{"id":2706,"date":"2019-11-12T15:18:40","date_gmt":"2019-11-12T20:18:40","guid":{"rendered":"https:\/\/blogs.nejm.org\/general-medicine\/?p=2706"},"modified":"2019-11-13T09:53:11","modified_gmt":"2019-11-13T14:53:11","slug":"can-minor-changes-in-a-program-affect-resident-burnout","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/11\/can-minor-changes-in-a-program-affect-resident-burnout\/","title":{"rendered":"Can Minor Changes in a Program Affect Resident Burnout?"},"content":{"rendered":"
\"Dr.<\/a>

Dr. Orlovich is a Chief Resident of Wellness at Stanford University<\/p><\/div>\n

\u201cHow did you like it there?\u201d I ask, sitting down next to a new fellow (between bites of a plump sandwich, hoping there is no spinach in my teeth).\u00a0<\/span><\/p>\n

I expect to hear the standard <\/span>resident talking points \u2014 long hours, frequent call, and ballooning student loans. Instead, she surprises me.\u00a0<\/span><\/p>\n

\u201cDo you know how much they charged\u00a0us to park there every month?\u201d<\/span><\/p>\n

I frequently text friends who are residents at her previous program. It is a program I respect \u2014 complex cases, the right amount of autonomy, meaningful research opportunities, and faculty dedicated to resident development. Things a resident wants in a program and things a quality program delivers.<\/span><\/p>\n

She continues to list off things that could appear to be so inconsequential \u2014 lack of call rooms, cafeteria overcharging and closing early, and being called by her first name by staff in front of patients. I just met her, but I sense she isn\u2019t whining or trying to win a pity award. Instead, she is opening up. Being vulnerable. Speaking trainee to trainee. I dab my mouth with the beige napkin and continue to listen.\u00a0<\/span><\/p>\n

\u201cDo you know how many cavities I have now?!\u201d I perk up and\u00a0shake my head in disbelief as I finally swallow that bite of sandwich.\u00a0<\/span><\/p>\n

The more I think about these minor things and how they make some residents feel, the more the whole concept begins to make sense.<\/span><\/p>\n

Minor Things<\/b><\/p>\n

Most residents I\u2019ve talked to will embrace the inherent challenges of residency. That means waking up early, staying late, and mastering the nuances of a field that proposes intellectual, emotional, physical, and moral challenges. Residency <\/span>should<\/span><\/i> be challenging. Residents know that it is temporary. But here is the sticking point: R<\/em><\/span>esidency shouldn\u2019t have to be any more challenging than that<\/span><\/i>.<\/span>\u00a0<\/span><\/i><\/p>\n

Minor things may be making residency unnecessarily more laborious and taxing than it has to be.<\/p>\n

At times, I get the sense that the discussion about resident burnout is centered around large system-wide changes. Such sweeping changes merit careful consideration. However, do talks about the system overshadow and crowd out an additional issue \u2014 the <\/span>minor<\/span><\/i> things?\u00a0<\/span><\/p>\n

\"\"<\/a>

Maybe improving resident burnout doesn’t require moving a mountain. Photo allowed with permission from Solving Resident Burnout.<\/p><\/div>\n

I propose we consider these seemingly inconsequential and minor changes. This is <\/span>in addition to<\/span><\/i>, rather than instead of<\/em>, larger changes. Things like getting quarters for laundry, going to the DMV, getting something notarized, picking up packages at the post office and, yes, going to the dentist.\u00a0<\/span><\/p>\n

In isolation, one could view these minor changes as trivial. I can certainly see how it can be taken that way. To be clear, these minor annoyances are not more important than learning to become a physician. But here is the main message \u2014 taken in the right context, although the theme is clear: \u201cY<\/em><\/span>our input is valued and<\/span><\/i> we are listening<\/span><\/i>, <\/span>you are a human being, and we respect you<\/span><\/i>.\u201d<\/span><\/p>\n

So here is the key question: A<\/strong><\/span>re there <\/b>minor<\/i><\/b> ways in which programs can <\/b>listen <\/i><\/b>to what residents want and then deliver those things <\/b>without<\/i><\/b> radically changing the system? <\/b>This means a residency program <\/span>may already<\/span><\/i> have allocated the time or money. These minor measures won\u2019t fundamentally change the well-described barriers (culture, leadership, and financial incentives) to improving the system.\u00a0Nor do these minor changes excuse us from having frank discussions and acknowledging ripe areas of opportunity.\u00a0<\/span>However, these tiny steps are a start. They may serve as a small foundation of trust and communication between programs and residents. They may herald a new way of approaching old problems. They may seem more <\/span>real<\/span><\/i> and tangible. And, they may even be easier to implement, since they offer a way to gradually make changes from <\/span>within <\/span><\/i>the system instead of retooling the entire system.\u00a0<\/span><\/p>\n

A Recent Study<\/b><\/p>\n

Are there any data to support using an existing framework to promote resident wellness in a minor way? Let\u2019s look at a recent study of nearly 60 radiology residents (J Am Coll Radiol 2019; 16:221<\/a>). These residents had 15 vacation days and 12 sick days. That means the program already had these days covered and funded. But here is where it got interesting \u2014 the program renamed 5 sick days and instead called them \u201cwellness days.\u201d\u00a0Simple rebranding.\u00a0These new \u201cwellness days\u201d could not be used on Mondays or Fridays to extend a vacation. What was the result?<\/span><\/p>\n