Advertisement

How Perceived Burnout Alters Frontline Educators’ Assessments in the Clinical Learning Environment

Published:December 16, 2021DOI:https://doi.org/10.1016/j.acap.2021.12.014

      Abstract

      Objective

      This study explores frontline educators’ experience with learner burnout in the clinical learning environment (CLE) and how perceived burnout may impact assessment.

      Methods

      A survey was sent to 105 Pediatric Hospital Medicine faculty and fellows at 7 sites across the United States representing diverse CLEs. They were invited to participate in an 11-question web-based survey that was developed, edited, and revised in step-wise fashion. It consisted of 5-point Likert scale, forced-choice, and dichotomous questions. Data from the web-based survey were compiled for descriptive purposes and analyzed for trends.

      Results

      The response rate was 53%. Most respondents (83%) perceive learner burnout at least once per year, but median comfort in identifying burnout was 3 (scale 1–5, 3 = neutral). Factors associated with comfort were education as primary niche (P = .01) and having wellness training (P = .045). In terms of the impact of perceived learner burnout impacts on assessment, 88% report impact on feedback sessions and 60% reported impact on summative assessment; most are more lenient. Stated belief in whether perceived burnout should or should not impact assessment had 60% sensitivity and 84% specificity in predicting whether it does.

      Conclusions

      Frontline educators routinely perceive learner burnout in the CLE and it often impacts educators’ assessment of a learner. The discrepancy between the expected and actual impact may suggest amplification of known barriers to accurate assessment in the CLE. Comfort associated with wellness training suggests that interventions targeting frontline educators in the CLE may improve their ability to simultaneously support and assess learners.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ishak WW
        • Lederer S
        • Mandili C
        • et al.
        Burnout during residency training: a literature review.
        J Grad Med Educ. 2009; 1: 236-242
        • Dyrbye LN
        • West CP
        • Satele D
        • et al.
        Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population.
        Acad Med. 2014; 89: 443-451
        • Kemper KJ
        • Schwartz A
        • Wilson PM
        • et al.
        Burnout in pediatric residents: three years of national survey data.
        Pediatrics. 2020; 145e20191030https://doi.org/10.1542/peds.2019-1030
      1. Burn-out an “occupational Phenomenon”: International Classification of Diseases. Vol 2020 2019:WHO.org. Available at: https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases. Accessed June 10, 2021.

        • Maslach C
        • Jackson SE.
        The measurement of experienced burnout.
        J Organ Behav. 1981; 2: 99-113
        • Gruppen LD
        • Irby DM
        • Durning SJ
        • et al.
        Conceptualizing learning environments in the health professions.
        Acad Med. 2019; 94: 969-974
        • West CP
        • Dyrbye LN
        • Erwin PJ
        • et al.
        Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis.
        Lancet. 2016; 388: 2272-2281
        • Wilson PM
        • Kemper KJ
        • Schubert CJ
        • et al.
        National landscape of interventions to improve pediatric resident wellness and reduce burnout.
        Acad Pediatr. 2017; 17: 801-804
        • McKinley TF
        • Boland KA
        • Mahan JD.
        Burnout and interventions in pediatric residency: a literature review.
        Burnout Res. 2017; 6: 9-17
      2. Physician health and wellness: learning environment. Vol 2020. AAP.org. Available at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/physican_health_wellness/Pages/Learning-Environment.aspx. Accessed July 14, 2021.

