LIFE curriculum

Residency Program Insider, July 5, 2005

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Dear residency program colleague:

What do these scenarios have in common?

Each of these scenarios may be a sign of physician impairment.

If you are an experienced residency director, you probably remember the first time you were confronted with a situation like those described above. If you haven't had such an experience-wait. Though fortunately rare for an individual program, an institution that sponsors graduate medical education (GME) usually faces these issues at some point.

These events are often anxiety-provoking, and require education, performance evaluation, human resources, employment law, and employee health expertise to resolve. Not only must programs be skilled in managing the "acute" situation, the Accreditation Council for Graduate Medical Education (ACGME) also expects programs to monitor and teach resident well-being and impairment. Since 2002, the ACGME has required GME programs to monitor resident well-being and fatigue. The expectation is clear, but many of us have been challenged in coming up with the content for this educational program.

In early 2003, the major resident training institutions in North Carolina met with the North Carolina Board of Medical Examiners to discuss what should be taught to fight impairment and how these lessons could be measured.

To address these issues, Duke University Hospital, and the University of North Carolina Hospital's GME programs teamed with other local health organizations to develop an instructional program that could help program directors, faculty, and residents prevent, identify, and manage fatigue and impairment.

They developed a case-based curriculum named the LIFE curriculum (Learning to address Impairment and Fatigue to Enhance patient safety) that focuses on seven vignettes situations that illustrate impaired performance and inappropriate behavior-fatigue, disruptive behavior, stress and depression, substance abuse, burnout, and boundary violations. Faculty experts address prevention, modeling programs to promote resident well-being, early identification, and techniques of practical intervention. The curriculum includes sample policies and documents that address a range of problems, from written remediation plans to institutional policy directives, as well as a teacher's guide, self-assessments, and a post test.

Go to the LIFE curriculum Web site to learn more about the program.

That's all for this week!

All the best,

Kathryn M. Andolsek, MD, MPH
Clinical Professor, Department of Community and Family Medicine
Duke University School of Medicine
Associate Director, Duke Office of Graduate Medical Education
Duke Hospital

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