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.
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.