University of Washington School of Medicine Effective: 12/12/2019

 
 
University of Washington School of Medicine     Effective: 12/12/2019 
Graduate Medical Education Policy    Page 1 of 5 
 
Well-Being Policy 
 
Scope:   All University of Washington (UW) residencies and fellowships accredited by the 
Accreditation Council for Graduate Medical Education (ACGME) and sponsored by the UW 
School of Medicine (UWSOM). Non-ACGME accredited programs or programs accredited by 
the Commission on Dental Accreditation (CODA) may choose to utilize this policy. 
 
Background:  Well-being of residents, fellows (inclusively referred to as “residents” hereafter), and faculty 
members is a key element of a positive learning and working environment. Each program, in 
partnership with its Sponsoring Institution (UWSOM), has the responsibility to address 
clinicians’ psychological, emotional, and physical well-being. All members of the health care 
team share responsibility for the well-being of others.  
 
Policy:  Each residency and fellowship program, in partnership with its Sponsoring Institution, must 
ensure healthy and safe learning and working environments that promote resident well-being 
[ACGME Common Program Requirements (CPR) I.D.2.]. The program must monitor the 
clinical learning and working environment at all participating sites [CPR I.B.3]. 
 
The program, in partnership with the Sponsoring Institution, must offer appropriate 
infrastructure, services, resources (including space, technology, and supplies), and leave 
from training when needed. The responsibility of the program, in partnership with the 
Sponsoring Institution, must include efforts to enhance the meaning that each resident finds 
in the experience of being a physician, including (1) protecting time with patients, minimizing 
non-physician obligations, providing administrative support, promoting progressive autonomy 
and flexibility, and enhancing professional relationships
 
[CPR VI.C.1.a)]; and (2) attention to 
scheduling, work intensity, and work compression that impacts resident well-being [CPR 
VI.C.1.b)]. 
 
Sponsoring Institution’s Responsibilities  
The Sponsoring Institution must (1) oversee its programs’ fulfillment of responsibility to 
address well-being of residents and faculty members, consistent with the Common and 
(sub)specialty-specific Program Requirements, addressing areas of non-compliance in a 
timely manner [ACGME Institutional Requirements (IR) III.B.7.a)]; and (2) ensure that 
programs provide a professional, respectful, and civil environment that is free from 
unprofessional behavior [IR III.B.6.d)]. 
 
Diversity, Equity, and Inclusion (DEI) 
Programs must create and nurture a safe work environment for all. Programs, in partnership 
with their Sponsoring Institutions, must provide a professional, equitable, respectful, and civil 
environment that is free from discrimination, sexual and other forms of harassment, 
mistreatment, abuse, or coercion of students, residents, faculty, and staff [CPR VI.B.6]. No 
staff, resident, or faculty member should experience discrimination or harassment. Any bias 
incidents--offensive remarks/actions--are subject to the UW Medicine Policy on Professional 
Conduct and UW Executive Order 31. For support and resources, see: 
 UW GME Commitment to Diversity, Equity, and Inclusion 
 UW Diversity Blueprint 
 UW Medicine Healthcare Equity Toolkit 
 UW SOM Center for Health Equity, Diversity, and Inclusion 
 UW Network of Underrepresented Residents and Fellows (NURF) 
 UW SOM Committee on Minority Faculty Advancement (CMFA) 
 UW Diversity (UW campus-wide resources on diversity) 

 
University of Washington School of Medicine    Effective: 12/12/2019 
Graduate Medical Education    Page 2 of 5 
 
 
 
Infrastructure and Services 
The program, in partnership with its Sponsoring Institution, must provide for (1) access to 
food while on duty
 
[CPR I.D.2.a)]; (2) safe, quiet, clean, and private sleep/rest facilities 
available and accessible for residents with proximity appropriate for safe patient care
 
[CPR 
I.D.2.b)]; (3) clean and private facilities for lactation that have refrigeration capabilities, with 
proximity appropriate for safe patient care [CPR I.D.2.c)]; (4) accommodation of clinical and 
non-clinical schedules to allow milk expression/pumping during the work day, in accordance 
with federal law (space and time required for lactation are critical for the well-being of the 
resident and their family); (5) safe transportation options for residents who may be too 
fatigued to safely return home [CPR VI.D.3.]; (6) security and safety measures appropriate to 
the participating site
 
[CPR I.D.2.d)]; and (7) accommodations for residents with disabilities 
consistent with the Sponsoring Institution’s policy
 
[CPR I.D.2.e)].  
 
In addition, each program, in partnership with its Sponsoring Institution, must provide access 
to appropriate tools for self-screening
 
[CPR VI.C.1.e).(2)], as well as confidential and 
affordable mental health assessment, counseling, and treatment, including access to urgent 
and emergent care 24 hours a day, seven days a week.
 
[CPR VI.C.1.e).(3)]. Resources at 
participating sites vary by location. Residents should contact the program’s site director for 
more information about a specific site. 
 
