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Thakore NL, Lan M, Winkel AF, Vieira DL, Kang SK. Best Practices: Burnout Is More Than Binary. AJR Am J Roentgenol 2024. [PMID: 39016454 DOI: 10.2214/ajr.24.31111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Burnout among radiologists is increasingly prevalent, with potential for substantial negative impact on physician well-being, care delivery, and health outcomes. To evaluate this phenomenon using reliable and accurate means, validated quantitative instruments are essential. Variation in measurement can contribute to wide-ranging findings. This article evaluates radiologist burnout rates globally and dimensions of burnout as reported using different validated instruments and provide guidance on best practices to characterize burnout. Fifty-seven studies between 1990 and 2023 were included in a systematic review, and 43 studies were included in a meta-analysis of burnout prevalence using random effects models. Reported burnout ranged from 5% to 85%. With the Maslach Burnout Inventory (MBI), burnout prevalence varied significantly depending on instrument version. Among MBI subcategories, the prevalence of emotional exhaustion was 54% (95% CI, 45-63%), depersonalization was 52% (95% CI, 41-63%), and low personal accomplishment was 36% (95% CI, 27-47%). Other validated burnout instruments showed less heterogeneous results; studies using the Stanford Professional Fulfillment Index yielded burnout prevalence of 39% (95% CI, 34-45%), whereas the Validated Single-Item instrument yielded 34% (95% CI, 29-39%). Standardized instruments for prevalence alongside multidimensional profiles capturing experiences may better characterize radiologist burnout, including change over time.
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Affiliation(s)
| | - Michael Lan
- NYU Grossman School of Medicine, New York, NY
| | | | - Dorice L Vieira
- Health Sciences Library, NYU Grossman School of Medicine, New York, NY
| | - Stella K Kang
- Associate Professor, Department of Radiology, NYU Langone Health, New York, NY
- Department of Population Health, NYU Langone Health, New York, NY
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Seeland GR, Williams BM, Yadav M, Bowden E, Antoniewicz LW, Kilpatrick CC, Mastrobattista JM, Ratan BM. Implementation and Evaluation of a Comprehensive Resident Wellness Curriculum During the COVID-19 Pandemic. JOURNAL OF SURGICAL EDUCATION 2024; 81:397-403. [PMID: 38135549 DOI: 10.1016/j.jsurg.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/27/2023] [Accepted: 11/09/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of resident-led and faculty-led initiatives for physician wellness after implementation of a resident wellness program. DESIGN We initiated a wellness curriculum with both resident and faculty-led components in a large academic OB/GYN residency program in October 2020. The curriculum was created and evaluated using the Logic model. Residents were surveyed pre and 8 months postintervention with the Maslach Burnout Inventory (MBI) and the Physician Well-Being Index (PWBI), with activity-related questions added to the second survey. Descriptive statistics, Mann-Whitney test, Chi-square test, and theme analysis were performed as appropriate. SETTING A large academic OB/GYN residency at Baylor College of Medicine in Houston, Texas PARTICIPANTS: All residents (n = 48) were invited to take part in the surveys. Response rate was 31/48 (65%) pre and 28/48 (58%) postintervention. RESULTS Residents scored moderate for emotional exhaustion and depersonalization and high for personal accomplishment on both pre and post-MBI surveys. All indices of the PWBI improved over time; however, no significant differences were found in pre and postmeasures. Resident-led activities, which were alternated between individualized time off and group resident socialization, were rated significantly higher than faculty-led activities; 93% (52/56) of respondents rated resident-led activities in their top 2 most helpful initiatives compared to 7% (4/56) who rated faculty-led activities in their top 2 most helpful (p < 0.01) initiatives. Open-ended comments revealed that continued focus on wellness, attention to personal health, and systematic change were the most important ways to improve resident wellness. CONCLUSION Decreases in burnout were not achieved over an 8-month period with program-level resident-led and faculty-led initiatives. Providing scheduled time for residents to use at their discretion and the continuation of events that encourage socialization are tools that are highest rated by residents to facilitate wellness.
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Affiliation(s)
- Gianna R Seeland
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Brinley M Williams
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Menaka Yadav
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Emily Bowden
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Leah W Antoniewicz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Charlie C Kilpatrick
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - Bani M Ratan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Sobczuk P, Gawlik-Urban A, Sigorski D, Kiszka J, Osmola M, Machulska-Ciuraj K, Wilk M, Brodziak A. Prevalence and factors associated with professional burnout in Polish oncologists-results of a nationwide survey. ESMO Open 2024; 9:102230. [PMID: 38266421 PMCID: PMC10937194 DOI: 10.1016/j.esmoop.2023.102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/03/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND High rates of burnout are observed among health care professionals worldwide, which could have negative consequences on personal and organizational levels. We aimed to evaluate the burnout prevalence and factors associated with burnout among oncologists in Poland. MATERIALS AND METHODS An online survey was conducted using the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and additional work/lifestyle questions. Descriptive statistics, parametric and nonparametric tests, and multivariate logistic regression were used to identify factors associated with burnout. RESULTS A total of 228 physicians participated in the survey, including 168 medical oncologists, 43 radiation oncologists, and 17 from other specialties. Data collected from 211 medical and radiation oncologists were included in the final analyses. Most participants were female (71.6%) and ≤40 years of age (70.1%). A self-reported feeling of burnout was present in 65.9% of participants. Based on the MBI-HSS, 74.9% showed evidence of burnout with burnout subdomains as follows: depersonalization 37.0%; emotional exhaustion 64.5%; low accomplishment 43.1%. There were no differences in burnout rates based on specialization (oncology/haematology-75.6%, radiotherapy-72.1%), career stage, gender, or age groups. Lack of work-life balance was the only significant factor associated with the risk of burnout in the logistic regression (relative risk 2.6, 95% confidence interval 1.3-5.4). Only 20.9% of physicians had access to psychological support in their workplace; however, 70.1% desired such support. Three main factors impacting burnout in cancer care workers were: bureaucracy and administrative duties overload, admissions of many patients, and poor work culture. CONCLUSIONS Burnout is common among medical and radiation oncologists in Poland. There is a high demand for psychological support and organizational changes in the workplace to reduce risk and mitigate the adverse effects of burnout among health care professionals.
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Affiliation(s)
- P Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw.
| | - A Gawlik-Urban
- Clinical Oncology Department with Chemotherapy Subunit, Provincial Hospital Saint Luke, Tarnów; Faculty of Health Sciences, University of Applied Sciences in Tarnów, Tarnów
| | - D Sigorski
- Department of Oncology, University of Warmia and Mazury, Olsztyn; Department of Oncology and Immuno-Oncology, Warmian-Masurian Cancer Center of the Ministry of the Interior and Administration's Hospital, Olsztyn
| | - J Kiszka
- Department of Clinical Oncology, Subcarpathian Cancer Center, Brzozów
| | - M Osmola
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw
| | - K Machulska-Ciuraj
- Department of Clinical Oncology and Chemotherapy, Independent Public Clinical Hospital No. 4, Lublin
| | - M Wilk
- Oncology Department, ECZ-Postgraduate Medical Center European Health Center, Otwock
| | - A Brodziak
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw; Laboratory of Centre for Preclinical Research, Department of Experimental and Clinical Physiology, Medical University of Warsaw, Warsaw, Poland
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Gillingham N, Gupta D, Kamath A, Kagen A. Implementation of Medical Students as Radiology Reading Room Coordinators. Curr Probl Diagn Radiol 2024; 53:150-153. [PMID: 37925236 DOI: 10.1067/j.cpradiol.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE Effort has been made to minimize the burden of non-interpretive tasks (NITs), in particular by hiring and training non-radiologist support staff as reading room coordinators (RRCs). Our medical center recruited and trained senior medical students from our affiliated school of medicine to work alongside on-call radiology residents as RRCs. METHODS A 12-month Malpractice Carrier monetary grant was acquired to fund medical students at with the aim to reduce malpractice risk. After the first year, residents were surveyed regarding the impact of the RRCs on perceived on-call efficiency and morale. Furthermore, report turnaround times (TAT) on call shifts that were and were not accompanied by a RRC were compared. RESULTS 89 % of residents strongly agreed that the RRC improved workflow efficiency, decreased distractions, and felt less stressed during the call shift when the RRC was on duty. 78 % strongly agreed to be more likely to contact a referring clinician when the RRC was able to help coordinate. The mean TAT in the presence of a RRC was 36.8 min, and the mean TAT in the absence of a RRC was 36.9 min DISCUSSION: After hiring medical students to assist on-call radiology residents with noninterpretive tasks, residents reported subjective indicators of program success, but average report turnaround time was unaffected. Nevertheless, we predict that this type of program will continue to grow among academic radiology departments, though additional research is required to evaluate national trends and impacts on radiologist productivity and well-being.
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Affiliation(s)
- Nicolas Gillingham
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai West. 1000 10th Ave, Radiology Department, 4B 25, New York, NY 10019, USA.
| | - Divya Gupta
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai West. 1000 10th Ave, Radiology Department, 4B 25, New York, NY 10019, USA
| | - Amita Kamath
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai Hospital and Mount Sinai West. 1000 10th Ave, Radiology Department, 4B 25, New York, NY 10019, USA
| | - Alexander Kagen
- Site Chair, Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai West and Mount Sinai St. Luke's Hospitals, Icahn School of Medicine at Mount Sinai. 1000 10th Ave, Radiology Department, 4B 25, New York, NY 10019, USA
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Fawzy NA, Tahir MJ, Saeed A, Ghosheh MJ, Alsheikh T, Ahmed A, Lee KY, Yousaf Z. Incidence and factors associated with burnout in radiologists: A systematic review. Eur J Radiol Open 2023; 11:100530. [PMID: 37920681 PMCID: PMC10618688 DOI: 10.1016/j.ejro.2023.100530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023] Open
Abstract
Rationale and objectives Burnout among physicians has a prevalence rate exceeding 50%. The radiology department is not immune to the burnout epidemic. Understanding and addressing burnout among radiologists has been a subject of recent interest. Thus, our study aims to systematically review studies reporting the prevalence of burnout in physicians in the radiology department while providing an overview of the factors associated with burnout among radiologists. Materials and methods The search was conducted from inception until November 13th, 2022, in PubMed, Embase, Education Resources Information Center, PsycINFO, and psycArticles. Studies reporting the prevalence of burnout or any subdimensions among radiology physicians, including residents, fellows, consultants, and attendings, were included. Data on study characteristics and estimates of burnout syndrome or any of its subdimensions were collected and summarized. Results After screening 6379 studies, 23 studies from seven countries were eligible. The number of participants ranged from 26 to 460 (median, 162; interquartile range, 91-264). In all, 18 studies (78.3%) employed a form of the Maslach Burnout Inventory. In comparison, four studies (17.4%) used the Stanford Professional Fulfillment Index, and one study (4.3%) used a single-item measure derived from the Zero Burnout Program survey. Overall burnout prevalence estimates were reported by 14 studies (60.9%) and varied from 33% to 88%. High burnout prevalence estimates were reported by only five studies (21.7%) and ranged from 5% to 62%. Emotional exhaustion and depersonalization prevalence estimates were reported by 16 studies (69.6%) and ranged from 11%-100% and 4%-97%, respectively. Furthermore, 15 studies (65.2%) reported low personal accomplishment prevalence, ranging from 14.7% to 84%. There were at least seven definitions for overall burnout and high burnout among the included studies, and there was high heterogeneity among the cutoff scores used for the burnout subdimensions. Conclusion Burnout in radiology is increasing globally, with prevalence estimates reaching 88% and 62% for overall and high burnout, respectively. A myriad of factors has been identified as contributing to the increased prevalence. Our data demonstrated significant variability in burnout prevalence estimates among radiologists and major disparities in burnout criteria, instrument tools, and study quality.
