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Babal JC, Lelkes E, Kloster H, Zwemer E, Lien ER, Sklansky D, Coller RJ, Moreno MA, Schultz R, Webber S. Pediatric Resident Well-being: A Group Concept Mapping Study. Acad Pediatr 2024; 24:535-543. [PMID: 38215904 DOI: 10.1016/j.acap.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/11/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Pediatric residency programs invest substantial resources in supporting resident well-being. However, no pediatric resident well-being conceptual model exists to guide interventions. This study aimed to understand how a diverse stakeholder sample conceptualized well-being. METHODS We used group concept mapping methodology. We sent a brainstorming survey to pediatric residents and program leaders at 24 US residencies with the prompt, "The experience of well-being for resident physicians includes…" Participants at 4 residencies sorted well-being ideas conceptually and rated idea importance. We performed multidimensional scaling and hierarchical cluster analysis to develop cluster maps. Using participant feedback and a consensus-driven process, we determined best cluster representation. We used pattern matching to compare domain ratings between subgroups. RESULTS In brainstorming, 136 residents and 22 program leaders from 22 residency programs generated 97 unique ideas. Ideas were sorted and rated by 33 residents, 14 program leaders. Eight domains aligning with 4 resident roles were identified. Domains were: 1) positive, safe, and diverse culture; 2) unity and connection; 3) professional fulfillment and mindset; 4) personal health and life satisfaction; 5) professional development and recognition; 6) schedule protections and downtime; 7) work systems and benefits; 8) proactive and compassionate leadership. Domains aligned with the following roles: 1) individual, 2) colleague, 3) employee, 4) emerging pediatrician. Residents placed higher value on schedule protections and downtime than program leaders, P < .05. CONCLUSIONS Pediatric resident well-being may be conceptualized as inter-related domains corresponding with various resident roles. Participants aligned on many well-being priorities but differed regarding work schedules.
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Affiliation(s)
- Jessica C Babal
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Efrat Lelkes
- Department of Pediatrics (E Lelkes), University of California San Francisco.
| | - Heidi Kloster
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Eric Zwemer
- Department of Pediatrics (E Zwemer), University of North Carolina, Chapel Hill.
| | | | - Daniel Sklansky
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Ryan J Coller
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Megan A Moreno
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Roger Schultz
- Department of Neurobiology (R Schultz), University of Wisconsin, Madison.
| | - Sarah Webber
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
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Jiffry AJ, Cho CS, Schmidt AR, Pham PK, Nager AL. A Mixed Methods Needs Assessment for a Debriefing Intervention Following Critical Cases. Acad Pediatr 2023; 23:85-92. [PMID: 35605897 DOI: 10.1016/j.acap.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/02/2022] [Accepted: 05/14/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The emergency department (ED) is a demanding environment, and critical events have been identified as contributors to stress. Debriefing is a possible intervention for staff, but there is little information regarding formulation and implementation. A needs assessment was conducted to describe the emotions of pediatric ED (PED) staff following critical events and assess opinions regarding debriefing. METHOD This mixed methods study used convergent design for triangulation. After critical cases, PED staff members were given the Peritraumatic Distress Inventory (PDI). Additionally, a questionnaire with 2 open-ended questions on debriefing was administered. Themes were extracted from the questionnaire using directed content analysis. RESULTS A total of 719 responses were collected for 142 critical cases. Physical reactions were often endorsed in the PDI, and these reactions were mirrored in the qualitative data, which included physiological responses such as stress, adrenaline high, anxiety, fatigue, and overwhelm. Helplessness and grief were 2 of the emotional PDI items frequently endorsed, which were reflected in the qualitative strand by themes such as helplessness, sadness, disheartenment, and regret. There was considerable variability between critical cases such that not every critical case elicited a desire for a debrief. CONCLUSIONS PED staff report measurable levels of stress after critical patient cases that warrant follow-up. Formal debriefing immediately after critical patient cases with specific caveats may be valuable for the reduction of stress. Any formal debriefing program will need to balance various goals with attention to the session length, setting, and timing.
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Affiliation(s)
- Arshad J Jiffry
- Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif; Department of Pediatrics (AJ Jiffry, CS Cho, and AL Nager), Keck School of Medicine, University of Southern California, Los Angeles, Calif.
