Well-being for trainees caring for homeless veterans

Health care trainees caring for homeless patients may experience stress and burnout. Reasons for this include high rates of medical and psychiatric illness and complex social needs within this patient population. This can lead to feelings of inadequacy and exhaustion among health care trainees. To address this, we developed a toolkit for trainees from multiple professions caring for homeless veterans and examined its impact on trainee well-being.

Fifteen trainees and six faculty members participated in a half-day workshop given by a national expert that demonstrated a variety of well-being practices. Trainees and faculty members then identified 14 evidence-based practices relevant to the clinic for inclusion in the well-being toolkit. Half of the tools were for personal use and half were intended for teams. We developed simple graphics demonstrating each tool, and these were displayed as posters throughout the clinic. Tools were reviewed through workshops and handouts. To assess the trainee response to the toolkit, we used validated measures of burnout, stress, resilience and mindfulness at the beginning and at the end of the academic year. Trainees also rated the value of each tool.

Trainees did not experience burnout during the year, and nor did the stress levels change. Both resilience and mindfulness trended towards improvement. Trainees rated the team-based tools as more important than the personal tools; they were also more confident in using the team-based tools. Burnout among physicians caring for marginalised patients can originate from a sense of futility and from witnessing needless suffering DISCUSSION: Team-based well-being tools may represent a better avenue for residency programmes and training sites to pursue well-being programmes, especially for trainees caring for marginalised populations.