Resident and Fellow Well-being Flashcards

A sponsoring institution's GME Committee is reviewing whether its well-being infrastructure meets ACGME Common Program Requirements. Which of the following gaps would represent a DIRECT violation of Section VI (Resident & Fellow Well-Being) institutional requirements?

Answer: Mental health services are available but require residents to pay a co-pay equal to 20% of their visit cost

ACGME Common Program Requirements explicitly state that residents must have access to mental health services without financial barriers or fear of negative career consequences. Any cost-sharing requirement — even a modest co-pay — constitutes a financial barrier and violates this requirement. Peer support programs may be voluntary, wellness curriculum frequency is not rigidly prescribed, and the specific burnout measurement instrument is left to institutional discretion.

A PGY-2 internal medicine resident works the following hours over a 4-week period: Week 1: 82 hrs, Week 2: 76 hrs, Week 3: 78 hrs, Week 4: 84 hrs. Additionally, she performs 6 hours of approved internal moonlighting in Week 3. What is the ACGME compliance determination?

Answer: Non-compliant, because the 4-week average including moonlighting hours exceeds 80 hours per week

The ACGME 80-hour limit is averaged over 4 weeks, not applied as a per-week hard cap. However, ALL moonlighting hours — both internal and external — must be counted toward the 80-hour weekly average. Total clinical hours: 82+76+78+84 = 320. Add 6 moonlighting hours: 326 ÷ 4 = 81.5 hours per week average. This exceeds the 80-hour limit, making the schedule non-compliant regardless of individual week performance.

During an ACGME self-study site visit, the review committee discovers that a program's fatigue management policy instructs residents to 'self-assess for fatigue and adjust clinical duties accordingly,' but provides no structured mechanism for doing so. Under ACGME requirements, what is the MOST significant deficiency this represents?

Answer: Programs must ensure residents can hand off patient care when too fatigued, and the mechanism must be structured and free of consequences — a self-assessment-only policy lacks the required safe reporting pathway

ACGME requires that programs provide residents with a structured, consequence-free mechanism for handing off patient care when fatigue impairs safe performance. A policy that merely asks residents to self-assess and 'adjust' is insufficient because it places the entire burden on the impaired individual and creates no safe escalation pathway. Residents must be explicitly protected from adverse consequences for invoking fatigue mitigation, and the handoff process must be operationally defined — not left to individual judgment in the moment.

A program director informs the program administrator that a fellow disclosed passive suicidal ideation during a routine check-in but stated she does not want any HR or GME documentation created. The fellow is currently providing patient care. What is the program administrator's MOST appropriate FIRST action?

Answer: Ensure the fellow is immediately connected to mental health crisis services and facilitate removal from patient care duties during assessment, while coordinating with the program director — confidentiality does not override imminent safety obligations

Active patient care while experiencing suicidal ideation represents an immediate safety concern for both the fellow and patients. ACGME well-being requirements and standard duty-of-care obligations supersede resident confidentiality preferences when there is imminent risk. The administrator's role is to support the program director in facilitating immediate mental health crisis intervention and safe patient care handoff. Neither a delayed follow-up nor an administrative-first approach addresses the immediate clinical and safety urgency appropriately.

A program administrator is auditing resident well-being survey data and finds that 68% of residents report 'high burnout' on the validated Maslach Burnout Inventory administered annually. Under ACGME expectations for well-being program oversight, which response BEST reflects the program administrator's role?

Answer: Proactively analyze root causes by correlating burnout data with duty hours, rotation schedules, and workload metrics, then prepare an action plan with measurable interventions for the program director's review before the next GME Committee cycle

A 68% burnout rate demands proactive, data-driven root cause analysis — not passive escalation or delayed Annual Program Evaluation inclusion. The program administrator's role includes operationalizing well-being monitoring, which means identifying correlations between burnout and structural program factors (duty hours, scheduling, supervision intensity) and supporting evidence-based interventions. Waiting for the next annual cycle or defaulting to social events misses both the urgency and the systemic nature of burnout causation. ACGME expects continuous, not retrospective, quality improvement for well-being.

A program receives a report that an attending surgeon routinely humiliates residents in the OR in front of patients and scrub staff. Two residents have documented incidents but are afraid to file formal complaints for fear of poor evaluations. The program administrator confirms the attending's evaluations of these two residents are due next month. Which sequence of actions BEST demonstrates compliance with ACGME's requirements regarding mistreatment and retaliation prevention?

Answer: Escalate to the DIO and department chair immediately, document the conflict of interest in the evaluation timeline, and ensure the two affected residents' evaluations are reviewed by a neutral evaluator — then proceed with the mistreatment investigation concurrently

ACGME requires programs to have explicit anti-retaliation protections and to take immediate action when mistreatment is reported. The convergence of a pending mistreatment investigation with an imminent evaluation by the accused attending creates a clear retaliation risk that must be proactively addressed — not avoided by delay. Escalating to senior GME leadership, documenting the conflict of interest, and routing evaluations through a neutral party addresses both the mistreatment allegation and the structural retaliation risk simultaneously. Silent reassignment without disclosure and passive referral to hotlines both fail the ACGME's active institutional protection standard.