Burnout Levels and Patterns in Postgraduate Medical Trainees: A Systematic Review and Meta-Analysis

Wellbeing interventions in family medicine and general practice trainees: a preliminary meta-analysis

BACKGROUND

Medical trainees experience occupational stress, prompting increasing research to explore wellbeing interventions. To date, few meta-analyses have evaluated intervention effects, and none have focused on trainees in family medicine or general practice (FM/GP), specifically. Aim: To synthesise available literature on psychosocial interventions to promote wellbeing, and subsequently reduce ill-being or burnout, among FM/GP specialty trainees.

METHODS

Preferred Reporting Items for Systematic Review and Meta-Analysis were followed and online databases (Embase, Medline, PsycINFO, ProQuest, Scopus) systematically searched (no date limits) for published studies and dissertations. The methodological quality of included studies was reviewed (Mixed Methods Appraisal tool, GRADE assessment), and pre-post changes (Hedges' g) pooled using random effects modelling.

RESULTS

Eleven independent studies, involving 182 FM/GP trainees, were included in this review. Evaluated studies varied in their design and the results were characterised by imprecision. Interventions differed in their content, delivery, and length. The data did not favour a single type of intervention, although supporting individuals to monitor their wellbeing did produce significant, positive effects.

CONCLUSIONS

There is a lack of evidence about the best ways to promote wellbeing in FM/GP trainees. Both the methodology and design of training and educational initiatives for FM/GP need careful consideration in order to progress this research.

[Graduate medical education in old age psychiatry: a scoping literature review]

BACKGROUND

Gerontopsychiatry will become increasingly relevant as a discipline for primary care based on current demographic forecasts, destigmatization of mental illness and specific diagnostic and therapeutic developments. Hence, high quality graduate medical training in old age psychiatry is needed. Objectives The goal of this review was to summarize the literature on medical education relevant to residency training in old age psychiatry and to contrast the findings with international developments in competency-based medical education.

MATERIALS AND METHODS

The authors used the scoping review method of Arksey and O'Malley.

RESULTS

The initial search yielded 913 hits. After full text screening, 20 original articles were used for data extraction. The study content was summarized under three categories: trainee recruitment, length and structure of graduate training curricula in old age psychiatry, and learning goals and competencies in old age psychiatry training. Surveys and expert consensus were mostly used as study methods. High-quality clinical training experience with gerontopsychiatric patients and supervision of residents was an important factor for stimulating interest in old age psychiatry. Few studies provided evidence for educational benefit of digital learning and teaching formats and simulation training in old age psychiatry. Overall, there were no studies in old age psychiatry with explicit reference to concepts of competency-based graduate medical education.

CONCLUSIONS

Clinical rotations and mentoring foster interest of clinical residents in the discipline of old age psychiatry. Systematically introducing clinical rotations in old age psychiatry in general psychiatry residency programs seems necessary to enable residents to gain relevant knowledge and skills. Educational research in old age psychiatry considering patient outcomes seems to be a meaningful next step.

Learning to work and working to learn: a phenomenographic perspective on the transition from student to doctor

The transition from being a medical student to working as a doctor is a pivotal phase, often marked by challenges in balancing learning with the demands of clinical practice. Despite extensive research on the struggles faced by junior doctors, there remains a gap in understanding how other key stakeholders perceive this transition and how it can be viewed as more than just a struggle. In this phenomenographic study, we used the Swedish medical internship as a proxy for the transition and explored internship programme directors' (PDs) perceptions of the medical internship from a developmental point of view. A phenomenographic approach was chosen to capture the variation in how PDs conceptualise the meaning of the internship, offering a more nuanced understanding of the transition and its implications for educational practice. Interviews with twelve PDs gave rise to three perceptions: the internship as an education, as working as a doctor, and as a space for learning through work. These views highlighted the transition not merely as a preparatory phase but as a dynamic process in which learning and clinical work were intertwined. Our findings suggest that instead of focusing solely on better preparing students for work, empowering junior doctors to learn through work-supported by structured guidance-can turn this challenging period into an opportunity for professional and personal growth. This study offers a novel contribution by shedding light on the role of PDs in shaping the transition to clinical work and emphasising the need to view it as a learning-centred, reflective experience.

The Representation of Wellness Programs in Plastic Surgery Residency

Background

Plastic surgery residency comprises a significant portion of early adulthood. The difficulties of residency are well documented, particularly with the impact on wellness and risk of burnout. Structured wellness programs, mentorship, social support, and autonomy can decrease residency burnout. This study looked at how plastic surgery program websites and GME websites represent wellness and support programs between both integrated and independent plastic surgery residencies.

Methods

A cross-sectional analysis of US plastic surgery residency programs was performed during the month of April 2024. The authors conducted a systematic content analysis on the available websites of these residency websites, GME websites, and associated programs' Instagram and X (formally Twitter) pages. Data points included (1) mention of wellness on the program website, (2) vacation time mentioned on the website, (3) protected time available, (4) spouse support options, (5) day care options, (6) connections with mentors, (7) images of social events on the website, and (8) images of social events on Instagram. Data were compiled and analyzed in JASP (JASP Team [2024]. JASP [version 0.18.3; computer software]) as well as Microsoft Excel. Categorical variables were compared using binomial tests and chi-squared tests. Statistical significance was defined a P value less than or equal to 0.05.

Results

The majority of plastic surgery residencies did not discuss or describe their wellness programs on their official website, regardless of program size. Similar results were displayed when searching for spousal support and daycare. GME websites were more comprehensive than the program websites but still showed significant discrepancies with vacation policies and day care. Mentorship was mentioned in under half of all plastic surgery residencies. Integrated programs were more likely to display social events on Instagram when compared with independent programs.

Conclusions

Plastic surgery residencies do not provide evidence of existing wellness programs on their program websites. Although a lack of public information on wellness programs does not mean they do not exist, this could easily be mitigated by providing more comprehensive information on both GME and program websites.

