Members shared personal stories of hardship, identified obstacles to wellness, and brainstormed solutions to this multifaceted problem. This online collaboration also served as the virtual platform to asynchronously collaborate on pre-work for the inaugural Resident Wellness Consensus Summit in Las Vegas, NV, on May 15, 2017.4 One of the working groups was to develop a structured, longitudinal, residency curriculum based on the existing literature to address resident wellness and burnout. Herein we report the consensus recommendation of the Wellness Curriculum Development working group. The wellness curriculum was developed in two phases. During the first phase, members of the Wellness Curriculum Development working group in the Wellness Think Tank collectively performed an extensive literature search, targeting articles that focused on resident wellness, physician wellness, and previous wellness initiatives. These articles were divided up among the group members and carefully evaluated. They found 21 relevant articles.These themes informed the initial framework of 10 core topics for the curriculum. For each topic, a sub-team conducted a deeper analysis before providing a description of the module, recommended approach, and additional resources and recommended readings. The second phase of curriculum development occurred at the RWCS event. Members of the Wellness Curriculum Development work group presented the proposed curriculum to other summit attendees for feedback and further evaluation. This working group had a total of 30 members, 27 residents and three attending physicians.
The resident cohort of this group specifically contained 15 Wellness Think Tank members, an additional 12 non-Think Tank residents. At the summit,rolling benches hydroponics there was consensus that the initial 10 topics were necessary components for the curriculum. Gaps, however, were identified and through further discussion, an additional seven topics were added. Each topic was subsequently reviewed after the RWCS for a final total of 17 modules for the resident physician wellness curriculum.This four-part series focuses on the following high-stress activities that resident physicians encounter in the emergency department : delivering bad news, managing difficult patient encounters, managing difficult consultants and staff members, and debriefing traumatic events. Because delivering bad news to patients and their families can produce high levels of real-time and ongoing anxiety for the resident, one module focuses on these stressful conversations. A framework is provided to help them navigate these conversations. Difficult patient encounters can also put undue strain onto the emergency physician. One module thus focuses on dealing with difficult patients, specifically identifying triggers and creating preformed responses while also maintaining physician empathy and the physician-patient relationship. Such preparation often leads to better patient care and less physician burnout.In the same way that a difficult patient can lead to decreased physician happiness and satisfaction, so can a bad interaction with a consultant or staff member. This module focuses on practical strategies to keep these encounters professional, positive, and effective. The last topic in this series is debriefing traumatic events that occur in the ED. Practical tips are outlined to overcome many of the barriers to conduct these guided group reflections. Within this last module, one might incorporate a discussion of the second victim syndrome, which is an educator toolkit developed by one of the RWCS work groups.This phenomenon, whereby a healthcare provider is traumatized by an unanticipated, adverse, patient-related event, is an important but often under-recognized problem facing emergency physicians.
The term “physician wellness” has many definitions, and might best be defined as “one’s personal recipe for thriving” and not just surviving.It is not, however, merely the absence of burnout, depression, or suicide. Teaching this concept during residency training is an ideal time to address physician wellness. This is especially crucial for EM residents, because EM as a specialty has the highest rate of burnout per the Maslach Burnout Inventory.These new physicians can develop healthy mindset practices, coping skills, and work-life balance habits that they will use throughout their careers. The proposed 17-topic wellness curriculum focuses on the spectrums of wellness and burnout in a modular fashion, as framed by the existing literature. Based on residency program needs, these modules can be rearranged. Alternatively, suggested materials from some/all of the modules can be emailed to residents to serve as self-study resources. One study demonstrated that discussing and reflecting on wellness topics in small groups has positive downstream effects. West et al. performed a randomized clinical trial in which all participating physicians were given paid time off to work on aspects of wellness.9 The intervention arm met in a small group for one hour every two weeks to discuss wellness topics, while the control arm had no formal intervention. The study found that empowerment and engagement at work significantly increased in the intervention arm, and decreased in the control arm. They also found that rates of overall burnout, emotional exhaustion, and depersonalization in the intervention arm dropped substantially and only decreased slightly in the control arm. Thus, a formal wellness curriculum during residency training, if done well,hydro tray has the potential to make a lasting positive impact on resident wellness. The recent mandate from ACGME to address resident wellness in the Common Program requirements is an important step towards improving resident wellness. Ultimately, a multi pronged approach toward improving resident wellness will be needed and must include systemic changes in order to reach its full potential.
