Resident wellness and burnout

WELLNESS. WHY SHOULD IT
MATTER TO YOU?

LEARNING OBJECTIVES-
QUESTIONS TO BE ANSWERED
1. What is wellness, what are it’s dimensions?
2. Is it different from health?
3. Is it lacking in the population? If so, how to build up on it?
4. What is burnout (specifically in healthcare workers)?
5. What is the size of the problem and factors influencing it?
6. What should be done to alleviate the physician burnout?
7. What can be done feasibly?
8. How would you enforce wellness in your healthy OPD patients?

CONTENTS
Definition
Dimensions
Population Wellness
Physician Burnout
Intervention

DEFINITION
Merriam-Webster defines wellness as
“The state of being in good health,
especially as an actively pursued goal.”
Brady KJS, Trockel MT, Khan CT, Raj KS, Murphy ML, Bohman B, et al. What Do We Mean
by Physician Wellness? A Systematic Review of Its Definition and Measurement. Acad
“The absence of ill-being and the
presence of positive physical,
mental, social, and integrated
well-being experienced in
connection with activities and
environments that allows one to
develop their full potentials
across personal and work-life
domains. “
“The absence of ill-being and the
presence of positive physical,
mental, social, and integrated
well-being experienced in
connection with activities and
environments that allows one to
develop their full potentials across
personal and work-life domains. “

THE OTTAWA CHARTER
Prerequisites for Health:
• Peace
• Shelter
• Education
• Food
• Income
• A stable ecosystem
• Sustainable resources
• Social justice and equity
The WHO. The Ottawa Charter for Health Promotion, 1986

Wellness encompasses 8 mutually interdependent
dimensions:
Attention must be given to all the dimensions, as
neglect of any one over time will adversely affect the
others, and ultimately one’s health, well-being, and
quality of life.
Emotional
Occupati
on
Intellectu
al
Environm
ent
Financial Social Spiritual Physical
Stoewen DL. Dimensions of wellness: Change
change your life. Can Vet J. 2017;58(8):861–8

I am
truly
well
Emotional:
understan
ding your
feelings,
coping
with stress
Enviroment
al: nature
and
personal
environmen
t
Financial:
manage
financial
expenses.
Intellectua
l: having
an open
mind for
new ideas
Occupation
: enjoying
your
occupation
al
contributio
Physical:
healthy
body and
seeking
care when
needed.
Social:
perform
social
roles ,
create a
support
network
Spiritual: a
set of
values
that help
seek
meaning
and
purpose

YOUR WELLNESS IS NOT
SAME AS MINE
•The above dimensions do not, however, have to be equally
balanced.
•We should aim, instead, to strive for a “personal harmony”
that feels most authentic to us.
•We naturally have our own priorities, approaches, and
aspirations, including our own views of what it means to live
life fully.

Q&A
1. Do you consider yourself healthy? Do you consider yourself “well”?
2. Do you promote wellness to your friends, family?
3. What interventions do you think will improve wellness?
4. Do you prescribe/promote wellness interventions to your patients?
5. Do you feel interventions for wellness are part of evidence based
medicine?

PROBLEM STATEMENT
2019 CIGNA 360 WELL-BEING SUR

SANDWICH GENERATION
The sandwich generation (defined as those
between 35-49):
Scored lowest in most dimensions
Worries are on the rise
Response rate to their needs has been slow.
Core talent group driving the economy.

FACTORS AFFECTING
WELLNESS
Stress: 84% are stressed, with 13% considering their stress
unmanageable.
Top stress triggers is Finance 17%
Stress at Work: 87% of workers say they are stressed, 12% feel their
stress is unmanageable
Lack of Employer Support: 46% received support but only 28% felt it
was adequate.
Time-poor mentality: 26% of those who feel time-poor experience

CAN WELLNESS BE
MEASURED?
• Warwick-Edinburgh Mental Well-being Scale
(WEMWBS) has been validated for use in both
student and general population samples
• 14 item scale of mental well-being covering
subjective well-being and psychological
functioning
• All items are worded positively
• 1 to 5 Likert scale.

