Chief residents offer 4 ways programs can fight burnout

With residents in some medical specialties reporting physician burnout at rates exceeding 60%, it is critical to understand what is driving the phenomenon and how to fix it. Four chief residents from one of the nation’s most prestigious hospitals have laid out essential remedies they believe could make a dent in the problem.

Committed to making physician burnout a thing of the past, the AMA has studied, and is currently addressing, issues causing and fueling physician burnout to better understand and reduce the challenges physicians face.

The AMA STEPS Forward™ module, “Resident and Fellow Burnout: Create a Holistic, Supportive Culture of Wellness,” will help you discover what’s needed to develop a wellness program.

Promoting well-being in training is one key goal of the AMA Reimagining Residency initiative—a grant program that aims to transform residency training to best address the workplace needs of our current and future health care system.

The four chief residents assumed the title at the Brigham and Women’s Hospital medicine department during the 2017–2018 academic year. In an Academic Medicine article, “Fostering Meaning in Residency to Curb the Epidemic of Resident Burnout: Recommendations From Four Chief Medical Residents,” they argued for returning the focus of residency training to medicine’s higher calling.

“To truly alter the resident experience of emotional exhaustion and depersonalization, we believe residency programs and hospitals must shift their focus from addressing burnout to fostering meaning within residency,” says the Academic Medicine essay.

The article’s authors—David D. Berg, MD, Sanjay Divakaran, MD, Robert M. Stern, MD, and Lindsay N. Warner, MD—highlighted four ways to foster meaning in residency training.

The problem: Drawing on their personal experiences and observations, the chief residents found that a minimal amount of time is directed to patient care. They cited a 2018 study finding that internal medicine residents spend just 13% of their shift working in direct patient care.

The remedy: Lessen inpatient volume for individual residents and transfer indirect patient care tasks away from medical residents. Learn more about how much time first-year medical residents spend on patient records.

The problem: The educational experiences that are considered a critical part of empowering residents and allowing them to assume graduated responsibilities on the wards are often an afterthought, the four Brigham chief residents argued. They noted research finding that “internal medicine residents across the country spend only 7.3% of their inpatient shifts on educational activities.”

The remedy: The authors believe that protecting educational time both during formal lessons and during educational conferences. The shift is also cultural, meaning that protected time is time in which residents wouldn’t feel obligated to return pages and call consults.

The problem: The chief residents wrote of time in which they witnessed bias against many female and minority trainees. Both overtly disrespectful acts and unconscious biases can cause residents to lose their sense of meaning in the work.

The solution: In their program, the chiefs observed residents creating badges that identified them as “Doctors” in clear lettering. The authors also wrote that “programs and teaching hospitals must commit to formal, transparent, and closed-loop mechanisms for reporting and investigating harassment.” Learn more with the AMA about how often medical resident bullying happens.

The problem: The pressures and emotionally-charged experiences of training can make residents vulnerable to social isolation, which can impact performance and cause loss of meaning. The solution: Institutionally-promoted social events, including events that go across different residency programs, such as dinners or holiday parties can help create community. For residents who are less socially motivated, the chief residents supported the idea of programs creating peer discussion groups to build community. Read about why a strong support system is key to resident well-being.