Burnout In Trainees Research Articles

Enhanced Stress Resilience Training in Surgeons: Iterative Adaptation and Biopsychosocial Effects in 2 Small Randomized Trials.

To determine the effects of ESRT (an iteratively adapted and tailored MBI) on perceived stress, executive cognitive function, psychosocial well-being (ie, burnout, mindfulness), and pro-inflammatory gene expression in surgical (ESRT-1) and mixed specialty (ESRT-2) PGY-1 volunteers. Tailored MBIs have proven beneficial in multiple high-stress and high-performance populations. In surgeons, tailored MBIs have been shown to be feasible and potentially beneficial, but whether mindfulness-based cognitive training can improve perceived stress, executive function, well-being or physiological distress in surgical and nonsurgical trainees is unknown. In 2 small single-institution randomized clinical trials, ESRT, a tailored mindfulness-based cognitive training program, was administered and iteratively adapted for first-year surgical (ESRT-1, 8 weekly, 2-hour classes, n = 44) and mixed specialty (ESRT-2, 6 weekly, 90-minute classes, n = 45) resident trainees. Primary and secondary outcomes were, respectively, perceived stress and executive function. Other prespecified outcomes were burnout (assessed via Maslach Burnout Inventory), mindfulness (assessed via Cognitive Affective Mindfulness Scale - Revised), and pro-inflammatory gene expression (assessed through the leukocyte transcriptome profile "conserved transcriptional response to adversity"). Neither version of ESRT appeared to affect perceived stress. Higher executive function and mindfulness scores were seen in ESRT-1, and lower emotional exhaustion and depersonalization scores in ESRT-2, at pre-/postintervention and/or 50-week follow-up (ESRT-1) or at 32-week follow-up (ESRT-2), compared to controls. Pooled analysis of both trials found ESRT-treated participants had reduced pro-inflammatory RNA expression compared to controls. This pilot work suggests ESRT can variably benefit executive function, burnout, and physiologic distress in PGY-1 trainees, with potential for tailoring to optimize effects.

Burnout in gastroenterology registrars: a feasibility study conducted in the East of England using a 31-item questionnaire

ObjectiveThe scale of burnout in UK gastroenterology trainees and the feasibility to determine its prevalence using the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS) tool are unknown. The primary objective...

The Spiritual Works of Mercy as a Tool to Prevent Burnout in Medical Trainees.

Burnout is highly prevalent in medical students and in doctors during their residency or fellowship training, but multiple studies have shown regular practice of religion and spirituality to be protective against burnout. The Seven Spiritual Works of Mercy (Counsel the Doubtful, Instruct the Ignorant, Admonish the Sinner, Comfort the Sorrowful, Forgive All Injuries, Bear Wrongs Patiently and Pray for the Living and the Dead) provide a framework of powerful examples for teaching physicians, particularly Catholic teaching physicians, to uplift their students and potentially transfer this benefit to reduce their students' risk for burnout.

A Call to Restore Your Calling: Self-care of the Emergency Physician in the Face of Life-Changing Stress: Part 6 of 6: Trainee Burnout.

Whereas our last article focused on burnout in practicing pediatric emergency medicine (PEM) physicians, this article centers on burnout in PEM fellows. Our discussion is based solely on trainee burnout literature. As graduates of pediatrics or emergency medicine residencies, PEM fellows are charged with achieving attending-level clinical expertise while continuing to cope with trainee challenges, such as limited practice autonomy, low pay, financial debt, and uncertain future employment. In this article, we discuss PEM fellow burnout and review risk and protective factors, presentation, and evidence-based interventions to mitigate it. In the absence of PEM fellow-specific literature, we share pediatrics and emergency medicine residency data.This article is dedicated to the trainees we have lost to suicide. We miss you.

BURNOUT AND RESILIENCE IN U.S. PEDIATRIC CARDIOLOGY FELLOWS DEPENDS ON PROGRAM SUPERVISOR SUPPORT

Burnout is thought to be a contributing factor to high rates of physician substance abuse and mental health problems. We aimed to define factors associated with burnout and resilience in pediatric cardiology trainees. Using RedCap, pediatric cardiology fellows (years 1-3) in ACGME-accredited

Etiology of Burnout in Canadian Radiologists and Trainees.

