A PERMA-nent Commitment to Family Medicine

By Elizabeth Ferruzzi, MD Novant Health Family Medicine Residency that our wellness as residents can be embraced - and there is a better way.

Positive emotion: “the right balance of heartfelt positivity to boost our resilience.”

On my birthday last year as an intern, I discovered we had missed a brain mass on a patient with a headache because we did not initially get a head CT. Immediately, I felt a sense of personal failure and began to question, “What if?” and “Why did I not think about that?”

It was around this time last year I felt it as an intern- the growing sense of burnout. We have all felt it at some point, whether in training or practice. What leads us there? A series of continuous inpatient rotations without break, winter’s chill, and minimal daylight hours, among other things. Even at a program that puts a priority on wellness, I felt a loss of energy, a loss of enthusiasm, and a loss of confidence. However, with support from my classmates, my spouse, and my program, I made it through intern year and entered second year with joy, not only surviving but also learning how to thrive.

Recently in my cohort’s wellness group, our director of behavioral science introduced us to a model that brings life experiences into perspective in the demands of this profession. Moving past a one-size-fits-all approach to wellness, another lecture on the elusive “work-life balance,” or a one-time yoga workshop, our program encourages us to use the PERMA model (designed by Professor Martin Seligman, leading researcher for positive psychology and human flourishing). It allows residents to tailor lifestyle adjustments to enhance their well-being based on what is important to them, their strengths, and their personal preferences. It stands for Positive emotion, Engagement, Relationships, Meaning, and Accomplishment. As I reflect on residency through the lens of PERMA, and compare my well-being to this time last year, I have truly come to believe

Tearing up while trying to explain to my attending, she took me aside and gently told me the most powerful words I had heard all year: “We are perfectionists in a field that is imperfect, so give yourself grace.” As residents and physicians, we will make mistakes, but it is about learning from them and moving forward. We have compassion for our patients, and cases such as these offer a unique opportunity to learn, and be better for the next patient. We can be optimistic and grateful, seeing the opportunities to learn from our mistakes. Heartfelt positivity, gratitude, and giving ourselves grace helps build continued resilience. Engagement: “the regular development of our strengths – those things we are good at and enjoy doing.” I enjoy building relationships with others. Talking with people, getting to know them, and representing them is energizing to me. A highlight of my intern year that has continued into this year has been my involvement with the NCAFP. With fellow residents, I’ve had the privilege to meet, greet, and represent Family Medicine residents, physicians, and potential future residents in various venues both within North Carolina and nationally. The mentors and colleagues I have gotten to know through this involvement have encouraged my growth in so many areas of my professional life. My hope is to continue to encourage other residents to be able to find their opportunities for engagement to share their gifts in the specialty of Family Medicine. Dr. Ferruzzi is a PGY-2 at the Novant Health Family Medicine Residency Program in Cornelius, NC, and is currently serving as the Resident Director on the Academy Board of Directors. She hails from Lenoir, North Carolina, and completed her undergraduate degree in Marine Biology at NC State University, where she was Valedictorian and a University Scholar, and went on to graduate from the Brody School of Medicine at East Carolina University in 2018. As a medical student, Ferruzzi participated in the NCAFP’s Eastern Rural Health Immersion Program, served as a Trustee on the NCAFP Foundation Board of Trustees, and was a Leaders in Innovative Care (LINC) Scholar during her time at Brody. When she has a moment to spare, her hobbies include dancing, swimming, racquetball, rock climbing, running and reading.

Relationships: “the creation of authentic, energizing connections.”

Residency may be busy, but the relationships that grow within a class give us the foundation to support each other and persevere during difficult times. A favorite memory I have from this year began with defying the odds of our busy schedules. Every single second year resident and their people (spouses, significant others, children) met at an apple orchard this fall for a Saturday outing. It was beautiful - a chance to catch up with everyone without the pressures of clinic or didactics; we even got a family photo to document the day. Delicious apple cider and donuts, a hayride, and authentic, energizing conversations were true highlights of the season. It did take some scheduling and effort, but in prioritizing our relationships with one another, we were able to walk away with renewed appreciation for our relationships.

