Physician resilience: a grounded theory study of obstetrics and gynaecology residents
OBJECTIVE:Enhancing physician resilience has the promise of addressing the problem of burnout, which threatens both doctors and patients and increases in residents with each year of training. Programmes aimed at enhancing physician resilience are heterogeneous and use varied targets to measure efficacy, because there is a lack of clarity regarding this concept. A more robust understanding of how resilience is manifested could enhance efforts to create and measure it in physicians in training. METHODS:A qualitative study used grounded theory methodology to analyse semi-structured interviews with a purposive, intensity sample of obstetrics and gynaecology residents in an urban academic health centre. Longitudinal engagement through two sets of interviews 3-6 months apart allowed for variations in season and context. Thematic saturation was achieved after enrollment of 18 residents representing all 4 years of postgraduate training. A three-phase coding process used constant comparison, reflective memos and member checking to support the credibility of the analysis. RESULTS:A conceptual model for resilience as a socio-ecological phenomenon emerged. Resilience was linked to professional identity and purpose served to root the individual and provide a base of support through adversity. Connections to others inside and outside medicine were essential to support developing resilience, as was finding meaning in experiences. The surrounding personal and professional environments had strong influences on the ability of individuals to develop personal resilience. CONCLUSIONS:Physician resilience in this context emerged as a developmental phenomenon, influenced by individual response to adversity as well as surrounding culture. This suggests that both programmes teaching individual skills as well as systematic and cultural interventions could improve a physician's capacity to thrive.
A Gift to My Intern
Thriving in Scrubs: Understanding OBGYN Resident Resilience [Meeting Abstract]
Narrative Medicine Workshops for Obstetrics and Gynecology Residents and Association With Burnout Measures
OBJECTIVE: To determine whether a workshop Narrative Medicine curriculum can improve burnout among obstetrics and gynecology residents. METHODS: A Narrative Medicine curriculum was conducted at three obstetrics and gynecology training programs. An explanatory research design examined correlation between Narrative Medicine attendance and changes in survey responses. Residents completed a pretest and 1-year posttest survey that included validated measures of burnout and empathy. A within-participants design used baseline pretest scores as an internal control and measured changes in individual scores. The primary outcome of the study was change in burnout rates. Mann-Whitney U and Kruskal-Wallis tests were used to analyze the data. RESULTS: A total of 66 residents at three institutions participated in the Narrative Medicine curriculum. Of those, 54 (81%) enrolled in the study by completing any part of the surveys, and 43 (80%) of those enrolled had complete data for analysis. Burnout was high on all Maslach Burnout Inventory subscales and increased over 1 year. Participants with high Narrative Medicine attendance had decreased burnout on the Emotional Exhaustion subscale (-4.1 [+/-8.1]) points compared with an increase of 0.5 (+/-6.0) for low-attendance participants (U=134, P=.02, d=0.65). Lower self-care ratings were associated with improved Personal Accomplishment (+0.5 [+/-5.0]) compared with +2.0 (+/-2.7), U=84, P=.01]. Other characteristics did not significantly correlate with burnout or empathy. CONCLUSION: Burnout was high and worsened over time among obstetrics and gynecology residents in these three programs. Higher attendance at Narrative Medicine workshops was associated with improved Emotional Exhaustion.
Surgical Catastrophe. Supporting the Gynecologic Surgeon After an Adverse Event [Editorial]
Medical errors and adverse events are unavoidable. The effect of adverse outcomes on providers can be devastating. An intraoperative adverse event is often directly attributable to surgeon's technical error or suboptimal intraoperative judgment. To prevent the potential devastating psychological consequences that cases with adverse outcome pose on the surgeons involved it is essential to provide adequate support to the individuals involved in cases with intraoperative adverse events. Common reactions to adverse events, individual and organizational strategies to support clinicians through the aftermath are reviewed. The goal of this commentary is to create awareness of the mental health impact and to describe options to help physicians involved in intraoperative adverse events to recover from their experience related to bad surgical outcomes.