There is worsening of burnout symptoms experienced by radiologists and trainees. We explored potential factors that exacerbate burnout symptoms observed in the Canadian radiological community and currently available protective factors as next steps for establishing viable solutions for burnout. An 11-question electronic survey was distributed to Canadian radiologists and trainees through the Canadian Association of Radiologists (CAR). Approval from a local ethics board and the CAR were obtained. The survey contained demographics-related questions as well as questions based on common risk factors for burnout. Qualitative and quantitative analyses were performed. The survey was distributed to 2200 CAR members, and a response rate of 23.3% was achieved. Most radiologists experienced frequent unexpected high workload with no statistically significant difference by the type of practice. Trainees experienced a statistically significantly (P < .0001) higher frequency of on-call shifts compared to staff radiologists. A statistically significant difference (P < .0001) was observed for perceived threats to career longevity dependent on length of career. Although support mechanisms for radiology were perceived as available, survey commentary suggested inefficiency in their usage and lack of prioritization, which was a trend observed across all types of practice. While there is awareness for radiology needs, changes are required at the workplace level to reduce burnout symptoms at their source. Communication between radiologists and hospital administration, as well as among radiology group members, is key to prioritize radiology needs in our imaging-driven era of health care.

Decreasing Resident Physician Burnout Requires a Multifaceted Approach

* Abbreviation: PRB-RSC — : Pediatric Resident Burnout-Resilience Study Consortium The alarming rate of physician burnout is a call to action on behalf of current trainees and future generations of doctors. Although this concern was identified more than a decade ago, little progress has been made. Symptoms of emotional exhaustion, cynicism, and inefficiency are widespread in this work environment. In addition, physicians also face high levels of individual stress, anxiety, and depression. The Pediatric Resident Burnout-Resilience Study Consortium (PRB-RSC) surveyed a cross-section of pediatric residents from 49 programs across the United States. The survey revealed a >50% burnout rate among pediatric residents.1 Importantly, this study also identified protective and risk factors that impact burnout. As medical educators, it is our responsibility to take an evidence-based approach and evaluate these factors. Afterward, a comprehensive plan to modify trainee burnout and improve overall wellness can be further developed. Resident burnout in pediatrics is not unique; it is present in all specialties. Chaukos … Address correspondence to Jeanine C. Ronan, MD, MS, MSEd, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, 9th Floor, Philadelphia, PA 19104. E-mail: ronan{at}email.chop.edu

The importance of defining trainee gender-based discrimination in the era of Time's Up

The authors address this timely topic of physician wellness from the perspective of trainee burnout, specifically identifying gender-based discrimination and bias (GBDB) as a cause.1 Women enrollment in medical school continues to increase (now >50%), yet female representation in surgery residencies is increasing more slowly and women are more likely to leave residency. Burnout and decreased wellness play a crucial role in loss of residents but, more important, can be associated with physician suicide and poor patient outcomes.

Work engagement in medical students: An exploratory analysis of the relationship between engagement, burnout, perceived stress, lifestyle factors, and medical student attitudes

There is a need to expand the current focus of burnout in medical trainees so that we can understand not only trainee distress but also trainee well-being. Work engagement as measured by the Utrecht Work Engagement Scale-15 (UWES-15) is a positive construct that is conceptually related to burnout and is a component of the Job Demands-Resources Model (JD-R). We sought to explore the relationship of work engagement to burnout, perceived stress, lifestyle factors, and medical student attitudes to testing whether work engagement could serve as a positive construct to study medical student well-being. We surveyed 287 1st and 2nd-year medical students at a large academic medical center in the United States. Our survey consisted of demographic measures, UWES-15, Burnout Measure short version, Perceived Stress Scale-4, lifestyle factors, and medical student attitudes. Statistical analysis revealed work engagement is negatively correlated with burnout and perceived stress. Work engagement and its subscales are correlated to exercise, sleep, drugs and alcohol use, maintaining relationships, and financial stress. Work engagement is negatively correlated with thoughts of dropping out and questioning the decision to enter medical school. Work engagement can be a useful measure to assess medical student well-being and identify areas for intervention.

