SWIU recap: Expert discusses wellness and burnout in urology

Jennifer M. Taylor, MD, MPH

In the following interview, Jennifer M. Taylor, MD, MPH, provides an overview of the discussion on wellness and burnout that took place at theSociety of Women in Urology (SWIU) Annual Clinical Mentoring Conference in Scottsdale, Arizona. She also provides advice for what urologists can do to prevent burnout, drawing from her own experience. Taylor is an assistant professor of urology at Baylor College of Medicine in Houston, Texas.

Could you provide a recap of your talk on wellness and burnout at the meeting?

The program committee asked me to give a session about individual steps that can be taken to try to promote one's own well-being. I gave a summary of what we have developed in our program in Houston at Baylor College of Medicine using what we designated as a resident wellness curriculum. Over the course of several years, we implemented multiple steps to try to improve the experience for the residents in terms of their wellness and try to reduce their burnout.

We showed that through these strategies, we were able to lower the reported rates of burnout on average among our resident group and maintain their personal feelings of achievement and satisfaction with the program. We've taken it a step further, which I went on to report during the session, in developing or trying a course that teaches stress resilience. What we know is that physicians are very burned out; residents are even more burned out. The [Accreditation Council for Graduate Medical Education] (ACGME), which governs how we run our residency programs and what we teach residents, mandates that we are paying more attention to and putting strategies in place for our residents.

We wanted to create something that was more like a skill that they learned during residency just in the same way that we teach how to do a certain surgery or how to address a certain medical condition that we treat. The stress resilience training teaches cognitive skills to give the individual better habits that are more mindful. So really taking some mindfulness practices, but inserting them into day-to-day, even before an operation, in the middle of an operation, after an operation, the kinds of things that you run through your own mind, how you address stressors that you're experiencing, and how you process that.

All that to be said, we tried this course that has been developed by a surgeon at University of California, San Francisco named Carter Lebares, MD. This course we ran in our program, and we did see some nice indication that it was thought to be valuable and could be something we could try to continue doing.

The interesting thing that's come out of the research that Dr. Lebares has done is that burnout can be countered by mindfulness. That's been shown in a lot of different lines of work and professions, but also, maybe a marker of that, we don't want to put wellness and burnout on opposite ends of a scale. We want to look at ways that someone can thrive and do better in their day-to-day.

Dr. Lebares identified something called flourishing, which I brought up in my talk, in that if someone has sustained wellness or sustained feelings of well-being, even when they have more stress, they're able to bounce back and deal with it on a on a better day-to-day scale. That was the summary that I gave on Friday. It was highlighting some things that we've done in our program that are not specific to women trainees or even women in practice, but all of those who are in the profession and in training. [I] tried to give some examples that could be easily implemented in other places without a huge undertaking from the program in terms of cost or time.

You also attended a panel discussion on wellness and burnout as a member of the audience. What were some key takeaways from that discussion?

This was a nice program on Saturday that was moderated by a resident, Dr. Christina Peterson from Vanderbilt, and the panel consisted of Dr. Kate Kraft, who's the program director at University of Michigan, Dr. Kristen Scarpato, who's the program director at Vanderbilt, Dr. Danica May, who's a faculty member at the University of Kansas, and then a chief resident, Dr. Keerthana Mohankumar, and she's at Medical College of Wisconsin. They each talked about some interesting ideas of why it can be difficult to implement programming into a residency that centers around wellness.

I think one of the key takeaways was that wellness is very individual. The definition of wellness can be something that's set by what is important to you in your life. It can be hard to do some type of blanket change for a group, because how each person considers their lives to be more and less fulfilling is going to depend on their circumstances and their context. If they have kids, vs if they have a family member they want to see, vs if their close significant other lives in another city, all of these factors influence if someone's wellness could be getting out early on Friday to take a trip, vs wanting to have an earlier day so they can attend something with their kids. Trying to set up wellness strategies can be challenging because of that inherent difference that individuals might have.

Within the talk, they also talked about different strategies that they've seen to be successful, or that they've personally been practicing to maintain their own wellness. A lot of the things described were just trying to make sure that you aligned some changes in your habits that were able to fulfill those individual things that are your wellness. Dr. Kraft talked about taking an extra day when she could that was aligned with her kids' days off from school. Dr. Scarpato talked about setting up sessions for the residents that were optional so that they could get together and do something social, but using the residents’ input as to what activity or what event that might be. Dr. May talked about how the University of Kansas has an opt-out program for mental health. You're given protected time to meet with a mental health professional that you had to actually opt out instead of opt in. That was well received and had a decent amount of utilization by the residents in a still-anonymous way.

I thought that one of the other themes of their talk was that we all have to normalize these mental health concerns—men and women—in the profession. As we model that to our trainees and admit "I had a hard day" or "I see a therapist time to time" or even something like, "I take medication for helping me manage my anxiety,” all of those elements that we might have been unwilling to share in the past, we should be a little more forthcoming, and then it helps everyone feel like they're not the only ones dealing with that stress or anxiety or symptom of burnout. Those were the takeaways I got from it.

What advice do you have for urologists in the field in tackling burnout?

I think that the profession demands so much of us. Caring for patients demands so much of us. Probably the number one thing that the audience told me when I gave my talk was it's documentation and EMR and administration, all of these things. You have to pick an area that you're going to protect. If that's going to be time in your schedule to exercise, if that's going to be time in your week so that you can spend time without your phone with your family, if that's going to be allotting time in your monthly or annual calendar to do certain things that are important to you. You have to manage and maintain the other parts of yourself that are not answering all those needs from work. I think that's one of the best things I can recommend.

Personally, I grew up with singing as a huge hobby and side activity of mine. There was a long period a little bit after training where I didn't have it in my life on a regular basis. I've been able to find some avenues recently where I can participate more and perform again, and it really keeps me going. So, I protect that time to get together with my bandmates and practice and do my best in that respect.

I think remembering that you need somebody, too. You often need somebody to help you process hard experiences. Don't shy from that, because of whatever it might be, the macho or stigma or the idea that we're invincible. Those are some of the things I would recommend to somebody. Try to find ways that you can make a skill and a habit out of preserving that well-being. It will help you in your approach to your profession and your job, but it'll also help you in your approach to the people you interact with in your day-to-day, probably driving down the street dealing with traffic, all of those things.

What do you do to prevent burnout in your own life?

Besides the thing I mentioned about finding some time for music and making music with some friends, I also try to have limited time every night where I'm with my family and not answering my phone or answering my emails, trying to preserve that time. I give my full attention. That's an important thing.

I also exercise, and I think a huge thing that I realized is what waxes and wanes with demands is sleep. Sleeping enough and sleeping in a restorative way without screen time right before bed and all of those things that you hear about, they really make a big difference.

Is there anything else that you'd like to add?

I guess the only other suggestion that came out many times in the SWIU meeting was there are a lot of resources out there that are podcasts or books or recordings. Here are some different perspectives that can help you change what you call the quote on quote "chatter in your mind" or the way you approach certain stressors. If you don't have a lot of time to read a book, then find something you can listen to when you're exercising or coming into work.

The other thing is that we all say all of these recommendations with the understanding that there's still heavy-duty systemic issues that are going on in health care and around us. Those things in our institutions or organizations are not to be ignored. They're still as much a part of the challenge and the source of burnout. We don't want to create this casting the responsibility onto the individual with all of these recommendations and ideas. Although every institution and organization needs to tackle this, there are still ways you can try to live more fully and more healthily with individual strategies too