Resident/Fellow Wellness

Scope

This policy applies to all Indiana University School of Medicine (IUSM) Graduate Medical Education (GME) resident and fellow trainees. 

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Policy Statement

Psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician and require proactive attention to life inside and outside of medicine. Well-being strives for physicians to retain the joy in medicine while simultaneously integrating their individual lives separate from their educational training. Self-care and responsibility to support other members of the health care team are important components of professionalism; they are also skills that must be modeled, learned, and nurtured in the context of other aspects of GME training.

Programs, in partnership with their Sponsoring Institutions, have the same responsibility to address well-being as other aspects of trainee competence. Physicians and all members of the health care team share responsibility for the well-being of each other. A positive culture in the clinical learning environment models constructive behaviors and prepares residents and fellows with the skills and attitudes needed to thrive throughout their careers.

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Reason for Policy

IUSM is committed to addressing trainee physician well-being for individuals and as it relates to the learning and working environment. The creation of a learning and working environment with a culture of respect and accountability for physician well-being is crucial to physicians’ ability to deliver the safest, best possible care to patients.

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Procedures

The responsibility of the program, in partnership with the Sponsoring Institution, to address well-being must include:

• efforts to enhance the meaning that each resident finds in the experience of being a physician, including protecting time with patients, minimizing non-physician obligations, providing administrative support, promoting progressive autonomy and flexibility, and enhancing professional relationships;
• attention to scheduling, work intensity, and work compression that impacts trainee well-being;
• evaluating workplace safety data and addressing the safety of trainees and faculty members;
• policies and programs that encourage optimal trainee and faculty member well-being;
• encouragement of trainees to make use of allowed time away from training each year as well as a reasonable number of personal days;
• the opportunity for trainees to attend medical, mental health, and dental care appointments, including those scheduled during their working hours;
• attention to trainee and faculty member burnout, depression, and substance abuse. The program, in partnership with its Sponsoring Institution, must educate faculty members and trainees in identifying symptoms of burnout, depression, and substance abuse, including means to assist those who experience these conditions. Trainees and faculty members must also be educated to recognize those symptoms in themselves and how to seek appropriate care. The program, in partnership with its Sponsoring Institution, must:
  • encourage residents and faculty members to alert the program director or other designated personnel or programs when they are concerned that another resident, fellow, or faculty member may be displaying signs of burnout, depression, substance abuse, suicidal ideation, or potential for violence;
  • provide access to appropriate tools for self-screening; and,
  • provide 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.

GME will use well-being survey data to monitor trainee well-being, professional fulfillment, and burnout.

There are circumstances in which trainees may be unable to attend work due to factors including, but not limited to, fatigue, illness, family emergencies, and parental leave. Each program must allow an appropriate length of absence for residents unable to perform their patient care responsibilities. The program must have policies and procedures in place to ensure coverage of patient care.

These policies must be implemented without fear of negative consequences for the trainee who is or was unable to provide the clinical work.

Each program must ensure continuity of patient care, consistent with the program’s policies and procedures in the event that a trainee may be unable to perform their patient care responsibilities due to excessive fatigue.

The program, in partnership with its Sponsoring Institution, must ensure adequate sleep facilities and safe transportation options for trainees who may be too fatigued to safely return home.

Each program must develop and integrate wellness curricular activities within the existing educational program

Personal Days

Personal time is meant to improve resident health and wellbeing by providing trainees with the flexibility to schedule doctor’s appointments, dentist’s appointments, car repairs, et cetera, and to encourage trainees to model healthy lifestyles for their patients. 

All training programs must have policies in place regarding personal time off.

Fatigue Management and Mitigation

1. The Program must:

1. implement policies and procedures consistent with the institutional and program requirements for trainee work hours;
2. educate all faculty and trainees to recognize the signs of fatigue and sleep deprivation;
3. educate all faculty and trainees in alertness management and fatigue mitigation processes;
4. encourage trainees to use fatigue mitigation processes to manage the potential negative effects of fatigue on patient care and learning. Each program must ensure continuity of patient care, consistent with the program’s policies and procedures, in the event that a resident may be unable to perform their patient care responsibilities due to excessive fatigue; and,
5. in partnership with its Sponsoring Institution, ensure adequate sleep facilities and safe transportation options for residents who may be too fatigued to safely return home.

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Definitions

ACGME is the Accreditation Council for Graduate Medical Education.

A trainee is an IUSM resident or fellow, or a non-IUSM resident or fellow electively rotating through IUSM who provides clinical care as part of a GME program.

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Implementation

The Designated Institutional Official (DIO) for Graduate Medical Education is responsible for implementation of this policy. 

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Oversight

Policy authority for this document resides with the Graduate Medical Education Committee.  The DIO and the Graduate Medical Education Committee are responsible for oversight.  This policy will be reviewed every three years or more often if deemed necessary.

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History

1. Policy gme-adm-0045 discussed at GMEC 19 August 2020.
2. Reviewed by Policies & Procedures 12 October 2021.
3. Approved by GMEC 20 April 2022.
4. Policy updated 11 March 2026. 
5. Policy approved by GMEC 18 March 2026.

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