Wellness Support Group Shows Promise in Reducing Burnout

Pharmacy residency well-being and risk of burnout has been a popular topic of discussion in recent years among many national associations, including the American Society of Health-System Pharmacists and the American Association of Colleges of Pharmacy. These associations have been creating certificate programs and commitments to promote well-being and resilience.^1,2

Burnout illustration | Image credit: melita - stock.adobe.com

However, burnout is not a new concept. The term was first used in 1974, when Herbert Freudenberger, a German American psychologist, described burnout as the combination of emotional exhaustion, depersonalization, and reduced sense of personal accomplishment.³ This triad often impedes a staff member’s ability to work effectively and sometimes causes them to leave the workplace entirely.

It is also known that residency training is associated with burnout and significant reductions in well-being markers. These include decreased sleep, exercise, family interactions, religious activities, and an increase in missing significant events.⁴

Because of more highly publicized events, there has also been heightened awareness around well-being and support for second victims.^5,6 A second victim is a health care professional who is involved in an unanticipated adverse patient event, a medical error, and/or a patient-related injury, who can become victimized in the sense that the provider is traumatized by the event.⁷ Pharmacy residents are at an increased risk of becoming a second victim because of limited experience both as a pharmacist and within their institution. In the absence of healthy coping mechanisms, second victims are at heightened risk of burnout.⁷

Lastly, these factors have been amplified by the COVID-19 pandemic and have led to increased rates of burnout since 2020.^8,9

To combat compounding risk factors of burnout and promote a culture of wellness, UK HealthCare’s pharmacy residency program created the Residents at the University of Kentucky (R UoK?) support group. The R UoK? support group is a resident-led committee composed of a postgraduate year 2 chair and postgraduate year 1 cochairs, with preceptor mentorship. Their role is to develop a holistic wellness curriculum (TABLE).

Topic discussions are led by a variety of preceptors experienced in various domains to provide insight, strategies, and resources from difficult patient situations to personal financial planning. Wellness activities are resident led and focus on physical and mental health, with an emphasis on unplugging from patient care.

The success of R UoK? at UK HealthCare is possible through support from the residency program, preceptors, and pharmacy administration. Preceptors volunteer their time to host topic discussions, given their experience and training in specific areas (TABLE). After 1 year, residents requested a formalized committee to allow for a budget to help support residents with potential financial barriers to participation in R UoK? events.

During fiscal year (FY) 2021, many social events were halted due to the COVID-19 pandemic. Excess residency funds were reallocated to R UoK? and targeted at physical wellness, specifically a high-intensity interval training class. When this event was sponsored, attendance increased compared with attendance for the out-of-pocket event, which was yoga (FIGURE 1).

However, it was recognized that these funds would not always be available, as many social events are supported by the residency budget. Subsequently, residents advocated for departmental funds to support resident wellness. Based on previous spending (FIGURE 1), the department agreed to invest $500 per year. Attendance continued to increase in FY 2022, as all events were free to residents. Awareness of R UoK? also increased.

An R UoK? survey was created and dispersed to all UK HealthCare residents, including postgraduates year 1 and 2. Of 31 residents, 52% of them responded to the survey (FIGURE 2). Based on survey results, events were well attended and received by residents. Of the 16 residents who responded, 14 attended at least 1 event. Additionally, most residents (71%) felt their wellness was positively impacted by R UoK? events. Areas of opportunity included more active events, topic discussions, and mental health and counseling resources.

Resident support groups should be resident-specific, given the unique factors that face residency programs, in addition to all health care workers. At UK HealthCare, the resident support group was well received by pharmacy residents. Topic discussions and wellness events were well attended, and investments from the pharmacy department allowed for additional barriers to attendance to be lifted. R UoK? plans to incorporate survey feedback into its next curriculum to continue optimizing resident wellness.

About the Authors

Sally Jagielski, PharmD, BCPS, is a 2019 graduate of the UNC Eshelman School of Pharmacy in Chapel Hill, North Carolina. She completed both her PGY1 in pharmacy practice and her PGY2 in Medication-Use Safety and Policy at UK HealthCare. She is now an internal medicine pharmacist at Good Samaritan UK HealthCare, where she continues to focus on resident wellness, medication optimization, and research.

Blake Robbins, PharmD, MBA, BCCP, is a 2020 graduate of the University of Health Sciences and Pharmacy in St Louis, Missouri. He completed both a PGY1 and PGY2 critical care specialty residency at UK HealthCare. Robbins now serves as an emergency medicine clinical pharmacist at UK HealthCare's Albert B. Chandler Hospital.

Liz Hess, PharmD, MS, FISMP, CPPS, is a 2013 graduate of The Ohio State University College of Pharmacy in Columbus. She completed her PGY1, PGY2, and MS of Health-System Pharmacy Administration residency at UNC Medical Center, followed by a fellowship in safe medication management at the Institute for Safe Medication Practices. She has been at UK HealthCare for 5 years, where she provides medication safety oversight, guidance on accreditation, and support for second victims.

References

1. ASHP statement on commitment to clinician well-being and resilience. American Society of Health-System Pharmacists. Accessed December 19, 2022. https://nam.edu/wp-content/uploads/2017/11/American-Society-of-Health-System-Pharmacists_Commitment-Statement.pdf

2. AACP Statement on commitment to clinician well-being and resilence. American Association of Colleges of Pharmacy. Accessed December 19, 2022. https://www.aacp.org/article/commitment-clinician-well-being-and-resilience

3. Freudenberger HJ. Staff burn-out. Soc Issues. 1974;30(1):159-165. doi:10.1111/j.1540-4560.1974.tb00706.x

4. Perry MY, Osborne WE. Health and wellness in residents who matriculate into physician training programs. Am J Obstet Gynecol. 2003;189(3):679-683. doi:10.1067/S0002-9378(03)00889-5

5. Safety enhancements every hospital must consider in wake of another tragic neuromuscular blocker event. Institute for Safe Medication Practices. January 17, 2019. Accessed December 19, 2022. https://www.ismp.org/resources/safety-enhancements-every-hospital-must-consider-wake-another-tragic-neuromuscular

6. Criminalization of human error and a guilty verdict: a travesty of justice that threatens patient safety. Institute for Safe Medication Practices. April 7, 2022. Accessed December 19, 2022. https://www.ismp.org/resources/criminalization-human-error-and-guilty-verdict-travesty-justice-threatens-patient-safety

7. Tamburri LM. Creating healthy work environments for second victims of adverse events. AACN Adv Crit Care. 2017;28(4):366-374. doi:10.4037/aacnacc2017996

8. Amanullah S, Ramesh Shankar R. The impact of COVID-19 on physician burnout globally: a review. Healthcare. 2020;8(4):421. doi:10.3390/healthcare8040421

9. Raj KS. Well-being in residency: a systematic review. J Grad Med Educ. 2016;8(5):674-684. doi:10.4300/JGME-D-15-00764.1