Facilitated peer discussion for promoting Better REsident Wellness (BREW) in anesthesia trainees: a qualitative program evaluation (Preprint)

BACKGROUND Anesthesia residents experience nonroutine clinical events during perioperative patient care, including workplace stressors or adverse incidents that may cause physical and emotional stress. These events can lead to burnout and negative mental health outcomes. Burnout and depression rates are lower when residents have adequate support systems within their workplace. Better REsident Wellness (BREW) rounds are a weekly one-hour peer discussion for anesthesia residents, facilitated by a registered psychologist at our institution. Although shown to improve residents’ wellbeing, a deeper understanding of the benefits of such programs may support their expansion to other residency programs. OBJECTIVE This study aimed to explore the benefits and most effective features of BREW Rounds to guide the development of similar programs at other institutions. METHODS Following Research Ethics Board approval, we conducted semi-structured interviews with anesthesia residents who had participated in one or more BREW sessions and with the main BREW Rounds facilitator. Topics of discussion included community building, belonging, mentorship, facilitation, discussion of non-clinical aspects, and removal of hierarchy. Interviews were conducted on videoconferencing software by researchers who were not involved in supervising or assessing the trainees. Audio recordings were auto-transcribed, de-identified, verified, and interpreted using thematic analysis. Further perspectives on BREW Rounds were obtained from staff anesthesiologists through an anonymous online survey. RESULTS We interviewed 10 residents (six junior, three senior, and one transition-to-practice) and one facilitator. Emerging themes included: (1) access to a safe space free of judgement allowing participants to be vulnerable about clinical or non-clinical aspects of their training; (2) building a sense of community in a fast-paced and often isolating environment; (3) providing opportunities for mentorship between junior and senior residents in a frequently-changing colleague network; (4) the characteristics that create a “BREW culture”, such as behaviour norms during sessions and staff respect for protected time, (5) the importance of a good facilitator from outside the anesthesia department, especially during smaller sessions; (6) expanding BREW Rounds to other institutions; and (7) areas for improvement for the current program. Sixteen anesthesiology staff survey responses were available for analysis: 12/16 (75%) anesthesiologists supported residents leaving their clinical duties early for BREW Rounds, and 12/16 (75%) believed BREW Rounds benefitted residents’ well-being. CONCLUSIONS This qualitative study confirms previous findings that BREW Rounds are beneficial to anesthesia training, improve the psychological wellness of residents, and may positively contribute to patient care. Program directors should recognize their potential positive impact on the learning environment, ensure that all staff and trainees understand the need to create protected time for this activity, consider partnering with wellness initiatives at the institutions in which residents are training, and endeavour to identify experienced and unbiased facilitators to moderate sessions.