Is medical training solely to blame? Generational influences on the mental health of our medical trainees

INTRODUCTION

The negative impact of medical training on trainee mental health continues to be a concern. Situated within a sociocultural milieu, Generation Z and Generation Y, defined by their highly involved parents and the widespread use of technology, currently dominate undergraduate and graduate medical education respectively. It is necessary to explore medical trainees' generational characteristics and job-related factors related to stress, burnout, depression, and resilience. This might provide different perspectives and potential solutions to medical trainees' mental health.

METHODS

A cross-sectional study was conducted among medical trainees (students and residents) from two institutions in Qatar. A self-administered online survey included measures for trainees' social media overuse, their parent's parenting style, the educational support by the clinical teacher, job (demands, control, and support), and work-life balance and their relation with their stress, burnout, depression, and resilience. Relationships were tested with multiple linear regression analyses.

RESULTS

Of the 326 medical trainees who responded, 142 (44%) trainees - 93 students and 49 residents - completed all items and were included in the analysis. Social media overuse and inability to maintain a work-life balance were associated with higher levels of stress, depression, and student burnout. Higher levels of job support were associated with lower levels of stress, depression, and resident burnout, and a higher level of resilience. Job control was associated with lower burnout levels. Parenting style was unrelated to trainees' mental health.

DISCUSSION

The two generations 'Y' and 'Z' dominating current medical training showed more stress-related complaints when there is evidence of social media overuse and failure to maintain a work-life balance, while job support counterbalances this, whereas parenting style showed no effect. Measures to enhance medical trainees' mental health may include education about the wise use of social media, encouraging spending more quality social time, and enhancing job support and job control.

"Hey, can I go home?": a qualitative case study of wellbeing and the work environment in surgical training

PURPOSE

Surgical trainees are at high risk of burnout and poor wellbeing during their training. A range of workplace factors have been linked to poor wellbeing, including excessive work hours, lack of support networks, and training program demands. However, little is understood about the individual experiences of Australian trainees and their perceptions of the impact of the work environment on wellbeing. The aim of this study was to explore the experiences of Australian surgical trainees regarding their wellbeing in the surgical learning environment.

METHODS

Eleven semi-structured interviews were conducted with Australian surgical trainees at the start of their training and 18 months later, exploring their perspectives of wellbeing in the workplace. Results were analyzed thematically using the Job Demands-Resources model as a scaffold.

RESULTS

Seven themes emerged: (1) relationships with colleagues, (2) work hours and workload, (3) the learning environment and supervision, (4) training program requirements, (5) moving around, (6) hospital and team administration, and (7) hospital facilities and programs. Participant experiences between training commencement and 18 months follow-up did not change.

CONCLUSION

Trainees have unique experiences of wellbeing in the workplace. Some workplace factors, such as relationships with colleagues, can be demands or resources depending on their nature. Effective leadership and administrative practices, mentorship, and proactive rostering act as resources for trainees to balance workplace demands, and these should be prioritized by hospitals and training institutions to improve and protect trainee wellbeing.

Changing Medical Student Perceptions of Mental Illness Through a Psychiatry Clinical Clerkship: A Longitudinal Qualitative Study

OBJECTIVE

This study sought to understand whether perceptions of mental illness change during the course of students' psychiatry clerkships, and what facilitates such change.

METHODS

Using a longitudinal qualitative study design, the authors followed up 14 medical students, interviewing them before, during, and after their psychiatric clerkship.

RESULTS

Prior to clerkships, students perceived psychiatric patients to be dangerous, fragile, hard to treat, and to exert a disproportionate emotional toll on clinicians. Stigma was reinforced by safety measures including the provision of alarms, but this improved following "real life" engagement with patients. Students experienced little emotional distress from clinical contacts, particularly those where they led the consultation. Pre-existing beliefs about mental illness being hard to "fix" showed less change over time. Although uncommon, when staff referred to patients using pejorative language, students emulated these negative attitudes.

CONCLUSIONS

Among medical students, direct patient contact plays an important role in counteracting pre-existing negative attitudes towards mental illness. This can be facilitated by supportive supervisors, clinical teams allocating students a clear practical role, involving patients in teaching, and roleplay to alleviate potential concerns about seeing patients.

Scrolling to Success: Leveraging Social Media to Highlight Wellness Culture in Orthopedic Surgery Residency Programs

Background Burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, profoundly affects interprofessional collaboration. Despite rising burnout rates, there is a paucity of research regarding the use of social media to support wellness culture, particularly among orthopedic surgery residents. Methods A list of all US orthopedic surgery residency programs was compiled through the Accreditation Council for Graduate Medical Education (ACGME) and associated social media accounts were identified. Authors tallied and organized all posts into these categories: work-life balance, attendance to physical health team building activities, healthy work environments, activities or lectures designed to promote wellness, images that imply participating in wellness activities, educational events that include wellness, and resident spotlight. All posts were included up to November 19, 2022. Results Out of 197 programs, 110 (55.8%) had a dedicated Instagram account, 10 (5.07%) had a specific Facebook page, and 30 (15.2%) had an X (formerly Twitter) account for their residency programs, generating 13,203 posts for analysis. Across all three social media platforms, posts addressing work-life balance constituted the highest percentage of wellness-related content (n=1211,22.98%), followed by images implying participation in wellness activities (n=1182,22.43%) and promoting a healthy work environment (n=849,16.11%). Specifically, for Instagram, programs ranked within the top 100 on Doximity had significantly more posts and followers compared to those ranked over 100 (92.64 vs. 59.7, p<0.001; 1680.72 vs 1125.02, p<0.001). Additionally, accounts linked to programs with 25 or more residents had significantly more posts and followers compared to those with 20 or fewer residents (97.54 vs. 61.03, p<0.001; 1726.87 vs 1196.32, p<0.001). Conclusion Social media possesses substantial potential to promote and emphasize wellness among residents. However, its utilization for this purpose remains underdeveloped, particularly in smaller and lower-ranked orthopedic surgery training programs. Further research is needed to determine the most effective ways to harness online activity to highlight and enhance wellness efforts among trainees.

