Meet and Greet Sessions: A Unique Virtual Opt-Out Approach to Support Trainee Well-Being

Well-being, burnout, and mental health during residency and fellowship training are associated with resident performance, work satisfaction, and attrition, as well as patient safety.^1-5  As a result, the Accreditation Council for Graduate Medical Education mandates access to counseling services, wellness-related educational content for graduate medical education (GME) trainees and program directors, and time off for trainees to access medical and mental health–related appointments.⁶  Despite these requirements, barriers such as lack of time, perceptions of stigma, fear of others’ perceptions or licensure issues, and financial constraints can prevent trainees from seeking mental health care.^7-9 

Programs have typically used an “opt-in” model, by providing trainees information about how to access services, with the expectation that trainees will reach out when in need.¹⁰  An alternative “opt-out” approach seeks to reduce access barriers.^11-15  This approach preschedules sessions for trainees with mental health professionals and has been associated with more residents establishing care with mental health services.¹⁶  One recent study reported a 350% relative increase in utilization of counseling sessions for opt-out compared to opt-in sessions.¹⁰  To date, opt-out initiatives have focused on assessments or screenings. For example, at the University of Colorado,¹²  all interns in internal medicine (IM) and IM-pediatrics were offered an opt-out program consisting of mental health screening during a half day off taken from continuity clinic. The additional financial cost or required time commitment for assessments may not be feasible for many programs.

To reduce these potential barriers, we examined participation rates, feasibility, and acceptability of an opt-out approach that used brief, virtual, individual, nonassessment “meet and greet” sessions during orientation for incoming trainees from participating programs.

From 2021 to 2023, all GME programs at a large urban, university-based hospital (University of California Davis Health) were invited to participate. During orientation, all incoming residents and fellows from participating GME programs were sent individual Zoom invitations for a 20-minute meet and greet session. The sessions were held during protected time within work hours.

The opt-out initiative, called Meet and Greet, was a collaboration between the hospital Employee Assistance Program (EAP), Office of GME, and individual GME programs. Trainees received an email from their program directors introducing the optional initiative. The EAP counselor then sent out individual private Zoom links with a standard description attached to the invite (online supplementary data). Sessions consisted of informal introductions, sharing information about available resources, and general discussions about the kinds of concerns that might prompt trainees to seek help, with the intention of normalizing help-seeking and facilitating familiarity with counselors.

During the first year of implementation, the initiative was delivered in a modified manner for the IM program due to their request for support during a COVID-19 resurgence. Modifications included offering the opt-outs midyear, as opposed to during orientation, and for all residents instead of only new trainees.

Session attendance was used to assess utilization and acceptance. Counselor time and ability of interested programs to block protected time were used to assess feasibility. Feedback was assessed using a 6-question informal survey (online supplementary data), which was developed by the authors without prior testing. It included 4 multiple-choice questions on perceptions about accessibility and acceptability, 1 open-ended question about timing of implementation, and 1 multiple-choice question for those who had chosen to not participate. Following completion of all sessions, each participating program set aside protected time during regular meetings for completion of the Qualtrics survey (Qualtrics) which was given to all trainees whether they attended or not.

Attendance rate as well as requests for counseling sessions following the opt-out sessions was used to measure utilization. Frequency counts from multiple-choice survey questions and nonformal assessment of themes from the open-ended survey questions were used to examine perceptions of intervention.

The University of California Davis Health Institutional Review Board deemed the intervention exempt from review and approved the survey.

Twelve of 74 (16%) GME programs (7 residency and 5 fellowship) participated over the course of the 3 years (Table 1). An average of 8 of 74 (11%) programs participated each year. Of 334 trainees who were sent invitations over 3 years, 182 (54%) attended the sessions, and 116 (35%) scheduled follow-up counseling sessions.

One hundred eight out of 334 trainees (32%) responded to the survey. Of 108 respondents, 80 (74%) attended and 28 (26%) did not attend the sessions. Reports were calculated based on totals for each question, as not everyone filled out every question (Table 2). Fifty-nine of 81 (73%) reported that the session had helped to reduce barriers to seeking out mental health care, and 70 of 81 (86%) felt that the program cared for their well-being. Forty-four of 68 (65%) indicated that they were more likely to seek mental health services as a result of the opt-out sessions. Responses to open-ended questions were indicative of overall agreement with the timing of when opt-outs were offered, though some trainees suggested either midyear, or additional midyear check-ins. Those who chose not to opt in reported spending time with friends/family and using it for down time as the top 2 reasons (Table 2).

The intervention was feasible, as it required an average of 7 hours of counselor time per week over an 8-week period. Program coordinators identified protected time in trainee schedules for the sessions. Use of internal counseling resources added no extra cost.

This opt-out, virtual, individual, brief introduction to mental health resources during orientation was attended by more than half of trainees from participating programs, with one-third reaching out subsequently to start counseling. Feedback from the survey was encouraging, and the approach was highly feasible due to the use of internal resources.

These results suggest that brief virtual opt-out sessions offered to and prescheduled during orientation for new GME trainees may improve the culture surrounding seeking mental health care. Many respondents felt that the strategy reduced barriers and increased the likelihood of them seeking care in the future. Survey findings are comparable to other recent studies on opt-out initiatives.^11,15  This virtual, brief approach is likely easier to implement for most institutions and may also increase access to care when a need arises, due to familiarity with the counselors.¹¹ 

This study is limited by an inability to compare the opt-out strategy with prior use of counseling services. Also, given that a small sample of programs chose to participate, it is not possible to report specialty-specific data due to preserving confidentiality, which limits generalizability of the findings. The low survey response rate and lack of survey validity further limits conclusions.

Currently, the initiative is sustained in its fourth year of implementation. Future studies could examine expanding the initiative to additional GME programs offering midyear check-ins, tracking counseling services use, and following resident well-being measures. This program has been extended to faculty¹⁷  as part of their onboarding process.

Use of an opt-out strategy for virtual, brief, individual, nonevaluative meetings with mental health counselors during orientation of new GME trainees appeared acceptable, with half of trainees participating. The approach is feasible and has been continued. The initiative has the potential for institutions to change culture by normalizing help-seeking with the ultimate goal of impacting the mental health and well-being of our physician workforce.

The authors would like to thank data analyst Kim Ho, MA, for computing the intake numbers from our database related to this initiative. Also, this project would not have been possible had it not been for the support of the UC Davis ASAP team members, UC Davis Health program directors, and program coordinators. They wish to thank them for their interest in the initiative. Lastly, they wish to thank the reviewers and editor of JGME for their valuable comments and guidance.

The online supplementary data contains the participant invitation and the survey used in the study.

Funding: The authors report no external funding source for this study.

Conflict of interest: The authors declare they have no competing interests.

Portions of this study were previously presented at the Western Group Collaborative Educational Spring Conference, April 14-17, 2023, Honolulu, Hawaii, USA.