UTSW offering students, residents tools to tackle burnout
By Patrick Wascovich
Stress is part of both medical and graduate education, but leading academic medical centers across the country have recognized its accumulative downside and are working to address some of the factors that can sidetrack students’ and trainees’ paths to success.
“Medical school should be hard, residencies should be hard, because being a practicing clinician is hard. But we want to head off burnout,” said Dr. Blake Barker, Associate Dean for Student Affairs, during his “Grit and Resilience in Learners” presentation at June’s Internal Medicine Grand Rounds.
Centuries ago, metallurgists in Asia – embracing the philosophy that the finest steel had to go through the hottest fire – made weapons unsurpassed in holding their razor-sharp edges. The heat, along with quick quenching in a liquid bath of water or oil, produced the hardest metal. But it also was brittle, they found. The solution was tempering, the process of reheating the hardened steel to a temperature below the critical point and then allowing it to slowly cool in still air before fashioning it.
Today’s education and training are introducing tempering to their processes as well. Stress should never hit the critical point, Dr. Barker said, and there must be programs and resources available to cool down. Every student and resident will inevitably go through stress, but institutions have to develop and provide tools and training to identify and effectively thwart potential burnout. Among medical students, demonstrated contributors to stress include testing (specifically, percent of time taking tests) and the grading scale.
“Times of stress often come down to a negative situation or outcome and an internal message of ‘What are you going to do next?’ ” said Dr. Barker, also Assistant Professor of Internal Medicine. “For that, you have to go back and use the personal and environmental factors that helped you get through before.”
Beginning this fall at UT Southwestern Medical School, first- and second-year students will have a new required course, “Strive: Personal and Professional Development for Careers in Training.” Instruction will include some of the universal factors that lead to stress and various strategies to deal with them.
“The Strive course will include curriculum on wellness, leadership, cultural competency, financial management, time management, conflict resolution, and career exploration,” said Dr. Angela Mihalic, Associate Dean for Student Affairs and Professor of Pediatrics.
UT Southwestern’s three-level medical curriculum – specifically its opening pre-clerkship phase – has alleviated the stressful grade-point average chase since the Class of 2019 arrived on campus two years ago.
“We are now pass/fail in the pre-clerkship phase,” Dr. Mihalic said. “This was implemented to address issues of stress in medical school and to foster teamwork and collaboration.”
The new curriculum also teaches pre-clerkship blocks of instruction and now switches educational gears quicker by introducing clinical clerkships to second-year students six months earlier than previous classes.
“That makes sense,” Dr. Barker said. “Students benefit from being able to directly participate in the practice of medicine at an earlier stage. We all want to pick a ‘tribe’ and begin the process of identifying a specialty to practice.”
Institutionally, UT Southwestern also will official launch a new Resident Wellness Center in the coming months. Dr. Preston Wiles, Professor of Psychiatry, and Dr. Alyson Nakamura, Associate Professor of Psychiatry – who were involved in the Center’s planning – said the facility will provide needed mental health resources for residents, such as counseling, mindfulness classes, and support groups.
The initial focus of the Resident Wellness Center is to address acute mental health and crisis management issues, Dr. Wiles said, but the scope of service can expand as the Center becomes more established. As planned, two psychiatrists will initially offer services, with a psychologist and a social worker onboarding soon afterward.
The Resident Center’s staff already is working with the chief residents in Pediatrics and in Internal Medicine, Dr. Wiles said. “Residencies can be a tough environment where the perception is you can never take a day off, you can never get sick. Medical professionals often are bad at recognizing their own problems and issues,” he said.
Dr. Barker said today’s educational and training processes need to include assessments, observations by invested faculty members, and self-reporting. Internal medicine residents at UT Southwestern, for instance, now use a new screening tool developed by Dr. Salahuddin “Dino” Kazi, Professor of Internal Medicine and the Department’s Vice Chair of Education, and Dr. Shannon Scielzo, Assistant Professor of Internal Medicine, which works to identify residents in potential distress. This well-being assessment “Fuel Gauge” breaks down identifiable areas of need or concern before they can fester.
Dr. Wiles holds the Drs. Anne and George Race Professorship of Student Psychiatry.