Burnout In Pediatric Residents Research Articles

Burnout During the COVID-19 Pandemic: A Report on Pediatric Residents.

The Pediatric Resident Burnout and Resilience Consortium (PRB-RSC) has described the epidemiology of burnout in pediatric residents since 2016. We hypothesized burnout rates during the pandemic would increase. We explored resident burnout during the COVID-19 pandemic and its relationship to resident perception of workload, training, personal life and local COVID burden. Since 2016, PRB-RSC has sent an annual, confidential survey to over 30 pediatric and medicine-pediatrics residencies. In 2020 and 2021, 7 questions were added to explore the relationship of COVID-19 and perceptions of workload, training and personal life. In 2019, 46 programs participated, 22 in 2020, and 45 in 2021. Response rates in 2020 (n=1,055, 68%) and 2021(n=1702, 55%) were similar to those of previous years (p=0.09). Burnout rates in 2020 were significantly lower than in 2019 (54% versus 66%, p<0.001) but returned to pre-covid levels in 2021 (65%, p=0.90). In combined 2020-2021 data, higher rates of burnout were associated with reported increased workload (AOR 1.38, 95% CI 1.19-1.6) and concerns regarding the effect of COVID on training (AOR 1.35, 95% CI 1.2-1.53). Program-level county COVID burden in combined 2020-2021 data was not associated with burnout in this model (AOR=1.03, 95% CI=0.70 - 1.52). Burnout rates within reporting programs decreased significantly in 2020 and returned to pre-pandemic levels in 2021. Increased burnout was associated with perceived increases in workload and concerns regarding effect of the pandemic on training. Given these findings, programs should consider further investigation into workload and training uncertainty on burnout.

Well-being factors associated with confidence in providing calm, compassionate care in pediatric residents

ObjectiveEngagement in calm, compassionate care (CCC) is important in fostering patient-centered care. We aimed to study factors which predict confidence in providing CCC in pediatric residents. MethodsWe performed a retrospective, multi-center, cohort study utilizing data from the Pediatric Resident Burnout and Resilience Study (PRB-RSC) from 2016 to 2018. The Calm Compassionate Care Scale (CCCS) was used to assess confidence in delivering CCC. We examined cross-sectional associations between CCC, demographic measures, programmatic features, and psychological scales. ResultsThe following showed significant positive associations with confidence in providing CCC: Cognitive and Affective Mindfulness Scale, Neff’s Self Compassion, Patient Reported Outcomes Measures-mental health, and Interpersonal Reactivity Index-empathetic concern. For the Maslach Burnout Index subscales, decreased personal accomplishment, increased emotional exhaustion, and increased depersonalization showed significant negative associations. ConclusionsWe found that several well-being measures and an increased sense of personal accomplishment are associated with increased confidence in providing CCC. These findings underscore the interrelatedness of these measures and highlight the importance of personal accomplishment as a positive factor in trainee development. Practice implicationsProgram level interventions that decrease trainee burnout and enhance resiliency as well as support trainees’ development of empathy and compassion may help trainees develop skills that promote patient-centered, compassionate care.

Update on Mistreatment and Burnout in Pediatric Residents.

When we published on mistreatment and burnout in pediatric residents in Academic Pediatrics 1, we wanted to expand the focus on risk factors for burnout to include systemic cultural factors like mistreatment. In the 2019 survey, 45% of residents met criteria for burnout and 33% reported having experienced mistreatment: bullying (19%), discrimination (18%), sexual harassment (5.4%), and/or physical violence (1.3%); the most common sources of mistreatment were clinical staff (60%), patients’ families (54%), and faculty (43%).

