This article explores why residents are at even higher risk of burnout and mental health deterioration than the average physician population. We then look at the evidence base for resident burnout prevention programs and consider why postgraduate education providers should seriously consider investing in these. Resident Coaching programs are examined as having a strong, growing, and relevant evidence-base if we are to solve physician burnout.
The attentive reader may notice some recurring themes highlighted in yellow in the evidence from 3 studies below, which comes from an excellent review of studies on nearly 100,000 residents over 30 years:
So some things can’t be changed by hospitals – age, relationship status, gender, use of mental health services.
But the hospitals training our residents NEED to address workload, rest, supervision, poor workplace relations, and also support those with mental health issues (25%+).
They can also help by skilling residents to overcome neuroticism, workplace conflict, missing coping strategies, and a lack of confidence. This is where brain-based interventions may have a role.
Factors identified in psychological well-being research which are associated with increased resident well-being are:
… and (who knew!) greater well-being is associated with increased empathy.
We argue that the toxicity needs to be addressed, but of course would never refuse help to better manage what is a stressful – literally life and death – profession.
A number of interventions have looked at helping residents lower their stress levels, or at least manage the toxic stress of residency a bit better.
Multiple studies show that coaching may reduce burnout and improve well-being among physicians and trainees, but 1:1 coaching delivered face-to-face is resource-intensive and incompatible with a busy resident’s working life. Post pandemic, virtual coaching has opened up opportunities for time- and cost- effective ways of delivering quality physician coaching, both 1:1 and group based.
Recently, 2 studies of group-based web-delivered coaching were trialed, with impressive results.
In a 6-month web-based group-coaching program for female residents, Fainstad and colleagues found that the intervention group experienced statistically significantly reduced measures of emotional exhaustion and impostor syndrome compared with controls. The intervention residents also reported increased self-compassion scores, while the control group – residents going through training as usual with no coaching – experienced decreased self-compassion scores.
No statistically significant differences in depersonalization, professional accomplishment, or moral injury scores were observed.
Another 2022 trial of a Virtual Professional Development Coaching Program for surgical residents by Palamara and colleagues showed similar results. T he intervention group showed significant improvement in professional fulfilment (P=0.021), burnout (0.026), work exhaustion (0.017), self-valuation (0.003), and well-being (P=0.002); whereas the control group showed significant improvement in self-valuation (P=0.015) and significant decline in resilience (P=0.025). The intervention group had a significant improvement in well-being (P=0.015) and intolerance of uncertainty (P=0.015) compared to controls.
What did these coaching programs include?
Takeaways? Group coaching improves emotional exhaustion, imposter syndrome, and self-compassion.
And, critically, doing nothing sees these metrics deteriorating during “normal” residency.
Professional coaching uses inquiry around perceptions, beliefs, and habits to define, reframe, and align work with personal values. Coaching differs from mentoring, advising, and teaching in that it uses inquisition and metacognition, rather than advice, to help the individual receiving coaching to manage thoughts, feelings, and actions, to move toward fulfilment.
Unlike therapy, coaching does not diagnose or clinically treat the individual receiving coaching.
When supported institutionally, coaching is highly accessible and does not require insurance approval or a copay.
Although coaching is widely used in corporate environments, it is relatively new in academic medicine. Yet a growing body of evidence supports its efficacy in reducing burnout, improving resilience, and cultivating thriving doctors during some of the most challenging training conditions.
The evidence informs us that structured group coaching interventions for resident doctors improves emotional exhaustion, imposter syndrome, and self-compassion scores.
And doing nothing causes harm: mental health metrics deteriorate during “normal” residency.
Resident burnout prevention is entirely possible, and training organizations should seriously consider investing in their residents. The cost of one resident going off sick with burnout will more than pay for a coaching course.
If you are interested in the Physicians Anonymous Burnout Vaccine Program, please contact us for more information.