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Slovin A, Bora S, Barber JR, Kloster HM, Rogers SR, Green CM, Selbst SM, Kemper KJ, Serwint JR, Garg A, Lim SW. Meaningful Work, Career Fit, and Professional Well-Being of Pediatric Academicians in the United States. Hosp Pediatr 2024; 14:364-373. [PMID: 38596849 DOI: 10.1542/hpeds.2022-007080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Examine associations between time spent in academic activities perceived as meaningful and professional well-being among academic pediatrics faculty. METHODS The sample comprised 248 full-time pediatric faculty (76% female, 81% white, non-Hispanic, 41% instructor or assistant professor) across the United States who completed an online survey in November 2019. Survey items included sociodemographic and professional characteristics, professional well-being measures (Stanford Professional Fulfillment Index; Maslach Burnout Inventory; Intention to Leave Academic Medicine), perceived meaningfulness of academic activities and assigned time to those activities. We defined global career fit as total percentage time assigned to professional activities considered meaningful by individuals, and activity-specific career fit as percentage time assigned to each meaningful professional activity. RESULTS As global career fit scores increased, professional fulfillment increased (r = 0.45, P < .001), whereas burnout (r = -0.29, P < .001) and intention to leave (r = -0.22, P < .001) decreased. Regarding activity-specific career fit, for individuals who considered patient care meaningful, as assigned time to patient care increased, professional fulfillment decreased (r = -0.14, P = .048) and burnout (r = 0.16, P = .02) and intention to leave (r = 0.26, P < .001) increased. There was no significant correlation between assigned time for teaching, research, or advocacy and professional well-being. Faculty were less likely to intend to leave academic medicine as assigned time increased for administrative or leadership activities if considered meaningful (r = -0.24, P = .01). CONCLUSIONS Time assigned to meaningful work activities may relate to professional well-being of academic pediatrics faculty. More time assigned to patient care, despite being meaningful, was associated with poor self-reported professional well-being. Effort allocation among diverse academic activities needs to be optimized to improve faculty well-being.
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Affiliation(s)
- Ariella Slovin
- Division of General Pediatrics, Children's National Medical Center, Washington, District of Columbia
| | - Samudragupta Bora
- Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - John R Barber
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Heidi M Kloster
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stephen R Rogers
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cori M Green
- Department of Pediatrics, Weill Cornell Medicine, New York, New York
| | - Steven M Selbst
- Division of Emergency Medicine, Nemours Children's Hospital, Wilmington, Delaware Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kathi J Kemper
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Janet R Serwint
- Division of General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children's Medical Center, Worcester, Massachussetts; and
| | - Sylvia W Lim
- Division of Academic General Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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2
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Lee H, Going M, Tivnan V, Tollefson M, Comander A, Frates E. Restoring Well-Being for Physicians Through Lifestyle Medicine. Am J Lifestyle Med 2024; 18:260-268. [PMID: 38559786 PMCID: PMC10979729 DOI: 10.1177/15598276231194290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
In the wake of the COVID-19 pandemic, physician burnout is a more relevant concern than ever. Pre-existing stressors in health care, such as poor work-life balance, perfectionism, and inadequate social support, have been exacerbated by uncertainty, increased risk exposure, and general anxiety. Burnout places not only physicians, but also patients, systems, and communities at risk. The promotion of physician well-being is critical to sustaining the health care system. Actions to reduce burnout and increase well-being can and should occur on multiple levels. Organizations and leaders must take steps to create a culture of support and respect for health care providers. Such steps may include improved time-off policies, destigmatizing the use of mental health services, and reducing administrative burden. Physician well-being may benefit from action on an individual level as well. The pillars of Lifestyle Medicine provide a framework for engaging in behaviors compatible with overall well-being, such as physical activity, social connection, and sleep. Lifestyle Medicine plays a key role in mitigating the impact of physician burnout, and will be essential to the success of the health care system moving forward.
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Affiliation(s)
- Hannah Lee
- Massachusetts General Hospital Cancer Center, Boston, MA, USA (HL, AC)
| | - Michelle Going
- Metropolitan State University of Denver, Denver, CO, USA (MG, MT)
| | | | | | - Amy Comander
- Massachusetts General Hospital Cancer Center, Boston, MA, USA (HL, AC)
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3
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Peteet JR. The Moral Dimension of Mental Health Treatment. J Psychiatr Pract 2024; 30:157-161. [PMID: 38526404 DOI: 10.1097/pra.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Patients regularly bring value-laden concerns to treatment, but clinicians are often unsure about what role to play in their patients' moral lives. Addressing problems in moral functioning depends on assessing how individuals are accomplishing basic moral tasks: developing moral commitments, making moral decisions, implementing these decisions, assessing the correspondence between their ideals and behavior, dealing effectively with moral failure, and developing morally admirable character traits, or virtues. Clarity about the moral dimension of clinical work is important for shaping the direction of treatment, achieving clinical aims, and engaging the moral challenges that clinicians face.
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Affiliation(s)
- John R Peteet
- PETEET: Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
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4
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Tartaglia A, White KB, Corson T, Charlescraft A, Johnson T, Jackson-Jordan E, Fitchett G. Supporting staff: The role of health care chaplains. J Health Care Chaplain 2024; 30:60-73. [PMID: 36520544 DOI: 10.1080/08854726.2022.2154107] [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: 12/23/2022]
Abstract
The aim of this study was to describe the range of spiritual care activities in support of clinical colleagues at a subset of U.S. hospitals. A descriptive cross-sectional design using a 76-item Zoom/telephone guided survey containing a subset of staff care questions was employed. Data were provided by directors/managers responsible for spiritual care services at the 2020-2021 U.S. News & World Report top hospitals. Results identified staff support as an important chaplaincy function at both organizational and spiritual care department levels. Staff chaplains at over half of the hospitals spend an estimated 10-30% of their time on staff care, with chaplains in five hospitals spending greater than 30%. The most frequently reported activities were religiously associated, such as blessings and rituals for hospital events. Additionally, chaplains actively support staff during critical events such as patient deaths and through organizational protocols such as code lavender and critical incident debriefings. Chaplain support for staff most commonly grew out of personal relationships or referrals from clinical managers. Future research opportunities in this area include systematic data collection for chaplains' specific staff support activities as well as efforts to investigate the impact of those activities on patient experience.
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Affiliation(s)
- Alexander Tartaglia
- Patient Counseling, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Kelsey B White
- Patient Counseling, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Tyler Corson
- Adjunct Faculty, College of Health Sciences, Rush University, Chicago, IL, USA
| | - Ann Charlescraft
- Retired Faculty, Patient Counseling, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Tricia Johnson
- Professor, Health Systems Management, College of Health Sciences, Rush University Chicago, IL, USA
| | | | - George Fitchett
- Professor, Religion, Health and Human Values, College of Health Sciences, Rush University, Chicago, IL, USA
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5
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Dobrowolski J, Chreim S, Yaya S, Ramlawi S, Dingwall-Harvey ALJ, El-Chaâr D. Occupational stressors and coping mechanisms among obstetrical nursing staff during the COVID-19 pandemic: a qualitative study. BMC Nurs 2023; 22:384. [PMID: 37845635 PMCID: PMC10577898 DOI: 10.1186/s12912-023-01557-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Due to heightened occupational stress throughout the COVID-19 pandemic, hospital nurses have experienced high rates of depression, anxiety, and burnout. Nurses in obstetrical departments faced unique challenges, such as the management of COVID-19 infection in pregnancy with limited evidence-based protocols and the unknown risks of the virus on pregnancy and fetal development. Despite evidence that obstetrical nurses have experienced high levels of job stress and a decrease in job satisfaction during the COVID-19 pandemic, there is less known about the working conditions resulting in these changes. Using the Job Demands-Resources (JD-R) model, this study aims to offer insight into the COVID-19 working environment of obstetrical nurses and shed light on their COVID-19 working experiences. METHODS The study was conducted using a qualitative approach, with data collection occurring through semi-structured interviews from December 2021 to June 2022. A total of 20 obstetrical nurses recruited from the obstetrical departments of a tertiary hospital located in Ontario, Canada, participated in the study. Interviews were audio-recorded, transcribed verbatim, and coded using NVivo. Data was analyzed using a theoretical thematic approach based on the JD-R model. RESULTS Four themes were identified: (1) Job stressors, (2) Consequences of working during COVID-19, (3) Personal resources, and (4) Constructive feedback surrounding job resources. The findings show that obstetrical nurses faced several unique job stressors during the COVID-19 pandemic but were often left feeling inadequately supported and undervalued by hospital upper management. However, participants offered several suggestions on how they believe support could have been improved and shared insight on resources they personally used to cope with job stress during the pandemic. A model was created to demonstrate the clear linkage between the four main themes. CONCLUSIONS This qualitative study can help inform hospital management and public policy on how to better support and meet the needs of nurses working in obstetrical care during pandemics. Moreover, applying the JD-R model offers both a novel and comprehensive look at how the COVID-19 hospital work environment has influenced obstetrical nurses' well-being and performance.
