Watch for signs of burnout

Residency Program Insider, October 7, 2005

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Dear residency program colleague:

Stress can lead to resident burnout. The resident becomes exhausted, emotionally, and physically. Signs of burnout can include excessive alcohol use, poor grooming, unusual weight gain or lose, a decrease in attention span, more complaints of physical ailments, unusual irritability or disruption, or inappropriate comments and jokes. Frequent visits to the emergency department for minor accidents can be a sign that the resident is abusing alcohol. Other warning signs include

Take the following steps to help residents better deal with stress:

  • Remind them that the residency does not last forever. Learning should be a lifelong goal, but the intense pressure of a residency has an endpoint.
  • Encourage residents to use sugar and caffeine sparingly, to avoid the low that comes when these substances wear off.
  • Discourage residents from living on tomorrow's expected income. Residents who live on future earnings that may or may not be there only exacerbate stress of debt problems.
  • Encourage more exercise and better diet.
  • Endorse the idea of breaks. The culture of medicine often teaches residents just the opposite, so it's important to show residents that it is more than okay for them to take a break now and then.
  • Allow for the extra stress of night float. Night float may be a necessary solution for scheduling residents, but you must consider the stress it causes residents.
  • Ask the resident during evaluations how they handle stress and what activities they pursue outside the hospital.
  • After an adverse event, be especially careful not to diminish the resident's feelings. Express empathy, support, and understanding. Remember that a bad patient outcome can be especially hard on residents and the way they react to it can influence the rest of their residency experience.
  • Urge residents to develop a buddy check system. If the resident is out sick one day, his buddy should call and ask how he's doing and if anything is needed. Residents can grow isolated even thought they are interacting with people every day.
  • Distinguish work hours from the larger issue of work conditions. With so much focus on the issue of work hours, it is easy to overlook the many other factors that contribute to the overall environment for residents. Does the system have a system for blood draws and patient transportation that takes the burden off residents?
  • Whenever you discuss any potential stress-related difficulty, establish a time to follow up on the problem. Don't just tell the resident to come back if necessary. When you tell them to come back if they need to, you rarely see them in your office again. That makes it too easy to assume that you solved the problem and everything is fine.

    That's all for this week!

    All the best,

    Acacia Aguirre, MD, PhD
    Medical director
    Circadian Technologies, Inc.

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