Internal Medicine Residency Program Director Support and Burnout During the COVID-19 Pandemic: Results of a National Survey

Background: Burnout is common among physicians and physician leaders, including residency program directors (PDs). The effects of the COVID-19 pandemic and other stressors in 2020 on PDs is unknown. Objective: To measure the prevalence of burnout among internal medicine (IM) residency PDs 6 months into the COVID-19 pandemic. Methods: A total of 429 IM PDs, representing 83% of accredited residency programs, were surveyed from August to December 2020. Burnout, using a 2-item screening tool, and self-reported consideration of resigning in 2020, were compared to their annual prevalence since 2012 and tested for possible associations with pandemic stressors and program characteristics. Results: The survey response rate was 61.5% (264 of 429). One-third (33.6%, 87 of 259) of PD respondents met burnout criteria, and 45.1% (110 of 244) reported considering resigning in the past year, which were within the range of preceding years. PDs who reported feeling highly supported by institutional leadership were less likely to meet burnout criteria and to have considered resigning. There were no associations between burnout or consideration of resigning and the amount of clinical time PDs spent in their roles, duration of maximum stress on programs, budget cuts to programs, or geographic region. Conclusions: The prevalence of burnout among PDs in fall 2020 was similar to the prevalence of burnout in pre-pandemic years despite uniquely extreme stressors. PDs\u27 perception of being highly supported by institutional leadership was associated with lower prevalence of burnout and consideration of resigning. Perceived leadership support may be a protective factor against burnout during periods of high stress

Evidence-Informed Facilitated Feedback: The R2C2 Feedback Model

Abstract Introduction While feedback continues to pose challenges, new understanding is emerging. Feedback is now being seen as an interaction in which learner engagement, supportive relationships, reflection, and cooperative planning are important. In response and through research, we developed and tested the R2C2 model and teaching materials to support its use. Methods R2C2 is an evidence-based reflective model for providing assessment feedback. It includes four phases: (1) relationship building, (2) exploring reactions to the feedback, (3) exploring understanding of feedback content, and (4) coaching for performance change. It provides a strategy for facilitating feedback conversations that promote engagement with performance data and enable coaching for improvement. This package of educational materials includes paper-based and video resources designed to support interactive learning and skills development in facilitating feedback and coaching. Specific strategies are described and demonstrated for each phase of the R2C2 model and include a learning change template for the coaching phase. Resources can be used by an individual or group. A workshop outline with presentation slides and a practice scenario are also included. Results Through research, invited and peer-reviewed presentations, and feedback from colleagues who have used the materials and the R2C2 model, we have learned that the model is intuitive and easy to use, that it can engage the learner and support coaching, and that the educational materials are clear and useful. Discussion The model is intuitive, especially within competency-based education, is easy to follow, and makes sense to faculty, which makes it easy to implement in most programs

Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection.

BackgroundCharacterizing the prevalence and persistence of symptoms associated with COVID-19 infection following hospitalization and their impact is essential to planning post-acute community-based clinical services. This study seeks to identify persistent COVID-19 symptoms in patients 35 days post-hospitalization and their impact on quality of life, health, physical, mental, and psychosocial function.Methods and findingsThis prospective cohort study used the PROMIS® Instruments to identify symptoms and quality of life parameters in consecutively enrolled patients between March 22 and April 16, 2020, in New Jersey. The 183 patients (median age 57 years; 61.5% male, 54.1% white) reported persistent symptoms at 35 days, including fatigue (55.0%), dyspnea (45.3%), muscular pain (51%), associated with a lower odds rating general health (41.5%, OR 0.093 [95% CI: 0.026, 0.329], p = 0.0002), quality of life (39.8%; OR 0.116 [95% CI: 0.038, 0.364], p = 0.0002), physical health (38.7%, OR 0.055 [95% CI: 0.016, 0.193], p ConclusionsCOVID-19 symptoms commonly persist to 35 days, impacting quality of life, health, physical and mental function. Early post-acute evaluation of symptoms and their impact on function is necessary to plan community-based services