A narrative medicine intervention in pediatric residents led to sustained improvements in resident well-being

Background Burnout in pediatric residents is widespread. Certain factors are associated with decreased burnout, such as empathy, self-compassion, mindfulness, and resilience, while perceived stress is associated with increased burnout. Narrative medicine may reduce burnout by its impact on protective and exacerbating factors and can be an active tool to promote wellness. The objective of this pilot study was to evaluate immediate and delayed benefits of a longitudinal narrative medicine intervention for pediatric residents using qualitative and quantitative measures. Materials and Methods We designed a voluntary longitudinal narrative medicine intervention implemented via Zoom teleconferencing software over five months for pediatric residents at Nationwide Children’s Hospital. It consisted of six one-hour long sessions where residents engaged with literature, responded to a writing prompt, and shared their reflections. It was evaluated using open-ended survey questions and established quantitative assessment tools of well-being with validity evidence. Results were compared before the intervention, immediately after, and six months later using one-way ANOVA and multiple linear regression. Qualitative data was analyzed using thematic analysis. Results Twenty-two (14% of eligible) residents participated in at least one session. After the intervention, the following themes emerged for benefits to resident well-being: the ability to Build Community, have an Outlet for Self-Expression, reap Emotional and Mental Health Benefits, and work on Personal Growth. Benefits were sustained even six months later, which has not been shown previously. While there were significant qualitative findings, between all three time points, there was no change in any quantitative well-being measures. Conclusion Our longitudinal narrative medicine pilot study showed meaningful sustained qualitative benefits, though no quantitative changes, in measured well-being outcomes that have been previously associated with lower resident burnout. While not a panacea, narrative medicine can be a useful strategy for residency programs to improve pediatric resident well-being even after completion of planned interventions. Key Message We used a mixed-methods approach to assess the effects of a longitudinal narrative medicine intervention on well-being in pediatric residents. Open-ended responses indicated that residents found utility in and appreciated the intervention and experienced sustained improvements in their mental and emotional health, though the sample size was likely too small to show quantitative changes in well-being measures. Narrative medicine is not a panacea, but it can be a useful tool to provide to pediatric residents to promote sustained improvements in their well-being through the framework of relationship-centered care.

Pediatric residents’ burnout in Indonesia: a national survey during the pandemic

Background The uncertain and somewhat chaotic clinical learning environment during the COVID-19 pandemic may potentially trigger burnout in pediatric residents.&#x0D; Objective To investigate the prevalence of burnout in pediatric residents in Indonesia during the COVID-19 pandemic and to identify potential risk factors associated with burnout.&#x0D; Methods This analytic observational study was conducted between April and June 2020. A questionnaire-based survey using an Indonesian translation of the Maslach Burnout Inventory-Human Services Survey was conducted online across 15 pediatric training institutions treating COVID-19 patients in Indonesia. Results were interpreted in accordance with the inventory guidelines. The chi-square test was used to analyze for possible associations between each subscale and gender, marital status, training stage, as well as institution of origin. One-way ANOVA of each subscale was performed on pediatric training institutions located in different regions.&#x0D; Results Of 983 respondents (82% average response rate), the prevalences of high emotional exhaustion and high depersonalization were 28.0% and 15.8%, respectively, while more than half of respondents (50.2%) had a low sense of personal accomplishment. Most respondents felt more exhausted than depersonalized. The location of pediatric training institution (Java or outside Java) was the only significant factor associated with burnout (P=0.003).&#x0D; Conclusion In the early stages of the pandemic, more than half of pediatric residents in Indonesia had a low sense of personal accomplishment. The only significant factor associated with burnout among was the location of training institution (Java or outside Java), suggesting a potential role of differences in hospital situation and clinical learning environment during the pandemic between Java and outside Java.

