Physician Trainees' Compassion Satisfaction, Burnout, and Self-Efficacy in Harm Reduction for Persons Who Inject Drugs

Background: Trainee physicians frequently care for people who inject drugs (PWID) and can positively influence their patients' lives with competent, empathetic treatment. Training in this area can improve provider attitudes toward PWID but is often lacking [1,2]. Providers of PWID can experience burnout including emotional exhaustion and reduced sense of personal accomplishment [3]. Few studies have examined factors protective against burnout from caring for PWID, including harm reduction counseling skills. Our aim was to measure self-efficacy in harm reduction counseling, burnout, and compassion satisfaction among Internal Medicine (IM) trainees caring for PWID.

Methods: Electronic surveys were sent to IM interns (post graduate year 1) and residents (post graduate year 2 and 3) at an urban, safety net institution. Self-efficacy was assessed by asking trainees about their comfort in counseling PWID on harm reduction on a five-point Likert scale. Trainees also completed a 20-question adaptation of the Professional Quality of Life Scale measuring compassion satisfaction and burnout when caring for PWID [4]. We used chi-square and ANOVA to compare self-efficacy, compassion satisfaction, and burnout between interns and residents. We used correlational analysis to examine the relationship between these three variables.

Results: Sixty IM trainees completed the survey (25 interns and 35 residents). Interns reported significantly higher levels of burnout than residents (mean score 25.4 +/- 4.9 vs 22.3 +/- 5.0, ps <0.05), and residents reported higher levels of compassion satisfaction (mean score 30.0 +/- 4.8 vs 35.4 +/- 5.5, ps <0.05). Compared to interns, residents reported higher self-efficacy in harm reduction counseling (29 (83%) vs 3 (12%), p<0.001). Across training levels, we found a moderately sized, negative correlation between burnout and compassion satisfaction (r = -0.58, p<0.001) and a positive correlation between compassion satisfaction and self-efficacy (r = 0.43, p<0.01). There was no significant relationship between self-efficacy and burnout.

Conclusions: Among IM trainees at an urban institution serving a large population of PWID, self-efficacy in harm reduction counseling and compassion satisfaction increase with time in training while burnout decreases. Compassion satisfaction was inversely related to burnout. Strengthening trainees’ capacity to deliver harm reduction counseling for PWID may improve their compassion satisfaction in caring for this population, potentially leading to improved care for PWID. This relationship should be explored in larger cohorts and longitudinally post-training.

References:

References:
1. Van Boekel LC, Brouwers EPM, Van Weeghel J, Garretsen HFL. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend. 2013;131(1–3):23–35. doi: 10.1016/j.drugalcdep.2013.02.018
2. Wakeman SE, Pham-Kanter G, Donelan K. General internists’ attitudes, practices and preparedness related to substance use disorder. J Gen Intern Med. 2016;31(2):S231–S232.
3. Rapid Response Service. Burnout among service providers addressing substance use disorders. Toronto, ON: Ontario HIV Treatment Network; November 2019. https://www.ohtn.on.ca/wp-content/uploads/2019/11/RR142_Burnout_FINAL.pdf
4. Hudnall Stamm B. Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL). Professional Quality of Life Scale, 2009. https://proqol.org/uploads/ProQOL_5_English_Self-Score.pdf