Reaching Out to Distressed Medical Residents, Fellows, and Faculty Through the OHSU Resident and Faculty Wellness Program Interactive Screening Program (ISP)
Phase: NA
Conditions: Depression, Suicide
Sponsor: Oregon Health and Science University

Reaching Out to Distressed Residents, Fellows, and Faculty through the Resident and Faculty Wellness 
Program Interacting Screening Program 
 
 
NCT02010866 
 
4/27/24 
 
 
 

 
 “Reaching Out to Distressed Residents, Fellows, and Faculty through the Resident and Faculty 
Wellness Program Interacting Screening Program” 
Short Title: Reaching Out  
IRB #00009003 
Principal Investigator:   Marie Soller, MD 
Co-Investigators:  
Joanne Chan, PhD, Sydney Ey, PhD, Christie Kesserwani, DO, and Ben Ladd, 
Ph.D. (statistician)  
Sponsor:  
 
OHSU (Graduate Medical Education) 
Purpose/Aims: 
A recent survey of 7000+ US physicians indicated that almost half of all physicians are struggling with 
clinical levels of burnout, 38% with clinical depression, and 6% with suicidal ideation in the past 12 
months (Shanafelt et al., 2012). Similar rates of burnout and distress are present among medical 
trainees (e.g., Prins et al., 2007; Schwenk et al., 2010). Patient care, physician-patient communication, 
and physician career satisfaction and retention are negatively impacted by untreated physician distress 
(e.g., Wallace et al., 2009). Of particular concern, rates of suicide among male physicians are somewhat 
higher than males in other professions and are at least 2 times higher among female physicians when 
compared to their nonphysician female counterparts (Center et al., 2003; Schernhammer, 2005).  US 
physicians who killed themselves were unlikely to have received adequate treatment for their 
depression and/or substance abuse—even though they had health insurance and presumably knew 
about appropriate interventions for mental health problems (Gold et al., 2012). Many medical trainees 
and physicians in practice appear to avoid counseling or taking psychiatric medication due to concerns 
about possible stigma, confidentiality/privacy, cost, accessibility/time, reportability to state 
licensing/credentialing bodies, and helpfulness of counseling with their stressors (Guile et al, 2010; 
Givens Tija, 2002).  
In 2004, OHSU Resident Wellness Program was created to address and remove known barriers to 
medical residents and fellows receiving counseling and psychiatric medication services. On-site, quickly 
accessible, free, confidential counseling was provided by clinicians expert in treating medical providers. 
Educational outreach efforts to clarify that counseling is not reportable to state medical boards—
impairment is reportable—were conducted with faculty and medical trainees. In presentations to 
trainees, faculty and faculty leaders, RWP clinicians described how counseling was helpful to many of 
their colleagues and how normal and appropriate this level of self-awareness and self-care are for health 
care providers. The utilization rate of the Resident Wellness Program in 2004-05 was 6% of all 
residents/fellows and then rose to 17% of residents/fellows in 2012-2013—suggesting that the program 
was reaching a larger group of distressed medical trainees. Several years ago at the request of faculty 
members, the program was expanded to include offering services to full-time SOM faculty and was 
renamed the Resident and Faculty Wellness Program (RFWP).  Faculty utilizations rates have yet to be 
evaluated.  

