- Email: [email protected]
Caring for Caregivers – Resident Physician Health and Wellbeing
ARTICLE IN PRESS ORIGINAL REPORTS
Caring for Caregivers Resident Physician Health and Wellbeing Ioana Baiu, MD, MPH, Ashley Titan, MD, Cindy Kin, MD, MS, and David A. Spain, MD Department of Surgery, Stanford University School of Medicine, Stanford, California OBJECTIVE: There is a national epidemic of physician
burnout and serious concerns exist regarding the wellbeing of future physicians. This project seeks to address resident physician health, by creating a sense of support and community during training, as a method to target one of the many facets of burnout. DESIGN: We created a program that allows residents who fall ill to receive a health package, delivered to work or home, consisting of essential medications, vitamins, nutrition, and hydration. The recipients were asked to answer a short survey regarding their experience. SETTING: Stanford Health Care, Department of Surgery, Division of General Surgery, Palo Alto California. RESULTS: Eighteen packages have been delivered since
the start of the project. One hundred percent of residents agree that this program fulfills an otherwise unmet need in residency. Similarly, all felt that the supplies they received helped them recover faster. The majority (83%) of the packages were requested by colleagues of the ill residents. CONCLUSIONS: We present an innovative project
aimed at improving resident physician health, fostering a feeling of support, and helping to reduce resident burnout. This is the first report of a program of this kind and we hope that it incentivizes a broader discussion and implementation of similar initiatives in other residency programs across the country. ( J Surg Ed 000:1 5. Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery.) KEY WORDS: Burnout, Resident wellness, Resident health COMPETENCIES: Professionalism, Interpersonal and
Communication Skills, Practice-Based Learning and Improvement
Correspondence: Inquiries to Ioana Baiu, MD, MPH, Stanford University General Surgery, 300 Pasteur Dr H3463, Stanford CA 94305.; e-mail: [email protected]
INTRODUCTION A 2019 report published by the Massachusetts Medical Society together with the Harvard Global Institute identified the current state of physician burnout as a national public health crisis.1 The pattern of burnout that starts during training carries through to practicing physicians. As much as 75% of residents have experienced burnout, but resident wellness programs have shown promising results.2,3 There has been a call for action directed by the Accreditation Council for Graduate Medical Education and the Clinical Learning Environment Review Program to prioritize resident wellness, requiring all training program to have assistance services available for all residents.4,5 A study of American resident physicians noted that 26% to 43% of participants had health-related problems that required medical attention, and that avoidance in seeking care was associated with poorer self-rated mental and physical health and greater health concerns.6 The biggest stressors faced by doctors include lack of support by colleagues, balancing work and home, and isolation.7 Physicians often push themselves to physical and emotional limits, without adequate support structures, thus risking personal wellbeing. In a cross-sectional survey of practicing clinicians, 95% of respondents agreed that they are putting patients at risk and that 83% worked while sick.8 Despite having access to free care, 25% of Canadian residents with chronic illnesses, and 40% of those who use prescription medications do not have a primary care physician.9 More than 40% of residents admitted to receiving or writing prescriptions from or for colleagues.9 The barriers to this phenomenon were quoted as knowledge, time, and accessibility to timely care. In this paper, we describe an intervention that allows residents to request a health package for themselves or others during times of acute illness. The goal was to provide residents with timely and easy access to basic supplies to alleviate their symptoms. Furthermore, we aimed to create a sense of community and support by having residents help each other, thus also combating a major cause burnout—lack of social support. Lastly, we hoped to challenge the deeply entrenched culture of self-imposed “toughness” by
Journal of Surgical Education Published by Elsevier Inc. on behalf of Association of Program Directors in 1931-7204/$30.00 Surgery. https://doi.org/10.1016/j.jsurg.2019.08.007
1
ARTICLE IN PRESS allowing residents to ask for help when ill without the threat of judgment.
