How To Improve Morale And Combat Burnout In Residency

Given the workload for podiatric residents and potential for burnout, these residency directors discuss strategies for keeping morale high among residents and addressing concerns about residents’ satisfaction with residency programs.

Q:

How do you measure your residents’ morale and satisfaction with your program? Do you meet with residents on a regular basis? Is there a forum or pathway for residents to speak up about issues that are affecting them or ideas they may have for improving the residency program?

A:

Jarrod Shapiro, DPM, FACFAS, FACFAOM has six residents in his program at the Chino Valley Medical Center in Chino, Calif. He maintains a “heavy interaction” with the residents on a daily to weekly basis, making an effort to speak directly with them and gauge their morale. Additionally, Dr. Shapiro asks the residents to complete a monthly evaluation of each of their rotations. His program also does annual satisfaction surveys and an exit interview upon graduation.

“As a director, I attempt to create an environment that is open and safe for the residents to express their views, opinions and dissent,” says Dr. Shapiro.

David Bernstein, DPM, FACFAS, meets with all residents as a group once per month to discuss all topics. During that time, he says each resident has a chance to express opinions on anything. Dr. Bernstein says he personally speaks to each resident individually on a weekly basis to discuss how they view the residency program with regard to likes and dislikes. He often modifies rotations based on residents’ input.

Leslie Niehaus, DPM, FACFAS, meets with all the residents weekly in a morning discussion before his program’s didactic lectures, noting he and residents can cover any issues that arise. He points out that residents all rotate through his office for one week every quarter and he is available anytime to address any issues they might have. Residents can also text or email Dr. Niehaus.

“We are always open to new formats to enhance their educational experiences and we do make changes that are positive or recommended by the Council on Podiatric Medical Education,” says Dr. Niehaus.

Q:

What is your experience with addressing burnout among your residents? What steps do you take to prevent potential burnout from occurring among residents?

A:

Dr. Bernstein’s program monitors the number of hours residents work on a weekly basis with an online service. As he says, anyone on night call who has to go to the hospital is not allowed to return for eight hours. He encourages residents to leave the hospital early when they are tired, noting the chief resident follows residents’ energy levels closely.

“I constantly tell (residents) to go home and be with their family and friends,” says Dr. Bernstein.

Dr. Niehaus’s residents seem most stressed during their third year as they prepare for their boards. He notes boards “are never a pleasant experience for them.” Dr. Niehaus’s program offers a more “family-friendly” atmosphere in which residents have fair work hours and call weeks are shared fairly as much as possible. His residents can take vacations or sick time when they need to.

“I treat (residents) as family and not skilled labor,” says Dr. Niehaus. “We are a small community hospital that prides itself on people first. We have never lost a resident to excessive stress. Residents are also good at helping each other.”

As Dr. Shapiro notes, Chino Valley Medical Center maintains psychological support for residents who may be having personal or professional issues. He also makes every attempt to provide an open environment for residents to discuss personal concerns. He says his residents are able to take call from home and this allows them to see their loved ones on a regular basis.

“Having a program that balances personal life with professional responsibility and job duties additionally decreases resident burnout,” says Dr. Shapiro.

Dr. Bernstein adds that his hospital has monthly required lectures for residents on topics such as morale, sleep deprivation, communication, etc.

Q:

Do you meet with your residents off the clock to learn about their goals and expectations?

A:

Dr. Niehaus has occasional dinner meetings that are non-educational, or he and residents go out for beer as a group. He has had residents over to his house for swim picnics and for Christmas parties with Santa to visit their kids. Dr. Niehaus has always made himself available for any needs that he can help with, such as job searches.

Dr. Bernstein encourages all attendings to offer residents lunch or dinner after hours or a late surgery. He will personally invite residents to go to dinner after an educational meeting. The conversation is directed toward non-hospital topics like family, friends, hobbies and vacations. He and residents also discuss what type of podiatry practice they think they might want.

Generally, Dr. Shapiro does not meet with the residents off the clock other than at planned social events such as various dinners. At the beginning of the residents’ program, he meets with them individually to discuss personal goals and concerns. At biannual performance review, he evaluates their personal goals again so both the residents and the administration are aware of their original goals, progress toward completion, and any adjustments they need to make.

Q:

Do you offer non-residency activities to help bolster morale?

A:

Dr. Shapiro’s program occasionally has social events such as holiday parties to give residents a chance to reconnect with each other and the administration. He says these events most commonly revolve around hospital functions and graduation events. For example, Dr. Shapiro’s hospital puts on a series of lunches throughout the year during important events and holidays.

Dr. Bernstein’s hospital provides for Resident Appreciation Day with events like going to a Phillies baseball game, golf or bowling. His hospital has a Resident Committee designed for residents to bring important issues to directors. He says residents attend and provide a report to the Graduate Education Committee on a regular basis. 

Dr. Niehaus tries to do extracurricular activities when the group can. His program celebrates the third-year residents’ graduation with a family and attending dinner every year.

Dr. Bernstein is the Director of the Podiatric Residency Program at Bryn Mawr Hospital in Wayne, Pa. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Niehaus is the Director of the Podiatric Residency Program at Alliance Community Hospital in Alliance, Ohio.

Dr. Shapiro is an Associate Professor with the College of Podiatric Medicine at the Western University of Health Sciences in Pomona, Calif. He is the Director of the Chino Valley Medical Center PMSR/RRA Podiatric Residency in Pomona, Calif.