Wellness and Resilience in Medicine
At the University of Kansas Internal Medicine Residency Program, we place priority on wellness and resident well-being. We follow, respect and go beyond all ACGME requirements on well-being (2018, in effect July 1, 2019).
ACGME Common Program Residency Requirements on well-being:
"Psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician and require proactive attention to life inside and outside of medicine. Well-being requires that physicians retain the joy in medicine while managing their own real-life stresses. Self-care and responsibility to support other members of the health care team are important components of professionalism; they are also skills that must be modeled, learned, and nurtured in the context of other aspects of residency training.
Residents and faculty members are at risk for burnout and depression. Programs, in partnership with their Sponsoring institutions, have the same responsibility to address well-being as other aspects of resident competence. Physicians and all members of the health care team share responsibility for the well-being of each other. For example, a culture which encourages covering for colleagues after an illness without the expectation of reciprocity reflects the ideal of professionalism. A positive culture in a clinical learning environment models constructive behaviors, and prepares residents with the skills and attitudes needed to thrive throughout their careers.
V1.C.1) The responsibility of the program, in partnership with the Sponsoring institution, to address well-being must include:
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;" (V1.C.1.a)
- Creative opportunities for residents to engage in "My Life My Story" with veterans, while engaging in the value of physician/patient relationships
- Utilization of 30/60 minute ambulatory slot on a graded basis as residents project through training to protect time with patients
- Minimized interruptions for clinical work completion on inpatient rotations (interdisciplinary huddles; standard times for scheduled didactics)
- Mitigation of non-physician work through delegation of tasks for patient care items such as dedicated phlebotomy, EKG, NG placement, IV therapy, patient transportation; as well as standardized nursing protocols (ex: Foley removal, PICC line removal and care, etc) and nursing protocols for patient care (ex: electrolyte replacement, anticoagulation protocols, c.dif testing, DKA insulin management, enteral nutrition management, high-risk antibiotic monitoring and management)
- Standardized ambulatory nurse telephone triage system for patient care; standard ambulatory medication refill protocols/standing orders
- Promotion of progressive autonomy and flexibility by integrating residents into the role of medicine admissions triage while still an intern with senior oversight and progressive consult/elective opportunities that can be tailored to the resident's individual needs as they progress in training
- An ambulatory practice with a substantially high level of autonomy and documented, consistent patient continuity rates at 75% (well above all national averages)
- Standardized and stream-lined resident:resident mentorship, resident:chief mentorship, and resident:program leadership mentorship
"attention to scheduling, work intensity, and work compensation that impacts resident well-being" (VI.C.1.b)
- Inpatient care teams at lower caps than national average to allow for improved teaching (16 patients on a 1 senior:2 intern team)
- Self-scheduling among firm-based teams for ward/ICU/night rotations for PGY2 and PGY3 years, allowing residents to work in a team-based setting for transparency of inpatient months, as well as timing of 'busier' rotations
- Progressive scheduling in the ambulatory setting to allow for growth and responsibility as residents progress through training
- Longitudinal 3:1 curriculum allowing for adjusting work intensity throughout training as well as tailoring clinical experiences towards desired career destination
- "Golden weekend" (both Saturday and Sunday free of duty) after each ambulatory week throughout training
- Programmatic didactic meal coverage at 50% of conferences
- $60/month food allocation budget with free coffee and fountain beverages for each resident, compensated by GME
- Free membership to onsite fitness center
- Free parking in an onsite dedicated garage with secure direct access to hospital facilities
- Lactation-dedicated space and timing throughout clinical activities
- GME-sponsored educational funds for scholarly productivity dissemination as well as funds for board preparation
"evaluating workplace safety data and addressing the safety of residents and faculty members" (VI.C.1.c)
- Every-other-month Patient Safety Conferences that are resident-led
- QuEST Committee (Quality/Safety Educational Steering Team) that includes a core group of program leadership, hospital leadership, chief residents, and residents. This committee meets monthly and addresses ongoing quality improvement and safety at the program level.
- CRQS (Chief Resident of Quality and Safety) who reviews ongoing culture of safety and represents residents at the institutional level at our KCVA site
- Quarterly resident debriefing session with skilled/unbiased faculty leads in a protected environment, offering the opportunity for residents to discuss challenging patient care scenarios
"policies and programs that encourage optimal resident and faculty member well-being;and, residents must be given the opportunity to attend medical, mental health, and dental care appointments, including those scheduled during their working hours" (VI.C.1.d)
- Equivalent of 2 half-days free of clinical duty per 6 months for scheduled wellness appointments (dental, medical, mental health, etc.) for all categorical and prelim residents
- Opt-out scheduling for all PGY1 residents for introduction to on-campus counseling and educational support services in a confidential, protected environment to directly assess well-being and mitigate burnout
- Resident social committee which organizes optional social events around Kansas City for residents and their families
- Wellness and social lunches as well as +1 week cohort events scheduled throughout the year in place of typical noon conferences and Friday School sessions
"attention to resident and faculty member burnout, depression, and substance abuse. The program, in partnership with its Sponsoring Institution, 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. The program, in partnership with its Sponsoring Institution, must: (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; (2) provide access to appropriate tools for self-screening; and, (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.
- Confidential, longitudinal, semi-annual screening for physician burnout
- 24/7 access to counseling, education and support services with self-scheduling and off-site options if desired for ongoing counseling services
- Programmatic scheduled wellness consultations in lieu of clinical work during PGY1 year to familiarize all residents with available on-site services
- Cultivation of a culture of respect and confidentiality with multiple built-in layers of mentorship and advising to allow for several avenues to escalate any concern
- "Resident Response Team" to organize support mechanisms for residents facing personal or health crises, such as arranging volunteers to provide meals/care packages and support outside the workplace
- HOPE (Helping Our People Endure) Team faculty and resident trained volunteers available for 1:1 colleague confidential counseling and support following adverse patient care outcome events
VI.C.2) "There are circumstances in which residents may be unable to attend work, including but not limited to fatigue, illness, family emergencies, and parental leave. Each program must allow an appropriate length of absence for residents unable to perform their patient care responsibilities.
- The program must have policies and procedures in place to ensure coverage of patient care. (VI.C.2.a)
- These policies must be implemented without fear of negative consequences for the resident who is or was unable to provide the clinical work. (VI.C.2.b)"
- Consistent, shared-pool backup senior and backup intern availability for inpatient coverage needs in setting of resident absence from work. These 'jeopardy' weeks are assigned 1-2 weeks per year and are shared among all residents.
- 3 weeks (15 business days) of vacation per year, and 2 weeks (10 business days) sick leave per year for all PGY levels
- After one year continuous employment, eligibility for up to 6 weeks paid parental leave for the primary caregiver or 3 weeks paid parental leave for the secondary caregiver in addition to standard vacation and sick leave
Exercise - KU Kirmayer Fitness Center
Healthy Recipes From KU
Academic Resources - GME link to writing center, practice interviews