Wellness

The Stanford Health Care (SHC) Graduate Medical Education (GME) and Stanford _________________________________ training program strive to create an environment for our house staff (residents & fellows) that are conducive to learning, intellectually stimulating, personally satisfying and safe from physical and emotional harm. The house staff’s well-being is imperative to our success as teachers and to our residency and fellowship training programs. Resources are offered throughout our training programs to ensure our house staff understand the safety concerns not only for the patients, but for themselves as well.

Policy Statement
In the current health care environment, house staff and faculty members are at increased risk for burnout and depression. Psychological, emotional, and physical well-being are critical to the development and maintenance of the competent, caring, and resilient physician. Self-care is an important component of professionalism and high-quality patient care; it is also a skill that must be learned and nurtured in the context of other aspects of residency and fellowship trainings. This policy outlines the responsibility of the Stanford Office of Graduate Medical Education and Stanford training programs to address trainee wellness.

Responsibilities
GME Responsibilities
•	Assist program directors (PDs) in their initiatives to protect trainee time with patients, minimize non-physician obligations and promote progressive training.
•	Provide PDs with resources to educate faculty and trainees about the symptoms of burnout, depression, and substance use and their avoidance.
•	Identify resources for trainee burnout, depression, and substance use.
•	Encourage PDs, trainees, and faculty members to alert designated personnel when they are concerned about a community member who is displaying signs of burnout, depression, substance use, suicidal ideation, or potential for violence, or who is not proactively engaging in self-care.
•	Provide access to confidential, affordable, mental health assessments including access to urgent and emergent care 24 hours a day, 7 days a week.
•	Provide a way for house staff to report unprofessional behavior and a respectful process for reporting, investigating and addressing such concerns.

Program Responsibilities
•	Pay attention to trainee/faculty schedules to look at work intensity and compression factors. Allowing trainees/faculty to attend medical, dental, and mental health care appointments, including those scheduled during work hours.
•	Educate trainees/faculty about symptoms of burnout, depression, substance use and their avoidance, including means to assist those experiencing such issues.
•	Educate trainees/faculty on how to seek appropriate care.
•	Teach and nurture self-care practices, an important component of professionalism and high-quality patient care.
•	Provide a respectful, professional, and civil environment that is free from mistreatment, abuse, or coercion.
•	Provide education about professional behavior and a confidential process for reporting concerns.
•	Encourage trainee/faculty members to alert the _________________________________ Stanford training program when they are concerned about themselves and/or the well-being of others.

Trainee/Faculty Responsibilities
Learning self-care is an important component of professionalism and patient care and trainees have a responsibility to themselves and to their patients and programs to ensure that they are fit for work through behaviors such as:
•	Proactive self-care and model healthy lifestyles and behaviors for patients, students and colleagues.
•	Time management surrounding clinical assignments.
•	Impairment recognition and notification, either from illness, fatigue and substance use in themselves, their peers, and other members of the health care team.
•	Lifelong learning.
•	Performance improvement indicator monitoring.
•	Report duty hours, patient outcomes and clinical experience (such as case logs).
•	Use self-assessment tools provided for personal use.

Resources-List of Wellness Links
Program List:

	

GME List:
•	Ann Dohn, Executive Director of GME, and the Designated Institutional Official (DIO):
Has an "open door" policy and is always ready and willing to help with house staff concerns and problems.

Contact Ann Dohn at 650 723-5948 or adohn1@stanford.edu

•	Anonymously Report a Concern:
https://med.stanford.edu/gme/housestaff/all-topics/anon_report.html

•	Health Connect:
Consultation and service jointly sponsored by the Department of Psychiatry and Stanford Healthcare to facilitate timely access to counseling, stress management and coping skills and mental health services at phone: 650-724-1395
•	
Mickey Trockel, MD, PhD, Clinical Associate Professor, Director
•	Christina Khan, MD, PhD, Clinical Assistant Professor
•	Kristin Raj, MD, Clinical Instructor

With:
•	24x7 Access (someone is always on call via the phone number above- also available for emergencies)
•	Non-urgent issues also can be communicated via e-mail to wellconnect@stanford.edu and will be reviewed and answered on business days
•	Confidential
•	One-time visits or longer-term care through Stanford or referral to providers in the community

•	Office of the Ombudsperson:
The Office of the Ombudsperson, James Laflin, at Stanford University School of Medicine provides a neutral, confidential, and independent resource for dispute resolution for faculty, house staff, postdoctoral scholars and students. The office assists members of the School of Medicine community with any work-related difficulty, including interpersonal conflict or misunderstandings, as well as academic or administrative concerns.