        • Iobst WF
        • Sherbino J
        • Cate OT
        • et al.
        Competency-based medical education in postgraduate medical education.
        Med Teach. 2010; 32: 651-656
        • Lockyer J
        • Carraccio C
        • Chan MK
        • et al.
        Core principles of assessment in competency-based medical education.
        Med Teach. 2017; 39: 609-616
        • Ende J.
        Feedback in clinical medical education.
        JAMA. 1983; 250: 777-781
        • Bing-You R
        • Hayes V
        • Varaklis K
        • et al.
        Feedback for learners in medical education: what is known? A scoping review.
        Acad Med. 2017; 92: 1346-1354
        • McQueen SA
        • Petrisor B
        • Bhandari M
        • et al.
        Examining the barriers to meaningful assessment and feedback in medical training.
        Am J Surg. 2016; 211: 464-475
        • Ramani S
        • Könings KD
        • Mann KV
        • et al.
        About politeness, face, and feedback: exploring resident and faculty perceptions of how institutional feedback culture influences feedback practices.
        Acad Med. 2018; 93: 1348-1358
        • Yepes-Rios M
        • Dudek N
        • Duboyce R
        • et al.
        The failure to fail underperforming trainees in health professions education: a BEME systematic review: BEME guide No. 42.
        Med Teach. 2016; 38: 1092-1099
        • Scarff CE
        • Bearman M
        • Chiavaroli N
        • et al.
        Keeping mum in clinical supervision: private thoughts and public judgements.
        Med Educ. 2019; 53: 133-142
        • Shanafelt TD
        • Bradley KA
        • Wipf JE
        • et al.
        Burnout and self-reported patient care in an internal medicine residency program.
        Ann Intern Med. 2002; 136: 358-367
        • Dyrbye LN
        • Massie FS
        • Eacker A
        • et al.
        Relationship between burnout and professional conduct and attitudes among US medical students.
        JAMA. 2010; 304: 1173-1180
        • Beckman TJ
        • Reed DA
        • Shanafelt TD
        • et al.
        Resident physician well-being and assessments of their knowledge and clinical performance.
        J Gen Intern Med. 2012; 27: 325-330
        • Baer TE
        • Feraco AM
        • Tuysuzoglu Sagalowsky S
        • et al.
        Pediatric resident burnout and attitudes toward patients.
        Pediatrics. 2017; 139e20162163https://doi.org/10.1542/peds.2016-2163
        • Fahrenkopf AM
        • Sectish TC
        • Barger LK
        • et al.
        Rates of medication errors among depressed and burnt out residents: prospective cohort study.
        BMJ. 2008; 336: 488-491
        • Shanafelt TD
        • Noseworthy JH.
        Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout.
        Mayo Clin Proc. 2017; 92: 129-146
        • Artino AR
        • La Rochelle JS
        • Dezee KJ
        • et al.
        Developing questionnaires for educational research: AMEE guide no. 87.
        Med Teach. 2014; 36: 463-474
        • Artino AR
        • Gehlbach H
        • Durning SJ
        AM last page: avoiding five common pitfalls of survey design.
        Acad Med. 2011; 86: 1327
        • Rickards G
        • Magee C
        • Artino AR.
        You can't fix by analysis what you've spoiled by design: developing survey instruments and collecting validity evidence.
        J Grad Med Educ. 2012; 4: 407-410
        • Harris PA
        • Taylor R
        • Thielke R
        • et al.
        Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Allan JM
        • Kim JL
        • Ralston SL
        • et al.
        Gender distribution in pediatric hospital medicine leadership.
        J Hosp Med. 2021; 16: 31-33
        • McClafferty H
        • Brown OW
        • et al.
        • Committee on practice and ambulatory medicine. Section on integrative medicine
        Physician health and wellness.
        Pediatrics. 2014; 134: 830-835
      3. Accreditation Council for Graduate Medical Education (ACGME) common program requirements. Vol 2021. Accreditation Council for Graduate Medical Education; 2020. Available at: https://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements. Accessed August 27, 2021.

      4. Clinical learning environment review (CLER). Vol 20212000- 2021. Available at: https://www.acgme.org/What-We-Do/Initiatives/Clinical-Learning-Environment-Review-CLER. Accessed August 27, 2021.

        • Bateman ST
        • Dixon R
        • Trozzi M.
        The wrap-up: a unique forum to support pediatric residents when faced with the death of a child.
        J Palliat Med. 2012; 15: 1329-1334
        • Fromme HB
        • Ryan MS
        • Gray K
        • et al.
        A script for what ails your learners: feedback scripts to promote effective learning.
        Acad Pediatr. 2020; 20: 721-723