In the painting “Landscape with the Fall of Icarus,” the boy who flew too close to the sun has crashed into the sea. His legs are just visible above the waves in one small corner of the scene. The majority of the canvas shows daily life progressing as usual – a farmer plowing, a shepherd tending his flock, and ships sailing from the coast. The depiction often resonates with medical learners and healthcare providers in the early phases of their career.
“They look at this and relate to Icarus,” said Ethan Stonerook, Director of Student Services for PA Studies at the Wake Forest University School of Medicine. “They say, ‘yeah, I’m drowning, and nobody sees me’.”
Using the arts and humanities as a starting point for conversations on difficult topics – like feelings of isolation – is a key component of PA Studies’ new Planting Sequoias program. Members of the Class of 2026 were invited to join as they began PA school in May. Students who elected to participate were assigned to small groups led by a PA faculty “host” from their respective campuses.
Groups are expected to meet about 10 times throughout students’ didactic and clinical years. Faculty host meals in their homes or in private spaces at restaurants to create a comfortable atmosphere that fosters trust and vulnerability. Activities are supported by a grant from the Educating Character Initiative.
According to Stonerook, Planting Sequoias aims to help students build a community now and learn to develop support systems in the future that can empower them to become the best providers that they can be. By developing habits of mind and practices that lead to flourishing, they can challenge the trends toward professional and personal burnout.
“The underlying theory is that within safe and healthy community, you can bring certain aspects of yourself and your experiences and have other people look at them and reflect them back to you to help you start to make sense of them,” Stonerook said. “We need people around us to encourage us, support us, and listen to us. People who can provide us with accountability and help us refine our vision. People who can bear witness to our own experiences.”
Battling Burnout
Prior to launching Planting Sequoias, Stonerook served on the advisory board for a program with similar goals at Duke University. The Project on the Good Surgeon is intended to help surgical residents maintain their mental health, empathy, and compassion while they contend with the rigorous demands of their training in a health care environment that increasingly values efficiency over humanity. Like Planting Sequoias, the Good Surgeon curriculum utilizes art, poetry, history, and philosophy to inspire thoughtful small group discussions.
The Good Surgeon was developed in response to an increasing number of surgeons who reported a loss of meaning and purpose in their lives. The program’s website cites a study found that 40% of surgeons met criteria for burn out, 30% screened positive for symptoms of depression, and 28% reported low mental quality of life. In the same study, when asked if they would encourage their own children to pursue a career in surgery, about half said “no.”
Burnout is a growing problem for all types of medical providers. According to a 2023 report by the National Commission on Certification of Physician Assistants (NCCPA), about 34% of PAs feel some level of burnout with the highest concentrations among PAs working in community health centers.
With these types of statistics in mind, PA Program Director Brian Peacock thought Planting Sequoias could be a valuable addition to the student experience.
“I think it has the potential to increase emotional intelligence, enable you to identify early signs of burnout, and just get to know yourself better so you can take care of yourself and your patients,” Peacock said. “Having a safe space to go and be vulnerable, that’s something that is hard to find in society now, so creating that space and encouraging those in-depth personal discussions among your peers holds a lot of value.”
Having worked as an EMT and ER Tech prior to starting PA school, first-year student Alexcy Shmat is familiar with the risks of burnout. He joined Planting Sequoias to better understand how to mitigate those risks and said the sessions have prompted a great deal of growth and reflection.
“One of the first exercises we did was drawing the rivers of our lives,” he said. “We would widen the river where life seemed to flow really smoothly, and we would draw boulders where things became more turbulent. I sometimes have trouble thinking about myself and where I've been, but this exercise really helped put things in perspective.”
Many of the Planting Sequoias readings, exercises and reflections explore themes of identity and purpose. Why become a PA? What does it mean to master your craft? How do you navigate failure, how do you recover from it, and how does it shape your self-perception? How do you cope with the inevitability of tragedy and loss? How do you balance authentic emotional connection and detached concern?
Shmat said the program has helped reintroduce humanity back into medicine for him. “Sometimes it feels like things are becoming more and more algorithmic, but this has interjected much more thought and life into the process,” he said.
Planting the Seeds for Success
Planting Sequoias has been beneficial for both students and their faculty hosts. Peacock said the program has provided a unique opportunity to get to know students personally and to learn about the challenges they’re currently facing, as well as those they’ve already overcome. Another faculty host, Lauren Eyadiel, said the meetings have been one of the highlights of her year.
“It is such a gift to have time carved out specifically to grapple with difficult questions in medicine and caregiving that go beyond the traditional medical education,” Eyadiel said. “It has challenged me to think deeper, broader, and more comprehensively about how I manage my time personally, clinically, and professionally as a faculty member. I am excitedly looking forward to our upcoming sessions.”
While Stonerook and the other hosts hope Planting Sequoias will be helpful in the short term, its full impact may not be apparent for many years to come. This forward-looking approach inspired the program’s name, which was adopted from lines in a Wendell Berry poem:
Invest in the millennium. Plant sequoias.
Say that your main crop is the forest,
that you did not plant,
that you will not live to harvest.
“To me, it means that we won't be around to see the most beautiful moments of what we're doing,” Stonerook said. “Those will come 30 years from now, with a provider alum at a bedside or in an exam room somewhere, who is still practicing habits of close attention and care for someone who is ill or suffering.”
