SAEM PULSE | MAY-JUNE 2017
18
Higher rates of burnout and decreased physician well-being carry consequences not just for the health of the individual physician but also for the safety of patients and the quality of care they receive.8 The death of Libby Zion in a New York hospital in 1984, attributed by members of the Bell Commission to cognitive errors made by unsupervised residents who were sleep deprived, incidentally led to the first wellness revolution in GME. The Accreditation Council for Graduate Medical Education (ACGME) implemented the first duty hour restrictions in 2003 with an update to the Common Program Requirements (CPRs), the accreditation framework to which all residency programs must adhere. In addition to mandating a minimum number of days off each month, residents’ weekly work hours and continuous duty hours were limited. This was the first attempt to forcibly restrict the GME clinical work environment specifically to protect patients by simultaneously protecting residents’ wellbeing.
"The emergency medicine and broader graduate medical education communities now appreciate the human consequences that the training environment and clinical practice have on physician wellness." While burnout prevention is an important component of wellness—and indeed might be the most obvious concern for many physicians—it’s part of the larger wellness paradigm, and efforts to move beyond merely prevention of burnout toward the broader goal of personal wellness and happiness across the entire wellness spectrum are underway.9 The ACGME recently revised the CPRs that will become effective in July 2017. “Well-Being” is now included as a core requirement, while “Alertness
Management and Fatigue Mitigation” has been modified and expanded from previous CPR iterations. By recognizing that physician mental, emotional, psychological, and physical wellness are integral to the maintenance of a resilient, capable, healthy, and sustainable workforce, the ACGME has elevated resident well-being to the level of a programmatic requirement.10 Owing to the growing emphasis on resident duty hours, fatigue management is one of the most highly regulated aspects of wellness from the ACGME