INTERVENTIONS IN GENERAL
POPULATION
1. Yoga
2. Wellness program
3. Mindfulness
4. Meditation
5. Limiting harmful activities- cell phones
6. Nutrition
7. Physical Activity

YOGA: PROVEN TO
REDUCE BURNOUT
Upon completion of an 8-week
supervised yoga instruction for
the intervention group and
usual care for the control
group, yoga participants
(n=20) reported improvement
in scores from pre- to post-
intervention for self-care,
mindfulness , emotional
exhaustion and
depersonalization outcomes.
Alexander GK, Rollins K, Walker D, Wong L, Pennings J. Yoga for Self-Care
and Burnout Prevention Among Nurses. Workplace Health Saf. 2015 Oct

MINDFULNESS
•Sit in a straight-backed chair or sit cross-legged on the floor or a
cushion
•Close one’s eyes and bring attention to either the sensations of
breathing in the proximity of one’s nostrils or to the movements of
the abdomen when breathing in and out
•Do not try to control one’s breathing, but simply be aware of one’s
natural breathing process/rhythm
•The mind will often run off to other thoughts and associations, and if
this happens, one passively notices that the mind has wandered, and
in an accepting, non-judgmental way, returns to focusing on
breathing.

MINDFULNESS
33 pediatric residents at the University of Chicago
Pre- and post test abbreviated Maslach Burnout Inventory (aMBI) and
the Mindful Attention Awareness Scale.
Participants then used the free smartphone application “Headspace” to
complete a 10-day program in mindfulness meditation. Each session
being a10-minute recording, which was a combination of educational
material and a short guided meditation.
Taylor M, Hageman JR, Brown M. A Mindfulness
Intervention for Residents: Relevance for
Pediatricians. Pediatr Ann. 2016 Oct 1;45(10):e373–

MEDITATION
Practice is thousands of years old
Research on its health benefits is
relatively new, but promising.
Meditation helpful for relieving anxiety,
pain, and depression.
For depression, meditation was about as
effective as an antidepressant.
Goyal et al. JAMA Internal Medicine, Jan

MEDITATION: TYPES
Transcendental Meditation :repeat a mantra—a word, phrase, or
sound—to quiet your thoughts and achieve greater awareness.
Concentration meditation teaches you how to focus your mind.
It's the foundation for other forms of meditation.
Mindfulness meditation encourages you to focus objectively on
negative thoughts as they move through your mind, so you can
achieve a state of calm.
Tai chi and qigong are moving forms of meditation that
combine physical exercise with breathing and focus.

WELLNESS PROGRAMS: RAND STUDY
(SPONSORED BY U.S. DEPARTMENT OF LABOR)
1. Half of U.S. employers surveyed offer wellness promotion
initiatives
2. 46% undergo clinical screening or complete a health risk
assessment
3. Exercise frequency, smoking behavior, and weight control
improved
4. Lower health care costs and decreasing health care use. $157 per
employee
5. Financial Incentives
Mattke, Soeren, Harry H. Liu, John P. Caloyeras, Christina Y.
Huang, Kristin R. Van Busum, Dmitry Khodyakov, and Victoria
Shier, Workplace Wellness Programs Study: Final Report. Santa

SOCIAL MEDIA, CELL
PHONES
Fixed scheduling
Blue light emitted from devices can speed up the aging process by
increasing oxidative stress
Use within two to three hours of sleep can affect circadian rhythm.
*Pros: access to meditation tools, social network of friends, family,
colleagues

SMOKING CESSATION
•All current smokers should be counseled at each visit for
smoking cessation with a consideration of pharmacotherapy.
•A standardized test (eg: Ferguson test) may be used to assess
nicotine dependence.
•Pharmacotherapy may be initiated as soon as after 2 weeks
following an MI
•Pharmacotherapeutic options: Nicotine replacement;Vassiliou et al. A Guide for Smoking Cessation. ESC Jun 2017

ALCOHOL AND HEALTH
Low Risk for Alcohol Use Disorder:
 Women: No more than 3 drinks* on any day and no more than 7 drinks in a week.
 Men: No more than 4 drinks on any day and no more than 14 drinks in a week.
Moderate Drinking:
1 drink per day for women and 2 drinks per day for men
Binge Drinking:
4 or more alcoholic drinks for females and 5 or more alcohol drinks for males on
the same occasion
Heavy Alcohol Use
5 or more binge drinking days in the past month
1 standard drink: 350 mL (1 can) of beer or 150 mL of wine or 50 mL shot of NIAAA. Drinking Levels Defined. Accessed online on 20th Jun 2019

