Blogger: Sumit Bhargava, MD
About the blogger: Dr. Bhargava is Clinical Associate Professor of Pediatrics, Stanford University. He is board certified in Pediatric Pulmonology and Sleep Medicine and serves as the Medical Director, Lucille Packard Children’s Hospital Sleep Laboratory. He has a strong interest in medical education and serves as an Educator 4 CARE at the Stanford School of Medicine. His research interests include medical education and pediatric sleep medicine, with a focus on pediatric obstructive sleep apnea.
Citation: McKenna, K.M.; Hashimoto, D.A; Maguire, M.S.; Bynum IV, W. E.
Academic Medicine Issue: Volume 91(9), September 2016, p 1197–1199
DOI: 10.1097/ACM.0000000000001311
ISSN: 1040-2446
Accession: 00001888-201609000-00013
Article: The Missing Link: Connection Is the Key to Resilience in Medical Education.
Why this article:
Over the past few years, multiple publications have characterized persistently high and increasing rates of burnout, depression, and suicidality in physicians. Regulatory authorities and training programs have responded by imposing duty hour restrictions and a variety of programmatic initiatives to enhance wellness. These initiatives primarily involve activities outside the hospital implying that physicians cannot find joy and fulfillment in their work and must seek it elsewhere, to reduce the risk of burnout.
This commentary is focused on how to find fulfillment within work, rather than outside it. The authors propose that human connection with other colleagues may enable the long hours of emotionally draining, physically exhausting work to be both meaningful and personally rewarding. They propose that connection with each other will foster mutual trust and increase bonding between physicians that share adversity and endure stress together. The authors, resident physicians themselves, identify shift work, the demands of the electronic medical record (EMR) and duty hour restrictions as undermining interpersonal connection and professional satisfaction. They propose that simple interventions such as protected time and space to gather at work without faculty, the creation of peer mentoring programs and training in effective use of the EMR and other technology may lead to physicians and trainees finding value and meaning in the work they do.
This meaningful commentary reminds us that the regulations and technology that were meant to improve physician wellness and patient’s safety may not necessarily do so. Duty hour restrictions, with the imperative to ‘sign it out” may erode personal responsibility in complex, stressful medical situations which are ideally managed by the primary resident caring for the patient. While stressful and demanding, it is these very situations that deepen trust between the doctor and patient and connect practitioners to the core values of their profession, reaffirming the reasons why they chose to become physicians in the first place. It is these interactions that allow physicians in training to truly realize their indispensable role in patients care, in contrast to perceiving themselves as “shift workers”. Notably, there are no duty hour restrictions for attending physicians and perceived generational differences in training can only add to hierarchical tensions in our training programs. Furthermore,the demands of the EMR reduces the time available to connect with patients, families and each other and only deepens the sense of disconnection many physicians feel from their chosen path. Perhaps, it is time to realize that our life and our work are too intertwined to be artificially balanced and focus on nurturing personal connections, thereby increasing well-being at work and making our work a functional, enjoyable part of our lives.