Safety Monitoring 
Each program shares responsibility with the Sponsoring Institution for gathering information 
and utilizing systems that monitor and enhance resident and faculty member safety. The 
responsibility of the program, in partnership with the Sponsoring Institution, must include 
evaluating workplace safety data and addressing the safety of residents and faculty 
members [CPR VI.C.1.c)] (e.g., monitoring of workplace injuries, physical or emotional 
violence, and emotional well-being after adverse events.) 
 
Leave 
Each program must allow an appropriate length of absence for residents in circumstances in 
which they may be unable to perform their responsibilities or to attend work, including but not 
limited to fatigue, illness, family emergencies, and parental leave [CPR VI.C.2.)]. In addition, 
residents must be given the opportunity to attend medical, mental health, and dental care 
appointments, including those scheduled during their working hours
 
[CPR VI.C.1.d).(1)].   
 
Each program must (1) adhere to the relevant stipulations stated in University of Washington 
Housestaff Association (UWHA) Contract (Collective Bargaining Agreement) and Residency 
and Fellowship Position Appointment (RFPA); and (2) refer to other pertinent policies and 
procedures, including UW GME Guidance on Reporting Paid and Unpaid Leave Time for 
Residents and Fellows, relevant specialty board leave policies, and program-specific leave 
policies.  
 
Coverage/Continuity of Patient Care 
The program must have policies and procedures in place to ensure coverage/continuity of 
patient care [CPR VI.C.2.a)] when residents are unable to perform their patient care 
responsibilities. Coverage mechanisms should be applied to situations in which resident 
fatigue precludes safe delivery of patient care. These policies must be implemented without 
fear of negative consequences for the resident who is or was unable to provide the clinical 
work [CPR VI.C.2.b). 
 
Schedule Release 
Each program is required to release residents’ clinical and non-clinical schedules to 
residents and faculty in a timely manner in order to accommodate their planning of 
professional and personal lives. See the Program Policy section for the specific 
requirements and recommendations. 

 
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Graduate Medical Education    Page 3 of 5 
 
 
 
Concern Reporting System 
The program director must provide a learning and working environment in which residents 
have the opportunity to raise concerns and provide feedback in a confidential manner as 
appropriate, without fear of intimidation or retaliation [CPR II.A.4.a).(10)]. The program, in 
partnership with its Sponsoring Institution, must encourage residents and faculty members to 
alert the program director or other designated personnel or programs when they are 
concerned that another resident or faculty member may be displaying signs of burnout, 
depression, substance abuse, suicidal ideation, or potential for violence [CPR VI.C.1.e).(1)]. 
Residents and faculty are strongly encouraged to follow the mechanisms developed by the 
UW GME when reporting their concerns. Any bias incidents or violation of nondiscrimination 
and nonretaliation must be reported through the mechanisms described in the UW Medicine 
Policy on Professional Conduct, UW Bias Reporting Tool, University Complaints 
Investigation and Resolution Office (UCIRO), or UW Executive Order 31. In case of 
physician impairment, every individual, including program directors, faculty, and residents, is 
responsible to (1) monitor signs of impairment; and (2) follow the UW GME Physician 
Impairment Policy for reporting. Remediation may take place based on the UW GME 
Remediation Policy and Grievance Procedure. 
 
The Sponsoring Institution with more than one program must ensure availability of an 
organization, council, town hall, or other platform that allows all residents from within and 
across the programs to communicate and exchange information with other residents relevant 
to their programs and their learning and working environment [IR II.C.]. The Resident and 
Fellow Open Forum serves as the platform for communication among residents regarding 
working and learning environments. This Open Forum ensures that all residents have (1) the 
opportunity to directly raise a concern [IR II.C.1]; (2) the option, at least in part, to conduct 
their forum without the DIO, faculty members, or other administrators present [IR II.C.2.]; and 
(3) the option to present concerns that arise from discussions at the forum to the DIO and 
GMEC [IR II.C.3].  
 
Educational Requirements 
The Sponsoring Institution, in partnership with its programs, must educate residents and 
faculty members concerning the professional responsibilities of physicians, including their 
obligation to be appropriately rested and fit to provide the care required by their patients [IR 
III.B.6.b)]. Programs, in partnership with their Sponsoring Institutions, should have a process 
for education of residents and faculty regarding unprofessional behavior and a confidential 
process for reporting, investigating, and addressing such concerns [CPR VI.B.7]. The 
program must integrate residents’ personal and professional well-being as part of 
professionalism into the curriculum
1
. Residents must demonstrate competence in ability to 
recognize and develop a plan for one’s own personal and professional well-being as part of 
professionalism
 
[CPR IV.B.1.a).(1).(f)]
1
.  
 
The responsibility of the program, in partnership with the Sponsoring Institution, must include 
attention to resident and faculty member burnout, depression, and substance abuse [CPR 
VI.C.1.e)]. The program, in partnership with its Sponsoring Institution, must educate 
residents and faculty members to (1) identify the symptoms of burnout, depression, and 
substance abuse, including means to assist those who experience these conditions
 
[CPR 
VI.C.1.e)]; and (2) recognize those symptoms in themselves and how to seek appropriate 
care
 
[CPR VI.C.1.e)]. In addition, programs must educate all faculty members and residents 
to (1) recognize the signs of fatigue and sleep deprivation
 
[CPR VI.D.1.a).]; (2) be aware of 
alertness management and fatigue mitigation processes [CPR VI.D.1.b)]; and (3) use fatigue 
mitigation processes to manage the potential negative effects of fatigue on patient care and 
learning
 
[CPR VI.D.1.c.].   
 
