APGO

Elizabeth M. Speed
NYU School of Medicine, New York, NY

Background: Increasing levels of burnout and a steady decrease in empathy have been identified among residents across various medical and surgical specialties. These levels of burnout have been shown to be associated with self-reported suboptimal patient care practices, with high levels of depersonalization being most predictive of these suboptimal practices. Narrative medicine has been employed as a means of promoting empathy, preventing burnout, and building teams on clinical services. Increased burnout and reduced empathy are associated with increased odds of self-perceived error. Many medical educators feel that narrative medicine can address this problem of burnout and decreased empathy and that it may be a pathway to improving cultural competency in a more meaningful way than the more traditional methods already in place. Despite this, few residency programs in OB/GYN, a field with high levels of burnout, have successfully integrated a formal narrative medicine curriculum into their longitudinal curriculum as a means to address this problem.

Study Objective: To assess levels of burnout and empathy among OB/GYN residents in an urban academic medical center and to develop and implement a formal narrative medicine curriculum to address stresses of training, the doctor-patient relationship, and specific issues challenging OB/GYNs which lead to levels of burnout among residents. Through a structured curriculum for reflective writing, residents have a forum to explore all of these issues and strengthen their connection with their calling. We sought to develop a 2-year curriculum that can be taught by OB/GYNs without training in narrative medicine that can be shared with other institutions and ultimately can help us further explore the impact of narrative medicine on burnout and empathy among OB/GYN residents.

Methods: An online survey was distributed all OB/GYN residents. The survey included the (1) the Maslach Burnout Inventory, a validated scale used to assess burnout for 30 years among different disciplines of health care providers, and includes three subscales: Depersonalization, Emotional exhaustion and Personal accomplishment (2) selected items from the Interpersonal Reactivity Index, and (3) a questionnaire regarding their subjective experience on the clinical service. The 2-year narrative medicine curriculum consists of 15, one hour-long workshops included as a part of the weekly resident didactic time. Topics covered in the workshops range from work-life balance to pregnancy loss and making mistakes. They generally consist of a few minutes of discussion among the group about the topic at hand followed by 1-2 short readings and writing exercise that may be shared with the group.

Results: Of 29 Ob/GYN residents, 24 responded to the survey. Residents showed high levels of burnout on the Maslach Burnout Inventory on the subscales of Emotional Exhaustion (EE), mean 27.5(High)(SD 8.94) and Depersonalization (DP), mean 15.8 (High) (SD 4.05). On the subscale of personal accomplishment, residents displayed low burnout, mean 40(Low)(SD 4.04). On the Interpersonal Reactivity Index subscales of Perspective Taking (PT) and Empathetic Concern (EC), residents scores for empathy were higher than average. Resident responses to the questionnaire about their subjective experience of their training and, particularly, how their understandings of the doctor-patient relationship have changed were varied. While only one felt “it has not changed”, another felt “it is definitely much more demanding on my personal life and emotional state than I expected…I often take the patient's problems home with me.” Other responses were, “it's harder to be a real human being than it used to be” and “being a good doctor doesn't always mean knowing the science behind medicine, but knowing how to relate to your patients and make them feel cared for every step of the way.”

Conclusions: Ob/GYN residents at our institution display high levels of burnout, consistent with what has been demonstrated overall among residents. However, while emotional exhaustion and depersonalization are high, our residents have high levels of personal accomplishment and empathy at baseline. A formal narrative medicine curriculum may be an innovative way to address emotional exhaustion and depersonalization and to leverage their baseline high empathy and sense of personal accomplishment for the benefit of their patients, careers and their own wellbeing. Evaluation of the curriculum’s impact on resident burnout and empathy will be performed with a post-test similar to the initial survey.

Key words: Narrative medicine, burnout, graduate medical education