Health Professions Resilience & Well-Being for the Educator (Part Two)

Good afternoon welcome to everyone so good to see so many names so many people popping in welcome welcome welcome uh and happy monday so today we have our um really resilience and well-being for the educator part two this was a highly requested uh second session so it's a little bonus session it's gonna very very disco discussion oriented today there's a lot to get through but please if you'd like to make a comment or have a question or concern feel free to either unmute yourself um and put your video on if you want either or and or go ahead and tap something type something in the chat box and we're happy to facilitate the chat function for our presenters today so today we have dr david music our senior dean for faculty affairs and emily holt forced our director of academic counseling and enrichment services at the medical school so sandy will throughout the presentation for at least the first half hour of the presentation she's going to go ahead and put the links for the evaluation form for you all to claim cme and or faculty development related to teaching so without further ado i'm going to turn it over to our presenters enjoy this session thank you very much dr wicker it's a pleasure to be here for part two i want to start by telling you that i've been having some issues with my computer audio i have a support ticket in but they haven't gotten to me yet so occasionally hopefully this is not going to happen but if my audio cuts out for a few words we'll just try to make the best of it i can't tell when it happens but hopefully if i miss anything important i can go back and restate it or do something about that so we'll jump right in here we're providing continuing education credit today it's necessary to put up a disclosure site and a slide and neither emily or myself have anything relevant to disclose as noted on this colorful graphic here we often say in education research we wish we had something to disclose but we don't have anything today okay hopefully by the end of this time you'll be able to describe at least some of the factors that have an influence on resilience and well-being at the three different levels that we're going to talk about the individual level the team level and system levels we also hope you'll be able to describe at least some strategies and resources that you can use to enhance your own well-being or the well-being of your team or the well-being of our organization at the system level i want to expose you to three model programs that we have researched and feel like really are setting uh the trends and are out in front in terms of what they're doing to enhance the well-being of folks in their academic medical center so we'll introduce you to the with the ability to identify a well-being champion for your team or your department so those are our objectives today they're they're pretty ambitious we hope we can get through all of them we do want this to be uh to meet your needs so please uh interject with uh questions comments feedback or opinions at any time and we'll do the best we can if we don't get through all the material then we don't get through it and it's no big deal it'll all be posted online for your review later on we want to start today by pointing out that we're doing a little bit of review from our may the fourth session and at that time we had this slide where we talked about two different things we talked about the decimal the definition of burnout which appears on the right hand portion of this slide and then also a broader construct called professional distress and really what we need to think about and talk about when we're talking about burnout is this larger construct which includes not just burnout but depression stress work-life integration professional satisfaction fatigue we also like to talk about faculty vitality and well-being so we don't want to just focus on the term burnout but we want to talk about what can we do to increase our opportunities to experience as little professional distress as we can and at the same time do well in regard to the issue of burnout i also want to point out very carefully that although a lot of our comments today are going to be focused really on our clinical faculty and our clinical colleagues we don't want you to come away from this with the idea that this is not a message that applies to our non-clinical colleagues it certainly does and in fact i recently sent out a note to all of our faculty along these lines pointing out that challenges to our sense of well-being right now apply across the board to to all faculty and and really a lot of different people and whatever type of work you're doing but our comments today will focus primarily on clinical faculty also we'll just point out by way of review from last time that really when you think about well-being uh you you really need to think about it as a continuum often we tend to think somebody's either burned out or they're not burned out they're really struggling or they're not struggling at all and that's really dichotomous and what we've suggested in our prior talk uh and this is going up in the literature is that in fact our well-being really is a continuum it's possible for a person to be at different points along this continuum at different points in time our goal should be as an organization though to try to do everything we can to ensure that people stay to the far right of this as much as possible and so that when they're at work or in any part of their lives that they're in the category of well and thriving but just know that this is not a dichotomous variable at all and we agree just reviewing uh last week that wellness comes in a variety of areas and using the core wellness program model for identifying areas of wellness we have all of these topic areas that we think are involved when we're seeking to improve the wellness of our co-workers we've tinkered with it slightly normally environmental isn't doesn't span all the other ones but we we see it more as encompassing all of the other areas and when it comes to solutions it's not just at the individual level it also involves the team level and the systems level but in the interest of time we've selected some specific areas within each one of these three categories so that we can kind of narrow our focus today given that we only have an hour so the ones that have been highlighted in the respective colors are going to be the areas where we focus today well the real question is how can we build a resilient organization when we think about where we all work we're all part of an academic health center and we want to focus a bit on how can we build a resilient organization that allows everyone to be at the far end right hand side of that continuum for the majority of their time and it's challenging to do that it really is because um you know we're more than one organization involved so it says you know this is especially challenging