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Affiliation(s)
- Nader A. Fawzy
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Muhammad Junaid Tahir
- Pakistan Kidney and Liver Institute and Research Center (PKLI & RC), Lahore 54000, Pakistan
| | - Abdullah Saeed
- Pakistan Kidney and Liver Institute and Research Center (PKLI & RC), Lahore 54000, Pakistan
| | | | - Tamara Alsheikh
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya, Selangor, Malaysia
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
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Bahr TJ, Ginsburg S, Wright JG, Shachak A. Technostress as source of physician burnout: An exploration of the associations between technology usage and physician burnout. Int J Med Inform 2023; 177:105147. [PMID: 37517300 DOI: 10.1016/j.ijmedinf.2023.105147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/20/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The cause of physician burnout is multifactorial. Health care systems pressures, excessive workloads, fatigue, poor self-care, administrative burdens, work hours, technological advancements, and work-home life conflicts, are all prominent themes throughout the literature. To date, little is known about whether, and to what extent, stressors related to the use of information and communication technology (ICT) use, other than electronic health records, outside of working hours, contribute to physician burnout. PURPOSE The purpose of this study was to explore whether work related ICT use outside of working hours is associated with physician burnout. METHOD A cross-sectional survey delivered online using The Maslach Burnout Inventory (MBI), a Physician Technology Usage Scale (PTUS) (and 7 personal characteristics questions. Data were analyzed using bivariate correlations, analysis of variance (ANOVA) and t-tests, and multiple linear regression. RESULTS Of 2,108 participants invited to complete the survey, 403 responded to and completed the survey (19% response rate). Results identified two significant factors associated with physician burnout: work related technology use outside of working hours, and the number of years in practice. CONCLUSION This research highlights the need for additional in-depth research into areas such as: 1. work-home life issues and how the use of technology outside of work hours may affect or be affected by burnout; 2. physician age and experience and burnout; 3. The differences between specialties and whether and how specialty-specific factors are related to burnout.
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Affiliation(s)
- Tamara J Bahr
- Faculty of Information, University of Toronto, Canada.
| | - Shiphra Ginsburg
- The Wilson Centre for Research in Education, Toronto, Canada; Sinai Health, Toronto, Canada; Department of Medicine, University of Toronto, Canada; Institute of Health Policy, Management and Evaluation (Dalla Lana School of Public Health), University of Toronto, Canada
| | - James G Wright
- Institute of Health Policy, Management and Evaluation (Dalla Lana School of Public Health), University of Toronto, Canada; Ontario Medical Association, Canada; The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Canada
| | - Aviv Shachak
- Faculty of Information, University of Toronto, Canada; The Wilson Centre for Research in Education, Toronto, Canada; Institute of Health Policy, Management and Evaluation (Dalla Lana School of Public Health), University of Toronto, Canada
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Li W, Chen L, Hsu M, Mo D, Xia L, Min K, Jiang F, Liu T, Liu Y, Liu H, Tang YL. The association between workload, alcohol use, and alcohol misuse among psychiatrists in China. Front Psychiatry 2023; 14:1171316. [PMID: 37426098 PMCID: PMC10325676 DOI: 10.3389/fpsyt.2023.1171316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Aim Survey alcohol use and workload among Chinese psychiatrists and explore their associations. Methods We conducted an online questionnaire among psychiatrists working in large psychiatric institutions across the country. We collected data including demographic factors, alcohol use, and workload. Alcohol use was assessed using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), and workload-related questions included working hours, night shifts, and caseloads. Results In total, 3,549 psychiatrists completed the survey. Nearly half (47.6%) reported alcohol use, and the percentage of alcohol use in males (74.1%) was significantly higher than in females. 8.1% exceeded the AUDIT-C cutoff scores for probable alcohol misuse (19.6%in males and 2.6%in females). AUDIT-C scores were significantly correlated with working hours per week (p = 0.017) and the number of outpatient visits per week (p = 0.006). Regressional analysis showed that alcohol use was significantly associated with the following factors: longer working hours (Working more than 44 h/week, OR = 1.315), having an administrative position (OR = 1.352), being male (OR = 6.856), being single (OR = 1.601), being divorced or widowed (OR = 1.888), smoking (OR = 2.219), working in the West (OR = 1.511) or the Northeast (OR = 2.440). Regressional analysis showed that alcohol misuse was significantly associated with the following factors: fewer night shifts (Three to four night shifts/month, OR = 1.460; No more than 2 night shifts/month, OR = 1.864), being male (OR = 4.007), working in the Northeast (OR = 1.683), smoking (OR = 2.219), frequent insomnia (OR = 1.678). Conclusion Nearly half of the psychiatrists in China reported alcohol use and 8.1% had probable AUD. Alcohol consumption is significantly associated with several workload-related factors, such as long working hours, heavy caseload, and administrative duties. Alcohol misuse was inversely associated with the number of night shifts per month. While the direction of causality is unclear, our findings may help identify vulnerable professional groups and develop more targeted interventions to improve healthcare professionals' well-being.
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Affiliation(s)
- Wenzheng Li
- Department of Psychiatry, Chao Hu Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Long Chen
- Department of Psychiatry, Chao Hu Hospital of Anhui Medical University, Hefei, China
- Hefei Fourth People’s Hospital, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Michael Hsu
- Addiction Psychiatry Fellowship Program, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Daming Mo
- Hefei Fourth People’s Hospital, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Lei Xia
- Department of Psychiatry, Chao Hu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Anhui Psychiatric Center, Hefei, China
| | - Kaiyuan Min
- State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Jiang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Tingfang Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanzhong Liu
- Department of Psychiatry, Chao Hu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Anhui Psychiatric Center, Hefei, China
| | - Yi-lang Tang
- Addiction Psychiatry Fellowship Program, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
- Atlanta Veterans Affairs Medical Center, Decatur, GA, United States
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Ponsford MW, Bilszta JL, McKenzie D, Fedele B, Olver J. Investigating burnout of Rehabilitation Medicine trainees: an Australian cross-sectional study. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2023. [DOI: 10.1097/ph9.0000000000000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Utilizing Remote Access for Electronic Medical Records Reduces Overall EMR Time for Vascular Surgery Residents. J Vasc Surg 2023; 77:1797-1802. [PMID: 36758909 DOI: 10.1016/j.jvs.2023.01.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Survey data suggests that surgical residents spend 20-30% of training time using the electronic medical record (EMR), raising concerns about burnout and insufficient operative experience. We characterize trainee EMR activity in the vascular surgery service of a quaternary care center to identify modifiable factors associated with high EMR use. METHODS Resident activity while on the Vascular Surgery service was queried from the EMR. Weekends and holidays were excluded to focus on typical staffing periods. Variables including daily time spent, post-graduate year (PGY), remote access via mobile device or personal laptop, and patient census including operative caseload were extracted. Univariate analysis was performed with t-tests and chi-squared tests where appropriate. We then fit a linear mixed-effects model with normalized daily EMR time as the outcome variable, random slopes for resident and patient census, and fixed effects of PGY level, academic year, and fractional time spent using remote access. RESULTS EMR activity for 53 residents from July 2015 to June 2019 was included. The mean daily EMR usage was 1.6 hours, ranging from 3.6 hours per day in PGY1 residents to 1.1 hours in PGY4-5 residents. Across all post-graduate years, the most time-consuming EMR activities were chart review (43.0-46.6%) and notes review (22.4-27.0%). In the linear mixed-effects model, increased patient census was associated with increased daily EMR usage (Coefficient = 0.61, p-value < 0.001). Resident seniority (Coefficient = -1.2, p-value < 0.001) and increased remote access (Coefficient = -0.44, p-value < 0.001) were associated with reduced daily EMR usage. Over the study period, total EMR usage decreased significantly from the 2015-2016 academic year to 2018-2019 (mean difference 2.4 hours vs 1.78, p-value <0.001). CONCLUSIONS In an audit of EMR activity logs on a vascular surgery service, mean EMR time was 1.6 hours a day, which is lower than survey estimates. Resident seniority and remote access utilization were associated with reduced time spent on the EMR, independent of patient census. While increasing EMR accessibility via mobile devices and personal computers have been hypothesized to contribute to poor work-life balance, our study suggests a possible time-saving effect by enabling expedient access for data review, which constitutes the majority of resident EMR activity. Further research in other institutions and specialties is needed for external validation and exploring implications for resident wellness initiatives.
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Puder D, Dominguez C, Borecky A, Ing A, Ing K, Martinez AE, Pereau M, Kashner TM. Assessing Interpersonal Relationships in Medical Education: the Connection Index. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:683-691. [PMID: 35064549 DOI: 10.1007/s40596-021-01574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The relationship between a resident physician and his/her supervising attending is foundational to graduate medical education and may impact the clinical learning environment and resident well-being. This paper focuses on how to measure connection between a resident and their clinical supervisor. Connection includes the subdomains of psychological safety, empathy, educational alliance, and feedback. METHODS After reviewing the literature, the authors designed the 12-item, 7-point Connection Index (CI12) to quantitatively measure connections between a resident and his/her supervisor during a 6-month period (supervision dyad), and based on educational alliance, empathy, psychological safety, and effective feedback. A 9-criteria evaluation framework was applied to assess its reliability and validity on a sample of psychiatry residents at a residency program, July 2016 through June 2018. RESULTS Out of a total possible number of 50 residents, 100% participated to rate 41 supervisors over 201 supervision dyads; the CI12 satisfied all eight of the eight testable criteria, including high scalability (H = 0.78), consistency (alpha = 0.98), test-retest validity (ICC = 0.95), and construct validity where CI12 was found to have statistically significant correlations with outcomes measures (greater connection was associated with less negative emotional experiences, less mistreatment or bias, less burnout, and higher attendance to supervision sessions). CONCLUSION The authors showed the CI12 can be a valid and reliable instrument to quantify whether a resident and his/her supervisor connects during a 6-month supervision with respect to empathy, psychological safety, educational alliance, and feedback. We recommend assessing connections as part of the overall evaluation of a resident's experience with the clinical learning environment.
