Pre-reading establishes a basic knowledge base for the learners and encourages personal reflection prior to the classroom session. Group discussions aid in the practical incorporation of that knowledge into the residents’ practice. It is recommended that the four modules be spaced over several months to maximize retention of the material via spaced repetition.16 The mini-modules may also be combined into a single 60-90 minute session to accommodate didactic conference schedules. The first module exposes learners to the concept of SVS, as well as potential stages of recovery. This module emphasizes establishing a foundation of knowledge pertaining to SVS, laying the groundwork for later modules to introduce practical tools and concepts for coping with and preventing SVS. The second module describes a method to help recognize SVS in colleagues. Residents and faculty are encouraged to help colleagues identify when they are suffering from SVS and to help create an appropriate follow-up plan. In addition, a method for performing a “hot debriefing” is described, which occurs immediately following a significant mistake or negative patient outcome. The third module serves to make learners aware of resources that are available at their individual institution and encourages learners to access them prior to being affected by SVS. Finally, the fourth module focuses on department-wide prevention of SVS through culture change and the use of routine, group debriefings following difficult resuscitations.Mindfulness is the practice of purposeful and nonjudgmental attentiveness to one’s own experience, thoughts, and feelings. Meditation is a technique for resting the mind and attaining a state of consciousness that is distinctly different from the normal waking state. A regular practice of meditation can provide a lasting sense of mindfulness that lasts throughout the day. Both mindfulness and meditation have become more mainstream and socially acceptable ways to manage stress and increase productivity.
Within the field of medicine, research has shown that being mindful or developing a meditation practice improves job satisfaction and decreases burnout.Multiple studies have demonstrated benefits to mindfulness and meditation,ebb and flow flood table such as increased empathy, life satisfaction and self-compassion, and decreased anxiety, rumination, and burnout, and decreased cortisol levels.Because EM residents stand to benefit tremendously from these effects, we determined that mindfulness and meditation were important as a wellness toolkit for educators. Although mindfulness and meditation have become more integrated into some medical schools, these concepts are not frequently found in residency training programs.We developed a mindfulness and meditation lesson plan to address this gap. Our educator toolkit consists of three 30-minute modules and a longitudinal, guided group meditation practice designed to span several months or an academic year. The two initial modules outline and define meditation, as well as describe how to start a meditation practice. These modules include an opportunity to practice meditating as a group, an invitation to start an individual practice, and a chance to discuss barriers to practice. Ideally, these modules would be offered during the first month of the academic year, separated by one to four weeks. Following the second module, a longitudinal, guided meditation practice should be incorporated at regular intervals throughout the residency conference schedule. The final module should be implemented toward the end of the academic year following the longitudinal meditations. This module provides the residents a forum to debrief and reflect on their practices of meditation and mindful thinking, cultivated throughout the year. It also serves as a chance to consider and evaluate how meditation and mindfulness have impacted individual residents, the residency program, and the department.Positive psychology is the conscious participation in acts to improve well being by creating and nurturing positive feelings, thoughts, and behaviors. In contrast to traditional psychology, which focuses on mitigating illness, positive psychology focuses on the strengths that allow individuals to thrive.
Use of positive psychology interventions has been shown to improve well being and decrease depressive symptoms.Positive psychology interventions can serve as a useful tool to improve team dynamics and success in stressful situations such as trauma resuscitations.Practicing gratitude, positive self-talk, and intentional acts of kindness have the potential to make emotionally difficult shifts more tolerable and improve physician-patient interactions. Despite the literature describing the benefits of positive psychology, similar to SVS and mindfulness and meditation, we found no described use of a positive psychology curriculum for residents. To address this gap, we developed a flexible and easy-to-implement positive psychology toolkit, focusing on two positive psychology principles, PERMA and BTSF. Although these positive psychology principles can be taught together as a two-part, positive psychology lesson plan, each can also be given as a stand-alone session. PERMA is an evidence-based model for well being that can help residents to more fully engage with their work and thrive in their careers.The PERMA toolkit includes a slide set presentation, brainstorming period, and both paired and group discussion over a period of 50 minutes. The slide set provides a basic introduction to positive psychology, followed by a more detailed description of the PERMA model. Interactive audience participation during the slide presentation is encouraged. A brainstorming activity in pairs and in a larger group follows the slide presentation. The session concludes with a “commitment to act,” an exercise in which the learners write down one specific thing that they plan to do differently based on their participation. BTSF is a skill that can be quickly taught to residents and used in a wide variety of settings. This technique helps an individual cope with an acute stress or by employing one or all four of the following: tactical or box breathing; positive self-talk; visualizing success; and stating or intentionally thinking a specific focus word to hone attention.Similar to the PERMA lesson plan, the BTSF session includes a slide set presentation,hydroponic drain table active group discussion, and an acute stress or exercise for participants to practice BTSF in a simulated stressful environment over a period of 45 minutes. The slide set specifically describes each of the components of BTSF and concludes with a tactical breathing exercise.
