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Kim DT, Applewhite MK, Shelton W. Professional Identity Formation in Medical Education: Some Virtue-Based Insights. TEACHING AND LEARNING IN MEDICINE 2024; 36:399-409. [PMID: 37140086 DOI: 10.1080/10401334.2023.2209067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
Issue: In 2010, the Carnegie Foundation published a call to reorient medical education in terms of the formation of identities rather than mere competencies, and the medical education literature on professional identity formation (PIF) has since grown rapidly. As medical learners navigate a hectic clinical learning environment fraught with challenges to professionalism and ethics, they must simultaneously orient their skills, behaviors, and evolving sense of professional identity. The medical education literature on PIF describes the psychosocial dimensions of that identity formation well. However, in its conceptual formulations, the literature risks underappreciating the pedagogical significance of the moral basis of identity formation-that is, the developing moral agencies and aspirations of learners to be good physicians. Evidence: Our conceptual analysis and argument build on a critical review of the medical education literature on PIF and draw on relevant insights from virtue ethics to deepen the conceptualization of PIF in moral, and not just psychosocial, terms. We show that a narrowly psychosocial view risks perpetuating institutional perceptions that can conceive professionalism norms primarily as standards of discipline or social control. By drawing on the conceptual resources of virtue ethics, we highlight not just the psychosocial development of medical learners but also their self-reflective, critical development as particular moral agents aspiring to embody the excellences of a good physician and, ultimately, to exhibit those traits and behaviors in the practice of medicine. Implications: We consider the pedagogical relevance of this insight. We show that drawing on virtue theory can more adequately orient medical pedagogy to socialize learners into the medical community in ways that nurture their personal growth as moral agents-in terms of their particular, restless aspirations to be a good physician and to flourish as such.
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Affiliation(s)
- Daniel T Kim
- Alden March Bioethics Institute, Albany Medical College, Albany, New York, USA
| | - Megan K Applewhite
- Alden March Bioethics Institute, Albany Medical College, Albany, New York, USA
| | - Wayne Shelton
- Alden March Bioethics Institute, Albany Medical College, Albany, New York, USA
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Fisher J, Leahy D, Lim JJ, Astles E, Salvatore J, Thomson R. Question banks: credit? Or debit? A qualitative exploration of their use among medical students. BMC MEDICAL EDUCATION 2024; 24:569. [PMID: 38790034 PMCID: PMC11127331 DOI: 10.1186/s12909-024-05517-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Online question banks are the most widely used education resource amongst medical students. Despite this there is an absence of literature outlining how and why they are used by students. Drawing on Deci and Ryan's self-determination theory, our study aimed to explore why and how early-stage medical students use question banks in their learning and revision strategies. METHODS The study was conducted at Newcastle University Medical School (United Kingdom and Malaysia). Purposive, convenience and snowball sampling of year two students were employed. Ten interviews were conducted. Thematic analysis was undertaken iteratively, enabling exploration of nascent themes. Data collection ceased when no new perspectives were identified. RESULTS Students' motivation to use question banks was predominantly driven by extrinsic motivators, with high-stakes exams and fear of failure being central. Their convenience and perceived efficiency promoted autonomy and thus motivation. Rapid feedback cycles and design features consistent with gamification were deterrents to intrinsic motivation. Potentially detrimental patterns of question bank use were evident: cueing, avoidance and memorising. Scepticism regarding veracity of question bank content was absent. CONCLUSIONS We call on educators to provide students with guidance about potential pitfalls associated with question banks and to reflect on potential inequity of access to these resources.
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Affiliation(s)
- James Fisher
- Newcastle University School of Medicine, Newcastle upon Tyne, UK.
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
| | - Declan Leahy
- Newcastle University School of Medicine, Newcastle upon Tyne, UK
| | - Jun Jie Lim
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
- Newcastle University Medicine Malaysia, Gelang Patah, Johor, Malaysia
| | - Emily Astles
- Newcastle University School of Medicine, Newcastle upon Tyne, UK
| | - Jacobo Salvatore
- Newcastle University School of Medicine, Newcastle upon Tyne, UK
| | - Richard Thomson
- Newcastle University School of Medicine, Newcastle upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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Al Hassani W, Achhab YE, Nejjari C. Challenges faced by human resources for health in Morocco: A scoping review. PLoS One 2024; 19:e0296598. [PMID: 38713675 PMCID: PMC11075827 DOI: 10.1371/journal.pone.0296598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Human resources for health (HRH) play a pivotal role in effective health system operation, yet various impediments challenge sustainable development. This scoping review aimed to explore these challenges and potential solutions in aligning the health workforce to meet the evolving healthcare needs of the Moroccan population. METHODS We conducted a scoping review searching PubMed, Science Direct, Cairn and Google Scholar for relevant articles published between 2014 and 2023. Additionally, non-peer-reviewed literature sourced from Ministry of Health consultations and allied websites was included. RESULTS Among the nineteen studies meeting our inclusion criteria, the majority were cross-sectional and predominantly focused on challenges faced by nurses. While some papers delineated multiple HRH challenges (5/19), the rest addressed specific challenges. The identified challenges span organizational and personal levels. Organizationally, the focus was on training, lifelong learning, continuing education, health coverage and shortages, and job satisfaction. At a personal level, HRH in the public health sector encountered challenges such as burnout, stress, and broader occupational health concerns. CONCLUSIONS The reviewed publications underscored a spectrum of challenges necessitating robust policy interventions. Despite promising developments in the Moroccan healthcare system, addressing the unequal urban-rural HRH distribution, augmenting funding, and enhancing HRH quality of life stand as pivotal imperatives.
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Affiliation(s)
- Wafaa Al Hassani
- Euromed of Nursing Sciences and Health Technics, Euromed University of Fez, Fez, Morocco
| | - Youness El Achhab
- CRMEF Fez-Meknes, Fez, Morocco
- Department of Epidemiology, Clinical Research and Community Health, Faculty of Medicine, Dental Medicine and Pharmacy of Fez, Fez, Morocco
| | - Chakib Nejjari
- Department of Epidemiology, Clinical Research and Community Health, Faculty of Medicine, Dental Medicine and Pharmacy of Fez, Fez, Morocco
- Euromed Research Center, Euromed University of Fez, Fez, Morocco
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Acampora M, Paleologo M, Graffigna G, Barello S. Uncovering influential factors in human antibiotic prescribing: a meta-synthesis study informed by the Theoretical Domains Framework. J Hosp Infect 2024; 144:28-55. [PMID: 38092303 DOI: 10.1016/j.jhin.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/28/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024]
Abstract
This study aimed to identify modifiable determinants (facilitators and barriers) related to the choice of prescribing antibiotics in human medicine across clinical settings. Enhanced management of antibiotics can help slow the spread of resistant bacteria. A qualitative meta-synthesis approach was used, according to Sandelowski and Barroso's method. Included studies were evaluated using the Critical Appraisal Skills Programme. Findings were extracted and organized to form a qualitative meta-summary. The Theoretical Domains Framework, the Capabilities-Opportunities-Motivation (COM-B) model and the Behaviour Change Wheel were used as a coding matrix for data interpretation. The analysis of 63 included studies revealed barriers and facilitators in 12 of 14 domains specified by the Theoretical Domains Framework. Prescribers' capabilities, motivation and opportunities were found to be the main drivers of antibiotic prescribing behaviour. Knowledge, skills, beliefs, expectations, the influence of patients and colleagues, organizational culture and infrastructure characteristics have a significant impact on prescribing behaviours. A comprehensive inventory of factors related to antibiotic prescribing has been compiled. Interventions to promote appropriate antibiotic prescribing should take a systemic approach rather than focusing solely on individual-level variables. Furthermore, the adoption of co-design approaches for such interventions is desirable to ensure greater applicability and sustainability in the real-world context of organizations.
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Affiliation(s)
- M Acampora
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore di Milano e Cremona, Milan and Cremona, Italy; Department of Psychology, Università Cattolica del Sacro Cuore di Milano, Milan, Italy
| | - M Paleologo
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore di Milano e Cremona, Milan and Cremona, Italy; Department of Psychology, Università Cattolica del Sacro Cuore di Milano, Milan, Italy
| | - G Graffigna
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore di Milano e Cremona, Milan and Cremona, Italy; Department of Psychology, Università Cattolica del Sacro Cuore di Milano, Milan, Italy; Faculty of Agricultural, Food and Environmental Sciences, Università Cattolica del Sacro Cuore di Cremona, Cremona, Italy
| | - S Barello
- Department of Brain and Behavioural Sciences, Università di Pavia, Pavia, Italy.
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Elzahhar R, Aylott J, Indrasena BSH, Wrazen R, Othman A. Exploring the motivation of surgeons to lead juniors and the impact of their leadership on junior doctors motivation and leadership preference. Leadersh Health Serv (Bradf Engl) 2023; ahead-of-print. [PMID: 37971782 DOI: 10.1108/lhs-05-2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE The purpose of this paper is to conceptualise a research study to examine leadership as a relational concept between leaders and followers. The context is within surgical practice examining how motivated consultant surgeons are to lead junior doctors and which type of leadership style they use. From a follower perspective, the motivation of junior doctors will be explored, and their leadership preferences will be correlated with those of the actual style of consultant surgeons. DESIGN/METHODOLOGY/APPROACH In this paper, the authors provide a detailed description of the methods for an international quantitative research study, exploring sequentially how motivated consultant surgeons are to lead and how leadership styles impact on the motivation of junior doctors. The objectives, method and data collection of this study are explained, and the justification for each method is described. FINDINGS The findings for this outline study illustrate how critical it is to redefine leadership as a relational concept of leader and follower to ensure adequate support is provided to the next generation of consultant surgeons. Without consideration of the relational model of leadership, attrition will continue to be a critical issue in the medical workforce. RESEARCH LIMITATIONS/IMPLICATIONS The research limitations are that this is a proposed quantitative study due to the need to collect a large sample of data from surgeons across the UK, Egypt and Germany. This research will have immense implications in developing new knowledge of leadership as a relational concept in medicine and healthcare. This study additionally will impact on how leadership is conceptualised in the curriculum for specialist surgical practice. PRACTICAL IMPLICATIONS The practical implications are that relational leadership is supportive of generating a supportive leadership culture in the workplace and generating more effective teamwork. ORIGINALITY/VALUE To the best of the authors' knowledge, this is the first study of its kind to look at a relational model of leadership in surgical practice between consultant surgeons and surgical trainees. This study will also identify any specific country differences between the UK, Germany and Egypt.
