Burnout During the COVID-19 Pandemic: A Report on Pediatric Residents.

BACKGROUND AND OBJECTIVE: The Pediatric Resident Burnout and Resilience Consortium (PRB-RSC) has described the epidemiology of burnout in pediatric residents since 2016. We hypothesized burnout rates during the pandemic would increase. We explored resident burnout during the COVID-19 pandemic and its relationship to resident perception of workload, training, personal life, and local COVID burden. METHODS: Since 2016, PRB-RSC has sent an annual, confidential survey to over 30 pediatric and medicine-pediatrics residencies. In 2020 and 2021, seven questions were added to explore the relationship of COVID-19 and perceptions of workload, training, and personal life. RESULTS: In 2019, 46 programs participated, 22 in 2020, and 45 in 2021. Response rates in 2020 (n = 1055, 68%) and 2021(n = 1702, 55%) were similar to those of previous years (P = .09). Burnout rates in 2020 were significantly lower than in 2019 (54% vs 66%, P < .001) but returned to pre-COVID levels in 2021 (65%, P = .90). In combined 2020-2021 data, higher rates of burnout were associated with reported increased workload (Adjusted Odds Ratio (AOR) 1.38, 95% CI 1.19-1.6) and concerns regarding the effect of COVID on training (AOR 1.35, 95% CI 1.2-1.53). Program-level county COVID burden in combined 2020-2021 data was not associated with burnout in this model (AOR=1.03, 95% CI 0.70-1.52). CONCLUSIONS: Burnout rates within reporting programs decreased significantly in 2020 and returned to prepandemic levels in 2021. Increased burnout was associated with perceived increases in workload and concerns regarding effect of the pandemic on training. Given these findings, programs should consider further investigation into workload and training uncertainty on burnout.

Resident Education and Virtual Medicine: A Faculty Development Session to Enhance Trainee Skills in the Realm of Telemedicine.

Introduction: COVID-19 accelerated the use of telemedicine. Subsequently, clinical sites began conducting virtual visits. Academic institutions implemented telemedicine for patient care and simultaneously had to teach residents the logistics and best practices. To meet this need, we developed a training session for faculty focused on telemedicine best practices and teaching telemedicine in the pediatric realm. Methods: We designed this training session based on institutional and society guidelines and faculty experience with telemedicine. Objectives included telemedicine documentation, triage, counseling, and ethical issues in telemedicine. We conducted all sessions in a 60-minute or 90-minute format over a virtual platform for small and large groups using case scenarios with photos, videos, and interactive questions. A novel mnemonic ABLES (awake-background-lighting-exposure-sound) was created to guide providers during the virtual exam. Following the session, participants completed a survey evaluating content and presenter effectiveness. Results: We presented the training sessions between May 2020 and August 2021 to 120 participants. Participants included pediatric fellows and faculty, reaching 75 participants locally and 45 nationally (at Pediatric Academic Society and Association of Pediatric Program Directors meetings). Sixty evaluations (response rate: 50%) showed favorable results for general satisfaction and content. Discussion: This telemedicine training session was well received by pediatric providers and addressed the need for training faculty to teach telemedicine. Future directions include adapting the training session for medical students and developing a longitudinal curriculum that applies telehealth skills learned with patients in real time.

Understanding burnout in Pediatric residency through the lens of the 'Areas of worklife'.

BACKGROUND AND OBJECTIVES: Burnout is a widespread problem in medicine, especially among trainees. Despite this, data on effective interventions are limited. An organizational context for burnout entitled Areas of Worklife identified six areas of the work environment that can affect burnout through mismatches between individuals expectations of that area and the reality of the work environment. This study aimed to gain a deeper understanding of pediatric residents' perspectives of the Areas of Worklife to allow programs to utilize this framework in the development of future interventions. METHODS: Using qualitative methodology founded in grounded theory, we employed an iterative data collection by conducting semi-structured interviews, until data saturation was achieved, with 15 pediatric residents in 2018. We recorded interviews and transcribed them verbatim. Content analysis was conducted concurrently with data collection using constant comparison methods; the principal investigator and co-investigators worked jointly to generate codes and identify themes. RESULTS: Themes were identified for the individual Areas of Worklife that represented resident perspectives and mismatches with the work environment. Overall, patient care was a central focus connecting the areas of control, reward, values, and workload; themes in these areas concentrated on resident's ability to interact with and learn from patients. CONCLUSIONS: Residents' definitions of the Areas of Worklife can be used to identify mismatches between residents' expectations and their work environment, which can inform organizational interventions. These findings highlight the importance of a patient-focused approach to residency training, which is consistent with literature that shows patient care is a means to find meaning in their work. Resident definitions of the Areas of Worklife offer residency programs a practical approach in their battle against burnout by providing focused direction to respond to resident needs and identify tangible targets for intervention.

Reshaping the residency environment to enhance education and mitigate burnout.

Burnout remains a widespread issue in graduate medical education, with current trends to mitigate burnout shifting toward institutional systematic interventions as opposed to personal individual interventions. In this article, we propose utilizing Knowle's adult learning theory in conjunction with Maslach's organizational context for burnout to implement systemic changes within the postgraduate training environment that we posit would both optimize the learning experience and reduce the incidence of burnout.