Stress & Well Being
Wellness goes beyond merely the absence of distress and includes being challenged, thriving, and achieving success in various aspects of personal and professional life (Wallace). The Department of Psychiatry strongly encourages residents to find ways to maintain their own health and wellbeing. Residency can be a challenging period of ongoing change, multiple demands, examinations coupled with a lack of experience of how to manage growing responsibilities. Like all physicians, residents face an increased risk of burnout and mental health issues compared to the general population.
1. Psychiatry Resident Association of Toronto (PRAT)
PRAT offers two retreats each academic year. These retreats are aimed at providing residents at each training year an informal avenue to provide feedback regarding their rotation experiences to the incoming year. The retreats are held off-site and without staff presence. Guest speakers focus on resident wellness and stress management.
In addition to the retreats, PRAT offers social events for residents all year round. This can range from games night, pub night, to sessions on career planning.
2. Psychiatry’s Resident Advisor
Contact the Department of Psychiatry’s Resident Advisor for confidential discussion, advice or involvement. The Resident Advisor works at arm’s length from the postgraduate training program. No one in the department will know that you have contacted the Ombudsperson, or what you have disclosed, without your permission. Please visit the Resident Advisor page at: http://www.psychiatry.utoronto.ca/education/postgraduate-program/current-residents/resident-advisor/
3. The Office of Resident Wellness
The Office of Resident Wellness is part of the Department of Postgraduate Medicine at the University of Toronto. It provides the following services
- Family doctor registry
- Referrals to GP-psychotherapists
- Short-term counseling and wellness coaching
- Support during remediation/academic difficulty
- Educational programming/wellness workshops
For more information contact (416) 946-3074 or firstname.lastname@example.org
4.Ontario Medical Association (OMA)
The OMA offers various Wellness Resources through their website:
- Professionals Health Program offers range of direct services to physicians and their family members. Call 1-800-851-6606 for direct access
- Podcasts on managing stress, resilience and anxiety
- Mindfulness exercises
5. Ephysician Health
EPhysicianHealth is interactive multi-media based website that offers surveys, video vignettes/advice, information on burnout, suicide, nutrition, and much more. Information provided is up-to-date and directed towards health professionals. The site also includes a list of resources (i.e., books, articles, online, local resources).
6. List of Psychiatrists
A list of psychiatrists offering care to residents is available on Portal. Residents can access it by logging in and clicking on “Resident Wellness”. The list is available as an Excel file.
Intimidation and Harassment
1. Department Supports
Residents are encouraged to consider chief residents and PRAT representative as supports. Concerns will be addressed in a confidential manner. If the concern involves intimidation and/or Harassment residents are strongly encourage to bring the issue forward to either their staff supervisors, the Program Director, and/or the Committee for Supervisor Evaluation and Support.
2. Professional Association of Interns and Residents (PAIRO)
PAIRO believes that resident intimidation is unacceptable. The PAIRO-CAHO contract includes policies that protect residents from Intimidation and Harassment. If resident feels they are being harassed, they can contact the PAIRO office for information and advice 1.877.979.1183. Calls will remain confidential and the office will not proceed further until you direct them to do so.
1.Cohen J, Patten S. Well-being in residency training: a survey examining physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Medical Education. 2005. 5(21); 1-11.
2.Dunn PM, Arnetz BB, Christensent JF, Homer L. Meeting the imperative to improve physician well being: assessment of an innovative program. J Gen Intern Med. 2007; 22: 1544–52.
3.Ishak. Burnout during residency. J Grad Med Educ. 2009. 1(2):236-42.
4.Frank E, Segura C. Health practices of Canadian Physicians. Can Fam Physician. 2009. 55; 810-811.
5.Martini S et al. Burnout comparison among resident in different medical specialties. Acad Psychiatry. 2004. 28(3): 240-242.
6.Physician Health Matters: A mental health strategy for physicians in Canada. Canadian Medical Association. 2010.