It Is Time to Prioritize Education and Well-Being Over Workforce Needs in Residency Training.

Residents inhabit an ambiguous world. They are no longer medical students but are still learners. They are not yet attendings but are still paid employees. This ambiguity leads to a misalignment of departmental incentives and trainee expectations. Trainees expect their learning and well-being to be prioritized, while departments are under pressure to meet staffing needs and cut costs. This sets up a fundamental disconnect between the "formal" Accreditation Council for Graduate Medical Education (ACGME) message of well-being and the dominant "hidden" workplace forces that pull in the opposite direction, possibly contributing to the epidemic of burnout in trainees. It is critical that all parties-health systems, graduate medical education (GME) programs, the ACGME, and residents-recognize this disconnect and collaborate to meaningfully implement current ACGME requirements to decompress work intensity and address well-being. Real change will require more than general directives. The ACGME will likely need to take the lead and consider taking a design-thinking approach to structuring regulations governing how and when residents work and how they are supported. It would also be worthwhile to revisit the Institute of Medicine recommendations on GME from 2014 related to funds flow and transformation initiatives. Taking a more comprehensive approach to residents as people, workers, and vital health care professionals is the right thing to do and may well improve retention, reduce burnout, decrease medical errors, and improve care.

Building bridges: multidisciplinary faculty specialist and trainee burnout workshop.

Building bridges: multidisciplinary faculty specialist and trainee burnout workshop.

Cross-Sectional Survey Results on Mental Health Among Orthopedic Surgery Residents Across North America

With recent increasing rates of medical student and physician suicide, there has been a focus on examining depression in medical providers and trainees, particularly surgical residents. However, there is a paucity of data specific to orthopedic surgery. Our goal was to evaluate the mental health status of current trainees across North America in order to determine whether or not there were specific demographic or program characteristics correlated with improved mental health scores. A cross-sectional survey was developed and administered to collect basic demographic information as well as residency program qualities. The Mental Health Inventory 5 (MHI-5) was used to assess depression and anxiety in study participants. We then evaluated the associations between various resident and program characteristics and depression scores with a p value set at <0.05 for significance. Orthopedic Surgery residency programs across the United States and Canada. Surveys were distributed to 44 programs and responses were received from 41 of those programs. An anonymous survey was distributed to Orthopedic Surgery residents across the United States and Canada; participation in the survey was voluntary and free of coercion. We received a total of 279 responses from 41 institutions across North America. The mean MHI-5 score of all respondents was 71.5 (range 8.0-100). Women, PGY2 and PGY3 residents and those working >80 hours per week were found to have significantly lower MHI-5 scores. Greater MHI-5 scores were seen in respondents who felt their program offered them an adequate level of surgical independence, case volume/variety, mentorship, and educational opportunities as well as adequate resources to deal with personal or work-related issues. This study illustrates the prevalence of low-level depression in United States and Canadian orthopedic surgery residents. Additionally, we identified several characteristics that residency programs may focus on to help prevent burnout and depression in trainees.

The effectiveness, feasibility, and acceptability of a dialectical behaviour therapy skills training group in reducing burnout and psychological distress in psychology trainees: A pilot study

ObjectiveHigh levels of burnout, stress, and distress are reported in trainee psychologists. This study aimed to investigate the effectiveness, acceptability, and feasibility of an 8‐week dialectical behaviour therapy (DBT) skills training group for reducing study burnout and psychological distress and increasing study engagement and wellbeing.MethodSeventeen psychology trainees (16 females; age: M = 31.53; SD = 6.60; range 23–51) took part in the DBT skills training group. Intervention change scores were compared with a non‐randomised control group (n = 57; 53 females; age: M = 30.84; SD = 6.37, range 24–52). Outcome variables included burnout, psychological distress, study demands, engagement, emotional stability, psychological flexibility, and mindfulness.ResultsChange scores for the intervention group were significantly higher than those for the control group, and changes were largely maintained at 6‐month follow up. Quantitative and qualitative analysis suggested that the group was well received by participants.ConclusionsPreliminary support was found for the effectiveness, acceptability, and feasibility of the DBT skills training group for psychology trainees in reducing burnout and psychological distress and increasing engagement, psychological flexibility, emotional stability, and mindfulness. More research into burnout and distress reduction in psychology trainees is needed to determine effective and efficacious interventions.

