Building a culture of well-being in primary care resident training programs

Abstract

Background: Monitoring and improving resident physicians’ well-being are crucial because clinical care burdens can cause burnout, depression, and suicide. Burnout negatively affects patient care. Promoting well-being requires cultural change best achieved through a merging of institutional top-down efforts with resident and faculty bottom-up efforts. Methods: The Wayne State University Office of Graduate Medical Education targeted three residency programs (52 residents) at one hospital site for wellness interventions as part of the Alliance of Independent Academic Medical Centers (AIAMC) National Initiative VI. Institution-led efforts included promotion of employee wellness resources, prioritization of wellness at administrative meetings, and program evaluation and assessment. Resident-and faculty-led efforts included the formation of wellness committees that organized events and activities and communicated with program evaluation committees to address wellness concerns. Impact was assessed using mixed methods: the quantitative Resident Wellness Scale, a modified form of the Medical School Learning Environment Survey, and a qualitative Resident Wellness Semi-Structured Interview. Results: Institutional efforts were successfully applied through multiple administrative channels. Resident-led efforts were less successful initially, but wellness committees led by faculty champions were formed within programs and strengthened the resident-led efforts. Quantitative measures indicated that well-being increased and then declined, perhaps attributable to cohort effects. Qualitative analysis revealed multiple dimensions of well-being. We discuss limitations of the work and future directions. Conclusion: Resident well-being requires cooperation and a combination of top-down institutional and bottom-up trainee efforts. Because resident well-being is a complex phenomenon, efforts to improve and sustain it must also be multidimensional and broadly applied.