The Incorporation of Stress Management Programming Into Family Medicine Residencies—Results of a National Survey of Residency Directors: A CERA Study

摘要

Background and Objectives: Residents’ stress and burnout is a concern among family medicine residency programs. Our objective is to assess stress management options available to family medicine residents.Methods: In 2012, the Council of Academic Family Medicine Educational Research Alliance (CERA) e-mailed a survey to US residency directors. Questions were asked on four types of stress management programming (SMP): (1) access to counselors, social workers, or mental health providers, (2) residency support or Balint groups, (3) stress management lectures or workshops, and (4) residency retreats. We assessed how many programs contained all four types of SMP and their relationship to the following topics: stress management techniques for patients, spirituality, mind/body techniques, and self-care for residents.Results: Of the 212 responses, 29% reported having all four types of SMP. Eighty-three percent reported stress management lectures or workshops, and 79% reported residency retreats. Smaller and mid-size residencies (36%) and residencies in the West (36%) were more likely to have all four types of SMP. There was a correlation between having didactics, clinical rotations, and electives on stress management techniques for patient care and having stress management lectures or workshops for residents. There was statistical significance between having resident self-care curriculum and (1) having retreats and (2) stress management lectures or workshops.Conclusions: It is necessary to evaluate whether residency programs are providing appropriate stress management skills for residents that will improve physician wellness and patient outcomes.(Fam Med 2015;47(4):272-8.)It is well researched that residency is marked with increased stress levels.1-3 Sleep deprivation, long work hours, increasing complexity of patient health issues, debt, and high levels of responsibility all affect resident mental and physical health.4,5 Decreased resident well-being and increased prolonged stress during postgraduate years leads to depression and burnout among residents.6-9 In a survey distributed to first-year family medicine residents, researchers found that 23% of residents scored in a range consistent with depression risk, 14% scored in the high emotional exhaustion range, and 24% in the high depersonalization range.10 In one study, 76% of internal medicine residents met the criteria for burnout.9 To assess the state of family medicine residency programs in addressing resident stress, this paper reviews the current state of implementation of stress management services and programming in family medicine residency.When physicians pay less attention to their well-being and stress management, patients become at risk for medical errors related to physician burnout.11,12 For example, a study found that resident fatigue and stress is associated with self-perceived medical errors among internal medicine residents.12,13 Consequences of decreased resident well-being can influence patients directly as well as job performance.14 Physicians who are stressed may exhibit hostility toward patients and have difficult relationships with coworkers.15 Burnout is also related to low job satisfaction, high rates of absenteeism, and job turnover.10 By consistently providing physician stress management skills, appropriate mental health support, and resilience training, residency programs can optimize physician performance and decrease medical errors.16The Accreditation Council for Graduate Medical Education(ACGME) requires that residency programs make assistance services available for residents to address stressors.5 Traditionally, in residency settings, stress management has been reinforced through the use of assistance programs such as Balint groups, mental health providers, support groups, and residency retreats.5 In addition to assistance services, little is known about the other types of stress management programming offered in family medicine residencies, the charac