Prevalence of burnout and its relation to the neuroendocrine system among pediatric residents during the early Covid-19 pandemic: A pilot feasibility study

BackgroundMeasuring burnout relies on infrequent and subjective surveys, which often do not reflect the underlying factors or biological mechanisms that promote or prevent it. Burnout correlates with cortisol levels and dysregulation of the hypothalamic-pituitary-adrenal axis, but the chronology and strength of this relationship are unknown. ObjectiveTo determine the prevalence and feasibility of studying burnout in pediatric residents using hair cortisol and hair oxytocin concentrations. Design/Methods: Longitudinal observational cohort study of pediatric residents. We assessed burnout using the Stanford Professional Fulfillment Index and hair cortisol (HCC), and hair oxytocin concentrations (HOC) at four 3-month intervals from January 2020–January 2021. We evaluated test-retest reliability, sensitivity to change using Pearson product-moment correlations, and relationships between burnout and hair biomarkers using hierarchical mixed-effects linear regression. Results17 Pediatrics residents provided 78 wellness surveys and 54 hair samples. Burnout symptoms were present in 39 (50%) of the surveys, with 14 (82%) residents reporting burnout in at least one time point. The lowest (41%) and highest (60%) burnout prevalence occurred in 04/2020 and 01/2021, respectively. No significant associations between burnout scores and HCC (β −0.01, 95%CI: 0.14–0.13), HOC (β 0.06, 95%CI: 0.06–0.19), or the HCC:HOC ratio (β −0.04, 95%CI: 0.09–0.02) were noted in separate analyses. Intra-individual changes in hair cortisol concentration were not associated with changes in burnout score. ConclusionsBurnout was prevalent among Pediatrics residents, with highest prevalence noted in January 2021. This pilot longitudinal study demonstrates the feasibility of evaluating burnout with stress and resilience biomarkers in Pediatrics residents.

App-Based Three Good Things and Gratitude Journaling Incentive Program for Burnout in Pediatric Residents: A Nonrandomized Controlled Pilot.

Despite extensive literature measuring the prevalence and the consequences of burnout among resident physicians, effective interventional controlled trials are lacking.1,2 Mindfulness, therapy, and schedule changes have shown small benefits, but require learning a new skill, significant institutional resources, or organizational change.2 Additionally, ability to safely participate in many group or self-care activities has been limited by the recent COVID-19 pandemic. Gratitude3 and 3 good things3 (G/3GT) journaling are low-cost, individual-level interventions that have been shown to significantly improve measures of burnout, happiness, depression, gratitude, and stress; studies so far have not focused on resident burnout.

7. ASSOCIATION OF SELF-REPORTED QUALITY OF CARE MEASURES AND BURNOUT: AN INVESTIGATION FROM THE PEDIATRIC RESIDENT BURNOUT-RESILIENCE STUDY CONSORTIUM

Background The Pediatric Resident Burnout-Resilience Study Consortium (PRB-RSC), established in 2015, is committed to studying the epidemiology, natural history, and impact of interventions designed to address burnout and improve resilience in pediatric residents. Annual surveys demonstrate a prevalence of burnout of 40-55% over the last 4 years. Previous regional work has shown an association between resident burnout and sub-optimal patient care. Design/Methods The PRB-RSC distributed the annual survey to pediatric residents in participating programs in the spring of 2019. Data was de-identified, collected and maintained by the Association of Pediatric Program Directors’ Longitudinal Educational Assessment Research Network. Residents were classified as burned out on the basis of a 2-item screen for emotional exhaustion/depersonalization. An ordinal mixed effects generalized additive model regression was used to examine the effect of burnout on reported quality of care behaviors. For the ten behaviors queried, perceived stress scale (PSS), cognitive and affective mindfulness scale (CAMSR), and overall quality of life score (QOL) were compared between those with recent ( 12 months) poor quality behaviors reported. Results A total of 46 pediatric programs participated in the 2019 PRB-RSC survey, with an overall response rate of 62% (n=1648). The recency of reported sub-optimal behaviors between those with and without burnout is shown in the Figure. After controlling for training year, age, male gender, white race, program size and region, and clustering of learners in programs, each p-value is Conclusion(s) In this national survey, pediatric resident burnout is associated with sub-optimal care delivery, while recent experience with sub-optimal care is associated with higher stress, lower mindfulness, and decreased overall QOL.

Global Health Experiences, Well-Being, and Burnout: Findings From a National Longitudinal Study.

