As residents we get bombarded with resources & info abt “wellness”.

But there’s often a mismatch between institutional discourses of #residentwellness & and learner-generated discourses.

We often point out what wellness is NOT. So what IS “wellness”?

Welcome to my thread

I research discourses of wellness in medical education using critical social science methods. We look at how language & social practices reproduce & legitimize the way we understand specific phenomena. How do “wellness” discourses perpetuate cultural norms of the “good resident”?

But when I talk to co-residents about what actually contributes to our wellbeing, it’s harder to point to something specific — & something that we can change within our programs. Here are some thoughts ~~ would love to hear yours

1. Wellness as a sense of psychological safety. That’s the ability to bring up problems to the team without feeling judged, feeling cared for as a person on our clinical teams. https://pubmed.ncbi.nlm.nih.gov/31365407/ 

How do we get that? Dedicated orientation time to actually get to know our teams when we start a rotation? Faculty development? Protected time for getting to know our interprofessional teams & their roles?

2. Feeling represented among your peers, based on race, gender identity, sexuality, disability, religion, socioeconomic background.

We can get there with admissions and recruitment strategies with specific pathways for underrepresented applicants in medicine. (Shout out @cos_uoft!). & teaching that engages specifically, frequently & thoughtfully w intersections of identity with care & professional identity.

3. Feeling your program actually meaningfully supports diversity and social justice in its stance on public issues as well as recruitment/hiring practices for faculty. Needs to go beyond mission statements.

4. Access to mentorship from diverse faculty, with attention to supporting & providing opportunities to residents who are underrepresented in the program and medicine more generally.

5. A sense that the program listens to our feedback, and considers & incorporates it thoughtfully, and is transparent about decisions about program changes.

6. Dedicated time and space to consider ethical issues in our work. This is especially the case in psychiatry!! Getting to debrief about responses to agitation, restraints, and coercion is important.

7. Feeling supported as a parent, if you have kids. Residents need transparent policies around parental leave, return to work, call policies, and space for pumping breast milk.

8. Feeling a sense of meaning in the work we do. Ironically for many of us COVID has actually *increased* our sense of meaning at work — so many people have stepped up & volunteered to be redeployed to areas of need or to cover extra shifts.

9. Time to attend to personal mental & physical health. This is a big one. We need time to access appointments, and systems in place to give residents that time, especially when many specialist clinics only operate during work hours.

10. Transparent & robust accommodations policies, with a disability service provider who has expertise in clinical accommodations and does not function in an evaluator role in the program. This is based on @AAMCtoday recommendations: https://store.aamc.org/accessibility-inclusion-and-action-in-medical-education-lived-experiences-of-learners-and-physicians-with-disabilities.html

11. Opportunities to give back as a mentor to more junior learners. This often happens informally, but what are more systematized peer-driven ways of providing peer mentorship?

12. Feeling a sense of belonging in your residency program. Do you feel connected to your co-residents? Are the social events in the program accessible to you based on hours, location, and access to protected time?

Anyway, this is just a start! So many ways to think abt wellness that go beyond ice cream socials (which are nice too! no shade to ice cream!). But when we ask for wellness from our programs, there’s so much more we can work on

Would love to hear what y’all are thinking about

I love this point! Thank you I completely agree. residency programs can feel v inflexible and it feels like much of the onus is left on the resident to reorient & reintegrate into the program (& maybe a new class). Would be so helpful to have policy & next steps laid out. https://twitter.com/SASmithMD/status/1272971837576826882

Thank you!! And 100% yes! Having programs actively check in with residents for feedback is so essential It’s been great to see some programs doing regular needs assessments on resident wellness https://twitter.com/janlambod/status/1273055805944795137

Completely agree!! Opt-out models for therapy for residents completely reframe help-seeking as expected and normalized! I loved of the example at @LACUSCMedCenter that @heathsweensMD tweeted last week

Do folks know of other programs organizing this for trainees? https://twitter.com/jonesmcella/status/1273274265714987008