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Affiliation(s)
- Ramy Elzahhar
- Department of Orthopaedics and Traumatology, Benedictus Krankenhaus Tutzing, Tutzing, Germany
| | - Jill Aylott
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK and QiMET Medical Institute (QMI), QiMET International Ltd., Sheffield, UK
| | - Buddhike Sri Harsha Indrasena
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK and Department of General Surgery, Provincial General Hospital, Badulla, Sri Lanka
| | - Remig Wrazen
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK
| | - Ahmed Othman
- Department of Orthopaedic Surgery, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
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Neufeld A, Rahman A, Orakwue-Ononye N. Community physician perceptions of managing complex child and adolescent psychiatric patients: a self-determination theory perspective. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2023; 32:264-271. [PMID: 38034410 PMCID: PMC10686220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/20/2023] [Indexed: 12/02/2023]
Abstract
Children and adolescents with complex mental health needs often require a level of care that is unsustainable in tertiary settings. Yet, the psychological impact of this on community physicians, who are tasked with providing quality care to this population, is not well understood. Grounded in Self-Determination Theory (SDT), the present study explores how the challenges of caring for these patients is affecting community physicians' basic psychological needs (autonomy, competence, and relatedness) and intrinsic motivation. Participants from Calgary, Alberta, Canada, were invited to complete an anonymous online survey containing questions about managing complex child and adolescent psychiatric patients. We used SDT's needs-based framework and 22-item Intrinsic Motivation Inventory as a component of our pilot study, to explore and understand their ideas. Community physicians reported moderate-high interest/enjoyment and moderate perceived competence in managing complex child and adolescent patients, but little perceived choice and high tension/pressure in carrying out this task. Physician remarks provided meaningful insights into how these clinical experiences are impacting them, psychologically, and where opportunities may exist for interventions to support them and their patients. Findings from this study suggest that the participating community physicians feel interested and adequately skilled to manage complex child and adolescent psychiatric patients, but that systemic barriers are hindering their basic psychological needs and intrinsic motivation to do so. Potential explanations and implications for these findings are discussed.
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Affiliation(s)
- Adam Neufeld
- Department of Academic Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Abdul Rahman
- Department of Child and Adolescent Psychiatry, University of Calgary, Calgary, Alberta
| | - Nneka Orakwue-Ononye
- Department of Child and Adolescent Psychiatry, University of Calgary, Calgary, Alberta
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Kruger JM, De Klerk JJ. A pathway to greater meaning in life and well-being for senior executives beset by anti-meaning. Front Psychol 2023; 14:1187913. [PMID: 37533714 PMCID: PMC10390789 DOI: 10.3389/fpsyg.2023.1187913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Although work is a significant source of meaning for most people, the role of senior executive generates different meaning and well-being complexities than those experienced or faced by general employees. This study explored how meaning and anti-meaning components affect senior executives' experiences of meaning in life and well-being. The findings enabled devising a pathway to enhance senior executives' net experiences of meaning in life and well-being. Methods A cross-sectional, semi-structured interview study design was used to gather rich qualitative data. Eight participants from southern and eastern Africa, who had held the position of chief executive officer or managing director for at least five years, were interviewed. Results The findings demonstrated that senior executives' work roles provide a significant source of meaning. However, the roles are accompanied by unavoidable anti-meanings, which are likely to generate additional anti-meanings if not tempered sufficiently, thus reducing the net meaning experienced. Discussion From the findings, a practical pathway was devised to assist top executives to deal with the bipolar relationship between meaning and anti-meaning. Consulting and counseling practitioners can utilize the pathway to guide, support, and counsel senior executives towards improved meaning, temper anti-meaning and improve well-being.
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Toubassi D, Schenker C, Roberts M, Forte M. Professional identity formation: linking meaning to well-being. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:305-318. [PMID: 35913664 PMCID: PMC9341156 DOI: 10.1007/s10459-022-10146-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
Trainee distress and burnout continue to be serious concerns for educational programs in medicine, prompting the implementation of numerous interventions. Although an expansive body of literature suggests that the experience of meaning at work is critical to professional wellbeing, relatively little attention has been paid to how this might be leveraged in the educational milieu. We propose that professional identity formation (PIF), the process by which trainees come to not only attain competence, but additionally to "think, act and feel" like physicians, affords us a unique opportunity to ground trainees in the meaningfulness of their work. Using the widely accepted tri-partite model of meaning, we outline how this process can contribute to wellbeing. We suggest strategies to optimize the influence of PIF on wellbeing, offering curricular suggestions, as well as ideas regarding the respective roles of communities of practice, teachers, and formative educational experiences. Collectively, these encourage trainees to act as intentional agents in the making of their novel professional selves, anchoring them to the meaningfulness of their work, and supporting their short and long-term wellbeing.
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Affiliation(s)
- Diana Toubassi
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
- University Health Network - Toronto Western FHT, 440 Bathurst Street - Suite 300, Toronto, ON, M5T 2S6, Canada.
| | - Carly Schenker
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Roberts
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Milena Forte
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Zutautiene R, Kaliniene G, Ustinaviciene R, Radisauskas R. Prevalence of psychosocial work factors and stress and their associations with the physical and mental health of hospital physicians: A cross-sectional study in Lithuania. Front Public Health 2023; 11:1123736. [PMID: 36860387 PMCID: PMC9968968 DOI: 10.3389/fpubh.2023.1123736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/20/2023] [Indexed: 02/15/2023] Open
Abstract
Background A negative psychosocial work environment causes stress to the physicians of healthcare institutions, which affect their physical and mental health. This study aimed to evaluate the prevalence of psychosocial work factors and stress and their associations with the physical and mental health of hospital physicians in the Kaunas region of Lithuania. Materials and methods A cross-sectional study was performed. It was based on a questionnaire survey, which contained the Job Content Questionnaire (JCQ), three scales of Copenhagen Psychosocial Questionnaire (COPSOQ), and Medical Outcomes Study Short Form-36 (SF-36) health survey. The study was carried out in 2018. A total of 647 physicians completed the survey. Multivariate logistic regression models were performed by using the stepwise method. In the models potentially, confounding factors such as age and gender were controlled. In our study, the dependent variables were stress dimensions, and the independent variables were psychosocial work factors. Results The analysis showed that a quarter of surveyed physicians were classified as having low job skill discretion and decision-making authority, and the support of supervisors was weak. Approximately one-third of the respondents had low decision latitude, low co-worker support, and high job demands, and felt insecure at work. Job insecurity and gender were found to be the strongest independent variables for general and cognitive stress. The support of the supervisor was found as a significant factor in the case of somatic stress. Better evaluation of mental health was related to job skill discretion and co-workers' and supervisors' support, but it did not affect physical health. Conclusion The confirmed associations suggest that looking at work organization factors, reducing exposure to stress, and increasing perception of the psychosocial environment can be linked to better subjective health evaluation.
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Affiliation(s)
- Rasa Zutautiene
- Department of Environmental and Occupational Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania,*Correspondence: Rasa Zutautiene ✉
| | - Gintare Kaliniene
- Department of Environmental and Occupational Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania,Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ruta Ustinaviciene
- Department of Environmental and Occupational Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Department of Environmental and Occupational Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Tunks Leach K, Simpson P, Lewis J, Levett-Jones T. The Role and Value of Chaplains in an Australian Ambulance Service: A Comparative Study of Chaplain and Paramedic Perspectives. JOURNAL OF RELIGION AND HEALTH 2023; 62:98-116. [PMID: 36402854 PMCID: PMC9676825 DOI: 10.1007/s10943-022-01685-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 05/11/2023]
Abstract
Chaplains are embedded in several ambulance services across Australia, however as Australia's religiosity is currently in decline and questions are being asked about retaining chaplains, little is actually known about their role and value within Ambulance services. The aim of this paper is to present the key findings from interviews with chaplains about their role and value of being ambulance chaplains. These findings are then compared with those of paramedics derived from an earlier phase of this study. Thirteen chaplains participated in semi-structured interviews, and data were analysed using framework analysis. The results indicated that ambulance chaplains provided paramedic-centred emotional and spiritual care through proactively and reactively supporting paramedics in their work. Chaplains saw value in their relational approach which facilitated trust and access, did not seek to 'fix' or diagnose but instead offered physical and emotional presence, and promoted supportive conversations. Chaplains and paramedics valued operationally trained and equipped ambulance chaplains who provided a relational, around the clock, 'frontline' staff support presence in paramedic workplaces, regardless of the paramedic's personal religious/spiritual beliefs.
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Affiliation(s)
- Katie Tunks Leach
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
- New South Wales Ambulance, Sydney, Australia.
| | - Paul Simpson
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Joanne Lewis
- School of Nursing and Health, Avondale University, Wahroonga, Australia
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Morishita K, Katase K, Ishikane M, Otomo Y. Motivating factors for frontline healthcare workers during the COVID-19 pandemic: A survey in Japan. CURRENT PSYCHOLOGY 2022:1-9. [PMID: 36618542 PMCID: PMC9803592 DOI: 10.1007/s12144-022-04177-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
Healthcare workers (HCWs), who are at the frontline of the COVID-19 pandemic, treated COVID-19 patients under many types of stress for over a year. As an external motivating factor, incentives could be important for HCWs dealing with COVID-19. However, there has been no research regarding the change in the consciousness of HCWs during the unrelenting waves of COVID-19. Therefore, we conducted a survey of HCWs during different waves of COVID-19 (the second and fourth waves in Japan). An open web-based survey was conducted among HCWs who wore PPE while treating COVID-19 patients. The first survey of HCWs in Japan was conducted from August 27 to September 9, 2020, while the second survey was conducted from April 7 to May 10, 2021, during the second and fourth waves, respectively. The first and second surveys had 157 and 125 participants, respectively. There were no significant differences in the characteristics of the participants in the first and second survey groups regarding the types of occupation, age, sex, or full-time status. The percentage of HCWs who required financial incentives to maintain motivation remained high (88.5% vs. 82.7%). In addition, most frontline HCWs hope for regular SARS-CoV-2 PCR testing, which will be provided free of charge, as a necessary incentive. External motivating factors, such as financial and other incentives, were important to maintain the motivation of HCWs during the second and fourth waves of the COVID-19 pandemic in Japan. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-022-04177-6.
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Affiliation(s)
- Koji Morishita
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510 Japan
| | - Kozo Katase
- Section of Research Development, Department of Public Health, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510 Japan
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Kim J, Kim J, Shen E, Yoon JD. Sustaining the Intrinsic Motivations of the "Good Physician": A Content Analysis of Medical Students' and Physicians' Responses from Two National Surveys. South Med J 2022; 115:727-733. [PMID: 36191907 DOI: 10.14423/smj.0000000000001450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Physician motivation has been described as the reason, purpose, and force that drives people to pursue their work, and motivating factors include those that are intrinsic or extrinsic to the work. Social forces may contribute to motivational disparities between medical school and actual practice. METHODS A secondary data analysis of two national surveys (medical students and practicing physicians from various specialties) was conducted. Content analysis was performed on open-ended survey items that elicited students' and physicians' responses to meaningful experiences in medicine. RESULTS In the medical student sample, four themes were identified as factors intrinsic to medicine: role models, clinical experiences, patient interactions, and peer interactions. In total, intrinsic factors comprised 86.5% (193/208) of coded responses. In the practicing physician sample, five themes were identified as factors intrinsic to medicine: difficult patient interactions, conflict with colleagues or staff, meaningful patient interactions, involvement in medical education-research-academia, and medicine as a calling/mission. In total, intrinsic factors comprised 24.0% (140/582) of coded responses. CONCLUSIONS Our findings suggest that the reality of social forces in medicine threatens the ability of practicing physicians to derive meaning from their work, although students and physicians still report intrinsic motivation from establishing meaningful relationships. Further research is needed to explore what strategies enable physicians to wisely navigate the dynamic interactions of intrinsic and extrinsic motivators over various stages of their careers. These strategies could include encouraging reflective spaces in physicians' workplaces that have a specific focus on sustaining intrinsic motivation in medicine.
