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Original Investigation
January 2, 2020

Association of Weekly Protected Nonclinical Time With Resident Physician Burnout and Well-being

Author Affiliations
  • 1Department of Otolaryngology, University of Minnesota, Minneapolis
  • 2Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis
  • 3Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis
  • 4Hennepin Healthcare Research Institute, Department of Otolaryngology–Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
JAMA Otolaryngol Head Neck Surg. Published online January 2, 2020. doi:10.1001/jamaoto.2019.3654
Key Points

Question  Is 2 hours per week of protected nonclinical time associated with decreased burnout and increased well-being in otolaryngology residents?

Findings  In this prospective, nonrandomized crossover study, 2 hours per week of protected nonclinical time was associated with decreased burnout and increased well-being in otolaryngology residents.

Meaning  The preliminary results of this intervention in a small sample size are encouraging and warrant further investigation in larger cohorts of residents in randomized clinical trials to confirm the effectiveness of the protected time intervention to decrease burnout and increase well-being.

Abstract

Importance  Burnout among physicians is high, with resulting concern about quality of care. With burnout beginning early in physician training, much-needed data are lacking on interventions to decrease burnout and improve well-being among resident physicians.

Objectives  To design a departmental-level burnout intervention, evaluate its association with otolaryngology residents’ burnout and well-being, and describe how residents used and perceived the study intervention.

Design, Setting, and Participants  A prospective, nonrandomized crossover study was conducted from September 25, 2017, to June 24, 2018, among all 19 current residents in the Department of Otolaryngology at the University of Minnesota. Statistical analysis was performed from June 28 to August 7, 2018.

Interventions  All participants were assigned 2 hours per week of protected nonclinical time alternating with a control period of no intervention at 6-week intervals.

Main Outcomes and Measures  Burnout was measured by the Maslach Burnout Inventory and Mini-Z Survey. Well-being was measured by the Resident and Fellow Well-Being Index and a quality-of-life single-item self-assessment. In addition to a baseline demographic survey, participants completed the aforementioned surveys at approximately 6-week intervals during the study period.

Results  Among the 19 residents in the study (10 men [53%]), the overall protected time intervention (week 0 to week 32) was associated with a mean decrease of 0.63 points (95% CI, −1.03 to −0.22 points) in the Maslach Burnout Inventory emotional exhaustion score, indicating a clinically meaningful decrease in burnout, and a mean decrease of 1.26 points (95% CI, −2.18 to −0.34 points) in the Resident and Fellow Well-Being Index score, indicating a clinically meaningful improvement in well-being. The baseline to week 32 mean changes in the Maslach Burnout Inventory depersonalization score, Maslach Burnout Inventory personal accomplishment score, and quality-of-life single-item self-assessment were not clinically meaningful. There were clinically meaningful improvements in 4 of 6 tested Mini-Z Questionnaire items from baseline to week 32: job stress (weighted κ statistic, 0.21; 95% CI, −0.11 to 0.53), burnout (weighted κ statistic, 0.25; 95% CI, −0.02 to 0.53), control over workload (weighted κ statistic, 0.26; 95% CI, −0.01 to 0.53), and sufficient time for documentation (weighted κ statistic, 0.31; 95% CI, 0.08 to 0.54).

Conclusions and Relevance  This study found that 2 hours per week of protected nonclinical time was associated with decreased burnout and increased well-being in a small sample of otolaryngology residents. Future randomized clinical studies in larger cohorts are warranted to infer causality of decreased burnout and increased well-being as a result of protected nonclinical time.

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