Abstract
BackgroundThere is growing recognition that wellness interventions should occur in context and acknowledge complex contributors to wellbeing, including individual needs, institutional and cultural barriers to wellbeing, as well as systems issues which propagate distress. The authors conducted a multiple-methods study exploring contributors to wellbeing for junior residents in diverse medical environments who participated in a brief resilience and stress-reduction curriculum, the Stress Management and Resiliency Training Program for Residents (SMART-R).MethodsUsing a waitlist-controlled design, the curriculum was implemented for post-graduate year (PGY)-1 or PGY-2 residents in seven residency programs across three sites. Every three months, residents completed surveys, including the Perceived Stress Scale-10, General Self-Efficacy Questionnaire, a mindfulness scale (CAMSR), and a depression screen (PHQ-2). Residents also answered free-text reflection questions about psychological wellbeing and health behaviors.ResultsThe SMART-R intervention was not significantly associated with decreased perceived stress. Linear regression modeling showed that depression was positively correlated with reported stress levels, while male sex and self-efficacy were negatively correlated with stress. Qualitative analysis elucidated differences in these groups: Residents with lower self-efficacy, those with a positive depression screen, and/or female residents were more likely to describe experiencing lack of control over work. Residents with higher self-efficacy described more positive health behaviors. Residents with a positive depression screen were more self-critical, and more likely to describe negative personal life events.ConclusionsThis curriculum did not significantly modify junior residents’ stress. Certain subpopulations experienced greater stress than others (female residents, those with lower self-efficacy, and those with a positive depression screen). Qualitative findings from this study highlight universal stressful experiences early in residency, as well as important differences in experience of the learning environment among subgroups. Tailored wellness interventions that aim to support diverse resident sub-groups may be higher yield than a “one size fits all” approach.Trial registrationNCT02621801, Registration date: December 4, 2015 – Retrospectively registered.
Highlights
There is growing recognition that wellness interventions should occur in context and acknowledge complex contributors to wellbeing, including individual needs, institutional and cultural barriers to wellbeing, as well as systems issues which propagate distress
There is growing recognition that wellness interventions should occur in concert with an integrated and contextual wellness strategy — one that attends to individual needs, institutional and cultural barriers to wellbeing, as well as systems issues which propagate distress [3]
SMART-R is a skills-based stress-reduction program that teaches junior residents to identify their own early stress responses, de-stigmatizes common distressing emotional experiences and environmental stressors unique to junior doctors, and promotes self-efficacy through development of adaptive coping skills and perspectives. This curriculum has been implemented in diverse institutions and specialty residency programs, and it was well received by junior residents [5]
Summary
There is growing recognition that wellness interventions should occur in context and acknowledge complex contributors to wellbeing, including individual needs, institutional and cultural barriers to wellbeing, as well as systems issues which propagate distress. The authors conducted a multiple-methods study exploring contributors to wellbeing for junior residents in diverse medical environments who participated in a brief resilience and stressreduction curriculum, the Stress Management and Resiliency Training Program for Residents (SMART-R). There is growing recognition that wellness interventions should occur in concert with an integrated and contextual wellness strategy — one that attends to individual needs, institutional and cultural barriers to wellbeing, as well as systems issues which propagate distress [3]. We report the results of a multiple-methods study of a skills-based, peer-facilitated group curriculum that teaches stress awareness, exposes common thought distortions propagated by the culture of medicine, and introduces positive coping skills (mindfulness, adaptive perspective taking). We sought to better understand the subjective experience of residency training across diverse groups of residents in different hospital settings, residency programs, and in diverse specialties, recognizing that the time allocated for formal wellness or stressreduction curricula is only a small part of residents’ overall experience
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