Remote Physiologic Monitoring of Resident Wellness and Burnout
Maneno muhimu
Kikemikali
Maelezo
Sleep deprivation contributes to workplace burnout, a psychological work-related syndrome characterized by depersonalization, emotional exhaustion and feelings of decreased personal accomplishment [Montgomery, 2019]. Medical residency training is associated with decreased sleep and exercise as well as an increase in burnout, which may also be associated with depression [Kamblach, 2019]. Resident wellness has become a focal point of many residency programs in order to prevent depression and long-term physician burnout. Many previous studies tracking sleep have used self-reporting, which institutes a certain level of bias, and some newer technologies such as FitBit tracking have become more prevalent [Case, 2015; de Zambotti, 2018]. Real-time physiologic metric tracking, such as resting heart rate (RHR) and heart rate variability (HRV), in addition to accurate sleep tracking, could provide a far more accurate and objective assessment of resident wellness [Sekiguchi, 2019]. These metrics have not been compared directly to subjective assessments of wellness, burnout and depression, thus their true value in this realm is unknown [Mendelsohn, 2019; Kamblach, 2018]. However, having an objective assessment of resident wellness, stratified by specific rotation, could help identify, develop, and institute interventions to prevent burnout and depression and improve resident well-being.
Previous studies have attempted to make an association between sleep hours, duty hours, exercise and wellness, burnout, depression; however, they have used primitive forms of physiologic tracking (i.e. counting steps as a surrogate for exercise and self-reporting of sleep), which is likely why the results have been relatively inconclusive [Mendelsohn, 2019; Kamblach, 2018; Poonja, 2018; Basner, 2017; Marek, 2019]. A systematic review and meta-analysis of studies attempting to identify factors associated with greater resident well-being showed that increased sleep and time away from work were the strongest influencers of improved resident wellness [Raj, 2016]. Objective, real-time assessment of sleep may identify a stronger association and the addition of RHR and HRV to this analysis could further validate subjective assessment of wellness.
HRV, or the fluctuation in the time intervals between adjacent heart beats, has never before been used to track resident well-being but it is an established metric for prediction and management of disease states such as heart failure [Jimenez-Morgan, 2017; Goessl, 2017, Shaffer, 2017; Bullinga; 2005; Tsuji, 1996]. HRV has been shown to predict mortality in Heart Failure with reduced Ejection Fraction (HFrEF) and new cardiac events (angina, myocardial infarction, coronary artery disease-related death, or HF) in the Framingham study, and it also correlates with improved hemodynamics in response to beta-blocker therapy for HF [Bullinga; 2005; Tsuji, 1996].
The investigators propose to use the WHOOP strap 3.0 for remote monitoring of residents to determine a relationship between its measured data (RHR, HRV, and sleep duration) and wellness using literature-validated surveys (Maslach Burnout Inventory, Mini-ReZ survey, Physician Well Being Index, Patient Health Questionnaire-9) [Montgomery, 2019; Linzer, 2016; Olson 2019; Kroenke, 2001; Levis, 2019]. There is no published literature or known ongoing studies investigating this relationship Recent studies have, however, validated the WHOOP device for sleep tracking and determined its efficacy to be nearly identical to that of the gold standard of polysomnography (PSG) [Berryhill, 2020]. This study also showed that the precision of HRV measurements using the wearable WHOOP device had less than 10% error when compared to continuous ECG monitoring, as part of PSG.
There is an established relationship between HRV and anticipated stress, quantified by salivary cortisol levels, yet there has not been studies linking salivary cortisol as a marker of stress, to subjective assessments in physicians nor against data from wearable devices. Biomarkers of stress (salivary cortisol and alpha-amylase) will compared at baseline and on different rotation considered to be associated with varying levels of stress (i.e. outpatient clinic and inpatient consult services versus the intensive care unit (ICU) setting) [Dickerson, 2004; Petrakova, 2015]. Saliva samples provided by subjects will allow the investigators to validate the WHOOP device as a novel tool to measure stress by allowing the team to assess the association between HRV and other device metrics and objective stress-based analytes found in saliva (e.g., cortisol and alpha amylase). These results will be correlated with each other and with work hours via duty logging to determine whether specific rotations in medical residency have better or worse objective and subjective metrics; these results will also be correlated to baseline (according to baseline characteristics survey).
