Resident Burnout

Residency training is arguably one of the most challenging periods of a physician’s career. A multitude of stressors are encountered during residency training including long work hours, sleep deprivation, limited social interactions, and relationship strain. These stressors, left unchecked, contribute to both emotional and physical exhaustion and ultimately a state known as burnout.

Burnout has been identified in residents across all specialties and has been associated with suboptimal patient care. Burnout has been linked to higher rates of depression and anxiety among residents and has been shown to significantly increase the risk of suicide. Because of its negative implications, burnout may be the single most important factor influencing resident well-being and patient outcomes. Yet, few residency programs have implemented initiatives to target burnout.

Duty hour reforms by the Accreditation Council for Graduate Medical Education aimed to decrease the rate of medical errors and adverse patient events attributed to resident fatigue. While it was hoped that these reforms would result in substantial improvements in these areas, the effects have been largely inconclusive.

A new paradigm has shifted the focus from issues contributing to sleep deprivation and fatigue to efforts to prevent burnout. At the forefront of such efforts are comprehensive programs known as Resident Wellness Programs (RWPs). RWPs have shown potential to reduce burnout rates among residents primarily through early intervention.

RWPs use a combination of active and passive initiatives to address four main areas that reduce burnout: physical, mental, social, and intellectual wellness. While only a few residency programs nationwide have implemented RWPs, the results, to date, are very promising.

If you are interested in starting an RWP at your institution, the simple steps below can guide you in the process.

• Find a team of wellness champions. Wellness champions are the individuals who will spearhead efforts to create and implement a resident wellness program. Choose at least two faculty members and one resident (for example, chief resident). Faculty and resident involvement will help to promote the longevity of your program.

• Set up regular meetings for the wellness champions. Meetings should be held at least one or two times a month. The initial meeting should focus on defining wellness.

• Solicit resident feedback regarding changes that will help to promote wellness. Residents are more likely to participate in a wellness program if their concerns are validated.

• Use a tool to assess resident burnout at baseline and compare the results to reported burnout after the initiation of your RWP. This will help determine the efficacy of your program. The Maslach Burnout Inventory is a standardized instrument that can be used to measure burnout.

• Decide what areas your RWP will address. Effective wellness initiatives target five main areas of wellness: physical, mental, social, financial, and intellectual wellness.

• Publicize the RWP to your residents and faculty. It may be helpful to have a kickoff event to mark the start of the RWP (for example, a social gathering for residents and faculty such as a happy hour or lunch event).

• Get started! Implement your RWP.

• Solicit feedback from residents on an ongoing basis. It’s helpful to know what aspects of the RWP are successful and those that can be improved.

Examples of RWP Activities

• Mental: Meditation/mindfulness seminar, process group

• Social: Resident happy hours, potlucks

• Intellectual: Promote opportunities for scholarly activity

• Physical: healthy snacks for residents on call, hiking

• Financial: Debt management lunch talks

Comprehensive RWPs offer hope to counteract the challenges of residency training. Preliminary findings suggest that such programs are well received by residents and faculty and may have great potential to reduce resident burnout and positively impact resident wellness and patient care. It is hoped that more studies to support the efficacy of RWPs will increase the number of such programs utilized by U.S. medical residencies. After all, we cannot effectively care for our patients until we first take care of ourselves. ■