Resident Preferences for Program Director Role in Wellness Management

How's Your Soul?

In this narrative essay, a physician reflects on the way in which his residency program director’s unique background as a Master of Divinity helped him to focus on his growth as a human being rather than concentrating solely on clinical evaluations.

Pediatric Resident Well-being: A Group Concept Mapping Study

OBJECTIVE

Pediatric residency programs invest substantial resources in supporting resident well-being. However, no pediatric resident well-being conceptual model exists to guide interventions. This study aimed to understand how a diverse stakeholder sample conceptualized well-being.

METHODS

We used group concept mapping methodology. We sent a brainstorming survey to pediatric residents and program leaders at 24 US residencies with the prompt, "The experience of well-being for resident physicians includes…" Participants at 4 residencies sorted well-being ideas conceptually and rated idea importance. We performed multidimensional scaling and hierarchical cluster analysis to develop cluster maps. Using participant feedback and a consensus-driven process, we determined best cluster representation. We used pattern matching to compare domain ratings between subgroups.

RESULTS

In brainstorming, 136 residents and 22 program leaders from 22 residency programs generated 97 unique ideas. Ideas were sorted and rated by 33 residents, 14 program leaders. Eight domains aligning with 4 resident roles were identified. Domains were: 1) positive, safe, and diverse culture; 2) unity and connection; 3) professional fulfillment and mindset; 4) personal health and life satisfaction; 5) professional development and recognition; 6) schedule protections and downtime; 7) work systems and benefits; 8) proactive and compassionate leadership. Domains aligned with the following roles: 1) individual, 2) colleague, 3) employee, 4) emerging pediatrician. Residents placed higher value on schedule protections and downtime than program leaders, P < .05.

CONCLUSIONS

Pediatric resident well-being may be conceptualized as inter-related domains corresponding with various resident roles. Participants aligned on many well-being priorities but differed regarding work schedules.

Comparing Resident and Program Director Perspectives on Wellness Curricula: A CERA Study

Introduction

Mitigating the stress of graduate medical education has been the focus of residency leadership in the United States. This study examined family medicine (FM) resident and program director (PD) satisfaction with current wellness curricula, including perceptions of availability of resources and emphasis on well-being.

Methods

The Council of Academic Family Medicine Educational Research Alliance administered online surveys to PDs accredited by the Accreditation Council for Graduate Medical Education, US-based FM residencies, and resident American Academy of Family Physicians members from April to May 2021. The present study included an assessment of wellness curriculum implementation using the Wellness Element Count (WEC), a satisfaction rating with wellness programming, and a single question assessing perceived changes in emphasis on wellness during COVID-19.

Results

A total of 242 residents (5% response rate) and 263 PDs (42% response rate) completed the survey. Residents reported lower WEC indicators compared to PDs (P<.001). Overall, 67.8% of resident respondents were satisfied with their program's wellness efforts, compared to 89.3% of PDs ( P<.001). Perceived emphasis on wellness curricula in the program was associated with greater resident satisfaction (OR=2.75, P<.05); less emphasis on wellness was associated with less resident satisfaction (OR=0.15, P<.001).

Conclusions

Residents reported overall lower perceived availability and satisfaction with program wellness efforts compared to PDs, suggesting a disparity between perspectives. Ongoing efforts should be directed at encouraging use of available wellness resources and supporting a culture of well-being.

Virtual Open House: Incorporating Support Persons into the Residency Community

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Practical tips for navigating a program director transition

Residency and fellowship program directors profoundly impact trainees, institutions, and patient safety. Yet, there is concern for rapid attrition in the role. The average program director tenure is only 4-7 years, and that timeline is likely a result of burnout or opportunities for career advancement. Program director transitions must be carefully executed to ensure minimal disruption to the program. Transitions benefit from clear communication with trainees and other stakeholders, well-planned successions or searches for a replacement, and clearly delineated expectations and responsibilities of the outgoing program director. In this Practical Tips, four former residency program directors offer a roadmap for a successful program director transition, with specific recommendations to guide critical decisions and steps in the process. Themes emphasized include readiness for a transition, communication strategies, alignment of program mission and search efforts, and anticipatory support to ensure the success of the new director.

Residency Program Responses to Early COVID-19 Surges Highlight Tension as to Whether Residents Are Learners or Essential Workers

PURPOSE

To quantify the extent to which internal medicine (IM) residents provided care for patients with COVID-19 and examine characteristics of residency programs with or without plans (at some point) to exclude residents from COVID-19 care during the first 6 months of the pandemic.

