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In a national survey of 7409 surgical residents, 32% reported discrimination based on their self-identified gender, 32% verbal or physical abuse, 10% sexual harassment, and 38% burnout symptoms. Mistreatment was more frequently reported by female residents, and burnout symptoms were more common among residents who reported mistreatment.

Just as the country rallied to care for September 11 first responders who suffered long-term health effects, we must take responsibility for the well-being of clinician first responders to Covid-19 — now and in the long run. Five high-priority actions can help to protect health care workers.

The American Council of Graduate Medical Education is moving from accrediting residency programs every 5 years to a new system for the annual evaluation of trends in measures of performance. In 1999, the Accreditation Council for Graduate Medical Education (ACGME) introduced the six domains of clinical competency to the profession, 1 and in 2009, it began a multiyear process of restructuring its accreditation system to be based on educational outcomes in these competencies. The result of this effort is the Next Accreditation System (NAS), scheduled for phased implementation beginning in July 2013. The aims of the NAS are threefold: to enhance the ability of the peer-review system to prepare physicians for practice in the 21st century, to accelerate the ACGME's movement toward accreditation on the basis of educational outcomes, and to . . .

The National Academy of Medicine, the Association of American Medical Colleges, and the Accreditation Council for Graduate Medical Education have launched a national Action Collaborative on Clinician Well-Being and Resilience to combat the clinician-burnout crisis.

A task force of the Accreditation Council for Graduate Medical Education (ACGME) has proposed modifications in the current requirements for medical residency training programs, including in the limits on resident hours. This article explains the proposed changes and the rationale for them and invites input on the new requirements, which are scheduled for implementation in 2011.

On the basis of site visits that it has conducted for its Clinical Learning Environment Review program, the Accreditation Council for Graduate Medical Education reports finding a generalized lack of resident engagement in systems-based practice. “Approximately 2 months ago, I had a patient where I accidently administered a wrong dose of fentanyl during a procedure. The patient developed severe hypotension, and the procedure had to be temporarily halted until we could get her blood pressure back up. My attending was close by. He responded quickly. Ultimately, no harm was done . “The reason I believe this happened is that during a procedure I'm sometimes required to administer fentanyl and must dilute it during the procedure. There are two dilutions, either to directly administer by syringe, or for use as an intravenous drip. We do this . . .

From 2000 to 2014, the leading causes of medical resident death in the United States were neoplastic diseases and suicide. To examine whether US medical resident rates of death have changed since 2014 and whether causes of resident death differ by specialty. In this cross-sectional study, residents and fellows who were enrolled in Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs and who died from January 2015 to December 2021 were submitted to the National Death Index to obtain causes of death. These decedents were compared with residents and fellows who died between January 2000 and December 2014. Data were analyzed between July 2024 to March 2025. Death while actively enrolled in an ACGME-accredited residency and fellowship training program. The primary outcome was the difference in rates of death for US residents and fellows between 2 time periods, 2000 to 2014 and 2015 to 2021. Poisson regression modeling was used to calculate incidence rate ratios (IRRs) with 95% CIs for this comparison. Rates were also compared across specialties. Secondary outcomes included comparing trainee decedents with age- and gender-matched peers in the general population and querying differences in causes of death by specialty from 2000 through 2021. Between 2015 and 2021, 370 778 residents and fellows participated in 961 755 person-years of training. In that same period, 161 residents (50 [31.1%] female; median [IQR] age, 31 [29-35] years) died during training. Forty-seven residents (29.2%) died by suicide, 28 (17.4%) by neoplastic diseases, 22 (13.7%) from other medical and surgical diseases, 22 (13.7%) from accidents, and 21 (13.0%) from accidental poisoning. The highest number of resident suicides occurred during the first quarter of the first year. The death rate from neoplastic diseases decreased since 2000 to 2014 (IRR, 0.59; 95% CI, 0.38-0.90). Rates of other causes remained unchanged. Resident death rates from 2000 to 2021, including rates of death by suicide, were lower than age- and gender-matched peers across causes. The highest specialty suicide rate was for pathology (19.76 deaths per 100 000 person-years). The highest death rate from neoplastic diseases was psychiatry (9.67 deaths per 100 000 person-years). The highest death rate from accidental poisoning was anesthesiology (15.46 deaths per 100 000 person-years). In this cross-sectional study comparing rates of US medical resident deaths from 2000 to 2014 with rates observed in 2015 to 2021, the rate of resident deaths from neoplastic diseases decreased, while the rates of death from all other causes remained unchanged. Nevertheless, the number of residents who died by suicide during their very first academic quarter, observed during both study windows, remains concerning. Future efforts to address trainee well-being must focus on the drivers and mitigating factors of distress, particularly during transitions.

The authors designed the present study to examine the association between individuals' scores on the Jefferson Scale of Physician Empathy (JSPE; M. Hojat, J. S. Gonnella, S. Mangione, T. J. Nasca, & M. Magee, 2003; M. Hojat, J. S. Gonnella, T. J. Nasca, S. Mangione, M. Vergare, & M. Magee, 2002; M. Hojat, S. Mangione, T. J. Nasca, M. J. M. Cohen, J. S. Gonnella, J. B. Erdmann, J. J. Veloski, & M. Magee, 2001), a selfreport empathy scale, during medical school and ratings of their empathic behavior made by directors of their residency training programs 3 years later. Participants were 106 physicians. The authors examined the relationships between scores on the JSPE (with 20 Likert-type items) at the beginning of the students' 3rd year of medical school and ratings of their empathic behavior made by directors of their residency training programs. Top scorers on the JSPE in medical school, compared to Bottom scorers, obtained a significantly higher average rating of empathic behavior in residency 3 years later (p < .05, effect size = 0.50). The findings support the long-term predictive validity of the self-report empathy scale, JSPE, despite different methods of evaluations (self-report and supervisors' ratings) and despite a time interval between evaluations (3 years). Because empathy is relevant to prosocial and helping behavior, it is important for investigators to further enhance our understanding of its correlates and outcomes among health professionals.

To the Editor: The Perspective article on U.S.-citizen international medical graduates (IMGs) by Eckhert and van Zanten (April 30 issue) 1 used data from the National Resident Matching Program (NRMP) 2 to assert that “the forecasts that there would soon be no room in U.S. residency programs for IMGs were not accurate: since the number of positions for postgraduate-year-1 [PGY-1] residents increased by 26% between 2004 and 2014.” Before the 2013 “all-in” policy of the NRMP, data for the Residency Match did not accurately reflect the number of PGY-1 residents who actually entered training, because programs could fill positions (e.g., with IMGs) . . .