The department strives to create an environment for our residents that are conducive to learning, intellectually stimulating, personally satisfying, and safe from physical and emotional harm. The resident’s well-being is imperative to our success as teachers and a residency as a whole. Resources are offered throughout residency to ensure our residents understand the safety concerns not only for the patients, but for the resident as well.
In the current health care environment, residents, fellows and faculty members are at increased risk for burnout and depression. Psychological, emotional, and physical well-being are critical to the development and maintenance of the competent, caring, and resilient physician. Self-care is an important component of professionalism and high-quality patient care; it is also a skill that must be learned and nurtured in the context of other aspects of residency training. This policy outlines the responsibility of the Office of Graduate Medical Education and ARMC Programs to address trainee and faculty wellness.
- Assist program directors (PDs) in their initiatives to protect trainee time with patients, minimize non-physician obligations, provide administrative support to trainees, promote progressive
- Provide PDs with resources to educate faculty and trainees about the symptoms of burnout, depression and substance use and their avoidance.
- Identify resources for trainee burnout, depression and substance use.
- Encourage trainees and faculty members to alert designated personnel when they are concerned about a community member who is displaying signs of burnout, depression, substance use, suicidal ideation or potential for violence, or who is not proactively engaging in self-care.
- Provide access to confidential, affordable, mental health assessment including access to urgent and emergent care 24 hours a day, seven days a week.
- Ensure that programs have sufficient back-up plans to provide patient care in the event that a trainee is unable to perform their patient care responsibilities.
- Provide a way for residents to report unprofessional behavior and a respectful process for reporting, investigating and addressing such concerns.
- Paying attention to trainee/faculty schedules to look at work intensity and compression factors.
- Allowing trainees/faculty to attend medical, dental and mental health care appointments, including those scheduled during work hours.
- Educating trainees and faculty about symptoms of burnout, depression and substance use, and their avoidance, including means to assist those experiencing such issues.
- Educate trainees and faculty on how to seek appropriate care
- Teaching and nurturing self- care practices, an important component of professionalism and high-quality patient care.
- Providing a respectful, professional and civil environment that is free from mistreatment, abuse or coercion. Provide education about professional behavior and a confidential process for reporting concerns.
- Encourage resident and faculty members to alert the program when they are concerned about themselves and/or the well-being of others.
Learning self-care is an important component of professionalism and patient care, and trainees have a responsibility to themselves and to their patients and programs to ensure that they are fit for work through behaviors such as:
- Proactive self-care, and modeling of healthy lifestyles and behaviors for patients, students, and colleagues.
- Time management surrounding clinical assignments
- Impairment recognition and notification, either from illness, fatigue and substance use in themselves, their peers and other members of the health care team
- Lifelong learning
- Performance improvement indicator monitoring
- Reporting duty hours, patient outcomes and clinical experience (such as case logs)
- Use self-assessment tools provided for personal use
Fatigue Mitigation Policy & Coverage of Patient Care Responsibilities Protocol
- There may be circumstances in which residents may be unable to attend work including, but not limited to fatigue, illness, family emergencies and parental leave.
- Our program will allow for an appropriate length of absence for residents unable to perform their patient care responsibilities.
- The program will educate all faculty members and residents to recognize all signs of fatigue, fatigue mitigation processes and encourage residents to manage potential negative effects.
It is important for residents/fellows to have adequate rest before and after clinical responsibilities.
Strategies to be used for fatigue mitigation include:
- Strategic napping
- Judicious use of caffeine
- Availability of other caregivers
- Time management to maximize sleep off duty
- Learning to recognize the signs of fatigue
- Self-monitoring performance and/or asking others to monitor performance
- Remaining active to promote alertness
- Maintaining a healthy diet
- Using relaxation techniques to fall asleep
- Maintaining a consistent sleep routine
- Exercising regularly
- Increasing sleep time before and after call
- Ensuring sufficient sleep recovery periods
When a resident/fellow identifies him/herself or peers or an attending identifies the resident/fellow as being too fatigued, there are several options for faculty/resident:
- Call rooms/sleep quarters are available at all facilities for the faculty/resident to use for a nap until the resident/fellow is less fatigued.
- Public or private transportation if available may be utilized.
- Peers, attendings, family may be called to assist transporting fatigued faculty/resident to their residence.
- Patient care responsibilities maybe transferred to another provider to ensure continuity of patient care. Attending in charge or the Program Director should be notified to arrange for the appropriate transfer of care.