An Approach to Addressing Trainee Burnout: Revising Fellow Shift Scheduling in the Intensive Care Unit

Introduction: Rotating shift patterns and night shifts are associated with fatigue and sleep deprivation, which in turn contribute to burnout. The aim of this quality improvement initiative at Mayo Clinic Rochester critical care fellowship programs was to implement a new critical care fellow shift schedule in the medical intensive care unit while evaluating the impact on self-reported burnout scores. Materials and Methods: Focus groups of fellows weighed pros and cons of the existing schedule and selected a revision of the schedule in which night shifts were grouped into blocks with limited frequency and incorporated a recovery period. Baseline self-reported burnout amongst critical care fellows was assessed using an abbreviated Maslach burnout inventory (MBI) screening questionnaire and re-evaluated at the end of the implementation period. Results: At baseline, 33 of 45 (73%) fellows responded to a survey with the abbreviated Maslach Burnout Index questionnaire. Median (IQR) scores for each of the domains were 10 (6-12) emotional exhaustion, 3 (1-9) depersonalization, and 15 (13-17) personal accomplishment. For the post-intervention survey, 17 out of 24 (71%) responded. The median (IQR) score for critical care internal medicine and pulmonary and critical care fellows was 7 (4-11), P=.06 and 9 (7-11), P=0.5 for emotional exhaustion; 3 (0-6), P=.07 and 5 (0-11), P=1.0 for depersonalization score; and 16 (11-17), P=.31 and 15 (12-17), P=.75 for personal accomplishment score. Discussion: Reducing the number of day-night rotations, incorporating a scheduled recovery period, and limiting the number of recurrent consecutive nights resulted in a trend towards improvement of self-reported burnout amongst critical care fellows.

Impact of Electronic Health Record Implementation on Ophthalmology Trainee Time Expenditures

Abstract Objective Electronic health records (EHRs) are widely adopted, but the time demands of EHR use on ophthalmology trainees are not well understood. This study evaluated ophthalmology trainee time spent on clinical activities in an outpatient clinic undergoing EHR implementation. Design Prospective, manual time-motion observations of ophthalmology trainees in 2018. Participants Eleven ophthalmology residents and fellows observed during 156 patient encounters. Methods Prospective time-motion study of ophthalmology trainees 2 weeks before and 6 weeks after EHR implementation in an academic ophthalmology department. Manual time-motion observations were conducted for 11 ophthalmology trainees in 6 subspecialty clinics during 156 patient encounters. Time spent documenting, examining, and talking with patients were recorded. Factors influencing time requirements were evaluated using linear mixed effects models. Main Outcome Measures Total time spent by ophthalmology residents and fellows per patient, time spent on documentation, examination, and talking with patients. Results Seven ophthalmology residents and four ophthalmology fellows with mean (standard deviation) postgraduate year of 3.7 (1.2) were observed during 156 patient encounters. Using paper charts, mean total time spent on each patient was 11.6 (6.5) minutes, with 5.4 (3.5) minutes spent documenting (48%). After EHR implementation, mean total time spent on each patient was 11.8 (6.9) minutes, with 6.8 (4.7) minutes spent documenting (57%). Total time expenditure per patient did not significantly change after EHR implementation (+0.17 minutes, 95% confidence interval [CI] for difference in means: –2.78, 2.45; p = 0.90). Documentation time did not change significantly after EHR implementation in absolute terms (+1.42 minutes, 95% CI: –3.13, 0.29; p = 0.10), but was significantly greater as a proportion of total time (48% on paper to 57% on EHR; +9%, 95% CI: 2.17, 15.83; p = 0.011). Conclusion Total time spent per patient and absolute time spent on documentation was not significantly different whether ophthalmology trainees used paper charts or the recently implemented EHR. Percentage of total time spent on documentation increased significantly with early EHR use. Evaluating EHR impact on ophthalmology trainees may improve understanding of how trainees learn to use the EHR and may shed light on strategies to address trainee burnout.

