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July 2019 SEA-Q


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. [1] 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. [2]

-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. [3]. 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.


  1. 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
  2. Roberts M. Balint groups: a tool for personal and professional resilience. Can Fam Physician. 2012;58(3):245–247.
  3. Shawn Achor and Michelle Gielan. Resilience Is About How You Recharge, Not How You Endure. Harvard Business Review 2016

Author Information:

Barbara Orlando, MD, PhD
Mount Sinai West
Assistant Professor of Anesthesiology
Clinical Base Year Director
OB Anesthesia Research Director
Wellness Champion


The SEA is proud to be a member-driven organization, dedicated to the teaching and development of future anesthesiologists, and to the advancement of those who educate them.

Contact Info:

Society for Education in Anesthesia
6737 W. Washington St, Suite 4210 • Milwaukee, WI 53214 • (414) 389-8614