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Affiliation(s)
- Jenny Kim
- From the University of Texas Southwestern at Dallas, Dallas, the College at the University of Chicago, Chicago, Illinois and the Department of Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| | - Jae Kim
- From the University of Texas Southwestern at Dallas, Dallas, the College at the University of Chicago, Chicago, Illinois and the Department of Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| | - Elizabeth Shen
- From the University of Texas Southwestern at Dallas, Dallas, the College at the University of Chicago, Chicago, Illinois and the Department of Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| | - John D Yoon
- From the University of Texas Southwestern at Dallas, Dallas, the College at the University of Chicago, Chicago, Illinois and the Department of Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
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Jacobson N, Westein R, Nordstrom R, Pilarski A. #WhyIDoIt: A Multidisciplinary Wellness Initiative in an Academic Emergency Department. West J Emerg Med 2022; 23:693-697. [PMID: 36205660 PMCID: PMC9541993 DOI: 10.5811/westjem.2022.4.55813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/18/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Healthcare clinicians in critical care settings such as the emergency department (ED) experience workplace stressors and are at high risk for burnout. This correlates with substance abuse, suicidality, career dissatisfaction, early retirement, and suboptimal patient care. Therefore, recognizing, and mitigating, burnout is critical to a healthcare worker’s health and wellbeing. While gratitude and positive psychology are shown to increase resilience and decrease burnout, no prior studies have examined specific ED care team motivators for continued career satisfaction and workplace engagement. To increase the wellness in our ED, we implemented a wellness initiative titled #WhyIDoIt. Our goal was to have all care team members share what motivates them to work in our ED. Methods Participants were asked what motivates them in the workplace. We gathered responses each February for three consecutive years, 2017–2019, at our academic Level I trauma center. Emergency department clinicians, nurses, and staff were recruited to participate at grand rounds, nursing huddles, and sign out. Participants self-selected to contribute by writing their response on a sticky note and posting it in the department. After three years of implementing this initiative, we analyzed the collected qualitative data using thematic analysis based on grounded theory. Submissions were subjectively categorized into initial themes and then reconciled into three overarching classifications. Results In total, we collected 149 responses. Themes included team work (35, 23.5%), pride in a unique skill set (26, 17.4%), helping patients in a time of need (26, 17.4%), teaching/learning opportunities (15,10.1%), humor and levity (14, 9.4%), building relationships with patients (11,7.4%), financial motivation (9, 6.0%), patient gratitude (7, 4.7%), and philosophical and moral motivators (6, 4.0%). These themes were reconciled into three overarching classifications including team-centered motivators (76, 51%), patient-centered motivators (37, 24.8%), and reward-centered motivators (36, 24.2%). Conclusion Responses that showed the greatest motivator for ED clinicians and nurses were team-centered. This highlights the importance of relationship building and a sense of shared purpose and suggests that future workplace well-being initiatives should include strengthening and maintaining professional team relationships.
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Affiliation(s)
- Nancy Jacobson
- Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin
| | - Riley Westein
- Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin
| | - Rachel Nordstrom
- Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin
| | - Alicia Pilarski
- Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin
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Laura SM, Friedrich S, Mehdi G, Céline B. Calling: Never seen before or heard of - A survey among Swiss physicians. Work 2022; 72:657-665. [PMID: 35527597 DOI: 10.3233/wor-205282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Research is needed to gain a deeper understanding of what motivates physicians to do their work and what keeps them in the profession. OBJECTIVES To explore calling as an approach to work in a sample of physicians. METHODS We designed an online survey addressing career choice and career calling among physicians in French-speaking Switzerland, and measured associations between calling and categorical variables (participant characteristics, motivations for choosing medicine, career choice(s) and consistency, and definition of calling). RESULTS The majority of physicians (n = 229) reported that a calling was not a career motivator. The main reasons for becoming a physician were to be useful (n = 173), the scientific aspects of medicine (n = 168), and altruism (n = 153). Viewing medicine as a calling was significantly associated with having been attracted specifically and only to the medical career and stability of this career choice. Physicians defined a calling as internal summons (n = 140), passion (n = 126), and sense of purpose in life (n = 101). Being in the right place, internal summons, and passion were significantly more often considered as a definition for calling by physicians with a calling. CONCLUSIONS A sense of calling influences career choice and professional stability, and might play a protective role in exhaustion or dissatisfaction at work.
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Affiliation(s)
- Simões Morgado Laura
- School of Medicine, Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Stiefel Friedrich
- Psychiatric Liaison Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gholam Mehdi
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Bourquin Céline
- Psychiatric Liaison Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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15
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Wang X, Zhu Y, Wang F, Liang Y. Association of organizational and patient behaviors with physician well-being: A national survey in China. PLoS One 2022; 17:e0268274. [PMID: 35639674 PMCID: PMC9154115 DOI: 10.1371/journal.pone.0268274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
Abstract
This study aims to investigate the association of organizational and patient behaviors (reflecting the internal and external environment of hospital, respectively) with physician well-being. A national cross-sectional survey was conducted in 77 hospitals across seven provinces in China between July 2014 and April 2015. Physician well-being was assessed with job satisfaction, career regret and happiness. Organizational behaviors were assessed with organizational fairness, leadership attention and team interaction; patient behaviors were assessed with patient trust and unreasonable requests from patients. Of a study sample of 3,159 physicians, 1,788 were men (56.6%) and 1,371 were women (43.4%). Overall, positive organizational and patient behaviors reported by physicians were relatively low. Negative organizational behaviors and patient behaviors including lower organizational fairness, lower leadership attention, lower team interaction and lower patient trust were associated with lower job satisfaction and lower life satisfaction, and higher career regret. The association between organizational behaviors and physician well-being exhibited some gender differences, while no clear gender difference was found for the relationship between patient behaviors and physician well-being. Given the importance of physician well-being for the healthcare system, interventions for improving internal and external hospital environments (e.g., organizational fairness, leadership attention, team interaction and patient trust) may benefit physician well-being.
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Affiliation(s)
- Xiaoyu Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yimei Zhu
- School of Media, Communication and Sociology, University of Leicester, Leicester, United Kingdom
| | - Fang Wang
- Department of Epidemiology and Health Statistics, School of Health, Wuhan University, Wuhan, China
| | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: ,
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16
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Simon P, Chiniara G, St-Pierre L, Ahossi E, Dogba MJ, Cléophat J, Chénier C, Dubuc É, Landry C, Vonarx N, Pilote B. [First wave of COVID-19 in Quebec: Healthcare workers' motivation to treat infected patients]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; Vol. 33:853-862. [PMID: 35485017 DOI: 10.3917/spub.216.0853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Retention of healthcare workers (HCWs) in the healthcare system during the COVID-19 pandemic could become a challenge. It is therefore important to better understand what are the motivational elements that could explain a greater or lesser motivation to care for infected patients. OBJECTIVES To evaluate factors modulating HCWs' willingness to treat COVID-19 infected patients. METHODS HCWs from Québec, Canada, were invited to complete an online survey during the first wave of the COVID-19 pandemic between the months of April and July 2020. The survey focused on the intention to avoid treating infected patients, prior experiences in treating COVID-19 patients and anxiety levels. Descriptive statistics and multiple regression analysis were used to assess which factors explained differences in HCWs intention to avoid treating patients. RESULTS A total of 430 HCW completed the survey. A majority were women (87%) and nurses (50%). Of those, 12% indicated having considered measures to avoid working with COVID-19 infected patients and 5% indicated having taken actions to avoid working with infected patients. A further 18% indicated that they would use a hypothetical opportunity to avoid working with infected patients. Having previously treated infected patients was associated with a significant reduction in the intention to avoid work (OR: 0.56 CI 0.36-0.86). Amongst HCWs, physicians had a significantly reduced intention to avoid treating infected patients (OR: 0.47 CI 0.23-0.94). We also found that an increase in anxiety score was associated with a greater intention to avoid treating COVID-19 infected patients (OR: 1.06 CI 1.04-1.08). CONCLUSION Study results suggest that previous experience in treating COVID-19 infected patients is protective in terms of work-avoidance intentions. We also found that amongst HCWs, physicians had a significantly lower intention to avoid working with COVID-19 infected patients. Finally, our results show that increase in anxiety is associated with a higher intention to avoid treating infected patients. Characterization of factors associated with low anxiety levels and low reluctance to work during the COVID-19 pandemic could be useful in staffing facilities during the present and future healthcare crisis.
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Huang SX, Ham SA, Varghese M, Yoon JD. Moral Elevation, Physician Role Models, and Selected Markers of Professional Identity Formation and Well-Being: A Secondary Analysis from Two National Surveys. South Med J 2022; 115:129-135. [PMID: 35118502 DOI: 10.14423/smj.0000000000001357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Moral elevation is the underlying emotion that arises when witnessing admirable acts, and it is theorized to be the psychological mechanism driving the impact that positive clinical role models have on medical students' professional identity formation (eg, growth in professional virtues, higher sense of meaning, and well-being). This proof-of-concept study explores the development of the Moral Elevation Scale in Medicine by testing the association of moral elevation with various markers of professional identity formation. METHODS A secondary data analysis of two nationally representative samples of 960 medical students and 2000 physicians was performed. Respondents completed validated measures of moral elevation as well as markers of professional identity formation, including patient-centered virtues (empathic compassion, interpersonal generosity, mindfulness) and measures of well-being (life meaning, life satisfaction, spirituality, burnout). RESULTS The study obtained adjusted response rates of 56.2% (1047/1863, physician survey) and 48.7% (448/919, student survey). The national estimates for mean moral elevation in medical students and physicians are 4.34/5.00 and 4.22/5.00, respectively. In medical students and physicians, high moral elevation was associated with higher empathic compassion (student odds ratio [OR] 1.30, 95% confidence interval [CI] 1.02-1.67; physician OR 1.22, 95% CI 1.23-1.65) and, similarly, generosity. In addition, higher moral elevation in the physician cohort was associated with greater life meaning (OR 2.03, 95% CI 1.25-3.32) and similarly spirituality. CONCLUSIONS In medical students and practicing physicians, self-reported experiences of high moral elevation with physician role models were associated with higher self-reported measures of patient-centered virtues, spirituality, and life meaning. Our Moral Elevation Scale in Medicine demonstrates preliminary promise as a measure to assess environmental precursors needed for virtue development in professional identity formation, but further reliability and validity testing of this measure is needed.