Tarehe
| Imethibitishwa Mwisho: | 05/31/2020 |
| Iliyowasilishwa Kwanza: | 03/04/2020 |
| Uandikishaji uliokadiriwa Uliwasilishwa: | 03/08/2020 |
| Iliyotumwa Kwanza: | 03/10/2020 |
| Sasisho la Mwisho Liliwasilishwa: | 06/23/2020 |
| Sasisho la Mwisho Lilichapishwa: | 06/24/2020 |
| Tarehe halisi ya kuanza kwa masomo: | 06/30/2020 |
| Tarehe ya Kukamilisha Msingi iliyokadiriwa: | 06/29/2021 |
| Tarehe ya Kukamilisha Utafiti: | 07/29/2021 |
Hali au ugonjwa
Uingiliaji / matibabu
Device: Internal Medicine resident subjects
Awamu
Vikundi vya Arm
| Mkono | Uingiliaji / matibabu |
|---|---|
| Internal Medicine resident subjects Subjects who are categorical Internal Medicine residents at Penn State Hershey Medical Center (PGY1-PGY3), and meet inclusion/exclusion criteria, will be enrolled in this study and wear the WHOOP strap 3.0 for real-time measurement of physiologic metrics. | Device: Internal Medicine resident subjects WHOOP strap 3.0, a photodiode-based device that tracks sleep, resting heart rate, and heart rate variability. |
Vigezo vya Kustahiki
| Zama zinazostahiki Kujifunza | 18 Years Kwa 18 Years |
| Jinsia Inastahiki Kujifunza | All |
| Njia ya sampuli | Non-Probability Sample |
| Hupokea Wajitolea wa Afya | Ndio |
| Vigezo | Inclusion Criteria: - Internal Medicine Residents of Penn State Milton S. Hershey Medical Center (PGY-1 to PGY-3; categorical residents only). - Age greater than 18 years old. - Willing to wear WHOOP device for at least 80% of the time. - Willing to complete weekly surveys at least 80% of time. - Willing to provide and return saliva samples for analysis of stress biomarkers. - Own smart phone for pairing with WHOOP device. Exclusion Criteria: - Preliminary or Transition-Year (TY) Internal Medicine Residents of Penn State Milton S. Hershey Medical Center |
Matokeo
Hatua za Matokeo ya Msingi
1. Change in Heart Rate Variability (HRV) [12 months, change measured every 2 weeks]
2. Change in Maslach Burnout Inventory score (3 subscales: 0-54, 0-30, 0-48) [12 months, change measured every 2 weeks]
Hatua za Matokeo ya Sekondari
1. Change in Sleep (hours per night) [12 months, change measured every 2 weeks]
2. Change in Resting Heart Rate (RHR) [12 months, change measured every 2 weeks]
3. Change in Average Weekly Duty Hours [12 months, change measured every 2 weeks]
4. Change in Mini ReZ score (15-76 scale) [12 months, change measured every 2 weeks]
5. Change in Physician Well-Being Index (PWBI) (0-7 scale) [12 months, change measured every 2 weeks]
6. Change in Patient Health Questionnaire-9 (PHQ-9) score (0-27 scale) [12 months, change measured every 2 weeks]
7. Change in Hospital Anxiety and Depression Subscale (HADS) score (0-42 scale, Anxiety: 0-21 subscale, Depression 0-21 subscale) [12 months, change measured every week]
8. Change in Perceived Stress Scale (PSS-4) score (0-16 scale) [12 months, change measured every week]
9. Change in Salivary Stress Biomarkers (cortisol, alpha-amylase) [12 months; baseline during week 1 of study (2 consecutive collection days), clinic/consult rotations (4 consecutive weeks, every Friday), ICU (4 consecutive weeks, every Friday)]