The conclusion of the BTSF lesson plan is an acute stress or exercise. We suggest using the children’s game, Operation , or other similar game to simulate stress while practicing the BTSF model. The lesson plan also concludes with a “commitment to act” exercise.The 2017 Resident Wellness Consensus Summit was convened with the ultimate mission to empower EM residents from around the world to lead efforts aimed at decreasing burnout, depression, and suicidality during residency and to increase resident well being. Leading up to the event, many residents collaborated in the Wellness Think Tank over an eight-month period to conduct much of the consensus event pre-work. Specifically our Educator Toolkit working group focused on developing three widely applicable, high-yield lesson plans for EM residency programs on the topics of SVS, mindfulness and meditation, and positive psychology. The lesson plans may stand alone or be incorporated into a larger wellness program. The three tool kits differ in length, scope, and duration for the individual sessions. This design provides greater flexibility for residency programs to schedule into their existing training curriculum. For example, programs with limited time or resources may find a single 45-minute session on positive psychology easier to incorporate than a year-long curriculum that includes classroom sessions and monthly guided meditations, as described in the mindfulness and meditation toolkit. In an effort to address widespread burnout and unwellness, our goal is for these three topics to be widely covered and implemented by residency programs through the use of these templated lesson plans. Each toolkit provides instruction on practical skills training that can be used on a daily basis, both within and outside of the emergency department. Next steps include measuring the effects of these lesson plans on resident satisfaction, learning, behavior change, and ultimately patient outcomes, as well as burnout, resilience, and job satisfaction. Physician wellness has recently become a popular topic of conversation and publication within the house of medicine and specifically within emergency medicine.The purpose of this summit was to identify areas of overlap and synergy so that collaborative projects and possibly best practices could be established for emergency physician wellness.National organizations, such as the Accreditation Council on Graduate Medical Education, have recently placed a high priority on resiliency and wellness in trainees.Similar efforts have been undertaken by the American Medical Association,8 the American College of Emergency Physicians,and the American Academy of Emergency Medicine.Mirroring recent literature showing that emergency physicians are at particularly high risk of burnout syndrome,the rate of burnout among trainees is as high as 60%.Several recent studies have identified factors associated with increased resiliency with one meta-analysis demonstrating several interventions associated with increased resiliency and lower incidence of burnout syndrome in graduate medical education.No literature, however, has focused exclusively on the high-risk burnout population of EM residents.
Through a joint collaboration involving Academic Life in Emergency Medicine’s Wellness Think Tank, Essentials of Emergency Medicine , and the Emergency Medicine Residents’ Association , a one-day Resident Wellness Consensus Summit was organized. This summit primarily convened a group of essential stakeholders to the conversation, EM residents, to clarify the present state of wellness initiatives among EM training programs, and potentially identify best practices and tangible tools to increase physician wellness. To our knowledge, this is the first national consensus event of its kind comprised primarily of residents focusing on resident wellness.The RWCS event is the first step of a transformative, cultural journey focusing on resident health and well being. To our knowledge, this is the first time that residents from across the world collaborated and convened to reach a consensus on these critical issues. The tools developed by the four RWCS working groups will serve as a resource for resident health and well being leaders looking to influence clinical learning environments at the local organizational level for the future. Working at an organizational level is foundational but not sufficient for cultural transformation. An additional paradigm to look at resident health and well being is through the paradigm of a social movement, which the Wellness Think Tank and RWCS event embody. Veteran organizer and policy expert Marshall Ganz describes four elements necessary to lead successful social movements: relationships, story, strategy, and action.The Wellness Think Tank and RWCS have made inroads in relationships and story, and will hopefully catalyze strategy and action to ensure that resident health and well being becomes a successful social movement.The RWCS leadership team had experience working within the ALiEM culture prior to the RWCS. This led to the development of the Wellness Think Tank to congregate a critical mass of EM residents into a virtual community. Mirroring the ALiEM culture, the Think Tank’s culture was based on deep, reciprocal relationships that complement knowledge transactions. These relationships are facilitated by trust,communication,and personal learning networks that allow for exponential growth. The networks developed have both strong ties that facilitate commitment and motivation, and weak ties that facilitate entry into new networks and domains.The relationships that the Wellness Think Tank and RWCS created will fuel the networks needed to implement a successful resident health and well being social movement in the future.Many recent academic and popular publications have highlighted the fact that physicians are at much higher risk for burnout, depression, and suicide than the general population of the United States. Data from the National Violent Death Reporting System indicate that each year more than 200 physicians in the U.S. commit suicide.1 Medical students and residents are at especially high risk.Furthermore, emergency physicians are consistently ranked at the top of most burnt-out doctors.This dark problem was recently brought to the forefront in an email written to the Council of Emergency Medicine Residency Directors by Dr. Christopher Doty, the residency program director at the University of Kentucky, detailing his tragic loss of a resident and its effects on the residency and broader hospital community. The Accreditation Council for Graduate Medical Education has included the mandate that residency programs address resident wellness within the Common Program Requirements. Emergency medicine residency programs are now required to provide education to residents and faculty on burnout, depression and substance abuse and are instructed to implement curricula to encourage optimal well being. In 2016 a group of 142 EM residents from across the world began discussing ways to address this issue through the Wellness Think Tank, a virtual community of practice focusing on resident wellness.