NUTRITION: 10 TIPS FOR
HEALTHY EATING

RACING TO HEALTH
150 minutes/ week moderate-
intensity physical activity
OR
75 minutes per week vigorous
intensity physical activity
ACC/AHA. Guideline on Primary Prevention of Cardiovascular

“SWASTH NAGRIK ABHIYAN” –A
SOCIAL MOVEMENT FOR
HEALTH•Under Ayushman Bharat: Indigenous health,
system and Yoga will be mainstreamed.
•Health and Wellness Centres: Platform for enabling
this integration
Family/HouseHold and Community level
The ASHA and MPW: Undertake house visits supported and supplemented by the MPWs
ASHAs support follow up for compliance to treatment
Community platforms such as Village Health and Nutrition Days (VHNDs), Village Health,
Sanitation, Nutrition Committees ( VHSNCs), Mahila Arogya Samities (MAS), would be
leveraged.Health and Wellness Centres
HWC: must be kept open with services available for at least six hours in the day
Outreach services and home visits.
Follow up of chronic illness: patient group meetings on fixed days at the HWC
First referral level
Referral care and sites will vary with each illness.
Acute illness: PHC-MO or CHC/DH specialist
States will progress to establishing an FRU at the CHC level

AGE-SPECIFIC HEALTH
PROMOTION: A SUMMARY
Age-Group Health Promotion Activity
20-35 years • Emphasize Healthy Diet and Exercise, Smoking Cessation; Limit
Alcohol Use
• Safe Sexual Practices
• Genetic Counselling
• Blood pressure screening in all adults
• If overweight or obese, screen for diabetes. Follow up normal tests
at minimum of 3 years. Impaired tests: annually.
• All patients, fasting or non-fasting lipid profile. Follow up normal
tests at a minimum of 5 years.
• Single time HCV screening for persons who received blood
transfusions prior to 1992
• Cervical Cancer Screening: 3 yearly cytology at age 21-29 years.
Prefer 5 yearly co-testing with cytology and high-risk HPV.
• Annual Influenza Vaccination
• HPV Vaccination for unvaccinated or incompletely vaccinated women
upto 22 years and men upto 26 years.

AGE-SPECIFIC HEALTH
36-50 years • Emphasize Healthy Diet and Exercise
• Smoking Cessation; Limit Alcohol Use
• If overweight or obese (36-45 years), screen for diabetes. Screen all
> 45 years of age.
• All patients, fasting or non-fasting lipid profile.
• Single time HCV screening for persons born between 1945 to 1965
• Colon Cancer Screening: Start at 45 years of age for average-risk
adult. Non-colonoscopic or colonoscopic (testing)
• Breast Cancer Screening: Annual mammography in women older
than 40 years of age.
• Cervical Cancer Screening: 5 yearly co-testing with cytology and
high-risk HPV.
• Annual Influenza Vaccination

AGE-SPECIFIC HEALTH
51-65 years • Emphasize Healthy Diet and Exercise
• Screen all patients for diabetes.
• Lung Cancer Screening: Annual LDCT in all patients older than 55
years with a 30 pack year smoking history who currently smoke or
have quit less than 15 years ago.
• Colon Cancer Screening: Start at 45 years of age for average-risk
adult. Non-colonoscopic or colonoscopic (preferred) testing.
than 40 years of age.
• Cervical Cancer Screening: 5 yearly co-testing with cytology and
high-risk HPV.
• Osteoporosis Screening: All post-menopausal women with one
additional risk factor

AGE-SPECIFIC HEALTH
65 years
and older
• Emphasize Healthy Diet and Exercise
• Screen all patients for diabetes.
• Lung Cancer Screening: Annual LDCT in all patients 55-80 years
with a 30 pack year smoking history who currently smoke or have
quit less than 15 years ago.
• Colon Cancer Screening: All patients 45-75 years of age for
average-risk adult. Non-colonoscopic or colonoscopic (preferred)
testing.
than 40 years.
• Osteoporosis Screening: All Women older than 65 years of age to be
screened with DXA (USPSTF). All Men > 70 years of age to be
screened (NOF).
• Aortic Aneurysm Screening: Single time abdominal ultrasound for

PHYSICIAN WELLNESS
AND BURNOUT

CASE STUDY: HUI WANG
•32-year-old Chinese ophthalmologist
•Experienced sudden cardiac death after working with fever for 6
days in Beijing.
•Father of a 1-year-old girl, married to a doctor, who donated
Hui’s corneas to two patients after his death.
•The circumstances of Hui’s devotion to his work and his family’s
selfless donation have evoked sympathy as well as raised
concerns about physician burnout in China.
•Hui wang is one of many thousands: Not the first case of a
doctor collapsing after work in recent years in China.

