“From Exhaustion to Invigoration”: a mixed-methods study exploring the role of a community in supporting resilience of pediatric education leaders

Abstract

Objectives

It is critical to identify factors in the work environment that contribute to physician burnout to foster a professional culture that nurtures wellness. This study examined the prevalence of burnout symptoms among a group of Canadian pediatric undergraduate education leaders and explored how membership in a national community (Paediatric Undergraduate Program Directors of Canada, PUPDOC) may serve as a potential mitigating factor.

Methods

This mixed-methods study involved a survey and subsequent focus groups of PUPDOC members. Survey comprised questions from the Maslach burnout index (MBI) adapted for the educational context. Data were analyzed using descriptive statistics. A qualitative descriptive approach was selected and focus group transcripts were analyzed using content analysis. Themes were generated that relate to PUPDOC’s role in shaping members’ educational and academic work.

Results

Sixteen members completed the survey (16/23, 70%). On the traditional MBI screen, three of 16 participants scored high-risk for burnout, but none reported high levels of symptoms on the adapted questions. Eighteen members participated in focus groups. Themes were interrelated, and included the significance of a sense of community, strengths and stressors of the job, finding meaning in one’s work, opportunities, and legitimacy associated with belonging to a group.

Conclusions

Our small group of pediatric undergraduate education leaders demonstrated a relatively low burnout rate compared to published rates in physician colleagues. We propose a sense of community that transcends institutions may help to mitigate burnout. By encouraging membership in such organizations, academic institutional leadership can support resilience and invest in the wellbeing of their education leaders.

Introduction

Physician burnout has been referred to as a public health crisis [1] and addressing it is increasingly recognised as a strategic priority by organisations and governing bodies. Burnout is a phenomenon defined by emotional exhaustion, depersonalisation and a perception of low personal accomplishment [2], and is an important contributor to physicians’ personal health, patient outcomes, and productivity of the health care system [3,4]. A large US survey study demonstrated that physicians report higher rates of burnout symptoms than matched working population controls (39.8% vs 28.1%) [5]. Canadian physicians report similar burnout rates which have increased since the global pandemic, from 31% in 2017 to 53% in 2021 [6,7]. A systematic review of studies involving physicians from 45 countries reported a prevalence of burnout up to 80.5%; however, there was noted variability in estimates and assessment methods [8].

There is comparatively less data regarding the incidence of burnout that is specific to medical education leaders including its impact on trainees. Survey studies of U.S. internal medicine clerkship directors demonstrated that between 58-62% met criteria for burnout, which impacted both their attitudes towards medical students and medical education in general [9,10]. In contrast, a study of internal medicine residency programme directors showed that only 28.7% of respondents met criteria for burnout [11]. Recent studies of psychiatry and paediatric clerkship directors also demonstrated lower rates of burnout at 22% and 23% respectively [12,13]. Across these studies, potential risk factors for burnout were identified and include: younger age, female gender, less salary support and less protected time for educational responsibilities. Data specific to medical educators outside of North America is relatively sparse. Burnout in medical and health-sciences educators in low-income settings is characterised as “being a pressing global concern,” noting common stressors such as heavy teaching and clinical workloads, rapid curricular change, and limited institutional support [14]. A mixed-methods study of medical educators in Pakistan found burnout rates approaching 100% [15]. Another study of medical educators at 3 institutions across the Western Balkans reported a prevalence of moderate levels of burnout at 85.6% [16]. In response to this global concern, an Asian study examined the validation of the World Health Organisation Well Being Index (WHO-5) in a cohort of medical educators in Hong Kong [17].

Factors protective of burnout have recently begun to receive attention. There has been a shift in focus for institutions to identify and nurture interventions at both the individual and organisational level to promote physician resilience and well-being [1,18,19]. Resilience has been variably defined [20] but simply put, it may be viewed as a process of positive adaptation to adversity [21]. Resilience may be supported by identifying the most relevant resources for individuals facing challenges in different contexts which necessitates close relationships with other people [22]. Relatedly, models of physician well-being also highlight the importance of community and institutional support [23]. Seligman’s PERMA (Positive emotions, Engagement, Relationships, Meaning, and Achievement) model describes relationships as “all the social connections that enable a person to experience a sense of belonging and mutual support;” and meaning as “the sense of connection to a higher purpose.” [24] While the literature presents several conceptual models of physician well-being [23], the focus is primarily on how physicians receive support and community at the institutional level; furthermore, models are not specific to medical education leadership roles.

