A narrative review of maintaining and promoting the well-being of residents and faculty in the United States

doi:10.3760/cma.j.cn115259-20240829-00895

Abstract

Abstract: Well-being refers to the individual satisfaction and emotion towards life quality and professional experience. The United States, as the initiator of national standardized residency training, proposes that the well-being of residents and faculty is positively correlated with the residency training quality and outcomes of healthcare services. A series of studies on the theories of well-being of residents and faculty has been conducted, and measures promoting well-being have been explored with the support of themajor medical education organizations since the national standardized residency training in 1981 in the USA. We conducted a narrative review of the primary outcomes from theoretical research and programmatic practices related to well-being in residency training, with the aim of informing residency training in China.

Key words: United States, Well-being, Standardized residency training, Faculty, Residents

CLC Number:

Feng Li, Kuang Ming, Yang Daya, Chen Wei. A narrative review of maintaining and promoting the well-being of residents and faculty in the United States[J]. Chinese Journal of Medical Education, 2025, 45(8): 634-640.

References

[1] Kennedy DR, Clapp P, Deluca JL, et al. Enhancing pharmacy faculty well-being and productivity while reducing burnout [J]. Am J Pharm Educ, 2022, 86(5): 450-456. DOI:10.5688/ajpe8764.
[2] Hart D, Paetow G, Zarzar R. Does implementation of a corporate wellness initiative improve burnout?[J]. West J Emerg Med, 2019,20(1):138-144. DOI: 10.5811/westjem.2018.10.39677.
[3] Panagioti M, Geraghty K, Johnson J, et al. Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis[J]. JAMA Intern Med, 2018,178(10):1317-1331. DOI: 10.1001/jamainternmed.2018.3713.
[4] Dyrbye LN, Leep Hunderfund AN, Moeschler S, et al. Residents' perceptions of faculty behaviors and resident burnout: a cross-sectional survey study across a large health care organization[J]. J Gen Intern Med, 2021,36(7):1906-1913. DOI: 10.1007/s11606-020-06452-3.
[5] Gaeta ED, Gilbert M, Johns A, et al. Effects of mentorship on surgery residents' burnout and well-being: a scoping review[J]. J Surg Educ, 2024,81(11):1592-1601. DOI: 10.1016/j.jsurg.2024.08.001.
[6] Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents[J]. Med Educ, 2016,50(1):132-149. DOI: 10.1111/medu.12927.
[7] Tawfik DS, Profit J, Morgenthaler TI, et al. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors[J]. Mayo Clin Proc, 2018,93(11):1571-1580. DOI: 10.1016/j.mayocp.2018.05.014.
[8] Bilimoria KY, Quinn CM, Dahlke AR, et al. Use and underlying reasons for duty hour flexibility in the flexibility in duty hour requirements for surgical trainees (FIRST) Trial [J]. J Am Coll Surg, 2017, 224(2): 118-125.DOI:10.1016/j.jamcollsurg.2016.10.046.
[9] Martini S, Arfken CL, Churchill A, et al. Burnout comparison among residents in different medical specialties[J]. Acad Psychiatry, 2004,28(3):240-242. DOI: 10.1176/appi.ap.28.3.240.
[10] Shanafelt TD, Bradley KA, Wipf JE, et al. Burnout and self-reported patient care in an internal medicine residency program[J]. Ann Intern Med, 2002,136(5):358-367. DOI: 10.7326/0003-4819-136-5-200203050-00008.
[11] Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population[J]. Arch Intern Med, 2012,172(18):1377-1385. DOI: 10.1001/archinternmed.2012.3199.
[12] Ortega MV, Hidrue MK, Lehrhoff SR, et al. Patterns in physician burnout in a stable-linked cohort[J]. JAMA Netw Open,2023,6(10):e2336745.DOI: 10.1001/jamanetworkopen.2023.36745.
[13] Desai SV, Asch DA, Bellini LM, et al. Education outcomes in a duty-hour flexibility trial in internal medicine[J]. N Engl J Med,2018, 378(16):1494-1508. DOI: 10.1056/NEJMoa1800965.
[14] Hu YY, Ellis RJ, Hewitt DB, et al. Discrimination, abuse, harassment, and burnout in surgical residency training[J]. N Engl J Med, 2019,381(18):1741-1752. DOI: 10.1056/NEJMsa1903759.
[15] Engelhardt KE, Bilimoria KY, Johnson JK, et al. A national mixed-methods evaluation of preparedness for general surgery residency and the association with resident burnout[J]. JAMA Surg, 2020,155(9):851-859. DOI: 10.1001/jamasurg.2020.2420.
[16] Brajcich BC, Chung JW, Wood DE, et al. National evaluation of the association between resident labor union participation and surgical resident well-being[J]. JAMA Netw Open, 2021,4(9):e2123412. DOI: 10.1001/jamanetworkopen.2021.23412.
[17] Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014[J]. Mayo Clin Proc, 2015,90(12):1600-1613. DOI: 10.1016/j.mayocp.2015.08.023.
[18] Yaghmour NA, Brigham TP, Richter T, et al. Causes of death of residents in ACGME-accredited programs 2000 through 2014: implications for the learning environment[J]. Acad Med, 2017,92(7):976-983. DOI: 10.1097/ACM.0000000000001736.