Two years ago Ey and colleagues (2013) conducted an anonymous, online questionnaire of OHSU 
residents and fellows (response rate of 71%) and found most residents/fellows knew about the program 
and were “somewhat to very likely” to access the RFWP if needed. Thirteen percent of the residents and 
fellows, however, indicated that they would be unlikely to access services if they were distressed. When 
all trainees were asked about possible barriers to accessing counseling, fewer were concerned about 
stigma, confidentiality, reportability, and helpfulness than medical students and residents surveyed in 
other academic medical centers (e.g., Guile et al., 2010; Givens Tija, 2001) but perceived barriers to 
counseling were reported by at least 20% of the trainees. Being uncertain about how to take time out of 
duty hours to come for an appointment continued to be the largest interfering factor with accessing the 
RFWP—especially among women and primary care residents. By contrast, ethnic minority residents and 
male residents expressed more concerns about whether counseling would be helpful in addressing 
residency/fellowship related stressors (Ey, Moffit, Kinzie, Choi & Girard., 2013).  Although the RFWP staff 
have tried to address these concerns each year through orientations to new trainees and faculty and 
workshops to various residency programs and departments, there appear to be a group of residents, 
fellows, and probably faculty (they were not included in this 2011 survey) who continue to be 
uncomfortable and/or unwilling to seek professional help if distressed.  
Following the suicide of a female resident two years ago at OHSU, the RFWP staff searched for 
additional ways to reach residents and faculty who continue to be unaware of the seriousness of their 
level of distress and risk and/or to be highly concerned about possible barriers to treatment. Of note, in 
the general population, the most distressed patients typically report the greatest concerns about 
seeking mental health treatment (Kushner Sher, 1989).  Most patients who died due to suicide met 
criteria for a psychiatric diagnosis at the time of the suicide (Hirschfeld et al, 1997) and most college 
students who killed themselves were unlikely to have been in treatment at the time (e.g., Gallagher, 
2005) . Although population wide screening for suicidal ideation may not directly prevent suicide, 
screening for risk factors for suicide (e.g., prior attempts, current depression and substance abuse), is 
associated with increased likelihood to receive treatment and may prevent more negative outcomes 
(Gaynes et al., 2004). 
According to theories such as motivational interviewing and stages of change (Prochaska et al., 1992; 
Vogel et al., 2007), individuals change health behaviors when the benefits (e.g., being less stressed) 
outweigh the risks (e.g., concerns about confidentiality of treatment). Educational programming to 
promote the benefits and counter the perceived risks of counseling  did increase adults’ motivation to 
get professional help (Vogel et al., 2007). Distressed physicians’ motivation to seek help following an 
educational intervention has not been evaluated but organizations such as the American Foundation for 
Suicide Prevention, ACGME (2012), and the AMA (2011) have developed policies and programming to 
educate physicians about the importance of treating depression and reducing suicide risk in themselves 
and their colleagues.   
A “best practices” suicide prevention program in 50+ US universities, the American Foundation for 
Suicide Prevention’s Interactive Screening Program (ISP), was identified by the RFWP clinicians as a 
possible avenue by which to reach distressed OHSU trainees and faculty and encourage them to get 
help. The “Stress and Depression Questionnaire” is an anonymous, online screening tool for stress, 

depression, substance abuse, eating disorders, and suicide risk. Responses are scored and ranked 
according to level of distress and risk with Tier 1 representing “high risk, high distress” and Tier 2 
“moderate distress, less risk” and Tier 3 “low or no distress or risk”. RFWP clinicians will monitor 
responses, provide prompt communication back to the participants with information about how they 
scored, resources available to them, address any questions/concerns they might have and invite them to 
set up an appointment at the RFWP (if distressed). A similar size academic medical center to OHSU, 
UCSD, administered this survey to all medical students, residents, fellows, and faculty (13% completed 
it) and the majority eventually seen by clinicians indicated that they never would have sought help if 
they had not received feedback on the ISP and been encouraged to come in for evaluation/treatment 
(Moutier et al., 2012). Being able to anonymously dialogue with a clinician about their specific situation 
and questions appeared to persuade some participants to come in for an evaluation or accept a referral. 
This academic medical center did not have an in-house counseling program for residents and faculty like 
the OHSU RFWP—UCSD trainees received an initial evaluation from a clinician and then were provided 
with community referrals. Their participation rate of 13% is similar to rates of participation in the ISP in 
undergraduate populations (e.g., Haas et al., 2008). We hypothesize that our highly visible and utilized 
RFWP may lead to a higher ISP participation rate among the residents, fellows, and faculty.  
Although the ultimate goal is to save lives (i.e., reduce the rate of suicide among medical trainees and 
faculty), the low base rate of suicide in a population (Rodgers et al., 2007) does not allow us to evaluate 
whether the implementation of the ISP at OHSU will lead to a drop in suicide rates at our institution. 
Even using patient suicidal ideation and attempts as outcomes is problematic as this information can be 
difficult to gather unless the patient is actively involved in treatment at the time. Rather in the present 
study we propose to measure the effectiveness of our suicide prevention program by trying to measure 
proxy variables to suicide risk—increasing protective factors and decreasing risk factors (Goldney, 2005). 
Specifically, we are seeking to decrease known risk factors (e.g., identify and intervene with untreated 
depression, substance abuse, high level of stress) and increase protective factors (e.g., promote self-
awareness, receipt of support and resources and delivery of mental health services if needed).  
Our aims are to: 
• 
reduce known risk factors of untreated psychological distress (e.g., depression, high stress level, 
substance abuse) by encouraging all residents, fellows, and SOM faculty to complete a self-
assessment of their level of stress and risk using the ISP and then offer professional help through 
a personalized message/dialogue that directly addresses any concerns/barriers about seeking 
help at the RFWP and offers resources for better coping; 
 
