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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">https://twitter.com/acgme/sta...
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">https://twitter.com/acgme/sta...
2/ Today is 9/17, National Physician Suicide Awareness Day. Every year, a few hundred of us commit suicide. Many are trainees. It& #39;s terrible. It& #39;s tragic. Understandably, we want to fix this.
So we started talking about wellness. We started talking about grit and resilience.
So we started talking about wellness. We started talking about grit and resilience.
3/ Here& #39;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& #39;re not & #39;well& #39; enough.
You don& #39;t balance your life and your work.
You don& #39;t find the time to go to a therapist.
You don& #39;t balance your life and your work.
You don& #39;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& #39;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?
Sometimes we& #39;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& #39;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.
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?
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& #39;t get along with? How would you take an expression of concern from these people?
Personally, I wouldn& #39;t trust it.
Would you?
And then when you turn that concern away... "doesn& #39;t meet level 1 competency".
Personally, I wouldn& #39;t trust it.
Would you?
And then when you turn that concern away... "doesn& #39;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?
Can anyone honestly believe that will happen at even a third of programs?
9/ Let& #39;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?
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& #39;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& #39;t just do it, I have to perform it.
I can& #39;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& #39;t like wants to reflect on a difficult case together?
If I refuse, will I fail to meet this competency?
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?
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& #39;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?
But for a learner who values their autonomy over their hours worked, is this really good?
15/ When that learner requests the faculty don& #39;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"?
"Fails to recognize when they need assistance in work tasks"?
16/ Look, I love #CBME. But that doesn& #39;t mean everything should be a competency.
Hawthorne effect is real and it& #39;s something we should be very very careful with when it comes to the very real issues of mental health.
I& #39;m having a very difficult time seeing how this helps.
Hawthorne effect is real and it& #39;s something we should be very very careful with when it comes to the very real issues of mental health.
I& #39;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
@maxabillioncruz @Midwest_MedPeds @DrDanSchumacher @JonLimMD @JavyB_MD @RachelPauleyIM @CincyIM @MariaSiowMD @B_Riedlinger @NODlike
