Natural history of burnout, stress, and fatigue in a pediatric resident cohort over three years.

BACKGROUND: Burnout is known to be high amongst physician trainees. Factors such as stress, fatigue, social environment, and resilience could affect burnout. Cross-sectional data describe burnout in pediatric residents, but the trajectory of burnout in a cohort of residents followed longitudinally through the full course of residency training has not been reported. We prospectively examined the prevalence and trajectory of burnout, stress, fatigue, social connectedness, and resilience in a pediatric resident cohort from orientation through three years of residency. The cohort (N = 33) was surveyed six times between 2015-2018 using the Abbreviated Maslach Burnout Inventory (AMBI), Perceived Stress Scale (PSS), Epworth Sleepiness Scale (ESS), Social Connectedness Scale-Revised (SCS-R), and Connor-Davidson Resilience Scale (CD-RISC10). Data were analyzed using repeated measures mixed effects models. Significant change from baseline was considered to be adjusted p < 0.05. Response rate was >50% at each timepoint; 69% of trainees completed surveys ≥4 times. Scores were significantly worse than baseline in all surveys, at every timepoint, with the exception of AMBI-PA (personal accomplishment) at the PGY1/PGY2 transition and SCS-R and CD-RISC10 at the end of training. The most significant changes from baseline occurred mid-PGY1 to mid-PGY2. At least 65% of residents demonstrated worse scores than baseline on 36/40 (90%) follow-up surveys. Furthermore, ≥65% met criteria for emotional exhaustion and moderate stress at every timepoint. SCS-R was the only survey measure to improve at residency completion compared to baseline. CONCLUSION: Within 6 months of starting residency this pediatric resident cohort became burned out, stressed, fatigued, less socially connected, and less resilient. Burnout is only one factor that indicates impaired resident well-being. To fully address this, a comprehensive examination of how residents are trained is needed to identify effective interventions. ABBREVIATIONS: MBI - Maslach Burnout Inventory; AMBI - Abbreviated Maslach Burnout Inventory; AMBI-EE - Emotional Exhaustion; AMBI-D - Depersonalization; AMBI-PA - Personal Accomplishment; AMBI-SAT - Satisfaction with Medicine; LCH - Ann & Robert H. Lurie Children's Hospital of Chicago/Lurie Children's Hospital; P/CN - Pediatrics/Child Neurology; PSS - Perceived Stress Scale; ESS - Epworth Sleepiness Scale; CD-RISC10 - Resilience; SCS-R - Social Connectedness Scale Revised; PGY - Post-Graduate Year.

Epidemic Adolescent Binge Drinking at Lollapalooza, A Music Festival in Chicago.

OBJECTIVES: Lollapalooza (LP) is an annual 3-day outdoor music festival in Chicago. Underage drinking and drug use are believed to be common, but the burden on emergency departments (EDs) has not been documented. We assessed the burden on health care resources associated with this music festival. METHODS: We performed a retrospective chart review of adolescent (aged 11-20 years) ED visits during LP weekend and 4 summer comparison weekends at Lurie Children's Hospital in Chicago, Ill, in 2014 (n = 356). We then analyzed adolescent alcohol- and drug-related hospital visits to all Chicago hospitals for each weekend in 2014 0 using Illinois hospital discharge data. RESULTS: Adolescents accounted for a greater proportion of our ED visits during LP weekend than comparison weekends (25% vs 19%, P < 0.02). Lollapalooza weekend patients were more likely female (P = 0.025), older (P = 0.0067), more often unsupervised (P < 0.0001), and less likely to live in the city (P < 0.001) than adolescents seen during comparison weekends. Thirty-one underage adolescents who attended LP were treated in our ED; 84% were intoxicated (blood alcohol content, 88-328 mg/dL). Citywide there was an 11-fold increase in adolescent alcohol-related hospital visits during LP weekend compared with an average weekend. Drug intoxication was much less common. CONCLUSIONS: Adolescents seen in our ED the weekend of LP were older, more often female, frequently unsupervised, and less likely to be city residents than those seen during comparison weekends. Those who attended LP had high rates of alcohol intoxication. This surge of intoxicated adolescent patients affected numerous EDs in the city.