The focus of this mixed methods study is to examine how a group of Canadian paediatric undergraduate education leaders receive support and experience a sense of community through membership in a national organisation that crosses multiple institutions. The aims of this study are twofold: to examine the prevalence of burnout symptoms among a group of paediatric undergraduate clinician educators and to explore how belonging to a national group supports resilience and well-being.

Methods

Context

Paediatric Undergraduate Programme Directors of Canada, (PUPDOC) is a national organisation of paediatric undergraduate and/or clerkship directors from all 17 medical schools in Canada. PUPDOC was founded in 2000 to connect paediatric undergraduate leaders from across the country, modelled after national postgraduate medical education leadership groups, but recognising the unique needs of individuals in paediatric undergraduate leadership roles. The organisation is supported by individual institutions and the Paediatric Chairs of Canada. The total number of members varies over time, and there is typically between one to three members from each institution who attends organised meetings which occur twice-yearly to collaborate on the development of shared curricular materials, and to mentor and support each other in medical education leadership and scholarship.

Data collection

This mixed-methods study was conducted in two phases involving an initial electronic survey, followed by in-person focus groups six months later. Results from the survey were used to inform areas of enquiry in the focus groups. Data from the quantitative and qualitative components were used to complement each other and provide a richer description of the participants and their experiences in their medical education leadership roles.

Survey

An electronic survey (Appendix 1) was distributed to active members in spring 2019, and included questions adapted from the Maslach burnout index (MBI) screen, an educational MBI screen, and questions assessing engagement in PUPDOC. All items related to burnout were scored as described previously [13]. Although our numbers were not sufficient to calculate Cronbach’s α on our sample, all instruments have been previously validated. Briefly, the questions included a validated two-question scale originating in the Maslach inventory and assessing depersonalisation (DP) and emotional exhaustion (EE). The two-item summative score correlates strongly with the EE and DP domains of burnout measured by the full MBI and have been validated in several studies of physicians and medical trainees [25–27]. Two additional questions modelled after questions on the MBI for DP and EE were previously validated for educators regarding relationships with learners [9]. Finally, we used two additional questions validated by Fealy et al. to assess emotional tenor towards students assessing educator guilt and sense of reward [13]. For our study, all questions were analysed independently with a positive score defined as reporting symptoms at least weekly (score ≥ 4); the question regarding feelings of reward was reverse scored. Burnout was defined as either EE or DP positive for symptoms at least weekly (disjunction approach) [27].

To preserve anonymity due to the small group size, the survey included demographic information limited to practice, roles and experience. Ethics approval was sought by the Research Ethics Board at the University of Toronto, and this project was granted exempt status as it was deemed to fall under Educational Quality Improvement. Consent was implied by participation in the survey, and written informed consent was obtained for focus group participation.

Focus groups

In-person focus groups were conducted to further explore the role of PUPDOC in members’ educational leadership portfolios. Focus groups were chosen to capitalise on communication between participants to hear their experiences and examine group culture and priorities [28]. Eighteen out of 23 group members, attended the 2019 fall semi-annual meeting and were invited to participate; participation was voluntary and members could opt out. Written consent was obtained from all participants, and all members attending the meeting participated (n = 18), representing members from varied programmes and geographic locations. Demographic data was not collected to maintain anonymity due to small group size but was presumed to be similar to that collected in the survey portion of this study in terms of practice, roles and experience.

Question development was informed by survey responses and the literature (Appendix 2). Two focus groups were run simultaneously for one hour and each was facilitated by two authors. Discussions were audio-recorded, transcribed verbatim and anonymized prior to analysis. The size of the focus groups was based on pragmatic constraints; we captured all attendees at the annual meeting. Member checking was conducted one year later in 2020, virtually, to validate results through a formal return of findings. Identified themes with representative quotes were shared with the membership and feedback was elicited. Respondents reported the analysis accurately reflected the data; no substantive changes were made.