when silos exist i realize that the word silos has a bit of a negative connotation so perhaps it would be better to say that part of what makes this so challenging is the fact that each of our organizations whether it's virginia tech curriculum clinic the medical school radford university carillon we all have our own sort of interesting and unique goals structures and culture we all have a lot in common but we also also have some things about each organization that are different and so we want to talk a little bit about this issue of organizational culture from the very beginning of this presentation we do this to have this as a framework in mind when you think about the materials that we present today because this culture phenomenon is so important to this issue of well-being and burnout so what do we mean by organizational culture well here's one definition came from the journal of general internal medicine just a few years ago as an organization's culture is manifested and sustained as everyday patterns of human interaction for example how one behaves in a meeting and or cannot be talked about with those in authority who makes decisions or how differences are handled work culture is a field of in of study that has been fascinating to me for basically my entire career i was first exposed to it very early in my phd training and i've thought about it a lot ever since and organizational culture really has three components it's it's made up of our underlying assumptions or beliefs about what value what is valuable our organizational values and norms and then our behaviors this is the framework that we really would like you to think about and keep in mind again as we work through these slides today different academic health centers have vastly different cultures i can tell you that before i came here i spent some time a few years ago at a very high powered ivy league medical center in the northeast part of the country that culture was very different than the culture here because they were focused on rankings on being the best and it was a very competitive sort of culture i mean when you walked in the doors and you were in meetings you could feel this it was very palpable and real i have a more nurturing uh culture without a doubt culture has a lot to do with the way we do things that's another sort of definition of organizational culture it's quote how we do things around here on how we function in our jobs and how we look at this issue in particular of vitality and well-being every organization also there's not one big organizational culture that applies across the board there are lots of different what is called microcultures within each organization so these microcultures probably have even more of an impact so what do i mean by that well the culture of a given inpatient unit can be very different than the one on a different floor or the culture of this department can be very different than the culture of that department so these are microcultures and everybody fits into one of those smaller groups of people where you actually get your work done and where you spend the most of your time sir edgar shine of mit a few years ago wrote something about this that i think is very profound he said the only thing of real importance that leader is to create and manage culture if you and its culture it manages you you may not even be aware of the extent to which this is happening end of quote really something important to think about i think this slide is really a good way to kind of depict visually what we mean by organizational culture the things that are above the surface are the things that are easily seen things like slogans ceremonies special language that is used how we dress the physical settings and how they're put together what they look like not easy to see though are those things underneath the surface which are the underlying values and assumptions and beliefs that we might have the attitudes we might hold feelings of trust issues related to transparency these are things that are under the under the surface and not as easily seen every organization has statements of culture where do we find things like that typically our value statements perhaps in our strategic plans and those are the things that the organization says are really important and they are really important the organization or they wouldn't be in those statements but don't pay attention to the things under the surface if you don't have that sense of trust or transparency if you don't see that the organization is living up to its values in any in some way then there could be an issue with organizational culture this is a challenge for every organization i do not mean to make any attributions to any particular organization i'm simply giving you a description of what this literature is like now dr baird breitman is a phd psychologist who has written a lot about these topics and in particular has tied this to the issue of well-being and burnout and dr breitman says that when we talk about this we have to make the invisible visible about burnout and issues pertaining to vitality or well-being this is what we see physicians often do not want to talk about this issue for a variety of reasons part of it is the way they're socialized that's probably true for other disciplines as well we're not really socialized to talk about this administrators sometimes don't want to hear about it not always but sometimes and patients and payers frequently do not know about it how accurate this description might be depends on your particular microculture where it is that you spend your time every day i'm not saying this is true here across the board i'm simply suggesting that this is one way that dr brightman says that we look at it and we have to take this matter of our organizational culture seriously and try to make the visible invisible so to kind of sum this up every organization has its own unique patterns or behaviors ways of doing things and this is a particularly important issue when we talk about well-being vitality or burnout and that's the framework that we want to use to help you think about this today keep this framework in mind as we move through the balance of these materials david found this great graphic from hedette and stein from 2006 and it goes through some of the things narratives that contribute to culture and medicine doctors don't make mistakes doctors must be perfect or there's always one right answer uncertainty complexity are to be avoided it's okay to be rude when you're doing something important outcomes are more important than process doctors are married to medicine um medicine represents a higher calling than other professions i do believe that medicine is a calling just as any service career is but medicine doesn't always have to take a priority over everything else you must not question doctors more senior than you i have a responsibility to question people always it's the only way we get better so working at the individual level