Safeguarding Against Pathology Residents Burnout

Burnout has long been identified as a source of concern for pathology residents. This phenomenon is not only detrimental to personal wellness, it also has the ability to erode workplace well-being and increase attrition. To safeguard the wellbeing of the workforce as well as the field, this issue requires study, and broad-based mitigation strategies. 

To learn more about the phenomenon of burnout among pathology residents, a Pathology Wellness Committee, geared toward finding solutions, was formed within a large pathology residency program at Johns Hopkins University School of Medicine. The Committee’s report, Evaluation of a Pathology Resident Wellness Initiative, Initial Establishment and Subsequent Expansion Through a Time of High Stress, the COVID-19 Pandemic, was recently published in the American Journal of Clinical Pathology (AJCP).¹ 

To learn more about burnout and the Committee’s findings on mitigation techniques, Critical Values spoke to Pathology Wellness Committee member, Dr. Alisha D. Ware, MD, Assistant Professor of Pathology at the Johns Hopkins University School of Medicine. 

The need to track wellness 

Burnout among pathology residents and laboratory professionals has been cited at alarming rates in multiple studies. In 2018, a formal Pathology Wellness Committee was established at Johns Hopkins that sought to identify and address growing concerns about the well-being of pathology residents. To acquire information, the Committee generated a voluntary and anonymous Annual Resident Wellness Survey that was used to gauge burnout indicators, and aid in intervention planning. In 2020, the COVID-19 pandemic exacerbated burnout to a large extent by increasing isolation, workhours, and anxiety about exposure risk. The survey was modified to assess this additional impact on burnout potential. It continues to be modified on an annual basis, with modifications guided by trends and current events.  

“When I was a second year pathology resident, I was involved in multiple graduate medical education committee initiatives that were designed for institution-wide, forward-facing specialties. These initiatives largely dealt with issues like difficult patient interactions that don’t significantly apply to pathology residents, who generally work behind the scenes. However, the Committee used these interventions as a starting point and a guide for the pathology well-being initiatives,” explains Dr. Ware. 

The annual needs assessment surveys include requests for suggestions on increasing job satisfaction and wellness. “This input gives our trainees a voice and opens up discussions surrounding difficult topics. We have received a variety of suggestions that include yoga sessions, pet therapy, healthy snack options, resident holiday gatherings, art classes, and more,” she adds. In addition to these types of activities, procedural changes that impact upon day-to-day workloads are also stressed. For example, the pathology leadership noted that major improvements could be made to one of the resident rotations. “We’d been doing this rotation at Johns Hopkins this way for years, but now people felt empowered to speak up. The rotation underwent significant modification that restructured the daily and weekly schedules to prioritize education and resident satisfaction. This simple modification resulted in less burnout and increased rotation satisfaction for the residents,” she says.

Understanding resident burnout

Burnout is loosely defined as being in a complete state of physical, mental, and emotional exhaustion.² It can cause people to question, or even leave, their chosen field. It can also cause depression, reduced work performance, and physical symptoms including headaches, stomachaches, fatigue, and all-over bodily aches and illness. 

Even people who love their work and value its relevance can experience job-related burnout from long hours, chronic stress, and unending, high levels of pressure. A survey, generated and managed by ASCP, found that over a third of pathology residents fall into this category, and that the main driver of this phenomenon is a too-high workload.³ “We need unique and targeted, well-being interventions to reduce or eradicate burnout in pathology residents. Higher rates of burnout are reported by medical residents than it is in college graduates of a similar age. In addition to emotional exhaustion, reported symptoms among this population include a low sense of personal accomplishment, and depersonalization,” says Dr. Ware. 

According to ASCP’s Job Satisfaction, Well-Being, and Burnout study, which garnered online survey results from a large national sample of pathology residents and fellows, signs of burnout included struggles with academics, work-life balance, and emotional well-being.³ In addition to the impact on personal well-being, burnout may increase the number of sick days residents require to manage their mental state, and physical symptoms. This can, in turn, increase burnout among other employees, who are forced to pick up the slack. 

One of the main drivers of career growth in the laboratory is positive word of mouth recommendations among family members and friends. In addition to its detrimental impact upon pathology residents, burnout can dampen this conduit of laboratory recruitment, further reducing an already too-small workforce. 

Combating burnout with practical solutions 

Because pathology can be a stressful, behind-the-scenes specialty, the Pathology Wellness Committee strove to ensure that the interventions being put in place were tailor-made to the needs of pathology residents. “We wanted to zero in on the most important issues to residents, and to make sure that we acknowledged the areas where change was most needed. We also wanted to ensure that we included the types of events they would like, in appropriate formats. We compiled survey results and started structuring our initiatives based upon the answers given. We did residents-only events, and a residents retreat that included fun activities, like cornhole and team-building activities,” Dr. Ware explains. 

To reduce reported feelings of depersonalization, the Committee instated simple measures, like acknowledging birthdays and trainee successes. “We started with didactics on well-being topics. The first set was focused on individual physical health topics such as nutrition, exercise, and yoga. From there, we built a more structured well-being curriculum, which was led by a resident and Wellness Committee Chair. She put together a Wellness Didactic Series to more extensively cover well-being topics such as sleep , negotiations, having difficult conversations, and managing finances. This team-based effort relied highly upon the experiences of seasoned and new residents, and on hospital administrators, who approved the initiatives and provided budget,” says Dr. Ware. 

These well-being initiatives were a consistent reminder that the residents were valued, and that their work was appreciated by the department. The Wellness Didactic Series also served to educate residents on the tools they could use in their own lives to increase self-care and reduce burnout. 

Ongoing solutions and next steps 

Well-being initiatives that address the emotional, social, and physical well-being of pathology residents are most effective when they’re coupled with system-based improvements. To be successful, an appropriate budget must be allocated on an ongoing basis to ensure that smaller projects, such as celebrating birthdays, become built into the day-to-day workings of laboratories. 

Since the field of pathology is significantly impacted upon by periods of high stress, it’s important to initiate prompt well-being interventions as needed. These can include team-building events and personalized interventions. It’s also important to tailor each initiative to the needs of the current staff. Younger residents may require more social opportunities with their colleagues. Residents with families may require time off and support to address childcare concerns.  

“The main result we’ve seen from our work is less burnout. Pathology residents report feeling supported and appreciated within an inclusive environment. They also feel better able to discuss difficult topics with management, and are empowered to take on larger issues,” says Dr. Ware. She also notes an improved cohesiveness between faculty and residents. “Wellness-based initiatives have had the added impact of encouraging collegiality,” she adds.  

In order to prolong and continually improve upon the results of well-being initiatives, Dr. Ware stresses the need to check in with residents periodically. “You have a new class of residents coming in each year and another class leaving each year, so reassessing needs at least annually, to determine if needs are changing over time, is vital.”