Understanding burnout in Pediatric residency through the lens of the ‘Areas of worklife’

Figures & data

Table 1. Areas of worklife definitions.

Areas of Worklife	Definition
Control	includes individual autonomy and the ability to influence decisions affecting one’s work^Citation6.
Values	“encompasses the ideals and motivations” that originally attracted an individual to their job^Citation6.
Reward	“addresses the extent to which rewards- monetary, social, and intrinsic – are consistent with expectations.”^Citation6
Fairness	can be seen as whether “decisions at work are perceived as being fair and people are treated with respect.”^Citation6
Workload	can be seen as both qualitative and/or quantitative and is essentially the demands of an individual’s job^Citation6.
Community	defined as “the overall quality of social interaction at work.”^Citation6

Figure 1. Residency areas of worklife: connectedness through patient care.

Table 2. Themes and representative quotes.

Control	Schedule		‘I think having control over your work means you know your schedule and you can help control the schedule. You know what time you’re gonna be rounding and you get to divvy up the patients and what patients you’re gonna see … ’
			‘At least getting to put in what most important day you want off or just the important things … that month to make sure you can be able to go to for mental wellness’
	Autonomy in Patient-Care Decisions		‘Autonomy gives you a sense of purpose. That you are making decisions, growing as a clinician. There’s going to be so many things outside of your control, but if you’re allowed to have control, safely, within your realm of what’s expected and safe for the patient so that you can grow, I think that’s important.’
Values	Learning	Patient Care	‘I think as values for us we get more out of actual patient care and the learning process that goes along the way … ’
			‘I value providing optimal care for patients, spending time with patients, and trying to learn from them.’
		Peer-to-Peer	‘You had a resident work room with other third years … People came in with a lot of different ideas, and you could bounce things off each other.’
Reward	Helping sick children get well		‘Well there’s the intrinsic rewards, right, of feeling like what we’re doing is actually contributing value to somebodies life or to some family and that’s always kind of irreplaceable if you actually feel like you’re making an impact’
	Recognition/Appreciation		‘Feeling appreciated like you did something that was helpful … or just feeling kind of recognized’
Fairness	Scheduling Equity		‘Yeah. I guess for me, the idea of fairness is … the sense that there is no exceptional treatment, that everyone is within the range of a certain expectation, like getting more or less the same thing out of the experience’
Workload	Recovery Time		‘ – it’s the relentless nature of back to back to back. I go through periods of months where I’m like, “I have not had a single day off.” Then they’re like, “Well, that’s not true. You had four.” I’m like, “Well, that was just recovering from – ” You know what I mean? If there was a way to have, during the really intense months, an actual, just a little bit of time where you don’t need to just be home … ’
	Non-educational Tasks		‘I don’t mind doing medical work, and I find that rewarding … what I don’t like about it is, fielding 1,000 phone calls, and changing this order or changing that order. That’s work that is just frustrating.’
Community	Nursing	Collaborative	‘At its best, it is collaborative and everyone recognizes that they’re on the same team.’
		Lack of Awareness	‘Maybe educating, nurses knowing when a resident is working might help because a lot of tension between residents and nurses comes when a nurse will call at 3:00 in the morning to ask about a clarification when a resident is on a 28-hour shift and that is their only hour to sleep’
		Increased interaction	‘we try to do nurse included rounds and I think those are really good but it’s still only a few minutes a day and it’s not really a conversation … but If there was some opportunity to have conversations in a group … just all sit and have lunch together, that might be interesting.’
			‘Maybe even doing more whole floor events, or lunches for the nurses and residents, or things that could help build relationships more’
	Advanced Practice Providers	Helpful Resource	‘They are fantastic. They help you out. When we have questions, they’re a great resource.’
		Lack Camaraderie	‘Separate. Isolated. Even when we are on the same team, it’s just very-they have their patients; we have our patients.’
		Increased Interaction	‘More interactions, I think it’s just getting to know people. Just working with them daily is gonna bring more of like a friendship’
	Attendings	Absence of Hierarchy	‘It’s not as hierarchical here, and so I think, in general, their relationship is very positive. You see your attending as a teacher, but also as a role model and as an ally.’
		Teaching	‘I think we have, for the most part, really fantastic attendings who like teaching.’
			‘I think to me what makes a good attending is that they support resident autonomy, they value education and teaching, they respect resident’s time, and they aren’t above offering to help and chip in.’
	Leadership	Supportive	‘I feel like they would go the extra mile to help a resident out’
		More Time	‘It might be helpful to be able to meet with more program leadership to talk about issues.’
	Residents	Biggest Support	‘I think that the other residents are probably our best resource as far as helping sort of cope and manage the difficulties of residency because they are some of the only people that have an understanding of the situations we are going through.’
		More Time	‘I don’t think we have enough time or opportunity to see the other residents.’

Table 3. Areas of worklife, mismatches, and proposed solutions.

Area of Worklife	Resident Perception	Mismatch	Proposed solution
Control	Control over schedule	General lack of control over resident schedules.	Increase schedule flexibility
			Provide more choice in the structure of the work day or rotation
	Control regarding decisions related to patient care.	Lack of autonomy over patient care decisions	Train the teams in communication Set expectations Conduct discussions on rounds outside the patient room
Value	Patient related and focused education	Clerical work taking away from learning, dedicated teaching time often interrupted	Engage care/discharge coordinators Protect teaching/didactic time in larger chunks to eliminate interruptions and task shifting
Reward	Extrinsic – Recognition and appreciation	None	Give regular verbal praise and acts of appreciation from the program or hospital
	Intrinsic – Helping sick children	Inability to witness this by lack of time at bedside, increased clerical work	See value solution* Enhance patient follow-up through established avenues (continuity clinic)
Fairness	Scheduling equity	None	Make scheduling process transparent
Workload	Clerical work	Negative contributor to workload	See value solution* Engage residents in medical decision making to offset clerical work
	Recovery time	None	Minimize back to back call months Protect time during the work day to decompress
Community	Collaboration with nursing	Lack of nursing awareness of resident schedule	Increase communication and interaction with nursing colleagues
	Camaraderie with Advanced Practice Providers (APPs)	Lack of camaraderie	Increased informal interaction with APPs
	Absence of hierarchy among attendings	None	Get to know residents personally Foster mutual respect
	Approachability of program leadership	None	Leadership is receptive to change Be approachable if residents have questions or concerns
	Residents as main form of support	None	Organize class events

Leiter MP, Maslach C. Six areas of worklife: a model of the organizational context of burnout. J Health Hum Serv Adm. 1999; 472–8.

 PubMedGoogle Scholar