Brief Oral Papers
Training and Education
Sara Nash, MD, FACLP, DFAPA
Program Director - Fellowship in Consultation-Liaison Psychiatry
Columbia University Irving Medical Center
New York, New York
Laurel Mayer, MD
Director, NYP-House Staff Mental Health Service, CUIMC
Columbia University Irving Medical Center
New York, New York
Subani Chandra, MD
Program Director
Columbia University
New York, New York
Allison Borowski, MD
Assistant Professor
Columbia University
New York, New York
David Horowitz, MD
Associate Professor of Radiation Oncology
Columbia University
New York, New York
Briana Short, MD
Assistant Professor of Medicine
Columbia University Irving Medical Center
New York, New York
Sheau-Yan Ho, PhD
Assistant Professor in Medical Psychology
Columbia University Irving Medical Center
New York, New York
Heather Paladine, MD
Assistant Professor of Medicine at Columbia University Irving Medical Center
Columbia University Vagelos College of Physicians and Surgeons
New York, New York
Maria De Miguel, MD
Associate Professor of Medicine
Columbia Internal Medicine Residency Program
New York, New York
Kristin Burkart, MD
Professor of Medicine
Columbia University Irving Medical Center
New York, New York
Jasnit Makkar, MD
Assistant Professor of Radiology
Columbia University Irving Medical Center
Old Tappan, New Jersey
Background/Significance: Pre-dating the COVID-19 pandemic, physician trainees have exhibited elevated rates of burnout (44-55%) and depression (25-35%) compared to the general population. Prompted by the overwhelming stress of the COVID pandemic, in 2020-2021 the New York-Presbyterian House Staff Mental Health Service (HSMHS) at Columbia University Irving Medical Center launched a pilot program to evaluate the feasibility, acceptability, and initial efficacy of 1:1 psychiatrist-run, opt out wellness check-ins for Internal Medicine (IM) residents. In 2021-2022, this pilot was expanded to include 6 additional departments and twice-yearly check-ins. Check-ins offered validation, opportunity to process challenging experiences, and enhance resilience with mental health (MH) clinicians experienced in trainee MH (2 C-L and 3 HSMHS faculty), stigma reduction and linkage to care, and innovative preliminary information in a field with little quantitative literature. Program leadership scheduled the check-ins, but MH faculty informed trainees of the appointment, including the option to opt-out. Program leadership was blind to trainee participation. Discussion/
Methods: All trainees received an IRB-approved online survey prior to and at the end of the year (EOY). Check-in participants received an online, 2-question survey shortly after the check-in. Check-in participation was not contingent on research participation.
Results: In the initial pilot, 57% of residents completed the check-in, 36% opted out, with participation equally distributed across PGY levels. The two most common opt-out reasons were engagement in therapy or preference for other wellness activities. 11% of participants were referred to the HSMHS. 96% of participants found the check-in helpful; 99% supported the initiative. In the 2021-2022 multi-departmental pilot 52% of trainees completed the first check-in, 39% completed the second, with 13% overall referred to the HSMHS. 96% of participants found the first check-in helpful, 95% the second. 96% of participants in the first check-in and 100% in the second recommended check-ins become a regular part of the curriculum. 81% felt that check-ins enhanced well-being; even among those who opted out, 87% agreed. 89% agreed check-ins were helpful to process training experiences; 82% appreciated that the check-in was scheduled for them. Ninety percent exceeded the HIGH threshold on the Perceived Stress Scale (PSS); PSS scores significantly decreased from pre- to post-survey (p=0.02), although PSS remained HIGH. Some measures of stigma improved.
Conclusion: Psychiatry-led 1:1 check-ins are both feasible and meaningfully support the well-being of physician trainees. Consultation-liaison psychiatrists, physically present in the hospital and regularly interacting with house staff, are in unique position to be leaders in field of trainee wellness.
References:
Drybye LN, Leep Hunderfund AN, Winters RC et al. The relationship between burnout and help-seeking behaviors, concerns, and attitudes of residents. Acad Med 2020 May 1; 96(5):701-708
Baker K, Sen S. Healing medicine's future: prioritizing physician trainee mental health. AMA J Ethics 2017 July 10; 18(6):604-613.
Shechter A, Diaz F, Moise N et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psych 2020 Sept-Oct, 66:1-8.