one of the things that we can do to foster a healthy environment for ourselves and our colleagues is to normalize seeking support and during the pandemic there's been a lot of conversations around mental health and it has helped us with normalizing asking for help and along that way on the recent um and during this pandemic along that way a recent twitter post from mallory jackman who's in toronto canada but i still wanted to um point out her post because i think it speaks to what we're saying here and she she has a medical condition both physical as well as mental and she posted it on twitter when she was in the hospital recently and shared her experience and she wanted to do so as an as an effort to help normalize what needs to be normalized that it is okay for doctors to get help too it is okay for doctors to feel unwell um sometimes and so she she shared this but in this process i'll try to sum it up as quick as i can but um she essentially um said that the reason she's been reticent to share her health concerns previously is because she had negative response however that hasn't been the case in her current work environment and she lauds them for um for their support and further to that point after she posted this um 10 message post she received a whole lot of really positive feedback from her twitter um the twitter world and so she posted again this final message saying um thank you to everyone i never expected to receive such a positive response and i think that that is it's a testimonial to to the headway that is being made and it gets to david's point you know in different um subcultures it it's going just as it should we are making headway key is to continue to spread this further powerful story thank you so when we think about level the individual levels of support and support specifically for mental health and how important it is to have a culture that provides a variety of opportunities for people to seek support for their mental health in particular or to seek support if they're really feeling frustrated or burned out we start with our employee assistance programs and you know we're very fortunate that here in our academic health center we have two very strong employee assistance programs carillion clinic has a strong program that's made widely available uh and i can't forget the i mean i can't remember the specific rules around how many sessions you have but i think it's it's variable but i know for a while that the residents for example had a certain number of uh eap visits that they could go to without any type of charge to their insurance or anything like that same thing probably for other folks but eap is strong eap is strong at the university i'm sure that they have something like this at ruc as well so we're very fortunate that we have dedicated support professionals in these programs through either the university or through carillion health system or through radford some people have gone a step further in terms of offering how to make this available and tried some opt-out approaches so there are some articles in the literature you can read about where people have said we want to assign people automatically to have one or two visits to eap every year just go ahead and build it into their schedule and make it an expectation for them and then allow them to opt out if they decide that they don't want to go so instead of leaving it up to people to schedule it then they schedule it for the individuals and then they have to opt out and this has been tried with with mick success so in some places it's worked extremely well in other places uh it has not been as effective um but that's something that we wanted to mention now for a variety of reasons i think it's it's pretty clear that there is some hesitancy sometimes associated with seeking out support from employer-sponsored programs for a variety of reasons so therefore i think it's very important that this should not be viewed as an either or situation either go to eap or you're on your own i think we can do better than that i think we have to say that we need to provide a menu of choices for folks both internal and external so that their comfort level will match up with the resources available if they're not comfortable seeking support from an eap program that's okay here's some other options that are available to you also probably true that if everybody that actually needed support all went to the eap programs they may not in fact have the capacity to handle that that's another reason to make sure that we have a menu of options available for folks in this regard something called safe haven which you can see on the left hand side of the slide here the different aspects of this program what they provide things like peer coaching 24 7 professional support via the phone other types of support and this is originally put to be offered to physicians nurses and physician assistants and i believe now it's also available to pharmacists if i'm not mistaken the cost of this is about a dollar a day if you're not a member of the medical society of virginia it's less than that if you are already happen to be a member and not only are the services provided to you but they're also provided for your entire immediate family and very importantly uh when they put this program together they worked with the virginia trial lodgers association to build in some protection to this so that if a clinician seeks services from this it's protected information that you don't have to reveal it unless you're ordered to do so by a court now we'll talk more a little bit about this later on in the presentation but this is a huge issue for clinicians in terms of having a chilling effect on their willingness to see seek out support is it going to be become known is it confidential is it really confidential so when they put this program together they built that in and it's really the first program like this in the country to to feature that type of protection i know we've already colleagues here enroll in this program and it's a very good program that is there for your consideration in the text physician mental health and well-being they outline a variety of different ways that we can support learners in the arena of well-being and mental health one of the things they say straight off is start early start supporting medical learners in their their well-being at orientation and do it consistently from that point forward include stakeholders that could be when and where appropriate they could help in this journey it's not uncommon for family and close friends to not fully understand um the medical journey and so for a learner and so giving incorporating a level of understanding for them where appropriate can go a long way and supporting the learner that they care about provide a variety of means so help educate learners around mental health support from a variety of vantage points through websites and through literature and through programming opportunities that you can offer