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Cited by 33Healthcare professionals’ stress and burnoutStress and Burnout ResearchInnovations in Medical Education

Resident Burnout, Wellness, Professional Development, and Engagement Before and After New Training Schedule Implementation

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Heppe, Daniel, Baduashvili, Amiran, Limes, Julia E., Suddarth, Katie, Mann, Adrienne, Gottenborg, Emily, Sacro, Yasmin, Davis, Lisa +2 more·2024·JAMA Network Open
DOI 10.1001/jamanetworkopen.2024.0037PMC PMC10902722
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Abstract

Importance: Burnout is a work-related syndrome of depersonalization (DP), emotional exhaustion (EE), and low personal achievement (PA) that is prevalent among internal medicine resident trainees. Prior interventions have had modest effects on resident burnout. The association of a new 4 + 4 block schedule (4 inpatient weeks plus 4 outpatient weeks) with resident burnout has not previously been evaluated. Objective: To evaluate the association of a 4 + 4 block schedule, compared with a 4 + 1 schedule, with burnout, wellness, and self-reported professional engagement and clinical preparedness among resident physicians. Design, Setting, and Participants: This nonrandomized preintervention and postintervention survey study was conducted in a single academic-based internal medicine residency program from June 2019 to June 2021. The study included residents in the categorical, hospitalist, and primary care tracks in postgraduate years 1 and 2 (PGY1 and PGY2). Data analysis was conducted from October to December 2022. Intervention: In the 4 + 4 structure, resident schedules alternated between 4-week inpatient call-based rotations and 4-week ambulatory non–call-based rotations. Main Outcomes and Measures: The primary outcome was burnout, assessed using the Maslach Burnout Inventory subcategories of EE (range, 0-54), DP (range, 0-30), and PA (range, 0-48), adjusted for sex and PGY. Secondary outcomes included In-Training Examination (ITE) scores and a questionnaire on professional, educational, and health outcomes. Multivariable logistic regression was used to assess the primary outcome, 1-way analysis of variance was used to compare ITE percentiles, and a Bonferroni-adjusted Kruskal Wallis test was used for the remaining secondary outcomes. The findings were reexamined with several sensitivity analyses, and Cohen’s D was used to estimate standardized mean differences (SMDs). Results: Of the 313 eligible residents, 216 completed the surveys. A total of 107 respondents (49.5%) were women and 109 (50.5%) were men; 119 (55.1%) were PGY1 residents. The survey response rates were 78.0% (85 of 109) in the preintervention cohort and 60.6% (63 of 104) and 68.0% (68 of 100) in the 2 postintervention cohorts. The PGY1 residents had higher response rates than the PGY2 residents (119 of 152 [78.2%] vs 97 of 161 [60.2%]; P < .001). Adjusted EE scores (mean difference [MD], −6.78 [95% CI, −9.24 to −4.32]) and adjusted DP scores (MD, −3.81 [95% CI, −5.29 to −2.34]) were lower in the combined postintervention cohort. The change in PA scores was not statistically significant (MD, 1.4 [95% CI, −0.49 to 3.29]). Of the 15 items exploring professional, educational, and health outcomes, a large positive association was observed for 11 items (SMDs >1.0). No statistically significant change in ITE percentile ranks was noted. Conclusions and Relevance: In this survey study of internal medicine resident physicians, a positive association was observed between a 4 + 4 block training schedule and internal medicine resident burnout scores and improved self-reported professional, educational, and health outcomes. These results suggest that specific 4 + 4 block combinations may better improve resident burnout than a 4 + 1 combination used previously.

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  • In the organizational work-hour intervention subgroup, there was no significant post-intervention effect across all outcome domains: EE -0.20 (95% CI -0.58 to 0.17, p = 0.29, I2 = 67.1%), DP -0.16 (95% CI -0.48 to 0.16, p = 0.33, I2 = 55.8%), and PA 0.04 (95% CI -0.12 to 0.20, p = 0.60, I2 = 0%).

    “Subgroup analyses revealed no post-intervention Cohen’s d SMD in work-hour interventions [44, 45, 47, 73, 76] across all outcome domains: EE (-0.20, 95% CI -0.58 to 0.17, p = 0.29, I2 = 67.1%), DP (-0.16, 95% CI -0.48 to 0.16, p = 0.33, I2 = 55.8%), and PA (0.04, 95% CI -0.12 to 0.20, p = 0.60, I2 = 0%).”

    From Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis (2024) · cites this paper as [76]

  • Organizational interventions showed no statistically significant association with any burnout domain (EE, DP, PA).

    “In organizational intervention studies [44, 45, 47–49, 73, 76], pooling of post-intervention intervention Cohen’s d SMD yielded non-statistically significant resulted in all outcomes, EE (-0.22, 95% CI -0.47 to 0.04, p = 0.10, I2 = 62.6%) (Fig. 3A), DP (-0.15, 95% CI -0.38 to 0.08, p = 0.21, I2 = 53.0%) (Fig. 3B), and PA (0.12, 95% CI -0.01 to 0.25, p = 0.07; I2 = 0%) (Fig. 3C).”

    From Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis (2024) · cites this paper as [76]

  • The majority of studies employed non-randomized, non-concurrent designs, with 9 using historical controls, 13 utilizing self-control studies, and 11 randomized controlled concurrent trials.

    “The majority of studies employed non-randomized, non-concurrent designs, with 9 (27.2%) using historical controls [44, 48, 49, 56, 59, 68, 71, 75, 76] and 13 (39.4%) utilizing self-control studies [47, 50, 53, 54, 58, 61, 65–67, 69, 70, 72, 73]. Eleven (33.3%) studies were randomized, controlled, concurrent trials [45, 51, 52, 55, 57, 60–64, 74].”

    From Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis (2024) · cites this paper as [76]

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Authors
Heppe, D., Baduashvili, A., Limes, J. E., Suddarth, K., Mann, A., Gottenborg, E., Sacro, Y., Davis, L., Chacko, K., & Connors, G.
Affiliations
  • University of Colorado Anschutz (US)
  • Denver Health Medical Center (US)
Corresponding author
Heppe, Daniel
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2024-02-28
Volume
7
Issue
2
Pages
e240037
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2024.0037
PMC
PMC10902722
OpenAlex
W4392242475
Cited by
33
References
45
Citations by year
2026: 13 · 2025: 15 · 2024: 5
FWCI
19.38
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
Topics
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Keywords
resident burnout, internal medicine residency, resident well-being, professional engagement, professional development, clinical preparedness, emotional exhaustion, depersonalization, personal accomplishment, academic medicine workforce, physician well-being, Maslach Burnout Inventory
MeSH terms
Burnout, Psychological, Emotional Exhaustion, Female, Humans, Inservice Training, Male, Psychological Tests, Hospitalists, Self Report

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