Medical student and resident wellness – Progress, but much more work to be done

The most important part of our job as physicians is to assist our patients in the achievement and maintenance of good health. Patients who are physically active, maintain a healthy diet and have healthy personal relationships are happier, more productive, acquire fewer diseases and illnesses, and access the acute and chronic disease management sectors of our health care system less frequently.

It is ironic that, for so many years, we have neglected these principles when it comes to our own trainees – medical students and residents.

There are several reasons for this; chief among them, a misguided culture of “toughness” that is stubbornly persistent. “We all went through it and it didn’t kill us – it made us stronger and better doctors”, goes the refrain – as if one must be unwell and unhealthy to become highly competent. The absurdity of the argument is astounding.

Fortunately, progressive forces are working on this problem. Resident wellness is now a postgraduate training program accreditation requirement. These standards ensure, among other things, that assistance (social workers, mental health professionals and other resources) is provided for residents who need them. Royal College and CFPC accreditation has teeth; this has and will continue to make a difference.

The recent Quebec decision to limit on-call duty to a maximum of 16 consecutive hours has sent a shock wave throughout the country. Other provinces are likely to follow suit. This has generated a lot of discussion. How will we provide medical person-power for hospitals that have come to rely on residents for high workloads (many of whom work for less than minimum wage when the per-hour math is worked out). Despite these potential issues and legitimate concerns, no one seriously challenges the assertion that this will improve resident wellness, and in turn, reduce fatigue-related errors. In short, it’s the right thing to do and everyone knows it.

The Canadian Medical Association has also been active on the issue of wellness with their Canadian Physician Health Network (http://www.cma.ca/living/provincialphysicianhealthprograms#cphn). This collaborative group is important not only because they specifically target trainees, but because they address all physicians – the initiative therefore helps to advance the transformation to a physician wellness culture by emphasizing that it’s not too late for even older, seasoned physicians to pay attention to their own health. The Canadian Association of Internes and Residents (http://www.cair.ca/en/wellbeing/resources/), the Professional Association of Internes and Residents of Ontario (http://www.pairo.org/Content/Default.aspx?pg=1009), the Ontario Medical Students Association (www.omsa.ca) and the Canadian Federation of Medical Students (http://www.cfms.org/index.php/resources/wellness.html) are also doing excellent work on this file.

So much more work needs to be done, though. The medical student experience across the country remains highly variable – they do not derive the same consistent benefit from wellness programs as their postgraduate colleagues do because wellness is not enshrined in undergraduate medical education accreditation standards. Given that health and wellness habits are learned early, it is this population of medical colleagues who, arguably, would benefit the most from a more activist wellness agenda.

Even in the postgraduate world, significant pockets of resistance to change remain, and we are often our own worst enemy. It reminds me of the duty call issue in Ontario in the mid-1990s, when I was an elected PAIRO representative. The year that we won the “go home the next day after call” battle, I was persona non grata at my training centre for quite a long time. My attending physicians made it clear to me that they did not support my (our) position. I am hearing all the same arguments now, so I appreciate the courage that it takes to keep resident wellness on the front burner of political discourse.

Kudos to the student and resident leaders who are diligently pursuing this important agenda. Building healthier doctors is in everyone’s best interest.