Working Together to End our Physician Well-being Crisis

The article, “Making Sense of Family Medicine Resident Wellness Curricula: A Delphi Study of Content Experts” by Dr Lauren Penwell-Waines and colleagues published in the September 2019 issue of this journal does an excellent job of filling the literature gap with expert consensus of the most essential components of a residency wellness curriculum.¹ The article ends with an important message that should not be overlooked: “Equipped with this information, [residency programs, faculty, and residents] can move tomorrow’s physician workforce toward greater wellness.” As a former associate program director at a family medicine residency program and current resident remediation specialist, the topics of wellness and well-being come up frequently. Each year I cofacilitate a statewide family medicine chief resident workshop with a wellness small-group session. Feedback from the residents is the same year after year: incorporating things like mindfulness education, yoga, and team-building activities are just adding to their to-do list and are not actually helpful. Furthermore, residents note that their own faculty are burnt out and do not role model wellness as leaders. Table 2 of the article appears to agree: faculty role modeling wellness behaviors was thought to be essential to well-being action plans. On the other hand, things that scored much lower included structured reflection activities and nurturing and enhancing interprofessional relationships.

We do not equip our residents with the proper tools needed to proactively address their individual struggles. This is borne out in the data: nearly half of US resident physicians experience professional burnout during training.² While reading the article by Penwell-Waines and colleagues, I gained a new perspective on a program in our residency designed to proactively identify and help residents struggling early in their training in order to prevent them from struggling to meet the ACMGE competencies later on. Customized competency-based assessments coupled with individualized learning plans (ILPs) were implemented at the beginning of internship year. The plans were assessed and evolved over time as residents’ knowledge, skills, and behaviors improved throughout their training.

In retrospect, I am astonished that we did not view this as a wellness program in addition to an academic intervention. The intervention embodied key elements of wellness: encouraging self-disclosure of struggles; self-assessment; setting and monitoring achievement of personal and professional goals per an ILP; and mentorship and role-modeling by faculty. It also meets the new ACGME requirement for use of ILPs and the subcompetency that each resident should be able to “recognize and develop a plan for one’s own personal and professional well-being.”³

While we did not formally study the effects of our program on resident well-being, feedback from our residents was positive overall. In addition, a literature search identified only one similar program where an integrated advisory and assessment pilot program was implemented with reassuring results on resident well-being.⁴ I believe the use of resident assessments early in training coupled with ILPs and skilled mentoring may not only address residents’ academic difficulties, but can also help pave the path toward increasing residents’ sense of well-being during their training and beyond.

This is a clear call to action to promote the personal and professional development and well-being of trainees. I challenge my peers to be the driving force for a proactive, innovative, and customized approach to residency wellness curricula. We must arm this next generation of physicians with the tools needed to circumvent the physician well-being crisis.