379TF Understanding Emotions: Combating Burnout With Empathy During Emergency Medicine Residency

Abstract

In 2014, Bodenheimer and Sinsky expanded on the Triple Aim’s three pillars1 of (1) quality, (2) patient satisfaction and (3) costs by incorporating (4) provider burnout in their Quadruple Aim, explaining that burnout among front-line workers threatens the goals of the Triple Aim. Medical trainees develop high rates of burnout during medical school that peaks during residency, and continues to outpace their peers throughout their early career. Emergency physicians consistently report the highest levels of burnout compared to other specialties. While residents are trained to develop growing skills in quality and process improvement, patient safety, informatics, etc, to improve delivery systems, there is very little training to identify and mitigate burnout. High rates of provider burnout, depression and suicidal ideation have encouraged residency programs to support resident “wellness.” However, the responsibility is often placed on residents to improve their own well-being by finding extra time for activities such as exercising, meditating, sleeping or socializing. Burnout includes emotional exhaustion, decreased feelings of purpose, and cynicism, and is associated with strained interpersonal relationships and a decline in empathy. Studies have shown that providers demonstrating greater empathy have higher satisfaction and that patients’ perception of their provider’s empathy even predicts outcomes. Thus, there is growing interest in empathy training for health professionals. Contemporary contemplative science, an interdisciplinary approach based on Eastern contemplative philosophy and practices, seeks to improve wellness through various applications of meditative practice. In this module, educators seek to cultivate empathy among emergency medicine residents through contemplative training of emotional awareness, attention, and emotional resilience. Upon completion of this course, learners will be able to: (1) Describe the characteristics of emotions, (2) state the definition and benefits of attention, (3) identify the three levels of burnout, (4) reflect on intention, (5) Define compassion, empathy and practice compassion for self and others, (6) discuss the core emotions groups of anger, sadness, fear, enjoyment, disgust, contempt and surprise. This course is designed for first-year and second-year emergency medicine residents as a 6-session small-group seminar during regularly scheduled didactic time. UCSF clinical psychology faculty with formal training in contemplative science guide groups of learners through sessions that incorporate didactics, group discussion, personal reflection and meditation. Between monthly sessions, residents are encouraged to practice the self-reflection, attention and meditation practice they have learned during their clinical and nonclinical experience as well as participate in online modules designed to reinforce discussion topics. There is no formal evaluation of learners during this seminar, and course feedback is solicited periodically through surveys and in-person debriefing. After completion of this curriculum, residents will have a framework for identifying and discussing personal burnout, empathy and core emotions, and practice techniques to mitigate burnout in their careers.