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00:00:01:02 - 00:00:23:19
Tom Haederle
Welcome to Advancing Health. Today's medical residents and fellows are tomorrow's doctors. In this podcast, we hear about Boston Medical Center's innovative program to provide mental and emotional support during the rigors of medical training, and to address the tendency of many medical trainees to deprioritize their own health.

00:00:23:21 - 00:00:53:21
Jordan Steiger
My name is Jordan Steiger, and I am the senior program manager for Clinical Affairs and Workforce at the AHA. I'm joined today by Simone Martell, who is the director of Boston Medical Center's Employee Resilience Program, and Dr. Jeff Schneider, the associate chief medical officer, designated institutional official and chair of the Graduate Medical Education Committee at Boston Medical Center, and the assistant dean for graduate medical education at BU Chobanian & Avedisian School of Medicine.

00:00:53:23 - 00:01:16:04
Jordan Steiger
So just to set the stage a little bit, in 2022 and 2023, the AHA received some funding from the CDC to identify the leading interventions for preventing suicide in the health care workforce. And we got to know the Boston Medical Center team through this learning collaborative that we hosted that focused on implementing these practices at hospitals and health systems across the country.

00:01:16:06 - 00:01:20:04
Jordan Steiger
So, Simone and Jeff, thank you so much for being here with us today.

00:01:20:06 - 00:01:21:18
Simone Martell
Thank you for having us.

00:01:21:20 - 00:01:22:22
Jeff Schneider, M.D.
Thank you.

00:01:22:24 - 00:01:35:03
Jordan Steiger
So to get us started, I'd love for the audience to just learn a little bit more about your roles at BMC, and how the two of you work together to support workforce well-being. So Jeff, let's start with you.

00:01:35:05 - 00:01:53:09
Jeff Schneider, M.D.
Sure. Thank you very much for having us. And, happy to share what we have done and also what we've made to do moving forward. By training, I am an emergency medicine physician, and I still work clinically in our emergency department. And then the other part of my job is I oversee all of our residency and fellowship training programs across the organization.

00:01:53:09 - 00:02:15:02
Jeff Schneider, M.D.
So it's more than 750 residents and fellows across roughly about 70 training programs. And I really oversee those residency and fellowship programs from a bunch of different perspectives, everything from operations, to finance to accreditation. Obviously, working very closely with our program directors and our program administrators, and the educators and teachers that we have here at BMC.

00:02:15:04 - 00:02:16:20
Jordan Steiger
Great, Simone?

00:02:16:23 - 00:02:44:06
Simone Martell
So I joined BMC in June of 2023. My background is I'm an LICSW, licensed independent clinical social worker in Massachusetts. And, the program here is to provide mental and emotional support and resources to all of our workforce, clinical and non-clinical, in the realm of mental health, emotional well-being, stressors around the workplace, occupational stress injuries.

00:02:44:08 - 00:03:04:10
Simone Martell
And we have a couple of initiatives that target residents and medical trainees in particular. One of the first I was also introduced to was this initiative that had started the year before I joined, which are these wellness chats for incoming trainees at the beginning of the academic year.

00:03:04:13 - 00:03:28:28
Jordan Steiger
That's great. So I know that health care workers overall can experience barriers to receiving mental health services, can experience challenges around well-being and taking care of themselves. I think everybody listening to this podcast probably knows that. But we also know there's a lot of research that shows that residents have some kind of special challenges and adjustments that they need to make as they're starting residency.

00:03:29:01 - 00:03:33:29
Jordan Steiger
But could you tell the audience about some of those maybe special challenges that face residents?

00:03:34:01 - 00:03:55:21
Jeff Schneider, M.D.
The genesis of our program really actually goes back probably 6 or 7 years now, when we realized that our residents and fellows really deprioritized their own health on many occasions, given the choice between learning something clinical, or learning how to do something or gaining experience and taking care of their own health. Residents across the country tend to deprioritize throughout health.

00:03:55:24 - 00:04:13:08
Jeff Schneider, M.D.
So one of the things that we did very early on was trying to understand what are the barriers for our residents taking care of themselves? If they're not taking care of themselves, how can we expect them to take care of patients, to learn and to grow? So we had an idea that we would introduce primary care appointments during intern orientation.

