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Acad Psychiatry. 2018 Feb;42(1):78-83. doi: 10.1007/s40596-017-0808-z. Epub 2017 Nov 2.

SMART-R: A Prospective Cohort Study of a Resilience Curriculum for Residents by Residents.

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Mount Sinai Hospital, Toronto, ON, Canada.
Massachusetts General Hospital, Boston, MA, USA.
University of California, San Francisco, San Francisco, CA, USA.
University of Massachusetts Medical School, Worcester, MA, USA.



This study aimed to determine the feasibility of a resident-led resiliency curriculum developed by residents, for residents.


The Stress Management and Resiliency Training Program for Residents (SMART-R) is a 6-h group-based curriculum that teaches meditation, behavioral skills, and positive perspective-taking strategies. SMART-R was implemented for all medicine and psychiatry interns at a large US teaching hospital during the first 6 months of internship. Risk and resilience factors for burnout were assessed before and after the curriculum. A wearable health-tracking device was used to assess feasibility of wearables for studying resident health behaviors.


All 73 medicine and 17 psychiatry interns participated in the SMART-R curriculum. Seventy-five of 85 interns (88%) consented to be in the study. Thirty-one of 75 (41%) completed both baseline and post surveys of risk and resilience factors for burnout. Preliminary curriculum feedback was enthusiastic. Twenty-five of 62 (40%) wore the health tracker more than half the time in the first 3 months of the study.


Implementation of a resident-led resiliency curriculum for internal medicine and psychiatry interns at an academic medical center during the most challenging first months of internship is feasible. Future controlled studies are needed to determine efficacy of SMART-R on risk and resilience factors. Over the first 6 months of internship, we observed an expected increase in burnout, fatigue, and depression, though other key risk and resilience factors were unchanged.


Physician wellness; Resident resilience; SMART-3RP; SMART-R

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