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Affiliation(s)
- Shay X Huang
- From the Department of Medicine, Pritzker School of Medicine and the Center for Health and the Social Sciences, University of Chicago, and Mercy Hospital & Medical Center, Chicago, Illinois
| | - Sandra A Ham
- From the Department of Medicine, Pritzker School of Medicine and the Center for Health and the Social Sciences, University of Chicago, and Mercy Hospital & Medical Center, Chicago, Illinois
| | - Merlin Varghese
- From the Department of Medicine, Pritzker School of Medicine and the Center for Health and the Social Sciences, University of Chicago, and Mercy Hospital & Medical Center, Chicago, Illinois
| | - John D Yoon
- From the Department of Medicine, Pritzker School of Medicine and the Center for Health and the Social Sciences, University of Chicago, and Mercy Hospital & Medical Center, Chicago, Illinois
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Holzer BM, Ramuz O, Minder CE, Zimmerli L. Motivation and personality factors of Generation Z high school students aspiring to study human medicine. BMC MEDICAL EDUCATION 2022; 22:31. [PMID: 35016664 PMCID: PMC8753872 DOI: 10.1186/s12909-021-03099-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 12/31/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND A new generation of medical students, Generation Z (Gen Z), is becoming the predominant population in medical schools and will join the workforce in a few years' time. Medicine has undergone serious changes in high-income countries recently. Therefore, it is unclear how attractive the medical profession still is for high school students of Gen Z. The aim of this study was to investigate what motivation leads Gen Z students in their choice to study human medicine, and how they see their professional future. Our study was guided by motivation theory and the influence of personality traits and other personal factors on students' choice of university major. METHODS In a cross-sectional online survey, we included third- and fourth-year high school students in Northern Switzerland. We examined the importance of criteria when choosing a university major: personality traits, career motivation, life goals, and other considerations influencing the choice of human medicine versus other fields of study. Results Of 1790 high school students, 456 (25.5%) participated in the survey (72.6% women, mean age 18.4 years); 32.7% of the respondents aspired to major in medicine at university. For all respondents, the foremost criterion for selecting a field of study was 'interest in the field,' followed by 'income' and 'job security.' High school students aiming to study human medicine attached high importance to 'meaningful work' as a criterion; supported by 36.2% of those students answering that helping and healing people was a core motivation to them. They also scored high on altruism (p < 0.001 against all groups compared) and intrinsic motivation (p < 0.001) and were highly performance- (p < 0.001) and career-minded (p < 0.001). In contrast, all the other groups except the law/economics group had higher scores on extraprofessional concerns. CONCLUSIONS Swiss Gen Z students aspiring to study human medicine show high intrinsic motivation, altruism, and willingness to perform, sharing many values with previous generations. Adequate work-life balance and job security are important issues for Gen Z. Regarding the current working conditions, the ongoing shortage of physicians, and recent findings on physicians' well-being, the potential for improvement and optimization is high.
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Affiliation(s)
- Barbara M Holzer
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Oriane Ramuz
- Department of Internal Medicine Cantonal Hospital Olten, Solothurner Spitäler AG, Olten, Switzerland
| | - Christoph E Minder
- Department of Internal Medicine Cantonal Hospital Olten, Solothurner Spitäler AG, Olten, Switzerland
| | - Lukas Zimmerli
- Department of Internal Medicine Cantonal Hospital Olten, Solothurner Spitäler AG, Olten, Switzerland.
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19
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Fu MM, Chen RY, Fu MW, Kao HC, Kao HC, Chan HL, Fu E, Lee TSH. Life Satisfaction of US-trained Dental Specialists in Taiwan. Int Dent J 2022; 72:194-202. [PMID: 35065797 PMCID: PMC9275317 DOI: 10.1016/j.identj.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/05/2022] Open
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20
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Bazargan-Hejazi S, Shirazi A, Wang A, Shlobin NA, Karunungan K, Shulman J, Marzio R, Ebrahim G, Shay W, Slavin S. Contribution of a positive psychology-based conceptual framework in reducing physician burnout and improving well-being: a systematic review. BMC MEDICAL EDUCATION 2021; 21:593. [PMID: 34823509 PMCID: PMC8620251 DOI: 10.1186/s12909-021-03021-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The PERMA Model, as a positive psychology conceptual framework, has increased our understanding of the role of Positive emotion, Engagement, Relationships, Meaning, and Achievements in enhancing human potentials, performance and wellbeing. We aimed to assess the utility of PERMA as a multidimensional model of positive psychology in reducing physician burnout and improving their well-being. METHODS Eligible studies include peer-reviewed English language studies of randomized control trials and non-randomized design. Attending physicians, residents, and fellows of any specialty in the primary, secondary, or intensive care setting comprised the study population. Eligible studies also involved positive psychology interventions designed to enhance physician well-being or reduce physician burnout. Using free text and the medical subject headings we searched CINAHL, Ovid PsychINFO, MEDLINE, and Google Scholar (GS) electronic bibliographic databases from 2000 until March 2020. We use keywords for a combination of three general or block of terms (Health Personnel OR Health Professionals OR Physician OR Internship and Residency OR Medical Staff Or Fellow) AND (Burnout) AND (Positive Psychology OR PERMA OR Wellbeing Intervention OR Well-being Model OR Wellbeing Theory). RESULTS Our search retrieved 1886 results (1804 through CINAHL, Ovid PsychINFO, MEDLINE, and 82 through GS) before duplicates were removed and 1723 after duplicates were removed. The final review included 21 studies. Studies represented eight countries, with the majority conducted in Spain (n = 3), followed by the US (n = 8), and Australia (n = 3). Except for one study that used a bio-psychosocial approach to guide the intervention, none of the other interventions in this review were based on a conceptual model, including PERMA. However, retrospectively, ten studies used strategies that resonate with the PERMA components. CONCLUSION Consideration of the utility of PERMA as a multidimensional model of positive psychology to guide interventions to reduce burnout and enhance well-being among physicians is missing in the literature. Nevertheless, the majority of the studies reported some level of positive outcome regarding reducing burnout or improving well-being by using a physician or a system-directed intervention. Albeit, we found more favorable outcomes in the system-directed intervention. Future studies are needed to evaluate if PERMA as a framework can be used to guide system-directed interventions in reducing physician burnout and improving their well-being.
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Affiliation(s)
- Shahrzad Bazargan-Hejazi
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA.
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Anaheed Shirazi
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Andrew Wang
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nathan A Shlobin
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Krystal Karunungan
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Joshua Shulman
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
| | - Robert Marzio
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
| | - Gul Ebrahim
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
| | - William Shay
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
| | - Stuart Slavin
- Accreditation Council for Graduate Medical Education, Chicago, USA
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Mantri S, Song YK, Lawson JM, Berger EJ, Koenig HG. Moral Injury and Burnout in Health Care Professionals During the COVID-19 Pandemic. J Nerv Ment Dis 2021; 209:720-726. [PMID: 34582400 DOI: 10.1097/nmd.0000000000001367] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The coronavirus pandemic (COVID-19) is predicted to increase burnout in health professionals (HPs), but little is known about moral injury (MI) in this context. We administered the Moral Injury Symptoms Scale for Health Professionals (MISS-HP) and the abbreviated Maslach Burnout Inventory via online survey to a global sample of 1831 HPs in April and October 2020. Mean MISS-HP increased from 27.4 (SD, 11.6) in April to 36.4 (SD, 13.8) in October (p < 0.001), with an accompanying increase in personal accomplishment (April: 4.7; SD, 3.1; October: 9.3; SD, 3.1; p < 0.001) and no change in other burnout subscales. In April, 26.7% of respondents reported at least moderate functional impairment from MI, increasing to 45.7% in October (p < 0.001). Predictors of MISS-HP included younger age and being a nurse. Odds of functional impairment were higher in respondents who were widowed, divorced, never married, or had direct experience caring for patients with COVID-19. COVID-19 has increased MI but not burnout in HPs; younger or unmarried individuals, nurses, and frontline workers may benefit from targeted outreach to reduce downstream effects of MI, depression, and/or posttraumatic stress disorder.
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Affiliation(s)
| | | | | | - Elizabeth J Berger
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
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Du M, Tak HJ, Yoon JD. Association of Intrinsic Motivating Factors and Joy in Practice: A National Physician Survey. South Med J 2021; 114:583-590. [PMID: 34480191 DOI: 10.14423/smj.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In response to the need to identify positive measures that more accurately describe physician wellness, this study seeks to assess the validity of a novel joy in practice measure using validated physician well-being measures and test its association with certain intrinsic and extrinsic motivators. METHODS Secondary data analysis using a nationally representative dataset of 2000 US physicians, fielded October-December 2011. Multivariable logistic models with survey design provided nationally representative individual-level estimates. Primary outcome variables included joy in practice (enthusiasm, fulfillment, and clinical stamina in an after-hours setting). Secondary outcomes were validated measures of physician well-being such as job and life satisfaction and life meaning. Primary explanatory variables were sense of calling, number of personally rewarding hours per day, long-term relationships with patients, and burnout. RESULTS The survey response rate was 64.5% (1289/2000). Physicians who demonstrated joy in practice were most likely to report high life satisfaction (odds ratio [OR] 2.75, 95% confidence interval [CI] 1.52-4.98) and high life meaning (OR 2.62, 95% CI 1.41-4.85). Joy in practice was strongly associated with having a sense of calling (OR 10.8, 95% CI 2.21-52.8) and ≥ 7.5 personally rewarding hours per day (OR 3.75, 95% CI 1.51-9.36); meanwhile, it was negatively associated with burnout (OR 0.26, 95% CI 0.14-0.51). Extrinsic factors such as specialty, practice setting, and annual income were not significantly associated with joy in practice in most regressions. CONCLUSIONS The joy in practice measure shows preliminary promise as a positive marker of well-being, highlighting the need for future interventions that support physicians' intrinsic motivators and foster joy in one's practice.