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Affiliation(s)
- Julia Dobrowolski
- Telfer School of Management, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
| | - Serine Ramlawi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Alysha L J Dingwall-Harvey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Darine El-Chaâr
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Canada.
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
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Al Sad S, Padela AI. Career Satisfaction and Burnout among American Muslim Physicians. Avicenna J Med 2023; 13:117-129. [PMID: 37483993 PMCID: PMC10361258 DOI: 10.1055/s-0043-1770701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background Career satisfaction and burnout among physicians are important to study because they impact healthcare quality, outcomes, and physicians' well-being. Relationships between religiosity and these constructs are underexplored, and Muslim American physicians are an understudied population. Methods To explore relationships between career satisfaction, burnout, and callousness and Muslim physician characteristics, a questionnaire including measures of religiosity, career satisfaction, burnout, callousness, and sociodemographic characteristics was mailed to a random sample of Islamic Medical Association of North America members. Statistical relationships were explored using chi-squared tests and logistic regression models. Results There were 255 respondents (41% response rate) with a mean age of 52 years. Most (70%) were male, South Asian (70%), and immigrated to the United States as adults (65%). Nearly all (89%) considered Islam the most or very important part of their life, and 85% reported being somewhat or very satisfied with their career. Multivariate models revealed that workplace accommodation of religious identity is the strongest predictor of career satisfaction (odds ratio [OR]: 2.69, p = 0.015) and that respondents who considered religious practice to be the most important part of their lives had higher odds of being satisfied with their career (OR: 2.21, p = 0.049) and lower odds of burnout (OR: 0.51, p = 0.016). Participants who felt that their religion negatively influenced their relationships with colleagues had higher odds of callousness (OR: 2.25, p = 0.003). Conclusions For Muslim physicians, holding their religion to be the most important part of their life positively associates with career satisfaction and lower odds of burnout and callousness. Critically, perceptions that one's workplace accommodates a physician's religious identity associate strongly with career satisfaction. In this era of attention to physician well-being, the importance of religiosity and religious identity accommodations to positive career outcomes deserves focused policy attention.
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Affiliation(s)
- Sondos Al Sad
- Initiative on Islam and Medicine, Brookfield, Wisconsin, United States
| | - Aasim I. Padela
- Initiative on Islam and Medicine, Brookfield, Wisconsin, United States
- Department of Emergency Medicine, HUB for Collaborative Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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7
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Bonvin S, Stiefel F, Gholam M, Bourquin C. Calling situated: a survey among medical students supplemented by a qualitative study and a comparison with a surveyed sample of physicians. BMC MEDICAL EDUCATION 2022; 22:619. [PMID: 35971124 PMCID: PMC9376571 DOI: 10.1186/s12909-022-03642-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Calling within the medical context receives growing academic attention and empirical research has started to demonstrate its beneficial effects. The purpose of this study is to investigate what motivates students to enter medical school and what role calling may play (i), to evaluate if calling influences the way in which they experience their studies (ii), and to compare medical students' experience of calling with those of physicians. METHODS A questionnaire survey was distributed among medical students (N = 1048; response rate above 60%) of the University of Lausanne in Switzerland. It was supplemented by a group discussion between bachelor medical students (N = 8) and senior physicians (N = 4), focusing on different facets of calling. An existing data set of a survey among physicians, addressing calling with the same questionnaire, was used to compare students' and physicians' attitudes towards calling. Survey data were analyzed with the habitual statistical procedures for categorical and continuous variables. The group discussion was analyzed with thematic analysis. RESULTS The survey showed that experiencing calling is a motivational factor for study choice and influences positively choice consistency. Students experiencing calling differed from those who did not: they attributed different definitions to calling, indicated more often prosocial motivational factors for entering medical school and perceived the learning context as less burdensome. The analysis of the group discussion revealed that the concept of calling has a fluid definition. It was conceived as having the characteristics of a double-edged sword and as originating from within or outside or from a dialectic interplay between the inner and outer world. Finally, calling is experienced less often by physicians than by medical students, with a decreasing prevalence as the immersion in the clinical years of the study of medicine progresses. CONCLUSIONS Calling plays an important role in study choice and consistency of medical students. Given its relevance for medical students and its ramifications with the learning context, calling should become a topic of the reflexive parts of the medical curriculum. We critically discuss the role played by calling for medical students and provide some perspectives on how calling could be integrated in the reflection and teaching on physicianhood.
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Affiliation(s)
- S Bonvin
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - F Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Gholam
- Center of Epidemiological Psychiatry and Psychopathology (CEPP), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Humayun S, Saleem S, Shabbir R, Shaheen S. “No Pain No Gain”: Presenteeism Evaluation Through Calling with Job Crafting as a Sensemaking Strategy. Psychol Res Behav Manag 2022; 15:1837-1851. [PMID: 35923162 PMCID: PMC9342708 DOI: 10.2147/prbm.s369764] [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: 04/06/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Researchers have a wide-ranging consensus on the negative side of presenteeism that leads to productivity loss; however, little is known about its flipside that has undertaken motivational factors as potential antecedents. This implicit gap is addressed by exploring a new perspective of presenteeism and proposing employees’ calling as its precursor with the help of self-determination theory (SDT). The mediating mechanism is explicated with job crafting by considering it a sensemaking strategy that offers a plausible explanation of the positive association between an employee’s calling and presenteeism. This research is an attempt to explore the positive side of presenteeism and generalize the presenteeism findings in another sector apart from the medical field, as this phenomenon is gaining widespread acceptance in HR literature. Methods The data were collected from 274 employees from the textile sector, and the hypotheses were tested using SmartPLS software. We collected time-lagged data from the textile sector employees of Pakistan. The individual-level data have been collected to test the relationship between calling, job crafting, and presenteeism. Results The results indicate the positive association between calling and presenteeism through direct and indirect paths. However, the mediating mechanism through two dimensions of job crafting, crafting challenging job demands and crafting social job resources, was not supported. Conclusion Drawing on SDT, we contribute to the literature by identifying calling as an antecedent of presenteeism. We propose and test the direct and indirect relationships between calling, job crafting, and presenteeism. Future researchers might attempt to test this model in different sectors like multinational companies, educational institutions, healthcare, retail, etc. The proposed relationships also lend themselves to be explicated with other mediators.
