1. No More Discussions of Wellness!
In Search of Direction in truly Assisting Residents in Flourishing and Being inoculated to Burnout
Thomas W. Bishop, PsyD
University of Michigan
Jill Schneiderhan, MD TB

2. Only that We are Trying to Do Better
Disclosures
Only that We are Trying to Do Better TB

3. Goals and Objectives
Articulate the most common negative themes that emerge in the developing of wellness curriculum in residency education.
Define the commonly used terms of wellness, well-being, burnout, and resilience.
Articulate strategies to align expectations of the residents with the faculty in regard to curriculum designed to promote well-being. TB

4. What Do We Know?
The effects of resident burnout has found its way into headlines.
The intersection of the Quadruple Aim’s addition of provider wellness and the ACGME inclusion of trainee wellness to requirements has led to more inclusion of wellness in resident curriculum.
Even with the shift to system factors for burnout, there has been little guidance for training programs.
Since program have little control over the “larger systemic drivers” of burnout, they are left focusing on what they can control, and with little direction. TB

5. So, What Has Been Tried? Our Program had 3 guiding principles: TB
Allocation of Resources
Evidence-Based Interventions
Iterative Developmental Feedback
Our Program had 3 guiding principles: TB

6. Our Program Factors that Drove Change Resource Allocation
Curricular elements
Resident Involvement JS

7. Initial Curriculum Design
Session
Timing
Topic
Content
1 - Interns
July – During Orientation
Mindfulness Introduction
Mindfulness exercises (meditation, walking, mindful movement)
2 - Interns
November
Mindfulness Review and addition of self- compassion
Mindfulness exercises (meditation, walking, mindful movement) and Self-Compassion exercises
3 - Interns
February
Mindfulness Based Cognitive Therapy
Incorporating an overview of MBCT
4 - Interns
May
Acceptance and Commitment Therapy Principles
Incorporating emotional regulation, acceptance and value centered living 5
Hourly All Resident Sessions
Variety of Topics
Time management and Efficiency
Flower arranging
Mindful walks
Scavenger Hunts
Team building
Self-compassion leading to thriving JS

8. Current Curriculum Design
Session
Timing
Topic
Content
1 - Interns
July – During Orientation
Skill Focus: CBT 101 and how emotional awareness can be helpful
Reflection Focus: fears/hopes on what they are envisioning over this year.
Opening: group mingle time, eat, get settled
Mindfulness Exercise: Body Scan
Nature Walk: personal values statements, Stone Cutter story, self-reflection, group discussion
CBT 101
Group exercise – lizard puzzle
2 - Interns
November
Skill Focus: Self-awareness, boundary setting, expression/getting needs met, sense of control
Reflection Focus: Meaningful patient interactions
Opening: same
Nature Walk: think/pair share
Group Discussion: TED talk, Group exercise
3 - Interns
February
Skill Focus: Self - Compassion
Reflection Focus: Burnout/depression awareness/prevention
Mindfulness Exercise – self compassion focus
Skill session: Cognitive reframe of medical errors/Awareness of burnout in colleagues and what to do
Nature Walk: scavenger hunt indoor terrarium
4 - Interns
May
Skill Focus: Review
Reflection Focus: mastery and how far they have come over the year
Mindfulness Exercise
Skill session: Think/Pair/Share – stories of mastery, Group Conversation, reminder of values statements
Nature Walk: Collect an object that typifies who they are now 5
Hourly All Resident Sessions
Variety of Topics
Similar Constantly Adjusting Content JS

9. What Have You Tried?
JS - Limit to 2-3 examples

10. The push back and most common negative themes
What have you all noticed?
JS : Run discussion
TB: Write Items on paper
Dreamstime.com

11. Tensions Multiple concepts Faculty use of wellness time:
Structured Didactic vs Experiential Skills
Unstructured processing time Connection & Processing vs Going to Deep
Resident use of time:
what is the definition of well-being
Lack of time to implement wellness.
Locus of control: Resident vs faculty directed
JS to describe what our tensions are
TB to comment on what the group came up with and overlaps

12. Definitions Happy all the time Well-being Increased leisure time
No work from home
Being present to patients and family – “able to be ON all the time”
Meals with colleagues
Well-being
Wellness
Resilience
Burnout
Flourishing
Thriving
TB – conflicting understanding of definitions

13. TB

14. Approaching “Push Back” by Building Scaffolding
Group Activity:
Defining Wellness
We have done this two years running
Has worked well
Tom to introduce activity – goal is to come to shared understanding around definitions and curriculum content
Jill to run it: Four pieces of paper
Buckets:
Skills/processing
Relationship and connection/team building
Leisure and self care
Structural/systemic components components

16. What Would Work in Your Program?
Think – what’s the biggest tension you face
Pairs – share an idea how you would address that tension
Share – large group discussion of ideas generated
Write down an action you could take on returning from what you have heard
TB – introduce and run discussion
JS – write ideas on white paper
Both to walk around and listen to discussions

17. Brainstorming Share – large group discussion of ideas generated
Write down an action you could take on returning from what you have heard

18. Summary & What’s Next Identified tension around resident wellness
Many opportunities for scholarly endeavors in this area
Great ideas generated here today
Tom to share next steps for the curriculum
Jill to share next steps on broader national stage for understanding scope