Physicians are at high risk of burnout, depression and suicidal ideation, outcomes that affect not only individual physicians but also their patients and the health systems in which they work. For example, poor physician health has been linked to decreased patient satisfaction and increased medical errors, as well as an increase in the likelihood that the physician will reduce their work hours and retire early. These all have a negative impact on the health care system. In terms of career stage, research has shown that medical students are at a particularly high risk of burnout, with rates increasing during the clerkship years. This has been attributed to several professional and personal stressors experienced during training (e.g., heavy workload, sleep deprivation, training years coinciding with major life events such as marriage and childbirth).
Medical students are on the path to becoming residents, and a study by Shanafelt et. al. shows that burned out residents report higher rates of suboptimal patient care and medical errors, which can lead to lower patient satisfaction. We must educate medical learners about this issue using an evidence-based approach and embed physician wellness into educational programs and accreditation standards.
The Royal College Physician Wellness Task Force report provides guidelines and recommendations to help promote physician health and wellness in medical education and throughout the physician career cycle. It emphasizes the shared responsibility of educators, leaders, the profession, learning and clinical environments, the health system, individuals and other stakeholders to optimize wellness. This article will focus primarily on how the recommendations in the report can be applied to promote wellness in medical education.
How the report was created
This report involved the participation of Canadian physician wellness experts on the Physician Wellness Task Force and the Physician Wellness Advisory Committee. It was created to develop evidence-based guidelines and recommendations aligning with the CanMEDS 2015 Physician Competency Framework for optimal physician wellness, including during medical education, evidenced through physician performance, care delivery and health care outcomes.
Five guiding principles were defined to help inform the Royal College’s decision-making.
- Physician wellness is an essential and evidence-based aspect of medical education, practice and quality patient care.
- Physician wellness is important in all phases of the physician career life cycle, from medical school through to retirement.
- The responsibility for physician wellness is shared by the medical profession, individual physicians and medical learning and practice environments.
- Physician wellness requires commitment and engagement from stakeholders across the entire health care system to optimize physician health and well-being.
- Physicians have a collective responsibility to communicate when experiencing difficulties and to listen with support and without judgment when colleagues reveal they are struggling.
The Royal College adapted Brynjolfsson and colleague’s (1997) matrix of change to guide their approach. They followed four steps:
- Identify existing goals and processes:
- They conducted an environmental scan of wellness programming at Canadian medical schools for medical students, residents and faculty.
- They looked at resources offered provincially and nationally.
- They identified target processes and goals.
- They compiled a wish list of what evidence-informed physician wellness programming could look like.
- Look at system interactions:
- To understand how these practices fit together within larger systems, they considered three levels of the medical system: culture/profession, organization/environment and individuals.
- They developed a template to capture this information.
- Identify transition interactions:
- To address the degree of difficulty and necessary transitions in moving from existing to ideal practices, they asked what an ideal physician wellness curriculum could look like.
- They reviewed and culled articles published between 2010 and 2018 to identify evidence-based best practices in physician wellness substantiated by empirical data, ending up with a collection of 156 articles.
- Survey the stakeholders:
- They invited physician wellness experts to share their feedback and expertise.
- They gathered additional suggestions at two workshops, at the International Conference on Physician Health and the International Conference on Residency Education, in 2018.
The report’s 15 recommendations
This report provides 15 recommendations to achieve health and wellness standards. Use them as a checklist to establish wellness in medical education programming at your university.
The recommendations are rooted in the physician wellness competencies of the CanMEDS Professional Role.
Professional Role: As Professionals, physicians are committed to the health and well-being of individual patients and society through ethical practice, high personal standards of behaviour, accountability to the profession and society, physician-led regulation, and maintenance of personal health.
Key Competency: Physicians are able to demonstrate a commitment to physician health and well-being to foster optimal patient care.
Enabling Competency 4.1: Physicians are able to exhibit self-awareness and manage influences on personal well-being and professional performance.
1. Develop and implement educational programming to build awareness around physician wellness at every stage of the physician life cycle
2. Develop programming to raise awareness about systemic issues influencing physician wellness
3. Implement processes that measure and evaluate the state of wellness of medical learners and faculty
4. Implement educational programming to teach skills to promote a culture of wellness in the clinical and learning environments
5. Develop programming to teach advanced leadership skills in physician wellness
6. Develop programming to teach skills to enhance wellness for the individual
Enabling Competency 4.2: Physicians are able to manage personal and professional demands for a sustainable practice throughout the physician life cycle.
7. Promote sustainable practice by creating policies, processes and strategies to facilitate flexibility in training and work
8. Make tools and educational programming available to enable physicians to manage personal and professional demands
9. Acknowledge and support wellness initiatives and programs
10. Make resources that support wellness of all physicians available and easily accessible
11. Encourage leaders to promote and create a culture of wellness
Enabling Competency 4.3: Physicians are able to promote a culture that recognizes, supports, and responds effectively to colleagues in need.
12. Make resources available to support and promote health and wellness
13. Make resources available to support and respond to individuals in need
14. Institute policies to support individuals in acute distress
15. Ensure policies and practices support flexibility in training and practice to meet varied needs and circumstances
The Royal College suggests that these recommendations should not simply lead to didactic sessions, but rather inspire a toolkit of activities and learning experiences in a variety of settings, for a variety of participants. Examples are provided with all recommendations on how they can be achieved.
How to use the report
The CMA hopes you will use this report to inspire change at your institution and find ways to engage and empower learners and instructors to identify wellness challenges, and to support initiatives that foster wellness within your medical school.
Read the entire report here and use the following resources to learn more about teaching a wellness mindset.
The Physician Wellness Task Force members included representation from the CMA, where members were recruited specifically for their expertise and experience with physician wellness.
- American Medical Association: 4 steps to creating an effective physician well-being program
- CMA: Policy on physician health
- Shanafelt et al.: Burnout and self-reported patient care in an internal medical residency program
- Bourcier et al.: Medical student wellness in Canada: time for a national curriculum framework
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