METHODS The study protocol was reviewed and approved by the Institutional Review Board (IRB protocol number: 49840). Funding for this pilot was obtained from the Stanford HealthySteps to Wellness Team Grant from the Stanford WellMD Center. The money was used to purchase supplies and create health packages. Each bag included a 3-day supply of ibuprofen, acetaminophen, DayQuil, NyQuil, Airborne, Emergen-C, cough drops, a can of chicken noodle or vegetarian soup, Gatorade, tea bags, and masks. The cost per bag was approximately $7.00 and supplies were purchased from a large retailer at discounted prices. In addition, each bag contained a sheet of advice about care for oneself, as well as administration instructions and expiration dates for each medication (Appendix 1). The caregivers were all volunteers who were not incentivized or reimbursed for their work. These included surgical residents in their clinical and research years, as well as faculty and their spouses. Having a wide variety of caregivers was important in order to maximize their availability to deliver a package. Each volunteer was provided with several bags that were prepackaged by a group of residents. Deliveries home or at work were organized based on the availability of the volunteers on a case-by-case basis. A listserv email account and text messaging group were created and advertised widely through fliers and e-mail announcements. Residents who fell ill or their colleagues could send an e-mail or text to the designated address to request a
package. The package was then delivered to the ill resident’s house or directly at the hospital within a few hours. If residents requested a package for a classmate, they would have the option to deliver the package themselves. The caregiver then checked on the resident for the next few days until they felt better. A week after the delivery of the package, the recipients received a brief 5-question survey through SurveyMonkey (Appendix 2).
RESULTS Eighteen packages have been delivered over the course of 2 months since the start of the program, 16 of them at work and 2 at home. Fifteen (83%) of the packages delivered had been requested by colleagues. The response rate on the survey was 100%. Sixty-one percent of residents reported that they fall ill 1 to 2 times/year, while 39% are ill 3 to 4 times/year, and none more than that. 100% of residents answered that they felt the program addressed an unmet need for themselves and others. Similarly, 100% of residents noted that they felt that the supplies they received helped them feel better while sick. The written responses were extremely positive, commenting on the fostering of a sense of community and feelings of support (Table 1).
DISCUSSION Despite extensive research, burnout in medicine is an incredibly complex problem without one simple solution. Engrained from very early in training, the pervasive culture of self-sacrifice often drives physicians to surrender their own well-being for the benefit of humanity. We
TABLE 1. Examples of Resident Comments This program literally saved me. In my 7 years of residency, I had never before felt unwell enough that I couldn't take care of my own needs while sick. But it finally happened, and I could not be more thankful for this program. The only reasons I had the food, fluids, and medications I needed was because of the wonderful people running this program. They reached out to me immediately and ensured my needs were met. An incredible support system that got me over my illness much faster. Having not had time to get medications or hydration supplements I usually got sick for 2 weeks at a time when I did this time I was able to kick the bug in half the time. It also did wonders psychologically to have that support from my fellow residents! Really helped turn around a bad day saved a trip to CVS to buy medicine, Gatorade/soup were a life saver, and the little card is so silly but so cute and put a smile on my face:) Encourages an atmosphere of compassion and empathy. Delivered to my door within 2 hours, really helped me get better and feel valued. Very timely response both the Rx and the sustenance were much appreciated. As was knowing that my fellow residents care! I wouldn’t have asked for it myself, but it was really nice to have easy access to meds and a reminder to rest as much as I could. Thank you! Pills are helpful for random headaches etc. as well as taking care of symptoms of viral URI When my coresidents noticed I was sick, they pushed me to get a Babushka. And when the Babushka arrived, I was touched by how generous it was not just the contents of the Babushka but that my surgical family would spend so much time to help me feel better. The beauty of the program is not only in the fact that it provides timely help, but also it creates a feeling of family and support which is truly powerful. Amazing pick-me-up that helped me to keep going. A great service that made all the difference when I was sick at the hospital. The best part of residency this year. Turns bad to good!
