Pediatric Cardiology Fellow Children's National Hospital Washington, District of Columbia, United States
Abstract:
Objective: Many studies have highlighted the prevalence and negative impact of physician burnout, but there are few that focus on understanding and promoting resilience, especially in physician trainees. Our primary objective was to understand what contributes to ‘in-the-moment’ resilience for pediatric cardiology fellows while on-call in the Cardiac intensive Care Unit (CICU). Our secondary objective was to identify potential interventions to improve cardiology fellowship training.
Methods: This is an IRB-exempt, multi-center, mixed-methods study. The qualitative data consisted of semi-structured, in-depth, individual interviews with categorical pediatric cardiology fellows from two training programs. Transcripts were coded and analyzed using phenomenology through an inductive approach with the lens of “protective” and “compensatory” conceptual frameworks for resiliency, until thematic sufficiency was obtained. Quantitative data included baseline demographics, an evidence-based two-question burnout screen and enumeration of various negative outcome categories.
Results: 16 total fellows participated. Baseline demographics and burnout screening showed that 87.5% of the participants met the primary definition of burnout according to the Masloch Burnout Inventory-Human Services Survey (75% scored >/=3 for at least one question, and 12.5% scored 2 for both questions). Preliminary results show predominant themes for the risk category as meeting basic human needs, pre-call anticipation, and cognitive and emotional burden. Some of the main themes for protective and compensatory factors for resilience were debriefing and feedback, having adaptable perspectives, and practicing post-call recovery. Finally, ‘in-the-moment’ factors were explained through a sense of responsibility and self-improvement, having an immediate support system, and employing coping strategies. We found that systems familiarity and appropriate staffing applied to all three categories (risk, compensatory/protective, and “in the moment”). Potential interventions were identified as real-time feedback and debriefs, easier access to mental health resources, and scheduled breaks.
Conclusion: Our study uncovered themes from the in-depth experience of cardiology fellows on-call in the CICU. These themes are useful in understanding contributory factors for ‘in-the-moment’ resilience, major risk and major protective factors that may help improve overall cardiology fellowship training.
