Resident wellness program lowers burnout risks for urology trainees

With heavy workloads and high professional and personal demands, medical residents in training - and those in urology residency programs—face a high risk of burnout. At one urology department, a wellness program designed by and for residents produced meaningful reductions in burnout risks, reports a study in Urology Practice, an Official Journal of the American Urological Association (AUA).

The Resident Wellness Curriculum (RWC) in the Scott Department of Urology at Baylor College of Medicine, Houston, led to significant improvements in key aspects of burnout, according to the new research by Jennifer M. Taylor, MD, and colleagues. "We found a purposeful approach to promoting residents' well-being can improve their perceptions of the training program's organizational culture—leading to measurable improvement in some of the defining characteristics of burnout," Dr. Taylor comments.

Proactive approach to addressing high risk of burnout in urology residents

"The RWC grew out of a purposeful programmatic effort to effect true positive culture change in our urology residency program in the domains of wellness and burnout," comments Program Director and co-author Dr. Wesley Mayer. "We began by facilitating open and honest dialogue with our residents in flipped classroom sessions, leading to a detailed needs assessment. We then executed on resident feedback and suggestions, which helped build a culture of trust between the residents and program leadership."

The program includes resident-faculty social groups, seeking to bolster relationships and build rapport outside the work environment; structured mentorships, with time set aside for formal mentoring meetings between residents and faculty; resident social outings, for trainees to interact and socialize outside of work; and wellness education, including education and information on physician wellness. It also includes an annually restocked Wellness Fund, which gives the residents a mechanism to request an event or a resource that they have chosen as a group.

Developed in collaboration between urology faculty, residents and department leadership, the RWC was entirely funded by donations from program faculty. "We were fortunate to have 100 percent participation from faculty members," said urology resident Dr. James Anaissie, lead author of the study. "It really affirmed our department's commitment to resident wellness, and led to improvements in residents' perceptions of the program's culture."

The researchers performed before-and-after surveys to evaluate how the program affected residents' burnout risks and well-being. A standard assessment (the Maslach Burnout Index) was used to assess the RWC's effects on the three defining characteristics of burnout, resulting in:

• Scores for depersonalization decreasing by 28 percent. On average, the residents moved from high to moderate depersonalization scores from before to after the RWC.
• Scores for emotional exhaustion decreasing by 20 percent. Again, the average score improved from the high to the moderate range.
• Scores for personal accomplishment showing no significant change and remaining in the moderate range.

Scores on a rating of physicians' wellness (the Mayo Clinic Well-Being Index) improved by more than 50 percent, indicating decreased levels of distress. Of all initiatives included in the RWC, the resident social outings were rated most meaningful by the residents.

The promising results have encouraged the authors to continue to improve the program's culture in innovative ways. They continue periodic de-identified surveys of the residents and evaluate the responses. Most recently, a resident-designated ombudsman role was created, providing a structured and trusted mechanism for residents to anonymously bring up topics regarding wellness and program improvement with their program leadership.

"Our experience adds to studies from other training programs in showing proactive and comprehensive identification of the potential causes of burnout can enhance residents' well-being, including significant reductions in some of the key aspects of burnout," says Dr. Taylor. "Making systematic changes to our department culture, with input from residents and full support from faculty, helped to promote trainees' professional growth in a demanding specialty while supporting their mental health and well-being."