METHOD

The authors used data from a nationally representative, annually recurring survey of U.S. IM program directors (PDs) to quantify early (March-August 2020) resident participation in COVID-19 care. The survey was fielded from August to December 2020. PDs reported whether they had planned to exclude residents from COVID-19 care (i.e., PTE status). PTE status was tested for association with program and COVID-19 temporal characteristics, resident schedule accommodations, and resident COVID-19 cases.

RESULTS

The response rate was 61.5% (264/429). Nearly half of PDs (45.4%, 118/260) reported their program had planned at some point to exclude residents from COVID-19 care. Northeastern U.S. programs represented a smaller percentage of PTE than non-PTE programs (26.3% vs 36.6%; P = .050). PTE programs represented a higher percentage of programs with later surges than non-PTE programs (33.0% vs 13.6%, P = .048). Median percentage of residents involved in COVID-19 care was 75.0 (interquartile range [IQR]: 22.5-100.0) for PTE programs, compared with 95.0 (IQR: 60.0-100.0) for non-PTE programs ( P < .001). Residents participated most in intensive care units (87.6%, 227/259) and inpatient wards (80.8%, 210/260). Accommodations did not differ by PTE status. PTE programs reported fewer resident COVID-19 cases than non-PTE programs (median percentage = 2.7 [IQR: 0.0-8.6] vs 5.1 [IQR: 1.6-10.7]; P = .011).

CONCLUSIONS

IM programs varied widely in their reported plans to exclude residents from COVID-19 care during the early pandemic. A high percentage of residents provided COVID-19 care, even in PTE programs. Thus, the pandemic highlighted the tension as to whether residents are learners or employees.

Proxy Detection of Resident Burnout by Program Directors and Domestic Partners

BACKGROUND

Resident burnout is associated with increased incidence of depression, suicide, and poor patient outcomes, yet identification of it is difficult. This study was designed to compare how well program directors (directors) and a resident's spouse or domestic partner (partner) can serve as a proxy to identify burnout in the resident.

STUDY DESIGN

An electronic survey, including the Maslach Burnout Inventory, was distributed to residents, their partners, and directors of all ACGME-accredited residencies at a single university-affiliated hospital. Burnout rates were compared with McNemar's test. Emotional exhaustion and depersonalization rates were compared with Spearman's correlation.

RESULTS

The response rate by respondent type was 33% (292 of 876) for residents, 48% (55 of 114) for partners, and 57% (13 of 23) for directors. Residents' self-reported burnout rate was 51% (148 of 292), while partners' proxy predicted burnout rate was 25% (14 of 55), and directors' was 5% (9 of 174). There was moderate correlation of partners' prediction of resident emotional exhaustion (ρ = 0.537, p < 0.01), depersonalization (ρ = 0.501, p < 0.01), and personal accomplishment (ρ = 0.416, p < 0.01). There was poor correlation of directors' prediction of residents' emotional exhaustion (ρ = 0.361, p < 0.01) and depersonalization (ρ = 0.223, p < 0.01). Partners had a 50% sensitivity, 94% specificity, 86% positive predictive value, and 71% negative predictive value in predicting resident burnout. Directors had a 6% sensitivity, 96% specificity, 56% positive predictive value, and 54% negative predictive value in predicting resident burnout.

CONCLUSIONS

Directors are not skilled in detecting burnout in their trainees. Partners are an underused group for detecting burnout and may represent an important target audience for awareness of available resources to benefit residents.

"Everybody in this room can understand": A qualitative exploration of peer support during residency training

OBJECTIVES

Though peer support groups are often utilized during residency training, the dynamics, content, and impact of social support offered through peer support are poorly understood. We explored trainee perceptions of the benefits, drawbacks, and optimal membership and facilitation of peer support groups.

METHODS

After engaging in a peer support program at an emergency medicine residency program, 15 residents and 4 group facilitators participated in four focus groups in 2018. Interview questions explored the dynamics of group interactions, types of support offered, and psychological impacts of participation. The authors conducted a reflexive thematic analysis of data, performing iterative coding and organization of interview transcripts.

RESULTS

Discussions with experienced senior residents and alumni normalized residents' workplace struggles and provided them with insights into the trajectory of their residency experiences. Vulnerable group dialogue was enhanced by the use of "insider" participants; however, residents acknowledged the potential contributions of mental health professionals. Though groups occasionally utilized maladaptive coping strategies and lacked actual solutions, they also enhanced residents' sense of belonging, willingness to share personal struggles, and ability to "reset" in the clinical environment.

