September 29, 2016 | Sanah Christopher, MD
Career Development

Burnout syndrome is a significant concern in contemporary medical training, often leading to impairment of personal and work outcomes in health care providers. Burnout frequently establishes its early roots during training, which can have unfortunate lingering effects on future career goals and development.

Cardiology fellowship trainees often face a unique constellation of working conditions characterized by high time requirements and emotionally stressful situations, and many first year fellows begin to experience burnout as they transition from a resident role to undertaking the new challenges of cardiology as a specialty. Female FITs face additional pressures similar to those in other male-dominated specialties, where they experience a higher level of scrutiny and an increased desire to maintain work-life balance which places them at higher risk for burnout. Disengagement and alienation are very commonly experienced by many female FITs while navigating the requirements of a demanding first year of fellowship.

In an article in the Journal of the American College of Cardiology (JACC) about burnout during cardiology fellowship, Oral A. Waldo, MD, notes that it takes three times the amount of energy to recover from burnout than to prevent it. Gender differences in the development, and experience of burnout have become more evident with growing numbers of women graduating from medical school. For example, of the three major dimensions of burnout syndrome as defined by the Maslach Burnout Inventory Survey – emotional exhaustion, depersonalization, and reduced sense of personal accomplishment – emotional exhaustion is more prevalent in the onset of burnout for women in medicine.  Such differences emphasize how prevention of burnout in female FITs may require specific approaches to address the interplay of both systemic and individualized stressors particular to this group. I would like to suggest some approaches that can be employed in the workspace to strengthen resilience and prevent professional fatigue.

Mentorship: Overall, women with mentors have higher productivity in terms of research and higher overall career satisfaction than those without mentors. Newer mentoring models, such as Female Peer Mentoring (FPM), have emerged as being uniquely advantageous as they add a beneficial social dynamic to the traditional model of dyadic mentoring. FPM models involve using a senior faculty mentor to guide and facilitate similar ranked mentees who then serve as peer mentors for each other. Such models can be hugely beneficial for female FITs as they can provide a common platform to identify markers of early burnout in peers, share strategies for prevention and build on a positive work experience. Although some programs have formally incorporated female peer mentoring groups, innovating groups among FIT peers and faculty in programs that do not have an established program can initiate the groundwork for future growth.

Pregnancy and child-care resources: Many female FITs report that they perceive barriers for pregnancy in fellowship training. However, positive changes have occurred as many institutions have incorporated on-site childcare facilities, lactation rooms, education and options for radiation safety in the cath lab during pregnancy.  In an article published in JACC, Tabitha G. Moe, MD, suggests modification of training schedule for imaging rotations to limit radiation exposure during pregnancy, and the concept of remote training during these months may also help ease stressors related to exposure. Additionally, other education modifications such as online conference attendance can enable more flexibility during maternity leave.  Motherhood and career are paths can be pursued simultaneously and having discussions with fellowship directors for resources and schedule flexibility can minimize stressors during this joyful experience.

Mastering time management: As a busy cardiology fellow, managing all tasks may seem to require more than 24 hours in a day. Establishing daily, short and long term goals, with allocated priorities and frequent reminders can help ease work flow. For example, a hectic consult service can often be triaged based on acuity, geographic location or procedural requirements, which can organize rounding and can set up for the following day. For short and longer term goals, establishing physical reminders on phones, tablets or paper calendars work well in ensuring sufficient lead up time prior to deadlines for manuscripts, conferences or presentations. Above all, finding frequent breaks from a busy schedule during the day, or at regular long term intervals to focus on non-work activities can help with mental relaxation and promote fresh thinking.

Networking, and Professional groups: Many professional groups provide opportunities for collaboration and interaction with other women in cardiology where members can share common experiences and develop coping skills specific to cardiology training and practice. They also arrange for workshops that can assist with many aspects of the trainee experience, including burnout and, furthermore, help build connections for future career advancement. The ACC has a Women in Cardiology Member Section and Leadership Council that can that be a great resource for FITs seeking guidance as they transition through their training.

As female FITs, we belong to a group of highly motivated professionals that are changing the dynamics of an entire specialty. Cardiology is a truly rewarding field, and developing a clear perspective of strategies specific to the niche that is evolving for us can make the journey enjoyable.

This article was authored by Sanah Christopher, MD, a Fellow in Training (FIT) at Virginia Commonwealth University Health System.