Abstract

Burnout among internal medicine (IM) and internal medicine–pediatrics (Med–Peds) residents is at epidemic levels, yet few studies use systems-based methods to identify the specific work-system factors that drive it. Guided by the National Academy of Medicine (NAM) systems model of clinician burnout, we conducted a five-phase sequential mixed-methods study—survey, focus groups, contextual inquiry, affinity modeling and validation, and impact–effort prioritization—among 119 IM and Med–Peds residents at one academic medical center. Burnout (two-item Maslach Burnout Inventory [MBI]), resilience (two-item Connor–Davidson Resilience Scale), and 21 NAM-derived work-system factors were assessed, along with analyses report means, standard deviations (SD), 95% confidence intervals (CIs), and internal-consistency reliability. Among 36 respondents (30% response rate), 55.6% screened positive for burnout (95% CI 39.6–70.5%); mean emotional exhaustion was 3.78 (SD 1.12), and depersonalization was 3.17 (SD 1.38). The 21-item severity scale showed good reliability (Cronbach’s α = 0.85). The highest-severity factors were interruptions/distractions, excessive workload, time pressure, and work-life integration. Focus groups (n = 30), contextual inquiries (n = 14, ~80 observation hours), and validation sessions (n = 8) yielded 167 breakdowns and 11 priorities. An impact–effort analysis (n = 19) identified clinic workflows and in-basket workload as high-impact/lower-effort priorities. This participatory, systems-based method yields contextually grounded, prioritized targets for reducing resident burnout that survey data alone would not surface.

IPC Classification

Keywords