Decreasing Resident Physician Burnout Requires a Multifaceted Approach

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 et al²  determined that trainee burnout exists before entering residency. One-third of surveyed internal medicine and psychiatry interns from a university-based program experience burnout before starting on the wards.²  Interns who begin residency with symptoms of fatigue and worry, and who have poor coping skills and limited exposure to mindfulness, will begin training with higher levels of burnout.²  This finding indicates that beginning supportive programs during residency training may already be too late.

The PRB-RSC previously demonstrated that the ability to practice mindfulness and self-compassion was protective for combating high levels of stress and improving confidence in the delivery of compassionate care.³  However, the best technique to educate residents on mindfulness is unclear. Although there is a curriculum available to address mindfulness, the feasibility, effectiveness, and impact have not yet been evaluated on a larger scale. In 2016, the American Academy of Pediatrics developed the “Resilience in the Face of Loss and Grief Curriculum.” This program focuses on skill development for disclosing difficult information and expressing and labeling a provider’s emotional response to a complex medical situation.⁴  Shahid et al⁵  demonstrated that emotional intelligence training may play a role in decreasing stress and improving wellness. Moving forward, as different training programs are developed, more attention must be spent on proving its efficacy to determine best practices.

In their 2017 white paper, the Institute for Healthcare Improvement challenged us to improve employee engagement by finding joy in the workplace.⁶  Similarly, an evaluation of the clinical learning environment is needed to address pediatric resident burnout. The PRB-RSC showed the negative impact of the environment on trainee performance and ability to cope with stress.¹  Residency training programs should evaluate different scheduling and staffing models to determine if there are opportunities to enhance the learning environment. Because high rates of physician burnout have been linked to the electronic health record and administrative tasks, it could also be assumed that identifying ways to lessen task burden on trainees may also decrease burnout. Academic half-days and protected time for resident learning may also have a positive impact on wellness but have yet to be evaluated. In addition, it can be inferred that improving resident connectivity among each other and with other members of the health care team may also improve engagement.

Mental health services must also be made readily available to trainees. Oregon Health and Science University has developed a Comprehensive Wellness and Suicide Prevention Program, which in addition to receiving education and training on coping strategies, residents and faculty are provided with access to on-site counselors.⁷  By decreasing barriers and improving access, more trainees and faculty were able to use counseling services.

The high burnout rate among pediatric residents must be addressed. A comprehensive approach would include developing evidence-based training in mindfulness and coping techniques for the individual resident, an institutional approach to improve resident engagement and increase joy in the workplace, and the availability of mental health services when needed to address both urgent and chronic concerns. In the future, data collected from the PRB-RSC may be able to stratify programs with various levels of burnout and determine potential beneficial educational program and workplace factors.

PRB-RSC

Pediatric Resident Burnout-Resilience Study Consortium