P2A046: Physiologic Correlates of Pediatric Resident Burnout and Stress

Background: Resident burnout has components of emotional exhaustion, depersonalization, and a reduced sense of personal achievement. Prior studies have demonstrated national pediatric resident burnout rates to be greater than 50%. Potential consequences of burnout are decreased job performance and an increase in medical errors. The field of medical education is lacking in objective data to identify and target individuals most affected by burnout, or to predict factors in a trainee's experience that make them at higher risk of developing burnout. If these factors were known, it would be possible to develop interventions to prevent and/or address the syndrome.
Heart rate variability (HRV) analysis has been used to assess the impact of the sympathetic and parasympathetic nervous system on a subject. Frequency domain analysis has been performed to assess the impact of stress on a subject's HRV. To our knowledge, HRV analysis has not yet been attempted in first year pediatric residents, and has not been performed over an entire day's period. In this pilot study, we intend to 1) observe HRV trends over the course of a 24 hour period in first year pediatric residents, 2) determine the most physiologically stressful parts of a work day, and 3) assess whether there is a relationship between HRV trends and indices of burnout.

Methods: A total of seven first year pediatric residents at Children's National Hospital were monitored with an ambulatory EKG device (Hexoskin) for 24 consecutive hours inclusive of a standard day shift during an inpatient rotation, where activities were monitored using periodic surveys. Burnout and resilience surveys including the Maslach Burnout Inventory were administered prior to data collection. EKG data was analyzed using Kubios, a standard HRV analysis software, where frequency domain variables (LF/HF ratio, SD2/SD1 ratio) were extracted. Linear regression analysis was performed comparing timepoints of interest with frequency domain variables.

Results: Survey data reveals all subjects had moderate-high levels of depersonalization, and all subjects had moderate-low levels of personal achievement at work. LF/HF ratios were uniformly significantly higher for subjects at work compared to baseline. Work performed in the later part of the day shift had significantly higher LF/HF ratios than those of rounding or work done in the morning after rounds. We did not find a relationship between burnout indices and degree of physiologic stress.

Conclusion: Our subjects demonstrated burnout levels above the national average. HRV statistical analysis reveals significantly higher stress levels at work compared to baseline, specifically with work performed later in the day as most stress-inducing. A larger sample size is likely required to see a relationship between burnout indices and degree of physiologic stress. Our data support the need for ongoing mental health resource access for pediatric residents, and for ongoing investigations into reducing burnout rates.