Advertisement

Wellness among Canadian ophthalmology resident physicians: a national survey

Published:September 22, 2021DOI:https://doi.org/10.1016/j.jcjo.2021.08.014
      Residency is a particularly stressful and dynamic period during which learners must balance the demands of patient care, education, and personal responsibilities. Evidence of high levels of burnout among resident physicians has driven the development of initiatives and programs to help address this negative consequence of residency training. As a novel topic in the realm of medical education, more information is required to further characterize the sources of burnout and depression and the nuances of various specialities. Although surveys have been completed among resident physicians in Canada,
      • Taher A
      • Hart A
      • Dattani ND
      • Poonja Z
      • Bova C
      • Bandiera G
      • Pardhan K.
      Emergency medicine resident wellness: lessons learned from a national survey.
      • Nolan KJ
      • Writer H
      • Ladhani M
      Canadian Pediatric Program Directors Research Group. Wellness in Canadian paediatric residents and their program directors.
      • Ferguson C
      • Low G
      • Shiau G.
      Resident physician burnout: insights from a Canadian multispecialty survey.
      to the best of our knowledge, there have not been any ophthalmology-specific residency wellness surveys conducted on a national level.
      Our study aimed to explore causes of stress and reduced wellness, incidences of depression and burnout, and resources available to Canadian ophthalmology residents through an online anonymous survey.
      A 24-question survey was developed based on a similar U.S. national ophthalmology resident survey
      • Tran EM
      • Scott IU
      • Clark MA
      • Greenberg PB.
      Resident wellness in US ophthalmic graduate medical education: the resident perspective.
      as well as previous medical education studies on residency wellness.
      • Taher A
      • Hart A
      • Dattani ND
      • Poonja Z
      • Bova C
      • Bandiera G
      • Pardhan K.
      Emergency medicine resident wellness: lessons learned from a national survey.
      • Nolan KJ
      • Writer H
      • Ladhani M
      Canadian Pediatric Program Directors Research Group. Wellness in Canadian paediatric residents and their program directors.
      • Ferguson C
      • Low G
      • Shiau G.
      Resident physician burnout: insights from a Canadian multispecialty survey.
      Themes of the survey included causes of stress and reduced wellness, incidence of depression and burnout, and resources available. Definitions of both depression and burnout were presented to the respondent prior to the corresponding question. The survey was reviewed, modified, and validated by 2 ophthalmologists, 2 senior ophthalmology residents, and 1 senior psychiatry resident.
      All ophthalmology residents in Canada (N = 217) were emailed a short anonymous survey (Google Forms) from May 6 to June 13, 2020. The survey was distributed via a resident physician mailing list of the Canadian Ophthalmological Society–Société canadienne d'ophtalmologie (COS-SCO) that included all 15 Canadian programs. Programs with a high resident response rate (>70.0%) were entered in a draw for a $500 prize as an incentive to boost participation. The funding for this prize was provided by the COS-SCO. The survey was originally distributed on May 11, 2020, with biweekly reminder emails. The survey closed on June 13, 2020. This survey was the second part of a two-part survey; the first part investigated the impact of COVID-19 on residency training.
      • Szigiato AA
      • Palakkamanil M
      • Aubin MJ
      • Ziai S.
      Canadian ophthalmology resident experience during the COVID-19 pandemic.
      Survey data were exported to Microsoft Excel 2013 (Redmond, Wash). All descriptive statistics were performed using Microsoft Excel.
      Of 217 residents across Canada, 102 completed the survey (47.0%), representing all 15 residency programs. Table 1 summarizes the survey questions and results. Respondents encompassed all years of residency similarly, and there was equal representation of male and female respondents. Participation in the survey was higher in the larger residency programs (>20 residents [37.3%]).
      Table 1Results of the national wellness survey of Canadian ophthalmology resident physicians
      QuestionCount%
      Which postgraduate year (PGY) are you enrolled in?
       PGY42726.5
       PGY22625.5
       PGY11817.6
       PGY31615.7
       PGY51514.7
      How do you identify your gender?
       Male5150.0
       Female5049.0
       Prefer not to answer11.0
      How many residents are in your residency program?
       >203837.3
       11–152928.4
       6–101716.7
       ≤51312.7
       16–2054.9
      As a resident, do you have access to free counselling and behavioural health services as part of your program?
       Yes6664.7
       Don't know3231.4
       No43.9
      If yes, do you know how to access counselling and behavioural health services?
       No4873.2
       Yes1826.8
      How much emphasis does your residency program place on promoting a culture of resident wellness?
       Moderate5654.9
       Minimal3635.3
       Extensive54.9
       None54.9
      What are the main obstacles to addressing resident wellness in your residency program? (Pick any that apply.)
       Lack of time to attend wellness programming6148.4
       Lack of wellness programming4233.3
       Lack of access to free and confidential counselling/behavioural health services118.7
       Other86.3
