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August 2018 SEA-Q

Question:

The anesthesiology residency program at your institution is developing a curriculum to address trainee burnout. Which of the following interventions has been shown to be MOST effective in reducing burnout among residents?

  • A.) Protected sleep periods
  • B.) Duty hour limitations
  • C.) Incentivized exercise program
  • D.) Communication skills training

Answer:

B.): Duty hour limitations

Discussion:

Burnout is associated with medical errors, low job satisfaction, mood disorders, stress-related health issues, decreased empathy, and absenteeism. Rates of resident physician burnout range from 40 to 76% and have increased in recent years. Recently published review studies have summarized the efficacy data of burnout interventions specifically aimed at residents.
 
Duty hour restrictions has been the most commonly studied intervention. Studies have demonstrated that the 2003 and 2011 ACGME work hour standards were associated with significant reductions in emotional exhaustion scores and burnout rates. Of note, the 2011 duty hour standards also were associated with interns reporting decreased readiness for more senior responsibilities and reduced quality of life for senior residents.
 
Randomized controlled trials evaluating protected sleep periods and communication and stress management demonstrated no effect on burnout rates. An incentivized, 12-week exercise program was examined with over 1000 residents and fellows. Burnout was lower in participants than in nonparticipants, although the difference was not statistically significant.
 
Unfortunately, there are a limited number of studies designed to investigate the efficacy of interventions on this group of physicians. And many of these studies had relatively small sample sizes. Larger longitudinal studies are needed to better evaluate the effectiveness of specific interventions on resident burnout.
 

Reference(s):

  1. Busireddy KR, Miller JA, Ellison K, Ren V, Qayyum R, Panda M. Efficacy of interventions to reduce resident physician burnout: A systematic review. JGME 2017;9:294-301.
  2. Holmes EG, Connolly A, Putnam KT, Penaskovic KM, Denniston CR, Clark LH, Rubinow DR, Meltzer-Brody S. Taking Care of Our Own: A Multispecialty Study of Resident and Program Director Perspectives on Contributors to Burnout and Potential Interventions. Acad Psychiatry 2017;41:159–66.
  3. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systemic review and meta-analysis. Lancet 2016;388:2272-81.
     

Author Information:

Amy C. Robertson, MD
Associate Professor of Anesthesiology
Vice Chair for Clinical Affairs
Director of Medical Student Education
Department of Anesthesiology
Vanderbilt University School of Medicine
Nashville, TN

Results:

The SEA is proud to be a member-driven organization, dedicated to the teaching and development of future anesthesiologists, and to the advancement of those who educate them.

Contact Info:

Society for Education in Anesthesia
6737 W. Washington St, Suite 4210 • Milwaukee, WI 53214 • (414) 389-8614