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1. ASSESSMENT OF WELLBEING AND PHYSICAL ACTIVITY AMONG RESIDENTS
TAGEDENACADEMIC PEDIATRICS
ABSTRACTS
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e3
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may mitigate burnout such as training in medical errors response, and healthy scheduling paradigms.
*Winner − APPD Quality Improvement (QI) project award* 5. CREATION AND IMPLEMENTATION OF A STANDARDIZED TOOL TO IMPROVE INPATIENT CONSULT COMMUNICATION Sara Pavitt, MD, Anne McHugh, MD, Kevin Chi, MD, Kim Hoang, MD, Elizabeth Lippner, MD, Kiran Mudambi, MD, Katelyn Saarela, MD, Hannah Basset, MD, Rachel Goldstein, MD, Jennifer Tsai, MD, Nivedita Srinivas, MD, Stanford University, Palo Alto, CA BACKGROUND: Communication failures are the most common root cause of patient safety events. Consults provide a significant opportunity for miscommunications to occur; however, trainees receive little education on how to effectively convey consult requests. Based on literature review and needs assessment of pediatric residents and fellows at Stanford, we identified essential consult elements (ECE) for optimal consult communication. 54 consult requests were audited, and our baseline data showed that only 9% included all ECE. At our institution, 98% of residents (n=56) and 95% of fellows (n=41) reported miscommunication around consults, 85% of which led to perceived patient safety errors. Only 13% of residents reported receiving teaching from fellows during the consultation. AIM STATEMENT: 1) Develop a standardized consult communication tool that includes all ECE 2) Increase consult requests containing all ECE by pediatric residents from 9% to 40% within a 6-month period. INTERVENTIONS: A consult communication tool containing ECE was developed using modified SBAR (Situation, Background, Assessment, Recommendations) and taught to pediatric residents from July-Aug 2018 through a series of workshops. Multimedia interventions (flyers, screen savers, name badge cards) were disseminated throughout the hospital. During the initial PDSA cycle, residents and fellows were queried to inform subsequent cycle changes, such as targeting faculty engagement and monthly reminder emails. MEASURES: The primary outcome measure was the percentage of inpatient consult requests containing all ECE by pediatric residents. The process measure was adherence to the modified SBAR tool. Secondary outcomes included clarity of consult question, perceived teaching and learning, and miscommunication. Resident and fellow satisfaction was used as a balancing measure. RESULTS: Post intervention from Sep-Dec 2018, 51 consults were audited and consults including ECE increased from 9% to 49%. SBAR was used in 76% of consultations. With SBAR, 96% of consult questions were clear/very clear and 100% of fellows reported being satisfied/very satisfied with communication. CONCLUSIONS AND NEXT STEPS: Our modified SBAR tool resulted in increased inclusion of essential elements for consult communication. It led to greater clarity of consult question and satisfaction by pediatric fellows. Data regarding its effect on teaching, learning, and patient safety will be available in March 2019.
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Wellness/Resilience/Burnout 1. ASSESSMENT OF WELLBEING AND PHYSICAL ACTIVITY AMONG RESIDENTS Naomi O’Sullivan, MD, Irene Paoakonstadopoulos, MD, Inna Kaminecki, MD, Brunetto Jacqueline, MD, Renuka Verma, MD, Prasiksha Sitaula, MD, Monmouth Medical Center, Long Branch, NJ BACKGROUND: Burnout is common among residents, occurring in 40-75% of trainees across multiple disciplines. Studies demonstrate that regular physical activity correlates with improved sense of well-being, increased empathy, decreased burnout and increased career satisfaction. Evidence suggest that the level of physical activity of physicians can be correlated directly with physician counselling patterns. METHODS: This prospective observational study was conducted at Monmouth Medical Center and included categorical residents from the following residency programs: Dentistry, Internal Medicine, Obstetrics and Gynecology, Orthopedic Surgery, Pediatrics, Radiology and Surgery. Residents completed pre-participation questionnaire and PWBI questionnaire. All residents were provided a wearable physical activity tracker. The data were collected over the 3 months period. RESULTS: 83 residents participated in the study: 6 from Dentistry, 27 from Internal Medicine, 14 from Obstetrics and Gynecology, 8 from Orthopedic Surgery, 15 from Pediatrics, 4 from Radiology, and 9 from Surgery. Results of pre-participation questionnaire showed that 96% of residents believed that physical activity improves wellness, 77% counsel patients on physical activity, and 59% counsel patients on intensity of physical activity. 28% participants were identified as having risk of burnout using PWBI. Total of 45 residents (54%) uploaded their activity data during the study period. The average amount of steps by month per resident is presented on Figure. Step counts of residents in Internal Medicine, Pediatrics, Orthopedics, & Obstetrics and Gynecology were similar, and averaged 5817 steps/day. The average amount of steps by residents in Radiology was 7345 steps/day and in Surgery was 7937 steps/day. However, it did not reach statistical significance in comparison with other specialties. There was weak negative correlation between PWBI and physical activity (r =-0.03) CONCLUSION: Residents among multiple specialties in this study are not achieving CDC recommendations regarding
