For Educators

Governance, Responsibility & Accountability

Everyone has a shared responsibility for managing fatigue-related risks and maintaining safety in the clinical practice and training environment.

To ensure a FRM plan or strategy will be prioritized and effective, it is necessary to establish a local governance structure that clearly outlines the roles and responsibilities of key organization leaders, including Hospital Administrators, Decanal Team, Postgraduate Medical Education Offices, Program Directors, and clinical and educational supervisors, as well as learners. An important component of any governance structure is clearly defined mechanisms of accountability. Accountability for FRM will vary based on locally available resources, personnel and care delivery settings. While autonomy for the establishment of a governance structure that is reflective of the local context rests with each training site, the roles and responsibilities within should be ultimately fortified by a commitment to both learner and patient safety, as outlined in the FRM Foundational Principles.

Options for FRM Actions

Principle 1

Roles for Leaders:

Leaders of both educational institutions and clinical learning environments are responsible for ensuring that FRM is a priority and that healthcare providers and trainees can effectively contribute to the creation of a management plan.

Leaders includes, but is not limited to; Clinical supervisors/Senior educational staff/Chief of Staff, Most Responsible Physician (MRP), Program Directors, Postgraduate Deans.

Options for leaders

Establishment of a local FRM working group or a chief FRM officer
Formal obligation for leaders to report on established FRM practices and training to staff, including trainees, and the organization

Principle 2

Trainee role:

Every trainee bears a responsibility to self, to their peers, and to those they provide care for, to manage their own fatigue during training and as they transition into practice.

Options for trainees

Conduct a fatigue self-assessment prior to/during call
Declaration of fatigue to supervisors and to team
Ensure adequate rest, nutrition are obtained prior to call
Avoid excessive overtime hours -> 24 hours
Report fatigue related incidents via established reporting routes
Employ individual controls/fatigue risk countermeasures while on call (caffeine intake, napping/breaks, task variation, nutrition and hydration)

Principle 3

Clinical training facility role:

All clinical resident training facilities must develop and implement an institution-wide FRM policy and also enable the trainees and other healthcare providers to effectively contribute.

Options for clinical training facilities

Incorporate and offer educational resources and information on fatigue prevention, mitigation and recognition strategies for trainees and healthcare providers
Establish a taxi reimbursement/alternative safe commuting program
Integrate/align FRM within existing health and safety policies
Establish clear Handover Protocols

Principle 4

Duty to uphold reporting practices and policies:

All clinical institutions involved in clinical training must create a just culture learning environment that enables the reporting of fatigue-related incidents.

Options for reporting practices

Established reporting pathways/mechanisms in place to identify fatigue related incidents in a just culture and proactive learning environment
Support declaration of fatigue to team, team double-checking, for both trainees and senior educational and clinical leaders
Ensure policies and procedures align with just culture and professional practice standards, are reviewed regularly and are made available to all participants

Principle 5

Shared role to support deployment & implementation:

All clinical institutions involved in training must support faculty and trainee development in FRM policies, practices, and procedures.

Options for faculty and trainee development

Educational & training opportunities – workshops and resources offered by PG Office
Incorporate physician fatigue content into curriculum for trainees and clinical educators/teachers
Alignment with OH&S programs/procedures
Incorporate FRM evaluation processes to determine if the system needs are being met
Create faculty development opportunities to support and engage faculty in FRM/mitigation

Principle 6

Shared role and commitment to co-produce CQI:

All stakeholders to clinical FRM must collaborate on an evaluative process for CQI of the local FRM approach, that includes a process for governance, performance evaluation, and review and audit functions.

Options for Continuous Quality Improvement (CQI)

Develop outcomes-based procedures to assess and evaluate policy effectiveness
Ensure evaluation data is captured reliably & regularly
Support collaboration between institutions and respective local health authority to ensure alignment with FRM principles and practices

Exemplary Indicator

Duty to contribute to dissemination of good practices:

Clinical institutions participating in clinical training actively identify, collect, and disseminate good practices and innovative research in FRM to the medical education community.

Options for sharing good practices

Promote research & innovation on fatigue-related implementation & evaluation strategies to address trainee/ physician fatigue
Facilitate partnerships with organizations to conduct FRM related researchIncorporate FRM evaluation processes to determine if the system needs are being met
Share practices of positive deviance aimed at solutions for managing fatigue within the medical education community

Include Fatigue Risk Management training in your program’s academic half day.

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Fatigue Risk Management

The FRM Toolkit Resource is the first national resource for Canadian postgraduate medical education. Non-prescriptive in nature, this toolkit will help to foster guidelines within your own institution.

Download Toolkit