Working in the healing professions challenges people like no other vocation. We need an ability to cope with stress and bounce back after challenges to survive, or even thrive, in medicine. We can, of course, be blessed with innate resilience, and we can also learn resilience skills. While they do not solve the underlying systemic issues, they may help us to cope better with the unacceptable pressures, and there is an evidence-base. In this article, we present the evidence base for interventions for physician resilience.
“Physician resilience programs” are not without their critics, and rightly so. These programs in medicine are linked to a set of initiatives for tackling physician burnout, breakdown, and suicide. They are not uncontroversial because simply enhancing individual resilience is one small element in what is a much larger systemic problem. Further, by putting the responsibility back onto physicians, not only do we have to take more on, but it distracts from the root causes: our system.
The impact on doctors can be framed in terms of stress response-burnout-illness, moral injury, or human rights violations.
Controversy aside, by practicing self-care and enhancing our ability to cope with the inherent stresses of the medical system, we will be better able to serve our patients, families, colleagues, and communities. And there are both an evidence base and resources of interventions for enhancing physician resilience.
So, the idea of physicians boosting their own resilience seems reasonable – at least as this relates to the personal resilience required for being a doctor. Resources that enhance physician resilience are clearly an important piece of the physician burnout puzzle.
Below, I summarize the evidence base for interventions that have helped others. Credit to Carolina Venegas and colleagues (2019) for their excellent review on this topic.
According to the American Medical Association (AMA), physicians actively pursuing their own resilience may be better equipped to handle the many challenges presented in a medical career.
As such, they are often less likely to experience burnout, and physicians who are not burned out have higher quality of life scores, make fewer errors, leave medicine less, are sued less often, and receive higher patient satisfaction scores.
The Canadian Medical Association (CMA) recognizes that “a career in medicine is challenging and demanding, but there are ways to manage the stress. Even though some of the causes of that stress, such as medical culture and the health care system itself, require large-scale, long-term efforts to change, developing individual resilience is something you can do today to support your own well-being”.
An excellent Mayo Clinic review by Cordova et al (2020) notes that a number of important leading educational organizations stress the importance of systems- and individual-level initiatives to promote physician well-being. These interventions for physician resilience set the stage for training institutions to delineate and operationalize the appropriate systems changes, skills, and teaching methods.
A recent PLoS One Systematic Review on interventions for physician resilience who have completed training noted variation in study quality and no evidently superior approach. This study however highlighted a number of approaches with at least some evidence (for brevity we have included only RCTs or observational studies with significant findings).
Interventions that improve burnout measures in physicians (Adapted from Venegas et al., 2019)
Mache et al. 2016 (RCT)
Psychosocial skills training + CBT and solution-focused counseling.
Significant improvements in resilience at both follow-up surveys, with no comparable results seen in the control group
Sood et al. 2011 (RCT)
Stress Management and Resiliency Training (SMART) program adapted from the Mayo Clinic Attention and Interpretation Therapy (AIT) + brief structured relaxation intervention (pace breathing meditation).
One 90 min session and an optional 30–60 min extra follow up session
Statistically significant improvement for resilience and anxiety in the study arm compared to the wait-list control arm
Goodman et al. 2012 (Before-and-after study)
Mindfulness-Based Stress Reduction (MBSR) for healthcare providers.
2.5 hours a week for 8 weeks, and included a 7-hour silent retreat between the 6th and 7th weeks
Burnout scores improved significantly from the first to the last class for physicians
Krasner et al. 2009 (Before-and-after study)
Intensive educational program in mindfulness, communication, and self-awareness.
An 8-week intensive phase (2.5 hour/week, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 hours/month)
Burnout showed improvement across all subscales.
Isaksson et al. 2010 (Cohort study)
Integrative approach incorporating psychodynamic, cognitive, and educational theories:
1) Single day, 6 to 7-hour counseling session for one physician with a psychiatrist or a specialist in occupational medicine
2) Five day, group-based course for 8 participants, led by one of the same counselors in collaboration with an occupational therapist
Significant reduction in emotional exhaustion (Burnout subscale) from baseline to one year after the intervention, maintained at 3-year follow-up
Sherlock et al. 2016 (Prospective cohort study)
Course on adaptation practice, which is a behavioral program of self-discipline designed to cope with stress, anxiety, and depression.
HADS scores for anxiety and depression improved significantly compared with those of the control group (doctors who could not attend)
Winefield et al. 1998 (Uncontrolled intervention study)
Three, 3-hour meetings in 4 weeks
Significant reduction of emotional exhaustion (Burnout subscale)
CBT, cognitive behavioral therapy; HADS hospital anxiety and depression score.
Clearly, physician burnout is an important and urgent issue affecting doctors and patients.
There are a number of evidence-based approaches of interventions to boost physician resilience, even within a toxic system.
By all means, check these out. Learn new ways of coping. Be able to bend with the hurricane rather than break. Become stronger.
Please don’t burn out, or worse.
If you need more, though, please check out our Forums and Support Groups – which are for doctors only and are all completely confidential, anonymous, and secure.