- SECOND Toolkit

WHAT?

The goals of this intervention are to:

Educate residents’ family and loved ones on resident lifestyle and day-to-day work
Provide family members with a “support group” to process their unique perspective and struggles as they also transition to residency life
Provide information about warning signs regarding depression and burnout to family members as well as reduce barriers to seeking help
Foster a sense of community and belonging among and between residents and their families and the learning community at large

WHY?

Family members are often the most important source of support for residents. Data from our post-ABSITE survey demonstrated that residents who reported not being in a relationship had significantly higher odds of suicidal thoughts compared to those who were married or in a relationship.1 However, residents who were not in a relationship had lower odds of burnout compared to those in a relationship, demonstrating a seemingly paradoxical effect of relationship status on negative outcomes. These findings may be partially due to difficulty in balancing demands on residents’ time, but also presents an opportunity to help residents’ families better understand and therefore support their work and lifestyle. It also provides families with information and resources to bring any concerns about their loved one to attention. Finally, it is also important to recognize the stress and difficulty that family members themselves may feel in adapting to a lifestyle in which their access to their loved one is limited. This intervention provides a useful “support group” for these family members to discuss and process through their unique struggle. [4]

Resident Camaraderie	Family members may get to know one another and socialize outside of the hospital, promoting camaraderie among their residents.
Organizational Culture and Values	Involving residents’ family members indicates that your program encourages work-life integration and understands the value of developing social support for trainees. Incorporating family members in the departmental activities helps to foster an inclusive culture and nurturing environment for both residents and their families.
Work-Life Balance	Work and life are often presented as a dichotomy of competing interests. This intervention engages families as members of the department and helps foster an understanding of residents’ work environment to help them appreciate and/or support them. It also provides support for family members who may be undergoing a difficult transition into residency.

How?

Step 1. Identify point person in the department to coordinate family orientation.

This may be a person in program leadership, a coordinator, or a faculty surgeon with interest navigating personal relationships through residency.
If this intervention becomes an annual occurrence, it may be transitioned from a faculty member or program leadership to someone in an administrative role.
Prepare materials:
1. The University of Rochester made a video showing life inside an OR and asks rising PGY2s to develop a daily resident life video for the incoming interns
2. Incoming interns are contacted in advance with a brief survey regarding personal and familial needs that will help connect them to community. As part of this, the orientation is introduced and they are asked to connect with those they would want in attendance to determine best time of day for this event (eg, over breakfast, dinner, etc)
3. The University of Rochester has also prepared this example slide deck used for Friends & Family Orientation

Step 2. Identify individuals to serve as panelists for orientation session.

Identify suitable faculty members to speak on a panel about family relationships. Ideally, identify individuals and couples who can offer differing experiences and perspectives on both training and practice, in order to reach a broad audience and encourage discussion:
1. a surgeon and non-surgeon physician spouse
2. a two surgeon couple
3. a surgeon and a non-physician academic spouse
4. a surgeon and a non-academic working spouse
5. a surgeon and a stay-at-home spouse
6. a surgeon and their parent
7. ensure that there is adequate representation from LGBTQ couples, racial/ethnic minorities, etc
Also try to identify people with experiences at different stages of career:
1. surgeon and partner who were together before residency
2. surgeon and partner who met during or after residency
3. surgeon who had children before residency (coupled or not)
4. surgeon who had children during residency (coupled or not)
5. surgeon who had children after residency (coupled or not)
6. ensure that they also represent in training, early to mid-career for a longitudinal focus
Encourage panelists to prepare by reflecting on their experiences, perspectives, and any lessons they have learned along the way.
1. How did training influence individuals and families? Did it impact family planning? Selected geography for fellowship training/early career? What was it like to go through certain aspects alone vs. partnered? What was it like to suddenly be inaccessible by phone or to miss family events? What were the benefits (e.g., pride in a loved one)

Step 3. Identify and reach out to institutional support resources to participate.

Identify internal institutional resources for wellness (e.g., counseling, Employee Assistance Program, physician wellness committee/leadership, mental health providers).
Invite representatives to attend and provide an overview of physician wellness issues (e.g., burnout, depression) and resources (e.g., mental/behavioral health providers, marriage/family counseling), with a special focus on interns if possible, both within the institution and in the community.
It may be helpful to compile these resources into a handout or pamphlet, along with contact information for program leadership.

Step 4. Schedule family orientation event approximately 1 month after interns start.

Allow time for interns to “settle in” and for family members to get a sense for lifestyle; avoid hectic start of year when, even if already present, these issues are likely to be overshadowed by other concerns.
Ask residents to identify their sources of support (e.g., spouses, partners, parents, children, friends, etc) and invite them to participate.
We recommend allotting at least 2.5 hours for the session and conducting it during the evening
Ask family for general availability (e.g., weekday evenings vs. weekends).
Plan to have remote capabilities for families who cannot attend (e.g., don’t live in the area, have small children at home and no childcare) via videoconference (Skype, Zoom, etc.). This is a critical step not to be overlooked, as these residents and/or family members may be particularly at risk for isolation.
Send RSVPs in May or June.
Plan for senior residents to provide coverage to clinical services so that all interns can participate.
Schedule a meal delivery.

Step 5. Conduct session.

This timeline may be adjusted to fit your needs.

Introductions
1. Program leadership should introduce themselves and thank family for their sacrifices and support of their loved ones.
2. Family members should introduce themselves.
Explain what residency is
1. Generally explain the structure of residency (e.g., what happens in internship, PGY 2-3, +/- research, PGY 4, chief residency).
2. Discuss day-to-day life at work, including a typical schedule.
3. Introduce the available EAP resources.
4. Show video from Step 1.
Panel session
1. Have panelists speak briefly about their experience (e.g., a mixture of faculty and/or family members).
2. Invite questions and discussion.
Educate families on how to support loved ones in training/identify when a loved one may be at risk, and who to contact if they are worried about them.
1. At Oregon Health & Science University (OHSU), spouses have played a key role in identifying resident behavior changes that were concerning for underlying distress.
2. At University of Rochester, multiple residents have identified a need for external resources in response to spouses/family feedback regarding identified wellness issues following family orientation. Family members have also contacted the program to seek their own care in response to the stressors they face because their loved one is in training.
Identify and validate that this can be a stressful time for family members as well, and that their own self-care is important.
Serve meal and allow family members to mingle to encourage sense of community and foster discussion and relationships (including those who are remote). This also has facilitated wonderful dialogue regarding the respect and pride they have in their loved ones and allowed us to learn fun facts about our new learners.

Helpful Resources

Webinar Webinar recording available here

Coaches/Successful Implementations

University of Rochester Coach: Lauren DeCaporale-Ryan, PhD, APD Wellness

Oregon Health & Sciences University Coach: Karen Brasel MD, MPH, Program Director

Family Orientation

WHAT?

WHY?

Resident Camaraderie

Organizational Culture and Values

Work-Life Balance