Columbia University Irving Medical Center
New York, NY

Program Director: Vivek Moitra

Program Type: Anesthesiology/Critical Care

Abstract Authors: Cortessa Russell MD, Claire Barshied PhD, Victoria Danhakl MD, Vivek Moitra MD, and George Gallos MD

Description of Fellowship Program: Each year we welcome nine fellows to our ACGME-accredited program in Manhattan.  Our fellows have the opportunity to train with us in a supportive environment that seeks to care, lead, educate, and discover.  We know that learning preferences are changing, and in the spirit of Columbia’s history of innovation, we believe our teaching should be interactive, intensive, innovative, and inspiring, our 4I principle.  This has led us to reimagine our wellness curriculum.

Abstract

RATIONALE

Physician burnout has received increasing recognition throughout medicine, with national surveys indicating that more than 50% of physicians exhibit symptoms of burnout1.  To address this concerning trend, the ACGME has called upon training programs to implement new strategies aimed at mitigating stress and symptoms of burnout.   While changes are now prescribed in the form of the Clinical Learning Environment Review (CLER), the exact methods by which to effect and assess these changes remain undetermined.  Precipitators of burnout are diverse, and we believe interventions that address the modifiable workplace occupational and organizational factors are an important component of any comprehensive wellbeing initiative2.  We have recently launched a voluntary, year-long Wellness Curriculum (WC) that provides a mixture of didactic stress relief lectures, interactive emotional processing groups (Balint), and social events. In addition, we incorporated assessment tools to gauge stress and burnout symptoms sequentially throughout the year.  Although certain quantitative psychometric questionnaires (ex. The Maslach Burnout Inventory (MBI)) are validated for determining burnout, we have experienced challenges with low participation rates when these inventories are a voluntary component of a wellbeing initiative.  In addition, MBI does not identify specific areas for quality improvement or adequately gauge trainees’ subjective experience of burnout. To address these issues, we incorporated a qualitative assessment intervention, by way of medical sociologist interviews (MSI), as a novel innovation to complement our pilot wellbeing curriculum for Anesthesiology Critical Care fellow trainees.  We hypothesized that implementing MSI would reveal information not captured by traditional inventories.

METHODS 

The WC began in July 2016 as a voluntary initiative.  In parallel with didactic lectures, social programming, and Maslach assessments, we hired a medical sociologist to interview participants in October, March, and June (7 of the 8 trainees participated in both MBI and MSI). Interviews were kept confidential from curriculum developers.  At the conclusion of the academic year, an MSI report analyzing the trainees’ subjective experiences and assessments of the effectiveness of the curriculum was generated.  In addition, we assessed the sustainability of utilizing MSI by having fellows subjectively compare the two assessment tools (MBI vs MSI) with regard to assessment efficacy, potential burnout mitigation, and satisfaction (Table 1).  Given the small sample size (n=7), ordinal values, and matched pairs of responses, we used nonparametric Wilcoxon signed-rank tests to compare the results.  We also provide a comparison between the two modalities with regard to curriculum changes that were made as a direct result from each report. 

RESULTS

MSI scores were significantly higher than MBI scores regarding stress assessment and satisfaction in 2 of the 4 parameters we assessed (Table 1). In addition, we observed a 100% MSI participation rate compared to only 75% for MBI.  The MSI results led to identifying 6 areas for quality improvement compared to none by MBI.  

CONCLUSIONS

We report on utilizing qualitative information derived from MSI as an innovative component of a dynamic and responsive wellbeing curriculum.  The MSI report revealed insights and emotions from the trainees’ that were completely absent from other quantitative analyses of our curriculum. MSI revealed areas of misalignment, where interventions were negatively affecting the fellows’ experience, allowing us to overhaul the curriculum to feature only the highest impact interventions.    Given that burnout symptoms and well-being are experienced subjectively, measuring them using solely objective methods does not adequately capture trainee sentiments.  Expanding the evaluation of a curriculum’s efficacy to incorporate qualitative data illuminates program weaknesses that are unlikely to be spontaneously reported, reflects the experience of trainees more fully, and provides a novel means to adapt training curricula to best benefit the end-user.