Process Groups for Supporting Resident Wellbeing: Factors Influencing Resident Wellness amid the COVID-19 Pandemic

Background: Burnout is a well-recognized problem among resident physicians. The COVID-19 pandemic impacted the dynamics of the patient/resident relationship and introduced new stressors for medical trainees, such as new restrictions in the hospital, increased patient death, and uncertainty around safety. There is limited research on the implementation of group therapy for residents to address issues of wellbeing and burnout during the pandemic. Method: In response to perceived burnout amongst internal medicine residents, a university-based internal medicine residency program in the Northeast United States implemented process groups, a form of group therapy, in the curriculum. These sessions were held hourly once every five weeks for each cohort of twelve residents during the academic year. We sought to measure resident burnout and identify themes that impacted wellbeing to facilitate the intervention of process groups during the pandemic. In 2021 and 2022, internal medicine residents were invited to complete the Maslach Burnout Inventory (MBI) and answer two open-ended questions about the factors that most negatively and positively influenced their wellness. Results: Of the 134 participants, 82% had high emotional exhaustion or depersonalization. The most prevalent themes hindering wellness were negative personal interactions at work, most notably rude behavior by patients, unsupportive attendings, residency program expectations, and work intensity. Findings unique to the pandemic include social isolation from family, distress from poor outcomes, and fear of contracting or spreading the virus. The most prevalent themes for supporting wellness were personal life, camaraderie, professional satisfaction, and program structured support. Conclusions: Our findings suggest that programs can tailor structured support to improve wellness, despite the presence of significant stressors.

The mediating role of self-efficacy in the relationship between past professional training and burnout resilience in medical education: a multicentre cross-sectional study

BACKGROUND

Meta-analyses indicate a high prevalence of burnout among medical students. Although studies have investigated different coping strategies and health interventions to prevent burnout, professional experience's influence on burnout resilience as seldom been explored. Therefore, in our study we aimed to examine the self-efficacy's mediating role in the relationship between past vocational training and burnout resilience. In the process, we also analysed the associations between study-related variables and burnout resilience.

METHODS

In our cross-sectional study, we analysed the data of 2217 medical students at different stages of their university education (i.e. 1st, 3rd, 6th, 10th semester, and final year) at five medical faculties in Germany. The questionnaire included items addressing variables related to medical school, previous professional and academic qualifications, and validated instruments for measuring burnout and self-efficacy.

RESULTS

The overall prevalence of burnout was 19.7%, as defined by high scores for emotional exhaustion and notable values in at least one of the other two dimensions (cynicism or academic efficacy). Higher levels for self-efficacy (p < .001), having children (p = .004), and financing education with personal earnings (p = .03) were positively associated with burnout resilience, whereas having education financed by a partner or spouse (p = .04) had a negative association. In a mediation analysis, self-efficacy exerted a suppressor effect on the relationship between vocational training and burnout resilience (indirect effect = 0.11, 95% CI [0.04, 0.19]).

CONCLUSIONS

Self-efficacy's suppressor effect suggests that the positive association between vocational training and burnout resilience identified in the mediation analysis disappears for students who have completed vocational training but do not feel efficacious. Those and other findings provide important insights into the psychological mechanisms underlying the development of burnout resilience in medical students and suggest the promotion of self-efficacy in medical education.

Mindfulness training in healthcare professions: A scoping review of systematic reviews

PURPOSE

The effectiveness of mindfulness training (MT) on mental health and wellbeing in different groups and contexts is well-established. However, the effect of MT on different healthcare professionals' (HCPs) mental health and wellbeing needs to be synthesised, along with a focus on outcomes that are specifically relevant to healthcare settings. The aim of this study is to summarise the effect of MT interventions on HCPs' mental health and wellbeing, to explore its effect on communication skills and to identify potential gaps in the literature.

METHODS

A scoping review of systematic reviews (SRs) investigating MT interventions in HCPs was conducted. A comprehensive systematic search was conducted from database inception to 22 February 2023 on Ovid MEDLINE, Ovid Embase, Scopus, Cochrane (CENTRAL), EBSCHOhost CINAHL, Ovid PsycINFO, Web of Science (Core Collection), OpenGrey, TRIP Database and Google Scholar. Snowballing of reference lists and hand-searching were utilised. Risk of bias and quality of included SRs were assessed using the ROBIS and AMSTAR2 tools.

RESULTS

Sixteen SRs were included in this review. We found substantial evidence for MT interventions improving mental health and wellbeing across different HCPs, with the exception of burnout, where evidence is mixed. There is a paucity of SRs evaluating communication skills other than empathy. However, the available evidence is suggestive of improvements in self-reported empathy. Details of MT fidelity and dosage are largely absent in the SRs, as is study populations from representative EDI samples.

CONCLUSIONS

Synthesis of SRs suggests that MT improves mental health and wellbeing in HCPs. The exception is burnout, where results are inconclusive. Insufficient data exists to evaluate effects of MT on the full spectrum of communication skills. Other HCPs than medicine and nursing are inadequately represented. Further research is required that considers the specific target population of HCPs and MT curriculum, and reports on fidelity, dosage and the effects on communication skills.

The importance of creating the right conditions for group intervision sessions among medical residents- a qualitative study

BACKGROUND

The burnout rates among residents urge for adequate interventions to improve resilience and prevent burnout. Peer reflection, also called group intervision sessions, is a potentially successful intervention to increase the resilience of young doctors. We aimed to gain insight into the perceived added value of intervision sessions and the prerequisite conditions to achieve this, according to residents and intervisors. Our insights might be of help to those who think of implementing intervision sessions in their institution.

METHODS

An explorative, qualitative study was performed using focus groups and semi-structured interviews with both residents (n = 8) and intervisors (n = 6) who participated in intervision sessions in a university medical center in the Netherlands. The topic list included the perceived added value of intervision sessions and factors contributing to that. The interviews were transcribed verbatim and coded using NVivo. Thematic analysis was subsequently performed.

RESULTS

According to residents and intervisors, intervision sessions contributed to personal and professional identity development; improving collegiality; and preventing burn-out. Whether these added values were experienced, depended on: (1) choices made during preparation (intervisor choice, organizational prerequisites, group composition, workload); (2) conditions of the intervision sessions (safety, depth, role of intervisor, group dynamics, pre-existent development); and (3) the hospital climate.

