Exploring Burnout and Resiliency Using the Photovoice Experience

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. 
  1. Look for opportunities to highlight and normalize shared experiences (debunk the “I thought it was just me” myth). 
  2. 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.  

  1. 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. 
  2. Go through each image asking participants to share their thoughts and reactions.
  3. 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

Pharmacists as Family Medicine Teachers

Editors Note: In honor of American Pharmacists Month, STFM Member Scott Bragg, PharmD, former STFM Member at Large, pens an essay outlining his journey as a pharmacist in family medicine education.

by Scott Bragg, PharmD, Medical University of South Carolina

My journey to teaching family physicians started in 2009 as a second-year pharmacy student at West Virginia University. The previous year, I developed late-onset type 1 diabetes, which led me to volunteer at a diabetes camp called Camp Kno Koma in West Virginia. My first night at camp, one of the nurses asked me to check blood glucose values for the campers in our cabin and treat kids for any lows they experienced. Being relatively inexperienced with making treatment decisions with patients, I was anxious but made it through the night without incident. The whole week was a crash course in following trends, learning on my feet, and trusting others on our care team. My experiences at camp and subsequent learning in pharmacy school led me to pursue pharmacy residency training, because I loved working with a diverse care team and developing autonomy as a clinician.

In pharmacy, exposure to family medicine as a discipline is uncommon, as it is not a recognized specialty for residency programs. Also, there are very few opportunities for holistic training in interprofessional education. Many pharmacist educators in family medicine stumble upon this career path after residency training when they start their first clinical job and find they have a chance to start teaching. Like my experience at diabetes camp, it can be a challenging, learn-as-you-go opportunity. I was very fortunate to complete two years of residency training at UPMC St. Margaret in Pittsburgh, Pennsylvania, where they welcome pharmacy residents into their faculty development fellowship. This is where my love for teaching and family medicine grew. I was surrounded by passionate teachers who viewed their careers as a calling to better the lives of learners and their patients. The faculty development fellowship provided opportunities to partner with family physicians to develop curricula, research collaborations, and patient care initiatives. As a family medicine pharmacist, I hope to encourage more pharmacists to pursue positions within family medicine and contribute to the next generation of family medicine educators.

Family medicine is a uniquely interprofessional discipline, and that’s something I learned when working as a family medicine educator with the Medical University of South Carolina in Charleston, South Carolina. I knew early on that I had found a home when, during my first week on inpatient, one of our attendings insisted I round on their team. I observed early on as a faculty member that pharmacists often possess skills (eg, eye for detail, focus on transitions of care, attention to patient costs) useful to family medicine teams. Many of the pharmacy students I precept are surprised at how easy it is to collaborate with our family medicine team. More than other disciplines, family medicine educators and trainees create an environment that truly values an interprofessional approach.

The nuances of providing patient care in family medicine make it consistently challenging and rewarding. Family medicine teams proactively apply evidence-based medicine, navigate an evolving health care system, practice population health management, and consider social determinants of health. Family medicine providers are often described with the phrase “jack of all trades, but a master of none.” I disagree. I like to say that family medicine teams are a jack of all trades and a master of many. Our holistic team approach helps us deliver on patient-oriented outcomes that matter, despite many of the complex issues we encounter.

So how do we continue to push for innovation and optimize patient care outcomes? One way is by including pharmacists and other interprofessional team members, such as nurses, behavioral health providers, and social workers on family medicine care teams. With the transition in focus to value-based care, building bridges to multiple interprofessional groups will only strengthen the family medicine discipline. STFM and other organizations that make up the family of family medicine continue to serve as catalysts for innovation in our practice model and inclusion of interprofessional educators.

STFM has provided me and many other pharmacists with valuable professional development opportunities. I have worked as a fellow in the Emerging Leaders Fellowship, a member at large on the board of directors, and the program assessment chair for STFM. These leadership experiences have helped me understand the complexities of medical education and advocacy for family medicine as a discipline. I also belong to STFM’s Pharmacist Faculty Collaborative where I’ve grown in my understanding of the ways pharmacists contribute to family medicine education and networked with pharmacists across the country. Despite the name, the Pharmacist Faculty Collaborative is open to all STFM members; please check us out on STFM Connect.

Together Again for the 2022 STFM Annual Conference

For the first time in three years, STFM members were able to come together at the 2022 STFM Annual Spring Conference. Attendees from all over the world converged for three days in Indianapolis, Indiana — some traveled from as far as South Africa — for workshops, general sessions, poster presentations, meetings, networking, and the STFM Foundation’s Marathonaki, and Medipalooza events.

Donations made to the STFM Foundation — large or small — create scholarships, fellowships, awards, and more, allowing the STFM Foundation to provide up-and-coming family medicine talent with training, mentoring, and scholarship opportunities. These programs would not be possible without the generosity of the members of STFM. Thank you to all who have already participated in the 20 in 2022 We Can’t Do It Without You, and we invite those who haven’t to make a donation today.

It was a true joy to be together again. We can’t wait to see you all again in Join us for the 2023 STFM Annual Conference from April 29-May 3, 2023 in Tampa, Florida.

The 2023 Call for Presentations opens in Late June 2022.