“Think back to your last two or three blocks. Did you have a troublesome encounter? Were you faced with a difficult diagnosis, or a challenging interaction with a patient, family or staff member? Explore how this encounter affected you.”

These are the questions that Dr. Ricardo Viana asks as he leads a group of residents in the Department of Physical Medicine & Rehabilitation (PM&R) through a reflective practice session.

During the session, residents use stream of consciousness writing to dive deeper into their actions and feelings, analyze biases that they brought to the encounter and look at the scenario through another lens.

It’s a practice they will carry with them throughout their careers.

Taking place at least four times a year, it is just one wellness initiative that has become a formal part of the residency curriculum in the Department this past year.

Dr. Steven Macaluso, the Department’s Director of the Postgraduate Medical Education program, says that the Department has always been focused on wellness, but identified a need to more formally integrate the activities into the curriculum.

In a 2019 systematic review, “Burnout Among Specialists and Trainees in Physical Medicine and Rehabilitation,” published in the Journal of Rehabilitation Medicine, Drs. Viana and Ali Bateman, PGY5, PM&R, found that more than half of all rehabilitation doctors, including specialists and trainees, experience burnout. This rate is higher in PM&R than it is in other non-rehabilitation specialties. “Working in PM&R is a unique risk factor among doctors,” they wrote.

With a strong understanding about the challenges that come from and can contribute to a lack of wellness, the Department made changes to its curriculum.

Using a people-first philosophy, they began to build on the already rich culture of wellness in their work environment.

“Wellness is important to health systems, the organization and most importantly, to patients. Providers need to be well themselves in order to care for others,” said Dr. Macaluso.

• “Wellness is a broad term and encompasses a lot. Residents have different needs and we wanted to be responsive to those needs. We felt it was important to teach people how to do wellness. This is a skill they build on and use throughout their career.”

  Dr. Steven Macaluso, Associate Professor, Physical Medicine & Rehabilitation

In addition to the reflective practice sessions, the Department has set up four resident half-days with protected time for the learners. Ideas for the activities, which tap into mental and physical wellness, are proposed by the residents themselves. This past year, as part of their half days, they have learned how to ‘bob’ and ‘weave’ through a kickboxing class, discovered how to make traditional dumplings and enjoyed a meal together at a local restaurant.

“Having these sessions integrated into the schedule is important,” said Dr. Bateman. “In this Department, we feel well supported by our faculty and our Chair/Chief and their investment demonstrates their commitment to wellness.”

Dr. Macaluso says the goal with the curriculum is to expose the residents to as many tools as possible, so they can take what works best for them and use it throughout their career.

That was the philosophy behind a wellness half-day session that the Department developed alongside their colleagues from the Department of Psychiatry.

The day was planned by Drs. Viana and Bateman, along with Dr. Jonathan Gregory, a resident in Psychiatry. It offered sessions focused on the evidence-based impact of burnout, the importance of wellness, an exploration of strategies to help deal with burnout, along with workshops on meditation and gratitude.

Residents have responded positively to the incorporation of wellness into the curriculum and their ongoing feedback will guide future changes. Dr. Macaluso says that the short-term plan is to get feedback from the current residents and determine how they will move forward next year.

“Formal wellness days, reflective practices and a quality improvement day on wellness will continue,” said Dr. Macaluso. “And it is just as important that we continue to introduce new ideas and wellness tools – which we hope will be brought forward by our residents and staff.”