Evaluating Wellness Interventions for Resident Physicians: A Systematic Review

Abstract

Background Wellness initiatives implemented by graduate medical education programs can help mitigate burnout in resident physicians. Objective This systematic review seeks to identify factors that impact the effectiveness of resident wellness interventions and to provide a conceptual framework to guide future interventions. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 6 electronic databases were searched in November 2019 using variations of the keywords “resident physicians,” “wellness,” and “intervention.” Peer-reviewed full-text English-language articles on controlled studies were considered for inclusion. The quality of the studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. Results The initial search disclosed 1196 articles, of which 18 studies enrolling 666 resident physicians met inclusion criteria for qualitative review. Interventions using peer support and individual meditation enhanced well-being. Effective wellness interventions also used educational theory to guide program development, surveyed participants to guide intervention design, incorporated programming into existing didactic curricula, and recruited voluntary participants. The quality of most of the included studies was poor (13 of 18, 72%) and could be improved by using standardized wellness assessments supported by validity evidence. Conclusions This systematic review suggests that future resident wellness initiatives should focus on grounding interventions in educational theory, forging consensus on wellness instruments with validity evidence, and examining the impact of initiatives on patient outcomes. A logic model can provide a framework for designing and implementing effective wellness interventions.

Skills-Based Programs Used to Reduce Physician Burnout in Graduate Medical Education: A Systematic Review

“…The most common content types included stress management, resilience, general wellness, and mindfulness-based stress reduction; the teaching methods most often employed were small groups, discussion groups, and didactic learning sessions. Using these findings as a baseline for burnout reduction in conjunction with the conceptual logic model proposed by Eskander and colleagues 37 could greatly assist those who want to develop a burnout reduction intervention for their GME program. Instituting burnout reduction programs for residents will help provide necessary interpersonal and professional skills to aid in the development of wellness, mindfulness, resilience, and ultimately lower burnout scores during the residents' time in the training program.…”

“…This systematic review adds to the current knowledge regarding best practices in addressing and reducing burnout among GME trainees. Previously published reviews in this area identify prevalence of burnout and interventions to prevent burnout such as the wellness intervention systematic review published in the Journal of Graduate Medical Education, 37 and our review serves as a complement to this important piece of literature. Interventions addressing wellness may be perceived as a variant of burnout reduction programs, but there are distinct differences between wellness and burnout, as evidenced by having just 4 studies in common with Eskander and colleagues' review 37 and ours.…”

“…Previously published reviews in this area identify prevalence of burnout and interventions to prevent burnout such as the wellness intervention systematic review published in the Journal of Graduate Medical Education, 37 and our review serves as a complement to this important piece of literature. Interventions addressing wellness may be perceived as a variant of burnout reduction programs, but there are distinct differences between wellness and burnout, as evidenced by having just 4 studies in common with Eskander and colleagues' review 37 and ours. The relationship between wellness and burnout is much more complex than a simple dichotomous relationship that sits at either end of a continuum.…”

Moving beyond personal factors: A national study of wellness interventions in emergency medicine residency programs

“…Following this emphasis on improving the learning environment, a broad array of efforts have been implemented by residency programs to improve resident well‐being. A recently published systematic review of wellness interventions for resident physicians across all specialties recommends that interventions are grounded in educational theory, using validated wellness instruments 10 . Within EM residency programs, existing publications of wellness interventions spotlight a few programs with modest impact 11 .…”

To the Editor: Children of Residents: What About Their Well-Being?

“…e read with great interest the recent article by Eskander et al, ''Evaluating Wellness Interventions for Resident Physicians: A Systematic Review.'' 1 The authors should be commended for their efforts to review the interventions developed thus far.…”