Introducing the ACGME’s New “Mental Health and Well-Being during Transitions” Resources – An Interview with Dr. Stuart Slavin
May is Mental Health Awareness Month, which makes it an ideal opportunity for Sponsoring Institutions and programs to address burnout and well-being among residents, fellows, and faculty and staff members, as well as for individuals to prioritize their own well-being. It’s also an important time in graduate medical education (GME) as the academic year is winding down and physicians are transitioning along the medical education continuum through residency, fellowship, and beyond. This month, the ACGME is proud to unveil a new resource dedicated to supporting the mental health and well-being of residents and fellows during these key transitional phases.
ACGME Vice President, Well-Being Stuart Slavin, MD, MEd spearheaded the creation of “Mental Health and Well-Being during Transitions,” available in the ACGME’s online learning portal, Learn at ACGME.
We talked with Dr. Slavin to learn more about this new resource and other ACGME efforts to combat burnout and improve well-being. Dr. Slavin joined the ACGME in 2018 after serving on the faculty at the University of California, Los Angeles (UCLA) and as the Associate Dean for Curriculum at Saint Louis University (SLU), where he led efforts to improve the mental health of medical students. He took the lessons he learned at UCLA and SLU and brought them to the ACGME, where he now leads the organization’s efforts to improve the mental health of residents, fellows, and faculty and staff members across the country.
ACGME: Can you share a little about your background, work, and role? How did you get where you are, especially regarding mental health and well-being education at the ACGME?
Dr. Slavin: My interest and work in mental health and well-being was a completely unexpected career turn for me. I earned a master’s degree in education early on, and was really a curriculum person for much of my career. At UCLA, I held several educational leadership positions, including pediatric residency director, pediatric clerkship director, doctoring course director, and co-chair of the medical school curriculum committee. I moved to SLU to take on the associate dean for curriculum role in 2004, and soon thereafter became aware of research coming out of Mayo Clinic showing high rates of burnout, depression, and suicidality in medical students. That led us to assess depression and anxiety in our own students and embark on a multi-year initiative that ultimately reduced depression and anxiety rates in our pre-clerkship students by 80 percent. I joined the ACGME in 2018, building from that experience, initially as a senior scholar for well-being, and then ultimately into my current role, in which I focus my attention on resident, fellow, and faculty and staff member well-being. It has been a gratifying experience for me!
ACGME: Why is mental health awareness so important in medical education?
Slavin: Learners across the medical education continuum (and faculty and staff members) continue to experience high rates of burnout, depression, and anxiety, and it is incumbent on all of us to be aware of and strive to improve the mental health of all in the GME community. This is particularly important because of strong evidence of the positive impact of practitioner well-being on patient outcomes.
ACGME: Can you talk a little about the ACGME's perspective on mental health in GME and about the organization’s role or influence in this area?
Slavin: I believe that the ACGME was the first education accrediting organization to create significant requirements related to mental health and well-being, and importantly, to identify the learning environment as the primary source of the problem. Substantial resources are being directed by the ACGME to address the problem, most notably through sponsorship and support of the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience; the Clinical Learning Environment Review (CLER) Program; the Back to Bedside initiative, hosting of national well-being symposia, and creation of well-being resources for Sponsoring Institutions, programs, and individuals.
ACGME: Can you share more about the new “Mental Health and Well-Being During Transitions” resource and what inspired its development?
Slavin: The GME community has been aware of the threats to well-being and mental health associated with transitions during medical education, particularly in the transition from medical school to residency, which is characterized by a sudden increase in responsibility, often significant life changes, such as moves to new cities and medical centers, and potential feelings of incompetence. A key piece of evidence of this threat was found in a study conducted by the ACGME that found that the highest suicide rate in residency is in the first three months of the educational program. Suicides represent the tip of the iceberg however, with far larger numbers of residents experiencing self-doubt, worry, anxiety, and/or depression. This new collection of resources was spurred in part by conversations by and with the members of the ACGME’s Council of Review Committee Residents [a council of the Board made up of the resident/fellow representatives from each of the ACGME Review and Recognition Committees].
ACGME: How should people use these resources? What do they need to know?
Slavin: What’s provided in the Transitions materials are inexpensive and easy-to-implement strategies that can be instituted to support residents and fellows during this particularly vulnerable time. There are also resources for residents and fellows themselves, to assist them in managing common and potentially problematic mindsets, such as impostor phenomenon and maladaptive experience, as well as potential feelings of inadequacy, embarrassment, or shame that can contribute to distress.
ACGME: What advice would you give to educators, program directors, and others in medical education about implementing these strategies?
Slavin: I would urge people to act and endeavor to create welcoming and supportive learning environments where residents and fellows – and everyone in the clinical learning environment – feels cared for and safe asking for help when needed.
ACGME: What else are you working on and what comes next?
Slavin: The Transitions resource will continue to grow! We are recording a series of podcast episodes with medical educators and residents about supporting residents during transition periods. A commentary, which I co-authored with Drs. Josepha Cheong, Jessica Bienstock, and Carol Bernstein, will be published in the June issue of JGME [the Journal of Graduate Medical Education]. It focuses on overcoming stigma and other barriers to accessing mental health care, which is another critically important topic. Though stigma appears to be waning somewhat with this generation of learners, far too few residents and fellows seek mental health care when needed. This piece highlights great work being done across the country to increase mental health care utilization.
The ACGME will continue adding to its new Mental Health and Well-Being during Transitions resources, which, as mentioned above, can be accessed in Learn at ACGME. Stay tuned for announcements as new materials are developed and made available, as well as for information about the ACGME’s broader efforts to enhance physician well-being.