A former resident’s suicide inspired a wellness program in the Department of Surgery. Years later, the program continues to promote psychological and physical well-being for busy new surgeons.
September 17, 2014 - By Tracie White
Surgical residents working 80 hours a week tend not to get a lot of time to play around. But on a recent weekday morning, about 30 of them gathered on Alumni Green for a few hours and, dressed in scrubs with beepers on their hips, jumped, screamed, tied blindfolds over their eyes and played games.
“It’s a switch from dealing with parathyroid cancer,” said Stanford resident Blake Read, MD. He had just finished a memory game that involved hopping across a giant checkerboard and was now heading across the lawn to help lift colleagues through a spiderweb of ropes. He admitted it’s hard to take time away from work — “All of us love to be in the operating room” — but that he made the morning’s activities a priority.
The residents were participating in what was essentially structured playtime: a series of games set up by Adventure Associates as part of the Balance in Life program for surgical residents. The games, designed to build teamwork and trust among colleagues, were set up at different stations across the lawn.
It was mostly for fun, but the fun was for a serious reason.
Taking time out for play is essential for these residents as they enter their first years as full-time physicians and regularly face life or death decisions, said Ralph Greco, MD, one of the founders and director of Balance in Life. The Stanford program was founded in 2011 following the suicide of a well-respected former surgical resident, Greg Feldman, MD.
“I can tell you a surgical resident would rather be in the operating room than anywhere else on Earth,” said Greco, former director of the general surgery residency program and the Johnson & Johnson Distinguished Professor in Surgery. “They’re passionate about it. We have to force them to take time out to see the doctor and the dentist for themselves.”
‘They are not alone’
The Balance in Life program has continued to thrive over the years and includes a refrigerator stocked with healthy snacks, weekly group therapy with a psychologist, and a mentoring partnership between junior and senior residents. The residents themselves are active in planning and coordinating group activities.
The goal of the team-building games, which were new this year to the program, is to bring residents together in a relaxed atmosphere, and to show them most importantly “that they are not alone,” said Arghavan Salles, MD, a chief surgical resident who was busy coaching blindfolded colleagues through an obstacle course.
“Some people think this is kind of hokey,” said Salles, who was one of a group of residents who helped found the program along with Greco. “But at the end of the day, if we want to have better patient care, we need to take care of each other, too.”
She paused to instruct a blindfolded colleague: “Step left! Step left!
“Surgery is a super critical field,” she continued. “You face constant judgment in everything you do and say. Everyone is working at the fringes of their abilities. They’re stressed.”
Trend toward wellness programs
In recent years, hospitals, medical schools and residency programs have been making changes to help medical students and residents better cope with stress stemming from the pressure to excel, the constantly increasing amount of information to absorb and the secondhand trauma of caring for sick people.
In 2003, work hours were reduced to 80 hours a week from 120 hours a week for residency programs nationwide. A growing number are providing confidential counseling services. At Stanford, several other residency programs in addition to surgery now have wellness programs, including pediatrics and anesthesia. And this year, the medical school established an Office of Medical Student Wellness.
But promoting wellness — learning how to balance psychological and physical health throughout a career in medicine — holds particular meaning for Stanford’s surgical residency program because of Feldman’s death, Greco said.
“The residency program was just rocked to its knees,” he said. Feldman was widely considered a role model and mentor. He died after completing his surgical residency at Stanford and just four months into his vascular surgery fellowship at another medical center.
“It was a very frightening time,” Greco said. “Residents were questioning whether they’d made the right choices.”
In the months following the tragedy, Greco and Thomas Krummel, MD, professor and chair of surgery, met every Monday to write down different ideas on a yellow legal pad on how to prevent anything like this from happening again, Greco said. With the support of Feldman’s family and several surgical residents, the Balance in Life program was born.
Remembering a colleague
Thirty-eight weeks pregnant, surgical resident Cara Liebert was carefully maneuvering through the rope web while her teammates giggled. Liebert was a medical student at Stanford when Feldman was a surgical resident.
“He had a lot to do with mentoring me to apply to general surgery residency,” said Liebert, who organized the morning’s event. “We didn’t even know he was struggling.”
After several hours, the games would end, and the residents would head back to their jobs. But not before bringing many of their job skills to bear on the games at hand. This was a competitive group and prided itself on doing a job well, said Adventure Associates director Bill Jacox.
No one slacked off. They furrowed their brows; several bit their nails. Sometimes they barked instructions a bit too loudly to their colleagues: “No, no, no, dude! Go left! Go left!”
Or got a bit too critical: “Oh my god, why are you going so fast?! Take your time!”
But mostly they laughed, took time to breathe in the outdoor air and cheer for one another before heading back to the OR.
Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.