Using Reflective Writing to Explore Resident Resilience during Global Health Electives

Pediatric residents participating in global health electives (GHEs) report an improved knowledge of medicine and health disparities. However, GHEs may pose challenges that include cost, personal safety, or individual mental health issues. The objective of this study was to describe the use of guided reflections to understand resident resilience during GHEs. Forty-five residents enrolled in two pediatric training programs were asked to respond in writing to weekly prompts during a GHE and to complete a post-trip essay. Analysis of the reflections and essays, including an inductive thematic analysis, was completed. Two coders performed a second analysis to support classification of themes within the Flinders Student Resilience (FSR) framework. Four themes emerged from the initial analysis: 1) benefits, 2) stresses and challenges, 3) career development, and 4) high-value care. Analysis using the FSR framework revealed the following themes: acknowledgment of personal limitations, importance of relationships in coping throughout the GHE, and discernment of career focus. Reflective writing provided insight into how residents mitigate GHE challenges and develop resilience. Despite statements of initial distress, residents focused on their personal benefits and growth during the GHE. The FSR framework revealed the residents’ robust self-awareness of limitations and that strong relationships on the ground and at home were associated with perceived benefits and growth. Programs should consider helping residents to identify healthy coping practices that can promote personal resilience during GHEs as part of pre-departure preparation and debriefing, as well as providing for supportive communities during the GHE.

Transcending Distance in Long-Term Care: Can Serious Games Increase Resident Resilience?

In Canada, over 15,000 residents of long-term care have died from COVID-19 since the start of the pandemic representing 59 percent of all COVID-19 deaths (National Institute of Ageing, 2021). Urgent research and subsequent applied action are needed to save life and quality of life including the presence of family (CFHI, 2020). Social and physical frailty are major systemic patient safety gaps and are challenges for most healthcare organizations. This practitioner-led panel of experienced human factors, implementation science and healthcare experts used a case study of a project at North York General Hospital’s Seniors’ Health Centre in Toronto to discuss how these challenges can be addressed with serious games. The project discussed used games that aim to reduce social and physical frailty through exercise while interacting with remote families. Lessons learned to-date and challenges observed, in rapidly implementing safety and human factors programs intended to create resilient residents in a real healthcare context were discussed.

EXPLORING EMPATHY IN PEDIATRICS RESIDENTS AT AN URBAN CHILDREN’S HOSPITAL IN CANADA

BACKGROUND Empathy is fundamental to the physician-patient relationship, promoting both patient compliance and increased treatment efficacy. Studies attempting to quantify changes in empathy during residency are inconsistent in their findings; those examining paediatrics training specifically, are no more definitive. The mixed conclusions may stem from the use of self-reporting scores, which may fail to capture the essence of the effect. OBJECTIVES This study aimed to explore the state, and map a trajectory, of empathy in paediatrics residents, to identify factors influencing the learning and retention of empathy. DESIGN/METHODS This qualitative descriptive study was conducted at an urban children’s hospital in Canada. A constructivist phenomenological approach was used. Participants were recruited for semi-structured interviews via a purposive sampling strategy; thereafter, a thematic analysis was employed. Emerging themes were discussed at research meetings. Sufficiency was felt to be achieved after ten interviews. RESULTS Senior residents reported an overall increase in empathy, in part attributed to a better understanding of paediatric illnesses and greater perspective of the impact on families. There appeared to be a reconciliation with the changing shape of their empathy: managerial and administrative responsibilities could be performed empathically if patient priorities remained a central objective. Challenges to the retention of empathy correlated with published literature: time constraints, compassion fatigue and burnout with poor coping, and the hidden curriculum. Empathy was learned from role modelling by peers, preceptors, and other health care providers. Resident resilience, as a product of personal adversity, was protective against the loss of empathy; this could be considered in the postgraduate admissions process, and should be fostered with resident wellness strategies. Residents advocated for increased autonomy and patient ownership, and fuller exposure to longitudinal care, including the patient’s social context and home life, both of which could be considered as additions to residency training curricula to increase resident empathy. CONCLUSION Residents demonstrated an increase in empathy during training. Resident resilience is valuable in protecting empathy and could be considered in admissions processes. Longitudinal clinics and home visits should be considered as additions to residency training curricula.

Initial Characterization of Internal Medicine Resident Resilience and Association with Stress and Burnout

Introduction. Burnout is prevalent in medical trainees. Little data exists on resident resilience. Methods. Anonymous surveys were provided to a convenience sample of internal medicine residents. Resilience was assessed using the Connor-Davidson resilience scale. Responses were categorized into low (<70), intermediate (70–79), and high (80–100) resilience. Results. 77 residents from six institutions completed surveys. 26% of residents had high resilience, 43% intermediate, and 31% low. The mean resilience score was 73.6±9.6 and lower than the general population (mean 80.4±12.5, p<0.001). Trainees with high resilience were more likely to never have stress interfere with their relationships outside of work (high: 40%; low: 0%; p<0.001). High resilience residents were more likely to have the skills to manage stress and burnout (high: 80%; low: 46%; p=0.02) and less likely to feel inferior to peers (high: 20.0%; low: 70.8%; p<0.001). There was a trend towards those with high resilience reporting less burnout (high: 40.0%; intermediate: 27%; low: 16.7%; p=0.08). Only 60% report a program outlet to discuss burnout. Conclusions. There is a wide range of resilience among IM residents and scores were lower than the general population. Low resilience is associated with more stress interfering with relationships, feeling inferior to peers, and fewer skills to manage stress and burnout.