A Systems Approach to Improving Well-Being in Graduate Medical Education

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, less focus has been 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. Co-sponsored 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.