BACKGROUND AND OBJECTIVES: During medical residency, indicators of well-being decline while rates of burnout increase. As part of a Preparing the Personal Physician for Practice (P4) innovation, this residency program used a relationship-centered periodic resident assessment process to reinforce values of adult learning within the curriculum. It was predicted that the revised assessment process would contribute to an improved educational climate for residents as reflected in global scores of well-being either remaining at the same level or improving throughout residency.
METHODS: Resident Assessment Facilitation Team (RAFT) is an innovative feedback process utilizing small-group dialogue that replaces the traditional semi-annual, faculty-wide review of resident performance. As a pilot study to investigate the impact of RAFT, the Arizona Integrative Outcome Scale (AIOS) was used to describe trends in the well-being of P4 resident cohorts from internship through PGY-3. A comparison group was derived from a resident cohort that started before full implementation of the P4 curriculum and also completed the AIOS.
RESULTS: ANOVA comparing AIOS scores across PGY cohort groups was not significant. An independent samples t test comparing AIOS scores from the PGY-3 pre-P4 group with those of the PGY-3 post-P4 group was also not significant. Although this pilot study was not powered for a complete inferential analysis, the descriptive data suggest a downward trend in the pre-RAFT group and stable measures of well-being in the post-RAFT group.
CONCLUSIONS: The trend in our pilot data suggests a stability of well-being among our residents that contrasts with patterns of resident burnout noted in existing research. The RAFT has become a key feature of our assessment and advising culture that is intended to mitigate the deleterious effects of more autocratic assessment processes. It may also be an important factor in the stability of resident well-being indicated by this pilot.
Peer Reviewed for front end display
The Dorothy Rider Pool Health Care Trust
Foster, E., Biery, N., Dostal, J., & Larson, D. (2012). RAFT (Resident Assessment Facilitation Team): supporting resident well-being through an integrated advising and assessment process. Family Medicine, 44(10), 731-734.