Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study

Occurrence and associated factors of self-reported medical errors among Chinese physicians and nurses: a cross-sectional survey

BACKGROUND

Medical errors (MEs) significantly threaten patient safety globally. This study aimed to explore multidimensional factors associated with self-reported MEs among Chinese physicians and nurses.

METHODS

A cross-sectional online survey using snowball sampling collected 7197 valid responses from Chinese physicians and nurses between October 2020 and April 2022. A self-reported question assessed MEs within the past three months. Sociodemographic characteristics, work-related factors, and mental distress were collected. Data were analyzed using stepwise logistic regression.

RESULTS

1285 (17.9%) physicians and nurses self-reported MEs during the previous 3 months. Factors associated with higher odds of self-reported MEs included male sex (OR: 1.44, 95% CI: 1.23-1.69), physician status (OR: 1.48, 95% CI: 1.26-1.73), history of mental illness (OR: 1.49, 95% CI: 1.16-1.91), longer weekly working hours (OR: 1.20-1.23, 95% CI: 1.03-1.47), workplace violence experience (OR: 1.54-1.75, 95% CI: 1.30-2.17), and dissatisfaction with the medical practice environment (OR: 1.20, 95% CI: 1.05-1.37). Conversely, being married (OR: 0.74, 95% CI: 0.62-0.89), holding a bachelor's degree or higher (OR: 0.82, 95% CI: 0.70-0.97), and having more years of professional practice (OR: 0.96, 95% CI: 0.95-0.97) were associated with lower odds of self-reported MEs. Self-reported MEs were significantly and positively correlated with burnout (OR: 1.40, 95% CI: 1.20-1.62), depressive symptoms (OR: 1.38-1.45, 95% CI: 1.04-1.84), perceived stress (OR: 1.28-1.62, 95% CI: 1.06-2.02), and excessive daytime sleepiness (OR: 1.27-1.46, 95% CI: 1.10-1.79).

CONCLUSIONS

Self-reported MEs are relatively common among Chinese physicians and nurses, and are associated with various factors. Poor workplace conditions and mental distress are linked to an increased risk of MEs. Implementing effective interventions to improve workplace conditions and mental health is crucial for reducing MEs.

Ability and utility of the Physician Well-Being Index to identify distress among Chinese physicians

BACKGROUND

Despite the high prevalence of mental stress among physicians, reliable screening tools are scarce. This study aimed to evaluate the capability of the Physician Well-Being Index (PWBI) in identifying distress and adverse consequences among Chinese physicians.

METHODS

This cross-sectional online survey recruited 2803 physicians from Southern Mainland China via snowball sampling between October and December 2020. Data on socio-demographic characteristics, the PWBI, mental distress (including quality of life [QOL], burnout, sleepiness, fatigue and suicidal ideation) and adverse outcomes (medical errors and turnover intention) were collected. Chi-square tests and logistic regression were used for data analysis.

RESULTS

Seven items of the PWBI (emotional exhaustion, depression, stress, poor mental and physical QOL, low work meaning and dissatisfaction with work-life integration) were independently associated with low QOL (all p < 0.05). Physicians with lower QOL were more likely to endorse each item (OR: 1.76-5.86) and less likely to have favourable index scores (all p < 0.001). Assuming a prevalence of 29.2% for low QOL, the PWBI could reduce the post-test probability to 6.9% or increase it to 70.8%. Physicians scoring ≥4 on the PWBI were at increased risk (likelihood ratio >1) for experiencing various mental distress, with sensitivity exceeding 80% in detecting burnout, depression, high stress and anxiety. Additionally, the PWBI score helped stratify physicians' likelihood of reporting medical errors and turnover intention.

CONCLUSIONS

This study provides preliminary insights into the validity and utility of the 9-item PWBI as a screening tool for assessing distress and well-being among Chinese physicians, helping identify those at higher risk of medical errors or turnover. However, these findings should be interpreted with caution due to the limited sample size.

Voices of Frontline Leaders: Challenges and Opportunities from Frontline Primary Care Clinic Leaders in a Safety-Net Health Care System

BACKGROUND

Burnout, disengagement, and turnover among clinicians is a major challenge for the US health care industry. Research has shown that higher direct supervisor leadership scores correlate with decreased provider burnout and increased professional fulfillment. Safety-net health systems such as Federally Qualified Health Centers (FQHCs) face increased challenges due to limited financial resources, more complex social determinants of health among patients, and often fewer physician leaders who can serve as mentors compared to large, integrated health systems.

METHODS

The authors interviewed frontline physician leaders of primary care clinics in a large, urban FQHC network regarding their approach to leadership, prior training and support, opinions related to provider burnout, and ideas for improvement. Qualitative data analysis was completed using the Immersion-Crystallization method, reaching theme saturation.

RESULTS

Key themes were structure of leaders' roles, challenges in daily leadership that outstripped time set aside for leadership activities, and the nature of and response to team members' burnout. Leaders found their roles meaningful and viewed themselves as a bridge between institutional decisions and frontline providers. Longer duration in leadership roles, formal and informal mentoring, and networks of support were related to increased confidence. Variation existed in the amount and perceived value of leadership training, development, and support. Physician leaders emphasized the importance of a high-functioning clinic leadership team and expressed frustration with a lack of connection to institutional decision-making. Leaders were empathetic to the drivers of burnout among their teams and strove to assist individual providers while facing challenges from structural causes of burnout.

CONCLUSION

Frontline leaders in safety-net clinics play a powerful role in the well-being and resilience of their provider care teams and typically are highly engaged despite facing significant barriers to success. Investing in development and formal support for frontline physician leaders in primary care safety-net settings is important to ensure their longevity and a resilient provider workforce.

Compassionate Behavior of Clinical Faculty: Associations with Role Modelling and Gender Specific Differences

Introduction

For future doctors, learning compassion skills is heavily dependent on female and male faculty's role modelling in practice. As such, more insight into the relationships between faculty's compassionate behavior, faculty gender and role modelling is needed.

Methods

In this cross-sectional survey, we analyzed 12416 resident evaluations of 2399 faculty members across 22 Dutch hospitals. The predictor variables were: observed compassionate behavior, faculty gender (reference category: female), and an interaction term between those two. Our outcome variables were: person, teacher and physician role model. All variables, except for faculty gender, were scored on a 7-point Likert scale ranging from 1 "totally disagree" to 7 "totally agree".

Results

Female faculty scored slightly but significantly higher (M = 6.2, SD = 0.7) than male faculty (M = 5.9, SD = 0.6) on observed compassionate behavior. Observed compassionate behavior was significantly positively associated with being seen as a role model teacher (b = 0.695; 95% CI = 0.623 - 0.767), physician (b = 0.657; 95% CI = 0.598 - 0.716) and person (b = 0.714; 95% CI = 0.653 - 0.775). Male gender showed significant negative associations with role model teacher (b = -0.847; 95% CI = -1.431 - -0.262), physician (b = -0.630, 95% CI = -1.111 - -0.149) and person (b = -0.601, 95% CI = -1.099 - -0.103). The interaction term showed positive significant associations with role model teacher (b = 0.157, 95% CI = 0.061 - 0.767), physician (b = 0.116, 95% CI = 0.037 - 0.194) and person (b = 0.102, 95% CI = 0.021 - 0.183).

Discussion

Dutch residents, in general, observed their faculty to be compassionate towards patients and families and faculty's observed compassionate behavior is related to being seen as a role model. However, male faculty benefit more from demonstrating compassion, as it has a greater positive influence on their perceived role model status compared to female faculty.

Compassion Dynamics in Medical Students: An Ecological Momentary Assessment Study

Effective interventions to support compassionate patient- and self-care requires an understanding of how to best assess compassion. Micro-ecological momentary assessment (micro-EMA), a method in which participants provide brief responses in real-time within their own environments, can capture changes in compassion across time and contexts. This study examined a micro-EMA approach for measuring the temporal dynamics of compassion in medical students during the COVID-19 pandemic. Medical students (N = 47) completed demographic information and self-report questionnaires assessing empathy and compassion for self and others. Participants then completed six bursts of micro-EMA smartphone-delivered surveys. Each burst was 14 days, with 28 days between bursts. During each burst, participants received four daily micro-EMA surveys assessing compassion, stress, positive affect, and negative affect. Dynamic structural equation modeling was used to examine micro-EMA responses. The overall micro-EMA response rate was 83.75%. On average, daily compassion did not significantly change across the academic year. However, there was significant within-person variability in medical students' compassion trajectories over the training year (b = 0.027, p < .01). At concurrent timepoints, micro-EMA assessed compassion was associated with greater happiness (b = 0.142, p < .001) and lower stress (b = -0.052, p < .05) but was not associated with sadness. In lagged analyses, higher micro-EMA assessed compassion predicted higher next day happiness (b = 0.116, p < .01) and vice versa (b = 0.185, p < .01). Results suggest it is feasible to use micro-EMA to assess daily levels of compassion among medical students. Additionally, there is wide variability in day-to-day fluctuations in compassion levels among medical students, with some students showing substantial increases in daily compassion across the training year and others showing decreases. Positive affect as opposed to negative affect may have particularly strong associations with compassion. Further examination of antecedents and consequences of fluctuations in daily compassion could inform potent intervention targets.

