Positive Psychology and Preventing Burnout in Medical Residents
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Positive Psychology and Preventing Burnout in Medical Residents


June 22, 2023

The Master of Applied Positive Psychology Program at PCOM is tackling the well-documented problem of burnout among medical residents.

Dr. Scott Glassman and recent MAPP graduate Linda Martin are shown in a classroom.
Dr. Scott Glassman and Linda Martin presented a workshop designed to help residents deal with stress and become more proactive about mental health.

This month, MAPP Director Dr. Scott Glassman, and recent MAPP graduate Linda Martin (’23), presented a positive psychology-based workshop as part of PCOM’s annual multi-site resident orientation. They hope it will bolster a culture of wellness in residency and reduce the potential for burnout.

The workshop offers a preventive health perspective that aims to better insulate residents against the damaging effects of chronic stress. It also helps them implement practices like gratitude and strengths-finding that could enhance their sense of well-being.

“If we just focus on the worst instances of burnout, with a triage mentality, we miss opportunities to help residents become more proactive about their mental health,” says Dr. Glassman.

The Problem of Burnout in Residency

Residency is a demanding time that marks a medical student’s transition into the rigorous and in-depth work of a physician. Sleep disruption, high stress work environments, conflicts with coworkers, and overloaded shifts are just some of the factors that contribute to the condition.

According to Maslach and colleagues, there are three core features of burnout: detachment, emotional exhaustion, and low sense of personal accomplishment.

Residents experience these symptoms at high rates, with 55% and 76% meeting burnout criteria according to two studies. The consequences can include depression, suicidal thoughts, medical errors, and poorer patient care.

Dr. David Kuo, associate dean for Graduate Medical Education at PCOM, cites the additional pressure of autonomy in clinical decision-making.

“You are making treatment decisions about very complex medical problems that could have very serious repercussions if you don't choose correctly,” states Kuo. “That is a lot of pressure on someone who is still learning.”

Kuo added that the long hours residents work can negatively affect their personal relationships, limiting time spent with friends and loved ones.

This can create a perfect storm of high stress, diminished connection with others, and a reduction in activities that naturally generate positive emotions.

Preventing Burnout: Self-Awareness and Opportunities for Positive Experiences

The first part of an effective prevention plan is increasing self-awareness. This involves helping residents identify when they are entering a “burnout danger zone.”

Glassman and Martin presented a validated two-question burnout screener that can assist with catching early signs. Respondents rate how often they’ve felt burned out and callous toward others. If they indicate once a week or more, they would want to take action to prioritize self-care.

Beyond noticing increases in burnout symptoms, Glassman and Martin presented four strategies around activating gratitude and focusing on personal strengths, which can increase positive emotions and strengthen a positive sense of self:

  • Keeping a daily gratitude journal can contribute to feelings of fulfilment in residency work. The journal can also double as a diary of positive events from residency work. Evidence supports the connection between gratitude and positive mental health.
  • Expressing appreciation for peers, attending physicians, and staff on a regular basis can create a culture of hope and motivation. This can be done through text, email, brief notes, or verbally.
  • Identifying personal strengths through the VIA Character Survey can remind residents of what their personal strengths are, which may prove most useful when they feel a low sense of personal accomplishment. They can also make a plan that involves using those strengths in activities that make them feel good.
  • Electing a Resident Wellness Champion can add a formal structure and accountability around wellness as a team-supported value. The champion can organize fun events and help make sure positive connection and self-care remain a priority.

Dr. Kuo has already elevated personal well-being and burnout prevention to a prominent place in the residency programs he coordinates. A faculty member meets with all programs on a quarterly basis to discuss wellness. Additionally, each program has money set aside for wellness events.

“Some programs have had a day at a park where they enjoyed the outdoors and had food catered,” says Kuo. “Others have gone golfing, bowling, or out to dinner.”

For Kuo, collaborating with the MAPP program represents part of the preventive health mindset.

“I hope the presentation brought to the forefront, the idea of gratitude,” he says. “Gratitude not only for others, but for themselves. They need to remember to be kind to themselves and appreciate the high quality care they are providing to the community.”

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