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Affiliation(s)
- Shazia Humayun
- Lyallpur Business School, Government College University Faisalabad, Faisalabad, Pakistan
| | - Sharjeel Saleem
- Lyallpur Business School, Government College University Faisalabad, Faisalabad, Pakistan
| | - Rizwan Shabbir
- Lyallpur Business School, Government College University Faisalabad, Faisalabad, Pakistan
- Correspondence: Rizwan Shabbir, Lyallpur Business School, Government College University Faisalabad, First Floor, Jinnah Block, GCUF New Campus, Jhang Road, Faisalabad, Punjab, 38000, Pakistan, Tel +92-334-5666556, Email ;
| | - Sadia Shaheen
- Lyallpur Business School, Government College University Faisalabad, Faisalabad, Pakistan
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Bykov KV, Zrazhevskaya IA, Topka EO, Peshkin VN, Dobrovolsky AP, Isaev RN, Orlov AM. Prevalence of burnout among psychiatrists: A systematic review and meta-analysis. J Affect Disord 2022; 308:47-64. [PMID: 35398112 DOI: 10.1016/j.jad.2022.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 02/20/2022] [Accepted: 04/02/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Burnout is a consequence of chronic occupational stress exposure. Psychiatrists are prone to burnout due to specific work-related factors. This study examined the burnout prevalence among psychiatrists. METHODS The study protocol was registered in PROSPERO (CRD42020204615). We searched MEDLINE, EMBASE, CENTRAL, PsycINFO, Web of Science, ClinicalTrials.gov, and OpenGrey for relevant publications. Random-effect meta-analysis was performed. We used subgroup analysis and meta-regression to reveal any association of geographical region, survey year, participants' age, gender, and response rate with burnout. RESULTS Thirty-six studies involving 5481 participants were included. The prevalence of overall burnout was 25.9% [11.1%-40.7%] as measured by a Maslach Burnout Inventory (MBI) and 50.3% [30.9%-69.8%] as measured by a Copenhagen Burnout Inventory (CBI). The pooled prevalence was 43.5% [27.9%-59%] for high emotional exhaustion (EE), 28.2% [17.5%-38.9%] for high depersonalization (DP), and 32.4% [3.4%-61.3%] for low personal accomplishment (PA). The mean scores of 22-item MBI subscales were 21.51 [18.64%-24.38%] for EE, 6.57 [5.53%-7.62%] for DP, and 31.83 [25.73%-37.94%] for PA. European psychiatrists revealed (p = 0.045) lower EE score (20.82; 95% CI 7.24-24.41) measured by 22-item MBI compared to their non-European colleagues (24.99; 95% CI 23.05-26.94). Other results include mean scores for 16-item MBI-General Survey, burnout rates, and scores in CBI subscales. LIMITATIONS The main limitation was high heterogeneity in terms of statistics, screening methods, burnout definitions, and cut-off points utilized in included studies. CONCLUSIONS Burnout is highly prevalent among psychiatrists. Future research should focus on finding consensus on burnout screening, longitudinal evaluation of psychiatrists' burnout predictors, and development of effective intervention strategies.
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Affiliation(s)
- Kirill V Bykov
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation.
| | - Inna A Zrazhevskaya
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Elvira O Topka
- Mental Hospital №13, Moscow Healthcare Department, Moscow, Russian Federation
| | - Valery N Peshkin
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
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10
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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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11
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Xu Q, Wang M, Wu Y, Qin K, Li Y, You X, Ji M. Linkage of calling and burnout among Chinese airline pilots: The role of psychological capital and organizational identification. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2022; 29:902-910. [PMID: 35659499 DOI: 10.1080/10803548.2022.2086756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. The burnout of airline pilots has an extremely adverse impact on their physical and mental state, work efficiency, and the safe operation of airlines, and is thus an important issue in occupational safety and health. Therefore, it is crucial to identify the factors that may reduce burnout among airline pilots. Drawing on conservation of resources theory, the present study investigates the relationships between calling, psychological capital, organizational identification and burnout in order to understand the mechanisms underlying pilot burnout. Method. A cross-sectional survey was conducted to measure calling, psychological capital, organizational identification and burnout among a sample consisting of 242 Chinese commercial airline pilots (Mage = 31.60 years, SDage = 6.44). Correlation analysis, mediation analysis and moderated analysis were conducted. Results. The results showed that calling has a direct and negative effect on pilot burnout, and an indirect effect on burnout through influencing psychological capital. Moreover, organizational identification was found to positively moderate the negative relationship between calling and pilot burnout. Conclusion. This study contributes to deepening the theoretical research on burnout, and provides empirical evidence for effective intervention in the burnout of airline pilots, which is beneficial to reduce pilot human error and ensure flight safety. Future research directions are also discussed.
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Affiliation(s)
- Quan Xu
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China.,Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China
| | - Mengyun Wang
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China.,Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China
| | - Yaoliang Wu
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China.,Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China.,Flight Department, China Eastern Airline Ltd. Anhui Branch, Hefei, Anhui 230031, China
| | - Kuiyuan Qin
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China.,Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China
| | - Yuan Li
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China.,Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China
| | - Xuqun You
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China.,Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China
| | - Ming Ji
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi 710062, China.,Shaanxi Provincial Key Laboratory of Behavior and Cognitive Neuroscience, Xi'an, Shaanxi 710062, China
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12
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The Conceptual Model of Role Stress and Job Burnout in Judges: The Moderating Role of Career Calling. LAWS 2022. [DOI: 10.3390/laws11030042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Judges are the central actors in the organization and functioning of the judicial system. Concerns about work efficiency, driven by the European Commission for the Efficiency of Justice, led countries to adopt a set of reforms in line with private sector ideals applied to the public field to better manage their financial and human resources. In the last decades, the Portuguese judicial system has undergone a reform based on New Public Management principles by adopting the new Law on the Organization of the Judiciary System (LOSJ), significantly altering judges’ duties, who beyond their traditional role of applying the law, perform the additional role of court-of-law judge-manager. The objective of this study is to explore the influence of role conflict and role ambiguity in occupational burnout among judges and to analyze the influence of calling orientation as a moderating variable, so as to present a conceptual model of role-stress management among the judiciary. Theoretically, this work contributes to the literature on role-stress management through its introduction of calling moderation, as well as to the literature on the positive influence of calling on burnout. In terms of its practical implications, the work contributes to a reconsideration of the current organizational structure of judicial work.
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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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Thriving among Primary Care Physicians: a Qualitative Study. J Gen Intern Med 2021; 36:3759-3765. [PMID: 34047922 PMCID: PMC8642558 DOI: 10.1007/s11606-021-06883-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/03/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND Burnout is high in primary care physicians and negatively impacts the quality of patient care. While many studies have evaluated burnout, there have been few which investigate those physicians who are satisfied with their careers and life-a phenomenon we term "thriving." OBJECTIVE To identify factors contributing to both career and life satisfaction through qualitative interviews. PARTICIPANTS The subjects were primary care physicians. APPROACH Qualitative interviews were performed between July 2018 and March 2020. Physicians were identified by snowball sampling and were asked to complete validated instruments to identify job/life satisfaction and lack of burnout. Semi-structured interviews were conducted, focused on aspects of participants' career and life which contributed to their thriving, including work environment, social networks, family life, institutional support, coping strategies, and extracurricular activities. Transcripts were analyzed using thematic content analysis using a grounded theory approach. MAIN MEASURES Personal, professional, and life factors that contributed to achieving career and life satisfaction in primary care physicians and potential solutions for burnout. RESULTS Thirty-two physicians were interviewed (9.4% family physicians, 9.4% combined internists-pediatricians, 40.6% internists, and 40.6% pediatricians) with a mean age 54.7 years and 23.8 years in practice. No physicians included met the criteria for burnout. All met the criteria for career and life satisfaction. Five themes were identified as critical to thriving: an intrinsic love for the work, a rich social network, a fulfilling doctor-patient relationship, a value-oriented belief system, and agency in the work environment. CONCLUSIONS Several factors contribute to professional fulfillment and life satisfaction among primary care physicians, which we propose as a model for physicians thriving. Some factors were intrinsic, such as having value-oriented beliefs and inherent love for medicine, while others were extrinsic, such as having a fulfilling social network. Barriers and opportunities to apply these lessons for the wider physician community are discussed.
