Pulling our lens backwards to move forward: an integrated approach to physician distress

The medical community has recently acknowledged physician stress as a leading issue for individual wellness and healthcare system functioning. Unprecedented levels of stress contribute to physician burnout, leaves of absence and early retirement. Although recommendations have been made, we continue to struggle with addressing stress. One challenge is a lack of a shared definition for what we mean by ‘stress’, which is a complex and idiosyncratic phenomenon that may be examined from a myriad of angles. As such, research on stress has traditionally taken a reductionist approach, parsing out one aspect to investigate, such as stress physiology. In the medical domain, we have traditionally underappreciated other dimensions of stress, including emotion and the role of the environmental and sociocultural context in which providers are embedded. Taking a complementary, holistic approach to stress and focusing on the composite, subjective individual experience may provide a deeper understanding of the phenomenon and help to illuminate paths towards wellness. In this review article, we first examine contributions from unidimensional approaches to stress, and then outline a complementary, integrated approach. We describe how complex phenomena have been tackled in other domains and discuss how holistic theory and the humanities may help in studying and addressing physician stress, with the ultimate goal of improving physician well-being and consequently patient care.

Physician Wellness Interventions and Distress Assessment During the Coronavirus Pandemic

Introduction: Physician burnout and interventions to decrease physician burnout on organizational and individual levels have been theorized and implemented. The Coronavirus pandemic has increased the need to continue physician burnout assessment and increase wellness programming. Few studies have had the opportunity to address physician wellness amidst the Coronavirus pandemic using the strategy of multi-dimensional interventions. The purpose of this study is to document interventions to reduce burnout and stress among physicians during the Coronavirus pandemic while assessing overall physician distress and well-being. Methods: A cohort study of 304 pediatric physicians at a large healthcare organization in the United States was designed to measure distress in physicians using the Well-Being Index. Participation was voluntary. A third-party collected and disseminated de-identified aggregate data through a secure website portal. Organizational and individual wellness initiatives were introduced to the cohort population and voluntary participation tracked. Results: 145 (48%) Well-Being Index assessments were completed between March 16 and September 30, 2020. Mean distress over the 6-month period was 1.22, with high distress indicated by a score greater than 3.0. Monthly averages show a 111.5% decrease in distress scores during the time period. Over 91% of respondents reported feeling “somewhat” or “very supported” by the organization, and these respondents had overall low mean distress scores. Conclusion: Overall, the cohort population experienced decreased distress levels at program initiation and during the observation period compared to national physician distress data. Contributing factors may be participation in various organizational and individual interventions to target well-being, perceived support from the organization, or regional implications of the Coronavirus pandemic on population health.

Experiential Communications Curriculum to Improve Resident Preparedness When Responding to Discriminatory Comments in the Workplace

ABSTRACT Background Patients and families can make discriminatory comments leading to physician distress. Residents receive little training in appropriate responses to such comments and may be ill equipped to respond to intolerance without alienating the individual(s) making the comments. Objective We assessed whether a simulated curriculum would enhance pediatrics residents' ability to effectively respond to discriminatory comments. Methods In the 2016–2017 academic year, we modified an existing communication skills curriculum for senior pediatrics residents. Residents engaged a simulated parent who used discriminatory speech in 4 scenarios, followed by a group debriefing. We conducted anonymous surveys to assess residents' preparedness to respond to these comments before and immediately following participation and examined their experience with discriminatory comments in the workplace. Results The majority of residents reported prior experience with discriminatory comments (32 of 45 [71%] witnessed such comments, and 27 of 48 [56%] were targeted by such comments), most often regarding age, race, and ethnicity. Mean precourse scores ranged from 2.1 to 3.1 (on a 5-point scale) regarding ability to engage in a firm yet respectful dialogue, to reference the hospital code of conduct, to coach a learner to respond, and to facilitate a team debrief. Mean postcourse scores improved significantly for these questions (range 3.8–4.1). The greatest improvement was in referencing the code of conduct (2.1 versus 4.0, P < .001). Conclusions Immediately after participating in simulation, pediatrics residents reported a significant improvement in self-reported readiness to respond to discriminatory comments made by a parent and reported the simulation experience was beneficial.

Establishing a Culture of Intentional Wellness:

Introduction: Residency training is a peak time of physician distress, but also a venue in which residents can learn skills to thrive in a high-risk career. The goal of this study was to examine residents’ perceptions of the value of teaching wellness as an integrated component of a residency program. Methods: Researchers at the University of Utah Family Medicine Residency Program conducted a focus group with graduating family medicine residents regarding their perception of wellness and wellness skills, after having completed an intentional wellness curriculum integrated through their 3 years of residency. We used open coding to identify themes of the residents’ perceptions of the wellness curriculum. Results: Four interconnected themes emerged: (1) describing the relevance of wellness to a medical career; (2) the wellness curriculum as prioritized and intentional; 3) The value of wellness skills learned through the curriculum; and (3) the role of community ethos in maintaining wellness. Conclusions: Residents consider wellness to be a critical facet of being an effective physician. Our results suggest that a culture of wellness can be created through deliberate and transparent curricular design, helping residents to view wellness as a priority.