• 
increase self-awareness in mildly/moderately distressed trainees and faculty who fill out the ISP 
and offer preventive/early intervention educational resources via the ISP on topics that are 
relevant to them (based on their responses); 
 
• 
evaluate whether all RFWP patients (ones who come to the program via ISP and other referral 
sources) report decreased psychological distress, burnout, and risk of suicide across treatment; 
 

• 
asses RFWP participants’ levels of psychological distress, flourishing, burnout, and risk of suicide 
across treatment; 
• 
assess at intake whether intent to quit medicine, training program or faculty position within the 
next 12 months is associated with level of client’s distress, burnout, demographics and is a 
factor in seeking treatment; 
 
• 
assess level of satisfaction with the RFWP educational outreach workshops, consultation to 
department leaders (and referral of their trainees and/or faculty), and clinical services provided 
to distressed trainees and faculty. 
 
Research Questions: 
1. How many trainees and faculty participate in the online, anonymous ISP survey and review the 
clinician’s response to their surveys? In addition, how many highly distressed/high risk (Tier 1) 
trainees and faculty communicate anonymously with the RFWP clinician (via the dialogue 
function) and accept referrals or come in for an in-person evaluation? 
2. How representative are the ISP participants of the overall OHSU population of SOM trainees 
and faculty, Providence and Legacy residents that could have participated?  
a. Hypothesis: we hypothesize a greater overall participation rate from OHSU, Providence, 
and Legacy trainees and OHSU faculty than seen with UCSD SOM (13%) due to our 
greater utilization rate at the RFWP,and visibility as an on-site program and the higher 
response rate to our 2011 anonymous survey (71% among residents/fellows).  We are 
uncertain how many Tier 1 respondents will communicate with our clinicians and agree 
to services—this question is exploratory. 
b. Exploratory question re: representativeness—we hope that our participants will be 
similar to the overall Providence, Legacy and OHSU population so that results will be 
more generalizable. 
3. What is the relationship among level of distress (ISP tiers), type of symptoms reported on ISP 
and willingness to seek treatment?  Is participation in the ISP (as reported in 1st session intake 
questionnaire) related to response to treatment (change in distress and burnout ratings and 
risk level, attendance of sessions)?  
a. Hypothesis: level of distress/risk on the ISP will be positively related to greater 
willingness to accept referrals or make appointment .  We are uncertain if participation 
in the ISP per self-report on intake paper work will led to different treatment response 
than others seen at our program. We are uncertain whether respondents with certain 
symptoms (e.g., substance abuse, suicide risk) may be anxious about communicating 
with us and to come in for an in-person meeting—this question is exploratory. 
4. How helpful were components of the ISP (getting feedback on level of distress, being able to 
dialogue with clinician re: concerns, and having specific resources offered) according to 
participants in the ISP who came for initial intake at RFWP?  

a. Prior ISP studies with undergraduate and graduate samples (e.g., Haas et al., 2008) 
would suggest that the online dialogue with a clinician re: concerns will be rated as 
especially helpful and instrumental to ISP participants who eventually sought treatment. 
5. How many residents, fellows, and faculty show significant change in their levels of distress and 
burnout while in treatment at the RFWP? What demographic variables (gender, ethnicity), 
training/work variables (trainee/faculty status, type of program, year of training are 
associated with change in distress and burnout ratings across treatment? 
6.  Is dose of treatment (# of sessions over 12 month period) associated with lower risk 
of quitting training program, leaving faculty position or leaving clinical medicine as a 
field? 
7. At intake, what is the association between descriptive variables (i.e., demographics, 
programmatic factors), level of distress, burnout, and intent to quit medicine and/or training 
program or faculty position? Is dose of treatment (number of sessions over a 12 month 
period) associated with lower risk of quitting training program or faculty position?  
a. Questions about intent to quit will be based on Boroff et al. measure used by employers 
and now being used in healthcare setting (e.g., OHSU Pulse Survey). 
b. Status in training program, faculty position will be based upon clinician rating in last 
session. 
8. How do consumers of RFWP services compare to the overall Providence, Legacy and OHSU 
population of trainees and SOM faculty in terms of demographics, program type? Are they 
representative?  
a. Hypothesis: This first question is exploratory as little research exists on specific rates of 
recovery (e.g., decrease in distress) in health care providers in counseling/coaching. In 
general outpatient clinics, there are no gender or racial/ethnic differences in response 
to high quality mental health services (e.g., Lambert , 2007). 
b. Hypothesis: the 2nd question—prior studies with a general population would suggest 
that women and primary care physicians, will be more likely to have sought counseling.  
9. What is the level of client satisfaction reported by trainees and faculty seen for individual 
treatment at the RFWP or department leaders who have consulted with the RFWP staff re: 
referrals?   
a. Hypothesis: this question is exploratory. 
Procedures 
ISP Protocol: The OHSU, Providence, and Legacy SOM leadership will announce to the SOM faculty, 
residents, and fellows and Providence and Legacy residents that the “Stress and Depression 
Questionnaire” (ISP) is now part of Providence’s and OHSU’s commitment to promote the well-being of 
trainees and faculty. Note: effective 7/1/21, Legacy residents/fellows will no longer be seen through 
RFWP so they will no longer be invited to enroll in this study. Throughout the year, the RFWP clinicians 
will visit SOM departments/program to introduce the ISP and present a 45-60 minute workshop/Grand 
Rounds on stress and depression in health care providers. Shortly after each presentation to a 
department, an email invitation (with a link to the secure ISP website) will be sent to all faculty, 

