165. Wellness Needs Assessment In Adolescent Medicine Trainees: An Appreciative Inquiry Approach To Quality Improvement

Abstract

There is an increasing awareness of the impact of medical training on the mental health and wellbeing of medical students, residents, and fellows. The prevalence of depressive episodes is estimated to be nearly 30% among resident physicians (1). There are currently no specific studies addressing the effect of medical training on the mental health of senior trainees, such as subspecialty fellows. The purpose of this study is to conduct a needs assessment of past and present Adolescent Medicine trainees at the Hospital for Sick Children to determine areas of need with respect to psychological and emotional well-being. We conducted a needs assessment of current and former subspecialty trainees utilizing an appreciative inquiry approach. Appreciative inquiry is a qualitative method of organizational development to understand transformational change from a positive light. It is used to recognize areas that require improvement while also appreciate the successes of an organization. Qualitative responses were collected through an electronic survey. Trainees were asked to reflect on a difficult time where they emerged resilient, what promoted resilience in the learning environment, what are the characteristics of an ideal learning environment, and what changes need to be made to achieve such an environment. Responses were coded using thematic analysis by two members of the project team. 20 surveys were distributed, and there were 15 responses (75% responses rate) with 6 current trainees (40% of respondents) and 9 past trainees (60% of respondents). Analysis highlighted 4 key themes related to the wellness needs of current and former Adolescent Medicine trainees: 1) Adolescent Medicine trainees experience significant emotional burden in their clinical work 2) Uncertainty at different stages in training is a source of stress 3) The culture of the work environment contributes to wellness 4) Trainees seek support from individual relationships and formal systems. Adolescent medicine trainees experience challenges to their psychological wellbeing. Such difficulties include clinical challenges such as a high level of vicarious trauma from working with specific vulnerable and marginalized populations. Trainees also navigate complex patient and family interactions when working with a youth with evolving capacity and independence and the youth’s family system. This needs assessment demonstrated that senior level trainees Wellness needs relate primarily to advanced self-actualization needs, as opposed to more basic needs such as fatigue and nutrition management. Adolescent medicine trainees can be supported through career development, clarity at points of transition, formalized psychological support mechanisms such as Balint Groups, as well as informal mentorship relationships.