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Honesty and Transparency, Indispensable to the Clinical Mission-Part III: How Leaders Can Prevent Burnout, Foster Wellness and Recovery, and Instill Resilience. Otolaryngol Clin North Am 2021; 55:83-103. [PMID: 34823722 DOI: 10.1016/j.otc.2021.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The hidden epidemic of burnout exacts a staggering toll on professionals and patients, reflected in increased risk of medical errors, complications, and staff turnover. For surgeons, nurses, and other team members working at the sharp end of care, adverse events can amplify work exhaustion, interpersonal disengagement, and risk of moral adversity. Visionary leaders are not content to mitigate burnout and moral injury; they elevate the human experience throughout health care by modeling wellness, fostering moral courage, promoting safety of professionals, and restoring joy in work. Part 3, Health Professional Wellness and Resilience, introduces the final pillar for advancing the clinical mission.
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Kelly EP, Myers B, Kelly-Brown J, Waterman BL, Stevens E, Pawlik TM. Spiritual Motivations to Practice Medicine: A Survey of Cancer Care Providers. Am J Hosp Palliat Care 2021; 39:1046-1051. [PMID: 34607493 DOI: 10.1177/10499091211049802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is increased interest in the role of spirituality in the cancer care context, but how it may inspire individuals to pursue a career as a healthcare provider is unknown. We sought to determine the relationship between intrinsic religiosity, religious identity, provider role, and spiritual motivations to practice medicine. METHODS A cross-sectional survey was administered to healthcare providers at a large, Midwest Comprehensive Cancer Center. The relationship between provider type, intrinsic religiosity, religious identity, and spiritual motivations to practice medicine was assessed with binary logistic regression. RESULTS Among 340 participants, most were female (82.1%) or Caucasian (82.6%) and identified as being religious (57.5%); median age was 35 years (IQR: 31-48). Providers included nurses (64.7%), physicians (17.9%), and "other" (17.4%). Compared with physicians, nurses were less likely to agree that they felt responsible for reducing pain and suffering in the world (OR: 0.12, p = 0.03). Similarly, "other" providers were less likely than physicians to believe that the practice of medicine was a calling (OR: 0.28, p = 0.02). Providers with a high self-reported intrinsic religiosity demonstrated a much greater likelihood to believe that the practice of medicine is a calling (OR:1.75, p = 0.001), as well as believe that personal R&S beliefs influence the practice of medicine (OR:3.57, p < 0.001). Provider religious identity was not associated with spiritual motivations to practice medicine (all p > 0.05). CONCLUSION Intrinsic religiosity had the strongest relationship with spiritual motivations to practice medicine. Understanding these motivations may inform interventions to avoid symptoms of provider burnout in cancer care.
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Affiliation(s)
| | - Brian Myers
- The Ohio State University, Columbus, OH, USA
| | | | - Brittany L Waterman
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erin Stevens
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 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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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: 4] [Impact Index Per Article: 1.3] [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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Crozier D, Greene A, Schleicher M, Goldfarb J. Teaching spirituality to medical students: a systematic review. J Health Care Chaplain 2021; 28:378-399. [PMID: 34137668 DOI: 10.1080/08854726.2021.1916332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Though it has become increasingly clear that religion and spirituality are important aspects of whole patient care, little is known about how this topic is taught to medical students. This systematic review examined the structure of courses teaching spirituality to medical students and assessed their impact on reported student outcomes. METHODS In October 2020, the authors conducted a systematic review of the literature from 1926 to 2020 to identify published articles describing medical school spirituality curricula. Included studies were English-language articles that described spirituality courses predominantly designed for medical students, specified a curricular structure, and evaluated outcomes of the course. The authors used the Medical Education Research Study Quality Instrument (MERSQI) to assess the quality of the included studies and summarized course structures, curricular content, and study outcomes. RESULTS Nineteen publications of the 1889 reviewed met the inclusion criteria. These studies were of moderate quality (mean MERSQI = 9.9). The majority of curricula were taught in United States medical schools. Courses were evenly split between mandatory versus elective classes, with mandatory courses having a shorter duration and higher total student participation. Most studies with clear student outcome evaluation had a pre- and post-test design. Common themes throughout the curricula included teaching how to take a spiritual history, delineating differences between spirituality and religion, and experience shadowing chaplains interacting with patients. CONCLUSIONS This broad systematic review of the literature revealed a small but growing number of studies describing specific course structure and curricula for teaching spirituality at the medical student level. For the most concise approach, one short, mandatory didactic session followed by application with standardized or hospital patients can be an effective method of introducing students to the importance of spirituality. Important topics to address include the differences between religion and spirituality, recognizing spiritual distress, how to take a spiritual history, and the relevance of spirituality to student well-being. Measured student outcomes should encompass behavioral changes during patient care in addition to changes in knowledge and attitudes. Suggested methods of evaluation include reflective writing and adding a standardized patient case in which the patient is in spiritual distress in an Objective Structured Clinical Examination (OSCE).
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Affiliation(s)
- Dena Crozier
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Amy Greene
- Center for Spiritual Care, Cleveland Clinic, Cleveland, OH, USA
| | - Mary Schleicher
- Floyd D. Loop Medical Library, Cleveland Clinic, Cleveland, OH, USA
| | - Johanna Goldfarb
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Goštautaitė B, Bučiūnienė I, Dalla Rosa A, Duffy R, Kim HJ. Healthcare professionals with calling are less likely to be burned out: the role of social worth and career stage. CAREER DEVELOPMENT INTERNATIONAL 2020. [DOI: 10.1108/cdi-10-2018-0255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PurposeThe association of calling with burnout is not well understood. This study investigates how calling influences burnout and what the roles of social worth and career stage are in this relation. Drawing from the Conservation of Resources Theory, we expect that calling may be negatively associated with burnout through increased social worth and that career stage moderates these relationships.Design/methodology/approachBased on a sample of 566 healthcare professionals, we conducted regression analyses with bootstrapping procedures to test the proposed hypotheses.FindingsThe findings show that social worth mediates the negative relation between calling and burnout. Additionally, the positive relation between calling and social worth was more pronounced for late-career employees; yet, the negative relation between social worth and burnout was stronger for early-career employees.Practical implicationsThe findings suggest that searching and pursuing a professional calling is beneficial for individuals. Additionally, social worth is crucial in this relation and could be used to actively prevent burnout.Originality/valueThe study advances our understanding of the consequences of calling for employees by explaining the underlying mechanism between calling and burnout and its importance at different career stages.
