GME Policy on Well-Being

I. PURPOSE

To provide a framework for meaningfully addressing the well-being of Residents, Fellows, Program Faculty, and Program Staff in Graduate Medical Education programs sponsored by New York Medical College (“NYMC” or the “College”).

II. POLICY

NYMC is aware that in the current health care environment, Residents, Fellows, Program Faculty, and Program Staff are at increased risk for burnout and depression. Psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician, as well as for effective, caring, and resilient Program Faculty and Program Staff. Self-care is an important component of professionalism.  It is also a skill that must be learned and nurtured in the context of other aspects of residency and fellowship training. Residency and fellowship programs have the same responsibility to address well-being as they do to educate and evaluate in other aspects of Resident/Fellow and Program Faculty competence.

Programs must address the well-being of Resident/Fellow and Program Faculty consistent with the procedures below.

III.  SCOPE

This policy applies to all ACGME- or CODA-accredited or recognized programs sponsored by NYMC.

IV. DEFINITIONS 

A. Resident refers to any person enrolled in a residency program accredited by the ACGME or CODA and sponsored by NYMC.

B. Fellow refers to any person enrolled in a fellowship program accredited by the ACGME and sponsored by NYMC.

C. Program Faculty refers to teaching clinicians and other individuals providing significant education or training within the program as indicated on a program’s ACGME (or equivalent CODA) roster.  Program Faculty includes the Program Director and Associate/Assistant Program Directors.

D. Program Staff refers to program coordinators and other program staff who regularly interact with Residents, Fellows, and/or Program Faculty and may serve as first-line individuals for reporting of well-being concerns, as indicated on a program’s ACGME (or equivalent CODA) roster.

E. ACGME is the Accreditation Council for Graduate Medical Education.

F. CODA is the Commission on Dental Accreditation.
 
G. GMEC is the New York Medical College Graduate Medical Education Committee.
 
H. Program Evaluation Committee (PEC) refers to a program committee composed of Program Faculty members and at least one Resident/Fellow that reviews the program’s self-determined goals and progress toward meeting them, guides ongoing program improvement, and reviews the current operating environment to identify strengths, challenges, opportunities, and threats as related to the program’s mission and aims.
 
I. Annual Program Evaluation (APE) refers to the annual comprehensive evaluation of a program with an associated action plan for continued improvement, conducted by the Program Evaluation Committee.
 
J. Individualized Learning Plan (ILP) refers to a Resident/Fellow developed plan aiming to capitalize on strengths and identify areas for growth, reviewed with the Program Director or designee at least semiannually as part of the semi-annual evaluation.
 
K. Work Intensity refers to the amount of mental or physical effort required to complete a task or handle a workload within a given time frame.
 
L. Work Compression refers to a situation in which an unchanged and greater amount of clinical and educational work must be accomplished in fewer work hours, resulting in a more frenetic pace of work.

V. PROCEDURES

A. Program Policies

1. Programs must have a Well-Being Policy that addresses Resident/Fellow, and Program Faculty well-being.
2. Programs must have policies and procedures that address circumstances in which Residents/Fellows are unable to attend work, including but not limited to fatigue, illness, family emergencies, and medical, parental, or caregiver leave.
3. These policies and procedures must ensure coverage of patient care in a manner that does not unduly burden other Residents/Fellows and that facilitates continuity of patient care and must be implemented without fear of negative consequences for the Resident/Fellow unable to provide the clinical work.
4. Policies must be regularly reviewed (at least every 2 years) and updated as needed.