Describe the demographics of pediatric and internal medicine/pediatric residents participating in global health (GH) experiences and examine relationships between GH involvement and self-perceived burnout, resilience, mindfulness, empathy, and spirituality. The Pediatric Resident Burnout and Resilience Study Consortium developed a national longitudinal study through collaboration with the Association of Pediatric Program Directors' Longitudinal Educational Assessment Research Network. Electronic surveys were administered to pediatric trainees annually (2016-2018). GH and well-being data were extracted. Descriptive statistics were calculated. Of 9653 eligible pediatric and medicine/pediatric residents from 55 institutions, 6150 responded to the survey in 1 or more years, with average completion rate of 63.7% over a 3-year period. Controlling for repeat survey-takers, 12.7% (536/4213) of residents reported involvement in a GH-specific pathway, curricula, or track. GH participants were significantly more likely to be unmarried (P < .001), childless (P=.003), and medicine/pediatric trainees (P < .001). Controlling for repeated measures and demographic factors, GH participants demonstrated higher levels of empathic concern (P < .001) and higher spirituality scores in 2 of 3 domains (P < .01/<.05). GH involvement was not associated with lower reports of burnout or improved resilience/mindfulness. Although GH involvement is associated with increased levels of empathy and spirituality, it was not protective against burnout in this study. This highlights the need to study and promote the well-being of all residents, and perhaps especially those experiencing the challenges of working in low-resource settings. Future efforts should determine the impact of predeparture training, programmatic support, and post-trip debriefing on resident well-being.

Bullying, Discrimination, Sexual Harassment, and Physical Violence: Common and Associated With Burnout in Pediatric Residents.

Many pediatric residents suffer from burnout. We aimed to describe the prevalence, source, and epidemiology of bullying, discrimination, harassment, and physical violence, and the relationship between these experiences and burnout. We analyzed data from the Spring, 2019 Pediatric Resident Burnout and Resilience Study Consortium's 72-item online survey. Surveys included screening questions about burnout; residents' characteristics and experiences, and attitudes about their learning environment. Nineteen hundred fifty-six residents (66% of those eligible) from 46 programs participated; most (70%) were women and most (66%) were Caucasian. Overall 45% reported weekly or more frequent burnout symptoms; 33% reported 1 or more of these experiences ("mistreatment") during the past year: 19% reported experiencing bullying; 18% reported discrimination; 5% reported sexual harassment; and 1% reported physical violence. The most frequent sources of mistreatment were clinical staff (60%), patients' families (54%), and faculty (43%). Women were more likely than men to report mistreatment (36% vs 25%, P < .01) Residents who reported experiencing mistreatment were more likely than those who did not to report symptoms of burnout (adjusted odds ratio 1.98; 95% confidence interval, CI 1.62-2.42); they also reported higher stress levels, lower quality of life, and were less likely to agree that their program prioritized collaboration, education, or mentoring (P < .001 for all). Mistreatment occurs frequently among pediatric residents, especially women; mistreatment is associated with burnout, stress, lower quality of life, and worse attitudes about the learning environment. Future studies could explore whether institutional efforts to improve workplace civility improves resident well-being and attitudes about training.

Burnout in Pediatric Residents: Three Years of National Survey Data.

We aimed to describe the national epidemiology of burnout in pediatric residents. We conducted surveys of residents at 34 programs in 2016, 43 programs in 2017, and 49 programs in 2018. Survey items included the Maslach Burnout Inventory, demographics, program characteristics, personal qualities, experiences, and satisfaction with support, work-life balance, and learning environment. Analyses included cross-sectional comparisons and cross-sectional and longitudinal regression. More than 60% of eligible residents participated; burnout rates were >50% in all years and not consistently associated with any demographic or residency characteristics. Cross-sectional associations were significant between burnout and stress, sleepiness, quality of life, mindfulness, self-compassion, empathy, confidence in providing compassionate care (CCC), being on a high-acuity rotation, recent major medical error, recent time off, satisfaction with support and career choice, and attitudes about residency. In cross-sectional logistic regression analyses, 4 factors were associated with an increased risk of burnout: stress, sleepiness, dissatisfaction with work-life balance, and recent medical error; 4 factors were associated with lower risk: empathy, self-compassion, quality of life, and CCC. Longitudinally, after controlling for 2017 burnout and 2018 risk factors (eg, recent error, sleepiness, rotation, and time off), 2017 quality of life was associated with 2018 burnout; 2017 self-compassion was associated with lower 2018 stress; and 2017 mindfulness, empathy, and satisfaction with learning environment and career choice were associated with 2018 CCC. A majority of residents met burnout criteria. Several identified factors (eg, stress, sleepiness, medical errors, empathy, CCC, and self-compassion) suggest targets for interventions to reduce burnout in future studies.

