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What gets resident physicians stressed and how would they prefer to be supported? A best–worst scaling study
  1. Andrew Wu1,2,
  2. Ritika S Parris3,4,
  3. Timothy M Scarella1,2,
  4. Carrie D Tibbles3,5,
  5. John Torous1,2,
  6. Kevin P Hill1,2
  1. 1 Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  3. 3 Office of Graduate Medical Education, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  4. 4 Medicine, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Emergency Medicine, Harvard Medical School, Boston, MA, USA
  1. Correspondence to Dr Andrew Wu, Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; anwu{at}


Introduction Physician burnout has severe consequences on clinician well-being. Residents face numerous work-stressors that can contribute to burnout; however, given specialty variation in work-stress, it is difficult to identify systemic stressors and implement effective burnout interventions on an institutional level. Assessing resident preferences by specialty for common wellness interventions could also contribute to improved efficacy.

Methods This cross-sectional study used best–worst scaling (BWS), a type of discrete choice modelling, to explore how 267 residents across nine specialties (anaesthesiology, emergency medicine, internal medicine, neurology, obstetrics and gynaecology, pathology, psychiatry, radiology and surgery) prioritised 16 work-stressors and 4 wellness interventions at a large academic medical centre during the COVID-19 pandemic (December 2020).

Results Top-ranked stressors were work-life integration and electronic health record documentation. Therapy (63%, selected as ‘would realistically consider intervention’) and coaching (58%) were the most preferred wellness supports in comparison to group-based peer support (20%) and individual peer support (22%). Pathology, psychiatry and OBGYN specialties were most willing to consider all intervention options, with emergency medicine and internal medicine specialties least willing to consider intervention options.

Conclusion BWS can identify relative differences in surveyed stressors, allowing for the generation of specialty-specific stressor rankings and preferences for specific wellness interventions that can be used to drive institution-wide changes to improve clinician wellness. BWS surveys are a potential methodology for clinician wellness programmes to gather specific information on preferences to determine best practices for resident wellness.

  • health economics
  • medical education & training
  • mental health
  • human resource management

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors AW, KPH, RSP and TMS made significant contributions to the design and conception of this study. RSP, CDT and TMS were involved from a graduate medical education perspective in data acquisition. AW was primarily involved with data analysis, with assistance from KPH, JT and TMS on interpretation of data. All authors revised the article for important intellectual content, with AW taking lead manuscript writing responsibilities. All authors approved the final version of the manuscript being submitted. AW is acting as the guarantor of the study and accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding Dupont-Warren Fellowship, Department of Psychiatry, Harvard Medical School (internal grant, no associated grant/award #). Sawtooth Software Academic Grant (no associated grant/award #).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.