Mayo Clinic
Rochester, MN

Program Type: Pulmonary/Critical Care

Abstract Authors: Nicholas Braus, MD, Diana Kelm, MD, Joseph Skalski, MD, Roberto Benzo, MD,

Jeff Rabatin, MD, Kannan Ramar, MD

Description of Fellowship Program

The Pulmonary and Critical Care Medicine Fellowship at Mayo Clinic's campus in Rochester, MN is an ACGME-accredited 3-year program that emphasizes clinical training and research and customizes training depending on individual career goals. Mayo Clinic's 56 staff pulmonologists and intensivists serve as teachers and mentors to 18 fellows. Fellows spend up to 23 months rotating through clinical services and at least 13 months conducting mentored research.

Abstract

Background

Physicians specializing in pulmonary and critical care medicine (PCCM) face stressors in their daily practice putting them at high risk of burnout. There is a growing interest among trainees, faculty, and professional societies in developing ways to prevent burnout and promote well-being among trainees. Reading literature has been shown to improve participants’ social perception and empathy, which are crucial to emotional intelligence and wellbeing. We therefore developed and piloted a book club for PCCM fellows to cultivate well-being by encouraging self-reflection and social relatedness.

Methods

The study team identified When Breath Becomes Air by Paul Kalinithi as a suitable title for the first meeting. The book—a posthumous memoir of a neurosurgery resident diagnosed with terminal lung cancer—was intended to resonate with participants’ clinical experiences caring for patients with advanced lung disease, as well as their personal encounters with adversity and loss during the rigors of training. Copies of the selected title were made available to all participants at least two months before scheduled book club date. The discussion was sponsored by the fellowship program, but kept informal and held off-campus at the personal residence of a faculty host. All PCCM fellows were invited. The discussion was conducted over a family-style dinner. A shared meal was intended to better denote a departure from work, and encourage group cohesion through the familiar rituals of sharing food. One day later an electronic survey was distributed to all fellows in attendance.

Results

Out of 19 fellows invited, 10 attended the book club (53%) along with three invited faculty to help moderate the discussion. Survey response rate was 100%. Overall satisfaction with the book club and the selected title were high, with median scores of 2.5 and 1, respectively (0=very satisfied, 100=very dissatisfied). All ten participants noted that “peer discussion” was one of the most beneficial aspects of the book club. Other beneficial aspects cited frequently included “meeting with colleagues after hours” (9), “self-reflection on themes relevant to personal life” (8), and “self-reflection on themes relevant to clinical practice” (8). Most participants agreed that the format of the discussion was conducive to good discussion (median score 5, IQR 0-24; 0=strongly agree, 100=strongly disagree). 60% of participants reported that participating in the book club had changed or influenced their clinical practice. Elaborating on those changes, fellows reflected that it “encouraged building true relationships with peers and patients” and highlighted “the balance of personal life, devotion to clinical practice and the necessity to have a dynamic open communication to maintain this balance.”

Discussion

The results of our pilot suggest that an informal, off-site, fellowship-sponsored book club is feasible, well attended, well received, and may buttress trainee wellness while enriching clinical practice. Improving and further validating this wellness intervention will require additional inquiry into the genre and title selection parameters, optimal format and frequency for discussions, and the effects on various domains of trainee and faculty well-being.

References

1. Moss M, Good VS, Gozal D, Kleinpell R, Sessler CN. A Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health-care Professionals. A Call for Action. American Journal of Respiratory and Critical Care Medicine 2016;194(1):106–13.

2. Raj KS. Well-Being in Residency: A Systematic Review. Journal of Graduate Medical Education 2016;8(5):674–84.

3. Kidd DC, Castano E. Reading literary fiction improves theory of mind. Science 2013;342(6156):377-80.