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Ganeshan D, Rosenkrantz AB, Bassett RL, Williams L, Lenchik L, Yang W. Burnout in Academic Radiologists in the United States. Acad Radiol 2020; 27:1274-1281. [PMID: 32037261 DOI: 10.1016/j.acra.2019.12.029] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the prevalence and associated factors of burnout among U.S. academic radiologists. MATERIALS AND METHODS An online survey was sent to the radiologists who were full members of the Association of University Radiologists in December 2018. Burnout was measured using the abbreviated Maslach Burnout Inventory Human Services Survey. Survey respondents were also requested to complete questions on demographics, potential professional stressors, sense of calling, and career satisfaction. Associations between survey participants' characteristics and burnout were tested using logistic regression model. RESULTS The survey response rate was 27% (228/831). Twenty-nine percent met all three criteria for high burnout, including high emotional exhaustion, high depersonalization, and low personal accomplishment. Seventy-nine percent had one or more symptoms of burnout. Numerous factors including work overload, inability to balance personal and professional life, lack of autonomy, lack of appreciation from patients and other medical staff were significantly associated (p < 0.05) with high burnout. Older age (OR, 0.95; 95%CI 0.92-0.98; p < 0.05), higher number of years of experience practicing as radiologists (OR, 0.95; 95%CI 0.92-0.98; p < 0.05), and holding academic rank of professor (OR, 0.25; 95%CI 0.11-0.56; p < 0.05) were factors associated with lower odds of experiencing burnout. Radiologists with high burnout were more likely to be dissatisfied with their career (OR, 2.28; 95%CI 1.70-3.07; p < 0.0001) and less likely to identify medicine as a calling. CONCLUSION Multiple factors contribute to high burnout in academic radiologists. Familiarity with these factors may help academic radiology departments to develop strategies to promote health and wellness of their faculty.
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Welle D, Trockel MT, Hamidi MS, Hickson GB, Menon NK, Shanafelt TD, Cooper WO. Association of Occupational Distress and Sleep-Related Impairment in Physicians With Unsolicited Patient Complaints. Mayo Clin Proc 2020; 95:719-726. [PMID: 32247345 DOI: 10.1016/j.mayocp.2019.09.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/03/2019] [Accepted: 09/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study the relationship between occupational distress and sleep-related impairment in physicians and unsolicited patient complaints. PARTICIPANTS AND METHODS We used deidentified data from an academic medical center's physician survey administered in April and May of 2013 to perform a retrospective cohort study. Third-party stewards of the identifiable information regarding unsolicited patient complaints from January 1, 2013, through December 31, 2016, matched these data with corresponding physicians' occupational distress data. Unsolicited patient complaints were used to calculate the Patient Advocacy Reporting System (PARS) score, a validated predictor of malpractice litigation risk and clinical outcomes. Physicians were grouped into 1 of 3 PARS risk categories based on previously defined thresholds: low risk (score of 0), intermediate risk (score of 1-12), or high risk (score ≥13). RESULTS Each 1-point increase in burnout and sleep-related impairment, on a 5-point scale, was associated with a 69% (odds ratio [OR], 1.69; 95% CI, 1.12-2.54) and 49% (OR, 1.49; 95% CI, 1.08-2.05) increased odds of being in the next higher PARS risk category, respectively, averaged across all 4 years. Professional fulfillment was a protective factor, associated with fewer unsolicited patient complaints. Each 1-point decrease in professional fulfillment was associated with a 68% (OR, 1.68; 95% CI, 1.16-2.44) increased odds of being in the next higher PARS risk category. The effect of depression on PARS risk category was not significant (OR, 1.33; 95% CI, 0.84-2.10). CONCLUSION Findings from this research suggest that occupational distress and sleep-related impairment in physicians are associated with unsolicited patient complaints.
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Affiliation(s)
- Dana Welle
- Stanford Medicine, Stanford, CA; The Risk Authority, Columbia, SC.
| | | | | | - Gerald B Hickson
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; Quality Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - William O Cooper
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN; Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN
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Abstract
Global public health has several persistent challenges that require partnerships to properly solve. A global institution with the resources and influence of the Catholic Church, even though its health-related efforts have traditionally focused on the provision of direct medical care, could be a more valuable partner for global public health than it traditionally has been. The challenges are not technical in nature, but are conceptual ones that prevent global public health from achieving its full potential. For example, the intellectual resources of the Church could help cultivate a sense of vocation among public health professionals, similar to the awareness of vocation enjoyed in healing professions. Additionally, the social teaching of the Church, particularly the preferential option for the poor, could help shift the enduring issue that global resources often flow where they are least needed. Further, dignity and solidarity could provide the conceptual grounding needed to invest more energy in capacity building in low-resource settings. Such efforts also require conversion within the Church itself, suggesting that deeper partnership could benefit both the Church and global public health.
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Affiliation(s)
- Michael Rozier
- Department of Health Management and Policy, Saint Louis University College for Public Health and Social Justice, St. Louis, MO, US
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Hu Y, Hu J, Li L, Zhao B, Liu X, Li F. Development and preliminary validation of a brief nurses' perceived professional benefit questionnaire (NPPBQ). BMC Med Res Methodol 2020; 20:18. [PMID: 32000690 PMCID: PMC6993446 DOI: 10.1186/s12874-020-0908-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background With the increased empirical interest in the positive significance of improving nurses’ sense of professional benefits, there is a requirement for measures of nurses’ perceived professional benefit (NPPB). Our objective was to develop and psychometrically test a brief Nurses’ Perceived Professional Benefit Questionnaire (NPPBQ). Methods After expert consultation and nurse interviews, a primary questionnaire was developed for an exploratory factor analysis (EFA). The seventeen items of the NPPBQ were used for verification of the theorized factor structure and content validity using a confirmatory factor analysis (CFA). The NPPBQ’s concurrent validity was evaluated. Three samples of nurses were collected in Shanghai, Hangzhou and Nanjing between November 2017 and August 2018. Results The results of the EFA and CFA verified the five dimensions of nurses’ occupational benefit discovery. The results demonstrated that the NPPBQ has adequate internal consistency and is fully consistent with the theorized factor structure. This 5-factor solution explained an adequate percentage of the total variance. The Cronbach’s alpha of each dimension of the NPPBQ was good. The concurrent validity was significantly correlated with all aspects of the Maslach Burnout Inventory (MBI). Conclusion The results suggest that the NPPBQ is a psychometrically sound measure for evaluating perceived professional benefits among a wide range of nurses.
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Affiliation(s)
- Yanli Hu
- School of Nursing, Jilin University, Changchun, China
| | - Jing Hu
- School of Nursing, Naval Medical University, Shanghai, China
| | - Liping Li
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bin Zhao
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaohong Liu
- School of Nursing, Naval Medical University, Shanghai, China.
| | - Fan Li
- School of Nursing, Jilin University, Changchun, China. .,Department of Pathogenobiology, the Key Laboratory of Zoonosis Research, Chinese Ministry of Education, College of Basic Medicine, Jilin University, Changchun, China. .,The Key Laboratory for Bionics Engineering, Ministry of Education, Jilin University, Changchun, China. .,College of Basic Medical Science, Jilin University, No.126 Xinmin Street, Changchun, 130021, China.
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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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Riasnugrahani M, Riantoputra CD, Takwin B, Panggabean H. Discerning Work as a Calling: The Role of Job Crafting. THE CAREER DEVELOPMENT QUARTERLY 2019. [DOI: 10.1002/cdq.12203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Bagus Takwin
- Department of PsychologyUniversitas Indonesia Depok West Java Indonesia
| | - Hana Panggabean
- Department of PsychologyAtma Jaya Catholic University of Indonesia Jakarta Indonesia
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Abraham CM, Zheng K, Poghosyan L. Predictors and Outcomes of Burnout Among Primary Care Providers in the United States: A Systematic Review. Med Care Res Rev 2019; 77:387-401. [PMID: 31736420 DOI: 10.1177/1077558719888427] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary care providers (PCPs) in the United States work in challenging environments and may be at risk for burnout. This article identifies the predictors and outcomes of burnout among PCPs in the United States. A comprehensive literature search of eight databases was conducted to identify studies investigating predictors or outcomes of PCP burnout. The Joanna Briggs Institute's critical appraisal checklists for cross-sectional and cohort studies were used for quality appraisal. Overall, 21 studies met inclusion criteria, had sufficient quality, reported personal and/or organizational predictors of burnout, and described burnout outcomes at the patient, provider, or organizational level. Prevalence of PCP burnout ranged from 13.5% to 60%. The primary care practice environment was the most common predictor of PCP burnout. In conclusion, developing interventions to improve the practice environment may help reduce PCP burnout. Future studies using robust study designs and standardized instruments to consistently measure burnout are needed.