00:04:13:08 - 00:04:37:11
Jeff Schneider, M.D.
Again, this is probably 6 or 7 years ago now. And we set up a process, a mechanism really carved out an afternoon that was protected for residents and fellows, where those that wanted to get primary care appointments could have them here at Boston Medical Center. Our goal again really, just a little bit around reducing stigma, reducing barriers and normalizing the conversation around taking care of your own health is very, very important.

00:04:37:14 - 00:04:56:23
Jeff Schneider, M.D.
I will admit that when we started this I had no idea if anyone was going to show up. We put a lot of time and effort, operations and planning into organizing this, but not really knowing frankly how well it would land. And we were pleased to see that even after year one, the majority of our residents and fellows were very interested in participating in this.

00:04:56:23 - 00:05:22:18
Jeff Schneider, M.D.
And we continued to grow the program a little bit, to learn, to iterate. And a few years later we said, well, if we're introducing primary care, maybe we should do the same thing with behavioral health or mental health to really, really try to accomplish three things. The first was we really wanted to normalize the conversation. It is totally normal for residents and fellows who need any behavioral health support, any behavioral health or mental health contexts.

00:05:22:20 - 00:05:42:28
Jeff Schneider, M.D.
How can we help them do that? To really normalize the conversation? It's as normal as in anything else that we do. And then really trying to reduce the stigma around it. Talking about it in the wide open, not behind closed doors or at hush voices. It was something we talked about very early on, when these new residents and fellows were coming and really tried to make the conversation part of what we do.

00:05:42:29 - 00:06:01:14
Jeff Schneider, M.D.
It's an expected part of what we do. And then really trying to figure out how we decrease the barriers, how do we make it as easy as possible for residents and fellows to take advantage of the wonderful resources we've had here? And Simone and her team have really taken an idea and grown it so that it's flourished. I'll let Simone talk a little bit more about some of the details of how she's actually executed.

00:06:01:15 - 00:06:32:27
Simone Martell
Yeah, yeah. Thank you. So I do also want to give credit to the team that preceded me as well, because I inherited this. And so the first year that the behavioral health component was launched was in 2022. So now we're going into our fourth year doing it. I think the whole framework, at least as how I view it in our approach, is like this philosophy of preventative care, which I think, you know, as trainees who are going to be, fully practicing doctors would preach to their patients.

00:06:32:27 - 00:07:06:14
Simone Martell
We want them to be able to and have it, or embody that themselves as well. The way that it's been structured right now through a couple of key learning points over the past couple of years is that we use different tools for signups. So in the welcome letter that gets sent out by, Dr. Schneider's office in April, welcoming folks, there is a portion of the letter that talks about the PCP visits and a portion of the letter that talks about signing up for these wellness resource chats. And they're 15 minute chat sessions.

00:07:06:20 - 00:07:32:06
Simone Martell
They're not therapy, but they are really focused on an opportunity to talk about any concerns somebody might have, letting them know about the resources that are available to them, helping them kind of highlight what are some anticipated stressors or things that they can do ahead of time again, from a preventative standpoint. So oftentimes we'll talk about what are some coping skills that got me through medical school.

00:07:32:08 - 00:07:56:09
Simone Martell
What are some things and ways we can augment that knowing that you're going to be in a new situation, a new territory now, maybe away from the support community that you'd established and been a part of and need to kind of configure here. So sometimes, you know, it might come up where somebody and I think, generationally there's a stigma which has been really lovely to see and kind of capitalizing on that.

00:07:56:09 - 00:08:22:05
Simone Martell
So some folks might come in and they've had, experiences with mental health supports before, but they might not realize, oh, that person doesn't have a license to practice in Massachusetts. So I need to be able to keep that going and find the resources locally and work within my insurance, because now my insurance plan is moving from what I had previously to BMC is now their employer and putting on the network that that's here.

00:08:22:07 - 00:08:47:15
Simone Martell
And so we want to set it up so that it can be something where again, coming from how do we anticipate what some of those barriers might be? What are those challenges going to potentially be? And a big piece is about access point because it might be early on, there's a lot of excitement. They're still riding the wave of having just graduated, you know, and starting out their new program. Which is a stressor in itself.

00:08:47:15 - 00:09:06:06
Simone Martell
You know, sometimes there are positive stressors and this is a positive stressor. But at the time when, you know, mental health challenges potentially do arise or distress does arise, we don't want it to be, oh, now I'm having to start from scratch at the time where I'm already struggling. We want the groundwork to already be laid for them.

00:09:06:06 - 00:09:10:24
Simone Martell
So that's really sort of the framework, by which we're trying to approach this.

