Resident Stress Survey Lija Joseph M.D. Boston University School of Medicine

Aim/Objective Does stress exist among pathology residents? Discover the main sources of stress –Residents –Program Directors

Design Approved by IRB Online Questionnaire –Directed to residents via Program Directors PRODS listserv Question Selection –Literature review –Personal experience –final 20 questions out of a potential 100 review from Office of Medical Education

Design Sample questions Greatest stress Least stress Work overload Faculty Bias Other Comment

Participants Boston University School of Medicine Ball Memorial Hospital Cedar Sinai Medical Center Creighton University Duke University Indiana University LSUHSC-Shreveport Loyola University Medical Center Medical University of South Carolina Madigan Army Medical Center Mayo Clinic Medical College of Virginia Montefiore Medical Center/Albert Einstein College National Capital Consortium Naval Medical Center Northwestern Penn State Milton S Hershey Medical Center Scott and White Memorial Hospital St.Louis University Thomas Jefferson University Hospital Tufts-New England Medical Center Univ.of Arkansas for Medical Sciences Univ.of Alabama at Birmingham UC Davis Health System UTHSCSA UTMB-Galveston Univ.Hospital of Cleveland U-Mass Medical Center Univ.of Missouri- Columbia Univ. of North Carolina Hospital Univ.of Vermont Virginia Commonwealth University

Results 36 residency programs participated (23%) –All listed items were selected as a source of greatest stress (5) Mean stress score ( ) Highest –Work Overload (4.8) and Variability in faculty expectations (4.5) Lowest –Inattentive program co-ordinator (1.7)

Highest stressors (Residents) Variability in faculty expectations (4.5) Work overload (4.3) A disorganized program (4.2) Poor mentoring by faculty(4.2) Faculty favoritism and bias (4.2)

Highest stressors (PRODS) Work overload (4.8) Variability in faculty expectations (4.6) A disorganized program (4.5) Inadequate supervision of residents (4.3) Poor mentoring by faculty (4.1)

Stressors not included in questionnaire that were identified by respondents Unprofessional faculty –“shouting” “lack of respect” “philosophy of learning by humiliation” “low priority of teaching” “Verbally abusive faculty” Faculty stress passed on to residents Poor support staff Lack of autonomy Too many conferences and presentations

Other “stressors” Boards/RISE/Job –More of a concern for PRODS than residents Family/Financial/Lack of fellowship opportunities –not frequent

Volunteered Comments Residents –Excellent survey, programs should adapt the questions to address issues specific to a program PRODS –Mostly supportive –Two disagree and state “Stress is not "caused" by one or more extrinsic factors, but by how the individual reacts to / handles such situations.” “Look at stress management strategies”

Additional stressors identified by program directors Poor orientation of roles and responsibilities (4.1) Lack of a regular forum to discuss concerns (4.0) Inadequate feedback from faculty (3.9) Poor communication of evaluation criteria (3.8) Insufficient support from peers (3.8)

Conclusions Stress exists among pathology residents PRODS are aware of major resident stressors –Work overload –Variability in faculty expectations –A disorganized program –Poor mentoring by faculty

Conclusions Major Stressor for residents not well recognized by program directors Faculty Favoritism/Bias

Acknowledgments Peter Shaw Ph.D Suzette Levinson Ph.D John C. O’Hara B.S Bruce Smoller M.D Michael O’Brien M.D., M.P.H Fred Silva M.D. Teresa Cox M.D. All my current and former residents