November 12th, 2019
Can Minor Changes in a Program Affect Resident Burnout?
“How did you like it there?” I ask, sitting down next to a new fellow (between bites of a plump sandwich, hoping there is no spinach in my teeth).
I expect to hear the standard resident talking points — long hours, frequent call, and ballooning student loans. Instead, she surprises me.
“Do you know how much they charged us to park there every month?”
I frequently text friends who are residents at her previous program. It is a program I respect — complex cases, the right amount of autonomy, meaningful research opportunities, and faculty dedicated to resident development. Things a resident wants in a program and things a quality program delivers.
She continues to list off things that could appear to be so inconsequential — lack of call rooms, cafeteria overcharging and closing early, and being called by her first name by staff in front of patients. I just met her, but I sense she isn’t whining or trying to win a pity award. Instead, she is opening up. Being vulnerable. Speaking trainee to trainee. I dab my mouth with the beige napkin and continue to listen.
“Do you know how many cavities I have now?!” I perk up and shake my head in disbelief as I finally swallow that bite of sandwich.
The more I think about these minor things and how they make some residents feel, the more the whole concept begins to make sense.
Most residents I’ve talked to will embrace the inherent challenges of residency. That means waking up early, staying late, and mastering the nuances of a field that proposes intellectual, emotional, physical, and moral challenges. Residency should be challenging. Residents know that it is temporary. But here is the sticking point: Residency shouldn’t have to be any more challenging than that.
Minor things may be making residency unnecessarily more laborious and taxing than it has to be.
At times, I get the sense that the discussion about resident burnout is centered around large system-wide changes. Such sweeping changes merit careful consideration. However, do talks about the system overshadow and crowd out an additional issue — the minor things?
I propose we consider these seemingly inconsequential and minor changes. This is in addition to, rather than instead of, larger changes. Things like getting quarters for laundry, going to the DMV, getting something notarized, picking up packages at the post office and, yes, going to the dentist.
In isolation, one could view these minor changes as trivial. I can certainly see how it can be taken that way. To be clear, these minor annoyances are not more important than learning to become a physician. But here is the main message — taken in the right context, although the theme is clear: “Your input is valued and we are listening, you are a human being, and we respect you.”
So here is the key question: Are there minor ways in which programs can listen to what residents want and then deliver those things without radically changing the system? This means a residency program may already have allocated the time or money. These minor measures won’t fundamentally change the well-described barriers (culture, leadership, and financial incentives) to improving the system. Nor do these minor changes excuse us from having frank discussions and acknowledging ripe areas of opportunity. However, these tiny steps are a start. They may serve as a small foundation of trust and communication between programs and residents. They may herald a new way of approaching old problems. They may seem more real and tangible. And, they may even be easier to implement, since they offer a way to gradually make changes from within the system instead of retooling the entire system.
A Recent Study
Are there any data to support using an existing framework to promote resident wellness in a minor way? Let’s look at a recent study of nearly 60 radiology residents (J Am Coll Radiol 2019; 16:221). These residents had 15 vacation days and 12 sick days. That means the program already had these days covered and funded. But here is where it got interesting — the program renamed 5 sick days and instead called them “wellness days.” Simple rebranding. These new “wellness days” could not be used on Mondays or Fridays to extend a vacation. What was the result?
- The non-burnout group used more wellness days (71%) than did the burnout group (45%).
- 86% of residents strongly agreed or agreed that “wellness days can help reduce or prevent burnout.”
- 68% of residents strongly agreed or agreed that “wellness days have had a positive impact on experience as a resident.”
On the surface, these minor changes seem, well, minor. With a closer look, they reflect an expert understanding of the following:
- Listening to residents
- Implementing cost-effective solutions
- Working within an existing framework
- Allowing residents the autonomy and freedom to engage in wellness activities of their choice
We all know by now how bad resident burnout is. So minor solutions like the one above are reasons for hope and measured optimism. Of course, minor solutions certainly won’t fix all the structural maladies plaguing our training system. Nor are minor changes ideal. But they are a practical step in the right direction. And it is a step that doesn’t require asking for money, going through 12 committees, or depending on large governing bodies to approve changes.
The main message is this:
- Residents are on the front line — listen to them, because they may have creative solutions and insight.
- Solutions don’t have to be expensive or require a dramatic overhaul — the framework may already exist.
- These solutions may be considered “minor” but may be highly valued by residents and decrease resident burnout.
- Residents know what makes them well — allow them to engage in activities of their choice. It is not a one-size-fits-all approach.
And now I’d welcome and encourage your feedback. Would this work or not? Are there any other “minor” solutions that could be implemented?