Introduction: Previous research has suggested an association between lack of sleep and well-being. Given higher rates of burnout among female clinicians, the Sutter Health “Joy of Work” team (a multidisciplinary group dedicated to improving organizational well-being) conducted a pilot among female clinicians in ambulatory services to assess factors associated with sleep, professional fulfillment, and intention to leave/reduce work hours. Methods: The intervention consisted of several components: an Oura ring (a wearable smart ring device that tracks activity, sleep, and heart rate); health coaches who sent text messages to participants and advised those participants with additional resources and questions; and three online group education sessions with the health coaches and a physician sleep expert to support sleep hygiene and sleep behavioral change. Participants used the Oura ring for 8-12 weeks. Baseline and post-intervention surveys and Oura ring data were collected upon participants’ agreement. Fisher’s Exact test and Unpaired t-tests were used to assess associations between sleep and wellness indicators. Linear mixed-effect models were conducted to capture the weekly change of Oura ring sleep outcomes. Results: Twenty-six clinicians completed the baseline survey and 19 completed the post-intervention survey. All 26 participants were female and composed of 23 physicians and 3 advanced practice clinicians. When asked if they believed they improved their sleep during the pilot experience, 78.9% reported yes/maybe. 82.2% reported improvements on their well-being. Regarding Oura ring sleep outcomes, the average nightly awake time and light sleep time were statistically significantly reduced by 1 minute and 3 minutes over the weeks. In comparison, the average deep sleep time was statistically significantly increased by 1 minute. Conclusion: Understanding sleep patterns and health education on improving sleep quality may be associated with an increase in self-reported perceptions of overall well-being and professional fulfilment. The subjective improvements in well-being were combined with slight objective improvement in deep sleep time. Additional research is needed to understand the differences between subjective and objective measures of sleep and clinician well-being.
This is not just a story of kidney transplantation in a tertiary care hospital in a tier-2 city of South India. It is all about a true clinical journey of resilience, where a young woman with congenital hearing loss, battling chronic kidney disease, discovered hope, understanding, and companionship through a physician assistant's compassionate communication.
Introduction: Clinician well-being remains a persistent challenge, with ongoing burnout and psychological distress despite efforts by systems and individuals. This Journal of Wellness annual review covers studies published in 2025. Methods: The Editors searched PubMed and Google Scholar for prospective and interventional studies / clinical trials in humans, with focus on well-being. Authors utilized artificial intelligence (AI)–based large language model (LLM) (ChatGPT, OpenAITM) to assist with preliminary identification of relevant studies, however authors noted significant AI-associated errors and outright misrepresentations requiring hand curated product generation and manual PubMed searches. Literature in Review: We continue to appreciate a shift toward system-level and scalable interventions. Randomized trials of AI and workflow tools targeted documentation burden and efficiency and had perceived improvements in efficiency and documentation quality. Digital and mobile health interventions, specifically resilience training and mindfulness platforms, showed modest but scalable effects. Coaching and peer-support interventions demonstrated improvements in physician well-being. Mindfulness-based approaches remain common, but emerging work in psychotherapy highlights overlap between burnout and mental health conditions. Conclusion: Recent literature continues to include individual and system level focus to address burnout and enhance flourishing of healthcare professionals. Addressing structural drivers of burnout may offer the most meaningful improvements in well-being.
