Wellness: we must support one another

This week, the CoM hosted its fifth annual senior leadership retreat. Every year, we delve into a discussion of one of our strategic directions to assess how we are doing and plan next steps. This year we focused on wellness.

I witnessed engagement and keen interest among my colleagues in leadership in this vitally important focus for our whole CoM team. While the day held some hard conversations, they were not hard in the sense of dissension on the value and importance of wellness as a key area of attention. This was wonderful to see as we will need teamwork and alignment to move forward effectively on this front.

So, why wellness now? Most, if not all of us, have been impacted by wellness—our own or that of others in our lives—and I think we share a common understanding of how dramatic the consequences can become when we, or someone we know, is increasingly unwell. What many fail to acknowledge or address is an inherent resistance to being open, or vulnerable, about our own struggles.

I believe the many resources I will share in this blog are useful to all, though several focus specifically on physicians and medical learners. There is no shortage of data on the wellness challenges inherent in medical practice. Wellness, however, is an issue for us all. For the scientist waiting for the results of a grant application, or seeking a potential cure or treatment that could benefit so many and yet not knowing where the process of discovery will ultimately lead. For the graduate student who must work hard for opportunities even while facing significant uncertainty in future employment. For the employee trying to support the needs of researchers, professors, physicians, learners, other staff members, partners and stakeholders.

I included in my February 8 blog a quote from Jordin Tootoo that, “We all fight a fight no one knows about.” One of the strongest messages from our day is this: it is courageous to be vulnerable. We can support one another in this with kindness and compassion.

What exactly do we mean by wellness? We had help from four experts in this regard, who set the stage for our team to have a meaningful discussion. On behalf of our team at the retreat, I acknowledge and thank: Peter Hedley, Director of Student Support and Services, who leads USask wellness initiatives; our own Drs. Anita Chakravarti, Department of Medicine and Alana Holt, Department of Psychiatry; and Brenda Senger, Director, Physician Support Programs at the Saskatchewan Medical Association.

Peter shared details of our university’s work and evolving approach on wellness, guided by the University of Saskatchewan Wellness Strategy, which offers a holistic approach of “healthy mind, healthy body, healthy life.” Through the strategy, USask has committed to comprehensive programming across wellness promotion, prevention and intervention.

Brenda spoke about these wellness elements: physical, spiritual, social, intellectual, emotional, occupational, environmental and financial. The culture of medicine has tended to reward traits such as control, perfectionism, and high dedication to others built on principles of patients coming first; the pressures associated with this culture can and does strain individual wellness in relation to these elements.

The CMA National Physician Health Survey provides a snapshot of the current environment for our physicians. On the positive side, a significant number of the 3,000 CMA members who responded demonstrated resilience, psychological well-being, and, overall, flourishing mental health. However, the survey also shares stark information of burnout, depression and suicidal ideation (this last particularly among residents, so we need to continue with the good work we are already doing to support our residents while considering what else might be needed).

There is too much evidence of both individual and system level factors that are contributing to distress and moral injury, as the 2018 study, Physician burnout: contributors, consequences and solutions, shows us. If our physicians are unwell, patient care and the health care system cannot help but suffer too.

Background information for the CMA Policy on Physician Health highlights that poor health for physicians may develop before or during training and persist into medical practice. As Saskatchewan’s medical school, we set the foundations for success for physicians through the training and environment we establish for our learners. More broadly, we will support everyone in our CoM community—faculty, staff and learners—with improvements in how we support wellness.

For all of us in attendance at the retreat, an important takeaway (highlighted by the likes of health leadership expert Dr. John Van Aerde) is that leadership, engagement and trust are successful when we have a psychologically safe environment where we limit distrust, moral distress and burnout.

We can ensure a culture of wellness in many ways, and we are already moving along this path. Our five-year strategic plan highlights how we are currently supporting wellness:

  • In our Quality education strategic direction, we emphasize safe, effective and learner-focused environments and carry that through the design of our medical education programming and leadership development programs.
  • In our Faculty engagement strategic direction, we will maximize faculty participation in planning and decision-making, and in how we foster a culture of engagement, work satisfaction and academic success.
  • In our Enablers strategic direction, we aim to recruit and retain great leaders, professors, researchers, physicians, students and staff, while ensuring safe, respectful workplaces and a culture of lifelong learning.

