Addressing Physician Burnout with Implementation of a Resident Directed Wellness Curriculum

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Background: Resident physicians are offered minimal formalized training in methods to sustain personal resiliency and wellbeing. Pediatric residents experience a burnout rate of more than 50% throughout training (1). Due to the increasing prevalence of physician burnout, the ACGME instructed residency programs to address resident wellness (2). However many programs lacked a positive result post-implementation of a standardized wellness curriculum. Therefore a needs-based curriculum was introduced to address issues specific to the Pediatric Residents of Maria Fareri Children's Hospital. Curricula included experiential and didactic sessions on topics of meditation, mindfulness, stress management, and allied therapies. Additional initiatives to create positive systemic culture change included formalizing a wellness committee, quarterly program leadership events, and robust mentoring (table 1).

Objective: Assess resident perception of wellbeing and burnout pre- and post-implementation of a resident directed wellness curriculum over one year.

Methods:  Annual ACGME surveys were distributed to pediatric residents in March of 2019 and 2020. This data was aggregated and de-identified, and relayed back to our program. Descriptive statistics were used to compare percentages in wellness categories pre- and post-implementation of a wellness curriculum for the academic year of 2019-2020. Chi square calculations were used to compare proportions in wellness agreement between groups.

Results: After implementation of our program wide wellness initiatives and curricula, wellness values in all but one domain improved with an overall mean change of +7.78% (min 1.9%, max 15.3%, median 8.85%). While almost all of the wellness items showed trends towards improvement, only resident self-report of feeling less emotionally drained at work was statistically significant (12.2%, 95%CI 0.6, 24; p value = 0.03). Categories with greatest improvement of >10% gross change, though not statistically significant, included reasonable workload, work being a positive challenge, and time to think and reflect (table 2). The only domain of 12 categories where there was a reduction of wellness was in needing more time after work to relax (-9.5%, 95%CI -4.2, 23).

Conclusion: Culture and systemic changes to address program specific resident wellness concerns can improve self-reported resident wellness measures such as residents feeling more equipped in self-reflection and emotional management. Our implementation of the wellness curriculum alongside program-wide changes elicited positive change in all but one wellness domains on an annual nationally recognized survey. Constant interrogation of the curriculum and affiliated activities with resident input via wellness committee meetings, wellness projects, and continual prompting by program leadership are thought to be most contributory. Future work will be dedicated to formalizing monthly evaluations of the current curriculum and activities.

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Maria Fareri Children's Hospital/Westchester Medical Center
Westchester Medical Center/Maria Fareri Children's Hospital

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