| | - Christine S Cho
- Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif; Department of Pediatrics (AJ Jiffry, CS Cho, and AL Nager), Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Anita R Schmidt
- Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif
| | - Phung K Pham
- Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif
| | - Alan L Nager
- Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif; Department of Pediatrics (AJ Jiffry, CS Cho, and AL Nager), Keck School of Medicine, University of Southern California, Los Angeles, Calif
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Corgan S, Ford Winkel A, Sugarman R, Young JQ. From Burnout to Wholehearted Engagement: A Qualitative Exploration of Psychiatry Residents' Experience of Stress. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:709-717. [PMID: 33410608 DOI: 10.1097/acm.0000000000003912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Physician burnout is endemic across medical education and has numerous deleterious effects. Given the prevalence and negative effects of burnout, there is an urgent need to understand how residents experience and cope with stress and develop explanatory models that inform the development of more effective interventions. METHOD Using a qualitative, constructivist approach informed by grounded theory, the authors conducted semistructured interviews from March to April 2019, in which psychiatry residents were asked about their experiences of stress and how they coped. First- through fourth-year trainees at Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, were invited. Two authors independently and inductively coded deidentified transcripts. A constant comparative approach was used to analyze data and support construction of themes. Theoretic sufficiency was observed after 14 interviews. RESULTS The authors constructed an explanatory model for how residents cope with stress and whether they tended toward burnout or wholehearted engagement. The model included 3 themes: self-care, work relationships, and meaning making. Self-care, including time spent with others, provided connection and belonging that bolstered physicians' developing identities. Interpersonal relationships at work profoundly influenced the experience of residents. Positive peer and supervisor relationships enhanced confidence and perseverance. Negative role models and conflict engendered feelings of inadequacy. The ability to shift perspective and build meaning through examining moral values in the face of challenges was crucial for residents who reported success at coping with stress. Residents identified personal psychotherapy as an especially important strategy to facilitate meaning making. CONCLUSIONS These findings provide guidance for how residency programs may help residents cope with stress and move away from burnout toward wholehearted engagement. Strategies may include reducing barriers to self-care and to accessing help early in training, creating spaces that promote peer connection and providing training in addressing conflict, and facilitating engagement in meaning-making activities.
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Affiliation(s)
- Sondra Corgan
- S. Corgan is a fellow in child and adolescent psychiatry, Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Abigail Ford Winkel
- A. Ford Winkel is associate professor and vice chair for education, Department of Obstetrics and Gynecology, and assistant director, Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York
| | - Rebekah Sugarman
- R. Sugarman is a medical student, University of Michigan Medical School, Ann Arbor, Michigan
| | - John Q Young
- J.Q. Young is professor and vice chair for education, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York; ORCID: http://orcid.org/0000-0003-2219-5657
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Hilgenberg SL, Bogetz AL, Leibold C, Blankenburg RL. Advancing Our Understanding of Pediatric Resident Communication Skills and Disruptive Behavior and Mistreatment Strategies. Acad Pediatr 2021; 21:435-437. [PMID: 33220461 DOI: 10.1016/j.acap.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/29/2020] [Accepted: 10/31/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Sarah L Hilgenberg
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford School of Medicine (SL Hilgenberg and RL Blankenburg), Palo Alto, Calif.
| | | | - Collin Leibold
- University of Massachusetts School of Medicine (C Leibold), Worcester, Mass
| | - Rebecca L Blankenburg
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford School of Medicine (SL Hilgenberg and RL Blankenburg), Palo Alto, Calif
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Abstract
OBJECTIVES To explore resident learning in the context of emergency situations. The guiding research questions were: How do residents learn in emergency situations? What factors facilitate or hinder their learning? DESIGN A qualitative approach was used in order to understand the different perspectives of participants and explore the context of emergency situations. Aware of the complex sociocultural interactions in emergency situations, we used the methodology of constructivist grounded theory. SETTING A medium-sized pediatric academic hospital in San Antonio, TX. SUBJECTS Twenty pediatric residents participated in semi-structured interviews. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We used an iterative process of data collection and analysis. The process continued until thematic saturation was reached. The data were coded and analyzed using constant comparison. Codes were clustered into themes informed by the theory of situated learning. Several methods were used to ensure trustworthiness of results. Three main themes were identified. First, resident participation in emergency situations takes different forms. Residents participate mostly in helping roles. Watching is an under-recognized form of participation yet offered unique experiences. Managing roles are rarely afforded to residents. Second, resident participation is informed by the context of the emergency situation. Based on contextual clues (e.g., safety, needs), residents infer potential risks and values from their participation, which guides their participatory role. Residents may shift their form of participation, based on changes in the context. Supervisors play a significant role in guiding resident participation. Third, engagement, a state of cognitive and emotional focus, is critical in learning. The context of the emergency situation plays a role in the level of resident engagement. Supervisors may also foster resident engagement. CONCLUSIONS Resident participation in emergency situations is complex and informed by the context. Learning in emergency situations is influenced by residents' level of mental engagement. Supervisors may positively guide resident participation, foster engagement, and enable them to reach their learning goals in emergency situations.
