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How to Foster a Healthy Training Environment

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Rates of burnout and mental health issues among physicians are at an all-time high. This is extremely problematic given numerous studies show that psychologically distressed physicians are more prone to making medical errors, experiencing professional lapses, and leaving medical training altogether

Medical training is a particularly stressful period, and a study from the Mayo Clinic showed that medical students were two to five times more likely to have clinically significant depression than similarly aged college graduates pursuing other careers. Another 2016 meta-analysis showed that the rate of depression in medical students was 27%, far higher than rates in the general population.

When considering the contributors to burnout and mental health issues among residents, it is not difficult to imagine that the training environment plays a significant role. A heavy workload and high-pressure work environment coupled with high expectations all lead to significant amounts of stress. What is even more troubling is that many trainees are burned out by the medical profession before they even begin their careers. As a result, many institutions are recognizing the need to provide better support for resident burnout.

To combat burnout, initiatives to help create an environment of well-being for residents have been implemented among many training programs. Such initiatives include resiliency training, wellness retreats, and community-building events. However, the efficacy of these added initiatives remains unclear. Adding required extracurriculars to an already busy curriculum is arguably detrimental to the well-being of residents. Instead, rather than layering solutions to combat burnout, perhaps a more effective means is to revise existing policies such that these policies inherently promote wellness. 

When it comes to creating policies that foster a healthy training environment, much can be learned from the business and education world. Here are three frameworks for educational leaders to consider incorporating into their curriculum when creating learning objectives for trainees:

1) Encourage autonomy and adult learning

Consider that the average age of a resident in training is a 30-year-old who has spent 12 years in grade school, four years in undergraduate, and four years in medical school prior to starting a three to seven-year residency. That resident has spent 27 years or more in an academic setting, during which that resident has transformed from an adolescent to an adult. In the hierarchical world of medical training, it is easy to forget that residents who have evolved to be increasingly independent would benefit from being treated as adult learners. An adult learning environment is one that offers autonomy and flexibility. Residents need to be involved in directing their own learning in order to stay engaged and motivated. This type of learning environment encourages residents to develop an extrinsic motivation to learn, one which is healthy and sustainable throughout a career.

2) Recognize important achievements

Given the numerous oral and written exams required in medical training, it is easy to diminish the effort that goes into preparing for and overcoming these requirements. Giving residents praise and recognition for these achievements, no matter how small these achievements may be, can reinstall meaning in a resident’s work. Further, recognition is an important motivator that can help build a culture of respect and trust. Recognition should be given not only to professional achievements, but also personal achievements, as recognition reinforces what is valued by a work culture.

3) Value individuality

Residents should be treated as individuals rather than as a group. Every resident has a unique set of skills and experiences, and they should not be treated as if they are all the same. By recognizing individuality and the unique perspectives of each resident, this creates a culture that sees these unique qualities as assets rather than burdens. Such an environment has the potential to leverage residents for their strengths, which can lead to higher levels of engagement in day-to-day work. 

According to WHO, burnout is a syndrome that results from workplace stress that has not been successfully managed. A few common themes that recur when discussing resident burnout include disillusionment, cynicism, exhaustion, and mistrust. When considering development of training curricula and implementation of training policies, incorporating a framework that promotes autonomy, recognizes important achievements, and values individuality are a handful of steps toward improving well-being and decreasing burnout in residency.

What do you think can be done to ensure residents’ well-being? Share in the comments.

Thea L. Swenson received a bachelor’s degree in engineering, product design from Stanford University and a medical degree from the University of Colorado. She is currently a resident in physical medicine and rehabilitation at Vanderbilt University and hopes to specialize in sports medicine.

Illustration by April Brust

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