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    How residents are increasingly feeling burnout


    Relationships with patients play a role, too, with residents who experienced suboptimal patient attitudes and behaviors also reporting higher rates of burnout. Residents endorsing burnout related to suboptimal patient attitudes and behaviors report feeling guilty about how they had treated a patient from a humanitarian perspective and for their lack of attention to the personal or social impact of an illness.

    In an effort to improve patient safety, a number of residency programs have implemented changes to reduce burnout, such as limiting consecutive work hours. The Accreditation Council for Graduate Medical Education has made efforts over the last decade to revise residency program standards, limiting residents in 2003 to 80 hours of work per week, with that subsequently limited to 30 consecutive hours. Those standards were further limited in 2011 to reduce first-year residents to 16 continuous hours of work. Those changes, however, do not appear to have had a positive impact on reports of burnout, well-being, sleep, or perceptions in quality of patient care.

    Next: Preventing physician burnout

    Some studies have found that residents who are able to separate their personal feelings from patients fare better when it comes to staving off burnout. More compassionate residents are able to compensate their feelings for a brief period, but then are overcome by burnout and begin a cycle of perceived poor patient care, according to the study.

    Previous studies examining the effects of self-care workshops as interventions, however, did little to improve rates of burnout. More research is needed to find interventions that are more effective in preventing and managing burnout among pediatric residents, the report states. There has been some improvement among internal and pediatric residents in studies where acceptance, active coping, positive reframing, self-compassion, and mindfulness strategies were employed.

    “Although data on effective burnout interventions are limited, we believe that systematic workflow changes that reduce administrative burden, increase time at the bedside, and address workload compression may have the greatest effects on burnout,” Baer says. “Additional structural supports, such as loan forgiveness programs and parental leave policies, should also be addressed. Although open dialogue and coping strategies are important mechanisms to address burnout on an individual level, physicians, including pediatricians, must advocate for humanistic and family-friendly work environments, not just for ourselves, but for our patients and society at large.”

    Quality patient care is a top priority across the profession, but to take good care of patients, physicians must also remember to stay healthy and motivated, Baer says. Medical training is a particularly stressful time for physicians, she adds. Whereas burnout among pediatric residents has not been well studied up to this point, Baer says research in other specialties shows that internal medicine residents were more likely to self-report suboptimal patient care attitudes and behaviors.

    “We hope that our research brings awareness of the impact of burnout on patient care, and the importance of addressing burnout in the healthcare system,” Baer says.


    Rachael Zimlich, RN
    Ms Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and ...

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      I guess that when I was inPediatric residency training, my colleagues and I were too busy to think about burnout. We did our work and if we needed some time off we would ask each other to cover for us, e.g. if we wanted to leave early. We knew what we had to do and we were eager to do it. That is why we worked hard in medical school and why we continued to work hard in our residency. If any of us felt a sense of burnout, we never discussed it. We had out Attending MD's to help support us. In my own training and all throughout my practice, I have always tried to have a close relationship with my patients and their families. An office visit was more like seeing a young friend and doing what I could to help them. This made the hard work easier to bear. I have always made it my practice to let a family/patient know if I have made an error however small or easily hidden. I reveled in making an astute diagnosis, but made it my policy not to soak it in for too long because you can miss something the next day just as easily. If you remain humble, have integrity, and note your limitations, it does make life easier. Do not expect to know everything all the time. Tell your patients that you do not know what is going on and get that consultation. It makes life easier. Did I have dark periods in my practice? Of course I did. But I always found joy in continuing to try to make my patients' lives better and when I couldn't, I found someone who could. I am semi-retired now to my "second job" of 43 years as the School Physician at an independent private preparatory school, work that I did in addition to my solo practice. I have never considered my practice nor my private school work as a job. If you do that, then you will certainly go down the path toward burnout. Medical practice must be a vocation, something to which you are called and to which you are devoted. Anything less and you are in the wrong profession and you will experience burnout. Steven L. Johnson M.D. Ohio State University COM 1969-1973 Akron (Ohio) Children's Hospital 1973-76


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