B. Program Oversight of the Clinical Learning Environment

1. Programs must monitor Resident/Fellow work hours with attention to Work Intensity and Work Compression that may impact well-being and adjust scheduling as needed.
2. Programs must be aware of Program Faculty work hours with attention to Work Intensity and Work Compression that may impact the well-being of Program Faculty Members and address scheduling, or advocate for changes, as needed.
3. Programs must be aware of Program Staff work hours with attention to Work Intensity and Work Compression that may impact the well-being of Program Staff and address scheduling, or advocate for changes, as needed.  For example, flexible scheduling may be considered surrounding times of significantly increased Work Intensity, such as application season and surrounding Clinical Competency Committee meetings.
4. Programs must monitor the safety of Residents/Fellows and Program Faculty in the clinical learning environment and promptly address safety concerns.
5. Issues to be addressed include, but are not limited to monitoring of workplace injuries, physical or emotional violence, vehicle collisions related to work fatigue/distraction, and emotional well-being after safety events.
6. Programs must provide adequate sleep facilities and safe transportation options for Residents/Fellows who may be too fatigued to safety return home, inclusive of all pertinent training sites.

C. Program Well-Being Directors

1. Programs must designate a Well-Being Director to provide leadership, along with the Program Director and other program leaders, on areas related to Resident/Fellow, Program Faculty, and Program Staff well-being, inclusion and belonging.
2. The Well-Being Director should not be the Program Director.
3. Programs with less than 10 Residents/Fellows may choose to have a shared Well-Being Director with another program that shares a significant clinical training site (such as with a related fellowship program).
4. The Well-Being Director should serve on and/or provide a report to the PEC at least annually on well-being indicators, activities, and needs of the program.
5. The Well-Being Director serves as a member of the NYMC GMEC Wellness Subcommittee.
6. The Well-Being Director should have protected time dedicated to addressing the responsibilities of this role.
7. The Well-Being Director should be supported to participate in professional development activities aimed to enhance their effectiveness in this role.

D. Program Well-Being Resident/Fellow Liaisons

1. Programs must designate a Resident/Fellow Well-Being Liaison to provide leadership, along with the Program Director and other program leaders, on areas related to Resident/Fellow well-being, inclusion, and belonging.
2. The Well-Being Liaison should not be the Administrative or Educational Chief Resident/Fellow, if applicable.
3. Programs with less than 10 Residents/Fellows may choose to have a shared Well-Being Liaison with another program that shares a significant clinical training site (such as with a related fellowship program).
4. The Well-Being Liaison should serve on and/or provide a report to the PEC at least annually on well-being indicators, activities, and needs of the program from the Resident/Fellow perspective.
5. The Well-Being Liaison serves as a member of the NYMC GMEC Wellness Subcommittee.
6. The Well-Being Liaison should have protected time dedicated to addressing the responsibilities of this role.  Programs might address this protected time through a reduction in the number of continuity clinics or other assigned shifts, or through other mechanisms effective for the program.
7. The Well-Being Liaison should be supported to participate in professional development activities aimed to enhance their effectiveness in this role.

E. Well-Being Education for Residents/Fellows

1. Programs must educate and train Residents/Fellows on their ability to recognize and develop a plan for their own personal and professional well-being.
2. Programs must have a plan to document competency in this area.  This may be addressed as part of ILPs, through structured mentor meetings, or in other manner(s) as effective for the program.
3. Programs must educate Residents/Fellows:

a. Concerning their professional obligation to be appropriately rested and fit to provide the care required by their patients.
b. In identification of the symptoms of burnout, depression, and substance use disorders, suicidal ideation, or potential for violence, including means to assist those who experience these conditions and recognition of these symptoms in themselves and how to seek appropriate care.
c. In recognition of the signs of fatigue and sleep deprivation, alertness management, and fatigue mitigation processes.

4. Content related to Resident/Fellow well-being must be regularly incorporated into structured education time/activities.

a. Programs should consider implementation of programming in areas such as mindfulness, stress reduction techniques, financial health, medical humanities, and narrative medicine, as well as in other areas that meet specific program needs.
b. Programs are encouraged to host at least one grand rounds per year focused on well-being.

F. Well-Being Education for Program Faculty and Program Staff

1. Program Faculty must, and Program Staff should, pursue professional development at least annually in fostering their own and Resident/Fellow well-being. 

a. Such professional development may take place synchronously or asynchronously.
b. Programs must track Program Faculty and should track Program Staff participation in such professional development activities.
c. Programs must address participation in such professional development activities as part of the annual evaluations of Program Faculty.
d. Program Faculty and Program Staff should have protected time to participate in these required activities.

