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Wellness Fostering Social Connectedness in Residency Through Residency “Pods”
Fostering Social Connectedness in Residency Through Residency “Pods”
By Suzanne Bentley, MD, MPH and Daniel Lakoff, MD, MBA, MS on behalf of the SAEM Wellness Committee
Stress is rampant among health care professionals with resident physicians often facing particularly high levels of stress and overall strain on wellness and social connection. A 2022 survey revealed that from 2021 to 2022, there was a major increase in burnout in emergency physicians from 43% to 60%, landing emergency medicine in the #1 most burned-out physician specialty.
Residents face unique stressors, some throughout residency and others more unique to individual residency years. Fortunately, there are several strategies and techniques to increase resident support.
Target Social Isolation
One key intervention is to target the social isolation that can occur as new interns begin residency and find themselves dealing with a magnitude of life changes. Away from their home cities, friends, and other supports, the initial few months of residency are challenging for all, but overwhelming for others. While these initial challenges do improve over time, new and different challenges occur over the course of the residency program. Fortunately, these challenges can often be eased through connectedness and support among coresidents.
Peer Support Systems: Residency Pods
To aid in establishing meaningful, friendly, collegial, mentoring relationships among residents that will assist and support them in navigating the complexity of residency, consider peer support systems. An effective type of peer support system is the residency “pods” concept. Residency pods are effectively a variation on more common peer support models and similarly offer the benefit of normalizing and encouraging psychologically safe discussions around the shared experience of practicing modern clinical medicine; associated stresses; and possible stigma. Overall, the goal of the residency pod is to foster and enhance social connectedness among colleagues.
Structure of Residency Pods
Residency pods may be structured in a variety of ways at the discretion of the individual residency program and continued on Page 54
Some Important Questions to Guide You in Starting a Residency Pod
What does the faculty selection process entail? How will you solicit volunteers?
Should you hold an open call to all faculty at attending meeting? A call for volunteers to core faculty? Will PD/APDs be included as faculty mentors?
What type of incentive/support will be provided to faculty?
Is a stipend possible for individual faculty? Is financial support in a set amount provided to support pod gatherings? (Note: some of the most meaningful activities are free or low-cost, e.g. picnic, hike, shared meal at pod member’s house)
What is the desired structure for the pod?
This should be based on logistics, size of program, and other preferences and used to guide the number of faculty mentors who are recruited. Conversely, pods may be structured to accommodate the number of faculty who volunteer. Goal: inclusion across training years of a size that is manageable for group conversation without being so large that internal “subgroups form. If staffing allows, it is preferable to have more than one faculty mentor to ensure meetings can occur, even if just one of the two mentors are free.
What is the process for establishing and maintaining pods? Who will assume the task of assigning residents, by year, to a mentor?
Some programs utilize chief residents to establish the pods and assign new interns at start of each academic year; other programs are developed and maintained by the residency program director.
What is the best way to establish pod composition?
The goal is to decrease social isolation and build connectedness and networks; with this in mind, work to ensure pods are either randomly assigned or somewhat deliberately “mixed up” with friends being assigned to different pods when possible so that new interns will feel less like outsiders. Another goal is for pods to compliment organically occurring residency friendships and collegiality and potentially provide a lifeline to socially isolated trainees struggling with forming connections on their own.
Who will be responsible for ensuring the pods are successfully meeting?
Senior resident expectations should be clear: they are tasked with collaborating with faculty mentors to assist in leading the pod (planning events). The faculty mentor should not be tasked with all the effort of finding convenient dates, scheduling, and planning. Since residents rotate every year, everyone will have the opportunity to fulfill this duty at some point. Additionally, senior residents are expected to act as the “big sibling” to the junior residents — checking in on them regularly. Every resident can offer wisdom, guidance, and support to more junior residents below them.
What meeting schedule and cadence will the pod follow? What type of activities will they conduct?
Scheduling, cadence, and type of activity is at the preference and decision of the pod. Some pods may predesignate dates at the start of the year to allow for advanced planning or during a recurring protected day/time (e.g. evening before academic conference). Pods may consider holding some gatherings with other pods (e.g., larger Thanksgiving gathering) to increase the potential for fostering social connectedness.
What resources, tips, and/or ideas might be offered to pods to bolster engagement?
Senior residents or other volunteers could be tasked with collating resources to make pod initiation and engagement easier. Provide suggestions for ice-breaker games for initial meetings and low-cost local activities (e.g., hikes, parks, happy hours, museum free days, etc.). Consider multiple pod meetups, meet-ups with inter-residency pods, and extending an occasional invitation for nursing or other ED staff to join in a pod’s activity. Be creative!
WELLNESS
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based on considerations such as size of residency program, expectation of level of faculty involvement, and other logistics.
A common and recommended model for a residency pod consists of an attending faculty mentor (or multiple mentors); senior resident(s); mid-program resident(s); and intern(s) assigned at the start of every academic year to replace graduating senior resident(s) (although some graduating seniors who remain local may continue their involvement with their pods).
With this model, the composition of the pods remains the same over the residency years, unless changes in structure are made. Ideally, the pod concept is designed to work best with ongoing pod formation, so interns remain in the same pods for their entire residency, with new junior residents being added as others progress through the years. Changes can obviously occur as needed (e.g. swapping in a new faculty mentor) or if conflicts or other extenuating circumstances arise.
Alternatively, if there are no faculty willing or available participate, a pod may consist of a senior resident(s), mid-program resident(s), and intern(s) — again with assignment of new intern(s) at the start of each new academic year.
Pods may be similarly implemented at non-residency sites and structured to include an array of attending faculty members who, ideally, have volunteered to be a part of the program, are aware of and willing to commit to expectations (e.g., at least monthly pod check-ins), and agree to serve as the pod leader and mentor. Faculty are expected to meet with the group in a mutually agreed upon social setting for a minimum number of times annually (e.g., 3-4 times per year). These gatherings could be for a meal, hike, or any other type of outing or activity on which the pod agrees. Additional meetings can be scheduled at the discretion of the group. Individual meetings are also encouraged for one-to-one guidance and support and a faculty mentor is expected to serve as a point person for residents in the pod, to field questions, offer advice, and ensure a reliable and invested advisors for all residents.
ABOUT THE AUTHORS
Dr. Bentley is an associate professor of emergency medicine and medical education at the Icahn School of Medicine and the chief wellness officer and director of simulation innovation and research at NYC Health + Hospitals/Elmhurst in Queens, NY. Her passions are workforce wellness and advocacy, debriefing, simulation, and medical education.
Dr. Lakoff is an assistant professor of emergency medicine, associate director of clinical services, and associate director of the healthcare leadership and management fellowship at NewYork- Presbyterian/Weill Cornell. With a clear vision to improve compassionate patient-centered care, he has turned his attention to optimizing the quality of work-life experience for physicians.
