Family Medicine Vital Signs

By: Katherine Fortenberry, PhD; Jordan Knox, MD; and Sonja Van Hala, MD, MPH, FAAFP

Previously published in Academic Medicine, March 2018

Dr. Ripp and colleagues’ recent call to action on well-being in graduate medical education emphasizes the importance of multilevel interventions in addressing well-being. We concur with these recommendations but want to emphasize the importance of considering residents’ voices when addressing wellness.

The University of Utah Family Medicine Residency Program has incorporated wellness longitudinally into the curriculum through a variety of mechanisms including protected support groups, structured wellness check-ins, and mindfulness training.

Even with these changes, residents continue to report burnout and depression symptoms at higher rates than program leaders would like, leading to the question, What do residents want for burnout prevention?

During a recent resident meeting, we authors asked, “What else could our residency program do to support wellness?” Using a nominal group technique, residents shared their ideas, without filtering, then weighted their top eight priorities.

What emerged was that residents overwhelmingly prioritize time. Almost half (n = 35; 42%) of all resident votes supported increasing time for personal and professional needs. Residents want more time for self-care (i.e., going to the dentist, exercising, and getting adequate sleep), as well as for patient care (i.e., completing notes, managing patient panels, and reading about challenging cases). While residents endorsed other aspects of wellness (e.g., mindfulness training, expanding support groups, and receiving snacks or meals) as important, they indicated—through both the number of raters selecting time and how highly they rated it—that having adequate time was most critical.

While we conducted this survey to improve our own residency program, we suspect that the theme of more time runs across residencies and settings. Wellness interventions designed, for example, to improve mindfulness skills or provide a sense  of meaning cannot correct work schedules and responsibilities that allow little time for anything else. When baseline needs of adequate sleep and self-care are not met, the capacity for self-actualization is limited. The strained, moment-to-moment mentality many residents experience does not permit introspection, processing of emotions, or learning from challenging patient encounters and may be a leading factor in dissatisfaction with medical careers. The U.S. system of training normalizes overcommitment. Now is the time to open a conversation about redesigning medical training to reflect what we physicians and physicians-in-training— all of us, as people really need: time for work and time for life.

Katherine Fortenberry, PhD, is currently an Assistant Professor (Clinical) in the University of Utah Division of Family Medicine, where she serves as the Behavioral Science Education Director and sees patients at the Madsen and Sugarhouse Family Clinics. 

Jordan Knox, MD, is a third-year resident in the University of Utah Divison of Family Medicine and practices at the Sugarhouse Clinic.

Sonja Van Hala, MD, MPH, FAAFP, has served as Program Director of the University of Utah Family Medicine Residency Program since 2005 and is a board-certified family medicine physician who welcomes obstetric, pediatric, and family medicine patients to her practice.