residents, and fellows in that department inviting them to fill out a 10 minute anonymous online 
questionnaire about their level of stress, depression, substance use, eating disorder issues, current 
treatment status, and risk for suicide.  The respondent will be asked to create a username and password 
that only he/she will know –so he/she can log back on to the website to see the clinician’s response to 
the survey. This website will explain the rationale for the questionnaire, explain that the website is not a 
crisis intervention service but will provide crisis hotline numbers and information about how to contact 
the RFWP staff for urgent consultation.  At the end of the questionnaire, the respondent will be given 
the option of giving an email address so that they can be informed when the RFWP clinician has posted a 
response on the secured ISP website (they then log on with their user name and password). Students 
will be reminded that their email address is encrypted to protect their identity and is never available to 
anyone (including the RFWP clinicians). If respondents do not wish to give their email address, they will 
be asked to return to the ISP website link 24-48 hours after completing the questionnaire to log on with 
their username and password to look up the clinician’s response to them.  The ISP staff found that 90% 
of all respondents in prior studies with the ISP chose to give their email address and those who did not 
give their email address were significantly less likely to look up the clinician’s response on the website 
(Haas and Mortelli, personal communication, 2013). Therefore, a decision was made to give 
respondents an option to include their email address so they will automatically receive a notice from the 
computer when the clinician has posted a response to their ISP measure or a response to their questions 
re: seeking help.  
When the ISP has been completed by an individual, the ISP computer immediately analyzes the 
responses on the questionnaire and classifies the questionnaire into 3 Tiers according to level of distress 
on the PHQ-9 ( a standard depression screen) and level of suicide risk with Tier 1 (highest risk) and 3 
(lowest risk).  Clinicians are able to review answers to each question and the open-ended question re: 
recent stressors. The ISP protocol requires clinicians to respond to Tier 1 respondents within 24 hours, 
Tier 2 in 36 hours and Tier 3 in 48 hours. The clinician sends a response specific to the respondent’s tier, 
introduces himself/herself (provides email, pager) and offers responses. For Tier 1 and 2 respondents, 
the clinician will urge them to schedule an in-person meeting via official OHSU email or the clinician’s 
pager. For Tier 3 respondents, the clinician may offer an in-person meeting and/or 
educational/preventive resources (e.g., websites/handouts via the message posted). All respondents will 
be given the option to dialogue further with the clinician about any concerns/questions they might have 
via posting responses on the ISP website to the clinician and respondent. Once the clinician posts a 
response, the computer accesses the respondent’s encrypted email address and send a notification that 
a response is available for viewing. Several reminders will be sent automatically to Tier 1 and 2 students 
and then 15 and 30 days after the clinician’s response is posted. If they did not contact the clinician, a 
final brief update questionnaire is sent to the respondent to ask about how he/she is doing in the past 
few weeks and ask about possible reasons for not responding the clinician’s invitation to dialogue or 
meet. Respondents can dialogue with the RFWP clinician as frequently as they need to although the goal 
is to address their concerns and facilitate them coming in for an in-person evaluation at the RFWP.    
An ISP database will be created with this de-identified data for each participant that completes the ISP 
and will include the responses on their ISP, Tier status, any communications between the participant 

