Exploring Gratitude Journals as a Tool for Resident Wellness

Residency training is known to be a stressful experience. Emergency departments present a demanding environment due to high patient acuity, fast pace, and exposure to suffering. Journaling can provide a private, nonjudgmental space to express struggles and fears, and it has been shown to help manage anxiety and reduce stress. The objective of this study was to explore how gratitude journaling can impact emergency medicine (EM) resident wellness.

A 13-question survey was sent to 56 EM residents exploring their stress levels and coping mechanisms. Participants were then asked to complete short written reflections of gratitude in journals that were provided to them. Prompts were sent out weekly to encourage participation. A 22-question survey was sent to participants after 4-week and 8-week journaling periods to assess for changes in stress or wellbeing. De-identified responses were analyzed with Mann-Whitney U test comparing pre- and post-intervention results.

Twenty-two residents (39%) responded to the initial survey. Six residents (11%) responded to the 4-week follow-up survey. There was an increase in journal utilization post-intervention (p = 0.01), although this was in the setting of a substantial dropout rate. There was no significant difference in reported stress levels (p = 0.70) or overall wellbeing (p = 0.74) at 4 weeks. However, there was a significant increase in residents reporting acknowledgment of grateful thoughts during clinical shifts (p = 0.02). At 8 weeks, only one resident completed the follow-up survey.

Gratitude journaling may lead to more awareness of grateful thoughts while on shift. Conclusions are limited by the high dropout rate and short time frame of the study. This study highlights the difficulty that can be encountered with wellness research in the residency training space. Residents as a research population are busy and stressed, and participation in wellness studies may require them to use more of their limited time and cognitive effort. Future wellness studies would benefit from low burden for participation, such as shorter surveys and ongoing incentives to improve engagement.