Adibe Bryant, Brown Lawrence, Goulder Alison, Lee Elizabeth, Owen Leena, Roberts William, Yarru Gabrielle
Acad Med. 2025 Aug 1;100(8):884-890. doi: 10.1097/ACM.0000000000005969. Epub 2025 Jan 6.
The imperative to improve the well-being of graduate medical education (GME) trainees has been well documented. While existing interventions have largely centered on increasing individual trainee resilience, there has been less focus on the role of national health policy, economics, and the overall U.S. care delivery system in acting as antecedent contributors to burnout among learners. To explore the impact of these national system level factors, Princeton University hosted the Systems Summit on Clinical Wellbeing in October 2023. Cosponsored by the Accreditation Council for Graduate Medical Education, American Medical Association, and Healing Works Foundation, the event brought together thought leaders, policymakers, and experts from a myriad of backgrounds, including GME leaders and trainees.Through a systems lens, summit attendees identified opportunities and barriers for well-being at both the national and health care organization levels. At the national level, identified barriers included historical national policy decisions, longstanding economic pressures in health care, and their combined cumulative impact on trainees. At the health care organization level, trainees pointed to an incongruity between common institutional wellness offerings and their more immediate support needs, along with unsustainable workload expectations, including the added toll of non-physician tasks (e.g., scheduling). A lack of appropriate tools for assessing well-being through a systems lens further compounds these issues. More actionable outputs may be achievable through the integration of operationally oriented well-being metrics (e.g., clinical and academic workload hours, call frequency, stay intent).Long overdue updates to ill-fated national policy decisions, along with a redirection of the focus of GME well-being efforts at the programmatic level, could, in combination, fundamentally reshape the experience of trainees, contributing to lower incidences of depression, exhaustion, and burnout.
改善毕业后医学教育（GME）学员福祉的必要性已有充分记录。虽然现有的干预措施主要集中在提高学员个人的复原力，但对于国家卫生政策、经济以及美国整体医疗服务体系在导致学员倦怠方面的先行作用关注较少。为了探讨这些国家系统层面因素的影响，普林斯顿大学于2023年10月举办了临床福祉系统峰会。该活动由毕业后医学教育认证委员会、美国医学协会和康复工作基金会共同赞助，汇集了来自众多背景的思想领袖、政策制定者和专家，包括GME负责人和学员。通过系统视角，峰会与会者确定了国家和医疗保健组织层面在福祉方面的机遇和障碍。在国家层面，确定的障碍包括历史性的国家政策决策、医疗保健领域长期存在的经济压力及其对学员的综合累积影响。在医疗保健组织层面，学员指出常见的机构健康福利与他们更直接的支持需求之间存在不协调，以及不可持续的工作量期望，包括非医师任务（如排班）带来的额外负担。缺乏通过系统视角评估福祉的适当工具进一步加剧了这些问题。通过整合以运营为导向的福祉指标（如临床和学术工作时长、值班频率、留任意愿），可能会取得更具可操作性的成果。早就该对注定失败的国家政策决策进行更新，同时在项目层面重新调整GME福祉工作的重点，两者结合起来可能会从根本上重塑学员的体验，降低抑郁、疲惫和倦怠的发生率。
