Photo caption: Through a new residency program wellness initiative, internal medicine residents can sign up for informal activities that help promote well-being. Above, second-year resident Dr. Nan Sethakorn takes an introductory boxing class.

Medical residency has long been recognized as an essential phase in transforming “book knowledge” to clinical expertise. But residency is also increasingly recognized by medical educators as an experience so intense that it can elicit depression, burnout, and even suicide. A 2015 meta-analysis by researchers at Brigham and Women’s Hospital in Boston, Massachusetts covering 18,000 physicians worldwide found that 29 percent of medical residents experience depression during their residency program, a rate four-fold higher than the general population. 

“As we were about to start our chief year, we were talking about ways we could proactively address the risk of burnout and depression by exposing residents to strategies to enhance well-being throughout training, and build skills in resiliency,” said Vidthya Abraham, MD (pictured at a boxing class), Trowbridge Endowed Primary Care Track Chief Resident, Department of Medicine, and Emily Joachim, MD, Bridges Family Endowed Chief Resident, Department of Medicine.

The idea manifested as the Internal Medicine Wellness Committee, led by Drs. Abraham and Joachim. They worked closely with faculty champion Mariah Quinn, MD, MPH, assistant professor (CHS), General Internal Medicine.

“Dr. Quinn has helped advise us about specific wellness resources, techniques, and underlying principles ranging from developing a growth mindset and self compassion, to using narrative medicine to process some of the challenging moments, triumphs, and joys that fill our days as residents,” said Dr. Abraham.

The team launched a monthly newsletter called Wellness Today to communicate information to internal medicine residents and attendings about events, resources, and resident achievements. “These included everything from family-friendly events going on in Madison, to shout-outs of gratitude to residents, to wellness tips, to recognition of resident poster presentations at international meetings,” said Dr. Joachim. “I realized that what we needed was something I would have wanted to have at the start of my own residency: tools for reflection, decompression, and taking care of yourself.”

“We also looked for ways to increase resident camaraderie outside of the hospital,” said Dr. Abraham. An open-invitation group now gathers regularly, dubbing themselves “The BFG” for “Bennett’s Fun Group” (named in honor of Internal Medicine Residency Program Director Bennett Vogelman, MD, professor (CHS), Infectious Disease and vice chair for education.) Supported by financial sponsorship from Department of Medicine members,* the Wellness Committee and BFG have organized trips to boxing classes, orchestra concerts, a visit to a corn maze and pumpkin patch, an “ugly sweater” holiday party, and a cooking class led by Alexis Eastman, MD, clinical assistant professor, Geriatrics and Gerontology. On June 3, 2017, the group will hold its inaugural Internal Medicine Field Day at Garner Park. Resident classes will compete in games for the coveted “Benny Trophy,” enjoy a potluck, and even sport group T-shirts created by third-year internal medicine resident Melissa McDonald, MD.

The activities are lighthearted, but also highly intentional. In addition to working with Dr. Quinn on ways to promote specific aspects of wellness, Drs. Abraham and Joachim sought out ideas from other institutions and a workshop on “Resilience and Grit” at the 2017 Society of General Internal Medicine annual meeting. “One of the things that hit home for us was that our larger goal needed to be about promoting and maintaining a culture of wellness, not just creating events,” said Dr. Abraham.

In the future, residents intend to further integrate wellness techniques such as periodic meditation or reflective writing sessions directly into the residency curriculum so the practices fit naturally into the learning experience rather than being an additional task. In 2017-18, the committee will be led by residents Drs. Alex Hristov (currently PG-1), Ann Chodara (PG-2), Brian Lewis (PG-2), and Amber Hertz-Tang (PG-3).

“We are excited that the Wellness Committee will continue to build on our efforts to promote resident wellness, as this is an important time to explore ways to develop skills in resilience and well-being in both our personal and professional lives as physicians”, said Dr. Joachim.

*The Internal Medicine Residency Wellness Committee recognizes and thanks sponsors who have become “Friends of the BFG” in 2016-17: Dr. Amy Zelenski, Dr. Sean O’Neill, Ian Todaro, Dr. Richard Page, Dr. Mariah Quinn, Dr. Laura Zakowski, Dr. Bennett Vogelman, Dr. Tom Shiffler, Dr. Prakash Balasubramanian, Dr. Alexis Eastman, and Vonnie Schoenleber. To become a sponsor by donating online, click here and select “Internal Medicine Residency Wellness Fund."

Resources:

• “Long hours, grim tasks: Doctors in training face high risk of depression,” STAT News, December 8, 2015
• “‘The fallout has been all around me’: How becoming a doctor has taken a mental toll,” STAT News, September 19, 2016