Why well-being? The easiest answer is that it’s an Accreditation Council for Graduate Medical Education (ACGME) requirement, which all accredited residencies incorporate via processes and programs in order to promote trainee wellness.
While requirements are a great impetus for change, that’s not the only reason programs should ensure their residents have the resources they need to stay both physically and mentally healthy. Suicide and burnout rates in residents — and physicians in general — are alarmingly high. In fact, between 300 and 400 physicians commit suicide every year, and a recent longitudinal study determined that suicide was the second leading cause of death in residents (second only to cancer).
Studies show that physicians who practice self-care, scoring high on a well-being index, tend to make fewer clinical errors and provide better care overall for others. Physicians who are emotionally exhausted tend to engage less in their profession, leading to poorer patient care and higher burnout rates (turnover) as individuals lose track of their professional accomplishments and withdraw from their environment.
Therefore, teaching physicians how to manage stress and maintain a work-life balance, while providing them with novel ways to engage in the workforce and how to efficiently and effectively use resources, can lead to less burnout, less turnover and higher quality of patient care. Physician well-being is so important to the success and sustainability of health professions that the ACGME has dedicated a page of their website to tools and resources that health care facilities can leverage to promote well-being, address burnout and suicide and even help residents cope with tragedy.
In addition to the resources offered by the ACGME, we believe the following four well-being strategies are integral to the success of any residency:
Create a Resident Forum
Creating a resident forum gives residents a space to themselves — with no faculty or administration personnel involved — and a private space that they can use to raise issues and make requests that improve overall well-being. Resident Forums do not have to be solely Q&A sessions but are often more effective with a robust semi-formal agenda — with invited speakers to bring further awareness to issues such as burnout and substance abuse.
If you have more than one GME program, creating a resident forum is an ACGME requirement. But it’s still a great idea if you only have one GME program or are in the process of building your first GME program. Giving your residents a voice is a vital step in ensuring their needs are met and your health care facility is a preferred place to train and work.
Typically, a representative of the Resident Forum attends graduate medical education committee (GMEC) meetings and provides a standing report. This report may include any concerns or issues of the residents about the program, faculty or institution. Having your resident forum update the GMEC at a regular interval provides resident concerns of significance an opportunity to be vetted to a larger audience, and when you should initiate interventions.
Provide Access to Facilities
From gym memberships to onsite daycare to sleeping rooms for residents too fatigued after a shift to safely return home, GME programs are increasingly providing greater access beyond that which ACGME requires to facilities and programs that increase quality of life. Providing access does not always have to be a significant financial investment for programs; for example, while some hospitals build their own gyms, paying for (or cost-sharing with) residents to have access to a nearby gym is also acceptable.
Outside of the resident’s physical health, providing access to a variety of mentorships and scholarships is another way to invest in well-being. Providing trainees with an assortment of ways to participate in their work and promoting life-long learning increases engagement and lowers physician burnout.
Set Up Subcommittees Focused on Different Aspects of Well-Being
Resident programs that create subcommittees devoted to educating and assisting residents with specific issues have a leg up on figuring out how to address and mitigate those issues at their facility. Substance abuse, for example, is a large concern within the medical profession, since it is high-stress and may have a level of access to controlled substances that most of the general population does not. Setting up a committee on substance abuse with specific goals and objectives has a multi-directional role of promoting education, facilitating risk reduction and providing health professionals with the tools they need to identify and even remediate any areas of deficiency.
Consider setting up similar subcommittees to address fatigue, burnout, suicide prevention and even strategies for creating a better, healthier work environment at your facility. For example, will you offer counseling? How will you balance duty hours and combatting fatigue with ensuring a comprehensive learning environment? Subcommittees are important in determining the answers to difficult questions. Always include one or more residents, selected by their peers, on the sub-committees and provide a vehicle for the GMEC to be aware of the work of the sub-committee.
Develop a Well-Being Plan
Developing and implementing a comprehensive plan is essential to the success of any well-being program. This could be done through the designation of a subcommittee with a well thought out mission or at the institutional level. There is no standard framework for your well-being plan — it simply must address common issues such as fatigue, suicide and burnout — which allows ultimate flexibility and the ability to be customized to your facility.
When building a GME program, facilities should consider a variety of topics and issues (such as LGBT, work-life balance, fatigue, substance abuse, mental health, etc.) and the short-term and long-term consequences of action or inaction. Your top priority should be creating a healthy, positive environment for your residents and patients alike. Without a safe and healthy environment, you will compromise patient care, resident education and staff morale; you will likely not have the anticipated level of resident retention; and you will not see the return on investment (ROI) you were expecting of your GME program.
Taking advantage of the opportunities brought by the initiation and implementation of well-being programs is a great way to further build a recognized, sought-after GME program. If you have questions about implementing a well-being program at your institution or would like to start a GME program, contact Wipfli.
 Nicholas A. Yaghmour, MPP; Timothy P. Brigham, MDiv, PhD; Thomas Richter, MA; Rebecca S. Miller, MS; Ingrid Philibert, PhD, MBA; DeWitt C. Baldwin Jr., MD; Thomas J. Nasca, MD, “Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment,” Academic Medicine (July 2017): Volume 92, issue 7, pages 976-983.
 Daniel S. Tawfik, MD; Jochen Profit, MD, MPH; Timothy I. Morgenthaler, MD; Daniel V. Satele, MS; Christine A. Sinsky, MD; Liselotte N. Dyrbye, MD, MHPE; Michael A. Tutty, PhD; Colin P. West, MD, PhD; Tait D. Shanafelt, MD, “Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors,” Mayo Clinic Proceedings (November 2018): Volume 93, issue 11, pages 1571-1580.
 Andrew J. Jager, MA; Michael A. Tutty, PhD; Audiey C. Kao, MD, PhD, “Association Between Physician Burnout and Identification With Medicine as a Calling,” Mayo Clinic Proceedings, (March 2017): Volume 92, issue 3, pages 415-422.