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Why Resident Wellness is so Difficult to Achieve

5/4/2017

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A powerful article written by a resident pediatrician, on how "resident wellness" while a great idea in theory, in practice is much more difficult to achieve without a major reform to the underlying culture of medicine, work hours, and immense demands, stress, and responsibilities placed on young physicians.

"But the fundamental barriers to well-being remain here as in other programs nationwide: our 80-hour workweeks, our massive debt-to-income ratios, and the accumulated grief of years of medical training. The first time I went to counseling was during my first month in the ER, when I had a week of day shifts, followed by a week of nights, then a week of days and then another week of nights. The therapist’s first question was about my sleep schedule—the likely cause of my distress, but also absolutely beyond my control...

...The goal of preventing physician suicide seems reasonable to me: suicide is concrete, measurable, and important. “Wellness,” on the other hand, is fishy and elusive. The duty to promote one’s own wellbeing can feel like another burden on our time, and the idea that we residents have control over our wellbeing—or much of anything in our lives—is laughable.

My residency program’s individualized learning plan survey asks us what we are doing to promote wellness. I am able to list a couple of things in the box—I walk to work, I have a husband who makes me food—but the fact is I do not believe wellness is available to me. Not in this environment, and not at 80-hour weeks."

To read the full article, visit:
"When Doctors Can't Afford to Feel" by Dr. Rachel Pearson (The Daily Beast)

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How to Survive Residency While Maintaining Your Happiness

4/12/2017

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In this powerful article, physician and University of Toronto physician Dr. Shelly Dev, shares her revelations and lessons on surviving (and enjoying) residency while also maintaining our sense of self and happiness. Her messages include having self-compassion, focusing on our patients, and having a work-life balance that allows us to enjoy our passions outside of medicine. A must read for all med students and residents!

"Our ability to show caring and compassion is not infinite. It gets depleted and can become replaced by dark humour, cynicism, anger, resentment, complacency and, worst of all, apathy. 

This job doesn’t make you a bad person. You don’t lose your empathy or your goodness. It’s just hard to care about other people when you don’t feel cared for, or are not caring for yourself. Knowing what refuels you back to your normal, good self is as important as knowing how to resuscitate someone who is sick."

To read the full article, visit:
"How Therapy Revealed the Ills of Residency" by Dr. Shelly Dev (University of Toronto)

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A Med School Dean Speaks Out About How the Culture of Medical Training is Fraught With Stress

3/23/2017

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Speaking out about a tragedy involving the suicide of one of their own medical students, Dr. David Muller, the dean at Icahn School of Medicine at Mount Sinai powerfully expresses how the culture of medical training programs and the expectations of those pursuing a career in medicine can be fraught with stress, leading to anxiety, depression, burnout and suicide. 

More importantly, beyond addressing some of these "root causes" of medical learner and physician mental health issues, he reminds us all of the importance of support, whether that be provided between peers and colleagues, or through more formal programs and initiatives in medical schools and residency programs. 

"All these questions will have to be addressed, and the answers incorporated into whatever plan we propose to implement. But in my opinion they will fall far short of addressing one of the root causes of this national epidemic of burnout, depression, and suicide: a culture of performance and achievement that for most of our students begins in middle school and relentlessly intensifies for the remainder of their adult lives. Every time students achieve what looks to the rest of us like a successful milestone — getting into a great college, the medical school of their choice, a residency in a competitive clinical specialty — it is to some of them the opening of another door to a haunted house, behind which lie demons, suffocating uncertainty, and unimaginable challenges. Students bravely meet these challenges head-on while we continue to blindly ratchet up our expectations.

From their very first shadowing experience to their first foray in the lab; from high school advanced-placement courses and college admissions tests to grade point averages and the Medical College Admissions Test (MCAT); with helicopter parents, peer pressure, violins and varsity soccer, college rankings, medical school rankings, medical licensing exams, and the residency Match, we never let up on them — and it’s killing them."


To read the full article, visit:
http://www.nejm.org/doi/full/10.1056/NEJMp1615141

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RDoC Roles Out New Resident Resiliency Training

2/28/2017

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Many of those who work in the health professions can attest to the stress that comes with the job; the result of a combination of an environment involving sleep deprivation, high demands and responsibility, and pressure-fueled situations that are constantly changing and which we have limited control of. Due to this, physicians and medical trainees are at increased risk of burnout, depression and anxiety, and suicide. 

While there is a growing body of evidence that demonstrates the problem of stress among those who work in the healthcare industry, we haven't yet caught up with ways to tackle the problem. However, the Resident Doctors of Canada are implementing a new program that aims to improve physicians' resiliency and in doing so prevent burnout. Interestingly, the initiative is based on a training program utilized by the US Navy Seals and Canadian military to enhance the psychological and emotional strength of their troops. 

"The training consists of two key pillars.

Participants are taught to spot where they fall at any given time on a mental health "continuum" or colour-coded stress scale. 

Four zones — green, yellow, orange and red — represent escalating levels of stress and dysfunction and include recommended actions that doctors can take to reduce their levels of stress.
The second pillar consists of four skills that can control the body's hormonal response to stress, with the goal of overriding fear.

The skills seek to bypass the brain's amygdala — the emotional response centre that can stimulate a fight-or-flight response — and favour the frontal lobe, where rational decision-making occurs."