ICU Patient-to-Pharmacist Ratios: A Prospective, Multicenter Time-Motion Study

OBJECTIVES

To evaluate the relationship among ICU patient-to-pharmacist ratio, perceived quality of patient care, and pharmacist burnout.

DESIGN

A prospective, multicenter, time-motion study conducted over a 10-month period (from May 1, 2022, to February 28, 2023).

SETTING

Adult ICU, PICU, or neonatal ICU.

SUBJECTS

ICU clinical pharmacists.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Overall, 128 ICU pharmacists completed 703 unique time-motion observation days and recorded their time associated with direct/indirect patient care activities, Maslach Burnout Inventor survey scores, and perceived quality of patient care provided (5-point Likert scale). Total pharmacist time on direct and indirect patient care activities were 5.9 ± 1.9 and 3.3 ± 1.7 hours per shift, respectively. The number of assigned patients in the ICU and overall (ICU and non-ICU) per shift was 19.3 ± 12.9 and 23.4 ± 17.9, respectively. The overall frequency of pharmacist burnout was 38.1%. Burnout was associated with incremental increases in the number of assigned total patients (odds ratio [OR], 1.03; 95% CI, 1.01-1.05) and overtime worked (OR, 1.18; 95% CI, 1.03-1.35). Higher compared with lower perceived quality of patient care was associated with significantly smaller assigned ICU patients (17.0 ± 7.4 vs. 30.6 ± 23.8, respectively; p < 0.001). Additional direct patient care time allocated per patient was predictive of a high quality of care perception (OR, 1.53; 95% CI, 1.03-2.05). Burnout was inversely associated with high quality of care (OR, 0.59; 95% CI, 0.36-0.96). The ICU patient-to-pharmacist ratio between 16:1 and 19:1 was associated with the highest perceived quality of patient care and comprehensive patient assessment completion rates.

CONCLUSIONS

Critical care pharmacist practice models across healthcare institutions are inconsistent regarding patient assignments and time allocated toward direct and indirect patient care activities. The ICU patient-to-pharmacist ratio range between 16:1 and 19:1 may optimize quality of care and burnout risk at large academic institutions.

Prevalence of mistreatment in veterinary medical education; a survey of 3rd year veterinary students at a single university

BACKGROUND

Improving quality of life in veterinary medicine has emerged as an important topic. One factor which may influence quality of life in medical education is mistreatment (verbal abuse, power abuse, and physical abuse to establish and maintain a power hierarchy). Although it has been documented in medical education, its occurrence in veterinary education is not yet known.

METHODS

Third year veterinary students were invited to participate in an anonymous and voluntary survey on mistreatment during the preclinical and clinical education. Students were asked if they witnessed and/or experienced a mistreatment, the type of mistreatment, and the person responsible for administering the mistreatment. Quality of life scores were obtained using the Medical Outcomes Trust short form questionnaire (SF-36). An analysis of variance (ANOVA) model followed by pairwise Least Significant Difference post hoc comparison was used to investigate the relationship variables.

RESULTS

Fifty-five of 60 students (91.7%) that completed the questions on mistreatment indicated that they experienced and/or witnessed a mistreatment during veterinary education. 92% of students that experienced a mistreatment said that it interfered with the learning environment but only 29% of students reported the mistreatment at the time that it occurred. The most common mistreatment was public humiliation (78.3%) followed by special treatment based on gender (63.3%) and racially or ethnically offensive remarks (28.3%). Only racially or ethnically insensitive remarks were associated with a lower quality of life score in the social functioning category (p = 0.0131).

CONCLUSIONS

Mistreatment frequently occurred during the preclinical and clinical education of veterinary students in this population and interfered with the learning environment. The only mistreatment associated with a lower quality of life score was racially insensitive remarks. Programs to educate students and clinicians/staff about mistreatment and how to handle education in a stressful clinical and a preclinical setting may be of benefit in the future.

CLINICAL TRIAL NUMBER

Not applicable.

Validity and reliability of an abbreviated Copenhagen Burnout Inventory in Canadian emergency physicians and residents

OBJECTIVES

Emergency physicians have the highest rates of burnout among all medical specialties. There is a need for accurate and reliable burnout assessment tools to monitor changes and assess the effects of interventions. However, existing tools are typically long and/or costly. We sought to validate an abbreviated Copenhagen Burnout Inventory among emergency physicians and trainees in Canada.

METHODS

We conducted a planned secondary analysis of a national, cross-sectional survey of emergency physicians and trainees in Canada. Exploratory factor analysis was performed followed by confirmatory factor analysis. Kaiser's eigenvalues rule, a scree plot, and Horn's parallel analysis guided the number of factors to extract. Structural validity fit indices and internal consistency were compared to pre-specified cutoffs. Criterion validity was assessed compared to the full Copenhagen Burnout Inventory (burnout defined as mean ≥ 50/100).

RESULTS

One hundred eighty-two responses were randomly split into separate cohorts for exploratory factor analysis and confirmatory factor analysis. Data were confirmed to be statistically suitable for factor analysis. Using exploratory factor analysis, a ten-item, two-factor abbreviated Copenhagen Burnout Inventory was reached after removing items based on over correlation (≥ 0.80), cross-loading (≥ 75%), and low factor loading (< 0.60). In confirmatory testing, the abbreviated inventory had a good Comparative Fit Index (0.91) though did not meet cutoffs for the remaining fit indices. Internal consistency was 0.92 (95%CI 0.90-0.95). Using a cutoff of 33/50, sensitivity was 0.99, specificity was 0.82, and area under the ROC curve was 0.86.

CONCLUSION

With further validation, an abbreviated ten-item Copenhagen Burnout Inventory has potential to serve as a short, freely available burnout assessment tool among Canadian emergency physicians and trainees. This abbreviated inventory has evidence to support its internal consistency and criterion validity, albeit with inconsistent structural validity. Future validation with larger samples is required, with special attention paid to content validity, test-retest reliability, and correlation with important outcomes.

Characterizing the Relationships Amongst Psychological Safety, the Learning Environment, and Well-Being in Surgical Faculty and Trainees

OBJECTIVE

Learning environments affect the well-being of surgical faculty and trainees. Psychological safety (PS) has been linked with learning behaviors and aspects of well-being within medicine; however, given the unique challenges inherent to the surgical learning environment, there is a need to more closely examine these concepts for surgical faculty and trainees. The objective of this study is to examine the relationships between learning environment and PS, as well as PS and well-being with surgery.

DESIGN

Multi-institutional, cross-sectional survey study. The electronic survey included assessments of PS, professional fulfillment, and the learning environment. Exploratory and confirmatory factor analyses were performed to identify learning environment constructs. Index construct scores were generated. Multivariable multivariate regression analyses were used to examine the relationships between constructs in the learning environment and PS as well as PS and well-being.

SETTING & PARTICIPANTS

The electronic survey was distributed to surgical faculty, fellows, and residents at 8 institutions across the United States.

RESULTS

For faculty, higher levels of professional interactions and rapport/climate within the learning environment were significantly associated with higher levels of PS (β = 0.39, p < 0.01; β = 0.34, p < 0.01, respectively). Higher levels of PS were significantly associated with lower levels of interpersonal disengagement (β = -0.16, p = 0.04). For trainees, higher levels of disrespect/retaliation and personal performance worry within the learning environment were significantly associated with lower levels of PS (β = -0.45, p < 0.001; β = -0.11, p = 0.048, respectively). Higher levels of PS were significantly associated with higher levels of professional fulfillment (β = 0.24, p = 0.01) and lower levels of work exhaustion (β = -0.27, p < 0.01) and interpersonal disengagement (β = -0.36, p < 0.001).

CONCLUSIONS

This study identified factors within the learning environment that were positively and negatively associated with psychological safety for surgical faculty and trainees. In addition, it identified a direct relationship between psychological safety and elements of well-being and burnout.

Burnout status of Japanese healthcare workers and the association with medical errors: A 1-year follow-up

BackgroundBurnout and medical errors are the most prevalent issues affecting health and life outcomes among healthcare professionals.ObjectiveThis study aimed to investigate the longitudinal association between burnout and medical errors in healthcare workers in Japan.MethodsWe conducted a prospective cohort study involving 539 healthcare workers from January 2017 to January 2018. Burnout was evaluated using the Maslach Burnout Inventory-General Survey (MBI-GS), which included exhaustion, cynicism, and professional efficacy dimensions. Medical errors during the previous year were measured by self-assessment at follow-up. Multivariate modified Poisson regressions estimated the association between baseline burnout and follow-up medical errors.ResultsIn the age and sex-adjusted model, overall burnout was significantly associated with medical errors (p = 0.008). Participants with high burnout levels exhibited a greater risk of medical errors than those with low or moderate levels (RR = 1.19, 95% CI: 1.05-1.35). Exhaustion and cynicism correlated significantly with medical errors (p < 0.05). High or moderate levels of exhaustion and cynicism were associated with elevated risks of medical errors (RR = 1.31 [95% CI: 1.10-1.55]; 1.25 [1.02-1.53]), (RR = 1.31 [95% CI: 1.13-1.53]; 1.20 [1.03-1.41]), compared to low-level counterparts, respectively.ConclusionHealthcare workers who experience burnout may be at an increased risk for medical errors.

