Medical Faculty Need to Foster Resilience in Students (and in Themselves)

“Do as I say, not as I do,” won't solve the problem. Faculty members in academic medicine must model and support self-care for students.

Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.

Abaza
Mona M. Abaza, MD

We know the issue well. More than half of physicians face burnout, and our suicide rate is significantly higher than in the general population. What’s more, it’s clear that the problem starts early, with larger numbers of medical students and residents suffering burnout and depression than their peers. As a residency program director, I see this in the faces of my students—and my colleagues—on a regular basis. And I have made a personal commitment to enact solutions to a problem that has reached crisis proportions.

To be clear, we have made some progress. In collaboration with the AAMC and the Accreditation Council for Graduate Medical Education (ACGME), the National Academy of Medicine has brought together more than 50 organizations in the Action Collaborative on Clinician Well-Being and Resilience to highlight and delve into challenges to clinician well-being.

But faculty members at medical schools and teaching hospitals have a unique opportunity—and obligation—to model and support resiliency.

“We have an obligation to help our learners experience their own joy and to support them as they build a resilient future for themselves and the practice of medicine.”

To begin with, “do what I say, not what I do” is no longer acceptable. We must consistently model self-care. In fact, the 2017 ACGME common program requirements call self-care “an important component of professionalism ... that must be learned and nurtured.” And ACGME’s updated Clinical Learning Environment Review requirements include several systematic and institutional well-being areas of focus.

Meditation and yoga certainly work well for some people, but learners need to see a wide range of self-care options used consistently. Personally, I find that relaxation lies not in the final minutes of the Shavasana pose, but in a soothing massage. And I don’t hide behind the claim that I need to go “to a meeting.” Transparency around self-care is essential.

Mindfulness—consciously being present in the moment—is one proven technique for reducing burnout. And we can remind our students that learning to be mindful does not require an elaborate training process. Mindfulness can be as simple as my colleague’s approach: “I listen before I talk. I pause before I move.” Or it can be stopping during rounds to look at a beautiful sunrise and then sharing that joy with others.

One important way I stay in the moment is separating my professional and personal identities, another fact I share openly with my trainees. For example, I let them know when I figured out how to balance residency interview obligations with a promise to take my daughter to a cupcake-decorating class. Trainees don’t have the scheduling flexibility that faculty have, but we can show them ways to juggle their roles and responsibilities once they do. 

There also are times when I am less peacefully capable of simultaneously handling all my responsibilities, such as when my daughter called crying with a headache and needing to leave school while I was conducting interviews. And that, too, is a fact I have an obligation to share with my trainees.

We physicians must avoid the “Facebook effect,” in which people share unrealistic images that can make others feel inadequate. Yes, we develop a degree of professional detachment when we need to share bad news with a patient, for example. But we should also be willing to share more of our true selves. We must let our learners know when we are not our best because we’re tired, sick, or emotionally drained. Resilience is about learning adaptability, and how can we adapt if we don’t acknowledge our limitations?

“We need to advocate for convenient mental health services, peer support programs, trainings in recognizing signs of distress and, whenever possible, a reduction in administrative tasks.”

And we need to offer support when we notice that those around us are not at their best. A colleague described how after she freed up the brain space focused on her own struggle, she was better able to sense when members of her team needed help and to communicate effectively about it. Moreover, we can work to create an environment for our learners that is less stressful, harsh, and competitive and more compassionate, altruistic, and respectful.

But we as faculty can do more than act as models and supports to our learners and each other. We can—and should—call for systemic changes. We can advocate for convenient mental health services, peer support programs, training in recognizing signs of distress, and, whenever possible, a reduction in administrative tasks.

We also need to emphasize how much finding meaning in work can combat burnout. And this can begin in small but powerful ways. The ACGME-funded Back to Bedside initiative, in which residents and fellows develop projects that foster meaning, offers dozens of creative models. One project, for example, set up a tracking system to encourage residents to spend more time in hospital rooms. Another reduced duties for pediatric residents so they could sit and play with their patients. Of course, no one can eliminate all the administrative or draining aspects of medicine, but we can find new ways to enhance the sense of meaning that draws us and learners to this profession.

The hope and the privilege of being faculty members is that not only our patients but also our learners can bring joy to our workdays. We have an obligation to help our learners experience their own joy and to support them as they build a resilient future for themselves and the practice of medicine. 

Mona M. Abaza, MD, is residency program director for the Department of Otolaryngology at the University of Colorado School of Medicine and chair of the AAMC Council of Faculty and Academic Societies (CFAS) Faculty Resilience Working Group. Dr. Abaza is also a CFAS Administrative Board member.