Program Director Well-Being Resources
for House Officers
The Accreditation Council for Graduate Medical Education (ACGME) revised its Common Program Requirements for all accredited residency and fellowship programs to address well-being more directly and comprehensively. These resources were compiled to include policies, resources, and ideas/best practices from residency programs that will help your program meet these requirements. A complementary resource was created for House Officers & Fellows.
Well-Being Responsibility
In the current healthcare environment, residents and faculty members are at increased risk for burnout and depression. Psychological, emotional, and physical well-being are critical in the development of a competent, caring, and resilient physician. Self-care is an important component of professionalism; it is also a skill that must be learned and nurtured in the context of other aspects of residency training. Programs, in partnership with their Sponsoring Institutions, have the same responsibility to address well-being as they do to evaluate other aspects of resident competence.
VI.C.1.a : Efforts to enhance the meaning that each resident finds in the experience of being a physician, including protecting time with patients, minimizing non-physician obligations, providing administrative support, promoting progressive autonomy and flexibility, and enhancing professional relationships
Policies
Organization-wide Policies
Program-specific Policies
Ideas & Best Practices
Protected times for wellness
Each class has separate blocked half days during the year in which they are released from service/clinical duties and meet for wellness sessions and team bonding.
Months that have 5 Wednesdays: 5th Wednesday is free for engaging in self-directed personal wellness.
Encourage residents to take personal days.
Professional development
Monthly division case conference sessions.
Programs like “Doctor Life Hacks” and “Faculty War Stories”.
National meetings attendance and supported expense are not counted against vacation time.
Pro Skills program.
Reviews and goal setting
Opportunity to personalize own wellness activities.
Residents include a wellness goal in their learning plan that is reviewed and reinforced at semi-annual reviews.
Social Activities
Social events with peers and faculty: BBQs, tailgating, welcome parties, holiday parties and happy hours, Departmental Families Group.
Team building activities: Annual retreats, group volunteering, charity events.
Wellness-focused book clubs.
Gratitude events: "Friday fellow high fives" or “Props” sessions for expressing gratitude and giving positive feedback to fellows, resident appreciation days.
Wellness Communications
Websites are specific to Resident Wellness on the departmental site.
Departmental newsletters with wellness articles and challenges.
Bulletin boards with wellness information.
Emails forwarded with wellness opportunities.
Annual program report.
Physical Activities & Resources
Planned group activities: boxing, kickball, soccer, yoga, running clubs, kayaking, monthly 10-minute exercise routines, and physical fitness challenges.
Incentives: Gym access/memberships, Fitbit/Mhealthy Rewards.
Committees and resource people such as Resident Ombudsperson.
Wellness Committees & Resident Wellness Committees.
Dedicated Associate Chair for Department Life and Culture to develop wellness curriculum.
VI.C.1.b: Attention to scheduling, work intensity, and work compression that impacts resident well-being
Policies
Organization-wide Policies
Program-specific Policies
Work/Duty Hours:
Vacation
Resources
Ideas & Best Practices
Schedule administrative time during electives.
Scheduling is made so that fellows are not on service for more than 2 weeks at a time, or more than 4 nights of home calls in a row. Fellows are never required to work consecutive weekends (exceptions made for accommodating vacation requests).
Have lactation guidelines in place for House Officers similar to Internal Medicine Guidelines.
Two weekends off per month; work hour restrictions.
Encourage working from home when duties permit.
Duty hours are reviewed during PEC and monthly with the program director, PD and APD meet for feedback as well.
Strict compliance to work hour compliance.
Creation of call schedule with a focus on having free weekends.
VI.C.1.c : Evaluating workforce safety data and addressing the safety of residents and faculty members.
Resources
Environmental Health & Safety: Workplace Safety Training & Videos
Prevention Education, Assistance & Resources (PEAR) provides sexual and gender-based misconduct prevention education. Michigan Medicine specialist: Pedro Coradcides
Safety First Awards: Nominate individuals, work groups or departments that excel in creating and maintaining a safe workplace.
Ideas & Best Practices
Fellows and other division members receive workplace safety training through a series of online modules that are updated on a regular basis.
Establish Patient Bias and Racism Response protocol similar to the Department of Surgery.
Free taxi service is available 24/7 to provide transportation for fellows who may be too fatigued to drive home safely. In addition, the cost of ride services (e.g., taxi, Uber, Lyft) will be reimbursed up to six times per academic year.
Post safety data in work areas or refer to links on House Officer Well-being pages.
Invite speakers from any of the departments listed in "Resources" for training or workshops.
