Seems like a legitimate question right? And a wearable device is so much more scientific, high tech and sexy than your attending asking you how you are doing today ... right?
Researchers at Penn State College of Medicine are getting ready to start a trial with a wristband wearable medical device - to see if it can diagnose burnout in internal medicine residents.
Let's lift up the hood and examine the details of this study protocol released this week. Does it make sense? Could it make a difference?
Before we begin, come on this thought experiment with me. Imagine you have a wrist device that tells you your stress level in real time, notifying you with - let's say - a soft red light and an intermittent vibration - when your stress levels are high.
- Would that help you be less stressed and burned out?
- Do the researchers know that resident burnout is a whole different beast than burnout in physicians out in private practice?
- How about if your CMO also was notified if you took the device off (sort of like the ankle bracelet on a felon under house arrest)?
That's enough for now.
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Let's look at the study protocol and see what they are actually planning.
The trial recruited 38 internal medicine residents from the Milton S. Hershey Medical Center and began on July 1, 2020. Here is what we know about the study protocol from their press release - my comments follow these bullet points
- Each participant will wear a device manufactured by WHOOP (1) for one year that will measure their heart rate, respiratory rate, sleep and other physiologic data.
- The research team will compare the data collected by the device to subjective assessments of wellness and burnout collected in weekly surveys (2) to see if physiologic trends in the data align with how residents report they feel.
- During the study, if signs of stress are indicated in the residents’ results, appropriate health care measures will be implemented. (3)
- Researchers will particularly evaluate heart rate variability (HRV), the fluctuation in the time intervals between adjacent heartbeats, during the study. (Sounds like Heart Math to me) (4) HRV is a measure of the balance of the autonomic nervous system, which acts largely unconsciously and regulates bodily functions, such as the heart rate, digestion and respiratory rate. It can be used as a surrogate measure for physical, mental and emotional stress.
- ... the researchers will also periodically measure salivary cortisol levels (5) as a secondary objective indicator of stress.
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Let's dig a little deeper here.
(1) What is WHOOP ??
The WHOOP website showcases their WHOOP Strap 3.0 as a way to "Know Yourself". It has celebrity endorsements and you will be pleased to know that it is the "Officially Licensed Recovery Wearable of the NFLPA - National Football League Players Association.
In case you are wondering about a financial conflict of interest, the research announcement finishes with this statement
"This research is being conducted using funds from the Penn State College of Medicine Office of Graduate Medical Education and the Department of Medicine. This research utilizes WHOOP strap 3.0 purchased using the aforementioned funding mechanisms. The Pennsylvania State University does not endorse, promote or recommend the WHOOP strap 3.0 or any other commercial product or service."
(2) Weekly physician burnout and wellness surveys
If your employer surveyed you weekly for burnout and wellness, how long would it take for you to either;
- Just check the boxes to get it over with
- Begin to simply tell them what you think they want to hear
(3) Appropriate health care measures will be implemented (as needed).
This statement makes no sense if you have the best interests of the residents at heart to begin with. I think they are just making this up.
Why do they not provide such "appropriate healthcare measures" as a routine - right now - for this at-risk population? If they know what is appropriate, why withhold the interventions until that whiz bang WHOOP Strap 3.0 starts flashing on one of the residents' wrists?
(4) Heart Math
There is plenty of controversy on the "science" behind Heart Math.
(5) Salivary Cortisol?
Here, suck on this cotton ball and spit it into this test tube. BTW, salivary cortisol does not reliably correlate with serum levels, so I am not sure what value this measure provides, but hey, at least you don't have to stick me with a needle.
This is a tech solution looking for a tech problem that does not exist.
The prevention of physician burnout is the responsibility of the physician leadership team - NOT the result of a heart rate variability score, survey score or the amount of cortisol in a cotton ball soaked in spit.
This appears to be a high tech, academic distraction to the leaders actually doing their jobs.
Burnout is an imbalance in your personal energy system. Your withdrawals exceed deposits and the balance in your energy account is sliding into the negative.
The structure of a medical residency is a classic Canary in a Coal Mine dilemma.
You prevent burnout by teaching residents how to manage their personal stress levels and energy recharge (their Canary strategy) AND working to lower stress in the workplace (the Coal Mine Strategy).
Wrap all of that in a culture of support and teamwork ... and burnout will no longer be such a serious issue.
What does a WHOOP STRAP have to do with any of that?
I was hoping you could answer that for me.
PLEASE LEAVE A COMMENT:
What do you think of this "wearable solution" to burnout?
Would you wear a Whoop Strap for your organization?