University of Virginia
Charlottesville, VA

Program Director: Eric Davis, MD

Program Associate Director: Sarah Kilbourne, MD

Program Type: Pulmonary/Critical Care

Abstract Authors: Sean J. Callahan MD, Kyle Enfield MS MD, Jeffrey M. Sturek MD PhD, Ryan Richard MD, Galina Lyles MD, Cheryl Etelvari BA, Sarah Kilbourne MD, Eric M. Davis MD

Description of Fellowship Program: Our pulmonary and critical care fellowship has a rich history with an overall mission of recruiting and training the future leaders in the field.  Our approach is multifaceted and includes a) outstanding clinical training spanning the breadth of pulmonary and critical care, b) a mentored and structured research program and c) focused attention on the career development and wellness for our fellows.

Abstract

Background

Rates of burnout and professional dissatisfaction are high amongst physicians, affecting more than 1 in 3, with critical care physicians approaching  50%. Research indicates professional dissatisfaction and burnout negatively affect both patient care and physician personal wellness on a number of fronts, including mental health. Reasons for physician displeasure are numerous and diverse, with unique underlying causes. Based on concerning indicators of physician well-being, our program sought to implement data-proven strategies specific to our fellowship to improve the trainee experience, as described by the ACGME Common Program Requirements focus on well-being. 

Methods

We analyzed the yearly anonymous ACGME Fellow Survey results and identified areas for improvement in the domains of Duty Hours, Educational Content, Resources, and Patient Safety. Within each of these domains we identified specific opportunities for quality improvement. Using A3 methodology, we then developed an ideal state and an action plan for interventions.  The fellowship program developed interventions through a PubMed query for evidence-based interventions to improve burnout and professional satisfaction, and modified interventions specifically to fit the fellowship program. In the absence of an evidence-based strategy, we implemented interventions developed by the fellows based on the target state defined in the A3. This resulted in a bundle of interventions over the subsequent six months (Figure 1). To assess the efficacy of our multi-faceted intervention, fellows completed a 15-question Likert scale survey pre- and post- (3 months) bundle implementation, with plans to repeat the survey at 6 and 12 months. Fellows also completed Epworth Sleepiness Scales (ESS) pre- and post-implementation of the bundle. The chi-square test was used to analyze categorical data for all questions. 

Results

All fellows completed both assessments. An improvement was observed in 13 of the 15 domains queried between pre- and post-implementation surveys, which included improvements in all domains measuring quality of life and sleep. Despite the small dataset (n=9), several domains demonstrated statistically significant improvement, including 1) satisfaction with weekend schedules (p=0.004), 2) increased ability to do non-clinical activities, such as research (p=0.004), and 3) overall quality of life (p=0.018) (Figure 2a). We also observed a statistically significant improvement in abnormal ESS scores (p=0.018), with a reduction in the mean ESS from 12 to 7 (Figure 2b). 

Discussion

Implementation of an innovative wellness bundle directed to improve fellow well-being was successful in improving trainee-perceived quality of life, sleep, and time afforded to do projects which complement patient care. These interventions were primarily designed by, or in conjunction with, the primary stakeholders. When applicable, we utilized proven problem-solving approaches such as lean methodology to implement changes. Consistent with the physician burnout literature, we found organizational interventions (such as work reduction and increasing employee influence) to be markedly effective. The innovative wellness bundle implemented by our trainees has portability in the sense that other training programs can identify their areas of improvement and use similar engagement strategies and data monitoring to enact change and measure the response. 

References

1. Shanafelt TD. “Enhancing Meaning in Work. A Prescription for Preventing Physician Burnout and Promoting Patient-Centered Care.” JAMA, 2009;302(12):1338-40.

2. Squeiers JJ, et al. “Physician Burnout: Are We Treating the Symptoms Instead of the Disease?” Ann Thorac Surg 2017;104:1117-22.

3. West CP, et al. “Interventions to Prevent and Reduce Physician Burnout: A Systematic Review and Meta-analysis.” Lancet 2016;388(10057):2272-81. 4) Panagioti M, et al. “Controlled Interventions to Reduce Burnout in Physicians. A Systematic Review and Meta-Analysis.” JAMA Intern Med, 2017;177(2):195-205.