To the Editor:
In the September 2015 issue of Academic Medicine, Drs. Jennings and Slavin1 propose that the Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review program should go further, expecting training programs to create wellness initiatives and gather data on resident burnout. Although depression and burnout go hand-in-hand, these syndromes are different2 and, more important, must be treated differently. Just as lifestyle changes are only a part of the treatment for hypertension, wellness programs focused on social events may simply mask the problems faced by trainees who are depressed.
Although the etiology of resident burnout is undoubtedly multifactorial, over the past 10 years, few of the interventions developed to support resident well-being have been evaluated. At the institution level, strategies have ranged from wellness programs emphasizing coping skills or mindfulness, to community-building events and initiatives, to multipronged approaches. The impact of the 2003 ACGME duty hours regulations on burnout has not yet been systematically assessed. In addition to programs designed to address burnout, other institutions have focused on removing barriers to treatment for mental health problems, including depression.
The historical blurring of programs to foster resiliency with initiatives to combat stigma and enhance access to care may have some advantages. Residents and other physicians may be more willing to engage in programs promoting well-being than to seek treatment for depression. However, we argue that it is critical to separate these initiatives from each other. Efforts to improve access to care and provide treatment for trainees are an equally important part of the process to promote well-being and change the culture of medicine.
As the ACGME policy makers, educators, and program directors around the country make efforts to address resident wellness, let us consider separately the issues of resident burnout and depression to ensure that we find effective interventions for each.
Deanna Chaukos, MD
Chief resident, Massachusetts General Hospital and McLean Hospital Adult Psychiatry Residency Training Program, Boston, Massachusetts; [email protected]
Heather S. Vestal, MD, MHS
Associate program director, Massachusetts General Hospital and McLean Hospital Adult Psychiatry Residency Training Program, Belmont, Massachusetts.
Carol Bernstein, MD
Associate professor of psychiatry, vice chair for education, and director of residency training, New York University School of Medicine, New York, New York.
1. Jennings ML, Slavin SJ. Resident wellness matters: Optimizing resident education and wellness through the learning environment. Acad Med. 2015;90:12461250.
2. Iacovides A, Fountoulakis KN, Kaprinis S, Kaprinis G. The relationship between job stress, burnout and clinical depression. J Affect Disord. 2003;75:209221.