GME Patient Safety Quality and Innovation Symposium

Needs and Objectives  

Medical residents face significant emotional challenges during demanding rotations, such as the two-week ward rotation at UCSD Jacobs Medical Center. During this rotation, residents care for patients with complex medical conditions and frequently lead goals of care discussions. In our pre-survey, 56% of residents agreed or strongly agreed that they “feel personally affected when providing care to terminally ill patients.” 56% also disagreed or strongly disagreed with the statement, “I have time to process emotionally challenging patient encounters during clinical rotations.” Therefore, we developed and implemented the Resiliency Roundtable Process Group to provide a safe and structured environment to debrief and process emotionally distressing events and to equip residents with practical tools for engaging in self-care.    

Setting and Participants 

The process group is held every other Tuesday at 1 pm, occurring half-way through each two-week rotation. Groups meet outside on a private patio or in a conference room at UCSD Jacobs Medical Center. Participants include the four PGY2-PGY3 medical residents who are currently on the rotation and one facilitator—an internal medicine attending or palliative care fellow. 

Description 

Each 45-minute Resiliency Roundtable Process Group begins with a 5 to 10-minute mindfulness or meditation exercise led by the facilitator. The remainder of the session is dedicated to open discussions guided by patient care events. These sessions provide a confidential space for residents to debrief emotionally challenging events, share coping strategies with their peers, and engage in self-care practices. 

Evaluation 

Among the 21 residents who participated in at least one process group and completed the post-survey, 81% agreed or strongly agreed that the unstructured time for group discussion helped them better reflect on and cope with difficult patient encounters. 62% agreed that debrief groups gave them the time and space to process emotionally challenging patient encounters. 

Lessons Learned 

Though residents initially requested that the groups be held during regular work hours for maximum impact and attendance, resident participation was sometimes interrupted by urgent patient care needs. Facilitator recruitment was another challenge and could limit further expansion of this or similar programs. Future opportunities include extending process groups to other rotations and practice settings, securing pager-protected time, and measuring the impact of these process groups on resident and facilitator satisfaction, burnout rates, and patient care outcomes.