 
 

 
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Program/Faculty Assessment 
Each program’s Program Evaluation Committee (PEC) should consider aggregate resident 
and faculty well-being elements in its assessment of the program
 
[CPR V.C.1.c).(5).(a)]. 
Faculty members must pursue faculty development designed to enhance their skills in 
fostering their own and their residents’ well-being at least once a year [CPR II.B.2.g).(3)]
2
. 
See UW GME Annual Program Evaluation policy.  
 
Well-Being Resources/Tools 
 UW GME Wellness Service (this includes self-screening tools as well as confidential and 
free counseling for residents and their significant others) 
 The Whole U (holistic wellness) 
 UW CareLink (counseling, legal advice, work-life solutions, incident response services) 
 UW Childcare Resources 
 Washington Physicians Health Program 
 ACGME Tools and Resources 
 Well-Being Index (free online tool to assess medical professional’s well-being) 
 Action Collaborative on Clinician Well-Being and Resilience (National Academy of 
Medicine) 
 Now Matters Now (skills and support for coping with suicidal thoughts) 
 American Foundation for Suicide Prevention 
 
Program 
Policies:  Each program must create a well-being policy that encourages optimal resident and faculty 
well-being [CPR VI.C.1.d)] and share it with members of the program. The policy must 
address:  
 
Diversity, Equity, and Inclusion (DEI): Each program must list and share services and 
resources on DEI. 
 
Infrastructure, Services, and Resources: Each program must list and share on- and off-
campus infrastructure, services, and resources on well-being. Each program, in collaboration 
with training sites, must create and share a procedure to adjust breastfeeding-mothers’ 
schedules to protect adequate time for regular milk expression/pumping during the workday.  
 
Safety Monitoring: Each program must designate (an) individual(s) who will collaborate with 
UW GME to collect, analyze, and evaluate workplace safety data. The designee may 
collaborate with the site directors at participating sites to collect data in those sites. 
 
Leave Request and Reporting: Each program must develop a clear, transparent, and 
equitable leave request and reporting process and share it with residents annually. The 
program must use the Residency Management System to report all leave types. Unpaid time 
off must be recorded in Workday (UW’s HR/payroll system). Leave request processes must 
include information on how to report leave related to fatigue, illness, and 
medical/dental/mental care appointments scheduled during working hours. 
 
Coverage/Continuity of Patient Care: Each program must develop a clear system for 
coverage/continuity of patient care. This system must (1) include coverage plans for 
residents who take leave, including leave because of fatigue and medical/dental/mental 
health appointments scheduled during working hours; (2) outline the mechanism to ensure 
that residents who are unable to provide clinical work can utilize leave and request coverage 
for patient care without fear of negative consequences; and (3) explain how the program 
ensures that the coverage system is implemented equitably.  
 

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Graduate Medical Education Page 5 of 5

Schedule Release: Yearly block schedules, including identification of months that will have

call or jeopardy responsibilities, must be distributed no later than the beginning of the

academic year. Exclusive of the first block of the academic year, complete schedules,

including specific shifts, call and clinic schedules, and days off, must be provided no later

than 30 days in advance of the rotation start date. GME strongly encourages distribution of

complete schedules 60 days prior to the rotation start date for those programs with capacity

to do so. [This new schedule expectation will be developed over the remainder of AY20, with

an implementation date of July 1, 2020.] Last minute changes should be communicated to

residents directly and promptly after the release of the schedule, with a notification to the

program director and affected faculty.

Concern Reporting System: Each program must (1) distribute the UW GME Reporting

System to encourage residents to report their concerns; (2) share the UW Medicine Policy

on Professional Conduct, UW Bias Reporting Tool, University Complaints Investigation and

Resolution Office (UCIRO) and Executive Order 31 for bias incident reporting; and (3) outline

and share its own reporting system with all members of the program.

Educational Requirements: Each program must (1) ensure all incoming residents’

completion of an online physician well-being module; (2) list and share fatigue mitigation and

alertness management resources; and (3) incorporate well-being into the curriculum of its

choice

. The program should (1) identify or create a supplemental curriculum

(training/workshops/ conferences) that addresses residents’ personal and professional well-

being, attending to diversity and inclusion; and (2) use survey, individual/focus-group

interview, or other methods of choice to evaluate residents’ ability to recognize and plan for

their own well-being.

Program/Faculty Assessment: Each program should analyze data collected through the

Annual Program Evaluation (APE), resident evaluations of faculty, faculty evaluations of

residents, and other evaluations to improve well-being of all members of the program.

References

Fellowship programs are exempt from this requirement.

Faculty in fellowship programs are exempt from this requirement.