January 12, 2022

Lindeman’s path led to her surgical education, trainee wellbeing research

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Headshot of Dr. Brenessa Lindeman, associate professor in the Department of Surgery. Dr. Lindeman, wearing a blue-ish gray shirt and white coat, is smiling against a blue backdrop.Brenessa Lindeman, M.D., MEHP, FACS, comes from a long line of educators.

“My mother, who’s a high school business teacher, always told me that she would be upset if I chose a career in education. So I was a good daughter, and I went into medicine, but I found that during medical school, the people who inspired me most were the educators,” Lindeman said.

She was particularly inspired in medical school at Vanderbilt by Dr. Bonnie Miller, the school’s associate dean for education and a surgeon.

“She was a mentor of mine, and I wanted to be like her when I grew up.”

And with that, Lindeman said, she found a path to be both a surgeon and an educator.

Training the next generation of physicians & surgeons

Originally from Phelps, Kentucky, Lindeman, now an associate professor in the Department of Surgery, attended medical school at the Vanderbilt University School of Medicine in Nashville, followed by residency at Johns Hopkins Hospital in Baltimore and a fellowship in endocrine surgery at Brigham and Women’s Hospital in Boston. 

Lindeman went into her surgery residency to study education and its applications in surgery.

“Over the course of my training, I realized that so much of what we do is based on merely what we have done in the past, and there was little actual science behind the way that we teach and train surgeons specifically. So that’s been one of my longstanding interests,” she said.

“What we have done for so long is measure competency by a surrogate marker of how many cases that you have done in specific categories or how much time you’ve spent on particular procedures. But what we have found is that doing a certain number of something does not necessarily equate to competence for performance.”

So one project she and others nationally are assessing is moving surgical education toward a competency-based assessment and creating more defined goalposts and structured, objective outcomes throughout residents’ time in surgical training.  

UAB was selected in 2018 as a pilot site for the American Board of Surgery’s Entrustable Professional Activities project, making our General Surgery Residency Program one of only 26 programs in the U.S. piloting the use of the EPAs framework in residency evaluation.

“These EPA measures would put the trainees in the driver’s seat, helping them see where they are, compared to defined training outcomes,” she said. “There’s a long way to go, but we’re making great progress.”

She has served as a member of the Board of Directors for the Association of American Medical Colleges for four years among her professional work. She is also a Councilor for the American Association of Endocrine Surgeons and the American Board of Surgery and a Director of the General Surgery Board, and Associate Member of the American College of Surgeons Academy of Master Surgeon Educators. At UAB, she’s chief in the Section of Endocrine Surgery, program director for the UAB Endocrine Surgery Fellowship, and chief wellness officer for the Department of Surgery. 

Beyond her roles in surgery, she has worked alongside the GME leadership in the UAB Heersink School of Medicine and UAB Hospital as associate designated institutional official for the clinical learning environment in the hospital since she joined UAB in 2017.

In October, she was named assistant dean for Graduate Medical Education in the Heersink School of Medicine, a new position created to support initiatives improving residents’ and fellows’ ability to practice medicine in a safe and welcoming learning environment.

When asked about some of the “big wins” in her time as associate DIO, Lindeman cited several initiatives accomplished, along with the key partnerships and collaboration involved in achieving the goals. These included initiatives like implementing a new rounding and handoff communications system within the hospital and collaborating with the Office of Diversity and Inclusion to create an institution-level Healthcare Disparities Academy for trainees.

“I think one of the biggest wins was streamlining and adding validity evidence to the assessments that we have been conducting around trainee well-being,” she said. “We had measured burnout for a while but had done less around the work environment and the resources that our trainees perceive. And so a win is that we’ve been able to make all of this align and that we are using instruments that have stood the test of time to do that and are used comparably across multiple institutions.”

The following step teams are working on now, she said, is leveraging that data, finding ways to visualize it, and presenting it to each training program in digestible ways.

Measuring and addressing trainee well-being

Lindeman says it’s not enough to understand that trainees are experiencing burnout. She said it’s time to move the conversation toward ways to decrease instances of burnout by improving well-being.

“Information in the latest literature shows that for trainees working in a learning environment, the people who supervise them and their overall perceptions of well-being flow directly into—or impact directly— their degree of burnout,” she said. “By measuring these other factors, we can gain a more nuanced understanding of where we need to focus our limited resources.”

Burnout—the state of having a depressed mental, physical, and/or emotional well-being—can have tremendous effects on the individual physician. Lindeman says this also carries forward impacts on patients and society because doctors experiencing burnout are more likely to report medical errors and are more likely to leave the profession.

“Whatever factors we can mitigate in the working and learning environment or as part of training, we must do that,” she said, “We must secure not only the health of our trainees, which is of utmost importance, but also to ensure the health and well-being of our patients and populations we serve.”

One aspect of addressing trainee well-being that Lindeman, along with other UAB leaders, has championed is the GME Wellness Resource Center, a new facility inside UAB Hospital that will be dedicated to supporting trainees during their years in residency and fellowship by creating a dedicated space for them to decompress, collaborate, visit with their families, study and exercise.

Construction delays due to COVID-19 have slowed the project. Still, Lindeman considers securing the space footprint within the hospital and funding support from the Heersink School of Medicine, UAB Health System, and the UA Health Services Foundation is a big win.

When asked what she is looking most forward to in her new role in GME, Lindeman said her excitement is in continuing initiatives that teams have already started.

“I’m looking forward to continuing to move the needle in terms of the working and learning environment for trainees at UAB and across the country,” she said. “I’m also looking forward to completing our initiative to better leverage data we receive from our trainees so we can target solutions to improve well-being for our residents and fellows. Those are my highest priorities.”