R. Quirk is program director, Internal Medicine Residency Program, Hennepin Healthcare, and assistant professor of medicine, University of Minnesota, Minneapolis, Minnesota.
H. Rodin is a scientist, Analytic Center of Excellence, Hennepin Healthcare, Minneapolis, Minnesota.
Acad Med. 2021 May 1;96(5):690-694. doi: 10.1097/ACM.0000000000003940.
Rates of burnout are high in physicians in the United States. While others have reported on the success of burnout-reduction strategies on practicing physicians and residents, few strategies have approached the problem longitudinally in residents.
From 2014 to 2019, the authors used a previously developed survey to assess factors related to resident burnout, including sleep, personal time, professional fulfillment, effects on relationships, program recognition, and peer support. At Hennepin Healthcare, a safety-net hospital in Minneapolis, Minnesota, the authors created a reproducible process for collecting data from internal medicine residents annually, and for using evidence-based conceptual frameworks to develop a continuous improvement method to address worklife across training years. Interventions included jeopardy coverage for essential life events, a newsletter celebrating resident achievements, removal of after-hours consult pager call, an extra day off for senior residents on the wards, and care packages distributed to night teams.
Annually from 2014 to 2019, 40/66 (60.6%) to 62/73 residents (84.9%) completed the survey (average response rate was 72.1% over 6 years). Survey results were shared with residents in multiple formats, and feedback was requested, demonstrating that burnout reduction is a priority for program leadership. High professional fulfillment scores were documented every year. Self-reported rates of burnout were between 25% and 35%. Significant improvements were seen in perception of empathy, sleep impairment, and peer support.
The authors developed a plan for minimizing burnout, which includes the following evidence-based domains: workload, control, balance in effort and reward, work-life balance, fairness, values, support, gender equity, moral distress, and moral injury. Additional interventions include protected time for didactics, trauma-informed care training, and addressing workplace racism. The authors aspire to achieve an integrated culture of well-being for residents and faculty; foster an efficient, effective, and fair learning environment; and reduce-and ultimately eliminate-burnout.
美国医生的倦怠率很高。虽然其他人已经报道了针对执业医生和住院医师的倦怠减少策略的成功，但很少有策略从纵向角度解决住院医师的问题。
从 2014 年到 2019 年，作者使用先前开发的调查来评估与住院医师倦怠相关的因素，包括睡眠、个人时间、专业满足感、对人际关系的影响、项目认可和同伴支持。在明尼苏达州明尼阿波利斯的亨内平县医疗中心，作者创建了一种可重复的流程，每年从内科住院医师那里收集数据，并使用基于证据的概念框架来开发一种持续改进方法，以解决整个培训年限的工作生活。干预措施包括为重要生活事件提供紧急覆盖、庆祝住院医师成就的时事通讯、取消下班后咨询传呼、为病房的高级住院医师额外提供一天休假、以及向夜班团队分发护理包。
从 2014 年到 2019 年，每年有 40/66（60.6%）到 62/73 名住院医师（84.9%）完成了调查（6 年来的平均回复率为 72.1%）。调查结果以多种格式与住院医师分享，并征求了反馈意见，表明减少倦怠是项目领导层的首要任务。每年都记录了高专业满足感得分。自我报告的倦怠率在 25%至 35%之间。在同理心感知、睡眠障碍和同伴支持方面看到了显著的改善。
作者制定了一个最小化倦怠的计划，其中包括以下基于证据的领域：工作量、控制、努力和回报之间的平衡、工作与生活的平衡、公平、价值观、支持、性别平等、道德困境和道德伤害。其他干预措施包括为教学提供受保护的时间、进行创伤知情护理培训以及解决工作场所种族主义问题。作者渴望为住院医师和教师实现健康的综合文化；培养高效、有效和公平的学习环境；并减少-最终消除-倦怠。
