https://doi.org/10.4081/qrmh.2018.7417

Stress and burnout in anesthesia residency: an exploratory case study of peer support groups

Vol. 2 No. 2 (2018)
Submitted: 14 March 2018
Accepted: 3 August 2018
Published: 3 September 2018
Anesthesia residency training, Burnout, Stress, Physician health, Peer support.
Abstract Views: 2431
PDF: 800
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Authors

Jessica Spence
Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
David Smith
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
Anne Wong
wongan@mcmaster.ca
Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
Stress and burnout are alarmingly prevalent in anesthesiologists, with the highest risk occurring during anesthesia residency training. To better understand this phenomenon, we conducted a mixed methods case study of our anesthesia training program to explore the residents’ accounts of stress and burnout and the potential value of peer support groups. Eight out of thirty eight residents participated in nine monthly peer support group (PSG) meetings followed by a focus group interview about stress and burnout in training and the value of PSG. We compared the participants’ mean pre-and post-PSG Maslach Burnout Inventory® (MBI) and Perceived Stress Scale® (PSS) and analysed the focus group interview for recurring themes. We captured the perspectives of twenty seven out of thirty residents who did not participate in support groups (non-participants) through an online survey on stress and burnout. We found evidence of a high prevalence of stress and burnout from the MBI and PSS scores and survey responses. Analysis of the focus group interview showed that the specific stressors of anesthesia training included: an individually-based model of training that predisposes to isolation from peers, an over-reliance on the quality of the faculty-resident relationship and the critical, high stakes nature of the profession. Residents strongly endorsed the value of PSG in decreasing isolation, enhancing validation, and support through the sharing of experiences. Lack of dedicated time and integration into the training program were major barriers to PSG participation. These barriers need to be overcome in order to fully realize its role in mitigating stress and burnout.

