Burnout common in med school and residency, KU study finds, but so is combatting it
Multi-pronged approaches to burnout and wellness are underway, building off the belief physicians must take good care of their own health to properly care for patients.
New research from KU School of Medicine-Wichita's Department of Family & Community Medicine has found it doesn't take a long career in medicine to start feeling burned out, as even resident physicians and medical students report high rates.
The numbers aren't pretty. Just over 51% of Wichita resident physicians reported signs of burnout, slightly more than Wichita doctors as a whole and above recently reported national averages. The overall burnout rate among all KU School of Medicine medical students was 48% at all three medical school campuses (Kansas City, Wichita and Salina), rising steadily from 22% in the first year to nearly two-thirds among fourth-year students.
The research by Samuel Ofei-Dodoo, Ph.D., MPA, M.A., CPH, research educator and assistant professor; Rick Kellerman, M.D., department chair; and two family medicine residents, Karissa Gilchrist, M.D., and Eastin Casey, M.D., is appearing in a series of journals. The first, in the Kansas Journal of Medicine's May issue, focused on physician members of the Medical Society of Sedgwick County, while others on residents and students will be in upcoming issues of Family Medicine Journal and Medical Science Educator.
Researchers measured three burnout dimensions: emotional exhaustion, depersonalization and personal accomplishment, as well as overlapping factors such as depression, fatigue, thoughts of suicide and intentions to retire early from medicine or switch careers. Commonly cited contributors include electronic health records, administrative burdens and maintaining both healthy work and personal lives.
Highly driven and motivated, with perfectionist tendencies, "Those are all the things you would want in physicians, but our strengths could be our failures," said Kellerman. "You want a conscientious physician, but those very attributes could result in feelings of inadequacy and burnout."
"The finding of burnout among the KU medical students was very scary," Ofei-Dodoo said. "It's a red flag , a warning sign indicating all is not well between people and their workplaces."
KU School of Medicine-Wichita continues to be proactive in addressing the issue. On campus, in the curriculum and in residency programs, multi-pronged approaches to burnout and wellness are underway, building off the belief physicians must take good care of their own health to properly care for patients.
Some approaches involve things students and doctors can control themselves, such as eating healthier, exercising and making meaningful connections with others both inside and outside work. Others provide such resources as personal, educational and financial counseling. Additional elements - such as electronic health records and battling insurers to get care for patients - are challenging because they involve factors outside one's direct control.
Delivering resources can be tricky.
"A piece we have struggled with is finding things that work across the board for all residents," said Redonda Gates, director of the Wichita Center for Graduate Medical Education (WCGME), which oversees 13 KU-sponsored residencies. "We don't want to make residents feel like we're providing resources just to check the requirement boxes. We also want to make sure that when we do something, it doesn't make them feel like it's creating extra work."
Scott Moser, M.D., KU School of Medicine-Wichita associate dean of curriculum and professor in the Department of Family & Community Medicine, said the Active, Competency-based and Excellence-driven (ACE) curriculum instituted two years ago involves individual wellness training and aims to address components, such as exam schedules, that can be particularly stress inducing. ACE emphasizes small groups, teamwork and case-based learning, which provide interaction and a support system of sorts.
"We introduced professional coaching whereby medical students meet regularly with a physician faculty member to discuss their progress and introduce burnout preventive measures, as well as recognize signs of burnout early," Moser said.
If medical students feel stress, they can obtain counseling for depression, marital or other issues. The Wichita campus has a counselor whom students can call directly and visit for free.
Students also can see psychologists from the Kansas City campus via Skype or through periodic visits, said Heather van Buuren, director of Academic & Student Affairs at KU School of Medicine-Wichita. For academic issues, students can contact educational coaches who help students with study techniques, time management and test anxiety.
Residents can access counseling as well. Last year, WCGME switched its employee assistance program so residents can meet with a counselor they could access locally. In addition, the residents can see a professional coach who can work with them on test taking, efficiency, communication, professionalism or other skills required during residency. Counseling and coaching also helps residents with the transition from medical school to residency, as well as the rising levels of responsibility that come with each year of residency.
One initiative WCGME launched last year is a program for residents named in a malpractice claim. Community physicians with similar legal experiences provide support for residents facing a lawsuit, making sure they are taking care of themselves during this particularly stressful time.
Some residency programs have implemented strategies and activities to combat high rates of burnout among residents. The Via Christi Family Medicine Residency Program has created a motivational wellness curriculum where residents can access podcasts on financial, spiritual and nutritional wellness, said Ofei-Dodoo. Another practical approach involves a behavioral health didactic dedicated to providing residents with electronic health record shortcuts to decrease the amount of time spent on the records and "increase time spent with patients," he said.
The struggle to maintain a healthy integration of work and personal lives is a frequently mentioned factor in burnout. With residencies split almost evenly between men and women, and with roles and responsibilities different than those confronted by doctors trained decades ago, "spending 100 hours a week or more at the hospital, that's not acceptable any longer," Gates said.
Because lack of control over one's schedule is a big contributor to burnout, the Wesley Family Medicine Residency Program has provided residents some control over their time. Residents are given their schedule for one year out, so they can plan vacation and personal time. Scheduling vacations requires a 45-day notice, but residents can use "Golden Tickets" to get exceptions to the policy twice each year, Ofei-Dodoo said.
The Department of Academic & Student Affairs offers outlets to keep students physically and mentally active and allow escapes from the academic grind. They've had sessions on healthy eating and the basics of boxing, in case students want to punch out their stress. They've brought in massage chairs, gone indoor rock climbing and offered zoo days, archery, axe throwing at a local nightspot, movie and theater tickets, and - aaawww - even puppy yoga, mixing yoga and puppies.
There are YMCA discounts and a workout room on campus. The campus has offered a professional development week, educating on topics such as managing anxiety, healthy eating on a budget and ways one shouldn't relieve stress, such as leaning on alcohol or drugs.
"We have evolved to listening more intently and asking them about their needs," said van Buuren. "That has helped guide us and not just guess what they need."
Through the Via Christi Family Medicine Residency Program, there's the Happiness Project, with a faculty member hosting a program each month involving yoga, cooking or painting. It allows faculty and residents to socialize outside the medical setting.
Ofei-Dodoo is a fan of mindfulness yoga, combining exercise and meditative techniques for stress release, and recently received a grant from the Dean's Office to bring in trained yoga instructors for on-campus sessions open to medical students, residents and faculty.
The challenge of burnout and wellness is it involves many facets and possible solutions.
"There is no one-size-fits-all approach to combating burnout experiences," Ofei-Dodoo said.
Read the study
The study of Wichita doctors appeared in the May 2019 issue of the Kansas Journal of Medicine.
Pictured above: Self-defense sessions and puppy yoga are among the many Enrichment Program activities offered by the Academic & Student Affairs department to promote cultural, intellectual, spiritual, social, physical and emotional well-being among students at KU School of Medicine-Wichita.