Natural history of burnout, stress, and fatigue in a pediatric resident cohort over three years

Figures & data

Table 1. Study site, residency program, and study population baseline demographics.

Resident Baseline Demographics^a	N	%
Residents	33	100
Gender
Prefer not to say	1	3
Female	27	82
Male	5	15
Race
Asian/Pacific Islander	4	12
Black/African-American	2	6
White/Caucasian	22	67
Multiple races	5	15
New to Chicago
No	3	9
Yes	29	91
No response	1
Living Arrangement
Alone	13	39
Roommate	5	15
Spouse/Partner	15	45
Marital Status
Single	21	64
Engaged	2	6
Married	9	27
Divorced	1	3
Hospital Characteristics
Inpatient Admissions^b	10,891
ED Visits^b	47,079
Deliveries^c	11,648
Residency Schedule	Inpatient	Outpatient/ED^d/Elective
PGY1	8–9 months	3–4 months
PGY2	6–7 months	5–6 months
PGY3	4–5 months	7–8 months

^aDemographic Data from PGY1 residents at T1 (Orientation)

^b2015–2016 data (Cohort’s PGY1 year)

^cCalendar year 2016 deliveries at Prentice Women’s Hospital, where pediatric residents rotate through Newborn Nursery and NICU

^dEmergency Department

Table 2. Survey timing and response rates.

Timepoint	Description of Timepoint	Dates of Survey Administration	# Residents at timepoint^a	# Residents who completed survey at timepoint	Response Rate
T1	Orientation prior to PGY1	June 2015	33	33	100%
T2	Mid-PGY1	January 2016	33	26	79%
T3	PGY1/2 Transition	June 2016	33	17	52%
T4	Mid-PGY2	January 2017	33	20	61%
T5	PGY2/3 Transition	June 2017	33	23	70%
T6	Mid-PGY3	Surveys not administered
T7	Completion/End of residency	June 2018	31	19	61%
# Total surveys completed by an individual resident		Number of Residents		% of Residents
1^b		3		9%
2		4		12%
3		3		9%
4		6		18%
5		8		24%
6		9		27%

^aThere were 33 PGY1 residents at orientation (T1). There were 31 PGY3 residents at T7. Two residents began the neurology portion of their Pediatrics/Child Neurology training after T5

^bResidents who only completed 1 survey (baseline T1) and no other surveys were not included in the statistical analysis

Table 3. Change from baseline mean at each study timepoint.