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Affiliation(s)
- Matthew Du
- From the Pritzker School of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and the Department of Medicine, Section of Hospital Medicine, and MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago
| | - Hyo Jung Tak
- From the Pritzker School of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and the Department of Medicine, Section of Hospital Medicine, and MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago
| | - John D Yoon
- From the Pritzker School of Medicine, University of Chicago, Chicago, Illinois, the Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, and the Department of Medicine, Section of Hospital Medicine, and MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago
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Rediscovering Meaning and Purpose: An Approach to Burnout in the Time of COVID-19 and Beyond. Am J Med 2021; 134:1065-1067. [PMID: 33989605 PMCID: PMC9746258 DOI: 10.1016/j.amjmed.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022]
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Pololi LH, Vasiliou V, Bloom-Feshbach K. Midcareer Medical School Research Faculty Perspectives on Vitality and Professionalism During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2120642. [PMID: 34387678 PMCID: PMC8363912 DOI: 10.1001/jamanetworkopen.2021.20642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022] Open
Abstract
Importance As medical faculty have central roles during the COVID-19 pandemic, it is important to study the pandemic's association with the vitality and careers of medical school faculty. Objective To examine how the COVID-19 pandemic affected midcareer research faculty in academic medicine. Design, Setting, and Participants This qualitative study included medical school faculty who participated in the C-Change Mentoring and Leadership Institute. All US medical school faculty recipients of recent National Institutes of Health (NIH) RO1, RO1-equivalent, and K awards were invited to apply to the institute. The 99 applicants who met inclusion criteria were stratified by degree (MD or MD/PhD vs PhD), gender, and race/ethnicity. Enrollment was offered to applicants randomly selected for 40 spots, demographically balanced by sex, underrepresented in medicine minority (URMM) status, and degree. In April 2020, an inquiry was emailed to faculty enrolled in the institute requesting responses to questions about meaning in work, career choice, and values. A qualitative analysis of narrative data responses, using grounded theory, was undertaken to determine key themes. This study is part of a NIH-funded randomized trial to test the efficacy of a group peer mentoring course for midcareer faculty and study the course's mechanisms of action. Main Outcomes and Measures Key themes in data. Results Of 40 enrolled participants, 39 responded to the inquiry, for a response rate of 97%. The analytic sample included 39 faculty members; 19 (47%) were women, 20 (53%) identified as URMM, and 20 (53%) had an MD or MD with PhD vs 19 (47%) with PhD degrees. Key themes in the data that emerged describing faculty lived experience of the pandemic included increased meaningfulness of work; professionalism and moral responsibility; enhanced relationships with colleagues; reassertion of career choice; disrupted research; impact on clinical work; attention to health disparities, social justice and advocacy; increased family responsibilities; psychological stress; and focus on leadership. Conclusions and Relevance During the pandemic, diverse PhD and physician investigators reported increased meaningfulness in work and professionalism and enhanced relationships, all intrinsic motivators associated with vitality. Working during the pandemic appears to have produced intrinsic rewards positively associated with vitality, in addition to adverse mental health effects. These findings have implications for combatting burnout and retaining investigators in the future.
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Affiliation(s)
- Linda H. Pololi
- National Initiative on Gender, Culture and Leadership in Medicine: C-Change, Brandeis University, Waltham, Massachusetts
| | - Vasilia Vasiliou
- School of Management, Clark University, Worcester, Massachusetts
| | - Kimberly Bloom-Feshbach
- Medicine, Section of Hospital Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
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Physician Well-being and the Future of Health Information Technology. Mayo Clin Proc Innov Qual Outcomes 2021; 5:753-761. [PMID: 34377947 PMCID: PMC8332366 DOI: 10.1016/j.mayocpiqo.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The issue of clinician burnout has become a growing concern in health care, with an increased emphasis on health information technology as a contributing factor. Technology-mediated stresses have arisen with the electronic health record, and we can anticipate new and different impacts from future information tools. This article discusses technology's pivotal role in physician well-being, not only in the quality of its design but also through its capacity to enable future models of care that are more manageable for physicians and more effective for patients. Three general aims along with specific efforts are proposed to benefit physician well-being in technology-mediated work.
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Mitchell P, Cribb A, Entwistle V, Singh G. Pushing poverty off limits: quality improvement and the architecture of healthcare values. BMC Med Ethics 2021; 22:91. [PMID: 34256744 PMCID: PMC8278597 DOI: 10.1186/s12910-021-00655-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people's lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative (PSI) into paediatric practice using the discourse and methodology of healthcare quality improvement (QI). DISCUSSION Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty 'off limits.' We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. CONCLUSIONS We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods.
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Affiliation(s)
- Polly Mitchell
- Centre for Public Policy Research, School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK.
| | - Alan Cribb
- Centre for Public Policy Research, School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK
| | - Vikki Entwistle
- Health Services Research Unit and School of Divinity, History and Philosophy, University of Aberdeen, 3rd floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Guddi Singh
- Mary Sheridan Centre for Child Health, Guy's and St. Thomas' NHS Foundation Trust, 5 Dugard Way, London, SE11 4TH, UK
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Lin X, Zhu Y, Wang C, Wang F. Relationship among affective commitment, occupational stressors, and calling of psychiatrists in Shanghai. Medicine (Baltimore) 2021; 100:e26615. [PMID: 34232218 PMCID: PMC8270634 DOI: 10.1097/md.0000000000026615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/18/2021] [Indexed: 01/04/2023] Open
Abstract
The aim of the study is to investigate the levels of affective commitment, occupational stressors and calling in psychiatrists in Shanghai and try to find the relationship among 3 variables in the participants.We enrolled 81 participants using a survey with a combination of demographic information, affective part of organizational commitment questionnaire, portion of the scale for occupational stressors on clinicians and the calling and vocation questionnaire. Correlation analysis and multiple linear regression analysis were applied to probe into the relationship among the three variables. t Test and nonparametric test were utilized to compare the differences between the groups of individuals who were divided according to the demographic information.The mean score of the affective commitment, occupational stressors and calling of Shanghai psychiatrists were all at a moderate level. The scores in affective commitment had a significantly negative relationship with that of the occupational stressors, especially in the respect of organization and management, occupational interest, and development of work. Whereas the scores of calling revealed a remarkably positive connection with affective commitment. In addition, demographic groups under comparison, individuals who were >35 years' old, male, or have worked for >10 years are more likely to suffer from higher occupational development and interpersonal relationship stress.We found that the levels of affective commitment, occupational stressors and calling in psychiatrists in Shanghai were all moderate. These people who were men, >35 years' old, and had >10 years of work experiences had suffered from higher levels of occupational stressors, especially occupational development and interpersonal relationship stress. The affective commitment was positively correlated to the calling while negatively associated to the occupational stressors in Shanghai psychiatrists. For stronger bond for the psychiatrists, strengthen the calling and lessen the occupational stressors are required. These results provide some ideas for enhancing the occupational commitment of psychiatrists and conducting psychological interventions in a timely manner henceforth more effectively.
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Affiliation(s)
- Xiao Lin
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
| | | | - Chao Wang
- Shanghai Changning Mental Health Center
| | - Fang Wang
- Shanghai Yangpu Mental Health Center, Shanghai, China
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Shanafelt T, Trockel M, Rodriguez A, Logan D. Wellness-Centered Leadership: Equipping Health Care Leaders to Cultivate Physician Well-Being and Professional Fulfillment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:641-651. [PMID: 33394666 PMCID: PMC8078125 DOI: 10.1097/acm.0000000000003907] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
These are challenging times for physicians. Extensive changes in the practice environment have altered the nature of physicians' interactions with patients and their role in the health care delivery system. Many physicians feel as if they are "cogs in the wheel" of austere corporations that care more about productivity and finances than compassion or quality. They often do not see how the strategy and plan of their organization align with the values of the profession. Despite their expertise, they frequently do not feel they have a voice or input in the operational plan of their work unit, department, or organization. At their core, the authors believe all of these factors represent leadership issues. Many models of leadership have been proposed, and there are a number of effective philosophies and approaches. Here, the authors propose a new integrative model of Wellness-Centered Leadership (WCL). WCL includes core skills and qualities from the foremost leadership philosophies along with evidence on the relationship between leadership and physician well-being and distills them into a single framework designed to cultivate leadership behaviors that promote engagement and professional fulfillment. The 3 elements of WCL are: care about people always, cultivate individual and team relationships, and inspire change. A summary of the mindset, behaviors, and outcomes of the elements of the WCL model is presented, and the application of the elements for physician leaders is discussed. The authors believe that learning and developing the skills that advance these elements should be the aspiration of all health care leaders and a foundational focus of leadership development programs. If cultivated, the authors believe that WCL will empower individual and team performance to address the current problems faced by health care organizations as well as the iterative innovation needed to address challenges that may arise in the decades to come.
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Affiliation(s)
- Tait Shanafelt
- T. Shanafelt is chief wellness officer, Jeanie and Stewart Ritchie Professor of Medicine, and associate dean, Stanford School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-7106-5202
| | - Mickey Trockel
- M. Trockel is clinical associate professor, Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California
| | - Ashleigh Rodriguez
- A. Rodriguez is currently a consultant, CMA Wellness Services, California Medical Association, Sacramento, California. At the time of writing, she was a graduate student, USC Marshall School of Business, Los Angeles, California
| | - Dave Logan
- D. Logan is chief executive officer, CMA Wellness Services, California Medical Association, Sacramento, and senior lecturer, Department of Management and Organization, University of Southern California, Los Angeles, California
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Zhang JQ, Dong J, Pardo J, Emhoff I, Serres S, Shanafelt T, James T. Burnout and Professional Fulfillment in Early and Early-Mid-Career Breast Surgeons. Ann Surg Oncol 2021; 28:6051-6057. [PMID: 33876361 DOI: 10.1245/s10434-021-09940-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prior work has shown that burnout among breast surgeons is prevalent and highest in those earlier in their clinical practice career. Therefore, we sought to better understand and identify specific contributors to early-career breast surgeon burnout. METHODS We analyzed data from our 2017 survey of members of the American Society of Breast Surgeons. The 16-items of the Professional Fulfillment Index were used in determining overall burnout and professional fulfillment scores. Multivariable regressions were performed to evaluate factors related to overall burnout and professional fulfillment. RESULTS The mean overall burnout score was 1.23 (0-4 scale; higher score unfavorable) for surgeons in practice < 5 years, compared with 1.39 for surgeons in practice 5-9 years and 1.22 for those in practice ≥ 10 years. The mean professional fulfillment score was 2.71 (0-4 scale; higher score favorable) for surgeons in practice < 5 years, 2.66 for surgeons in practice 5-9 years, and 2.67 for surgeons in practice ≥ 10 years. Multivariable analysis showed that burnout was positively correlated with ≥ 60 work hours per week in the group practicing for < 5 years, and dedicating less than full time to breast surgery in the group in practice 5-9 years. Professional fulfillment was negatively associated with single relationship status in surgeons practicing < 5 years, and dedicating less than full time to breast surgery for those in practice 5-9 years. CONCLUSION Our study suggests that breast surgeons who have been in practice for 5-9 years have particularly high overall burnout rates and additional support focused on this group of breast surgeons may be needed.