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Scopus
Google Scholar
Europe PMC
Dyrbye LN, Harper W, Moutier C, et al. A multi-institutional study exploring the impact of positive mental health on medical students' professionalism in an era of high burnout. Acad Med 2012;87:1024-31. DOI: https://doi.org/10.1097/ACM.0b013e31825cfa35
Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Sateli D, Sloan J, West CP. Changes in burnout and worklife balance in physicians between 2011-2014. Mayo Clin Proc 2015; 90(12) :1600-13. DOI: https://doi.org/10.1016/j.mayocp.2015.08.023
Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996.
Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004;161:2295-2302. DOI: https://doi.org/10.1176/appi.ajp.161.12.2295
Larsson J, Sanner M. Doing a good job and getting something good out of it: on stress and well-being in anaesthesia. Br J Anaesth 2010;105:34-7. DOI: https://doi.org/10.1093/bja/aeq125
Larsson J, Rosenqvist U, Holmstrom I. Enjoying work or burdened by it? How anaesthetists experience and handle difficulties at work: a qualitative study. Br J Anaesth 2007;99:493-9. DOI: https://doi.org/10.1093/bja/aem233
Larsson J, Rosenqvist U, Holmstrom I. Being a young and inexperienced trainee anesthetist: a phenomenological study on tough working conditions. Acta Anaesthesiol Scand 2006;50:653-8. DOI: https://doi.org/10.1111/j.1399-6576.2006.01035.x
Hyman SA, Michaels DR, Berry JM, et al. Risk of burnout in perioperative clinicians: a survey study and literature review. Anesthesiology 2011;114:194-204 DOI: https://doi.org/10.1097/ALN.0b013e318201ce9a
Nyssen AS, Hansez I, Baele P, et al. Occupational stress and burnout in anaesthesia. Br J Anaesth 2003;90:333-7. DOI: https://doi.org/10.1093/bja/aeg058
De Oliveira GS, Chang R, Fitzgerald PC, Almeida MD, Castro-Alves LS, Ahmad S, et al. The prevalence of burnout and depression and their association with adherence to safety and practice standards: A survey of United States anesthesiology trainees. Anesth Analg 2013; 117(1):182-93 DOI: https://doi.org/10.1213/ANE.0b013e3182917da9
Alexander BH, Checkoway H, Nagahama SI, Domino KB. Cause-specific mortality risks of anesthesiologists. Anesthesiology 2000;93:922-30. DOI: https://doi.org/10.1097/00000542-200010000-00008
Kuhn CM, Flanagan EM. Self-care as a professional imperative: physician burnout, depression, and suicide. Can Anesth 2017; 64:158-68. DOI: https://doi.org/10.1007/s12630-016-0781-0
Fry RA, Fry LE, Castanelli DJ. A retrospective survey of substance abuse in anaesthetistis in Australia and New Zealand from 2004-2013. Anaesth Intensive Care 2015; 43(1): 111-117. DOI: https://doi.org/10.1177/0310057X1504300117
Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet 2009;374:1714-21. DOI: https://doi.org/10.1016/S0140-6736(09)61424-0
Engel KG, Rosenthal M, Sutcliffe KM. Residents' responses to medical error: coping, learning, and change. Acad Med 2006;81(1):86-93. DOI: https://doi.org/10.1097/00001888-200601000-00021
Hu YY, Fix ML, Hevelone ND, et al. Physicians' needs in coping with emotional stressors: the case for peer support. Arch Surg 2012;147(3):212-7. DOI: https://doi.org/10.1001/archsurg.2011.312
Satterfield JM, Becerra C. Developmental challenges, stressors and coping strategies in medical residents: a qualitative analysis of support groups. Med Educ 2010;44(9):908-16. DOI: https://doi.org/10.1111/j.1365-2923.2010.03736.x
van Wyk BE, Pillay-van Wyk V. Preventive staff-support interventions for health workers. Cochrane Database Syst Rev 2010(3):CD003541. DOI: https://doi.org/10.1002/14651858.CD003541.pub2
Kjeldmand D, Holmstrom I, Rosenqvist U. Balint training makes GPs thrive better in their job. Patient Educ Couns 2004;55(2):230-5. DOI: https://doi.org/10.1016/j.pec.2003.09.009
Holden M, Buck E, Clark M, et al. Professional identity formation in medical education: the convergence of multiple domains. HEC Forum 2012;24(4):245-55. DOI: https://doi.org/10.1007/s10730-012-9197-6
Rosenzweig S, Reibel DK, Greeson JM, et al. Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med 2003;15(2):88-92. DOI: https://doi.org/10.1207/S15328015TLM1502_03
Warnecke E, Quinn S, Ogden K, et al. A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Med Educ 2011;45(4):381-8 DOI: https://doi.org/10.1111/j.1365-2923.2010.03877.x
Charon R. At the membranes of care: stories in narrative medicine. Acad Med 2012;87(3):342-7. DOI: https://doi.org/10.1097/ACM.0b013e3182446fbb
Yin RK. Case study research : design and methods. 3rd ed. Thousand Oaks, CA: Sage Publications; 2003
Merriam SB. Qualitative research : a guide to design and implementation. San Francisco: Jossey-Bass; 2009.
Creswell JW, Plano-Clark V. Designing and conducting mixed methods research. 2nd ed. Thousand Oaks: Sage Publications; 2007
Rafferty JP, Lemkau JP, Purdy RR, Rudisill JR. Validity of the Maslach Burnout Inventory for family practice physicians. J Clin Psychol 1986;42(3):488-92. DOI: https://doi.org/10.1002/1097-4679(198605)42:3<488::AID-JCLP2270420315>3.0.CO;2-S
Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med 2006;81(1):82-5. DOI: https://doi.org/10.1097/00001888-200601000-00020
Thomas NK. Resident burnout. JAMA 2004;292(23):2880-9. DOI: https://doi.org/10.1001/jama.292.23.2880
West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med 2009;24(12):1318-21. DOI: https://doi.org/10.1007/s11606-009-1129-z
West CP, Dyrbye LN, Satele DV, et al. Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment. J Gen Intern Med 2012;27(11):1445-52. DOI: https://doi.org/10.1007/s11606-012-2015-7
West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA 2011;306(9):952-60. DOI: https://doi.org/10.1001/jama.2011.1247
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24(4):385-96 DOI: https://doi.org/10.2307/2136404
Duffrin C, Larsen L. The effect of primary care fellowship training on career satisfaction, happiness and perceived stress. Postgrad Med J 2014;90(1065):377-82. DOI: https://doi.org/10.1136/postgradmedj-2012-131512
Shah M, Hasan S, Malik S, Sreeramareddy CT. Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani medical school. BMC Med Educ. 2010;10:2. DOI: https://doi.org/10.1186/1472-6920-10-2
Cohen S, Janicki-Deverts D. Who's stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006 and 2009. J Appl Soc Psychol 2012;42:1320-34. DOI: https://doi.org/10.1111/j.1559-1816.2012.00900.x
De Oliveira GS, Almeida MD, Ahmad S, Fitzgerald PC, McCarthy RJ. Anesthesiology residency program director burnout. J Clin Anesth 2011;23(3):176-82. DOI: https://doi.org/10.1016/j.jclinane.2011.02.001

Supporting Agencies

Funding from a Special Projects Grant, the Canadian Physician Health Institute.

How to Cite

Spence, Jessica, David Smith, and Anne Wong. 2018. “Stress and Burnout in Anesthesia Residency: An Exploratory Case Study of Peer Support Groups”. Qualitative Research in Medicine and Healthcare 2 (2). https://doi.org/10.4081/qrmh.2018.7417.

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