00:09:10:26 - 00:09:35:24
Jordan Steiger
You both hit on so many important things that I feel like we could dig into forever on this podcast, but I think, you know, addressing that stigma piece, I think is so important. Bringing that to the front of the table, the front of the room, the second a resident starts at BMC and saying, this is okay, we expect that you're going to be stressed because residency is hard and you're learning and there's a lot of things going on for you.

00:09:35:26 - 00:09:56:19
Jordan Steiger
I think just getting out in front of it is so important. I think one thing you mentioned, Simone as well, is that, it's not therapy. You know and I wonder sometimes if people kind of shy away from these programs or thinking about mental health because it's they don't want to be providing those therapy services, but it really sounds like it's just more connecting people to those services.

00:09:56:21 - 00:10:22:00
Simone Martell
Yeah, it has a lot to do with the awareness and the access piece. So what we've done with the chats is that, in addition to myself, some of my colleagues who are, you know, doctors level will be able to join in and hold the discussions. Also, they won't have to have the pressure of going into to anything that's outside of their territory.

00:10:22:00 - 00:10:58:12
Simone Martell
We also don't want to give a false impression to the residents for this session, either. I'll say residents or fellows, because we do this for fellows as well. But it's more about here are the different resources that you are eligible for and have access to, and here's the route with which to do it. And here's at least, you know, through our internet source, our fliers, our point of contact, so that you have an easy way of - you don't have to remember all of this - but there's just, a streamlined way to think about how do I set up what I might need.

00:10:58:15 - 00:11:19:17
Simone Martell
And then again, for, you know, folks that maybe have had experiences before or are just saying, like, you know, coming into this, I know that this is something that was difficult for me in med school or something that I've found challenges with. So I want to kind of be thinking ahead. We can roughly just touch upon what are some coping strategies that have been helpful for you.

00:11:19:17 - 00:11:39:24
Simone Martell
Again, this being a new territory, a new framework, what do you think that you might need in anticipation and have you think through ahead of that without it being anything that would delve into the territory of therapy per se? That said, trainees are able to schedule confidential appointments with a licensed clinician in the resilience program at any point through their tenure.

00:11:39:27 - 00:11:47:18
Simone Martell
And we also help them navigate how to get connected to a therapist through their behavioral health benefits, if that's something they'd like to pursue.

00:11:47:21 - 00:12:10:09
Jeff Schneider, M.D.
I think another really important piece of this is getting the residents and fellows to normalize a conversation amongst themselves. So for every resident or fellow that Simone or her team meets with who goes through or has their eyes open to some of the resources that we have here, my hope, my deep hope is that even if you know, maybe it's not applicable to them today or tomorrow or the next day...

00:12:10:12 - 00:12:26:24
Jeff Schneider, M.D.
but if they see a colleague, if they see a friend, if they see someone, a resident or fellow who maybe they don't even know all that well and they just look at them and say, I'm worried about you. Are you okay? Like, that's always the right currence. It's always the right question to ask. It's never the wrong question to ask.

00:12:26:26 - 00:12:41:21
Jeff Schneider, M.D.
And then also so they can start arming themselves and say you know what, at the very beginning I went to this talk and I had this resilience chat, I learned a little bit about some of the resources we have at Boston Medical Center. I don't remember all the details, but I know that there's help out there. And I remember here's how you can help access it.

00:12:41:21 - 00:12:53:16
Jeff Schneider, M.D.
So again, the more we can start normalizing these conversations, I think for every resident fellow that Simone touches, the hope is that that spreads almost virally so that they can help themselves but also help their colleagues.

00:12:53:19 - 00:13:19:24
Jordan Steiger
Absolutely. I think the program and the work that you are doing at Boston Medical Center is setting such an incredible example for our membership, and we're so happy that we get to share your story with everybody today. Simone and Jeff, thank you so much for being here with us today. I think the work that you have shared and the work that you're doing and continue to do to support your teams is really setting such a strong, incredible example for our membership.

00:13:19:24 - 00:13:30:03
Jordan Steiger
And I'm just so happy that we get to share your story and hopefully others will get to learn from it and start to maybe, implement some of the things that you shared today.

00:13:30:06 - 00:13:31:00
Jeff Schneider, M.D.
Thank you.

00:13:31:02 - 00:13:33:03
Simone Martell
Thank you so much.

00:13:33:06 - 00:13:41:17
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.