Stress and burnout in residents: impact of mindfulness-based resilience training

Abstract

Background and objective: Stress and burnout impact resident physicians. This prospective study tests the hypothesis that a mindfulness-based resilience intervention would decrease stress and burnout in residents.

Methods: Resident physicians from the Departments of Family Medicine, Psychiatry, and Anesthesia at Duke University, Durham, NC, USA, participated in two or three 1-hour sessions of mindfulness-based resilience activities, which introduced mindful-awareness and included practical exercises for nurturing resilience. Anonymous surveys were distributed before (completed by 47 residents) and after the intervention (both completed by 30 residents); a follow-up survey was distributed 1 month later (seven residents completed all three surveys). The survey included the Depression Anxiety Stress Scale, 21-question version (DASS-21), the Oldenburg Burnout Inventory, the Mindful Attention Awareness Scale, and ten questions from the Cognitive Failures Questionnaire.

Results: At baseline, most residents' scores were in the normal range with respect to stress; however, female residents had higher DASS-21 scores than male residents (31.7, females vs 18.4, males; P=0.002). Most residents' burnout scores were in the abnormal range, both with respect to exhaustion (38/47 residents, subscore ≥2.25) and disengagement (37/47 residents, subscore ≥2.1). Higher perceived levels of stress correlated with the instruments. Analysis of the surveys before and after the intervention showed no significant short-term change in stress, burnout, mindful-awareness, or cognitive failure. There was a trend for females and post-medical school graduate year 1 and 2 (PGY1 and PGY2) residents to have a reduction in DASS-21 scores after intervention. There was also a trend of reduced stress and burnout in residents who perceived higher stress.

Conclusion: Residents who are female, PGY1 and PGY2, and who perceive residency to be stressful may benefit most from a mindfulness-based resilience intervention.

Keywords: medical trainees; physician; self-care; wellness.

Figure 1

Stress, burnout, mindful awareness, and cognitive failure scores in residents before and after the mindfulness-based resilience intervention. Notes: (A) Thirty residents completed both the initial and follow-up paper-based surveys. Mean scores for the DASS-21 (with stress, anxiety, and depression subscales), OLBI (with exhaustion and disengagement subscores), MAAS, and CFQ are shown. There is no significant difference in the scores before and just after the intervention. (B) Seven residents completed the initial paper-based survey (“Initial timepoint”), the follow-up paper-based survey (just following the intervention), and the online survey (~ 1 month after the intervention, “Last timepoint”). Mean scores for the DASS-21 (with stress, anxiety, and depression subscales), OLBI (with exhaustion and disengagement subscores), MAAS, and CFQ scores are shown for the initial survey and the final survey (~ 1 month after the intervention). Although there is no significant difference in the scores before and just after the intervention, there appears to be a trend toward lower stress scores at the longer follow-up timepoint. Error bars, standard deviation. Abbreviations: DASS-21, Depression-Anxiety-Stress Scale, 21-question version; OLBI, Oldenburg Burnout Inventory; MAAS, Mindful Attention Awareness Scale; CFQ, Cognitive Failures Questionnaire.

Figure 2

Trends in demographic characteristics and effect of the intervention. Notes: For each resident, the difference in means was calculated for each instrument by subtracting the follow-up score from the initial score. For example, the total DASS-21 score from the follow-up survey was subtracted from the total DASS-21 score from the initial survey. A negative difference in means indicates that the score decreased due to the intervention; this decrease was the goal of the intervention with regard to the stress and burnout instruments (DASS-21 and OLBI). A positive difference would indicate that the score increased due to the intervention; an increasing score on the MAAS would indicate greater mindful awareness after the intervention. The difference in means is graphed for each demographic group. The results suggest that female residents and residents early in the program may benefit most from the intervention. Error bars, standard deviation. Abbreviations: DASS-21, Depression-Anxiety-Stress Scale, 21-question version; OLBI, Oldenburg Burnout Inventory; MAAS, Mindful Attention Awareness Scale; CFQ, Cognitive Failures Questionnaire.

Figure 3

Trends in perceived stress and effect of the intervention. Notes: For each resident, the difference in means was calculated for each instrument by subtracting the follow-up score from the initial score. For example, the total DASS-21 score from the follow-up survey was subtracted from the total DASS-21 score from the initial survey. A negative difference in means indicates that the score decreased due to the intervention; this result was the goal of the intervention with regard to the stress and burnout instruments (DASS-21 and OLBI). A positive difference would indicate that the score increased due to the intervention; an increasing score on the MAAS would indicate greater mindful awareness after the intervention. The difference in means is graphed for the groups of residents who perceived residency to be occasionally stressful, somewhat stressful, and very stressful. The results suggest the trend that residents who perceive residency to be more stressful had decreasing stress and burnout after the intervention. All P-values were >0.05, except where indicated, for the OLBI disengagement subscore. Error bars, standard deviation. ^*P-value based on Kruskal–Wallis test. Abbreviations: DASS-21, Depression-Anxiety-Stress Scale, 21-question version; OLBI, Oldenburg Burnout Inventory; MAAS, Mindful Attention Awareness Scale; CFQ, Cognitive Failures Questionnaire.