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Affiliation(s)
- David Puder
- Loma Linda University School of Medicine, Loma Linda, CA, USA.
| | - Chloe Dominguez
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Adam Borecky
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Alice Ing
- University of California at Irvine, Irvine, CA, USA
| | - Kevin Ing
- University of California at Irvine, Irvine, CA, USA
| | | | - Melissa Pereau
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - T Michael Kashner
- Loma Linda University School of Medicine, Loma Linda, CA, USA
- Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC, USA
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Bogaert KC, Lieb WE, Glazer KB, Wang E, Stone JL, Howell EA. Stress and the Psychological Impact of the COVID-19 Pandemic on Frontline Obstetrics and Gynecology Providers. Am J Perinatol 2022; 29:1596-1604. [PMID: 35640618 DOI: 10.1055/s-0042-1748315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic rapidly overwhelmed global health care systems in 2020, with New York City (NYC) marking the first epicenter in the United States. High levels of stress amongst health care workers have been reported in pandemics, but less is known about stress amongst Obstetrics and Gynecology (OB/GYN) providers. We sought to describe levels of stress, anxiety, depression, and other aspects of mental health among OB/GYN health care workers during the first wave of the COVID-19 pandemic. STUDY DESIGN We conducted an anonymous cross-sectional electronic survey of a wide range of OB/GYN clinicians in a large NYC hospital system in the spring of 2020. We used both original survey questions and validated screening tools to assess stress, anxiety, depression, and burnout. We calculated median scores for these tools and compared median score between provider types. We also adapted questions on pandemic-related stressors from the MERS and SARS pandemics to fit the context of the COVID-19 pandemic and OB/GYN providers. RESULTS A total of 464 providers met study inclusion criteria, and 163 providers completed the survey (response rate = 35.1%). Approximately 35% of providers screened positive for anxiety and 21% for depression. Scores for depression, burnout, and fulfillment varied by provider type, with nurses scoring higher than physicians (p <0.05). The majority of respondents reported stress from pandemic and OB-specific stressors, including the possibility of transmitting COVID-19 to friends and family (83.9%, [95% confidence interval or CI 78.0-89.8%]), uncertainty regarding the pandemic's trajectory (91.3% [86.7-95.8%]), and frequent policy changes on labor and delivery (72.7% [65.1-80.3%]). CONCLUSION OB/GYN providers reported high levels of stress during the COVID-19 pandemic. The stress of caring for laboring patients during a pandemic may disproportionately affect nurses and trainees and highlights the need to provide interventions to ameliorate the negative impact of a pandemic on the mental health of our OB/GYN health care workers. KEY POINTS · COVID-19 led to stress amongst OB/GYN providers.. · Some stressors were unique to providing obstetric care.. · Nurses and trainees were more affected by this stress..
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Affiliation(s)
- Kelly C Bogaert
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California
| | - Whitney E Lieb
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Blavatnik Family Women's Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kimberly B Glazer
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Blavatnik Family Women's Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eileen Wang
- Department of Obstetrics & Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanne L Stone
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.,Blavatnik Family Women's Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth A Howell
- Department of Obstetrics & Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Yi-Frazier JP, O’Donnell MB, Adhikari EA, Zhou C, Bradford MC, Garcia-Perez S, Shipman KJ, Hurtado SE, Junkins CC, O’Daffer A, Rosenberg AR. Assessment of Resilience Training for Hospital Employees in the Era of COVID-19. JAMA Netw Open 2022; 5:e2220677. [PMID: 35796151 PMCID: PMC9250051 DOI: 10.1001/jamanetworkopen.2022.20677] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Health care workers face serious mental health challenges as a result of ongoing work stress. The COVID-19 pandemic exacerbated that stress, resulting in high rates of anxiety, depression, and burnout. To date, few evidence-based programs targeting mental health outcomes in health care workers have been described. OBJECTIVE To assess the feasibility, acceptability, and preliminary outcomes of a skills-based coaching program designed to reduce stress and build resilience. DESIGN, SETTING, AND PARTICIPANTS A pilot cohort study was conducted between September 2020 and April 2021 using preprogram and postprogram assessments and a mixed-methods analysis. Duration of follow-up was 7 weeks. The coaching program was delivered via video conferencing. Participants were health care workers and staff from a large urban health system. INTERVENTION The Promoting Resilience in Stress Management (PRISM) program, a manualized, skills-based coaching program originally developed for adolescents and young adults with serious/chronic illness, was adapted to support health care workers and staff ("PRISM at Work"). It included 6 weekly 1-hour group sessions. MAIN OUTCOMES AND MEASURES Feasibility was defined a priori as 70% completion rates. Acceptability was defined quantitatively (satisfaction scores) and qualitatively (open-ended questions regarding experience with program). Preliminary outcomes were assessed with preprogram and post program assessments of self-reported resilience, stress, anxiety, and burnout using validated instruments. Descriptive statistics summarized demographic variables and feasibility and acceptability. Linear mixed effects regression models examined preliminary outcomes, controlling for relevant covariates. RESULTS A total of 153 participants (median [SD] age, 40.6 [10.1] years; 142 [92%] were female; 128 [84%] identified as having White race; 81 [53%] were in patient-facing roles) enrolled. Of the 132 health care workers who provided follow-up surveys, 120 (91%) had completed the program, and 116 (88%) reported being satisfied. Answers to open-ended questions suggested that participants wanted more PRISM either with longer or additional sessions. Participant-reported resilience (β = 1.74; 95% CI, 1.00-2.48), stress (β = -2.40; 95% CI, -3.28 to -1.51), anxiety (β = -2.04; 95% CI, -2.74 to -1.34), and burnout-exhaustion (β = -0.37; 95% CI, -0.56 to -0.18) improved after the program. CONCLUSIONS AND RELEVANCE Results of this study suggest that PRISM at Work may have utility for health care workers and staff in that the program was found to be feasible, acceptable, and associated with improved outcomes.
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Affiliation(s)
- Joyce P. Yi-Frazier
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Maeve B. O’Donnell
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Elizabeth A. Adhikari
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Miranda C. Bradford
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children’s Research Institute, Seattle, Washington
| | - Samantha Garcia-Perez
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Kelly J. Shipman
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Samantha E. Hurtado
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Courtney C. Junkins
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Alison O’Daffer
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Abby R. Rosenberg
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle
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Abstract
BACKGROUND Resident burnout is associated with increased incidence of depression, suicide, and poor patient outcomes, yet identification of it is difficult. This study was designed to compare how well program directors (directors) and a resident's spouse or domestic partner (partner) can serve as a proxy to identify burnout in the resident. STUDY DESIGN An electronic survey, including the Maslach Burnout Inventory, was distributed to residents, their partners, and directors of all ACGME-accredited residencies at a single university-affiliated hospital. Burnout rates were compared with McNemar's test. Emotional exhaustion and depersonalization rates were compared with Spearman's correlation. RESULTS The response rate by respondent type was 33% (292 of 876) for residents, 48% (55 of 114) for partners, and 57% (13 of 23) for directors. Residents' self-reported burnout rate was 51% (148 of 292), while partners' proxy predicted burnout rate was 25% (14 of 55), and directors' was 5% (9 of 174). There was moderate correlation of partners' prediction of resident emotional exhaustion (ρ = 0.537, p < 0.01), depersonalization (ρ = 0.501, p < 0.01), and personal accomplishment (ρ = 0.416, p < 0.01). There was poor correlation of directors' prediction of residents' emotional exhaustion (ρ = 0.361, p < 0.01) and depersonalization (ρ = 0.223, p < 0.01). Partners had a 50% sensitivity, 94% specificity, 86% positive predictive value, and 71% negative predictive value in predicting resident burnout. Directors had a 6% sensitivity, 96% specificity, 56% positive predictive value, and 54% negative predictive value in predicting resident burnout. CONCLUSIONS Directors are not skilled in detecting burnout in their trainees. Partners are an underused group for detecting burnout and may represent an important target audience for awareness of available resources to benefit residents.
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Kratzke IM, Woods LC, Adapa K, Kapadia MR, Mazur L. The Sociotechnical Factors Associated With Burnout in Residents in Surgical Specialties: A Qualitative Systematic Review. JOURNAL OF SURGICAL EDUCATION 2022; 79:614-623. [PMID: 34836841 DOI: 10.1016/j.jsurg.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/14/2021] [Accepted: 11/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The consequences of burnout remain prevalent within general surgery training programs, yet there is no comprehensive description of the factors associated with burnout. Using sociotechnical systems theory, this review aims to qualitatively evaluate the factors associated with burnout in surgical residents. DESIGN A systematic review of the literature was performed according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review was conducted using PubMed, Web of Science, Scopus, and Embase. Two reviewers independently selected studies, extracted data, and assessed quality, with a third reviewer acting as a moderator to resolve conflicts. The Systems Engineering Initiative for Patient Safety framework was utilized to categorize factors as either contributing to or mitigating burnout. The study was registered with PROSPERO (CRD42021237448). SETTING Included studies were conducted within the United States and published prior to November 11, 2020. PARTICIPANTS Included studies were peer-reviewed primary data, that were written in English and evaluated the sociotechnical factors associated with burnout in surgical residents. RESULTS A total of 4387 articles were identified and after review, 15 studies were included for analysis. Reported burnout rates ranged from 17 to 94%, with a total mean rate of 57%. Factors found to contribute to burnout include financial stress, work-life imbalance, excessive charting, insufficient job resources, poor social support, and mistreatment. Mitigating factors include having time away from work, increased didactics, supportive faculty, attending social events, and the presence of program-based wellness initiatives. Consequences of burnout include depression, substance abuse, and decreased job satisfaction. CONCLUSIONS Reported burnout rates among surgical residents are high. A complex number of sociotechnical factors were found to contribute to burnout, yet many factors are also shown to mitigate burnout. Surgical residencies may address burnout by making changes based on the presence or absence of these factors within their program.
