Bern Melnyk, The Ohio State University Office of the Chief Wellness Officer
Resilience is an individual's ability to bounce back after adversity or failure. Isolation, long work hours, losing a patient, feeling out of control, unresolved conflict with a team mate, family issues that are challenging-- all of these challenge our level of resilience. But they don't define it.
People who appear hardy, unfazed by challenge appear to others to have just been born with the right emotional set-up to be resilient. But Dr. Wiley Souba MD, MBA in the Department of Surgery at Dartmouth has another view:
"What distinguishes them is that they have learned to see, understand and deal with their challenges differently than most people do...Their level of resilience is not so much a function of what they're doing or how they're doing it... it's the result of 'reframing' circumstances to see challenges differently."
Cognitive therapists have identified 'cognitive distortions"- automatic thoughts we have that are self defeating. "I'll never learn this", or "I'm not as good as any of these other people" are examples of overgeneralizing distortions. When we begin to recognize automatic thought patterns that defeat us we can begin to replace them with positive approaches. "I am struggling here; but I can learn this." For more on this, check the references under "Resilience" elsewhere on this resource page.
The Wellness Initiative began during the first year of designing a Resident Core Curriculum for all of our resident and fellowship programs. It became clear a separate group of educators, residents, therapists and physicians would be needed to design a sustainable approach to wellness in the educational enterprise.
1. Develop a sustained strategy to promote wellness and resilience across all residencies, including faculty and learners.
2. Track measures of impact, starting with burnout, well being, and later, measures of work efficiency and patient outcomes.
3. Develop educational expertise in our health system that can benefit the larger institution to improve and sustain high levels of physician well being and retention.
Members of the Wellness Initiative have access to this page to develop a common resource of reviews, articles and committee projects.
Krall, Edward J. Clinical Medicine & Research Volume 12, Number 1-2: 6-9
An intensely personal perspective with practical insights and tips for individual physicians to build their own resistance. The author believes physicians need to take ownership of their stress and develop a healthy response through a lifetime of practice.Download article
Zwak et al. Acad Med.2013;88:382-389.
This article seeks to identify health-promoting strategies employed by experienced physicians in order to define prototypical resilience processes and preventative actions others can take. Well organized and useful.Download article
Trockel et al. Acad Psychiatry (2018) 42:11-24.
Shanafelt and others present a validated tool to briefly assess burnout and professional fulfillment. Unlike the Maslach Burnout Inventory, this tool is calibrated to register changes after interventions in as short a time as three weeks. Unlike the Well Being Index, this tool includes sleep impairment measures. It may be a good candidate for rapid tests of change in a medical workforce.Download article
Shanafelt T, et al. JAMA Internal Medicine. Online September 25, 2017. E1-7.
Understanding the business case to reduce burnout and promote engagement as well as overcoming the misperception that nothing meaningful can be done are key steps for organizations to take action.Download article
Panagioti, et al. JAMA Intern Med. 2017;177(2):195-2015
Recent intervention programs for burnout in physicians were associated with small benefits that may be boosted by adoption of organization-directed approaches. This finding provides support for the view that burnout is a problem of the whole health care organization rather than individuals.Download article
Squires et al. Ann Thorac Surg 2017;104:1117-22.
Healthcare organizations in the United States are implementing committees and support groups in an attempt to reduce burnout among their physicians, but these efforts are typically focused on increasing resilience and wellness among participants rather than combating problematic changes in how medicine is practices in the current era. A call for a shift in the focus of these efforts toward one proposed root cause of burnout.Download article
Jensen M et al. Canadian Fam Phys. Vol 54:May 2008 pp 722-29
While some might argue that resilience is a result of inherited personality traits, some of the factors described in this study as contributing to resilience can be learned behaviors.Download article
This pre-publication study is the first to relate high stress in residency with higher levels of stress in practice.Download article
Eckleberry-Hunt, et al. J Grad Med Ed, December, 2009; 225-230
The benefits of cultural change include providing a more positive educational environment for residents and faculty, raising awareness of burnout and its symptoms, decreasing the stigma associated with burnout symptoms, enabling the development of prevention strategies.Download article
Aaronson et al. Acad Psychiatry (2018) 42:469-472
Resident and fellow physicians are at higher risk for developing depression compared tot he general population, but they re also less likely to utilize mental health services. This study identifies barriers to receiving care which included lack of time, concerns about confidentiality, concerns about what others would thing, cost, and concern for the effect on one's ability to obtain licensure.Download article