       Clinical duties21.6
       No obstacles21.6
      What are situations that lead to or cause stress and decreased wellness in your program?
       Academic stressors (e.g., exams, rounds)7217.6
       Call-related stress6916.9
       Stress in finding postresidency jobs and/or fellowships4511.0
       Inadequate rest (e.g., lack of a postcall day)389.2
       Paperwork and administrative requirements368.8
       Lack of a culture wherein it is ok to seek assistance/help without being considered incompetent368.8
       Clinic time duration338.1
       Fear of making errors that result in patient injury327.8
       Understaffing at clinical sites (residents, support staff, or both)276.6
       Financial stress112.7
       Sexism or racism in the workplace102.4
      In the past 12 months, did you fit the above criteria for depression or burnout?
       Yes5755.9
       No3938.2
       Prefer not to say65.9
      If yes, did you have to take time off clinical duties?
       No5189.3
       Yes47.0
       Prefer not to say11.7
      Does your ophthalmology program provide access to a formal wellness program intended to reduce resident stress, burnout, and depression?
       Don't know3938.2
       No3736.3
       Yes2625.5
      If yes, what are the components of your resident wellness program? (Select all that apply.)
       Mentorship program2528.1
       Debriefing or support group sessions1415.7
       Self-care, mindfulness, or meditation training1415.7
       Education in fatigue and stress management1112.4
       Ability to give feedback to address systemic issues910.1
       Psychological therapy (web-based or in person)89.0
       Screening for burnout or depression55.6
       Tracking of burnout or depression prevalence33.4
      Which aspects of resident wellness programs do you think are most important? (Pick three most important to you.)
       Self-care, mindfulness, or meditation training6422.3
       Screening for burnout or depression5920.6
       Debriefing or support-group sessions5318.5
       Education in fatigue and stress management4315.0
       Psychological therapy (web-based or in person)3411.8
       Tracking of burnout or depression prevalence289.8
       Other62.1
      Which of the following does your resident program use to promote wellness? (Select all that apply.)
       Social wellness (e.g., casual gatherings that foster camaraderie)5233.5
       Professional wellness (mentorship pairs or teams between junior and senior residents that facilitate open dialogue about personal or work-related concerns, training to improve doctor-patient relationships)4227.1
       Adequate rest (e.g., postcall days, reasonable frequency of calls)2918.7
       Psychological wellness (e.g., meetings with a professional who teaches skills that improve resilience)149.0
       Physical wellness (availability of healthy food, exercise as a part of the residence schedule)74.5
       None of the above95.8
       Not sure21.3
      Have you been involved in a case when your fatigue, burnout, or depression adversely affected a medical outcome or your judgement?
       No8684.3
       Yes1615.7
      Have you accessed personal counselling services?
       No8280.4
       Yes2019.6
      If yes, would use these services again?
       Yes1155.9
       No944.1
      If you did not access personal counseling services, why not? (Please check all that apply.)
       No need4232.6
       No time3829.5
       Did not think it would be helpful2317.8
       Fear of lack of confidentiality/stigma1410.9
       Did access it107.8
       It was inaccessible21.6
      Have you experienced any form of intimidation or aggression at work?
       No5957.8
       Yes4342.2
      If yes, who was the cause of this stress?
       Attending physician(s)3142.5
       Patient1723.3
       Other resident(s)1317.8
       Other hospital employee(s) (e.g., allied health)1115.1
       Program director11.4
      Have you felt concern for your safety when on call?
       No7371.6
       Yes2928.4
      If yes, why were you concerned for your safety? (Select all that apply.)
       Experience of physical assault by a patient or fear of physical assault by a patient1737.0
       Verbal aggression by a patient1634.8
       Safety concerns walking to and from the clinic1226.1
       Too tired to safely drive home12.2
      If structural changes could be made that could improve the wellness of you and your peers, which changes would you suggest should be made? (Pick any three.)
       Decreased demands on resident time (morning and nighttime lectures, after-hours responsibilities)7025.0
       Provide additional time for wellness, arrange social or exercise activities6422.8
       Shift attitudes toward mental health issues among residents4616.4
       Improve shift/call schedules4014.2
       Decreased administrative burden3612.8
       Availability of free and confidential counselling and behavioural health services145.0
       Additional professional counselling113.9
      How can the Royal College of Physicians and Surgeons or the Canadian Ophthalmological Society better promote resident wellness? (Pick any three.)
       Mandate the inclusion of a resident wellness program in ophthalmology residency training programs7432.5
       Offer strategies for developing and continuously evaluating wellness programs4318.9
       Provide resources for training in resilience skills4017.5
       Provide resources for burnout and depression screening3816.7
       Fund research on wellness interventions229.6
       Mandate humane training/call hours, staff support, and learning culture31.3
       Other83.5
