The Accreditation Council on Graduate Medical Education’s Policy and Recommendations Regarding Psychiatry Residencies’ Monitoring and Managing the Stress Levels of Their Trainees: A White Paper

Abstract

The Accreditation Council for Graduate Medical Education (ACGME) has tasked me to consult on whether they should mandate that all ACGME-approved psychiatry residency programs should monitor and manage the stress levels of their residents. Psychiatry residents may face significantly severe occupational stresses during their training— including facing the aftermath of a patient suicide and frequently encountering emotional distress—and may subsequently develop anxiety and comorbid depression as measured by one of several standardized and validated instruments assessing burden or burnout . In some instances, the psychiatry resident may eventually burn out and become impaired in his or her ability to competently care for patients.

Current epidemiological evidence suggests that while a majority of psychiatric residents are exposed to threshold adverse events such as patient suicides, a minority of them are offered non-punitive formal or informal debriefing opportunities to learn from such denouements. However, an examination of the published literature reveals that there is no clear dose-response relationship between psychiatric residents’ exposures to threshold adverse events and their subsequent development of clinically significant mental illness or impairment. Moreover, residents from other specialties besides psychiatry may be equally exposed to the occupational stresses of residency training and may also benefit from having their stress levels monitored and managed.

Residency programs differ widely in their protocols to debrief residents who face significant morbidity and mortality of their patients. Furthermore, residents are unique individuals with varying degrees of innate or learned ability to handle occupational stresses relevant to patient care. Thus, in line with their goal to improve the training environment of residents to maximize patient safety and quality, the ACGME should encourage all residency program directors to offer informal and formal stress reduction programs such as yoga, meditation, relaxation, and fitness classes—ideally within departments of GME—as well as confidential counseling whenever practically possible. Residents of all specialties should be provided ample opportunities to learn pragmatic skills in anxiety reduction and stress management specifically regarding the occupational stresses of patient care. In this manner, resident physicians are able to learn to optimize their ability to offer compassionate care for their patients over the span of their careers.