Natural history of burnout, stress, and fatigue in a pediatric resident cohort over three years

ABSTRACT Background Burnout is known to be high amongst physician trainees. Factors such as stress, fatigue, social environment, and resilience could affect burnout. Cross-sectional data describe burnout in pediatric residents, but the trajectory of burnout in a cohort of residents followed longitudinally through the full course of residency training has not been reported. We prospectively examined the prevalence and trajectory of burnout, stress, fatigue, social connectedness, and resilience in a pediatric resident cohort from orientation through three years of residency. The cohort (N = 33) was surveyed six times between 2015–2018 using the Abbreviated Maslach Burnout Inventory (AMBI), Perceived Stress Scale (PSS), Epworth Sleepiness Scale (ESS), Social Connectedness Scale-Revised (SCS-R), and Connor-Davidson Resilience Scale (CD-RISC10). Data were analyzed using repeated measures mixed effects models. Significant change from baseline was considered to be adjusted p < 0.05. Response rate was >50% at each timepoint; 69% of trainees completed surveys ≥4 times. Scores were significantly worse than baseline in all surveys, at every timepoint, with the exception of AMBI-PA (personal accomplishment) at the PGY1/PGY2 transition and SCS-R and CD-RISC10 at the end of training. The most significant changes from baseline occurred mid-PGY1 to mid-PGY2. At least 65% of residents demonstrated worse scores than baseline on 36/40 (90%) follow-up surveys. Furthermore, ≥65% met criteria for emotional exhaustion and moderate stress at every timepoint. SCS-R was the only survey measure to improve at residency completion compared to baseline. Conclusion Within 6 months of starting residency this pediatric resident cohort became burned out, stressed, fatigued, less socially connected, and less resilient. Burnout is only one factor that indicates impaired resident well-being. To fully address this, a comprehensive examination of how residents are trained is needed to identify effective interventions. Abbreviations MBI – Maslach Burnout Inventory; AMBI – Abbreviated Maslach Burnout Inventory; AMBI-EE – Emotional Exhaustion; AMBI-D – Depersonalization; AMBI-PA – Personal Accomplishment; AMBI-SAT – Satisfaction with Medicine; LCH – Ann & Robert H. Lurie Children’s Hospital of Chicago/Lurie Children’s Hospital; P/CN – Pediatrics/Child Neurology; PSS – Perceived Stress Scale; ESS – Epworth Sleepiness Scale; CD-RISC10 – Resilience; SCS-R – Social Connectedness Scale Revised; PGY – Post-Graduate Year

Burnout in Pediatric Residents: When is Burnout Most Likely to Occur during an Inpatient Service Month and What are its Associated Factors?

Burnout in Pediatric Residents: When is Burnout Most Likely to Occur during an Inpatient Service Month and What are its Associated Factors?

