As high achieving professionals, we have been hardwired with a thirst for improvement and a results-oriented approach to life. In all aspects of our lives we have pushed ourselves to work harder and demanded that we are better. I believe there is good that comes from this drive—by striving for goals just out of grasp we grow in ways that a more casual disposition may not facilitate. However, the danger of a constant endeavor toward future and greater achievement is that many of us link our happiness with these elusive goals that are always evolving with us. Thus, these goals and subsequent achievements stay constantly out of reach. We feel that to be happy we need to be better; when we become better, we realize that better isn’t quite good enough, and strive to become better yet.

Emergency Medicine physicians make life and death decisions with limited information. It is a challenging profession for even the most experienced attending physician. For residents, this challenge is compounded by the need to learn and simultaneously develop experience in an environment that is often fast-paced, information sparse, and high stakes. Professional success can feel especially elusive with lofty goals of becoming an expert in every field and saving every patient. Overworked, underpaid, and often feeling underappreciated, Emergency Medicine residents are at high risk for depression, self-medication, and suicidality.

In recognition of this, the Office of Graduate Medical Education at Stanford University, together with the Department of Emergency Medicine , have emphasized resident wellness as a priority. Recently implemented changes positively impact residents on every shift, including a fridge with healthy food in the ED fishbowl and newly encouraged 15 minute break to hydrate, eat, or see the sun on a 12 hour shift. As the newly established Director of Resident Wellness, it is my responsibility to brainstorms ideas and coordinate with program leadership to improve the mental, physical, spiritual, and emotional wellbeing of the residents.

In order to improve resident wellness in a meaningful and lasting way, it is important to consider what helps us become well and stay well. In 2003, Emmons and McCullough published a study of individuals who were simply asked to reflect on gratitude, and found they were happier, healthier, and sleeping better after only a couple of weeks of intervention. Shawn Achor, a positive psychology researcher, reports in his book, The Happiness Advantage: The Seven Principles of Positive Psychology That Fuel Success and Performance at Work, that spending two minutes a day writing gratitude emails or listing three new things one is grateful for leads to greater happiness. Furthermore, he found that happiness leads to greater professional success for physicians specifically, who are 19% faster and more accurate at coming up with the correct diagnosis when compared with a negative, neutral, or stressed state.

With these results in mind, and with the support of the program director, Dr. Sarah Williams, I recently teamed up with the department chair, Dr. S.V. Mahadevan, and first year resident, Dr. Jess Rainey, to create a novel wellness initiative for emergency medicine, called ROAR—Resident Ovation, Appreciation, and Rewards. The program now has ROAR forms in the ED for any member of the clinical staff who would like to jot down a few words of appreciation for any emergency medicine resident. Each emergency medicine resident is also assigned an account with wellness funds. These funds provide credits toward meal delivery, house cleaning, groceries, or even a massage. Residents can obtain access to the wellness funds only through obtaining a ROAR form. Undoubtedly, receiving praise and valuable services would be expected to increase resident happiness, but this is only a small portion of the program. The heart to the program lies not in the receiving of praise, but in giving praise. Residents are also incentivized through credits to their wellness account to write ROARs for their co-residents. This is all an effort to cultivate gratitude and a positive work environment among the residents and the rest of the clinical team.

Dr. Rainey is spearheading an ongoing study to look at resident happiness before and after the ROAR intervention. Even before we have started distributing the rewards to the residents, I see a shift in the attitude and morale of the group. “I roared you for that!” is now commonly heard in the ED fishbowl. During a shift I see attending physicians focusing not on the incomplete note that fell to the wayside, but instead on the excellent teaching a resident provided to an intern during a challenging procedure. Nurses are motivated to notice not just the careless resident who leaves sharps out, but also the thoughtful resident who notices and cleans them up. I see residents sit down with a stack of ROARs at the end of a hard shift and write a half dozen recognitions to the team that got them through it.

While the scientific results of our intervention have yet to be seen, I can confidently say that we all feel positive about the changes we already see and feel hopeful for the future results. And as we know, that, in and of itself is not inconsequential.


  1. Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377-389
  2. Shawn Achor . The Happiness Advantage: The Seven Principles of Positive Psychology That Fuel Success and Performance at Work 2010