others such as peers or staff in the healthcare setting could be associated with increased health and wellness . For example , the residents indicated that sharing experiences such as events or activities with peers and nursing and ancillary staff resulted in positive reports of wellness . Examples that suggest non-connectedness such as feeling unappreciated or disrespected were associated with threats to the wellness of the residents . Figure 1 illustrates the contextual , role-specific social connectedness model of wellness .
Although individual traits heavily influence wellness , the working environment can be a key contributor to negative experiences , such as burnout . 18 The Accreditation Council for Graduate medical Education addresses importance of this environment on resident wellness in the Clinical Learning Environment Review ( CLER ). The CLER outlines expectations for graduate medical education and can be used to evaluate programs and teaching institutions for medical education . The CLER also requires that programs address workload / working environments and create programs to address resident burnout and fatigue . Individually focused interventions such as self-care and resilience training programs can be effective in combatting burnout . 19 However , these programs should be done in coordination with systemic considerations such as improving the workplace for residents . 20
Over 900 residents in approximately 85 training programs provide essential care to the people of West Virginia . 21 The health and wellbeing of this physician cohort should be a priority for all members of the healthcare system . Results from the current study identify the influence of the greater community and how the workplace can contribute to and support ( or detract from ) resident wellness within Hale ’ s framework . Suggestions from the residents often include low-cost interventions such as being included and feeling part of the team . Social support from co-residents and faculty and feeling respected and appreciated were common . Figure 2 illustrates the external environment ( program , faculty , co-residents , and nursing / ancillary ) as an integrated framework encircling Hale ’ s revised Maslow ’ s hierarchy of need for residents . 7
LIMITATIONS
This study has some limitations . Firstly , all the participants were from one institution , which may limit the generalizability of the results . Secondly , the relatively low response rate to the survey , the limited number of participants in the face to face interview , and the lack of representation of every specialty will also limit generalizability . However , qualitative studies on resident wellness have been reported with similar smaller sample sizes . 21 – 23 In addition , residency demands and encroachment on personal wellness vary among specialty and therefore wellness levels may vary along specialty lines . Future research could explore resident wellness from the broader medical community ’ s perspective through interviews or survey methods .
A subsequent debrief of the REDCap questionnaire was conducted with a participant for feedback and suggestions for future research . Suggestions included separating professional from personal strategies to manage wellness . Other suggestions included adding a drop down menu as a “ yes or no ” to indicate if experiences impacted wellness followed by the free text box , rather than just the free text box , which might have discouraged some participants from completing the survey . Also , the term ancillary staff was felt to be too broad and should be more specific .
CONCLUSION
Although response rate was low for our study , the residents who did participate provided their valuable insight into the concepts of the wellness of physicians in training . This study is one of few to consider the relationships within the learning environment and how these interactions can support or negatively impact resident wellness . Despite the focused interest in resident wellness , the prevalence of burnout remains high . The proposed model expanding on Hale ’ s revised Maslow ’ s Hierarchy of Needs could be useful to inform programs aimed at the greater graduate medical education community to support and encourage residents during their education . A healthy workplace that encourages social connectedness and support between the multidisciplinary healthcare team members will create a better workplace for everyone and contribute to a better of sense of wellness for the residents who are working and learning there .
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