Resilience and Burnout: Students vs Practicing Clinicians
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Chloe Cornemann, SPT, Sydney Giese, SPT, Abby Mettler, SPT, MEd, ATC, & Hannah Wolzen, SPT
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Chloe Cornemann, SPT, Sydney Giese, SPT, Abby Mettler, SPT, MEd, ATC, & Hannah Wolzen, SPT
USD PT Research 
It’s quite remarkable that PT clinicians exercise almost 7.5 hours per week. I read somewhere that only 20% of people in the US meet the 150 minute/week exercise guidelines. Two things I’m curious about after reading your poster. I know you tracked exercise between PT clinicians and PT students. However, I’d be curious to know (1) the exercise differences between PTs and the other professional variables – OTs and PAs. (2)Why would PT clinicians exercise more so than PT students? This seems like a pretty significant difference.
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Thanks for the questions, James. Student PTs reported exercising an average of 5.53 hours/week, Student OTs 4.00 hours/week, and Student PAs 2.63 hours/week compared to PT clinicians who reported averaging 7.39 hours/week. We didn’t survey any of the other professions outside of students, but I would imagine that our profession’s focus on movement and physical activity might promote a more active lifestyle than that of the general population. I think some of the difference between students and clinicians likely is related to available time. Students in this study reported an average of 21.59 hours studying outside of class, which would place them in what would be considered an over-time workload in the clinic setting. So even though both student and clinician PTs rated exercise highly as a coping strategy for stress, the students potentially might not have the same amount of time available to exercise.
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Excellent work! Your presentation is well-written, visually appealing, and your findings are very thought-provoking. I appreciate the time and effort you put into shedding light on a topic that deserves more recognition. I realize you didn’t analyze this, but I’d be interested to know if there are significant differences in burnout and resilience scores when comparing genders. Additionally, in your future research section you mention the need to investigate the effectiveness of interventions designed to decrease the level of burnout in current students. Are you referring to the effectiveness of popular coping strategies (i.e. exercise, time with family/friends) or are you alluding to formal strategies that have been designed to be implemented and ingrained in our professional programs? Either way, I’m curious to know if you have any suggestions for how we can integrate these interventions to better serve our student population.
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Hi ladies. Great job shedding light on a subject we’ve all dealt with. Curious– do any of you have a guess as to why SPT have higher rates of burnout compared to SOT or SPA? SPA’s program is faster pace since its a two year program and SOT’s have the same level of education. I would also be interested to see if these burnout rates fluctuated depending on the semester a student was currently in. Thanks!
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Hey Lexie, thanks for leaving a great question! Unfortunately it was difficult to collect data about semesters through differing programs as they tend to be a bit ambiguous. We did collect data on years in the program, and burnout appears consistent across the years, however we did not run a statistical analysis on this. As for why SPTs demonstrate higher levels of burnout compared to SOTs and SPAs, a possibility could be the difference in course load. At the local Midwestern University where most students attended, the first year course load was 10 credit hours higher for SPTs compared to SOTs or SPAs. This initial high course load could lead to burnout in the first year that carries through the rest of the program.
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Taylor, thanks for the kind comments and great questions. You bring up a good point with analyzing the burnout and resilience scores between genders. As you said, we did not analyze this and this statistic was not present in our literature review. In our study, the research participants were heavily female (students and practicing clinicians), so recruiting more male participants would be important. In order to do this we may have to broaden our geographical area as the PT, OT, and PA classes at the Midwestern University utilized are heavily female. In my opinion, I feel the rates of burnout and resilience would be similar between genders as these academic programs are challenging and require a certain baseline of resilience, but more research on the topic would be very interesting!
To address your second question, both options would need to be explored more. The coping strategies stated in the study were common between students and practicing clinicians, so one would assume that they are effective, but the health professional students state that they have less time to engage in these coping strategies. This is where more formal techniques for coping may need to be implemented. We believe that it is important for professors to be aware of the high rates of burnout that students experience and possibly work with the students to find ways to combat this in times of high academic stress. Some ideas that we have discussed include a pre-screening for all students by completing the MBI at various points within their academic schooling. Students that have higher burnout scores should work with faculty to find positive ways to combat this. Another possibility includes looking at setup of schedule and increasing communication between faculty and students. I also think that it is important for students to get a sense of personal accomplishment (an item that PT students scored low on) while in their academic program. For me, this would include being able to work with more patients in order to remind myself of why I am going through the rigorous schedule of PT school.
