Job burnout isn’t a medical diagnosis listed in the DSM-5. In fact, it can be hard to define. The usual description includes emotional exhaustion, a sense of detachment and a feeling of disillusionment caused by chronic work stress. For resident physicians, that may sound all too familiar.

At Monday’s workshop “Improving Resident Well-Being Through RAPID Response: Confessions, ALEEN, and Increased Responsiveness,” six faculty leaders from Johns Hopkins University will share insights into and solutions for resident burnout. The lead moderator will be Jed T. Wolpaw, M.D., Assistant Professor and Residency Program Director of Anesthesiology.

“Addressing the specific concerns of residents has not traditionally been a priority in medical residencies. That’s one of the reasons burnout is high,” said Dr. Wolpaw. “The consequences of burnout, including depression, impaired cognitive function and increased rates of medical errors, are serious.”

In 2017, Dr. Wolpaw and his team created a communications bundle called RAPID response. The program combines a set of interventions that can improve resident well-being and reduce burnout. The RAPID mnemonic stands for Real-time, Anonymous, Protocol-driven, Individualized and Defend.

“The bundle includes a variety of communication techniques that help us address our learners as adults and help them feel supported throughout their training,” he explained.

To allow for real-time (R) and anonymous (A) feedback, residents are invited to participate in a confessions activity described by Suzanne B. Karan, M.D., and colleagues. Residents submit questions or concerns on notecards. The cards are read aloud anonymously by the program director and discussed as a group. For many residents, hearing that other students have similar issues can greatly relieve stress.

The protocol-driven (P) piece of RAPID refers to another mnemonic device, ALEEN, a communication method developed by Peter Pronovost, M.D. It spells out strategies for listening, empathizing and negotiating with people who are distressed.

“While this method was originally developed for patients, it is equally effective when interacting with distressed residents,” said Dr. Wolpaw. “Many of our techniques, especially ALEEN, serve as powerful tools for communicating with anyone in your life – co-workers, employees, patients, even your own spouse or children.”

The individualized (I) component of RAPID response encourages leadership to commit to a one-on-one visit with each resident at least once per month. The final factor of RAPID is to defend (D) and advocate for the resident when there is a concern about a resident’s performance.

During the interactive, three-hour workshop, there will be role-playing opportunities for audience members. The moderators will gear the session toward medical staff who work with residents in training, but any anesthesiologist in a supervisory role will benefit.

Participants will receive printed descriptions of the RAPID response methods, along with comprehensive recommendations for introducing the concepts back home.

“Implementing these techniques at other institutions is easy and essentially cost neutral,” added Dr. Wolpaw. “All it takes is a belief that learners deserve to be treated like adults and that supporting residents throughout training is a worthwhile goal.”

The Hopkins team would like to see RAPID response or similar programs take hold at universities, hospitals and clinics across the country. They believe better communication is one way to help address resident burnout.

“Since launching this program at Johns Hopkins, our resident survey results have improved steadily in every category,” he said. “We now have burnout rates nearly one-third the national average for anesthesia residents.”

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