Final results of the National Oncology Mentorship Program 2023 and its impact on burnout and professional fulfilment

BACKGROUND AND AIMS

Significant burnout and low professional fulfilment are noted among medical oncologists and trainees. The National Oncology Mentorship Programme (NOMP23) was designed to evaluate the impact of a 1-year mentorship program between oncology trainees (mentees) and consultants (mentors) on improving professional fulfilment and burnout.

METHODS

NOMP23 was a single-arm, prospective cohort study. One hundred twelve participants (56 mentors and 56 mentees) across Australia were recruited. Mentee/mentor pairs were orientated to the program virtually and met at least three times throughout 2023. The primary outcome was improvement in professional fulfilment as assessed using the Stanford Professional Fulfilment Index at conclusion of NOMP23 compared to baseline.

RESULTS

A total of 112 participants enrolled. Eighty-six (77%) completed the baseline and 63 (56%) completed the end-of-program survey. At baseline, 82% of mentees and 77% of mentors were classified as burnt out, which reduced to 57% and 51% at the conclusion of NOMP23; a reduction of 25% and 26% (P < 0.01). Baseline professional fulfilment was 0% and 5% for mentees and mentors respectively, which improved to 21% and 34% at the end of NOMP23 (P < 0.01). However, significant reduction in feelings of regret towards oncology as a profession was seen for mentees and mentors between baseline and the conclusion of NOMP23 (40% vs 14% and 29% vs 0% respectively, P < 0.01).

CONCLUSIONS

NOMP23 demonstrated that a centrally coordinated, low-cost mentorship program could be feasible and was of high value. Mentorship programs, alongside multifactorial institutional, state-based and national interventions to improve well-being, can help ensure a sustainable workforce.

The Dark Side of Empathy: The Role of Excessive Affective Empathy in Mental Health Disorders

Empathy, which is typically regarded as a positive attribute, is now being critically evaluated for its potential negative implications for mental health. A growing body of research indicates that excessive empathy, particularly a high level of affective empathy, can lead to overwhelming emotional states, thereby increasing susceptibility to psychological distress and psychiatric disorders. In this review, we aim to explore the negative effects of empathy on mental health. We review both human and animal studies concerning the relationship between empathy and psychological disorders, revealing that while empathy enhances social interactions and emotional understanding, it may also heighten empathic distress and potentially contribute to the development of pain, internalizing disorders, depression, anxiety, emotional overinvolvement, burnout, vicarious trauma, and posttraumatic stress disorder. This review contributes to the broader discourse on empathy by delineating its dual impacts, integrating insights from neurobiology, psychology, and behavioral studies. This review may enhance our understanding of empathy's complex role in mental health, offering a nuanced perspective that acknowledges both its beneficial and detrimental impacts.

Stress and Burnout Among Anesthesia Technologists, Technicians, and Trainees: A Cross-Sectional Study in a Tertiary Hospital in Saudi Arabia

Background/Objectives: Occupational burnout poses a significant burden to healthcare personnel, institutions, and service users. Anesthesia technologists and technicians work in the shadow of the perioperative team, and a lack of attention to anesthesia support personnel may pose a significant risk to their wellbeing and the quality of care delivered. To date, only a few studies have investigated the prevalence of burnout among anesthesia technologists and technicians worldwide and in Saudi Arabia. Thus, the aim of this cross-sectional study was to assess the prevalence and contributing factors to burnout among anesthesia technologists and technicians in a single tertiary hospital in Saudi Arabia. Methods: The study utilized the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) to assess burnout and a 10-point scale to assess stress levels. The MBI-HSS inventory consists of three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Univariate and multivariate linear regression analyses were used to identify correlates of each burnout subscale. Gender was included in the multivariable regression analysis in addition to significant variables from univariable analysis. Results: A total of 89 participants completed the survey. Based on each subscale of the MBI-HSS, more than 60% of the participants reported high to moderate EE, and more than half reported high to moderate DP. For PA, only 25.8% of participants reported low PA. We found that age (β = -0.58, 95% CI: -0.95, -0.20; p = 0.003) and stress (β = 3.3, 95% CI: 2.1, 4.5; p < 0.001) were independently associated with EE. In addition, night shift (β = 3.3, 95% CI: 0.44, 6.1; p = 0.024) and stress (β = 0.73, 95% CI: 0.13, 1.3; p = 0.017) were independently associated with DP. Independent factors for PA were identified including night shifts (β = 6.6, 95% CI: 1.4, 12; p = 0.014) and stress levels (β = -1.3, 95% CI: -2.4, -0.12; p = 0.03). Conclusions: This research underscores the alarmingly high prevalence of burnout and the strong link between elevated EE and DP rates and workplace stress, emphasizing the necessity to identify and mitigate these stressors. It is therefore crucial to evaluate the effectiveness of the current wellbeing and mental health initiatives and programs in Saudi Arabia to ensure that they address evolving challenges and the overall mental health of healthcare personnel.

Learning environment as a predictor for medical students' empathy: a multicenter cross-sectional study from 12 medical schools in China

BACKGROUND

Empathy of medical students is crucial, yet it tends to decline as students enter later academic years. Empathy appeared to be affected by the learning environment (LE), which could be a potential contributor. We conducted a cross-sectional study to investigate the association between LE and empathy.

METHOD

The study comprised overall 10,901 medical students from 12 Chinese medical schools. Jefferson Scale of Empathy (JSE) was utilized to assess empathy, while a 5-point question and the Johns Hopkins Learning Environment Scale were employed to evaluate LE. JSE scores were compared across LE levels using Pearson Chi-square, Welch's ANOVA, and univariable linear regression. After adjusting for covariates, multivariable linear and logistic regression were used to assess the independent connection between LE and empathy. Confounders were controlled by stratified subgroup analysis.

RESULTS

LE was significantly associated with medical students' empathy, as shown by the Pearson Chi-square test (p < 0.001) and Welch's ANOVA (p < 0.001). In multivariable logistic regression analysis, lower JSE scores were linked to common, bad, and terrible LE (OR = 2.226, 95% CI = [2.011, 2.465], p < 0.001; OR = 2.558, 95% CI = [1.745, 3.751], p < 0.001; OR = 1.889, 95% CI = [1.131, 3.153], p = 0.015), while excellent LE was associated with higher JSE scores (OR = 0.348, 95% CI = [0.312, 0.388], p < 0.001). Linear regression and stratified subgroup analysis confirmed logistic regression's findings.

CONCLUSION

LE was a significant predictor for empathy. Better LE was associated with higher empathy and worse LE was related to lower empathy. This inspired us to improve LE to enhance medical students' empathy.

A systematic review of the prevalence of burnout in orthopaedic surgeons

INTRODUCTION

Professional burnout is a syndrome of emotional exhaustion, depersonalisation and low sense of personal achievement related to the workplace. Orthopaedic surgeons train and practise in highly demanding environments. Understanding up-to-date trends in burnout, particularly following the COVID-19 pandemic, is vital. For this reason, we carried out a systematic review on this topic.

METHODS

A scoping literature review of two databases was conducted. Two authors independently screened articles and conflicts were resolved by panel discussion. Articles pertaining to orthopaedic surgeons that used validated scales and were peer reviewed research were included. Non-English or abstract-only results were excluded.

RESULTS

A total of 664 papers were identified in the literature search and 34 were included in the qualitative review. Among 8,471 orthopaedic surgeons, the mean burnout prevalence was 48.9%. The wide range in rate of burnout between the studies (15-90.4%) reflected the variety in setting, subspecialty and surgeon grade. Common protective factors comprised dedicated mentorship, surgeon seniority, sufficient exercise and family support. Substance abuse, malpractice claims, financial stress and onerous on-call responsibilities were risk factors. Burnout prevalence during the COVID-19 pandemic was not noticeably different; there were a number of pandemic-associated risk and protective factors.

CONCLUSIONS

Nearly one in two orthopaedic surgeons are burnt out. There is a paucity of data on the short and long-term impact of COVID-19 on burnout. Burnout has deep organisational, personal and clinical implications. Targeted organisational interventions are required to prevent burnout from irrevocably damaging the future of orthopaedic surgery.

How is work-family conflict linked to nurse-assessed patient safety among intensive care unit nurses? A serial multiple mediation analysis

AIM

The aim of this study was to test whether rumination and negative affectivity mediate the relationship between work-family conflict and nurse-assessed patient safety among intensive care unit nurses.

BACKGROUND

Most intensive care unit nurses experience work-family conflicts that jeopardise patient safety. Although prior studies have explored the effect of work-family conflict on patient safety, few have investigated whether work-family conflict is associated with patient safety through rumination and negative affectivity among intensive care unit nurses.