7.Puddester D, Flynn L, Cohen J. (Ed.) CanMEDS Physician Health Guide. The Royal College of Physicians and Surgeons of Canada. 2009.
8.Rossi et al. Burnout, compassion fatigue, and compassion satisfaction among staff in community-based mental health services. Psychiatry Res. 2012.
9.The Future of Medical Education in Canada: Postgraduate Project. The Association of Faculties of Medicine of Canada. 2012
10.Wallace JE et al. Physician wellness: a missing quality indicator. Lancet. 2009. 374; 1714-21.
Confidential Contact Person for Residents in Distress:
Dr. Tatyana Barankin is a coordinator of the Ontario Medical Association Physician Health Program and can be contacted confidentially by all U of T psychiatry residents in distress for all non-emergency situations. Dr. Barankin will ensure confidentiality and will facilitate timely referral to competent psychiatrists and mental health experts in the community.
Dr. Tatyana Barankin
Telephone: 416-535-8501 Ext. 4967
Posen, D. The Little Book of Stress Relief. 52 Prescriptions for a Calmer Life, Sep 2003
Posen, D. Stress Management for Patient and Physician. Canadian Journal of CME, April,1995. http://www.mentalhealth.com/mag1/p51-str.html
Stress management for Physicians
BC Ministry of Health Stress Management Tools
Mind Tools Stress Management Techniques
PAIRO resident wellbeing committee
PARO Helpline 1-866-HELPDOC (1-866-435-7362)
24 hour crisis counseling
Physician Health Program, OMA. 1-800-851-6606
Provides triage, referral, management and monitoring (if required) of mental health and substance use issues. Practitioners are screened for expertise with health care professionals. Quick turn around time.
CAIR position paper on resident well being
American Colleges of Physicians Resident Stress and Wellbeing (please consult the ACP website):
Peterkin, Allan. Staying Human During Residency, 3 rd edition, 2004
Gautam, Mumta. Iron Doc. Practical Stress management Tools for Physicians.
CMA Guide to Physician Health and Wellbeing
Balancing Act Series from American Academy of Family Practitioners:
15 tips for managing life at work and home
The Day care Stare
5 Ways to Say No Effectively
6 Ways to Make Play a Priority
Running on Empty
Five Priority Setting Traps
Life Balance:17 tips from doctors for doctors
Grieving the death of a Patient
The 80/20 Rule of Time Management
Ideas for Managing Stress and Extinguishing Burnout:
Please visit the AAFP website for more helpful articles.
MENTAL HEALTH RESOURCES
Physician Health Program, OMA (see above)
Site for all counseling services available in the GTA (psychiatry, psychology, social work)
Women’s Counseling, Education and Referral Centre 534-7501
Provides triage for counseling services for women in Toronto.
Psychiatric Services for female residents with psychological problems related to trauma, violence, harassment, or psychological disorders linked to menstrual disorders, infertility, pregnancy, or menopause: Women’s Mental Health Clinic (UHN) 340-4462. Have agreed to see residents with these issues.
RESOURCES FOR PROGRAM DIRECTORS
Levey, R. Sources of Stress for Residents and Recommendations for Programs to Assist Them. Academic Medicine. 2001;76(2):142-50.
Thomas, N.K. Resident burnout. JAMA. 2004;292:2880-89. http://jama.ama-assn.org/cgi/content/full/292/23/2880
Broquet K, Rockey, P. Teaching residents and program directors about physician impairment. Academic Psychiatry. 2004; (28):221-225. http://ap.psychiatryonline.org/article.aspx?articleid=48067
Cohen JS, Patten S. Well-being in residency training: a survey examining resident physicians both within and outside of residency training and mental health in Alberta. BMC Med Educ. 2005;5:21.
Shapiro SL, Shapiro DE, Schwartz GER. Stress management in medical education: a review of the literature. Acad Med 2000;75:748-759.
Toews JA, Lockyear JM, Dobson DJG et al. Analysis of stress levels among medical students, residents and graduate students at four Canadian schools of medicine. Acad Med 1997;72(11):997-1002.