Response to “Behavioral Science Rounds: Identifying and Addressing the Challenging Issues That Residents Face on a Family Medicine Inpatient Service”

George Saba, MD, et al’s recent article regarding behavior science rounds¹ highlighted the importance of providing a safe space for family medicine residents to reflect on the common challenges faced on a family medicine inpatient service. Discussion of these challenges will always remain a vital step in improving resident wellness. For resident wellness to move forward, however, medical education has an obligation to critically evaluate the current systems of care delivery that contribute to these challenges. By addressing these systemic factors, medical educators have the opportunity to improve patient care, enhance resident wellness, and decrease burnout. 

An aspect of the article’s described model for behavior science rounds includes “soliciting personal strategies for preventing and dealing with burnout.” In response to the burnout crisis, many residency programs have implemented a wellness curriculum; these curricula tend to emphasize personal resilience.² However, the systemic factors of the training environment are at least as important to the conservation of wellness, and deserve equal investment of time and energy by educational faculty and administrators. Since the 2003 rollout of the duty-hour restriction, resident caseloads have not significantly decreased, leading to work compression.³ Nonphysician tasks such as scheduling, paperwork, and social work issues, are a major contributor to this work compression. The Institute of Medicine Committee “believes that the often high workload of residents and the compression of work into fewer hours are unrecognized contributors to risks for patient safety and resident well-being.”³ They concluded that the transfer of “scut” work to nonphysicians could allow residents to maintain their educational patient experience while still reducing duty hours.⁴

Reducing the amount of nonphysician task work is just one example of systemic change that supports resident wellness. Burnout is not a personal battle. If the medical community wants to accomplish wellness, then a team approach will be necessary to combat burnout. Medical educators need to not only emphasize personal resilience but also advocate for systems of care that support physician wellness. Family physicians, who excel at seeing the big picture, are in the perfect position for pioneering the change they would like to see in the structure of medical education.