Healthy Living During Residency Urged

While it might seem implied that doctors-in-training would maintain healthy habits, some say that is frequently not the case. The instructor of an RSNA 2008 course on healthful living for residents said nothing short of a change in culture is needed to resolve a growing problem.

Robert F. Kushner, M.D., M.S. Northwestern University

Jannette Collins, M.D., M.Ed. University of Wisconsin

J. Louis Hinshaw, M.D. University of Wisconsin

"I don't expect seminar participants to go back and demand a treadmill be placed in the reading room, although that would be nice," said Jannette Collins, M.D., M.Ed., recipient of the 2005 RSNA Outstanding Educator award. "I do expect them to become more informed."

Living Healthy During Residency (RC202) will be offered Monday, December 1, from 8:30 to 10 a.m. Leading the course with Dr. Collins are Robert F. Kushner, M.D., M.S., and J. Louis Hinshaw, M.D.

Dr. Collins, a professor in the Departments of Radiology and Medicine at the University of Wisconsin Hospital and Clinics in Madison, is passionate about this subject. "We are doctors—we should know and follow the government recommendations for good health," said Dr. Collins, whose study, "Indicators, Trends and Recommendations for Living a Longer and Healthier Life" was published in the November 2007 issue of the Journal of the American College of Radiology (JACR).

"A lot of people in and out of the medical field think they know the guidelines, but they may not," she said.

In the JACR article, Dr. Collins wrote of the need for research into how radiology training programs influence trainees' compliance with health recommendations. "Radiology faculty members serve as role models to residents and medical students, potentially influencing the choices trainees make regarding their health," she wrote. Dr. Collins will present "Lifelong Learning in the 21st Century and Beyond" during the RSNA 2008 opening session.

Work Hours, Environment Questioned

Dr. Collins specifically questions resident work hours and program flexibility. An increasing number of medical errors led to a federal cap on resident work hours at 80 hours a week, but that is still double the number of hours for office and factory workers, she pointed out.

Then there is the food served at department functions, she said. "Is there a bowl of chocolate at workstations?" she asked. "Are residents getting served pizza during Grand Rounds? How do you say no to that, when you are so pressed for time?"

Dr. Collins said when she talks to residents about why they don't get enough physical activity, they tell her they don't have the time. "Is that true or is it how they're scheduling their time?" she asked. "Are we pressuring residents to the point where they can't make the time to take care of their own health, or is it self-pressure? Residents are very self-motivated people."

The solution, said a highly respected wellness expert, is resident program directors championing the healthy living cause and showing residents exactly what to do to achieve better habits.

Dr. Kushner, a professor of medicine at the Northwestern University Feinberg School of Medicine in Chicago and medical director of the Center for Lifestyle Medicine, said residents appreciate the importance of practicing better self-care. But, in an extension from their medical school days, they still leave that self-care behind, he said.

Sleep deprivation, said Dr. Kushner, is the greatest area for concern. Also vital are getting exercise and improving ergonomics, along with eating healthy, balanced meals throughout the day while being mindful of their on-call priorities, he said.

"We want them to pause and think about improvements in their productivity, because this career is for a lifetime," he said.

Northwestern Course Encourages Change

Dr. Kushner teaches a six-week behavior modification course called "Healthy Living" to second year medical students at Northwestern. He offers some examples of opportunities for improvement—a student chronically late for class can modify his behavior to arrive on time, while another can work to add fruits and vegetables to an unhealthy diet. "These life lessons can be a great struggle for some students," he said.

The Centers for Disease Control and Prevention issued a report in July 2008 showing one out of every four adults in the U.S. is obese. To date, Dr. Kushner said he is not seeing obesity in medical students at Northwestern. He added, however, that the extra pounds creep up later in life—the time to develop good habits is now.

Some wonder, were the work environment adjusted, would residents take advantage of that time to improve their own health? Dr. Collins suggested allowing residents to leave work early once or twice a week to enable them to spend some time with their families or exercise. She acknowledges that such a change may create more work for faculty members. "This is a barrier to change," she said. "It's tough for residents and faculty members to balance personal and professional needs."

Dr. Hinshaw, an assistant professor of radiology at the University of Wisconsin School of Medicine and Public Health, said that while he follows an exercise regimen, not everything he does is healthy. "Some things go by the wayside, like sleep," he said.

Dr. Hinshaw is married to a physician and they have two young children. He gets up early to exercise. "It's a challenge because it's difficult to find the time," he said, adding that exercising at a consistent hour makes it a little easier.

Residents' Schedules Offering More Flexibility

He noted that many of his residents who don't maintain healthy habits assume they'll have time to make up for it later, saying it's more important now to learn about radiology. He said he agrees in part but added, "It's all about making choices with the time you have."

Limiting the number of hours a resident can work provides today's residents with more time to make healthier choices, said Dr. Hinshaw. "When I was an intern, there were times that I worked 100-120 hours a week," he said. "Reducing that to 80 hours means a lot more available time. And, with one day off per week required, residents can take that day to focus on improving their own health and fulfilling their personal needs." It's all about motivation and discipline, he said, noting, "You can watch TV while eating a bowl of chips and dip or you can put on a pair of gym shoes and go exercise."

In his role as chair of the selection committee for the Department of Radiology at his institution, Dr. Hinshaw said he tells incoming residents they need to maintain their health and pursue other interests besides radiology. His goal with the RSNA 2008 session is to encourage participants to think about making changes, he said.

Dr. Collins said participants will come away with knowledge of federal guidelines for good health including diet and nutrition, physical activity, blood pressure, cholesterol and body mass index. They'll also discuss how radiology programs are complying with the national guidelines and talk about workplace environmental restrictions and potential modifications, she said.

Said Dr. Kushner, "We need residency program directors to make balance in life and self-care a priority."