and the RFWP clinician and whether he/she accepted a referral for services and expressed willingness to 
schedule  an in-person evaluation at the RFWP. Note: no identifying information will be included in the 
ISP database other than gender, broad categories of year of training or faculty status, broad category of 
age and type of program (e.g., primary care vs. nonprimary care). If the participant reveals his/her name 
in any communications with the RFWP clinician, this data will be deleted from the ISP database. 
Appointments will be scheduled outside of the ISP system by instructing the participant to contact the 
RFWP clinician directly via OHSU email and at that time revealing who they are.  
At the first in-person or telehealth (during modified operations under COVID-19, all RFWP visits became 
telehealth) appointment at the RFWP, the client will be asked to review and sign a (1.) consent form to 
participate in treatment at the RFWP and (2.) a research consent form. Clients may be given a copy of 
the research consent form to review and then be given the option to sign the research consent form in 
subsequent sessions. The research consent form will include wording that the client is giving permission 
for retrospective data (prior to signature on research consent form) to be included in the study. Due to 
all visits now being telehealth, the intake paperwork and research consent forms are presented and 
reviewed in the telehealth session and client then can complete them and email them back to the 
clinician via secure OHSU email.  
RFWP Client Outcomes Protocol:  After completing (1.) an informed consent to be in treatment at the 
RFWP and (2.) a research consent form, all patients being seen at the RFWP (referred by ISP, other 
referral sources or self-referred) will be asked to complete a brief measure of a level of distress, 
burnout, level of risk and treatment history and needs.  Specifically, the ACORN (a psychometrically 
sound, standardized 13-item measure of psychological distress within the past 2 weeks) and 2 screening 
questions for emotional exhaustion and depersonalization from the Maslach Burnout Inventory (MBI) 
will be given at the first session and subsequent sessions to measure client progress in treatment. The 
Maslach Burnout Inventory (MBI) is a psychometrically sound measure often used with health 
professionals;  West and colleagues (2009) found that 2 items are highly predictive of physician burnout 
as a quick screen.  Clinicians will review with their patients how they responded to these 
questionnaires—as one indicator of their response to treatment. This type of regular brief assessment 
and collaborative discussion with patients about their progress in mental health treatment has been 
shown to be highly effective in preventing patients from prematurely terminating from treatment and in 
facilitating the delivery of tailored, relevant interventions with patients (e.g.,https://psychoutcomes.org; 
Lambert, 2004). Patients will also complete the Flourishing Scale (a positive psychology measure that 
asks about whether patients feel their activities are meaningful, whether they feel optimistic about their 
future, feel respected). This measure is correlated with life satisfaction.  
Patients also will be invited out to fill out a psychometrically sound measure of patient satisfaction, the 
Client Satisfaction Questionnaire (CSQ-8; Atkinson, 1979) on their level of satisfaction with services at 
the RFWP. They will be asked to fill the CSQ-8 out anonymously and mail back the survey or put it in a 
locked drop box in the waiting room areas.  

Note: At the time of treatment, clients will be asked if they completed the ISP and whether it was 
helpful to get feedback on their level of distress and to be able to dialogue with a clinician. Data 
Collection 
Sample and Measures 
ISP Sample of Residents, Fellows, and Faculty: All OHSU residents and fellows (approximately 800 
annually) and all full-time (0.5 FTE) faculty (approximately 3000) will be sent via OHSU email a link to the 
ISP survey following the RFWP clinician’s presentation of the Stress and Depression workshop to their 
department. Note: only residents, fellows and full-time SOM faculty will be included as they are the only 
ones who are eligible for services through the RFWP (we don’t have capacity to provide services to all 
adjunct faculty).  All Legacy residents (approximately 90 a year) will be invited by RFWP clinicians (during 
workshops/orientation to these groups) to participate in completing the ISP.Note: new Legacy 
residents/fellows effective 7/1/21 will no longer be enrolled.  All Providence residents (approximately 90 
a year) will be invited by RFWP clinicians (during workshops/orientation to these groups) to participate 
in completing the ISP. RFWP Client Outcomes Sample: All patients seen at the RFWP (to start with IRB 
approval) will be invited to participate in the research study—estimated to be 200-300 annually that are 
seen at the program. This estimate is based on 17% of 800 OHSU residents/fellows and approximately 
2% of 3000 SOM faculty utilizing services through the RFWP in 2012-13. Increased outreach efforts 
through this proposed project “Reaching Out” will likely raise the visibility of the RFWP (especially 
among faculty) and lead to a slightly higher number of faculty and medical trainees utilizing future RFWP 
annually.  
All clinical data are entered into an encrypted ACCESS clinical records database that only RFWP 
clinicians have permission to access. Participants who also complete the Research Study Consent Form 
will have the following clinical data exported into a research database for analyses: RFWP Subject ID 
number* randomly assigned (by computer) to the resident, fellow, or faculty member at time of intake, 
• 
demographic  and work/training program information (gender, year of birth, ethnic/race, year of 
training if relevant, resident/faculty status, type of program/specialty) from the “Personal 
History and Data Form” completed by the patient in the first meeting 
• 
reason for referral, referral source, knowledge of RFWP 
• 
psychological, suicide, and medication history (if relevant) based on clinical interview 
• 
participation in the ISP and ratings of helpfulness of the ISP components (in “Personal Health 
History and Data Form”) 
• 
clinician ratings of patients’ sources of stress, interventions and referrals provided in session 
• 
client self-report of current level of distress (ACORN) and burnout (MBI emotional exhaustion 
and depersonalization items),  
• 
at intake, client rating on intent to leave medicine, intent to leave training program 
(resident/fellow) or faculty position (faculty clients) in next 12 months,  
• 
client self-report of Professional Fulfillment Index (PFI; Trockel et all, 2018)—new measure of 
physician professional fulfillment and burnout  
• 
number of sessions, year of sessions, 

