M e di c a l P r o f essio n Medical Professionalism a l ism B Best Practices: est P r a Addressing Burnout and c ti c es: Resilience in Our Profession Addressing Burnout and Resilience in Our Profession Edited by Richard L. Byyny, MD, FACP Richard Byyny, MD Sean Christensen, MD Jonathan D. Fish, MD Alpha Omega Alpha Honor Medical Society 12635 E. Montview Blvd., Suite 270 Aurora, Colorado 80045 2020 ISBN # 978-1-7923-3158-9 Alpha Omega Alpha Honor Medical Society Aurora, Colorado ` Medical Professionalism Best Practices: Addressing Burnout and Resilience in Our Profession Edited by Richard L. Byyny, MD, FACP Richard Byyny, MD Sean Christensen, MD Jonathan D. Fish, MD 2020 Alpha Omega Alpha Honor Medical Society i ii Dedicated to the members of Alpha Omega Alpha Honor Medical Society and the medical profession. Publication of this monograph was funded in part by a President’s Grant from the Josiah Macy Jr. Foundation. © 2020, Alpha Omega Alpha Honor Medical Society ISBN: 978-0-578-64178-2 eBook ISBN: 978-1-7923-3158-9 iii iv Table of Contents Dedication...........................................................................................................iii Contributors .......................................................................................................vii Acknowledgments .............................................................................................xi Preface: Burnout and Resilience in Our Profession Richard L. Byyny, MD, FACP, and George E. Thibault, MD................ 1 Chapter 1 - Burnout and Resiliency Richard L. Byyny, MD, FACP .....................................................................7 Chapter 2 - A Personal and Professional Perspective on the Burnout Crisis Darrell G. Kirch, MD ...................................................................................15 Chapter 3 - The Juggler’s Handbook: A Conversation About Life Linda Hawes Clever, MD, MACP ..............................................................25 Chapter 4 - Electronic Health Records: Maintaining Professionalism Carrie A. Horwitch, MD, MPH, MACP ..................................................33 Chapter 5 - Burnout, Resilience & (The Logic of) Professionalism: Reframing Our Historical Moment Frederic W. Hafferty, PhD, and Jon C. Tilburt, MD .............................. 41 Chapter 6 - For Whom the Bell Tolls: The System and Cultural Influences Affecting the Next Generation of Health Professionals Holly J. Humphrey, MD, MACP, and Heather Snijdewind, BA........... 57 Chapter 7 - Development of a Resilient Professional Identity Molly Blackley Jackson, MD .......................................................................67 Chapter 8 - Re-examining Exams: National Board of Medical Examiners’ Efforts on Wellness (RENEW) Miguel Paniagua, MD, Madeline DelVescovo, BA, and Liselotte N. Dyrbye, MD, MHPE ...............................................................73 v Chapter 9 - Professional Development: Professionalism and Resilience in the Learning Environment Douglas S. Paauw, MD, MACP, and Sheryl Pfeil, MD .......................... 81 Chapter 10 - Well-being Definition and Measures in Medical Education Anne Eacker, MD, FACP .............................................................................91 Chapter 11 - Personal Strategies to Beat Burnout: The 20 Percent You Can Control Christina M. Surawicz, MD ........................................................................105 Chapter 12 - Changing the Behavior of Organizations Steven A. Wartman, MD, PhD, MACP ....................................................115 Chapter 13 - Recovering the Joie de Vivre in Medicine: The Importance of Organizational Culture Eve J. Higginbotham, SM, MD, and Dominique Alexis ........................ 121 Chapter 14 - Resilience, Burnout, and Communities of Practice Sylvia R. Cruess, MD, and Richard L. Cruess, MD ................................ 133 Reflections on Best Practices for Addressing Burnout and Resilience in Our Profession Richard L. Byyny, MD, FACP .....................................................................145 vi Contributors Richard L. Byyny, MD, FACP (AΩA, Keck School of Medicine of the University of Southern California, 1964), is Executive Director of Alpha Omega Alpha Honor Medical Society, and Editor of The Pharos. Contact Dr. Byyny at: Alpha Omega Alpha, 12635 E. Montview Blvd., Suite 270, Aurora, CO 80045; [email protected]. Richard Byyny, MD (AΩA, Keck School of Medicine of the University of Southern California, 2000), is an Emergency Medicine Physician, and an Associate Professor of Emergency Medicine. Contact Dr. Byyny at: rbyyny@ yahoo.com. Sean Christensen, MD (AΩA, University of South Carolina School of Medicine, 