278 Taking Action: Addressing Burnout in Emergency Medicine Through “Action Learning”

Abstract

Burnout in emergency medicine (EM) has been linked to poor patient care, low patient satisfaction, malpractice, and physician turnover. The Department of EM (DEM) at Thomas Jefferson University (TJU) collaborated with educators at Teachers College (TC), Columbia University to address this problem through “action learning” (AL) to better understand the complex problem of burnout in the Department. AL is an approach to problem solving that involves group work to reframe a given problem, reflect on possible solutions, conduct fieldwork, and propose actions to address the problem. Investigators used AL to 1) identify contributing factors of burnout; 2) describe the department’s culture of wellness; and 3) propose specific actions that may improve providers’ personal wellness. Twenty-one TC graduate students participated in this project. Three teams were created to address the three aforementioned objectives, respectively. Faculty from the Education Division from the DEM visited TC in January 2019 to introduce the DEM at TJU, describe the practice of EM, and frame the burnout problem. Student groups then collected data over the following two months, achieved through structured interviews with faculty and residents; focus groups; shadowing in the clinical environment; and researching best practices within the field. Teams qualitatively coded collected data to arrive at several themes. In March 2019, student groups presented their findings and proposed action items to the DEM. Findings and recommendations were divided in categories, which included: DEM organization; mission and strategy; structure and systems; leadership; interpersonal relationships; individual needs; and the nature of the job itself. A detailed analysis was presented including strengths (ie, strong peer relationships, passion for EM, professional advancement); weaknesses (ie, heavy workload, complicated work environment); opportunities (ie, longitudinal wellness curriculum), and threats (ie, scheduling, institutional prioritization, system-wide practices). A 17-item toolbox of suggested recommendations which can be integrated into already existing systems was also offered. The application of AL to optimize the DEM’s challenges with wellness and burnout at TJU provided in-depth contextualization of the factors that precipitate burnout in the department. Equally as important, the process of AL identified immediately actionable interventions that could address the problem. The next step will include convening a task force to decide how to systematically implement recommendations to better support and promote personal wellness and engagement in the DEM.