CONCLUSIONS

Intervision sessions are perceived to be of added value to the identity development of medical residents and to prevent becoming burned out. This article gives insight in conditions necessary to reach the added value of intervision sessions. Optimizing preparation, meeting prerequisite conditions, and establishing a stimulating hospital climate are regarded as key to achieve this.

'A sense of self, empowerment and purposefulness': professional diversification and wellbeing in Australian general practitioners

BACKGROUND

Burnout and workforce shortages comprise a vicious cycle in medicine, particularly for Australian general practitioners (GPs). Professional diversification, whereby individuals work multiple roles across their week, may help address this problem, but this strategy is under-studied.

METHODS

We surveyed 1157 Australian GPs using qualitative and quantitative questions examining professional diversification, values, autonomy, and wellbeing. Quantitative data were analysed using inferential statistics, whilst qualitative data were analysed using inductive thematic analysis. We triangulated the data by using the qualitative findings to inform further quantitative testing.

RESULTS

Approximately 40% of the sample had diversified. Although diversifying was not significantly associated with wellbeing, the qualitative data indicated that diversification supported GPs' wellbeing by enhancing career sustainability, accomplished through various pathways (e.g. value fulfilment, autonomy, variety). Subsequent quantitative analyses provided evidence that these pathways mediated the relationship between diversification and wellbeing. To diversify, GPs needed particular personal qualities, external supports, flexibility, and serendipity. Barriers to diversifying mirrored these factors, spanning individual (e.g. skillset) and situational levels (e.g. autonomy, location).

CONCLUSIONS

Diversification can support GPs' wellbeing if it meets their needs. Organisations should focus on publicising opportunities and accommodating requests to diversify.

Competency-based medical education: The spark to ignite healthcare's escape fire

High-value care is what patients deserve and what healthcare professionals should deliver. However, it is not what happens much of the time. Quality improvement master Dr. Don Berwick argued more than two decades ago that American healthcare needs an escape fire, which is a new way of seeing and acting in a crisis situation. While coined in the U.S. context, the analogy applies in other Western healthcare contexts as well. Therefore, in this paper, the authors revisit Berwick's analogy, arguing that medical education can, and should, provide the spark for such an escape fire across the globe. They assert that medical education can achieve this by fully embracing competency-based medical education (CBME) as a way to place medicine's focus on the patient. CBME targets training outcomes that prepare graduates to optimize patient care. The authors use the escape fire analogy to argue that medical educators must drop long-held approaches and tools; treat CBME implementation as an adaptive challenge rather than a technical fix; demand genuine, rich discussions and engagement about the path forward; and, above all, center the patient in all they do.

Moderating role of family functioning and resource support in the relationship between career calling and academic burnout among Chinese medical students during the controlled COVID-19 pandemic: a cross-sectional study

PURPOSE

This cross-sectional study aims to assess the level of academic burnout among Chinese medical students during the controlled COVID-19 pandemic and identify the potential demographic factors affecting academic burnout. It also explored the relationship between career calling, family functioning, resource support, and academic burnout, as well as investigated whether family functioning and resource support could moderate the relationship between career calling and academic burnout among Chinese medical students.

METHODS

The study was conducted in five Chinese cities in 2021. A total of 3614 valid questionnaires were collected to assess the relationship between academic burnout, career calling, family functioning, and resource support, and determine whether demographic factors contribute to academic burnout. Hierarchical multiple regression analysis was used to explore factors correlated with academic burnout and test the moderating effect of family functioning and resource support on the relationship between career calling and academic burnout.

RESULTS

The mean academic burnout score was 3.29 ± 1.17. Sex, major, academic performance ranking, monthly living expenses, physical health, and sleep quality significantly affected academic burnout (p < 0.05). Academic burnout was negatively correlated with career calling, resource support, and family functioning. Family functioning and resource support moderated the relationship between career calling and academic burnout. Simple slope analysis revealed that high family functioning and resource support strengthened the impact of career calling on academic burnout.

CONCLUSIONS

Most medical students in China experienced relatively high levels of academic burnout during the controlled COVID-19 pandemic. Furthermore, specific demographic factors contribute to academic burnout. Family functioning and resource support moderate the relationship between career calling and academic burnout. These findings emphasize the importance of implementing career-calling education, supplementing family functioning in the form of school support, and providing sufficient smart learning resources among medical students in the post-pandemic era.

The medical internship as a meaningful transition: A phenomenographic study

BACKGROUND

The transition from student to doctor is often depicted as a struggle in the literature, and previous research has focused on interventions to minimise difficulties in transitioning from undergraduate to postgraduate training. In considering this transition as a potential transformative experience, we intend to produce new insights into how junior doctors experience the transition to clinical work. The aim of this study was to explore medical interns' conceptualisations of the transition from student to doctor through studying the Swedish medical internship, which serves as a bridge between undergraduate and postgraduate studies. The research question was formulated as follows: How do medical interns perceive the meaning of the medical internship?

METHODS

The data were collected through in-depth interviews with 12 senior medical interns in western Sweden. The transcribed interviews were analysed using a phenomenographic approach, which resulted in four qualitatively varying ways of perceiving the meaning of the internship, organised hierarchically in a phenomenographic outcome space.

RESULTS

The interns perceived the meaning of the internship as an opportunity to work and learn in an authentic setting (internship as in-service training) and in a protected environment (internship as a space). The internship guaranteed a minimum level of competence (internship as a quality marker) and allowed the interns to gain new insights into themselves and their world (internship as an eye-opener).

DISCUSSION

Being allowed to be learners in a protected space seemed pivotal for the interns to develop into competent, confident and independent practitioners. The medical internship studied here could be viewed as a meaningful transition into new ways of experiencing, allowing for an increased understanding of oneself and the world. This study adds to the scientific literature on what constitutes a transformative transition.

Burnout, grit and resilience among Jordanian orthopedic surgeons: a cross-sectional study

BACKGROUND

Burnout is a serious issue that affects physicians more than the general population; however, those with higher levels of grit and resilience have been shown to experience lower levels of burnout. The primary aim was to determine the prevalence of burnout among Jordanian orthopedic surgeons, explore its risk factors, and investigate the relationship between burnout and grit and resilience.

