TAGME Resident and Fellow Well-being 5 — Questions and Answers
Question 1: An anonymous report to the GMEC alleges that a program's culture discourages residents from using sick leave. Which ACGME principle is most directly at risk?
- Program accreditation status
- Resident access to appropriate rest and self-care (Correct answer)
- Faculty-to-resident ratio requirements
- Scholarly activity requirements
Correct answer: Resident access to appropriate rest and self-care
ACGME well-being requirements explicitly include that residents must be able to access sick leave and self-care without fear of reprisal or stigma.
Question 2: The 'second victim' phenomenon in residency training refers to:
- A patient harmed by a resident's clinical error
- Healthcare providers psychologically traumatized after being involved in an adverse patient event (Correct answer)
- Family members of patients who experience malpractice
- Residents who are targets of workplace harassment
Correct answer: Healthcare providers psychologically traumatized after being involved in an adverse patient event
The 'second victim' concept describes the emotional and psychological impact on clinicians who are involved in unanticipated adverse patient events.
Question 3: A fellow requests a schedule accommodation to attend weekly therapy sessions. Under ACGME policy and the ADA, the program director should:
- Deny the request to maintain scheduling equity among all fellows
- Provide a reasonable accommodation unless it creates undue hardship on the program (Correct answer)
- Require the fellow to disclose the diagnosis before any accommodation is considered
- Refer the request exclusively to human resources with no program involvement
Correct answer: Provide a reasonable accommodation unless it creates undue hardship on the program
Reasonable workplace accommodations for mental health treatment are required under the ADA and align with ACGME's commitment to resident well-being.
Question 4: Which metric is the most direct indicator that a program's well-being initiatives are effective?
- Increased number of wellness events hosted per year
- Decreased scores on validated burnout instruments over time (Correct answer)
- Growth in the program's wellness committee membership
- Higher resident attendance at optional wellness seminars
Correct answer: Decreased scores on validated burnout instruments over time
Validated instruments such as the Maslach Burnout Inventory provide objective, longitudinal data on whether burnout is actually decreasing.
Question 5: A resident with a known history of depression approaches the coordinator asking whether their medical records from institutional counseling could be accessed by their program director. The correct answer is:
- Yes, program directors can access records to monitor impairment risk
- No, counseling records are confidential and cannot be shared without written consent (Correct answer)
- Yes, but only the GMEC chair may review them
- No, unless the resident is placed on formal probation
Correct answer: No, counseling records are confidential and cannot be shared without written consent
Confidentiality of mental health counseling records is legally and ethically protected; disclosure without written consent violates HIPAA and ACGME confidentiality requirements.
Question 6: Peer support programs in GME are most effective when they are designed with which core feature?
- Mandatory participation for all residents showing performance concerns
- Voluntary, confidential access led by trained peer supporters (Correct answer)
- Oversight by the program director who reviews all sessions
- Formal documentation of all peer support interactions
Correct answer: Voluntary, confidential access led by trained peer supporters
Voluntary participation and confidentiality are essential to peer support effectiveness because they build psychological safety and reduce stigma.
Question 7: When evaluating a resident's fitness for duty after a mental health leave of absence, the program's primary framework should be:
- Whether the resident disclosed the diagnosis voluntarily
- Whether the resident can safely perform essential functions of the training role with or without reasonable accommodation (Correct answer)
- The total number of days of leave taken
- Whether the resident received inpatient versus outpatient treatment
Correct answer: Whether the resident can safely perform essential functions of the training role with or without reasonable accommodation
Fitness-for-duty determinations must be grounded in the resident's functional ability to perform essential job functions, consistent with ADA and patient safety standards.
TAGME Resident and Fellow Well-being 5
An anonymous report to the GMEC alleges that a program's culture discourages residents from using sick leave.
Which ACGME principle is most directly at risk?