Whose Problem Is It? The Priority of Physician Wellness in Residency Training
OBJECTIVE: Physician wellness is associated with improved outcomes for patients and physicians. Wellness is a priority of the Accreditation Council on Graduate Medical Education, and many residencies have programs in place to improve wellness. This study sought to understand how stakeholders in graduate medical education perceive wellness among other educational priorities and whether these programs are improving the experience and training of residents. METHODS: The Council on Resident Education in Obstetrics and Gynecology (OBGYN)/Association of Professors in Gynecology Wellness Task Force created a survey and distributed it electronically to all OBGYN residents and program directors (PDs) in 2015. The survey included demographics, questions about the priority of wellness in the educational programs, experience with wellness programming, and problems with resident wellness (burnout, depression, binge drinking, suicide/suicide attempts, drug use, or eating disorders). Data rated on a Likert scale were analyzed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: Among 248 OBGYN PDs, 149 (60%) completed the survey. Of a total 5274 OBGYN residents nationally, 838 (16%) completed the survey. Most of the residents, 737 (89.4%) reported that they or a colleague experienced some problem with wellness. Many PDs also reported problems with wellness, but 46 (33.9%) reported not being aware of problems in the previous 5 years. When asked to rate the priority of wellness in resident education, <1% (1) PD stated that this was not a priority; however, 85 residents (10%) responded that wellness should not be a priority for residency programs. Resident reports of problems were higher as year in training increased (depression chi2 = 23.6, p = 0.001; burnout chi2 = 14.0, p = 0.003; suicide attempt chi2 = 15.5, p = 0.001; drug use chi2 = 9.09, p = 0.028; and binge drinking chi2 = 10.7, p = 0.013). Compared with community programs, university programs reported slightly fewer problems with wellness (chi2 = 5.4, p = 0.02) and suicide/suicide attempts (chi2 = 13.3, p = 0.001). Most PDs reported having some programming in place, although residents reported lower rates of feeling that these programs addressed wellness. CONCLUSIONS: There is a discrepancy between the perspective that residents and PDs have on resident wellness, and its priority within the residency program. PDs may not be aware of the scope of the problem of resident wellness. These problems increase with year of training, and may be more common in community programs. Current wellness programming may not be effective, and a significant minority of residents feels that wellness is beyond the scope of the training program.
Thriving in scrubs: a qualitative study of resident resilience
BACKGROUND:Physician well-being impacts both doctors and patients. In light of high rates of physician burnout, enhancing resilience is a priority. To inform effective interventions, educators need to understand how resilience develops during residency. METHODS:A qualitative study using grounded theory examined the lived experience of resilience in residents. A cohort of obstetrics and gynecology residents were selected as a purposive, intensity sample.. Eighteen residents in all years of training participated in semi-structured interviews. A three-phase process of open coding, analytic coding and thematic analysis generated a conceptual model for resilience among residents. RESULTS:Resilience among residents emerged as rooted in the resident's calling to the work of medicine. Drive to overcome obstacles arose from personal identity and aspiration to professional ideals. Adversity caused residents to examine and cultivate coping mechanisms. Personal connections to peers and mentors as well as to patients and the work helped buffer the stress and conflicts that present. Resilience in this context is a developmental phenomenon that grows through engagement with uncertainty and adversity. CONCLUSION/CONCLUSIONS:Resilience in residents is rooted in personal and professional identity, and requires engagement with adversity to develop. Connections within the medical community, finding personal fulfillment in the work, and developing self-care practices enhance resilience.
Recovery From the Burnout Epidemic: How the Academic Community Can Help (Commentary)
Promoting Diversity, Equity, and Inclusion in the Selection of Obstetrician-Gynecologists
In the setting of long-standing structural racism in health care, it is imperative to highlight inequities in the medical school-to-residency transition. In obstetrics and gynecology, the percentage of Black residents has decreased in the past decade. The etiology for this troubling decrease is unknown, but racial and ethnic biases inherent in key residency application metrics are finally being recognized, while the use of these metrics to filter applicants is increasing. Now is the time for action and for transformational change to rectify the factors that are detrimentally affecting the racial diversity of our residents. This will benefit our patients and learners with equitable health care and better outcomes.
The Role of Gender in Careers in Medicine: a Systematic Review and Thematic Synthesis of Qualitative Literature
BACKGROUND:Gender disparities exist in the careers of women in medicine. This review explores the qualitative literature to understand how gender influences professional trajectories, and identify opportunities for intervention. METHODS:A systematic review and thematic synthesis included articles obtained from PubMed, Cochrane Central Register of Controlled Trials (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), and GenderWatch (ProQuest) on June 26 2020, updated on September 10, 2020. Included studies explored specialty choice, leadership roles, practice setting, burnout, promotion, stigma, mentoring, and organizational culture. Studies taking place outside of the USA, using only quantitative data, conducted prior to 2000, or focused on other health professions were excluded. Data were extracted using a standardized extraction tool and assessed for rigor and quality using a 9-item appraisal tool. A three-step process for thematic synthesis was used to generate analytic themes and construct a conceptual model. The study is registered with PROSPERO (CRD42020199999). FINDINGS/RESULTS:Among 1524 studies identified, 64 were eligible for analysis. Five themes contributed to a conceptual model for the influence of gender on women's careers in medicine that resembles a developmental socio-ecological model. Gender influences career development externally through culture which valorizes masculine stereotypes and internally shapes women's integration of personal and professional values. CONCLUSION/CONCLUSIONS:Medical culture and structures are implicitly biased against women. Equitable environments in education, mentoring, hiring, promotion, compensation, and support for work-life integration are needed to address gender disparities in medicine. Explicit efforts to create inclusive institutional cultures and policies are essential to support a diverse workforce.