Electronic Winter 2023 | Issue 57

Area 4 Hosts 4th Annual RFM and ECP Event on Stress and Resilience

By: Jasleen Singh, MD

On Saturday, December 2nd, Area 4 of the APA Assembly hosted its 4th Annual event for Residents/Fellows (RFMs) and Early Career Psychiatrists (ECPs). This virtual event focused on Stress and Resilience in Training and Practice. Presentation topics included: 1) Research Studies on the Prevalence of Depression in Residency Training, 2) Personal Psychotherapy for RFMs and ECPs, 3) Protective Strategies for Stress Reduction, and 4) Boundaries and Ethics in the Treatment of Colleagues. At the conclusion of the four presentations, there was a panel discussion with Q&A.

The event began with a warm welcome from Area 4 Representative, Dr. Kenneth Busch, introducing some of the key Area 4 members involved. Overall, it was packed with great conversation and a wealth of knowledge! 

Below is a brief overview of some highlights from the program. 

Dr. Poojajeet Khaira (PGY-2 at MetroHealth Hospital and RFM Deputy Representative for Area 4) started the presentations by touching on the prevalence of depressive symptoms in residents - a stark 28% (with no significant difference across specialty or country). Furthermore, within a year of beginning training, the median absolute increase in depressive symptoms among trainees is 15.8%. The ramifications of this spreads wide and far, affecting patients, peers, the trainee and their loved ones. It is also notable that vulnerabilities start prior to entering residency. Per a recent Elsevier report, 25% of medical and nursing students were considering quitting their studies and 60% reported symptoms of anxiety and depression. 

Next, Dr. Karen Jacobs (Vice Chair of Education, Program Director of Adult Psychiatry Residency at Cleveland Clinic, and Assembly Representative from Ohio) discussed the DEPRESS-Ohio study, a pre-pandemic survey of residents training in Ohio. She noted that residents who felt they were well-supported, knew how to access resources for wellness were less likely to be depressed. Residents with depressive symptoms reported barriers to pursuing treatment as stigma, cost, timing issues, and confidentiality. To address this, programs have employed various strategies, such as inclusion of a wellness curriculum, trainee retreats, process groups, employing staff psychologists, offering off-campus mental health treatment clinics, and overall enhancing communication amongst trainees and attendings. 

The next presentation by Dr. Fi Fonseca (Senior Associate Consultant in Psychiatry at the Mayo Clinic, Mayo Clinic Scholar, 2022-2023 Chair for the APAF Diversity Leadership and SAMHSA fellowships, and CL psychiatry fellow). Dr. Fonseca spoke to the importance of recognizing transference/countertransference and self-exploration, through various routes including supervision and individual therapy. 

The presentation followed with Dr. Jeffrey Taxman (President-Elect of the American Psychoanalytic Association and Associate Clinical Faculty at Medical College of Wisconsin). Dr. Taxman talked about exploring the dynamics between trainees and their patients. He also discussed the concept of "second year blues" - a time of increased frustration, anxiety, and depression a couple months into the second year of residency - where people often question their role and place in the program. He highlighted the transition from being a 4th year medical student who has risen through the ranks of medical school to "bottom of the food chain" where one might doubt their abilities and feel insecure, with internal fears and conflicts rising. He recognized the importance of a mentor to help individuals work through this internal angst. Of note, it was further recognized that there may be recurrence of this self-doubt when transitioning to practice or transitioning to fellowship. 

The third presentation delved into wellness, resilience, physician burnout, and physician suicide. Dr. Michael Peterson (Professor in Psychiatry at the University of Wisconsin, Residency Program Director, Director of Hospital Psychiatric Services) broke down the concept of burnout into 3 domains: emotional exhaustion, depersonalization, and reduced personal achievement. There is a close relationship between burnout and depression/suicide, yet the impact of burnout extends beyond mental health and can effect patient care. Dr. Peterson reminded attendees that 300-400 physicians die from suicide every year, with a disproportionate emphasis on female physicians. He also reviewed the AMA-APA Physician Mortality Project, noting that 1/3 of physicians who died by suicide had mentioned the possibility of suicide and 2/3 died on their first attempt. Protective factors were emphasized, with the need to bolster resilience (and decrease burnout) by strengthening domains of personal characteristics, workplace characteristics, and social network.

Dr. Kyle LeMasters (Area 4 ECP Deputy Representative, inpatient psychiatrist in Iowa, and faculty member for UnityPoint Broadlawns Psychiatry Residency program) followed with a highlight of well-being resources from the APA. He walked through a sample breakdown of organizational interventions for a wellbeing plan and ways to address burnout. Proposed interventions included teaching practical skills such as mindfulness or exercise, fostering community building, allowing time for reflection, ensuring access to care, and increasing awareness on a larger scale.

The presentations concluded with Dr. Lisa Schock (inpatient psychiatrist at Prairie St. John’s Hospital in Fargo, ND, Associate Program Director and Clerkship Director at University of North Dakota, and Assembly 

representative for North Dakota) and Dr. Brooke Olson (PGY-3 at the University of Iowa Hospitals and Clinics, 1st year APAF Public Psychiatry Fellow, and RFM Representative for Area 4) discussed ethical considerations when treating colleagues. Prior knowledge about colleagues, overlap in social circles, privacy and liability concerns, and potential dissatisfaction with care can all lead to a difficult relationship. Navigating a working and therapeutic relationship can be difficult. However, it was also noted that shared professional experiences can also be a potential benefit, offering an ability to empathize with stressors and challenges in the profession. The importance of maintaining boundaries and keeping the relationship professional was highlighted, with a need to set expectations, have clear conversations about reporting requirements, using proper channels for communications, and possibly referring to other providers.

Overall, a wonderful event with lots of valuable information. Be sure to keep an eye out for details on Area 4's upcoming annual MLK event on January 13th to honor the life and legacy of Reverend Dr. Martin Luther King Jr. We hope to see you there!