Judy A Shea1, Lisa M Bellini2, Sanjay V Desai3, Frances K Barg4, Whitney Eriksen5, Larissa E Wietlisbach6, Abdul-Rakeem Yakubu7, David A Asch8. 1. J.A. Shea is the Leon Hess Professor of Internal Medicine, Department of Medicine, and associate dean of medical education research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-7334-4192 . 2. L.M. Bellini is professor, Department of Medicine, and senior vice dean for academic affairs, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-0985-2384 . 3. S.V. Desai is director, Osler Medical Residency, and vice-chair for education, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0002-9759-7696 . 4. F.K. Barg is director, University of Pennsylvania Mixed Methods Research Lab, and professor, Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-3328-1980 . 5. W. Eriksen is a senior researcher, University of Pennsylvania Mixed Methods Research Lab, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-2196-1815 . 6. L.E. Wietlisbach is a medical student and research assistant, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-8375-3264 . 7. A.-R. Yakubu is a research assistant, University of Pennsylvania Mixed Methods Research Lab, Philadelphia, Pennsylvania. 8. D.A. Asch is a professor, Perelman School of Medicine and Wharton School at the University of Pennsylvania, and physician, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-7970-286X .
Abstract
PURPOSE: Most of what is known about resident burnout and wellness comes from cross-sectional snapshot surveys. The purpose of this study was to elicit qualitative perspectives on wellness from a cohort of internal residents over time using ecological momentary assessment. METHOD: Drawing on principles of ecological momentary assessment, 13 different open-ended survey prompts were delivered between October and March during the 2019-2020 academic year. Participants were 88 randomly selected internal medicine residents from 4 internal medicine training programs in the Northeast. RESULTS: The response rate was 95%. Three main themes regarding wellness were self, program/education environment, and medical/structural system. A fourth theme, the desire to provide quality patient care, cut across all other themes. The patient care theme repeatedly stressed residents' desire to spend more time with patients. The self theme primarily reflected messages about personal emotions and the need for work-life balance and wellness. The program/education environment theme reflected the value of learning, teamwork and community, and program culture. The medical/structural system theme showed that residents' experiences were shaped by the efficiency of their days and largely a product of their schedules and administrative support. Closing advice to future trainees was optimistic and reassuring. CONCLUSIONS: While findings support much of what has been learned via single-occasion survey snapshots, an ecological momentary assessment design allowed a deeper dive into contextual associations. The results affirm the primacy of patient care and also highlight the value of teamwork and culture. Peers and program leaders are heavily influential in setting the tone for the learning experience, whether for the day or with a more enduring message of respect and support. There is opportunity to maximize high- or higher-value learning experiences for residents and find solutions to reduce and reframe the perceived "low-value administrative work" that is part of care coordination.
PURPOSE: Most of what is known about resident burnout and wellness comes from cross-sectional snapshot surveys. The purpose of this study was to elicit qualitative perspectives on wellness from a cohort of internal residents over time using ecological momentary assessment. METHOD: Drawing on principles of ecological momentary assessment, 13 different open-ended survey prompts were delivered between October and March during the 2019-2020 academic year. Participants were 88 randomly selected internal medicine residents from 4 internal medicine training programs in the Northeast. RESULTS: The response rate was 95%. Three main themes regarding wellness were self, program/education environment, and medical/structural system. A fourth theme, the desire to provide quality patient care, cut across all other themes. The patient care theme repeatedly stressed residents' desire to spend more time with patients. The self theme primarily reflected messages about personal emotions and the need for work-life balance and wellness. The program/education environment theme reflected the value of learning, teamwork and community, and program culture. The medical/structural system theme showed that residents' experiences were shaped by the efficiency of their days and largely a product of their schedules and administrative support. Closing advice to future trainees was optimistic and reassuring. CONCLUSIONS: While findings support much of what has been learned via single-occasion survey snapshots, an ecological momentary assessment design allowed a deeper dive into contextual associations. The results affirm the primacy of patient care and also highlight the value of teamwork and culture. Peers and program leaders are heavily influential in setting the tone for the learning experience, whether for the day or with a more enduring message of respect and support. There is opportunity to maximize high- or higher-value learning experiences for residents and find solutions to reduce and reframe the perceived "low-value administrative work" that is part of care coordination.
Authors: Judy A Shea; Lisa M Bellini; David F Dinges; Meredith L Curtis; Yuanyuan Tao; Jingsan Zhu; Dylan S Small; Mathias Basner; Laurie Norton; Cristina Novak; C Jessica Dine; Ilene M Rosen; Kevin G Volpp Journal: J Grad Med Educ Date: 2014-06
Authors: Anke Versluis; Bart Verkuil; Philip Spinhoven; Melanie M van der Ploeg; Jos F Brosschot Journal: J Med Internet Res Date: 2016-06-27 Impact factor: 5.428
Authors: Larissa E Wietlisbach; David A Asch; Whitney Eriksen; Frances K Barg; Lisa M Bellini; Sanjay V Desai; Abdul-Rakeem Yakubu; Judy A Shea Journal: Postgrad Med J Date: 2022-04-04 Impact factor: 4.973