Wellness Policy

University of Toronto

Neurosurgery Residency Program

Resident Wellness Guidelines

Introduction

The purpose of these guidelines is to acknowledge the potential negative physical and psychosocial impacts of neurosurgical residency and to outline the role of the program in promoting resident wellness.  This supplements the PGME Wellness Guidelines for Postgraduate Trainees.

‘Burnout’ is a phenomenon consisting of emotional exhaustion, reduced sense of personal accomplishment, and depersonalization.  Physician burnout has been linked to depression, substance abuse, as well as poor patient outcomes.  Surgery, and in particular several of its subspecialties, have been identified as having high rates of burnout, depression, and suicidal ideation.  In the 2013 Residency Doctors of Canada (RDoC) survey, eight out of ten respondents noted negative impacts of work related fatigue on their physical health and relationships.  Evidence further suggests that resident physicians are more prone to depression, have higher levels of fatigue, and lower quality of life scores when compared to other members of the population.

Objective: The objective of these guidelines is to outline the role of the University of Toronto’s Neurosurgery Program in promoting wellness as well as preventing and mitigating the effects of acute/chronic stress and/or burnout on residents throughout the course of their training.

1.0 Resiliency Training

• Resiliency is defined as “the ability to recover quickly, resist, and possibly even thrive in the face of direct/indirect traumatic events and adverse situations”.  Resiliency training has reduced the negative mental health effects of acute and chronic stress in military personnel and has more recently been incorporated into physician wellness programs.
  • Resiliency training will be incorporated into the Neurosurgery academic curriculum, including training in mindfulness techniques and seminars from the University of Toronto’s PGME Wellness Workshop Series (https://pg.postmd.utoronto.ca/current-trainees/while-youre-training/access-wellness-resources/wellness-workshop-series/)

2.0 Access to Support

• Resident physicians must have access to various types of support on an ongoing basis as well as acutely for trainees in crisis.  Information on how to access support is reviewed with the Residency Program Director (PD) on entry into the program during their orientation meeting and is also available on the University of Toronto’s PGME website (https://pg.postmd.utoronto.ca/current-trainees/while-youre-training/access-wellness-resources/wellness-support/).

• 2.1 Mentors:
  • All PGY1s will be assigned a senior resident mentor with whom they will meet on a regular basis.  

• 2.2 Residency Program Director:
  • The Program Director maintains an ‘open-door’ policy with respect to being available to residents for advice, informal counselling, and assistance with day to day and acute concerns of residents.  Residents are provided with the PD’s office and email contact information on entry into the program.  As a routine, residents are expected to meet with the PD at least 3 times during the year.  The PD is in attendance and available at the majority of academic half-day lectures on Friday mornings. When necessary, the PD can assist residents in obtaining support locally including assisting them in finding medical consultation for their own health issues, or formal counselling.  The PD may access resources for residents through his/her own medical contacts, PGME, as well as the Department of Surgery’s Postgraduate Education Director.

• 2.3 Program Administrator
  • The Program Administrator is often the point of first contact for residents who wish to discuss non-urgent concerns or seek advice.  A seasoned Program Administrator is often able to identify residents in distress and assists in bringing them to the attention of the PD or assisting them in accessing resources through PGME.

• 2.4 Postgraduate Medical Education (PGME) Wellness Office
  • The PGME Wellness office provides a number of services to residents including:
    • Confidential counselling/psychotherapy and wellness coaching
    • Support during remediation/academic difficulty
    • Career and postgraduate training guidance
    • Disability and accommodation support
    • Educational programming/workshops on themes related to wellness & performance
    • Faculty development related to physician and resident well-being
    • Research pertaining to resident wellness
    • Contact information to the U of T community
  • Contact information for PGME wellness office:

390-500 University Avenue

Toronto, Ontario M5G 1V7

P: (416) 946-3074

E: pgwellness@utoronto.ca

• 2.6 Additional Contacts for resident support:
  • Residents may also access resources from outside the University of Toronto, including support services from PARO, the OMA, Toronto Distress Centre, as well as Telehealth Ontario (see below for contact details).

• • • PARO: Residents or their partners and family members may also contact the Professional Association of Residents of Ontario (PARO) 24 hour Helpline at the toll-free number, 1-866-HELP-DOC (1-866-435-7362), which is accessible anywhere in Ontario, 24 hours a day, 7 days a week. In order to provide this service, PARO has partnered with Distress Centres of Toronto.

• • • Ontario Medical Association (OMA) Physician Health Program (1-800-851-6606)
      • The Physician Health Program (PHP) provides a range of direct services to physicians, residents, and medical students, as well as supportive services to respective family members.

• • • Toronto Distress Centre (24hr) 416-408-4357

• • • Telehealth Ontario1-866-797-0000

• 2.7 Confidentiality
  • All resident supports are offered in a confidential manner without impact on resident education, standing in the program, or future employment.  Insofar as is possible, all steps will be taken to best avoid conflicts of interest with respect to residents in crisis in order to facilitate them obtaining help from the program.  Residents must however understand that patient safety requirements may limit confidentiality in the case of impaired or incapacitated physicians.

3.0 Building a healthy work environment

• Addressing resident wellness requires a holistic approach to the physical and psychosocial environment in which residents train and practice.  Residents are students, care providers, as well as hospital and University employees working under provincial collective agreements.  Their experiences are subject to national postgraduate accreditation standards, local university and departmental and hospital policies.  Consequently, optimizing a healthy work environment involves the engagement of multiple stakeholders by the residency program to advocate on behalf of the residents.

• 3.1 Fatigue Management:
  • Duty hours and their impact on training surgeons is a contentious topic. 
  • On-call hours:  Resident on-call hours are dictated by the PARO-CAHO provincial contract.  The Neurosurgery Program abides by this contract.

• 3.2 Supporting leaves of absence:
  • The residency program shall support residents in need to take a leave of absence on a planned or emergency basis.  Such leaves may include:
    • Sick leave
    • Parental leave
    • Compassionate leave
  • When possible, residents will endeavour to provide the PD and Program Administrator with as much notice as possible when it is anticipated that they will need to take a leave of absence
  • Residents recognize that on rare occasions with sudden and unexpected leave of absence of one of their colleagues, that they may have to be redeployed from one rotation to another in order to assist in the maintenance of a core site resident team to ensure that the remaining residents are not overwhelmed

• 3.3 Resident and Faculty Interactions:
  • Faculty interacting with residents are expected to do so in a respectful fashion that is free of intimidation or harassment. 
  • Faculty who interact with trainees including Fellows, residents, and students are expected to agree to abide by the Department of Surgery’s Guidelines on Respectful Relationships
  • Faculty are required to provide residents with timely and constructive feedback in order to be able to optimize their performance
  • Faculty and Residents are required to review the Department of Surgery’s Policy and Procedures on harassment and the responsibility to report incidents of harassment to the University of Toronto’s PGME Office of Resident Wellness

• 4.0 Physical Environment:

• • • • Ensuring a safe physical work environment for residents is important, as dictated by the Neurosurgery Program’s Safety Policy (see separate document).