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Affiliation(s)
- Jennifer Q Zhang
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joe Dong
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jaime Pardo
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Isha Emhoff
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stephanie Serres
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, CA, USA
| | - Ted James
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,BreastCare Center, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Bayer ND, Taylor A, Fallon A, Wang H, Santolaya JL, Bamat TW, Washington N. Pediatric Residents' Sense of Meaning in Their Work: Is This Value Related to Higher Specialty Satisfaction and Reduced Burnout? Acad Pediatr 2021; 21:557-563. [PMID: 33127591 DOI: 10.1016/j.acap.2020.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Physician wellness is frequently measured as the absence of burnout, rather than the perception of meaningful work. This study of pediatric residents aimed to test the hypothesis that their sense of meaning at work is associated positively with specialty satisfaction and negatively with burnout. METHODS In June 2018, we surveyed residents at a large urban pediatrics program, using the Work and Meaning Inventory (WAMI), the Global Specialty Satisfaction measure, and a single-item burnout measure. Residents were surveyed at the end of their intern, second or third/fourth year. We compared resident responses to outcome measures by year, gender, race, and type of program (pediatrics and medicine-pediatrics). We assessed the associations between WAMI scores and specialty satisfaction using linear regression and between WAMI scores and burnout using logistic regression, both adjusted for residency year and characteristics. RESULTS The survey was completed by 119/154 (77.3%) residents. Mean WAMI score was 40.6 ± 5.6 (standard deviation), mean specialty satisfaction score was 11.9 ± 2.4, and 48.7% (58/119) of residents reported burnout with no significant differences in scores by residency year, gender, race, or type of program (all P > .05). Residents' WAMI scores were positively associated with specialty satisfaction (r = +0.57, P < .001) and negatively associated with burnout (adjusted odds ratio = 0.80, 95% confidence interval 0.73-0.89). CONCLUSIONS Pediatric residents' sense of meaning at work was significantly positively associated with specialty satisfaction and negatively associated with burnout. We recommend that efforts to improve resident wellness focus on interventions to foster meaning in work, such as supporting team cohesion and autonomy in job design.
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Affiliation(s)
- Nathaniel D Bayer
- University of Rochester, Golisano Children's Hospital (ND Bayer, A Fallon, and H Wang), Rochester, NY.
| | - April Taylor
- Children's Hospital of Philadelphia (A Taylor, JL Santolaya, TW Bamat, and N Washington), Philadelphia, Pa
| | - Anne Fallon
- University of Rochester, Golisano Children's Hospital (ND Bayer, A Fallon, and H Wang), Rochester, NY
| | - Hongyue Wang
- University of Rochester, Golisano Children's Hospital (ND Bayer, A Fallon, and H Wang), Rochester, NY
| | - Jacobo L Santolaya
- Children's Hospital of Philadelphia (A Taylor, JL Santolaya, TW Bamat, and N Washington), Philadelphia, Pa
| | - Tara W Bamat
- Children's Hospital of Philadelphia (A Taylor, JL Santolaya, TW Bamat, and N Washington), Philadelphia, Pa
| | - Nicole Washington
- Children's Hospital of Philadelphia (A Taylor, JL Santolaya, TW Bamat, and N Washington), Philadelphia, Pa
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Kader N, Elhusein B, Al Abdulla S, Hamza AH, Al Maslamani M, Chandra P, Perayil R, Vincent J, Gunashekaran J, Alabdulla M. Risk Perception and Psychological Impact of COVID-19 Pandemic Among Healthcare Workers in Primary and Secondary Healthcare Settings in Qatar: A National Study. J Prim Care Community Health 2021; 12:21501327211039714. [PMID: 34392716 PMCID: PMC8366132 DOI: 10.1177/21501327211039714] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION During the coronavirus disease 2019 (COVID-19) pandemic, primary and secondary healthcare workers (HCWs) have faced unprecedented stress, jeopardizing their mental well-being. AIMS To compare risk perception and psychological distress between primary and secondary HCWs. METHOD A cross-sectional web-based survey was conducted with HCWs in Qatar from April 5 to July 5, 2020. Psychological distress and risk perception were assessed using the Kessler Psychological Distress Scale, a perceived COVID-19 risk questionnaire, and a sociodemographic questionnaire. RESULTS Of the 4417 participating HCWs, 3421 (90.3%) felt that their job increased their risk of COVID-19 exposure, 3759 (90.9%) accepted this as part of their job, and 3440 worried that this also increased the risk of exposure to their families. Moreover, 2911 (84.8%) believed that their employer would look after their needs if they contracted COVID-19. Moderate to severe psychological distress was present in 1346 (30.5%) HCWs. Primary HCWs were less likely to experience moderate to severe psychological distress than secondary HCWs (adjusted OR, 0.48; 95% CI 0.29-0.77, P = .003). Secondary HCWs who worked in COVID-19 designated areas had greater psychological distress. CONCLUSIONS HCWs' exposure to outbreaks has various psychological effects, which may have long-term consequences and affect their decision-making capacity. Strategies to enhance the mental well-being of HCWs exposed to COVID-19 should be introduced immediately.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Majid Alabdulla
- Hamad Medical Corporation, Doha, Qatar
- Qatar University, Doha, Qatar
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Can Organizational Leaders Sustain Compassionate, Patient-Centered Care and Mitigate Burnout? J Healthc Manag 2020; 64:398-412. [PMID: 31725567 DOI: 10.1097/jhm-d-18-00023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
EXECUTIVE SUMMARY Organizational leaders are recognizing the urgent need to mitigate clinician burnout. They face difficult choices, knowing that burnout threatens the quality and safety of care and the sustainability of their organizations. Creating cultures and system improvements that support the workforce and diminish burnout are vital leadership skills. The motivation to heal draws many health professionals to their chosen work. Further, research suggests that compassion creates a sense of personal reward and professional satisfaction. Although many organizations stress compassion in mission and vision statements, their strategies to enhance well-being largely ignore compassion as a source of joy and connection to purpose.Passage of the HITECH (Health Information Technology for Economic and Clinical Health) Act in 2009 and the Affordable Care Act in 2010 ushered in a new era in healthcare. Little is known about how changes in the healthcare delivery system related to these legislative milestones have influenced health professionals' capacity to offer compassionate care. Further, advances such as artificial intelligence and virtual care modalities brought more attention to the elements that form the clinician-patient relationship.This study analyzed the views of U.S. healthcare providers on the status of compassionate healthcare compared with 2010. Postulating that compassion is inversely correlated with burnout, we studied this relationship and contributing factors. Our review of evidence-based initiatives suggests that leaders must define the organizational conditions and implement processes that support professionals' innate compassion and contribute to their well-being rather than address burnout later through remedial strategies.
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Heath C, Sommerfield A, von Ungern-Sternberg BS. Resilience strategies to manage psychological distress among healthcare workers during the COVID-19 pandemic: a narrative review. Anaesthesia 2020; 75:1364-1371. [PMID: 32534465 PMCID: PMC7323405 DOI: 10.1111/anae.15180] [Citation(s) in RCA: 246] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/22/2022]
Abstract
The COVID-19 pandemic marks an extraordinary global public health crisis unseen in the last century, with its rapid spread worldwide and associated mortality burden. The longevity of the crisis and disruption to normality is unknown. With COVID-19 set to be a chronic health crisis, clinicians will be required to maintain a state of high alert for an extended period. The support received before and during an incident is likely to influence whether clinicians experience psychological growth or injury. An abundance of information is emerging on disease epidemiology, pathogenesis and infection control prevention. However, literature on interventions for supporting the psychological well-being of healthcare workers during disease outbreaks is limited. This article summarises the available management strategies to increase resilience in healthcare workers during the COVID-19 pandemic and beyond. It focuses on self-care and organisational justice. It highlights various individual as well as organisational strategies. With the success of slowing disease spread in many countries to date, and reduced work-load due to limitations on elective surgery in many institutions, there is more time and opportunity to be pro-active in implementing measures to mitigate or minimise potential adverse psychological effects and improve, restore and preserve the well-being of the workforce now and for years to come. The purpose of this review is to review available literature on strategies for minimising the psychological impact of the COVID-19 pandemic on clinicians and to identify pro-active holistic approaches which may be beneficial for healthcare workers both for the current crisis and into the future.
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Affiliation(s)
- C Heath
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia
| | - A Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Department of Peri-operative Medicine, Telethon Kids Institute, Perth, WA, Australia
| | - B S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
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Vainiomäki S, Heponiemi T, Vänskä J, Hyppönen H. Tailoring EHRs for Specific Working Environments Improves Work Well-Being of Physicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134715. [PMID: 32630043 PMCID: PMC7369852 DOI: 10.3390/ijerph17134715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022]
Abstract
Electronic health records (EHRs) have an impact on physicians’ well-being and stress levels. We studied physicians’ experiences with EHRs and their experienced time pressure and self-rated stress by an electronic questionnaire sent to Finnish physicians aged under 65 in 2017. Our sample was 2980 physicians working in the public sector, health care centers (35.5%) or hospitals (64.5%). Experienced technical problems were positively associated with experienced time pressure, whereas user-friendliness of the EHRs was negatively associated with experienced time pressure. Low perceived support for internal cooperation was associated with high levels of time pressure in hospitals. Those experiencing high levels of technical problems were 1.3 times more likely to experience stress compared to those experiencing low levels of technical problems. Better user-friendliness of the EHRs was associated with lower levels of self-rated stress. In both working environments but more strongly in primary health care, technical problems were associated with self-rated stress. Technical problems and user-friendliness of EHRs are the main factors associated with time pressure and self-rated stress. Health care environments differ in the nature of workflow having different demands on the EHRs. Developing EHR systems should consider the special needs of different environments and workflows, enabling better work well-being amongst physicians.
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Affiliation(s)
- Suvi Vainiomäki
- Department of Clinical Medicine, University of Turku, 20014 Turku, Finland
- Turku Welfare Division, 20100 Turku, Finland
- Correspondence: ; Tel.: +358-407-517-471
| | - Tarja Heponiemi
- Department of Health and Social Care Systems, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (T.H.); (H.H.)
| | - Jukka Vänskä
- Finnish Medical Association, 00271 Helsinki, Finland;
| | - Hannele Hyppönen
- Department of Health and Social Care Systems, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (T.H.); (H.H.)
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Santosa A, Cross G, Oon JEL, Archuleta S, Dan YY. Coronavirus 2019 Silver Linings. Open Forum Infect Dis 2020; 7:ofaa230. [PMID: 32617382 PMCID: PMC7313805 DOI: 10.1093/ofid/ofaa230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/09/2020] [Indexed: 11/15/2022] Open
Abstract
A heightened state of alert due to the Coronavirus Disease 2019 (COVID-19) outbreak was declared by the Singapore Ministry of Health on February 7, 2020. Within the hospital, team reorganizations, workflow revisions, and physical segregation caused anxiety among healthcare workers (HCWs). Fear of the unknown and emotional and physical fatigue started to take their toll on HCWs. We share our learning journey over the first 8 weeks of COVID-19: the importance of acknowledging fears and questions, and transforming them to collective knowledge; the role of empathic, hands-on leadership that brings camaraderie and calms scepticism; the importance of validating efforts and acknowledging hardship; and, most importantly, the security that comes from camaraderie, breaking down hierarchical barriers, and motivating each other to keep on going.