Introduction: Healthcare worker wellness has received increasing attention from medical educators and healthcare systems given its importance to provider longevity and patient care. Wellness is multidimensional, and very few instruments evaluate all domains of wellness. Our team developed a comprehensive measure to evaluate the multi-dimensional nature of wellness. The purposes of this study were divided into four phases: phase 1) detail the development, design, and initial dissemination of the instrument, phase 2) collect feasibility and normative data for a diverse sample of healthcare workers, phase 3) evaluate the internal reliability of the measure and its component domains, and phase 4) evaluate the validity of our instrument compared to an existing tool designed to assess burnout. Methods: The CoreWellness Index (CWI) is a 42-item instrument that evaluates wellness in general and eight specific domains of wellness. We aimed to collect normative data from a robust sample of healthcare workers. A confirmatory factor analysis was performed to assess how items fit within CWI domains and intercorrelations between domains. Internal consistency of the CWI domains was evaluated with McDonald’s omega. We aimed to establish validity by comparing the CWI to the Copenhagen Burnout Inventory (CBI), a commonly used tool to assess burnout. Results: The CWI was completed by 1143 participants (53% medical students, 84% were between the ages of 20 and 30 years old, 57% female) from 26 institutions. All items had a moderate to strong fit within their domains and had a moderate correlation with each other. Regarding internal consistency, McDonald’s omega of the CWI was 0.92 and all wellness domains had an omega above 0.65. The CWI demonstrated significant negative correlations with all CBI subscales. Conclusions: The CWI is a unique assessment tool designed to assess the multidimensional nature of wellness. The instrument exhibited high completion feasibility, and strong reliability and validity evidence when evaluating its internal consistency and relationship to other established measures. The CWI may prove to be a useful tool for assessing wellness and can be used in organizations and institutions to identify areas of need for their learners in conjunction with initiatives to enhance wellness.
Introduction: Burnout in residency is a significant concern. There is an urgent need for feasible and transferable interventions that enhance resident well-being. Toward this end, we implemented a wellness intervention in a psychiatry residency program in 2019. Goals of the intervention included: 1) creating a safe space for sharing experiences in a supportive environment, 2) fostering group cohesion, and 3) addressing developmental challenges in training. We evaluated the feasibility and acceptability of the intervention. Methods: This study utilized a mixed methods design. Following the 2022-2023 academic year, residents completed a survey examining their perceptions of how well the intervention met its goals. Facilitators completed semi-structured interviews to explore the intervention's feasibility, acceptability, and required resources for broader implementation. Results: Of 31 eligible residents who participated in the intervention, 22 (71%) completed the survey. All four facilitators completed interviews. Quantitative and qualitative data demonstrated that residents largely felt positively about the intervention and found that it met its goals, with 86% saying the intervention provided a safe place to share experiences and 73% that the intervention increased group cohesion. Implementation required buy-in from department and program leadership as well as budgeted time for the facilitators. Conclusion: Despite its implementation in a single psychiatry residency program, the wellness intervention's simplicity and adaptability suggest its potential for broader application across residencies in various specialties and institutions.
Introduction: Trainees experiencing burnout, depression, or career dissatisfaction challenge educators and may have patient care consequences. Grit, defined as the “perseverance and passion for long-term goals,” buffers against hopelessness and quantifies an aspect of personality shown to predict fewer career changes. Higher grit has been associated with positive outcomes in physicians, including lower burnout rates. Our objective was to determine the correlation between emergency medicine (EM) resident Short Grit Scale (Grit-S) scores and components of well-being: burnout, a positive depression screen, and career satisfaction. Methods: This was a prospective, multicenter trial involving ten urban/suburban EM residencies. The subjects were PGY 1-4 EM residents. Surveys administered included Grit-S, Maslach Burnout Inventory, Prime-MD PHQ-2 depression screen, and a career satisfaction scale. Correlation and regression analysis were utilized to assess the relationship between residents’ grit and well-being characteristics. Results: 434 residents were available to participate; 49 were excluded for not completing a Grit-S (88% participation). The mean Grit-S score was 3.62. Grit correlated negatively with burnout (r = -0.22, n = 355, p < 0.001), and positive depression screen (r = -0.16, n = 382, p = 0.001). Grit correlated positively with career satisfaction (r = 0.15, n = 381, p = 0.003). Conclusion: EM residents with higher grit are less likely to experience burnout or screen positive for depression; they are more likely to have high career satisfaction. These findings could be useful in the early identification of residents at higher risk for burnout, depression, and dissatisfaction with their careers.
