Bringing Trainee Wellness to the Forefront

By Katlyn Campbell, Communications Specialist, CHEST
June 14, 2024 | VOLUME 2, ISSUE 2

Before the spread of COVID-19, and increasingly during the pandemic, Ilana Krumm, MD, noticed a burgeoning focus on wellness for trainees and how to combat burnout in the medical space.

But Dr. Krumm also noticed that most of the existing programs focused on the individual level, rather than the system level. The onus was on the trainees to manage their wellness and burnout.

“I wanted to look at something that could be instituted at a systems level as opposed to putting all the burden of this wellness on the resident, as someone who already has a huge burden of work, stress, and time constraints as they try to learn their discipline,” Dr. Krumm said. “Asking them to meditate on their own time seemed very impractical.”

Eager to research this idea, Dr. Krumm applied for the CHEST Research Grant in Medical Education.

“The fact that CHEST is willing to support medical education research is really important for all those trying to better the educational environment. Although there's a movement toward more support for medical education research and more recognition of its value, I think the fact that CHEST has already done so has helped advance the field and the support for the field as a whole,” Dr. Krumm said.

With the support of a CHEST medical education research grant, and under the mentorship of Rosemary Adamson, MBBS, Dr. Krumm began studying how incorporating a system-level program called Reflection Rounds could help trainees alleviate burnout.

“Having the support from a reputable institution like CHEST inherently gave the work that I was doing value,” Dr. Krumm said. “It gave folks an understanding that this research in medical education has importance.”

Dr. Krumm’s project focused on the monthly Reflection Rounds between the ICU, palliative care, and chaplaincy staff that were held at the Seattle VA Medical Center, where residents could discuss the challenges of caring for critically ill patients during a protected time. While similar interventions around death and dying have been shown to help residents reduce burnout in medical intensive care rotations, it was unknown which aspects of these sessions would be most effective.

Participant interviews were conducted before and after the residents' monthly sessions to understand the impact these sessions had on wellness and burnout levels.

“With the grant funding from CHEST, our team was able to purchase the recording equipment, transcription, and software necessary to complete a thorough qualitative research project, which greatly accelerated the project timeline,” she said.

Through these interviews, Dr. Krumm’s team identified three key themes that shed light on the impact of Reflection Rounds.

1) Cultural precedent
Participants were encouraged to participate as little or as much as they wanted during the session. Despite some residents being less vocal during these discussions, every resident agreed that this type of session set an important cultural precedent in their program and acknowledged the value of a program that encouraged space for decompression and reflection.

2) Shared experiences
During this project, many residents experienced an increased sense of isolation, as COVID-19 precautions were stricter in the ICU. Having this protected time together allowed residents to discover their shared experiences and find comfort in them while feeling supported.

"A lot of residents commented that it was nice to know that others were going through this as well or that they were also finding this particular instance difficult," Dr. Krumm said.

3) Ritual
At the opening of each hour-long session, participants were invited to light a candle and say aloud or think to themselves the name of a patient they had lost, had a hard time with, or cared for during their time in the ICU.

"Every single person pointed to that moment as meaningful and impactful," Dr. Krumm said.

This ritual gave the residents time to center and have a common focus with their peers to think about patient stories that they were carrying with them.

“Maybe just incorporating a small moment like that, a point of reflection, could potentially have a big impact on the weight we carry as providers who care for [patients who are] critically ill,” Dr. Krumm said. “What I've learned from this project will make me a better leader in the ICU, not only in taking care of critically ill individuals but also in taking care of the team doing that work.”

Dr. Krumm credits the CHEST grant funding and subsequent research project with helping her join a highly competitive fellowship program at the University of California San Francisco, where she can continue to conduct research in the field of medical education.

"I am working closely with medical education faculty and peers to design new research studies and further establish myself in the field of medical education, leading to my ultimate goal of becoming a program director at a strong med-ed-focused program."