Friday, August 7, 2015

Application of the Social Ecological Model for Understanding Stressors and Coping Strategies of Pediatric Residents Related to End of Life Care

Paria Wilson, MD, MEd
Cincinnati Children's Hospital Medical Center

Introduction: Resident physicians are faced with many stressful encounters that may results in burnout, but little is known about the situations residents find most stressful and optimal interventions to alleviate these stressors. We hypothesized that residents would perceive stress from caring for terminally ill children and lack positive coping skills required to deal with these difficult situations.

Methods: Pediatric residents at a large urban tertiary care hospital were included. We performed a qualitative analysis with a participatory methodology using group level assessment to define stressors reported by residents and coping skills utilized to deal with these stressors. Reported findings were analyzed and grouped using a modified social ecological model.

Results: Twenty broad categories of stressors and coping mechanisms were identified by the 31 residents in attendance, which were further mapped into intrapersonal stressors, interpersonal stressors, stressors related to the residency, stressors related to the institution as a whole, and the culture of medicine. Residents reported feelings of inadequacy and self-doubt, especially in regards to dealing with end of life issues. They reported stress from lack of a work-life balance and formal mentorship, autonomy at work, and the lack of understanding of the resident role within the institution. Additionally, they struggled with the overall hierarchy of medicine and the role parents played in the care of their children. Residents identified both positive and negative coping mechanisms and requested additional training in the form of a wellness committee to aid them in developing optimal coping skills.

Discussion: The stressors identified by the residents in this study were multifaceted, emphasizing the need to address them within the actual level they arise. Wellness programs geared towards reducing resident stress and burnout and fostering positive coping skills will need to address the complexity of these stressors.