The graduate medical education (GME) community received practical, tangible solutions through candid, unscripted conversations in the 2025 Annual Educational Conference Featured Plenary entitled, “Keep Calm and Carry On: Managing Crisis in GME.” ACGME Chief Financial and Administrative Officer and Executive Vice President, ACGME Global Services John Ogunkeye, MBA moderated a panel of three experts who offered steps, strategies, and a toolkit for creating a crisis plan that stemmed from real-world examples they had faced at their own institutions.
“How do we stay composed, how to we stay resolute among uncertainty?” Mr. Ogunkeye asked the audience as he introduced the speakers. “The key is to persevere, adapt, and thrive.”
Cristin Hart, MEd, national director at Tenet Healthcare, outlined the three main crisis types: environmental (natural disasters, weather); facility (active shooter); and human, which tend to be the personal issues GME leaders manage. “Coordinators, program directors, and DIOs [designated institutional officials] tend to be first responders when it comes to human crisis,” she said.
Developing Policy from Experience
Ms. Hart walked the audience through a short history of crises and their results, including the invention of SWAT teams following the 1970 shooting at Kent State; the creation of TSA Security following the attacks on September 11, 2001; and the creation of behavior assessment teams following the 2007 mass shooting at Virginia Tech.
Ms. Hart also discussed examples of her institution’s experience with residents behaving badly. Once, she said, a resident was arrested on charges of drunken disorderly behavior. Another time, a resident was admitted as an intoxicated patient to the emergency room where he practiced and started offering medical advice to other patients in the waiting room. Rather than immediately firing the residents, the program created interventions, final-warning systems, and fitness-for-duty exams for alcohol-related incidents. These policies provide a more measured approach than the two extremes, she said: “They don’t just come back to work and it’s business as usual and we’re not just terminating them and throwing them into the street.”
At one institution, a resident loan fund was created so residents could take out interest-free loans that needed to be paid back before the resident graduated, Ms. Hart shared. The fund provided tangible support, reduced stress, and allowed residents to focus more fully on their jobs.
Maximizing Relationships
George Sarosi, MD, program director for general surgery at the University of Florida, concentrated on how to leverage the expertise of others.
“You’re often going to be called on to do things you’re not prepared to do,” he said, adding that having someone available who could help navigate those things was vital.
With only two years at the institution and one year as associate program director, Dr. Sarosi shared an experience in which he had to meet the parents of a resident who died in a car accident. A quick-thinking program coordinator suggested contacting the organ procurement social worker who worked with the surgical team regularly. The social worker helped Dr. Sarosi meet and manage communication with the grieving family.
Another time, a resident didn’t turn up to a weekend retreat; the resident had died. Dr. Sarosi discovered that a critical care physician at the hospital had previously conducted family notifications while serving in the US Armed Forces. “That military experience was incredibly valuable, because he had been trained to do this,” he said.
Dr. Sarosi advised the audience to establish partnerships before a problem occurs. For example, if residents “no call, no show,” determine who will check on them. Sending another resident or a faculty member to do so could potentially put the checker in a dangerous position; asking police to do a wellness check is a much more appropriate and safe option for all involved, he said, and that call goes much smoother if there’s a relationship with the police before that request is made.
Communicating with Compassion
Jarrett Weinberger, MD, the DIO of the Detroit Medical Center, focused on partnering with the institutional Communications team and Human Resources to provide concise, empathetic and appropriate information, which can build trust within the GME community.
Building a plan for communications ahead of time and knowing what kind of information to report out immediately, two hours after, a day after, and two days after a crisis event is key, he said, warning that, “any delay can lead to accusations that you were denying or downplaying the event.”
He also suggested making sure everyone in a program understands the institution’s existing social media policies, and advised against trying to “beat the news to social media.” Doing so often only leads to more confusing communications, he said.
Dr. Weinberger shared that in June 2024, a resident died in a call room on site following a shift. The entire care team—residents, fellows, faculty members, other care workers, security personnel—“were not only mourning the loss of a colleague and a friend, but grappling with being the first responders” he said.
He recommended having a pre-determined, written action plan of who and how next of kin and/or emergency contacts are notified of a crisis in the immediate aftermath, followed by other key stakeholders: residents in the program, service lines, academic and other hospital affiliates as well. Once you have followed that action plan, he said, your next mission is to be present with the program’s residents.
“I can’t [overstate] the importance of being in the room with the residents in a time of crisis,” he said, noting that in the case of the resident who died on site, “being present and listening were by far and away the most important things we did to support our residents.”
Wrapping up the session, Dr. Weinberger emphasized that GME leaders should remember to be compassionate with themselves.
“Give yourself grace… Servant leaders are consistently putting the needs of others ahead. Give yourself time to reflect and grieve.”