TAGME Resident and Fellow Well-being 4 — Questions and Answers
Question 1: Under ACGME requirements, which entity holds primary responsibility for developing and implementing a resident well-being program?
- The designated institutional official (DIO)
- The sponsoring institution (Correct answer)
- Individual program directors
- The Graduate Medical Education Committee (GMEC)
Correct answer: The sponsoring institution
The sponsoring institution is ultimately responsible for establishing and maintaining a well-being program that applies across all training programs.
Question 2: A program director notices a fellow consistently arriving late and making uncharacteristic documentation errors over several weeks. The most appropriate first step is to:
- Issue a formal written warning
- Refer the fellow directly to the employee assistance program
- Have a private, supportive conversation to assess the fellow's well-being (Correct answer)
- Notify the department chair immediately
Correct answer: Have a private, supportive conversation to assess the fellow's well-being
Direct, private, supportive inquiry is the appropriate first response to identify whether a performance concern stems from a well-being issue before escalating.
Question 3: Which of the following is classified as a major depressive episode symptom that GME administrators should recognize as potentially impairing a resident's function?
- Occasional frustration with long call shifts
- Persistent anhedonia lasting at least two weeks (Correct answer)
- Mild anxiety before a high-stakes procedure
- Short-term fatigue after a busy overnight call
Correct answer: Persistent anhedonia lasting at least two weeks
Persistent anhedonia (loss of interest or pleasure) lasting at least two weeks is a hallmark symptom of major depressive disorder that can impair performance.
Question 4: ACGME's Institutional Requirements mandate that residents must have access to mental health services that are:
- Available only through a referral from the program director
- Confidential, affordable, and easily accessible (Correct answer)
- Limited to in-person counseling at the hospital
- Provided exclusively by psychiatrists within the health system
Correct answer: Confidential, affordable, and easily accessible
ACGME requires that mental health services be confidential, affordable, and easily accessible so residents are not deterred from seeking help.
Question 5: A residency program tracks resident satisfaction surveys and notices a sustained decline in scores related to autonomy and feedback. This data is most useful for:
- Placing the program on probation
- Guiding program improvement efforts at the GMEC level (Correct answer)
- Dismissing the program director
- Reporting the program to state licensing authorities
Correct answer: Guiding program improvement efforts at the GMEC level
Sustained negative trends in resident surveys are quality indicators that the GMEC should use to drive targeted program improvement efforts.
Question 6: When a resident discloses a substance use disorder to their program director, the program director's primary obligation is to:
- Report the resident to the state medical board immediately
- Maintain complete confidentiality with no further action
- Ensure the resident receives evaluation and treatment while protecting patient safety (Correct answer)
- Terminate the resident's contract pending investigation
Correct answer: Ensure the resident receives evaluation and treatment while protecting patient safety
Program directors must balance compassionate support and access to treatment with the non-negotiable duty to protect patient safety.
Question 7: Which well-being intervention has the strongest evidence for reducing physician burnout at the organizational level compared to individual-level strategies?
- Mandatory mindfulness training for all residents
- Structural changes to workflow and scheduling (Correct answer)
- Resilience coaching workshops
- Journaling and gratitude exercises
Correct answer: Structural changes to workflow and scheduling
Evidence consistently shows that systemic/organizational changes to workload and workflow produce larger and more durable reductions in burnout than individual coping strategies.
TAGME Resident and Fellow Well-being 4
Under ACGME requirements, which entity holds primary responsibility for developing and implementing a resident well-being program?