Introduction: Medical students experience stress, anxiety, and depression at rates greater than those of the general population. Medical students also underutilize mental health services. There exists a need for a comprehensive, multivariate analysis of the reasons medical students do not pursue mental health services, and the undesirable mental health outcomes that are associated with these barriers. This study associates psychiatric phenomena of stress, anxiety, and depression within the context of barriers to use of mental health services in medical students. Methods: In this cross-sectional study, medical students (N = 128) from the University of South Florida engaged with an online survey on their degree of perceived stress, anxiety, and depression using the Perceived Stress Scale (PSS), Generalized Anxiety Disorder-7 scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), respectively. They also provided responses to a study-specific measure designed to assess barriers to use of mental health services. Multiple regressions were performed to determine the weights of associated variables—barriers to use of services—relative to the aforementioned psychiatric phenomena. Results: Stress, anxiety, and depression were significantly associated— F(13, 113) = 4.541, p < 0.001; F(13, 113) = 3.976, p < 0.001; F(13, 113) = 6.296 p < 0.001, respectively—with lack of time, stigma of mental health care, feeling that “my problems are not that important,” cost, fear of unwanted intervention, and fear of documentation on academic record. Conclusion: Future interventions by relevant stakeholders can target specific barriers to use of mental health services to reduce stress, anxiety, and depression among medical students.
Introduction: The health of our nation’s healthcare workforce continues to decline. A comprehensive, whole-system, evidence-based approach is key to a successful wellness initiative and is the foundation for culture change. Building a culture of wellness leads to better mental health outcomes, healthier lifestyle behaviors, higher levels of engagement and job satisfaction, improved patient satisfaction and employee retention, and a positive return (ROI) and value on investment (VOI). Methods: The purpose of this cross-sectional, descriptive, anonymous survey was to assess the organizational wellness culture of participants who attended the National Summit on Promoting Well-being and Resilience in Healthcare Professionals. A 21-item survey was distributed to attendees of the Summit. Results: Eighty-eight individuals responded to the survey (29% response rate). Cronbach’s alpha of the 21 items was 0.95. The majority of respondents were white, female, and from a healthcare system/hospital. Almost half were unaware if there was a wellness team at their organization. Over 50% of the survey items scored under the 2.5 mean, the lowest including addressing the determinants of health, using a scorecard and data management process, visual triggers at decisional points, offering meaningful incentives, and recognizing and rewarding leaders and employees for their wellness contributions. Items that scored the highest above the 2.5 mean include dedicated resources for wellness, building practices based on best evidence, and having a wellness leader. Conclusion: There is need and opportunity to create and sustain cultures of wellness in healthcare settings and systems. By doing so, organizations can improve population health, affect system operations, retain talent, increase productivity, and enhance quality outcomes of importance to stakeholders.
Introduction: Cadaveric dissection is a central component to anatomy education. However, for many students, dissection can be emotionally taxing, highlighting a potential area for increased support. This project evaluated the implementation of a wellness program within a dissection-based anatomy course. Methods: Throughout a 12-week first-year medical student anatomy course, two teaching assistants (TAs) served as “Wellness TAs” and implemented a structured wellness program that included weekly office hours, supportive emails to students that addressed emotionally challenging coursework, and scheduled “wellness breakfasts/snack breaks.” An anonymous survey was distributed following the course. The survey assessed demographics, perceptions of the anatomical donor, emotional difficulty of course, coping mechanisms, utilization and efficacy of the wellness interventions. Results: The survey response rate was 44% (72/162). Emotional difficulty of anatomy was rated on a scale from 0 (not challenging) to 100 (extremely challenging), with respondents reporting a mean emotional difficulty of 44.4 ± 22.4 (SD); (range = 95, mode = 50, median = 50). Male gender was associated with a lower reported emotional difficulty compared to female gender (34.7 ± 22.3 (SD) vs. 48.3 ± 22.5 (SD), p=0.02, t=-2.338, F(2,62)=3.32, R2=0.097, Adjusted R2=0.068). Additionally, the specimen-view was associated with lower reported emotional difficulty compared to the person-view (35.4 ± 21.6 (SD) vs. 55.8 ± 19.4 (SD), p <0.001, t=-3.99, F(1,66)=15.97, R2=0.195, Adjusted R2=0.183). Age, first-generation physician status, and preferred specialty choice were not associated with emotional difficulty. When asked about coping and support mechanisms, the majority of respondents utilized informal, peer-based coping mechanisms. Respondents found the email warnings to be the most effective initiative, followed by the wellness breakfasts/snacks. Qualitative survey responses commonly highlighted difficulties surrounding the first day of dissection and head/neck dissections. Conclusion: Within a first-year medical student anatomy course, students more commonly engaged in informal coping mechanisms compared with formal wellness support. When engaged with, wellness initiatives were seen as very or extremely effective by almost half of respondents. Proactive strategies and food-based meetings were most effective. Future iterations of wellness programs could benefit from a focus on these strategies.