2
Journal of Surgical Education Volume 00 /Number 00 Month 2019
ARTICLE IN PRESS hypothesized that creating a supportive community with humanistic values that provides residents with some control over their health is one way to steer the seemingly inevitable trajectory towards burnout. This pilot is grounded in our belief that a culture shift focusing on wellness must start organically from the basic awareness about the well-being of colleagues, as well as self-recognition when one needs help. Although our program does not advertise itself as a solution, its goal is to ultimately prevent resident burnout by addressing one of the numerous facets that are its causal core. This study has several important limitations. First, we do not have preimplementation data on resident rates of burnout and well-being. Second, the survey given to residents does not specifically ask about burnout. Third, the respondents of the survey include only residents who received care packages. At our institution, residents receive several hospital-wide surveys assessing burnout, and our priority was to evaluate the effectiveness of the program rather than assessing the broader issue at hand. The sample size is limited by the fact that, fortunately, few residents fall ill. In order to demonstrate an objective improvement and cultural shifts, we are planning to expand our program to other departments. Future research directions will include pre- and postintervention data on burnout, time away from work, improved health, cultural attitudes, and perceived role that this program has in fighting burnout. Nevertheless, this pilot program has received a strongly positive response. Our intervention is unique as it prioritizes both aspects of self-care as well as care for colleagues by motivating residents to recognize illness and help others in a concrete way. As one of the residents noted, “The beauty of the program is not only in the fact that it provides timely help, but also it creates a feeling of family and support which is truly powerful.” We believe that self-care and caring for colleagues is a new form of professionalism that needs to be developed and propagated in the healthcare profession. Notably, the majority of the packages were requested by colleagues and not by the sick residents themselves. While it was concerning that most residents didn’t ask for assistance, it was encouraging that their colleagues were watching out for them and felt comfortable asking for help on their behalf. This fosters community building, but does point to the fact that residents are still reluctant to advocate for themselves. More work remains to be done in normalizing personal health and encouraging sick residents to attend to themselves while caring for patients. Having demonstrated success in a small sample
of residents using an inexpensive intervention (only $7.00 each), we aspire to use this pilot program as a model for other institutions to create programs designed to care for their caregivers.
ACKNOWLEDGMENTS The authors would like to thank Stanford WellMD Center for their support of this project through the Stanford Healthy Steps to Wellness Team Grant.
REFERENCES 1. Jha A, Iliff A, Chaoui A, et al. A Crisis in Health Care: A
Call to Action on Physician Burnout. Partnership with the Massachusetts Medical Society. Massachusetts Health and Hospital Association, Harvard TH Chan School of Public Health, and Harvard Global Health Institute; 2018. 2. IsHak WW, Lederer S, Mandili C, et al. Burnout during
residency training: a literature review. J Grad Med Educ. 2009;1:236–242. 3. Lefebvre D. Perspective: resident physician wellnessa
new hope. Acad Med. 2012;87:598–602. 4. Jennings ML, Slavin S. Resident wellness matters: opti-
mizing resident education and wellness through the learning environment. Acad Med. 2015;90:1246–1250. 5. Levey RE. Sources of stress for residents and recom-
mendations for programs to assist them. Acad Med. 2001;76:142–150. 6. Dunn LB, Green Hammond KA, Roberts LW. Delaying
care, avoiding stigma: residents’ attitudes toward obtaining personal health care. Acad Med. 2009;84:242–250. 7. Linzer M, Gerrity M, Douglas JA, et al. Physician
stress: results from the physician worklife study. Stress Health. 2002;18:37–42. 8. Szymczak JE, Smathers S, Hoegg C, et al. Reasons why
physicians and advanced practice clinicians work while sick: a mixed-methods analysis. JAMA Pediatr. 2015;169:815–821. 9. Campbell S, Delva D. Physician do not heal thyself.
Survey of personal health practices among medical residents. Can Fam Physician. 2003;49:1121–1127.
SUPPLEMENTARY INFORMATION Supplementary material associated with this article can be found in the online version at doi:10.1016/j. jsurg.2019.08.007.
Journal of Surgical Education Volume 00 /Number 00 Month 2019
3
ARTICLE IN PRESS APPENDIX 1. SUPPLIES AND INFORMATION
○ Tylenol 500 mg tab
○ ○
○ ○ ○
○
Brought to you by the “Surgical Babushka Program” We’re sorry that you’re sick, but we’ll do everything we can to get you better faster! We know you’re a doctor. . . But even doctors get sick and need to be taken care of! In your package, you’ll find medications, healthy foods, and hydration. Please read instructions and take medications as instructed. We will check in with you tomorrow and every day until you’re feeling better. If you feel worse or this little package isn’t enough, call your doctor or an ambulance. Let us know how we can assist you! This program is a pilot is funded by a Stanford Wellness Grant. Please take 30 seconds to fill out the survey that we will email you after you’re better so that we know if we should continue doing this in the future.
