Pediatric Resident Burnout & Resilience Study Consortium Overview

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This study aims to investigate the factors influencing burnout and resilience in pediatric residents, with a focus on enhancing well-being and performance. The Pediatric Resident Burnout Resilience Study Consortium (PRB-RSC) involves over 20 residency programs in the U.S. to examine the epidemiology, natural progression, and interventions related to burnout and resilience. Objectives include analyzing the relationships between burnout, resilience, empathy, and compassionate care, identifying modifiable risk factors, and testing interventions to promote positive wellness factors.

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Defining Key Factors in Burnout and Resilience in Pediatric Residents and the Relationship to Performance: A Study of the Pediatric Resident Burnout Resilience Study Consortium A Study of the Pediatric Resident Burnout Resilience Study Consortium Maneesh Batra, MD and John D Mahan MD for the PRB-RSC Steering Committee

Agenda Pediatric Resident Burnout Resilience Study Consortium Steering Committee APPD LEARN Study Goals/Objective/Rationale/Hypotheses Study Overview Recruitment and Retention Data to be Collected/Survey Instruments Incentives Scholarship

PRB-RSC Steering Committee Maneesh Batra, MD, MPH John D Mahan, MD Kathi Kemper, MD, MPH Betty Staples, MD Janet Serwint, MD, MPH Chuck Schubert, MD, MPH Paria Wilson, MD Hilary McClafferty, MD

APPD LEARN APPD LEARN (Longitudinal Educational Assessment Research Network) Provides infrastructure for multicenter, collaborative pediatric educational research Requires approval by APPD LEARN Protocol Review Committee - obtained Study Assistance Provide IRB kits and help Provide Data Capture system and enrolling emails and links Provide feedback on enrollment activity Assist in presentations Assist in data analysis and sample manuscript language

Goal To improve pediatric resident resilience, compassion, confidence in providing calm, compassionate care and wellness. Through creation of a Pediatric Resident Burnout - Resilience Study Consortium (PRB-RSC), involving pediatric residents in more than 20 residency programs in the US, we will be equipped to study the epidemiology, natural history and impact of interventions designed to address burnout and resilience in pediatric residents.

Objectives The PRBRSC is dedicated to achieving 4 objectives: Describe the epidemiology and relationships between burnout, resilience, empathy, and confidence in providing compassionate care in pediatric and medicine-pediatric (P/M-P) residents. Define the natural history of these parameters over time in P/M-P residents during training. Identify modifiable factors that increase or decrease the risk of developing burnout and promoting positive wellness factors. Develop and test different interventions (such as in-person seminars, on-line mind-body skills training, and individualized curricula such as global health electives) to affect burnout, resilience, empathy, compassion and wellness.

Rationale The importance of creating a consortium devoted to addressing these issues is well-established, measurement tools are now available, and interest in positive interventions has never been higher: Burnout is associated with poor physical and mental health in health care professionals Burnout is associated with increased error rates, poor communication, low adherence to guidelines, poor quality of care, and low patient satisfaction in graduate medical education trainees Early intervention may provide long-term benefits to young health care professionals

Hypotheses 1. Residents with more mindfulness and self-compassion will have higher resilience and lower burnout. a. Residents with higher mindfulness and self-compassion will have higher ability to provide compassionate care. b. Burnout penetrance in residents will be more affected by internal factors (mindfulness, self-compassion and resilience) than external factors (work and life factors; special educational activities). c. There will be significant interest in mind-body skills training and other wellness education among residents related to perceived stress and self- compassion but independent of degree of burnout. Residents with more personalized educational pursuits (global health activities, advocacy, rural/primary care track, etc) will evidence more resilience and less burnout over time than those without these personalized pursuits. Residents with higher mindfulness, self-compassion, resilience and lower burnout will achieve higher performance levels as determined by pediatric milestones assessments, controlling for independent demographic factors. 2. 3.

Study Overview Phase 1) conduct cross-sectional survey in Spring 2016 [April 1-May 31, 2016] in trainees from a national sample of > 15 pediatric and medicine-pediatric residencies assessing relationships between mindfulness, self-compassion, resilience, burnout, confidence in providing calm, compassionate care, demographic factors of individual residents, engagement in special educational activities (including global health, advocacy and mindfulness training). Phase 2) assess the relationships of burnout and resilience to resident performance as assessed by ACGME milestones. Phase 3) provide platform to study educational and skills training [interventions] on preventing and/or mitigating negative aspects of burnout in our residents. Phase 4) define natural history of burnout and resilience by repeating survey in selected residents in same programs in Spring 2017.

Study Overview: Phase 1a Phase 1a) conduct cross-sectional survey of Program Directors to define wellness efforts currently underway in programs Led by Paria Wilson and Kathi Kemper Accomplished in February 2016 Provide initial work to develop most effective method to define this important program level intervention

Study Overview: Phase 1 Phase 1) conduct cross-sectional survey in Spring 2016 [April 1- May 31, 2016] in trainees from a national sample of > 15 pediatric and medicine-pediatric residencies assessing relationships between mindfulness, self-compassion, resilience, burnout, confidence in providing calm, compassionate care, demographic factors of individual residents, engagement in special educational activities (including global health, advocacy and mindfulness training).

Recruitment and Enrollment 4 week window anticipated (April 1 May 31, 2016) Programs may elect to keep window open longer Recruitment strategies High recruitment is key for powering this study Programs are encouraged to employ their own recruitment strategies (including inducements) as desired Residents respond to engagement of Program Leadership and commitment to address wellness APPD LEARN will facilitate reminders to non-respondents

Data To Be Collected Phase 1 data requirements include the 14 survey items (with 1-22 questions each) to be completed by pediatric and medicine- pediatric residents from participating programs using our APPD LEARN central data capture resources [similar to RedCap].

Study Instruments 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Resident Career Satisfaction Survey (9) 11. Davis Empathy Scales - PT and EC (14) 12. Calm, Compassionate Care Scale (10) 13. Epworth Sleepiness Scale (8) 14. Prior Training in Mind-Body Skills (4) [* 141 items] on average residents have taken 15 minutes to complete Demographics (10)/Resident characteristics (15) Promis Global Health scale (7) Perceived Stress Scale (Cohen s) (10) Hatch Spirituality Questions (3) Cognitive and Affective Mindfulness Scale Revised CAMS-R (10) Neff s Self-Compassion Scale (12) Brief Resilience Scale (Smith s) (6) Maslach Burnout Inventory HSS Format (22) One Item Burnout Assessment (1)

Incentives 3 leading enrolling programs (based on percent of residents completing survey) will qualify for a group incentive Leading enroller - $1500 2ndenroller - $1000 3rdenroller - $500 Sites may incorporate additional local rewards to participates (as approved and funded locally) Reports to sites de-identified program reports from APPD LEARN

Scholarship Writing teams will be developed for each phase of study (and any future phases) based on site investigator interest Each site will be able to have one local PI volunteer and participate in at least one of the initial 3 writing teams (based on interest) Consortium platform will be available to investigators interested in evaluating specific wellness interventions International opportunities (Global Health)