DESIGN

Cross-sectional study.

METHODS

This study included 209 intensive care unit nurses from five general hospitals. The Work-Family Conflict Scale, the Ruminative Response Scale, the Positive and Negative Affect Schedule-Negative Affectivity, and three items indicating nurses' perception of overall patient safety were used to gather data. Associations between work-family conflict, rumination, negative affectivity, and nurse-assessed patient safety were assessed using correlation and serial multiple mediation analysis.

RESULTS

Work-family conflict, rumination, negative affectivity, and nurse-assessed patient safety were significantly correlated (p < 0.01). Work-family conflict can have not only a direct negative impact on the nurse-assessed patient safety (effect = -0.0234; standard error [SE] = 0.0116; 95% confidence interval [CI]: lower limit [LL] = -0.0464, upper limit [UL] = -0.0005) but also an indirect impact on nurse-assessed patient safety through three paths: the independent mediating role of rumination (effect = -0.0118; SE = 0.0063; 95% CI: LL = -0.0251, UL = -0.0006), the independent mediating role of negative affectivity (effect = -0.0055; SE = 0.0039; 95% CI: LL = -0.0153, UL = -0.0001), and the chain-mediating role of rumination and negative affectivity (effect = -0.0078; SE = 0.0031; 95% CI: LL = -0.0152, UL = -0.0027).

CONCLUSION

Our findings indicated that work-family conflict could influence nurse-assessed patient safety through increasing rumination and negative affectivity among intensive care unit nurses. Based on the results, interventions aimed at decreasing work-family conflict would be beneficial for intensive care unit nurses' emotional stability and patient safety.

From Healer to Harmer: Preparing Senior Medical Students for Patient Harm Events in a Transition-to-Residency Course

Introduction

A physician's first patient harm event oftentimes occurs during the intern year. Residents encounter and are responsible for medical errors, yet little training is offered in how to properly cope with these events. Earlier and more in-depth education about how to process patient harm events is needed.

Methods

We developed a 110-minute workshop focused on coping strategies for patient harm events and delivered it to a cohort of fourth-year medical students during a transition-to-residency course just before graduation. The workshop emphasized interns' increasing exposure to medical errors, how to personally process them, and how to debrief near-peers in processing them.

Results

A total of 190 students participated in the workshop. Our survey response rate was 88%. Students' confidence in defining second casualty after the workshop grew from eight responding very or extremely confident (7%) to 95 responses (87%). Comfort utilizing positive coping mechanisms improved from 14 very or extremely confident responses (12%) to 73 responses (67%). Confidence utilizing first responder structure grew from three very or extremely confident responses (3%) to 61 responses (56%). Comfort helping colleagues cope with patient harm events grew from 16 very or extremely confident responses (14%) to 78 responses (72%).

Discussion

This workshop fills an important gap in UME by preparing senior-level students to resolve emotional conflict related to patient harm events. Our findings illustrate that a short-term intervention on this topic can impact students' confidence. We believe discussion around how patient harm events emotionally impact trainees should be expanded.

Understanding the Second Victim Phenomenon Among Healthcare Workers in an Italian Hospital

Second victim syndrome (SVS) refers to the psychological trauma experienced by healthcare workers (HCWs) as a result of being involved in an adverse event (AE). Research on the prevalence of SVS and the support needed for HCWs who experience it is limited. A cross-sectional study was conducted at the Health Local Unit of Lecce, in Puglia, to identify the phenomenon of SVS among HCWs and recognize the forms of support received and desired. A validated questionnaire, IT-SVEST, was administered to doctors and nurses. The survey received responses from 250 HCWs, and 41% of respondents reported being involved in an AE that could cause SVS. Among the seven dimensions measuring the effects of the SVS and two outcome variables, the highest percentage of agreement was found for psychological distress (23.5%), followed by turnover intentions (19.8%) and physical distress (9.9%); 23.8% of the interviewees declared that they did not receive institutional support, and 9.9% identified help resources mostly in non-work-related support (9.9%), followed by supervisor support (9.3%). The multivariable binary logistic regression analysis showed a positive association between the occurrence of an AE and the medical doctor profession (OR = 4.267, p ≤ 0.0001), and affiliation to intensive care departments (OR = 5.133, p ≤ 0.0001) and male gender (OR = 2.069, p = 0.033). SVS is a serious problem that affects the entire health system, systematic surveys and appropriate institutional responses including formal support programs for affected HCWs are a priority.

Development and Assessment of a Deceased Donor Organ Recovery Workshop for Surgical Fellows

OBJECTIVE

To assess the impact of a deceased donor organ procurement training workshop on the transplant fellow's confidence and proficiency in organ recovery. This pilot workshop was designed to address the current gap in the transplant fellow's training in North America.

DESIGN

Participants' confidence and competence in deceased donor organ recovery were assessed pre- and postworkshop (immediate, 1- and 6-month) using a survey questionnaire. Participants' responses were compared using T-test and Wilcoxon tests before and after the workshop.

PARTICIPANTS

The hepatopancreatobiliary-transplant fellows from the University of Toronto participated in the workshop.

RESULTS

Seven fellows participated, with 57% reported very limited exposure to deceased donor operations in the past year. Fellows' confidence improved significantly immediately postworkshop (69% vs. 85%, p = <0.05), persisting at 1 month (86%, p = <0.05) and 6 months (91%, p = <0.05). Competence scores also demonstrated improvement postworkshop (88% vs. 78%, p = 0.3), remaining constant at 1 month (88%, p = 0.18), and further increasing at 6 months (92%, p = 0.19).

CONCLUSION

This pilot study represents a notable step as the first workshop tailored for transplant fellows in Canada, demonstrating sustained improvement in both confidence and competence for deceased donor organ procurements. The study is limited by results from a single center and small sample size, impacting the generalizability of findings. However, the workshop addresses variability in transplant fellows' exposure and confidence levels, emphasizing the importance of structured training in organ procurement to enhance skills and readiness for real-time procedures.

Agreement between the Maslach Burnout Inventory and the Copenhagen Burnout Inventory among emergency physicians and trainees

BACKGROUND

Emergency physicians have the highest rates of burnout among all specialties. Existing burnout tools include the Copenhagen Burnout Inventory (CBI) and single-item measures from the Maslach Burnout Inventory (MBI). While both were designed to measure burnout, how they conceptualize this phenomenon differs and their agreement is unclear. Given the close conceptual relationship between emotional regulation strategies such as distancing and distraction with the MBI subscale of depersonalization, we examined agreement between the two inventories and association with emotional regulation strategies as a lens to explore the conceptualization of burnout.

METHODS

We conducted a cross-sectional survey of adult and pediatric emergency physicians and trainees in Canada. Survey questions were pretested using written feedback and cognitive interviews. "Frequent use" of an emotional regulation strategy was "most" or "all" shifts (≥4 on 5-point Likert scale). Burnout was defined as mean ≥50/100 on the CBI and scoring ≥5 (out of 7) on at least one of the single-item measures from the MBI. Associations with burnout were examined using multivariable logistic regression.

RESULTS

Of 147 respondents, 44.2% were positive for burnout on the CBI and 44.9% on the single-item measures from the MBI. Disagreement was 21.1% overall, ranging from 12.5% for older (≥55 years) physicians to 30.2% for younger (<35 years) physicians. Use of distraction and use of distancing were strongly associated with burnout on the single-item measures (adjusted odds ratio [aOR] 14.4, 95% confidence interval [CI] 3.4-60.8]) and CBI (aOR 10.1, 95% CI 2.5-39.8, respectively.

CONCLUSIONS

Despite near-equal rates of burnout, agreement between the CBI and single-item measures from the MBI varies and was lower for younger emergency physicians/trainees. While emotional regulation strategies were felt to be important in supporting a career in emergency medicine, they were strongly associated with burnout. Future research is needed to better understand this phenomenon and which tools to use to measure burnout.

How Doctors Talk About Medical Errors: A Qualitative Study of Junior Doctors' Experiences

During the last three decades, an increased amount of research on errors in health care has been conducted. Studies show that physicians find it challenging to handle errors because of the blame and guilt that errors cause. Communicating with colleagues has been identified as vital for coping with errors and for creating a just culture; however, many physicians do not usually discuss their errors. Knowledge about how junior doctors experience errors is vital to ensure that they both receive emotional support and learn from errors. To capture junior doctors' perceptions and experiences, we used a qualitative, exploratory design based on virtual focus groups. We conducted seven virtual focus groups with 22 junior doctors from 11 specialties. We defined three main themes: (1) how the junior doctors conceptualized medical errors, (2) how they experienced talk about errors among colleagues, and (3) the context in which this talk took place. The participants experienced errors as challenging elements in their working life; however, they struggled to define it. They described inconsistencies regarding the reasons for discussing errors within the learning environment, with some being experienced as constructive (providing education and support) and some as destructive (involving blame and shame). There was a discrepancy between the wish to normalize error and the lack of sharing between colleagues. Our study shows that error in health care is a complex phenomenon that challenges junior doctors' navigation in clinical practice. Despite efforts to implement an open and just culture, this has not yet been achieved.

