How to Cope with Residency Stress

Anyone who has survived a pharmacy residency knows that the demands, the educational workload, and issues in their personal life can cause tremendous stress.

“Stress is caused by the number of things you are trying to juggle when you are a resident. You have patients you are taking care of, as well as projects, committees, and other tasks you are trying to juggle all at once,” said Molly Wascher, PharmD, BCPS, a post-graduate year two (PGY2) pharmacy resident at Johns Hopkins Hospital in Baltimore. “You are excited about the career you chose, but getting all these tasks done-and getting them done on time-is difficult.”

But how severe is the impact of stress on pharmacy residents? Does stress cause depression or worse-suicide? Pharmacy educators, researchers, and organizations such as the American Society of Health-Systems Pharmacists (ASHP) are beginning to take a closer look at stress during residency, so they can determine ways to help residents who are faced with high stress levels.

Related article: New standard for pharmacy residency programs approved

“We really haven’t studied this a lot. On the medical side, they have been looking at [the impacts of stress on residents] longer. It is the same clinical environment for a medical, nursing, or pharmacy resident, so we can make

Janet A. Sylvester, PharmDsome extrapolations: if medical residents are experiencing stress, pharmacy and nursing residents likely are, too,” said Janet A. Silvester, PharmD, Vice President of Accreditation Services for ASHP.

The first study on pharmacy resident stress, “Evaluation of stress by pharmacy residents”, was published in the April 15, 2017, issue of the American Journal of Health-System Pharmacy.

After surveying 542 post-graduate year one (PGY1) and PGY2 residents, researchers from VA Texas Valley Coastal Bend Health Care System in Harlingen found that pharmacy residents-especially those who worked very long hours each week-exhibited high levels of perceived stress.

“Pharmacy residents who reported working more than 60 hours per week were significantly more likely than those working fewer hours to have higher MAACL-R subscale scores for depression, hostility, and dysphoria,” the researchers wrote. MAACL-R is the Multiple Affect Adjective Checklist-Revised, which is a measure of both temporary and long-term affect, or the experience of feeling emotion. “When the pressures of being overworked exceed a resident’s ability to cope, his or her psychological well-being is in danger and there is the potential for physical exhaustion and feelings of burnout, distress, and depression.”

The researchers found no significant difference in the stress levels of PGY1 and PGY2 residents.

Up next: Helping to manage stress

Helping residents manage stress

At The Johns Hopkins Hospital, residents can talk to their peers when they are feeling stressed, as well as their facilitators. Each facilitator-a pharmacist preceptor at the hospital-is assigned to one resident. “They help set up your rotation, guide you through the program, and help you with various issues throughout residency. From day one, my facilitator asked what my work-life balance plan was,” Wascher said. “People who are willing to talk to you about not just pharmacy, but you as a person, are really important.”

“With our large residency program, the residents are there to support each other, and they have support from the facilitator,” echoed Cathy Walker, RPh, Assistant Director for Education and Training, and Residency Program

Cathy Walker, RPhDirector for PGY1 Pharmacy at Johns Hopkins Hospital. Residents can also reduce stress by having a strong family support system, Walker said.

However, family situations can sometimes cause additional stress. For example, “residents who have had health issues with parents or extended family members, especially if those family members are not local, can be under a lot of stress,” Walker said.

Related article: Pharmacy residents find a competitive edge

Preceptors are also more cognizant of work load and check in with the residents at busier times of the residency, such as before their research projects are due, to see how they are coping.

Working more than 60 hours per week is one stress factor, while another is isolation. “Rotations might be structured so a resident doesn’t have a peer group and feels isolated,” Silvester said.

However, stress is a complex issue and affects residents in different ways. Some residents thrive on working 60 hours or more per week, while others are not able to handle the workload, Silvester said.