Raising AWAREness of Mental Health Resources
In a previous blog, we spoke to Jeremy Weleff, DO, a psychiatry resident now at Yale University, who launched several programs to address and improve mental health among residents. Research suggests that the pandemic has exacerbated the already high rates of anxiety, depression, and burnout among physicians in particular; fortunately, there are many resources that may help.
One such initiative, ACGME AWARE, is designed to promote well-being among residents, faculty members, and others in the GME community.
We recently interviewed Stuart Slavin, MD, MEd, the senior scholar for well-being at the Accreditation Council for Graduate Medical Education (ACGME), who launched ACGME AWARE based on his previous experience with medical students as associate dean for curriculum at St. Louis University.
The NBOME is exploring resources available in support of medical students, can you give us a little background on the ACGME AWARE initiative?
It is important to remember that while the environment is the primary driver [of stressors], there are other factors to consider, including individual susceptibilities and the persistent biases within healthcare against acknowledging stressors or seeking assistance.
When we say environment is the driver, we refer to stressors within the residency program which may include increased demands from what an intern experienced as a medical student. We also refer to global issues which impact physicians personally and professionally, such as the COVID-19 pandemic.
ACGME AWARE seeks to develop materials which can teach residents how to recognize stressors and reactivity to those stressors, and then manage those mindsets or thought processes that contribute to distress.
On the site, you give a lecture about Cognitive Skill-Building for Well-Being. Can you tell us about the skillset you describe and how it applies to medical students and residents?
Cognitive skill-building is fundamentally important for medical students. It comes from the world of cognitive psychology and cognitive restructuring is the main skill we teach in that video workshop and the associated podcasts and lectures. Cognitive restructuring forms the basis of cognitive behavioral therapy which is still gold standard treatment for anxiety and helpful for depression. The question is why do we withhold these techniques until one has a mental health problem and needs to see a therapist. We believe that everyone can benefit from learning these techniques and that is the primary focus of the ACGME AWARE materials. Cognitive restructuring can be very useful in dealing with common problematic mindsets like imposter phenomenon, maladaptive perfectionism, or feelings of inadequacy and shame about performance.
While cognitive skill-building cannot banish those mindsets, it can give people the tools to recognize when they experience those thoughts and emotions, know when those mindsets are occurring, and learn how to not be so harsh on themselves.
Not only are these excellent life skills, they are wonderful for physicians who tend to be very hard on themselves. A great example would be how the maladaptive perfectionism mindset, which can occur during licensure assessment, interprets performance as identity, so, thinking “I didn’t just get this Level 2 score, I AM this Level 2 score.” When performance is not ideal, it can be much more distressing when one views your performance as who you are rather than how you have performed.
Because patient care, exposure to mortality, and the demands of education and assessment require a lot of mental fortitude, the inherent mental health challenges can be substantial hurdles to overcome. One of the best ways we can support physicians is by providing practical skills and resources to help manage their mental health.
What is Psychological First Aid and how does it apply to medical students and residents as caregivers?
I started to learn more about psychological first-aid at the beginning of the pandemic health care providers were experiencing huge amounts of stress. It was clear that there are not enough psychologists to embed them in clinical settings to help the healthcare workers.
Psychological First Aid is a tool that was developed jointly by the National Child Traumatic Stress Network and the National Center for PTSD, which is a branch of Veteran’s Affairs, and was designed to provide psychological support to first responders. These same principles can be used in any traumatic setting.
The tools are set up as guidelines, essentially do’s and don’ts, which can help providers as they assist colleagues to navigate stressful situations. Psychological First Aid teaches physicians how to listen empathically to their colleagues without succumbing to the natural impulse to try and solve the problem for that person or assume the role of a counselor. The goal is to teach physicians how to provide the correct type of support for other physicians in a moment of need without trying to directly solve the problem.
What are some of the key areas of need you are seeing in medical students as they transition from UME to GME?
The transition to residency is an incredibly challenging and stressful experiences. Interns are very psychologically vulnerable, particularly to imposter syndrome early in their training. The huge leap in responsibility can present significant challenges. Studies indicate that the highest suicide rate in residency is within the first three months of residency, and I worry that impostor phenomenon may play a role in some of these tragic events.
It would be incredibly beneficial if every medical student going into residency was aware of both imposter syndrome and the mental health resources available to them. It is vitally important that both medical students and residents have a network of support. We should work to make sure these resources are abundant, available, and not stigmatized. If a physician is struggling, they never should hesitate to reach out and get the support they need.
For more on ACGME AWARE and other resources, visit the NBOME’s Mental Health and Wellness Toolkit.