ABSTRACTS
TAGEDENe4
physical activity level. More than a quarter of residents were identified as having risk of burnout using PWBI. Additional interventions designed to improve residents’ physical activity and wellbeing should be encouraged
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2. BURNOUT AND EMPATHY DURING THE FIRST QUARTER OF PEDIATRIC INTERNSHIP Colin M. Sox, MD, MS, Christine M. Cheston, MD, Children’s Hospital/Boston Medical Center, Boston, MA, Celeste Allen, MD, Children’s Hospital-Oakland, Oakland, CA, Andrea G. Asnes, MD, MSW, Yale-New Haven Medical Center, New Haven, CT, Jefferson M. Barrett, MD, MPH, Tufts Medical Center, Boston, MA, Maneesh Batra, MD, MPH, University of Washington, Seattle, WA, William Bernstein, MD, St. Peter’s University Hospital, New Brunswick, NJ, Tammy Bleeker, MEd, University of Florida, Gainesville, FL, Pam M. Dietz, MD, Maine Medical Center, Portland, ME, Joanna Lewis, MD, Advocate Christ Medical Center, Park Ridge, IL, Su-Ting Li, MD, MPH, University of California (Davis) Health System, Sacramento, CA, T.M. Ma, MD, Loyola University, Maywood, IL, John D. Mahan, MD, Nationwide Children’s Hospital/Ohio State University, Columbus, OH, Catherine D. Michelson, MD, MMSc, Children’s Hospital/Boston Medical Center, Boston, MA, Sue E. Poynter, MD, MEd, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, Mark A. Vining, MD, University of Massachusetts, Worcester, MA, Katherine Watson, DO, UPMC Medical Education, Pittsburgh, PA, Yarden S. Fraiman, MD, Children’s Hospital/Boston Medical Center, Boston, MA BACKGROUND: Epidemic among trainees, physician burnout has been associated with delivery of unsafe care. Little is known about early markers of burnout in pediatric interns. OBJECTIVES: To determine the rates of and factors associated with burnout during the first quarter of pediatric internship. METHODS: From June through September 2017, we invited a cross-section of pediatric interns training at 15 programs to complete the Maslach Burnout Inventory (MBI) and an empathy index. Burnout was defined as an Emotional Exhaustion score >= 27 and a Depersonalization score >= 10. Empathy was measured using a continuous index (higher scores indicate greater empathy). We conducted bivariate logistic and linear regressions clustered on program to determine if between-group differences were statistically significant. RESULTS: Of the 365 interns invited, 213 responded in June, 51 in July, and 76 in late August and September, for a 93% response. Most participants were >26 years old (58%), female (75%), and training in programs with >16 interns (78%). Thirty percent of participants were in the Midwest, 42% in the East, 24% in the West, and 4% in the South. Emotional exhaustion
ACADEMIC PEDIATRICS scores were high for 90 participants (25%) and depersonalization scores were high for 99 (28%); of these, 44 (13%) met MBI criteria for burnout. Burnout was significantly less common in June (7%) than July (16%) or August and September (29%, p = 0.001). Among interns who were not burned out, emotional exhaustion and depersonalization increased over this timeframe at similar rates (both p < 0.0005). Participants’ mean empathy score was 51.3 (SD = 3.9; range 40-64). Empathy was significantly lower among burned out interns (50.1) than those who were not burned out (51.5, p < 0.0005), and was lower among interns who had begun clinical work (50.5) compared to those who completed the survey during orientation in June (51.8, p < 0.02). CONCLUSION: Burnout early in pediatric internship is associated with lower empathy and the onset of clinical responsibilities. Some pediatric interns enter training with burnout. Interventions are needed early in training to decrease burnout. 