5. DO WELLNESS INTERVENTIONS IN A LARGE PEDIATRIC RESIDENCY PROGRAM IMPACT RESIDENT BURNOUT?

BackgroundThe ACGME has called upon programs to more directly address resident physician well-being. In recent years, the pediatric residency program at Children's Hospital of Pittsburgh (CHP) has implemented multiple interventions aimed at improving resident wellness. Examples include the addition of an elective to the intern year, incorporation of wellness weeks, and visits for interns with a clinical therapist. The program monitors individual resident burnout biannually using the Maslach Burnout Inventory (MBI), a validated survey which evaluates three domains: emotional exhaustion, depersonalization and personal accomplishment. The aim of this study was to evaluate the prevalence of burnout in pediatric residents, and to examine changes in burnout rates over time as the program has implemented wellness interventions.MethodsRetrospective analysis of MBIs completed by pediatric residents at CHP between July 2015 and July 2018 was performed. Burnout was defined as a high score in either emotional exhaustion or depersonalization. Data were analyzed using descriptive statistics.Results92 pediatric residents were included. Residents were excluded from sub-analyses if they did not complete MBIs for all the terms being analyzed. During the 2017-2018 academic year, 42% of residents experienced burnout. Following a cohort from the 2015 PGY-1 class (N=16), 80% of residents who were burned out during their intern year had burnout at later points in residency. Between 2015-2018, there was a decrease in PGY-1 burnout rates. Prevalence of burnout in PGY1s during the fall and spring terms was 40% and 45% in 2015/2016 (N=20), 27% and 40% in 2016/2017 (N=30), 22% and 28% in 2017/2018 (N=32).ConclusionsThe prevalence of burnout in pediatric residents at CHP was comparable to rates reported in the literature. When following a cohort of individuals through their residency, burnout seemed to persist over time. Burnout rates were higher for interns in the spring compared to the fall. With an increase in wellness interventions the program has seen a decrease in intern burnout over the past three years. The ACGME has called upon programs to more directly address resident physician well-being. In recent years, the pediatric residency program at Children's Hospital of Pittsburgh (CHP) has implemented multiple interventions aimed at improving resident wellness. Examples include the addition of an elective to the intern year, incorporation of wellness weeks, and visits for interns with a clinical therapist. The program monitors individual resident burnout biannually using the Maslach Burnout Inventory (MBI), a validated survey which evaluates three domains: emotional exhaustion, depersonalization and personal accomplishment. The aim of this study was to evaluate the prevalence of burnout in pediatric residents, and to examine changes in burnout rates over time as the program has implemented wellness interventions. Retrospective analysis of MBIs completed by pediatric residents at CHP between July 2015 and July 2018 was performed. Burnout was defined as a high score in either emotional exhaustion or depersonalization. Data were analyzed using descriptive statistics. 92 pediatric residents were included. Residents were excluded from sub-analyses if they did not complete MBIs for all the terms being analyzed. During the 2017-2018 academic year, 42% of residents experienced burnout. Following a cohort from the 2015 PGY-1 class (N=16), 80% of residents who were burned out during their intern year had burnout at later points in residency. Between 2015-2018, there was a decrease in PGY-1 burnout rates. Prevalence of burnout in PGY1s during the fall and spring terms was 40% and 45% in 2015/2016 (N=20), 27% and 40% in 2016/2017 (N=30), 22% and 28% in 2017/2018 (N=32). The prevalence of burnout in pediatric residents at CHP was comparable to rates reported in the literature. When following a cohort of individuals through their residency, burnout seemed to persist over time. Burnout rates were higher for interns in the spring compared to the fall. With an increase in wellness interventions the program has seen a decrease in intern burnout over the past three years.

14. BURNOUT IN PEDIATRIC RESIDENTS: WHEN IS BURNOUT MOST LIKELY TO OCCUR DURING AN INPATIENT SERVICE MONTH AND WHAT ARE ITS ASSOCIATED FACTORS

