TY - JOUR
T1 - It Is Time to Prioritize Education and Well- Being over Workforce Needs in Residency Training
AU - Wolpaw, Jed T.
N1 - Publisher Copyright:
Copyright © 2019 by the Association of American Medical Colleges.
PY - 2019
Y1 - 2019
N2 - Residents inhabit an ambiguous world. They are no longer medical students but are still learners. They are not yet attendings but are still paid employees. This ambiguity leads to a misalignment of departmental incentives and trainee expectations. Trainees expect their learning and well-being to be prioritized, while departments are under pressure to meet staffing needs and cut costs. This sets up a fundamental disconnect between the "formal"Accreditation Council for Graduate Medical Education (ACGME) message of well-being and the dominant "hidden"workplace forces that pull in the opposite direction, possibly contributing to the epidemic of burnout in trainees. It is critical that all parties - health systems, graduate medical education (GME) programs, the ACGME, and residents - recognize this disconnect and collaborate to meaningfully implement current ACGME requirements to decompress work intensity and address well-being. Real change will require more than general directives. The ACGME will likely need to take the lead and consider taking a design-thinking approach to structuring regulations governing how and when residents work and how they are supported. It would also be worthwhile to revisit the Institute of Medicine recommendations on GME from 2014 related to funds flow and transformation initiatives. Taking a more comprehensive approach to residents as people, workers, and vital health care professionals is the right thing to do and may well improve retention, reduce burnout, decrease medical errors, and improve care.
AB - Residents inhabit an ambiguous world. They are no longer medical students but are still learners. They are not yet attendings but are still paid employees. This ambiguity leads to a misalignment of departmental incentives and trainee expectations. Trainees expect their learning and well-being to be prioritized, while departments are under pressure to meet staffing needs and cut costs. This sets up a fundamental disconnect between the "formal"Accreditation Council for Graduate Medical Education (ACGME) message of well-being and the dominant "hidden"workplace forces that pull in the opposite direction, possibly contributing to the epidemic of burnout in trainees. It is critical that all parties - health systems, graduate medical education (GME) programs, the ACGME, and residents - recognize this disconnect and collaborate to meaningfully implement current ACGME requirements to decompress work intensity and address well-being. Real change will require more than general directives. The ACGME will likely need to take the lead and consider taking a design-thinking approach to structuring regulations governing how and when residents work and how they are supported. It would also be worthwhile to revisit the Institute of Medicine recommendations on GME from 2014 related to funds flow and transformation initiatives. Taking a more comprehensive approach to residents as people, workers, and vital health care professionals is the right thing to do and may well improve retention, reduce burnout, decrease medical errors, and improve care.
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U2 - 10.1097/ACM.0000000000002949
DO - 10.1097/ACM.0000000000002949
M3 - Review article
C2 - 31425182
AN - SCOPUS:85074309784
SN - 1040-2446
VL - 94
SP - 1640
EP - 1642
JO - Academic Medicine
JF - Academic Medicine
IS - 11
ER -