Defining Key Factors in Burnout and
Resilience in Pediatric Residents and
the Relationship to Performance:
A Study of the Pediatric Resident
Burnout – Resilience Study Consortium
A Study of the Pediatric Resident Burnout –
Resilience Study Consortium
Maneesh Batra, MD and John D Mahan MD
for the PRB-RSC Steering Committee
PRB-RSC
Steering Committee
– Maneesh Batra, MD, MPH
– John D Mahan, MD
– Kathi Kemper, MD, MPH
– Betty Staples, MD
– Janet Serwint, MD, MPH
– Chuck Schubert, MD, MPH
– Paria Wilson, MD
– Hilary McClafferty, MD
APPD LEARN
• APPD LEARN (Longitudinal Educational Assessment
Research Network)
– Provides infrastructure for multicenter, collaborative
pediatric educational research
– Requires approval by APPD LEARN Protocol Review
Committee - obtained
• Study Assistance
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Provide IRB kits and help
Provide Data Capture system and enrolling emails and links
Provide feedback on enrollment activity
Assist in presentations
Assist in data analysis and sample manuscript language
Goal
To improve pediatric resident resilience,
compassion, confidence in providing calm,
compassionate care and wellness. Through
creation of a Pediatric Resident Burnout - Resilience
Study Consortium (PRB-RSC), involving pediatric
residents in more than 20 residency programs in
the US, we will be equipped to study the
epidemiology, natural history and impact of
interventions designed to address burnout and
resilience in pediatric residents.
Objectives
The PRBRSC is dedicated to achieving 4 objectives:
• Describe the epidemiology and relationships between burnout,
resilience, empathy, and confidence in providing compassionate
care in pediatric and medicine-pediatric (P/M-P) residents.
• Define the natural history of these parameters over time in P/M-P
residents during training.
• Identify modifiable factors that increase or decrease the risk of
developing burnout and promoting positive wellness factors.
• Develop and test different interventions (such as in-person
seminars, on-line mind-body skills training, and individualized
curricula such as global health electives) to affect burnout,
resilience, empathy, compassion and wellness.
Hypotheses
1.
Residents with more mindfulness and self-compassion will have higher
resilience and lower burnout.
a. Residents with higher mindfulness and self-compassion will have higher
ability to provide compassionate care.
b. Burnout penetrance in residents will be more affected by internal factors
(mindfulness, self-compassion and resilience) than external factors (work and
life factors; special educational activities).
c. There will be significant interest in mind-body skills training and other
wellness education among residents related to perceived stress and selfcompassion but independent of degree of burnout.
2.
3.
Residents with more personalized educational pursuits (global health
activities, advocacy, rural/primary care track, etc) will evidence more
resilience and less burnout over time than those without these
personalized pursuits.
Residents with higher mindfulness, self-compassion, resilience and
lower burnout will achieve higher performance levels as determined by
pediatric milestones assessments, controlling for independent
demographic factors.
Study Overview
Phase 1) conduct cross-sectional survey in Spring 2016 [April 1-May 31, 2016]
in trainees from a national sample of > 15 pediatric and medicine-pediatric
residencies assessing relationships between mindfulness, self-compassion,
resilience, burnout, confidence in providing calm, compassionate care,
demographic factors of individual residents, engagement in special
educational activities (including global health, advocacy and mindfulness
training).
Phase 2) assess the relationships of burnout and resilience to resident
performance as assessed by ACGME milestones.
Phase 3) provide platform to study educational and skills training
[interventions] on preventing and/or mitigating negative aspects of burnout in
our residents.
Phase 4) define natural history of burnout and resilience by repeating survey
in selected residents in same programs in Spring 2017.
Study Overview: Phase 1a
Phase 1a) conduct cross-sectional survey of Program Directors
to define wellness efforts currently underway in programs
– Led by Paria Wilson and Kathi Kemper
– Accomplished in February 2016
– Provide initial work to develop most effective method to define this
important program level intervention
Study Overview: Phase 1
Phase 1) conduct cross-sectional survey in Spring 2016 [April 1May 31, 2016] in trainees from a national sample of > 15
pediatric and medicine-pediatric residencies assessing
relationships between mindfulness, self-compassion, resilience,
burnout, confidence in providing calm, compassionate care,
demographic factors of individual residents, engagement in
special educational activities (including global health, advocacy
and mindfulness training).
Study Instruments
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Demographics (10)/Resident characteristics (15)
Promis Global Health scale (7)
Perceived Stress Scale (Cohen’s) (10)
Hatch Spirituality Questions (3)
Cognitive and Affective Mindfulness Scale – Revised CAMS-R (10)
Neff’s Self-Compassion Scale (12)
Brief Resilience Scale (Smith’s) (6)
Maslach Burnout Inventory – HSS Format (22)
One Item Burnout Assessment (1)
Resident Career Satisfaction Survey (9)
Davis Empathy Scales - PT and EC (14)
Calm, Compassionate Care Scale (10)
Epworth Sleepiness Scale (8)
Prior Training in Mind-Body Skills (4)
[* 141 items] – on average residents have taken 15 minutes to complete
Phase 1 Study Completed – June 12,
2016
Factors Associated with Burnout and Resilience in
Pediatric and Medicine-Pediatric Residents
34 of 40 PRB-RSC programs successful
1692 residents complete the survey
 Analysis – APPD LEARN
 Writing Groups, Abstracts – 6 manuscripts outlined
 Database will be open to other inquires/projects
Incentives
• 3 leading enrolling programs (based on percent of
residents completing survey) will qualify for a
group incentive
– Leading enroller - $1500
– 2nd enroller - $1000
– 3rd enroller - $500
• Sites may incorporate additional local rewards to
participates (as approved and funded locally)
• Reports to sites – de-identified program reports
from APPD LEARN
Phase 2 Study Completed – Sep 12,
2016
Define the Relationships Between Burnout and
Resilience and Performance as Assessed by ACGME
Milestones in Pediatric and Medicine-Pediatric
Residents
31 of the 34 programs from Phase 1 entered the resident
Milestone data
Scholarship
• Writing teams will be developed for each phase
of study (and any future phases) based on site
investigator interest
• Each site will be able to have one local PI
volunteer and participate in at least one of the
initial 3 writing teams (based on interest)
• Consortium platform will be available to
investigators interested in evaluating specific
wellness interventions
• International opportunities (Global Health)
Manuscripts – Round 1
Topic
1st Author
Abstract Deadline*
1.
Study Design/Burnout variability and
predictors of Burnout
Batra
APPD/PAS
2.
Burnout – Interplay of Resident &
Program factors
Mahan
APPD/PAS
3.
1 Question Burnout; key items from
surveys [item analysis]
Schwartz
PAS
4.
Burnout – Program interventions
Wilson
PAS
5.
Burnout – PIMR curriculum
McClafferty
PAS
6.
Burnout – Milestones Performance
Staples
APPD/PAS
7.
Program Wellness Activities
Wilson
APPD/PAS
8.
Others?
Writing Group Interest
Next Steps
• Analyze/Report from Data Treasure Trove
• Website
• Plan for Phase 3 (interventions) and 4
(longitudinal issues) studies
• Recruit new sites
• Consortium Evolution