Residency Training with a Side of Wellness

It’s a crisp, bright Sunday morning in Palo Alto, and over a dozen residents have congregated at the entrance to the Dish, a satellite structure reached by a popular 3.9-mile hiking trail that winds through the foothills behind Stanford’s campus. They’re joined by Bob Harrington, MD, the Arthur L. Bloomfield Professor of Medicine; Angela Rogers, MD, assistant professor of pulmonary and critical care medicine; Shriram Nallamshetty, MD, clinical assistant professor of cardiology; and several staff members from the Internal Medicine Residency Program.

This group has gathered for the pleasure of exercising and socializing, of course, but also to recognize the importance of well-being.

Over the last year, events like this one have happened with increasing frequency. They’re part of a new initiative called REACH (Resiliency, Education, Advocacy, Community, Health), which is committed, broadly, to resident wellness.

It’s no secret that medical residency training is intense, and the structure — long hours, compromised sleep, packed schedules — leaves little time for self-care. REACH, Karina Delgado-Carrasco, the residency program manager, says, is designed to help mitigate these stressors.

The program began as many in academia do: with a review of current research on the topic. “We read lots of publications on residency wellness and identified several domains that we wanted to cover,” Delgado-Carrasco details. These findings were shared and discussed with the Internal Medicine Residency Wellness Committee — composed primarily of current residents — and “everyone we identified as important to resident well-being.” The result? A multifaceted approach to wellness and burnout built on five pillars that Delgado-Carrasco believes “touch different aspects of residents’ lives.”

ROBERT HARRINGTON, MD (far left) and ANGELA ROGERS, MD (far right) hike alongside residents.

Fostering RESILIENCY with Laughter

Resiliency — the ability to recover, and learn from, stressful circumstances and adversity — is a prized characteristic in the medical field, and one that’s difficult to cultivate during stressful residency years. REACH is taking steps to change that through a monthly lecture series entitled “Residency Resilience” and other initiatives.

“Building resiliency skills can help prevent burnout and also promote a consistent feeling of wellness,” notes Neera Ahuja, MD, clinical professor of hospital medicine and associate residency program director. “A large part of resilience is being able to see life through a positive lens: being optimistic about the future and believing that one can overcome any obstacle and learn from the process.”

A key component to fostering this mindset, Ahuja explains, is to “seek and savor positive moments throughout one’s day.” To that end, the REACH program strives to “creatively sprinkle” exciting team-building activities throughout a resident’s work day. These moments create an opportunity for house staff to “laugh and bond together — even for only 15 minutes before returning to the wards — which can have a lasting, positive impact.”

Prioritizing EDUCATION through Mentorship

Faculty mentorship is seen as a way to supplement residents’ education and propel them into successful professional and academic careers. Mentors meet with mentees throughout a resident’s career, collaborating on research and providing career guidance. Other events, like the first-ever Residency Research Symposium, provide a forum for trainees to share their work with the broader Stanford community.

Supporting ADVOCACY by Providing a Seat at the Table

Through internal REACH advocacy committees, such as the Committee on Residency Reform and the Diversity Group, residents are provided avenues to effect change and make their voices heard.

“The committee is composed of elected resident class representatives, chief residents, and program directors and administration,” says Ron Witteles, MD, associate professor of cardiology and the residency program director. “It allows for a true ‘ground-up’ approach to program reform and is designed to turn feedback quickly into action. Residents work really hard; it’s important for them to know they have an outlet to effect change.”

Additional opportunities for advocacy abound and extend beyond the Stanford campus: A new diversity lecture series trains residents to better care for diverse patients, and tracks like Homeless Outreach and Social Medicine prime residents to care for the broader Bay Area community.

The group stops for a photo in fron to fthe dish satellite structure

Building COMMUNITY over Quality Coffee

On September 28, 2018, as bleary-eyed residents filed into Stanford’s Grant building for their morning report, they were met with a small surprise: artisanal coffee that had been brought in for them to celebrate National Coffee Day. Another morning, they received boba tea. At a scheduled lunch, unknowing residents were paired to complete an Amazing Race–style scavenger hunt all over campus.

These events, known informally as “pop-ups,” are an important tenet of REACH and have a marked positive impact on residents. Delgado-Carrasco explains the thought process behind these small gestures: “It’s about surprising residents to show that we appreciate them, to let them know that we know how hard they’re working.”

Other, larger events — like free tickets to Stanford’s homecoming football game — are specifically designed to connect residents with each other and the community around them, to carve out space for them to build rapport.

“These events bring people together so they can meet and support each other,” Delgado-Carrasco says. “That’s how we build community.”

Caring for Residents’ HEALTH on — and off — the Yoga Mat

REACH provides myriad ways for residents to care for their physical — and mental — health. Yoga aficionados will have the opportunity to unroll their mats and take a private yoga class taught by Ahuja later this spring. And each year, residents can lace up their sneakers and hit the softball field with their families, interns, program directors, and faculty for annual softball days. “It’s fun to get everyone and their families out to that event,” Delgado-Carrasco says.

REACH prioritizes mental health by clearly communicating available resources and destigmatizing the process of asking for help. Delgado-Carrasco elaborates: “We let all the residents know what’s available to them through Stanford Hospital — like access to mental health programs and wellness coaches. We post these resources on a poster board every day. We want them to know that if you need to reach out to someone, there are people — and resources — available.”

At the end of the Dish hike, residents, faculty, and program administrators chat with each other before heading home to enjoy the rest of their respective weekends. Pictures from the event broadcast the group’s enthusiasm — everyone has wide grins and cheeks flushed from outdoor exercise. This happy image is one Delgado-Carrasco is committed to continuing as REACH looks into the future. “We’re committed to supporting our residents during their time here and promoting their wellness, and we want them to know that everyone is invested in their well-being.”