This package contains:
○
EXPIRES 01/2020, Take 500-1,000 mg every 6 hours PRN pain/fever, MAX 4,000 mg/day DayQuil EXPIRES 03/2020, Take 2 tablets every 8 hours PRN fever/congestion NightQuil - EXPIRES 08/2020, Take 2 tablets every 8 hours PRN fever/congestion before sleep Cold-EEZE EXPIRES 11/2021, Dissolve 1 tablet in 8oz and water and drink daily while sick Cough Drops, Ricola, EXPIRES 02/2020, PRN sore throat/cough Emergency Immune Support, take once daily PRN for additional vitamins (take either emergency or airborne; dissolve in water) Airborne Immune Support, take once daily PRN for additional vitamins (take either emergency or airborne; dissolve in water) Food (soup, Gatorade, tea)
The greatest gift you can give to your patients is a healthy you! Take care of yourself so you can take care of others. [email protected]
APPENDIX 2. SURVEY 1. Do you feel that the Babushka program is addressing an unmet need for residents? ○ Yes ○ No 2. Do you feel that the supplies you received helped you feel better while sick? ○ Yes ○ Not sure ○ No 3. How many times/year do you get sick enough that you need to take over-the-counter medications (e.g. Tylenol, ibuprofen, DayQuil, NyQuil, cough drops, Airborne, Emergenc-E)? ○ 1-2 ○ 3-4 ○ 5 or more 4. Please rate the Babushka program
5. Please share some thoughts about the program
○ Ibuprofen 200 mg tab
EXPIRES 10/2020, Take up to 600 mg every 6 hours PRN pain/fever
4
Journal of Surgical Education Volume 00 /Number 00 Month 2019
ARTICLE IN PRESS APPENDIX 3. COST PER BAG Items
Tabs/Packets
Cost
Cost Per Tab
Units Per Bag
Cost Per Bag
Acetaminophen Ibuprofen Day Multi Night Multi Emergen-C Ricola Gatorade Zip-Lock Bags Soup Kind Note Tea Bags Mask Total Cost per bag
1000 1000 120 48 70 260 28 50 1 1 100 1
8.49 11.99 4.99 4.99 18.99 12.99 12.99 13.59 1.99 0.2 20.99 0.2
0.00849 0.01199 0.04158333333 0.1039583333 0.2712857143 0.04996153846 0.4639285714 0.2718 1.99 0.2 0.2099
20 25 2 2 3 15 2 3 1 1 3
0.0720801 0.29975 0.08316666667 0.2079166667 0.8138571429 0.7494230769 0.9278571429 0.8154 1.99 0.2 0.6297 0.2 6.989150796
Journal of Surgical Education Volume 00 /Number 00 Month 2019
5
Caring for Caregivers Resident Physician Health and Wellbeing Ioana Baiu, MD, MPH, Ashley Titan, MD, Cindy Kin, MD, MS, and David A. Spain, MD Department of Surgery, Stanford University School of Medicine, Stanford, California OBJECTIVE: There is a national epidemic of physician
burnout and serious concerns exist regarding the wellbeing of future physicians. This project seeks to address resident physician health, by creating a sense of support and community during training, as a method to target one of the many facets of burnout. DESIGN: We created a program that allows residents who fall ill to receive a health package, delivered to work or home, consisting of essential medications, vitamins, nutrition, and hydration. The recipients were asked to answer a short survey regarding their experience. SETTING: Stanford Health Care, Department of Surgery, Division of General Surgery, Palo Alto California. RESULTS: Eighteen packages have been delivered since
the start of the project. One hundred percent of residents agree that this program fulfills an otherwise unmet need in residency. Similarly, all felt that the supplies they received helped them recover faster. The majority (83%) of the packages were requested by colleagues of the ill residents. CONCLUSIONS: We present an innovative project
aimed at improving resident physician health, fostering a feeling of support, and helping to reduce resident burnout. This is the first report of a program of this kind and we hope that it incentivizes a broader discussion and implementation of similar initiatives in other residency programs across the country. ( J Surg Ed 000:1 5. Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery.) KEY WORDS: Burnout, Resident wellness, Resident health COMPETENCIES: Professionalism, Interpersonal and
Communication Skills, Practice-Based Learning and Improvement
Correspondence: Inquiries to Ioana Baiu, MD, MPH, Stanford University General Surgery, 300 Pasteur Dr H3463, Stanford CA 94305.; e-mail: [email protected]
