The BMC Department of Radiology supports a Wellness program primarily focused on the residents. This Wellness program includes social programming outside of work, coaching, and a dedicated curriculum. The WELCOME curriculum, designed by Michael Fishman, MD, (Department Wellness Champion, Section Chief of Breast Imaging, Assistant Professor of Radiology, and trained health and wellness coach) explores wellbeing and non-clinical skills.
WELCOME is an acronym for
•Coaching, Conflict resolution and Communication
•Organizational and positive psychology
These are examples of some of the topics the residents learn and discuss together, facilitated by Dr Fishman, within the confines of a confidential, safe space. Other topics include gratitude, resilience, happiness, and the residents are encouraged to suggest new topics. Guest speakers have included a professional executive coach Melissa Merres and BMC Employee Assistance Clinician, Beth Milaszewski, with more planned in the coming year. Each session begins with a wellness check-in to stimulate conversation. For example: What are you grateful for today?
In addition to the curriculum, Dr Fishman directs the COBRA (Coaching Opposes Burnout in Radiology) Coaching program for residents. Physician burnout remains an epidemic, which affects the majority of practicing radiologists. There are numerous drivers of burnout, including individual and organizational factors. Varied interventions have been considered to promote physician wellness and engagement, with few successful or generalizable across and between organizations. Residents are particularly at risk for burnout, in part due to the high stress training with limited emotional support. Not only can burnout result in medical error, but contributes to higher rates of depression, anxiety, substance use disorder, and suicide in physicians relative to the general public. Therefore, focusing on the emotional and psychological needs of all radiologists, and particularly the residents, is critical to future self-care, engagement, and optimal patient care.
Coaching has emerged as an increasingly respected resource in medical education, long used in business and athletics to help individuals achieve their personal best. Research involving residents in a structured coaching program has previously proved useful in developing awareness of academic accomplishment, interpersonal communication skills, and professional behaviors. A recent study of 88 mid-career practicing physicians participating in a six-month coaching intervention showed decreased burnout and decreased emotional exhaustion.
Positive psychology evaluates the practices and environments contributing to optimal functioning, whether for individuals, groups or organizations. Positive psychology coaching uses a strengths-based approach to help residents identify and achieve positive emotions, create meaningful relationships, increase engagement and purpose, and provide tools to cope with personal and professional stressors, including communication, improving resilience, team building, and mindfulness. Health and wellness coaching, which integrates positive psychology and promotes healthy behavior change as a means of averting or mitigating chronic lifestyle-related diseases, remains a relatively unexplored potential treatment for burnout and stress management.
Professional coaching differs from teaching, mentoring, and counseling. Coaching is a human partnership to help individuals promote growth to achieve the best version of their personal and professional selves by focusing on goal setting, intrinsic motivation, and accountability, resulting in positive sustainable change. Coaches drive self-determined efforts to help clients thrive mentally, emotionally and physically. Self-determination helps clients build confidence and reach empowerment “ability to reach highest level of motivation, performance, persistence, and creativity”. Traditionally, coaching is between one coach and one client in-person, by phone or tele-coaching, the latter two more common now due to COVID social distancing guidelines. Each coaching session lasts approximately 30-60 minutes.
In the COBRA program, nine faculty were selected to serve as coaches with Dr Fishman and attended an abbreviated coaching training in the fall of 2019. Each class of radiology residents is randomized to receive coaching from a faculty coach or continue with their usual mentoring during residency. Each coach is matched with two resident clients. Coaches are encouraged to meet with their resident clients at least quarterly, but the frequency and need should be driven by the client. All coaching sessions are confidential to ensure the psychological safety of the resident. Mindfulness exercises are incorporated into the sessions.