Wellness and Work: Mixed Messages in Residency Training

Abstract

Resident physicians are at higher risk for depression, anxiety, and burnout when compared with same-age peers, resulting in substantive personal and professional consequences. Training programs across the country have acknowledged the gravity of this situation and many have implemented programs and curricula that address wellness and resilience, yet the benefits of such initiatives are still largely unknown. While the development of wellness programming is well intentioned, it is often incongruent with the residency training environment. The mixed messaging that occurs when wellness programs are implemented in environments that do not support self-care may unintentionally cause resident distress. Indeed, outside of the time dedicated to wellness curricula, residents are often rewarded for self-sacrifice. In this commentary, we describe how the complexities of the medical system and culture contribute to mixed messaging and we explore the potential impact on residents. We offer recommendations to strengthen wellness programs through efforts to promote structural change in the training environment.

“Necessary Compromises”: A Qualitative Exploration of the Influence of Burnout on Resident Education

“…37 This mixed messaging, or hidden curriculum, is reiterated through faculty modeling when residents see that it is the norm for attending physicians to work while sick or forgo self-care in the interest of clinical obligations. 37 Many regulatory bodies and professional organizations-including ACGME, 9 NAM, 38 and the American Medical Association 39 -have recently issued standards and guidelines for addressing resident burnout during training. There remains little evidence-based guidance, however, on how these goals can be successfully executed in reality.…”

“…Compounding this sense of misalignment is a culture that suggests it is normal for residents to be burned out and unwell during training. Others have pointed out the incongruent messaging that occurs during training wherein residents are often rewarded for demonstrations of self‐sacrifice 37 . This mixed messaging, or hidden curriculum, is reiterated through faculty modeling when residents see that it is the norm for attending physicians to work while sick or forgo self‐care in the interest of clinical obligations 37 .…”

INSPIRED but Tired: How Medical Faculty’s Job Demands and Resources Lead to Engagement, Work-Life Conflict, and Burnout

“…Physicians are also embedded in a culture that normalizes high demands, long hours, going above and beyond for patients, and being selfless and self-sacrificing ( Maslach and Goldberg, 1998 ; Dumelow et al, 2000 ; Wallace and Lemaire, 2009 ; Dyrbye et al, 2012 , 2013 ). These cultural norms are perpetuated throughout physicians’ training (e.g., in residency; Meeks et al, 2019 ), their profession ( Maslach and Goldberg, 1998 ), and/or work setting (i.e., hospitals; Dumelow et al, 2000 ). In particular, medical faculty struggle with juggling work roles as researchers, administrators, clinicians, and teachers ( Wynn et al, 2018 ).…”

Residency training: a period of risk for mental health?

“…There is currently a wide-ranging international debate [1][2][3] on whether the residency period constitutes a health risk for resident physicians. The importance of this debate is reflected in the rise of resident associations in national and international scientific societies 4 , the programming of seminars, workshops and presentations at national and international conferences 5 and the creation of specific care programs for professionals with health problems, including mental health problems 3,6 .…”

“…For most residents, the period of training in their speciality involves a general level of activation that is stimulating and profitable, and they manage to adapt progressively to the professional environment without major problems. However, in some residents the training period may trigger their stress response, which, if prolonged in time and intensity, prevents adequate adaptation and may lead to psychobiological exhaustion or burnout 1,3 .…”