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Palliative care, resuscitation status, and end-of-life considerations in pediatric anesthesia. Curr Opin Anaesthesiol 2020; 33:354-360. [DOI: 10.1097/aco.0000000000000860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reilly MR, Perkins K, Carson SL, Li STT. Pediatric Program Leadership's Contribution Toward Resident Wellness. Acad Pediatr 2020; 20:440-441. [PMID: 31904437 DOI: 10.1016/j.acap.2019.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/18/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Maura R Reilly
- Department of Pediatrics, University of California, Davis (MR Reilly and S-TT Li), Sacramento, Calif
| | - Kate Perkins
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles (K Perkins)
| | - Savanna L Carson
- Department of General Internal Medicine and Health Services Research, University of California Los Angeles (SL Carson)
| | - Su-Ting T Li
- Department of Pediatrics, University of California, Davis (MR Reilly and S-TT Li), Sacramento, Calif.
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Selbst SM. The Highs and Lows of Pediatrics: May the Academic Pediatric Association Be With You. Acad Pediatr 2020; 20:295-300. [PMID: 31931185 DOI: 10.1016/j.acap.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Steven M Selbst
- Sidney Kimmel Medical College, Thomas Jefferson University, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Del.
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A pilot study exploring interventions for physician distress in pediatric subspecialists. Pediatr Res 2020; 88:398-403. [PMID: 32054989 PMCID: PMC7223747 DOI: 10.1038/s41390-020-0805-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND While institution-sponsored wellness programs may be effective, little is known about their availability and utilization in pediatric subspecialists, and about programs physicians wish were available. METHODS A survey of perceptions about, and availability and utilization of institutional wellness activities, was distributed electronically to pediatric subspecialists nationally. Bivariate analyses were performed using χ2 tests or independent t tests. Multivariable logistic regression models for categories of institution-sponsored programming as a function of potential predictors of program utilization were performed. Qualitative content analysis was performed for free-text survey answers. RESULTS Approximately 60% of respondents participated in institution-sponsored wellness opportunities. Debriefs, Schwartz Center Rounds, mental health services, and team building events were the most available institution-sponsored wellness activities, whereas debriefs, team building, Schwartz Center Rounds, and pet therapy were most frequently utilized. Respondents desired greater social/emotional support, improved leadership, enhanced organizational support, and modifications to the physical work environment, with no significant differences across subspecialties for "wish list" items. CONCLUSIONS Physician wellness requires more than a "one-size-fits-all" initiative. Our data highlight the importance of encouraging and normalizing self-care practices, and of listening to what physicians articulate about their needs. Pre-implementation needs assessment allows a "bottom-up" approach where physician voices can be heard.
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Gogo A, Osta A, McClafferty H, Rana DT. Cultivating a way of being and doing: Individual strategies for physician well-being and resilience. Curr Probl Pediatr Adolesc Health Care 2019; 49:100663. [PMID: 31564630 DOI: 10.1016/j.cppeds.2019.100663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The practice of medicine is rewarding on many levels, but demands of the work can result in mental and emotional exhaustion, self-isolation, burnout, depression, suicidal ideation and tragically, completed suicide. It is critical to have effective strategies to address the unique stressors of a medical career, mitigate burnout, and buffer the physiologic toll of chronic stress. Using Zwack and Schweitzer's widely published description of approaches to maintaining resilience and approaches to wellness, we have organized these strategies into three broad domains relevant to medical practice: (1) gratification (connection and communication, meaning and purpose); (2) resilience building practices (self-reflection, time for oneself, self-compassion, spirituality); and (3) useful attitudes (acceptance, flexibility, self-awareness). Several techniques are described including mindfulness-based stress reduction, narrative medicine, skillful communication, and practices in self-compassion, gratitude, and spirituality. The focus of the work is to introduce a spectrum of resilience strategies for individual consideration that can be tailored and combined to meet a physician's changing needs over the course of medical training and practice.
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Affiliation(s)
- Albina Gogo
- Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, California, United States.
| | - Amanda Osta
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, Illinois, United States
| | - Hilary McClafferty
- Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Deborah T Rana
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, San Diego, California, United States
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Serwint JR, Stewart MT. Cultivating the joy of medicine: A focus on intrinsic factors and the meaning of our work. Curr Probl Pediatr Adolesc Health Care 2019; 49:100665. [PMID: 31582295 DOI: 10.1016/j.cppeds.2019.100665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Physician burnout is at epidemic levels. In our role as healers, the concepts of humanism and relief of suffering are central themes in our work, yet burnout and depersonalization can threaten these values. While working to mitigate burnout, we need to move towards a focus on health and well-being and develop preventive strategies to cultivate resilience. This manuscript discusses the intrinsic factors that motivate us to be physicians: medicine as a calling, finding meaning in our work, and seeking joy in practice. Some strategies that enhance our resilience will be discussed including individual reflective practices, in addition to organizational strategies such as creating team mission statements, and participating in debriefing, Balint groups, and Schwartz Rounds. All of these practices provide opportunities to acknowledge the emotional impact of our care of patients and to focus on our values and the meaning of our work. Strategies to cultivate joy in practice are presented alongside a framework from the Institute for Healthcare Improvement to guide organizations.
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Affiliation(s)
- Janet R Serwint
- Department of Pediatrics, Charlotte Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Miriam T Stewart
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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