Applies to: Residents, Faculty, and Staff in the WSU Family Medicine Residency – Pullman residency program.
Date: January 30, 2024
1.0 Policy Statement
It is the WSU College of Medicine Family Medicine Residency Pullman policy to provide a safe environment and to protect the health and welfare of patients, students, faculty, visitors, trainees, and staff. Residents and faculty members are at an increased risk for burnout and depression. Psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician. Self-care is an important component of professionalism and is a necessary tool in the delivery of high-quality patient care. This policy outlines the terms used in discussing physician wellness and responsibilities of the program, leadership, faculty, and trainees regarding physician wellness.
2.0 Definitions
Accreditation Council for Graduate Medical Education (ACGME)
Accredits Sponsoring Institutions and residency and fellowship programs, confers recognition on additional program formats or components, and dedicates resources to initiatives addressing areas of importance in graduate medical education.
Burnout
Long-term stress syndrome composed of three primary dimensions; emotional exhaustion, cynicism, and depersonalization, reduced professional efficacy and personal accomplishment.
Well-being
A person’s physical, mental, emotional, and social health factors combined to a state of being healthy, happy, and successful.
Trainees
A resident or fellow.
3.0 Responsibilities
Program Director
4.0 Procedures
Trainees are expected report to all rotations and clinical and educational experiences fit for duty and able to perform their clinical duties in a safe, appropriate, and effective manner showing concern, respect, care, and cooperation with faculty, staff, patients, and visitors.
Residents have a professional responsibility to appear for duty appropriately rested and must manage their time before, during, and after clinical assignments to prevent excessive fatigue. Strategies that may help manage or mitigate fatigue as identified by the ACGME include, but are not limited to:
- Strategic napping
- Use of caffeine
- Requesting assistance from other caregivers
- Time management to maximize sleep when off-duty
- Learning to recognize the signs of fatigue
- Asking others to monitor your performance
- Remaining active to promote alertness
- Maintaining a healthy diet
- Using relaxation techniques to fall asleep
- Maintain a consistent sleep routine
- Increasing sleep time before and after call
Residents are responsible for assessing and recognizing impairment, including illness and fatigue, in themselves and other healthcare providers. Residents can hand-off patient care to faculty/attendings as needed to ensure safe and continuous care. Residents are to contact their program director or program administrator for assistance in this process.
The program encourages residents to seek assistance voluntarily before clinical, educational, or professional performance is negatively affected. Residents who voluntarily seek assistance for physical, mental, emotional, and/or personal problems, including drug and alcohol dependency, before their performance is adversely affected will not jeopardize their status as a resident by seeking assistance.
The program, in partnership with the Sponsoring Institution, is responsible for:
- Educating all faculty members and residents to recognize the signs of fatigue and sleep deprivation. In addition, the program is responsible for education on alertness management and fatigue mitigation processes.
- Educating all faculty members and residents in identification of the symptoms of burnout, depression, and substance abuse as well as the means to assist those who experience those conditions.
The program will include a thorough assessment and review of resident and faculty well-being as part of the Annual Program Evaluation. The review of the program will also include review of minimizing non-physician obligations and attention to scheduling, work intensity, and work compression that impacts resident well-being. The program will also evaluate workplace safety data to address safety of residents and faculty members as part of the annual review.
The program director and all faculty members are responsible for awareness of resident behavior and conduct. If the program director, faculty, or staff member observes physical, mental, or emotional concerns affecting the performance of a resident, the faculty or staff must take steps to verify the impairment and take appropriate actions. If the program director or faculty member determines that a resident is unable to continue care for patient due to fatigue, illness, emergency, or other-they must assume responsibility of the patient(s) and/or alert appropriate care providers to ensure safe and continuous care.
The program, in coordination with the Sponsoring Institution, will ensure a healthy and safe clinical and education environment that provides for:
- Access to food during clinical and educational assignments
- Sleep/rest facilities that are safe, quiet, clean, and private
- Clean and private facilities for lactation with proximity appropriate for continued safe patient care. Refrigeration resources will be available for the clean and safe storage of breast milk.
- Accommodations for residents with disabilities consistent with Sponsoring Institution and WSU policies
- Access to sleep rooms and safe transportation following work hours for the excessively fatigued resident.
Residents must be given the opportunity to attend medical, mental health, and dental care appointments, including those scheduled during work hours. The program is responsible to provide reasonable accommodations to enable the resident to participate in mandated counseling while also having a process to ensure coverage of patient care.
The program, in collaboration with the Sponsoring Institution, provides appropriate services and resources and leave from training when needed. In certain circumstances in which residents may be unable to attend work, including but not limited to fatigue, illness, family emergencies, and parental leave, the program allows an appropriate length of absence for residents unable to perform their patient care responsibilities without negative consequences.
Resources Available to All Residents
- Residents have resources available for physician impairment and substance abuse, counseling, and psychological services. This includes access to tools for self-screening on the WSU Graduate Medical Education Wellness website. Residents are provided confidential means of seeking and obtaining treatment for addiction or impairment including access to urgent and emergent care 24-hours a day, 7-days a week.
- If a social or maladaptive or gendered/cultural/ethic issue exists, counseling regarding these concerns may be accessed through WSU Office for Equal Opportunity.
- If need for critical incident stress counseling occurs, residents are encouraged to contact WSU Employee Assistance or Washington Physicians Health Program (WPHP)
The program director must be informed of a resident undergoing treatment for impairment and/or substance abuse and will decide on further action, if any.
In the case of an observation of impairment, the program director will make all efforts to confirm the accuracy and validity of the observation brought to the program director’s attention. If further consultation is needed, the program director, in agreement with the resident, will pursue a referral of the resident to counseling and/or psychiatry services.
- Noncompliance by the resident may justify relief from patient care responsibilities or may be an indication for utilization of the disciplinary process.
- The program director can remove a resident from patient care duties if there is a concern for patient safety, safety for the resident, or others.
- The continuing services of the resident in patient care will depend upon expert advice regarding resident capability, degree of disability, and compliance with any planned treatment as determined by counseling/psychiatric evaluation and the program director. The program director has the responsibility to ensure that these guidelines are followed.
- Any continuing treatment will be monitored by the appropriately selected counseling/psychiatric entity and the program director will be required to be aware of the outcome in determining the fitness of the trainee to return to patient care responsibilities.
- During all phases of the counseling and consultation process, complete privacy and confidentiality for the trainee must be maintained
5.0 Related Policies
- GME Accommodations for Disabilities Policy
- GME Clinical and Educational Work Hours Policy
- Clinical and Education Work Hours Policy–Family Medicine
- GME Handovers and Transitions of Care Policy
- GME Physician Impairment Policy
- GME Safe Transportation Home Policy
6.0 Revision History
GMEC Approval: November 17, 2020
Revision/Review Date(s): January 30, 2024
Responsible Office: WSU Family Medicine Residency – Pullman
Policy Contact: Program Director
Supersedes: N/A