Aimed at promoting cross-cultural dialogue and exchange of ideas in the humanities, this article provides a Confucian response to the Stoic viewpoints expounded by Kutch in this journal. Two arguments are made in this paper: first, Confucius shares the Stoics’ emphasis on being mindful. Secondly, a significant difference between Confucius and the Stoics is that the former replaces the Stoics’ fate with Heaven (tian), which is a central Confucian spiritual ideal. Applying Confucian and Stoic insights to burnout, medical professionals are encouraged to (re)gain strength by reflecting on and embracing spiritual ideals, whether it is fate or Heaven. Burnout can be alleviated when medical providers are motivated by a sense of purpose through practicing memento mori and/or remembering to “leave a name behind after one’s death.”
Introduction: The Journal of Wellness has moved to a single calendar year editorial review of wellness literature. This annual review includes studies published in 2024. Methods: Authors conducted a PubMed and Google Scholar keyword search, narrowing results to interventional studies / clinical trials in humans. Literature in Review: We conducted a thematic review of a selection of relevant papers from the literature search. COVID-19 crisis has exacerbated the rate of burnout and impacted well-being of healthcare providers. Need for intervention in this area has arisen significantly since the pandemic. Post pandemic, working conditions have been normalized to some extent, however, the rate of burnout and reduction in well-being continues. Globally, poor well-being and burnout among healthcare professionals is a serious concern. We focused to identify and summarize studies which experimented various methods of addressing this issue. Conclusion: JWellness highlights developments around HCP wellness. In this review, we highlight studies with experimental research designs, randomized controlled trials, and a few prospective cohort and non-experimental cross-sectional studies with strong methodologies.
Introduction: The approach to physician well-being has transformed from a focus on identification of distress to embracing a comprehensive model that values vulnerability, growth, self-compassion, and a sense of purpose and community in the profession. This manuscript, a collaborative effort by the Council of Residency Directors in Emergency Medicine Well-being Committee and the Society for Academic Emergency Medicine Wellness Committee, presents the personal narratives of academic emergency physicians during which they faced challenges and stressors, as well as supportive resources they found helpful. The scenarios are written by the individuals themselves as they experienced them. Discussion: Through these shared and relatable experiences we underscore the dual responsibility of institutions and individuals in fostering physician well-being, advocating for a supportive and interconnected community among academic physicians, and emphasizing that none of us is alone as we navigate personal and professional challenges. While many resources exist, the most vital resource we have is each other.
Burnout among healthcare professionals is an increasingly recognized crisis, yet pathways to resilience remain underexplored. This narrative chronicles the author’s personal journey from profound exhaustion to self-discovery and renewal. Through the integration of contemplative practices, nature exposure, and mindful nourishment, the author navigated the challenges of residency and emerged with a deeper understanding of well-being. By incorporating Isha Kriya meditation, Surya Kriya yoga, and self-inquiry practices rooted in Advaita Vedanta, the experience evolved into a transformative path of inner resilience. This report highlights the necessity of prioritizing self-care within the medical profession and offers evidence-backed insights into holistic wellness practices, urging healthcare professionals to cultivate a foundation of well-being as essential to both personal and professional fulfillment.