Prevalence of depression and anxiety in orthopedic residents: a systematic review and meta-analysis

BACKGROUND

Orthopedics is one of the specialized fields of medicine and its residency has always been of interest. This systematic review and meta-analysis aim to evaluate the prevalence of depression and anxiety among orthopedic residents.

METHODS

Digital databases such as PubMed, Scopus and Web of Science were systematically searched until July 27, 2024.

RESULTS

The analysis included a total of 10 studies for anxiety (1,758 cases, 374 anxiety cases) and depression (2,389 cases, 381 depression cases). The pooled prevalence of anxiety was 31.6% [95% CI: 18.04-45.26%] with significant publication bias (Egger's test p = 0.0257). After removing a potential outlier, the prevalence of anxiety was recalculated as 25% [95% CI: 16.61-34.01%]. The pooled prevalence of depression was 22.2% [95% CI: 12.08-32.51%] with significant publication bias (Egger's test p = 0.0434). After removing a potential outlier, the prevalence of depression was recalculated as 18.6% [95% CI: 10.27-26.92%], showing no significant publication bias (Egger's test p = 0.1229).

CONCLUSION

Depression and anxiety are highly prevalent among orthopedic residents, with significant levels of psychological distress affecting nearly one-third of this population.

Assessment of stress level and depression among orthopaedic surgeons in Saudi Arabia

PURPOSE

The aim of this study was to assess the stress level and depression among orthopaedic surgeons in Saudi Arabia. In addition, to evaluate orthopedic training programs related factors that might have a critical role in the development of depression among orthopaedic surgeons.

METHODS

The study adopted a cross-sectional study design. Two validated questionnaires were utilized, the Patient Health Questionnaire 9 (PHQ-9) and the Perceived Stress Scale (PSS-10) for assessing depressive symptoms and stress levels. Data was collected by sending the survey to the Saudi Commission for Health Specialties so they could be distributed throughout all registered orthopaedic surgeons.

RESULTS

The study sample consisted of 325 participants. The results revealed that the severity of depression varied across the different groups. As per the PHQ-9 criteria, 74 (22.8%) were initially diagnosed with major depression. Among assistant consultants, 39.5% reported severe depression, while 34.9% reported mild depression. Consultants predominantly reported moderate perceived stress (82.9%) with a notable proportion experiencing high perceived stress (12.4%). Assistant consultants showed a balanced distribution, with 93.0% reporting moderate perceived stress and 4.7% reporting high perceived stress. Demographic variables gender, relationship status and having children revealed statistically significant relationship with PHQ-9 scores (p-value < 0.05) but not with PSS-10 scores.

CONCLUSION

The study highlights pressing need to address mental health concerns within orthopaedic surgeons. To address these challenges, healthcare institutions should implement comprehensive mental health support programs offering resources for stress management, counseling services, and peer support groups.

The Impact of Leadership Training on Burnout and Fulfillment Among Direct Reports

GOAL

Burnout, decreased professional fulfillment, and resultant attrition across the medical professions are increasingly recognized as threats to sustainable and cost-effective healthcare delivery. While the skill level of leaders as perceived by their direct reports has been correlated with rates of burnout and fulfillment, no studies, to our knowledge, have directly evaluated whether intervention via leadership training impacts burnout and fulfillment among direct reports. The goal of this study was to evaluate the effectiveness of a leadership training intervention on direct reports' perceptions of the leadership skills of supervising residents and subsequently on the well-being of the direct reports.

METHODS

We implemented a leadership training program with supervising (i.e., chief) resident volunteers in two surgical residency programs. The leadership training included two sessions of approximately 2 hours each that consisted of interactive didactic and small group activities. The training focused on the following themes: defining leadership (i.e.,characteristics and behaviors), team building, fostering trust, managing conflict, navigating difficult conversations, and feedback. We administered pretraining and posttraining surveys to the direct reports (i.e., junior residents) to assess the perceived leadership skills of supervising residents, as well as burnout and professional fulfillment.

PRINCIPAL FINDINGS

Leadership scores significantly improved following the leadership training intervention. Additionally, improvement in leadership scores following training was positively correlated with professional fulfillment among the junior residents (direct reports).

PRACTICAL APPLICATIONS

The results of this study suggest that incorporating leadership training into residency programs may serve as an appropriate initial intervention to improve the leadership skills of supervising residents, and in turn, improve professional fulfillment and retention among medical professionals. This intervention involved minimal cost and time investment, with potentially significant returns in combating the well-being and attrition crisis. These findings may be applicable across the healthcare field to tackle the impending healthcare worker crisis.

Health, burnout and well-being of UK cardiology trainees: insights from the British Junior Cardiologists' Association Survey

BACKGROUND

Cardiology training is demanding and associated with high workloads. Poor lifestyle and health among clinicians may stretch workforces and impact patient care. It has not been established what impact training in cardiology has on the doctors undertaking it. We aimed to establish the prevalence of physical and mental illness, burnout and the ability to maintain a healthy lifestyle among cardiology trainees in the United Kingdom (UK).

METHODS

The 2023 British Junior Cardiologists' Association training survey included questions on ill health, burnout, healthy living and invited responders to complete screening questionnaires for depression (Patient Health Questionnaire 9; PHQ-9) and anxiety (Generalised Anxiety Disorder 7; GAD-7). Significant anxiety and depression were defined as scoring within the moderate or severe range (PHQ-9≥10; GAD-7≥10). Burnout was a self-reported outcome. Poisson regression was used to determine prevalence ratios (PR) between univariate predictors of anxiety, depression and burnout.

RESULTS

Of 398 responders, 212 consented to answer health and well-being questions. Prior physical and mental health conditions were reported by 9% and 7% of trainees, respectively. Significant depression and anxiety symptoms were reported by 25% and 18% of trainees, respectively. Burnout was reported by 76% of trainees. Less than full-time trainees reported greater anxiety (PR 2.92, 95% CI 1.39 to 6.16, p<0.01) and depression (PR 3.66, 95% CI 2.24 to 5.98, p<0.01), while trainees with dependents reported less burnout (PR 0.77, 95% CI 0.65 to 0.92, p<0.01). Exercise, good sleep quality and maintaining a healthy diet were associated with less burnout and depressive symptoms (p<0.05). Half of trainees reported training having a negative impact on well-being, driven by the amount of service provision, curriculum requirements and lack of training opportunities.

CONCLUSIONS

The prevalence of anxiety, depression and burnout is high among UK cardiology trainees. Further work should establish the impact of cardiology trainee health on the quality of patient care. Training bodies should consider how occupational factors may contribute to health.

Medical Error: Using Storytelling and Reflection to Impact Resident Error Response Factors

Introduction

Medical error is common and has a significant impact on physicians, learners, and patients' perception of the medical system; however, residents receive little formal training on this topic. This curriculum aims to foster sharing of personal medical error stories, review and practice error management and coping strategies, and impact error response factors.

Methods

Faculty identified factors related to effective physician error management and recovery in order to develop a targeted curriculum for family medicine residents. The curriculum consisted of three 1-hour didactic sessions in a medium-sized, urban program. Instructional methods included guided reflection after mentor storytelling, small-group discussion, role-play, and self-reflection.

Results

Twenty-two out of 30 (73%) residents completed the premodule survey, and 15 out of 30 (50%) residents completed the post module survey. Fewer than half of residents reported they knew what to do when faced with medical error, but this increased to 93% after curriculum delivery, as did rates of reported error story sharing. Resident reported self-efficacy (I can be honest about the errors I make as a doctor.) and self-awareness (I acknowledge when I am at increased risk for making errors) also increased following the curriculum.

Discussion

Family medicine residents are receptive to learning from peers and mentors about error management and recovery. A brief curriculum can impact the culture around disclosure and support. Future iterations should focus on the impact of targeted curricular interventions on patient-oriented outcomes related to medical error.

The effectiveness of Balint groups at improving empathy in medical and nursing education: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Empathy is crucial for patient health. The Balint group is a commonly used method for empathy training. However, the impact of Balint groups on empathy remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess the impact of Balint groups on empathy training among medical and nursing students, as well as doctors and nurses.

METHODS

This review involved searching multiple databases for relevant articles. Rigorous eligibility criteria were applied during the screening of titles and abstracts, and during the selection of records. Following a full-text eligibility evaluation, two reviewers independently extracted data from the final selection of studies, and a meta-analysis was conducted. The standardized mean difference (SMD) was calculated to assess the systematic outcomes.

RESULTS

A total of 11 studies were included in this systematic review and meta-analysis. Participants in Balint groups demonstrated a significant increase in empathy than those in the control group (SMD = 1.46, 95% confidence interval [CI] 0.86-2.06; p < 0.001). Studies conducted in China (SMD = 2.13, 95% CI 1.27-2.99; p < 0.001) revealed a greater impact of Balint groups on empathy than those conducted in France (SMD = 0.24, 95% CI 0.12-0.37; p < 0.001). The impact of Balint groups was significantly greater among physicians (SMD = 2.50, 95% CI 1.79-3.21; p < 0.001) and nurses (SMD = 2.88, 95% CI 1.34-4.43; p < 0.001) compared to medical students (SMD = 0.71, 95% CI = 0.35-1.06; p < 0.001). Participants who attended ten or more sessions (SMD = 2.37, 95% CI 1.35-3.39; p < 0.001) demonstrated better outcomes compared to those who attended fewer than ten sessions (SMD = 0.79, 95% CI 0.30-1.29; p < 0.01).

