duke GME Innovations Project: (Duke Endowment) Physician Self-Care: An Educational Workshop Series Resident Self-Care Web-based Curriculum The REFUGE: A Mindfulness-Based Practice Enrichment Service for Physicians: September 2011 present (Duke Integrative Medicine)

21 DUKE REFUGE PROGRAM A Mindfulness-Based Practice Enrichment program Weekly Drop-in sessions Individualized Consults Online wellness curriculum Customized training & CME programs

22 FUTURE DIRECTIONS Creation of a physician wellness committee at Duke Refine the existing REFUGE program based on ongoing feedback Development of a sustainable national model for an institutional physician wellness program Adaptation of a wellness curriculum for all health care professionals and health professions students

23 WORLD CAFÉ EXERCISE World Café Conversations Are: An intentional way to create a living network of conversation around questions that matter A creative process for sharing knowledge and creating possibilities for action in groups of all sizes SOURCE:

24 WORLD CAFÉ QUESTIONS INTERVENTIONS WITHIN MEDICAL PROFESSION OR MEDICAL PROFESSIONAL-- WHERE IS MOST USEFUL TO BEGIN? WHAT ARE THE CORE ELEMENTS/COMPETENCIES OF A PHYSICIAN RESILIENCY TRAINING PROGRAM? PREVENTION VS TREATMENT OF BURNOUT?

25 The Mindful Path to Self-Compassion by Christopher Germer

26 FOR RESOURCES ISIS handbook Reference list Student survey

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