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Affiliation(s)
- Ian M Kratzke
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Lindsay C Woods
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karthik Adapa
- Division of Health Engineering, Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lukasz Mazur
- Division of Health Engineering, Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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15
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Oliveira A, Slanetz PJ, Catanzano TM, Sarkany D, Siddall K, Johnson K, Jordan SG. Strengthening the Clinical Learning Environment by Mandate-Implementing the ACGME Common Program Requirements. Acad Radiol 2022; 29 Suppl 5:S65-S69. [PMID: 33303348 DOI: 10.1016/j.acra.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 11/01/2022]
Abstract
RATIONALE Three years ago, the Accreditation Council for Graduate Medical Education (ACGME) introduced updated Common Program Requirements in recognition of the need to further promote resident and faculty member well-being and patient safety. The ACGME acknowledged residencies would need time to comply with new requirements. This grace period, however, concluded as of July 1, 2019, and programs now risk citations for failure to implement new requirements. METHODS AND RESULTS The authors, members of the Association of Program Directors in Radiology Common Program Requirements Ad Hoc committee, developed downloadable resources provided in the Appendix delineating the 2019 Common Program Requirements and offering sample resources as compliant solutions. CONCLUSION The resources offer a national standardized approach to educating trainees in these essential skills and should be especially helpful to programs with access to fewer resources. In addition to achieving compliance, incorporation of these resources into residency training will ensure the next generation of radiologists are equipped to add value while remaining physically and emotionally healthy.
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16
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Ponsford MW, Bilszta JL, Olver J. Burnout in rehabilitation medicine trainees: a call for more research. Intern Med J 2022; 52:495-499. [DOI: 10.1111/imj.15709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Michael W. Ponsford
- Department of Rehabilitation Epworth HealthCare Melbourne Victoria Australia
| | - Justin L. Bilszta
- Department of Medical Education Melbourne Medical School, University of Melbourne Melbourne Victoria Australia
| | - John Olver
- Department of Rehabilitation Epworth HealthCare Melbourne Victoria Australia
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Lee JS, Wilson A, Okunowo O, Trinh J, Sivoravong J. Personal Health Practices and Perceptions of Lifestyle Counseling and Preventive Services Among Residents. Am J Lifestyle Med 2022; 16:203-213. [DOI: 10.1177/1559827619896301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background. Primary care residents are expected to provide lifestyle counseling and preventive services for patients with chronic diseases; also, physicians’ personal lifestyle practice impacts patient care. The purpose of this article is to assess healthy lifestyle behaviors and attitudes to engage in lifestyle counseling and preventive services among residents and fellows in different training levels and specialty. Methods. A cross-sectional pilot study was conducted on medical residents and fellows (n = 57). Surveys collected information on lifestyle behaviors and perceptions of lifestyle counseling and preventive services. Comparisons of study measures were made across residents’ specialty and training levels. Fisher’s exact and analysis of variance tests were used for statistical analysis. Results. There were several significant differences in perceptions of counseling and screening by specialty and training level. There were no significant differences in personal lifestyle behaviors between all resident specialties and training levels. Conclusion. Our findings suggest that there are opportunities to improve healthy lifestyle behaviors and perceptions of lifestyle counseling and preventive services among residents in different specialties and training levels. This knowledge can inform development of training programs in lifestyle and preventive medicine practice during residency and fellowship.
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Affiliation(s)
- Jenny Sunghyun Lee
- Department of Preventive Medicine, Loma Linda University Health, Loma Linda, California
| | - April Wilson
- Department of Preventive Medicine, Loma Linda University Health, Loma Linda, California
| | - Oluwatimilehin Okunowo
- Healthcare Analytics Unit, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer Trinh
- Family Medicine, Medical City Fort Worth, Fort Worth, Texas
| | - Jon Sivoravong
- Family and Geriatric Medicine, University of Louisville, Owensboro, Kentucky
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18
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Spieler B, Baum N. Burnout: A Mindful Framework for the Radiologist. Curr Probl Diagn Radiol 2021; 51:155-161. [PMID: 34876307 DOI: 10.1067/j.cpradiol.2021.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/11/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022]
Abstract
Burnout, the outcome of prolonged stress or frustration, manifests as both mental and physical fatigue affecting over half of healthcare workers. This article will discuss the etiologies, problems, and potential solutions to burnout related issues that are impacting radiologists. Factors placing radiologists at risk for burnout as well the impact of burnout upon the radiologist, the department, staff, and patients they serve will also be discussed. An emphasis will also be placed upon recognition, solutions, and a collective response to burnout. Readers should be able to perform a self-assessment of their own risk for burnout and understand what can be done to dissolve and prevent burnout amongst their colleagues. In doing so, our hope is that radiologists will develop greater insight, awareness, and ultimately empathy for the unique challenges that others in the radiology community may face.
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Affiliation(s)
- Bradley Spieler
- Department of Diagnostic Radiology, Louisiana State University Health Sciences Center, New Orleans, LA.
| | - Neil Baum
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
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19
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Vercio C, Loo LK, Green M, Kim DI, Beck Dallaghan GL. Shifting Focus from Burnout and Wellness toward Individual and Organizational Resilience. TEACHING AND LEARNING IN MEDICINE 2021; 33:568-576. [PMID: 33588654 DOI: 10.1080/10401334.2021.1879651] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Burnout is reported to be epidemic among physicians and medical trainees, and wellness has been the predominant target for intervention in academic medicine over the past several years. However, both burnout and wellness suffer from a lack of standardized definition, often making interventions difficult to generalize and extrapolate to different sites. Although well-meaning, current frameworks surrounding wellness and burnout have limitations in fully addressing the challenges of improving physician mental health. Wellness as a framework does not inherently acknowledge the adversity inevitably experienced in the practice of medicine and in the lives of medical trainees. During a crisis such as the current pandemic, wellness curricula often do not offer adequate frameworks to address the personal, organizational, or societal crises that may ensue. This leaves academic institutions and their leadership ill-equipped to appropriately address the factors that contribute to burnout. More recently, resilience has been explored as another framework to positively influence physician wellness and burnout. Resilience acknowledges the inevitable adversity individuals encounter in their life and work, allowing for a more open discussion on the tensions and flexibility between facets of life. However, emphasizing personal resiliency without addressing organizational resiliency may leave physicians feeling alienated or marginalized from critical support and resources that organizations can and should provide. Despite intense focus on wellness and burnout, there have not been significant positive changes in physicians' mental health. Many interventions have aimed at the individual level with mindfulness or other reflective exercises; unfortunately these have demonstrated only marginal benefit. Systems level approaches have demonstrated more benefit but the ability of organizations to carry out any specific intervention is likely to be limited by their own unique constraints and may limit the spread of innovation. We believe the current use of these conceptual lenses (wellness and burnout) has been clouded by lack of uniformity of definitions, an array of measurement tools with no agreed-upon standard, a lack of understanding of the complex interaction between the constructs involved, and an over-emphasis on personal rather than organizational interventions and solutions. If the frameworks of burnout and wellness are limited, and personal resilience by itself is inadequate, what framework would be helpful? We believe that focusing on organizational resilience and the connecting dimensions between organizations and their physicians could be an additional framework helpful in addressing physician mental health. An organization connects with its members along multiple dimensions, including communication, recognition of gifts, shared vision, and sense of belonging. By finding ways to positively affect these dimensions, organizations can create change in the culture and mental health of physicians and trainees. Educational institutions specifically would be well-served to consider organizational resilience and its relationship to individuals.
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Affiliation(s)
- Chad Vercio
- Pediatrics, Loma Linda University, Loma Linda, California, USA
| | - Lawrence K Loo
- Internal Medicine, Loma Linda University, Loma Linda, California, USA
| | - Morgan Green
- Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Daniel I Kim
- Internal Medicine, Loma Linda University, Loma Linda, California, USA
- Internal Medicine, Riverside University Health System, Moreno Valley, California, USA
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20
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Harvey SB, Epstein RM, Glozier N, Petrie K, Strudwick J, Gayed A, Dean K, Henderson M. Mental illness and suicide among physicians. Lancet 2021; 398:920-930. [PMID: 34481571 PMCID: PMC9618683 DOI: 10.1016/s0140-6736(21)01596-8] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/09/2021] [Accepted: 07/01/2021] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide. An emerging consensus exists that some aspects of physician training, working conditions, and organisational support are unacceptable. Changes in medical training and health systems, and the additional strain of working through a pandemic, might have amplified these problems. A new evidence-informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools, in health-care settings, and by professional colleagues is proposed. New initiatives are required at each of these levels, with an urgent need for organisational-level interventions, to better protect the mental health and wellbeing of physicians.
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Affiliation(s)
- Samuel B Harvey
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia.
| | - Ronald M Epstein
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Nicholas Glozier
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Katherine Petrie
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Jessica Strudwick
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Aimee Gayed
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Kimberlie Dean
- School of Psychiatry, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia; Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Max Henderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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21
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Lu DW, Germann CA, Nelson SW, Jauregui J, Strout TD. "Pulling the Parachute": A Qualitative Study of Burnout's Influence on Emergency Medicine Resident Career Choices. AEM EDUCATION AND TRAINING 2021; 5:e10535. [PMID: 34099988 PMCID: PMC8166306 DOI: 10.1002/aet2.10535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/30/2020] [Accepted: 09/11/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES About half of all resident physicians report symptoms of burnout. Burnout negatively influences multiple aspects of their education and training. How burnout may impact residents' career choices remains unclear. The authors explored the role burnout played in residents' career decisions. METHODS This was a qualitative study among a sample of 29 emergency medicine residents from four institutions. Qualitative data were generated through four semistructured focus groups. The authors employed a constructivist approach to thematic analysis. Transcripts were coded and organized into major themes. RESULTS Five major themes connecting burnout with residents' career choices emerged: 1) residents' current burnout and the prevention of future burnout figured prominently in their career considerations, 2) residents aimed to mitigate sources of burnout through their career choices, 3) residents' view of clinical work as a burden and a burnout contributor spurred the pursuit of other interests, 4) faculty advice and role modeling in relation to burnout shaped residents' career perspectives, and 5) residents weighed long-term burnout concerns with short-term financial needs. CONCLUSION Burnout played an important role in multiple aspects of residents' career considerations. Educators, program directors, and organization leaders can focus on identified target areas to address burnout's influence on residents' career decisions.
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Affiliation(s)
- Dave W. Lu
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
| | - Carl A. Germann
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
| | - Sara W. Nelson
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
| | - Joshua Jauregui
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
| | - Tania D. Strout
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
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22
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Corgan S, Ford Winkel A, Sugarman R, Young JQ. From Burnout to Wholehearted Engagement: A Qualitative Exploration of Psychiatry Residents' Experience of Stress. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:709-717. [PMID: 33410608 DOI: 10.1097/acm.0000000000003912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Physician burnout is endemic across medical education and has numerous deleterious effects. Given the prevalence and negative effects of burnout, there is an urgent need to understand how residents experience and cope with stress and develop explanatory models that inform the development of more effective interventions. METHOD Using a qualitative, constructivist approach informed by grounded theory, the authors conducted semistructured interviews from March to April 2019, in which psychiatry residents were asked about their experiences of stress and how they coped. First- through fourth-year trainees at Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, were invited. Two authors independently and inductively coded deidentified transcripts. A constant comparative approach was used to analyze data and support construction of themes. Theoretic sufficiency was observed after 14 interviews. RESULTS The authors constructed an explanatory model for how residents cope with stress and whether they tended toward burnout or wholehearted engagement. The model included 3 themes: self-care, work relationships, and meaning making. Self-care, including time spent with others, provided connection and belonging that bolstered physicians' developing identities. Interpersonal relationships at work profoundly influenced the experience of residents. Positive peer and supervisor relationships enhanced confidence and perseverance. Negative role models and conflict engendered feelings of inadequacy. The ability to shift perspective and build meaning through examining moral values in the face of challenges was crucial for residents who reported success at coping with stress. Residents identified personal psychotherapy as an especially important strategy to facilitate meaning making. CONCLUSIONS These findings provide guidance for how residency programs may help residents cope with stress and move away from burnout toward wholehearted engagement. Strategies may include reducing barriers to self-care and to accessing help early in training, creating spaces that promote peer connection and providing training in addressing conflict, and facilitating engagement in meaning-making activities.
