What gets resident physicians stressed and how would they prefer to be supported? A best–worst scaling study

Abstract

IntroductionPhysician burnout has severe consequences on clinician well-being. Residents face numerous work-stressors that can contribute to burnout; however, given specialty variation in work-stress, it is difficult to identify systemic stressors and implement effective burnout interventions on an institutional level. Assessing resident preferences by specialty for common wellness interventions could also contribute to improved efficacy.MethodsThis cross-sectional study used best–worst scaling (BWS), a type of discrete choice modelling, to explore how 267 residents across nine specialties (anaesthesiology, emergency medicine, internal medicine, neurology, obstetrics and gynaecology, pathology, psychiatry, radiology and surgery) prioritised 16 work-stressors and 4 wellness interventions at a large academic medical centre during the COVID-19 pandemic (December 2020).ResultsTop-ranked stressors were work-life integration and electronic health record documentation. Therapy (63%, selected as ‘would realistically consider intervention’) and coaching (58%) were the most preferred wellness supports in comparison to group-based peer support (20%) and individual peer support (22%). Pathology, psychiatry and OBGYN specialties were most willing to consider all intervention options, with emergency medicine and internal medicine specialties least willing to consider intervention options.ConclusionBWS can identify relative differences in surveyed stressors, allowing for the generation of specialty-specific stressor rankings and preferences for specific wellness interventions that can be used to drive institution-wide changes to improve clinician wellness. BWS surveys are a potential methodology for clinician wellness programmes to gather specific information on preferences to determine best practices for resident wellness.

Unmasking Resident Physician Burnout During the COVID-19 Era

“…However, there were other stressors that are common across all specialties. 6 Stressors that impacted residents included the novel pandemic, ethical dilemmas, depersonalization, role as a learner, training environment, and health concerns 3 ( Table 1 ). Of these, the novel pandemic and health concerns stressors are generalizable to the larger population, though the resident position brings unique components to each stressor that are role and position specific.…”

“… 1,5 These feelings are present across all specialties. 6 Vijay et al conducted a study of residents near the beginning of the pandemic and found that greater than 50% of residents had symptoms of emotional exhaustion, and only 42.9% felt valued by their institution. 1 Outside of work, Natsuhara et al described that the need to wear a mask leads to depersonalization because it hides emotions and the identities of practitioners, changing human interaction.…”

“…Residents spend a considerable amount of time with their peers and unsurprisingly find support among their co-residents. 6,9,10 Peer-support groups can help with the psychological impacts of training programs. 8 Natsuhara et al recommends building a longitudinal peer-support curriculum to help teach peer-support skills, instead of developing them by trial and error, and to help relay concerns about those who may need more support.…”

“…This has implications on patient care, including the possibility of medical errors and substandard patient care. 6 An international study of residents and fellows during the COVID-19 era found that burnout was more likely to be reported in practitioners who cared for a greater number of patients with COVID-19 infection. 7 Several studies during the COVID-19 era noted that between 35% and 60% of residents reported feeling overwhelmed and burnt out, regardless of direct involvement of COVID-19 care, and residents also reported an increased prevalence of depressive and anxiety symptoms.…”

Psychosocial and biological predictors of resident physician burnout

“…Various investigations carried out on burnout in resident physicians have shown that this group of professionals is especially vulnerable [3][4][5]. Burnout is described as having three dimensions (emotional exhaustion, depersonalization, and reduced personal accomplishment) [6].…”