To the Editor:
The concept of trainee wellness is a vital part of the discourse on improving the design and quality of undergraduate and graduate medical education. The study of physical and psychosocial wellness is encouraging as the links between wellness and performance, satisfaction, and resilience are strengthened.1 But as the practice of medicine is transformed by the digital age, definitions and applications of wellness should also reflect the evolving ways in which physicians engage and interact with their patients and colleagues digitally, electronically, and online.
Three aspects of “digital wellness” offer relevant ideas about how trainees may be better supported and prepared for the transition to contemporary practice. First, caring for patients in a digital environment is a frontier that, if not empathetically and effectively addressed during medical training, may have unanticipated consequences on the patient–clinician relationship.2 Today’s trainees may be facile users of technology who are accustomed to transitioning from “scene to screen,” but new platforms, including online patient portals tied to electronic health records, as well as telemedicine for triage, consultation, and rural primary care, are reshaping how both patients and physicians use digital media in clinical contexts. To deliver high-quality care and sustain career satisfaction, trainees may benefit from learning experiences that engage these technologies while remaining grounded in the principles of patient-centered practice.
Second, trainees can contribute to new standards for physician professionalism in the social media era. While the American Medical Association endorses separating one’s personal and professional online identities,3 trainees can and should help define more practical approaches to maintaining a digital presence that is accessible and acceptable to both patients and the profession. The Accreditation Council for Graduate Medical Education can strengthen these efforts by including online behavior as part of the professionalism core competency, which may help to reduce potential future repercussions in clinical practice.4
Finally, as patients now use the Internet not only to find but also to compare and rate their physicians, trainees need to be aware of how online decision-support tools, ranging from the ProPublica Surgeon Scorecard to Yelp, will begin to affect their future practices and reputations. The brave new online world of patient-reported quality metrics may also have profound effects on the value-based payment models that will influence how trainees maintain their careers.
Digital wellness should not be overlooked as a component of contemporary training. Students and residents can support and be supported in efforts to enhance engagement with digital innovation in clinical practice and education.
Kevin Koo, MD, MPH, MPhil
Resident physician, Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; [email protected]
1. Lefebvre DC. Perspective: Resident physician wellness: A new hope. Acad Med. 2012;87:598602.
2. Toll E. A piece of my mind: The cost of technology. JAMA. 2012;307(23):24972498.
3. American Medical Association. AMA Code of Medical Ethics: Chapter 2.3.2. Professionalism in the use of social media. https://www.ama-assn.org/sites/default/files/media-browser/code-of-medical-ethics-chapter-2.pdf
. Published 2016. Accessed March 21, 2017.
4. Greysen SR, Chretien KC, Kind T, Young A, Gross CP. Physician violations of online professionalism and disciplinary actions: A national survey of state medical boards. JAMA. 2012;307:11411142.