Q&A
Have you or anyone you know faced difficulty in your/their
worklife leading you/them to contemplate steps such as
quitting, resorting to violence or self harm?
In such a situation, were you able to help/alleviate the issue to
a sufficient degree?
If in such a situation, do you know who can help you?
Help is always just around the corner!!
AIIM
S
AIIMS: Psychiatry team 7131, 7132
NGOs
Sneha Foundation India: 24X7
helpline
+914424640050
Roshni Mon- Sat 9-9
+914066202000

DEFINITION: ICD-11
`Burn-out is a syndrome conceptualized as resulting from
chronic workplace stress that has not been successfully
managed. It is characterized by three dimensions:
•Feelings of energy depletion or exhaustion;
•Increased mental distance from one’s job, or feelings of
negativism or cynicism related to one's job; and
•Reduced professional efficacy.
Burn-out refers specifically to phenomena in the occupational
context.

WORK STRESS VS BURNOUT
•Reversible with time out vs irreversible
•Work stress is what we usually come across (roughly all of us,
on most days)
•Burnout is the edge of the rope

MEASURING BURNOUT-
MASLACH BURNOUT INVENTORY
• Psychological inventory consisting of 22
items pertaining to occupational burnout.
• Is a Likert scale (0-6) from never to daily
• 3 components: emotional exhaustion (9
items), depersonalization (5 items) and
personal achievement (8 items).
• Scales should not be combined to form a
single burnout scale
Maslach, C.; Jackson, S.E.; Leiter, M.P. (1996–
2016). Maslach Burnout Inventory Manual (Fourth Edition).

PROBLEM STATEMENT:
WORLD
•The Wellness Crisis: 300–400 physicians committing suicide
annually= losing up to three medical school classes.
•6-8% of medical students and residents report suicidal ideations (cf
<1% gen pop)
•Affects > 50% of practicing physicians in the USA and is rising.
•US: 78% of physicians had burnout, an increase of 4% since 2016.
•UK: 80% of doctors at high or very high risk of burnout

INDIAN SCENARIO
•Cross Sectional study: 558 interns and residents
•Assessment Tools: Copenhagen Burnout Inventory [CBI]
•>1/3rd were found to have burnout in some dimension of the CBI.
•Highest among the interns (64%) and in junior residents (40%).
•Surgical specialty - highest personal burnout (57 %)
•Medical specialty - highest patient related burnout (27%).
1.
Ratnakaran B, Prabhakaran A, Karunakaran V. Prevalence of burnout and its correlates
among residents in a tertiary medical center in Kerala, India: A cross-sectional study.
Journal of Postgraduate Medicine. 2016 Jul 1;62(3):157.

NOT ONLY THE YOUNGEST:
Cross-sectional survey was conducted among 482 registered medical
practitioners across India, using abbreviated
Maslach Burnout Inventory (aMBI).
45%- emotional exhaustion
65% -depersonalization scales
87% -personal accomplishment scale
Langade D, Modi PD, Sidhwa YF, Hishikar NA, Gharpure AS,
Wankhade K, et al. Burnout Syndrome Among Medical
Practitioners Across India: A Questionnaire-Based Survey.

CLOSER TO HOME- AIIMS
MEDICINE DEPTParticipant
Emotional
exhaustion Depersonalization
Personal
achievement
1 21 9 44
2 6 13 29
3 3 3 41
4 25 29 19
5 21 28 36
6 14 7 25
7 11 8 16
8 25 27 27
9 28 35 45
10 23 10 29
Median 21 11.5 29
Low 4 2 6
Moderate 6 3 1
High level 0 5 3

HOW IS IT DIFFERENT FROM
GENERAL POPULATION

WHY IS IT HAPPENING TO US?
1. Organizational transformation of the health care system
2. Reduction in professional autonomy
3. Increase in clerical duties, litigations (data, fear of unknown)
4. Medical training has acculturated physicians to neglect self-
care in the service of others.

