Association for Academic Surgery (AAS)

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#AASChat Twitter Topic for June 15th – Cultivating Culture: Promoting a Happier, Healthier Workplace (No Forced Meditation Required)

Join us on Tuesday, June 15th at 7 PM ET on Twitter @AcademicSurgery, #AASChat to discuss! Moderated by Dr. Kayla B. Briggs (@kaylabriggs) and Dr. Anne Stey (@AnneMStey)

  1. How do you define burnout? How did you know you or a colleague were experiencing burnout?
  2. If you or someone else has successfully managed burnout, what strategies work best?
  3. What are some new or innovative ways your workplace or training program has made wellness a priority?
  4. What practices do you engage in to prevent burnout? How do you model this to colleagues?
  5. Attendings, do you discuss and model work/life balance strategies to trainees?

As a general surgery resident (and now pediatric surgery research fellow), I have sat through my fair share of lectures focused on burnout, wellness, and resilience, buzzy topics in the world of graduate medical education. From the 3-part “Resident Wellness is a Lie” series, Jennifer Bernstein is correct in pointing out that these lectures often occur during mandatory education time during early morning hours.1 While well-intentioned, these lectures often overload trainees with yet more responsibilities to tackle on their massive list of to-dos.

The question is – how do we “fix” burnout? With the staggering number of residents who choose to admit they’re struggling (with more inevitably suffering in silence), how do we create an environment that supports and cares? One such concept that has interested me is workplace culture.2 A study of 665 general surgery residents surveyed, 69% met the criterion for burnout on at least one subscale.3 Longer work hours contributed to increased burnout.4 What impact does workplace culture have on happiness in medicine, and how can this be optimized to help prevent or mitigate burnout? I want to stress – burnout is a serious, multifaceted issue that takes a multidisciplinary approach to tackle. It also requires an overhaul of the medical education and practice system that many physicians fall victim to. However, the culture of medicine and the workplace cannot be overlooked when addressing the burnout crisis.

  1. Hospital organizations have mission and culture statements, but how often is this something known, followed, and believed by leadership, training programs, and trainees?

I advocate for creating a set of cultural values, both with program leadership and trainees, that outlines what is important to a training program and the principles that will govern their decisions. It’s easy to say, “We value time out of the hospital.” But how do you put that into practice? If this is a core tenant of your training program, perhaps you make it a mission to give residents “golden weekends” instead of one day off a week. As a cultural belief, those responsible for scheduling will make this a priority, as residents who work clustered call shifts gladly do so because they and their colleagues, families, and friends benefit. It is understood and accepted that this is a practice employed so the most significant number of residents can maximize their time outside of the hospital. Buy-in from attendings is required, as cross-covering residents are required. Focusing on maximizing a resident’s ability to have a more predictable life outside of the hospital personalizes this policy—culture matters.

  1. Create a residency culture that focuses first on trainee wellness. The rest will follow.

A tired and depleted trainee will not contribute their best, no matter how strong a program’s culture is or how tightly they adhere to their values. Create a culture that values and promotes health-focused habits but does not force them, like sleeping each night adequately or getting at least 30 minutes of exercise a day. Make it easier for residents to do such, with free or reduced rate gym memberships or more comfortable on-call accommodations. Residency government organizations, some of which are unionized, have helped advocate for such measures.6 Buy-in from the top down will ensure these values are respected and aren’t undermined.

The Ohio State University Wexner Medical Center is perhaps one of the more well-studied examples of creating a culture that focuses on wellness.5 They focused on institutional change by creating a “Mindfulness Medical Center” that focuses on provider wellness, offers support when providers experience a traumatic event, and offers flexibility to students. They’ve seen a reduction in the number of patient safety events and increased patient satisfaction due to clinicians feeling empowered to do their best work.

      3. Foster friendship and a healthy team environment.

Remember on the interview trail when you compared notes with other applicants about how “malignant” programs were? What was it that specifically made you feel as though a program wasn’t welcoming or wouldn’t foster your growth? Was it the general “vibe” of the program?

Surgical residents spend 80 hours a week (or nearly half their time) in the hospital. I would argue that fostering a culture that is more supportive, humane, and inclusive is one of the easiest and first places we can start when addressing the issue of resident happiness and burnout. Challenging old-fashioned notions of what it takes to be a surgeon or what surgical trainees must go through to be successful requires hard work, tough conversations, and new ways of thinking. I encourage my fellow surgical trainees to speak up when there are obvious injustices or even subtle issues that make work more difficult. It’s been found that even the most resilient physicians struggle with burnout at staggering rates.7 Placing the onus on providers to be more resilient – to engage in more wellness activities and to be responsible for the very real, very valid feelings of burnout that they have – misses the mark.

References

  1. Bernstein JR. Resident Wellness is a Lie (Part 2 of 3). In-House: The Agora for Medical Residents and Fellows. 2019. Available at: https://in-housestaff.org/resident-wellness-is-a-lie-part-2-1354. Accessed March 25, 2021.
  2. Tarver E. Corporate Culture. Investopedia. 2021. Available at: https://www.investopedia.com/terms/c/corporate-culture.asp. Accessed March 25, 2021.
  3. Elmore LC, et al. National survey of burnout among US general surgery residents. Journal of the American College of Surgeons. 2016;223(3): 440-451.
  4. Pulcrano M, SR Evans, and M Sosin. Quality of Life and Burnout Rates Across Surgical Specialties: A Systematic Review. JAMA Surgery. 2016;151(10): 970-978.
  5. 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.
  6. What We Do. Committee of Interns and Residents (CIR). 2021. Available at: https://www.cirseiu.org/well-being/#1490899487893-8fefd53a-901f. Accessed March 31, 2021.
  7. Goroll AH. Addressing Burnout—Focus on Systems, Not Resilience. JAMA Netw Open.2020;3(7):e209514. doi:10.1001/jamanetworkopen.2020.9514
Kayla B. Briggs, MD

Kayla B. Briggs, MD

Kayla B. Briggs, MD is a third-year general surgery resident performing a pediatric surgery research fellowship (Surgical Scholar) at Children’s Mercy in Kansas City, MO. She is a general surgery resident at the University of Missouri-Kansas City, where she will return after her dedicated research years. She has an active research interest in healthcare disparities, quality improvement, and appendicitis. Twitter: @kaylabbriggs