Category Archives: Public Health

Background:  

Understanding physician burnout is an area of intense research. Commonly cited studies by Mayo Clinic and Medscape indicate levels of physician-reported burnout continue to rise.  Traditional ways of measuring burnout include questionnaires and surveys.  While these are popular and validated ways to assess burnout, they do not allow providers to self-define burnout and use scripted words that limit individual expression.  The movement to discuss burnout and its causes is welcome. However, perhaps more important is the shift that has occurred in the conversation from problem to solution.  Increasingly, the focus has been on the study of resiliency and how systematic changes can impact burnout rates.  

This exercise uses photography as a way for individuals to connect with and express what burnout and resilience mean to them.  Individuals will have the opportunity to self-express and process the experience of burnout or distress with others. Participation in the group experience will allow for perspective-taking and recognizing commonalities with peers. The shared experience gives participants the opportunity to be exposed to new strategies for resilience building by learning from their peers. Additionally, the outcome from the collective experience can lay the groundwork for systematic change.   

Photovoice is a qualitative method generally used in community-based participatory research.  It is action-oriented and meant to give a voice to people that are considered disempowered.  The aim of this research method is to evoke dialogue and create movement on social issues.  In this curriculum, the residents are empowered to use photography to create a shared experience which can lead to bolstering personal resilience and promotion of systematic change.   

Objectives: 

After participating in the experience residents will … 

1. Use photography to express their personal views on burnout and how to combat burnout 
2. Enhance personal resiliency skills as a result of the shared experience  
3. Create a collective dialogue that can be used to influence systemic change 

Photovoice Assignment Participants Guide

Take two photographs*, one to answer each of the following questions. 

• What is burnout? 
• How do I prevent or overcome burnout? 

With each image, write a brief statement describing why you chose the image. 

*photographs should be taken personally by the participant, not images found on the internet  

Instructions regarding photographs: 

Do not take photographs that: 

• Include people who can be identified (you can see their faces clearly) 
• Include people’s body parts in a dehumanizing way 
• Are sexually explicit 
• Include protected health information

You are allowed to edit photos, but don’t spend a lot of time on this. The purpose of the exercise is not the photographs themselves, but the experience of reflection. 

Take a photo that you are comfortable sharing with your group.  

The photos will be part of a group discussion. 

Photovoice Assignment Facilitator’s Guide 

(for virtual learning experience) 

Pre-Group Session:  

1. Send out the assignment 1-2 weeks before the planned group session. 
2. Give instructions for participants to email the photos and their descriptions to you several days before the group session. 
3. Prior to the session, create a virtual visual display of the images and captions.
   1. Consider creating a PowerPoint or Google Slide presentation. 
   2. Place one picture on a slide and the caption on the following slide.
   3. The pictures and captions should be grouped with burnout images together and resiliency images together.
4. Send out a link to an online meeting platform.
5. Depending on the number of participants, 1-2 hours will be needed. 
6. The recommended group size for online learning is no greater than 10 people

During the Session: 

1. Create a safe space and discuss possible trigger warnings with the option for individuals to take a break if needed. 
2. Share the presentation with participants
   1. The presentation, because it is full of images, will likely be too large to mail.  Consider posting it as an online secure link (Example – Google slide file that has access through invitation only)
      1. Give the participants dedicated time to review the images and captions:
      2. 20 minutes is a good estimate but more time may be needed depending on the number of participants. 
3. Instruct participants to view each photo and answer the questions on a notes page:
   1. What do you see in the picture?  
   2. With which images do you connect and why? 
4. Transition to a group discussion.
   1. Group discussions on online platforms can be challenging due to a loss of normal conversational cues and conversational flow
   2. Facilitators may need to be more direct to evoke conversation
   3. Consider having a way to go through each image so they can be discussed (for example, using screen sharing of the presentation).  
   4. Consider going through each slide and asking for comments- either ad hoc or round robin style
5. Facilitator’s role in the discussion:  
6. Ask open-ended and follow-up questions to allow the dialogue to flow from the participants. 
7. Identify themes or highlight differing perspectives (for example, if there are similar images in both the burnout and resiliency categories). 
8. Help participants understand how their own context influences their perception of the images. 

4. Look for opportunities to highlight and normalize shared experiences (debunk the “I thought it was just me” myth). 
5. End the session with a conversation about how this exercise might spark individual or system-level change and what that could look like. 

Photovoice Assignment Facilitator’s Guide 

(for in-person learning experience) 

Pre-Group Session:  

1. Send out assignment 1-2 weeks prior to planned group session. 
2. Give instructions for participants to email the photos and their descriptions to you several days before the group session. 
3. Prior to the session, create a visual display of the images and captions.   
4. Think of this as a gallery walk experience- all the images should be on display at the same time in the space. 
5. This could be done by simply printing the pictures and captions and fixing them to large post notes on the walls of the room. 
6. The pictures and captions should be grouped with burnout images in one area and resiliency images in another. 
7. Depending on the number of participants, 1-2 hours will be needed. 

During the Session: 

1. Create a safe space and discuss possible trigger warnings with the option for individuals to take a break if needed. 
2. Give the participants dedicated time to walk through the images and captions:
   1. 20 minutes is a good estimate but more time may be needed depending on the number of participants. 
3. Instruct participants to view each photo and answer the questions on a notes page:
   1. What do you see in the picture?  
   2. With which images do you connect and why? 

**Consider having a handout with the above questions and space for note-taking.  

4. Transition to a group discussion- consider having a way to go through each image so they can be discussed- you may want to use a PowerPoint of the images to facilitate the discussion. 
5. Go through each image asking participants to share their thoughts and reactions.
6. Facilitator’s role in the discussion:
   1. Ask open-ended and follow-up questions to allow the dialogue to flow from the participants. 
   2. Identify themes or highlight differing perspectives (for example, if there are similar images in both the burnout and resiliency categories). 
   3. Help participants understand how their own context influences their perception of the images. 
   4. Look for opportunities to highlight and normalize shared experiences (debunk the “I thought it was just me” myth). 
   5. End the session with a conversation about how this exercise might spark individual or system-level change and what that could look like.  

Download the Resiliency Photos

Download the Burnout Images