CONCLUSION

Balint groups are effective for empathy training among doctors, nurses, and medical students. Future research should incorporate patient-led measurements to evaluate empathy and ascertain the long-term impact of Balint groups on empathy training.

TRIAL REGISTRATION

PROSPERO registration number CRD42023488247.

Burnout among Postgraduate Healthcare Trainees at a Tertiary Healthcare Center in Saudi Arabia

Objectives

The aim of this study was to investigate the level of burnout among postgraduate healthcare trainees at a tertiary care center in Riyadh, Saudi Arabia, and assess the need to establish a well-being program.

Methods

This cross-sectional study was conducted between December 2021 and January 2022 and used two validated questionnaires: the Copenhagen Burnout Inventory (CBI) for assessing burnout among postgraduate healthcare trainees, and a questionnaire for assessing program directors' opinion on the need for a well-being program.

Results

A total of 386 trainees and 85 program directors completed the questionnaire. In both groups, the majority of the respondents were male (trainees: 53.9%; program directors: 61.2%). A total of 226 trainees (58.5%) scored above the CBI burnout cut-off score, with the median score being highest in the personal domain (62.5,IQR: 45.8-75). In the univariate analysis, the mean burnout score was higher among trainees who were married (P = 0.036), had children (P = <0.001), and were seniors (P = 0.028), whereas in the multivariate analysis, the only significant predictor of burnout was having 1-2 children (P = 0.023) or 3-4 children (P = 0.013). In the program directors survey, 90.6% agreed that improving physicians' well-being would directly rectify patients' overall well-being, but only 28.2% stated that it is currently incorporated in the curriculum.

Conclusion

This study found that a large proportion of postgraduate healthcare trainees experience burnout, particularly in the personal domain. Although program directors supported the concept of trainees' well-being, its incorporation into the curriculum was lacking, suggesting the necessity of establishing a well-being program.

Risks and Warning Signs for Medical Student Suicide Mortality: A Systematic Review

INTRODUCTION

Medical students have been known to face numerous mental health issues at disproportionately high rates. Of pertinence, medical students have been shown to have high rates of suicidal thoughts and behavior. However, little is known about the risks and warning signs for death by suicide in this group. We therefore conducted a systematic review regarding the factors associated with medical student suicide mortality.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted searches in six different databases. Studies with stratified data on at least one suicide death by a medical student were eligible for inclusion.

RESULTS

Searches produced a total of 1744 articles, and of those, 13 articles were eligible for inclusion. There was a pooled total of 362 suicide deaths of medical students across five different countries. 67.6% of deaths occurred among male students, primarily in their early twenties. Students in their later years of medical school were shown to be more likely to die by suicide, as were those with a history of psychiatric issues such as depression. Motivations for suicide were academic stress/failure, harassment/bullying, and relationship issues. Warning signs for suicide among medical students were recent changes in mood/behavior and leaving a suicide note.

DISCUSSION

Numerous risks and warning signs of suicide have been described in our review. Medical schools may have an important role in lowering suicide deaths by medical students; impactful change can occur through better support, changes in curriculum, and appropriate data collection.

Global disparities in surgeons' workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI.

Could breaks reduce general practitioner burnout and improve safety? A daily diary study

BACKGROUND

Rates of burnout are currently at record high levels, and GPs experience higher burnout than many other specialties. Organisational interventions may reduce burnout, but few studies have investigated these in primary care.

AIM

The current study investigated whether breaks, both with and without social interactions, were associated with burnout and patient safety perceptions in GPs.

DESIGN

A within-subjects, interval contingent, quantitative daily diary design.

SETTING

UK GP practices.

METHOD

Participants completed questionnaires at baseline measuring demographic variables, burnout and patient safety perceptions. They then completed a questionnaire in the evening each day for a week which captured whether they had taken a break that day, whether it involved a positive social interaction, burnout (comprising subscales of disengagement and exhaustion), positive and negative affect and patient safety perceptions. The data were analysed using hierarchical linear modelling to assess same-day and next-day associations.

RESULTS

We included 241 responses from 58 GPs for analysis. Taking at least one break (involving any or no social interactions) was associated with lower disengagement that day and lower exhaustion the next day. Taking at least one break involving a positive interaction was associated with 1) lower disengagement, exhaustion, overall burnout and negative affect on the same day, as well as higher positive affect and improved perceptions of patient safety, and 2) lower exhaustion and improved patient safety perceptions on the next day.

CONCLUSION

Organizing daily team or practice breaks where staff can socialise may help to reduce burnout and improve perceptions of patient safety.

Wellness Strategies Among Bad Outcomes and Complications

Surgery of the chest is high stakes, and adverse events are common. Given the frequency and severity of such complications, cardiothoracic surgeons are at particularly high risk of becoming second victims. Even though our primary commitment as doctors is to take care of our patients, surgeons may fall into the emotional and intellectual trap of taking on the whole responsibility of a patient's poor outcome. This viewpoint may lead the physician to develop a heightened self-doubt, greater insecurity, and imposter syndrome, further affecting their ability to prevent complications and tackle difficult cases in the future.

Surgeon and Surgical Trainee Experiences After Adverse Patient Events

Importance

Adverse patient events are inevitable in surgical practice.

Objectives

To characterize the impact of adverse patient events on surgeons and trainees, identify coping mechanisms, and assess whether current forms of support are sufficient.

Design, Setting, and Participants

In this mixed-methods study, a validated survey instrument was adapted and distributed to surgical trainees from 7 programs, and qualitative interviews were conducted with faculty from 4 surgical departments in an urban academic health system.

Main Outcomes and Measures

The personal impact of adverse patient events, current coping mechanisms, and desired forms of support.

Results

Of 216 invited trainees, 93 (43.1%) completed the survey (49 [52.7%] male; 60 [64.5%] in third postgraduate year or higher; 23 [24.7%] Asian or Pacific Islander, 6 [6.5%] Black, 51 [54.8%] White, and 8 [8.6%] other race; 13 [14.0%] Hispanic or Latinx ethnicity). Twenty-three of 29 (79.3%) invited faculty completed interviews (13 [56.5%] male; median [IQR] years in practice, 11.0 [7.5-20.0]). Of the trainees, 77 (82.8%) endorsed involvement in at least 1 recent adverse event. Most reported embarrassment (67 of 79 trainees [84.8%]), rumination (64 of 78 trainees [82.1%]), and fear of attempting future procedures (51 of 78 trainees [65.4%]); 28 of 78 trainees (35.9%) had considered quitting. Female trainees and trainees who identified as having a race and/or ethnicity other than non-Hispanic White consistently reported more negative consequences compared with male and White trainees. The most desired form of support was the opportunity to discuss the incident with an attending physician (76 of 78 respondents [97.4%]). Similarly, faculty described feelings of guilt and shame, loss of confidence, and distraction after adverse events. Most described the utility of confiding in peers and senior colleagues, although some expressed unwillingness to reach out. Several suggested designating a departmental point person for event debriefing.

Conclusions and Relevance

In this mixed-methods study of the personal impact of adverse events on surgeons and trainees, these events were nearly universally experienced and caused significant distress. Providing formal support mechanisms for both surgical trainees and faculty may decrease stigma and restore confidence, particularly for underrepresented groups.

Analyzing Social Factors to Enhance Suicide Prevention Across Population Groups

Social factors like family background, education level, financial status, and stress can impact public health outcomes, such as suicidal ideation. However, the analysis of social factors for suicide prevention has been limited by the lack of up-to-date suicide reporting data, variations in reporting practices, and small sample sizes. In this study, we analyzed 172,629 suicide incidents from 2014 to 2020 utilizing the National Violent Death Reporting System Restricted Access Database (NVDRS-RAD). Logistic regression models were developed to examine the relationships between demographics and suicide-related circumstances. Trends over time were assessed, and Latent Dirichlet Allocation (LDA) was used to identify common suicide-related social factors. Mental health, interpersonal relationships, mental health treatment and disclosure, and school/work-related stressors were identified as the main themes of suicide-related social factors. This study also identified systemic disparities across various population groups, particularly concerning Black individuals, young people aged under 24, healthcare practitioners, and those with limited education backgrounds, which shed light on potential directions for demographic-specific suicidal interventions.

