A Patient-Centered Approach to Postgraduate Trainee Health and Wellness: An Applied Review and Health Care Delivery Model

Abstract

Attention to the health and wellness of postgraduate medical trainees has increased considerably in recent years, yet the scholarly literature consistently indicates that, in many instances, the medical and mental health care needs of this population remain unmet or only partially met. As a result, trainee health care often falls short of the current standards of the medical profession. Combined with the prevalence of burnout and other mental health conditions among trainees, inadequate health care for this patient population may result in significant negative consequences for trainees' health, safety, and performance.Here, the authors review the scholarly literature explicating the health care needs of postgraduate trainees. They explore the patient-centered medical home model as a potentially effective solution to address the unmet and partially met health care needs of trainees. The authors describe several practical interventions to improve access to care. These include care coordination and referral support, confidential care without perceived conflicts of interest in the training environment, co-location of medical and mental health care, and accommodations for schedule constraints. Finally, the authors explore the role of the medical home in developing and supporting broader institutional efforts to promote wellness.

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

“…Data from included studies show that doctors may encounter difficulties transitioning from medical education to clinical work, particularly 76,170,209 the emotionally demanding nature of the work, which includes long working hours and complicated rotas that frequently change at short notice; 168 being exposed to complex biopsychosocial situations, including seeing patients with symptoms that are not part of a recognised disease entity; 67,147 being exposed to death and dying; 67,91,169,176 being exposed to aggressive interactions with patients; 106,241 and doctors suffering from substance abuse 206 and financial concerns. 79,190 Our analysis shows that developing such awareness is portrayed as a constructive way to train doctors to deal with difficulties. Our analysis shows that developing awareness of the challenges doctors face in the workplace can be an important first step in preventing mental ill-health.…”

“…(The same providers are, however, more likely to self-prescribe antidepressants). Carvour et al, research, USA, medical trainees, 201679…”

Prediction of suicidal ideation risk in a prospective cohort study of medical interns

“…Thus, the prevalence of suicidal ideation within our study sample underscores the magnitude of poor mental health and suicide risk among training physicians and the need for systemic reform that creates a healthier work environment. Connecting training physicians experiencing suicidal ideation to appropriate clinical services is an important next step and shows promise in reducing suicide prevalence [ 7 , 8 , 15 , 23 , 45 , 46 ].…”

“…Importantly, the current study demonstrates that simple screening tools, such as the PHQ-9 [ 29 ] and NEO-FFI [ 35 ], can be used to assess key components of intern mental health. In turn, the screening results can be used by training programs to identify at-risk medical interns and connect them to appropriate clinical services [ 7 , 8 , 15 , 23 , 45 , 46 ].…”