October 11, 2019

Heather Burrows, MD, PhD: Taking care

Focus on well-being during physician training gains momentum

Dr. Heather Burrows, University of Michigan Medical School faculty

Heather Burrows, MD, PhD (on right, along with M-Home program director Jennifer Imsande, PhD) wears many hats within the Medical School, most recently adding the title of co-director of the medical student well-being steering committee to her list of roles. She is also director of our Professional Identity & Balance program, which includes the Healer’s Art course. Dr. Burrows co-leads the Graduate Medical Education Wellness Committee, which advocates for the House Officers Mental Health Program that supports residents as well as medical students. Here, she shares why well-being is integral to medical training and the plans for making it an official part of our students’ training.

What is your interest in well-being?

My main interest in well-being at all levels is really to help foster a community of physicians who find meaning and joy in their work. That really is the overriding piece of it for me, and what it is at its core.

Do you feel that well-being, like leadership, is one of those areas of physician life that can be taught?

I think the ability to reflect meaningfully on the work that you do to support yourself and to support your colleagues is absolutely something that can be fostered and nurtured and taught. People are not necessarily going to come to the field with those skills fully formed, and there are ways that we can continue to progress in that journey for everybody, all throughout their career.

You were already doing some of this work in the professional identity and balance part of the curriculum and also as co-teacher of the Healer’s Art course. How does well-being align with these areas?

I think that professional identity and balance really embodies many of the things that are core to the personal experience of a medical student or a physician: the ability to grow into the role of physician and understand the implications of that both from the amazing things that we get to do in that role, as well as navigating the challenges that are inherent to being someone who is intimately involved in really difficult times in many other people's lives and figuring out how to balance our own personal needs and responsibilities both within working outside of work with all of the other demands of a difficult profession.

So for me, that balance piece is often where challenges to well-being can exist, and helping to have an open conversation around that is important. The Healer’s Art course is one way people are able to learn skills that can be helpful for them in both of those arenas: What does it mean to be a physician? What does it mean for me to be the physician that I am and how do I stay true to that in my career? And then, how do I support myself when times are difficult and how do I support the people around me when things are difficult, which goes back to balance.

What are your plans for formalizing well-being at UMMS?

We have a steering committee, which consists of myself, the director of M-Home and two medical students that are part of the Student Council. There are also subcommittees in the four domains that we have identified as areas for impact. Faculty, staff and students are co-leading those subcommittees. We'll have regular meetings over the course of the next year, where students will have opportunities to make suggestions for projects that they want to work on. 

How will you foster well-being in the interim as you ramp up to your full mission?

A lot of the things that we have done in the past that were related to student well-being have been taken on by M-Home and the different houses. Peer support and some of the social activities and projects that have been done in the past few years are now being done within M-Home by the houses themselves. Our steering committee is looking at what's being done in the houses as well as ways that we can have impact outside of the houses or between houses. 

In the context of fostering well-being, there have been several peer mentoring programs that have been developed. We are trying to help them integrate so that we're not duplicating efforts. Communication of these efforts is another piece that can be challenging because how do you share what's happening with everybody in a way that is available to them at the moment that they want to know about it, but doesn't inundate them with information that feels overwhelming.

There is a catalog of information available to students, it’s more about how to connect them to that information at the time they want to know about it. 

The opportunity to build connections and build relationships between people is really critical to well-being, and not just in medical school. If you look at data on physician well-being, which translates to human well-being in the modern era, that is really the question of how do we go from having systems where we spent a lot of time siloed in devices and still build those human connections, which are what really bring value to the patient-physician relationship and to the person-person relationship.

Why is this focus on physician trainee well-being so important?

I think people go into medicine for wonderful reasons around being of service to others. Sometimes that gets lost in the training process. Being able to help people identify how to be of service to others without losing themselves is key to maintaining the long-term careers of physicians, which is in turn going to be important for the health of our patients.

How does fostering well-being for an M1 student differ from an M4 student, for example?

I think that the experience of an M1 is very different than the experience of an M2, M3 or M4, and so the things that are important for fostering their ability to thrive in that environment is going to be different, just as it's different to be a resident, or a young, mid-level or senior faculty member. There are many things in common, but many of the things that people are thinking about are very different.

I don't think that it's all personal. There are things that individuals can do that can be helpful, but I think there are also things that we as a system can do to help prepare students, and then later trainees and faculty, to be successful in their roles. 

Why is important to remind students that they belong at the med school?

It's a recognition that as we get feedback from students about concerns they have raised with their with their peers or with their faculty. We recognize the dangers of impostor syndrome, and want to help students figure out how to counteract that piece of that particular mind trap that you can get into because it can affect your ability to be resilient in cases of tough times.

We do talk about it as part of the Healer’s Art curriculum, and there are pieces of it that are built into the peer-led professionalism series. There are components about supporting yourself and supporting others. There are also pieces around burnout that are built into the Doctoring course where students and faculty are talking about ways to thrive in the clinical environment.