1. Being Well: Promoting Physician Well-Being
Emily M. Horvath, MD
University of Illinois College of Medicine at Peoria
Department of Internal Medicine
Jennie C. Hsu-Lumetta, MD, FACP
Carle Illinois College of Medicine
University of Illinois College of Medicine Urbana
Department of Internal Medicine

2. Disclosures
Emily M. Horvath and Jennie C. Hsu-Lumetta have no disclosures or conflicts of interest.

3. Goals and Objectives
Evaluate the concepts of “physician well-being” and a “culture of wellness.”
Discuss initiatives at Carle Clinic to promote a culture of wellness.
Discuss initiatives at UICOMP to promote a culture of wellness.
Describe ongoing and future Illinois ACP initiatives to promote resident and faculty well-being.

4. What does “well-being” mean to you?
Well-being Survey
Well-being Survey
What does “well-being” mean to you?

5. What is “well-being”?
Naci and Ioannidis: Well-being refers to “diverse and interconnected dimensions of physical, mental, and social well-being that extend beyond the traditional definition of health.”
It includes choices and activities aimed at achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfillment1.
NOT just the absence of burnout!
Huseyin Naci; John P. A. Ioannidis, (June 11, 2015). "Evaluation of Wellness Determinants and Interventions by Citizen Scientists". JAMA. 314: 121

6. What is “well-being”? What components does it encompass?
Carol Ryff’s Six factor model of well-being
Self-acceptance
Personal growth
Purpose in life
Environmental mastery
Autonomy
Positive relations with others
Ryff, Carol D. (1 January 1989). "Happiness is everything, or is it? Explorations on the meaning of psychological well-being". Journal of Personality and Social
Psychology. 57 (6): 1069–1081.

7. What is “well-being”?
Seligman’s model of PERMA – “positive psychology”
Positive emotions:  a wide range of feelings, not just happiness and joy, but excitement, satisfaction, pride and awe, amongst others. These emotions are frequently seen as connected to positive outcomes, such as longer life and healthier social relationships.
Engagement: involvement in activities that draws and builds upon one's interests. The task being done needs to call upon higher skill and be a bit difficult and challenging yet still possible. Engagement involves passion for and concentration on the task at hand and is assessed subjectively as to whether the person engaged was completely absorbed, losing self-consciousness.
Relationships: all important in fueling positive emotions, whether they are work-related, familial, romantic, or platonic. It is typical that most positive things take place in the presence of other people.
Meaning: also known as purpose. Discovering and figuring out a clear "why" puts everything into context from work to relationships to other parts of life. Finding meaning is learning that there is something greater than one's self.
Accomplishments: the pursuit of success and mastery. Unlike the other parts of PERMA, they are sometimes pursued even when accomplishments do not result in positive emotions, meaning, or relationships. That being noted, accomplishments can activate the other elements of PERMA, such as positive emotion.
Seligman, M. E. P. (2011). Flourish: A Visionary New Understanding of Happiness and Well-being. New York: Free Press. Ch 1.

8. Exercise #1: PERMA
What is something that contributes to your well-being that would cause distress if you lost it (associated with PERMA)?
Example: our department Keurig coffee maker

9. Physician well-being
Extraordinarily high — and increasing —prevalence of physician burnout, defined as emotional exhaustion, interpersonal disengagement, and a low sense of personal accomplishment.
The absence of burnout may not constitute total well-being, but the presence of burnout markedly impairs total well-being – “professional well-being.”

10. Creating a culture of wellness!
Physician well-being
Creating a culture of wellness!
Defined as a set of normative values, attitudes, and behaviors that promote self-care, personal and professional growth, and compassion for colleagues, patients, and self.
Leaders should expect physicians to attend to their own well-being and should view self-care as a professional core competency, abandoning the antiquated and dangerous misconception that self-care and patient care are competing interests.
Bohman B et al. Physician Well-Being: The Reciprocity of Practice Efficiency, Culture of Wellness, and Personal Resilience. NJEM Cataylst. Aug 2017.

11. Carle Illinois Well-Being Initiatives – creating a culture of wellness
Thrive – Student initiated wellness program developed by University of Illinois College of Medicine Urbana Students and imbedded into Carle Illinois College of Medicine program
Carle Illinois Innovation Pods – Carle Illinois Medical Students, University of Illinois College of Medicine peer student mentors, Carle Residents and pod faculty mentors – clinical, basic science and engineering faculty from University of Illinois at Urbana- Champaign

12. Carle Illinois Wellness
Mission–To cultivate a learning community and environment that is dedicated to providing health and wellness support for our medical students to thrive academically, professionally, and personally.
Vision –To develop a community of physicians that are self-aware of a balanced, healthy lifestyle that fosters academic excellence, promotes the shared values of our college, and inspires joy in learning in their profession.

