After news that a star surgical resident, who had recently left Stanford to pursue a fellowship, had committed suicide, the residency program leadership decided to create a new structure that addresses the underlying issues affecting resident health and promotes a healthier work-life balance.
Shifting toward work-life balance in residency
When Greg Feldman, MD, a general surgery resident from Stanford University, took his own life during his fellowship in Chicago, the general surgery department was shocked at the news. He had been one of the most accomplished resident physicians the program had ever seen. He was warm and outgoing and seemed happy.
One fellow trainee described him as “extremely good at balancing his work and non-work life and cared about getting other residents to have fun both at work and outside the hospital.”
During the healing process, the program leadership decided to take action to get to the heart of what affects resident health and began to develop a wellness program for residents.
Balance in Life is a holistic, multifaceted program with the primary mission to support and promote the physical, psychological, social and professional well-being of general surgery residents and to provide them with the tools they will need to successfully navigate life as a surgeon.
The four parts of a healthy medical life
Residents are trained in everything they need to know in the clinical setting so that they can be the most effective physicians possible, but why can’t residents also receive training in maintaining work-life balance?
The Balance in Life program focuses on four aspects of a healthy professional and personal lifestyle:
- Physical. Residents have 24-hour access to the Goodman Surgical Education Center which holds a residents-only refrigerator stocked with healthy food and drinks. Also available for residents is an “After Hours” guide that provides all the names of local primary care physicians, OB-GYNs and dentists recommended by colleagues. It also includes a list of gyms, fitness centers, grocery stores, movie theaters, restaurants and places for hiking and biking in the area. Residents are encouraged—and expected—to schedule regular dental and primary care appointments. Even if they can’t find an appointment time outside clinical duty hours, program faculty will make the time available if necessary. At the program director bi-annual meetings, residents are asked if they have seen their primary care physician and dentist.
- Psychological. Every Tuesday morning residents meet on a rotating schedule with Lisa Post, PhD, a clinical psychologist at Stanford with expertise in coaching high-performance teams. The meetings are mandatory and strictly confidential. The goal of the meetings is to facilitate difficult conversations about challenges residents face in both their personal and professional lives.
- Professional. Each September, first and second year general surgery residents are paired with fourth—and fifth-year residents to act as mentors throughout the year. The pairs are expected to meet at least three times per year and the program provides gift cards to coffee houses and other places for the meetings. Each class also elects a representative to the program directors to create an avenue for residents to discuss issues that arise and cultivate solutions constructively.
- Social. The social chair is responsible for organizing events that promote socializing among residents and to continue their extracurricular interests, which have included dinners, sporting events, happy hours, wine tastings and hiking. Team-building, camaraderie and communication among residents is also important to Balance in Life. So each year a full-day offsite retreat is provided for residents, which has included team sailing in the San Francisco Bay and a high-ropes course in the Santa Cruz Mountains.
Balance in Life has created a strong sense of community among residents and remains deeply embedded in the ethos of the training program. Residents feel they are part of an environment where asking for help is welcomed, encouraged and supported.
The AMA’s STEPS Forward™ collection of practice improvement strategies explains what is needed to prevent burnout among physician trainees, based on lessons learned by successful residency wellness programs.
Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the Transforming Clinical Practices Initiative.
