A Novel Surgical Intern Wellness Initiative Based on Longitudinal Reflective Writing Responses
Julia Rozenberg, Chelsey Ciambella, Thomas Miner, Kenneth Lynch, Daryl Appleton, Adena Osband
General Surgery, Brown University, Providence, Rhode Island, United States
Objective: Determine whether use of reflective questions asked on a twice monthly basis is a useful addition to our intern wellness curriculum, with a goal of longitudinal development. Prior studies demonstrate the use of brief written responses in processing educational experiences toward professional growth at both the medical student and resident level.
Design: Every two weeks, the interns were asked and answered two reflective prompts by email. Their responses went to a single faculty member and were then blinded for analysis. Participation was voluntary. Examples of questions are as follows: For this week, please tell me about two patient interactions: one that you wish you could do over and one that you feel you handled particularly well. Topics including patient interactions, education, teamwork, leadership, responsibility, and adjustment were addressed in the questions.
Setting: General Surgery Residency Program at an Academic Medical Center in the Northeast
Participants: The intern class is comprised of 13 individuals, 7 designated categorical general surgical interns and 6 non-designated preliminary interns. 30% are female, 46% are Caucasian. The designated preliminary interns of other programs, such as urology, were not included in this program.
Main Outcome Measure: Responses from July 2021 - December 2021 were collected and analyzed, consisting of 11 pairs of questions. A total of 123 responses were received. Response rates per week varied from 69% to 92%, with the numbers declining as the year progressed. For the categorical interns, response rates were maintained at 86 to 100%, with zero or one intern not responding each week.
Results: Participants had thoughtful responses to a wide range of questions covering many aspects of their personal and clinical experiences as interns. The average number of words per response was 164 (minimum 19, maximum 814), indicating robust involvement in this project. Seventy percent of responses had a positive valence. Themes that emerged in the answers included expectations, stressors, collaboration, and performance. As revealed by their responses, the interns took the time to consider their feelings, interactions, and reactions to typical surgical resident experiences.
Conclusions: Use of reflective questions is a valuable tool as part of an intern wellness curriculum and can be easily implemented. It encourages developing surgeons to recognize and share in their emotions as they encounter the new and stressful experiences inherent in residency and may help to prevent burnout. Sustained response rates through year suggests good resident engagement and acceptance of the program.
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