Residency can be an inherently stressful time, and the transition from medical student to resident can be an especially stressful event. Needs assessments and dedicated long-term resources have been essential in prioritizing resident well-being and cultivating a community of trust and compassion within Ohio State’s Department of Emergency Medicine.
This section was informed by interviews with Creagh Boulger, MD, Associate Professor, Associate Director of Ultrasound, and Fellowship Director, Department of Emergency Medicine; and Simiao Li-Sauerwine, MD, Assistant Residency Program Director, Assistant Professor, Department of Emergency Medicine.
Contact information for Simiao Li-Sauerwine: Simiao.Li-Sauerwine@osumc.edu.
Introduction and Overview
Within Ohio State’s Department of Emergency Medicine, resident well-being focuses on holistically building a community rooted in trust, compassion, and comradery. Incentives, social events, and empowered trainees are the foundation to building a “home away from home” in which residents feel they have tangible support from their peers and strong social connections to help them navigate the world of being a new doctor. Supported by a $1 million endowment matched by $1 million in departmental funds, resident well-being initiatives within the Department of Emergency Medicine are designed using informal needs assessments and resident input. Over the next year, the department plans to implement a structured survey to more fully understand the needs of its residents.
Resident-Specific Teaching Rounds
To support resident well-being and improve overall learning, residents at Ohio State participate in formal resident-only Schwartz Rounds.® Schwartz Rounds® offer residents regularly scheduled time to openly and honestly discuss the social and emotional issues they face in caring for patients and their families. Resident-only Schwartz Rounds® are led by Ohio State Stress, Trauma, and Resilience program staff and occur several times a year. Staff use resident feedback to develop future rounds and to identify issues or cases that residents may be dealing with.
Resident Support Features
A challenge for many residents is moving a long distance to complete their training. In most cases, they arrive without their usual support system, which can often lead to feelings of isolation and loss of community. In response to these challenges, residency program leadership prioritize developing a strong and supportive community in which residents and their families can thrive. Social events and activities, such as potlucks and sporting events, are designed so that residents’ families can also participate. Recently, faculty (led by Dr. Li-Sauerwine, Dr. Boulger, and Dr. Farhad Aziz) have begun volunteering to babysit several times a year. Residents drop off their children so that they can enjoy a date night with their spouse or have additional time for other activities.
The residency program within the Department of Emergency Medicine uses incentives to motivate residents to practice self-care and participate in activities that enhance their overall well-being. Residents accumulate points for activities such as going to the dentist, exercising, healthy eating, and spending time with their children. Residents can then use these points for gift cards to local restaurants, cleaning services, car repair, and more. While well-being programs must look beyond individual behaviors, this approach acknowledges the effort it takes to nurture and maintain well-being during the tumultuous time of residency and rewards individuals, with the hope that these incentives will support a culture in which more residents prioritize their own well-being.
Emergency medicine residents enjoy a community potluck event. Photo provided by The Ohio State University.
Communication Is Best When Coming from Peers
As with many programs and organizations, communication can be hard. When the residency program first instituted well-being programming, members of the leadership team were initially the frontline communicators in spreading the word to residents. Over time, leadership has learned that residents are more likely to participate in well-being activities when hearing about these opportunities from their peers. Careful communication and continual monitoring of messaging has reassured residents that leadership is not using well-being programming to identify “weaknesses” among their trainees.
“Five years ago, we had nothing to support resident well-being. We still have a lot to learn and a lot of room to grow, but starting small helped us find concrete ways in which we could at least begin this work. A needs assessment was key for us in taking a hard and honest look at where we were lacking. Setting small goals is also helpful. Having all residents become a 10/10 on well-being is unrealistic. But if we can help bring someone from a 3 to a 5, we’re doing our job right. Sometimes the things you think are frivolous can mean so much. Constantly reassessing and being very flexible in your programming is necessary. People change and they may need bigger or different resources.” (Dr. Creagh Boulger, The Ohio State University)
A $1 million endowment matched by $1 million in departmental funds provides a sustainable future for well-being programming and solidifies the department’s commitment to well-being. The Samuel Kiehl III Wellness Endowment was gifted in 2015. A Wellness Committee develops a budget each year and comprises several faculty and residents (numbers vary each year but there are approximately 12 representatives from the department). Residents can also request funds for events and activities by submitting proposals to the Wellness Committee. Each proposal must describe how the activity supports well-being and/or personal or professional development. The Wellness Committee follows up on approved activities to learn about challenges and successes and to brainstorm future improvements. This funding mechanism empowers residents to plan well-being-related activities that uplift the community.
A $1 million endowment @OSUEMEdu matched by $1 million in departmental funds provides a sustainable future for well-being programming. Residents are empowered to plan activities that uplift the community and support well-being #ClinicianWellBeing #MedEd
Recently, faculty from the Department of Emergency Medicine began volunteering to babysit several times a year so that residents can enjoy a night with their spouse or others. Photo provided by The Ohio State University.
Assessment and Continuous Improvement
Program leadership understands the importance of obtaining (and using) feedback from residents. In building well-being initiatives, leadership informally surveys residents to better understand their needs. While the execution of such surveys can be labor intensive, leadership credits these surveys with helping them remain responsive to the needs of residents. This continual reassessment and flexibility in program design has been critical to meeting needs year after year.
For example, a recent survey found that many residents with young children felt disengaged from well-being activities because they did not have child care or did not feel as though bringing their children to events would be acceptable. To remedy this concern, the program recently hosted a social outing in which faculty remained at the medical center after hours to babysit residents’ children so that they could enjoy social time without needing to find and finance their own child care.
Residency program leadership is currently working with the Office of the Chief Wellness Officer to identify a more rigorous and validated instrument to measure overall well-being and to identify their current strengths and opportunities. In coordination with the medical center, the residency program also administers the annual resident survey from the Accreditation Council for Graduate Medical Education.
Cappelucci, K., M. Zindel, H.C. Knight, N. Busis, and C.M. Alexander, eds. 2019. Improving clinician well-being at The Ohio State University: A case study. NAM Action Collaborative on Clinician Well-Being and Resilience, National Academy of Medicine, Washington, DC. https://nam.edu/clinicianwellbeing/case-study/ohio-state-university.
Conceptual Model Factors
- Professional Development Opportunities
- Professional Relationships
- Relationships and Social Support
- Work-Life Integration
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