Ethical Implications of Burnout in Residents

Residency programs that are successful in addressing burnout in residents have become proactive with respect to surveillance, recognition, prevention, mitigation, reassessment, and ongoing monitoring. These programs have also put into place a wide range of strategies that prepare residents for the challenges and disappointments that characterize a surgical career, while emphasizing the benefits and joys of being a caring, compassionate, and competent otolaryngologist. Teaching coping mechanisms for stress, emphasizing proper diet and exercise, facilitating appropriate rest time and vacations away from training, promoting faculty-resident mentoring programs that allow for discussions and encouragement, and offering the opportunity to take advantage of mental and physical wellness programs provided by the academic institution will all be salutary methodologies.

While early recognition of the signs of resident burnout is a prerequisite for mitigation, perhaps the most important effort is to prevent it, if possible, or at least to reduce its risk in a residency training program. Effective prevention or mitigation seems to involve two major elements—systems/environmental control and attention to the person. Regarding the former, many education programs on physician burnout are available, and these are excellent awareness tools for both residents and faculty—viewed and discussed as a group. Residency training is clearly not too early to learn about this issue, which may affect over 40% of practicing otolaryngologists to varying degrees during their clinical lifetime. Resident work hours are monitored for a reason—to prevent exhaustion and cognitive deterioration. A training program is responsible for monitoring the workload of residents and making changes if a systemic problem is identified.

Addressing the personal progress and status of individual residents has been one responsibility of training programs and faculty for many decades. We know that each resident brings a spectrum of personal attributes, technical and efficiency capabilities, learning styles, and yes, weaknesses, to a training program. Individual support for residents can be based, in part, on their personal capabilities, emphasizing their strengths and minimizing their weaknesses, in the context of excellent patient care and professionalism. Faculty role modeling and mentoring with respect to work/life balance, stress management strategies, personal diet and exercise, interpersonal relationship building, importance of family and friends, and ways to enhance the virtues of a physician all play a role in preventing burnout.

Resident physicians in surgical specialties have unique stressors that are different from those in medical specialties—namely, the potential risks and complications that can occur with surgical procedures. When complications occur—and they will—young physicians can be devastated by them. Faculty and/or professional counseling, including post-surgical procedure debriefing and family interaction, can guide them through the emotional trauma while helping them to learn from the events.