13. Carle Illinois Wellness
Carle Illinois College of Medicine BEING WELL AT CARLE ILLINOIS
Our Wellness Culture
Holistic
Comprehensive
Student Driven

14. Carle Illinois College of Medicine Wellness Wednesdays-Thrive
Instructional cooking
Mindfulness based stress reduction
Meditation
Yoga
Stress management
Work life balance
Career roundtable
Test taking skills
Debt management

15. Carle Illinois Innovation Pods
Pod mentor faculty training workshops:
1) Getting Started – “Becoming A Master Mentor” – June 2018:
Understanding your roles and expectations
Sharing existing wellness skills and discussing implementation
Review characteristics of effective mentoring relationships
Discussing the importance of mutual expectations compacts
2) Keeping It Going - “Telling Your Story” – August 2018
Modeling Vulnerability, Building Autonomy
Brene Brown video on vulnerability
Pre-post survey

16. Developing an Effective Mentoring Relationship
Characteristics of Effective Mentoring Relationships
Reciprocity: bidirectional, sustainable, mutually rewarding
Mutual respect: respect for time, effort, and qualifications
Clear expectations: outlined at outset and both accountable
Personal connection: empathy and proactivity
Shared values: professional and personal

17. Carle Illinois Pod Activities
Student and faculty collaboration on planning: 1) Potluck 2) Book discussion on being a patient 3) Bowling night 4) Community Service project 5) Sunshine “folders”
Sunshine folders lessons:
1) Lesson No. 1
Often, the most important service we provide a patient
is not what we think it is.
2) Much of what you are taught is wrong.
Someone once said that as we get older more of our patients
become friends and more of our friends become patients. I have
learnedtowelcome this as apartofmy jobandunderstandthe care-
ful nuance these relationships demand. I also know that much of
what I am taught and much of what I teach is probably wrong.
3) Lesson No. 3
Keep a sunshine folder.
At thebeginningofmy career,mydivisionchief suggestedI keep
a sunshine folder, a folder in which you stash thank you notes from
patients, commendations from your chairman, and other small ac-
colades.AcynicalNewYorker, I scoffedat this idea. I remember find-
ing the name “sunshine folder” especially distasteful. Neverthe-
less, on a day of weakness, I started one. E’s drawing is essentially
an item frommy sunshine folder that hangs onmy wall.
Why do you need a sunshine folder? Because medicine is hard.
Youwillworkhard.The stakes arehigh.Thingsoccasionally gobadly.
Therewillbepooroutcomeswhenyoudoeverythingright and,even
worse, when you fall short. On good days I tell myself that this as-
pect of medicine is wonderful—we can never become overconfi-
dent. Whenever I feel like I am really mastering the art and the sci-
enceofmedicine I amsure tobe remindedofhowendlessly complex
it is tocareforpeople.ToparaphraseOsler, theremaybeafinitenum-
berofdiseases,but there is aninfinitenumberofways that theypre-
sent and an infinite number of ways that we, as humans, react to
them.The sunshine folder is there tobrighten your spirits on thedif-
ficult days that lie ahead.
Adam Cifu, JAMA August 2018, Advice for a Student Starting Medical School

18. Carle Illinois Pods Service Project
ACP/HRS sponsored Atrial Fibrillation screening project as part of Stroke reduction initiative 1) Community screening of participants at risk – HTN, Obesity, age >65 2) CI MED Students – participation in obtaining informed consent, screenings with iECG devises, and providing participant results

19. UICOMP Well-Being Initiatives – creating a culture of wellness
Development of a Professional Development Resident Coaching Program
Modeled after the program pioneered at Massachusettes General Hospital, designed by Dr. Kerri Palamara-McGrath, MD and Dr. Carol Kauffman, PhD.
Designed to provide emotional and professional support to residents during one of the most challenging periods of their lives. The first program in the nation, it matched residents with non-supervisory faculty who, trained in the principles of Positive Psychology, helped the residents reflect on their experiences, develop an understanding of their strengths, and use those strengths to help them reach their potential.

20. Residency Coaching Program - why coaching?
Residency is a pressure-cooker of professional development and identity formation.
In general, in residency training, feedback and “growth” are focused on “fixing what is not working”, and are more retro-active.
There is a lack of “positive pushing” – identifying strengths and weaknesses proactively and setting goals based on this reflection.
Personal and professional development are focused primarily on the “long-term goal” through mentoring relationships and programs.
Day-to-day emotional needs of residents are inconsistently met, with burnout rates reaching up to 80% nationally.
Who focuses on overall development of residents?

