By Dr. Scarlett Hao and Dr. Halle Ellison
A critical point to address when discussing wellness is the lack of shared understanding in the language we use to think and talk about wellness. We use words like wellness and well-being interchangeably. There are similarities, yet each term has a different meaning. Wellness, the focus of this post is, “the quality or state of being in good health especially as an actively sought goal.”
We suggest considering wellness holistically, with eight interrelated domains coming together to form a whole. These domains include physical, intellectual, emotional, social, spiritual, occupational, financial, and environmental wellness (Figure 1). They are preferred for being broad, multidimensional, and naming areas not traditionally included in discussions about surgeon wellness. We have unique needs and values. Wellness domains may not have equal importance for individuals, and can vary over time, reflecting that wellness is not “one size fits all.” The key is understanding that any domain can influence and contribute to others, and therefore to one’s experience and quality of life.
Figure 1. Eight Domains of Wellness. Reprinted under Creative Commons License
(Source: Wikimedia)
Just as illness to health exists on a continuum, so do wellness and mental health (Figure 2). A similar challenge in lack of shared understanding exists for the term “mental health.” Elements of mental health may be represented across physical, emotional, and social wellness domains. With this perspective, mental health incorporates broad areas like feelings and emotions, self-care, stress, relationships, community, and connection. Thinking about mental health in discrete yet related components may help us better understand and communicate our needs. Although expressing individual needs is important, focus on the individual level is not sufficient.
Figure 2. Conceptual illustration of mental health as a continuum, adapted from the Mental Health Continuum Model (Keyes)
To improve mental health and wellness in surgery, it is time to focus on systems-level change. Consider the annual American Board of Surgery In-Training Examination (ABSITE®). The ABSITE is a high-stakes exam. Despite its role as a formative assessment, results are often interpreted and applied in a summative manner. The internal value placed on one’s score and external use of scores are sources of stress for residents. Scores have been used for residency promotion and fellowship application, and to predict passing the General Surgery Qualifying Exam. One’s score may be associated with the perception of self-worth, misinterpreted as a measure of competence, and lead to comparison, guilt, or shame. High-stakes exam preparation can have negative effects on physical, emotional, financial, and social wellness, regardless of exam performance.
ABSITE score reporting offers an opportunity for systems-level change with the potential for a positive impact on multiple wellness domains. Imagine if reports only included content categories and keywords for incorrect responses. Imagine that numerical values for percent correct, standard score, and percentile were not reported. How might resident mental health and wellness be impacted by these changes? This thought exercise is meant to encourage thinking about both systemic challenges and solutions related to wellness in surgery.
Applying systems thinking can help surgeons develop both infrastructure and processes to support wellness across the continuum of education and practice. By making mental health and wellness professional goals in surgery, we can advance our collective capacity for improvement, both now and in the future.
Please join us on January 17th at 8-9 PM EST for an AWS Tweetchat about Mental Health and Wellness in Surgery. The chat will be moderated by Dr. Scarlett Hao (@scarletthaomd), Dr. Halle Ellison (@hbemd), Dr. Taylor Riall (@TaylorRiall), Dr. Christie Buonpane (@clbuonpane), and Dr. Andrea Riner (@AndreaNRinerMD). The questions will be posted directly from the @WomenSurgeons Twitter account. You can also find them by following the hashtag #AWSchat. If you have not participated in a tweet chat with us before, check out this tutorial written by Dr. Heather Yeo (@heatheryeomd) to know more.
We will be discussing the following topics during our tweet chat:
- What does wellness mean?
- Can you teach wellness?
- Whose responsibility is wellness in surgical education?
- How can training programs structure/processes support, improve the mental health of surgical residents?
- How might mental health impact and be impacted by other wellness domains?
- How might the movement to pass/fail in UME and USMLE impact ABSITE scoring in the future?
Scarlett Hao, MD, is a PGY-5 general surgery resident at the Brody School of Medicine at East Carolina University. She received her medical degree from University of Maryland School of Medicine. Dr. Hao is a founding member of the department wellness team that leads initiatives to promote resident and faculty well-being and evaluates system barriers to wellness. She is also serving her second year on the wellness task force for the AAMC’s Organization of Resident Representatives. Outside of surgeon well-being, Dr. Hao is pursuing a Masters in Public Health and a career in academic surgical oncology, with a focus on disparities in cancer care.
Halle B. Ellison, MD, FACS, is the inaugural Director of Student Wellness at Geisinger Commonwealth School of Medicine (GCSOM). She also oversees the Personal and Professional Development Theme within GCSOM’s Total Health Curriculum. Dr. Ellison is Assistant Professor of Surgery and Palliative Care. She completed her General Surgery residency at Geisinger, remaining as faculty, then as Associate Program Director for the General Surgery Central Residency. She is one of few dually certified surgeon-palliative care specialists. She has completed a Medical Education Certificate Course, Surgical Education Research Fellowship, Certificate in Applied Surgical Education Leadership, and is completing a master’s degree in Patient Safety and Healthcare Quality. Her professional interests include areas that impact learners and learning across the medical education continuum.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.