Surviving Residency

In February of my intern year of residency in New York City, I sat for a test.  Every year, so the tradition went, interns had to take it, and it was rumored that our score would impact our reputation in the eyes of the program directors. Test day came.  After we had fumbled our way through the first page of the test, which required a perfect recreation of the coagulation cascade, the announcement was made: there was no test.  It was all fake, staged, a practical joke.  The program director told us that instead, we would be relieved of our clinical duties and whisked to a hot-shot gym across town for a day of team-building games and sports.

Although the day had been meticulously planned – buses waiting, lunch delivered, games coordinated – the truth was that I didn’t particularly enjoy the event.  I’m introverted and unathletic; it wasn’t my cup of tea. What mattered was the message underlying the entire hoax: that my program seemed to care about my well-being.  In the midst of the bitter New York winter and the throes of 80-hour workweeks, the day represented the acknowledgement that my mental health was not negligible.

My program wasn’t the only one paying attention to resident well-being.  Formal residency wellness programs have become increasingly commonplace over the last decade or so, and for good reason.   A growing body of evidence points to residency training as the nadir of personal wellness in a doctor’s life.  When compared to attending physicians and medical students, residents score lower in the realms of exercise, sleep, overall wellness, and event seatbelt use.  In a 2014 University of North Carolina study, reported burnout rates among surgical residents – measured by the widely used Maslach Burnout Inventory Tool – reached almost 90%, the highest of any specialty.  Perhaps the problem of resident unwellness is most poetically captured by a 2002 article entitled “Who is sicker: Patients – or residents?”

In response to epidemic burnout levels, the American Medical Association has put forth guidelines on the development of structured wellness programs for residents.  One of the most well-known examples is the Stanford General Surgery Balance in Life program, which involves a wellness curriculum, weekly group therapy with a psychologist, mentoring partnerships between junior and senior residents, group activities, and a hearty supply of healthy food.  The University of Massachusetts family medicine residency program, in a related but somewhat different approach, introduced a curriculum designed to cultivate mindfulness and self-compassion as part of a mandatory rotation.

While some small-scale evidence that programs like these may promote resident well-being, I wonder if efforts to create formalized wellness programs, while well-intentioned, are misguided in their structured, one-size-fits all approach.  For many, group activities and lectures on burnout do not inspire well-being.  In his famous Ted talk on work-life balance, Nigel Marsh posits that creating wellness and balance is too important to leave up to your employer.  It needs to be an individual endeavor.  “If you don’t design your life, someone will design it for you,” he warns.  

Using a blanket approach to resident wellness ignores the fact that personal well-being is just that: personal.  In designing wellness programs that best serve residents, perhaps we should devote resources not to formal curricula and group events, but to exploring, cultivating, and nourishing the needs of individuals.

And whatever the mechanism by which we try to deliver wellness, perhaps the most important function of a wellness program’s existence is the simple acknowledgement wellness matters.

By Nicole Van Groningen