I am incredibly opposed to "wellness as a competency". While I acknowledge the intent, I still find this in poor taste and ultimately tone-deaf.

Physician and specifically resident wellness absolutely needs to be addressed. This is not the way to do so.

1/ https://twitter.com/acgme/status/1306337235269287938

2/ Today is 9/17, National Physician Suicide Awareness Day. Every year, a few hundred of us commit suicide. Many are trainees. It's terrible. It's tragic. Understandably, we want to fix this.

So we started talking about wellness. We started talking about grit and resilience.

3/ Here's the rub: focusing on wellness and resilience places the burden of improvement on the individual. Suddenly, your stress and your burnout is b/c you're not 'well' enough.

You don't balance your life and your work.
You don't find the time to go to a therapist.

4/ Wellness as an individual competency fails the acknowledge the systemic issues that plague medical education.

Sometimes we're not well because we legitimately cannot be well w/in the myriad of systemic issues.

Is that failure now being placed at our feet?

5/ Let's look at level 1: recognizes the importance of getting help.

Ex provided: program leader reaches out about wellness, learner is receptive + acknowledges the concern

Basically, learners have to be able to recognize when they are burned out. Reasonable.

6/ But how do you assess that? Ex here seem to show we should be assessing learner response to program concerns.

This would probably work in a good program, w/ leadership that is trusted. But what if you have a PD who brushed aside your concerns about breaking duty hours?

7/ Or even a chief you don't get along with? How would you take an expression of concern from these people?

Personally, I wouldn't trust it.
Would you?

And then when you turn that concern away... "doesn't meet level 1 competency".

8/ This competency fails to recognize the complexities of the relationship b/t assessor and assessed. You would need an incredible amount of faculty development to get over this hurdle.

Can anyone honestly believe that will happen at even a third of programs?

9/ Let's look at level 3: w/ prompting, reflects on wellness impacting clinical practice.

Ex: writes a reflection, participates in post-code debriefs, seeks support

So, what happens when my reflections are discussions w/ a peer privately over a beer?

10/ If my reflections aren't visible enough, do I fail to meet this level of competency? Not only do I have to reflect (difficult enough at times), I have to make sure someone sees it.

I can't just do it, I have to perform it.

11/ What happens also when I find post-code debriefs uncomfortable in a bad way? What happens when an attending I don't like wants to reflect on a difficult case together?

If I refuse, will I fail to meet this competency?

12/ My reflections on my exp are vital to my growth and incredibly, incredibly personal. This competency forces me make them into some kind of act, a show for my program to feel better b/c now they know my thoughts.

13/ Next is level 4: incorporates self-care skills to support wellness.

No one thought it was a bad idea that a bunch of attendings can now judge and grade learners on what their idea of wellness is?

14/ Even w/ a well-meaning faculty member, who let's say really believes in getting residents out on time. They take on extra time-consuming tasks including talking to a family member.

But for a learner who values their autonomy over their hours worked, is this really good?

15/ When that learner requests the faculty don't do those things and then subsequently works late - but feels better about it b/c of increased autonomy - how does that attending view them?

"Fails to recognize when they need assistance in work tasks"?

16/ Look, I love #CBME. But that doesn't mean everything should be a competency.

Hawthorne effect is real and it's something we should be very very careful with when it comes to the very real issues of mental health.

I'm having a very difficult time seeing how this helps.

17/ As always, would welcome any thoughts.

@maxabillioncruz @Midwest_MedPeds @DrDanSchumacher @JonLimMD @JavyB_MD @RachelPauleyIM @CincyIM @MariaSiowMD @B_Riedlinger @NODlike