Setting and Problem
The poor well-being of resident physicians is a cause for significant concern. Burnout rates are high, and the consequences, including depression, impaired cognitive function, and increased rates of medical errors, are serious.
Employees who rate their leaders highly in terms of communication, willingness to listen, and response to concerns have significantly better well-being and job satisfaction compared to peers. Thus, we implemented a communications bundle to help residents feel supported and heard.
To improve communication with residents, starting in January 2017, we initiated a group of interventions that we described with the mnemonic RAPID (Real-time, Anonymous, Protocol-driven, Individualized, Defend). The bundle is easy to implement, has no associated cost other than finding time to meet with residents, is welcomed by residents, and can be replicated in any medical specialty.
To provide anonymous feedback in real time, we do the confessions activity described by Karan and colleagues (J Grad Med Educ. 2015;7(4):528–530). Residents write questions, concerns, or feedback on notecards and drop them in a hat. The program director chooses a card at random, reads it aloud, and responds. This allows for residents to get immediate responses from program directors and to hear their colleagues' concerns (which helps alleviate stress). For example, when we do this activity with residents at the end of their first week of residency, hearing that many others have struggled with the same skills (eg, arterial line placement) helps them realize they are not alone.
The second anonymous aspect of our protocol is an always open, online suggestion box. The program director reviews all submissions and writes a monthly e-mail to the residents detailing suggestions and concerns that were submitted and what is being done to address them. Therefore, residents know their concerns are being heard and taken seriously.
The protocol-driven aspect of the mnemonic refers to ALEEN, a method developed by Peter Pronovost, MD, to respectfully communicate with upset patients. It stands for Anticipate their anger and do not take it personally, Listen without interrupting, Empathize with what they are saying, Explain what happened and why, and Negotiate a way forward. We use this same protocol to communicate respectfully with distressed residents. If a resident is upset about a program director's decision, being heard and receiving an empathetic response can help even if the decision does not change.
Individualized refers to one-on-one check-ins between residency leadership and residents at least once a month to ensure they are feeling well and supported, and to hear concerns they want to share.
The last piece of the mnemonic is Defend. When a resident concern is brought to residency leadership, we avoid reactionary judgments. We ask the resident for his or her perspective and see ourselves as an advocate, willing to defend the resident if needed. If we determine resident wrongdoing, we approach our intervention from the framework of being an advocate for their greater goals—to help them build a reputation for the success they want to have.
Outcomes to Date
As seen in the figure, using the Well-Being Index (WebEd Web Solutions, Rochester, MN), a validated measure of well-being, our residents have rates of burnout well below national averages. Our Accreditation Council for Graduate Medical Education annual survey results have improved steadily in every category in the 2 years since we launched this communications bundle, suggesting improved overall resident satisfaction.