During the retreat, our experts and participants highlighted many other resources. We at the CoM all benefit from these strong programs and resources we offer now:

We can also do more to promote and leverage other programs and resources, such as:

A great framework from Drs. Tait Shanafelt and John Noseworthy, shared by Alana Holt, provides further useful information, with nine organizational strategies that can reverse the trend of burnout in health care organizations.

Our discussion throughout the day brought forward further suggestions that included, in keeping with the USask Wellness Strategy, that wellness programs and resources need to range from health promotion to crisis intervention. We have great supports in place, but we need to do more to integrate them. This would improve awareness and access, and support wellness more continuously across life transitions in education and careers. We need wellness embedded in our formal curriculum and supported through informal opportunities such as learning communities and mentorship programs. As well, we need to employ tactical strategies for promoting and sharing wellness resources through recruitment, in our orientation and onboarding materials, and so on.

Our participants identified steps they can take in their own departments and units, such as fostering spaces and times for peer connections and community building. Ideas shared included starting meetings with a wellness round-table discussion or check-in, hosting lunch time gatherings—yoga sessions, walking clubs, book clubs and more. There were also commitments offered to support one another in being vulnerable and honest about what we may be struggling with on a personal level.

As I said at the outset, our leadership team was engaged and active throughout the day!

Finally, I encourage you to consider your own wellness and how you can contribute to a culture of wellness. We can help one another on our wellness journey, we can reduce the stigma around seeking help, and we can permit ourselves to prioritize self-care.

As Jordan said, “It’s all about kindness.”

Collective discussion on diversity and inclusion

I hope you are all enjoying the early signs of spring as much as I am. (I saw someone running yesterday in shorts—hurray!)

I will get to my blog title, but want to first share a few words about things I have been doing over the past week. In a recent blog I talked about the development of a new biomedical science undergraduate program. That’s certainly exciting work, but we have great things happening in our current programming; for example, last week I spent some time viewing the research posters of our BMSC 210 (microbiology) students. As always, it was fascinating and I learned a lot, but more importantly I was inspired by the enthusiasm, energy, eloquence and creativity of our CoM students. It is always good to be reminded of why we are here.

This is the time of year when many of our programs, departments and other units showcase the research of our biomedical, graduate, medical and physical therapy students and our residents. I strongly encourage CoM (and other!) staff and faculty to attend these events, peruse the posters and listen to these learners present their work. You will be educated and inspired!

Now, getting to the topic of this blog: last week I attended a board meeting of the Saskatchewan Medical Association (SMA). I took the opportunity to thank them for what they do for our learners and their keen interest in the College of Medicine. While there, I obtained a copy of the spring 2019 issue of SMA Digest. The theme is Celebrating our Diversity and I read the entire issue. The SMA is to be commended for their advocacy and the excellent journalism used to convey some really important messages.

I want to highlight a few of the articles in the SMA Digest. First, a superb story on our SMA president, Dr. Siva Karunakaran, a nephrologist originally from Sri Lanka who has lived and worked in Regina for the past 18 years. As I read about his early life, I thought we have some things in common: growing up on an island (PEI for me); being the first in the family to go into medicine; and spending high school mostly studying! But fleeing the civil war in Sri Lanka was something I had no reference point for, other than one book (Anil’s Ghost by Michael Ondaatje) that remains vivid in my mind 15 years after reading it for the atrocities it described. Siva and his wife, Kumudhini, an infectious disease specialist, traveled a remarkable journey to be doctors in Saskatchewan. We are lucky to have them.

Among the many stories of Saskatchewan physicians and their families from diverse backgrounds and communities in the issue, one boldly and eloquently calls out the bias and prejudice our international medical graduate colleagues often face. Another emphasizes the prejudice and lack of “access to safe and sensitive medical care” faced by members of the LGBTQ+ community.

I would like to draw your attention to an excellent article on the Association of American Medical Colleges (AAMC) website entitled Keeping our promise to LGBTQ+ patients. Some of the stories and data in that article about the bias and health disparities faced by members of this community are disturbing, and reminded me of very similar circumstances I witnessed in the late 80s. I was caring for the first three patients with AIDS in my community and was shocked when colleagues refused to see them in consultation. So while it is remarkable to see where science has brought us in the care of people with HIV since that time, it is sad to see this type of prejudice is still so prevalent.