• 
clinician ratings of patient’s current suicide risk, risk to others and patients, and reasons for 
seeking treatment, clinician rating of whether client left program or faculty position 
prematurely, 
• 
client self-report on Flourishing Scale (Diener and Biswas-Diener, 2009) 
• 
whether they are experiencing COVID-19 related stress or have experienced a recent trauma 
(per clinician rating) 
The *RFWP Subject ID is generated randomly by a separate RFWP appointment book database and 
stored in a master list with the patient’s name and year of birth in a separate, encrypted ACCESS 
database that only Drs. Moffit, , Kesserwani, Ey and Soller have permission to access. One RFWP 
psychiatrist, Dr. Mark Kinzie, is the program director of Psychiatry, so he will not have access to this 
database (master list with names, id) in case there were psychiatry residents or faculty listed as patients 
of the RFWP. All psychiatry residents and faculty are seen by the other providers not Dr. Kinzie.  
A separate, anonymous measure of patient satisfaction, the Client Satisfaction Questionnaire (CSQ-8; 
Larsen, Attkinsson, Hargreaves, and Nguyen, 1979) will be given out in the clinic and patients asked to 
complete separately and mail back or put in a locked box in the waiting room area (to be collected by 
RFWP clinicians to review at a later date). This 8-item Likert scale questionnaire measuring clients’ 
satisfaction with counseling (RFWP) is a psychometrically sound (Cronbach alpha of .92 in Larsen, 1979) 
measure of client satisfaction in outpatient mental health settings that is significantly correlated with 
similar measure of client satisfaction with services and is predictive of client attendance and client 
symptom relief (Attkisson & Zwick, 1982). A total score of satisfaction is created based on the sum of 
individual items. 
Sample of Department Leadership:  All Program Directors (PDs) and chairs will be mailed annually a 
modified version of the CSQ-8 (given successfully in a prior survey of program directors in 2011) to 
assess their knowledge of the RFWP and ISP initiative and satisfaction with the RFWP as a service to 
their trainees and faculty. The expected number surveyed will be approximately 100. The surveys will be 
anonymous and only aggregate, de-identified data will be presented for purposes of data analysis and 
publication. 
SOM Summary Data 
In order to conduct analyses comparing participants in the ISP surveys and participants in the RFWP to 
the overall Providence and Legacy trainee and OHSU SOM trainee and faculty population, some 
summary SOM data will be provided to the researchers by the Dean’s Office and Graduate Medical 
Education data analyst. Specifically, deidentified, summary data will be gathered starting in 2014 
annually until the end of the project. Data requested will be: 
Number of residents, fellows, primary SOM faculty,  
% women/men,  
% ethnic/racial groups,  

average age in trainee, faculty groups,  
number of trainees, faculty in 5 specialty groups (primary care, hospital based, surgical, peds/IM 
specialty, other)  
Vulnerable Populations: 
There are no vulnerable populations included in this study as all residents, fellows, faculty, and 
department leadership are assumed to be mentally competent and able to respond to the English 
language survey (since they are working full-time and functioning as health professionals at OHSU).  
Consent and Measures to Protect Subjects’ Privacy 
Per federal and state law regarding providing confidential psychological services, all residents, fellows, 
and faculty seen for treatment at the RFWP will complete an informed Consent to Treatment and a 
separate Research Study Consent.   
All RFWP outcomes data included in the research study, ISP data, and department leadership surveys 
will be de-identified and only aggregated data reported in analyses for purposes of quality improvement 
and research presentations and publications.  No protected health information will be included in any 
analyses. No genetic information is gathered in any of the protocols. Subjects who do not wish to 
participate in the outcomes research study through the RFWP also may decline to complete the 
measures of distress (ACORN), burnout (MBI screen) or client satisfaction (CSQ). In addition, to help 
protect research subjects’ privacy, the researchers obtained a Certificate of Confidentiality for this study 
data and the repository it will be stored in. from the National Institutes of Health. With this Certificate, 
the researchers cannot be forced to disclose information that may identify research subjects, even by a 
court subpoena, in any federal, state, or local civil, criminal, administrative, legislative, or other 
proceedings. The researchers will use the Certificate to resist any demands for information that would 
identify research subjects, except as explained below: 
 