Data analysis

Quantitative survey data were analysed using descriptive statistics and summarised using frequency tables. A qualitative descriptive approach was selected for the study and data was analysed in a rigorous stepwise manner using content analysis [29]. An initial review of focus group transcripts was conducted independently by all authors, each developing a preliminary coding structure. The coding structures were then compared, and a single coding framework was refined in an iterative manner over a series of meetings until consensus was achieved. Each author then independently applied this coding structure to all data. Discrepancies were resolved by consensus, codes were then grouped into emerging themes, and final themes were defined. On occasion, data were identified to correspond to multiple codes which was accepted as a natural characteristic of the data, demonstrating how experiences could be represented by multiple interlinked themes. An independent reviewer familiar with qualitative analysis (TM) was invited to provide an outsider perspective to offer feedback on the relevance and fit of codes and categories; a necessary step to mitigate any biases in the analysis from members/researchers [30].

Positionality statement

As active members of PUPDOC, the researchers (AP, KLF, SLB, GW) acknowledge our inherent biases, particularly to the value we place on opportunities and the support afforded by our membership in the group. Our membership also gave us an intimate perspective from which to complete this project with the goal of continuous improvement and development of our community and its mission. Researchers both facilitated and participated in the focus group discussions, and given small group size, these perspectives were included to ensure a full understanding of the collective experiences of group members. Bracketing was utilised by researchers to enhance the rigour of the study and this involved writing memos to sustain a reflexive stance across all stages of qualitative enquiry including the analysis and reporting of results. This helped mitigate any possible unfavourable effects of unacknowledged assumptions or biases while also facilitating deeper levels of reflection [31].

Results

Survey results

Sixteen active PUPDOC members completed the survey (16/23, 70%). Baseline characteristics are shown in Table 1. Not all respondents provided complete demographic data, likely reflecting a wish for anonymity. Results of survey data are shown in Table 2. Fifteen of 16 respondents completed the burnout screens. Three of 16 participants scored high-risk on EE and one of these three also scored high-risk on DP, representing burnout in 3 of 16 participants. No respondents reported a high level of symptoms on the adapted educational MBI or lived experience questions. Fifteen of 16 of participants reported that they find working with students rewarding. One participant did not answer the question.

Table 1.

PUPDOC member survey demographics.

Demographic characteristics of respondents		N of 16
Type of practice	General paediatrics	8
	Subspecialty paediatrics	7
	Not answered	1
Years in practice	0–5 years	1
	5–10 years	4
	>10 years	9
	Not answered	2
Years in clerkship leadership	0–5 years	6
	5–10 years	4
	>10 years	5
	Not answered	1
FTE for education leadership activities	0.1–0.2	9
	0.3–0.5	4
	Not answered	3
Years participating in PUPDOC	0–5 years	4
	5–10 years	7
	>10 years	5
Scholarly activity through PUPDOC	yes	15
	no	1
Leadership activity through PUPDOC	yes	6
	no	10

Table 2.

PUPDOC member survey burnout screening.

Survey item	Response N of 16
	Never to a few times a month	Once a week to everyday	Not answered
2-item MBI: Emotional exhaustion “I feel burned out from my work.”	12	3	1
2-item MBI: Depersonalisation “I have become more calloused toward people since I took this job.”	14	1	1
Adapted 2-question education MBI “I don’t really care what happens to my students”	15	0	1
Adapted 2-question education MBI “Working with students directly puts too much stress on me.”	15	0	1
Lived experience “I feel guilty about my attitude at work towards students.”	15	0	1
Lived experience “I find working with students rewarding.”	0	15	1
Overall rate of burnout
High level of both EE and DP		1
High level of one of EE and DP		3

MBI—Maslach Burnout Index; EE—emotional exhaustion; DP—depersonalisation.

Focus group results

From the content analysis, five themes were identified: sense of community, the “job”, finding meaning, opportunity, and legitimacy. Table 3 lists these five themes and under each theme there are subthemes of supports or stressors to resilience along with codes and exemplar quotes. Attribution of quotes have been removed to maintain anonymity.

Table 3.

Qualitative data from focus groups, demonstrating emergent themes, subthemes, and exemplar quotes.