Hope this answered your questions, thanks for your post!
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Hi Ladies,
First off, excellent presentation. It is intriguing to see how the students in our profession relate to clinicians and other programs. I was pretty surprised to see that PT students had worse scores in depersonalization compared to PA students. I know PA programs are only two years of study and achieve a master’s degree, but I was always under the impression that they were along with the same pace that PT programs were. I don’t know the specifics about PA courseloads, so that may be where the difference lies. On the contrary, I wasn’t shocked to see that differences existed between PT and OT students, especially with personal accomplishment. As far as my knowledge goes, I know that OT programs seem to have a portion of their curriculum dedicated to emotional intelligence and self-assessment, as well as most OT programs having a lighter credit load. Overall, I think this information could be highly useful to PT faculty to potentially take a further look at how they could reduce burnout and improve the sense of accomplishment among PT students, so thank you for doing the research.
Now for my question(s): With the current state of the pandemic, would you expect to see different scores for all groups? Second question: depending on your answer to the first question, would you expect to see any differences between groups, since the pandemic is placing stress on all healthcare fields?
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Colton, thank you for your question! With the current state of the pandemic, we would expect to see increased rates of burnout amongst all participants. We would expect this because of the changes within the health care and school system. Practicing PTs have the increased burden of changing schedules, lost hours, cancellations, and increased time helping their children with school. Whereas the professional students have had to adjust to the change of increased online schooling, changing of clinicals, and the decreased social support of family and friends due to social distancing. As for your second question, I do believe there is an increased stress on health care workers at this time, however, I do not think this would change the levels of burnout between groups. Students and practicing PTs are all dealing with heightened levels of stress right now with the potential inability to fully cope due to regulations regarding social distancing, but PTs still can have a break once they leave their workplace. Students however still have scheduled class time and less time to cope due to studying and schoolwork.
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Wonderful presentation and poster ladies. As said above, the layout makes for easy reading and organized thoughts. This topic is extremely intriguing to me as a health care student, as we are all well aware of the burnout that occurs across health care fields. One of the things that surprised me the most about your presentation is that students have almost double the rate of emotional exhaustion than clinicians. The first question that comes to my mind would be, what would students rate their previous history of emotional exhaustion as compared to clinicians? And do you believe this could shed light on why students rank themselves as experiencing more emotional exhaustion than clinicians based on the understanding of needing resilience to combat this stressor and one of the definitions of resilience; “resilience does not exist independent of a signification stress or adversity state.” To me, it seems that one must have a past history of stress, allowing yourself to build resilience in order to learn cope with burnout. Beings the average clinician age is likely higher than the average student age, it would seem that they have likely faced more hardships throughout their life. Just some food for thought. Do you guys also think this may play a role in how one responds to their level of emotional exhaustion?
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Alana, thanks for the questions! Emotional exhaustion is one component of the Maslach Burnout Inventory, and it in particular assesses feelings of being “emotionally overextended and exhausted by one’s work”. While we do not have any data available on students during their previous educational experiences, I think it would be fair to speculate that PT school offers a unique environment where students may be overextended emotionally as they prepare to enter their chosen field without the protective layer of personal accomplishment that practicing clinicians may have from the satisfaction of successfully treating patients, generating an income, earning respect of other clinicians, etc. I think it is also important to note that coping skills and resilience are not necessarily the same thing. Resilience is more of a measure of one’s ability to return to baseline following a period of stress whereas coping skills are more so the way in which one accomplishes that. This is why resilience cannot exist out of a significant stress state – if one never leaves baseline, there is nothing to return to. Our study actually found similar resilience levels between clinicians and students and similar preferred coping strategies. Students, however, did not spend as much time in their preferred coping strategies, which could certainly play a role in the increased amount of reported burnout. It is hard to say if increased age/life experience would have an effect on an individual’s resilience over time from our data, but ideally recognizing early signs of burnout, enacting appropriate coping strategies, and quickly returning to a baseline state would be part of one’s intentional personal growth.
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Great presentation! I am very impressed with your professionalism and knowledge on such an important topic. At the begin of the presentation, it was stated, “The hypothesis was that there would be a trend in increasing resilience and decreasing burnout over time in healthcare students and clinicians.” However, according to the results of the CD-RISC, there were no significant difference in resilience between any group, regardless of time in school for the students and time practicing for the clinicians. With this being said, are there any factors that you would say attributed to this result? Again, wonderful job!
