Resident-led organizational initiatives to reduce burnout and improve wellness

Mari, Sundus; Meyen, Rachel; Kim, Bo

doi:10.1186/s12909-019-1756-y

Cited by 47 publications

(41 citation statements)

References 29 publications

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“…A study conducted in 2013 by Kathleen A et al (48) reported the annual attrition rate in pediatrics as 2.9%, which was found to be much lesser compared to other specialties i.e., General surgery (5.1%), Family medicine (4.7%), Anesthesiology (3.6%), Psychiatry (7.9%), and Obstetrics and Gynecology (4.2%). Other studies (17,21,23,49) have also depicted a lower average attrition score. This would suggest that an intervention was highly needed in our program to bring down the attrition rate, and indeed after applying all changes focusing on wellness using the TOC model, the average attrition rate came down to a shocking 1.75%.…”

Section: Discussionmentioning

confidence: 89%

“…A literature review was done through Google Scholar and PubMed, and several articles related to the process of initiating a wellness program were identi ed. One such study described that achieving resident wellness is a signi cant challenge, and to implement effective strategies resident-led continuous feedback and leadership cooperation is a must (21). A collection of ample literature on wellness depicted strategies for identifying the problem in the program and individual system-level interventions have shown improvement in resident wellness (22).…”

Section: Literature Review/frameworkmentioning

confidence: 99%

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A Systemic Approach to Trainee Physician Wellness: Using the Theory of Change to Restructure a Pediatric Residency Program

Raza¹,

Aj²,

Humayun³

et al. 2021

Preprint

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Background: Resident well-being leads to better patient care practices, but a systematic approach is needed to achieve the wellness agenda. The Theory of Change was used for developing an interventional model for wellness in our study, after identifying the causes of burnout and attrition in a pediatric residency program. Methods: This was a quality improvement project where residents were asked about their main stressors in an anonymous open-ended feedback form. Workload (n=63, 37.5%) was identified as the main source of dissatisfaction. A database of 43 residents who quit in the past ten years was examined to find 40.0% of residents left after the first year of training and the main cause was marriage and/or family concerns (28.9%). Then literature was reviewed to build a wellness intervention's framework. Finally, the Theory of Change was applied focusing on restructuring the residency core, accountability and communication, and stress management. The final theory of the change model included the assumptions that the program needed restructuring because of high attrition, low first pass exam rate, and decreased patient satisfaction. The goal was to increase resident wellness and performance, while keeping patient care at the core. Results: The short-term outcomes were drop in attrition rate from an average of 8.67% to 1.75%, decrease in FCPS exam attempt from 3.3 to almost 1, and an increase in patient satisfaction. Conclusion: Using the Theory of Change, it was possible to address residents’ concerns, increase their retention and improve patient satisfaction by reconstructing the wellness program.

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Section: Discussionmentioning

confidence: 89%

Section: Literature Review/frameworkmentioning

confidence: 99%

A Systemic Approach to Trainee Physician Wellness: Using the Theory of Change to Restructure a Pediatric Residency Program

Raza¹,

Aj²,

Humayun³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…10,11,40 These have generally focused on individual wellness and include mindfulness, journaling, self-reflection, stress management, and gratitude activities. 7 While these do provide potential skills for trainees to use throughout their careers, so far these individual approaches have only met with marginal success. Additionally exercises such as mindfulness are likely to frustrate those who recognize and are returned to dysfunctional environments that contribute to impaired wellness.…”

Section: Challenges With Wellnessmentioning

confidence: 99%

“…Burnout in medicine is reported in many studies to be above 40-60%, which has been the primary driver of this intense focus. [3][4][5][6][7] There have been several articles suggesting methods for changing our educational settings to impact what some have called an "epidemic" of burnout. 8,9 Interventions have included mindfulness training, guided reflection, wellness days, art therapy, and gratitude exercises.…”

Section: Introductionmentioning

confidence: 99%

Shifting Focus from Burnout and Wellness toward Individual and Organizational Resilience

Vercio

Loo

Green

et al. 2021

Teaching and Learning in Medicine

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Issue: Burnout is reported to be epidemic among physicians and medical trainees, and wellness has been the predominant target for intervention in academic medicine over the past several years. However, both burnout and wellness suffer from a lack of standardized definition, often making interventions difficult to generalize and extrapolate to different sites. Although well-meaning, current frameworks surrounding wellness and burnout have limitations in fully addressing the challenges of improving physician mental health. Wellness as a framework does not inherently acknowledge the adversity inevitably experienced in the practice of medicine and in the lives of medical trainees. During a crisis such as the current pandemic, wellness curricula often do not offer adequate frameworks to address the personal, organizational, or societal crises that may ensue. This leaves academic institutions and their leadership ill-equipped to appropriately address the factors that contribute to burnout. More recently, resilience has been explored as another framework to positively influence physician wellness and burnout. Resilience acknowledges the inevitable adversity individuals encounter in their life and work, allowing for a more open discussion on the tensions and flexibility between facets of life. However, emphasizing personal resiliency without addressing organizational resiliency may leave physicians feeling alienated or marginalized from critical support and resources that organizations can and should provide. Evidence: Despite intense focus on wellness and burnout, there have not been significant positive changes in physicians' mental health. Many interventions have aimed at the individual level with mindfulness or other reflective exercises; unfortunately these have demonstrated only marginal benefit. Systems level approaches have demonstrated more benefit but the ability of organizations to carry out any specific intervention is likely to be limited by their own unique constraints and may limit the spread of innovation. We believe the current use of these conceptual lenses (wellness and burnout) has been clouded by lack of uniformity of definitions, an array of measurement tools with no agreed-upon standard, a lack of understanding of the complex interaction between the constructs involved, and an over-emphasis on personal rather than organizational interventions and solutions. Implications: If the frameworks of burnout and wellness are limited, and personal resilience by itself is inadequate, what framework would be helpful? We believe that focusing on organizational resilience and the connecting dimensions between organizations and their physicians could be an additional framework helpful in addressing physician mental health. An organization connects with its members along multiple dimensions, including communication, recognition of gifts, shared vision, and sense of belonging. By finding ways to positively affect these dimensions, organizations can create change in the culture and mental health of physicians and tr...

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“…12 This is despite numerous emerging positive personal and professional impacts on resident trainees who engage with such programming. 13 Our appeal is therefore simple, whether during the COVID-19 pandemic or afterward: develop opportunities for resident physicians to participate in art-making or viewing, be it through writing, photography, drawing, or music. Empower trainees to share their work and reflect upon it.…”

mentioning

confidence: 99%

Sharing Stories Through Art: Promoting Resident Connection During and After the COVID-19 Pandemic

Korus

Rabinowitz

2021

Pediatrics

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This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version.

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Resident-led organizational initiatives to reduce burnout and improve wellness

Cited by 47 publications

References 29 publications

A Systemic Approach to Trainee Physician Wellness: Using the Theory of Change to Restructure a Pediatric Residency Program

A Systemic Approach to Trainee Physician Wellness: Using the Theory of Change to Restructure a Pediatric Residency Program

Shifting Focus from Burnout and Wellness toward Individual and Organizational Resilience

Sharing Stories Through Art: Promoting Resident Connection During and After the COVID-19 Pandemic

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