What If Training Programs Affirmed Their Commitment to Resident Well-being by Assigning Wellness Associate Program Directors?

Hustle culture is deeply pervasive in the medical community, and many believe that conversations about “wellness” are synonymous with “weakness.” However, wellness is multifaceted and is one of the most commonly inquired topics during residency interviewers. Traditionally, wellness programs within residencies involve outings away from the hospital settings, such as dinners, kayaking, canvas painting, or such. However, the need to evolve such efforts aligned with personal and professional needs is essential. While socialization is an essential component of resident wellness, this is not nearly sufficient to safeguard physicians-in-training from burnout and support them in becoming well-centered providers. In this article, topics ranging from why resident wellbeing programs are needed as well as considerations for developing a resident wellbeing program are provided.

Hustle culture is deeply pervasive in the medical community, and many believe that conversations about "wellness" are synonymous with "weakness." However, wellness is multifaceted and is one of the most commonly inquired topics during residency interviewers. Traditionally, wellness programs within residencies involve outings away from the hospital settings, such as dinners, kayaking, canvas painting, or such. However, the need to evolve such efforts aligned with personal and professional needs is essential. While socialization is an essential component of resident wellness, this is not nearly sufficient to safeguard physicians-in-training from burnout and support them in becoming well-centered providers.
Specialties have promoted wellness activities over the years and even focused on wellness weeks, such as Obstetrics and Gynecology (OBGYN) programs through the ACOG National Wellness Week. Additionally, many have augmented their support by encouraging these activities through funding. However, engagement and support vary markedly among specialties, programs, and institutions with no set annual or curricular expectations outcomes in mind. Although many have considered this activity a responsibility of the residents, residency and departmental leadership are critical for normalization of the conversation, focusing efforts, and demonstrating objective support of wellness programs . Five years ago, the Department of OBGYN at a large midwestern institution formulated a wellness program addressing such efforts. This significant change was implemented based on a quality improvement project aimed at identifying problems perceived and solutions devised by residents . Common themes identified included the timing of addressing wellness, misalignment of departmental wellness efforts whether based on need, effort, or modality used; and the need for attention to personal and not just group health. Specifically, most residents were not up to date on their preventative care needs, such as annual or dental exams. The irony of medical professionals not main taining their own self-care was markedly prevalent among many programs surveyed . Since a resident's vacation is most often spent visiting with loved ones, recuperating, or otherwise, our team hypothesized that protecting an afternoon in each quarter well in advance would improve and assure the ability of residents to schedule preventative health visits . This protected time was coined as the "Half-Day HealthDay." OBGYN, like many other specialties, includes significant mental stress that is not only physical, and thus the wellness effort was expanded to focus on mental needs 2 based on stressors encountered . Thus, physical and mental health were each addressed with separate half-day wellness days. Since the onset of this project, the OBGYN faculty widely supported it implementation while having exceptional appeal to the residents.
This was the first step in developing the wellness program in the department; however, its maturation occurred when faculty who were assigned specific time allocations, and accordingly expectations, were integrated to ensure the program's success. The residents were engaged directly in the design of this program from the input, development, and maintenance standpoints permitting for identification of desired expectations of the faculty. This resulted in the inception of the Wellness Assistant Program Director (Wellness-APD) position. The next step was identifying the faculty with genuine interest and dedication to wellness and empowering them to effect the change. The steps outlined in Table 1 summarize specific actions that were originally allocated to this faculty member at the onset of the program.
As wellness is multifaceted, evolving, and individualized, mentorship was identified as an important part of the program. The three-pronged approach was used (Program Director, Wellness-APD, and Mentor) for assuring wellness became the norm. Formal faculty mentorship allocation, assignments, and expectations were then devised. For incoming interns, these residents were given a short questionnaire to match them to a faculty member of similar interests. . This proactively started shortly following MatchDay. This permitted for early engagement of mentors with the new residents as well as added support for fellowship aspirations, if relevant. This relationship was also individualized based on the mentor-mentee goals, with meeting frequency varying on each grouping. Wellness-APD support was also provided through emails with proposed topics of discussion (ex. conflict resolution, goal setting, giving-and-receiving feedback), which were shared as potential launching points for conversations. Additionally, the communications included podcasts and articles to support the topics at hand. The Wellness-APD followed up quarterly with gentle reminders to assure that both sides were, at a minimum, touching base. Biannual assessment of progress, communicated with the program director, was incorporated in the mid-year evaluation meetings as the premise of such interactions was expanded to include performance, wellness, and support.
An additional duty of the Wellness-APD was the integration of monthly didactic topics focused on different components of wellness -mental, physical, financial, creative, career 1. Identification of a faculty member as a Wellness APD or as Wellness Advocate (Table 1)

5.
Resident representatives scheduling quarterly social or wellbeing outings with allocated funding 2. Identification of resident champions (one per class).

Matching mentors to Interns (and other residents) at beginning of the academic year
4. Incorporation of monthly professional development sessions with alignment of resident didactics 6. Incorporation of specialty-specific suggested and approved wellness curricula

Incorporation of "Health Day" models
Additional Considerations

Integration of wellness conversations into mid-year evaluations/ meetings
planning, outreach, etc. Guest lecturers from inside and outside of the department were integrated into these activities to maintain interest and engagement, thus enhancing the sessions' perceived value. These wellness lectures were also aligned with the academic schedule in a way to safeguard the portion of the academic year focused on in-service exam preparations.
Unlike the specific academic, medical, or surgical expectations within residency programs, the goals of wellness programs often lack concrete objectives. However, programs addressing such care need to be fluid and responsive to the needs of each specific program . Integrating a Wellness-APD with protected time assigned to ensuring resident wellbeing was a valued move as reported by faculty, residents, and applicants. The culture shift took more than six (6) simple steps mentioned in the table attached, as normalizing the conversation of wellness, and demonstrating support for this concept was vital for actual progress.
As the program matured, the Wellness-APD also started engaging the faculty from both wellness and professional development aspects. Ensuring their wellness was evident as critical to the team's well-being. While engaging both faculty and residents may seem daunting as an undertaking; however, having a platform to implement, devised over time according to departmental needs, would help with satisfaction and retention of those involved as 4 5 North American Proceedings in Gynecology & Obstetrics Fall 2022 well as with formal surveys whether institutional or of ACGME origin. Although opponents of assigning a Wellness-APD would focus on the potential portion of FTE needed as well as the resources necessary to help make such a person successful, the benefits to the department may offset the lesser financial implications associated.
It does seem that Wellness-APDs need to become a commonality, possibly a standard. ... After all, resident wellbeing is a critical indicator of the inherent candor, support, and security that departments and the graduate medical education construct offer to trainees.