For too long, the culture of medicine has perpetuated the idea that physicians should sacrifice themselves during medical training and beyond—to show up when sick, to neglect their needs, and so forth—in order to learn the art of medicine. Without a doubt, the tragedies and loss in the wake of COVID-19 has brought to the forefront the need for a paradigm shift.
As leaders in medicine, if we are to improve the wellbeing of our medical trainees, we must rise to the challenge and lead by example. Our actions speak louder than our words. Medical trainees look to us to teach them about gathering histories, completing an appropriate physical exam, creating a differential diagnosis with a thoughtful plan, and managing challenging situations. As they look to us for this guidance and education, our trainees also feel the pressure of performing, making sound decisions with limited or limitless data, “doing no harm,” and being evaluated. Our trainees take verbal cues from us, but more importantly, they learn the hidden curriculum from the consistent psychological and emotional cues we send as well. It’s critical that as leaders and educators, we establish a safe and inclusive learning environment that nurtures the trainees, their professional identities, and their wellbeing. Our words and actions must represent the wellbeing and wellness culture to which we aspire.
What will our medical trainees think if their physician education leaders come in sick, avoid going to the doctors, and struggle with burnout and mental health without seeking help? Similarly, if we e-mail late at night, on the weekends and holidays, and expect a reply, what does this say about our respect for work-life boundaries? These actions may negate the statements that “your wellbeing is a priority” and reinforce the toxic hidden curriculum of the past. When we send mixed messages, our mixed feelings are heard loud and clear. If wellness is important, but not for us, and not if you have more work to do, trainees may not feel comfortable confiding in us that they are sick, exhausted, unsure, or dealing with a serious life event. They may suffer in silence, thereby failing to meet their potential, losing important relationships or opportunities, leaving medicine altogether, and possibly committing self-harm. It’s alarming what we have seen across the country in medical schools, residency and fellowship programs, and the healthcare arena.
As we work to improve our healthcare systems, we must simultaneously improve our work culture to one that normalizes healthy boundaries, belonging, connection, joy, and fulfillment. It is crucial we share with our trainees how we connect to our meaning and purpose in medicine, recall what led us into medicine in the first place, and demonstrate setting the boundaries we all so desperately need. Recall the Japanese proverb of Ikigai—where passion, mission, profession, and vocation all align. When was the last time you connected with a trainee about what they most love to do? What they are good at? How they want to change the world? It’s amazing the sense of belonging we can create when we invite our trainees to reflect on what they love and when they are at their best. Promoting wellbeing with our trainees also involves mitigating their imposter syndrome, advocating for diversity, equity, inclusion, and role-modeling a growth mindset. We must remind and demonstrate that we’re in it for the long game—there is no race to the finish line here. While people admire our hard work, achievements, and awards, they may not always see the grit, sweat, tears, and failure along the way. Sharing these journeys with our trainees, opening to vulnerability, gives them permission to be human, too.
Adam Grant shares, “Resting is not a waste of time. It’s an investment in well-being. Relaxing is not a sign of laziness, it’s a source of energy. Breaks are not a distraction; they’re a chance to refocus attention. Play is not a frivolous activity. It’s a path to connection and creativity.”1
So, physician education leaders, let’s stand together as a united front to model that wellbeing is a priority. Let’s ensure our actions speak louder than our words so the next generation can flourish and create a culture were medical trainee and physician wellbeing is a priority now and beyond.