2016), is a Psychiatry Resident at the Medical University of South Carolina. Contact Dr. Christensen at: [email protected]. Richard L. Cruess, MD, is professor of Orthopedic Surgery and a Core Member of the Institute of Health Sciences Education at McGill University. Contact Dr. Cruess at: [email protected]. Sylvia R. Cruess, MD, is an Endocrinologist, Professor of Medicine, and Core Member of the Institute of Health Sciences Education at McGill University. Contact Dr. Cruess at: [email protected]. Linda Hawes Clever, MD, MACP, is Founder and President of RENEW, and Former Trustee and Associate Dean at Stanford University Medical School. She is a member of the National Academy of Medicine. Contact Dr. Clever at: 501 Portola Road #8080 Portola Valley, CA 94028; [email protected]. Samantha Dizon, MD (AΩA, University of Maryland School of Medicine, 2017), is an Internal Medicine-Pediatrics Resident, Duke University. She is a member of the AΩA Professionalism Committee. Contact Dr. Dizon at: [email protected]. Anne Eacker, MD, FACP (AΩA, University of Washington School of Medicine, 1996), is Senior Associate Dean for Student Affairs and Associate Professor, Kaiser Permanente School of Medicine. Contact Dr. Eacker at: 100 South Los Robles Ave., Suite 301, Pasadena, CA 91101; [email protected]. Jonathan D. Fish, MD (AΩA, State University of New York Upstate Medical University College of Medicine, 1999) is Associate Professor of Pediatrics, Cohen Children’s Medical Center, Zucker School of Medicine at Hofstra/Northwell; and a 2017 AΩA Fellow in Leadership. Contact Dr. Fish at: 269-01 76th Ave., Pediatric Hematology/Oncology Suite 255, New Hyde Park, NY 11040; [email protected]. Laurie Goss is the Graphic Designer at Alpha Omega Alpha Honor Medical Society. Contact Ms. Goss at: 12635 E. Montview Blvd., Suite 270, Aurora, CO 80045; [email protected]. vii Larry A. Green, MD, is Distinguished Professor, Epperson Zorn Chair for Innovation in Family Medicine and Primary Care, University of Colorado School of Medicine. Contact Dr. Green at: [email protected]. Frederic W. Hafferty, PhD, is Professor of Medical Education, Division of General Internal Medicine and Program in Professionalism and Values, Mayo Clinic. Contact Dr. Hafferty at: 200 First Street SW, Rochester, MN 55901; [email protected]. Eve J. Higginbotham, SM, MD (AΩA, Morehouse School of Medicine, 2008, Faculty), is Vice Dean for Penn Medicine Office of Inclusion and Diversity; Senior Fellow, Leonard Davis Institute for Health Economics; Professor of Ophthalmology, Perelman School of Medicine at the University of Pennsylvania. Contact Dr. Higginbotham at: University of Pennsylvania, 3400 Civic Center Blvd., Building 421 PCAM South Expansion, 6th Floor, Philadelphia, PA 19104-5162; ehig@upenn,edu. Carrie A. Horwitch, MD, MPH, MACP, is in General Internal Medicine, Virginia Mason Medical Center, Clinical Associate Professor of Medicine, University of Washington, Seattle WA; Contact Dr. Horwitch at: carrie. [email protected]. Holly J. Humphrey, MD, MACP (AΩA, University of Chicago Pritzker School of Medicine, 1983), is President of the Josiah Macy Jr. Foundation, Ralph W. Gerard Professor in Medicine Emerita, The University of Chicago. Contact Dr. Humphrey at: 44 East 64th Street, New York, NY; hhumphrey@ macyfoundation.org. Molly Blackley Jackson, MD (AΩA, University of Washington School of Medicine, 2007), is Assistant Dean for the Colleges at the University of Washington School of Medicine, and former Chair of the University of Washington Medicine Continuous Professionalism Improvement Committee. Contact Dr. Jackson at: CB 357430, 1959 NE Pacific St., Seattle, WA 98195; [email protected]. Darrell G. Kirch, MD (AΩA, University of Colorado School of Medicine, 1976), is Emeritus President and Chief Executive Officer, Association of Academic Medical Centers. Contact Dr. Kirch at: [email protected]. Dee Martinez is Chief of Staff at Alpha Omega Alpha Honor Medical Society, and Managing Editor of The Pharos. Contact Ms. Martinez at: 12635 E. Montview Blvd., Suite 270, Aurora, CO 80045; [email protected]. Douglas S. Paauw, MD, MACP (AΩA, University of Michigan, 1983), is Professor of Medicine, Rathman Family Foundation Endowed Chair in Patient- centered Clinical Education, and Clerkship Director for the Department of Medicine at the University of Washington School of Medicine. Dr. Paauw is Co- chair of the AΩA Professionalism Committee and AΩA Chapter Councilor at the University of Washington. Contact Dr. Paauw at: University of Washington School of Medicine, Department of Internal Medicine, Box 356420, 1959 NE Pacific St., Seattle, WA 98195-6420; [email protected]. viii Miguel Paniagua, MD (AΩA, University of Miami Miller School