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Residents get a room of their own

Sarah Mahoney , special to AAMCNews
September 10, 2019

Can massage chairs, pingpong tables, and yoga gardens ease the impact of long shifts and high stress? That’s the hope for medical schools and teaching hospitals that are turning humble break rooms into fully stocked wellness centers.

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lounge with people at University of Nebraska Medical Center
Guests celebrate the opening of the residents’ lounge at University of Nebraska Medical Center, which includes work and meditation spaces.
Kent Sievers, UNMC

Kaitlyn Brittan, MD, recalls exhausting stretches as an internal medicine resident at the University of Nebraska Medical Center (UNMC), when she’d go without sleep through 28-hour shifts. She never made it to the campus on-call rooms. “They were a 10-minute walk away, so if I knew I only had a 20-minute break, what was the point?” And she says those long shifts sometimes isolated her from the center's more than 500 other residents.

“We all work in such silos and we’re behind computer screens so much,” says Brittan, now a rheumatology fellow. “It’s easy to feel wiped out and disconnected.”

But since the opening of UNMC’s House Officers Wellness Lounge this summer, that’s changed. Besides offering cardio machines, showers, heated massage chairs, relaxation rooms, and a meditation space, it provides a conference room for collaborating with other residents. Importantly, it also offers plenty of work stations. That means residents can handle the grind of documentation without the repeated interruptions they can face on hospital wards.

“Some of us come here to socialize, get a snack, or catch up on charts,” she says. “And some come to unwind in the quiet rooms.”

These and other perks are no minor matter. As medical schools and teaching hospitals seek ways to ease stress and prevent burnout, some are reinventing the role of the staff lounge to provide a refuge for learners. From revamping musty old break rooms to building sun-lit new spaces, these institutions aim to buffer trainees against the impact of draining schedules and demanding work. It’s an urgent mission given that 23% of interns reported having suicidal thoughts and the rate of depression jumps five-fold in the first few months of residency.

“There isn’t any prototype. Finding role models, let alone any evidence about the part lounges can play in wellness efforts, is very difficult.”

Chandra Are, MD
University of Nebraska Medical Center

Currently, there are no statistics on how many hospitals have resident lounges, nor even any consensus about what a lounge should offer. When UNMC staff started planning its wellness lounge, they were taken unawares by how little anyone knew about what goes into such a lounge, says Associate Dean for Graduate Medical Education Chandra Are, MD, who oversees the center’s 64 residency and fellowship programs. In a universe where the placement of a hospital bed and the impact of lighting have been relentlessly researched, “there isn’t any prototype,” he says. “Finding role models, let alone any evidence about the part lounges can play in wellness efforts, is very difficult.”

But for institutions creating such lounges, the hope is that building an oasis — supportive spaces far beyond utilitarian on-call rooms — may help.

“When doctors come to work, we usually have an office space dedicated to us,” says Are. But residents, he notes, are on the move, working rotations in different clinics and even different hospitals. “Life in the hospital can be very stressful for residents. They aren’t just working long hours,” he says “they’re also geographic orphans.”

Combatting burnout

The focus on learners-only lounges comes as medical educators recognize the ways stress and burnout undermine students, residents, physicians, and ultimately patients. When Kaiser Permanente School of Medicine welcomes its first students next year, they’ll find a sun-drenched fourth floor devoted to their well-being, says Anne Eacker, MD, senior associate dean for student affairs at the school.

In addition to a meditation space, a yoga garden, pingpong tables, and a gym, the floor includes ample informal gathering spaces, a students-only lounge, and a teaching kitchen, part of the school's commitment to conveying that food is medicine too.

These aren’t frills, Eacker insists, but evidence-based decisions. “We know mindfulness practices help providers be more present with patients. It can help with racial bias. We know yoga treats back pain, and that exercise is a mood-booster. These are all important because burned-out physicians make more errors.”

A man in scrubs sits at the wellness lounge of UNMC.
A UNMC resident in one of the lounge’s individual “pods.”
Kent Sievers, UNMC

Most of all, she says, the lounge areas are meant to give students plenty of space for reflection, quieter moments away from patients and supervisors when they can process the intense lessons that fill their lives. “Finding meaning is so important in medicine. Students need a safe place to process what they’re learning, time to take a pause after you’ve had an end-of-life conversation with a patient, for example.”

Self-care is also a primary goal of the Office for Graduate Medical Education at the Hospital of the University of Pennsylvania, which recently transformed its existing resident lounge — a gloomy space with old furniture and not much else — into a well-appointed House Staff Wellness Center. “We wanted to let residents know it is okay to take care of themselves, to relax, to meet up with one another,” says Jeff Berns, MD, Penn Medicine’s associate dean for graduate medical education.

Residents can now catch their breath in a lounge area with a TV, work out in the well-equipped gym, and grab a shower. The space also offers a lactation room just for residents and comfortable, soundproof nap rooms.

