The Problem

Idea Series Logo debriefing

Emergency physicians (EPs) experience professional burnout more than 3 times that of the average physician.​1​ In a recent study, the prevalence of burnout among emergency medicine residents was found to be an astounding 76.1%, suggesting that burnout begins as early as residency training.​2​ The emotional impact of witnessing suffering and death and the high-stakes, stressful environment of the ED likely contribute to burnout among trainees.

One potential protective factor against burnout is the strategic use of debriefing to mitigate work-related stress. Debriefing involves taking the opportunity to discuss and reflect upon a recent experience with a group of peers who share an understanding of the experience’s context. Debriefing can create a space for peers to provide mentorship, support and feedback to each other, thereby reducing work-related stress.​3,4​

The Innovation

Saving Society is a podcast series that provides residents with a medium for self-reflection and an opportunity to debrief impactful experiences with each other. Thus far, 3 podcast episodes have been recorded and explore complex topics such as gun violence, death and dying, and diversity in medicine.

Target Learners

This innovation was targeted toward resident learners of all levels.

Group Size

Ideally, the group size is chosen to allow everyone the opportunity to both speak and listen. We aimed at 6-8 residents over the course of a 1.5 hour recording window.

Materials Needed

There are many free, online resources that describe the materials needed to record a podcast in depth. Below are the resources utilized by this innovation.

Sample MaterialsCost
Microphone$70
Headphones$20
Pop Filter$10
Portable Recorders$90
Storage$5
Sound Editing SoftwareFree

 

Description of the Innovation

Saving Society is a podcast series that consists of 1.5 hour long podcasts. In preparation for developing the podcast, the team watched Youtube tutorials to learn how to record and edit podcasts.

In order to record the podcasts, the team reserved a comfortable space that minimized ambient noise and provided those sharing their experiences with uninterrupted time to reflect. The team identified sensitive topics that are often difficult to discuss in large groups but have significant emotional impact on individuals, including gun violence, death and dying, and diversity in medicine. Residents were invited to participate in reflection on these topics.

Participants were notified in advance that the discussion would be recorded and released to the public. While residents spoke freely during the recording sessions, any information traceable back to a particular patient or institution was later edited out. After the final edits were made using sound editing software, the podcast episodes were shared with the involved residents to provide an opportunity for them to request removal of any clips thought to be inappropriate for public release.

When the final version was complete, the team uploaded the podcasts to a SoundCloud account. Subsequently, a Twitter account entitled @_Saving Society_ was created to disperse the audio files with commentary. Finally, the team created a Hootsuite account to schedule the podcast releases via Tweets over a 2-week window in July 2019.

Theory Behind the Innovation

Reflective Practice: Based on the work by Kolb and Fry in the 1970s, Saving Society incorporates reflective practice as its main educational learning tool.​5​ Reflective practice is similar to learning from past experiences. The predetermined questions for each interview prompted participants to consider their thought process and decision-making during some of their most emotionally-challenging experiences. A flexible outline, inspired by Graham Gibbs, an expert in the space of debriefing, was created to facilitate the conversation. The structure of each podcast episode was framed around Gibbs’ recommended stages: description, feelings, evaluation, analysis, conclusions and action plan.​6​

Lessons Learned

Despite the intense stress and frequency of emotionally challenging scenarios in the emergency department, there is a paucity of time and space to debrief in real-time. The opportunity for residents to unpack their thoughts on some of the more commonly shared difficult experiences faced such as violence in our communities, death and dying, and the ongoing fight to celebrate team diversity is critical to an emotionally-sustainable career.

From conversations with resident participants, we identified that they appreciated the podcast as an outlet for unloading their emotional cargo on to a wider audience. They found the process therapeutic and cathartic, and found value in using reflective practice techniques to support the conversation.

Challenges identified included learning the logistics of facilitating, recording, and editing podcasts. Recording clean audio was difficult in a large group with multiple voices present. Designating an individual to monitor audio in real-time to ensure speakers are at an appropriate distance from the microphone and ambient noise is minimized could improve the quality of the audio captured. Although strategies for cleaning up audio during the editing phase were identified, recording higher quality audio upfront and recording in a very quiet room makes this process significantly easier. After recording the episodes, the opportunity to rent space at a podcasting studio that can also perform podcast editing was identified and will be utilized for future recordings.

Read more about the IDEA Series.

 

References

  1. 1.
    Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. October 2012:1377. doi:10.1001/archinternmed.2012.3199
  2. 2.
    Lin M, Battaglioli N, Melamed M, Mott S, Chung A, Robinson D. High Prevalence of Burnout Among US Emergency Medicine Residents: Results From the 2017 National Emergency Medicine Wellness Survey. Ann Emerg Med. March 2019. https://www.ncbi.nlm.nih.gov/pubmed/30879701.
  3. 3.
    Gunasingam N, Burns K, Edwards J, Dinh M, Walton M. Reducing stress and burnout in junior doctors: the impact of debriefing sessions. Postgrad Med J. 2015;91(1074):182-187. https://www.ncbi.nlm.nih.gov/pubmed/25755266.
  4. 4.
    Michie S, Williams S. Reducing work related psychological ill health and sickness absence: a systematic literature review. Occup Environ Med. 2003;60(1):3-9. https://www.ncbi.nlm.nih.gov/pubmed/12499449.
  5. 5.
    Kolb D, Fry R. Towards an applied theory of experiential learning. In: Theories of Group Processes. London: John Wiley & Sons; 1975:33-58.
  6. 6.
    Gibbs G. Learning by Doing: A Guide to Teaching and Learning Methods. London: Further Education Unit; 1988.
Nicole Duggan, MD

Nicole Duggan, MD

Emergency Medicine resident
Harvard Affiliated Emergency Medicine Residency
Adaira Chou, MD

Adaira Chou, MD

Chief Operating Officer, 2015-16 ALiEM Chief Resident Incubator
Harvard Affiliated Emergency Medicine Residency
Assistant Program Director
Department of Emergency Medicine
Brigham and Women's Hospital
Adaira Chou, MD

@allarounddoc

Assistant Residency Director, HAEMR Cannon Society Advisor, HMS Ultrasound Fellowship Director, BWH