Table 2 GME Well-being Directors’ Perceptions of Unique Challenges in Their Roles

Resources

 • Lack of funding/budget

 • Lack of space

 • Broad scope of role

 • Limited time for trainees to attend to well-being needs

 • Need for offerings to be at off-hours due to trainee schedules

 • Being asked to design, implement, and staff programming

Culture

 • De-prioritization of well-being

 • Mismatch between institutional stated values and values in practice

 • Focus on individual well-being or social activities rather than systems and culture of well-being

 • “Underdog” or “us against them” trainee mentality

 • Hierarchy affecting reporting of mistreatment or toxic culture

 • Mixed reception by residents and fellows to institutional efforts, backlash against “wellness” initiatives

 • “It’s better now than it used to be,” rather than aspirational institutional mentality

Institutional Structure

 • Lack of resident/fellow institutional memory diminishes impact of bigger changes that take time and decreases institutional impetus for investment

 • Resident and fellow needs can fall between the cracks for institutional accountability

 • Large number and diverse structure of programs

 • Lack of seat at table for systemic change

 • Lack of authority to mandate changes at institutional or program level

 • Disconnect among different institutional well-being leaders stemming from organizational structure

 • Making the case for alignment with other institutional efforts

Regulatory Requirements

 • Tension between ACGME mandates for time to attend to well-being needs and health system status as workforce

 • Different specialty board/regulatory requirements can affect ability to make institution-specific policies supportive of well-being

 • Structural challenges of GME at national level can make it hard to improve structures locally (funding mechanisms separated from regulatory mechanisms)