Balance, belonging fostered in new program for residents

Mike Goodkind stress

Surgery faculty member Ralph Greco (center) with residents Greg Magee and Yulia Zak, in front of a refrigerator that has become emblematic of a program to help residents achieve balance in their lives.

Surgical resident Greg Magee, MD, is excited about the new refrigerator in a third-floor conference room of Stanford Hospital. He’s particularly pleased about what’s inside it. The Department of Surgery regularly stocks the stainless steel fridge with wholesome snacks, such as yogurt, fruit, skim milk and whole wheat bread. On a nearby counter and atop the fridge are packages of nuts, protein bars and boxes of cereal.

“It’s made a huge difference,” said Magee, MD, his slightly tired eyes almost twinkling when he mentions the fridge. Previously, he said, residents’ lunch bags were vulnerable to being tossed from other hospital refrigerators, a loss often discovered at an hour when the only readily available sustenance flops to the bottom of vending machines in wax-lined containers.

But the fridge constitutes just a small component of a larger effort by the department to nourish the physical and psychological health of its residents, whose stressful job and long hours can contribute to unbalanced living, said Ralph Greco, MD, former director of the general surgery residency program and the Johnson & Johnson Distinguished Professor in Surgery at Stanford.

The Program to Create Balance in the Lives of Our Residents, which Greco initiated, kicked off in July but will be formerly unveiled during grand rounds at 7 a.m. Sept. 20 in the Clark Center auditorium. The event is free and open to the public. The program is dedicated to the memory of Greg Feldman, MD, a popular and highly respected former chief surgical resident at Stanford who committed suicide in late 2010 while working as a surgical fellow at a hospital in the Midwest. His parents are scheduled to attend the Sept. 20 grand rounds.

Feldman’s death was not the trigger for the program, but has helped to shape it, Greco said. “The Department of Surgery has always had a supportive program for residents,” he said. “But we wanted to make sure we were doing as much as we could in a systematic way.”

In addition to healthy eating, the balance program encourages residents to make appointments with their primary care physicians and dentists and to get exercise. (Magee said he now feels empowered to carve out time to visit his doctor and dentist, which he had been reluctant to do even when an abscessed tooth eventually caused him to lose work time.)

The balance program mandates that residents meet in groups to discuss any difficulties they may be encountering on the job, such as dealing with the loss of a patient, fatigue or feelings of loneliness and exclusion. These weekly sessions, which are led by a Stanford psychologist, also encourage residents to reflect on the core values of their work and life as doctors — values such as compassion, service, healing and hope.

The program also includes an annual retreat for residents and selected faculty members, with a focus on developing interpersonal and communications skills. Team-building activities, such as a ropes course and organized sports, are in the works. Individual mentorships pair junior residents with senior residents, who can provide their less-experienced peers with personal and professional guidance, as well as help orient them to the Stanford and Silicon Valley lifestyle and community. Greco said the need to foster a sense of belonging may be more important than in the past because residents today increasingly come from a variety of cultures and backgrounds.

There also will be a resident chosen to serve as social chair, responsible for organizing events such as a quarterly dinner, happy hour gatherings, group jogs and other outings. In addition, the program gives a booklet to residents with lists of recommended physicians and dentists, as well as a list of gyms, hiking trails, movie theaters and other recreational resources.

Thomas Krummel, MD, chair of the department, said residents have shown enthusiasm for the program. “It reflects how we’re changing the way we think about performance optimization,” he said. “We’re saying, ‘This is what we do to train the most high-functioning and resilient surgeons; we not only teach them the techniques and responsibilities of the specialty, but how to withstand the pressures that come with it.’”

As it stands, however, the new refrigerator may wind up being the most popular aspect of the program. As Magee expounded on its bounties, Greco rolled his eyes. “We never really expected the refrigerator would make such a huge difference,” he said. 

This article was adapted by John Sanford from an earlier version that appeared in Medical Staff Update.

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