METHODS

We conducted a questionnaire-based cross-sectional study targeting a total of 180 orthopedic surgeons attending the yearly Jordanian National Orthopedic Conference (JNOC). Non-random sampling (i.e., convenience) was utilized to recruit participants. The abbreviated Maslach Burnout Inventory, short grit scale, and Connor-Davidson Resilience Scale were used. Scores were examined using the Mann-Whitney U, Kruskal-Wallis H, and Spearman's rho tests, of which results were corrected using the Bonferroni method.

RESULTS

Among 135 respondents, 62.2% were specialists and 37.8% were residents. About 52.0% practiced in public hospitals. Approximately 69.0% worked for more than 50 h weekly. The prevalence of burnout among all participants was 45.2% with more frequency among residents (66.7%). Burnout and the participants' grit and resilience showed an inverse relationship (ρ = -0.441 and ρ = -0.312, respectively). Age (ρ = 0.337), number of children (ρ = 0.245), and years of experience (ρ = 0.331) were positively correlated with grit. The median score for grit was higher in physicians who had or are having their residency outside Jordan (p < 0.001). Age (ρ = 0.233) and years of experience (ρ = 0.269) were positively correlated with resilience.

CONCLUSION

Jordanian orthopedic surgeons face significant rates of burnout. Institutional efforts should be taken to detect and prevent burnout in addition to enhancing the grit and resilience among orthopedic professionals.

Using poetry to elicit internal medicine residents' perspectives on wellness

PURPOSE

To elicit internal medicine residents' perspectives on wellness through poetry writing, examining (1) response rates, (2) the tone/sentiment of their submissions and (3) the primary thematic content.

STUDY DESIGN

In academic year 2019-2020, a random sample of 88 residents from four internal medicine residency programmes was invited to participate in a year-long study of wellness. In December 2019, an open-ended prompt asked residents to write a poem reflecting on their well-being. Responses were inductively coded using content analysis techniques.

RESULTS

The response rate for the poetry prompt was 94%. The tone of the entries was most often neutral or contradictory (42%), followed by negative (33%) and positive (25%). There were three main themes: (1) Mindsets: most residents simply wanted to make it through their programme; (2) wellness influencers: the main wellness supporters were external to the programme such as vacationing and exercise; within hospitals, friendships with colleagues and boosted wellness and (3) scheduling/repetition: difficult schedules drained energy as did the monotony of administrative tasks.

CONCLUSIONS

Poetry appears to be an innovative and effective vehicle to elicit residents' perspectives without compromising response rate. Poetry survey techniques allow medical trainees to provide powerful messaging to leadership. Most of what is known about trainee wellness is derived from quantitative surveys. This study showed medicine trainees' willingness to engage in poetry and add richness and personal detail to highlight key drivers of wellness. Such information provides context and brings attention in a compelling manner to an important topic.

Burnout, wellbeing and how they relate: A qualitative study in general practice trainees

PURPOSE

Although research has explored burnout risk factors among medical trainees, there has been little exploration of the personal experiences and perceptions of this phenomenon. Similarly, there has been little theoretical consideration of trainee wellbeing and how this relates to burnout. Our study aimed to conceptualise both constructs.

METHOD

We situated this study within a post-positivist epistemology using grounded theory to guide the research process. Participants were recruited from one Australian General Practice training organisation. Fourteen trainees completed interviews, while a further five focus groups explored the views of 33 supervisors, educators and training coordinators. Data collection and analysis occurred concurrently, drawing upon constant comparison and triangulation. Template analysis, using an iterative process of coding, was employed to generate conceptual models of the phenomena of interest.

RESULTS

Participants described burnout as an insidious syndrome lying on a spectrum, with descriptions coalescing under seven themes: altered emotion, compromised performance, disengagement, dissatisfaction, exhaustion, overexertion and feeling overwhelmed. Wellbeing was perceived to comprise personal and professional domains that interacted and were fuelled by an underlying 'reservoir'. Both constructs were linked by the degree of a trainee's value fulfilment, with burnout occurring when a trainee's wellbeing reservoir was depleted.

CONCLUSIONS

Participants in this study characterised burnout and wellbeing as multifaceted, connected constructs. Given the complexity of these constructs, preventive interventions should target both person and workplace-focused factors, with value fulfilment proposed as the basic change mechanism. A novel model that synthesises and advances previous research is offered based on these findings.

The Impact of COVID-19 on Postgraduate Training of Doctors in the United Kingdom: A Narrative Review

The COVID-19 pandemic caused significant disruption to healthcare systems globally. The delivery of medical education was consequently impacted as a result of this. In order to move past the pandemic, we must identify the gaps in postgraduate education. This literature review examines studies focusing on postgraduate training in the United Kingdom (UK) and attempts to bring together the issues that have been highlighted in these studies and the impact that this has had on trainees. It is important for the providers of healthcare education to have an understanding of the impacts of this disruption in order to maintain the quality of postgraduate medical education. Health Education England, along with the Royal Colleges, has published a report that sets a framework on how these issues can be addressed, with some of these changes starting to be implemented in 2022.

How UK surgeons experience burnout and the link between burnout and patient care: A qualitative investigation

Background and Aims

Poor well-being affects the performance of all kinds of workers, including surgeons. This study aimed to answer two questions: (1) how does burnout affect surgeons personally, and what is their burnout experience like? (2) How does burnout affect the care that surgeons provide in the United Kingdom (UK)?

Method

This study conducted thematic analysis of semi-structured interviews with 14 surgeons recruited from the UK National Health Service (NHS).

Result

The study found three themes in surgeons’ experiences of burnout: first, burnout is common but frequently not recognised nor understood; second, burnout is a personal crisis; and third, burnout creates vulnerability at work. The study also revealed four themes related to burnout's effect on patient care: first, burnout reduces the quality of surgeon-patient relationships; second, burnout affects patient safety; third, burnout impairs staff relationships; and fourth, burnout makes surgeons less motivated to improve.

