Which of the following interventions has not been described as a tool for building a "resilience toolkit" in a residency training program?
- A) Confession sessions
- B) Mindfulness interventions
- C) Recharging
- D) Quality Improvement sessions
D) Quality Improvement sessions
Burnout is defined as a state of mental and/or physical exhaustion caused by excessive and prolonged stress. Its rate among physicians in the US is as high as 50% with some specialties more affected than others, anesthesia being one of them.  As educators, it is imperative that we recognize burnout in our trainees and develop solutions for resilience. Resilience is the ability to bounce back from adversity and is essential in combating burnout. A "resilience toolkit" includes options to help build resilience and can be part of any residency program curriculum. Some of those options are:
-Confessions: initially invented by the psychoanalyst Michael Balint in the 1950s to improve physician-patient relationship, these small-group facilitated discussions have been developed in residency programs to help residents cope (anonymously) with critical situations that can impair their well-being. 
-Mindfulness and meditation: mindfulness is a state of active and open attention to the present that can be reached by, using meditation among other options. Initially used by Jon Kabat-Zinn in 1979 to create the Stress Reduction and Relaxation Program or MBSR Mindfulness Based Stress Reduction, this intervention has since been used in various professional bodies (including physicians).
-Recharging: "to build resilience at work, you need adequate internal and external recovery periods". The very lack of a recovery period is dramatically holding back our collective ability to be resilient and successful. Research has found that there is a direct correlation between lack of recovery and increased incidence of health and safety problems. . Recharging has been described as an adjunct to resilience: “The key to resilience is trying really hard, then stopping, recovering, and then trying again: ENERGY not TIME MANAGEMENT” Meditation is one of the means to reach this goal.
-Quality Improvement sessions: can be a strategy for improving departmental or organizational resilience and effectiveness by improving patient safety or improving workflow, but these have not been described as part of a resilience toolkit.
- Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors Related to Physician Burnout and Its Consequences: A Review. Behav Sci (Basel). 2018;8(11):98. Published 2018 Oct 25. doi:10.3390/bs8110098
- Roberts M. Balint groups: a tool for personal and professional resilience. Can Fam Physician. 2012;58(3):245–247.
- Shawn Achor and Michelle Gielan. Resilience Is About How You Recharge, Not How You Endure. Harvard Business Review 2016
Barbara Orlando, MD, PhD
Mount Sinai West
Assistant Professor of Anesthesiology
Clinical Base Year Director
OB Anesthesia Research Director