Resident and Fellow Well-being Flashcards

A program director receives a report that a fellow's Maslach Burnout Inventory scores reveal high emotional exhaustion and depersonalization but paradoxically high personal accomplishment. According to well-being research, which interpretation and response is MOST appropriate?

Answer: This 'overextended' burnout subtype still carries significant risk for compassion fatigue and departure; targeted workload and meaning-making interventions are indicated

Burnout is not a single uniform profile. The MBI identifies subtypes: individuals with high exhaustion and depersonalization but preserved personal accomplishment represent an 'overextended' pattern. Research shows this group still has elevated risk for attrition and compassion fatigue. The appropriate response is targeted intervention—workload review and programs that reinforce meaning and connection to purpose—not dismissal of the findings or mandatory counseling, which could deter future self-disclosure.

Under ACGME's 2017 Common Program Requirements, which of the following represents a SPECIFIC institutional obligation for resident and fellow well-being that goes BEYOND simply prohibiting retaliation against residents who report concerns?

Answer: Sponsoring institutions must provide residents with access to urgent and emergent mental health care with no financial barrier, and facilitate access to safe, affordable, and confidential counseling

The 2017 ACGME Common Program Requirements (Section VI.C) place explicit obligations on sponsoring institutions to provide access to urgent and emergent mental health care with no financial barrier to the resident, and to facilitate access to safe, affordable, and confidential counseling. This is a distinct and specific mandate. The other options—while potentially good practices—are not specifically required under the ACGME CPRs.

A training administrator is evaluating a newly proposed peer support program (PSP) following a sentinel adverse patient event involving a resident. Which element is MOST critical to include in program design to align with evidence-based PSP models such as the Johns Hopkins RISE program?

Answer: Training peer supporters in active listening and psychological first aid while explicitly protecting conversations from quality improvement and risk management disclosure

The cornerstone of effective peer support programs like RISE (Resilience In Stressful Events) is confidentiality—conversations must be protected from disclosure to risk management, QI committees, or supervisors. Peer supporters are trained in active listening and psychological first aid, not necessarily licensed clinicians. Mandating participation or integrating PSP into evaluation systems destroys the trust that makes these programs effective and reduces utilization by the residents who most need support.

A surgery resident works a 24-hour shift and then is involved in a post-call motor vehicle accident during the commute home. The GME office is reviewing duty hour compliance. Under ACGME requirements, which statement about transitional duty periods is MOST accurate?

Answer: Programs must educate residents about fatigue mitigation strategies and provide safe transportation or on-site rest facilities, representing a systemic well-being obligation beyond hours-tracking alone

While ACGME duty hour rules cap continuous duty at 24 hours (with up to 4 additional hours for transitions for upper-level residents), the well-being obligation extends to fatigue mitigation education and—critically—ensuring residents have safe options to get home after extended shifts. Programs are required to address the systemic risk that long-duration training creates, including transportation and sleep facilities. Simply tracking hours without addressing post-shift safety is insufficient. A post-call accident alone does not automatically trigger a for-cause visit.

A residency program conducts its annual program evaluation and finds that residents score the program highly on educational experience but report significantly elevated burnout on the Physician Well-Being Index (PWBI). The program director argues that since educational quality is high, the well-being scores reflect individual resilience deficits rather than program factors. Which response by the DIO/GME administrator is MOST aligned with current ACGME and well-being science frameworks?

Answer: Require the program to conduct a root cause analysis of systemic contributors—scheduling, workload distribution, psychological safety, and culture—rather than attributing burnout solely to individual factors

Contemporary well-being science and ACGME policy firmly reject an exclusively individual-deficit model of burnout. The ACGME Common Program Requirements explicitly call for programs to evaluate and address systemic contributors to distress—including scheduling practices, workload, culture, and psychological safety—not merely offer individual-level resilience training. High educational quality scores do not offset or excuse well-being deficits; both dimensions are independently required under ACGME Section VI.

During an ACGME self-study, a program discovers that residents are systematically under-reporting duty hours to avoid triggering a review, a practice tacitly encouraged by senior faculty. Which action by the program administrator demonstrates the MOST comprehensive and appropriate response consistent with ACGME requirements?

Answer: Implement a multi-pronged response: correct the immediate violation, address the culture of silence through faculty development and explicit non-retaliation policies, and remediate systemic workload issues driving the behavior—documented in the Annual Program Evaluation

Under-reporting driven by a culture of silence and faculty encouragement is a systemic program failure, not primarily a resident professionalism violation. A comprehensive response must address: (1) the immediate compliance gap, (2) the psychological safety and retaliation culture that caused it (faculty development, explicit non-retaliation policies), and (3) the underlying workload or scheduling pressures that made residents feel they needed to under-report. All of this must be documented and tracked through the Annual Program Evaluation cycle. Disciplining residents while ignoring faculty and structural contributors would be inappropriate and counterproductive.