Stress Management and Resilience Training to Combat Physician Burnout
Burnout is a sense of low personal accomplishment and the tendency to evaluate oneself negatively, to feel unhappy and dissatisfied with accomplishments on the job, emotional exhaustion and depersonalization. Burnout is epidemic among healthcare professionals affecting 50% of medical students and internal medicine residents, 54% of attending physicians and 21-67% of mental health clinicians (Dyrbe 2008, Shanagelt et al. 2015, Mealer et al. 2009, Cimiotti et al. 2012, Dyrbye et al. 2017, Morse et al. 2012.) Burnout can lead to negative, cynical attitudes and feelings about one’s patients, callous feelings and even dehumanized perception of others. Burnout is associated with anxiety, depression, suicidal ideation, substance use, decreased job satisfaction, absenteeism, reduction in work hours, job turnover, decreased empathy, decreased quality and safety of patient care and decreased patient satisfaction (Salyers et al. 2016, Lotte et al. 2107, West et al. 2011).
A recent study of more than 4000 neurologists in the U.S. showed that 60% had at least on symptom of burnout (Miyasaki et al. 2017). Clinical practice neurologists had a higher rate of burnout than academic (63.3% vs. 55.7%, p=0.004), and only 32% expressed that they had enough time for their family.
Strategies to reduce burnout: The antidote to stress and burnout is to recognize that there is a problem, address the systemic contributors to burnout and also to build resilience in physicians. One of the ways to build individual resilience is to teach physicians how to recognize their own stress and develop tools and adaptive strategies. Park et al. (2013) describes resilience as a multidimensional construct that refers to the ability to adapt and maintain effective functioning under significant adversity or challenging life conditions. Recent systematic reviews have shown that both organizationally-lead and individual-focused interventions for physicians were associated with small, significant reductions in burnout (Panagiotti et al. 2017, West et al. 2016). Some of the approaches that work on the individual level include mind-body approaches, cognitive behavioral techniques, stress-management training, narrative medicine, community building and connecting with meaning and purpose at work. (Shanafel et al. 2017, West et al. 2016, Panagiotti et al. 2016, Lee et al. 2016, Zwack et al.) Shanfelt et. al (2017) identified some organizational strategies to reduce burnout which include: acknowledge and assess the problem, harness the power of leadership, develop and implement target work interventions, cultivate community and at work, use rewards and incentives wisely, align values and strengthen culture, promote flexibility and work-life integration, provide resources to promote resilience and self-care and fund organizational science.
Study design: The investigators are working with 37 Neuroscience physicians and leaders to optimize the use of the SMART program (Stress Management and Resilience Training) through an 8-session course provided every other week and presented live, via Webcast or to be viewed later by video. A survey containing measures of resilience, burnout and stress were completed by participants using RedCAP prior to starting the SMART program. Surveys will be sent out again after completion of the SMART program and at 4 months after completion. Patient satisfaction scores from the 4 months prior to participation and 4 months after completing the SMART program will be requested from the neurosciences operations team.
About the SMART Program: The SMART program is an 8-session course designed by the Benson-Henry Mind Body Institute. The three foundations of the program are: the Relaxation Response (meditation, mindfulness, breath, yoga, etc.), learning how stress affects the body and mind and, thirdly, learning adaptive responses (positive psychology, cognitive reframing, appreciation, etc.) In each of the eight sessions participants learn new ways of eliciting the relaxation response, learn how to recognize the symptoms of stress emotionally, physically, cognitively and relationally and ultimately, learn how to develop adaptive responses.
Our goal in the study is to see whether participating in the SMART program leads to lower scores of burnout and increased patient satisfaction scores.
The program, itself will be completed in April of 2019 with follow up surveys given at that time and 4 months later.
- Understand the issue of burnout in clinicians and the factors contributing to burnout and how it impacts health care
- Describe the SMART program (Stress Management and Resiliency Program) and how it could be implemented to combat burnout in clinicians
- Stimulate ideas on how to combat burnout in clinicians and implementation of these programs in health care institutions for the benefit of the clinicians and the patients