3. EMPATHY AND SELF-COMPASSION CORRELATE WITH PERFORMANCE IN PEDIATRIC RESIDENTS Maren E. Olson, MD, MPH, University of Minnesota, Saint Paul, MN, Michael B. Pitt, MD, University of Minnesota, Minneapolis, MN, H. Mollie Grow, MD, MPH, Maneesh Batra, MD, MPH, University of Washington, Seattle, WA, Alan Schwartz, PhD, University of Illinois College of Medicine at Chicago, Chicago, IL BACKGROUND: Empathy and self compassion have emerged as strong, potentially modifiable corollaries with burnout, though little is known about how these correlate with resident performance over time. OBJECTIVES: Assess residents’ empathy and self-compassion during residency over time, and how these correlate with pediatric milestone scores. METHODS: As part of the Pediatric Resident Burnout - Resilience Study Consortium, we performed a subanalysis of a prospective cohort including all residents from 55 institutions. In each of the 3 data cycles, residents completed online cross-sectional surveys which included validated assessments of burnout (Maslach), empathic concern (EC; Interpersonal Reactivity Index), and self-compassion (SC; Neffs Self Compassion). Programs provided linked milestone data for each respondent. We fit linear mixed model growth curves predicting competency domain scores (mean milestones within each of the ACGME competencies) from EC, SC, PGY level, data cycle, interaction of data cycle x PGY, and with random intercepts and PGY slopes within learner and within program. RESULTS: 4929/4946 residents had responses for all variables. For all 6 competency areas (Medical Knowledge-MK, Patient Care-PC, Interpersonal Communication Skills-ICS, Problem Based Learning Improvement-PBLI, Systems-Based PracticeSBP, Professionalism-PROF), domain scores increased with PGY, as expected. EC and SC were associated with ICS and PROF domain scores; SC was associated with MK and PC; EC was associated with PBLI and SBP; (p< 0.05 for all comparisons) All significant associations had small magnitudes of difference, with changes of 1 SD in EC (»4.5 points on its 0-28 scale) or SC (»0.61 points on its 1-5 scale) associated with changes of 0.01-0.03 points in mean scores. Mediation analysis found the effects of SC on MK and PC domain scores were entirely mediated by burnout, but effects on other domains persisted when controlling for burnout. CONCLUSION: In a national longitudinal sample of pediatric residents, empathy and/or self-compassion were correlated with all ACGME core competencies. Targeting interventions to
ABSTRACTS
TAGEDPEN
e3
TAGEDFIUR
may mitigate burnout such as training in medical errors response, and healthy scheduling paradigms.
*Winner − APPD Quality Improvement (QI) project award* 5. CREATION AND IMPLEMENTATION OF A STANDARDIZED TOOL TO IMPROVE INPATIENT CONSULT COMMUNICATION Sara Pavitt, MD, Anne McHugh, MD, Kevin Chi, MD, Kim Hoang, MD, Elizabeth Lippner, MD, Kiran Mudambi, MD, Katelyn Saarela, MD, Hannah Basset, MD, Rachel Goldstein, MD, Jennifer Tsai, MD, Nivedita Srinivas, MD, Stanford University, Palo Alto, CA BACKGROUND: Communication failures are the most common root cause of patient safety events. Consults provide a significant opportunity for miscommunications to occur; however, trainees receive little education on how to effectively convey consult requests. Based on literature review and needs assessment of pediatric residents and fellows at Stanford, we identified essential consult elements (ECE) for optimal consult communication. 54 consult requests were audited, and our baseline data showed that only 9% included all ECE. At our institution, 98% of residents (n=56) and 95% of fellows (n=41) reported miscommunication around consults, 85% of which led to perceived patient safety errors. Only 13% of residents reported receiving teaching from fellows during the consultation. AIM STATEMENT: 1) Develop a standardized consult communication tool that includes all ECE 2) Increase consult requests containing all ECE by pediatric residents from 9% to 40% within a 6-month period. INTERVENTIONS: A consult communication tool containing ECE was developed using modified SBAR (Situation, Background, Assessment, Recommendations) and taught to pediatric residents from July-Aug 2018 through a series of workshops. Multimedia interventions (flyers, screen savers, name badge cards) were disseminated throughout the hospital. During the initial PDSA cycle, residents and fellows were queried to inform subsequent cycle changes, such as targeting faculty engagement and monthly reminder emails. MEASURES: The primary outcome measure was the percentage of inpatient consult requests containing all ECE by pediatric residents. The process measure was adherence to the modified SBAR tool. Secondary outcomes included clarity of consult question, perceived teaching and learning, and miscommunication. Resident and fellow satisfaction was used as a balancing measure. RESULTS: Post intervention from Sep-Dec 2018, 51 consults were audited and consults including ECE increased from 9% to 49%. SBAR was used in 76% of consultations. With SBAR, 96% of consult questions were clear/very clear and 100% of fellows reported being satisfied/very satisfied with communication. CONCLUSIONS AND NEXT STEPS: Our modified SBAR tool resulted in increased inclusion of essential elements for consult communication. It led to greater clarity of consult question and satisfaction by pediatric fellows. Data regarding its effect on teaching, learning, and patient safety will be available in March 2019.