Sleep, mental health and physical health in new shift workers transitioning to shift work: Systematic review and meta-analysis

This systematic review and meta-analysis (PROSPERO registration CRD42022309827) aimed to describe how shift work impacts new workers' sleep, mental health, and physical health during the transition to shift work and to consolidate information regarding predictors of shift work tolerance (SWT) during this transition period. Inclusion criteria included: new shift workers; sleep, mental health, or physical health outcomes; prospective study design with the first timepoint assessing workers within three months of starting shift work; and written in English. Searches from six databases returned 12,172 articles as of August 2023. The final sample included 48 papers. Publication quality and risk of bias was assessed using the critical appraisal skills program. Forty-five studies investigated longitudinal changes in sleep, mental health, or physical health outcomes and 29 studies investigated predictors of SWT (i.e., better sleep, mental and physical health). Sleep and mental health outcomes worsened following the onset of shift work, while physical health did not significantly change. Pre-shift work mental health, sleep, and work characteristics predicted SWT later in workers' careers. Shift work adversely impacts new workers' sleep and mental health early in their career, and interventions before beginning shift work are needed to promote better SWT.

Study Protocol for the Residents' Mental Health Investigation, a Dynamic Longitudinal Study in Italy (ReMInDIt)

Medical residents constitute a vulnerable population susceptible to mental health disorders. In Italy, this was evident during the COVID-19 pandemic, when medical residents served on the front line and provided significant support to healthcare services. Therefore, the working group on "Public Mental Health" of the Medical Residents' Council of the Italian Society of Hygiene, Preventive Medicine, and Public Health (S.It.I.) designed the "Residents' mental health investigation, a dynamic longitudinal study in Italy" (ReMInDIt). This longitudinal study aims to assess the mental status of medical residents and to explore potential cause-effect relationships between risk/protective factors (identified among sociodemographic, residency program, and lifestyle characteristics) and mental health outcomes (anxiety and depressive symptoms). Data will be collected from a study population of 3615 residents enrolled in Italian residency programs in public health, occupational medicine, and forensic medicine through an online questionnaire that includes validated tools, requires 10 min for completion, and is disseminated by the residents' Councils. It will be followed by a follow-up administration after 12 months. The ReMInDIt study will play a significant role in generating evidence crucial for enhancing mental health services and promoting protective factors for the mental well-being of this important segment of healthcare professionals.

The prevalence of post-traumatic stress disorder among emergency medical services personnel in Saudi Red Crescent Authority, Riyadh, Saudi Arabia

Background

Determining the prevalence of PTSD and contributing variables among (EMS) specialists was the goal of the current investigation. Furthermore, limited evidence exists regarding the application of PCL-5 for EMT practitioners, and the incidence of PTSD among different age groups and genders in Saudi Arabia.

Methods

This cross-sectional descriptive study includes 211 prehospital care providers of the Saudi Red Crescent Authority stations in Riyadh. The randomization was done using Google Forms into subgroups according to participants' gender, years of experience, occupations, and average working hours. The presence and severity of PTSD symptoms were evaluated using the 20-item PTSD Checklist for DSM-5 (PCL-5) self-report questionnaire. Data were analyzed using Pearson Chi-Square, Mann-Whitney and Kruskal-Wallis tests. The reliability statistics were calculated using Cronbach's Alpha for the 20-survey questionnaire.

Results

The comparison of PCL-5 total scores indicated more PTSD symptomatology among females (1.61 + 0.799) as compared to male workers (1.13 + 0.642). The total score of PTSD demonstrated no statistically significant (P=0.79) differences between our age group classifications. In terms of the participants' city (Riyadh), the total PTSD score was less than the cutoff point which is 31. PTSD total score may not be affected by working experience as indicated by the non-significant difference in prevalence among EMT practitioners having <5 years, 5-10 years and above 10 years of working experience (P=0.215 with X2 = 3.076). PTSD incidence is affected by the type of occupation as statistically significant differences between groups (P=0.001) were recorded depending on the position and responsibilities of EMS practitioners. PTSD is also affected by average working hours per week, and there were statistically significant differences between groups (P=0.001).

Conclusion

The total score of PTSD in the case of emergency service practitioners was found to be 33.7% among all the research participants, which may be regarded as a high prevalence when compared to the general population. Our investigations would contribute to a better understanding of the underlying factors of mental stress in EMS specialists in Saudi Arabia and to the development of adequate mental health practices.

"It's a Heavy Thing to Carry:" Internal Medicine and Pediatric Resident Experiences Caring for Dying Patients

BACKGROUND

Residents often feel unprepared to care for dying patients and may benefit from more training. Little is known about factors in the clinical setting that promote resident learning about end of life (EOL) care.

OBJECTIVES

This qualitative study aimed to characterize the experiences of residents caring for dying patients and elucidate the impact of emotional, cultural, and logistical factors on learning.

METHODS

6 US internal medicine and 8 pediatric residents who had cared for at least 1 dying patient completed a semi-structured one-on-one interview between 2019 and 2020. Residents described an experience caring for a dying patient including their confidence in clinical skills, emotional experience, role within the interdisciplinary team, and perspective on how to improve their education. Interviews were transcribed verbatim and investigators conducted content analysis to generate themes.

RESULTS

3 themes (with subthemes) emerged: (1) experiencing strong emotion or tension (loss of patient personhood, emerging professional identity, emotional dissonance); (2) processing the experience (innate resilience, team support); and (3) recognition of a new perspective or skill (bearing witness, meaning making, recognizing biases, emotional work of doctoring).

CONCLUSIONS

Our data suggests a model for the process by which residents learn affective skills critical to EOL care: residents (1) notice strong emotion, (2) reflect on the meaning of the emotion, and (3) crystallize this reflection into a new perspective or skill. Educators can use this model to develop educational methods that emphasize normalization of physician emotions and space for processing and professional identity formation.

Neurosurgery Residents' Satisfaction Toward Their Saudi Training Program: Insights from a National Survey

BACKGROUND

Given the high-stakes nature of their work, neurosurgery residents face constant pressure and require high-quality training to succeed. We aim to investigate the satisfaction levels of residents with their Saudi Neurosurgery Residency Training Program (SNRTP) and its influential factors.

METHODS

This is a nationwide, cross-sectional study that employed a questionnaire, structured based on the relevant literature, which was disseminated to neurosurgery residents, commencing from December 2021 and culminating in September 2022.

RESULTS

A total of 70 out of 143 neurosurgery residents were included, giving a response rate of 48.9%. Most participants (62.9%) aged 24-28 years old, 55.7% were males, and 40.0% were from the Central region of Saudi Arabia. The residents were further divided into juniors (R1-R3; 64.3%) and seniors (R4-R6; 35.7%). Approximately 13.3% of the juniors were satisfied with the SNRTP, whereas only 8.0% of the seniors were satisfied. Dissatisfaction rates over the SNRTP were significantly higher in the seniors (68.0%) compared to the juniors (28.9%; P = 0.006). The frequency of operating room sessions per week and presence of protected research time were the only 2 factors significantly associated with the junior and senior residents' satisfaction, respectively.

CONCLUSIONS

The SNRTP has a vision to provide the society with elite competent neurosurgeons. However, we found a degree of dissatisfaction among the residents, indicating a need for improving the SNRTP's policies. We recommend incorporating more hands-on training opportunities, implementing a mentorship model, setting tailored teaching sessions, and establishing resident wellness programs. We hope this study initiate dialogue on promoting residents' satisfaction and overall well-being.

Can Music Reduce Stress and Anxiety in the Operating Room Team? Insights from a Cross-Sectional Study in Northern Italy Healthcare Services

BACKGROUND

Music evokes positive emotions and reduces stress and anxiety. Operating room (OR) staff face various challenges which can lead to high levels of stress. The aim of the study is to assess whether listening to music during intraoperative phases improves the work environment by reducing anxiety and stress in the entire surgical team.

METHODS

A prospective observational study was conducted from February to September 2023, involving medical personnel, nursing staff, and nursing students. They were divided into two groups: Group 1 with music during surgical procedures, and Group 2 without music. Participants were administered two validated instruments: the Zung Anxiety Self-Assessment Scale (SAS) to measure anxiety, and the Positive and Negative Affect Schedule to assess emotions generating stress. Additional items were included for demographics, job satisfaction, and the organization method.

RESULTS

Music did not impact anxiety, but increased positive emotions while reducing negative ones. Music had an ancillary effect, highlighting the need for significant organizational interventions aimed at increasing operator satisfaction, including offering voluntary instead of mandatory assignments to nursing staff.

CONCLUSIONS

Music appears to reduce stress in the intraoperative team when supported by a positive work environment in which assigned operators have chosen to work in the OR.

Burnout and Quality of Work Life among Physicians during Internships in Public Hospitals in Thailand

Physicians are exposed to occupational stress and burnout, which have been identified as contributing to a decrease in the quality of work life (QWL). Thailand's medical education program, consisting of a six-year curriculum with government tuition support followed by three years of internships, provides the context for this investigation. This study aimed to assess the QWL among intern physicians (IPs) in public hospitals and investigated the association between burnout and QWL. A cross-sectional study was conducted among 241 IPs in public hospitals in Thailand utilizing an online self-administered questionnaire. The questionnaire included a Thai version of a 25-item QWL scale and the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. Data analysis was performed using multivariable logistic regression. A significant proportion of IPs experienced low to moderate QWL (72.6%), with low levels of home-work interface (39.4%) and employee engagement (38.6%). In the exploratory model, after adjusting for sex and age, IPs with high depersonalization and low personal accomplishment demonstrated an association with low QWL (adjusted OR, aOR 2.08, 95% CI 1.01 to 4.31; aOR 2.74, 95% CI 1.40 to 5.39). Healthcare organizations should regularly assess intern physicians' QWL and burnout, prioritizing interventions; ensure reasonable work hours, schedule adjustments, and open communication; and develop support systems for cost-effective interventions. Further research on the dynamic relationship between burnout and QWL is crucial for targeted and culturally sensitive interventions.