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Giæver F, Løvseth LT. Exploring presenteeism among hospital physicians through the perspective of job crafting. QUALITATIVE RESEARCH IN ORGANIZATIONS AND MANAGEMENT: AN INTERNATIONAL JOURNAL 2019. [DOI: 10.1108/qrom-11-2018-1699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to seek a deeper understanding of presenteeism by utilising the perspective of job crafting to explore how a selected group of physicians make sense of their decision to attend work while ill and of their experience of doing so. Job crafting implies that employees not only respond to their job description, but also proactively change tasks, relationships and perceptions in order to experience work in meaningful ways.
Design/methodology/approach
A narrative methodological framework involving interviews was adopted to explore the ways in which a selected group of 20 Norwegian hospital physicians engaged in job crafting during presenteeism. The resulting data were analysed using theory-led thematic analysis utilizing the theoretical perspective of job crafting.
Findings
It was evident that physicians were indecisive and insecure when evaluating their own illness, and that, via task, relational and cognitive crafting, they trivialised, endured and showcased their illness, and engaged in presenteeism in various ways. Furthermore, physicians to some extent found themselves caught in dysfunctional circles by contributing to the creation of a work environment where presenteeism was maintained and seen as expected.
Research limitations/implications
Future research should address a wider range of contexts, and use longitudinal methods to explore the multifaceted, context-specific and evolving nature of presenteeism and job crafting in more depth. Interventions aimed at countering the negative implications of presenteeism should address the issue from both a social and a systemic point of view.
Originality/value
The findings extend the current understanding of presenteeism by demonstrating the multifaceted and evolving nature of the ways in which personal illness and presenteeism are perceived and enacted over time.
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Houseknecht VE, Roman B, Stolfi A, Borges NJ. A Longitudinal Assessment of Professional Identity, Wellness, Imposter Phenomenon, and Calling to Medicine Among Medical Students. MEDICAL SCIENCE EDUCATOR 2019; 29:493-497. [PMID: 34457506 PMCID: PMC8368953 DOI: 10.1007/s40670-019-00718-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE This study assessed changes in professional identity, wellness, imposter phenomenon, and calling to medicine over time in medical school. METHODS Medical students from the first through third years anonymously completed four validated measures: Perceived Wellness Survey (PWS), Brief Calling Scale (BCS), Physician In-group Identification Scale (PID), and Clance's Imposter Phenomenon Scale (CIP). Survey completion implied informed consent. The study was exempted by the university IRB. RESULTS All class of 2018 students (n = 110) returned surveys at the beginning of year 1; 58 completed surveys at the end of the preclinical years (post year 2, n = 44) and/or end of the third-year clerkship (post year 3, n = 35) and were analyzed. From pre to post preclinical years, there was a significant decrease in the PID. There were no statistically significant changes in the PWS, BCS, and CIP. From pre year 1 to post third-year clerkships, the PWS and PID decreased, the CIP increased, and the BCS did not change. Only 19% of students participated in all three survey administrations and this group was excluded from the analysis due to the low response rate. CONCLUSION Student wellness and sense of professional identity (in-group identity) dropped over 3 years of medical education, while imposter phenomenon increased. The BCS did not change over time. The decrease in identity as part of the physician community is concerning; future curriculum initiatives should focus on integration of professional identity into students' individual identities and on initiatives to improve student well-being.
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Affiliation(s)
- Valerie E. Houseknecht
- Boonshoft School of Medicine, Wright State University, Dayton, OH USA
- Innovative Care Solutions, Dayton, OH USA
| | - Brenda Roman
- Boonshoft School of Medicine, Wright State University, Dayton, OH USA
| | - Adrienne Stolfi
- Boonshoft School of Medicine, Wright State University, Dayton, OH USA
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Abstract
Aims and methodThe concept of personal resilience is relevant to physician well-being, recruitment and retention, and to delivering compassionate patient care. This systematic review aims to explore factors affecting personal resilience among psychiatrists, in particular, those that may impair well-being and those that facilitate resilience practice. A literature search was performed of the Ovid®, Embase®, CINAHL and PsycINFO databases, using keywords to identify empirical studies involving psychiatrists that examined resilience, stress and burnout from the past 15 years. RESULTS: Thirty-three international English language studies were included, showing that a combination of workplace, personal and non-workplace factors negatively and positively influenced well-being and resilience.Clinical implicationsGiven that workplace factors were the most commonly cited, it would appear that any resilience package that predominantly targets interventions at the workplace level would be particularly fruitful. Future research, however, needs to address the absence of a universal measurement of well-being and its moderators so that any potential interventions are better evaluated.Declaration of interestNone.
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Thompson JA, Bunderson JS. Research on Work as a Calling…and How to Make It Matter. ANNUAL REVIEW OF ORGANIZATIONAL PSYCHOLOGY AND ORGANIZATIONAL BEHAVIOR 2019. [DOI: 10.1146/annurev-orgpsych-012218-015140] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The concept of work as a calling has the potential to provide unique and powerful insights into how individuals relate to their work and organizations. However, although this concept may be one of the oldest in the study of work—harking back to the Protestant Reformation—its impact on mainstream OP and OB research has been limited. We review the research literature on work as a calling, and identify several issues that are preventing research in this area from reaching its potential—issues of definition, differentiation, generalizability, and relevance. We consider each of these questions and propose a path forward. Central to that path forward is an integrated conceptualization of calling—what we call a transcendent calling—that puts dual emphasis on the inner requiredness of passion and enjoyment and the outer requiredness of duty and destiny.
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Affiliation(s)
- Jeffery A. Thompson
- Romney Institute of Public Management, Brigham Young University, Provo, Utah 84602, USA
| | - J. Stuart Bunderson
- Olin Business School, Washington University in St. Louis, St. Louis, Missouri 63130, 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: 930] [Impact Index Per Article: 155.0] [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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Shah S, Frey R, Shipman K, Gardiner F, Milne H. A survey to explore health care staff perceptions of spirituality and spiritual care working in a single district health area in New Zealand. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moussa H, Hosseini Nasab S, Fournie D, Ontiveros A, Alkawas R, Chauhan S, Blackwell S, Sibai B. The impact of time of delivery on gestations complicated by preterm premature rupture of membranes: daytime versus nighttime. J Matern Fetal Neonatal Med 2018; 32:3319-3324. [PMID: 29631461 DOI: 10.1080/14767058.2018.1463363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Perinatal death, in particular intrapartum stillbirth and short-term neonatal death, as well as neonatal short-term and long-term morbidity have been associated with the time of day that the birth occurs. Indeed, evening and nighttime deliveries were associated with an increased risk of an adverse perinatal outcome when compared to similar daytime deliveries. Impact of shift change, as well as time of day delivery have been extensively studied in the context of maternal and neonatal complications of cesarean delivery, however, no studies were previously performed on timing of delivery and its effect on the outcome of pregnancies complicated by preterm premature rupture of membranes. Objective: Our objective was to compare obstetric, neonatal as well as long-term outcomes between women delivered in the daytime versus nighttime, in singleton gestations whose pregnancies were complicated by preterm premature rupture of membranes. Study design: This was a secondary analysis of a trial of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network "A Randomized Clinical Trial of the Beneficial Effects of Antenatal Magnesium Sulfate for the Prevention of Cerebral Palsy." For this analysis, the time of delivery was divided into the daytime, from 07:01 to 19:00, and the nighttime, from 19:01 to 07:00. Epidemiological, obstetric characteristics as well as neonatal and long-term outcomes were compared between deliveries occurring during the daytime versus the nighttime periods. Inclusion criteria consisted of singleton gestations diagnosed with preterm premature rupture of membranes (PPROM). Multifetal gestations and pregnancies with preterm labor without preterm premature rupture of membranes were excluded. Results: A total of 1752 patients met inclusion criteria, 881 delivering during the daytime, while 871 during the nighttime. There were no differences in demographic maternal variables. There were no differences in the number of patients receiving steroids and the doses of steroids. Antibiotic prophylaxis was also equal in both groups. Postpartum endometritis, chorioamnionitis, and the latency to delivery were also equivalent between both the groups. Cesarean delivery for distress was the only different outcome, more prevalent in daytime deliveries (157 (44.7%) versus 108 (35.9%) of the nighttime ones p = .02). Neonatal adverse outcomes as well as long-term outcomes were similar between the two groups. Conclusions: In the setting of delivery at a tertiary care center, and in the era of universal use of steroids, and latency antibiotics for the management of preterm premature of membranes, there is no marked difference in pregnancy, neonatal as well as long-term outcomes for infants delivered in the daytime versus nighttime.