The Certificate cannot be used to resist a demand for information from personnel of the United States 
Government that is used for auditing or evaluation of federally funded projects or for information that 
must be disclosed in order to meet the requirements of the federal Food and Drug Administration (FDA). 
Subjects will be informed that a Certificate of Confidentiality does not prevent them or a member of 
their family from voluntarily releasing information about the subjects or their involvement in this 
research. If an insurer, employer, or other person obtains subjects’ written consent to receive research 
information, then the researchers may not use the Certificate to withhold that information. However, if 
we learn about abuse of a child or elderly person or that research subjects intend to harm themselves or 
someone else, or about certain communicable diseases, we will report that to the proper authorities. 
Compensation: Participants in the ISP or RFWP services will not be compensated for their participation. 
Both programs are seen as a benefit to participants in terms of increasing self-awareness and offering 
free resources and counseling as needed. There will be no benefit to participating in the research other 

than the knowledge that they may be helping the investigators to determine how to best help other 
distressed health care providers. 
Costs: there are no additional costs to subjects for their participation. All RFWP services are offered free 
of charge to eligible SOM faculty and all residents and fellows (the program is funded 100% by 
GME/OHSU hospital) and the Faculty Practice Plan.  
Process for Withdrawing/Termination: At any point during the ISP protocol (filling out the ISP survey, 
dialoguing with the RFWP clinician online), ISP participants can choose to not accept referrals  and 
withdraw from participation without any consequences. For example, even if participants report being 
high risk (Tier 1), they are anonymous so the RFWP clinician would not be able to identify for who they 
are and would simply encourage them to come in for an in-person evaluation or access crisis 
intervention services in the community.  Numbers to community and national hotlines and urgent 
consultation to the RFWP staff are posted on the ISP website for OHSU participants.  
In the RFWP program, participants being seen in-person or virtually (via telehealth) can withdraw from 
treatment and/or from the research study at any time without penalty. The RFWP is a voluntary service 
and does not provide mandated treatment or fitness for duty treatment/evaluations. If there are 
imminent concerns for the RFWP participant’s safety or others’ safety (e.g., patient safety), the 
participant is informed (in the first meeting and consent form) that the RFWP clinician may break 
confidentiality and communicate with the participant’s family members/emergency contact and/or 
program director/chair to assess safety concerns. A RFWP participant may be asked to take a leave of 
absence and have a fitness for duty evaluation before returning to duty if there are significant concerns 
about their ability safely practice as a health care provider.  
Statistical Analyses: 
Statistical analyses will be conducted by Dr. Soller and her research team and will consist of descriptive 
analyses (e.g., frequencies, means, standard deviations), correlational analyses, and some multiple 
regression analyses to determine whether participation in the ISP is predictive of engagement in 
treatment and recovery from depression, substance abuse, or suicide risk. In addition, pre-post 
comparisons of risk, distress and burnout levels will be conducted in relation to demographic and 
treatment factors for all participants in the RFWP. Additional analyses will be conducted comparing 
participants to overall Providence and OHSU SOM populations on demographics to see if samples are 
representative of their institution’s eligible population.  
 
 