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Affiliation(s)
- Amelia Santosa
- Department of Medicine, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gail Cross
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jolene Ee Ling Oon
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sophia Archuleta
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yock Young Dan
- Division of Gastroenterology & Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Recovery experiences mediate the effect of burnout on life satisfaction among Chinese physicians: a structural equation modeling analysis. Int Arch Occup Environ Health 2020; 94:31-41. [PMID: 32488352 DOI: 10.1007/s00420-020-01554-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/27/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Recovery experiences not only make it possible for individuals to restore their energy resources and return to pre-stressor levels but also contribute to the formation of their subjective well-being. This paper investigates the effect of burnout on life satisfaction among Chinese physicians who are frequently confronted with a considerable number of work-related stressors and examines the mediating role of recovery experiences in the relationship between burnout and life satisfaction. METHODS A total of 642 physicians working in five public tertiary hospitals in China responded to a self-administered questionnaire including demographic information, the Satisfaction with Life Scale, the Maslach Burnout Inventory-General Scale, and the Recovery Experience Questionnaire. Hierarchical multiple regression analysis was conducted to test the incremental variance of any given set of independent variables. Structural equation modeling was employed to test the presumed relationships between variables involved. Asymptotic and resampling strategies were used to examine the mediating effects of recovery experiences in the relationship between burnout and life satisfaction. RESULTS Burnout and recovery experiences were important predictors of life satisfaction and the direct effect of burnout on life satisfaction was statistically significant and negative and the path coefficients of burnout with life satisfaction were significantly decreased when recovery experiences were modeled as mediators. CONCLUSION Findings of the study highlight the importance of promoting recovery experiences to reduce burnout and improve life satisfaction among physicians rather than focusing on the less easily modifiable work-related stressors.
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Tung YC, Chou YY, Chang YH, Chung KP. Association of intrinsic and extrinsic motivating factors with physician burnout and job satisfaction: a nationwide cross-sectional survey in Taiwan. BMJ Open 2020; 10:e035948. [PMID: 32161163 PMCID: PMC7066621 DOI: 10.1136/bmjopen-2019-035948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The aim of this study was to systematically and simultaneously examine the association of intrinsic and extrinsic motivating factors with physician burnout and job dissatisfaction. DESIGN A nationally representative survey was fielded from September to November 2017. SETTING Hospitals and clinics throughout Taiwan. PARTICIPANTS A total of 6674 physicians. MAIN EXPOSURE MEASURE The main exposure measures were intrinsic motivators (sense of calling, personally rewarding hours per day and meaningful, long-term relationships with patients) and extrinsic motivators (income, work hours, autonomy, and pay-for-performance (P4P) and bundled payment initiatives). MAIN OUTCOME MEASURES The main outcome measures were physician burnout and job dissatisfaction. RESULTS A total of 1152 physicians returned the surveys. More sense of calling and personally rewarding hours per day were associated with less physician burnout (OR 0.16, 95% CI 0.10 to 0.26 and OR 0.25, 95% CI 0.13 to 0.47, respectively) and job dissatisfaction (OR 0.35, 95% CI 0.21 to 0.57 and OR 0.46, 95% CI 0.26 to 0.83, respectively). Longer work hours were associated with more physician burnout (OR 2.67, 95% CI 1.54 to 4.63) and job dissatisfaction (OR 1.71, 95% CI 1.05 to 2.79). Not receiving P4P bonuses from their organisations was associated with more physician burnout (OR 1.56, 95% CI 1.02 to 2.38). Not sharing the losses from caring for patients included in the bundled payment system was associated with less physician burnout (OR 0.59, 95% CI 0.36 to 0.97). CONCLUSIONS Fostering a healthcare work environment that supports intrinsic motivation and improves work hours may reduce physician burnout and job dissatisfaction. Rewarding physicians fairly and equitably may prevent them from feeling burned out. Value-based care delivery and payment model innovations, such as bundled payments, may encourage healthcare professionals to coordinate care through the standardisation of care to decrease burnout.
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Affiliation(s)
- Yu-Chi Tung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ying-Yi Chou
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsuan Chang
- Planning Division, National Health Insurance Administration, Taipei, Taiwan
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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van der Goot WE, Cristancho SM, de Carvalho Filho MA, Jaarsma ADC, Helmich E. Trainee-environment interactions that stimulate motivation: A rich pictures study. MEDICAL EDUCATION 2020; 54:242-253. [PMID: 31885121 PMCID: PMC7065236 DOI: 10.1111/medu.14019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/19/2019] [Accepted: 10/02/2019] [Indexed: 05/15/2023]
Abstract
CONTEXT Staying motivated when working and learning in complex workplaces can be challenging. When complex environments exceed trainees' aptitude, this may reduce feelings of competence, which can hamper motivation. Motivation theories explain how intrapersonal and interpersonal aspects influence motivation. Clinical environments include additional aspects that may not fit into these theories. We used a systems approach to explore how the clinical environment influences trainees' motivation and how they are intertwined. METHODS We employed the rich pictures drawing method as a visual tool to capture the complexities of the clinical environment. A total of 15 trainees drew a rich picture representing a motivating situation in the workplace and were interviewed afterwards. Data collection and analysis were performed iteratively, following a constructivist grounded theory approach, using open, focused and selective coding strategies as well as memo writing. Both drawings and the interviews were used to reach our results. RESULTS Trainees drew situations pertaining to tasks they enjoyed doing and that mattered for their learning or patient care. Four dimensions of the environment were identified that supported trainees' motivation. First, social interactions, including interpersonal relationships, supported motivation through close collaboration between health care professionals and trainees. Second, organisational features, including processes and procedures, supported motivation when learning opportunities were provided or trainees were able to influence their work schedule. Third, technical possibilities, including tools and artefacts, supported motivation when tools were used to provide trainees with feedback or trainees used specific instruments in their training. Finally, physical space supported motivation when the actual setting improved the atmosphere or trainees were able to modify the environment to help them focus. CONCLUSIONS Different clinical environment dimensions can support motivation and be modified to create optimal motivating situations. To understand motivational dynamics and support trainees to navigate through postgraduate medical education, we need to take all clinical environment dimensions into account.
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Affiliation(s)
- Wieke E. van der Goot
- Martini AcademieMartini HospitalGroningenthe Netherlands
- Center for Education Development and Research in health professions (CEDAR)Lifelong Learning, Education and Assessment Research Network (LEARN)University of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Sayra M. Cristancho
- Schulich School of Medicine and DentistryUniversity of Western OntarioLondonOntarioCanada
| | - Marco Antonio de Carvalho Filho
- Center for Education Development and Research in health professions (CEDAR)Lifelong Learning, Education and Assessment Research Network (LEARN)University of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
- Department of Emergency MedicineSchool of Medical SciencesUniversity of CampinasCampinasBrazil
| | - A. Debbie C. Jaarsma
- Center for Education Development and Research in health professions (CEDAR)Lifelong Learning, Education and Assessment Research Network (LEARN)University of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Esther Helmich
- Center for Education Development and Research in health professions (CEDAR)Lifelong Learning, Education and Assessment Research Network (LEARN)University of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
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Fischer JP, Clinite K, Sullivan E, Jenkins TM, Bourne CL, Chou C, Diemer G, Dunne D, Hartung PJ, Paauw D, Reddy S. Specialty and Lifestyle Preference Changes during Medical School. MEDICAL SCIENCE EDUCATOR 2019; 29:995-1001. [PMID: 34457576 PMCID: PMC8368833 DOI: 10.1007/s40670-019-00790-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
PURPOSE Medical student specialty choices have significant downstream effects on the availability of physicians and, ultimately, the effectiveness of health systems. This study investigated how medical student specialty preferences change over time in relation to their demographics and lifestyle preferences. METHOD Students from ten medical schools were surveyed at matriculation (2012) and graduation (2016). The two surveys included questions about specialty and lifestyle preferences, demographics, educational background, and indebtedness. Student data from 2012 to 2016 were paired together and grouped into those whose specialty preferences remained constant or switched. RESULTS Response rates in 2012 and 2016 were 65% (997/1530) and 50% (788/1575), respectively. Fourth-year students ranked "enjoying the type of work I am doing" as less important to a good physician lifestyle than did first-year students (from 59.6 to 39.7%). The lifestyle factors "having control of work schedule" and "having enough time off work" were ranked as more important to fourth-year students than first-year students (from 15.6 to 18.2% and 14.8 to 31.9%, respectively). The paired dataset included 19% of eligible students (237/1226). Demographic and lifestyle factors were not significantly associated with specialty preference switching. Additionally, no significant association existed between changing lifestyle preferences and switching specialty preference (p = 0.85). CONCLUSIONS During the course of medical school, lifestyle preferences became more focused on day-to-day factors and less on deeper motivational factors. Neither demographics nor lifestyle preferences appear to relate to a student's decision to switch specialty preference during medical school. These findings represent an important step in uncovering causes of specialty preference trends.
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Affiliation(s)
- Jonathan P. Fischer
- University of Chicago Pritzker School of Medicine, 924 E 57th St., Suite 104, Chicago, IL 60637 USA
| | - Kimberly Clinite
- Santa Rosa Family Medicine Residency, University of California, San Francisco, San Francisco, CA USA
| | - Eric Sullivan
- University of Chicago Pritzker School of Medicine, 924 E 57th St., Suite 104, Chicago, IL 60637 USA
| | - Tania M. Jenkins
- Department of Sociology, University of North Carolina- Chapel Hill, Chapel Hill, NC USA
| | - Christina L. Bourne
- Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC USA
| | - Calvin Chou
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA USA
| | - Gretchen Diemer
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA USA
| | - Dana Dunne
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT USA
| | - Paul J. Hartung
- Department of Family & Community Medicine, Northeast Ohio Medical University, Rootstown, OH USA
| | - Doug Paauw
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA USA
| | - Shalini Reddy
- Department of Medicine, Cook County Hospital and Health System, Chicago, IL USA
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Gogo A, Osta A, McClafferty H, Rana DT. Cultivating a way of being and doing: Individual strategies for physician well-being and resilience. Curr Probl Pediatr Adolesc Health Care 2019; 49:100663. [PMID: 31564630 DOI: 10.1016/j.cppeds.2019.100663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The practice of medicine is rewarding on many levels, but demands of the work can result in mental and emotional exhaustion, self-isolation, burnout, depression, suicidal ideation and tragically, completed suicide. It is critical to have effective strategies to address the unique stressors of a medical career, mitigate burnout, and buffer the physiologic toll of chronic stress. Using Zwack and Schweitzer's widely published description of approaches to maintaining resilience and approaches to wellness, we have organized these strategies into three broad domains relevant to medical practice: (1) gratification (connection and communication, meaning and purpose); (2) resilience building practices (self-reflection, time for oneself, self-compassion, spirituality); and (3) useful attitudes (acceptance, flexibility, self-awareness). Several techniques are described including mindfulness-based stress reduction, narrative medicine, skillful communication, and practices in self-compassion, gratitude, and spirituality. The focus of the work is to introduce a spectrum of resilience strategies for individual consideration that can be tailored and combined to meet a physician's changing needs over the course of medical training and practice.