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Affiliation(s)
- Hind Moussa
- a OBGYN , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Susan Hosseini Nasab
- b Obstetrics and Gynaecology , McGovern Medical School at The University of Texas Health Science Center at Houston , Houston , TX , USA
| | - David Fournie
- c Department of Mathematics , Columbia University , New York , NY , USA
| | - Alejandra Ontiveros
- d OBGYN , University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Rim Alkawas
- e University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Suneet Chauhan
- f Department of Obstetrics, Gynaecology and Reproductive Sciences, Lyndon B . Johnson General Hospital , Houston , TX , USA
| | - Sean Blackwell
- g Department of Obstetrics, Gynaecology & Reproductive Sciences , University of Texas Health Science Center , Houston , TX , USA
| | - Baha Sibai
- h Obstetrics and Gynaecology , University of Texas Health Science Center , Houston , TX , USA
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Rashid A. Yonder: Truthfulness, group visits, new care models, and a sense of calling. Br J Gen Pract 2017; 67:563. [PMID: 29192109 PMCID: PMC5697539 DOI: 10.3399/bjgp17x693749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmed Rashid
- UCL Medical School, UCL, London. E-mail: @Dr_A_Rashid
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Chae SJ, Jeong SM, Chung YS. The mediating effect of calling on the relationship between medical school students' academic burnout and empathy. KOREAN JOURNAL OF MEDICAL EDUCATION 2017; 29:165-173. [PMID: 28870019 PMCID: PMC5583431 DOI: 10.3946/kjme.2017.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/30/2017] [Accepted: 06/08/2017] [Indexed: 05/09/2023]
Abstract
PURPOSE This study is aimed at identifying the relationships between medical school students' academic burnout, empathy, and calling, and determining whether their calling has a mediating effect on the relationship between academic burnout and empathy. METHODS A mixed method study was conducted. One hundred twenty-seven medical students completed a survey. Scales measuring academic burnout, medical students' empathy, and calling were utilized. For statistical analysis, correlation analysis, descriptive statistics analysis, and hierarchical multiple regression analyses were conducted. For qualitative approach, eight medical students participated in a focus group interview. RESULTS The study found that empathy has a statistically significant, negative correlation with academic burnout, while having a significant, positive correlation with calling. Sense of calling proved to be an effective mediator of the relationship between academic burnout and empathy. CONCLUSION This result demonstrates that calling is a key variable that mediates the relationship between medical students' academic burnout and empathy. As such, this study provides baseline data for an education that could improve medical students' empathy skills.
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Affiliation(s)
- Su Jin Chae
- Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Korea
- Office of Medical Education, Ajou University School of Medicine, Suwon, Korea
- Corresponding Author: Su Jin Chae (https://orcid.org/0000-0003-3060-8933) Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82.31.219.4511 Fax: +82.31.219.4093
| | - So Mi Jeong
- Office of Medical Education, Ajou University School of Medicine, Suwon, Korea
| | - Yoon-Sok Chung
- Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Korea
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
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Tak HJ, Curlin FA, Yoon JD. Association of Intrinsic Motivating Factors and Markers of Physician Well-Being: A National Physician Survey. J Gen Intern Med 2017; 32:739-746. [PMID: 28168540 PMCID: PMC5481224 DOI: 10.1007/s11606-017-3997-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/16/2016] [Accepted: 01/09/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although intrinsic motivating factors play important roles in physician well-being and productivity, most studies have focused on extrinsic motivating factors such as salary and work environment. OBJECTIVE To examine the association of intrinsic motivators with physicians' career satisfaction, life satisfaction, and clinical commitment, while accounting for established extrinsic motivators as well. DESIGN AND PARTICIPANTS A nationally representative survey of 2000 US physicians, fielded October to December 2011. MAIN MEASURES Outcome variables were five measures of physician well-being: career satisfaction, life satisfaction, high life meaning, commitment to direct patient care, and commitment to clinical practice. Primary explanatory variables were sense of calling, personally rewarding hours per day, meaningful, long-term relationships with patients, and burnout. Multivariate logit models with survey design provided nationally representative individual-level estimates. KEY RESULTS Among 1289 respondents, 85.8% and 86.5% were satisfied with their career and life, respectively; 88.6% had high life meaning; 54.5% and 79.5% intended to retain time in direct patient care and continue clinical practice, respectively. Sense of calling was strongly positively associated with high life meaning (odds ratio [OR] 5.14, 95% confidence interval [95% CI] 2.87-9.19) and commitment to direct patient care (OR 2.50, 95% CI 1.53-4.07). Personally rewarding hours per day were most strongly associated with career satisfaction (OR 5.28, 95% CI 2.72-10.2), life satisfaction (OR 4.46, 95% CI 2.34-8.48), and commitment to clinical practice (OR 3.46, 95% CI 1.87-6.39). Long-term relationships with patients were positively associated with career and life satisfaction and high life meaning. Burnout was strongly negatively associated with all measures of physician well-being. CONCLUSIONS Intrinsic motivators (e.g., calling) were associated with each measure of physician well-being (satisfaction, meaning, and commitment), but extrinsic motivators (e.g., annual income) were not associated with meaning or commitment. Understanding the effects of intrinsic motivators may help inform efforts to support physician well-being.
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Affiliation(s)
- Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Farr A Curlin
- Trent Center for Bioethics, Humanities & History of Medicine, Duke University, Durham, NC, USA
| | - John D Yoon
- Section of Hospital Medicine, Department of Medicine and Associate Faculty, MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
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Louie AK, Trockel MT, Balon R, Coverdale JH, Beresin EV, Brenner AM, Guerrero APS, Roberts LW. "Physician Wellness" as Published in Academic Psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:155-158. [PMID: 28213884 DOI: 10.1007/s40596-017-0677-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Affiliation(s)
| | | | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Jager AJ, Tutty MA, Kao AC. Association Between Physician Burnout and Identification With Medicine as a Calling. Mayo Clin Proc 2017; 92:415-422. [PMID: 28189341 DOI: 10.1016/j.mayocp.2016.11.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the association between degree of professional burnout and physicians' sense of calling. PARTICIPANTS AND METHODS US physicians across all specialties were surveyed between October 24, 2014, and May 29, 2015. Professional burnout was assessed using a validated single-item measure. Sense of calling, defined as committing one's life to personally meaningful work that serves a prosocial purpose, was assessed using 6 validated true-false items. Associations between burnout and identification with calling items were assessed using multivariable logistic regressions. RESULTS A total of 2263 physicians completed surveys (63.1% response rate). Among respondents, 28.5% (n=639) reported experiencing some degree of burnout. Compared with physicians who reported no burnout symptoms, those who were completely burned out had lower odds of finding their work rewarding (odds ratio [OR], 0.05; 95% CI, 0.02-0.10; P<.001), seeing their work as one of the most important things in their lives (OR, 0.38; 95% CI, 0.21-0.69; P<.001), or thinking their work makes the world a better place (OR, 0.38; 95% CI, 0.17-0.85; P=.02). Burnout was also associated with lower odds of enjoying talking about their work to others (OR, 0.23; 95% CI, 0.13-0.41; P<.001), choosing their work life again (OR, 0.11; 95% CI, 0.06-0.20; P<.001), or continuing with their current work even if they were no longer paid if they were financially stable (OR, 0.30; 95% CI, 0.15-0.59; P<.001). CONCLUSION Physicians who experience more burnout are less likely to identify with medicine as a calling. Erosion of the sense that medicine is a calling may have adverse consequences for physicians as well as those for whom they care.