TAGEDEN
Wellness/Resilience/Burnout 1. ASSESSMENT OF WELLBEING AND PHYSICAL ACTIVITY AMONG RESIDENTS Naomi O’Sullivan, MD, Irene Paoakonstadopoulos, MD, Inna Kaminecki, MD, Brunetto Jacqueline, MD, Renuka Verma, MD, Prasiksha Sitaula, MD, Monmouth Medical Center, Long Branch, NJ BACKGROUND: Burnout is common among residents, occurring in 40-75% of trainees across multiple disciplines. Studies demonstrate that regular physical activity correlates with improved sense of well-being, increased empathy, decreased burnout and increased career satisfaction. Evidence suggest that the level of physical activity of physicians can be correlated directly with physician counselling patterns. METHODS: This prospective observational study was conducted at Monmouth Medical Center and included categorical residents from the following residency programs: Dentistry, Internal Medicine, Obstetrics and Gynecology, Orthopedic Surgery, Pediatrics, Radiology and Surgery. Residents completed pre-participation questionnaire and PWBI questionnaire. All residents were provided a wearable physical activity tracker. The data were collected over the 3 months period. RESULTS: 83 residents participated in the study: 6 from Dentistry, 27 from Internal Medicine, 14 from Obstetrics and Gynecology, 8 from Orthopedic Surgery, 15 from Pediatrics, 4 from Radiology, and 9 from Surgery. Results of pre-participation questionnaire showed that 96% of residents believed that physical activity improves wellness, 77% counsel patients on physical activity, and 59% counsel patients on intensity of physical activity. 28% participants were identified as having risk of burnout using PWBI. Total of 45 residents (54%) uploaded their activity data during the study period. The average amount of steps by month per resident is presented on Figure. Step counts of residents in Internal Medicine, Pediatrics, Orthopedics, & Obstetrics and Gynecology were similar, and averaged 5817 steps/day. The average amount of steps by residents in Radiology was 7345 steps/day and in Surgery was 7937 steps/day. However, it did not reach statistical significance in comparison with other specialties. There was weak negative correlation between PWBI and physical activity (r =-0.03) CONCLUSION: Residents among multiple specialties in this study are not achieving CDC recommendations regarding
ABSTRACTS
TAGEDENe4
physical activity level. More than a quarter of residents were identified as having risk of burnout using PWBI. Additional interventions designed to improve residents’ physical activity and wellbeing should be encouraged
TAGEDPEN
TAGEDFIUR
TAGEDEN
2. BURNOUT AND EMPATHY DURING THE FIRST QUARTER OF PEDIATRIC INTERNSHIP Colin M. Sox, MD, MS, Christine M. Cheston, MD, Children’s Hospital/Boston Medical Center, Boston, MA, Celeste Allen, MD, Children’s Hospital-Oakland, Oakland, CA, Andrea G. Asnes, MD, MSW, Yale-New Haven Medical Center, New Haven, CT, Jefferson M. Barrett, MD, MPH, Tufts Medical Center, Boston, MA, Maneesh Batra, MD, MPH, University of Washington, Seattle, WA, William Bernstein, MD, St. Peter’s University Hospital, New Brunswick, NJ, Tammy Bleeker, MEd, University of Florida, Gainesville, FL, Pam M. Dietz, MD, Maine Medical Center, Portland, ME, Joanna Lewis, MD, Advocate Christ Medical Center, Park Ridge, IL, Su-Ting Li, MD, MPH, University of California (Davis) Health System, Sacramento, CA, T.M. Ma, MD, Loyola University, Maywood, IL, John D. Mahan, MD, Nationwide Children’s Hospital/Ohio State University, Columbus, OH, Catherine D. Michelson, MD, MMSc, Children’s Hospital/Boston Medical Center, Boston, MA, Sue E. Poynter, MD, MEd, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, Mark A. Vining, MD, University of Massachusetts, Worcester, MA, Katherine Watson, DO, UPMC Medical Education, Pittsburgh, PA, Yarden S. Fraiman, MD, Children’s Hospital/Boston Medical Center, Boston, MA BACKGROUND: Epidemic among trainees, physician burnout has been associated with delivery of unsafe care. Little is known about early markers of burnout in pediatric interns. OBJECTIVES: To determine the rates of and factors associated with burnout during the first quarter of pediatric internship. METHODS: From June through September 2017, we invited a cross-section of pediatric interns training at 15 