Contact the Office of the Ombudsperson at 650-498-5744 or visit
http://med.stanford.edu/ombuds/

•	The Stanford Faculty and Staff Help Center:
The Help Center provides up to 10 free, confidential, brief counseling sessions to faculty and staff including housestaff, as well as spouses, children, and domestic partners. Their extensive range of services include individual, couple and family counseling, workshops, and peer support groups. All services are offered free of charge. 

To make an appointment call the Help Center at 650 723-4577 or email: Helpcenter@lists.stanford.edu.

•	SHC Mindfulness videos & Podcasts:
https://med.stanford.edu/gme/housestaff/all-topics/mindfulness.html

•	Well-Being Committee:
It is imperative that House Staff in a position of responsibility, whether for patient care or other areas, not have their performance impaired by drugs, alcohol, or other circumstances. For those who recognize that they have such a problem or feel they may be developing a problem or need advice concerning substance abuse, there is a Physician Support Panel which functions on a confidential basis. Members are knowledgeable about the subject and act as physician advocates, offering advice on sources of treatment and other aspects.

Contact Dr. William Berquist, Chairman of the Physicians Support Panel at Stanford University Medical Center, phone 650 498-5603 or visit SHC website.
•	
Well-Being Panel:
Led by psychiatrist Janet Spraggins, MD, the panel of 60 therapists offers 12 free sessions to all House Staff (courtesy of the Well-Being Committee), phone 650 346-3241.
•	Not for emergencies (you will receive a call back within 24 hours)
•	Confidential
•	Access to 60 Non-Stanford Clinic Psychiatrists & Psychologists
•	12 Free Visits (no insurance)
•	After 12 free visits, you can use insurance or pay cash

•	Well-Connect:
House Staff Mental Health and Wellness Program Mickey Trockel, MD, is Director of this confidential consultation and referral service jointly sponsored by the Department of Psychiatry and SHC to facilitate timely access to mental health services. 24x7 Access (someone is always on call - available for emergencies).

Contact Dr. Trockel at 650 724-1395

Fatigue Mitigation Policy & Coverage of Patient Care Responsibilities Protocol
Background
•	There may be circumstances in which house staff may be unable to attend work including, but not limited to fatigue, illness, family emergencies and parental leave.
•	Our training program will allow for an appropriate length of absence for house staff unable to perform their patient care responsibilities.
•	The program will educate all trainee/faculty members to recognize all signs of fatigue, fatigue mitigation processes and encourage house staff to manage potential negative effects.

Procedure
It is important for house staff to have adequate rest before and after clinical responsibilities. Strategies to be used for fatigue mitigation include:
•	Strategic napping.
•	Judicious use of caffeine.
•	Availability of other caregivers.
•	Time management to maximize sleep.
•	Off duty learning to recognize the signs of fatigue.
•	Self-monitoring performance and/or asking others to monitor performance.
•	Remaining active to promote alertness.
•	Maintaining a healthy diet.
•	Using relaxation techniques to fall asleep.
•	Maintaining a consistent sleep routine.
•	Exercising regularly.
•	Increasing sleep time before and after call.
•	Ensuring sufficient sleep recovery periods.

When a house staff identifies him/herself or peers or an attending identifies the house staff as being too fatigued, there are several options for trainee/faculty:

•	Call rooms/sleep quarters are available at all facilities for a nap until trainee/faculty are less fatigued.
•	Utilization of available public or private transportation (Uber).
•	Patient care responsibilities maybe transferred to another provider to ensure continuity of patient care. Attending in charge or the PD should be notified to arrange for the appropriate transfer of care.

			
Program name		Date approved