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interns. The intended goals were to promote patient safety and resident well-being
while maintaining educational standards. Whether these goals have been achieved
will be discussed later in this chapter. The ACGME Council of Review Committee
Residents (CRCR), a group of 29 residents and fellows representing all ACGME-
accredited specialties, convened to discuss current resident wellness resources, to
envision the ideal learning environment to promote resident wellness and how to
achieve it. They concluded a national policy on resident wellness should [ 19 ]:
- Increase awareness of stress of residency and destigmatize depression in
trainees - Develop systems to identify and treat depression in trainees in a confidential way
to reduce barriers to accessing help - Enhance mentoring by senior peers and faculty
- Promote a supportive culture
- Encourage additional study of problem to deepen understanding of the issue
Also relevant to graduate medical education is the discord between the actual and
perceived magnitude of the problem by residency program directors. Holmes et al.
found that 69% of residents were burned out; however an overwhelming majority of
program directors (92%) estimated the burnout rate in their program to be 49% or
less [ 7 ]. Only one program director accurately predicted a burnout rate of 50–74%.
Seventy five percentage of program directors also reported challenges managing
residents suffering from burnout or other mental health issues. The authors voiced
concern that despite the difficulties assisting residents with burnout, program direc-
tors still underestimated its prevalence. They hypothesized that a major obstacle for
program directors is the difficulty in identifying burned-out residents outside of the
rare case in which a resident comes forward or when burnout is obviously impeding
the resident’s clinical work. Perhaps more important to program directors is identi-
fying at-risk residents before they become burned out or clinical work is affected.
This will be further explored later in this chapter.
Another concern for surgical program directors is the disproportionately high
rate of attrition in general surgery residency, which is estimated to be between 14%
and 23% [ 20 ]. Program directors expend valuable time and resources to recruit
replacement residents, in addition to regular recruitment and management of cur-
rent residents. While burnout has not been directly associated with surgical resi-
dency attrition, it is likely related considering the most common reasons for leaving
are work hours and lifestyle [ 20 – 22 ].
Contributing Factors
Resident burnout is a real and prevalent problem; however we are just beginning to
explore and understand the contributing factors to burnout, including risk factors
and protective factors. A review in 2004 by Thomas et al. reviewed 15 heteroge-
neous articles on resident burnout and determined that the available data was
L.M. Douglass and A.C. North