References  
ACORN, Colloborative Outcomes Resource Network. https://psychoutcomes.org. 
Accreditation Council for Graduate Medical Education. ACGME institutional requirements. 
http://www.acgme.org/acgmeweb/Portals/0/irc_IRCpr07012007.pdf. Updated 2007. Accessed 
November 4, 2012. 
American Medical Association. Physician suicide webinars. http://www.ama-assn.org/pub/physician-
resources/physician-healtlh/physician-suicide. Accessed 11/20/2011. 
Boroff, K. E., & Lewin, D. (1997). Loyalty, Voice, and Intent to Exit a Union Firm: A Conceptual 
and Empirical Analysis. Industrial and Labor Relations Review, 51(1), 50-63. 
Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians. JAMA: the journal of 
the American Medical Association. 2003;289(23):3161-3166. 
Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D. W., Oishi, S., & Biswas-Diener, R. 
(2010). New well-being measures: Short scales to assess flourishing and positive and negative 
feelings. Social Indicators Research, 97(2), 143-156.Drum, DJ et al. New data on the nature of 
suicidal crises in college students: Shifting the paradigm. Professional Psychology. 2009; 40, 213-222. 
Ey S, Moffit M, Kinzie JM, Choi D, Girard DE. “If you build it, they will come”: Attitudes of medical 
residents and fellows about seeking services in a resident wellness program. JGME. 2013 (Sept).  
Gallagher RP. National Survey of Counseling Center Directors. Monograph Series Number 80. Alexandria, 
VA: International Association of Counseling Services. 2005.  
Gaynes BN et al. Screening for suicide risk in adults: A summary of the evidence for the US preventive 
services task force. Ann Intern Med. 2004; 140: 822-835. 
Givens JL, Tjia J. Depressed medical students' use of mental health services and barriers to use. 
Academic Medicine. 2002;77(9):918-921. 

Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the national violent 
death reporting system. General Hospital Psychiatry, 2012, 
http://dx.doi.org/10.1016/jgenhosppsych2012.08.005. 
Goldney RD. Suicide prevention: A pragmatic review of recent studies. Crisis. 2005; 26: 128-140. 
Guille C, Speller H, Laff R, Epperson CN, Sen S. Utilization and barriers to mental health services among 
depressed medical interns: A prospective multisite study. Journal of graduate medical education. 
2010;2(2):210-214. 
Haas A et al. An interactive web-based method of outreach to college students at risk for suicide. J of 
Amer College Health. 2008; 57 (1): 15-22.  
Hirschfeld RM, Russell JM. Assessment and treatment of suicidal patients. N Engl J Med. 1997;337: 910-
915. 
Kushner MG, Sher KJ. Fear of psychological treatment and its relation to mental health service 
avoidance. Professional Psychology: Research and Practice. 1989;20(4):251. 
Lambert MJ Bergin and garfield’s handbook of psychotherapy and behavior change. 2004.  
Maslach, C,  Jackson S, Leiter, MP. MBI: The Maslach Burnout Inventory: Manual. 1996. Palo Alto: 
Consulting Psychologists Press. 
Moutier C, Norcross W, Jong P, et al. The suicide prevention and depression awareness program at the 
university of california, san diego school of medicine. Academic Medicine. 2012;87(3):320 
Pitt E Rosenthal MM et al. Mental health services for residents: more important than ever.  Acad Med., 
2004; 79, 840-4 

Prins JT, Gazendam‐Donofrio SM, Tubben BJ, Van Der Heijden FMMA, Van De Wiel H, Hoekstra‐Weebers 
JEHM. Burnout in medical residents: A review. Med Educ. 2007;41(8):788-800. 
 
Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: Applications to addictive 
behaviors. Am Psychol. 1992;47(9):1102. 
Rodgers, PL et al. Evidence-based practices project for suicide prevention. Suicide and Life-Threatening 
Behavior.2007; 37 (2): 154-164.  
Schernhammer E. Taking their own lives—the high rate of physician suicide. N Engl J Med. 
2005;352(24):2473-247  
Schwartz AJ. College student suicide in the united states: 1990-1991 through 2003-2004. Journal of 
American College Health. 2006;54(6):341-352. 
Schwenk TL, Davis L, Wimsatt, LA. Depression, stigma, and suicidal ideation in medical students. JAMA, 
2010; 304, 1181-1190.  
Shanfelt T et al. Burnout and satisfaction with work-life balance among US physicians related to general 
US population. Arch Intern Med. 2012 Oct 8; 172 (18): 1377-85. 
Trockel M, Bohman B, Lesure E, Hamidi MS, Welle D, Roberts L, Shanafelt T. A brief instrument to assess 
both burnout and professional fulfillment in physicians: Reliability and validity, including correlation with 
self-reported medical errors, in a sample of resident and practicing physicians.Acad Psychiatry. 2018; 42: 
11-24.   
Vogel DL, Wester SR, Larson LM. Avoidance of counseling: Psychological factors that inhibit seeking help. 
Journal of Counseling & Development. 2007;85(4):410-422. 
Wallace JE, Lemaire JB, Ghali WA. Physician wellness: A missing quality indicator. The Lancet. 
2009;374(9702):1714-1721. 

 
-