The Burden of Leadership: a Survey of Burnout Experiences Among Psychiatry Program Directors.

OBJECTIVE: The objectives of this study were to examine the prevalence of burnout, specify contributors to and protective factors against burnout, and gather suggestions to improve well-being in psychiatry Program Directors. METHODS: A survey regarding burnout and wellness was distributed to psychiatric Program Directors through the email listserv of the American Association of Directors of Psychiatric Residency Training (AADPRT). RESULTS: The survey response rate was 273 responses out of 880 members surveyed (31%). The majority of respondents were current residency or fellowship Program Directors or Associate Program Directors or had another current educational role (93%, 227/245). Almost half of current Program Directors or Associate Program Directors reported feeling burned out almost daily or once a week (44%, 93/210). These Program Directors reported a desire to resign (77%), experienced discrimination within the past 5 years (66%), and struggled with finding meaning in their job (44%). The most frequently endorsed contributors to burnout were increasing administrative burden and insufficient support. CONCLUSIONS: The survey findings confirm that burnout characteristics are common among respondents, associated with a desire to resign and a struggle to find meaning in the highly demanding position of Program Director or Associate Program Director. Advocacy for resources, decreased administrative overload, and increased protected time would enhance well-being in Program Directors. Most striking was the frequency of discrimination reported and its relationship to burnout. Departments may benefit from a careful review of policies, procedures, and training to decrease hostile workplaces for women, international medical graduate, and under-represented in medicine Program Directors.

Group Training for Psychiatric Residents: Support Group Facilitation and Supervision with Didactics.

OBJECTIVE: Group psychotherapy merits dedicated training during psychiatry residency yet is challenging to implement given competing educational requirements. The authors implemented a voluntary support group training intervention for psychiatry residents consisting of a 6-h didactic series followed by at least 6 months of in vivo group facilitation and supervision. We hypothesized participation would improve residents' self-reported skill and knowledge in group facilitation. METHODS: Psychiatry residents (PGY I-IV) voluntarily participated in this novel intervention that included a didactic series followed by experiential group facilitation and supervision. To assess confidence and self-reported skill level in group facilitation, residents completed two brief self-report surveys: before the didactic series (pre-intervention) and after group facilitation for at least 6 months (post-intervention). Surveys included Likert scales and open-ended questions. Quantitative data were analyzed with descriptive statistics and open-ended qualitative data were analyzed using thematic analysis. RESULTS: Twenty-three residents attended 4 to 6 h of didactics between 2016 and 2018. Of these 23 residents, 12 facilitated groups and attended supervision for at least 6 months. Twenty residents responded to pre-intervention surveys and 14 responded to post-intervention surveys. After the intervention, respondents reported a significant increase in knowledge and skills in group facilitation of 88% (15/17) on Likert scale questions. CONCLUSIONS: This study implemented a novel educational intervention to train psychiatric residents in group dynamics and group facilitation. Participation increased residents' self-reported knowledge and skills in group facilitation. Future directions include incorporating feedback about group curriculum, evaluating resident knowledge and skills using assessment measures, recruiting more group participants, and focusing on peer-to-peer mentoring.

An Intervention in Social Connection: Medical Student Reflection Groups.

OBJECTIVE: Rates of medical student depression and suicide are higher than aged-matched peers. Although medical schools have implemented wellness interventions, no program has reported on interventions targeting social support. As one potential intervention, reflection groups for medical students led by psychiatry residents were designed and implemented. It was hypothesized that groups would encourage connectedness among peers, teach coping and emotional self-awareness skills, increase empathy, and decrease loneliness. METHODS: Voluntary, biweekly support groups were implemented between 2017 and 2018 at Stanford University School of Medicine for first- and second-year medical students. Participants were surveyed at baseline and 6 months. Surveys included qualitative assessments of groups and validated surveys to assess empathy, wellness, and loneliness. Separate surveys assessed attrition. Analyses included statistical analyses (descriptive statistics) and thematic analysis. RESULTS: In both cohorts, a total number of 30 students participated in groups, and 18 completed post-surveys. Students reported groups improved well-being (55.6% strongly agreed, 27.8% agreed), enhanced self-awareness (44.4% strongly agreed, 38.9% agreed) and ability to empathize (50.0% strongly agreed, 27.8% agreed), and promoted connection (61.1% strongly agreed, 33.3% agreed). Initial attrition was high, with 84% of students not continuing due to feeling too overwhelmed by classes. CONCLUSIONS: Thematic analysis demonstrated groups may benefit students in improving impostor syndrome and connection with others (decreased loneliness), allowing exposure and tolerance to diverse perspectives, increasing insight into the importance of self-care and emotional self-awareness, allowing practice for collaborative skills, and increasing thoughtful approaches to patient care. There is preliminary evidence reflection groups may be a feasible, effective intervention to improve loneliness and social belonging in medical school.

Faculty Development for Teaching Faculty in Psychiatry: Where We Are and What We Need.

OBJECTIVE: A Faculty Development Task Force surveyed the American Association of Directors of Psychiatric Residency Training membership to assess faculty development for graduate medical education faculty in psychiatry departments and barriers to seeking graduate medical education careers. METHODS: An anonymous Survey Monkey survey was emailed to 722 American Association of Directors of Psychiatric Residency Training members. The survey included questions about demographics, the current state of faculty development offerings within the respondent's psychiatry department and institution, and potential American Association of Directors of Psychiatric Residency Training faculty development programming. Two open-response questions targeted unmet faculty development needs and barriers to seeking a career in graduate medical education. Results were analyzed as frequencies and open-ended questions were coded by two independent coders. We limited our analysis to general psychiatry program director responses for questions regarding faculty development activities in an attempt to avoid multiple responses from a single department. RESULTS: Response rates were 21.0% overall and 30.4% for general program directors. General program directors reported that the most common existing departmental faculty development activities were educational grand rounds (58.7%), teaching workshops (55.6%), and funding for external conference attendance (52.4%). Of all survey respondents, 48.1% expressed the need for more protected time, 37.5% teaching skills workshops, and 16.3% mentorship. Lack of funding (56.9%) and time (53.9%) as well as excessive clinical demands (28.4%) were identified as the main barriers to seeking a career in graduate medical education. CONCLUSIONS: Despite increasing faculty development efforts in psychiatry departments and institutions, real and significant unmet faculty development needs remain. Protected time remains a significant unmet need of teaching faculty which requires careful attention by departmental leadership.