Fostering Resilience and Well-Being in Medical Education Kaiser Permanente School of Medicine | Washington, DC #MEDSTUDENTWELLBEING | April 20-21, 2017

We Came to Washington to work for #MedStudentWellBeing

We asked four key questions. In this story, we'll summarize key reflections and directions for our work together.

"Shining a light on an attitude that doesn't acknowledge stress" - Chris Cassel, MD, Planning Dean
"We have to take care of our caregivers to take care of our members" - Marc Klau, MD, MBA
1. What is the root cause of burnout?

Students

  • Face competition and academic pressure
  • Have an idealized image of medicine
  • Are separated from humanity throughout medical education
  • Feel isolation when studying alone in cubicles or at home
  • Are not emotionally prepared for the realities of caring for patients or changing identity
  • Start questioning why they are going into the medical profession

Culture

  • Schools don’t prepare students for the transition and the concept of failing
  • Technology could lead to more social isolation in the current generation
  • Social media and technology could support less personal connections and increased isolation
  • Lack of commitment from leadership and faculty on personal well-being
2. What are medical schools doing to help?

Medical Schools

  • Understand that it's difficult to study
  • Create facilitated small groups as a protected space
  • Promote a positive tone at the leadership level
  • Promote faculty support on a culture of well-being
  • Create protected flex time throughout all 4 years
  • Understand that behavior is a function of the person and the environment
  • Promote the necessity of physician and faculty role-modeling
  • Create curricula on functioning as team-members
3. Do diverse student groups have different well-being needs?

Evidence Base

  • Limited evidence with the need of a variety of interventions
  • Re-think what we think of as acceptable evidence
  • Significant amount of evidence on the impact of unconscious bias on culturally humble patient care
  • National Academy of Medicine currently doing a literature review on this topic

What we believe

  • Students coming from different groups want acknowledgement that their needs are different - equity vs. equality
  • Imposter syndrome may be more pronounced - if a student is the "first" in their family, there can be a sense of isolation
  • Connectivity, relationships, and feeling "known" create a culture of inclusion
  • Even the best organizations struggle with unconscious bias

What's needed

  • Informal mentors with concordant demographics, to share in an open and honest way
  • Mentors with specific skills and ongoing evaluations of these skills
  • Faculty who clearly show that they are allies and have the ability to support diverse student groups
  • Resources to support students to deal with microaggressions
  • Involvement of community
4. Based on what you have heard today, what recommendations do you have?

People

  • Deans must believe in the issues and back them up
  • Mentors need to recognize individual needs of students
  • Faculty should represent the diversity of the student body

Process

  • Every student and core faculty should participate in counseling
  • Professional passage thread - connected multiple times throughout training
  • Coaches that teach lifestyle, behaviors, skills
  • Student champions to help with well-being initiatives that could be tied to projects or research
  • Student participation in creating surveys and implementing solutions
  • Co-creation and co-evaluation of activities - measure and share
  • Maintain connection and develop support for students going to outside environments - give them the ability to lead
  • Those most affected by a decision should be engaged in the discussion and decision

Themes influencing our work ahead

Faculty and leadership exemplars

Human centered evaluation and assessment

Technology

Engaging with data

Prevention of burnout and depression

Resilience and how to deal with failure

Emotional support

Joy in practice

We need systemic and cultural change in medicine if we plan to address physician burnout - Kelly Thibert, DO, MPH, American Medical Student Association President, 2016-2017

With thanks from the planning team

Christine Cassel, MD • Marc Klau, MD • Nancy Spiegel, MS • Patrick Burkhardt, MEd • Preethi Kannan, MS • Amy Klawitter, MPH, CPH • Mi Chelle Sorey • Ted Eytan, MD

Created By
Kaiser Permanente School of Medicine
Appreciate

Credits:

Ted Eytan, MD, MS, MPH, Mohsin Hashmi

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