Survey Metric^a	Timepoint	N	Timepoint Mean	Baseline Mean^b	Change from baseline			Model-based Statistics
					Mean Change	Std Dev	95% CI	LS Means	Std Err	p-value
AMBI-EE^c	T1	33	6.64	6.64
	T2	26	11.46	7.04	4.42	3.79	(2.89, 5.95)	4.57	0.61	<.0001
	T3	17	12.94	6.65	6.29	3.39	(4.55, 8.04)	4.94	0.74	<.0001
	T4	20	11.05	6.75	4.30	4.18	(2.34, 6.26)	4.29	0.68	<.0001
	T5	23	11.39	6.70	4.70	5.09	(2.49, 6.90)	4.69	0.68	<.0001
	T7	19	11.63	6.53	5.11	4.48	(2.94, 7.27)	5.12	0.73	<.0001
AMBI-D^d	T1	33	2.55	2.55
	T2	26	6.15	2.19	3.96	3.47	(2.56, 5.36)	3.95	0.65	<.0001
	T3	17	7.53	2.41	5.12	3.02	(3.57, 6.67)	4.83	0.73	<.0001
	T4	20	6.00	2.25	3.75	3.01	(2.34, 5.16)	3.70	0.56	<.0001
	T5	23	6.39	2.17	4.22	4.08	(2.45, 5.98)	3.82	0.78	<.0001
	T7	19	7.26	2.42	4.84	4.38	(2.73, 6.95)	4.92	0.89	<.0001
PSS^e	T1	33	12.52	12.52
	T2	26	19.85	11.77	8.08	5.70	(5.78, 10.38)	8.17	1.06	<.0001
	T3	17	19.82	12.00	7.82	5.23	(5.13, 10.52)	7.65	1.09	<.0001
	T4	20	18.35	11.50	6.85	6.13	(3.98, 9.72)	7.07	1.10	<.0001
	T5	23	17.00	10.91	6.09	5.70	(3.62, 8.55)	5.45	1.07	<.0001
	T7	19	19.32	11.68	7.63	6.09	(4.69, 10.57)	7.91	1.32	<.0001
ESS^f	T1	33	7.47	7.47
	T2	26	10.77	7.71	3.06	3.03	(1.83, 4.28)	3.03	0.60	<.0001
	T3	17	11.18	7.94	3.24	3.40	(1.49, 4.98)	3.14	0.71	0.0001
	T4	20	11.55	7.63	3.93	2.63	(2.70, 5.15)	4.46	0.61	<.0001
	T5	23	10.74	7.28	3.46	3.72	(1.85, 5.07)	2.95	0.75	0.0005
	T7	18	10.78	6.81	3.97	3.19	(2.38, 5.56)	3.77	0.62	<.0001
AMBI-PA^g	T1	33	14.77	14.77
	T2	26	14.31	15.13	−0.83	2.23	(−1.73, 0.07)	−0.82	0.40	0.0468
	T3	17	14.62	15.18	−0.56	2.14	(−1.66, 0.54)	−0.25	0.33	0.4535
	T4	20	13.80	15.28	−1.48	2.19	(−2.50, −0.45)	−1.28	0.41	0.0044
	T5	23	13.74	15.28	−1.54	2.27	(−2.53, −0.56)	−1.53	0.37	0.0002
	T7	19	13.63	15.08	−1.45	2.74	(−2.77, −0.13)	−1.43	0.47	0.0049
AMBI-SAT^h	T1	33	14.73	14.73
	T2	26	6.77	14.88	−8.12	3.66	(−9.59, −6.64)	−8.25	0.49	<.0001
	T3	17	7.59	15.06	−7.47	4.56	(−9.81, −5.13)	−7.55	0.62	<.0001
	T4	20	13.30	14.85	−1.55	2.48	(−2.71, −0.39)	−2.07	0.67	0.0042
	T5	23	12.30	15.13	−2.83	4.03	(−4.57, −1.08)	−2.75	0.70	0.0005
	T7	19	11.42	15.11	−3.68	4.19	(−5.70, −1.66)	−3.10	0.78	0.0004
CD-RISC10^i	T1	33	30.61	30.61
	T2	26	28.77	30.42	−1.65	3.32	(−3.00, −0.31)	−1.71	0.61	0.0089
	T3	17	29.24	31.59	−2.35	3.00	(−3.89, −0.81)	−1.98	0.66	0.0060
	T4	20	28.25	30.35	−2.10	3.70	(−3.83, −0.37)	−2.03	0.69	0.0069
	T5	23	28.00	30.96	−2.96	4.20	(−4.77, −1.14)	−2.94	0.79	0.0009
	T7	18	29.50	30.72	−1.22	5.14	(−3.78, 1.33)	−1.22	1.19	0.3172
SCS-R^j	T1	33	99.85	99.85
	T2	26	93.27	100.69	−7.42	9.51	(−11.26, −3.58)	−7.30	1.80	0.0004
	T3	17	92.41	102.12	−9.71	11.43	(−15.58, −3.83)	−6.58	2.34	0.0089
	T4	20	95.20	101.55	−6.35	9.89	(−10.98, −1.72)	−6.00	1.92	0.0041
	T5	23	92.22	101.17	−8.96	12.68	(−14.44, −3.48)	−9.17	2.63	0.0017
	T7	18	100.83	103.94	−3.11	7.20	(−6.69, 0.47)	−5.23	1.44	0.0012

^aSee text for abbreviations and descriptions; References [9–11,14–22]

^bBaseline means at each timepoint were calculated for subjects who provided responses at the follow-up timepoint

^cAMBI-EE: Maximum score for subscale is 18; higher scores indicate feeling more emotional exhaustion

