The amount of “pajama time” that physicians clock after hours and on weekends to complete tasks in the EHR has been well-documented. Now researchers are starting to quantify another burden that can contribute to physician burnout: mandatory training modules.
Redesigning those modules—which are used in regulatory compliance—to make them more efficient and useful may help reduce physician burnout, Nicole Goldhaber, MD, said during the most recent American Conference on Physician Health.
“We found that off-hours completion of mandatory modules is common in our study population, suggesting that this exists as a substantial burden of this uncompensated effort on our physicians,” said Dr. Goldhaber, noting that in 32% of the mandatory modules, physicians undertook the training during off-hours or on the weekend.
There was also substantial variation based on department. For example, neurologists spend 29 minutes per module. Meanwhile, for pathologists, 11% of modules were completed after work hours or on weekends.
Dr. Goldhaber said that, in her health system, there are more than 1,000 physicians and 18 clinical departments, all of whom must complete online training modules.
On top of this, the existing model of corporate compliance training is complicated. All too often, physicians working at multiple institutions have to complete annual compliance trainings at each one, despite the fact that the subject matter they get trained on is, for the most part, the same across organizations.
To help ease corporate compliance consolidation, the AMA House of Delegates adopted policy in June to “encourage reciprocity for corporate compliance curricula between institutions to minimize duplicate training and assessment of physicians.”
Uncovering the burden
Physicians at Dr. Goldhaber’s health system who completed all six mandatory training modules would have spent almost five hours on the task, which she pointed out was “an uncompensated activity for most, if not all, physicians.”
“This is a huge burden,” said Dr. Goldhaber, a surgical resident at University of California, San Diego Health. “Some of our surgical subspecialists are spending over 40 minutes per module and initiating over 40% on weekends or off hours.”
“Despite limited evidence, required training modules are used in an effort to improve patient safety and quality of patient care,” she said. “These well-intentioned efforts have led to growing administrative burden for physicians and detracted from physician wellness. And additionally, they take time and cognitive load away from physicians in their necessary patient care and other clinical documentation.”
Measuring time spent after work hours is a key requirement in the AMA Joy in Medicine™ Health System Recognition Program, which empowers health systems to reduce burnout and build well-being so that physicians and their patients can thrive.
Rethinking online training
To streamline the process, Dr. Goldhaber said she and her colleagues created a multidisciplinary group that included physicians, quality improvement employees and owners of the modules.
“It was quickly apparent when this group met that the existing oversight process to assess and curate this content lacks clarity and contains superfluous, sometimes even outdated content which had accumulated in these modules,” she said. “Over time, the group identified several opportunities to reduce the burden of an annual mandatory training while adhering to regulatory and compliance requirements.”
One module was made voluntary or required only on a case-by-case basis, she said. The content that remained, Dr. Goldhaber said, was narrowed to focus on the essential information, with links provided for those who wished to get more nuance on the topic.
The timeline for completion was also extended to 60 days for the training modules, and an app was developed to allow physicians to complete the required training on their mobile devices.
Meanwhile, the module deadlines were also shifted to May. This allowed residents and fellows to complete the mandatory training modules as part of their onboarding. It also eliminated the need for residents and fellows to undertake more online training just before graduation.
“The high proportion of our off-hours module stats in this analysis suggest that this may be a modifiable factor to mitigate physician burnout,” Dr. Goldhaber said, adding that “health care organizations should prioritize physician wellness alongside regulatory compliance and educational needs in any mandatory online training initiatives moving forward.”
The next American Conference on Physician Health will be Sept. 11–13, 2025 in Boston.