Introduction: There has been a growing interest in understanding the role of gratitude in promoting well-being. Gratitude, defined as a feeling of thankfulness and appreciation in response to receiving a benefit from someone else, has been shown to improve mood, increase social support, and decrease symptoms of depression and anxiety. This research paper explores an innovative intervention using gratitude cards for faculty members and measures the emotional impact of this intervention. Methods: The study involved 32 clinical physicians from the Department of Emergency Medicine at the University of Utah. Participants were invited to write a gratitude card to a colleague and to receive a card from another colleague. Participants were randomly assigned a number using a random number generator and paired with another participant who had the corresponding number. After the intervention, 25 surveys were returned, resulting in a 78% response rate. The survey measured the degree of burnout on a 1-100 scale (with 100 representing a high level of burnout) and participants' feelings about writing and receiving a card on a 1-10 scale (with 10 being very positive). The study was reviewed by the Institutional Review Board (IRB) and determined to be exempt as non-human subjects research. Results: The average rating on a 1-10 scale for respondents regarding writing a card was 7.3, while for respondents receiving a card, it was 6.1 (10 being very positive).The average degree of burnout on a 1-100 scale before the card was 48.4 (100 representing a high level of burnout). Among the six participants who wrote cards but did not receive one, three reported no benefit, one experienced an increase in burnout, and two reported a potential improvement in burnout. Of the 11 participants who both sent and received a card, three felt it made no difference in their sense of burnout, five felt it may have improved, and three reported definite improvement. For participants who neither sent nor received a card, there was no impact on their burnout level. Additionally, 48% of respondents supported the continuation of gratitude cards in the future, while 16% suggested combining gratitude cards with a gift exchange program, and 28% felt neither was necessary. Conclusion: The study found that the gratitude intervention had a positive impact on burnout for some participants, highlighting the potential of gratitude interventions to promote well-being in the workplace. The findings underscore the importance of allowing individuals to choose how they improve their well-being, as the intervention's effectiveness varied based on individual preferences and age-related differences in resilience. The results suggest that expressing gratitude can be a cost-effective strategy to enhance well-being in professional settings. Future research should explore these factors further to optimize the implementation of gratitude practices in diverse workplace environments.
Introduction: Residency training is demanding and often leads to burnout. In 2017, Internal Medicine (IM) residents at our institution reported a poor collective residency experience. In response, we launched a longitudinal wellness program in 2018, featuring multi-pronged interventions to improve residents' well-being. The program, still active today, has undergone iterative modifications with ongoing input from residents. Approach: The resident-led Wellness Committee was established in 2018, and the following no to low-cost initiatives were implemented sequentially: quarterly group sessions with an institutional health psychologist, bi-annual self-checks, peer buddy support for incoming first-year residents, weekly 5-minute reflection sessions, and volunteer dog visits. Discussion: All planned activities were well-received by residents, as indicated by positive survey responses. Ninety percent of the survey respondents for the health-psychologist sessions strongly agreed or agreed that the sessions were very useful. Eighty-four percent of the responding first-year residents felt their peer buddy answered their questions, and 93% expressed interest in volunteering as a buddy in subsequent years. Additionally, 80% of survey respondents found the weekly 5-minute reflection sessions to be a positive experience. We also noticed an overall improvement in institutional annual Accreditation Council for Graduate Medical Education (ACGME) well-being survey scores from 2018 to 2023, especially in the domain of emotional exhaustion. Conclusion: We propose a feasible, low-cost wellness toolkit that is easy to implement and sustainable. The quantitative and qualitative data demonstrate that this approach is not only acceptable but successful in engaging residents and addressing various aspects of their well-being.
Introduction: Although more than half of pediatric residents report burnout, the incidence of moral distress, the course of moral distress and burnout during residency, and associations between this course and personal characteristics of residents are unknown. The purpose of this work was to examine the incidence, temporal course, and associations of moral distress and burnout in pediatric residents. Methods: In the pediatric training program of British Columbia Children’s Hospital, all residents were invited to complete the Moral Distress Scale-Revised thrice yearly, and the Maslach Burnout Inventory annually, between July 2016 and October 2018. In addition, residents reported a measure of moral distress for each rotation. Responses were tracked longitudinally using a unique identifier for each resident. We used longitudinal mixed effect modeling and generalized estimating equations to account for clustering of data. Results: A total of 86/101 residents completed at least one sequence of the surveys. The average moral distress score was 20 (maximum possible: 336), but 10% of respondents had considered leaving residency in the past due to moral distress. Highest levels of moral distress occurred after international and intensive care rotations. Seven percent of respondents met criteria for burnout, but female residents reported higher burnout scores than males (p = 0.04). Conclusion: Although moral distress and prevalence of burnout are low in pediatric residents at this institution, moral distress contributes to potential attrition. High-acuity rotations are associated with increased levels of moral distress.
