Background: Calls to action to address well-being recommend addressing systems drivers and improving the culture of medicine, in addition to devoting attention to individual self-care. In 2018, an internal medicine residency well-being elective was developed to teach residents about systems and cultural drivers of well-being in residency, and to facilitate deep exploration through individual systems improvement work. Elective objectives included using frameworks to identify factors that contribute to well-being and developing interventions to address organizational and cultural drivers of well-being. Given the recognition that well-being is a health systems issue, commonly used health systems improvement strategies such as Lean methodology and A3 problem solving likely have educational value in designing, implementing and evaluating well-being interventions. In addition, the use of a systems improvement framework in the field of well-being may offer trainees valuable exposure to this frequently used tool.
Purpose: We used a modified Lean A3 tool as a template for residents rotating on a well-being elective to teach residents to use frameworks to develop effective interventions to address cultural and systems drivers of well-being in residency.
Description: We designed a modified A3 template to structure project work during participation in a novel internal medicine residency elective to address well-being as a systems issue. Residents used this template as an educational tool to develop their projects, report results, and evaluate the success of the rotation. Left sided template sections included Background, Current Conditions, Target Conditions (Goals), and Challenge to Address. Right sided sections included Proposed Idea, Outcome/Deliverable, and Reflections/Next Steps. Elective objectives were stated under Current Conditions, to help residents frame their projects within the rotation’s scope. The commitments identified in the nationally-endorsed Charter on Physician Well-being were included in Target Conditions to situate project work in the greater well-being landscape. Residents worked through the left side of the template to develop project ideas, and filled in the right side as they designed and executed their projects. After finishing their projects over the elective month, residents completed the templates with reflections and identified next steps to continue their work. The templates are used to help evaluate the success of the elective. To date, two residents have used the template to pursue projects including developing a peer support group facilitation guide and exploring activities that residents perform outside the clinical environment that contribute to work hours. Additional resident projects are in progress and will be available at the time of presentation. Completed templates are uploaded into a shared folder for all participants to view and are shared with program leadership to update the residency on progress and next steps.
Conclusions: The use of a modified A3 template as an educational tool to structure internal medicine resident elective well-being project work aligns with the national movement to recognize well-being as a health systems issue. Using this template allows residents to use a framework to develop interventions to address systems and cultural drivers of well-being, and standardizes project evaluation.