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Affiliation(s)
- Sondra Corgan
- S. Corgan is a fellow in child and adolescent psychiatry, Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Abigail Ford Winkel
- A. Ford Winkel is associate professor and vice chair for education, Department of Obstetrics and Gynecology, and assistant director, Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York
| | - Rebekah Sugarman
- R. Sugarman is a medical student, University of Michigan Medical School, Ann Arbor, Michigan
| | - John Q Young
- J.Q. Young is professor and vice chair for education, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York; ORCID: http://orcid.org/0000-0003-2219-5657
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Lu DW, Germann CA, Nelson SW, Jauregui J, Strout TD. "Necessary Compromises": A Qualitative Exploration of the Influence of Burnout on Resident Education. AEM EDUCATION AND TRAINING 2021; 5:e10500. [PMID: 33842813 PMCID: PMC8019220 DOI: 10.1002/aet2.10500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Burnout is prevalent among resident physicians and has a negative impact on their well-being and effectiveness at work. How burnout shapes residents' educational experiences, attitudes, habits, and practices is not well understood. There is also a lack of research regarding self-identified mitigation strategies for residents. The authors qualitatively explored burnout's role in the educational experiences of resident physicians. METHODS Qualitative data were generated from a sample of 29 emergency medicine residents through four semistructured focus groups across four institutions in January and February 2019. The authors employed a constructivist approach to thematic analysis. Transcripts were coded and organized into major and minor themes. RESULTS Residents reported that a misalignment of their individual versus institutional priorities and a lack of agency were significant contributors to their burnout. Residents described how burnout affected multiple aspects of their education, including their motivation and curiosity to learn, engagement in scholarly activity, and teaching of others. Residents identified several ways of building a sense of community that they explained was most useful in mitigating their experiences with burnout. CONCLUSION Burnout had a negative influence on many facets of residents' educational experiences during training. Program directors and educators can take resident-identified steps to moderate its detrimental role on trainee education.
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Affiliation(s)
- Dave W. Lu
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
- Department of Emergency MedicineTufts University School of Medicine – Maine Medical CenterPortlandMEUSA
| | - Carl A. Germann
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
| | - Sara W. Nelson
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
| | - Joshua Jauregui
- Department of Emergency MedicineTufts University School of Medicine – Maine Medical CenterPortlandMEUSA
| | - Tania D. Strout
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
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24
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Doherty AM, Colleran GC, Durcan L, Irvine AD, Barrett E. A pilot study of burnout and long covid in senior specialist doctors. Ir J Med Sci 2021; 191:133-137. [PMID: 33713306 PMCID: PMC7955691 DOI: 10.1007/s11845-021-02594-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/07/2021] [Indexed: 11/30/2022]
Abstract
Background Covid-19 has placed unprecedented demand on healthcare systems and on healthcare professionals. There have been concerns about the risk of distress, moral injury and burnout among healthcare professionals, especially doctors. Aim To assess the effect of the ongoing Covid-19 pandemic on Irish doctors by investigating the incidence of burnout and long covid among senior medical staff in Ireland. Methods This is a cross-sectional pilot study of the prevalence of burnout and long covid among senior physicians. A survey was sent by email to members of the Irish Hospital Consultant’s Association. The survey included measures of mental and physical health and the 2-item Maslach Burnout Scale (MBS-2). The study explored the experience of delivering health care in the context of a pandemic and experience of the long covid syndrome. Results A total of 114 responses were received. Three-quarters 77% (N = 88) screened positive for burnout on the MBS, with mean score of 5.6 (SD3.3), nearly double the cut-off for burnout. Nearly two-thirds (64%, n = 72) reported that Covid-19 has had an adverse effect on their mental health. One-quarter reported that they or colleagues had experience of ‘long-covid’ secondary to the virus. Conclusion More comprehensive evaluation of the effect of the pandemic on front-line staff is needed to identify the extent of the problem and the factors which contribute to it. This will inform measures to mitigate these effects.
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Affiliation(s)
- Anne M Doherty
- School of Medicine, University College Dublin, Dublin, Ireland. .,Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Gabrielle C Colleran
- Children's Health Ireland, Temple Street, Dublin, Ireland.,National Maternity Hospital, Dublin, Ireland
| | - Laura Durcan
- Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alan D Irvine
- Children's Health Ireland, Temple Street, Dublin, Ireland.,Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Elizabeth Barrett
- School of Medicine, University College Dublin, Dublin, Ireland.,Children's Health Ireland, Temple Street, Dublin, Ireland.,Clinical Medicine, Trinity College Dublin, Dublin, Ireland
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25
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Stevens K, Davey C, Lassig AA. Association of Weekly Protected Nonclinical Time With Resident Physician Burnout and Well-being. JAMA Otolaryngol Head Neck Surg 2021; 146:168-175. [PMID: 31895461 DOI: 10.1001/jamaoto.2019.3654] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Burnout among physicians is high, with resulting concern about quality of care. With burnout beginning early in physician training, much-needed data are lacking on interventions to decrease burnout and improve well-being among resident physicians. Objectives To design a departmental-level burnout intervention, evaluate its association with otolaryngology residents' burnout and well-being, and describe how residents used and perceived the study intervention. Design, Setting, and Participants A prospective, nonrandomized crossover study was conducted from September 25, 2017, to June 24, 2018, among all 19 current residents in the Department of Otolaryngology at the University of Minnesota. Statistical analysis was performed from June 28 to August 7, 2018. Interventions All participants were assigned 2 hours per week of protected nonclinical time alternating with a control period of no intervention at 6-week intervals. Main Outcomes and Measures Burnout was measured by the Maslach Burnout Inventory and Mini-Z Survey. Well-being was measured by the Resident and Fellow Well-Being Index and a quality-of-life single-item self-assessment. In addition to a baseline demographic survey, participants completed the aforementioned surveys at approximately 6-week intervals during the study period. Results Among the 19 residents in the study (10 men [53%]), the overall protected time intervention (week 0 to week 32) was associated with a mean decrease of 0.63 points (95% CI, -1.03 to -0.22 points) in the Maslach Burnout Inventory emotional exhaustion score, indicating a clinically meaningful decrease in burnout, and a mean decrease of 1.26 points (95% CI, -2.18 to -0.34 points) in the Resident and Fellow Well-Being Index score, indicating a clinically meaningful improvement in well-being. The baseline to week 32 mean changes in the Maslach Burnout Inventory depersonalization score, Maslach Burnout Inventory personal accomplishment score, and quality-of-life single-item self-assessment were not clinically meaningful. There were clinically meaningful improvements in 4 of 6 tested Mini-Z Questionnaire items from baseline to week 32: job stress (weighted κ statistic, 0.21; 95% CI, -0.11 to 0.53), burnout (weighted κ statistic, 0.25; 95% CI, -0.02 to 0.53), control over workload (weighted κ statistic, 0.26; 95% CI, -0.01 to 0.53), and sufficient time for documentation (weighted κ statistic, 0.31; 95% CI, 0.08 to 0.54). Conclusions and Relevance This study found that 2 hours per week of protected nonclinical time was associated with decreased burnout and increased well-being in a small sample of otolaryngology residents. Future randomized clinical studies in larger cohorts are warranted to infer causality of decreased burnout and increased well-being as a result of protected nonclinical time.
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Affiliation(s)
- Kristin Stevens
- Department of Otolaryngology, University of Minnesota, Minneapolis.,Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis
| | - Cynthia Davey
- Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis
| | - Amy Anne Lassig
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis.,Hennepin Healthcare Research Institute, Department of Otolaryngology-Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, Minnesota
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26
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Naji L, Singh B, Shah A, Naji F, Dennis B, Kavanagh O, Banfield L, Alyass A, Razak F, Samaan Z, Profetto J, Thabane L, Sohani ZN. Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression. CMAJ Open 2021; 9:E189-E200. [PMID: 33688027 PMCID: PMC8034324 DOI: 10.9778/cmajo.20200068] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Burnout among postgraduate medical trainees (PMTs) is increasingly being recognized as a crisis in the medical profession. We aimed to establish the prevalence of burnout among PMTs, identify risk and protective factors, and assess whether burnout varied by country of training, year of study and specialty of practice. METHODS We systematically searched MEDLINE, Embase, PsycINFO, the Cochrane Database of Systematic Reviews, Web of Science and Education Resources Information Center from their inception to Aug. 21, 2018, for studies of burnout among PMTs. The primary objective was to identify the global prevalence of burnout among PMTs. Our secondary objective was to evaluate the association between burnout and country of training, year of study, specialty of training and other sociodemographic factors commonly thought to be related to burnout. We employed random-effects meta-analysis and meta-regression techniques to estimate a pooled prevalence and conduct secondary analyses. RESULTS In total, 8505 published studies were screened, 196 met eligibility and 114 were included in the meta-analysis. The pooled prevalence of burnout was 47.3% (95% confidence interval 43.1% to 51.5%), based on studies published over 20 years involving 31 210 PMTs from 47 countries. The prevalence of burnout remained unchanged over the past 2 decades. Burnout varied by region, with PMTs of European countries experiencing the lowest level. Burnout rates among medical and surgical PMTs were similar. INTERPRETATION Current wellness efforts and policies have not changed the prevalence of burnout worldwide. Future research should focus on understanding systemic factors and leveraging these findings to design interventions to combat burnout. STUDY REGISTRATION PROSPERO no. CRD42018108774.