Themes	Representative quotes
Sense of community
Supportive to resilience
Support	“…I value having these connections knowing that if I needed help or to bounce ideas off people individually outside of the meetings that I would have connections to all of those people that I think we meet frequently enough that I feel like I can email anyone on the committee and have that support. So sometimes for me that is a big strength.” “I think it’s helpful to have someone who understands what you’re going through. Some of these things aren’t solvable, and that has sometimes helped me to be more resilient.”
Motivation	“…has helped to push me down this road, I don’t think I would have probably done as much as I have without that sort of organised group.” “Individually not all of us would have had the energy to get past the initial part, we have kind of pushed each other to do it.”
Collaboration	“…there is something about the atmosphere we have collectively created, and seeing each other a couple times a year, and talking to each other at other times throughout the year because we have projects we are working on that has helped to encourage and sustain.” “It’s been great that we have moved into role where we can share some of those challenging time, we can also develop things together, and build scholarly projects together, and work on neat things, and build, and turn things into a very positive interaction.”
Help with local issues	“…can provide a different external perspective…because you can have this conversation, but then you know you’re not going to bump into that person the next day”
Stressors to resilience
Overcommitment	“I think there is also the potential to overdo it, you can get overinvolved…and still have the obligations of what is going on at your home programme, and that can be, you have to be very thoughtful about you’re going to do, just as everything else in your career, you are going to have to make decisions about what you’re going to work on, and what you’re not going to work on.”
Competing responsibilities	“Sometimes though, you do need someone to send you an email to say hey how’s this coming along because otherwise nobody reminds you, and then it remains as item number 100 on your things to do list…I’m not always feeling that resilient by the time I get that email.” “I think realistically, yes it’s a great group if you need to reach out and if you’re struggling, but if you’re over-worked, you’re over-worked.”
The “job”
Supportive to resilience	“Sometimes when you’re at a teaching and you’ve had a bad day, and a group of students come and you talk with them about your bad day, it can kind of turn it around. They can get very interested about your life and actually get something back from the students.”
Stressors to resilience	“I’m on service every other week so there is no time in my day for medical education, so I definitely end up doing that in my spare time, which I can see it being an issue in terms of office, because instead of spending time with my kids I’m doing the medical education piece.” “I definitely struggle with so many expectations as a paediatric [subspecialist], to be on national committees, so it’s tricky for me to try to do both [clinical and education].” “How easily one individual is tipped towards exhaustion versus invigoration, and that really has to do with how supported you are in the day to day.”
Finding meaning
Supportive to resilience
Making an impact on students	“And at the same time, it [working with the students] can be invigorating, and exciting, and fun, and awesome.” “It’s good to know a student was positively impacted.”
Finding meaning in UG education	“We have one opportunity to do the best that we can do because most [clerkship students] aren’t going to be paediatricians…. [They] need to know children and their families in one way, shape or form, [so] at some point we have a have a onetime opportunity to do the best that we can…. It’s such a huge opportunity.”
Having multiple roles	“Sort of breaks up the clinical common load and it’s okay I can switch that off now, and I can do some teaching, I can do some exam question writing or whatever it is.”
Timelines	“For me it’s always been a 5 year, then a 5 year supporting, then an out, and somebody comes in behind and does their thing.” “So, to me, I don’t view the clerkship or clerkship director UGME to be a 34-year endeavour.”
Stressors to resilience
Lack of meaning with an executive role	“I like this role. Yes, it’s an administrative role, and yes, I still have…opportunities to teach and not give up the clinical work …. Once you move to an assistant dean or whatever, I think it becomes administration, and we lose the big picture of what we need to do at the bedside in our small groups with those direct interactions with the students.
Opportunity
Supportive to resilience
Opportunity for scholarship, innovation, and professional development	“I think, absolutely, [Organisation X] has done all these things for me, supported my career, in terms of collaboration, and research, and building our curriculum, presenting workshops together with people in this room at [Organisation Y], doing posters together. Absolutely, all that.” “I wonder if there are some ways we can expand. We’ve talked in the past about assessment/exam tools that are dealt with differently at every site, but I do wonder if the exams have become more of an issue for us because of changing the exam set-up. But I think more people are going with standardised exams vs. local exams so they can say we have a unified curriculum, so we also have a unified assessment strategy.”
Stressors to resilience
Opportunity overload	The undergrad peds role feels removed from what my actual contact is and it’s tricky to piece that together so that’s why I’m careful about what’s coming up for extra stuff.
Legitimacy
Supportive of resilience
Career advancement	“…at my university you apply for associate professorship, you need people to write reference letters for you, who kind of understand what you do, who are in a professorial rank that is high[er] than yours, but are not at your university. And so, how do I know those people? I don’t know anyone outside of my university. But [Organisation X], it’s like hey, I know so and so, they do similar work to mine, so maybe I’ll write them down as referee, otherwise I wouldn’t have anybody. You don’t get to know people outside of your university, right? That is something very practical that [Organisation X] helps with.”
Role justification	“And I think recognition [by] our Chairs, [Organisation X] has contributed in that way, by letting the Chairs know that we are this organisation that’s cohesive, that we each as individuals have contributed to it and that’s something that [Organisation X] has helped us with.”
Stressors to resilience
Undergraduate less valued than Postgraduate Education	“You have fantastic medical students, with no interest in paediatrics, so if the staff want to ensure that the learners are interested in peds and engaged, they go with the paediatric residents as opposed to the medical students.” “Undergrad has to fight, fight, fight for every little thing.”

