We are grateful for the letter to the editor we received in response to our recent publication on resident and new graduate well-being according to length of training. 1 We heartily endorse the stated recommendations on both future research and evidence-based interventions to support physician well-being during training and beyond. The authors of the letter wisely point out that we need to better understand the development of emotional strength (resiliency), and there are validated instruments to measure this. 2 We also identified publications that describe educational programs designed to teach resilience. 3-5 Sadly, none of these publications assess the impact of their interventions on actual resilience development. This further underscores the need for this type of research.
Well-being is a complex multifaceted construct, and it will likely take multilayer/multicomponent interventions to fully address it, as these authors point out. We agree that while the Accreditation Council for Graduate Medical Education restricting duty hours is a meaningful start, it is unlikely to fully address burnout, sleep quality, and other factors that affect physician well-being. Rigorously testing interventions as suggested, such as structured education on sleep hygiene and flexible scheduling or clinical shifts instead of adjustment in duty time, as well as mindfulness, relaxation, and self-care techniques, would help build appropriate practical evidence to support physician well-being that would be useful in many contexts. We also agree that program design features and supportive leadership will also be needed. We wonder how many program directors are aware that their residents are falling asleep in public places. Doing all of this well will require a strong alignment between intervention features and instruments, and absolutely must stretch beyond whether learners liked it. This issue should continue to be a top priority for residency training programs in every specialty.
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