INTRODUCTION A 2019 report published by the Massachusetts Medical Society together with the Harvard Global Institute identified the current state of physician burnout as a national public health crisis.1 The pattern of burnout that starts during training carries through to practicing physicians. As much as 75% of residents have experienced burnout, but resident wellness programs have shown promising results.2,3 There has been a call for action directed by the Accreditation Council for Graduate Medical Education and the Clinical Learning Environment Review Program to prioritize resident wellness, requiring all training program to have assistance services available for all residents.4,5 A study of American resident physicians noted that 26% to 43% of participants had health-related problems that required medical attention, and that avoidance in seeking care was associated with poorer self-rated mental and physical health and greater health concerns.6 The biggest stressors faced by doctors include lack of support by colleagues, balancing work and home, and isolation.7 Physicians often push themselves to physical and emotional limits, without adequate support structures, thus risking personal wellbeing. In a cross-sectional survey of practicing clinicians, 95% of respondents agreed that they are putting patients at risk and that 83% worked while sick.8 Despite having access to free care, 25% of Canadian residents with chronic illnesses, and 40% of those who use prescription medications do not have a primary care physician.9 More than 40% of residents admitted to receiving or writing prescriptions from or for colleagues.9 The barriers to this phenomenon were quoted as knowledge, time, and accessibility to timely care. In this paper, we describe an intervention that allows residents to request a health package for themselves or others during times of acute illness. The goal was to provide residents with timely and easy access to basic supplies to alleviate their symptoms. Furthermore, we aimed to create a sense of community and support by having residents help each other, thus also combating a major cause burnout—lack of social support. Lastly, we hoped to challenge the deeply entrenched culture of self-imposed “toughness” by
Journal of Surgical Education Published by Elsevier Inc. on behalf of Association of Program Directors in 1931-7204/$30.00 Surgery. https://doi.org/10.1016/j.jsurg.2019.08.007
1
ARTICLE IN PRESS allowing residents to ask for help when ill without the threat of judgment.
METHODS The study protocol was reviewed and approved by the Institutional Review Board (IRB protocol number: 49840). Funding for this pilot was obtained from the Stanford HealthySteps to Wellness Team Grant from the Stanford WellMD Center. The money was used to purchase supplies and create health packages. Each bag included a 3-day supply of ibuprofen, acetaminophen, DayQuil, NyQuil, Airborne, Emergen-C, cough drops, a can of chicken noodle or vegetarian soup, Gatorade, tea bags, and masks. The cost per bag was approximately $7.00 and supplies were purchased from a large retailer at discounted prices. In addition, each bag contained a sheet of advice about care for oneself, as well as administration instructions and expiration dates for each medication (Appendix 1). The caregivers were all volunteers who were not incentivized or reimbursed for their work. These included surgical residents in their clinical and research years, as well as faculty and their spouses. Having a wide variety of caregivers was important in order to maximize their availability to deliver a package. Each volunteer was provided with several bags that were prepackaged by a group of residents. Deliveries home or at work were organized based on the availability of the volunteers on a case-by-case basis. A listserv email account and text messaging group were created and advertised widely through fliers and e-mail announcements. Residents who fell ill or their colleagues could send an e-mail or text to the designated address to request a
package. The package was then delivered to the ill resident’s house or directly at the hospital within a few hours. If residents requested a package for a classmate, they would have the option to deliver the package themselves. The caregiver then checked on the resident for the next few days until they felt better. A week after the delivery of the package, the recipients received a brief 5-question survey through SurveyMonkey (Appendix 2).
RESULTS Eighteen packages have been delivered over the course of 2 months since the start of the program, 16 of them at work and 2 at home. Fifteen (83%) of the packages delivered had been requested by colleagues. The response rate on the survey was 100%. Sixty-one percent of residents reported that they fall ill 1 to 2 times/year, while 39% are ill 3 to 4 times/year, and none more than that. 100% of residents answered that they felt the program addressed an unmet need for themselves and others. Similarly, 100% of residents noted that they felt that the supplies they received helped them feel better while sick. The written responses were extremely positive, commenting on the fostering of a sense of community and feelings of support (Table 1).
