Oral Themed Presentation
Resident and physician burnout has received increasing attention recently, leading to heightened awareness that physicians in training are at increased risk of burnout, depression, and suicidal ideation.1-6 Burnout is characterized by emotional, mental and physical exhaustion resulting from a chronic stressful work environment, occurring across medical specialties and potentially impacting interns most.7-13 This has implications for long-term workforce sustainability as well as near-term effects on medical errors and patient safety.14 There is a palpable urgency to address this phenomenon. 8,15-17 Organizational psychologists identified 6 categories of workplace stressors;18 of those, this study seeks to primarily impact workload. Individuals overburdened by work rush, become easily frustrated and fatigued, and are less attentive to detail, thus increasing errors.19 Resident workload is layered and effected by: hours of work; complexity of patients and tasks; availability and quality of support staff; number of new patients; and functionality of technology.20
This study seeks to assess if a novel simulation curriculum can mediate workload and burnout challenges, using 2 validated tools, the NASA Task Load Index (TLX)19, 21-26 and the Professional Quality of Life (ProQOL) Scale.27-31
Primary hypothesis: implementation of a novel simulation exercise will result in improved task efficiency, lower perceived workload scores and burnout levels in pediatric interns during in-patient rotations.
Secondary hypothesis: implementation of a novel simulation experience for interns will result in improved perceived workload scores and burnout levels in pediatric senior residents during in-patient rotations.
1. Compare time to completion rates of Epic documentation of daily progress notes, discharge summaries, admission orders, and documentation of high acuity patients between pre- and post-simulation implementation
2. Compare results of NASA TLX and ProQOL for interns and seniors between pre- and post-simulation implementation
Proposed approach to addressing the hypotheses
We are conducting a prospective cohort study of pediatric residents at Akron Children’s Hospital. In June 2018, a new curriculum was added to intern boot camp, including a 2-hour multi-patient simulation of a typical afternoon on the in-patient ward. Interns are responsible for 6 patients and a variety of tasks for those patients. They are intermittently interrupted to attend to additional tasks (e.g., answering pages). This session forces task prioritization, asking for needed help (a chief resident serves as supervising resident), and practicing time management. Interns also complete a 90-minute activity designed to improve mindfulness and communication with angry family or staff members. Debriefing follows each session.
For the 2017-18 academic year, pediatric residents rotating on the in-patient rotation were invited to complete the NASA TLX weekly and the ProQOL at the end of the rotation. The same process is occurring during the 2018-19 academic year to collect post-intervention data.
Conundrum or difficulty encountered
• Low trainee survey participation, despite evolving methods to increase participation
• Low priority for electronic health record (EHR) data analysis team—may not be able to gather EHR impact data
Questions for discussion
• Ideas to increase participation
• Other means to quantify impact on daily work