2. Programs must educate Program Faculty, and should educate Program Staff:

a. Concerning their professional obligation to be appropriately rested and fit to provide the care required by their patients.
b. In identification of the symptoms of burnout, depression, and substance use disorders, suicidal ideation, or potential for violence, including means to assist those who experience these conditions and recognition of these symptoms in themselves and how to seek appropriate care.
c. In recognition of the signs of fatigue and sleep deprivation, alertness management, and fatigue mitigation processes.

3. Content related to Program Faculty well-being must be regularly incorporated into professional development provided or facilitated by the program.

G. Mental Health Resources

1. Programs must provide to Residents/Fellows access to confidential, affordable mental health assessment counseling, and treatment, including access to urgent and emergent care 24 hours a day, seven days a week.
2. Programs must regularly educate Residents/Fellows on how to access such services.
3. Programs should consider an opt-out approach for Residents/Fellows to initial appointments with their Employee Assistance or similar programs, such as during orientation.

H. Medical Appointments

1. Residents/Fellows must be given the opportunity to attend medical, mental health, and dental care appointments, including those scheduled during their working hours.
2. Programs must have a policy in place to address appropriate mechanisms for requesting such time away for both urgent and non-urgent appointments.

I. Days Not Scheduled for Duty

1. Programs are encouraged to incorporate days in which Residents/Fellows are not scheduled for duty, which may also be known as flexible or wellness days.  
2. Such days are intended for Residents/Fellows to meet non-illness needs for self and family care, and to lower potential for misuse of sick days.
3. Such days may be considered to include time away for employment or fellowship interviews.
4. Programs should have procedures for how such days are appropriately requested and taken.
5. Programs must follow requirements for such days indicated in the Resident/Fellow collective bargaining agreement, as applicable.

J. Facilitated Discussions

1. Programs should enable regular facilitated discussions during protected time for Residents/Fellows to share and process professionally/emotionally challenging patient care and related situations.
2. Facilitated discussions should generally exclude participation by program leaders and Program Faculty involved in evaluating the Residents/Fellows.
3. Small programs (such as those with less than 10 Residents/Fellows) may opt to share these sessions with a related program(s) or facilitate alternative venue(s) for Residents/Fellows to participate in such discussions.

K. Mechanisms to Address Challenging Processes

1. Programs must have mechanism(s) in place to address factors that challenge Resident/Fellow and Program Faculty ability to protect time with patients, opportunities for meaningful collaboration with colleagues, and meaningful engagement in education.
2. Such challenges may include but are not limited to excessive reliance on Residents/Fellows and Program Faculty to perform non-physician obligations, Work Intensity or Work Compression, inadequate staffing, inefficiencies in the electronic health record and other patient care systems, physical plant inadequacies, and lack of appropriate resources.
3. Mechanisms to address these challenges may include regular meetings with program leadership; regular meetings with clinical site leadership; suggestion boxes, e-mails, or survey links; or other methods deemed effective by the program.

L. Strategic Planning/Well-being Retreats

1. Programs should facilitate strategic planning/well-being retreats for Residents/Fellows at least once annually.
2. Such retreats may include strategic evaluation and formulation of recommendations for continued improvement of the program (which may be used by the PEC), and/or teambuilding or stress-reduction activities.
3. Programs are encouraged to host such events off-site when feasible.
4. Programs are encouraged to consider similar retreats for Program Faculty and Program Staff.

M. Self-Assessment - Programs must provide and/or facilitate access to appropriate tools for self-screening related to well-being and provide education on appropriate use of such tools.

N.  Outcome Measures - Programs, in collaboration with their Well-Being Directors, must address well-being indicators and activities for their Residents/Fellows and Program Faculty and related professional development needs as part of their APE.

VI. EFFECTIVE DATE

This policy is effective July 1, 2025.

VII. POLICY MANAGEMENT

Executive Stakeholder: Dean of the School of Medicine
Oversight Office: Office of Graduate Medical Education