Safe delivery of consistent, high-quality patient care can only be sustained when the clinical learning environment ensures the support and well-being of its physicians and patient care providers. Promoting well-being and equity are part of the guiding principles of Mission Forward, which ensures a healthy future for UW Medicine.
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This message addresses Well-Being CLER domain activities UW Medicine and the University of Washington Medical Center, Montlake (UWMC-ML) have achieved since the last CLER site visit in 2019.
The COVID-19 pandemic front-lined our GME workforce, creating a lockdown that began earlier –
and lasted longer in Seattle than in other place in the country. It is difficult to overstate the impact that the pandemic had on the healthcare landscape, especially the well-being of the workforce at the individual level (e.g., illness, leave) and the institutional level (e.g., finance). Mission Forward has helped us recover from the pandemic by focusing on achieving “system-ness” and promoting wellbeing in our community. UWMC-ML, in partnership with GME, has made notable progress in the well-being space to deliver safe, quality care to every patient, every time.
2019 CLER Feedback
During our last CLER visit at UWMC-ML, the Executive Report we received from the ACGME CLER team explored several domains related to Well-Being.
Promoting the Well-Being of the Clinical Care Team
During conversations with the senior leadership team, it was unclear if the UWMC-ML has a comprehensive strategy to support the well-being of the clinical care team.
System Responses
- New Associate Dean for Well Being – Anne Browning, PhD chairs the School of Medicine (SOM) Well Being Steering Committee and has established multiple well-being resources to support our faculty.
- Participation in the “Healthcare Professional Well Being Academic Consortium” – UW Medicine has joined other academic institutions in this Consortium for data collection and sharing of best practices. We have had two UW Medicine Well-being surveys. The first survey encouraged department leaders to triangulate the data in context of their department and GME experiences and then to develop a practical action plan to promote wellbeing for their unique department. Data from the second survey is still under analysis.
- UW Medicine Well Being Grant Program – provided grants to several GME applicants for use at the program and department level. Many grant-awarded initiatives focused on (re)building community after the pandemic.
- Through a Well Being Grant, the GME Wellness Service piloted lightboxes to enhance mood, improve disrupted sleep and increase well-being during the winter months.
Workload and Work-Life Balance
In the group meetings, CLER site visitors reported:
- 39% of the faculty members and 40% of the program directors agreed or strongly agreed that the medical center creates an environment that promotes balance between faculty workload and their well-being.
- 52% of the faculty members and 67% of the program directors agreed or strongly agreed that the volume and intensity of faculty member’s clinical workload adversely impacts their ability to teach residents and fellows.
- Residents and fellows mentioned that back-up call may be viable for larger services but may not be an option for smaller services.
System Responses
- Expanded Moonlighting – As of November 2020, more moonlighting shifts were made available over many services, offering opportunities for clinical coverage and additional compensation for residents, fellows, and faculty.
- The GME Office tracks “Program or Department Advocacy for Enhanced Staffing in Response to High Workloads or Acuity” in the Annual Program Evaluation. (APE). Over the last few years, we have seen a steady decrease in the program needs for advocacy, which is currently at 60% for AY23.
- Advanced Practice Providers (APPs) – these key roles have been hired for services in which work hours posed persistent challenges for housestaff. Although this may have created some financial challenges, the overall effect on their well-being seems to have improved.
- Exit Interviews – All Program Directors are offered an exit interview so that the GME Office can better understand their experiences and continue to keep abreast of how best to support individuals in these leadership roles.
- ACGME Faculty & Resident/Fellow Surveys – GME has been following trending data on these surveys to predict trends on faculty supervision and teaching of trainees in the learning environment.
Fatigue / Burnout / Risk of Self-Harm
- Residents, fellows, nurses, and other health care professionals indicated that they were not aware of UWMC-MLs’ efforts to proactively recognize and address fatigue among the clinical care team.
- The residents and fellows” in the group interviews were presented with a scenario in which they are maximally fatigued, yet 55% of the residents and fellows indicated that they would power through to hand-off.
- The GME Office tracks “Programs or Initiatives in Place Intended to Mitigate Resident and Faculty Burnout” on the APEs. 91% of programs have initiatives in place.
- When asked about the UWMC-ML’s process to identify residents, fellows, and faculty members at risk of or demonstrating self-harm, the well-being representatives did not identify a consistent process for identifying these individuals.
- In the group sessions, 49% of the residents and fellows, 48% of the faculty members, and 77% of the program directors reported that they are moderately or very prepared to recognize members of the clinical care team at risk of or demonstrating self-harm.
System Responses
- Report a Concern and UW Medicine Bias Reporting Tools: Any UW Medicine system-level personnel can advocate for resident and fellow wellness using these tools described in Professionalism.
- Peer to Peer Support Program – This UW Medicine program is available to and has supported GME PDs and trainees.
- Program Director Development Series, now Educator Development for GME Excellence (EDGE) – For the last 16 years, the GME Office has offered faculty development events addressing such issues as “Peer Support” and “Supporting Trainees in Crisis.” Topics change depending upon the need of our learning community.
- Chief Resident Listening and Support Sessions facilitated by the GME Wellness Team to share best practices for new resident leaders, understand the stress continuum, discover ways to support residents and fellows who are struggling, and determine other possibilities of connecting.
- GME Wellness Service works with programs (Program Directors, APD’s, Chiefs) to normalize help seeking behaviors, destigmatize mental health struggles and encourage support from the larger system. The service was expanded by 1.0 FTE in June 2022 and its counselors navigated an effective pivot to virtual appointments, which increased access. Several programs have benefited from the “opt out” Wellness session model that can identify risk factors and connect trainees with resources.
- E-Learning Modules
- Physician Well Being – this practical training embeds self-screening is given to all incoming trainees.
- AY23 completion rate was 83%.
- Prioritizing Ourselves when Fatigued – this standardized training is an opt-in training for residents and fellows focused on practical strategies for fatigue mitigation and the system’s role in addressing fatigue.
- Physician Well Being – this practical training embeds self-screening is given to all incoming trainees.
- UWMC-ML Schwartz Rounds and Circle of Support – two interdisciplinary venues for humanizing the work we do as a caring community are held at UWMC-ML.
Being well is a part of all healthy work environments. UW GME and UWMC-ML are committed to supporting all individuals in our community and advocating for systems that enable them to thrive. Our partnership with UW Medicine, including UWMC-ML, is essential and ongoing!
For additional details, please see the CLER Website.
Jennifer Best, MD
Associate Dean, Accreditation and Education
Byron Joyner, MD, MPA
Vice Dean for GME and DIO