DISCUSSION Despite extensive research, burnout in medicine is an incredibly complex problem without one simple solution. Engrained from very early in training, the pervasive culture of self-sacrifice often drives physicians to surrender their own well-being for the benefit of humanity. We
TABLE 1. Examples of Resident Comments This program literally saved me. In my 7 years of residency, I had never before felt unwell enough that I couldn't take care of my own needs while sick. But it finally happened, and I could not be more thankful for this program. The only reasons I had the food, fluids, and medications I needed was because of the wonderful people running this program. They reached out to me immediately and ensured my needs were met. An incredible support system that got me over my illness much faster. Having not had time to get medications or hydration supplements I usually got sick for 2 weeks at a time when I did this time I was able to kick the bug in half the time. It also did wonders psychologically to have that support from my fellow residents! Really helped turn around a bad day saved a trip to CVS to buy medicine, Gatorade/soup were a life saver, and the little card is so silly but so cute and put a smile on my face:) Encourages an atmosphere of compassion and empathy. Delivered to my door within 2 hours, really helped me get better and feel valued. Very timely response both the Rx and the sustenance were much appreciated. As was knowing that my fellow residents care! I wouldn’t have asked for it myself, but it was really nice to have easy access to meds and a reminder to rest as much as I could. Thank you! Pills are helpful for random headaches etc. as well as taking care of symptoms of viral URI When my coresidents noticed I was sick, they pushed me to get a Babushka. And when the Babushka arrived, I was touched by how generous it was not just the contents of the Babushka but that my surgical family would spend so much time to help me feel better. The beauty of the program is not only in the fact that it provides timely help, but also it creates a feeling of family and support which is truly powerful. Amazing pick-me-up that helped me to keep going. A great service that made all the difference when I was sick at the hospital. The best part of residency this year. Turns bad to good!
2
Journal of Surgical Education Volume 00 /Number 00 Month 2019
ARTICLE IN PRESS hypothesized that creating a supportive community with humanistic values that provides residents with some control over their health is one way to steer the seemingly inevitable trajectory towards burnout. This pilot is grounded in our belief that a culture shift focusing on wellness must start organically from the basic awareness about the well-being of colleagues, as well as self-recognition when one needs help. Although our program does not advertise itself as a solution, its goal is to ultimately prevent resident burnout by addressing one of the numerous facets that are its causal core. This study has several important limitations. First, we do not have preimplementation data on resident rates of burnout and well-being. Second, the survey given to residents does not specifically ask about burnout. Third, the respondents of the survey include only residents who received care packages. At our institution, residents receive several hospital-wide surveys assessing burnout, and our priority was to evaluate the effectiveness of the program rather than assessing the broader issue at hand. The sample size is limited by the fact that, fortunately, few residents fall ill. In order to demonstrate an objective improvement and cultural shifts, we are planning to expand our program to other departments. Future research directions will include pre- and postintervention data on burnout, time away from work, improved health, cultural attitudes, and perceived role that this program has in fighting burnout. Nevertheless, this pilot program has received a strongly positive response. Our intervention is unique as it prioritizes both aspects of self-care as well as care for colleagues by motivating residents to recognize illness and help others in a concrete way. As one of the residents noted, “The beauty of the program is not only in the fact that it provides timely help, but also it creates a feeling of family and support which is truly powerful.” We believe that self-care and caring for colleagues is a new form of professionalism that needs to be developed and propagated in the healthcare profession. Notably, the majority of the packages were requested by colleagues and not by the sick residents themselves. While it was concerning that most residents didn’t ask for assistance, it was encouraging that their colleagues were watching out for them and felt comfortable asking for help on their behalf. This fosters community building, but does point to the fact that residents are still reluctant to advocate for themselves. More work remains to be done in normalizing personal health and encouraging sick residents to attend to themselves while caring for patients. Having demonstrated success in a small sample
of residents using an inexpensive intervention (only $7.00 each), we aspire to use this pilot program as a model for other institutions to create programs designed to care for their caregivers.
ACKNOWLEDGMENTS The authors would like to thank Stanford WellMD Center for their support of this project through the Stanford Healthy Steps to Wellness Team Grant.
REFERENCES 1. Jha A, Iliff A, Chaoui A, et al. A Crisis in Health Care: A
Call to Action on Physician Burnout. Partnership with the Massachusetts Medical Society. Massachusetts Health and Hospital Association, Harvard TH Chan School of Public Health, and Harvard Global Health Institute; 2018. 2. IsHak WW, Lederer S, Mandili C, et al. Burnout during
residency training: a literature review. J Grad Med Educ. 2009;1:236–242. 3. Lefebvre D. Perspective: resident physician wellnessa
new hope. Acad Med. 2012;87:598–602. 4. Jennings ML, Slavin S. Resident wellness matters: opti-
mizing resident education and wellness through the learning environment. Acad Med. 2015;90:1246–1250. 5. Levey RE. Sources of stress for residents and recom-
mendations for programs to assist them. Acad Med. 2001;76:142–150. 6. Dunn LB, Green Hammond KA, Roberts LW. Delaying
care, avoiding stigma: residents’ attitudes toward obtaining personal health care. Acad Med. 2009;84:242–250. 7. Linzer M, Gerrity M, Douglas JA, et al. Physician
stress: results from the physician worklife study. Stress Health. 2002;18:37–42. 8. Szymczak JE, Smathers S, Hoegg C, et al. Reasons why
physicians and advanced practice clinicians work while sick: a mixed-methods analysis. JAMA Pediatr. 2015;169:815–821. 9. Campbell S, Delva D. Physician do not heal thyself.
