Medical residency is a period of training that can bring significant challenges to well-being with long hours, critical patient care, and diminished work-life balance. According to studies, 40-75% of residents experience burnout. Approximately one-third of residents report symptoms of depression and 25% say they struggle with severe anxiety.
Given these risks, the Accreditation Council for Graduate Medical Education now requires residency programs to proactively address physician well-being and treat this aspect of training as seriously as other competency areas.
In line with this mission to create happy, healthy physicians, Dr. David Kuo, Associate Dean for Graduate Medical Education at PCOM, has created a dedicated space in each year’s resident orientation for the introduction of positive psychology principles and skills.
“I feel that if we can teach our residents the skills and strategies to cope with stress during their residency training,” Kuo said, “then they'll be successful and happy as attending physicians after graduation.”
Dr. Scott Glassman, director of the Master of Applied Positive Psychology program at PCOM, was enthusiastic about joining forces with Kuo to create innovative programming to bolster resident resilience.
“If we don’t make well-being support a norm in the residency training process, we will continue to see high rates of burnout and suicide among practicing physicians,” Glassman said, describing a sense of urgency in addressing the residency well-being gap.
Glassman’s Flourish workshop has now been a part of the annual residency orientation for the past two years. Flourish is an adaptation of his 7-week A Happier You program, helping residents apply skills of mindfulness, strengths-finding, accomplishment orientation, growth mindset, and gratitude, among other skills.
This year, for the first time, Glassman planned and co-presented the concepts and skills with current residents Abdul Walters and T.J. Muzzonigro. Both Walters and Muzzonigro enjoyed the opportunity to take a leadership role in wellness.
“I was really excited to work with [him] on the Flourish wellness workshop during orientation,” Walters said. “Wellness is often talked about in residency but very seldom actually practiced.”
Dr. Kuo further noted the value of this collaborative approach in promoting better engagement in wellness initiatives.
“I think the residents, and people in general, pay more attention when they see their peers up front talking about their experiences, because they can relate to them better,” Kuo said.
Walters, a PGY4 General Surgery resident, acknowledges the challenge of maintaining a positive, constructive mindset during this phase of training, while also expressing a desire for effective tools for refocusing.
“I believe practicing mindfulness and strength finding are useful tools in maintaining positivity in a scrutinizing work environment that tends to highlight negativity and unfavorable outcomes,” Walters said.
“I feel that if we can teach our residents the skills and strategies to cope with stress during their residency training, then they'll be successful and happy as attending physicians after graduation.”
Dr. David Kuo
In one of the activities in the Flourish workshop, Glassman shows a slide of 16 signature personal strengths and asks the residents to identify which two or three they feel they have shown recently. They then work in pairs to discuss examples of those strengths before sharing them with the larger group.
Glassman observes that this kind of personal and public recognition of personal strengths has a synergistic effect in making those strengths feel more real, evidence-based, and socially supported. Seeing a strength in action is framed as a win.
“The more residents are able to keep their strengths in the front of their awareness, the more likely they will be able to turn to them when a difficult event takes place that would otherwise undermine their sense of control and self-efficacy,” Glassman said.
Kuo points to how this kind of positive reinforcement can reduce self-criticism.
“Residents are harsh critics of themselves and I think they focus on the negatives of their work, when they should be focusing on all of the good things they are doing to help patients and their colleagues,” Kuo said.
Despite the widely recognized need for resident wellness curriculum, it is unclear how many of the nearly 13,000 graduate medical programs in the United States have implemented a formal program.
“If we don’t make well-being support a norm in the residency training process, we will continue to see high rates of burnout and suicide among practicing physicians."
Dr. Scott Glassman
In a review of evidence-based interventions, Parsons and colleagues highlight the importance of a multicomponent approach that includes mindfulness, resilience, and wellness across life domains.
Glassman is hoping to introduce the Flourish program to residency programs across the United States, using an interprofessional model that brings psychology and medical education expertise together.
Ultimately, he would like to see medical resident wellness “champions” receive training during their internship year in this positive psychology skill set and then disseminate these practices throughout their residency years.
“There is great promise for peer-led wellness education in residency since it multiplies exponentially the training resources that are available,” Glassman says, suggesting that this is a crucial step to reach a greater percentage of the 154,000 active residents and fellows across the U.S.
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