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Affiliation(s)
- Leen Naji
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
| | - Brendan Singh
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Ajay Shah
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Faysal Naji
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Brittany Dennis
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Owen Kavanagh
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Laura Banfield
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Akram Alyass
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Fahad Razak
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Zainab Samaan
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Jason Profetto
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Lehana Thabane
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Zahra N Sohani
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
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A Progressive Model for Quality Benchmarks of Trainees’ Satisfaction in Medical Education: Towards Strategic Enhancement of Residency Training Programs at Saudi Commission for Health Specialties (SCFHS). SUSTAINABILITY 2020. [DOI: 10.3390/su122310186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The latest developments in Sustainable Health focus on the provision of high quality medical training to health specialists, with a special focus on human factors. The need to promote effective Training Programs also reflects the job satisfaction needs of trainees. The objective of this study is to evaluate the trainees’ satisfaction with the quality of Training Programs and assess the degree of achievement based on the defined parameters to provide baseline data based on which strategies for improvement can be formulated. Our study was conducted in Saudi Arabia and our targeted population was residents in medical programs supervised by the Saudi Commission for the Health Specialties (SCFHS). The trainees’ response rate to the online survey was 27% (3696/13,688) and the key aspects of job satisfaction investigated include: Satisfaction with Academic Activities in the Center; Satisfaction with the Residents and Colleagues in the Center; Satisfaction with the Administrative Components in the Center; Satisfaction with the Training Programs; Satisfaction with the Specialty; Satisfaction with the Training Center; Satisfaction with the SCFHS. The main contribution of our work is a benchmark model for job satisfaction that can be used as a managerial tool for the enhancement of medical education with reference to the satisfaction of trainees. We analyze the key aspects and components of training satisfaction and we introduce our progressive model for Trainees’ Satisfaction in Medical Training. In future work, we intend to enhance the proposed framework with a set of key performance indicators as well as with a focused cause and effect focused survey on factors related to the key benchmark of this study.
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28
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Quality and Safety in Healthcare, Part LXIII. Clin Nucl Med 2020; 45:860-862. [DOI: 10.1097/rlu.0000000000002931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Gillen P, Byrt R, Egleston H, Egleston N, Boland F, Doherty EM. Five things I wish I had known when I became a consultant. Ir J Med Sci 2020; 190:949-953. [PMID: 33094467 DOI: 10.1007/s11845-020-02413-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the advice consultants wish they had received on their appointment and to see if that advice differs by gender, or length of time since appointment. METHODS An anonymous survey of consultants was undertaken through the alumni offices of the Royal College of Surgeons in Ireland, the Royal College of Physicians of Ireland and the College of Anaesthesiologists of Ireland. A link to a Qualtrics survey was sent and consultants were asked to list the five pieces of advice they wish they had been told on appointment. Free text boxes without limits were used. The responses were analysed and themes identified and subjected to statistical analysis. RESULTS A total of 379 consultants responded. The top five pieces of advice were, in order, self-care, work-life balance, relationships with colleagues, teamwork and continuous education. There was a majority of male respondents (60%) and just over 60% of respondents had more than ten years' experience as a consultant. Gender analysis showed that only one of the top five categories-continuous education-demonstrated a significant difference between male and female respondents (p < .001). Self-care was significantly less likely (p < .04) to feature as advice given in those more than twenty years a consultant. Females were significantly more likely to advise learning to 'say no' than males (p < .001). More males had responses in relation to 'financial advice' (p = .002) and 'teaching' (p = .04) compared to females. CONCLUSION The emergence of 'self-care' and 'work-life balance' as the top pieces of advice suggests that consultants regret that they have not looked after their health. The fact that 'self-care' was significantly less likely to feature among consultants more than twenty years in practice may point to generational differences.
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Affiliation(s)
- Peter Gillen
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Robyn Byrt
- Alumni Office, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Niamh Egleston
- London School of Economics and Political Science, London, UK
| | - Fiona Boland
- Department of Statistics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eva M Doherty
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
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Kalantarova S, Mickinac N, Santhosh S, Malik S, Surovitsky M, Madsen L, Rapoport I, Lee C, Hoffmann JC. Preventing Physician Burnout in Breast Imaging: Scope of the Problem and Keys to Success. Curr Probl Diagn Radiol 2020; 50:734-737. [PMID: 33069520 DOI: 10.1067/j.cpradiol.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
Physicians, including radiologists and specifically breast imagers, face many challenges, and stressors during their daily routine, many of which can contribute to burnout. While there is an increasing body of literature evaluating burnout, including its prevalence in and impact on radiologists, there is a relative lack of information specifically addressing this topic as it relates to breast imaging. This article reviews key concepts in burnout, describes the potential impact on physicians at all levels of training and work, highlights unique aspects to the specialty of breast imaging that may contribute to burnout, and suggests tool and/or strategies that may help to combat and prevent burnout among breast imagers.
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Affiliation(s)
| | | | - Sharon Santhosh
- University at Buffalo Jacobs School of Medicine, Buffalo, NY
| | - Swati Malik
- New York Institute of Technology School of Osteopathic Medicine, Westbury, NY
| | | | - Laura Madsen
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY
| | - Irina Rapoport
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY
| | - Cindy Lee
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY
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Quality and Safety in Healthcare, Part LXII. Clin Nucl Med 2020; 45:778-780. [DOI: 10.1097/rlu.0000000000002885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Evaluation of Key Performance Indicators (KPIs) for Sustainable Postgraduate Medical Training: An Opportunity for Implementing an Innovative Approach to Advance the Quality of Training Programs at the Saudi Commission for Health Specialties (SCFHS). SUSTAINABILITY 2020. [DOI: 10.3390/su12198030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Kingdom of Saudi Arabia is undergoing a major transformation in response to a revolutionary vision of 2030, given that healthcare reform is one of the top priorities. With the objective of improving healthcare and allied professional performance in the Kingdom to meet the international standards, the Saudi Commission for Health Specialties (SCFHS) has recently developed a strategic plan that focuses on expanding training programs’ capacity to align with the increasing demand for the country’s healthcare workforce, providing comprehensive quality assurance and control to ensure training programs uphold high quality standards, and providing advanced training programs benchmarked against international standards. In this research paper, we describe our attempt for developing a general framework for key performance indicators (KPIs) and the related metrics, with the aim of contributing to developing new strategies for better medical training compatible with the future. We present the results of a survey conducted in the Kingdom of Saudi Arabia (KSA), for the enhancement of quality of postgraduate medical training. The recent developments in the field of learning analytics present an opportunity for utilizing big data and artificial intelligence in the design and implementation of socio-technical systems with significant potential social impact. We summarize the key aspects of the Training Quality Assurance Initiative and suggest a new approach for designing a new data and services ecosystem for personalized health professionals training in the KSA. The study also contributes to the theoretical knowledge on the integration of sustainability and medical training and education by proposing a framework that can enhance future initiatives from various health organizations.
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Abstract
Some of the causes for resident burnout and other impairments of wellness are the same as for other physicians, but some are quite different. For example, residents have much less autonomy and control, are under more pressure to learn a huge amount of information quickly, are more frequently evaluated, have stress from taking more examinations, and have more financial pressure than a typical physician who has graduated from formal training. Residency education also involves oversight from the Accreditation Council of Graduate Medical Education, which seeks to decrease some of the pressures of residency, but an unintended consequence of their limitation of work hours has been, in some programs, the phenomenon of "work compression."
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Williams-Karnesky RL, Greenbaum A, Paul JS. Surgery Resident Wellness Programs: The Current State of the Field and Recommendations for Creation and Implementation. Adv Surg 2020; 54:149-171. [PMID: 32713427 DOI: 10.1016/j.yasu.2020.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Alissa Greenbaum
- Department of Surgery, MSC10 5610, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Jasmeet S Paul
- Department of Surgery, MSC10 5610, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA; Division of Acute Care Surgery, Department of Surgery, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Muhamad Ramzi NSA, Deady M, Petrie K, Crawford J, Harvey SB. Help-seeking for depression among Australian doctors. Intern Med J 2020; 51:2069-2077. [PMID: 32833296 DOI: 10.1111/imj.15035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Depression is common among doctors. However, concerns remain that doctors are unlikely to ask for help when symptoms of depression arise. AIMS To determine rates and patterns of help-seeking for depression among doctors and to identify predictors of and barriers to such behaviour. METHODS A secondary analysis was conducted on a nation-wide survey of 12 252 Australian doctors. The study sample consisted of doctors who reported having ever felt seriously depressed (n = 4154; 33.9% of total sample). Rates of help-seeking, professional help-seeking behaviours and self-reported barriers were explored. Logistic regression was used to examine the association between professional help-seeking and predetermined predictive factors. RESULTS Sixty percent (95% confidence interval (CI): 58.5-61.5) of doctors who have ever felt seriously depressed reported some form of professional help-seeking for depression. The most common barrier to help-seeking was 'privacy/confidentiality'. Females (odds ratio (OR) = 1.74; 95% CI: 1.50-2.01; P < 0.001), locally trained doctors (OR = 1.34; 95% CI: 1.12-1.59; P = 0.001) and senior doctors (OR = 1.35; 95% CI: 1.14-1.61; P = 0.001) were more likely to seek professional help than their counterparts. Compared with general practitioners, psychiatrists (OR = 1.565; 95% CI: 1.15-2.13; P = 0.004) were more likely to seek professional help while surgeons (OR = 0.518; 95% CI: 0.37-0.72; P < 0.001) and pathologists/radiologists (OR = 0.695; 95% CI: 0.49-0.99; P = 0.043) were less likely. CONCLUSION While it is reassuring that the majority of depressed doctors were able to seek professional help, many were not. Major barriers to professional help-seeking, particularly concerns about confidentiality and impact on career, remain a problem. Male, overseas-trained, junior doctors, surgeons and pathologists/radiologists were less likely to seek help for depression. Targeted interventions are required to increase appropriate help-seeking for depression in doctors.
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Affiliation(s)
| | - Mark Deady
- Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
| | - Katherine Petrie
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
| | - Joanna Crawford
- Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
| | - Samuel B Harvey
- Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
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Robbins JB, England E, Patel MD, DeBenedectis CM, Sarkany DS, Heitkamp DE, Milburn JM, Kalia V, Ali K, Gaviola GC, Ho CP, Jay AK, Ong S, Jordan SG. COVID-19 Impact on Well-Being and Education in Radiology Residencies: A Survey of the Association of Program Directors in Radiology. Acad Radiol 2020; 27:1162-1172. [PMID: 32571648 PMCID: PMC7293482 DOI: 10.1016/j.acra.2020.06.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES The COVID-19 pandemic has forced rapid evolution of the healthcare environment. Efforts to mitigate the spread of the virus through social distancing and shelter-at-home edicts have unintended consequences upon clinical and educational missions and mental well-being of radiology departments. We sought to understand the impact of the COVID-19 pandemic on radiology residencies with respect to the educational mission and perceptions of impact on well-being. MATERIALS AND METHODS This study was IRB exempt. An anonymous 22 question survey regarding the impact of COVID-19 pandemic on educational and clinical missions of residencies, its perceived impact upon morale of radiologists and trainees and a query of innovative solutions devised in response, was emailed to the Association of Program Directors in Radiology membership. Survey data were collected using SurveyMonkey (San Mateo, California). RESULTS Respondents felt the COVID-19 pandemic has negatively impacted their residency programs. Regarding the educational mission impact, 70.1% (75/107) report moderate/marked negative impact and 2.8% (3/107) that educational activities have ceased. Regarding the pandemic's impact on resident morale, 44.8% (48/107) perceive moderate/marked negative effect; perceived resident morale in programs with redeployment is significantly worse with 57.1% (12/21) reporting moderate/marked decrease. Respondents overwhelmingly report adequate resident access to mental health resources during the acute phase of the pandemic (88.8%, 95/107). Regarding morale of program directors, 61% (65/106) report either mild or marked decreased morale. Program innovations reported by program directors were catalogued and shared. CONCLUSION The COVID-19 pandemic has markedly impacted the perceived well-being and educational missions of radiology residency programs across the United States.
