Criteria for Excellence | Chapter 4: Resident and faculty well-being
Build a learning environment that supports resident and faculty well-being.
Resident and faculty well-being in family medicine residency
Beginning in 2017, the ACGME more directly and comprehensively addressed well-being in GME programs, emphasizing that psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician. Initially focusing on duty hours and fatigue management, the emphasis has expanded to also include work/life balance, burnout, and support of those at risk of or demonstrating self-harm.
Programs of Excellence are called to employ recognized best practices in well-being that both support individual residents in training, equipping them with the resiliency skills to succeed in practice and redesign the clinical learning environment using a systems approach to well-being. Programs of Excellence relentlessly explore innovations in this important, emerging field of resident education.
Programs of Excellence appreciate that “resiliency training,” focused on the individual physician is important, but that system transformation may be more powerful, hence the interdependence of well-being with professionalism, quality improvement, and safety.
The ACGME reports evidence showing significant variation in how specific institutions address resident and faculty well-being. Appreciating the best practices of those factors that contribute to well-being is foundational to our initial set of recommendations. Still, the strength of evidence for many recommendations is lacking, and thus we anticipate an acceleration of the pace of research and consequent evidence-based curriculum and system change recommendations over time.
Building resilience in residents and faculty
Resilience can be defined as the capacity to bounce back, to withstand hardship, and to repair oneself. Resilience requires capacity to positively adapt in the face of stress or disruptive change. It seems to be based on a combination of factors, including internal attributes (genetics, optimism) and external (modeling, trauma) with specific skills of effective problem solving and the ability to find meaning and purpose.
There is agreement on many aspects of what makes physicians resilient, but can it be taught and learned as other skills in medical training? Studies list a variety of skills and strategies that can be learned and practiced that support resiliency. These include:
Realistic recognition (i.e., overcoming denial is crucial)
Healthy exercise, sleep, and nutrition
Supportive professional relationships
Talking things out with others
Hobbies outside medicine
Healthy personal relationships
Setting boundaries
Humor
Time away from work
Passion for one’s work
Developing a residency well-being and resilience curriculum
Programs of Excellence incorporate well-defined curricula to improve resiliency.
Strategies for teaching resilience and well-being
Broadly they:
Teach mindfulness meditation
Stress awareness, and adaptive strategies
Engage residents (and faculty) during “protected” time
Engage in reflection, coping (using physical, cognitive, emotional, and relational skills)
Provide 1:1 coaching
Help to create meaning
Use humor
Teach other adaptive skills
Best practices for supporting resident and faculty well-being
Programs of Excellence engage in effectively changing the very culture of medicine by actively promoting resilience and well-being. Specifically, Programs of Excellence complete a needs assessment to facilitate the development of new initiatives to address resident and faculty well-being.
Assessing your residency program’s well-being needs
Engaging the designated institutional official, program director, and program coordinator to proactively identify stressors and supports, along with curricular innovations, coaching strategies, and faculty development activities to transform the clinical learning environment.
Using their program evaluation committee to intentionally redesign their curriculum based on needs assessment to develop solutions to issues in their own learning environments, using structured tools in their needs assessment and action plans that address resident well-being.
Developing and supporting a well‐being plan (a), including well-being curricula (b) that is reviewed and acted upon annually.
A Program of Excellence inventories core components of a well-being plan that include leadership, resident mental health resources, including crisis management, orientation and enforcement of policies related to duty hours, fatigue mitigation, sick call, supervision, grievances, and others.
Well-being curricula will make time/space for reflection with process groups (e.g., Balint, personal and professional development sessions), including building skills in mindfulness and resilience. It will include clinical care challenge discussions.
One-to-one mentorship and advising is designed to actively combat burnout while supporting resident acquisition of resiliency skill building throughout their training period. The curriculum intentionally creates community and connectedness supports for residents and faculty. It Includes faculty development with knowledge, skills, attitudes known to promote resiliency and wellness in themselves and learners.