While the hospital has other break rooms, “they aren’t in the best shape, and they are often dark, with no windows,” says Alex Bonnel, MD, a graduate of the internal medicine residency program and former president of Penn’s House Staff Governing Council. But the new lounge is welcoming and supportive. “It’s clean. It’s bright. It offers a respite.”

Building community

Penn’s new facility has been bustling since it opened earlier this year, and although residents appreciate its private spaces and amenities, Bonnel says the lounge is also fostering professional and personal connections.

Increased interaction between residents is among the main goals of today's lounge creators, particularly since physicians typically spend half their working time on electronic health records, leaving less time for connecting with each other. One hope is that lounges forge cross-discipline relationships, providing opportunities for interprofessional learning as well as social support that can buffer against isolation and depression.

“Physicians used to interact with each other a lot more than they do now, especially those with different specialties,” says Bonnel. “This is reviving that. For example, one day a group of residents from internal medicine-pediatrics were doing a teaching session in the lounge on infants following complicated births. Some residents from obstetrics happened to be there, and joined in. I think we’ll see that kind of collaboration more.”

Gautam K. Malhotra, MD, PhD, who is UNMC’s general surgery house officer, also sees tremendous value in getting to know colleagues better. “Residents are so separated by specialty,” he says. “Of course, if you have a mutual patient and you need someone from cardiology or radiology, you can always page them. But it’s been different to have a common meeting place, to get to know each other in a more relaxed way.”

Brittan appreciates the opportunity for emotional support. “It can be so helpful to talk about a bad day — and maybe a bad outcome with a patient — outside your immediate department,” she notes. “Other residents can be that shoulder. … I think loneliness is a big part of people burning out.”

“It’s not news that residents often feel overworked, underpaid, and unappreciated. And while a lounge won’t completely fix the problem, it does make residents feel more valued and alleviates stress.”

Alex Bonnel, MD
Hospital of the University of Pennsylvania

That kind of social glue was a key motivation for creating the resident lounge at Stanford University, a pioneer when the school opened that space back in 1976. The lounge there offers a gym, pool table, sundeck, large lounge area, and refrigerator stocked with healthy snacks as well as 29 on-call rooms.

“We limit the facility to house staff,” says Ann Dohn, MA, director of graduate medical education at Stanford Medicine. “Sometimes residents need to get away for 20 minutes, where no attending can see that they’re not studying, but just chatting. They can make personal phone calls. They can sit on the sun deck. They can read a newspaper — they like to read print newspapers! — or talk to each other. It’s a different kind of relaxation than at the cafeteria.”

Staying in tune with changing resident needs

Sometimes, as at UNMC, promoting well-being means providing a better place to work. Loma Linda University Health, in Loma Linda, California, for example, recently reorganized its decade-old resident lounge, which includes a prayer room and displays of student art and photography. Initially, the focus was on relaxation, says Daniel Giang, MD, Loma Linda's vice president for graduate medical education. “But residents have told us that they use the work part of the lounge more than the unwinding part.” So leaders replaced one quiet room with more work stations and standing desks.

A man at a desk at Loma Linda University Health.
At Loma Linda University Health, residents appreciate a quiet place to work.
Loma Linda University Health

“It surprised us,” says Giang. “They said, ‘If I want to unwind, I’ll leave the hospital. But while I’m here, I want a place to get my work done without interruptions.’”

Listening to those requests is important, administrators note, since a foundational principle is that lounges should support residents in the ways that make sense to them. At Stanford, for example, leaders are experimenting with a nap app, because residents valued the idea of booking on-call rooms in advance. And Penn is already making changes to its lounge just months after opening, including tweaks to the gym areas and building an additional lactation room.

One Penn anesthesiology resident noted the growing need for a pleasant, conveniently located lactation space. Yangseon Park, MD, pointed out that several of her colleagues would soon become mothers — and how challenging it had been to access a place to pump.

“I have 15-minute breaks every three or four hours only, so it was difficult for me to run all the way down to the locker room, pump for eight minutes, and run back. Now I come right down to my very own quiet lactation room, and there’s a restroom right next door, saving yet another two minutes of my break time! I’m sincerely thankful.”

Making medicine more human

Ultimately, lounges are about more than providing particular amenities.

Residents like Bonnel say the spaces represent a significant step in medicine’s slow march away from a punishing resident-training process.

“It’s not news that residents often feel overworked, underpaid, and unappreciated,” he notes. “And while a lounge won’t completely fix the problem, it does make residents feel more valued and alleviates stress. There is finally an understanding that if we want to train doctors to be emotionally adept and resilient, we have to stop that fraternity-like culture of hazing new residents.”

Berns agrees that, besides its practical function, the new lounge offers that symbolic message: “It expresses institutional appreciation,” he says.

But mostly, Brittan believes, lounges offer new physicians their own personal path to balance. “Some people like yoga and meditation. Some want to catch up on work. Some want to nap,” she says. “Wellness isn’t the same thing to everyone, and the lounge lets people find what they need.”

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