July 30, 2019 12:57 pm Michael Devitt – Stretch out a rubber band with your fingers, let go of one end, and it'll quickly snap back into its normal shape. That's an example of resiliency.
If only it were that easy for family medicine residents.
Although research estimates of burnout prevalence among family medicine residents can vary widely by study design and methodology, a large prospective cohort study that broke down burnout rates by specialty found that 37.2% of second-year residents from family medicine programs nationwide reported burnout symptoms. That 2018 study correlated closely with one conducted five years earlier among first-year family medicine residents in which 37.5% of participants reported symptoms of burnout.
In the face of this professional crisis, family medicine educators and researchers across the country are looking for ways to help residents develop resiliency skills and mitigate factors that lead to burnout. Results of a small trial published online July 5 in The International Journal of Psychiatry in Medicine indicate that a program focused on cultivating personal awareness, building social connections and coping skills, and maintaining work-life balance can provide both short- and long-term benefits for family medicine residents.
Thirty-two family medicine residents at two residency programs in Toledo, Ohio, were recruited to participate; 19 were assigned to an intervention group and 13 to a control group. Most were international medical graduates.
Residents in the intervention group engaged in interactive sessions that covered topics such as time management, mindfulness and coping skills. Each session included a handout and a didactic presentation by a health care professional, followed by practicing a skill such as breathing awareness, meditation or guided imagery. Residents participated in eight hours of training during their first year, and between four and six hours of advanced training in their second and third years.
Residents in the control group watched videos from a program called the LIFE curriculum, which consisted of learning modules designed to evaluate fatigue, stress, depression, substance abuse and disruptive behavior.
Of the residents originally recruited, 18 from the intervention group and 10 from the control group completed the study.
The researchers used multiple instruments to measure outcomes: the Maslach Burnout Inventory-Human Services Survey, the Professional Quality of Life measure and the Connor-Davidson Resilience Scale. Residents in the intervention group completed an evaluation at baseline, another immediately after completing the program, and others at one and two years post-program.
Immediately after completing the resiliency program, the intervention group scored significantly lower than the control group on the emotional exhaustion and depersonalization scales of the MBI. In control group residents, the average emotional exhaustion score was 21.4 (moderate range = 17-26), while in intervention group residents, the average score was 13.5 (low range = 0-16).
Compared with controls, residents in the intervention group showed a trend toward lower burnout and secondary traumatic stress scores, although this finding was not statistically significant. They also exhibited slightly higher sense of personal accomplishment and resiliency scores.
In response to the burnout dilemma that plagues family physicians and those training to be FPs, the AAFP has created a wealth of member resources designed to increase resiliency and improve the health and well-being of residents and physicians alike. And thanks to its role as an inaugural sponsor of the National Academy of Medicine's Action Collaborative on Clinician Well-being and Resilience, some of that work is benefiting other clinicians, as well.
The resiliency program appeared to be effective in keeping burnout rates from rising over the longer term, as has been reported in the literature. As noted, residents in the intervention experienced significantly lower depersonalization and emotional exhaustion scores from before the program to immediately after the program; burnout and secondary traumatic stress scores remained relatively stable over the duration of the assessments.
Overall, residents reported satisfaction with the resiliency program. They rated its usefulness and the likelihood of recommending the program to other residents an 8 on a scale of 1 to 10.
According to the researchers, their results showed the effectiveness of the resiliency program in reducing symptoms of burnout post-program. Moreover, they pointed out, there were no significant increases in any burnout measurements. They speculated that the peer support and interaction that occurred during the resiliency program may have provided residents an extra layer of protection that prevented symptoms of burnout from taking hold.
Finally, the authors called for more research to determine which aspects of the program were most useful and whether the program helped residents avoid burnout as they moved on to independent practice.
Psychologist Julie Brennan, Ph.D., director of behavioral health and associate professor in the Department of Family Medicine at the University of Toledo Medical Center/Glendale Medical East, served as the study's corresponding author. Brennan told AAFP News that the study's results should give family medicine residency directors a lot to consider.
"The take-home message is that resiliency or well-being programs should be included in curriculum throughout the three years, and well-being should be treated as a competency similar to the other competencies, including medical knowledge," Brennan said.
"It is important to note that residents are coming in with many strengths and skills already, and this curriculum is to supplement and apply their already existing strengths. Residencies should consider multi-tiered programs designed for residents with different needs," she added.
Still, according to Brennan, the resiliency program represents only one piece of a larger puzzle. She told AAFP News that a more comprehensive plan would be needed to move the needle on improving well-being and decreasing burnout in residents.
Obtaining approval from institutional review boards to collect and analyze data and garnering support among program directors and other faculty are critical elements when implementing a resiliency program, said Brennan, who offered to help any residency director interested in trying it out.
"We are willing to share our materials with other family medicine residency directors, who would of course have to modify our program for their specific needs," she said.
Finally, Brennan suggested that the resiliency program could be of value to FPs who have completed their residencies.
"We have not tested the program in practicing family medicine physicians, although there is reason to believe that they could benefit from peer connection and continuing to build more advanced resiliency skills," she said.
Related AAFP News Coverage
Finding Resiliency in Residency
Reversing Cycle of Burnout Starts With Knowing Yourself