21. Residency Coaching Program - The role of coaching in medicine
Coaching provides a new, proactive model for development
Goal: help residents develop, function and grow to the best of their abilities
• The keys :
* Help residents prioritize what THEY want to
work on and set their own learning goals – guiding them
through self exploration.
* Guide them to identify their strengths and how to use them
to overcome their challenges and stressors.

22. What exactly is coaching?
Teaching: helping an individual or group retain knowledge, develop cognitive skills and capabilities
Mentoring: helping to shape an individual’s life trajectory in a positive way; often a longer term career relationship from someone who has ‘done it before’, sharing advice and wisdom
Counseling: helping an individual to improve performance by resolving situations from the past
Coaching: helping another person to improve self- awareness, to set and achieve goals in order to improve a particular behavioral performance (professional and personal!)

23. Residency Coaching Program
Inaugural year at UICOMP
Includes ½ intern class from Internal Medicine, Pediatrics, Medicine-Pediatrics and Emergency Medicine.
Coaches are volunteer faculty from each of these programs who have undergone training in Positive Psychology (MGH curriculum).
Well-being metrics are evaluated pre-and post- coaching in both residents and coaches.

24. What will the coaching program structure look like?
Palamara K et al. Promoting success: A Professional Development Coaching Program for Interns in Medicine. JGME. Dec 2015

25. What will the evaluative metrics look like?
Palamara K et al. Promoting success: Professional Development Coaching for Residents: Results of a 3-year Positive Psychology Coaching Intervention. Journal of General
Internal Medicine. Nov Vol 33(11):

26. Residency Coaching Program - The role of coaching in medicine
Do people actually do this?

27. Exercise #2: Coaching by Numbers
If this year was a 10 out of 10 for you (BEST possible year!), what would this look like for you?
Between now and the next 6 weeks, what is one thing you can work on to get you closer to those goals?
How are you going to make that happen, and how will you know if you did it?

28. Exercise #2: Coaching by Numbers
Turn to your partner!
Coaches – ask your partner to pick ONE specific area of their life or work that they want to focus on.
ASK:
If time or money were no object, what would this part of your life look like, if it were a 10 out of 10?
What would you rate yourself now?
What can you do in the next 6 weeks to raise yourself up one half of a point (i.e. from a 6 to a 6.5)
How would you know if you did it?
Listen to your partner and then reverse roles.

29. Exercise #3: Utilizing PERMA to reflect
Positive emotion - what did you feel best about this year, was there a peak experience?
Engagement - what was the most compelling and interesting experience this year?
Relationships - describe a rewarding experience with a patient, colleague, friend or family?
Meaning - looking back over the year, when did your work really matter to someone?
Accomplishment - what accomplishments are you the most proud of?
Utilizing Positive Psychology techniques to promote self-reflection
into well-being and promote a culture of wellness… for both residents
and faculty?

30. Illinois ACP Wellness Initiatives – creating a Culture of Wellness
Physician Wellness Champion Roles:
Promote the rationale for investing in clinician well-being, share key evidence-based strategies to improve clinician well-being and professional satisfaction, and foster the development of chapter-based communities that support well-being and professional satisfaction.
Review chapter well-being survey results as available.
Integrate well-being/professional satisfaction information and strategies into Chapter programming, activities and communications.
Serve as a coach or mentor for at least 2 physicians in the chapter each year, providing a supportive connection and resources (and referral information for those in need of more intensive counseling).
Assess and work with at least one member’s practice to measure well-being, burnout and provide strategies for improvement.

31. Illinois ACP Wellness Initiatives – creating a Culture of Wellness
IL ACP Chapter – involved in early stages of working on a national curriculum for ACP on wellness for Residents
Sessions in Development:
The Current State of our Professional State: The problem of physician burn-out, why it matters, and what programs can do about it
Health, wellbeing, and the pursuit of happiness
Understanding roles, responsibilities, and boundaries in the physician workplace
Nothing stays the same: the transition from resident to attending physician

32. Give thanks to audience for time and attention

33. Acknowledgements Well-Being Champions
Dr. Joseph Fotijk, MD , FACP
Medical Coordinator, Illinois Medical Disciplinary Board
Illinois Department of Financial and Professional Regulations University of Illinois College of Medicine at Chicago
Well-Being
Champions
Dr. Irene Aluen-Metzler, MD, FACP
Associate Program Director, Cook County Internal Medicine
Residency Program
Dr. Suja Matthew, MD , FACP
ACP Governor, Illinois Northern Region
John H. Stroger Jr. Hospital of Cook County
Department of Internal Medicine