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Letters to the Editor

Making Meaning Through Institutional Engagement

Dyster, Timothy G. MD; Penner, John C. MD

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doi: 10.1097/ACM.0000000000003670
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To the Editor:

As resident physicians, we commend Dr. Berg and colleagues’ comments on meaning making to reduce burnout, especially their emphasis on systems-level change.1 Reflecting on our own training experiences, we certainly perceive interplay between resilience, burnout, and nonideal systems that preclude physicians from maximizing intellectual engagement or practicing the values that first drew them to medicine.

We see resident roles in programmatic change as a space where meaning making and engaging with a nonideal system intersect. Both of us participate in residency committees that aim to improve “the system” to enhance current and future residents’ experiences. As a consequence, we experience meaning and agency in our education and workplace. On occasion, well-meaning mentors have expressed concern that spending time on the residency program that would otherwise be free may contribute to burnout. However, each of us have felt that this work, while contributing to our total workload, fosters resilience—a relationship supported by the literature.2 We thus propose a fifth category for the meaning-making framework: institutional engagement.

Below are our recommendations to residency administrators and chief residents on how leaders and institutions might permit resident engagement in programmatic change:

  • (1) Collect feedback about the program from residents routinely and “close the loop”: Highlight when resident feedback catalyzes programmatic change. When changes cannot be made, acknowledge the feedback that was given and consider providing a rationale for the current state.
  • (2) Engage residents in efforts toward programmatic improvement: Involve residents in residency committees and initiatives, particularly those formed to tackle problems identified by resident feedback.
  • (3) Account for residents’ schedules when planning key meetings: Leverage technology to enhance resident access and, if possible, provide structural support (e.g., protected administrative time) for resident involvement.
  • (4) Acknowledge and celebrate residents’ commitment to improving the training environment: Avoid inadvertently discouraging residents’ attendance at meetings based on concerns for work–life balance.

Creating opportunities for institutional engagement can bolster trainees’ sense of agency in their work environment. This may require shifting away from a burnout prevention paradigm that encourages residents to spend time away from training and toward one that acknowledges the fulfillment in engaging their circumstances and their institution, to serve “something larger than themselves.”1


1. Berg DD, Divakaran S, Stern RM, Warner LN. Fostering meaning in residency to curb the epidemic of resident burnout: Recommendations from four chief medical residents. Acad Med. 2019;94:1675–1678
2. Zwack J, Schweitzer J. If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med. 2013;88:382–389
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