CONCLUSIONS

Participants offered insights into the benefits and drawbacks of peer support as well as optimal peer group composition and facilitation. Support groups may be more effective if they engage a complementary model of alumni and pre-briefed psychologist facilitators, avoid fatalism, and aim to foster intimate connections among residents. These findings can inform the development of future initiatives aiming to create a safe space for trainees to discuss workplace stressors.

Evaluating burnout during the COVID-19 pandemic among physicians in a large health system in New York

PURPOSE

The COVID-19 pandemic has generated significant psychological distress among health care workers worldwide. New York State, particularly New York City and surrounding counties, were especially affected, and experienced over 430,000 COVID-19 cases and 25,000 deaths by mid-August 2020. We hypothesized that physicians and trainees (residents/fellows) who were redeployed outside of their specialty to treat COVID-19 inpatients would have higher burnout.

METHODS

We conducted a cross-sectional survey to assess burnout among attending and trainee physicians who provided patient care during the COVID-19 pandemic between March-May 2020 across a diverse health care system in New York. Separate multivariable logistic regressions were performed to determine the association between redeployment and measures of burnout: Emotional Exhaustion (EE) and Depersonalization. Burnout measures were also compared by physician vs trainee status. The differential association between redeployment and outcomes with respect to trainee status was also evaluated.

RESULTS

Redeployment was significantly associated with increased odds of EE {OR =1.53, 95% CI: 1.01-2.31} after adjusting for gender and Epidemic-Pandemic Impacts Inventory (EPII) score. Similarly, being a trainee, especially a junior level trainee, was associated with increased odds of EE {OR = 1.59, 95% CI: 1.01-2.51} after adjusting for gender and EPII scores. However, neither redeployment nor trainee status were significantly associated with Depersonalization. Interactions between redeployment and trainee status were not significant for any of the outcomes (p>.05).

CONCLUSION

Physicians who were redeployed to treat COVID-19 patients had higher reported measures of EE. Trainees, irrespective of redeployment status, had higher EE as compared with attendings. Additional research is needed to understand the long-term impact of redeployment on burnout among redeployed physicians. Programs to identify and address potential burnout among physicians, particularly trainees, during pandemics may be beneficial.

The Impact of a Resident's Sense of Control on Burnout in Orthopaedic Surgery Residency

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Physician burnout is a barrier to the patient-centered approach to health care.

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One of the driving factors of resident burnout is the decreased level of control that residents have over their everyday lives.

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Providing residents with a sense of control over their lives and their jobs increases job satisfaction and leads to a decrease in reports of negative effects on health, rest, participation in extracurricular activities, and time with family.

Preserving wellness in dermatology residents

Although a dermatology residency is associated with a favorable lifestyle, nearly one in three budding dermatologists meet the criteria for burnout. The competitive nature of dermatology residency selection may confer a predisposition to burnout. Contributing factors during residency include a high-volume clinical experience and frequent use of electronic health records. Women may face particular pressures in managing work-life balance when starting a family during dermatology residency. In addition to preventing burnout before residency, fears of professional repercussions should be alleviated to ensure resident well-being. We have focusedW focus on the causes of burnout among dermatology residents and suggest solutions to promote wellness.

Current Wellness Practices among Otolaryngology Residencies

Objectives

To determine if and how resident emotional health is monitored among otolaryngology training programs and to determine what wellness resources are available to otolaryngology residents.

Study Design

Survey.

Setting

Tertiary academic medical centers.

Subjects and Methods

An anonymous 50-item survey sent via REDCap to the 107 allopathic American otolaryngology program directors (PDs).

Results

The response rate was 44%, of whom 47.7% regularly surveyed emotional health among their residents. A total of 33.3% used the Maslach Burnout Inventory, and 61.9% used another scale or did not know. Eighty-one percent of surveys were anonymous, and 45% surveyed yearly, which was mandatory in only 33.3% of programs. Whether surveys took place was not related to PD or program demographics. In total, 72.7% of programs utilized faculty mentors for their residents; 88.6% had a wellness lecture within the last year; and 74.5% had no-cost mental health resources with extended hours as required by the American Council of Graduate Medical Education. Within the last year, 31.8% had provided seminars in mindfulness or meditation. Seventy-five percent had financially supported social events for their residents; <15% supported athletic or mental wellness activities. Healthy foods were provided by 36.4%, and 67.4% of programs gave their residents days off in addition to vacation days for medical or dental appointments. Residents were allowed a mean 18.76 vacation days and 3.73 additional wellness days.

Conclusion

There is no standard practice for measuring and monitoring emotional health by otolaryngology programs. Programs struggle to offer interventions to prevent burnout, with 25% noncompliant with the wellness requirements mandated by the American Council of Graduate Medical Education.