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MEDICAL SCHOOL AL SCHOOL
MEDIC MEDICAL SCHOOL
TRAINING
TRAINING TRAINING

paring for inpatient services, overnight calls and graded responsibil- room and see how many patient safety concerns they can identify.
ity are also areas of focus. Inappropriate fluids, unattached oxygen tubing or inappropriate med-
ications are some examples. Mechanisms to report these safety issues
Interventions on or Around Orientation are also taught. Senior resident panels and rotation “tip sheets” provide
Financial Literacy: A majority of medical students enter residen- important lessons, practices or tools for various rotations.
cy with a large amount of debt. Most recent figures place the aver-
age medical school debt between $200-250,000 dollars, resulting in a Longitudinal Programs Initiated During First Year
large degree of initial stress that arises over financial concerns. Begin- Interactive Screening Program and Mental Health Resources:
ning shortly after residency MATCH, the OGME sends out detailed The Interactive Screening Program (ISP) is a voluntary and anony-
information about the resident’s salary, withholdings, budgeting, typ- mous screening tool produced by the American Foundation for Sui-
ical living expenses, apartment lease by size and location, and average cide Prevention and licensed to colleges, medical schools and residency
loan repayment amounts. We also provide information about student programs to provide a mechanism for ongoing screening of individuals
loan forgiveness programs like the Public Service Loan Forgiveness or for burnout, depression, anxiety, eating disorders, substance abuse and
Income-Driven Repayment Forgiveness. Resources are included. suicidal ideation. Residents who complete the survey are classified into
risk categories and the BHPs are sent the results with a unique identi-
Transition Screening: Starting a new residency program is challeng- fier but no identifying resident information. Counselors can respond
ing. For some residents, however, a disappointing match into a lower directly through the system with a personalized email and resources.
Landing on Your Feet: The Critical Focus on ranked program, an alternate specialty or leaving an established support
network can add to the stress. If you are someone with an underlying
Resident Well-Being Begins During the Transition mental health disorder, a physical disability or a major outside stressor References:
like a recent divorce, the transition to residency can be unbearable. The
from Medical School to Residency Transition to Residency Risk Index (TRRI) is a questionnaire devel- 1. IsHak W, Nikravest R, Lederer, S, et al. Burnout in Medical Stu-
dents, a systematic review. Clin Teacher. 2013; 10 (4): 242-245
oped in our institution and now used nationally by programs to assess
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incoming residents for predictors of a difficult transition. Participation 2. Morcos, G, Awan, 0. Burnout in Medical School: A Medical Stu-
By Jon Courand, MD, FAAP, and Paulina Mazurek, EdD is voluntary. Those who score themselves as moderate or high-risk range dent’s Perspective. Acad Radiol. 2023; 30 (6): 1223-1225
have a heightened degree of check-ins by program leadership, early fac- 3. Brazeau CM, Shanafelt T, Durning SJ, Massie FS, Eacker A,
ulty and peer mentorship, and an offer of mental health resources. Early Moutier C, Satele DV, Sloan JA, Dyrbye LN. Distress among
umerous studies show that the development of burnout in Interventions Occurring Within Medical School community building events are also recommended. In our program, matriculating medical students relative to the general population.