learners approach it from a variety of angles and keep it optional and keep it consistent if derby did a study about a man a mandated well-being program and it didn't go particularly uh it didn't have particularly strong outcomes so i i think the notion there is that it needs to be an optional thing but it also should be consistent so when a when an individual is in a position where they want it it is available and keep it confidential and then there's a variety of online resources through the school of medicine well-being website and here's some links to those and they're also available on the virginia tech website but one of them is an anonymous mental health screening tool that individuals can take to ascertain um what level of mental health they're currently at and so if and it will give them advice about next steps that they could pursue there's also a database of local care providers and it's it's a really nice database and and the fact that it offers a variety of details relating to types of care providers you can get as well as what insurance is covered and so this can be particularly helpful for the medical students for example who are on a variety of different health care plans i really like that searchable community provider database because it enables you to search on areas expertise it enables you to search based on what type of insurance you have and it returns a pretty good list of options for you based on your search criteria so it's really powerful and a good way to get connected with local resources in this region thinking about the individual level i want to say a word about the 20 rule that may not be what you think of when you hear the term 20 rule that that's a business term sometimes people will use but this is a little different and so i'm going to put up a couple of quotes here from studies that took place uh 10 years apart but basically found the same thing and they were in academic settings and in particular what they found in both instances was that physicians would report that if they could spend at least 10 to 20 percent of their total work time doing something that they really are passionate about or care the most about they would experience far less risk of being of suffering from burnout or far fewer challenges to their sense of well-being second quote evidence suggests that physicians who spend at least 20 percent of their professional effort focused on the dimension of work that they find the most meaningful are at dramatically lower risk for burnout so i guess the question is as we think about this as individuals how easy or how difficult is it for me to spend at least 20 percent of my time on activities that i'm the most passionate about for me i'll give you an example i i like to write i enjoy writing for uh journal articles and things like that i don't get as much chance to do that as i used to because i have so many other demands on my time i've often dreamed you know if i could somehow find a way to block off one day a week or at least or even half a day a week of my calendar where i could do nothing but that i think that would really make a positive contribution to my sense of well-being in fact i know it would the same principle is true of clinicians so i guess for us here how how important is this is it possible for us to do this what would happen if you ask this question of whoever your supervisor is or if you had a conversation with your supervisor and said hey what's the opportunity for me to carve out a half day a week to do this one thing that i really care the most about when we find that easy to do here difficult to do here i think that's a very important thing to think about now before we finish up with this section on the individual level solutions i just want to make the point again that we made last time hopefully we've made today already when we talk about individual level solutions we do not mean to place the entire burden of dealing with well-being on the individual as we said in may resilience training mindfulness exercise other similar activities are all very good things to do but you have to be careful not to place too much emphasis on that as the solution to this problem because when you do that you exonerate the system from any duty to address these concerns as one writer so eloquently said we are not going to resilience our way out of this problem so just wanted to put that clarifier in there there are things that we need to do for ourselves as individuals but we have to do more than that we have to go beyond that to look at solutions at both the team and system level so that's where we'll go next focusing next on team levels we want to talk start out talking about pain points what do we mean points well specifically what we mean is uh what are what are some things that in your microculture or in your particular work context are the things that challenge you the most in terms of your well-being across different contexts and it's probably also going to be very difficult or i mean very different across different specialties so what are the three most difficult things for a physician might be very different than the three most difficult things for a respiratory therapist or a nurse or a psychologist all of whom are dealing with clinical care but who have different contexts how to do the local work to find out what those pain points and solutions to them might be so we did an interesting thing a while back in faculty affairs we put this little blurb up on our website and you see the links at the bottom you can get to it from either one of those we'd be happy to work with your department or your unit or your program on a very brief internal survey that would be used to identify what these things are and one of the questions the first question on that very brief survey is if you could change three things about how work is done in your unit what would they be or if you could name three things that uh you would like to see addressed in order to increase your your sense of well-being what would they be and we had a few people who uh who took us we're always there we're interested in doing this work with you which is why we wanted to put this up part of what we've been able to do through that is we've been able to identify some local well-being champions here's a list of folks that through that work and through a previous committee we've identified as folks in each of the departments these are medical school departments who are very interested in this topic and would be very willing to work with you on identifying and addressing some of these very specific local issues i do realize i left a name off this slide i'm very sorry i should have put dr angela nardeckia also beside dr adams banky there for psychiatry so uh angela if you're on the if you're on this call i apologize for leaving you off there and i will fix that before we post the slides for well-being champions then you can consult with them and they will probably more than likely be willing