The Impact of Institutional Factors on Physician Burnout: A National Study of Urology Trainees

To determine the prevalence of burnout in urology trainees and examine the influence of personal, programmatic, and institutional factors on burnout rates. We conducted an anonymous survey of burnout in urology residents across the United States using a 50-question REDCap-based electronic questionnaire in May of 2018. The survey included demographic questions, an inventory of stress-reduction techniques and the Maslach Burnout Inventory. Univariate analysis and multinomial logistic regression models were used to assess associations between individual, program, and organizational factors and resident burnout. Overall response rate was 20.9%. Individual factors such as age, gender, exercise, and meditation were not associated with burnout while reading for relaxation (P = .022) and spending time with family (P = .025) were protective against burnout. Residents working >80 hours vs 60-80 hours and <60 hours per week were more likely to exhibit burnout (77.6% vs 66.1% vs 47.1%, respectively, P = .044). Institutional factors such as structured mentorship programs (P = .019) and access to mental health services (P <.001) were associated with decreased burnout. On multivariable analysis, unavailable or difficult-to-access mental health services were associated with increased odds of burnout (OR 5.38, 95%CI 2.20-13.16, P <.001, and OR 2.33, 95%CI 1.07-5.07, P = .034, respectively). The prevalence of burnout in urology trainees is high. Institutional factors such as formal mentorship and access to mental health services may play an important role in resident well-being.

FitFirms: A wellness option for oncology trainees.

10537 Background: Burnout in oncologists has been rising over the past decade. Burnout leads to poor patient outcomes and poor physician health. Younger oncologists are at higher risk for burnout. The Firm System was designed by Victor McKusick at the Johns Hopkins hospital in 1975 to integrate faculty and trainees into clinical and psychologically supportive cohorts. Here we describe an adapted Firm System called the FitFirms, which focused on social connectivity and altruistic service as means to combat burnout in oncology trainees. Methods: We divided the Hematology and Oncology Division of an academic Comprehensive Cancer Care center into four cohorts of faculty-fellow teams called FitFirms. Each FitFirm was named after a notable local or national female leader in the field of cancer medicine—The Henrietta Lacks Firm, The Jane Wright Firm, The Padmini Iyer Firm, and The Rita Mehta Firm. The faculty and fellows interacted on an at-minimum quarterly basis in casual social events and/or community service-oriented events for 15 months. The social events included group dinners, bowling, paint and game nights. The service events included participation in 5K walk/run fundraiser for our institution’s cancer center and support of a National Cancer Survivors Day event for US Veterans. A didactic discussion series was created to explore concepts of resiliency, work-life balance, and the role of art in medicine—mentored by faculty across the spectrum of oncologic disciplines (Surgical Oncology, Gynecologic Oncology, Palliative Care, and Health Communication). The Maslach Burnout Inventory survey was used to survey the oncology trainees before and after the interventions. Results: Nine pre-intervention surveys were collected with 78% of trainees describing themselves as on the burnout spectrum of feeling either ineffective, overextended, disengaged, or burned out (22% engaged). After 15 months, 10 post-intervention surveys were collected in which 60% of trainees described themselves on the burnout spectrum (40% engaged). Conclusions: The FitFirms are a novel system using social capital to reduce the problem of burnout in oncology trainees by engaging in social connectivity and altruistic service through faculty-mentored, historically-named divisional cohorts.

Resident burnout in USA and European urology residents: an international concern.

