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) |