to work with you on whatever it is that you feel would make a difference to these pain points in your particular context so again we also send out a survey in january of this year to all of those departments and we ask certain people in the departments to select the top three pain points or stressors that they thought affected the well-being of faculty or other folks in the department returns that were identified coveted of course being at the top of the list in january of 20 it was still raging on it hadn't abated at all and of course it got a little better and now we're back in a sort of delta curve delta variant and so it's an ongoing concern but in january certainly it was a big concern that people talked about the second thing well-being should be an agenda item for every departmental section meeting that was a bit of a surprise but that strikes me as something that would be relatively easy to do every time you have a meeting of your of your microculture your team your your work unit have an item on the agenda and just check in and say how's everybody doing and take a few minutes to do that issues related to the electronic medical record and the perfect serve system were prominent at that time as was concerned about staff turnover issues particularly in regard to to nursing and then finally the last item is very interesting for some sentiment expressed as this quote says we're tired of talking about it and yet it's real and i've tried to tease out exactly what might have been met by that it could be a factor of survey fatigue you know it could be that people are tired of being surveyed about this particular topic or it could be something beyond that like the fact that some people feel like we we've talked about this a lot and now we need to perhaps let our actions catch up a little bit with our words i think it was saint francis of assisi who said preach the gospel at all times and when necessary use words well we're we're sort of preaching the gospel of well-being today and words are important but uh actions are as well and so that's why we're doing part two to try to give you some specific uh suggestions for actions and things that can be done to help address some of these these concerns one of the things that comes up quite frequently in the literature particularly with regard to physicians and their well-being is concern about the electronic medical record into this is is what uh some people have started referring to as pajama time uh which is a phenomenon where clinicians are doing their electronic charting at night uh or early really early in the morning after midnight you know in the early morning hours some systems in fact are now measuring this systematically i guess there's a way you can go into the emr and find out the actual time when people are actually doing the work inside the system and so systems are starting to measure this and they find that if we if if they have too many people doing this in these off hours they get concerned about it and want to address it in some fashion the other thing that goes along with this is the often suggested solution is that of scribes scribes are non-clinician folks who have been trained to support physicians and other clinicians in documenting the details of clinical visits often in real time so i go to a local optometry practice here and i get my eyes checked a couple times a year and every time that i'm having an eye exam there's two people in the room the person who's doing the exam and another person who's sitting at the computer and the person doing the exam is talking out loud with the findings and saying okay right you know right out of this that but that person is not doing the charting the other person in the room is writing it or typing it all into the record so this is the way that the scribe system would work this is something that it suggests quite frequently or quite frequently in the literature as potential solution this often can result in lower documentation burden for clinician more opportunity for clinician patient interaction i know if you're like me you hate to go and when you see your clin your physician you don't want to see that person spend a lot of time looking at the computer screen you'd rather they'd be looking at you and talking with you and i know that that's challenging sometimes but that's just the way a lot of patients feel so this might be a potential solution to that it could help mitigate clinician burnout sometimes it involves aspiring medical students which strikes me as a win-win if you can get medical students or people who are trying to become medical students to do this they learn a lot about clinical medicine just by doing it it increases their their opportunities perhaps to to be admitted to medical school if they have this type of experience and then it also provides a much needed service for the clinicians who are doing the actual patient care certainly can be can be can work better in some practice settings than others it's more challenging to implement in some settings and of course you have to demonstrate that it's cost effective i don't really know that much about our use of scribes in our system here but we simply throw this out as an option of something that that we should seriously consider and i knew i know that a couple of our departments are using scribes at least in in a limited fashion another brilliant intervention that we wanted to talk about today is peer support so again i'm going to put a couple of blurbs up here about some peer support mechanisms that we have in place we are very very fortunate uh at carillion to have something called the trust team if we were in person i might ask for a show of hands to see you know who all is familiar with this the trust team is a program that is set up to respond to provide support for clinicians when they're experiencing difficult patient outcomes and in particular when uh the possibility of a near miss or an actual medical error has occurred sometimes these circumstances can be very very devastating for clinicians and so the trust team has been specifically set up to respond to those types of situations and we are on the cutting edge there recently came there was recently a review article that came out uh summarizing what is known about this and it's still true that there are relatively small number of health systems who offer a trust team or second victim type program so we're very fortunate to have that here also we have something relatively new at peru and called code lavender which is somewhat similar to the trust team in that it's a holistic rapid response to very emotionally stressful events these are usually uh ongoing like you would call a code lavender when something is literally taking place at the moment sort of real time and help you and be there to support you and help you think your way through whatever those circumstances are offered primarily right now through the pastoral care services at corillion and i believe this is a