489 - Neonatal-Perinatal Fellow Wellbeing: Definition and Drivers for Improvement from the Trainee Perspective

All-time high physician burnout and attrition rates in 2022 highlight the critical need to support physician-in-training wellbeing. Wellbeing is not merely the absence of burnout, but what it means for fellow physicians is not well-defined. A conceptual framework is key as the ACGME requires fellowship programs to have policies and programs that encourage optimal fellow wellbeing. Neonatal-perinatal medicine (NPM) fellows may have unique drivers of wellbeing as they train to care for critically ill newborns. Illustrating the NPM fellow perspective may instrumentally inform leaders to develop impactful initiatives and add to the literature so wellbeing drivers common to fellowship training may be identified.

Objective:

We aimed to identify drivers of NPM fellow wellness by qualitative analysis of semi-structured in person focus group interviews. Utilizing Shanafelt et al.’s conceptual framework model for practicing physician wellbeing, we created a novel, interactive tool to facilitate fellow ranking of drivers by importance, allow for addition of unique drivers, and elicit specific suggestions for program/policy development.

Design/Methods: We conducted 5 focus groups with NPM fellows in Philadelphia and surrounding regions, reaching thematic saturation. Two qualitative researchers coded transcripts using inductive coding. NVivo 12 software facilitated data analysis. Fellows ranked the 7 Shanafelt model driver dimensions from most to least impactful, first individually, then as a group. Rank positions were assigned numerical point values (1=least, 7=most impactful). Simple descriptive statistics were performed to determine Shanafelt driver mean point values (MPV) and overall individual and group consensus rankings (Fig 1).

Results:

Work-life integration (5.6), social support/community (4.4), and meaning(4.4) were most important to groups, and control/flexibility (2.8) ranked least. “Medical confidence” was added as a high-impact unique driver. Suggestions to support wellbeing (Fig 2) include focus on: prioritizing fellows’ time spent training at the top of the NPM physician license, equity and inclusion, and respect of fellows’ professional/personal priorities, rather than a desire to decrease their workload.

Conclusion(s):

Our novel tool helped elucidate NPM fellow perspectives on the impact of wellbeing drivers and suggestions for support. Generalizability is limited by small sample size, convenience sampling, and regional location. Further investigation is needed to determine whether potential unique drivers impact other physician populations’ wellbeing or findings inform effective policy development.