Internal Medicine Residency Program Director Burnout and Program Director Turnover: Results of a National Survey

O’Connor, Alec B.; Halvorsen, Andrew J.; Cmar, John; Finn, Kathleen; Fletcher, Kathlyn E.; Kearns, Lisa; McDonald, Furman S.; Swenson, Sara; Wahi‐Gururaj, Sandhya; West, Colin P.; Willett, Lisa L.

doi:10.1016/j.amjmed.2018.10.020

Cited by 35 publications

(36 citation statements)

References 27 publications

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“…Program director consideration of resigning was previously shown to be strongly associated with both burnout and program director turnover. 6 Our study confirms the strong association between burnout and consideration of resigning and also demonstrates that program directors who are burned out have stronger intent to resign than those not burned out. We identified many factors affecting consideration of resigning.…”

Section: Discussionsupporting

confidence: 82%

“…In a recent study of program director turnover, we found strong associations between turnover and consideration of resigning (hazard ratio [HR] 4.05) and between turnover and burnout (HR 1.89); notably, nearly one-half of program directors had considered resigning in the preceding year. 6 This study seeks to assess intent to resign and reasons associated with why program directors consider resigning.…”

Section: Introductionmentioning

confidence: 99%

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Why Do Residency Program Directors Consider Resigning? A Mixed-Methods Analysis of a National Program Director Survey

Fletcher

O’Connor

Kisielewski

et al. 2020

The American Journal of Medicine

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AAIM is the largest academically focused specialty organization representing departments of internal medicine at medical schools and teaching hospitals in the United States and Canada. As a consortium of five organizations, AAIM represents department chairs and chiefs; clerkship, residency, and fellowship program directors; division chiefs; and academic and business administrators as well as other faculty and staff in departments of internal medicine and their divisions.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Why Do Residency Program Directors Consider Resigning? A Mixed-Methods Analysis of a National Program Director Survey

Fletcher

O’Connor

Kisielewski

et al. 2020

The American Journal of Medicine

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“…In turn, burnout could affect the quality of life of these program directors, and ultimately the program as a whole. Evidence suggests that burnout is related to job turnover in medical residency program directors, 5 and frequent turnover in this important role can have ripple effects on the entire program.…”

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confidence: 99%

Awareness of Meaning in Life is Protective Against Burnout Among Family Physicians: A CERA Study

Hooker

Sherman

2020

Fam Med

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Background and Objectives: Burnout is considered a public health crisis among physicians and is related to poor quality of life, increased medical errors, and lower patient satisfaction. A recent literature review and conceptual model suggest that awareness of life meaning, or meaning salience, is related to improved stress and coping, and may also reduce experience of burnout. This study examined associations among meaning salience, burnout, fatigue, and quality of life among family medicine residency program directors. Methods: Data were collected via an online survey administered by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA; n=268, response rate of 45.4%) in December 2018. Program directors completed measures of meaning salience, burnout, fatigue, and quality of life. Data were analyzed using Spearman correlations and path analysis. Results: Program directors who reported greater experienced meaning salience also reported significantly less burnout (β=-.40, P<.001) and less fatigue (β=-.38, P<.001), which were then both significantly associated with greater quality of life (Ps<.001). Program directors who reported greater meaning salience also reported greater quality of life (β=.21, P<.001). Additionally, there were significant indirect associations between meaning salience and quality of life through less burnout and fatigue (β=.26, P<.001). Conclusions: The potential for increasing physicians’ awareness of their sense of meaning as a means to prevent or decrease burnout is underresearched and warrants further study. Both preventive measures (eg, wellness curricula) and interventions with already-distressed physicians may encourage regular reflection on meaning in life, especially during busy workdays.

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“…But more recent literature in management suggests that excess stability may be a liability, and may broadly represent stagnation or inflexibility [15]. This change in perspective is important, since PDs tend to be more senior physicians and have relatively long tenures: indeed, over 30% of Internal Medicine Residency PD’s have been in their positions for over 7 years and an equal percentage is above the age of 55 [16]. While other physicians can utilize the length of such experiences as a way to demonstrate and advance their expert power base in clinical medicine [12], that approach may not be as tenable for PD’s.…”

Section: Main Textmentioning

confidence: 99%

The ecology of program director leadership: power relationships and characteristics of effective program directors

2019

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BackgroundProgram directors are often perceived as strong and independent leaders within the academic medical environment. However, they are not as omnipotent as they initially appear. Indeed, PDs are beholden to a variety of different agents, including trainees (current residents, residency applicants, residency alumni), internal influencers (departmental faculty, hospital administration, institutional graduate medical education), and external influencers (the Accreditation Council for Graduate Medical Education (ACGME), medical education community, and society-at-large). Altogether, these agents form a complex ecosystem whose dynamics and relationships shape the effectiveness of program directors.Main bodyThis perspective uses management theory to examine the characteristics of effective PD leadership. We underline the importance of authority, accessibility, adaptability, authenticity, accountability, and autonomy as core features of successful program directors. Additionally, we review how program directors can use the six power bases (legitimacy, referent, informational, expert, reward, and coercive) to achieve positive and constructive change within the complexity of the academic medical ecosystem. Lastly, we describe how local and national institutions can better structure power relationships within the ecosystem so that PD leadership can be most effective.ConclusionKeen leadership skills are required by program directors to face a variety of challenges within their educational environments. Understanding power structures and relationships may aid program directors to exercise leadership judiciously towards fulfilling the educational missions of their departments.

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Internal Medicine Residency Program Director Burnout and Program Director Turnover: Results of a National Survey

Cited by 35 publications

References 27 publications

Why Do Residency Program Directors Consider Resigning? A Mixed-Methods Analysis of a National Program Director Survey

Why Do Residency Program Directors Consider Resigning? A Mixed-Methods Analysis of a National Program Director Survey

Awareness of Meaning in Life is Protective Against Burnout Among Family Physicians: A CERA Study

The ecology of program director leadership: power relationships and characteristics of effective program directors

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