{"id":2744,"date":"2019-12-19T15:23:57","date_gmt":"2019-12-19T20:23:57","guid":{"rendered":"https:\/\/blogs.nejm.org\/general-medicine\/?p=2744"},"modified":"2019-12-19T15:23:57","modified_gmt":"2019-12-19T20:23:57","slug":"yogurt-the-cure-to-resident-burnout","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/12\/yogurt-the-cure-to-resident-burnout\/","title":{"rendered":"Yogurt &#8211; The Cure to Resident Burnout"},"content":{"rendered":"<div id=\"attachment_2713\" style=\"width: 135px\" class=\"wp-caption alignright\"><a href=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2019\/11\/AU000_dorlovic.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-2713\" class=\"size-full wp-image-2713\" src=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2019\/11\/AU000_dorlovic.jpg\" alt=\"Dr. Daniel Orlovich\" width=\"125\" height=\"150\" \/><\/a><p id=\"caption-attachment-2713\" class=\"wp-caption-text\">Dr. Orlovich is a Chief Resident of Wellness at Stanford University<\/p><\/div>\n<p><span style=\"font-weight: 400\">What is the latest answer to resident burnout? It may surprise you.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Recent research from a large Midwest academic center suggests that not one but <strong>two<\/strong> dollops of yogurt may help stymie resident burnout. \u201c<\/span><span style=\"font-weight: 400\">When we first started to look at the reasons why so many residents were burned out, we couldn\u2019t understand it,\u201d stated the associate program director, \u201cso we started a dig a little bit.\u201d <\/span><span style=\"font-weight: 400\">This digging, of course, did not involve actually asking those most affected by resident burnout \u2014 residents themselves.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">So, to address that gap, here are some thoughts from actual residents: <\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400\"><span style=\"font-weight: 400\">One intern referenced the financial strain felt by some. \u201cI mean, average debt has gone up 270% from 1986 to 2018.\u201d (<a href=\"http:\/\/doi.org\/10.1097\/ACM.0b013e31821daf03\" target=\"_blank\" rel=\"noopener noreferrer\"><i>Acad Med<\/i> 2011; 86:840<\/a> and <a href=\"https:\/\/store.aamc.org\/medical-student-education-debt-costs-and-loan-repayment-fact-card-2018-pdf.html\" target=\"_blank\" rel=\"noopener noreferrer\">AAMC.org student debt<\/a><\/span><\/span><span style=\"font-weight: 400\">)<\/span><\/li>\n<li><span style=\"font-weight: 400\">Another brought up the pace of the current healthcare system. &#8220;In 1972, the average length of stay was about 14 days \u2014 in 2009, it was 4.8 days (<a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/383627\" target=\"_blank\" rel=\"noopener noreferrer\">JAMA 1990; 264:1984<\/a>). <\/span><span style=\"font-weight: 400\">And residents in 1972 and in 2009 took care of the same amount of patients, too\u201d (<a href=\"https:\/\/doi.org\/10.1177\/0022146512451130\" target=\"_blank\" rel=\"noopener noreferrer\">J Health Soc Behav 2012; 53:344<\/a>).<\/span><\/li>\n<li><span style=\"font-weight: 400\">Another senior, while clicking on the computer, stated plainly, \u201cthe average ER physician clicks more than 4000 times per day and spends 44% of his or her day doing data entry (<a href=\"https:\/\/doi.org\/10.1016\/j.ajem.2013.06.028\" target=\"_blank\" rel=\"noopener noreferrer\">Am J Emerg Med 2013; 31:1591<\/a>).<\/span><span style=\"font-weight: 400\"> And another study showed that IM residents spend as much as five times the amount of time documenting care as providing direct patient care\u201d (<a href=\"https:\/\/doi.org\/10.7326\/M16-2238\" target=\"_blank\" rel=\"noopener noreferrer\">Ann Intern Med 2017; 166:579<\/a>).<\/span><\/li>\n<li><span style=\"font-weight: 400\">A current PGY3 thinks the solution is probably more nuanced: \u201cWhere is the right balance between educational versus service requirements? How about the right amount of supervision versus autonomy? These aren\u2019t such a black and white issues, I suppose. I&#8217;m not saying residency is harder than it used to be \u2014 it is just different, that&#8217;s all.\u201d<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">None of these facts were considered for the study.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cResidents now have the 80-hour cap. That means they work less than residents did before. So, there shouldn&#8217;t be any burnout. Burnout is all about hours worked,\u201d stated the associate program director, noting how all professionals work hard early in training.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Yet, compared with other college graduates, residents are 1.6x more likely to be burned out, and 2x more likely to feel depersonalized, and they score lower on mental, physical, and emotional markers for quality of life <\/span><span style=\"font-weight: 400\">(<a href=\"https:\/\/doi.org\/10.1097\/ACM.0000000000000134\" target=\"_blank\" rel=\"noopener noreferrer\">Acad Med 2014; 89:443<\/a>).<\/span><\/p>\n<p><span style=\"font-weight: 400\">Without seeking to understand or pinpoint the root cause of the burnout, and after residents fell asleep during the lecture on sleep hygiene, a one-size-fits-all approach was proposed \u2014 yogurt. <\/span><\/p>\n<div id=\"attachment_2745\" style=\"width: 310px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2019\/12\/red-strawberry-and-raspberry-on-white-ceramic-bowl-128865.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-2745\" class=\"wp-image-2745 size-medium\" src=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2019\/12\/red-strawberry-and-raspberry-on-white-ceramic-bowl-128865-300x200.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2019\/12\/red-strawberry-and-raspberry-on-white-ceramic-bowl-128865-300x200.jpg 300w, https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2019\/12\/red-strawberry-and-raspberry-on-white-ceramic-bowl-128865-768x511.jpg 768w, https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2019\/12\/red-strawberry-and-raspberry-on-white-ceramic-bowl-128865-1024x681.jpg 1024w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-2745\" class=\"wp-caption-text\">How do we solve resident burnout? With yogurt, of course.