There is no conflict of interest.
Citation
Stansfield, R. B., Kenaga, H., & Markova, T. (2021). Building a culture of well-being in primary care resident training programs. Ochsner Journal, 21(1), 68-75.
Highlights
- The study's objective was to examine the impact of a primary care resident wellness intervention on health outcomes.
- The study used an interrupted time series design with survey data completed by participants who reported on their well-being. The authors used statistical tests to compare the outcomes of participants before the intervention and at two time points after the intervention was implemented.
- The study found a significant relationship between the resident wellness intervention and positive participant responses, such as a sense of purpose, vitality, and fulfillment of basic needs. It also found a significant relationship with negative responses related to support during tragic events and a deep connection to their work
- This study receives a low causal evidence rating. This means we are not confident that the estimated effects are attributable to the resident wellness intervention; other factors are likely to have contributed.
Features of the Intervention
The Wayne State University Office of Graduate Medical Education implemented a wellness intervention for primary care residents at a hospital site. Institutional resources (such as an employee assistance program, a university wellness program, and updated wellness policy) were promoted and well-being became a priority for the Resident Council. Resident-led initiatives included policy changes to allow breaks during intensive care unit (ICU) rotations, a Fitbit challenge to encourage physical activity, yoga sessions, and access to the hospital gym. Additionally, residents created a Facebook group for faculty engagement, received university-branded jackets, developed a wellness library, and organized an annual wellness event. Wellness committees were also established to support these efforts. The program specifically targeted residents in internal medicine, family medicine, and transitional year programs at Ascension Providence Rochester Hospital in Detroit, Michigan.
Features of the Study
The study used an interrupted time series design to compare the outcomes of participants before and at two time points after the resident wellness intervention was implemented. The sample included 52 residents (36 internal medicine residents, 12 family medicine residents, and 4 transitional year residents) who could receive the intervention. Residents reported their wellbeing using the Resident Wellness Scale, which has 10 items. The items assess feelings about meaningful work, personal abilities, life satisfaction, institutional support, social support, and personal growth. Baseline survey data were gathered in November 2017, with subsequent data collection occurring in April 2018 and November 2018. The authors conducted several statistical tests to examine how participant outcomes changed over time and analyzed each of the 10 items on the scale separately.
Findings
Health and Safety
- The study found a significant relationship between the resident wellness intervention and positive responses to the survey items: "Reflected on how your work helps make the world a better place,” “Felt the vitality to do your work,” and “You felt your basic needs are met.”
- However, the study found a significant relationship between the resident wellness intervention and negative responses to the survey items: “Knew who to call when something tragic happened at work” and "You felt connected to your work in a deep sense.”
- The study found no significant relationships between the intervention and responses to the remaining survey items.
Considerations for Interpreting the Findings
The authors compared the outcomes of participants measured before and after they participated in the resident wellness intervention. For these types of designs, the authors must observe outcomes for multiple periods before the intervention to rule out the possibility that participants had increasing or decreasing trends in the outcomes examined before enrollment in the program. That is, if participants who had increasing wellness tended to enroll in the program, we would anticipate further increases over time, even if they did not participate in the program. Without knowing the trends before program enrollment, we cannot rule this out. Therefore, the study receives a low causal evidence rating.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors did not control for trends in outcomes before the intervention. This means we are not confident that the estimated effects are attributable to the resident wellness intervention; other factors are likely to have contributed.