physicians begins in Medical School with some studies plac- Headspace for UT Health: Complimentary annual Headspace greater than 90 percent of those who score themselves as high-risk ulti- Acad Med. 2014 Nov;89(11):1520-5
TM
Ning the rate of burnout at 50 percent among all medical stu- memberships are offered to students. Headspace is a mobile applica- mately come into a counseling relationship with our Behavioral Health 4. Dyrbye L, Thomas M … Shanafelt T. The Learning Environment
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dents during training. Matriculating medical students report lower tion that guides users through the essentials of mindfulness using a Providers (BHP). and Medical Student Burnout: A Multicenter Study. Medical
burnout, less depression and higher quality of life compared to col- library of guided meditations, resources and videos. Users have report- The second tier of our transition screening is the scheduling of Opt- Education 2009; 43 (3) 274-282
lege graduates pursuing other fields, however, that pattern looks to be ed improved productivity, better sleep and reduced stress. Out visits with our BHP within the first three months of training for all 5. Slavin, S, Yaghmour, N, Courand, J. Support for Mental Health
reversed by the second year of medical school. To reverse this trend, PGY-1 residents. These 15–20-minute sessions allow for an introduc- and Well-Being in the Transitions to Residency. JGME. 2024
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the Office of Undergraduate Medical Education (OUME) developed Wellness Matters: Founded in 2018 by a medical student, this organi- tion to counseling, coaching and other resources, a chance to see how 16(2): 241-244
interventions, which give students agency to develop effective self- zation promotes the eight dimensions of wellness among medical students. well the resident is settling into the city and program, and to screen for
care strategies and strengthen their resilience. Changing the USMLE The group works closely with OUME, serving as an advisory board for other needs. Over the past two years, over 45 percent of all attendees
Step 1 exam to pass/fail in 2022, moving some curriculum to virtu- student well-being and assisting with events and programs. Members pro- have an essential need like medication refills, counseling, presenting in Jon Courand, MD, FAAP, served as Pediatric Residency Director
al or asynchronous learning, and limiting overnight call experiences mote a culture of wellness using the LSOM wellness pledge, encouraging crisis or information on accessing medical or dental services. for the UT Pediatric Residency Program and now serves as
have been some of the methods employed. In addition, students have use of wellness spaces on campus, and hosting the annual Wellness event Vice Chair for Graduate Medical Education. He divides his
access to wellness and professional identity coaching, and programs ReDiscover. Boot Camps time between Pediatrics and the Office of Graduate Medical
in stress-management. Comparable program adjustments have shown Many residency programs now use “Boot Camps” as a mechanism Education where he oversees all resident and fellow Wellness Programs for
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some improvement in reducing rates of stress and burnout. There have Self-Reflection Guide for Medical Students (SRG): The SRG to prepare incoming residents for the challenges they will face during the Institution. He is actively involved with physician wellness on a local,
been some consequences for incoming residents, with program direc- encourages reflection to enhance professional identity formation. It service time and during overnight call duties. The structure of these state and national level, and with the Healer’s Art Program in the Medical
tors across the country concerned their incoming PGY-1 residents may can be used at all stages of training to construct meaning, promote Boot Camps is determined by specialty. Common areas of focus for School. Dr. Courand is a member of the Bexar County Medical Society.
be less prepared for the rigors of internship. In our Graduate Medical individual and professional well-being, and internalize learning in cog- these Boot Camps revolve around team building, working in inter-
Education (GME) programs, the rates of residents accessing mental nitive and affective domains. In exploring personal values, acknowl- professional teams, or dealing with urgent or emergency patient care Paulina Mazurek, EdD, is the founding Director of Wellness and
health services has continued to increase each year since the 2018- edging human limitations, and understanding their authentic purpose, issues. Simulation Centers have been developed to increase the reality Professional Formation at UT Health Long School of Medicine,
2019 academic year. Clearly the transition from medical student to students become self-reflective practitioners. of the experiences. Introduction to the Electronic Health Record with Office for Undergraduate Medical Education. With 15 years of
resident is a critical waypoint on the path to becoming a practicing time to practice on simulated patient records is critical, along with experience working in higher education, the majority of which
physician, and a significant focus here provides the greatest opportuni- Transition Information Session: For the past four years, the tips and tools to improve efficiency. Basic procedural competencies have been in medical education, she has a key role in the strategic planning
ty to impact the resident’s well-being throughout training and beyond. OUME has offered an information session for all graduating medi- like placing IVs, obtaining arterial blood gases, sewing lacerations, and execution of programs within Student Affairs. Working collaboratively
Wellness Programs within UME and GME at the University of Texas cal students. The focus of this session offered jointly by both UME and practicing specialty specific procedures like lumbar punctures or with partners at the local, state and national levels, she is helping advance
Health in San Antonio have worked together to create a multi-tiered and GME representatives involves a brief presentation followed by speculum examinations may also happen here. A relatively new intro- initiatives to improve wellness among medical trainees. Paulina has been
approach to assisting medical students and residents during this adjust- a Q&A session. Presentations focus on challenging mindsets like duction in Boot Camps in a focus on identifying patient safety issues. recognized internationally as a thought leader in the field, named as
ment period. Imposter Syndrome, perfectionism and ways to avoid burnout. Pre- Patient Safety Rooms allow new residents to enter a simulated patient Headspace’s inaugural Mindful Leader of the Year in 2022.

14 SAN ANTONIO MEDICINE • June 2024 Visit us at www.bcms.org 15