WHY IS IT HAPPENING TO
THE PEOPLE WHO CHOOSE
TO BECOME DOCTORS?
“I solemnly pledge myself to consecrate my life to the service of humanity;
I will give my teachers the respect and gratitude which is their due;
I will practice my profession with conscience and dignity;
The health of my patient will be my first consideration;
I will respect the secrets which are confided in me, even after the patient has died;
I will maintain by all the means in my power, the honor and the noble traditions of the
medical profession;
My colleagues will be my brothers;
I will not permit considerations of religion, nationality, race, party politics or social
standing to intervene between my duty and my patient;
I will maintain the utmost respect for human life from its beginning even under threat
and I will not use my medical knowledge contrary to the laws of humanity;
I make these promises solemnly, freely and upon my honor.”
Declaration of Geneva of the World Medical Association: (adopted 1948, amended
1966 and 1983)
Role Overload –
expectations of others
exceed one’s ability to
perform
Role Conflict – forced to
make a choice about which
demand to satisfy
 Ex. Watching India v Pak cricket
match vs. writing daily progress
notes for your patients

TO CHOOSE BETWEEN-
DUCHENNE SMILE VS “SAY
CHEESE”

IMPACT
West CP, Dyrbye LN, Shanafelt TD. Physician
burnout: contributors, consequences and
solutions. Journal of Internal Medicine.

MENTAL AND PHYSICAL
HEALTH HAZARD1. 25% increased odds of alcohol abuse/dependence
2. 2x risk of suicidal ideation:
• Physicians>> general population
3. Increased risk of RTA even after adjusting for fatigue.
4. Burnout needs to be targeted, not only depression:
 Burnout :resident (60%)>Depression: 29–43%
5. Strong correlation with depression: odds ratio of suffering from
major depression was 46.0 for physicians with severe burnout.
1. Bianchi R, Schonfeld IS, Laurent E. Burnout‐depression overlap: a review. Clin Psychol Rev 2015; 36: 28–41.
2. Brown SD, Goske MJ, Johnson CM. Beyond substance abuse: stress, burnout, and depression as causes of
physician impairment and disruptive behavior. J Am Coll Radiol 2009; 6: 479–85.
3. van der Heijden F, Dillingh G, Bakker A, Prins J. Suicidal thoughts among medical residents with burnout. Arch
Suicide Res2008; 12: 344–6.
4. Center C, Davis M, Detre T et al. Confronting depression and suicide in physicians: a consensus

UNDERLYING THEMES TO
BURNOUT AND WELLNESS
Physician Well-Being: Efficiency, Resilience,
Wellness [Internet].

RESILIENCE: HOW DO THOSE
WHO ARE ABLE TO COPE
WITH IT, REALLY DO?
•The process of adapting well in the face of adversity, trauma, tragedy,
threats, or significant sources of stress
job- related
gratification from
physician–patient
interaction and/or
medical efficacy
strategies focused
on practices and
routines, such as
leisure-time
activities
strategies related to
attitudes such as
acceptance and
realism

WHAT CAN BE DONE TO
MITIGATE THIS DISASTER?
•Wellness goes beyond merely the absence of distress
•being challenged, thriving, and achieving success in various aspects
of personal and professional life
Subjective absence of stress ≠ adequate wellness

MASLOW’S ‘HIERARCHY OF
NEEDS’: PRIORITIZING
PROGRESS
•Abraham Maslow: “Theory of Human Motivation” in 1943.
•Defines five levels of human needs.
•How humans tend to prioritize their progress.
•People seek to satisfy needs on a higher level only when the needs on
the underlying levels have been adequately fulfilled.

Daniel E. Shapiro, Cathy Duquette, Lisa M et al. Beyond Burnout: A
Physician Wellness Hierarchy Designed to Prioritize Interventions at
the Systems Level, The American Journal of Medicine (2018)

•Interventions lead to small significant reductions in burnout (=3
points on emotional exhaustion domain of the MBI).
•Organization-directed interventions fared better than physician-
directed interventions
•Experienced physicians (≥5 years) and primary care physicians
were associated with higher improvement with intervention

ORGANIZATION DIRECTED >
PHYSICIAN DIRECTED
Organization-directed interventions:
 Work schedule changes
 Structural changes
 Fostering communication
 Cultivating teamwork
Physician-directed interventions:
 No evidence that content or intensity of these might increase
the derived benefits.
Panagioti M, Panagopoulou E, Bower P, Lewith G, Kontopantelis E,
Chew-Graham C, et al. Controlled Interventions to Reduce Burnout
in Physicians: A Systematic Review and Meta-analysis. JAMA Intern

RISK
FACTOR
TARGETE
D
APPROAC
H
West CP, Dyrbye LN, Shanafelt TD. Physician
burnout: contributors, consequences and
solutions. Journal of Internal Medicine.

