Promotion of Wellness and Mental Health Awareness Among Physicians in Training: Perspective of a National, Multispecialty Panel of Residents and Fellows

摘要

Introduction In August 2014, 2 resident physicians died by suicide within 2?weeks of each other in separate incidents in New York City. The temporal and physical proximity of these tragic events, and a poignant op-ed piece in The New York Times implicating the culture of medicine in promoting an environment where physicians ignore their own well-being,1 have renewed interest in medicine's ongoing struggle with depression and suicide. Systematic reviews and meta-analyses have consistently found significantly higher suicide rates among medical professionals in practice, with male and female physicians at 40% and 130% higher risk, respectively, compared with gender- and age-matched individuals in the general population.2 While resident physicians are not at an increased risk for suicide, studies have shown that the rate of depression among physicians in training is approximately 22% to 35%, compared with 17% in the general population,3 and high rates of burnout, suicidal ideation, and depression are seen as early as in medical school.4–6 These data support the notion that depression and suicide are indeed occupational hazards for physicians, and that these problems start early in training. The events in New York have caused self-reflection in the graduate medical education (GME) community. The Accreditation Council for Graduate Medical Education (ACGME) is convening a symposium of stakeholders—scholars, physician educators, residents, and advocates—to better characterize the problem and identify ways to improve resident wellness and resiliency.7 Resident groups like the American Medical Association Resident/Fellow Section8 and the Junior Doctor Network internationally9 are calling attention to the need to improve physician well-being during training. Individual institutions are providing leadership in this area by creating dedicated wellness programs for physicians in training.10 Despite these efforts, there is little information from the resident and fellow perspective on the utility of existing resources, and what resources are lacking. The ACGME Council of Review Committee Residents (CRCR), which encompasses 29 residents and fellows representing all ACGME-accredited specialties, met to discuss the need for promotion of wellness and mental health in GME from the perspective of the physician in training. The group is geographically diverse and represents the perspectives of medical, surgical, and hospital-based residents and fellows. We used appreciative inquiry11 to identify the best current resources for promotion of wellness during training, what resources ideally should exist, and how the gap between the current reality and the ideal may be bridged. We aggregated the information to identify the major themes that emerged from the exercise to provide concise, meaningful recommendations to the GME community.;Approach Idea Generation The 29 members of the CRCR comprise the resident representatives of all specialty Review Committees, the Institutional Review Committee, and the Clinical Learning Environment Review Committee. All participants in the discussion gave verbal consent to have the data aggregated for this article. Twenty-eight CRCR members participated in the exercise. We chose the appreciate inquiry approach to structure our discussion on resident wellness. Appreciative inquiry is a form of action research that attempts to generate ideas for solving a problem by identifying and building on the best available current resources.11 It avoids focusing on the negative aspects of training, and capitalizes on the strengths of the current learning environment. The general steps of appreciative inquiry are to determine the “best of what is,” then “what might be,” “what can be,” and finally “what should be.” Another way of describing these stages is to label them “Discovery,” “Dream,” “Design,” and “Destiny.” We use this annotation for the summary of our discussion. The 28 CRCR members were assigned to 4 groups. Participants