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Affiliation(s)
- Jessica B Robbins
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/374 CSC, Madison, WI 53792.
| | - Eric England
- University of Cincinnati Medical Center, Department of Radiology, Cincinnati, Ohio
| | - Maitray D Patel
- Mayo Clinic Arizona, Department of Radiology, Phoenix, Arizona
| | - Carolynn M DeBenedectis
- University of Massachusetts Medical School, Department of Radiology, Worcester, Massachusetts
| | - David S Sarkany
- Staten Island University Hospital Northwell Health, Department of Radiology, Staten Island, New York
| | | | - James M Milburn
- Ochsner Clinic Foundation, Department of Radiology, New Orleans, Louisiana
| | - Vivek Kalia
- University of Michigan Health System, Department of Radiology, Ann Arbor, Michigan
| | - Kamran Ali
- University of Kansas School of Medicine, Department of Radiology, Wichita, Kansas
| | - Glenn C Gaviola
- Brigham and Women's Hospital, Department of Radiology, Boston, Massachusetts
| | - Christopher P Ho
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia
| | - Ann K Jay
- MedStar Georgetown University Hospital, Department of Radiology, Washington, District of Columbia
| | - Seng Ong
- University of Chicago Medical Center, Department of Radiology, Chicago, Illinois
| | - Sheryl G Jordan
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Al-Jehani YM, Althwanay AM, Buainain HM, Abuhaimed AK, Almulhim AM, Abusrir FA, Alkhabbaz FL, Almustafa SS, Abdel Wahab MM. Burnout Prevalence and Associated Stressors in Medical Students of Traditional and Problem-Based Learning Curricula in a Saudi University. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 8:125-132. [PMID: 32587494 PMCID: PMC7305681 DOI: 10.4103/sjmms.sjmms_301_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/27/2019] [Accepted: 12/01/2019] [Indexed: 12/02/2022]
Abstract
Background: Medical students are prone to burnout, and several stressors have been associated with it. From the literature, it is yet unclear if type of curricula in medical schools plays a role in burnout among students. Aims: To assess the prevalence of burnout and its associated stressors in medical students in problem-based learning and traditional curricula at Imam Abdulrahman Bin Faisal University. Subjects and Methods: The analytical, cross-sectional study was conducted between February and May 2017 and included all third- to sixth-year medical students of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. In the 2016–2017 academic year, third- and fourth-year students were in problem-based learning, whereas fifth- and sixth-year students were in traditional learning. All eligible students were verbally invited to complete a 56-item questionnaire comprising three sections eliciting sociodemographic information, level of burnout (using a modified Copenhagen Burnout Inventory with personal, medical school- and faculty-related subsections) and stressors associated with burnout. Burnout was measured using a Likert-type scale, and scores of >50 were considered as high burnout. Chi-square and logistic regression analysis were used for statistical analysis. Results: Of 947 eligible students, 593 (62.6%) completed the questionnaire: 317 (53.5%) were in problem-based learning and 276 (46.5%) in traditional learning. Of these, 329 (55.5%) had high burnout, with no difference between type of curricula (problem-based learning = 178 [56.2%]; traditional = 151 [54.7%]; P = 0.73). All measured stressors were significantly associated with high burnout, including lack of sleep (odds ratio [OR] = 2.139, P = 0.005) and perceiving teaching staff as inflexible and unsupportive (OR = 2.995, P < 0.001). Conclusions: This study found high prevalence of burnout among medical students in a university from Saudi Arabia, but no significant difference between students in problem-based learning and traditional curricula. A longitudinal study is recommended to better understand the long-term effect of type of curricula on burnout.
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Affiliation(s)
- Yasser Maher Al-Jehani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Surgery, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | | | - Hessah Mohammed Buainain
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Surgery, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | | | | | - Fatima Adel Abusrir
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Salam Sami Almustafa
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Moataza Mahmoud Abdel Wahab
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Biostatistics, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Levy JL, Freeman CW, Cho JK, Iyalomhe O, Scanlon MH. Evaluating the Impact of a Call Triage Assistant on Resident Efficiency, Errors, and Stress. J Am Coll Radiol 2020; 17:414-420. [DOI: 10.1016/j.jacr.2019.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/02/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
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Abstract
Physician wellness is a critical component of any effective health care system, as physicians serve essential roles as diagnosticians, surgeons, and leaders in medical care. Physician burnout, defined as a combination of the presence of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, is an increasingly recognized problem in the US health care system, as rates of burnout among physicians are on the rise, now exceeding 50%. To date, few studies have examined the impact of burnout on dermatologists specifically, but existing studies evaluating physicians collectively have shed light on the problem that exists in our specialty. This review focuses on the causes of physician dissatisfaction and burnout and provides an overview on interventions to mitigate them while emphasizing wellness; where applicable, special emphasis is placed on dermatologists.
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Affiliation(s)
- Drew J B Kurtzman
- Department of Dermatology, Wright State University Boonshoft School of Medicine, Beavercreek, Ohio, USA.
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40
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Rühle A, Oehme F, Link BC, Metzger J, Fischer H, Stickel M, Delagrammaticas DE, Babst R, Beeres FJP. Swiss chocolate and free beverages to increase the motivation for scientific work amongst residents: a prospective interventional study in a non-academic teaching hospital in Switzerland. Trials 2020; 21:74. [PMID: 31931852 PMCID: PMC6958759 DOI: 10.1186/s13063-019-3956-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The success of a clinical trial depends on its recruitment of eligible patients; therefore, the recruitment period requires special attention. We hypothesized that with a new approach focused on continuous information and gratification, resident motivation to participate in scientific work will increase and recruitment rates will improve. METHODS Our new recruitment approach was applied to the recruitment phase of two prospective randomized trials (registered at the German Clinical Trials Register). Randomization of these trials was performed first using blinded envelopes; later a soft drink machine was used as the delivery tool of randomization as a lighthearted motivation to join scientific work and to reward the resident with free soft drinks for each recruitment. Residents were informed about the trial via a lecture and by mail. To increase interest everyone received Swiss chocolate. With a multiple choice survey we investigated the success of our actions at 6 and 12 months. Recruitment rates of the trials were evaluated and associated with the motivational approaches. RESULTS Our residents rated their awareness of the trials with median 9 (IQR 7;9) during the first and 8 (IQR 5;9) during the second survey and their interest in scientific work with median 7 (IQR 4;8) and 6 (IQR 5;8). The percentage of residents feeling highly motivated improved from 58% to 70%. The recruitment rates stayed stably high over time with 73% and 72% in trial 1 and 90% and 85% in trial 2; 24% of residents stated their motivation could be increased by gratifications. CONCLUSIONS After implementation of our new recruitment approach we found positively motivated residents and high recruitment rates in the corresponding trials. We propose this procedure may help to ensure the successful initiation of clinical trials. Larger studies testing this approach are warranted.
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Affiliation(s)
- Annika Rühle
- Department of General and Visceral Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland.
| | - Florian Oehme
- Department of General and Visceral Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Traumatology and Orthopaedic Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Jürg Metzger
- Department of General and Visceral Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Henning Fischer
- Department of General and Visceral Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland.,Emergency Department, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Michael Stickel
- Emergency Department, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Dimitri E Delagrammaticas
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair, Chicago, IL, 60611, USA
| | - Reto Babst
- Department of Traumatology and Orthopaedic Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Frank J P Beeres
- Department of Traumatology and Orthopaedic Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
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Occupational Burnout Syndrome in Polish Physicians: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245026. [PMID: 31835554 PMCID: PMC6950131 DOI: 10.3390/ijerph16245026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 01/08/2023]
Abstract
Due to the nature of their work, physicians are exposed to chronic stress. This may potentially lead to the widespread occurrence of occupational burnout syndrome (BS). The aim of this systematic review study was to summarize available published data concerning the prevalence of BS in Polish doctors. The literature search was performed using the following databases: PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar. The last search was performed on September 27th, 2019. Only articles in English or Polish on graduated doctors practicing in Poland were taken into account. All types of original research were considered eligible. However, review articles, book chapters, case reports, case series, conference papers, study protocols and articles in languages other than English and Polish were excluded. There were no restrictions on age, seniority or specialty of study participants. The literature search revealed a total of 21 studies that met the inclusion criteria. The results of individual studies were very diverse, which makes it difficult to draw specific conclusions. However, the problem of burnout among Polish doctors is valid and worth special attention from society, health policy leaders, and doctors themselves. High-quality research is essential to for a better understanding of this topic.
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Williford ML, Scarlet S, Meyers MO, Luckett DJ, Fine JP, Goettler CE, Green JM, Clancy TV, Hildreth AN, Meltzer-Brody SE, Farrell TM. Multiple-Institution Comparison of Resident and Faculty Perceptions of Burnout and Depression During Surgical Training. JAMA Surg 2019; 153:705-711. [PMID: 29800976 DOI: 10.1001/jamasurg.2018.0974] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Prior studies demonstrate a high prevalence of burnout and depression among surgeons. Limited data exist regarding how these conditions are perceived by the surgical community. Objectives To measure prevalence of burnout and depression among general surgery trainees and to characterize how residents and attendings perceive these conditions. Design, Setting, and Participants This cross-sectional study used unique, anonymous surveys for residents and attendings that were administered via a web-based platform from November 1, 2016, through March 31, 2017. All residents and attendings in the 6 general surgery training programs in North Carolina were invited to participate. Main Outcomes and Measures The prevalence of burnout and depression among residents was assessed using validated tools. Burnout was defined by high emotional exhaustion or depersonalization on the Maslach Burnout Inventory. Depression was defined by a score of 10 or greater on the Patient Health Questionnaire-9. Linear and logistic regression models were used to assess predictive factors for burnout and depression. Residents' and attendings' perceptions of these conditions were analyzed for significant similarities and differences. Results In this study, a total of 92 residents and 55 attendings responded. Fifty-eight of 77 residents with complete responses (75%) met criteria for burnout, and 30 of 76 (39%) met criteria for depression. Of those with burnout, 28 of 58 (48%) were at elevated risk of depression (P = .03). Nine of 77 residents (12%) had suicidal ideation in the past 2 weeks. Most residents (40 of 76 [53%]) correctly estimated that more than 50% of residents had burnout, whereas only 13 of 56 attendings (23%) correctly estimated this prevalence (P < .001). Forty-two of 83 residents (51%) and 42 of 56 attendings (75%) underestimated the true prevalence of depression (P = .002). Sixty-six of 73 residents (90%) and 40 of 51 attendings (78%) identified the same top 3 barriers to seeking care for burnout: inability to take time off to seek treatment, avoidance or denial of the problem, and negative stigma toward those seeking care. Conclusions and Relevance The prevalence of burnout and depression was high among general surgery residents in this study. Attendings and residents underestimated the prevalence of these conditions but acknowledged common barriers to seeking care. Discrepancies in actual and perceived levels of burnout and depression may hinder wellness interventions. Increasing understanding of these perceptions offers an opportunity to develop practical solutions.
