(116) A Pilot Study Measuring Pediatric Clinician Daily Physiologic Stress Using Heart Rate Variability

Introduction: Burnout, defined as emotional exhaustion, depersonalization, and a reduced sense of personal achievement, impacts more than half of pediatric residents. Burned out clinicians have lower job performance, increased medical errors, and are more likely to leave medicine. Objective data to identify and target individuals most affected by burnout is lacking, which may hinder development of measurable interventions to prevent and/or address the syndrome. Heart rate variability (HRV) is a reliable objective measure of autonomic nervous system tone, e.g. physiologic stress. This pilot study has two aims: 1) describe HRV trends in first year pediatric residents during a normal workday, and 2) investigate the association between HRV parameters and indices of well-being and burnout.

Methods: This is a prospective observational cohort study. Participants wore an ambulatory EKG device (Hexoskin) for 24 consecutive hours inclusive of a standard day shift during an inpatient rotation. Daily activities were monitored using periodic surveys to correlate with HRV timestamped data. HRV, specifically the low frequency (LF)/high frequency (HF) ratio as a measure of sympathetic activation (e.g. stress), was analyzed via linear regression to determine differences between baseline and work activities, At the start of the study, the Maslach Burnout Inventory (MBI) and Brief Resilience Scale were administered. Pearson correlation analysis was used to determine the association between burnout scores and HRV.

Results: Participant work stress levels (LF/HF ratio) were increased compared to baselines (p < 0.001), with the highest LF/HF ratios seen for clinical work performed later in the day. The MBI revealed moderate-high levels of depersonalization and moderate-low levels of personal achievement. No relationship was found between HRV and burnout scores.

Conclusions: Pediatricians in this pilot study experienced physiologic stress at work, most notably during the afternoons. By the end of their first year of training, clinicians demonstrated a significant degree of burnout. These results support the need for: expansion of this study on a larger sample size in the critical care environment where stress levels are higher, ongoing mental health support and targeted system-wide interventions for pediatric resident well-being.