Intraoperative adverse events among surgeons in Singapore: a multicentre cross-sectional study on impact and support

BACKGROUND

It is known that many surgeons encounter intraoperative adverse events which can result in Second Victim Syndrome (SVS), with significant detriment to their emotional and physical health. There is, however, a paucity of Asian studies in this space. The present study thus aimed to explore the degree to which the experience of an adverse event is common among surgeons in Singapore, as well as its impact, and factors affecting their responses and perceived support systems.

METHODS

A self-administered survey was sent to surgeons at four large tertiary hospitals. The 42-item questionnaire used a systematic closed and open approach, to assess: Personal experience with intraoperative adverse events, emotional, psychological and physical impact of these events and perceived support systems.

RESULTS

The response rate was 57.5% (n = 196). Most respondents were male (54.8%), between 35 and 44 years old, and holding the senior consultant position. In the past 12 months alone, 68.9% recalled an adverse event. The emotional impact was significant, including sadness (63.1%), guilt (53.1%) and anxiety (45.4%). Speaking to colleagues was the most helpful support source (66.7%) and almost all surgeons did not receive counselling (93.3%), with the majority deeming it unnecessary (72.2%). Notably, 68.1% of the surgeons had positive takeaways, gaining new insight and improving vigilance towards errors. Both gender and surgeon experience did not affect the likelihood of errors and emotional impact, but more experienced surgeons were less likely to have positive takeaways (p = 0.035). Individuals may become advocates for patient safety, while simultaneously championing the cause of psychological support for others.

CONCLUSIONS

Intraoperative adverse events are prevalent and its emotional impact is significant, regardless of the surgeon's experience or gender. While colleagues and peer discussions are a pillar of support, healthcare institutions should do more to address the impact and ensuing consequences.

Personalized Machine Learning-Based Prediction of Wellbeing and Empathy in Healthcare Professionals

Healthcare professionals are known to suffer from workplace stress and burnout, which can negatively affect their empathy for patients and quality of care. While existing research has identified factors associated with wellbeing and empathy in healthcare professionals, these efforts are typically focused on the group level, ignoring potentially important individual differences and implications for individualized intervention approaches. In the current study, we implemented N-of-1 personalized machine learning (PML) to predict wellbeing and empathy in healthcare professionals at the individual level, leveraging ecological momentary assessments (EMAs) and smartwatch wearable data. A total of 47 mood and lifestyle feature variables (relating to sleep, diet, exercise, and social connections) were collected daily for up to three months followed by applying eight supervised machine learning (ML) models in a PML pipeline to predict wellbeing and empathy separately. Predictive insight into the model architecture was obtained using Shapley statistics for each of the best-fit personalized models, ranking the importance of each feature for each participant. The best-fit model and top features varied across participants, with anxious mood (13/19) and depressed mood (10/19) being the top predictors in most models. Social connection was a top predictor for wellbeing in 9/12 participants but not for empathy models (1/7). Additionally, empathy and wellbeing were the top predictors of each other in 64% of cases. These findings highlight shared and individual features of wellbeing and empathy in healthcare professionals and suggest that a one-size-fits-all approach to addressing modifiable factors to improve wellbeing and empathy will likely be suboptimal. In the future, such personalized models may serve as actionable insights for healthcare professionals that lead to increased wellness and quality of patient care.

Psychosocial working conditions, perceived patient safety and their association in emergency medical services workers in Germany - a cross-sectional study

BACKGROUND

Emergency medical service (EMS) workers face challenging working conditions that are characterized by high stress and a susceptibility to making errors. The objectives of the present study were (a) to characterize the psychosocial working conditions of EMS workers, (b) to describe the perceived quality of patient care they provide and patient safety, and (c) to investigate for the first time among EMS workers associations of psychosocial working conditions with the quality of patient care and patient safety.

METHODS

For this cross-sectional study, we carried out an online survey among 393 EMS workers who were members of a professional organization. Working conditions were measured by the Demand-Control-SupportQuestionnaire (DCSQ) and seven self-devised items covering key stressors. Participants reported how often they perceived work stress to affect the patient care they provided and we inquired to what extent they are concerned to have made a major medical error in the last three months. Additionally, we used parts of the Emergency Medical Services - Safety Inventory (EMS-SI) to assess various specific errors and adverse events. We ran descriptive analyses (objective a and b) and multivariable logistic regression (objective c).

RESULTS

The most common stressors identified were communication problems (reported by 76.3%), legal insecurity (69.5%), and switching of colleagues (48.9%) or workplaces (44.5%). Overall, 74.0% reported at least one negative safety outcome based on the EMS-SI. Concerns to have made an important error and the perception that patient care is impaired by work stress and were also frequent (17.8% and 12.7%, respectively). Most psychosocial working conditions were associated with the perception that patient care is impaired due to work stress.

CONCLUSIONS

Work stress in EMS staff is pronounced and negative safety outcomes or potential errors are perceived to occur frequently. Poor psychosocial working conditions were only consistently associated with perceived impairment of patient care due to work stress. It seems necessary to reduce communication problems and to optimize working processes especially at interfaces between emergency services and other institutions. Legal insecurity could be reduced by clarifying and defining responsibilities. Communication and familiarity between team colleagues could be fostered by more consistent composition of squads.

Hard shell, soft core? Multi-disciplinary and multi-national insights into mental toughness among surgeons

Background

With the prevalence of burnout among surgeons posing a significant threat to healthcare outcomes, the mental toughness of medical professionals has come to the fore. Mental toughness is pivotal for surgical performance and patient safety, yet research into its dynamics within a global and multi-specialty context remains scarce. This study aims to elucidate the factors contributing to mental toughness among surgeons and to understand how it correlates with surgical outcomes and personal well-being.

Methods

Utilizing a cross-sectional design, this study surveyed 104 surgeons from English and German-speaking countries using the Mental Toughness Questionnaire (MTQ-18) along with additional queries about their surgical practice and general life satisfaction. Descriptive and inferential statistical analyses were applied to investigate the variations in mental toughness across different surgical domains and its correlation with professional and personal factors.

Results

The study found a statistically significant higher level of mental toughness in micro-surgeons compared to macro-surgeons and a positive correlation between mental toughness and surgeons' intent to continue their careers. A strong association was also observed between general life satisfaction and mental toughness. No significant correlations were found between the application of psychological skills and mental toughness.

Conclusion

Mental toughness varies significantly among surgeons from different specialties and is influenced by professional dedication and personal life satisfaction. These findings suggest the need for targeted interventions to foster mental toughness in the surgical community, potentially enhancing surgical performance and reducing burnout. Future research should continue to explore these correlations, with an emphasis on longitudinal data and the development of resilience-building programs.

Evaluating Systemic Burnout in Medical Oncology Through a National Oncology Mentorship Program

PURPOSE

Mentorship has a positive influence on trainee skills and well-being. A 2022 Pilot Mentorship Program in New South Wales involving 40 participants revealed high burnout rates in Medical Oncology trainees. As part of an Australia-wide inaugural National Oncology Mentorship Program in 2023 (NOMP23), a national survey was undertaken to assess the prevalence of burnout, anxiety, depression, professional fulfilment, and drivers of distress in the Australian medical oncology workforce.

METHODS

NOMP23 is a 1-year prospective cohort study that recruited medical oncology trainees and consultants using e-mail correspondence between February and March 2023. Each participant completed a baseline survey which included the Maslach Burnout Index (MBI), Stanford Professional Fulfilment Index, and Patient Health Questionnaire-4 for anxiety and depression.

RESULTS

One hundred and twelve participants (56 mentors, 56 mentees) were enrolled in NOMP23, of which 86 (77%) completed the baseline survey. MBI results at baseline demonstrated that 77% of consultants and 82% of trainees experienced burnout in the past 12 months. Professional fulfilment was noted to be <5% in our cohort. Screening rates of anxiety and depression in trainees were 32% and 16%, respectively, compared with 7% and 2% for consultants. When assessing reasons for workplace stress, two thirds stated that heavy patient load contributed to stress, while almost three quarters attributed a heavy administrative load. Lack of supervision was a key stressor for trainees (39%), as was lack of support from the training college (58%).

CONCLUSION

Trainees and consultant medical oncologists demonstrate high rates of burnout and low professional fulfilment. The NOMP23 program has identified a number of key stress factors driving burnout and demonstrated concerning levels of anxiety and depression. Ongoing mentorship and other well-being initiatives are needed to address these issues.