The Graduate Medical Education (GME) Committee at Icahn Mount Sinai is committed to restoring and maintaining system-wide “meaning in work and professional fulfillment” for physician trainees. By prioritizing this objective, the Committee aims to promote a culture supportive of the psychological, emotional, and physical well-being of all trainees through a balanced, safe, and enjoyable training experience. It is also well recognized that efforts to improve trainee well-being cannot be undertaken without addressing faculty well-being, which is carried out in conjunction with existing faculty-level wellness interventions.

Departments are expected to focus on resident and fellow well-being by supporting the following areas, as described in the Expectations for the Promotion of Trainee Well-Being:

• Education-to-service balance
• Work hours, leave, and coverage
• Trainee health needs
• Faculty mentorship programs
• Development of a wellness curriculum
• Mandate enforcement, evaluation, and monitoring

The Office of Graduate Medical Education created the GME Well-Being Champions Program to ensure that wellness is not lost among the many competing priorities in academic medicine. In this program, faculty members are appointed to work toward promoting a culture of well-being within a given residency or fellowship. Champions work to incorporate wellness into the daily operations of the training program in both curricular and extracurricular domains. The GME Well-Being Champions Program is directed by Sakshi Dua, MD. For a full list of the current GME Wellness Champions, please see our roster.

It is widely believed that one of the main drivers of physician burnout, as well as the erosion of resident and fellow well-being, is excess non-clinical work or clerical tasks. To promote well-being among our residents and fellow, grants have been made available to programs to support innovative initiatives that facilitate the reduction of these stressors in learning environments.

The expectation is that these grant awards will remove much (or all) of the financial burden many trainees experience. The anticipated outcome of this grant program is the identification of initiatives that produce measurable effects on trainee well-being, are sustainable, and can be replicated across programs and departments.

For the 2022-23 academic year, we were honored to bestow grants to several programs for the following projects:

• The Family Medicine Care Team Assistant Program
  Family Medicine, The Mount Sinai Hospital
  
  
• Facilitation of Accreditation Council for Graduate Medical Education (ACGME) Case Log Entry Through Leveraging of Electronic Medical Record Data
  Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Morningside/Mount Sinai West
  
  
• Addressing Psychiatry Resident Inpatient Clerical Burden Using a Discharge Specialist Staffing Model
  Psychiatry, Mount Sinai Beth Israel
  
  
• Decreasing Administrative Burden on Trainees for Inpatient Genetic Testing
  Medical Genetics, The Mount Sinai Hospital
  
  
• Patient Care Coordinator to Improve Resident Burden in Coordinating Care for Complex Patients
  Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai

• Reducing Work Intensity with a Neurologic Emergency Scribe Program
  Neurology, The Mount Sinai Hospital

In 2022, the ACGME awarded over twenty recipients in the third cycle of funding for Back to Bedside, a resident-led initiative to develop innovative strategies for finding deeper connections with patients to improve physician and patient well-being. 

Two Icahn Mount Sinai trainee-led projects were awarded, along with their team leaders:

• Improving the Home Visit Experience for Providers and Medically Complex, Socially Marginalized Patients
  Jasmine Blake, MD, MSPH, The Mount Sinai Hospital, Internal Medicine-Pediatrics
  
  
• SENOR: Spanish Education Nourishing Our Residents
  Rachel Wilkinson, MD, The Mount Sinai Hospital, Pediatrics

A new multi-program arm was also initiated with the intent of studying a previously successful Back to Bedside-funded project, which was awarded to the following team:

• Engaging Physician Trainees Through Bedside Intensive Care Unit(ICU) Narratives
  Alexander Davidovich, DO, Mount Sinai Morningside/Mount Sinai West, Pulmonary Disease and Critical Care Medicine

While system-level change will have the greatest impact on promoting well-being, there is a recognized additional benefit gained through the development of individual resilience skills.

As part of our continued efforts, the following evidence-based, well-being resources are available for programs, with the express purpose of integrating such activities into their curricula.

• Facilitated Discussion: Reflection is a critical component of training to become a physician. Young physicians are exposed to an enormous number of stressors, including difficult patients, death and dying, and the prospect of medical errors. The normal reaction to these exposures is an emotional response, and yet, there is no dedicated place in traditional training programs that allows one to reflect and process these experiences. Providing such a space to have a discussion, guided by an expert facilitator, and inspired by a brief reading, can be a great outlet for trainees to process the challenging events that occur routinely during training. Furthermore, routine meetings (monthly or bimonthly) with a group of peers has proven effective in reducing job burnout.

• Mindfulness Training: This offering aims to teach simple mindfulness practices to resident physicians with the intent of increasing their capacity for handling stresses of their training environment and increasing their overall sense of well-being. Mindfulness practices include formal practices of mindful attention, body scan, mindful movement, and walking meditation, as well as informal practices of mindful moments and awareness of daily activities. For those residents, fellows, and faculty seeking a broader exposure to mindfulness, an eight-week certificate course titled “Mindfulness Based Stress Reduction,” an evidenced-based practice of mindfulness, is offered twice annually with separate trainee and faculty cohorts.

• Narrative Medicine: Medicine is a storytelling enterprise. Research increasingly shows that attention to literature and the arts helps to develop and nurture skills of observation, analysis, empathy, adaptability, and self-reflection. Narrative medicine has two primary objectives: to strengthen clinical practice by using art to enhance observation, increase self-awareness, and explore different points of view, while providing a structured, noninvasive space for trainees to pause and reflect upon their lives and their work.
  
  
• Practice Enhancement, Engagement, Resilience, and Support (PEERS): The PEERS Program was designed at Icahn Mount Sinai in 2017 to allow medical students to process challenges and learn coping strategies in a supportive group setting.  This trainee-led program has been adopted by residency and fellowship programs, and includes structured, longitudinal content aimed at cultivating well-being, resilience, and community among medical trainees. Jacqueline Hargrove, PhD, is the PEERS Faculty Advisor.

• Resilience Workshops: Offered by The Center for Stress, Resilience, and Personal Growth, resilience workshops are designed to give residents and fellows the tools to meet life's challenges, big and small, and to build on their inherent strengths. The workshops focus areas include realistic optimism, facing fears, social support, self-care, finding meaning and purpose, and managing moral distress.