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Balance: A Focus on Public Health and Personal Wellness

Medicine can be a 24/7 sport, Nupur Mehta, MD, chief medical officer at CareMore Health, told George Washington University (GW) School of Medicine and Health Sciences (SMHS) third-year medical students during a panel discussion for the Clinical Public Health Summit titled, “How Physicians Can Help Improve Population Health in Every Specialty.”

The panel served as the kick-off to the final Clinical Public Health Summit that rising fourth-year MD students would participate in at GW and introduced topics they will explore over the next year: how they can improve public health outside of the exam room or hospital in their specialty of choice, and the foundational role investing in their own personal and professional wellness plays in that pursuit.

“Being super intentional about how I spend time has really been helpful,” said Mehta, a former attending hospitalist at GW. “You create boundaries [to allow time for] things that bring you joy and that you’re passionate about.”

This summit, which students start as third-years and complete during their fourth year as part of their core curriculum in clinical public health, presents two goals: first, research and pursue evidence-based Clinical Public Health Action Plans on topics relevant to their chosen specialties; and second, to develop personalized Wellness and Resilience Action Plans for their final year of medical school that can evolve over the course of their careers.

“We feel strongly — and the evidence shows — that physicians with a sense of mission or meaning in their work who also engage in personal self-care are significantly less prone to burnout and medical errors, are more satisfied with their jobs, and are perceived as more empathic with better patient outcomes,” said Kaylan Baban, MD, MPH, chief wellness officer and assistant professor of medicine at SMHS. “Our students are among the best and the brightest and we want the communities they serve to get the best of what they can offer. We hope the students will use this year as an opportunity to begin to define what personal wellness and professional engagement specific to their specialty will look like for them, and to use the skills we teach them here to iterate on that foundation for their years of professional practice to come.”

Through the summit, students learn how active pursuit of activities that are meaningful to them in the clinical public health arena can be one tool for professional balance and wellness. As students learned during one plenary session, perceiving just 20% of one’s work as meaningful is significantly protective against physician burnout, which in turn is correlated with improved patient health outcomes. Time dedicated to professional pursuits outside the exam or hospital room was cited by many of the panelists as one way to find mission and balance that bolsters professional and personal wellness.

Members of the panel were nominated by leadership in their programs as residents and junior faculty who exemplify wellness in both personal and professional arenas. In addition to Mehta, panelists included Sarah Cigna, MD ’14, assistant professor of obstetrics and gynecology; Alice Hughes, PGY-IV in orthopaedic surgery; Leah Steckler, PGY-IV in emergency medicine; Punam Thakkar, MD, assistant professor of surgery; Vanessa Torres-Llenza, MD, assistant professor of psychiatry and behavioral sciences; and David Yamane, MD, assistant professor of emergency medicine and of anesthesiology and critical care medicine.

Among the most significant advice the panelists offered students was to make time for the things they love outside medicine. “We have to take care of ourselves in order to take care of other people,” Torres-Llenza said. “Make time for what you’re passionate about.”

The panelists also emphasized the important positive impact engaging in activities outside of their regular duties can have on overall wellbeing, with many encouraging the students to eventually become mentors to their own residents down the road.

Cigna shared that as a medical student she became interested in sexual health after taking a course in her fourth year, which she continued to pursue as a resident. “I think the interest allowed me to have an outlet outside my day-to-day work and also gave me a kind of self-worth,” she said. “[My colleagues] would come ask me about patients who had sexual concerns. I was the person people went to. Having those special interests and really pursuing them as soon as you know you’re interested is helpful, because it gives you something to be curious about.”

“It’s important to think about how you maintain a professional life that is balanced by a happy, functioning, and resilient personal life,” Lawrence “Bopper” Deyton, MD ’85, MSPH, senior associate dean for clinical public health and Murdock Head Professor of Medicine and Health Policy at SMHS, told the audience at the start of the event. “When I look in the mirror in the morning [before I come into work], I know that my successes have been built on being good at what I do professionally, and also having a full and happy personal life.”

In approaching the topic of wellness, students in the summit considered physician burnout and compassion fatigue and how they can strike the balance between personal and professional life to minimize burnout and, ideally, to find synergy between the two.

In this spirit, during the first day of the summit as they began to develop their Clinical Public Health Action Plans, students had the opportunity to participate in wellness breakout sessions of their choice to learn more about how they can implement self-care. Options included How to Stay Active with Limited Time and Money, The Practice of Mindfulness, Financial Wellness, and Narrative Medicine. Elizabeth Ogunsanya, MSIII, enjoyed the chance to take a break from her busy schedule and unwind during the yoga session, led by yoga therapist Samantha Parker, who incorporates strategies for successful at-home practice with limited time into her teaching. “You hear the word ‘wellness’ and it’s kind of an ethereal, abstract term. It’s nice to see it incorporated into our courses,” Ogunsanya said.

Following the panel, third-year medical students broke into groups based on their specialty interests and listened to presentations by current fourth-year students who have completed their Clinical Public Health Action Plans. The completed fourth-year presentations served as inspiration to the third-year students, who will formulate topic ideas and develop Clinical Public Health Action Plans to pursue as they complete their medical school training and transition into residency.

“The [Clinical Public Health] summits that we do in medical school are a great opportunity to get students engaged in research in areas that are meaningful to them,” said Abraham Benavidas, MSIV, who partnered with Nick Gregorio, MSIII, to conduct a survey about how much medical students should learn about medicinal cannabis, an area of growing public health interest.

“Patients are going to have questions about it,” Gregorio explained. “As providers we should know the implications of medical cannabis.”

By participating in the summits, students have the opportunity for hands-on engagement with the community, said Madeline Taskier, MSIV, who, with classmate Katie Stricker, MSIV, presented a project on enhancing the skills of medical students as diabetes educators and managers. “[These summits can] take us out of the classroom and into D.C., where patients need care and they can help us determine what they would benefit from the most,” Taskier said.

Third-year MD student Becca Allen said she is excited for the opportunity to make a difference in the community through her project on the public health implications on gun violence.

“These opportunities are important because we don’t have a lot of time,” she said. “It’s great to have these days to sit down with friends and throw around ideas and brainstorm. We are fortunate to have time to pause and have the capability to be as creative as possible.”

The Clinical Public Health summits instill foundational knowledge and skill-building in public health and population health, public health research techniques, critical and creative thinking, teamwork and leadership skills, community engagement, and translation of knowledge into action. “We want to help you lay the groundwork through you projects this coming year so you will have a balanced foundation upon which to build the rest of your careers,” said Baban.