Helping Residents Iden.fy and Overcome Burnout. Coaches Faculty Development, April 2015 Alyssa Bogetz, M.S.W.

Transcription

1 Helping Residents Iden.fy and Overcome Burnout Coaches Faculty Development, April 2015 Alyssa Bogetz, M.S.W.

2 Objec.ves Define burnout and recognize its dis.nguishing characteris.cs Iden.fy the risk and protec.ve factors for burnout Describe 3 strategies to address burnout and prevent its occurrence Apply 1 strategy to coaching 2

3 Ques.ons for Self- Reflec.on 1. What do you find most meaningful about your work? 2. How do you achieve balance between your personal and professional lives? 3. What quali.es or apributes do you value most? Do these values align with your work? If not, how could they? 3

4 What is Burnout? Prolonged response to chronic emo.onal and interpersonal stressors Maslach & Jackson (1981) Maslach Burnout Inventory Psychological syndrome Emo.onal exhaus.on Depersonaliza.on Decreased feelings of accomplishment 4

5 Maslach Burnout Inventory Emo.onal Exhaus.on I feel like I m at the end of my rope. Depersonaliza.on I feel I treat some recipients as if they were impersonal objects. Personal Accomplishment I feel I m posigvely influencing other people s lives through my work. 5

6 Burnout During Residency 27-76% of residents meet criteria depending on specialty Dyrbye et al, 2014: 60.3% meet criteria 74% of pediatrics residents Risk is greatest during first 3-6 months of PGY1 Ishak et al, JGME, 2009 Fahrenkopf et al, BMJ, 2008 Sen S et al, 2010, Arch Gen Psych 6

7 Burnout During Residency Stanford Pediatric Residency (2010) Stage of Training % Burnout (High EE and DP) Start of Residency 2 17 Mid- PGY End- PGY Mid- PGY End- PGY Mid- PGY % Burnout (High EE or DP) Pantaleoni et al, 2014, Academic Pediatrics 7

8 Burnout Post Residency A pervasive problem 1 in 3 physicians currently experience symptoms of burnout Among all physicians: 1 physician dies by suicide each day Men = 1.41x more likely to die by suicide than general popula.on Women = 2.27x more likely to die by suicide Shanafelt et al, 2003, Am J Med Schernhammer et al, 2004, Am J Psychiatry 8

9 Effects of Burnout on Physicians Psychosoma.c insomnia Emo.onal - anxiety and depression Ajtudinal - apathy, distrust, hos.lity Behavioral - isola.on, aggressiveness, substance abuse, suicidal idea.on/suicide Thomas et al JAMA 9

10 Effects of Burnout on Pa.ent Care Pa.ent- physician rela.onship Quality of care Referral prac.ces Medical errors Adherence Pa.ent sa.sfac.on Neumann et al, 2011, Academic Medicine West et al, 2009, JAMA Sen et al, 2010, Arch Gen Psychiatry 10

11 Burnout is a Pathologic Effect of Stress Burnout arises when expectagons and demands exceed the resources available Selfless All- knowing Healthy and problem- free Iden.fica.on, preven.on and interven.on requires that we: Address internal and external factors Recognize the risk and protec.ve factors 11

12 Risk Factors Demographics Age Gender Marital status Personality type Job Demands Workload Control over work Work sejng (ICU, ED) Lack of feedback Debt Dyrbye et al, 2014, Academic Medicine Thomas, 2004, JAMA 12

13 Protec.ve Factors Environmental Feedback on performance Autonomy Chances for professional development Support from supervisors, peers, family Personal Deliberate self- care Boundary sejng Coping techniques Dyrbye et al, 2014, Academic Medicine Thomas, 2004, JAMA 13

14 How Coaches Can Help: 6 Strategies 14

15 How Coaches Can Help 1. Recognize that you are already a part of the solugon! 15

16 Coping Reserve Ann Ming Caroline Carrie L. Carrie R. David Debbie Hayley Jen KaGe Lucy Dunn et al, 2008, Academic Psychiatry 16

17 How Coaches Can Help 1. Recognize that you are already a part of the solu.on! 2. Embrace self- care as a core competency 17

18 How Coaches Can Help 1. Recognize that you are already a part of the solu.on! 2. Embrace self- care as a core competency PROF4: Self- awareness of emo.onal limita.ons PROF6: Capacity to accept ambiguity ICS2: Insight and understanding human response to emo.on that allows for management of interac.ons 18

19 How Coaches Can Help 1. Recognize that you are already a part of the solu.on! 2. Embrace self- care as a core competency 3. Complete a life review Meaning Balance Value 19

20 How Coaches Can Help 1. Recognize that you are already a part of the solu.on! 2. Embrace self- care as a core competency 3. Complete a life review 4. Meet fundamental needs AffiliaGon/Belonging AffecGon/Nurturance Self- efficacy 20

21 How Coaches Can Help 1. Recognize that you are already a part of the solu.on! 2. Embrace self- care as a core competency 3. Complete a life review 4. Meet fundamental needs 5. Meet personal needs Up- regulagng Down- regulagng 21

22 How Coaches Can Help 1. Recognize that you are already a part of the solu.on! 2. Embrace self- care as a core competency 3. Complete a life review 4. Meet fundamental needs 5. Meet personal needs Up- regula.ng Down- regula.ng 6. Expand coping toolkit 22

