Medical resident well-being: What helps, what hurts?

Outside-of-work wellness activities pursued by residents—with the notable exceptions of exercise and alcohol consumption—appear to have little effect on resident well-being and the prevalence of burnout and wellness problems, a recent study published in the Journal of Surgical Education found.

The study included responses from more than 5,000 ob-gyn residents across four years of training. Nearly half of all respondents indicated they had experienced burnout and 32% reported showing symptoms of depression.

The Journal of Surgical Education study—“Associations Between Residents’ Personal Behaviors and Wellness: A National Survey of Obstetrics and Gynecology Residents”—asked residents to identify the activities they did to improve wellness. The most common activities respondents indicated they participated in at least twice a week were:

• Social activity—93.2%.
• Watching TV—77.1%.
• Cooking—52.4%.
• Exercise—47.3%.
• Alcohol use—45.6%.
• Napping—39.4%.
• Reading for fun—20%.

Among activities in that group, respondents who exercised regularly were less likely to report a problem with well-being. That was the only activity that fell into the positive category.

“It may as much be a flag that people who are exercising are doing well,” said Abigail Winkel, MD, one of the study’s authors. “It’s probably true that there are mental health benefits of exercise, but it might be that the residents who are making time to exercise are doing so because they are not the ones feeling burnt out or depressed.”

1. Create a holistic, supportive culture of wellness

   1. This AMA STEPS Forward™️ module provides information about successful residency training wellness programs and identifies ways to create a sustainable culture of wellness.

2. Show leadership, assess resident burnout and take action

   1. According to preeminent physician burnout expert Lotte N. Dyrbye, MD, MHPE, residents in some specialties reported burnout in numbers that exceed 60%. Dr. Dyrbye offered a handful of solutions that residency programs can put in place to curb the trend.

3. Learn where physician burnout starts—and how to stop it

   1. An AMA Innovations in Medical Education webinar highlighted methods for educating medical students, residents and physicians to prioritize their own well-being and addressing the causes of distress and burnout.

4. Help medical residents combat sleep deprivation

   1. Insights on the science of stress and its reduction, are provided in a 19-minute training module, “Physician Health: Physicians Caring for Ourselves,” designed to address the self-care needs of residents. It’s one of the AMA GME Competency Education Program offerings, which include nearly 30 courses that residents can access online, on their own schedule.

Almost half of residents reported regular alcohol use. The data found that alcohol use was an activity had the strongest association among survey respondents who reported “any wellness problem.”

Respondents who said they drank four or more times weekly were three times likelier to report wellness problems. The study also found that the rate of binge drinking rose from 8.8% among first-year residents to 14.4% among fourth-year residents.

As she was conducting research, these results made Dr. Winkel—a program director, at the time—rethink the social programming in place for residents.

“As a program director, I stopped funding happy hours,” said Dr. Winkel, vice chair of education and assistant director of the institute for innovations in medical educations at New York University School of Medicine. “I said: ‘We like the social benefits of you all getting together and you’re young people, and drinking is common. But we’re also not going to say that with our programming that we put in place to try to support healthy residents that we should be putting our money into other kinds of social events.’

“We didn’t want our residents to think that alcohol is a good tool to combat work-related stress,” Dr. Winkel added.

Outside of the positive benefits of exercise and the negative results for those who drank heavily, most activities survey respondents did at least twice a week showed no association, or a slightly negative association, with well-being.

Still, Dr. Winkel warns against reading into the finding that some activities, such as cooking, charted as an activity linked to a higher likelihood of reporting a wellness problem.

“The fact that many activities have no association [with increased wellness] speaks to the fact that burnout is caused by chronic stresses in the workplace,” she said. “These things we do and engage in in life are really important to improve sanity, probably in a lot of other ways. Improving burnout is going to require addressing the root causes of burnout, which these activities can’t fix.

“But is it still worth having a social life, a healthy body and being mindful?” she asked. “Yes, it’s very much worth all those things.”