relatively new program but it's something that has happened in a lot of other health systems and i think it's a very very healthy and uh helpful response a lot have been written about peer support for clinicians here's a reference to an early article that talks about a program at mass general hospital in um in boston issue here is the question of who is my peer there's some evidence that certain groups prefer to talk only to other people in that same group so for example you might speculate that when physicians are experiencing a difficult outcome or they really need support they would prefer to talk to physicians nurses may prefer to talk to other nurses this is a preference this makes sense when you think about things like social identity theory which talks about how group membership has a powerful impact on the preferences and behaviors of people who are members of that particular group i don't think this is either good or bad i think it just is i think we have to recognize it though and we have to make sure that again our programs are in place accordingly if we have physicians who prefer to get their peer support from other physicians i think it's our obligation to identify a group of physicians who are willing to do that same thing with nurses same thing with other disciplines another form of peer support is the korean clinic moral distress consult service so some of you may know about this some of you may not again very innovative i think very cutting edge not very many health systems have this so moral distress is a situation where you feel like um you're in a situation where you know the ethically appropriate action to take but for various reasons you're unable to do follow your your ethical instincts there it can happen not deliberately but but but according to circumstances so the covet crisis has been a very good example of this where in the early days there were many health systems that did not quite have enough ppe on hand enough particular types of services or care to provide for overwhelming numbers of patients where you saw this in other countries where doctors were literally having to make life and death decisions about who they could give a limited treatment to in the face of these enormous coveted challenges this undoubtedly leads to a sense of moral distress and so if this happens to you just know that there is this moral distress consult service available through you to you through the carillon perfect serve system so you activate it that way and ask for a moral stress consultation another program that is relatively recent was just started by our own doctor mark greenwald i think about not quite two years ago is the prxmd program this is based on the principle that no one cares alone and that you should have a buddy or someone that you can turn to so the way this works you sign up with another person and it's completely up to you it's completely voluntary but the system will send you reminders every week in a suggested way that you can connect with your buddy and just check in with each other and there are different levels you know you check in once a week for maybe a minute or two you check in every three months for longer than that and then maybe every six months you you try to have lunch or something it's a very structured program but again it's all voluntary but it's designed to meet a specific need and it's based on this profoundly important idea that no one should care alone so this is a really innovative thing and i would encourage you to check this out at this website you feel so inclined here's a variety of resources we're using we're implementing at the school of medicine for the medical students it's a this slide is a hybrid of both recommendations from the physician mental health and well-being book as well as what we're actually doing the text recommends to engage students in learning opportunities developed to offer tools to provide peer support while maintaining healthy boundaries and along that line we are we have an m1m2 mentoring program where m2s receive an m1 mentee upon that m1's arrival at orientation and those pairings very customarily last throughout the students medical four years of medical school and probably beyond they support each other and with day-to-day questions as well as emotional support as well there's a peer educator program that's continues to get more and more robust at the school which i find incredibly wonderful because it's also an indication of medical students being willing to ask for help from somebody when they are struggling academically our students can receive one-on-one peer support or they can attend small group sessions that are led by a more upper-level medical student and so it also gives learners the opportunity to practice their medical educator skills early on in their medical education which has long-term benefits as well and then there's also the book recommends upper-level peer panels on a variety of different topics and we also have those as well for our students and we have panels anywhere from step one step two prep to transition to residency a variety of things throughout the student experience and the last topic um is mentoring communities and many of you may be familiar with that already it's a new program at the school we used to have our physician thought leader communities and that has transitioned into the mentoring communities and it really gives students an opportunity to connect in a a long-term way with individuals at different stages of the medical education process from medical student to resident to attending and so a variety of supports there okay so we want to turn now to system level issues and we want to start by talking a bit about measurement first thing we want to say about this is that we measure what we value about this is that we measure what we value a couple of quotes here from some very prominent folks who have been at this for a while and these are kind of self-explanatory lots of calls for us to measure systematically the health and well-being of our clinicians in particular and i would suggest all faculty and then not just to measure it but to report it in the transparent fashion dr sinsky writes in a very influential report that was published in november from the national academy of medicine that organizations should be transparent regarding the results of what they measured she goes on to suggest in that report some some things that we should measure well-being and burnout leadership quality efficiency of the practice environment culture and trust in the organization the organizational cost of burnout there are formulas one can use now to put a dollar figure on what it costs systems when when they have a high level of burnout workforce retention these are all things that must be measured now there's another one that i thought was quite creative that was done a couple of three years ago by a health system in hawaii and they came up with this idea of quote let's get rid of stupid stuff and so