As a component of the NAS, the ACGME has created the CLER Program (Clinical Learning Environment Review) to assess the learning environment of sponsoring institution and participating sites. The goal of the CLER is to increase the educational emphasis on patient safety and quality improvement and reduction of healthcare disparity. The ultimate goal is to help deliver high-quality physicians and higher quality and safer patient care.
In our Child and Adolescent Psychiatry Fellowship program, we provide ample opportunity for fellows to actively participate in the patient safety and quality improvement process at training sites. We also help our fellows develop strong professionalism and leadership skills in addition to clinical skills training. We have developed effective mechanisms to ensure smooth transitions in patient care. Duty oversight, fatigue management, and mitigation are essential and can significantly impact the quality of fellowship program. In addition to regular education, we also provide fellows and faculty seminars/grand rounds through the GME office, and monitor signs of fatigue for fellows and faculty. Fellows and faculty are encouraged to alert the program when they are concerned that fellows or faculty are displaying signs of burnout, depression, or substance abuse.
As pointed out in the Common Program Requirements, “Psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician and require proactive attention to life inside and outside of medicine. Well-being requires that physicians retain the joy in medicine while managing their own real-life stresses. Self-care and responsibility to support other members of the healthcare team are important components of professionalism; they are also skills that must be modeled, learned, and nurtured in the context of other aspects of fellowship training.
Fellows and faculty members are at risk of burnout and depression. Programs, in partnership with their Sponsoring Institutions, have the same responsibility to address well-being as other aspects of resident competence. Physicians and all members of the healthcare team share responsibility for the well-being of each other. For example, a culture which encourages covering for colleagues after an illness without the expectation of reciprocity reflects the ideal of professionalism. A positive culture in a clinical learning environment models constructive behaviors and prepares fellows with the skills and attitudes needed to thrive throughout their careers.
Additionally, our program has developed several mechanisms to ensure the wellness of fellows during the two years of fellowship training with the goal of an optimal learning and training experience.
- We have a Wellness Coordinator (a senior and experience faculty member) who is available 24/7 to fellows and faculty to process any concerns.
- Our fellows and program director are very active in the Wellness Committee at the GME level.
- Our program has fellow/faculty activities aimed at increasing wellness such as fellow-led peer support group, social outings, casual lunches, movie club, annual fellow retreat, annual department retreat, and wellness grand rounds.
- Wellness is a regular agenda item during monthly program director meetings with fellows and bimonthly chief fellow meetings.
- Wide variety of wellness topics (selected by program and fellows) are part of didactic curriculum including sleep deprivation, fatigue management, personal financial management, how to update CV, job search, transition to employment, setting up private practice, etc.