Promoting a Culture of

Wellness & Serving the Mental

Health Needs of Residents &
Fellows
Mindy Stern, LICSW
Director, Resident & Fellow Wellness
University of Washington School of Medicine
Seattle, Washington
 Todays Agenda
Identify top mental health concerns of GME
trainees
Develop strategies to promote use of counseling
Define a range of activities that trainees want
and appreciate
 My Background
33 year social work career
12 years in residency education
Behavioral Science Faculty member
Provider of Mental Health counseling to Family
Med residencys patients (not residents)
 UWSOM Background
Large AMC that serves and trains in the WWAMI
(Washington, Wyoming, Alaska, Montana and
Idaho) region
90 residencies and fellowships
1,190 trainees
75% of trainees at 4 main sites: UW Medical
Center, Harborview (regional trauma center),
Seattle Childrens Hospital, VA Puget Sound
~165 other sites where residents & fellows train!
 History of Wellness
Program
Tragedy in 2001 counseling service created
1.0 FTE dedicated staf
First 8 years regional & national leader
Inspiration for OHSU
September 2009 transition in program
management
 Range of Activities
FREE, Confidential Counseling for Individuals &
Couples
Workshops for Trainees
Arts & Food Events
Massages
 When, Who, How to Refer
Residents in distress or crisis
Changes in behavior or performance
Troubled colleagues
Remediation situations
 Current Staffing
Mindy Stern, LICSW, Director, Resident & Fellow
Wellness
0.7 FTE
Monday to Thursday, Monday evenings
Jill Gross, PsyD, Staf Psychologist
0.3 FTE
Wednesday & Thursday evenings, Friday afternoons
 Future Staffing
Mindy Stern, LICSW, Director, Resident & Fellow
Wellness
0.7 FTE
Monday to Thursday, Monday evenings
PsyD, LMHC, MSW, PhD - Staf Psychologist or Therapist
0.5 FTE
2 - 3 evenings + Friday
Staf Psychiatrist
0.1 - 0.2 FTE
Available for URGENT needs and medication
 EBM The Need
Burnout is an occupational hazard of medicine
Range: 25% - 70% of all physicians report
burnout
Onset residency training
740 Interns entering residency
PHQ-9 prior to internship and at 3-month
intervals during R-1 year
Depression rating increased from 2.4 to 6.4
A Prospective Cohort Study Investigating Factors Associated With Depression During Medical Internship Srijan Sen, MD, PhD;
Henry R. Kranzler, MD; John H. Krystal, MD; Heather Speller, MD; Grace Chan, PhD; Joel Gelernter, MD; Constance Guille, MD Arch Gen
Psychiatry. 2010;67(6):(doi:10.1001/archgenpsychiatry.2010.41).
 Physician Traits
Perfectionists
Poor delegators
Neglectful of selves
Self-doubters, lots of guilt
Exaggerated sense of responsibility
Alexythymic hard to express feelings (not facts!)

Reference: The Physician As Patient Michael Myers & Glen Gabbard

 Data Collection
Each counselee is assigned a code number
At every visit, record:
New / Repeat
Other Issues
Age
Prior Counseling?
Gender
Prior Diagnosis?
Single visit / Couple Visit
Medication Hx?
Program
Distress Level
PGY year
Referred To
Referred by
Discussed Medications?
Date
Debt
Chief Complaint
(eliminated FMG field)
 Basic Stats
366 total visits between September 2009 July
2010
118 new visits, 248 return visits
Why We Dont Limit # of
Visits
New Visits by Gender
Chief Complaint (New
Visits)
Chief Complaint (All Visits)
PGY Level at First Visit
Distress Level at First Visit
Clients by Program
 Marketing the Program
Free
Confidential/non-discoverable
Accessible
Convenient
Free parking
Part of a range of wellness services
Reach out to programs and trainees
 Where to Promote the
Service
Orientation talks
Chief residents
Workshops, retreat facilitation, group de-briefs,
support groups
Modeling self-care
Mandatory referrals
 Workshops for Trainees
Self Care
Narrative Medicine
Skill building: how to write a condolence note,
improving observational skills, giving bad news
Group facilitation neutral voice
Maybe a Baby
 Arts & Food Events
Art Walks
Live performances
Food talk - Whats in Your Fridge?
Peeps Contest
Whats In Your Fridge?
Therapeep
 Family Med the winner!

 Massages
Cortiva Institute Seattle
$25 for 60 minutes
Print out coupon
 Vision
Creating a Culture of Wellness
What does it take?
Your role as a leader?
Contact Info
mindywho@uw.edu
206-543-6408
 Holy Trinity
Im trying to find a way to balance my job,
my family, and my life.
4th year surgery resident