The Creation and Implementation of a Wellness Initiative in a Large Adult Psychiatry Residency Program.

Abstract

Being a physician is intrinsically stressful. Due to the steep learning curve in knowledge acquisition, long hours on call, and profound increase in the level of responsibility during residency, this may be the most stressful part of a physician’s training. As there are considerable data linking stress to the onset of depression, anxiety, and substance abuse, it is not surprising that these conditions are common among physicians, particularly resident interns [1]. Given this population’s professional responsibility, there has been growing concern regarding physician mental health. Unfortunately, physicians are often reluctant to seek mental health treatment [2]. One multi-site study assessing depression in interns found that barriers to seeking mental health treatment included lack of time, preference to manage problems individually, lack of convenient access, and concerns about confidentiality [3]. The same study found that interns who had previously sought treatment for depression were more likely to seek treatment during internship [3]. An emphasis on resident wellness has emerged as an attempt to improve physical and psychological wellbeing with the aim of reversing burnout and stress [4]. “Wellbeing” has been defined previously as a characteristic of positive psychological functioning that captures an individual’s level of positive affect, life satisfaction, and sense of purpose in life [5]. Intern wellbeing has been found to protect against future depression: individuals with lower wellbeing at baseline showed significant increases in depression symptoms across time [6]. Wellbeing has also been correlated with professionalism, including empathy and humanism [7]. Professionalism is a fundamental competency associated with being a physician. The effect of stress on core elements of physician performance—specifically, empathy and humanism—has become self-evident in recent years. This relationship between stress and decreased empathy and compassion likely starts in medical school, continues through residency, and then declines further as physicians move into practice [8]. However, wellbeing may promote professional attributes such as empathy and compassion [9]. Wellbeing is more than the absence of distress; wellbeing involves satisfaction in one’s emotional, physical, social, spiritual, occupational, environmental, and intellectual domains of life [10]. In recognition of the challenges of residency and of the potential value of wellness activities, we founded the Yale Psychiatry Wellness Initiative (YPWI). The YPWI was designed to provide opportunities for residents, faculty, and staff to promote physical and mental health and wellness, as well as foster an increased sense of community within the residency and department by connecting individuals with common interests. We describe below the process by which we created the program and preliminary assessment measures.