VI.C.1.d: Policies and programs that encourage optimal resident and faculty member well-being
Policies
Organization-wide Policies
GME Program Director Duties and Responsibilities Policy
Program-specific Policy
Resources
Office of Counseling and Workplace Resilience
QPR Suicide Training
Debriefing Training for House Officers
Clinical Consultations
Headspace App (2-year AMA member benefit)
Ideas & Best Practices
Work-Life Flexibility
Manual for new and expecting parents to navigate professional and personal areas.
Transition elective- that can be used as part of maternity/paternity leave or for recovery from a medical condition.
Department specified internal medicine providers who are accepting new patients for those who do not have PCP.
Weekly, monthly, quarterly, semi-annual, bi-annual, or tri-annual discussions on wellbeing, home/work environments.
Have lactation guidelines in place for House Officers similar to Internal Medicine Guidelines.
Professional development
Monthly division case conference sessions.
Programs like “Doctor Life Hacks” and “Faculty War Stories”.
National meetings attendance and supported expense are not counted against vacation time.
Pro Skills program.
Reviews and goal setting
Opportunity to personalize own wellness activities.
Residents include a wellness goal in their learning plan that is reviewed and reinforced at semi-annual reviews.
Social Activities
Social events with peers and faculty: BBQs, tailgating, welcome parties, holiday parties and happy hours, Departmental Families Group.
Team building activities: Annual retreats, group volunteering, charity events.
Wellness-focused book clubs.
Gratitude events: "Friday fellow high fives" or “Props” sessions for expressing gratitude and giving positive feedback to fellows, resident appreciation days.
Physical Activities & Resources
Planned group activities: boxing, kickball, soccer, yoga, running clubs, kayaking, monthly 10-minute exercise routines, and physical fitness challenges.
Incentives: Gym access/memberships, Fitbit/Mhealthy Rewards.
Committees and resource people such as Resident Ombudsperson.
Wellness Committees & Resident Wellness Committees.
Dedicated Associate Chair for Department Life and Culture to develop wellness curriculum.
VI.C.1.d.(1): Residents must be given the opportunity to attend medical, mental health, and dental care appointments, including those scheduled during their working hours.
Policies
Organization-wide Policies
Department-specific Policy
Resources
Please share any resources that may help program directors meet this criterion. Submit here.
Ideas & Best Practices
As early as possible, encourage House Officers to begin scheduling their healthcare needs as early as possible before arriving in Ann Arbor - it can take up to six months or more for Residents to get in for an appointment or connect with a doctor.
In onboarding and orientation messages, recommend that those taking prescriptive drugs, arrange for ongoing refills from their previous provider in the event they cannot secure timely appointments locally.
Ability to designate half-days for health activities (well visits, dental care).
Have lactation guidelines in place for House Officers similar to Internal Medicine Guidelines.
Include the Office of Counseling and Workplace Resilience (OCWR) and the Wellness Office mental and emotional health resources as part of the materials included in onboarding for new medical trainees.
VI.C.1.e: Attention to resident and faculty member burnout, depression, and substance abuse. The program must educate faculty members and residents in identification of the symptoms of burnout, depression, and substance abuse, including means to assist those who experience these conditions. Residents and faculty members must also be educated to recognize those symptoms in themselves and how to seek appropriate care.
Policies
Organization-wide Policies
Department-specific Policy
Ideas & Best Practices
Training
Survey House Officers to determine wellness event preferences.
Formats: online, MLearning training modules, didactic lectures, conferences, seminars, Grand Rounds, FIRE rounds, monthly lunch meetings, journal clubs, and program evaluation meetings on a variety of topics.
Topics: nutrition, psychological well-being sessions, OCWR guided sessions on well-being and suicide prevention, physician wellness session, sleep training, ethics, financial management, fatigue, and wellness.
Check-In Frequency
During semi-annual evaluations, MedHub includes questions regarding "unreasonable stress" and "fatigue in relation to excessive duty hours" - if yes addressed promptly.
Two-hour session once a month for interns not, post-call or on vacation.
Informal check-ins continually.
Formal check-ins at the tri-annual evaluation of the resident.
One-on-one wellness meetings with PD.
VI.C.1.e (1): Encourage residents and faculty members to alert the program director or other designated personnel or programs when they are concerned that another resident, fellow, or faculty member may be displaying signs of burnout, depression, substance abuse, suicidal ideation, or potential for violence.
Policies
Organization-wide Policies
Michigan Medicine Progressive Discipline Associated with Controlled Substance Management Policy, 04-06-049
Department-specific Policy
Resources
Diversion Prevention Program: team in pharmacy that works to prevent, detect and respond to diversion. Reach out with any diversion-related concerns. Pharm-DPT@med.umich.edu
Compliance Hotline: anonymous hotline that can be used to report any type of concern. 1-866-990-0111
Health Professional's Recovery Program: treatment program for licensed individuals. 1-800-453-3784
Addiction Treatment Services (UMATS): psychiatric evaluation and treatment of individuals, couples and families; intensive outpatient treatment and detoxification programs. 1-800-525-5188
Division of Public Safety and Security (DPSS): security can be called to report diversion, suspicious circumstances or safety concerns and they should also be called to pick up mishandled or possibly tampered with controlled substances. 1-734-936-7890
Ideas & Best Practices
Create a formal system for reporting such as Surgery's Michigan Action Progress System (MAPS).