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Affiliation(s)
- Albina Gogo
- Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, California, United States.
| | - Amanda Osta
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, Illinois, United States
| | - Hilary McClafferty
- Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Deborah T Rana
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, San Diego, California, United States
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Serwint JR, Stewart MT. Cultivating the joy of medicine: A focus on intrinsic factors and the meaning of our work. Curr Probl Pediatr Adolesc Health Care 2019; 49:100665. [PMID: 31582295 DOI: 10.1016/j.cppeds.2019.100665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Physician burnout is at epidemic levels. In our role as healers, the concepts of humanism and relief of suffering are central themes in our work, yet burnout and depersonalization can threaten these values. While working to mitigate burnout, we need to move towards a focus on health and well-being and develop preventive strategies to cultivate resilience. This manuscript discusses the intrinsic factors that motivate us to be physicians: medicine as a calling, finding meaning in our work, and seeking joy in practice. Some strategies that enhance our resilience will be discussed including individual reflective practices, in addition to organizational strategies such as creating team mission statements, and participating in debriefing, Balint groups, and Schwartz Rounds. All of these practices provide opportunities to acknowledge the emotional impact of our care of patients and to focus on our values and the meaning of our work. Strategies to cultivate joy in practice are presented alongside a framework from the Institute for Healthcare Improvement to guide organizations.
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Affiliation(s)
- Janet R Serwint
- Department of Pediatrics, Charlotte Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Miriam T Stewart
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Affiliation(s)
- Paria M Wilson
- Division of Emergency Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Maneesh Batra
- Department of Pediatrics, Division of Neonatology, Seattle Children's Hospital and the University of Washington, Seattle, WA
| | | | - John D Mahan
- The Ohio State University, Columbus, OH.,Department of Pediatrics, Division of Nephrology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Betty B Staples
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Janet R Serwint
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Song KW, Kim HK. Job stress and its related factors among Korean dentists: An online survey study. Int Dent J 2019; 69:436-444. [PMID: 31388997 DOI: 10.1111/idj.12513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aims of this study were to investigate the dentists' job-related stress using the newly developed Dentist Job Stress (DJS) questionnaire, and to explore the relationships among sociodemographic factors, job stress and mental health indicators, including psychosocial stress, depression, anxiety and sleep among Korean dentists. MATERIALS AND METHODS An online survey including 1,520 dentists was conducted using the Brief Encounter Psychological Instrument-Korean version (BEPSI-K), the Center for Epidemiologic Studies Depression Scale (CES-D), the State-Trait Anxiety Index (STAI) and the Pittsburgh Sleep Quality Index (PSQI). RESULTS The response rate was 15.2% (n = 231). The DJS questionnaire consisted of environmental and vocational factors, and Cronbach's α coefficient was 0.69. Dentists' job stress was significantly associated with income (P = 0.0230), work time (P = 0.0009) and job satisfaction (P < 0.0001). A bivariate correlation study revealed that the BEPSI-K, CES-D, STAI-S and PSQI exhibited a significant correlation with the DJS scale. Multiple regression analysis found that depression, job satisfaction and sleep quality were associated with dentists' job stress, and this model accounted for 37.9% of the variation in the DJS scale (P < 0.0001). CONCLUSIONS The findings of this study revealed that the DJS questionnaire showed acceptable validity and reliability, and dentists' job stress was associated with depression, job satisfaction and sleep quality. The major implication of this study is that a stress-management programme focusing on practical ways to improve the mental health status and job satisfaction of dentists is critical to the reduction of occupational stress among Korean dentists.
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Affiliation(s)
| | - Hye-Kyoung Kim
- Department of Oral Medicine, College of Dentistry, Dankook University, Cheonan, Korea
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Job satisfaction and guideline adherence among physicians: Moderating effects of perceived autonomy support and job control. Soc Sci Med 2019; 233:208-217. [DOI: 10.1016/j.socscimed.2019.04.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022]
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Green IC, Ainsworth AJ, Riddle J, Finnie DM, Chou B. Choosing a women's health career. BMC MEDICAL EDUCATION 2018; 18:251. [PMID: 30400940 PMCID: PMC6220517 DOI: 10.1186/s12909-018-1362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/26/2018] [Indexed: 05/13/2023]
Abstract
BACKGROUND In 2005, in response to a decline in residency applications in obstetrics and gynecology (OB GYN), the American College of Obstetrics and Gynecology Presidential Task Force outlined strategies for attracting medical students to OB GYN. Application rates have increased since then, but little is known about which interventions are effective. We aimed to identify modifiable and nonmodifiable variables that may contribute to students choosing OB GYN for their careers; this information could be used to inform curriculum design, faculty development, and innovative exposures to women's health. METHODS This qualitative study received institutional review board approval. Eligible participants were students who applied or recently matched into OB GYN residency programs from the class of 2014-2016 at our institution. Students were interviewed with open-ended questions and a Likert-type survey. Thematic analysis was performed. RESULTS Ten qualitative interviews were completed and analyzed. Intrinsic themes such as the potential for a meaningful job in women's health, advocacy for women, or empowerment of women were identified as factors contributing to participant career choice. Extrinsic themes such as positive impressions during the clinical clerkship and welcoming teams were also identified. Most students indicated that the clerkship was the most influential experience. CONCLUSIONS Participants identified important events, including some that even preceded medical school that guided them toward OB GYN. The data guide us to consider the importance of emphasizing the unique combination of characteristics in OB GYN and improving the learning environment in the clerkship as a way to encourage student recruitment.
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Affiliation(s)
- Isabel C. Green
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Alessandra J. Ainsworth
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Julia Riddle
- Department of Psychiatry, Johns Hopkins Hospital, Baltimore, MD USA
| | - Dawn M. Finnie
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Betty Chou
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD USA
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Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, Mata DA. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA 2018; 320:1131-1150. [PMID: 30326495 PMCID: PMC6233645 DOI: 10.1001/jama.2018.12777] [Citation(s) in RCA: 926] [Impact Index Per Article: 154.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022]
Abstract
Importance Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown. Objective To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout. Data Sources and Study Selection Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018. Data Extraction and Synthesis Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively. Main Outcomes and Measures Point or period prevalence of burnout assessed by questionnaire. Results Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined. Conclusions and Relevance In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.
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Affiliation(s)
- Lisa S. Rotenstein
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Brigham Education Institute, Boston, Massachusetts
| | - Matthew Torre
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Marco A. Ramos
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Rachael C. Rosales
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor
| | - Douglas A. Mata
- Harvard Medical School, Boston, Massachusetts
- Brigham Education Institute, Boston, Massachusetts
- Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
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Callahan K, Christman G, Maltby L. Battling Burnout: Strategies for Promoting Physician Wellness. Adv Pediatr 2018; 65:1-17. [PMID: 30053918 DOI: 10.1016/j.yapd.2018.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Kelly Callahan
- Department of Pediatrics, Harbor-UCLA Medical Center, UCLA David Geffen School of Medicine, 1000 West Carson Street, Box 460, Torrance, CA 90502, USA.
| | - Grant Christman
- Department of Pediatrics, Children's Hospital Los Angeles, USC Keck School of Medicine, 4650 Sunset Boulevard #94, Los Angeles, CA 90027, USA
| | - Lauren Maltby
- Department of Pediatrics, Harbor-UCLA Medical Center, UCLA David Geffen School of Medicine, 1000 West Carson Street, Box 460, Torrance, CA 90502, USA
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Huber MT, Ham SA, Qayyum M, Akkari L, Olaosebikan T, Abraham J, Yoon JD. Association between Job Factors, Burnout, and Preference for a New Job: a Nationally Representative Physician Survey. J Gen Intern Med 2018; 33:789-791. [PMID: 29582255 PMCID: PMC5975173 DOI: 10.1007/s11606-018-4412-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael T Huber
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5000, Chicago, IL, 60637, USA
| | - Sandra A Ham
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA
| | - Muneeba Qayyum
- Department of Medicine, Mercy Hospital and Medical Center, Chicago, IL, USA
| | - Lana Akkari
- Department of Medicine, Mercy Hospital and Medical Center, Chicago, IL, USA
| | | | - Joseph Abraham
- Department of Medicine, Mercy Hospital and Medical Center, Chicago, IL, USA
| | - John D Yoon
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5000, Chicago, IL, 60637, USA.
- Department of Medicine, Mercy Hospital and Medical Center, Chicago, IL, USA.
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Murali K, Makker V, Lynch J, Banerjee S. From Burnout to Resilience: An Update for Oncologists. Am Soc Clin Oncol Educ Book 2018; 38:862-872. [PMID: 30231394 DOI: 10.1200/edbk_201023] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Physician burnout remains a highly complex and topical issue. The negative impact of burnout on physicians, patients, and institutions has become increasingly apparent. Globally, a multitude of professional bodies and organizational leaders are giving this important subject much-deserved attention. In this review, we provide a summary of the latest evidence, with a focus on solutions and future strategies, while incorporating our own perspectives as practicing oncologists.
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Affiliation(s)
- Krithika Murali
- From The Royal Marsden NHS Foundation Trust, London, United Kingdom; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; College of Medicine, University of Florida, Gainesville, FL; Institute of Cancer Research, London, United Kingdom
| | - Vicky Makker
- From The Royal Marsden NHS Foundation Trust, London, United Kingdom; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; College of Medicine, University of Florida, Gainesville, FL; Institute of Cancer Research, London, United Kingdom
| | - James Lynch
- From The Royal Marsden NHS Foundation Trust, London, United Kingdom; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; College of Medicine, University of Florida, Gainesville, FL; Institute of Cancer Research, London, United Kingdom
| | - Susana Banerjee
- From The Royal Marsden NHS Foundation Trust, London, United Kingdom; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; College of Medicine, University of Florida, Gainesville, FL; Institute of Cancer Research, London, United Kingdom
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Hester CN, Tsai JW. Saving Ourselves, Our Patients, and Our Profession: Making the Case for Narrative Competence in Pediatrics. Acad Pediatr 2018; 18:243-247. [PMID: 29269032 DOI: 10.1016/j.acap.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Casey N Hester
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
| | - Jessica W Tsai
- Boston Combined Residency Program in Pediatrics, Boston Children's Hospital, Boston Medical Center, Boston, Mass
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