Arming surgical residents with the awareness, skills and permission they need to better manage stress in the workplace is the primary aim of a program entering its fourth year at the University of Miami Miller School of Medicine.
The initiative comes at a crucial time, as leaders in medicine nationwide scramble to find effective strategies to counter a recent spike in physician burnout and suicide rates.
“Thankfully, there is now a growing awareness on an international level about physician burnout, as well as an equally important dialogue about the current epidemic of physician suicide. Prior to this new awareness, the prevailing thought was that physicians were supposed to be ‘perfect’ and somehow immune to stress, depression and worry,” said Heidi Allespach, Ph.D., a clinical psychologist, associate professor of clinical surgery and director of behavioral medicine for the surgical residency program at the Miller School and UM/Jackson Memorial Hospital.
Dr. Allespach is facing these formidable challenges with a multidisciplinary team to address the whole surgeon — including the professional, emotional, physical, social and spiritual dimensions of well-being. Along with co-authors Danny Sleeman, M.D., professor of surgery, Gerd D. Pust, M.D., assistant professor of surgery, and Carl I. Schulman, M.D., Ph.D., professor of surgery, Dr. Allespach published highlights of the Behavioral Medicine Program in the American College of Surgeons’ journal RISE: Resources in Surgical Education.
Although stress and burnout can affect any physician, she said, “Surgeons, in particular, have unspoken rules such as, ‘Never complain, always work harder, and do as much as you can for as many hours as you can.’ We need to identify and aggressively address both individual and organizational/systemic factors involved in burnout in order to truly stem the tide of this growing epidemic among doctors.”
Through a series of interactive lectures, residents learn the four elements of the Stress Management Model. These evidence-based strategies include cognitive restructuring — also known as reframing of stressful thoughts — as well as mindfulness, diaphragmatic breathing and relaxation/imagery practices.
The program also helps prepare residents to interact with difficult patients, navigate adverse outcomes and communicate bad news to patients and families.
Dr. Allespach said response to the program from surgical residents has been “very positive. The residents are very welcoming and enthusiastic. Overall, they seem to be very grateful to have a forum to discuss issues that, historically, surgeons were never allowed to discuss.”
When any physician is feeling considerable distress, “Reach out for help. You’re not alone. That’s the most important message,” she said. When physicians start to feel overwhelmed, depressed or burned out, they tend to isolate, and then the problems can get a lot worse, she added.
“As we see the increased rate of burnout and foreshortened careers among medical doctors, it is important and timely that we focus on the wellness of our surgeons,” said Omaida C. Velazquez, M.D., chair of the DeWitt Daughtry Family Department of Surgery and surgeon-in-chief for UHealth and Jackson Health System.
“The physician’s well-being can impact the quality of care that they are able to provide and correlates directly with their career development and satisfaction,” she added.
“This program has many tangible and intangible benefits for our residents,” said Dr. Schulman, associate director of the surgical residency program and director of the William Lehman Injury Research Center, located in UM/Jackson’s Ryder Trauma Center. “The tangible benefits are potentially reduced stress and fatigue, both physically and mentally. Perhaps even more important, however, are the intangible benefits, knowing that their program cares about their well-being and is trying to do something about it. That inner sense of knowing we care and are there to help may be the biggest benefit of all.”
This concept of wellness is relatively new to overall medical education, but especially to surgery.
“I think we’re realizing now, especially given all the research on burnout, that neglecting yourself can have serious consequences. It’s not just personal well-being; it can also translate into how you view and treat patients,” said D. Dante Yeh, M.D., associate director of the surgical residency program.
“The most important change is the shift in the culture or mindset, where we emphasize to our trainees that it’s not weak or selfish to say ‘I need a day to decompress and recharge,’” Dr. Yeh added. “That kind of statement was unthinkable in the past.”
Program participant Maymoona Attiyat, M.D., a PGY5 chief surgical resident, likes the practicality of what she learned.
“This program has provided a very different way of looking at our daily activities,” she said. “It has been very helpful in improving the way I approach my patients and their families, especially in the office. I also appreciated the lecture and practical exercise session that helped me learn some new techniques to implement in the operating room that would make me less tired physically.”
In addition to its primary goal of improving the overall well-being of the surgical residents, the program is designed to serve as a template for other institutions looking to create similar burnout prevention and management initiatives.