[19] Dunn LB, Iglewicz A, Moutier C. A conceptual model of medical student well-being: promoting resilience and preventing burnout[J]. Acad Psychiatry, 2008,32(1):44-53. DOI: 10.1176/appi.ap.32.1.44.
[20] Kern ML, Waters LE, Adler A, et al. A multidimensional approach to measuring well-being in students: application of the PERMA framework[J]. J Posit Psychol, 2015,10(3):262-271. DOI: 10.1080/17439760.2014.936962.
[21] Slavin SJ, Schindler D, Chibnall JT, et al. PERMA: a model for institutional leadership and culture change [J]. Acad Med, 2012, 87(11): 1481.DOI:10.1097/ACM.0b013e31826c525a.
[22] Stewart MT, Reed S, Reese J, et al. Conceptual models for understanding physician burnout, professional fulfillment, and well-being [J]. Curr Probl Pediatr Adolesc Health Care, 2019, 49(11): 100658.DOI:10.1016/j.cppeds.2019.100658.
[23] Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout[J]. Mayo Clin Proc, 2017,92(1):129-146. DOI: 10.1016/j.mayocp.2016.10.004.
[24] Rosenberg AR. Seeking professional resilience[J]. Pediatrics,2018,141(3):e20172388. DOI:10.1542/peds.2017-2388.
[25] Kiratipaisarl W, Surawattanasakul V, Sirikul W. Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis[J]. BMC Med Educ, 2024,24(1):1234-1240. DOI: 10.1186/s12909-024-06195-3.
[26] Slavin S, Yaghmour NA, Courand J. Support for mental health and well-being in the transition to residency[J]. J Grad Med Educ, 2024,16(2):241-244. DOI: 10.4300/JGME-D-24-00195.1.
[27] Ginocchio LA, Rogener J, Chung R, et al. Brainstorming our way to improved quality, safety, and resident wellness in a resource-limited emergency department [J]. Curr Probl Diagn Radiol, 2022, 51(4): 438-44.DOI: 10.1067/j.cpradiol.2020.03.005.
[28] Ibrahim H, Abdel-Razig S, Konopasek L, et al. Interventions to support resident and fellow well-being during the COVID-19 pandemic: a scoping review[J]. J Grad Med Educ, 2024,16(5):545-556. DOI: 10.4300/JGME-D-24-00016.1.
[29] Kevern T, Davies DR, Stiel K, et al. Impact of opt-out therapy appointments on resident physicians' mental health, well-being, stigma, and willingness to engage[J]. J Grad Med Educ, 2023,15(6):734-737. DOI: 10.4300/JGME-D-22-00898.1.
[30] Edmondson EK, Kumar AA, Smith SM. Creating a culture of wellness in residency[J]. Acad Med, 2018,93(7):966-968. DOI: 10.1097/ACM.0000000000002250.
[31] Thomas LR, Nguyen R, Teherani A, et al. Designing well-being: using design thinking to engage residents in developing well-being interventions[J]. Acad Med, 2020,95(7):1038-1042. DOI: 10.1097/ACM.0000000000003243.
[32] Garrett CC, Doonan RL, Pyle C, et al. Student loan debt and financial education: a qualitative analysis of resident perceptions and implications for resident well-being [J]. Med Educ Online, 2022, 27(1): 2075303.DOI: 10.1080/10872981.2022.2075303.
[33] Philibert I, Friedmann P, Williams WT, et al. New requirements for resident duty hours[J]. JAMA, 2002,288(9):1112-1114. DOI: 10.1001/jama.288.9.1112.
[34] Philibert I, Nasca T, Brigham T, et al. Duty-hour limits and patient care and resident outcomes: can high-quality studies offer insight into complex relationships?[J]. Annu Rev Med, 2013, 64(1):467-483. DOI: 10.1146/annurev-med-120711-135717.
[35] Ahmed N, Devitt KS, Keshet I, et al. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes [J]. Ann Surg, 2014, 259(6): 1041-1053.DOI: 10.1097/SLA.0000000000000595.
[36] Fletcher KE, Reed DA, Arora VM. Patient safety, resident education and resident well-being following implementation of the 2003 ACGME duty hour rules[J]. J Gen Intern Med, 2011,26(8):907-919. DOI: 10.1007/s11606-011-1657-1.
[37] Bilimoria KY, Chung JW, Hedges LV, et al. National cluster-randomized trial of duty-hour flexibility in surgical training[J]. N Engl J Med, 2016,374(8):713-727. DOI: 10.1056/NEJMoa1515724.
[38] Kreutzer L, Dahlke AR, Love R, et al. Exploring qualitative perspectives on surgical resident training, well-being, and patient care[J]. J Am Coll Surg, 2017,224(2):149-159. DOI: 10.1016/j.jamcollsurg.2016.10.041.
[39] Ritenour C, Weiss KB. CLER pathways to excellence, Version 3.0: executive summary[J]. J Grad Med Educ, 2024,16(5):629-631. DOI: 10.4300/JGME-D-24-00701.1.
[40] Pipas CF, Courand J, Neumann SA. The rise of wellness initiatives in health care: using national survey data to support effective well-being champions and wellness programs[EB/OL].[2024-08-01]. https://store.aamc.org/the-rise-of-wellness-initiatives-in-health-care-using-national-survey-data-to-support-effective-well-being-champions-and-wellness-programs.html.
[41] Co J, Weiss KB, Committee CE. CLER pathways to excellence, Version 2.0: executive summary[J]. J Grad Med Educ, 2019,11(6):739-741. DOI: 10.4300/JGME-D-19-00724.1.
[42] Accreditation Council for Graduate Medical Education (ACGME), Accreditation Council for Continuing Medical Education (ACCME), Association of American Medical Colleges (AAMC), et al. The Clinician Educator Milestone Project[EB/OL].[2024-08-01]. https://www.acgme.org/globalassets/pdfs/milestones/standalone/2022/clinicianeducatormilestones.pdf.