While scanning through the peer evaluations at my recent semi-annual review, I happened upon the following comment:
“She appears to be Teflon to the daily frustrations of being a resident physician.”
I was flattered and immediately inspired by this observation. Did I hold the secrets to solving the physician burnout health crisis, and if so, wouldn’t that be an exciting thing to share with readers in my upcoming blog post?
If only it was that easy.
Insult to Injury
Mere weeks prior to that meeting, I replied to a weekly, voluntary self-assessment for a project between several Duke University health care programs called the Wellness Fuel Tank Initiative: "Overall, your Wellness Fuel Tank level is: 0." (see graphic).
Between being the off-service resident trying to acclimate to the steep learning curve of my latest rotation, the ever-growing pile of documentation to-do’s, the unanswered inbox messages from my clinic patients, prior authorizations still awaiting my signature, the feelings of inadequacy, the lack of sleep, and the nasty cold I was succumbing to … it was all too much. My enthusiasm, my drive, my energy, they had all vanished in an alarmingly short amount of time, and I was not acting like the physician I knew I could be or the person I wanted to be.
For many residents, scenarios like this (or worse) are not uncommon. More importantly though, weeks like this may have significant health implications based on changes happening at a cellular level.
Ta Ta Telomeres
As the protective caps at the ends of our chromosomes, telomeres are an important discovery in the study of human aging and disease, even earning the researchers who first characterized them the Nobel Prize in Physiology or Medicine in 2009. In more recent years, the shortening of telomeres has become associated with a number of chronic diseases and has emerged as a possible biomarker for the effects of stress.
Just last month, researchers from the University of Michigan published a paper in Biological Psychiatry that found the average telomere shortening during internship year was six times greater than the typical rate during an undergraduate freshman year. The longitudinal study involved 250 medical trainees from across the United States who volunteered DNA samples before beginning residency training and at the end of intern year. They also completed lengthy questionnaires prior to training and at various points throughout the year.
Of all the factors studied, the numbers of hours the interns worked each week presented the strongest link to telomere shrinkage.
According to senior author Srijan Sen, “The responses given by some of the interns in these surveys indicated that some were averaging more than 80 hours of work a week, and we found that those who routinely worked that many hours had the most telomere attrition.”
Officially, the Accreditation Council for Graduate Medical Education work hours requirement states that a resident should work no more than 80 hours per week averaged over four weeks. The results of the Intern Health study suggest a different reality for many residents and provides a novel perspective in the discussion on why — if not how — residency programs should prioritize and promote wellbeing as an integral part of training.
Resident Resilience
Fortunately, all is not lost. In fact, there is evidence that interventions such as stress management and social support may lengthen telomeres. With this in mind, simple tools like the Wellness Fuel Tank can help faculty and wellness officers allocate resources to individuals who need them and open communication between residents and residency leadership.
This past year, my fellow interns and I participated in biannual resiliency retreats, which served as both opportunities for intra-class bonding and brainstorming sessions to propose ways of improving our residency experience. This year, I have the honor of acting as our program’s inaugural Wellness Chair/Wellness Warrior and creating a resident-led culture change to make resilience an indelible component of our program’s identity to address those “daily frustrations of being a resident physician.”
Even Teflon has its limits, and it is important that residents train in an environment that encourages us to acknowledge those situations and seek recourse without shame or hesitation. For me, sending that text was an important first step to being well again, and my residency leadership and co-interns deserve a big shout out for stepping up when I needed to step away.
It’s nice to know my telomeres are in good hands.
Linh Nguyen is a second-year resident with the Duke Family Medicine Residency Program. Email linh.n.nguyen@duke.edu with questions.
Editor’s note: Duke Family Medicine residents guest blog every month. Blogs represent the opinion of the author, not the Duke Family Medicine Residency Program, the Department of Family Medicine and Community Health, or Duke University.