INTRODUCTION

Residents are more likely to experience burnout compared to their age-matched peers.1 The Accreditation Council of Graduate Medical Education (ACGME) has mandated that residency programs address resident and faculty well-being through their Clinical Learning Environment Review (CLER) program.2

Positive psychology coaching can help residents connect with and achieve positive emotions, meaningful relationships, strengths, engagement, and purpose.3 We implemented the Professional Development Coaching Program (PDCP) in our internal medicine residency program in 2012 and demonstrated a reduction in intern emotional exhaustion (EE) after year 1.4 In this paper, we report on the experiences of residents after year 3.

METHODS

Setting and Participants

The PDCP included 179 residents who were assigned a coach in the 2014–2015 academic year. Pairs were expected to meet quarterly and participation was logged administratively. We define full participation as ≥ 3 meetings per year; there was no consequence for not participating.

Intervention

Using positive psychology and coaching principles, the PDCP trains volunteer faculty “coaches” to work with resident “coachees,” intentionally matched outside of their discipline. Coaches were provided with a guide for each meeting. All meetings included reflection on experiences, goal-setting, and directions for engaging in a positive psychology coaching dialogue. Annually, each initial meeting focused on what personal and professional success would look like for that academic year, and ended with reflection on accomplishments. Year 1 included strengths exploration, coping with stress through building resilience, and finding engagement and meaning in their work. Year 2 added development of leadership capabilities and emotional intelligence. Year 3 added authentic leadership, finding their passion and purpose, and cultivating life’s lessons.

Measures

The measures used to assess the program process included (1) participation (administrative data), (2) communication (survey), and (3) reflection (survey). PDCP outcomes were (1) improved coping skills; (2) improved perception of professional roles/relationships; (3) decreased (EE) on the Maslach Burnout Inventory; (4) coachee experience; and (5) residency satisfaction.5,6

RESULTS

Characteristics of respondents and non-respondents were similar in terms of age, race, ethnicity, program year, and EE. Fifty-six percent were full participants. Survey completion and coaching participation were greatest in first and third years; 81.9% rated communication with coach as “excellent or good” and 80.0% reported “excellent or good” opportunities for reflection.

Perceived Coping Skills, Roles, and Relationships

Residents who participated fully in the program and had positive quality of communication with their coach were significantly more likely to report higher coping skills and better working relationships in several dimensions (Table 1).

Table 1 Coaching Program Measures and Coping
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Emotional Exhaustion

Residents who reported fair/poor opportunities for reflection were more likely to report high EE (85.0% vs. 44.9% from those reported good opportunities or 31.4% from those reported excellent opportunities, p < 0.001). EE did not differ by program year or full vs. partial participation.

Coachee Experience and Residency Program Satisfaction

Overall, 73.1% of coachees reported excellent/good experiences being a coachee, 92.2% of coachees would “definitely or probably recommend” our residency program to an incoming applicant, and 78.3% would “definitely or probably recommend” a coaching program to other residencies. Table 2 shows bivariate relationships of process and outcome measures. Extent of participation was significantly associated with an “excellent” overall experience of being a coachee (54.1% vs 20.9%, p < 0.001). Those with excellent opportunities for reflection were more likely to report excellent experience of being a coachee (68.6% vs. 35.0%, p < 0.001); more likely to “definitely recommend” the residency program to others (91.2% vs. 25.0%, p < 0.001); and more likely to definitely recommend the PDCP program (65.2% vs. 46.7%, p = 0.017).

Table 2 Program Processes with Coachee Experience, Workplace, and Coaching Program Satisfaction
Full size table

DISCUSSION

We implemented a positive psychology coaching program in a large internal medicine residency. Most residents participated fully. We observed a significant association between a positive program experience, opportunities to reflect, and positive residency experience, as well as increased coping and relationship skills.

While we measure several significant bivariate associations in this cross-sectional sample, our single-site study is limited by the small number of coaches with paired 3-year follow-up data. This limits longitudinal multivariate analyses on the full 3-year cohort.

The ACGME CLER Program now mandates that residency programs have mechanisms in place to assess and address resident burnout and well-being. Positive psychology coaching, using a strengths-based approach, provides participants with additional tools required to cope with the substantial personal and professional stressors they face during their residency.