Conclusion

Burnout is common but not well recognised in surgeons. Improving understanding and treatment of burnout could have benefits for both surgeons themselves and the care they provide to patients.

Australian general practice registrars' experiences of training, well-being and support during the COVID-19 pandemic: a qualitative study

OBJECTIVES

Providing well-supported general practice (GP) training is fundamental to strengthen the primary health workforce. Research into the unique needs of GP registrars during disasters is limited. Registrar burnout and insufficient support have been associated with personal and professional detrimental effects. This study aims to explore the experiences of Australian GP registrars with learning, well-being and support from their training organisation during the COVID-19 pandemic, and to guide training organisation efforts to support registrars through future disasters.

SETTING

Interviews were conducted via Zoom.

PARTICIPANTS

Fifteen GP registrars from South Australia, Victoria and New South Wales who had experienced community-based GP training in both 2019 (prepandemic) and 2020 (early pandemic).

OUTCOME MEASURES

Training, well-being and support experiences were explored. Interviews were recorded and transcribed and themes analysed.

RESULTS

Diverse experiences were reported: changes included telehealth, online tutorials, delayed examinations and social restrictions. Social and professional connections strongly influenced experiences. Personal and training factors were also important. Additional GP training organisation support was minimally needed when strong connections were in place.

CONCLUSIONS

This study identifies aspects of support which shaped registrars' diverse experiences of COVID-19, particularly regarding professional and social connections. Findings illustrate the importance of broad principles around supporting registrar well-being. Particularly significant aspects of support include connection to educational mentors such as supervisors and medical educators; connection and culture within practices; opportunities to share clinical experiences; and connection to personal social supports. Participation in this global disaster contributed to registrars' developing professionalism. GP training organisations are positioned to implement monitoring and supports for registrars through disasters. Although registrars may not require significant GP training organisation intervention where powerful professional and personal connections exist, strong foundational GP training organisation supports can be established and augmented to support registrars in need before and during future disasters. These findings contribute to the global developing field of knowledge of registrar training and well-being needs during crises.

Promoting Wellbeing among Family Medicine Trainees: A Hermeneutic Review of Intervention Mechanisms of Change and their Delivery Methods

PHENOMENON

Efforts to promote wellbeing and reduce burnout amongst postgraduate medical trainees have been hampered by little consideration of interventions' underlying mechanisms, as well as how interventions are delivered. The critical role of trainee specialty has also been overlooked, despite the unique personal and work-based stressors faced among subgroups - such as those completing Family Medicine/General Practice. A consolidation of intervention research can help to guide the design, implementation and evaluation of future targeted programs and potentially enhance their effectiveness. The present hermeneutic literature review addresses this gap.

APPROACH

The Embase, Ovid Medline, and Ovid PsycINFO databases were searched for articles exploring wellbeing and related concepts of burnout and stress amongst Family Medicine/General Practice trainees. Thirty-one studies were identified through seven iterative rounds, with articles that offered novel insights and/or addressed knowledge gaps identified in each round and analyzed, followed by refinement of the overarching coding structure. Thematic analysis was conducted by two researchers.

FINDINGS

Proposed and enacted wellbeing interventions typically involved a combination of individualistic (e.g., self-awareness), organizational (e.g., increasing policy flexibility), and cultural (e.g., leadership) strategies. Change mechanisms were interpersonal (e.g., comradery) and, to a greater extent, intrapersonal (e.g., normalizing and accepting feelings of insecurity). Key delivery methods included the need to ingrain trainee wellness into daily work life and the importance of contextualizing interventions to increase their relevance, acceptance, and effectiveness.

INSIGHTS

The present review identifies and consolidates key mechanisms of change intrinsic to wellbeing-promotion interventions, alongside delivery methods. These findings provide guidance for practice and research to identify these attributes of interventions in the design and evaluation stages. This, in turn, will enhance the clarity of what is being evaluated, facilitating more informed comparisons between evaluations.

Individual and residency program factors related to depression, anxiety and burnout in physician residents - a Brazilian survey

BACKGROUND

Psychological distress is common among medical trainees. This study aimed to assess the frequency of depression, anxiety and burnout among physician residents and their association with both individual and residency program-related factors.

METHODS

This was a cross-sectional study applying an online survey in a national-wide sample of medical residents from Brazil. Depression, anxiety, burnout and diurnal somnolence were assessed with validated tools (Patient Health Questionnaire-4, 2 items version of Maslach Burnout Inventory, and Epworth Sleepiness Scale). Socio-demographic and residency program-related factors were measured with internally validated instruments. We performed multivariate binary logistic regression analysis for each of the main outcomes.

RESULTS

Screening for depression, anxiety and burnout was positive respectively in 46.9%, 56.6% and 37.0% of our sample (n = 1,419). Depression was independently related to female sex, longer duty hours, absence of day off, poor learning perception, poor feeling about the residency program, overall occurrence of psychological abuse, anxiety, diurnal somnolence and burnout (AUROC = .859 [95%CI = .840-.878], p < .001). Anxiety was independently associated with female sex, higher age and duty hours, work-personal life conflicts, few classroom activities, providing assistance without supervision, depression and diurnal somnolence (837 [.816-.857], p < .001). Burnout was related to lower age and leisure time, male sex, longer duty hours, absence of day off, provision of care without supervision, choice of the wrong specialty, poor learning, psychological abuse, depression and diurnal somnolence (.780 [.753-.806], p < .001).

CONCLUSION

Frequency of psychological distress in residency training is high and related to both individuals and environmental factors, namely high workloads, occurrence of psychological abuse, poor faculty supervision, poor learning experience and work-personal life conflicts.

Hazard pay for internal medicine resident physicians during the COVID-19 pandemic: A national survey of program directors

BACKGROUND

Hazard pay for resident physicians has been controversial in the COVID-19 pandemic. Program director (PD) beliefs about hazard pay and the extent of provision to internal medicine (IM) residents are unknown.

OBJECTIVE

To evaluate hazard pay provision to residents early in the COVID-19 pandemic and pandemic and residency program characteristics associated with hazard pay.

