Impact of narrative medicine curriculum on burnout in pediatric critical care trainees

ABSTRACT

INTRODUCTION: Intensive care units have staff burnout levels reported to be as high as 47%. A recent study demonstrated high levels of burnout in pediatric intensive care unit (PICU) trainees. The practice of narrative medicine is one potential intervention to mitigate burnout. Narrative medicine could help medical trainees foster empathy and resilience, and renew compassion. While many narrative programs exist in medical training, there are no studies describing a narrative curriculum for PICU fellows. There are also few studies evaluating the effect of such programs on burnout. We hypothesized that a narrative medicine program is feasible to incorporate into the curriculum of a PICU fellowship, and that it will improve validated burnout metrics in ICU trainees. METHODS: The primary fellow investigator developed a literary curriculum for all of our PICU fellows (total of eight fellows). Each fellow completed baseline burnout evaluations, the abbreviated Maslach Burnout Inventory (aMBI) and the Professional Quality of Life Scale version 5 (ProQOL5). Each month, participants read a short narrative with group discussion facilitated by the primary fellow investigator. Fellows provided qualitative evaluation at the end of each session. Validated burnout scores and curriculum feedback were collected at the end of the study. RESULTS: Narrative medicine was a feasible addition to the fellowship curriculum, with 87.5% reporting they enjoyed the sessions. When asked if these sessions influenced their capacity to respond to peers, 62.5% responded favorably. Only 37.5% perceived that these sessions helped them respond to patients. Interestingly, qualitative feedback suggested sessions were more enjoyable and more appreciated after the start of the Covid-19 pandemic. aMBI average Emotional Exhaustion scores decreased, from 8 to 5.75 (p=0.003) and Depersonalization scores also decreased. Personal Accomplishment and Satisfaction scores increased. In addition, ProQOL Burnout and Secondary Trauma scores decreased. Compassion scores were unchanged. CONCLUSIONS: A narrative medicine curriculum is feasible and accepted within the educational structure of a PICU fellowship program. Burnout metrics improved after participation in the narrative medicine sessions. Further evaluation with a larger sample size is warranted.