New Resident Training Schedule Reduces Burnout, Improves Wellness

On February 28, 2023, JAMA Network Open published survey results revealing that an alternate internal medicine resident training schedule was linked to reducing burnout and self-reported professional, educational, and health outcomes. The analysis suggests the 4+4 block schedule is more favorable than the 4+1 block schedule.

According to the researchers, the survey used data from one institution’s internal medicine residency program (IMRP) that launched a new rotation structure in July 2019. Initially, students at this institution followed that 4+1 schedule, which meant spending 4 weeks working on inpatient care and then one week on outpatient care before the cycle repeated. The institution’s changes altered the rotation schedule by making residents spend 4 weeks working in the in-patent, call-based settings and then 4 weeks in the outpatient, non-call-based setting, referred to as the 4+4 schedule.

Researchers could assess how the change impacted burnout, wellness, professional development, and engagement by surveying internal medicine residents in their first and second postgraduate years (PG1 and PG2) before and after the intervention.

Burnout was evaluated using the Maslach Burnout Inventory, focusing on the emotional exhaustion, depersonalization, and personal achievement subcategories.

In the post-intervention surveys, the emotional exhaustion scores were an average of 6.78 points lower than in the pre-intervention surveys. Additionally, the depersonalization scores were significantly different, at an average of 3.81 points lower, in the post-intervention responses. However, researchers pointed out no statistical significance in personal achievement scores, with only a slight increase of 1.4 points after the intervention.

Collectively, these insights indicated that the 4+4 block schedule was better for reducing the risk of burnout.

Using the iCOMPARE study questionnaire, the researchers also evaluated wellness, professional development, and engagement as secondary outcomes. The questionnaire assessed multiple factors, including the following:

• The ability to acquire clinical skills, attend educational activities, participate in scholarly activities, and acquire clinical reasoning skills
• Availability of inpatient encounters, elective encounters, and continuity clinic encounters
• Professionalism
• Job satisfaction
• Morale
• Time outside of clinical settings and time for family and friends
• Career choice satisfaction
• Health and overall well-being

Researchers highlighted a positive post-intervention outcome in 11 of the 15 factors evaluated using the iCOMPARE questionnaire, specifically emphasizing time for scholarly activities or with family and friends, non-clinical experiences, and overall well-being.

“Residents reported markedly improved health, wellness, professional development, and engagement of trainees without a decrement in perceived clinical skills or standardized examination scores. These results suggest that specific X + Y block combinations may be better than others and warrant consideration for investigation and adoption by other IMRPs nationwide. Further study is needed to determine whether these results persist after graduation from residency,” concluded researchers in the publication.