Debrief to Reduce Burnout and Build Resilience in Pediatric Residents During Critical Care Rotations

Introduction: Trainee physicians are exposed to adverse patient outcomes and events. They can experience guilt, anxiety, incompetence, or anger in association with these events, leading to high rates of burnout (defined as emotional exhaustion (EE), depersonalization (DP), decreased personal accomplishment (PA)), and decreased resilience. Prior studies have identified the need for strategies to reduce burnout and build resilience in pediatric residents during critical care rotations. Debriefing sessions can be therapeutic, allowing members to discuss challenging cases. This study examines the effects of regular debrief on burnout and resilience in pediatric residents during their pediatric intensive care unit (PICU) rotation in a tertiary PICU.


Methods: Second and third-year pediatric residents completing a 4-week PICU rotation were asked to complete the Maslach Burnout Inventory (MBI) and Conor Davidson Resilience Scale (CDR) on the first and last day of rotation. In alternating 4-week blocks, residents received 2 debrief sessions to discuss sentinel events of their rotation amongst fellow residents (intervention arm) or were exposed to standard practice (controls). Participant survey responses were matched from beginning to end of rotation. Descriptive and inferential statistics were computed.


Results: In the interim analysis, 40 residents were enrolled; 20 received intervention and 20 as controls (mean±SD of age was 31.1±3.3 yrs). Change in MBI scores (EE, DP, and PA) from first to last day of the rotation were significantly lower in the intervention arm compared to controls (p=0.0003, p< 0.0001, p=0.0086, respectively); The median(IQR) score changes in the intervention arm were:-8.5(-16.0 to 6.0), -2.0(-5.5 to 4.0), -6.0(-12.0 to 0.0) for EE, DP and PA, compared to 9.5(4.0 to 20.5), 11.0(7.5 to 16.0), 3.5(-2.5 to 9.0) for EE, DP and PA, among controls, respectively. The distribution of change in CDR was significantly different between the arms; resilience increased in the intervention arm and decreased in the controls (12(3.5 to 27.5) and -13(-27 to -2) respectively, p< 0.0001).


Conclusions: There is evidence that debrief sessions focused on resident well-being reduce burnout and improve resilience skills. Implementing trainee debriefing sessions focused on well-being should be considered.