The article goes on to emphasize that we must create “more welcoming learning environments for LGBTQ+ students, faculty and patients.” We must not tolerate instances of prejudice our LGBTQ+ learners still face in the classroom and clinical setting, no matter if they are subtle, shared in the form of a joke, or blatant and intentional. We address these incidents when they come to our attention with education, advice and coaching or with stronger interventions if necessary. We can directly act when we hear about these types of incidents, and on a daily basis we can, together, act to create a positive learning environment.

In addition, this article shares some information on medical curricula around North America on LGBTQ+ content. I have taken some time to look into our own curricular content. We are weaving curriculum through different courses and segments across not just medical expert content, but also in communication, clinical reasoning and advocacy/professionalism areas of our curriculum. Our undergraduate curriculum includes historical content, clinical case content, gender identity education, and sexual health sessions, as well as LGBTQ+ health as a component of preparation for residency. We are doing a lot of what the article suggests, but I would welcome input from our learners and faculty on how we are doing from your experience.

Going back to the SMA article, Dr. Francois Reitz says it well:

“From the training of new physicians to re-education of the older physicians like myself – I think if one provides a safe space, and if, regardless of your personal, political or religious beliefs, you treat all individuals with the respect they deserve and undertake to keep and maintain their integrity as human beings and not just another label, I think that is a huge step forward.”

The content in these great pieces underlines why diversity and inclusion across our students, staff, faculty and leaders is critically important for our college. In another of my recent blogs, I asked our CoM faculty and academic leaders for their help by taking a short survey—we need data to understand where we are today. If you haven’t already completed our survey (in your email inbox with the subject line: College of Medicine Faculty – Self-Identification Survey), please take the time to do so.

Finally, my thoughts are with our Muslim colleagues and learners at this difficult time following the tragic events in New Zealand. It is hard to believe we continue to grapple with this level of intolerance in 2019. It is clear we must do more, even as we continue to provide education and share messages supporting compassion, understanding and tolerance.

As always, I welcome your feedback.

Many wins with engagement

Engagement in our work and our workplace goes well beyond just a win-win. In fact, to express the positive domino effect of individuals and teams fully engaged in what they are doing, I’d have to string “win” together too many times here to keep you engaged in this blog!

Engagement is key to both individual satisfaction and to the CoM’s success as a whole. It is among my own top priorities as dean, as I’ve mentioned previously.

We know we have work to do in this area at the CoM based on our results from the last USask employee engagement survey a few years ago. This time around, the survey is being distributed to our full staff and faculty complement, where previously it did not reach most of our medical faculty.

So, as you know from the messages from the university in your inbox recently, it’s time to take the survey and I encourage all our staff and faculty to do so. While it would be great to see better engagement numbers, more important is that you take a few minutes to include your voice so that your experience is reflected in the survey results. Your individual survey link was sent to you by email with the subject line “USask 2019 Employee Engagement Survey INVITATION.” The survey is open until March 12.

A lot of the focus placed on engagement is related to its role in higher productivity, or the benefits to the organization. That’s a great end result, but the reasons why engagement is important start well before that result is reached, at the individual level. Just reflect for a moment on something you do, whether at work or through a hobby, where you are so fully immersed that time (not to mention worry or stress) simply disappears. Not only is there pure joy in those moments, it is often where our best work is done.

Our leaders and supervisors have an important role in creating a positive work environment where engaged individuals and teams can thrive. In the past year, we have begun on a more defined path towards workplace engagement with our strategic plan and with the roll out of the new career engagement framework for administrative employees.

From our strategic plan, our vision and mission statements are something we all share a role in bringing to life, and in which we can all take pride. We’ve identified areas within our strategic directions of faculty engagement and enablers that directly and indirectly target engagement. Our plan can also provide us with a sense of what we each are contributing to in our individual roles on the CoM team.

For staff at the CoM, the implementation of the university’s new career engagement framework has included more professional development opportunities through lunch and learns, staff training sessions on things like using WebEx and Nuance PDF tools, and a workshop this week on workplace mental health and wellness. Within our strategic directions, retaining staff is a focus and will involve efforts that directly align with improved engagement.

For faculty, under our faculty engagement strategic direction, we’ve identified that we must enhance faculty involvement in CoM planning and decision making, and further develop alignment of our faculty within our One Faculty model. We need to better support and recognize our faculty in their work for the college. Gathering more data to ensure we understand from faculty what would improve their experience will be key in all our efforts, of course.

I believe we are moving in the right direction, but as I mentioned already, we have much more work to do to become a place where engagement is the norm. I welcome your thoughts and feedback, both here and through your responses to the employee engagement survey.