Theme 1: sense of community

Sense of community was identified as a central theme. PUPDOC members reported that belonging to the group made them feel supported and connected to their peers making it feel like an educational home and safety net. One participant noted how membership, “set [them] on a course, engaging with likeminded people, [who] had similar jobs, similar visions, sort of…like having a home where you can go and talk about things.” Participants also highlighted how membership gave them motivation. One noted that it prevented them from becoming “stagnant in our roles in our isolated environments.” Another agreed that “we come together once or twice a year…[which], gives that momentum to not just stick with the status quo but actually move on.”

Membership offered a space for collaboration and support. One participant recalled how they “phone each other, yes for advice and support, and for commiseration and help, but also to celebrate successes and to share great things.” Another participant noted that while the group offered support to manage problems, it came with the realisation that their local problem was also shared by others. In their words, “I didn’t realise this is similar elsewhere. It’s not ‘my’ problem, it’s ‘a’ problem, elsewhere too. I think it’s good for you to realise not everyone has an answer. It validates our own individual struggles.”

In contrast, some participants noted negative implications of belonging to the group. Factors contributing to additional stress included overcommitment and competing responsibilities. Members reported that they felt pressured to participate in group projects when they were already stretched with heavy workloads. In the words of one participant:

“I think it’s great that there is a lot of academic and scholarly projects, but I am going to be honest, out of my first…meeting, I left feeling overwhelmed, like I had so much more work to do, and that people were going to follow-up with me to make sure that the work was getting done, and I wasn’t really sure what I had just signed up for. It was a stress.”

Theme 2: the “job”

PUPDOC members value their roles as education leaders but identify that the “job” has both negative and positive aspects. On the one hand, their role offers opportunities to teach, educate, learn, and grow as professionals. As one participant puts it, working with students “can be invigorating, and exciting, and fun, and awesome,” and they “get something back from the students.” Although some participants appreciated the role’s positive aspects, others commented on feeling isolated and alone and spoke of the stresses of having a leadership role. In the words of one participant:

“I think sometimes working with students can be completely demoralising. It just sucks the life and energy right out of you, particularly with some of the negative feedback, the unsubstantiated feedback, the appeals and the hundreds of hours you have to put in to prepare an appeal and defend it.”

Theme 3: finding meaning

Finding meaning contributes to an overall sense of positivity and belonging which may help support resiliency. Participants recognised that their work is important on both an individual basis and on a larger scale. In the words of one member: “Knowing you’ve had a positive impact … is very empowering.” Another reflected on meaning with respect to the scale of the impact: “I think we have a huge responsibility to society that all of our graduating medical students have that base skill set, and I think the opportunity is huge.”

Participants also found meaning as undergraduate directors as opposed to having a similar role in postgraduate education. As one puts it, “I thought a lot about going to postgrad, but then I thought no, I don’t want to, I don’t think it’s better, there is a lot of perception about that it’s better, but I don’t think that it is better.”