ACTION PLAN FOR YOU: BUILD
RESILIENCE
A Change in Routine
Hobbies – once/twice a week (Karaoke
night, dance class, movie outing)
Exercise (you always have time!)- 30
mins a day
Ritualized time out periods (daily 4 pm
tea break)
Chit-chat with colleagues. Call your
parents
Sleep 7+ hours a day (no phones peri-
sleep)
Prioritise tasks you enjoy, while at work
A Better Attitude
Introspect
Active acceptance and mindfulness-
download Headspace today
Accepting your limits
Recognizing when help is necessary
Recognizing when change is
necessary
Appreciating the good things at
work and home
Zwack. Acad Med. 2013

TIME MANAGEMENT: THE
EISENHOWER MATRIX

TAKE HOME MESSAGE
1. Wellness goes above and beyond
health
2. Your wellness is unique and second
to none
3. Having burnout adversely impacts
you, your patients and the whole
system
4. Wellness should be “prescribed” to

DEPARTMENTAL
STRATEGIES TO
REDUCE RESIDENT
BURNOUT
A Good Laugh and A Long
Sleep: The Best Cures

PROBLEM FINDING
Mentorship Programs
1. Faculty Mentorship
2. ‘Buddy’ Programs:
1. Norm for most US Internal Medicine Residency Programs
2. Assignment of Senior JRs to each first year
3. Preferably to be allotted a few weeks prior to joining (subsequent to the
counseling results)
4. The ‘buddy’ may be asked to give monthly progress reports of the new residents
3. Resident Wellness Committee
1. Membership: 1-2 faculty members, 2-4 Senior Residents, ‘Buddy’ Residents, 4-
5 Nursing Staff
2. Allotted initially weekly, subsequently monthly discussion with all new residents

PROBLEM FINDING
Anonymous Problem Search
1. Online Portal/Anonymous Google form circulated among all
residents
2. A request may be registered by any resident facing a problem
3. Resident to then be allotted a faculty member/ ‘buddy’ resident to
assist with problem solving
Anonymous Bidirectional Feedback System
Similar Online Portal/ Anonymous Google Form for resident feedback

REDRESSAL AND SOLUTIONS
Periodic reinforcement and reassessment
1. Resident Burnout and Prevention Strategies may periodically be re-
iterated
2. All new batches of residents to have sessions on Physician Burnout
3. May take assistance of other departments (Psychiatry)
4. Periodic (Annual/ Biennial) burnout assessment
Well Resident Groups
1. Protected time (1 hour every 2 weeks) for trainee discussion
groups
2. Key elements of discussion: ‘Self’ ‘Patient’ and ‘Balance’West CP, Dyrbye LN, Rabatin JT et al. Intervention to Promote
PhysicianWell-being,

REDRESSAL AND SOLUTIONS
Improving Resident Safety
1. Improvement/Training in Soft Skills, Patient Communication, Breaking Bad
News
2. May conduct workshops in conjunction with CMET
3. Improving the security structure (Minimizing patient relatives in the wards
beyond visiting hours)
4. Training sessions on use of personal protective equipment
Blame Free Patient Discussions
1. Anonymous mortality meetings: analyze root cause rather than implicate
residents
2. Shared decision making
Avoiding Patient Errors
1. Mandatory off-time especially on ward post-duty days
2. Written hand-offs: Standardized hand-off pattern

REWARD SYSTEM
Appraisal of Work Quality
1. Monthly may consider unit-wise ‘Best Resident’ ‘Best-Managed
Case’ awards
2. All resident publications to be shared on the MD Medicine group
3. Senior residents/ senior JRs to be encouraged to incentivize a job
well done
Leisure Time
1. Monthly unit wise ‘time outs’: Outing for Lunch/Dinner
2. Departmental Recreational Activities: 3-monthly picnic/ movie/
sports activity
3. Weekly off: By rotation of residents on non-admission Sundays

THE GREATEST MEDICINE OF
ALL IS TO TEACH PEOPLE HOW
TO NOT NEED IT.

Resident wellness and burnout

Recomendados

Recomendados

Más contenido relacionado

Similar a Resident wellness and burnout

Similar a Resident wellness and burnout (20)

Último

Último (20)

Resident wellness and burnout

Notas del editor