23 Expand Coping Toolkit 23

24 Three Coping Orienta.ons Task- oriented Problem- solving Priori.zing tasks Learning from mistakes Seeking emo.onal support Prac.cing acceptance (mindfulness) Cogni.ve restructuring EmoGon- oriented Self- blame/responsibility Preoccupa.on or rumina.on Denial Wishful thinking Ac.ng out Displacement Avoidance- oriented Daydreaming Watching TV Seeking company Being with others 24

25 Three Coping Orienta.ons Task- oriented Problem- solving Priori.zing tasks Learning from mistakes Seeking emo.onal support Prac.cing acceptance (mindfulness) Cogni.ve restructuring EmoGon- oriented Self- blame/responsibility Preoccupa.on or rumina.on Denial Wishful thinking Ac.ng out Displacement Avoidance- oriented Daydreaming Watching TV Seeking company Being with others 25

26 Task- Oriented Coping Strategies Cogni.ve restructuring Mindfulness Breathing Exercises 26

27 Cogni.ve Restructuring 1. Iden.fy the mood triggering event 2. Describe what happened 3. Iden.fy automagc thoughts and cognigve distorgons I m a horrible doctor I fail at everything 4. Look for evidence 5. Iden.fy fair and balanced thoughts I may have messed up this one.me, but I ve done well other.mes 6. Evaluate the resul.ng mood/affect 27

28 Mindfulness Paying apen.on, on purpose, in the present moment, non- judgmentally Focus on being, not doing Lowers reac.vity to challenging experiences Changes rela.onship to emo.ons Is my awareness of my sadness sad? Expands repertoire for experiencing oneself I am not my thoughts I feel it but it s not necessarily true Generosity and compassion Kabat- Zinn,

29 Mindfulness Krasner et al, JAMA, PCPs, 8 wk course (2.5 hrs/wk) Didac.cs Mindfulness medita.on Narra.ve and apprecia.ve inquiry Pre/post test MBI, Jefferson Empathy Scale, Physician Belief Scale, Profile Mood States Significant reduc.ons in burnout, fa.gue, depression and anger Improvements in empathy Changes remained 12 and 15 mths post- interven.on 29

30 Mindfulness Fortney et al, 2013, Annals Family Medicine 26 PCPs, 18 hour course Mindfulness training (sijng, movement, compassion) Prac.ce min/day Pre/post MBI, Depression Anxiety Stress Scale, Resilience Scale, Brief Compassion Scale Significant reduc.on in burnout, anxiety, stress, and depression 30

31 Breathing Exercises Key component of mindfulness training programs Easy, simple and powerful Lowers physiological arousal Can be done any.me, anywhere Many different types (see handout) 31

32 When do we intervene? 32

33 When do we intervene? Lower Risk Behaviors Abrupt with pa.ents and/or colleagues Irritable Poor eye contact Hygiene changes Higher Risk Behaviors Missing mee.ngs/tardiness Labile mood/affect Anger Defensiveness Ea.ng changes APen.on deficits Rela.onship problems Substance use/abuse Suicidal comments 33

34 When do we intervene? Address immediately with residents exhibi.ng higher risk behaviors Be on alert with lower risk; discuss before it gets worse Discuss with resident first, ask for permission to pull in addi.onal support (excep.on: self- harm) Encourage u.liza.on of resources (see purple handout) Inform Becky and Carrie R. Seek support for yourself 34

35 Ques.ons? 35

36 Objec.ves Define burnout and recognize its dis.nguishing characteris.cs Iden.fy the risk and protec.ve factors for burnout Describe 3 strategies to address burnout and prevent its occurrence Apply 1 strategy to coaching 36

37 Cogni.ve Restructuring 1. Iden.fy the mood triggering event 2. Describe what happened 3. IdenGfy automagc thoughts and cognigve distorgons I m a horrible doctor I fail at everything 4. Look for evidence 5. IdenGfy fair and balanced thoughts I may have messed up this one Gme, but I ve done well other Gmes 6. Evaluate the resul.ng mood/affect 37

38 Goal Build Resilient Physicians Resilience is built through: Task- oriented coping strategies (cogni.ve restructuring) Emo.onal regula.on Strong support networks AffiliaGon/Belonging AffecGon/Nurturance Engagement in non- destruc.ve self- care ac.vi.es 38

39 References Dunn LB, Iglewicz A, Mou.er C. A conceptual model of medical student well being. Promo.ng resilience and preven.ng burnout. Academic Psychiatry. 2008;32(1): Fahrenkopf AM, Sec.sh TC, Barger LK, et al. Rates of medica.on errors among depressed and burnt out residents: prospec.ve cohort study. BMJ. 2008;336(7642): Ishak W, Lederer S, Mandili C, et al. Burnout during residency training: a literature review. J Grad Med Educ. 2009;1: Kearney M, Weininger R, Vachon M, et al. Self- care of physicians caring for pa.ents at the end of life. JAMA. 2009;301(11): Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, Calif: Consul.ng Psychologists Press;

40 References Prins JT, van der Heijden FMMA, Hoekstra- Weebers JEHM, et al. Burnout, engagement and resident physicians self- reported errors. Psychol Health Med. 2009;14: Ripp et al. The impact of duty hour restric.ons on job burnout in internal medicine residents: A three ins.tu.on comparison. Academic Medicine, Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self- reported pa.ent care in an internal medicine residency program. Ann Intern Med. 2002;136: West CP, Huschka MM, Novotny PJ. Associa.on of perceived medical errors with resident distress and empathy: a prospec.ve longitudinal study. JAMA. 2006;296: West CP, Tan AD, Habermann TM, et al. Associa.on of resident fa.gue and distress with perceived medical errors. JAMA. 2009;302:

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