DESIGN, SETTING, AND PARTICIPANTS

A nationally representative survey was conducted of 429 US/US territory-based IM PDs from August to December 2020.

MAIN OUTCOME AND MEASURES

Hazard pay provision and PD beliefs about hazard pay were tested for association with factors related to the pandemic surge and program characteristics.

RESULTS

Response rate was 61.5% (264/429); 19.5% of PDs reported hazard pay provision. PD belief about hazard pay was equivocal: 33.2% agreed, 43.1% disagreed, and 23.7% were uncertain. Hazard pay occurred more commonly in the Middle-Atlantic Census Division (including New York City) and with earlier surges and greater resident participation in COVID-19 patient care. Hazard pay occurred more commonly where PDs supported hazard pay (74.5% vs. 22.1%, p = .018). Reasons most frequently given in support of hazard pay were essential worker status, equity, and schedule disruption. Those opposed cited professional obligation and equity.

CONCLUSION

Hazard pay for IM residents early in the COVID-19 pandemic was nominal but more commonly associated with heavily impacted institutions. Although PD beliefs were mixed, positive belief was associated with provision. The unique role of residents as both essential workers and trainees might explain our varied results. Further investigation may inform future policy, especially in times of crisis.

Wellbeing Conceptualizations in Family Medicine Trainees: A Hermeneutic Review

PHENOMENON

High levels of burnout have been widely reported among postgraduate medical trainees, however relatively little literature has examined what 'wellbeing' means for this group. Moreover, the literature that does exist has generally overlooked the potential role of specialty factors in influencing such conceptualizations. This is particularly true for family medicine and general practice trainees - a specialty considered to be unique due, in part, to its focus on community-based care. The present review sought to explore conceptualizations of wellbeing specifically within the context of family medicine and general practice training.

APPROACH

The Embase, Ovid Medline, and PsycINFO databases were searched from inception to November 2019 for literature examining wellbeing in family medicine and general practice trainees. Literature was iteratively thematically analyzed through the process of a hermeneutic cycle. In total, 36 articles were reviewed over seven rounds, at which point saturation was reached.

FINDINGS

The findings confirm the complex and multifaceted nature of wellbeing as experienced by family medicine and general practice trainees. An emphasis on psychological factors - including emotional intelligence, positive mental health, self-confidence and resilience - alongside positive interpersonal relationships, rewards, and balanced interactions between trainees' personal and professional demands were deemed critical elements.

INSIGHTS

A model of wellbeing that emphasizes rich connections between trainees' personal and professional life domains is proposed. Further qualitative research will help to extend current understanding of wellbeing among medical trainees, including the individuality of each specialty's experiences, with the potential to enhance interventional efforts.

Shifting Focus from Burnout and Wellness toward Individual and Organizational Resilience

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. 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. 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 trainees. Educational institutions specifically would be well-served to consider organizational resilience and its relationship to individuals.

Factors that impact burnout and psychological wellbeing in Australian postgraduate medical trainees: a systematic review protocol

BACKGROUND

The stressful nature of medical training and other work-related factors put postgraduate medical trainees at high risk of burnout and poor psychological wellbeing. This has negative implications for patient care and the effectiveness of the healthcare system. The structure of the healthcare system and postgraduate medical education in Australia is different to that of other countries. Whilst a significant body of research exists on burnout and wellbeing in trainees in the USA, evidence specific to Australian trainees is lacking. The aim of this review is to synthesise the current knowledge on the factors that impact burnout and psychological wellbeing in Australian postgraduate medical trainees.

METHODS/DESIGN

A systematic review will be conducted across eight digital databases: Academic Search Complete, MEDLINE, Embase, Web of Science, PsychInfo, Scopus, CINAHL Plus and Informit Health Collection. Peer reviewed empirical studies and relevant grey literature published after 2000 that address an aspect of burnout or psychological wellbeing in Australian postgraduate medical trainees will be included. Two reviewers will independently review each article against the inclusion and exclusion criteria, with disagreements resolved via discussion and consensus. Data will be extracted using a standard form and quality will be assessed using the assessment tools available from the Joanna Briggs Institute. A thematic narrative synthesis of the studies will be presented, along with an assessment of current gaps in the literature and areas for future research.

DISCUSSION

This review will be the first to integrate the evidence on burnout and psychological wellbeing specific to Australian postgraduate medical trainees. The findings will contribute to a better understanding of the factors that impact burnout and psychological wellbeing in this population and will lay the foundation for future research into appropriate strategic interventions.

SYSTEMATIC REVIEW REGISTRATION

This protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020203195 ).

Examining the Association between Evidence-Based Practice and Burnout among Spanish Physical Therapists: A Cross-Sectional Study

The aim of this study was to quantify the level of burnout and competence for evidence-based practice among Spanish physical therapists and to determine if there is a relationship between these and other socio-professional factors. A cross-sectional study with 472 Spanish Physiotherapists. An electronic survey was conducted that included the Maslach Burnout Inventory, Evidence-Based Practice Questionnaire and sociodemographic data. The three subscales of the Burnout correlated with attitude and total Evidence-Based Practice Questionnaire. Attitude and practice for evidence-based practice, educational level and experience were the variables that showed the greatest influence on burnout. Burnout and the degree of evidence-based practice were identified as being discretely related. Specifically, it seems that the evidence-based practice could improve the lack of personal accomplishment, meaning that through interventions perceived as more effective and advantageous, a sense of mastery and self-efficacy is experienced.

Dark Clouds With Silver Linings: Resident Anxieties About COVID-19 Coupled With Program Innovations and Increased Resident Well-Being

BACKGROUND

The COVID-19 pandemic forced numerous unprecedented systemic changes within residency programs and hospital systems.

OBJECTIVE

We explored how the COVID-19 pandemic, and associated changes in clinical and educational experiences, were related to internal medicine residents' well-being in the early months of the pandemic.

METHODS

Across 4 internal medicine residency programs in the Northeast United States that have previously participated in the iCOMPARE study, all 394 residents were invited to participate in a study with open-ended survey prompts about well-being approximately every 2 weeks in academic year 2019-2020. In March and April 2020, survey prompts were refocused to COVID-19. Content analysis revealed themes in residents' open-ended responses to 4 prompts.