VI.C.1.e (2): Provide access to appropriate tools for self-screening.
Policies
Resources
Confidential and anonymous:
MHealthy Screening Tool
Ideas & Best Practices
Include access to screening tools both in 1:1 sessions, quarterly assessments, well-being communications, and on resident websites.
VI.C.1.e (3): 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.
Policies
Organization-wide Policies
Department-specific Policy
Departmental Policy #10427987 - Department of OBGYN Policy on Fellow and Faculty Well-Being
Ideas & Best Practices
Faculty openly discuss their own positive experience with the program as trainees to encourage use for a variety of different issues and help destigmatize utilizing this program.
Create specific programming or personal narrative panels to normalize help-seeking behaviors.
VI.C.2: There are circumstances in which residents may be unable to attend work, including but not limited to fatigue, illness, and family emergencies. Each program must have policies and procedures in place that ensure coverage of patient care in the event that a resident may be unable to perform their patient care responsibilities.
VI.C.2 (a): The program must have policies and procedures in place to ensure coverage of patient care.
VI.C.2 (b): These policies must be implemented without fear of negative consequences for the resident who is unable to provide the clinical work.
VI.C.2 (b): These policies must be implemented without fear of negative consequences for the resident who is unable to provide the clinical work.
Policies
Organization-wide Policies
GME Monitoring Sleep and Fatigue of Residents/Fellows Policy
UMH Global Clinical Program Trainee Supervision Policy, 04-06-043
UMH "Speak Up with Safety Concerns", 05-01-004
Department-specific Policies
Resources
LOA, personal emergency, parental leave is available per HOA contract to allow appropriate length of absence if circumstances occur in which the fellow may not be able to attend work
Ideas & Best Practices
Fellows are made aware that if they identify themselves as too fatigued to work, they are encouraged to request temporary relief of clinical duties to get rest.
Have lactation guidelines in place for House Officers similar to Internal Medicine Guidelines.
Faculty are strongly encouraged to assume full responsibility for all service-related clinical duties and mandate the fellow to rest if they identify the fellow as being too fatigued to function at the expected level.
Jeopardy system when the home call is too busy.
Publications on GME Well-Being
Sen, S. (2022). Is it burnout or depression? expanding efforts to improve physician well-being. New England Journal of Medicine, 387(18), 1629–1630. https://doi.org/10.1056/nejmp2209540
Viglianti EM, Meeks LM, Oliverio AL, Lee KT, Iwashyna TJ, Hingle ST. Self-reported Sexual Harassment and Subsequent Reporting Among Internal Medicine Residency Trainees in the US. JAMA Intern Med. Published online January 17, 2023. doi:10.1001/jamainternmed.2022.6108
Santosa, K. B., Lussiez, A., Bellomo, T. R., Matusko, N., Gauger, P. G., Choi, J. N., & Sandhu, G. (2022). Identifying strategies for struggling surgery residents. Journal of Surgical Research, 273, 147–154. https://doi.org/10.1016/j.jss.2021.12.026
Evans, J., Kemp, M. T., Rivard, S. J., Sharma, S. B., Williams, A. M., Coleman, D., Dimick, J., & Sandhu, G. (2021). Not just bystanders: A qualitative study on the vicarious effects of surgical training on the wellness of support persons for trainees. Annals of Surgery, 274(3). https://doi.org/10.1097/sla.0000000000004890
Foote, D. C., Donkersloot, J. N., Sandhu, G., Ziegler, K., & Lau, J. (2021). Identifying institutional factors in General Surgery Resident Wellness and Burnout. The American Journal of Surgery. https://doi.org/10.1016/j.amjsurg.2021.07.014
Kemp, M., Williams, A., Rivard, S., Perrone, E., & Sandhu, G. (2021). Physician Heal Thyself: A Call to Action for Prioritizing Trainee Health. Annals of Surgery, 274(3), 201–203. https://doi.org/https://doi.org/10.1097/sla.0000000000004918
Ortiz, D., Sandhu, G., Finks, J., Vallie, J., & Matusko, N. (2021). Vigilance, Resilience, and Intent to Pursue Medicine Among Underrepresented Students. MedEdPublish, 10. https://doi.org/10.15694/mep.2016.000000
Review a list of all Michigan Medicine well-being publications HERE.
