SPECIAL EDITION
Wellness

By JAMES C. BROWN, M.D., EDWARD F. FOGARTY, M.D., AND LISA P. LAURENT

Physicians have a less than stellar record for personal, emotional, and physical well-being. Data from Northwestern Mutual Life actuarial tables show that physicians have a higher annual risk of death after the age of 55 than other professionals. Other studies have found that they often have higher than average rates of divorce, stress-related ailments, and less family and church time.1,2

The literature regarding medical students and residents indicates that the rigors of education may cause higher levels of stress, which can lead to alcohol and drug use, relationship problems, depression, and anxiety disorders. Physicians' training rarely equips them with tools for healthier habits and skills in self-preservation, emotional wellness, physical maintenance, and social-spiritual balance.3-6

Two years ago, when Dr. James Brown was appointed director of the radiology residency program at Creighton University Medical Center, the educational gap was obvious. Methodist College, a local nursing college in Omaha, had been recognized by the Wellness Councils of America for its wellness curriculum and activities. Methodist College conveys a strong message to students that they cannot help others in their professional capacity unless they take care of themselves.7 Creighton's radiology wellness curriculum was based on similar principles of holistic wellness.

Residents at Creighton evaluate themselves in different wellness areas and define their objectives for improvement. Staff experts and local professionals lecture the residents and students and assist them in designing strategies to accomplish their goals. A fundamental element of Creighton's philosophy is to practice compassion, ethics, and spiritual health in every exchange with others.

Fifty years ago, the World Health Organization defined wellness as "the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Wellness can encompass all areas-intellectual, physical, social, emotional, and spiritual-of a person's life. In orienting students to this program, accountability is stressed as the overarching component.

As each resident improves his or her own dimensions of wellness, the collective functioning of our program improves, and hence the quality of service toward patients, staff, and the organization. In making the coursework mandatory, the radiology department confirms that this curriculum is critical for the total preparation of a quality physician.

We draw lecturers from Creighton's own inhouse community and beyond to discuss specific wellness areas twice each month. Each topic relates to more than one of the defined functional areas, such as physical and mental health. The crossover effect heightens the effectiveness of the message and emphasizes the critical interdependency of each wellness area. The following outlines our current presenters, their topics, and the techniques they use.

• - Cultural diversity. Dr. L. Blaine Shaffer, a professor of psychiatry at the University of Nebraska Medical Center, speaks at the beginning of the academic year. He explores the cultural diversity within our department and leads a roundtable discussion in which students describe the origin of their family name. It is a simple but effective technique for delving into each person's background in a comfortable way. In an hour's time, residents and students gain insight that might otherwise take months to glean.
• - Social wellness. Physicians often fail to maintain social awareness and contacts outside of medicine, causing them to lose cultural and social fluency and increasing their risk for loneliness and isolation. Kathy Brockman Oleson, Ph.D., who lectures in sociology, and Glenda Cottam, Ph.D., J.D., a lecturer in psychology, focus on the importance of diverse social networks in life and in work. They advise residents about dealing with the stress in medical training through a well-maintained social framework.
• - Ethics. The Creighton wellness program includes two annual ethics conferences that include radiology-specific discussions with examination of the most common day-to-day ethical decisions.
• - Spirituality. This is a sensitive issue to address, and it may cause discomfort for a student or resident. But it is a critical wellness area, as it affects all aspects of life. Residents are encouraged to spend time defining their own beliefs, learning about others' beliefs, and assessing how such beliefs can be a source of strength in daily life and during difficult times. The wellness program offers two evening retreat sessions led by the medical school's campus minister.
• - Intellectual wellness. Creative outlets that physicians pursued before residency are often the first to be trimmed from busy schedules. This is driven by the need for study during nonworking hours, the priority of academics, and the use of leftover time for rejuvenation or family time. The absence of recreational, artistic, or creative endeavors in residents' lives strips from them a hearty source of energy and sustenance. Don Doll, S.J., and James Scholz, two prominent educators and artists, lecture on ways a new doctor might maintain a balanced lifestyle.
• - Physical wellness. Health and physical fitness are another wellness area that residents tend to put on the back burner. Physical wellness helps maintain energy, self-esteem, and a positive outlook during difficult times. Anthony Bull, Ph.D., an exercise physiologist, reviews the options for maintaining physical health during residency at Creighton.
• - Financial wellness. Residency training rarely discusses the financial constraints and realities of a medical degree or the sudden increase in personal wealth that accompanies entering a practice. Byron McFarland, a local financial planner from Northwestern Mutual Financial Network, hosts quarterly discussions and financial learning sessions with residents. Topics include the importance of investing in Roth IRAs during residency as part of a retirement plan, better management of debt, realistic expectations for their children's college expenses, and issues concerning disability and life insurance.
• - Emotional wellness. At the start of each academic year, Amy Badura, Ph.D., an assistant professor of psychology at Creighton, distributes a questionnaire that evaluates how residents perceive their own wellness. As part of the self-evaluation process, the residents undergo a personality inventory. David Krecek, vice president of PI Midwest, administers the Predictive Index System, the most commonly used personality assessment tool, to define an individual's tendencies across four scales of motivational needs.
• - Accountability. The residency program uses 360 degree evaluations each year. These questionnaires are distributed among nonphysician personnel within the department to assess the quality of daily interpersonal interactions between the residents and other staff. The residents are also required to keep a journal of their progress.

ENRICHED EDUCATION

This pilot program is an example of the integration of wellness into an existing medical student and resident training curriculum. Physician educators have the responsibility to ensure that new physicians are equipped with beneficial and applicable preparation for their careers. Future practices would be more effective if doctors actually observed the dictum "heal thyself" as well as "do no harm." The introduction of healthier lifestyle habits and balance will also decrease those ugly insurance statistics.

The Creighton radiology department designed this program so that residents will be better trained as radiologists and better equipped as individuals to deal with the stress of life as a physician. Medical students and residents were at first skeptical, but they have finished their year's projects with new skills and enthusiasm.

Dr. Brown is director of the radiology residency program, Dr. Fogarty is chief resident, and Ms. Laurent is residency program coordinator, all at Creighton University Medical Center in Omaha.

References for this article are available at diagnosticimaging.com.

References