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Wellness: Building a Meaningful and Effective Program : Plastic and Reconstructive Surgery


Wellness. A word at the forefront of so many efforts and one that quickly loses meaning without concrete goals and tangible outcomes. James Baldwin wrote, “Not everything that is faced can be changed, but nothing can be changed until it is faced.” This quote motivated us to face the changes needed to demonstrate our commitment to resident wellbeing.

Our wellness leader is a patient-facing social worker who was previously involved in resident wellness efforts within another department. Of critical importance is that she is in no way an evaluator of our residents. The confidentiality and objectivity afforded in wellness interactions lead to trust and honest communication, and having a resource familiar with the institution of residency significantly reduces barriers to participation. By virtue of her profession, our facilitator is familiar with resources for psychosocial support and is able to facilitate referrals, meeting our goals for continuity and follow-through.

To make this program a reality, we needed buy-in on multiple levels, from division support for funding to program director and faculty willingness to participate in change efforts. Most importantly, the residents themselves need to believe that wellness efforts are more than a gesture and to partner in its success.

We set core goals, a primary one of which is to offer wellness intervention during protected time. We elected to include this program in our weekly teaching sessions to ensure resident availability and transparency regarding required participation and, most importantly, to avoid creating another demand on resident time. Including wellness in the core curriculum also contributes to normalization and an overall cultural shift toward prioritizing this component of the residency experience.

We knew that no one intervention would resonate with each individual resident and were prepared for variability in engagement, and even the occasional eye roll, as we began a wider discussion and trialed various approaches. The program is designed to include small group sessions, whole-residency meetings, and 1:1 intervention. No faculty, including our program director, are present for sessions, unless they are invited. Confidentiality, and its limits, are reviewed each time. Our facilitator works toward a dynamic and adaptable agenda to meet expressed needs in real-time with an eye toward solution-focused action items and a plan for follow-up after every encounter.

How will we know this is “working”? Without turning our residents into a study and to mitigate survey fatigue, we plan to evaluate our program with existing metrics, including the Accreditation Council for Graduate Medical Education Wellness Survey, utilization of 1:1 hours, and completion of resident-motivated projects. The last of these has been an evolving product of various sessions in which residents and the facilitator have formulated proposals and seen them through to implementation.

Plastic surgery residents are amazing. Over a period of several years, they go from running a simple subcuticular to reconstructing patients from head to toe. During their training, residents also experience the many highs and lows of life outside of the hospital walls. A wellness program is just one step toward supporting the whole resident, to improve the culture of medicine and the wellbeing of those who practice it.

DISCLOSURE

The authors have no financial interest to disclose in relation to the content of this article.

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