Training has its own unique stressors and threats to well-being. As chair of the AAP Section on Pediatric Trainees (SOPT), I hear from our members about the significant toll training takes on them. They struggle with the sheer number of hours they work, lack of control over the where they’ll train, living away from loved ones and challenges related to the hierarchy in medicine and its effect on clinical care, self-care and equity.
When wellness isn’t openly prioritized, trainees can feel as if they’re the only person struggling — an isolating mindset that can lead to devastating outcomes. The SOPT aims to normalize having difficult conversations by modeling vulnerability and promoting nonjudgmental peer support before tragic events occur.
Over the past year, the SOPT has focused on and altered its approach to wellness, given the pandemic’s wide-reaching effects on trainee members and the medical education and training process.
The section has compiled state- and community-based COVID-19 resource lists to aid trainees in local advocacy. We also have increased our online presence. Offerings include virtual interviewing preparation for fourth-year medical students; webinar series that support members as they transition from medical students to interns or interns to senior residents; and subspecialty 101 webinars that aim to demystify and quell concerns about pursuing a subspecialty. We also have distributed residency program social media handles to help applicants get a sense of programs without traveling for interviews.
In a survey of SOPT members, a majority of respondents reported that their programs or schools have wellness initiatives, but many are trainee-driven or underpublicized. Respondents said they longed for initiatives that allowed them to schedule time away from clinical responsibilities for their own doctor’s appointments and therapy. They also wanted residency community-building activities and those senior to them to model vulnerability, especially in times of grief.
This past summer, we piloted SOPT Safe Spaces, a virtual, semi-anonymous wellness platform for trainees across the country to connect and support each other. Each session begins with trainee speakers sharing their personal story on a sensitive topic like burnout, difficult patient encounters, clinical mistakes or unforeseen challenges. Trainees can join virtual breakout rooms where structured questions foster collaborative support with as much anonymity as each individual prefers. Our hope is that trainee stories of vulnerability, group processing and self-reflection will help ease the isolation and imposter syndrome that is so common among trainees.
Unfortunately, most trainees can share a story about well-intentioned wellness initiatives that fell short, whether it was a PowerPoint that missed the mark, lack of ample time for debriefing or lack of support for second victims.
As we focus on actionable physician wellness, we must find ways to work within training systems to bring joy back to trainees. The SOPT encourages implementation of specific, actionable wellness measures at the institutional level. At a minimum, all institutions should:
- provide dedicated time for self-care, physical health or mental health, and support trainee self-advocacy in that realm;
- teach trainees how to self-assess burnout levels, identify compassion fatigue and address those issues; and
- establish a second victims program and debriefing method for trainees.
To do this, it will be important to support scholarly activity around wellness initiatives and highlight trainees’ stories on large-scale platforms. Ultimately, trainee wellness requires time for trainees to meet their own needs and explore their own wellness and time for those working with trainees to listen, respond and act. This reallocation of time is a crucial step to enable physicians at all levels of training to prioritize their wellness and provide the best care to patients.
It is vital to start our wellness journeys by incorporating self-reflection and self-compassion into our practice; this is the oxygen mask model of wellness. Whether it is in your department, program or school, I ask all to advocate for intentional wellness initiatives that include trainees at every level of decision-making. As with any systemic change, people must be willing to dedicate themselves to it and make it a priority. Leaders should feel empowered to be curious and learn about what works for their trainees and then model their initiatives accordingly.
Dr. Kratlian is chair of the AAP Section on Pediatric Trainees Executive Committee.