Virginia Research Day 2021

IDENTIFYING WELLNESS OPTIONS AND MEASURING RESILIENCE AND BURNOUT TRENDS IN A RESIDENCY Caroline Moon Thompson, LPC, LSATP, Amber Stephens, DO Sovah Health Family Medicine Residency Program, Danville , VA

Abstract # CRF 1

Background: The Accreditation Council for Graduate Medical Education (ACGME) recognizes the importance of recognizing early burnout in resident trainees and provides guidelines to promote overall the overall wellness of residents in residency programs. According to a comprehensive literature review regarding burnout in residency, IsHak, Lederer, Mandili, Nikravesh, Seligman, Vasa, Ogunyemi, Bernstein (2009), physician burnout can be associated with depression, risk of medical errors, and may have negative effects on patient safety. Furthermore, burnout erodes job satisfaction, overall wellbeing and can lead to disharmony in interpersonal relationships. Various workplace-driven interventions are designed to assist residents in early recognition and whole person wellness. These include lectures on topics about physician burnout prevention, resilience, communication among team members, time management, physical and emotional wellbeing, monthly Balint groups, physicians suicide prevention discussion, substance use disorders in the medical community and stress management skills. Purpose : This poster examines the Sovah Health Family Medicine Residency Program wellness planning efforts and a basic analysis of trends using the self-administered Abbreviated Maslach Burnout Inventory (aMBI) and the Brief Resilience Scale (BRS) administered during the 2019-2020 academic year. During a Strengths, Weaknesses, Opportunities, and Threats analysis (SWOT) of the 2018-2019 Wellness activities, the SOVAH Family Medicine Residents studied the year and proposed a Wellness plan for the 2019-2020 Academic year. The plan included scheduling ACGME suggested wellness topics, team building activities during the year, secured funding for planned wellness events and held a fall retreat. The residency planned lighter wellness get togethers during the winter months and utilized two self- rating inventories for self-administration each quarter to determine potential burnout and resilience trends among residents. Method : T wo self-administered burnout inventories were distributed during planned wellness events in July, October, January, and May of the 2019-2020 academic year. The aMBI (which differs from a full 33 item Maslach Burnout Inventory) was selected to identify two burnout scales Emotional Exhaustion (EE) and Depersonalization (D)) and a third scale noting Personal Accomplishment (PA). Each scale ranges between 0-18 and higher scores of the EE and D scales yield higher rates of burnout. PA is noteworthy in identifying job satisfaction. The BRS was selected to determine the perception of one’s ability to “bounce back” indicating resilience and are rated as low (0-2.9), normal (3.00-4.30) and high (4:50- 6.00). The resident responses for each of the three (3) aMBI scales and the one (1) scale of the BRS were averaged to identify trends, and to establish a baseline for future reference. The participants included the PGY 1,2,3 Family Medicine residents in which there were seven (7) females, eleven (11) males for a total sample of eighteen (18) residents who ranged between the age of 28-49.

Results: Notable trends for the overall average resident responses for the aMBI D Scale increased with each training year. The aMBI EE scale averaged responses were lower for the PGY 1 and higher for the PGY 2 and PGY 3. The overall averages of aMBI D Scale responses show increases among the PGY 1, PGY2, and PGY3 reside . There was a slight increase in the averaged aMBI EE Scale responses for female residents and females scored lower on the aMBI D scale during the administration time frames. The overall averaged responses for aMBI PA were consistent across gender and training year with a slight increase for females. The BRS scale trends upward for July, October and January and shows a slight downward trend between the third and fourth quarter. It remained in the normal range (3.0-4.30) overall with an average of 3.85.

Female and Male Overall Score Averages female male

aMBI Overall Averages by Training Year

10.00 12.00 14.00

10.00 12.00 14.00 16.00

0.00 2.00 4.00 6.00 8.00

0.00 2.00 4.00 6.00 8.00

aMBI Score 0-18

Scale Score

PGY 3

PGY2

PGY 1

BRS 0-5 aMBI EE 0- 18

aMBI D 0- 18

aMBI PA 0- 18

aMBI EE 0-18 aMBI PA 0-18

aMBI D 0-18

Linear (aMBI D 0-18)

BRS Scale Averages During 2019-20

3.40 3.60 3.80 4.00 4.20

BSR 0-5

July

October

January

May

Discussion: Residency provides a unique opportunity for residents to develop lifestyles to promote work life balance. Residency programs may benefit from engaging residents in the planning and promoting efforts of this function and may use short self-assessment tools to monitor for potential burnout. By recognizing trends, residents and faculty can plan wellness programming options for the year and can target activities for each training year. The data may provide some understanding of a resilience and burnout response to COVID 19. Small sample size, COVID 19 challenges are notable limitations of this trend information. There is questionable validity of the 9 item aMBI vs. the 33 item Maslach Burnout Inventory as cited by a study by Lim, Ong, Ong, Hao, Abdullach, Koh and Mok (2019). Conclusion: It is helpful to establish a mechanism to involve residents and faculty in the planning efforts towards overall wellness to promote work life balance in training and set essential wellness awareness. The project provides trend information which can be used in planning future wellness activities to meet ACGME guidelines. Data trends in future years may yield useful comparisons and encourage wellness awareness. https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being Ishak WW, Lederer S, Mandili C, Nikravesh R, Seligman L, Vasa M, Ogunyemi D, Bernstein CA. Burnout during residency training: a literature review. J Grad Med Educ. 2009 Dec;1(2):236-42. Lim, W. Y., Ong, J., Ong, S., Hao, Y., Abdullah, H. R., Koh, D. L., & Mok, U. (2019). The Abbreviated Maslach Burnout Inventory Can Overestimate Burnout: A Study of Anesthesiology Residents. Journal of clinical medicine, 9(1), 61. https://doi.org/10.3390/jcm9010061

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