Systems-Based Interventions to Reduce Resident Physician Burnout: A Systematic Review
Poster #: 026
Session/Time: A
Author:
Fatima Wajid Chaudhry, BS, MS
Mentor:
Rehan Qayyum, MD, MHS, SFHM, FAHA
Research Type: Educational
Abstract
INTRODUCTION:
High prevalence of burnout is a major concern in the medical field and resident physicians are particularly vulnerable, as they are expected to carry heavier workloads, endure inconsistent schedules, and receive lower pay, all while still being regarded as trainees. A previous systematic review found that the prevalence of burnout in resident physicians is as high as 50%, which increased to 76% post-COVID-19. Residency programs responded by designing systems-based interventions to deter burnout development. This systematic review seeks to identify studies between July 2016 and September 2024 and assess the impact of these interventions on resident burnout.
METHODS:
A systematic review was performed following the PRISMA 2020 guidelines. Identical search on three major databases (PubMed, Embase, and Web of Science) was performed using the keywords "burnout" AND "residency" OR "residency" OR "intern." This identified 12,550 peer-reviewed articles. Studies were included if they met the following criteria: 1) peer reviewed articles, 2) published in English 3) original research, and 4) an intervention that aimed to improve, assess, and report 5) burnout outcomes for resident physicians. Duplicates were removed and data were extracted from each article. Study quality was assessed using the ROBINS-I tool for cohort studies and Cochrane RoB 2 for randomized controlled trials.
RESULTS:
were pooled using random-effects meta-analysis for both continuous and categorical outcomes, followed by a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to highlight the overall certainty of evidence.
RESULTS:
We found 14 non-randomized control studies, including a total of 1,002 residents, that implemented either structural or organizational systems-based interventions. Interventions included, but were not limited to, changes to call schedules, expanding outpatient time, protection of non-clinical time, and promotion of wellness initiatives. Thirteen of the 14 studies implemented passive interventions, while only 1 utilized an active approach. Pooled results from 5 studies, found a significant reduction in emotional exhaustion (pooled mean difference[PMD]=-0.38, CI: -0.52 to -0.23, p<.0001) and depersonalization (PMD=-0.28, CI: -0.42 to -0.14, p<.0001) and a significant increase in personal accomplishment (PMD=0.21, CI: 0.07 to0.34, p=.003). However, pooling of results from the 2 studies examining overall burnout did not find a significant effect (PMD= -0.25, CI: -0.26 to 0.25, p=0.33.). Moderate heterogeneity was noted among studies reporting with emotional exhaustion (I2=60%) and mild heterogeneity with depersonalization (I2=46%). No heterogeneity was reported in studies assessing professional accomplishment (I2=0%) or overall burnout (I2=0%).
CONCLUSION:
Implementing systems-based interventions to address burnout has demonstrated promising outcomes, including a meaningful reduction in emotional exhaustion and depersonalization, along with an enhancement of personal accomplishment in residents. Overall burnout was not affected; however, this result may be limited by the inclusion of only 2 studies. These findings support the integration of systems-based interventions to confront resident burnout and suggest further investigation to delineate the most effective ways to structure them.
High prevalence of burnout is a major concern in the medical field and resident physicians are particularly vulnerable, as they are expected to carry heavier workloads, endure inconsistent schedules, and receive lower pay, all while still being regarded as trainees. A previous systematic review found that the prevalence of burnout in resident physicians is as high as 50%, which increased to 76% post-COVID-19. Residency programs responded by designing systems-based interventions to deter burnout development. This systematic review seeks to identify studies between July 2016 and September 2024 and assess the impact of these interventions on resident burnout.
METHODS:
A systematic review was performed following the PRISMA 2020 guidelines. Identical search on three major databases (PubMed, Embase, and Web of Science) was performed using the keywords "burnout" AND "residency" OR "residency" OR "intern." This identified 12,550 peer-reviewed articles. Studies were included if they met the following criteria: 1) peer reviewed articles, 2) published in English 3) original research, and 4) an intervention that aimed to improve, assess, and report 5) burnout outcomes for resident physicians. Duplicates were removed and data were extracted from each article. Study quality was assessed using the ROBINS-I tool for cohort studies and Cochrane RoB 2 for randomized controlled trials.
RESULTS:
were pooled using random-effects meta-analysis for both continuous and categorical outcomes, followed by a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to highlight the overall certainty of evidence.
RESULTS:
We found 14 non-randomized control studies, including a total of 1,002 residents, that implemented either structural or organizational systems-based interventions. Interventions included, but were not limited to, changes to call schedules, expanding outpatient time, protection of non-clinical time, and promotion of wellness initiatives. Thirteen of the 14 studies implemented passive interventions, while only 1 utilized an active approach. Pooled results from 5 studies, found a significant reduction in emotional exhaustion (pooled mean difference[PMD]=-0.38, CI: -0.52 to -0.23, p<.0001) and depersonalization (PMD=-0.28, CI: -0.42 to -0.14, p<.0001) and a significant increase in personal accomplishment (PMD=0.21, CI: 0.07 to0.34, p=.003). However, pooling of results from the 2 studies examining overall burnout did not find a significant effect (PMD= -0.25, CI: -0.26 to 0.25, p=0.33.). Moderate heterogeneity was noted among studies reporting with emotional exhaustion (I2=60%) and mild heterogeneity with depersonalization (I2=46%). No heterogeneity was reported in studies assessing professional accomplishment (I2=0%) or overall burnout (I2=0%).
CONCLUSION:
Implementing systems-based interventions to address burnout has demonstrated promising outcomes, including a meaningful reduction in emotional exhaustion and depersonalization, along with an enhancement of personal accomplishment in residents. Overall burnout was not affected; however, this result may be limited by the inclusion of only 2 studies. These findings support the integration of systems-based interventions to confront resident burnout and suggest further investigation to delineate the most effective ways to structure them.