Reducing Suicide Among Resident Trainees: A novel approach to reducing suicide among resident physicians by altering culture, addressing stigma, and changing the conversation around suicide

Body of Abstract: Suicide rates among resident physicians in training has long been recognized as an area of critical need and intervention. Suicide is the second leading cause of death among those in training to become physicians and the first leading cause of death for male trainees (Yaghmour et. Al.). The statistics of suicidal ideation and psychiatric distress among trainees have largely remained unchanged over decades. OhioHealth has been on a multiyear journey to change these statistics through being the first ever residency training institution to implement 24/7 365 access to employed mental health providers and gatekeeper training through REACH. Though there are rules set by regulatory bodies that require access to mental health services and education we have continued as a nation to fail help those who help others. OhioHealth has exceeded recommendation to set a new standard for what our learners deserve in mitigating suicide risk.

OhioHealth is a non-for-profit health system based in Columbus, Ohio with 35,000 employees, over 400 learners in 40 different training programs. Over the past decade, we have been on a corporate journey to advocate, decrease stigma, change culture, and place real resources with financial backing to improve the well-being of those who serve. This has most recently culminated in the creation and implementation of a multi-year plan to create a sustained suicide prevention gatekeeper model utilizing the REACH © system to train all employees, including resident physicians.
The focused training for resident physicians required a different approach and protocol as compared to the rest of the health system employees. Residents face unique challenges that start with job assignments. During medical school students apply for residency spots across the nation. This is a highly regulated system that utilizes a version of the Gale-Shapley algorithm, an economic theory that resulted in the authors winning the 2012 Nobel Prize in Economics. Often this results in individuals being taken out of a city where they have friends and family and moving to a location where they may lack such safety nets. Additionally, as a resident they often have no control over their work hours, type of work, timing of work, or location of work. Working 80 hours a week is often the norm rather than the exception.

This unique culture creates a significant dilemma when implementing gatekeeper training. When a program requests gatekeeper training an initial audit is performed to identify the degree of stress and distress within the program. Unfortunately, there are programs that have recently been affected by suicide. Such programs must be analyzed first for safety, training should never result in increased distress among participants. Additionally, programs are asked to conform to very strict communication guidelines. This includes messaging leading to the event making it very clear that the training is not mandatory. Alternative activities have been developed to assist with this.
All this is of critical need because we know those in training seek mental health services at a rate of 4.2% with 11.1% admitting to suicidal ideation (Rotenstein et. Al.). We also are aware that these rates increase over time (Mata et. Al.). The use of the education during orientation is critical to suicide prevention as 21% of all suicides occur during the first 3 months of training showcasing an immediate need to resources during orientation (Yaghmour et. Al.). Like many other populations risk of suicide can be predicted with risk of other parallel needs offered in the well-being center such as treatment for use disorder, treatment for other mental health diagnosis, and life stressors (Center et. Al.). Physicians as a group differ from the general population in terms of contributing stressors having directly employed staff that understands this unique population is critical to saving lives (Gold et. Al.) especially within a group with a higher risk of suicide than the general population at 1.41 relative risk increase in males and 2.27 relative risk increase in females (Talbott et. Al.).

Over the last year this has led to the beginning of cultural change around the conversation of suicide prevention. There have been 48 total training courses. This has been across 12 separate care sites and reached 523 participants. The training occurs in small group settings with an average of 10.9 participants per training course. Among those trained nearly 50 are resident physicians representing close to 10% of all those trained. Among residents, 100% felt competent and confident in their ability to ask a colleague about suicide. Over 97% were willing to ask a colleague about suicide, and 100% felt that REACH was relevant to their work. This core measure of the effect of the training has resulted in at least 5 lives saved over the past year, as reported by REACH Gatekeepers.

Ultimately the lessons learned with the implementation of REACH has shown that special considerations need to be given to learners within our health system. Resident physicians face a unique set of challenges and delivering the training in a meaningful and safe manner requires intentional planning. As the first program in the nation to do the REACH intervention and offer 24/7 365 live resources we have set a new industry standard of what is expected. We aim to share this first ever intervention of this type in resident trainees to help pass the lessons we learned to others who look to do the same at their health system.

Learning Objectives:

• Analyze how REACH is changing the conversation around suicide.
• Demonstrate the planning necessary to address the unique power dynamics and challenges of resident trainees.
• Explain the unique barriers that exist for resident trainees.
• Explain the work that is yet to be done in this space.