Wellness Guidelines for Postgraduate Medicine
PGME Committee approval: 4 November 2021
The Postgraduate Medical Education Office, residency training programs, and Dalhousie University are committed to a safe, positive, and healthy learning environment for all postgraduate trainees.
Promotion of wellness is an active process involving trainees, training programs, Dalhousie University and Maritime Resident Doctors. The literature has consistently shown that postgraduate trainees are at increased risk of burnout which can affect quality and patient safety. It is imperative to ensure a healthy learning environment as mistreatment has been linked to poor mental health outcomes such as substance abuse, decreases in self-esteem, empathy and self-confidence and increased risk of depression.
Managing wellness is something that must be role modelled, taught, and supported through training, as it is intrinsically tied to professionalism and impacts not just the physician, but also patient care. Maintaining wellness is an important skill for residents to learn during residency, as this competency will be required throughout a career in medicine.
1. Training Program Responsibilities:
a) Resident Program Committees and Program Directors must be aware of themes and factors influencing postgraduate trainee health and wellness.
b) Programs should be proactive and creative with wellness initiatives and supportive of wellness committees within their program. Programs must also be aware of key barriers to wellness, including intimidation, harassment, mistreatment, and equity/diversity/inclusion concerns and ensure that residents in the program are not subject to these situations as part of their training.
c) Faculty members involved in the education of residents (including the Program Director) should recognize in themselves, colleagues, and trainees, situations where there may be physical, mental, or emotional problems affecting performance, including excessive fatigue. Any faculty member who recognizes problems must take steps to ensure the safety of the postgraduate trainee and patients.
d) Faculty must respond to resident concerns about physical, mental, emotional, and personal problems that could impact their fitness to perform necessary clinical duties.
e) Each program shall designate a dedicated ombudsperson or equivalent for residents in the program.
f) Programs must make residents aware of and help them access resources in times of difficulty, including:
I. The program director and program administrator
II. The Office of Resident affairs, as well as the Assistant Dean of Resident Affairs
III. The Professional Support Programs available through provincial medical societies
IV. Employee and Family Assistance Program (EFAP) via Health Authorities and Maritime Resident Doctors
V. A dedicated Ombudsperson or equivalent for postgraduate trainees (see above)
g) Program Directors (or designates) are encouraged to address burnout and wellness issues with residents during semi-annual reviews and provide appropriate advice and resources.
h) Programs must provide reasonable accommodations to enable residents to participate in required medical appointments or counseling as required.
i) Programs are required to adhere to the Accommodations Policy of the PGME Office.
j) Programs need to abide by the Maritime Resident Doctor’s contract.
k) Programs must refer all postgraduate trainees undergoing Formal Enhanced Learning Plans to the Resident Affairs Office (see below). Programs are recommended to also refer all postgraduate trainees undergoing an Informal Enhanced Learning Plan to the Resident Affairs Office.
l) Programs must make allowances for time away for emergency dental or medical issues (physical or mental) during working hours as required. These may include issues with the postgraduate trainee’s family. However, appointments that can be scheduled in advance will not be considered emergencies (see postgraduate trainee responsibilities, below).
m) Faculty members must model wellness and should, personally, follow all the responsibilities listed below under “Postgraduate Trainee Responsibilities”.
2. Postgraduate Trainee Responsible:
a) Postgraduate trainees are responsible for reporting fit for duty so that they can perform necessary clinical duties in a safe, appropriate, and effective manner. This includes attention to physical, mental, emotional, and personal problems that may impact one’s fitness.
b) Postgraduate trainees have a professional responsibility to appear for duty appropriately rested and must manage their time before, during and after clinical assignments to prevent fatigue.
c) Postgraduate trainees are responsible for assessing the signs of impairment in themselves, including issues with illness and/or fatigue. Residents experiencing such impairment are to seek appropriate help through the resources listed above. Seeking such assistance shall not jeopardize the status of a postgraduate trainee.
