Surgery residents set sail to keep life on an even keel

“These are called the shrouds,” explained sailing instructor Samuel Daly-Swenson, grasping a taut set of cables. “They hold up the mast of your new home for the next three hours.”

His audience of passengers, waiting on a dock at the Berkeley Marina, listened attentively. “This is the boom,” Daly-Swenson said, laying his hands on a thick pole, perpendicular to the mast and attached at one end to the bottom of it. “It’s called that because of the sound it makes when it hits you in the head.” From his audience came laughter of a somewhat nervous quality.

None of Daly-Swenson’s passengers were where they often are — which is indoors, in hospital operating rooms — and that was the point. Instead, nearly all of these Stanford general surgery residents, plus a few of their supervisors, were preparing to set sail together as part of the Department of Surgery’s Balance in Life Program, which aims to counteract the stress, both physical and mental, that accompanies the residents’ typical 80-hour workweek.

“A lot of people would argue with the notion that such a program is necessary,” said Ralph Greco, MD, the program’s director. “I know our day of sailing may raise some eyebrows, but our faculty decided that we should do whatever we could to give these young people the tools they need to help them deal with the vicissitudes of life and medicine through the rest of their careers.”

A little after noon, five sailboats full of surgeons hit the choppy, green waters of the bay. Some were content to sit and enjoy; others were eager to learn some sailing techniques. 

In memory of former surgical resident

Balance in Life was founded four years ago and is dedicated to the memory of Greg Feldman, MD, a former chief surgical resident at Stanford who committed suicide in late 2010 while working as a surgical fellow at a hospital in the Midwest. Each year, the program has expanded the resources and activities it offers to general surgery residents. Now, they have a refrigerator stocked with healthy, fresh foods; to sustain their physical well-being, attend group therapy sessions with a clinical psychologist for mental health; and, for social health, participate in mentoring partnerships and, if they want, social activities.

Resident Micaela Esquivel, MD, worked for a year to arrange the sailing activity. One of the biggest obstacles was figuring out a way to cover the absence of all 35 general surgery residents and several attending physicians from the hospital. Esquivel, who was a standout soccer player at Santa Clara University, said she understands the importance of teamwork. “The stronger your bond, the better,” Esquivel said. “Critical things happen in the hospital, and the closer you are to your colleagues, the better chance you stand of surviving the intensity of that environment.”

The numbers that motivate Esquivel, Greco and others involved with the program are distressing: One recent study compared residents to the general population and found them more likely to experience burnout and show symptoms of depression. A national study, published last year in Academic Medicine, found that 40 percent of surgeons said they were burnt out and 30 percent had symptoms of depression. 

When Greco was a medical student, more than 40 years ago, a resident’s workweek might last as long as 120 hours, he said. “But all we had to deal with were some blood tests and an X-ray,” said Greco, who is the Johnson & Johnson Professor of Surgery. “There were no CTs, no MRI, no hundreds of blood tests, no genetic testing. And there weren’t so many people watching what we did. It’s a much more intense workload than we had.”

Out of balance

The residents’ evolution from first year to final year is being tracked. What some of that data shows so far, Greco said, is that only incoming residents feel they have a life that’s well-balanced between work and play. “And by the time their training ends,” he said, “they are out of balance. No shock there.”

Residents think they can do it all, said Lisa Post, PhD, the clinical psychologist at Stanford who meets with the general surgery residents. “They are the most dedicated people and super responsible,” Post said. “We try to help them slow down a bit, to manage their stress better — and when you are taking a break at home, you really take a break.”

Greco believes Stanford’s program is unique, but he hopes that will change as standard-setting medical associations pay more and more attention to the problem.

“The fact that we have this Balance in Life Program is great for recruitment of like-minded individuals,” Esquivel said. “I can tell medical students considering us that they would be hard-pressed to find another program that cares enough about their well-being to offer what we do.”

The residents said they did indeed appreciate their day on the bay. “Just being able to spend time together without the pressure of work is nice,” said first-year resident Graeme Rosenberg, MD. “It gives you a better understanding and appreciation of the people you work with.” And, added Elizabeth George, MD, another first-year resident, “Surgery is a team sport. You become more of a team and want to work harder for and support each other as a member of that team when you know a bit more about your colleagues.”

Cara Liebert, MD, is a surgical education fellow and a general surgery resident who has been working with Greco to hone the program and monitor its effects. Liebert was as enthusiastic as everyone else, especially about being outside. Few of the residents see much daylight, she said. “You come in when it’s dark and you leave when it’s dark. This is the power of having a day outside, in the wind, in the fresh air.”