^dAMBI-D: Maximum score for subscale is 18, higher scores indicate feeling more depersonalization

^ePSS: 0–13 low stress, 14–26 moderate stress, 27–40 high stress

^fESS: 0–10 normal, 11–12 mild sleepiness, 13–15 moderate sleepiness, 16–24 severe sleepiness

^gAMBI-PA: Maximum score for subscale is 18, lower scores indicate feeling less personal accomplishment

^hAMBI-SAT: Maximum score for subscale is 18, lower scores indicate decreased satisfaction with medicine

ⁱCD-RISC10: mean score 31 with lower scores indicating less resilience

^jSCS-R: Maximum score 120 with lower scores indicating less social connectedness

Table 4. Differences between worst score and T7.

Survey^a,b	Worst Score	Ending Timepoint	Least Squared Mean Difference between worst score and T7	Standard Error	Adjusted p-value^c
AMBI-EE	T3	T7	−0.32	0.62	0.9952
AMBI-D	T3	T7	−0.14	0.64	0.9999
PSS	T2	T7	−0.03	1.79	1.0000
ESS	T4	T7	0.61	0.78	0.9675
AMBI-PA	T7	T7	NA	NA	NA
AMBI-SAT	T2	T7	−5.03	0.89	0.0000
CD-RISC10	T5	T7	−1.71	1.34	0.7947

^aSee text for abbreviations and descriptions; References [9–11,14–22]

^bSCS-R not included because T7 mean score was higher than baseline.

^cUsing Tukey-Kramer method

Table 5. Prevalence of survey scores suggesting resident impairment.

5a. All surveys (Prevalence of scores worse at follow-up than at baseline)^a
Survey^b	TIMEPOINT
	T2	T3	T4	T5	T7
AMBI-EE	88.5%	94.1%	80.0%	69.6%	84.2%
AMBI-D	80.8%	94.1%	85.0%	87.0%	89.5%
PSS	88.5%	94.1%	90.0%	91.3%	89.5%
ESS	80.8%	88.2%	90.0%	78.3%	89.5%
AMBI-PA	46.2%	41.2%	65.0%	65.2%	52.6%
AMBI-SAT	96.2%	94.1%	65.0%	69.6%	73.7%
CD-RISC10	57.7%	70.6%	65.0%	69.6%	68.4%
SCSR	73.1%	76.5%	65.0%	78.3%	73.7%
5b. Surveys with references ranges (Prevalence of scores beyond reference range)^c
Survey (Reported Reference Range)	TIMEPOINT
	T2	T3	T4	T5	T7
AMBI-EE (>9)	76.9%	82.4%	65.0%	69.6%	78.9%
AMBI-D (>6)	34.6%	58.8%	40.0%	39.1%	42.1%
PSS (>13)	84.6%	88.2%	75.0%	69.6%	68.4%
ESS (>10)	57.7%	47.1%	65.0%	52.2%	52.6%

^aProportion of competed surveys at each timepoint that were worse than at baseline (T1)

^bSee text for abbreviations and descriptions. References [9–11,14–22]

^cSee references [17–20,23] for reported reference ranges

Figure 1. Trends in survey metrics over time.

See text for abbreviations and descriptions; References [9–11] and [14–23] for original survey details and reference ranges. Panel 1, AMBI-EE: maximum score 18; higher scores indicate feeling more emotional exhaustion.Panel 2, AMBI-D: maximum score 18; higher scores indicate feeling more depersonalization.Panel 3, AMBI-PA: maximum score 18; lower scores indicate feeling less personal accomplishment.Panel 4, AMBI-SAT: maximum score 18; lower scores indicate decreased satisfaction with medicine.Panel 5, Perceived Stress Scale: 0–13 low stress, 14–26 moderate stress, 27–40 high stress.Panel 6, Epworth Sleepiness Scale: 0–10 normal, 11–12 mild sleepiness, 13–15 moderate sleepiness, 16–24 severe sleepiness. Panel 7, CD-RISC10: mean score 31; lower scores indicate less resilience.Panel 8, SCS-R: maximum score 120; lower scores indicate less social connectedness.

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