Background Burnout is a work-related syndrome characterized by emotional exhaustion (EE), depersonalization (DP), and a sense of lack of personal accomplishment (PA). Data show those in medical training suffer from burnout, but neither the timing of burnout in a narrower timeframe nor its associations is known. Objective A single center prospective study was conducted to establish the prevalence of burnout in pediatric residents during an inpatient month, monitor the pattern of burnout progression throughout the month, and ascertain what factors may be associated with that burnout. Methods Surveys assessing burnout, symptoms of depression, quality of life, fatigue, clinical and personal experiences were distributed to pediatric residents every week for a total of five weeks during an inpatient service month. Surveys included the Maslach Burnout Inventory (MBI), considered the gold-standard for measuring burnout, and the McCauley Survey, a survey created by one of our authors to measure burnout. Inpatient service months included a rotation on the wards, pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU). First, second and third year pediatric residents were included in the study. A washout period of at least one month was required before a resident was surveyed a second time. Results Mean values of EE had statistically significant worsening between the start and end of an inpatient month. Similarly, the prevalence of burnout increased from 71% to 83%. 71% of residents had positive screens for depression. 38% of residents had answered “yes” to the question “have you doubted your career choice in the last week.” The McCauley Survey results for burnout correlated well with the standard MBI surveys. Conclusions A large majority of pediatric residents are burned out and burnout increases during an inpatient rotation. Many pediatric residents trigger positive screens for depression and question their career choice during an inpatient rotation. Intervention is warranted in this center and is currently underway. Future multi-center studies are needed to validate this data, as well as follow-up studies to evaluate the possible impact of current interventions at this center.

13. EVALUATING THE RELATIONSHIP BETWEEN TEAMWORK, ORGANIZATION, CULTURE AND BURNOUT AMONG RESIDENTS

Rationale Little research has explored in depth the relationship between organizational, individual, and program factors contributing to burnout, and the resident perspective on how best to address burnout. Objective The Maslach Burnout Inventory (MBI) was administered to residents and focus groups were conducted to explore how organizational, individual and program factors affect burnout in a medium sized, urban, academic pediatric residency program. Methods A constant comparison analysis was used to derive themes from focus groups until achieving thematic saturation. Residents completed the MBI following a department wide saturation in training model of the Strategies and Tools to Enhance Performance and Patient Safety program. Burnout was defined as a high subscale score for the burnout domain (>27) and/or the depersonalization domain (>10) on the MBI. Results 3 focus groups of 10 total residents were conducted and 31 residents completed the MBI. 4 themes were identified from the focus groups. First, at a program level, offering an individualized approach to wellness is important. Second, ensuring residents feel appreciated prevents feelings of lack of personal achievement. Third, from an organization perspective, teamwork training boosts interdepartmental relationships, but may not provide adequate reinforcement and should be supported by frequent debriefings to promote positive team culture. Lastly, getting residents back to the bedside and reducing documentation burden is key. Quantitative data supported qualitative findings, with 61% of residents meeting criteria for burnout. Conclusions A multifactorial approach to addressing burnout in pediatric residents requires the development of organizational infrastructure and program level interventions to support residents. It is essential to create a culture that ensures residents can prioritize clinical education, develops effective communication and reflective skills through team training and debriefing, and gets residents back to the bedside. Program interventions should give residents autonomy around wellness and educational activities.

3. EMPATHY AND SELF-COMPASSION CORRELATE WITH PERFORMANCE IN PEDIATRIC RESIDENTS

Background Empathy and self compassion have emerged as strong, potentially modifiable corollaries with burnout, though little is known about how these correlate with resident performance over time. Objectives Assess residents’ empathy and self-compassion during residency over time, and how these correlate with pediatric milestone scores. Methods As part of the Pediatric Resident Burnout - Resilience Study Consortium, we performed a subanalysis of a prospective cohort including all residents from 55 institutions. In each of the 3 data cycles, residents completed online cross-sectional surveys which included validated assessments of burnout (Maslach), empathic concern (EC; Interpersonal Reactivity Index), and self-compassion (SC; Neffs Self Compassion). Programs provided linked milestone data for each respondent. We fit linear mixed model growth curves predicting competency domain scores (mean milestones within each of the ACGME competencies) from EC, SC, PGY level, data cycle, interaction of data cycle x PGY, and with random intercepts and PGY slopes within learner and within program. Results 4929/4946 residents had responses for all variables. For all 6 competency areas (Medical Knowledge-MK, Patient Care-PC, Interpersonal Communication Skills-ICS, Problem Based Learning Improvement-PBLI, Systems-Based Practice-SBP, Professionalism-PROF), domain scores increased with PGY, as expected. EC and SC were associated with ICS and PROF domain scores; SC was associated with MK and PC; EC was associated with PBLI and SBP; (p Conclusion In a national longitudinal sample of pediatric residents, empathy and/or self-compassion were correlated with all ACGME core competencies. Targeting interventions to modify empathy and self-compassion may support efforts to mitigate burnout and improve performance.