A leader/educator role also granted greater variety compared to working solely as a clinician: “I think it’s both. I think for me, medical education, teaching and admin, is a nice break from the clinical.” While participants found meaning in their current role, they also recognised that a higher leadership position could tip the balance towards more admin work and a possible loss of identity as clinician educators. As one puts it, “I’ve actually had this conversation with someone, I don’t want to be an administrator, I want to be an educator.” Although participants found meaning in their multiple roles, they also recognised that their leadership role was a limited position:

“This is how I constructed it when I took on the job, so when I take a position, I take it with the understanding of how I am going to leave that position, so there is no expectations. So, people know I’m in it for 5 years.”

Theme 4: opportunity

Education leaders appreciated that their job and membership in a national organisation provided opportunities to further their careers through innovation, scholarship, collaboration, and professional development: “In terms of supporting my career, PUPDOC made a place where scholarly activity happens.” Another participant agrees that group collaboration can offer innovative solutions to common problems:

“You have discussions around programme evaluation or assessment or best practices, and you take that back to your programme and you implement all of them and you start to see things start to change in the programme.”

Scholarship opportunities can be seen positively as ways to advance careers and support resiliency; however, as noted above, these opportunities may also become stressors which may have a negative impact on resiliency:

“ I will be honest, there was a lot of stuff going on, there is a little bit of pressure for everybody to sort of tow some weight to get these projects done. Sometimes it falls to the back burner, [but] people keep yanking it to the front burners, [and] sometimes it’s not always easy to get it done. It’s not all unicorns and rainbows.”

Theme 5: legitimacy

Some members feel that they are undervalued compared to their peers in residency education. One participant noted that “there is more prestige in [PGME]. There is more money, there is more admin support, there is more FTE, there are more rooms available in the hospital to book, there’s more everything for postgrad.” However, there is also recognition that belonging to a national organisation improves their standing with the Department Chair. As one participant puts it,

“The role of PUPDOC within the clerkship/residency sort of dichotomy ... has been interesting because I think since PUPDOC became a force, it probably has increased the appreciation of, at least for our department head, for clerkship.”

Another agrees that membership in PUPDOC increases their visibility in the Department and how “in the last couple of years…we have always done these things as part of our jobs [so membership] has kind of concretised it in a way.” Working on scholarly activities within a national context is also recognised by Division heads and helps members with career promotion. In the words of one participant,

“In terms of supporting my career, PUPDOC made a place where scholarly activity happens…because then when you are talking to your division head you say, well, I have this poster, it was a national collaboration, we did this workshop, we presented at this international meeting, like COMSEP. Like that’s the stuff that … the division head and chairs look at [which] is helpful.”

Discussion

This study sought to identify burnout rates in a small group of Canadian undergraduate paediatric education leaders and to explore the impact that engaging in a national organisation has on the professional lives of its members. Our group of paediatric education leaders report a lower rate of burnout (three of 16 members) compared to both Canadian and US national physician cohorts [5–7]. Regardless, burnout in our group remains substantial and reflective of underlying issues within our work environments. Reassuringly, leadership in medical education activities was considered fulfilling as most education leaders reported that they found working with students to be rewarding. Our findings suggest that while there were many aspects of membership that supported resiliency including legitimising the role of the undergraduate director, some members found that belonging to PUPDOC may induce stress because of overcommitment to group endeavours and having competing responsibilities.

Interventions to support resilience and well-being are promoted by institutions to help physicians navigate multiple tensions that they experience in their roles as clinicians, educators and leaders. The PERMA model, with its focus on the importance of community and institutional supports, has been recognised as a framework to support institutional leadership and cultural change [32] with respect to physician well-being. Our findings agree with this notion as participants valued the social connections and support that PUPDOC provides. However, we expand on this model and suggest that support and community building goes beyond the walls of one institution to include membership in a national organisation providing a sense of solidarity which some may find lacking in their own faculty. Education leadership roles are among many competing responsibilities of physicians, and it is important that paediatric education leadership is recognised and valued. Undervaluing has been cited as a concern for medical educators more broadly despite the professional satisfaction derived from working with learners across the domains of the PERMA model [33]. We recommend that institutions encourage and support medical education leaders to participate in national organisations to support their professional growth and longevity. As a result of this study, our organisation has made changes to our member orientation to help mitigate any negative implications of group membership such as being overwhelmed with multiple projects. For example, when embarking on group projects or activities, we are more explicit in recognising competing responsibilities of members and invite them to participate according to their present capacity.