programs to complete the Maslach Burnout Inventory (MBI) and an empathy index. Burnout was defined as an Emotional Exhaustion score >= 27 and a Depersonalization score >= 10. Empathy was measured using a continuous index (higher scores indicate greater empathy). We conducted bivariate logistic and linear regressions clustered on program to determine if between-group differences were statistically significant. RESULTS: Of the 365 interns invited, 213 responded in June, 51 in July, and 76 in late August and September, for a 93% response. Most participants were >26 years old (58%), female (75%), and training in programs with >16 interns (78%). Thirty percent of participants were in the Midwest, 42% in the East, 24% in the West, and 4% in the South. Emotional exhaustion
ACADEMIC PEDIATRICS scores were high for 90 participants (25%) and depersonalization scores were high for 99 (28%); of these, 44 (13%) met MBI criteria for burnout. Burnout was significantly less common in June (7%) than July (16%) or August and September (29%, p = 0.001). Among interns who were not burned out, emotional exhaustion and depersonalization increased over this timeframe at similar rates (both p < 0.0005). Participants’ mean empathy score was 51.3 (SD = 3.9; range 40-64). Empathy was significantly lower among burned out interns (50.1) than those who were not burned out (51.5, p < 0.0005), and was lower among interns who had begun clinical work (50.5) compared to those who completed the survey during orientation in June (51.8, p < 0.02). CONCLUSION: Burnout early in pediatric internship is associated with lower empathy and the onset of clinical responsibilities. Some pediatric interns enter training with burnout. Interventions are needed early in training to decrease burnout. 3. EMPATHY AND SELF-COMPASSION CORRELATE WITH PERFORMANCE IN PEDIATRIC RESIDENTS Maren E. Olson, MD, MPH, University of Minnesota, Saint Paul, MN, Michael B. Pitt, MD, University of Minnesota, Minneapolis, MN, H. Mollie Grow, MD, MPH, Maneesh Batra, MD, MPH, University of Washington, Seattle, WA, Alan Schwartz, PhD, University of Illinois College of Medicine at Chicago, Chicago, IL BACKGROUND: Empathy and self compassion have emerged as strong, potentially modifiable corollaries with burnout, though little is known about how these correlate with resident performance over time. OBJECTIVES: Assess residents’ empathy and self-compassion during residency over time, and how these correlate with pediatric milestone scores. METHODS: As part of the Pediatric Resident Burnout - Resilience Study Consortium, we performed a subanalysis of a prospective cohort including all residents from 55 institutions. In each of the 3 data cycles, residents completed online cross-sectional surveys which included validated assessments of burnout (Maslach), empathic concern (EC; Interpersonal Reactivity Index), and self-compassion (SC; Neffs Self Compassion). Programs provided linked milestone data for each respondent. We fit linear mixed model growth curves predicting competency domain scores (mean milestones within each of the ACGME competencies) from EC, SC, PGY level, data cycle, interaction of data cycle x PGY, and with random intercepts and PGY slopes within learner and within program. RESULTS: 4929/4946 residents had responses for all variables. For all 6 competency areas (Medical Knowledge-MK, Patient Care-PC, Interpersonal Communication Skills-ICS, Problem Based Learning Improvement-PBLI, Systems-Based PracticeSBP, Professionalism-PROF), domain scores increased with PGY, as expected. EC and SC were associated with ICS and PROF domain scores; SC was associated with MK and PC; EC was associated with PBLI and SBP; (p< 0.05 for all comparisons) All significant associations had small magnitudes of difference, with changes of 1 SD in EC (»4.5 points on its 0-28 scale) or SC (»0.61 points on its 1-5 scale) associated with changes of 0.01-0.03 points in mean scores. Mediation analysis found the effects of SC on MK and PC domain scores were entirely mediated by burnout, but effects on other domains persisted when controlling for burnout. CONCLUSION: In a national longitudinal sample of pediatric residents, empathy and/or self-compassion were correlated with all ACGME core competencies. Targeting interventions to