Survey of personal health practices among medical residents. Can Fam Physician. 2003;49:1121–1127.
SUPPLEMENTARY INFORMATION Supplementary material associated with this article can be found in the online version at doi:10.1016/j. jsurg.2019.08.007.
Journal of Surgical Education Volume 00 /Number 00 Month 2019
3
ARTICLE IN PRESS APPENDIX 1. SUPPLIES AND INFORMATION
○ Tylenol 500 mg tab
○ ○
○ ○ ○
○
Brought to you by the “Surgical Babushka Program” We’re sorry that you’re sick, but we’ll do everything we can to get you better faster! We know you’re a doctor. . . But even doctors get sick and need to be taken care of! In your package, you’ll find medications, healthy foods, and hydration. Please read instructions and take medications as instructed. We will check in with you tomorrow and every day until you’re feeling better. If you feel worse or this little package isn’t enough, call your doctor or an ambulance. Let us know how we can assist you! This program is a pilot is funded by a Stanford Wellness Grant. Please take 30 seconds to fill out the survey that we will email you after you’re better so that we know if we should continue doing this in the future.
This package contains:
○
EXPIRES 01/2020, Take 500-1,000 mg every 6 hours PRN pain/fever, MAX 4,000 mg/day DayQuil EXPIRES 03/2020, Take 2 tablets every 8 hours PRN fever/congestion NightQuil - EXPIRES 08/2020, Take 2 tablets every 8 hours PRN fever/congestion before sleep Cold-EEZE EXPIRES 11/2021, Dissolve 1 tablet in 8oz and water and drink daily while sick Cough Drops, Ricola, EXPIRES 02/2020, PRN sore throat/cough Emergency Immune Support, take once daily PRN for additional vitamins (take either emergency or airborne; dissolve in water) Airborne Immune Support, take once daily PRN for additional vitamins (take either emergency or airborne; dissolve in water) Food (soup, Gatorade, tea)
The greatest gift you can give to your patients is a healthy you! Take care of yourself so you can take care of others. [email protected]
APPENDIX 2. SURVEY 1. Do you feel that the Babushka program is addressing an unmet need for residents? ○ Yes ○ No 2. Do you feel that the supplies you received helped you feel better while sick? ○ Yes ○ Not sure ○ No 3. How many times/year do you get sick enough that you need to take over-the-counter medications (e.g. Tylenol, ibuprofen, DayQuil, NyQuil, cough drops, Airborne, Emergenc-E)? ○ 1-2 ○ 3-4 ○ 5 or more 4. Please rate the Babushka program
5. Please share some thoughts about the program
○ Ibuprofen 200 mg tab
EXPIRES 10/2020, Take up to 600 mg every 6 hours PRN pain/fever
4
Journal of Surgical Education Volume 00 /Number 00 Month 2019
ARTICLE IN PRESS APPENDIX 3. COST PER BAG Items
Tabs/Packets
Cost
Cost Per Tab
Units Per Bag
Cost Per Bag
Acetaminophen Ibuprofen Day Multi Night Multi Emergen-C Ricola Gatorade Zip-Lock Bags Soup Kind Note Tea Bags Mask Total Cost per bag
1000 1000 120 48 70 260 28 50 1 1 100 1
8.49 11.99 4.99 4.99 18.99 12.99 12.99 13.59 1.99 0.2 20.99 0.2
0.00849 0.01199 0.04158333333 0.1039583333 0.2712857143 0.04996153846 0.4639285714 0.2718 1.99 0.2 0.2099
20 25 2 2 3 15 2 3 1 1 3
0.0720801 0.29975 0.08316666667 0.2079166667 0.8138571429 0.7494230769 0.9278571429 0.8154 1.99 0.2 0.6297 0.2 6.989150796
Journal of Surgical Education Volume 00 /Number 00 Month 2019
5