To find out more, click here:
http://www.cbc.ca/news/health/doctors-military-training-pressure-stress-1.3994718

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The Effects of Sleep Deprivation on Physician Wellness

12/18/2016

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Any medical student or resident can attest to how sleepless nights on call can lead to one feeling pretty terrible the next day when you realize you've been up at least 24+ hours without a wink of sleep. 

While many in the medical profession advocate for physician wellness through proposals to lower work hours, this article points out the challenges and push-back such organizations face in making this happen. From sleepless demanding nights being termed "the culture of medicine", a way to "teach dedication", to new studies which suggest there is no increase in rates of death or serious complications of patients who have been operated on by surgical residents who were working under the traditional hours. 

However, regardless of this, the author in the article below reminds us that all of us in the health professions are humans who need sleep to optimally function ... and to keep both ourselves, and our patients, healthy and safe. We would never suggest to our patients that it's okay working 24 hours non-stop with little sleep, so why doesn't this recommendation apply to us as well?

"Getting five or six hours of sleep—substantial by many physicians’ self-standards—can leave drivers impaired to a degree that’s similar to drunkenness. That’s according to findings of a study released this month from the AAA Foundation for Traffic Safety: Drivers who sleep only five or six hours in a 24-hour period are twice as likely to crash as those who got seven or more...
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... Even if a surgeon doesn’t physically collapse on top of a person, drowsy doctors are more likely to experience lapses in memory and judgment that can prove critical. In other words, the brains of doctors are subject to the limits of physiology in much the same way as other human brains."

Read the full article here: 
https://www.theatlantic.com/health/archive/2016/12/no-doctor-should-work-30-straight-hours/510395/

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The Ongoing Issue of Physician Burn-Out and Ineffective Interventions to Address It

12/17/2016

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It is no surprise that resident physicians are at risk of burn-out and depression as they face new levels of responsibility, higher demands, and more 24 hour call shifts once they graduate from medical school. While the debate around limiting work hours continues, more focus is being placed on helping new doctors cope with such stressors. However, while multiple institutions have tried implementing various initiatives to help their physicians combat stress, often the problem still remains of doctors coming forward to ask for help and support in the first place.

"Two major studies in the past month, one from the Mayo Clinic and one in the medical journal the Lancet, looked at various ways institutions have tried to deal with doctors’ fatigue, emotional exhaustion (a.k.a. burnout) and extraordinary depression rate: 29 per cent, versus 12 per cent of the general population.

The Mayo clinic study found hospitals had the most success with organization-wide changes like regular psychological screening, leadership training for supervising doctors and bi-weekly group dinners where residents can vent to peers who understand. 

The Lancet paper, which reviewed previous studies, found pretty much all burnout-reduction programs were equally, and not very, effective. On average, they reduced burnout rates from 54 per cent to 44 per cent, as measured by a standard psychological test. 

And that’s assuming those who have a problem admit it."


To read the full article, click here:
http://www.metronews.ca/…/…/05/doctor-diagnosis-burnout.html

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1 in 4 Medical Students Have Experienced Depression 

12/12/2016

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Mental health issues among medical students is not a new concept. Many of us are aware that those in the medical profession, including med students, are at increased risk of burnout, depression, and suicidal ideation due to a multitude of factors including sleep deprivation as well as high stress and demands. However, recently a new systematic review and meta-analysis published in JAMA reveals that approximately 1 in 4 medical students experience depression; a rate thats higher than the general population. 
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Specifically the review which analyzed studies from over 43 countries revealed "the overall prevalence of depression or depressive symptoms among medical students was 27.2%, and the overall prevalence of suicidal ideation was 11.1%. Among medical students who screened positive for depression, 15.7% sought psychiatric treatment."

To learn more about the study, check out:
http://jamanetwork.com/journa…/jama/article-abstract/2589340
http://www.cbc.ca/news/health/medical-students-medicine-mental-health-depression-suicide-1.3883935​


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Code Lavender: Rapid Support For Medical Staff

10/2/2016

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Many of us who work in a hospital environment are familiar with emergency codes including Code Red, Code Blue and even Code White. But does your hospital happen to have a "Code Lavender"? A few hospitals in the US have begun employing this new code as a way to provide urgent care to patients, families, and more especially nurses and physicians who are in need of emotional and/or spiritual support. Physician burn-out, grief, or stress ... now there is a code for that!

At the Cleveland Clinic in Ohio, the Code Lavender Program has been operating for over 8 years, and provides holistic care services for both their patients and employees. In addition, they also have a rapid response team which can provide more intensive and immediate support for those who are struggling with stress, burnout, grief and loss while on the job. 

"Within 30 minutes of a call, the Clinic’s team of holistic nurses arrives at the unit in need to provide Reiki and massage, healthy snacks and water, and lavender arm bands to remind the nurse or physician to take it easy for the rest of the day...

The Healing Services Team employs holistic methods that include spiritual support, counseling and therapeutic massage. Bringing together conventional medicine and alternative remedies, the Clinic also offers employees yoga classes, weight loss programs and mindfulness training."


To find out more about this program, click the link below:
http://www.huffingtonpost.com/2013/12/02/the-amazing-way-this-hosp_n_4337849.html

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