what they did they asked clinicians i think it was about 150 200 clinicians and they said in your particular microculture or your particular work unit can you suggest some policies or tasks that could be eliminated in order to gain efficiency and they thought they might get a handful of suggestions and they got over 300 from physicians and nurses in that health system and this was published in the new england journal about three years ago it's a very very cool idea uh have we thought about doing something like that here could we do this here could you do it in a unit maybe that would help maybe you would identify some things that that could easily be ident by could easily be eliminated reduce everybody's frustration level a bit another very important system level issue is this matter of licensing and credentialing so i mentioned earlier that one of the concerns that clinicians have about seeking support for mental health concerns or burnout or things like that is the concern over the confidentiality and and what who might know about that and what impact this could potentially have on their licensing or credentialing processes so there's a lot of been written about this we don't have time to go into a lot of detail but i really like the way that the korean medical center words this uh on the credentialing application which you can read there on the left the licensing boards still have some work to do in certain parts of the country so a lot of times when when a clinician is applying for a license they'll be asked the question something along the lines of what you see in the right hand side the better way to ask it is do you currently have a medical or physical condition that impairs your ability to practice medicine that's a yes or no that reflects the current condition what many of these questions will ask though is have you ever been treated or cancelled for any type of mental emotional or other similar problems or within some time frame within the last five years within the last 10 years these questions are have a profound chilling effect on the willingness of people to seek assistance and in fact there is some feeling now that some of these questions are probably unlawful as under the americans with disabilities act so there was a paper that was published not long ago about this actually in may of 2021 in jama and each state licensing board was given a one to four rating where four was indicative of implementing all four recommendations from the federation of state medical boards about how to word these types of questions so if you get you got a four for doing it for for addressing all four of the concerns and you got a one if you only address one of them virginia was rated at two this is an issue that perhaps we can make some progress on in virginia and perhaps we could show uh show some traction on that i'm going to read this out but entirely but what this basically again from that very influential national academy of medicine report repeats all for health systems to have a chief wellness or a chief well-being officer it's very simple those organizations that do that according to this report will be more impactful impactful than those whose investment is limited to informal champions and standalone committees without a chief well-being officer ad hoc efforts to support clinician well-being often result result in siloed initiatives and frustrated efforts i think it's past time for us to appoint a chief well-being officer for our system i really do i think it's time that we that we take that step and make sure that that person is given the title and the adequate resources and the time necessary to really make this an area of focus moving forward on leadership is more what you might be thinking of when you think of leadership so this is an interesting study that was published in 2015 about a survey work that was done at mayo clinic with 2800 physicians who were surveyed at the same time about their perceptions around leadership furnished by their immediate supervisor as well as their current risk for burnout and what they found is that there was a correlation between those two things that every one point increase in the leadership score of a physician's immediate supervisor was associated with a reduction of 3.3 percent in the likelihood of burnout that's pretty important so it's their relationship between type your feeling of well-being or burnout according to their study there might be so somebody could say well how did they measure leadership the questions that they use so again you can look that study up and read about it our question is are we doing anything like that here i'm sure that we are we have a new leadership institute through carillion the university does a lot of work and leadership development are we making the connection though between leadership and well-being i hope that we probably can make some progress in this regard and at the medical school level uh things that are recommendations things that administrators can do is provide resources to your faculty it's possible that they don't have uh the skill set or the um the experience in in this realm that they would like to have and so empower them by providing them with the education and the training that they need incorporate well-being elements into curricular places where it makes sense just nest it in with other topics when it's when it logically flows provide learning and working supportive environments and so meaning is there a gym accessible to your medical professionals and learners are there healthy diet options available to them are there spaces and places they can go if they want to have mindfulness or meditation practice those types of things provide learners at all levels again optional educational programming covering topics that will help them as they as they move forward in their journey and some of the topics that contribute to burnout include cognitive distortions maladaptive perfectionism imposter phenomena but there's a variety of other things that lead to burnout beyond those individual topics but those are some examples and then reflect on the importance and the message that it sends to um to individuals when individuals and positions of authority participate in these events as well these this is just a list of some of the things that we're doing at the medical school level to to this end as it relates to some of those healthy educational programming opportunities for our learners there are a variety of models out there we do not have to recreate this wheel it exists and it uh and it is strong in a variety of programs and these are three example our programs that we encourage folks who are interested in this topic to explore because they have great ideas and incidentally they all have chief wellness officers um so the iacan school of medicine the stanford school of medicine and then the mayo clinic are three outstanding programs i want to say something about the stanford program they came up with a really