Introduction: Burnout has been described as “a state of mental and physical exhaustion related to work or caregiving activities.” Among resident physicians, burnout is a serious concern that can lead to medical errors and negative patient outcomes. To combat burnout among physiatry trainees during the COVID-19 pandemic, an innovative wellness retreat was created and implemented at the University of Miami’s Physical Medicine and Rehabilitation (PM&R) Residency Program in March 2021 and February 2022. Methods: The retreat curriculum was designed by the PM&R Residency Wellness Committee and supported by departmental funding. The retreat(s) consisted of three strategies: education and discussion on burnout, instruction and immediate practice in wellness techniques, and team building and bonding activities. All residents (n = 24) and fellows (n = 2) participated in a one-day wellness retreat. The main outcomes included the Copenhagen Burnout Inventory (CBI) questionnaire, administered at three time points: pre-retreat, 3 weeks post-retreat, and 3 months post-retreat. Results: The wellness retreat included 26 trainees. Their mean age was 31±2 years, 76% were male, 24% female, and self-identified ethnicities were 43% Hispanic, 29% White, 19% Black, and 9% Asian. The highest pre-retreat burnout scores were observed in the PGY-3 class; and the greatest overall improvements were observed in the PGY-2 class after the wellness intervention. Although not statistically significant, PGY groups of trainees trended toward decreased burnout after the intervention. Specifically, residents reported lower CBI scores at 3 weeks post-retreat (except for client-related burnout) and even lower CBI scores at 3 months post-retreat, indicating less total burnout (-11%), personal (-15%), work-related (-10%), and client-related burnout (-5%). Before the wellness retreat moderate burnout mean scores (50-74) were observed among PGY-2 residents in total burnout and work-related burnout, PGY-3 in personal and work-related burnout, and PGY-4 in personal burnout. At 3 months post-retreat, moderate burnout mean scores were only observed among PGY-3 in personal burnout. Conclusion: In response to the COVID-19 pandemic, this retreat was well received by PM&R residents and may have contributed to improved overall and specific burnout scores amongst participant trainees at all stages.
Introduction: Physician burnout is on the rise, and this is of particular concern in emergency medicine. Burnout is associated with medical errors, adverse events, poor professionalism, and litigation. A sense of community can build engagement and mitigate workplace stressors on well-being. Emergency physicians may have trouble connecting due to the nature of shift-work and various practice settings. Communication technology, and particularly podcasting, has the potential to help overcome these barriers and positively impact relatedness and well-being. Approach: We developed an inward-facing podcast, “The ER Break Room” within the Department of Emergency Medicine at the University of Florida. Through the podcast, we aimed to enhance wellness by facilitating a sense of community within our department. Each podcast episode broadcasts departmental initiatives and events, celebrates accomplishments, and highlights individual faculty and staff through in-depth interviews. We assessed faculty and staff perceptions of the first two years of the podcast as part of a quality improvement effort to ensure that the podcast aligns with faculty well-being priorities. Discussion: Development of “The ER Break Room” required a cost of $15 monthly and no formal podcasting infrastructure or experience. Over two years and 15 episodes, “The ER Break Room” has had 1,487 plays. Of 63 departmental faculty and staff, 21 (33%) provided feedback on the podcast. Responses highlighted two primary perceived benefits of “The ER Break Room”: 1) facilitating a sense of community belonging, and 2) staying up to date on department updates. Conclusion: Inward-facing podcasts that promote togetherness and facilitate communication are feasible to produce with low cost and no prior podcasting experience. We continue to expand the podcast with the inclusion of new themes and efforts to broaden our reach within the department. Future work will focus on assessing the impact of this initiative on well-being.