Meaning: “a sense of connection to something bigger than ourselves.”

During the past 8 months, I had seen my patient and her family almost weekly. She had newly diagnosed end-stage liver cirrhosis and each week she needed fluid drained from her abdomen. One day in December, she was admitted to the ICU. I was in clinic, but something inside told me to go visit her. During lunch, I surprised her and was able to sit with her and her family. She was sitting in the armchair and truly looking better. Upon leaving, I told her I would stop in to check on her Monday. She looked at me and said she would surely be out by Sunday, so I replied that I would gladly see her in clinic the following week. Later that night, I found out that she had gone into cardiac arrest, and she never woke up. The next week, amidst all they had been through, her family came by my clinic to give me flowers and to thank me. Their appreciation and selflessness

in their own time of loss and sorrow had me speechless. I will never forget my patient, their kindness, or what my time with their family meant to me and to them. In moments like that, I am reminded of why I chose Family Medicine - for the relationships and for reaching beyond myself to share what I’ve learned and truly care for and connect with others.

Accomplishment: “the belief and ability to do things that matter most to us.”

We signed up for the 5k on a whim, and the date snuck up on me. However, my fellow resident and I showed up that morning and gave it our all. We pushed ourselves to run faster than we thought, but had some fun along the way by singing as we ran and dumping the tiny water cups over our heads pretending to be marathon runners. We finished breathless but with the goofiest grins on our faces. We even got medals and sunglasses for running! We did not need to be perfect, or the fastest. We just needed to go out and have fun doing a race, because it mattered for us to set a goal, achieve it together, and enjoy the running and the fun company.

Looking back on intern year, it was challenging, but beautiful. Having started second year of residency training with the intentional goal of finding wellness and being able to frame life through the PERMA lens, I have noticed a significant difference. It is the middle of winter and I just finished a night shift rotation, yet I can see the beauty of the winter around me. I feel the support of those who are helping me to learn and shaping me to grow in resiliency and joy. It is not easy, and never perfect, but our wellness and resilience is worth choosing to prioritize and maintain. Taking well-being into our own hands, we can choose a sustainable, and joy-inspiring path; our commitment to our patients and the field of family medicine can be PERMA-nent.

Seligman M. Flourish: A visionary new understanding of happiness and well-being. New York: Atria; 2011.

Leadership Opportunities with the NCAFP and the AAFP

May 31st, 2020 Application Deadline

STATE LEVEL WITH THE NCAFP: Students and Residents interested in serving in a leadership role at the state level, can visit their student or resident page on the NCAFP website for more information, or contact Tracie Hazelett at the Academy’s office to inquire. Deadline to apply for all board and committee appointments for the 2020-2021 term is May 31st, 2020. For available positions and to meet the current student or resident leadership team, please visit www.ncafp.com.

NATIONAL LEVEL WITH THE AAFP: Although the AAFP deadlines are not until July, many national leadership options require support from the NCAFP; May 31st is the Chapter’s deadline for students and residents to submit their application for review by the NCAFP Nominating Committee for all elected positions and some appointed positions. Involvement at the Chapter level (this can be a former state if you are resident that attended medical school elsewhere) is required to be considered for a national position. Please note: there are a few appointed positions with a deadline of Aug. 5th. Please refer to the NCAFP policy on AAFP Nominations at www.ncafp.com and the AAFP site for a complete list of available leadership positions: www.aafp.org/nc.

The NCAFP CME & Meetings Department continues to explore new ways of bringing you the best possible educational and networking opportunities. With our promise of always providing top-notch CME on timely requested topics presented by first-rate speakers, to an advanced yet user-friendly mobile app and time-saving registration kiosks; we pride ourselves on providing members with a fantastic and rewarding experience at every event.

Discovery and feedback gathered in the 2018 Membership Survey inspired NCAFP leadership and staff to do a little brainstorming on ways to further enhance 2019 CME events. Armed with a fresh perspective of what members need and want, we began refocusing energy and resources towards providing elevated education and networking experiences to

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