← Advancing Health
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- [00:01]
A
Welcome to Advancing Health. Today's medical residents and fellows are tomorrow's doctors. In this podcast, we hear about Boston Medical Center's innovative program to provide mental and emotional support during the rigors of medical training and to address the tendency of many medical trainees to deprioritize their own health.
- [00:24]
B
My name is Jordan Steiger and I am the Senior Program Manager for Clinical affairs and Workforce at the aha. I'm joined today by Simone Martel, who is the Director of Boston Medical Center's Employee resilience program, and Dr. Jeff Schneider, the Associate Chief Medical Officer, designated Institutional Official and Chair of the Graduate Medical Education Committee at Boston Medical center and the Assistant Dean for Graduate Medical Education at BU Chobanian and Abedisian School of Medicine. So, just to set the stage a little bit, in 2022 and 2023, the AHA received some funding from the CDC to the leading interventions for preventing suicide in the healthcare workforce. And we got to know the Boston Medical center team through this learning collaborative that we hosted that focused on implementing these practices at hospitals and health systems across the country. So, Simone and Jeff, thank you so much for being here with us today.
- [01:20]
C
Thank you for having us.
- [01:22]
D
Thank you.
- [01:23]
B
So to get us started, I'd love for the audience to just learn a little bit more about your roles at BMC and how the two of you work together to support workforce wellbeing.
- [01:33]
E
So.
- [01:33]
B
So Jeff, let's start with you.
- [01:35]
D
Sure. Thank you very much for having us and happy to share what we have done and also what we plan to do moving forward by training. I am an emergency medicine physician. I still work clinically in our emergency department. And the other part of my job is I oversee all of our residency and fellowship training programs across the organization. So it's more than 750 residents and fellows across roughly about 70 training programs. And I really oversee those residency and fellowship programs from a bunch of different perspectives, everything from operations to finance to accreditation. Obviously working very closely with our program directors and our program administrators and the educators and teachers that we have here at BMC.
- [02:15]
B
Great, Simone.
- [02:17]
C
So I joined BMC in June of 2023. My background is I'm an LICSW licensed independent clinical social worker in Massachusetts. And the program here is to provide mental and emotional support and resources to all of our workforce, clinical and non clinical, in the realm of mental health, emotional well being, stresses around the workplace, occupational stress injuries. And we have a couple of initiatives that target residents and medical trainees in particular. One of the first I was also introduced to was this Initiative that had started the year before I joined, which are these wellness chats for incoming trainees at the beginning of the academic year.
- [03:04]
B
That's great. So I know that healthcare workers overall can experience barriers to receiving mental health services, can experience challenges around wellbeing and taking care of themselves. I think everybody listening to this podcast probably knows that. But we also know there's a lot of research that shows that residents have some kind of special challenges and adjustments that they need to make as they're starting residency. But could you tell the audience about some of those maybe special challenges that face residents?
- [03:34]
D
The genesis of our program really actually goes back probably six or seven years now, when we realized that our residents and fellows really deprioritized their own health on many occasions. Given the choice between learning something clinical or learning how to do something, or getting experience in taking care of their own health, residents across the country tend to deprioritize their own health. So one of the things that we did very early on was trying to understand what are the barriers for our residents taking care of themselves? If they're not taking care of themselves, how can we expect them to take care of patients, to learn and to grow? So we had an idea that we would introduce primary care appointments during intern orientation. Again, this is probably six or seven years ago now. And we set up a process, a mechanism really carved out an afternoon that was protected for residents and fellows, where those that wanted to get primary care appointments could have them here at a Boston medical center. Our goal, again, really was still a little bit around reducing stigma, reducing barriers, and normalizing the conversation around taking care of your own health is very, very important. I will admit that when we started this, I had no idea if anyone was going to show up. We put a lot of time and effort, operations and planning into organizing this, but not really knowing, frankly, how well it would land. And we were pleased to see that even after year one, the majority of our residents and fellows were very interested in participating in this. And we continued to grow the program a little bit, to learn, to iterate. And a few years later, we said, well, if we're introducing primary care, maybe we should do the same thing with behavioral health and mental health to really try to accomplish a few things. The first was we really wanted to normalize the conversation. It is totally normal for residents and fellows who need any behavioral health support, any behavioral health or mental health contacts. How can we help them do that? To really normalize the conversation? It's as normal as anything else that we do. And then really Trying to reduce the stigma around it, talking about it in the wide open, not behind closed doors or in hushed voices. It was something we talked about very early on when these new residents and fellows were coming, and really tried to make the conversation part of what we do. It's an expected part of what we do. And then really trying to figure out how do we decrease the barriers, how do we make it as easy as possible for residents and fellows to take advantage of the wonderful resources we've had here. And Simone and her team have really taken an idea and grown it so that it's flourished. And I'll let Simone talk a little bit more about some of the details of how she's actually executing.
- [06:02]
C
Yeah, yeah. Thank you. So I do also want to give credit to the team that preceded me as well, because I inherited this. And so the first year that the behavioral health component was launched was in 2022. So now we're going our fourth year doing it. I think the whole framework, at least as how I view it in our approach too, is like this philosophy of.
- [06:25]
E
Preventative care, which I think, you know, as trainees who are going to be.