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Thanks for the question Trey! The trends did indicate a reduction in CD-RISC scores from year 1 to year 3 however the differences were not reduced enough to show a statistically significant change. Some things that could impact this include small sample size and inconsistency with participation of the study all 3 years of school. Although the results of the study did not show a statistically significant result, I can subjectively state it gets better Trey!!
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Great presentation! This is a topic that is even more relevant in our current times, as students and healthcare professionals are enduring higher burnout rates as a result of the pandemic. As your results showed, the top methods for coping with stressors for both students and clinicians are spending time with friends/family and exercising. It is obvious that social support and physical activity are vital in preventing burnout and promoting resilience. However, our current situation presents challenges to both, and suggests that we may need to come up with new ways to combat stress. I would be interested to see how the data from your study would change if it was conducted now to highlight those approaches. Do you have any suggestions on strategies to help decrease burnout besides the ones listed in your study?
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Hi McKenze, great and relevant question! I agree it would be very interesting to see how our results might change if we continued the study into the pandemic. I believe we may find the biggest differences in types of stressors for students and clinicians and possibly see higher burn out rates all around due to decreased social support during online classes and social distancing. However, depending on time availability, I believe the coping strategies of time with loved ones and exercise are still feasible to combat burnout.
My suggestion for students and clinicians that are unable to spend physical time with their loved ones is to utilize technology like Zoom or FaceTime to be able to still talk, see, and spend time with people who are important in our lives. My family has played online games together while video chatting a few times, which was a lot of fun! Additionally, the same type of adaptivity can apply to exercise as well. There are many companies offering discounted prices for workout programs which can be streamed from home. I have also seen a huge influx of at-home workout programs being posted online that require little to no equipment.
As far as coping strategies not listed in our study goes, there was literature in our review which supported the use of department wide stress-management or resilience training sessions which improved occupational stressors in nurses. Some of the common techniques in these programs focus on improving communication, recognizing limitations, relaxation/meditation training, and creative expression. However these training sessions usually take several sessions for the practitioner to learn and implement, but if a person has a background of knowledge in these areas they may be able to apply these skills as well. I hope that answers your question!
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Great presentation and poster! This is such a relevant topic, and I think you guys did a great job by taking a deeper look into healthcare professionals and students’ stressors! You mentioned a reason for a PT student’s high burnout score is that we have less time to dedicate to our coping mechanisms. Do you think we, as students, might also be inefficient with that time? Do you think it could be possible we are ineffective with our coping mechanisms?
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Hi Cailey, thanks for the question! That’s certainly something to consider – clinicians could be more effective at time management. Looking at the demographics we did collect, we found that there were similar amounts of sleep reported between students and clinicians. Students and clinicians also reported relatively similar amounts of time spent in academic or work-related travel and time spent on social media. An interesting concept we came across when researching this topic was lack of control over one’s schedule as a specific contributor to burnout. If we consider that the students likely have less control over their schedules, and we see them having less time available for coping strategies, this lack of control could change the way they perceive the time that is available to them. So even if they are utilizing their time efficiently, it may be perceived differently if, for example, they have to schedule family time or exercise around other demands on their time that they are unable to influence.
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Excellent presentation! When I first heard about your research project last semester, I was really curious about what the results would be. Like many of the other students that have left comments, I was surprised to hear that PT’s students reported higher burnout rates than PA students because the PA program is only 2 years. With the practitioners that you sent the survey to, did you ask about what setting they currently practice in? If you did, did you see any differences between burnout rates based on setting? If you did not, would you expect there to be different burnout rates depending on setting?
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Hi Paige, thanks for the questions! We did ask about practice setting with our clinicians, and we did not see a significant difference there with our data. This certainly could be different this year with COVID, but our data was collected pre-pandemic. I would imagine that there might be higher levels of burnout across all settings this year, with the hospital staff experiencing greater amounts.
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Great presentation! I thought that this topic was very interesting, and I was curious what the results of this project would be. I was slightly surprised that physical therapy students had higher reported levels of burnout than the other students, but then when I began to think about it more it made sense with the workload of PT school. With the current pandemic, do you think that clinicians would have closer reported burnout rates to the students or do think students would still have higher burnout rates? Also, what are ways that you think the burnout rates in students, especially physical therapy students, could be decreased?
