Authors: Ramin Tabatabai MD (LAC+USC Medical Center), Arlene Chung MD (Icahn School of Medicine at Mount Sinai), Dan Lakoff MD (Icahn School of Medicine at Mount Sinai), Loice Swisher MD (Drexel University College of Medicine) on behalf of the CORD Resilience Committee
In 2015 and 2016, the Accreditation Council for Graduate Medical Education (ACGME) organized their first and second symposia on physician well-being to address the issues of physician well-being with a focus on positive transformational interventions and innovations at both the individual and program levels.
In March of 2017, the ACGME approved their latest version of the Common Program Requirements (CPRs) with a renewed emphasis on patient safety and resident and faculty well-being. These changes officially took effect on July 1st, 2017 and we’ve highlighted a few of the key well-being related requirements that will most certainly impact our individual programs (Section VI.C on Well-Being). A link to the comprehensive ACGME CPR document can be accessed at: http://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements
WHY THE ACGME SAYS IT’S IMPORTANT?
- Residents and faculty have increased risk for burnout and depression when compared to the general population
- Self-care and a focus on psychological, emotional, and physical well-being are critical in the development of a competent, caring, and resilient physician
- Programs have the same responsibility to address well-being as they do to evaluate other aspects of resident competence
WHAT ARE THESE SPECIFIC PROGRAM RESPONSIBILITIES?
- MEANING OF MEDICINE
- Dedicated efforts toward enhancing the meaning of medicine for trainees
- WORK SCHEDULES
- An effort by the program to address issues related to work scheduling, work intensity and work compression that may affect well-being
- WORKPLACE SAFETY
- Monitoring and addressing workplace safety (includes ensuring physical safety and providing resources for emotional well-being after adverse events)
- RESIDENT HEALTHCARE
- Residents must be given the opportunity to attend medical, mental health, and dental appointments (trainees must be provided with time away as needed to access care as dictated by their individual circumstances)
- Programs and supporting institutions should provide access to confidential, affordable mental health assessment, counseling, and treatment, including access to urgent and emergent care 24 hours a day, seven days a week (in-person, telemedicine, or telephonic means may be utilized to satisfy this requirement)
- Programs must provide physician well-being education to residents and faculty members. Education must include identification of symptoms of resident and faculty member burnout, depression, and substance abuse. Further education is required to assist physicians when these experiences occur along with resources for seeking appropriate care
- SCREENING & REFERRAL
- Programs must provide access to appropriate tools for self-screening
- Residents & faculty members are encouraged to notify designated personnel or program directors when they are concerned that a colleague may be displaying signs of burnout, depression, substance abuse, suicidal ideation or potential for violence
- CLINICAL COVERAGE
- Circumstances will occur when a resident may be unable to attend work due to fatigue, illness, or family emergencies. Each program must have policies and procedures in place to ensure coverage of patient care when these circumstances occur without fear of negative consequences for the resident
The ACGME has put these requirements into play after serious consideration on the issues of wellness, burnout and suicide. This included reviewing all the causes of resident deaths from 2000-2014. As we enter the implementation phase, the Resilience Committee is interested in questions, concerns and suggestions.