RESULTS

One hundred and eighty-six residents expressed interest, and 88 were randomly selected (47%). There were 4 main themes: (1) in early days of the pandemic, internal medicine residents reported fear and anxiety about uncertainty and lack of personal protective equipment; (2) residents adapted and soon were able to reflect, rest, and pursue personal wellness; (3) communication from programs and health systems was inconsistent early in the pandemic but improved in clarity and frequency; (4) residents appreciated the changes programs had made, including shorter shifts, removal of pre-rounding, and telemedicine.

CONCLUSIONS

COVID-19 introduced many challenges to internal medicine residency programs and to resident well-being. Programs made structural changes to clinical schedules, educational/conference options, and communication that boosted resident well-being. Many residents hoped these changes would continue regardless of the pandemic's course.

Burnout in Surgical Trainees: a Narrative Review of Trends, Contributors, Consequences and Possible Interventions

Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.

Cultivating the physician workforce: Recruiting, training, and retaining physicians to meet the needs of the population

In the 10 years since the Lancet Commission on Education of Health Professionals for the 21st Century suggested the changes necessary to transform medical education, the United States remains plagued by shortages of physicians and maldistribution of the physician workforce. Minoritized and rural communities usually suffer the most, with widely documented health disparities across the United States by race, ethnicity, gender identity, education, and zip code. Medical schools can respond by recruiting students more likely to practice in these settings and training them to address the community needs. In 2013, the American Medical Association launched an initiative to trigger transformation in medical education and formed a consortium of schools representing a diversity of U.S. institutions. Consortium member schools highlighted in this article share lessons learned in their efforts to strengthen social accountability and develop needed sectors of the physician workforce. Development of the physician workforce involves recruiting and widening pathways of entry for diverse groups, providing training settings and competencies aligned with community needs, and explicit programming in retention, inclusion and well-being to mitigate against workforce losses.

Does teaching Optimism lower Burnout in residency training- a pilot study

Background: Residents frequently experience burnout. Multiple interventions to decrease the risk of burnout have had inconsistent results. In non-medical settings, improving optimism promotes a positive outlook and enhances well-being. Thus, psychological interventions that improve optimism could have potential to decrease the risk for burnout.

Objective: Using Lazarus’ Ways of Coping as an organizational framework, this intervention sought to evaluate the impact of an optimism curriculum on residents’ burnout.

Methods: Thirty-six Internal Medicine residents participated in an optimism improvement program from November 2019 to April 2020. We determined pre- and post-curriculum measures of optimism, happiness, and burnout with validated surveys. The Optimism Curriculum was comprised of three one-hour long sessions, which included lectures, group and self-reflective exercises. A post - curriculum evaluation rating the effectiveness of the program was administered separately.

Results: Thirty-four out of thirty-six residents completed the post curricular surveys. Individuals with low optimism scores had a higher score for burnout compared to those with higher optimism scores. The post-intervention survey showed numerical improvement in optimism, happiness and burnout, although these changes were not statistically significant. The post-intervention survey showed a decrease in the measure of burnout; however, this was not significant (p = 0.24) with an effect size of 0.34 (Cohen’s d).

Conclusions: Teaching optimism to residents with the objective of decreasing the risk of burnout is feasible and easily integrated into residency education sessions. The encouraging results of this pilot study lay the foundation for additional studies and suggest a practical role for implementing optimism curricula in residency training programs.

Shortened pre-clerkship medical school curriculum associated with reduced student performance on surgery clerkship shelf exam

BACKGROUND

Many U.S. medical schools are modifying their curricula with limited understanding of the impact on students' clinical knowledge.

METHODS

The surgical rotations and Surgery Shelf Exam score reports of 1514 students at a single medical school over nine academic years (2010-2018), which included a four-year transition period to a condensed pre-clerkship curriculum. Subject-specific results were compared by rotation type using Mann-Whitney tests. Regression analysis was used to assess the relationship between scores and time.

RESULTS

Data from 1514 students were included. Shelf scores decreased each year of the transition curriculum compared to the reference year (2014-2015). However, clinical exposure to specific rotations resulted in better scores in related shelf subjects. For example, students who rotated on Vascular Surgery achieved statistically better scores on the related subject than their colleagues (3.62 vs. 3.44; p = 0.0014).

CONCLUSIONS

The transition curriculum was associated with a lower performance on the surgical shelf exam when compared to the traditional curriculum, regardless of when surgery was taken during their clerkship year.

A National Curriculum to Address Professional Fulfillment and Burnout in OB-GYN Residents

BACKGROUND

Physician well-being is a priority in graduate medical education as residents suffer high rates of burnout. With complex stressors affecting the clinical environment, conflicting evidence exists as to whether a formal curriculum improves resident well-being.

OBJECTIVE

We assessed the feasibility and impact of a national pilot of a yearlong wellness curriculum for obstetrics and gynecology (OB-GYN) residents.

METHODS

The Council on Resident Education in Obstetrics and Gynecology Wellness Task Force developed a national multicenter pilot group of 25 OB-GYN programs to participate in a prospective cohort study. The curriculum included 6 interactive wellness workshops using uniform teaching materials delivered during didactic time. Prior to and following their participation in the curriculum, residents completed a survey containing demographic information and the Professional Fulfillment Index.

RESULTS

Among 592 eligible participants, 429 (72%) responded to the pretest and 387 (65%) to the posttest. Average age of respondents was 29.1 years (range = 24-52 years) and included 350 (82%) women and 79 (18%) men. At baseline, 254 of 540 (47%) respondents met criteria for burnout, and 101 (23%) met criteria for robust professional fulfillment. Residents participated in an average of 3.9 workshops. While aggregate posttest scores did not differ from baseline, residents attending 4 to 6 workshops had improved rates of burnout (40% vs 50%, P = .017) and robust professional fulfillment (28% vs 20%, P < .001) compared with those with lower attendance.

CONCLUSIONS

A wellness curriculum was a feasible addition to OB-GYN residency program curricula in programs across the country. Residents with higher attendance experienced improved professional fulfillment and less burnout.