<\/p><\/div>\n<p><span style=\"font-weight: 400\">The program started to incorporate a mandatory dollop of yogurt during wellness lectures. This allowed the program to check off the box for \u201cwellness\u201d activities.\u00a0<\/span><span style=\"font-weight: 400\">Serendipity, the bedrock of all discoveries, occurred: as a medical student entered into this wellness lecture hoping to eat the free food, he ended up receiving not one but <\/span><i><span style=\"font-weight: 400\">two<\/span><\/i><span style=\"font-weight: 400\"> dollops of yogurt.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cAnd when I saw the medical student\u2019s face when he received <\/span><i><span style=\"font-weight: 400\">two<\/span><\/i><span style=\"font-weight: 400\"> dollops of yogurt, I knew we were on to something,\u201d said the associate program director. \u201cWithout any resident input at all, we then started a \u2018two-dollop\u2019 lecture. This was followed by a mandatory yogurt training module. Then, we worked with IT to create a checkbox to be clicked in the EMR to show that training was complete.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">Since those changes have been made, the following lectures were Band-Aids. Not in the figurative sense \u2014 actual Band-Aids were given out. Of course.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\">Author&#8217;s note:<\/span><\/p>\n<p><i><span style=\"font-weight: 400\">This is <strong>satire<\/strong>. <\/span><\/i><i><span style=\"font-weight: 400\">Of course, residency has become more humane.\u00a0 To have the opportunity to serve as a physician is an incredible privilege and special honor. Of course, it takes many hours to learn how to be an excellent physician. However, <\/span><\/i><a href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/11\/can-minor-changes-in-a-program-affect-resident-burnout\/\" target=\"_blank\" rel=\"noopener noreferrer\"><i><span style=\"font-weight: 400\">it doesn\u2019t have to be any harder<\/span><\/i><\/a><i><span style=\"font-weight: 400\">.\u00a0<\/span><\/i><\/p>\n<p><i><span style=\"font-weight: 400\">The question isn&#8217;t whether wellness lectures work. The issue is <span style=\"text-decoration: underline\">how<\/span> they are done. Presenters sometimes miss the mark when they hand down mandated solutions, refuse to seek resident input, and fail to show an interest in understanding and acknowledging the current training environment. <\/span><\/i><i><span style=\"font-weight: 400\">When done right, though, they can confer admirable and positive results. That means seeking out resident-led initiatives, being flexible in when they are performed, and addressing concerns that speak to residents.\u00a0<\/span><\/i><\/p>\n<h6><\/h6>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/resident360.nejm.org\/\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-926\" src=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2017\/03\/genMedRes360Ad540x250.jpg\" alt=\"NEJM Resident 360\" width=\"540\" height=\"250\" \/><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>What is the latest answer to resident burnout? It may surprise you.\u00a0 Recent research from a large Midwest academic center suggests that not one but two dollops of yogurt may help stymie resident burnout. \u201cWhen we first started to look at the reasons why so many residents were burned out, we couldn\u2019t understand it,\u201d stated [&hellip;]<\/p>\n","protected":false},"author":1301,"featured_media":2745,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[17,756,757],"class_list":["post-2744","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-about-residency","tag-chief-resident","tag-resident-burnout","tag-resident-wellness"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v17.1.2 (Yoast SEO v20.8) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Yogurt - The Cure to Resident Burnout - Insights on Residency Training<\/title>\n<meta name=\"description\" content=\"Dr. Orlovich describes the perfect way to conduct Wellness training for residents.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/12\/yogurt-the-cure-to-resident-burnout\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Yogurt - The Cure to Resident Burnout\" \/>\n<meta property=\"og:description\" content=\"Dr. Orlovich describes the perfect way to conduct Wellness training for residents.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/12\/yogurt-the-cure-to-resident-burnout\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2019-12-19T20:23:57+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2019\/12\/red-strawberry-and-raspberry-on-white-ceramic-bowl-128865.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"3872\" \/>\n\t<meta property=\"og:image:height\" content=\"2576\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Daniel Orlovich, MD, PharmD\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Daniel Orlovich, MD, PharmD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/12\/yogurt-the-cure-to-resident-burnout\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/12\/yogurt-the-cure-to-resident-burnout\/\",\"name\":\"Yogurt - The Cure to Resident Burnout - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2019-12-19T20:23:57+00:00\",\"dateModified\":\"2019-12-19T20:23:57+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/05498911aa0855df284fbfc403c64087\"},\"description\":\"Dr. Orlovich describes the perfect way to conduct Wellness training for residents.\",\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/12\/yogurt-the-cure-to-resident-burnout\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/12\/yogurt-the-cure-to-resident-burnout\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/12\/yogurt-the-cure-to-resident-burnout\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Yogurt &#8211; 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