      In total, 64.7% of respondents answered that they had access to free counselling services as part of their program. Of those who did have access, 73.2% of respondents knew how to access these services. In regard to emphasis placed on a culture of resident wellness, 35.3% of respondents believed there was minimal emphasis, whereas 4.9% stated that there was no emphasis at all. Obstacles to addressing residency wellness included lack of wellness programming (33.3%) and lack of time to attend such programming (48.4%). The top 3 scenarios that led to or caused stress and decreased wellness in residency programs included academic stressors (e.g., examinations, rounds, 17.6%), call-related stress (16.9%), and stress in finding postresidency fellowships and jobs (11.0%).
      In the 12 months prior to completing the survey, 38.2% of respondents answered that they met the criteria for depression or burnout. Of those, 7.0% had to take time off clinical duties. Based on those who reported the emphasis placed on resident wellness as minimal or none, 51.2% met the criteria for burnout or depression. Conversely, 29.5% of those who reported moderate or extensive emphasis on resident wellness met the criteria for burnout or depression; 36.3% of respondents answered that their program did not have access to a formal wellness program intended to reduce resident stress, burnout, and depression, and 38.2% of respondents were unaware of whether such a program existed. Of the respondents who had formal wellness programs, the main components were a mentorship program (28.1%); debriefing or support-group sessions (15.7%); self-care, mindfulness, or meditation training (15.7%); and education in fatigue and stress management (12.4%). Current methods that residency programs use to promote wellbeing include social wellness (e.g., casual gatherings) (33.5%), professional wellness (mentorship pairs or groups that facilitate discussion about personal or work-related concerns, 27.1%), and adequate rest (e.g., postcall days, reasonable frequency of calls, 18.7%). In addition, 15.7% of respondents had been involved in a case where fatigue, burnout, or depression had adversely affected an outcome or judgement.
      Some form of intimidation at work had been experienced by 42.2% of respondents, the cause of which was most often attending physicians (42.5%). Furthermore, 28.4% of respondents felt concerned about their safety while on call. The reasons for safety concerns included experience of physical assault or fear of physical assault by a patient (37.0%), verbal aggression by a patient (34.8%), and safety concerns walking to and from the clinic (26.1%).
      Respondents believed that the Royal College of Physician and Surgeons of Canada and the COS-SCO could better promote resident wellness by mandating the inclusion of resident wellness programs within ophthalmology training programs (32.5%) and offering strategies for developing and continuously evaluating wellness programs (18.9%).
      To the best of our knowledge, this is the first national wellness survey among Canadian ophthalmology resident physicians. Our study revealed that a large proportion of resident physicians met the criteria for depression or burnout within a year prior to taking the survey. Unfortunately, some residents believed that their state of fatigue, burnout, or depression had adversely affected a medical outcome or judgement.
      Coinciding with high levels of burnout and depression, many residents believed that there was minimal or no emphasis placed on promoting a culture of resident wellness within their respective training program. Furthermore, most residents did not have or were unaware of formal wellness programs intended to mitigate burnout. Moreover, aggression and intimidation at work was common, in addition to safety concerns while on call.
      Based on the results of our study, more emphasis must be placed on Canadian resident physician wellness. One possible solution to better promote resident wellness would be to mandate the inclusion of wellness programming within ophthalmology training programs, with guidelines for development and continued evaluation. Increased promotion of resident wellness may allow for environments that are more conducive to learning and may reduce adverse patient outcomes secondary to resident physician stress and fatigue.

      Disclosure

      The authors have no proprietary or commercial interest in any materials discussed in this correspondence.

      References

        • Taher A
        • Hart A
        • Dattani ND
        • Poonja Z
        • Bova C
        • Bandiera G
        • Pardhan K.
        Emergency medicine resident wellness: lessons learned from a national survey.
        CJEM. 2018; 20: 721-724
        • Nolan KJ
        • Writer H
        • Ladhani M
        Canadian Pediatric Program Directors Research Group. Wellness in Canadian paediatric residents and their program directors.
        Paediatr Child Health. 2017; 22: 199-202
        • Ferguson C
        • Low G
        • Shiau G.
        Resident physician burnout: insights from a Canadian multispecialty survey.
        Postgrad Med J. 2020; 96: 331-338
        • Tran EM
        • Scott IU
        • Clark MA
        • Greenberg PB.
        Resident wellness in US ophthalmic graduate medical education: the resident perspective.
        JAMA Ophthalmol. 2018; 136: 695-701
        • Szigiato AA
        • Palakkamanil M
        • Aubin MJ
        • Ziai S.
        Canadian ophthalmology resident experience during the COVID-19 pandemic.
        Can J Ophthalmol. 2020; S0008-4182: 30785-30787