- [06:30]
C
Fully practicing doctors, would preach to their patients, we want them to be able to inhabit or embody that themselves as well. The way that it's been structured right now through a couple of key learning points over the past couple years, is that we use different tools for signups. So in the welcome letter that gets sent out by Dr. Schneider's office in April, welcoming folks, there is a portion of the letter that talks about the PCP visits and a portion of the letter that talks about signing up for these wellness resource chats.
- [07:04]
E
And they're 15 minute chat sessions, they're.
- [07:07]
C
Not therapy, but they are really focused on an opportunity to talk about any.
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E
Concerns somebody might have, letting them know.
- [07:16]
C
About the resources that are available to them, helping them kind of highlight what are some anticipated stressors or things that they can do ahead of time, again.
- [07:26]
E
From a preventative standpoint. So oftentimes we'll talk about what are some coping skills that got you through medical school, what are some things and ways we can augment that, knowing that you're going to be in a new situation in your territory now, maybe away from the support community that you'd establish and been a part of and need to kind of configure here. So sometimes, you know, it might come up where somebody. And I think generationally there's been less stigma, which has been really lovely to see and kind of capitalizing on that. So Some folks might come in and they've had experiences with mental health supports before, but they might not realize, oh, that person doesn't have a license to practice in Massachusetts. So I need to be able to keep that going and find the resources locally and work within my insurance. Because now my insurance plan is moving from what I had previously to BMC's, now their employer, and getting on a network that fits here. And so we want to set it up so that it can be something where we're again coming from. How do we anticipate what some of those barriers might be? What are those challenges going to potentially be? And a big piece is that access point, because it might be early on. There's a lot of excitement. There's new. They're still riding the wave of having just graduated, you know, and starting out their new program, which is a stressor in itself. You know, sometimes there are positive stressors, and this is a positive stressor.
- [08:51]
C
But at the time when, you know, mental health challenges potentially do arise or distress does arise, we don't want it to be, oh, now I'm having to start from scratch at the time where I'm already struggling. We want that to the groundwork to already be laid for them. So that's really sort of the framework by which we're trying to approach this.
- [09:11]
B
You both hit on so many important things that I feel like we could dig into for forever on this podcast. But I think, you know, addressing that stigma piece, I think is so important. Bringing that to the front of the table, the front of the room, the second a resident starts at BMC and saying, this is okay. We expect that you're going to be stressed because residency is hard and you're learning, and there's a lot of things going on for you. I think just getting out in front of it is so important. I think one thing you mentioned, Simone, as well, is that it's not therapy, you know, and I wonder sometimes if people kind of shy away from these programs or thinking about mental health because they don't want to be providing those therapy services. But it really sounds like it's just more connecting people to those services.
- [09:57]
C
Yeah, it has a lot to do with the awareness and the access piece. So what we've done with the chats is that in addition to myself, some of my colleagues who are, you know, bachelor's level will be able to join and hold the discussions also. They won't have to have the pressure of going into anything that's outside of their territory. We also don't want to give a false impression to the residents for this session. Either I'll say residents or fellows, because we do this for fellows as well. But it's more about, here are the different resources that you are eligible for and have access to, and here's the route with which to do it. And here's at least, you know, through our intranet source, our flyers, our point of contact, so that you have an easy way of. You don't have to remember all of this, but there's just a streamlined way to think about how do I set up what I might need. And then again, for, you know, folks that maybe have had experiences before or are just saying, like, you know, coming into this, I know that this is something that was difficult for me in med school or something that I've found challenges with. So I want to kind of be thinking ahead. We can roughly just touch upon what are some coping strategies that have been helpful for you? Again, this being a new territory, new.
- [11:22]
E
Framework, what do you think that you might need in anticipation, and how do.
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C
You think through ahead of that without.
- [11:27]
E
It being anything that would delve into.
- [11:29]
C
The territory of therapy per se. That said, trainees are able to schedule confidential appointments with a licensed clinician in the Resilience program at any point through their tenure. And we also help them navigate how to get connected to a therapist through their behavioral health benefits, if that's something they'd like to pursue.
- [11:48]
D
I think another really important piece of this is getting the residents and fellows to normalize a conversation amongst themselves. So for every resident or fellow that Simone or her team meets with, who goes through or has their eyes open to some of the resources that we have here, my hope, my deep hope is that even if, you know, maybe it's not applicable to them today or tomorrow or to the next day, but if they see a colleague, if they see a friend, if they see someone, a resident or fellow who maybe they don't even know all that well, and they just look at them and say, I'm worried about you. Are you okay? That's always the right conference, always the right question to ask. It's never the wrong question to ask. And then also, so they can start arming themselves of, you know what, the very beginning, I went to this talk and I had this Resilience chat, and I learned a little bit about some of the resources we have at Boston Medical Center. I don't remember all the details, but I know that there's help out there. And I remember, here's how you can help access it. So again, the more we can start normalizing these conversations. I think for every resident fellow that Simone touches, the hope is that that spreads almost vi so they can help themselves but also help their colleagues.
- [12:54]
B
Absolutely. I think the program and the work that you are doing at Boston Medical center is setting such an incredible example for our membership and we're so happy that we get to share your story with everybody today. Simone and Jeff, thank you so much for being here with us today. I think the work that you have shared and the work that you're doing and continue to do to support your teams is really setting such a strong, incredible example for our membership and I'm just so happy that we get to share your your story and hopefully others will get to learn from it and start to maybe implement some of the things that you shared today.
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D
Thank you.
- [13:31]
C
Thank you so much.
- [13:33]
A
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