Well-Being in the Clinical Learning Environment
In the current health care environment, residents, fellows, and faculty members are at an increased risk for burnout and depression. Psychological, emotional, and physical well-being are critical for developing and sustaining competent, caring, and resilient physicians. Self-care is an important component of professionalism and high-quality patient care; it is also a skill that must be learned and nurtured in the context of other aspects of residency training.
The UW Neurology program, in partnership with UW Health, endeavors to enhance the meaning that each resident finds in the experience of being a physician. Some examples of how we accomplish this include:
- Careful attention to scheduling and workload compression. For example, we protect residents’ outpatient time with patients by having a designated Day Float resident manage inpatient issues during the residents’ continuity clinics.
- Minimizing non-physician obligations. UW Health has superb coordinated care services (e.g., case management and social work). Patient transport and phlebotomy services are readily available. Our pharmacy and advanced practice (RN and PA) colleagues assist with management of insulin regimens, anticoagulation, and other protocol-driven medications.
- Providing excellent administrative support from our program coordinator and assistant coordinators.
- Promoting progressive autonomy and flexibility in managing patients on the inpatient and consult services and in clinic.
- Enhancing social and professional relationships:
- Daily interdisciplinary rounds on our neuroscience ward
- Frequent didactic and case conferences
- Monthly wellness and resident administrative meeting (lunch provided)
- Journal clubs (over dinner at a faculty member’s house)
- Resident recruitment dinners at local restaurants
- Annual department-wide holiday party
- Annual Brain Bowl and resident graduation
It is important for both faculty members and residents to be able to identify the symptoms of burnout, depression, and substance use disorder in themselves and in others, and to know how and where to seek appropriate care. Residents and faculty members are to alert the program director, other departmental leaders such as the chair, or the GME office if they become concerned that another resident, fellow, or faculty member may be displaying signs of burnout, depression, substance use disorder, suicidal ideation, or potential for violence. To these ends:
- All residents receive well-being education as part of the on-boarding process.
- Well-being is also addressed at the required patient safety orientation.
- Our monthly resident wellness and administrative meeting provides an informal venue to discuss concerns within the program, including those related to well-being.
- Our monthly newsletter includes information about well-being resources at UW Health, including the Employee Assistance Program.
- Individual well-being and available resources are further discussed at each resident’s semi-annual review and any ad-hoc meetings with the program director.
Resident Medical Care and Patient Coverage
Our program recognizes that residents, like all people, require periodic and episodic medical, dental, and mental health care, which must often be scheduled during working hours. Our Jeopardy Resident and Day Float systems provide the flexibility to allow residents to receive the care they need, while their patients remain covered. Please refer to the Work Hours, Leave, and Moonlighting policy for more information on this coverage.
Primary care: The UW Health Welcome Center can assist in transitioning your care to UW Health (if desired), and in selecting a primary care physician. The phone# is 608-821-4819 and more information is available on the UW Health website here.
Women’s health: UW Health has a web page with resources for gynecologic care, pregnancy and fertility, and other specialty services for women.
Urgent care: UW Health has two urgent care clinics, on opposite sides of the city. The West Towne Urgent Care clinic is closer to University Hospital. The UW Health web page has more information, including wait times.
Video visits: UW Health offers on-demand video visits for low-acuity problems such as upper respiratory symptoms, GI upset, pink eye, joint pain and sprains, headache, and minor skin problems. Click here for more information about how to access this service.
It has been shown that sleep deprivation leads to impaired performance on cognitive tasks. Thus, when physicians are sleep deprived, they are at higher risk for committing medical errors and place their patients at risk. Furthermore, sleep deprivation may put the resident at personal risk, since fatigue is associated with increased rates of motor vehicle collisions. Residents learn about the importance of sleep hygiene as part of the onboarding and patient safety activities noted above, and through annual Safety and Infection Control training.
If patient care needs create resident fatigue sufficient to jeopardize patient care, the Jeopardy Resident (during the week) or the senior backup resident (on weekends) will step in to assume patient care duties. See the section titled The Jeopardy Resident.
Like all other UW Health employees, neurology residents are expected to report to work unimpaired in their ability to perform their duties at all times. If a resident’s medication use may impair his or her fitness for duty, the resident must report this to the program director or the Employee Health Service. Illicit drug use is, of course, not tolerated in the workplace. For more detailed information, please see the following UW Health policies:
- 9.20 Prospective Employee Health Assessment and Drug Screening
- 9.05 Drug-Free Workplace
- 9.34 Fitness for Duty: Impaired Employee
- 9.22 Health Clearance to Return to Work / Continue to Work
The Employee Assistance Program
LifeMatters® Employee Assistance Program is available to all residents, 24/7/365. The password is UWH1, and more information is available here on UConnect. Up to 10 free, confidential counseling sessions, per concern, are available for matters including, but not limited to:
- Stress, depression and personal problems
- Balancing work and personal needs
- Family and relationship concerns
- Alcohol or drug questions or problems
LifeMatters also provides well-being self-assessment tools, financial, and legal consultation services, and child and elder care resources and guidance.
LifeMatters services are available online via the link above, by phone at 1-800-634-6433, by texting “Hello” to 61295, and through the LifeMatters smartphone application, which is available through the Apple App store and Google Play.
If a resident is referred to an in-person counselor in the area, the resident will be advised about any costs, if any. Up to three free, confidential sessions, per presenting concern, are also available to family members, spouses, and other household members.
Numerous other well-being resources are also available to residents, which can be accessed via the UW Health Resident and Fellows Well-being website.
Finally, in the unfortunate event of an acute crisis, residents should call the National Suicide Prevention Lifeline at 1-800-273- TALK (8255) or contact the Crisis Text Line by texting “TALK” to 741741.
Latest revision: 04-12-2019
Justin A. Sattin, MD