d) If a postgraduate trainee recognizes physical, mental, or emotional problems affecting the performance of another trainee, including impairment due to excessive fatigue, that trainee should encourage their fellow trainee to notify the program director or designate and seek appropriate supports.
e) Postgraduate trainees are also bound by the provisions of the professional standard on the duty to report health professionals should they encounter a colleague who may put patients at risk (e.g. CPSNS Duty to report standards; CPSNB mandatory reporting standard, etc.). As set out in these standards, postgraduate trainees are required to report to the regulator upon forming reasonable grounds to believe that a colleague represents a risk to patients or the profession for reasons of impairment or incompetence. In such circumstances, postgraduate trainees are encouraged to seek out the support and guidance of the Program Director in response to this duty.
f) Postgraduate trainees should maintain their health through routine dental and medical care, including mental health care if needed. Non-urgent appointments should be scheduled in advance; where possible, appointments should be scheduled during times away from clinical duties or during flex days as per the Maritime Resident Doctors contract. If not possible, negotiation of time away from duties for such routine care should be communicated with services and/or faculty as far in advance as possible, employing the assistance of the chief resident, program administrator, and/or program director as required.
3. Postgraduate Medical Education Office Responsibilities:
a) The PGME Office will address issues with programs failing to adhere to their responsibilities as outlined in this policy and other policies, including but not limited to:
I. Resident Safety Policy
II. Accommodations Policy
III. Personal Harassment Policy for Postgraduate medical Education, or any policies on trainee mistreatment
IV. Maritime Resident Doctors contract
b) The PGME Office will assist programs in improving on issues that could impact postgraduate trainee wellness that are identified through internal and external reviews
4. Office of Resident Affairs:
The Office of Resident Affairs in the Faculty of Medicine supports the health and well-being of postgraduate trainees and advocates on their behalf, providing a multi-faceted support to trainees in family medicine and specialty training programs across the Maritimes.
For postgraduate trainees, who feel tremendous pressure to perform at the top of their game all the time, it is extremely important to have a safe place they can come to discuss personal issues or to air professional or academic concerns. The Office of Resident Affairs is at “arm’s length” from the PGME Office and does not share information without the permission of the resident. All discussions are confidential.
The Office of Resident Affairs provides counselling on matters including personal, academic, financial and wellness issues, providing advice to help accommodate the needs of learners with extenuating circumstances. The priority is to ensure postgraduate trainees are well supported and able to perform to the best of their abilities. This can include confidential referral to outside resources, as needed.
In addition to individual support, the Office of Resident Affairs also provides wellness support to groups or programs, with a focus on improving the quality of life and general well-being of residents, providing support to students in distress, and developing individualized wellness programs and workshops, including:
· Free and confidential coaching (in-person, phone, Skype or Facetime, MS Teams)
· Connections to community resources & other helping professionals
· Workshops on relevant health and wellness topics
· Wellness library of resources
· Stress and time management
· Transitioning and progressing in residency
· Self care
The Office of Resident Affairs has compiled relevant resources, tools, and opportunities for learners to promote and maintain their physical, professional and mental well-being. These are on the website: https://medicine.dal.ca/departments/core-units/resident-affairs.html
Academic support is also available to postgraduate trainees through the Office of Resident Affairs, including support for:
· Accommodations: The Office of Resident Affairs can provide advice and help accommodate the needs of postgraduate trainees with special or extenuating circumstances.
· Mistreatment: Postgraduate trainees experiencing mistreatment in the workplace are encouraged to contact the Office of Resident Affairs for confidential support, advocacy, and navigation of the reporting process should they wish to proceed with a complaint.
· Professionalism: CanMEDS 2015 defines the role of the “medical professional” as “a commitment to the health and well-being of individual patients and society through ethical practice, high personal standards of behaviour, commitment to the profession, profession-led regulation, and maintenance of personal health”. Resident Affairs can provide advice and guidance to residents around issues of medical professionalism.
· Health issues, including but not limited to, substance dependency, physical or emotional health issues.