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Affiliation(s)
- Andrew J Jager
- Ethics Standards Group, American Medical Association, Chicago, IL
| | - Michael A Tutty
- Professional Satisfaction and Practice Sustainability Group, American Medical Association, Chicago, IL
| | - Audiey C Kao
- Ethics Standards Group, American Medical Association, Chicago, IL.
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Broom A, Wong WKT, Kirby E, Sibbritt D, Karikios D, Harrup R, Lwin Z. A Qualitative Study of Medical Oncologists' Experiences of Their Profession and Workforce Sustainability. PLoS One 2016; 11:e0166302. [PMID: 27902706 PMCID: PMC5130192 DOI: 10.1371/journal.pone.0166302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/26/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Medical oncology is a steadily evolving field of medical practice and professional pathway for doctors, offering value, opportunity and challenge to those who chose this medical specialty. This study examines the experiences of a group of Australian medical oncologists, with an emphasis on their professional practice, career experiences, and existing and emerging challenges across career stages. METHODS In-depth qualitative interviews were conducted with 22 medical oncologists, including advanced trainees, early-career consultants and senior consultants, focusing on: professional values and experiences; career prospects and pathways; and, the nexus of the characteristics of the profession and delivery of care. RESULTS The following themes were emergent from the interviews: the need for professional reinvention and the pressure to perform; the importance, and often absence, of mentoring and feedback loops; the emotional labour of oncology; and, the impact of cascading workload volume on practice sustainability. CONCLUSIONS Understanding professional experiences, career trajectories and challenges at the workforce level are crucial for understanding what drives the oncological care day-to-day. The results indicate that there are considerable potential tensions between the realities of professional, workforce demands and expectations for patient care. Such tensions have real and significant consequences on individual medical oncologists with respect to their futures, aspirations, satisfaction with work, caring practices, interactions with patients and potentially therapeutic outcomes.
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Affiliation(s)
- Alex Broom
- School of Social Sciences, UNSW Australia, Sydney, New South Wales, Australia
| | - W. K. Tim Wong
- School of Social Sciences, UNSW Australia, Sydney, New South Wales, Australia
| | - Emma Kirby
- School of Social Sciences, UNSW Australia, Sydney, New South Wales, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Deme Karikios
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Nepean Hospital, Sydney, New South Wales, Australia
| | | | - Zarnie Lwin
- Royal Brisbane & Women’s Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
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Mitchell CM, Epstein-Peterson ZD, Bandini J, Amobi A, Cahill J, Enzinger A, Noveroske S, Peteet J, Balboni T, Balboni MJ. Developing a Medical School Curriculum for Psychological, Moral, and Spiritual Wellness: Student and Faculty Perspectives. J Pain Symptom Manage 2016; 52:727-736. [PMID: 27693904 PMCID: PMC5319601 DOI: 10.1016/j.jpainsymman.2016.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/31/2016] [Accepted: 05/20/2016] [Indexed: 11/30/2022]
Abstract
CONTEXT Although many studies have addressed the integration of a religion and/or spirituality curriculum into medical school training, few describe the process of curriculum development based on qualitative data from students and faculty. OBJECTIVES The aim of this study is to explore the perspectives of medical students and chaplaincy trainees regarding the development of a curriculum to facilitate reflection on moral and spiritual dimensions of caring for the critically ill and to train students in self-care practices that promote professionalism. METHODS Research staff conducted semiscripted and one-on-one interviews and focus groups. Respondents also completed a short and self-reported demographic questionnaire. Participants included 44 students and faculty members from Harvard Medical School and Harvard Divinity School, specifically senior medical students and divinity school students who have undergone chaplaincy training. RESULTS Two major qualitative themes emerged: curriculum format and curriculum content. Inter-rater reliability was high (kappa = 0.75). With regard to curriculum format, most participants supported the curriculum being longitudinal, elective, and experiential. With regard to curriculum content, five subthemes emerged: personal religious and/or spiritual (R/S) growth, professional integration of R/S values, addressing patient needs, structural and/or institutional dynamics within the health care system, and controversial social issues. CONCLUSION Qualitative findings of this study suggest that development of a future medical school curriculum on R/S and wellness should be elective, longitudinal, and experiential and should focus on the impact and integration of R/S values and self-care practices within self, care for patients, and the medical team. Future research is necessary to study the efficacy of these curricula once implemented.
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Affiliation(s)
- Christine M Mitchell
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Julia Bandini
- Department of Sociology, Brandeis University, Waltham, Massachusetts, USA
| | - Ada Amobi
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Cahill
- Theology Department, Boston College, Chestnut Hill, Massachusetts, USA
| | - Andrea Enzinger
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sarah Noveroske
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - John Peteet
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tracy Balboni
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael J Balboni
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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Yoon JD, Hunt NB, Ravella KC, Jun CS, Curlin FA. Physician Burnout and the Calling to Care for the Dying: A National Survey. Am J Hosp Palliat Care 2016; 34:931-937. [PMID: 27465404 DOI: 10.1177/1049909116661817] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Physician burnout raises concerns over what sustains physicians' career motivations. We assess whether physicians in end-of-life specialties had higher rates of burnout and/or calling to care for the dying. We also examined whether the patient centeredness of the clinical environment was associated with burnout. METHODS In 2010 to 2011, we conducted a national survey of US physicians from multiple specialties. Primary outcomes were a validated single-item measure of burnout or sense of calling to end-of-life care. Primary predictors of burnout (or calling) included clinical specialty, frequency of encounters with dying patients, and patient centeredness of the clinical environments ("My clinical environment prioritizes the need of the patient over maximizing revenue"). RESULTS Adjusted response rate among eligible respondents was 62% (1156 of 1878). Nearly a quarter of physicians (23%) experienced burnout, and rates were similar across all specialties. Half of the responding physicians (52%) agreed that they felt called to take care of patients who are dying. Burned-out physicians were more likely to report working in profit-centered clinical environments (multivariate odds ratio [OR] of 1.9; confidence interval [CI]: 1.3-2.8) or experiencing emotional exhaustion when caring for the dying (multivariate OR of 2.1; CI: 1.4-3.0). Physicians who identified their work as a calling were more likely to work in end-of-life specialties, to feel emotionally energized when caring for the dying, and to be religious. CONCLUSION Physicians from end-of-life specialties not only did not have increased rates of burnout but they were also more likely to report a sense of calling in caring for the dying.
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Affiliation(s)
- John D Yoon
- 1 Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA.,2 The MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Natalie B Hunt
- 3 The University of Chicago Divinity School, Chicago, IL, USA
| | | | - Christine S Jun
- 1 Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Farr A Curlin
- 5 Trent Center for Bioethics, Humanities, and History of Medicine, Duke University, Durham, NC, USA
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