Searching for the antidote for burnout and depression: Creating a culture of wellness in pediatric residency training

Background: Stress in medical education and its impact on resident well-being is well documented, and has been documented in pediatric trainees. Although 2012 ACGME guidelines require residencies provide curricula to enhance physician wellness and well-being as well as mindfulness and empathy in the doctor-patient encounter, few programs have been developed to address this critical training. The Pediatric Integrative Medicine in Residency program through the University of Arizona Center for Integrative Medicine introduces an integrative medicine framework to address and evaluate resident health and wellness in its national pilot program. Methods: First year pediatric residents (n=149) from 5 residencies participating in the Pediatric Integrative Medicine in Residency program completed standardized well-being measures (burnout, depression, perceived stress, satisfaction with life, positive and negative affect), mindfulness, emotional intelligence and empathy. The impact of burnout on well-being, emotional intelligence and empathy is examined. Physician wellness activities in place at the residencies are described. Results:  Approximately one-third experienced burnout risk with 21% of residents scoring in the high emotional exhaustion range and 34% scoring in the high depersonalization range on the Maslach Burnout Inventory. Seventeen percent scored in the high risk range for both emotional exhaustion and depersonalization. Twenty-two percent exceeded the cut point on the Center for Epidemiological Studies Depression Scale (CES-D) for risk of depression. A burnout risk variable was created as follows: at risk includes individuals scoring in the high burnout range on emotional exhaustion and depersonalization; low risk includes individuals scoring in the low burnout range on both scales; and moderate risk includes remaining individuals. In analyses examining the impact of burnout risk level on well-being, mindfulness, emotional intelligence, and empathy the at risk group had significantly lower well-being, emotional intelligence, and empathy than both the low and moderate risk groups. Retreats were offered at all of the residencies, followed by nutrition activities at 4 sites. Other activities included physical activity (n=2), stress management (n=2), conflict resolution/communication skills training (n=2), empathy skills training (n=2), burnout prevention (n=1), and self-regulation training (n=1).  The number of wellness activities offered at the sites ranged from 1 to 8, with an average of 4 activities available for residents. Conclusion: Results indicate that a substantial proportion of residents are beginning residency with significant levels of burnout and depression which, in turn, impacts well-being, emotional intelligence and empathy. The implementation of physician wellness activities is designed to both treat existing and ameliorate or reduce the effects of ongoing stress.