Do Mindfulness and Self-Compassion Predict Burnout in Pediatric Residents?

Burnout symptoms are common among health professionals. Gaps remain in understanding both the stability of burnout and compassion over time and relationships among burnout, self-compassion, stress, and mindfulness in pediatric residents. The authors conducted a prospective cohort study of residents at 31 U.S. residency programs affiliated with the Pediatric Resident Burnout-Resilience Study Consortium. Residents completed online cross-sectional surveys in spring 2016 and 2017. The authors assessed demographic characteristics and standardized measures of mindfulness, self-compassion, stress, burnout, and confidence in providing compassionate care. Of 1,108 eligible residents, 872 (79%) completed both surveys. Of these, 72% were women. The prevalence of burnout was 58% and the level of mindfulness was 2.8 in both years; levels of stress (16.4 and 16.2) and self-compassion (37.2 and 37.6) were also nearly identical in both years. After controlling for baseline burnout levels in linear mixed-model regression analyses, mindfulness in 2016 was protective for levels of stress and confidence in providing compassionate care in 2017. Self-compassion in 2016 was protective for burnout, stress, and confidence in providing compassionate care in 2017; a one-standard-deviation increase in self-compassion score was associated with a decrease in the probability of burnout from 58% to 48%. Burnout and stress were prevalent and stable over at least 12 months among pediatric residents. Mindfulness and self-compassion were longitudinally associated with lower stress and greater confidence in providing compassionate care. Future studies are needed to evaluate the effectiveness of training that promotes mindfulness and self-compassion in pediatric residents.

Burnout in Pediatric Residents: Comparing Brief Screening Questions to the Maslach Burnout Inventory

BackgroundMeasuring burnout symptoms is important, but the Maslach Burnout Inventory (MBI) has 22 items. This project compared 3 single-item measures with the MBI and other factors related to burnout. MethodsData were analyzed from the 2016 and 2017 Pediatric Resident Burnout-Resilience Study Consortium surveys, which included standard measures of perceived stress, mindfulness, resilience, and self-compassion; the MBI; and the 1- and 2-item screening questions. ResultsIn 2016 and 2017, data were collected from 1785/2723 (65%) and 2148/3273 (66%) eligible pediatric residents, respectively. Burnout rates on the MBI were 56% in 2016 and 54% in 2017. The Physician Work Life Study item generated estimates of burnout prevalence of 43% to 49% and, compared with the MBI for 2016 and 2017, had sensitivities of 69% to 72%, specificities of 79% to 82%, positive likelihood ratios of 3.4 to 3.8, and negative likelihood ratios of 0.35 to 0.38. The combination of an emotional exhaustion item and a depersonalization item generated burnout estimates of 53% in both years and, compared with the full MBI, had sensitivities of 85% to 87%, specificities of 84% to 85%, positive likelihood ratios of 5.7 to 6.4, and negative likelihood ratios of 0.18 for both years. Both items were significantly correlated with their parent subscales. The single items were significantly correlated with stress, mindfulness, resilience, and self-compassion. ConclusionsThe 1- and 2-item screens generated prevalence estimates similar to the MBI and were correlated with variables associated with burnout. The 1- and 2-item screens may be useful for pediatric residency training programs tracking burnout symptoms and response to interventions.

82 - Pediatric Resident Burnout: Impact of Debriefing

82 - Pediatric Resident Burnout: Impact of Debriefing