Limitations

Limitations of this study include small group size; however, the majority of group members participated, and it included individuals from multiple institutions from across the country providing richness of data and diversity of responses. The presence of researchers who are also members of the group may have introduced bias in the analysis; this was mitigated by bracketing and having an external reviewer familiar with qualitative research review the analysis. The survey and focus groups were conducted pre-pandemic and our findings may not have captured shifts in workplace dynamics as they relate to member wellness and resilience. Additionally, structural inequities within a community, such as the ability of junior versus senior members to engage, gender-related expectations in service work and other potential inequities were not explored but may have important impact on participation in a national organisation, remaining an area for future study.

Conclusion

Paediatric undergraduate education leaders demonstrate relatively lower rates of burnout compared to their physician colleagues. In examining the role of membership in PUPDOC, we propose that belonging to a national organisation may provide a sense of community that transcends one’s individual institutions and can help support resilience and provide value to one’s role in undergraduate education. Medical schools can support their academic leaders by encouraging membership in such organisations.

Appendices.

Appendix 1. PUPDOC Member Survey Questionnaire

1. Please answer the following questions about your emotions and symptoms.

	Every day	A few times a week	Once a week	A few times a month	Once a month or less	A few times a year or less	Never
I feel burned out from my work
I have become more callous towards people since I took this job
I don’t really care what happens to my students
Working with students directly puts too much stress on me
I feel guilty about my attitude at work towards students
I find working with students rewarding*

*Reverse scored. Do not include asterisk in question.

2. FTE dedicated to your role in the medical student paediatric clerkship. ______ (free response)

3. How does your role in medical education affect your wellness? What is the impact of wellness, or lack thereof, on your professional role in medical education?

Free response text box.

Appendix 2. PUPDOC Resiliency Focus Group Questions

We are trying to understand what role PUPDOC as a community of practice, may play in your professional development and wellness. This information will help us further develop as a group and tailor our activities accordingly.

This focus group is being conducted as part of a quality improvement cycle for PUPDOC. We would like to record and transcribe the discussion, and transcripts will remain de-identified with themes presented in aggregate and returned to the group for comment. The QI process and outcomes may be published for use by other similar groups.

What is the purpose of PUPDOC?

What do you value most about PUPDOC?

How has PUPDOC and its members supported your career? your programme? your wellness?

Has PUPDOC contributed to a sense of resiliency?

Has PUPDOC or its members influenced your level of personal and professional burnout?

To what extent does PUPDOC influence your desire to remain in your paediatric clerkship leadership role?

How does your role in medical education affect your wellness?

And vice versa- What is the impact of wellness, or lack thereof, on your professional role in medical education?

How comfortable do you feel contacting a PUPDOC member for advice and support?

Are there others to whom you can reach out around your educational activities?

What does PUPDOC do to implicitly or explicitly promoting equity, diversity and inclusion?

Any last thoughts?

Disclosure statement

The authors report that there are no competing interests to declare.

This work was presented as a platform presentation at the 2021 Council on Medical Student Education in Paediatrics (COMSEP) Annual meeting (virtual). The Role of a Community of Practice in Supporting Resiliency of Paediatric Undergraduate Clerkship Directors. Apr 7-10, 2021.

Funding

The authors report no funding or sponsorship for this work.

Data availability statement

Due to the nature of the research, in order to maintain participant anonymity, supporting data is not available.

Author contributions

Dr Angela S Punnett was involved in conceptualisation, data curation, formal analysis, investigation, methodology, writing—original draft and writing—reviewing & editing. Dr Karen L Forbes was involved in conceptualisation, data curation, formal analysis, investigation, methodology, writing—original draft and writing—reviewing & editing. Dr Susan L Bannister was involved in conceptualisation, data curation, formal analysis, investigation, methodology, writing—original draft and writing—reviewing & editing. Dr Gabrielle Weiler was involved in conceptualisation, data curation, formal analysis, investigation, methodology, writing—original draft and writing—reviewing & editing. Dr Tim Mickleborough was involved in formal analysis, methodology, validation, writing—review & editing.