SCIENTIFIC
Exploring Resident Physician Wellness at an Allopathic Medical School in West Virginia : A Qualitative Study
AUTHORS : Cara L Sedney , MD , MA
Patricia Dekeseredy , MScN , RN Rebecca Elmo Sarah Sofka , MD
INTRODUCTION
Wellness is a broad term consisting of the multidimensional aspects of one ’ s life that , in combination , lead to optimal levels of physical and emotional health and social functioning . Wellness is not a passive individual state but rather an active , lifelong process influenced by intentions , choices , and actions that allows one to flourish in all aspects of life . 1 Resident physician wellness is heavily influenced by a learning environment that includes overlapping physical , social , and psychological contexts . In this fluid environment , residents are in a constant process of transformation as they cultivate their professional identity . 2 This evolving identity is formed in part by how residents interpret and process their experience within the medical community . These experiences include interactions with mentors , teachers , role models , and others and formal and informal communication as they carry out their job as a resident physician . 2
Burnout syndrome is described as a psychological response to chronic interpersonal stressors on the job . 3 Maslach and Leiter describe a three-dimensional model of burnout which includes 1 ) overwhelming exhaustion , 2 ) cynicism and detachment from the job , and 3 ) a lack of accomplishment and ineffectiveness on the job . 3 This model highlights how burnout is experienced by an individual within a social context and influenced by understanding of self and others . 3 There is a high prevalence of burnout in residents , with many specialties reporting a rate of over 50 %. 4 Burnout has been linked to decreased quality of care 5 and negatively impacts relationships with others in the workplace . 6
ABSTRACT
INTRODUCTION Social support is key to wellness , especially during times of stress and uncertainty . The working climate , including the multidisciplinary medical community , provides both positive and negative wellness experiences . The purpose of this study is to explore residents ’ concepts of wellness and the influence of programs , faculty , peers , and nursing and ancillary staff .
METHODS An email with a link to the REDCap survey was sent to each resident ( n = 450 ) in the medical school at West Virginia University , asking them to give examples of ways their wellness has been supported ( or not ) by faculty members , their program , co-residents , and nursing and ancillary staff . The residents returned 51 completed surveys ( 11 % response rate ). Seven residents participated in a face to face interview . A content analysis using Hale ’ s adaptation of resident wellness ( based upon
In a systematic review and meta – analysis of physician burnout , authors identified 2,617 articles examining interventions to mitigate and reduce burnout in practicing physicians . 6 This review highlighted effective interventions that can be individually focused or organizational in nature ; however , studies combining the foci are lacking . Most commonly studied are those interventions that are individually oriented such as mindfulness , stress management , and small group discussions . Recently , scholars have adapted Maslow ’ s framework to identify a hierarchy of needs as it applies to resident physician experiences . 7 , 8 Hale et al expanded on Maslow ’ s basic needs to include fundamental health determinants for residents such as sleep , physical health and safety , and mental health . The authors identify a gap in the literature evaluating organizational or structural interventions to address the issue of physician burnout . The current study builds upon the individualistic study of wellness to explore how the greater community of the clinical learning
Maslow ’ s Hierarchy of Needs ) as the theoretical framework was conducted on the data .
RESULTS Positive wellness elements frequently focused on time , supportive actions , and social connection . Negative examples impacting wellness included feeling disrespected , not being included in decision making , conflicts , and feeling unappreciated . Suggestions from the residents often described low-cost interventions such as being included and feeling part of the team .
CONCLUSION The participants described how all healthcare team members could support resident wellness in various domains . Peers , support staff in the hospital environment , faculty supervisors , and the overall program can contribute to the basic physiologic needs , safety , belonging , esteem , and self-actualization of resident learners through social support .
environment and other healthcare team members influence the wellness of resident physicians . The purpose of this study is to explore how programs , faculty , peers , nursing , and ancillary staff can support and foster a culture of wellness for residents , through the analytical lens of Hale ’ s expanded theory of Maslow ’ s framework .
METHODS
This study was approved by the West Virginia University School of Medicine ( WVU SoM ) Institutional Review Board . WVU SoM is an allopathic medical school with its main campus located in North Central West Virginia and supports more than 75 residency and fellowship training programs . No compensation or course credit was offered for participation . The protocol consisted of a sequential mixed-methods design , with the first phase being a survey and the second phase being in-depth , semi-structured interviews . The researchers include three medical educators consisting of two physicians and a staff member from the
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