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Hannah E. Johnson, PharmD, BCPS, BCPP
Clinical Assistant Professor, Department of Pharmacy Practice and Science
University of Kentucky College of Pharmacy
Lexington, KY

C. Brooke Boils, PharmD, BCPS
Clinical Pharmacist, Acute Care Pharmacy Services
University of Kentucky Healthcare Good Samaritan Hospital
Lexington, KY

Pharmacists are at high risk for burnout, a form of work-related stress. Symptoms of burnout include emotional exhaustion, depersonalization, and low sense of accomplishment and may lead to poorer quality of patient care, medical errors, and personal consequences, such as depression and substance use.1 In a recent survey, 50% of health-system pharmacists reported symptoms of burnout.2 Pharmacy residents may also be at risk for burnout due to increased work demands, limited control, and the interference residency may have on personal relationships and self-care.3

Managing Stress and Preventing Burnout

Residency is expected to be a time of increased stress. Although the stress associated with residency is not intended to be detrimental, pharmacy residents have reported higher than average stress scores compared to healthy adults in the same age group.4 Higher than average rates of depressive symptoms have also been reported by pharmacy residents.5 Risk factors for increased stress in pharmacy residents included working more than 60 hours per week, distance from family or reduced time spent with family, and inadequate sleep.4,6 Therefore, interventions should be made to improve these areas and to encourage residents to develop strategies to manage stress, and prevent burnout and its consequences.

Creating a culture that promotes well-being, models effective time management, and work-life integration may help residents navigate the stress of residency and prepare them for their future careers. Examples of this include developing a wellness committee, disconnecting when away from the workplace, debriefing after difficult encounters or events, and incorporating wellness into their residency curriculum.

Time Management

Effective time management is associated with increased productivity and reduced levels of stress.7 The ability of pharmacy residents to multitask is tested early, and often increases in frequency as the year progresses. To combat falling behind on projects, identifying periods of high and low energy levels during the day can assist with prioritization and task completion based on the level of attention that is required.7 Likewise, addressing responsibilities according to importance and urgency, identifying both short and long-term goals, and utilizing to-do lists are supportive measures to improve prioritization and organization.

Equally important in facilitating time management is the avoidance of procrastination and elimination of activities that are ‘time wasters’.8 An essential step in overcoming procrastination is to identify why it is occurring. Is there an underlying fear of failure or the unknown? Do you consider yourself a perfectionist? Unsure of where to start? If answered “yes”, utilizing preceptor mentorship is an excellent way to determine an action plan moving forward.

Creating Boundaries: Drawing the Line between Work and Home

Although residents have little control of their work schedule, they may begin to put too much emphasis on work, which can impact relationships, sleep, and overall well-being.9 Therefore, it is important for pharmacy residents to gain confidence in creating boundaries and develop skills to improve work-life integration, including the above time management skills.

An important skill to begin to develop during residency is the art of confidently and graciously saying “no”.10 Many opportunities will arise that are beyond what is required of the residency program or resident’s workload. Taking on too many of these additional responsibilities can lead to increased stress, more time spent working on projects at home, and consequently impact work-life integration and well-being. Learning to say small “no’s” earlier in their careers, may help pharmacy residents say larger ones in the future.10 Setting a maximum amount of time spent on work or at work each day and setting aside allotted time throughout the day to respond to emails can improve work-life integration as well.

Residency program directors, preceptors, and resident advisors should encourage residents to spend time out of the work place with family and friends and use their allotted vacation and professional leave. Everyone involved with the program should model optimism and engagement in out-of-work enjoyable activities.11 Initiatives such as the development of a wellness committee, wellness mentorship, preceptor discussions of their own past struggles, and preceptor development in this subject could also be added to residency programming to address resident well-being.

References

  1. Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284-93. DOI: 10.1001/jama.2009.1384. PubMed PMID: 19773563.
  2. Whang Y, Silberklang M, Morgan A, Munshi S, Lenny AB, Ellis RW, et al. Expression of the Epstein-Barr virus gp350/220 gene in rodent and primate cells. J Virol. 1987;61(6):1796-807. PubMed PMID: 3033311.
  3. Thomas NK. Resident burnout. JAMA. 2004;292(23):2880-9. DOI: 10.1001/jama.292.23.2880. PubMed PMID: 15598920.
  4. Le HM, Young SD. Evaluation of stress experienced by pharmacy residents. Am J Health Syst Pharm. 2017;74(8):599-604. DOI: 10.2146/ajhp150763. PubMed PMID: 28235868.
  5. Williams E, Martin SL, Fabrikant A, Wang A, Pojasek M. Rates of depressive symptoms among pharmacy residents. Am J Health Syst Pharm. 2018;75(5):292-297. DOI: 10.2146/ajhp161008. PubMed PMID: 29472510.
  6. Williams E, Martin SL, Fabrikant A. Factors associated with depressive symptoms in pharmacy residents. Am J Health Syst Pharm. 2018;75(24):1973-1981. DOI: 10.2146/ajhp180211. PubMed PMID: 30377166.
  7. Mabus, CM. How to effectively time-manage without learning the hard way. APhA. January 2017. Retrieved from https://www.pharmacist.com/article/how-effectively-time-manage-without-learning-hard-way. Accessed November 7, 2019.
  8. McGuire R. Time management for pharmacists. Pharm J. February 2001. https://www.pharmaceutical-journal.com.learning/learning-article/time-management-for-pharmacists/20004091.article. Accessed November 8, 2019.
  9. McKinney KC, Hillebrand K. A careful balancing act. Am J Health Syst Pharm. 2015;72(23 Suppl 3):S168-70. DOI: 10.2146/sp150026. PubMed PMID: 26582304.
  10. Vickery PB, Brahm NC. The Art of Saying No Gracefully. The CPNP Perspective. 2018;5(1):11-3.
  11. Zinurova E, DeHart R. Perceived Stress, Stressors, and Coping Mechanisms Among PGY1 Pharmacy Residents. Am J Pharm Educ. 2018;82(7):6574. DOI: 10.5688/ajpe6574. PubMed PMID: 30323392.
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