Burnout, depression, and suicidality among residents of all specialties have become a critical focus of attention for the medical education community.In response to these findings, the Accreditation Council for Graduate Medical Education approved major changes to the Common Program Requirements in 2017. These changes establish a mandate to educate residents and faculty members in the identification of burnout, depression, and substance abuse and for implementing programs that encourage optimal resident and faculty well being.There are however, no road maps or guidelines for residency programs to create such wellness programs to adequately address this mandate. Many residency programs have already implemented wellness training and initiatives for their residents. Unfortunately, evidence supporting the efficacy of these interventions is sparse and often limited to single institutions and small sample sizes.Furthermore, there is no established method of sharing preliminary experiences and lessons learned from these interventions with other residency programs also seeking to improve their wellness curricula. The 2017 Resident Wellness Consensus Summit 5 convened as a pre-day to a national emergency medicine conference, Essentials of Emergency Medicine, to address many aspects of resident wellness and burnout. One of the working groups, Programmatic Initiatives, focused specifically on starting an online, crowd sourced, central repository of wellness initiatives in EM residency programs. Additionally, the working group aimed to develop a resident-based needs assessment and implementation instrument to assist programs launch their own wellness programs.In October 2016 a volunteer group of 142 EM residents from 100 training programs across North America formed the Wellness Think Tank, a virtual community of practice focusing specifically on resident wellness. All EM residency programs in North America were invited to enroll up to two EM residents as representatives in the Think Tank. Members of this online community, hosted by a medical education organization Academic Life in Emergency Medicine , communicated with each other using the online platform #Slack. On this shared workspace platform, members discussed the strengths and weaknesses of wellness programs at their respective training sites. During these discussions, residents noted duplicated efforts at different programs and a siloed approach to wellness initiatives, which they attributed primarily to a lack of shared knowledge among residency programs. All participating residents of the Wellness Think Tank as well as the broader EM resident population in the United States were invited to the in-person RWCS event on May 15, 2017.5 In preparation for the event, a Programmatic Initiatives working group was created within the Wellness Think Tank to develop an initial, centralized, crowd sourced database of existing wellness strategies in EM residency programs. Members of the Wellness Think Tank and the Chief Resident Incubator, another virtual community of practice hosted by ALiEM, were asked to contribute submissions about their local wellness strategies, specifically describing the resources required, whether the initiative or event was child-friendly, and practical implementation tips. A total of 22 resident members from the Wellness Think Tank, and 22 additional EM residents attended the live RWCS event. Of the 44 residents, 13 residents served as the final Programmatic Initiatives working group. At the RWCS event, the working group reviewed the residency program initiatives in the database and developed two tools for residency programs – a resident-based, needs-assessment tool to identify gaps in wellness programming and a systematic worksheet to help programs implement new wellness initiatives.
Following the RWCS event, the database and tools were further refined based on feedback, ideas, and comments from the Wellness Think Tank resulting in the final versions presented here.The working group also developed two tools. The first tool is a Resident-Based Needs Assessment Survey on residency wellness programming. This survey should be administered to individual residents to inform program wide strategic planning on wellness activities. This tool was created based on a framework modeled after existing needs-assessment tools on employee wellness in the general workplace.The resident needs assessment systematically evaluates the current wellness initiatives in a program, existing wellness interests of the residents, the perception of the culture of wellness, and leadership support for wellness activities. Open-ended questions were included throughout the survey to capture suggestions or further input from residents to encourage creative responses and novel ideas. Although some programs may have a wellness program already in place, the tool can still be used on a yearly basis to help programs adjust based on evolving resident needs. The second tool is a systematic worksheet to help residency programs implement new wellness initiatives. Using the principles from Kern’s six-step model for curriculum development,8 the worksheet is divided into two parts. Part I explores existing resources and previous experiences with wellness initiatives in one’s program and at the broader institutional level in a targeted, needs-assessment approach. Part II then focuses on building one, new wellness initiative or strategy. This guides readers to familiarize themselves with stakeholders and potential obstacles to implementation by addressing educational strategies, resource identification, implementation barriers, and outcome measures. Unanswered questions should be addressed before investing time and resources to the initiatives. A sample completed worksheet on developing a resident mentorship program is also included as a guide. Although physicians of all specialties are at increased risk of depression and suicide, emergency physicians are among those at greatest risk.Furthermore, burnout rates are high for medical students, residents, and early-career physicians across specialties.To address this, the resident driven 2017 RWCS event and 2016-17 Wellness Think Tank community focused on developing a consensus on various wellness issues and problems deemed high priority by EM residents. Through online discussions leading up to the RWCS event, residents realized multiple instances of duplicated wellness initiatives at different programs with little to no sharing of their experiences. Thus, the Programmatic Initiatives working group first focused on identifying and publicly sharing existing wellness activities in EM residency programs. The group also assisted programs launching new wellness initiatives and strategies. Our hope is that these collective resources serve as a framework for EM residency programs seeking guidance in meeting the 2017 ACGME Common Program Requirement mandate to build a robust infrastructure and educational strategy to address resident and faculty well being.Atrial fibrillation and atrial flutter independently increase the risk of ischemic stroke five-fold and account for an estimated 15% of ischemic strokes.1 For this reason, stroke prevention is one of the leading management objectives in the long-term care of patients with AF or AFL , regardless of rhythm duration or permanence.Validated thromboembolism risk scores exist to help readily identify the high-risk AF/FL population that would benefit from long-term anticoagulation.Nevertheless, under use of thromboprophylaxis persists nationally and internationally, in large measure because physicians incorrectly assess levels of risks and benefits.Non-anticoagulated patients with AF/FL commonly seek rhythm-related care in the emergency department.AF patients who present for emergency care have a higher incidence of stroke and death than patients seen in other venues.In some settings, more than half of AF patients discharged from the ED fail to achieve outpatient follow-up within 90 days of discharge, regardless of insurance status.In such cases, an ED visit may provide a critical opportunity for a stroke-prevention intervention.