Addressing Symptoms of Burnout Among Pediatric Rheumatology Fellows: A Quality Improvement Project

Objectives To report the results of a quality improvement initiative aimed at reducing burnout symptoms among pediatric rheumatology fellows in a tertiary academic hospital as measured by the Maslach Burnout Inventory (MBI) by 20% over 6 months. Methods Baseline MBI was completed by pediatric rheumatology fellows as a screen of burnout symptoms. All fellows were enrolled in 2023-2024 academic year. The MBI reports scores in 3 categories: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), with higher scores equating to higher risk of burnout. A stakeholder group was formed, including 8 pediatric rheumatology fellows, and engaged colleagues including allied health team members and staff physicians within the Division of Rheumatology. The workgroup identified key and modifiable contributors to burnout within the workplace. Processes were implemented and modified using multiple plans, do, study, act (PDSA) cycles. Wellness sessions were run by the study leads (fellows and faculty) and implemented with attendance and post-session feedback obtained as process measures to guide subsequent PDSA cycles. The MBI was followed at the 0, 3-, and 6-month mark to assess success of these strategies. Results A baseline MBI was completed by 3/12 pediatric rheumatology fellows as an audit. Average scores were EE = 15.7/36 (moderate), DP = 10.0/20 (moderate), and PA = 13.0/32 (low). Each wellness session represented a new PDSA cycle. Five PDSA cycles were completed from January to June 2024. The initial cycle highlighted that there was no process in place to address symptoms of burnout. Implementation strategies included “Treats and Talks” focused sessions during protected educational time, social events among fellows and external events that included the fellows’ families. Eight fellows completed the 6-month follow-up MBI. Six-month MBI scores showed improvement in all MBI domains with EE = 10.8/36 (low), DP = 4.6/12 (low), and PA = 8.8/32 (low), a decrease of 31%, 54%, and 32% respectively. Average session attendance was 7/12 fellows, and average benefit score was 6.1/10. Conclusion Our study has revealed a baseline risk of burnout among pediatric rheumatology fellows at our tertiary academic hospital. With a quality improvement-based approach we have implemented change strategies that show reduced risk of burnout, as measured by the MBI at 6 months. Ongoing change ideas will be focused on the sustainability of these changes.