The Trainee Perspective: What Can Residency Programs Do to Promote Learner Well-Being?

To the Editor: We thank Academic Medicine for highlighting issues surrounding well-being and resilience in the September 2016 issue. Based on our personal experience as well as that of our colleagues in the Association of American Medical Colleges Organization of Resident Representatives, we would like to share some potential institutional or programmatic interventions that can be implemented to promote learner well-being. Promote work/life integration and a sense of community.1 Encourage the development of a strong housestaff association that advocates for work/life synergy and allows trainees across specialties to meet and bond in a social rather than purely professional context. Provide infrastructural support for trainee health and well-being, including stigma-free access to mental health care, coaching, and coping skills training (mindfulness/meditation, etc.). Finding time for professional care is one of the biggest challenges of being a resident because the demands of patient care often extend beyond normal business hours and do not allow for sufficient breaks. Programs should identify rotations in which residents should schedule professional health and well-being appointments, including primary care and dental appointments, and encourage participation in these activities. Create an environment focused on education and well-being. In keeping with the ACGME Milestones, programs should set specific aims to achieve within an educational framework to help learners identify and celebrate accomplishments in clinical, academic, and leadership activities. Faculty should exemplify an institutional culture of well-being, in an effort to maintain faculty morale and to foster resilience and well-being in learners. A reliable feedback mechanism for faculty and department leaders should be available to address reports of duty hours violations, mental health concerns, and learner mistreatment and ensure that this feedback results in programmatic changes. Trainees want to know that their concerns are heard and addressed. Orientation should bring awareness to signs and symptoms of burnout and depression and should encourage peer monitoring and resident utilization of available resources for stress mitigation and mental health treatment. Institutions should consider creating a faculty position that focuses on meeting with residents to discuss well-being (e.g., resident wellness director). Solicit resident input. In an effort to diminish anxiety and to provide work/life synergy, solicit resident input into the rotation, grand rounds, and/or on-call schedule, to allow trainees to have influence and ownership in the development of their schedules. Daniel A. Hashimoto, MD, MSThird-year resident and Edward D. Churchill Surgical Education and Simulation Research Fellow, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; [email protected] Johanna B. Von Hofe, MDReproductive endocrinology and infertility fellow, Department of Obstetrics and Gynecology, University of Alabama Birmingham, Birmingham, Alabama. Matthew A. McDougall, MDClinical instructor, Department of Psychiatry, University of South Dakota Sanford School of Medicine, Vermillion, South Dakota.