This study investigated the long-term effects of implementing the OCS system at our institution as the pediatric residents’ wellness improvement initiative. We found that one element (i.e., DP) of the burnout scale decreased, and the residents’ compliance with the OCS system improved significantly eight years after the initiative implementation. This corroborates the 10% decrease in the frequency of depressive symptoms, although statistical significance was not found.
In our previous study focusing on the short-term outcomes of the initiative in 2011, we confirmed that the OCS system enabled us to reduce the residents’ work hours from 75 hours to 65 hours per week by restricting them from working before the shift on the day of the night duty. However, residents could not take daytime off after night work due to the high workload related to workforce shortages, and there was no improvement in the frequency of depressive symptoms in the residents (32.3% vs 31.7%) [6, 7]. In 2018, the “Work Style Reform Bill” was passed in Japan and partially enacted in April 2019, and this governmental policy could have increased the awareness for the wellness improvement of physicians and driven the establishment of the OCS system in our hospital. Consequently, in 2019, the established OCS system allowed the residents to take daytime off after night work and improve their wellness, which was indicated by the improved frequency of depressive symptoms and burnout subscale scores.
Faculties of pediatric residency programs recently have been paying attention to improving the residents’ wellness and learning environment [1–4]. A report from the United States indicated that many faculty leaders of pediatric residencies consumed their time and efforts to deal with the issues of residents’ wellness, and the leaders demanded the faculty development programs to learn the solutions to those challenges . It is also reported that almost all pediatric residency programs in North America have developed wellness programs to prevent residents’ burnout, but most of those wellness programs were not based on robust evidence . In this context, our current study showed evidence of the effectiveness of the OCS system, and this may be the first report investigating the long-term outcome of the wellness program in pediatric residency programs in Japan.
According to educational theories, arranging the learning environment is also important to maintain the well-being of the trainees [16, 17]. Several studies have demonstrated the relationship between the pediatric residents’ learning environment and their frequency of burnout [1, 3]. Specifically, the peer mentorship program has been suggested to provide the residents with “safe” training circumstances [18–20]. Therefore, it may be helpful to implement the peer mentoring program for arranging the residents’ learning environment [21, 22].
There are several limitations to this study. First, this is a single-center study with a small sample size, and the results cannot be directly generalized to other programs in Japan. However, we believe that it is valuable to share our experiences of the OCS system implementation with other institutions to further improve pediatric residents’ well-being in Japan. In this vein, this study could be a pilot trial for future multi-institution studies involving pediatric residents in Japan. Second, the longitudinal design might have included some confounding factors that affect the study outcomes. In addition, the subjects of each year (2011 and 2019) were not the same residents. However, we have confirmed that there were no significant differences in demographic data between the two groups. Furthermore, the selection process for entering residency and the training program structure have been unchanged during the study period. We therefore consider that the effect of the possible confounding factors on our study results was minimal, and this study’s feasible and realistic approach provided meaningful evidence for postgraduate pediatric education in Japan. A multi-center survey with larger sample size is needed to overcome these limitations and create robust, generalizable evidence.
Although our initiative was successfully implemented, the mean work hours of our residents was still high (i.e., 67 hours per week). The governmental overtime work hour regulations for physicians are scheduled for 2024 in Japan; thus, a further initiative on a large scale is needed to meet the requirements for the regulations.