Access to Mental Health and PCP Appointments Fatigue Mitigation Psychological Safety Well-Being National Resources The ABCs of Psychological Safety

Program leaders are encouraged to use institutional and national tools, as well as the implementation ideas collated by the leadership of the University of Arizona College of Medicine – Phoenix GME programs and listed on these resource pages to support their improvement efforts.

Well-being 1: Access to Mental Health and PCP Appointments

Level 1 Level 2 Level 3 Level 4 Level 5
The program supports residents and fellows who request time off for personal/ family* medical and mental health appointments by following the Banner Health and GME policies. The program has a written procedure shared with residents/fellows annually for residents/fellows to allow time off in advance for personal/immediate family medical and mental health appointments. The program's residents/fellows and faculty can describe the procedures for requesting and accessing time off in advance for personal/immediate family medical and mental health appointments.

The program has dedicated time in the schedule for all residents/fellows to attend to medical and mental health appointments at least several times a year.		 The program's residents/fellows actively apply and utilize the procedure for requesting and accessing time off in advance for personal/immediate family medical and mental health appointments.

The program reminds and reinforces the value of residents/fellows utilizing their dedicated time in the schedule to attend to medical and mental health appointments at least several times a year.		 The program is an institutional and/or national model for policy, resources, education, and positive culture around providing time away for personal/immediate family medical and mental health appointments. Other programs look to your program for guidance and advice on this topic.
💡Idea 1: Disseminate list of PCPs and dentists covered by Banner insurance at intern orientation
Tools: Implementation:
  • During orientation or the first month of residency/fellowship, have current trainees in your program share the list.
  • Set a calendar reminder or change the agenda to ensure that this happens as planned.
💡Idea 2: Create relationship with specific office (Banner FM or IM) to schedule residents with faculty physicians.
Tools: Implementation:
  • Send by email to all new trainees in your program in the first month.
  • Include the link for how to let the program know of their scheduled time.
💡Idea 3: Create a pathway, well known to residents and fellows, that allows immediate time off when needed for personal/immediate family medical and mental health appointments.
Tools: Implementation:
  • Have a process for reminding residents and faculty of this process quarterly with different voices.
  • Set a calendar reminder or change the agenda to ensure that this happens as planned.
Literature search 

Well-being 2: Fatigue Mitigation

Level 1 Level 2 Level 3 Level 4 Level 5
The program supports residents and fellows who request transition of care when maximally fatigued.

All residents/fellows & faculty receive training to recognize the signs of fatigue and sleep deprivation, alertness management & fatigue mitigation processes.		 The program has a written procedure shared with residents/fellows annually that highlights resources and processes for getting assistance when house staff are maximally fatigued. The program's residents/fellows and faculty can describe the procedures for identifying and supporting a resident/fellow who is maximally fatigued. The program's faculty and residents/fellows are comfortable requesting and apply the procedure when maximally fatigued and utilize it. The program is an institutional and/or national model for policy, resources, education, and positive culture around fatigue mitigation. Other programs look to your program for guidance and advice on this topic.
💡Idea 1: Training to recognize the signs of fatigue and sleep deprivation, alertness management & fatigue mitigation processes
Tools: Implementation:
  • Invite faculty from sleep medicine to present on shift work disorder during didactics.
  • Distribute fatigue mitigation tip sheet and duty hour logging FAQ at key times:
    • The start of training
    • As a reminder when questions arise about duty hours including if a resident/fellow logged something incorrectly.
    • The start of rotations with the most hours and those with night rotations
💡Idea 2: Create a written procedure to highlight resources and processes for getting assistance when maximally fatigued (level 2)
Tools: Implementation:
  • Have a process for reminding residents and faculty of this process at the start of every rotation with high duty hours.
  • Add this as a card in their U of A College of Medicine – Phoenix "sleeping bag."
Literature search 

Well-being 3: Psychological Safety

Level 1 Level 2 Level 3 Level 4 Level 5
The program is inclusive of all residents/fellows and keeps them from harm. It allows them to be themselves and accepts them for who they are, including their unique attributes and defining characteristics. The program satisfies the needs of all residents/fellows to learn and grow. They feel safe to ask questions, give and receive feedback, try new things, and even make mistakes. The program regularly engages residents/fellows to share ideas for improvement and incorporates these ideas in meaningful ways to improve the program. The program welcomes challenging feedback provided by residents/fellows to make the program better. Residents/fellows feel safe to speak up and challenge the status quo. The program communicates progress on the desired opportunities to change or improve. The program is an institutional and/or national model for policy, resources, education, and positive culture around improvement and gathering and receiving feedback. Others look to your program for guidance and advice on this topic.
💡Idea 1: Program Leadership Approachability
Tools: Implementation:
  • Plan CHIM events or other social times for program leaders to get to know trainee's and express interest in their lives and unique backgrounds.
  • Talk to another PD when you get difficult feedback to brainstorm, share ideas, and get support.
💡Idea 2: Forums for Residents/Fellows to share ideas and where the program can welcome challenging feedback and demonstrate the actions being taken based on it
Tools: Implementation:
  • Ombudsperson program
  • At regular intervals, monthly or quarterly provide an update to your PEC action plan to the residents/fellows
  • Each time that you update about improvements, remind them of how to report ideas/concerns (Program and institutional feedback)
💡Idea 3: Program flexibility and support for individualized goals
Tools:
Literature search 

The Leader's Tool Kit for Building Psychological Safety

  1. Setting the Stage 2. Inviting Participation 3. Responding Productively
Leadership Tasks: Frame the Work
  • Set expectations about failure, uncertainty, and interdependence to clarify the need for voice
  • Framing is ongoing process
Emphasize Purpose
  • Identify what's at stake, why it matters, and for whom it matters
 Demonstrate Situational Humility
  • Acknowledge gaps
  • Be inclusive
Practice Inquiry
  • Ask good questions
  • Model intense listening
Set Up Structures and Processes
  • Create forums for input
  • Provide guidelines for discussion
 Express Appreciation
  • Listen
  • Acknowledge and thank
Destigmatize Failure
  • Look forward
  • Offer help
  • Discuss, consider, and brainstorm next steps
To Accomplish: Shared expectations and meaning Confidence that voice is welcome Orientation toward continuous learning

The ABCs of psychological safety

The ABCs Table of psychological safety

Well-Being National Resources (update quarterly)

Do you have a well-being tool to share or need more help? Contact Keri.Watley@arizona.edu and Steven.Brown@bannerhealth.com