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Hi Deandra, thanks for your questions! In regards to your first question, I think it depends on what setting the clinician is in. Clinicians that are in acute care/inpatient settings may be seeing higher rates of burnout due to the influx of patients. On the other hand, I know a lot of outpatient clinicians that have had major decreases in case loads due to patients cancelling for being COVID positive or having COVID symptoms and waiting on test results. People also may not be seeking out active PT care in order to stay home and limit their exposure to people. So, I think it depends heavily on clinic setting. But it would be interesting to have inpatient PTs answer our survey to see if their results were more comparable to SPTs.
In regards to decreasing burnout in SPTs, I think it starts with monitoring students levels of burnout throughout their time in PT school. So, possibly on the first day of class having students take the MBI and possibly the CD-RISC then do a follow up at the end of the semester or midterm. Students that have had statistically significant increases in burnout may need extra mentorship from faculty or additional resources to cope with the increase in burnout. I think it would also be helpful to make students aware of burnout and teach them ways to self-assess and self-cope. There are lots of ways that can be used to target the issue, these are just few that we had discussed!
Thanks again for your question!
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Great presentation! I thought the presentation was visually appealing and was extremely interesting. Based on my personal experience, I was not too surprised that SPT had high rates of burnouts. Since major factors such as working out, sleep hours, and visitation with friends and families seem to be major correlators with burnout, would you expect there to be any correlation to a student’s grade point average? It would be interesting, although I am sure the research is out there, if student’s that live an overall healthier lifestyle that it would increase a student’s grade point average. I think this type of correlation study would be vital to show student’s during orientation week. That way we could explain to student’s that yes PT school and other graduate programs are stressful, but you can live a physically and mentally healthy lifestyle along with keeping good grades. Once again, great presentation and this is an area of study I am looking forward to read more research about.
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Ty, thanks for your questions! If I had to speculate I would agree with you in saying that implementing strategies to combat stress and burnout would benefit students and their GPA. I believe that if those strategies (exercise, adequate sleep, etc) can prevent burnout then that leaves the student with more energy/motivation/focus to give to his or her studies and potentially increase his or her GPA. Speaking from personal experience, I know that if I have had an adequate nights sleep, I am able to focus more in class and able to use my critical thinking skills more efficiently. I think it would be a great study topic and something to look into! Thanks again for your question!
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Great presentation! After this semester I consider myself somewhat of an expert on burnout, One question I have and maybe a potential future study is what do you speculate the longitudinal results of this study would find?
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Thanks for the question Paul! We actually set up the study so we could follow the students throughout their 1st-3rd year of study, however, we did not have enough return participants to run the data on. I do think it would be an interesting addition to our research if we were able to find a way to encourage students and clinicians to participate each year. I would speculate that there would be an improvement in resilience and decrease in burnout as this is what the trends of our data indicated although they were not statistically significant.
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Great job, everyone! Your table’s do an excellent job of showing a lot of data while still being easily interpreted! As we are nearing the jump to being licensed PTs, it is encouraging to see that PT clinicians have significantly lower depersonalization scores. My question is related to the comparison between PT, OT, and PA students. With these 3 groups of students having relatively similar areas of study, classes, and work loads – what do you feel is the reason behind PT students feeling less accomplishment, yet more depersonalization?
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Great presentation! I believe that burnout is currently becoming a pandemic in itself with students as well as practicing clinicians. Covid-19 has created ample amounts of burnout and stress among students due to online classes. Practicing clinicians, especially in acute care, are facing the demands of the virus frontline and may be experiencing burnout that way. What are ways to prevent this burnout from continuing to occur or reverse it through cultivating resilience?
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Hi Micah, great question! While I am not sure of the answer for why SPTs have a higher rate of burnout in the personal accomplishment and depersonalization categories, I do have some hypotheses. One reason could be that SPT’s have a higher course load in the first year than SOTs and SPAs at USD, leading to an initial overload that is maintained throughout the program. Another reason could be, specifically for SPA’s, is they are entered into clinical education sooner than SPTs and SOTs, theoretically leading to improved personal accomplishment as they are able to apply their skills.
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Hi Rachael, thanks for the question. That is an excellent idea for future research, however we cannot answer definitively based on our data. It would make sense, though, that fostering healthy coping skills for dealing with stress and promoting the development of personal accomplishment could help serve as a buffer during periods of stress such as the current pandemic. Identifying organizational factors that can contribute to burnout and addressing those issues could also be beneficial.
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