To describe the prevalence and predictors of burnout in USA and European urology residents, as although the rate of burnout in urologists is high and associated with severe negative sequelae, the extent and predictors of burnout in urology trainees remains poorly understood. An anonymous 32-question survey of urology trainees across the USA and four European countries, analysing personal, programme, and institutional factors, was conducted. Burnout was assessed using the validated abridged Maslach Burnout Inventory. Univariate analysis and multivariable logistic regression models assessed drivers of burnout in the two cohorts. Overall, 40% of participants met the criteria for burnout as follows: Portugal (68%), Italy (49%), USA (38%), Belgium (36%), and France (26%). Response rates were: USA, 20.9%; Italy, 45.2%; Portugal, 30.5%; France, 12.5%; and Belgium, 9.4%. Burnout was not associated with gender or level of training. In both cohorts, work-life balance (WLB) dissatisfaction was associated with increased burnout (odds ratio [OR] 4.5, P < 0.001), whilst non-medical reading (OR 0.6, P = 0.001) and structured mentorship (OR 0.4, P = 0.002) were associated with decreased burnout risk. Lack of access to mental health services was associated with burnout in the USA only (OR 3.5, P = 0.006), whilst more weekends on-call was associated with burnout in Europe only (OR 8.3, P = 0.033). In both cohorts, burned out residents were more likely to not choose a career in urology again (USA 54% vs 19%, P < 0.001; Europe 43% vs 25%, P = 0.047). In this study of USA and European urology residents, we found high rates of burnout on both continents. Despite regional differences in the predictors of burnout, awareness of the unique institutional drivers may help inform directions of future interventions.

Addressing Obstetrics and Gynecology Trainee Burnout Using a Yoga-Based Wellness Initiative During Dedicated Education Time.

To estimate the feasibility of implementing a yoga-based wellness program during training and its influence on burnout, depression, anxiety, stress, and mindfulness among obstetrics and gynecology trainees. We conducted a departmental quality improvement initiative consisting of weekly 1-hour yoga classes conducted during protected education time and nutrition and physical challenges for 24 obstetrics and gynecology residents and five maternal-fetal medicine fellows. Participants received a free wrist-worn fitness tracker device to record their activity. Preprogram and postprogram data collection included results from validated scales on burnout, mindfulness, depression and anxiety, blood pressure, heart rate, and weight. Wilcoxon signed rank tests were used for analysis. A P-value <.05 was considered significant. Over an 8-week period, 90% (n=26) of participants attended at least one yoga class and 68% attended at least 50% of the classes. No participant completed all sessions. Eighty percent (n=20) engaged in at least one nutrition challenge and 60% (n=15) in at least one physical challenge. After the program, a significant reduction in the depersonalization component of burnout (P=.04), anxiety (P=.02), and systolic (preprogram: 122, postprogram: 116 mm Hg; P=.01) and diastolic blood pressure (preprogram: 82, postprogram: 76 mm Hg; P=.01) occurred. Those participants who attended more than 50% of yoga classes demonstrated a significant reduction in systolic and diastolic blood pressure compared with less-frequent attendees (P=.02 and .04, respectively). A postprogram survey revealed feelings of increased camaraderie, appreciation, motivation, and overall training experience. Implementing a wellness program consisting of weekly yoga classes is feasible and may be beneficial. A wellness initiative that emphasizes active participation during education time with the autonomy to implement daily wellness activities may reduce burnout and improve well-being.

Twelve tips for thriving in the face of clinical uncertainty

Background: Effectively managing clinical uncertainty is increasingly recognized as a goal of medical education. Stress from uncertainty has been associated with depression and burnout in trainees and may also impact patient care. Despite its importance, however, strategies to embrace uncertainty in clinical practice are lacking.Aims: The literature on uncertainty in medicine was reviewed. Incorporating insights from faculty and students, 12 tips for healthcare educators to help themselves and others thrive in the face of clinical uncertainty were developed.Results: Educators will find the tips practical and easy to implement in their day-to-day interactions as clinicians and teachers. Tips are divided into tips for oneself; for implementing with students and trainees; and for implementing with patients and in healthcare systems.Conclusions: These tips can enhance healthcare professionals’ and students’ ability to thrive in the face of uncertainty. Strategies to embrace uncertainty are critical for ourselves, our trainees, our patients, and our healthcare systems.