innovative way to work with each with their various departments uh and they came up with a a time banking system so i think you can probably read about this on their website but what they did they went to the faculty in each department and they said would you come up with a list of things that you feel like should be rewarded because people have really gone the extra mile so it was a way to recognize people for doing positive things and then they came up with a way to be able to give faculty credits for doing those things and then they could use those credits in exchange for very specific designated things like tangible goods and service such as child care delivered meals etc and things on that list included things like agreeing to take a call at the last minute or covering for a colleague when they wanted to be with their child for some for a school related event something along those lines so they came up with this very innovative time banking system and they studied over a period of a couple of years and they found that it not only resulted in a better sense of well-being but it also actually led to an increased research productivity as well in terms of both obtaining grant funds as well as just being able to conduct research so they they're all in on that and i thought it was just a marvelous example of a very specific program that could be emulated quite easily it would require an investment of resources to furnish those very tangible things but it might be worth it okay so here's our summary slide we're almost at the end talked about a lot of these things already but i think number one we have to recognize the well-being deserves a high priority i don't think there's any question in my mind that we recognize that here in our health system things that we have in place it's obvious that this is something that people care about i think we can do more and i think part of what we hope to convey today with some specific suggestions around how we could be even more effective than we are now and do some things that we're not doing now that will make this even better uh we have to make it normal to talk about this you know you go back to that idea of culture and what can and can't be talked about we have to somehow overcome that if it's a barrier in your particular microculture we have to make it normal to check in with each other and say how are you doing and not be afraid to to really tell somebody i really need your support i need some help figure that out provide a comprehensive menu of services or resources both internal and external and make them easy to find and talk about them frequently as a leader make it your duty to find out what is the 20 of people 20 that really satisfies the people that work with you exercise is something we could think about related to that within your own area of influence and your identified champions to address the three issues that are most important in your particular unit or microculture if you don't have a champion think about being one yourself presence on this uh in this meeting today indicates that you're interested in this you could be a champion measure measure measure and report the results be transparent about what the results are find and use a peer support mechanism that works best for you name a chief well-being officer and provide that person with the needed time and resources to really make this area move ahead in our system and then finally work hard to change our overall organizational culture and make it even stronger around these issues pertaining to faculty well-being arm charter this is something that the american medical association came out with a couple years ago our medical school was signed on as a sponsoring member you can read that um some of have we we have made some good progress since we first started talking about this in 2014 and we have developed some great resources over the past five years are we doing enough i don't think so i think we can do better and we try to be very concrete and very specific about some suggested ways that we could do even better than we are doing now in this regard only time will tell whether we're willing to devote the time and the resource to do that yeah we just want to conclude today with a list of various resources for folks to check out as at their leisure and please don't hesitate to reach out to david or myself if you have any questions or you'd like to keep this dialogue going thank you both so much for this fabulous session and i really appreciate i hope others do um continuing this important discussion really providing local uh resources and potential solutions um there there were a couple of comments in the chat one um was earlier on when we were talking about individual issues so the problem with the emr is not just the burden of documentation it is in the reading it is so overloaded with junk that it takes too long to review it all mistakes get made mistakes of omission i am absolutely convinced that the emr causes me as many errors as it stops um and that is certainly not a localized problem that is a lo that is a a national issue uh do you do you all have any comments on that uh david or emily i think you're right it's certainly not a local issue and it's it's one that is hard to wrap your head around and really do something about because it works so differently in different contexts i know this was probably three years or so ago we had somebody come here from a different health system so this was not in our health system this was a person who worked in a different health system in a long-term care setting and having how many clicks it took in their version of the emr to order two tylenol for a patient and it was something like 45 clicks or something like that and and he was saying this is absurd you know and they were trying to figure out what to do about it and how to address it and i'm sure they probably eventually made a way to streamline that but it's it's a huge problem that clinicians talk about all the time well i hope this helped to meet the the requested needs of the folks who were chanting in unison we need a second session um and we will continue to offer these sessions and other things um that are valuable to you if you speak up and let us know what is important to you all and what you all desire we have another comment here we really need a champion that can provide these services to nursing and ancillary departments as well someone that can help administer the administration see the value in these services and the value in their staff whereas it always seems to be the bottom line thank you for that comment anything else anything else before we let y'all go get back to your work thank you all so much um emily and david are always available and this is always something that they want to talk about and they've provided with you you with a ton of uh resources that you can also look into if you so desire please continue the conversation keep it transparent thank you all have a great day.