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Affiliation(s)
| | - Sara Scarlet
- Department of Surgery, University of North Carolina at Chapel Hill
| | - Michael O Meyers
- Department of Surgery, University of North Carolina at Chapel Hill
| | - Daniel J Luckett
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Jason P Fine
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Claudia E Goettler
- Department of Surgery, East Carolina Brody School of Medicine, Greenville, North Carolina
| | - John M Green
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Thomas V Clancy
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina
| | - Amy N Hildreth
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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44
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Thrush CR, Guise JB, Gathright MM, Messias E, Flynn V, Belknap T, Thapa PB, Williams DK, Nada EM, Clardy JA. A One-Year Institutional View of Resident Physician Burnout. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:361-368. [PMID: 30820845 DOI: 10.1007/s40596-019-01043-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 02/13/2019] [Indexed: 05/28/2023]
Abstract
OBJECTIVES This prospective study explores the prevalence, associated characteristics, and trajectory of burnout over one academic year in a multidisciplinary sample of resident physicians using a relatively new burnout survey instrument. METHODS All residents from a U.S. academic health center (n = 633) were invited to complete the Copenhagen Burnout Inventory (CBI) three times, with 4-month time lags between invitations. A total of 281 (44%) provided complete CBI survey responses at least once, and 43 (7%) did at all three times. Descriptive statistics, cross-sectional analyses, correlations, and multivariable linear regression analyses were computed, as well as repeated measures ANOVAs and paired t tests, as appropriate, for each CBI domain (personal, work, patient-related burnout). RESULTS About half had CBI scores indicating moderate-to-high levels of personal burnout (49-52%) and work-related burnout (45-49%), whereas patient-related burnout was less common (14-24%). However, patient-related burnout increased significantly from the beginning to the end of the year. Regression analyses indicated patient-related burnout was significantly higher for postgraduate year 1-2 residents compared to PGY 4+ residents, but was not significantly different by gender. Personal and work burnout scores were significantly higher for females. Persistently high burnout was observed in only 6% of respondents. CONCLUSIONS In this study of resident physicians using the CBI, burnout was prevalent and higher levels of burnout were observed for females on the personal and work burnout domains, while junior residents had higher patient-related burnout. Persistently, high burnout was rare. The CBI demonstrated high reliability, was practical to administer, and produced similar results with existing burnout research.
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Affiliation(s)
- Carol R Thrush
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - J Benjamin Guise
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Erick Messias
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Victoria Flynn
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Toby Belknap
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - D Keith Williams
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eman M Nada
- University of Massachusetts Medical School, Worcester, MA, USA
| | - James A Clardy
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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The Association of Program Directors in Radiology Well-Being 2019 Survey: Identifying Residency Gaps and Offering Solutions. J Am Coll Radiol 2019; 16:1702-1706. [PMID: 31302059 DOI: 10.1016/j.jacr.2019.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE The Well-Being subcommittee of the Association of Program Directors in Radiology (APDR) Common Program Requirements (CPR) Ad Hoc Committee and the APDR Academic Output Task Force jointly conducted a study of APDR members' current level of understanding and implementation of the 2017 ACGME CPR regarding well-being. METHODS A survey instrument consisting of 10 multiple-choice and open-ended questions was distributed to the 322 active members of the APDR. The survey focused on three main content areas: APDR member knowledge of the 2017 CPR, composition of department well-being curricula, and residency well-being innovations. RESULTS In all, 121 members (37.6%) responded to the survey. Of those, 67% rated their knowledge of requirements as incomplete. Responses also indicated that 74% of departments have not implemented a comprehensive well-being curriculum; 53% of programs do not offer the mandated self-screening tool; 15% of respondents do not offer residents protected time for medical, mental health, and dental appointments; and 42% do not offer their trainees access to an institutional mental health clinic. Survey comments offer numerous individual well-being initiatives from across the membership. CONCLUSIONS The results of the APDR Well-Being Survey indicate that many programs have substantial work remaining to achieve ACGME compliance. Well-being innovations were included in an effort to share best practices.
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Gali HE, Baxter SL, Lander L, Huang AE, Millen M, El-Kareh R, Nudleman E, Chao DL, Robbins SL, Heichel CWD, Camp AS, Korn BS, Lee JE, Kikkawa DO, Longhurst CA, Chiang MF, Hribar MR, Ohno-Machado L. Impact of Electronic Health Record Implementation on Ophthalmology Trainee Time Expenditures. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2019; 11:e65-e72. [PMID: 33954272 DOI: 10.1055/s-0039-3401986] [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: 10/25/2022] Open
Abstract
Objective Electronic health records (EHRs) are widely adopted, but the time demands of EHR use on ophthalmology trainees are not well understood. This study evaluated ophthalmology trainee time spent on clinical activities in an outpatient clinic undergoing EHR implementation. Design Prospective, manual time-motion observations of ophthalmology trainees in 2018. Participants Eleven ophthalmology residents and fellows observed during 156 patient encounters. Methods Prospective time-motion study of ophthalmology trainees 2 weeks before and 6 weeks after EHR implementation in an academic ophthalmology department. Manual time-motion observations were conducted for 11 ophthalmology trainees in 6 subspecialty clinics during 156 patient encounters. Time spent documenting, examining, and talking with patients were recorded. Factors influencing time requirements were evaluated using linear mixed effects models. Main Outcome Measures Total time spent by ophthalmology residents and fellows per patient, time spent on documentation, examination, and talking with patients. Results Seven ophthalmology residents and four ophthalmology fellows with mean (standard deviation) postgraduate year of 3.7 (1.2) were observed during 156 patient encounters. Using paper charts, mean total time spent on each patient was 11.6 (6.5) minutes, with 5.4 (3.5) minutes spent documenting (48%). After EHR implementation, mean total time spent on each patient was 11.8 (6.9) minutes, with 6.8 (4.7) minutes spent documenting (57%). Total time expenditure per patient did not significantly change after EHR implementation (+0.17 minutes, 95% confidence interval [CI] for difference in means: -2.78, 2.45; p = 0.90). Documentation time did not change significantly after EHR implementation in absolute terms (+1.42 minutes, 95% CI: -3.13, 0.29; p = 0.10), but was significantly greater as a proportion of total time (48% on paper to 57% on EHR; +9%, 95% CI: 2.17, 15.83; p = 0.011). Conclusion Total time spent per patient and absolute time spent on documentation was not significantly different whether ophthalmology trainees used paper charts or the recently implemented EHR. Percentage of total time spent on documentation increased significantly with early EHR use. Evaluating EHR impact on ophthalmology trainees may improve understanding of how trainees learn to use the EHR and may shed light on strategies to address trainee burnout.
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Affiliation(s)
- Helena E Gali
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego (UCSD), La Jolla, California.,UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Sally L Baxter
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego (UCSD), La Jolla, California.,UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Lina Lander
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Abigail E Huang
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Marlene Millen
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Robert El-Kareh
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Eric Nudleman
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego (UCSD), La Jolla, California
| | - Daniel L Chao
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego (UCSD), La Jolla, California
| | - Shira L Robbins
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego (UCSD), La Jolla, California
| | - Christopher W D Heichel
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego (UCSD), La Jolla, California
| | - Andrew S Camp
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego (UCSD), La Jolla, California
| | - Bobby S Korn
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego (UCSD), La Jolla, California
| | - Jeffrey E Lee
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego (UCSD), La Jolla, California
| | - Don O Kikkawa
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego (UCSD), La Jolla, California
| | - Christopher A Longhurst
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Michael F Chiang
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.,Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Michelle R Hribar
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.,Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Lucila Ohno-Machado
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California.,Division of Health Services Research and Development, Veterans Administration San Diego Healthcare System, La Jolla, California
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Singman EL, Boland MV, Tian J, Green LK, Srikumaran D. Supervision and autonomy of ophthalmology residents in the outpatient clinic in the United States II: a survey of senior residents. BMC MEDICAL EDUCATION 2019; 19:202. [PMID: 31196084 PMCID: PMC6567568 DOI: 10.1186/s12909-019-1620-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/22/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND A balance between autonomy and supervision can be difficult to obtain in medical education. In this study, we sought to determine whether the presence and level of supervision of ophthalmology resident outpatient clinic correlates with metrics of resident success, professionalism and stress. METHODS A survey was emailed to all US ophthalmology program directors requesting it be forwarded to PGY4 residents. Questions included whether their program provided a resident-hosted outpatient clinic, and if so, whether residents were mandated to discuss every patient with faculty. Residents were assigned to three categories based on this question (0: no clinic, 1: mandated faculty input, 2: discretionary faculty input). Success metrics included numbers of manuscripts submitted, OKAP scores and success in obtaining fellowships. Professionalism metrics included rating comfort obtaining informed consent, breaking bad news, managing time in clinic, and confidence in providing care in various settings. Residents affirming participation in a continuity clinic also provided perceptions of the level of supervision and how the clinic affected stress. RESULTS Category 1 residents perceived somewhat too much supervision, while category 2 residents felt that they had somewhat insufficient supervision. The majority of residents in either category did not feel that the continuity clinic affected their overall stress, although those who reported a change in stress usually indicated that the presence of the clinic increased stress. There were no other statistically significant differences between the responses from any category. CONCLUSIONS The presence of a resident-hosted continuity clinic neither adds nor detracts from the success or sense of professionalism of ophthalmology residents. However, when such a clinic is present, the degree of supervision appears to correlate inversely with resident perception of autonomy. These results suggest that the decision of a training program to offer a clinic hosted by residents offering comprehensive continuity care can be informed primarily by faculty and trainee philosophy and personal preferences without comprising education quality, clinical efficiency, residents' perception of stress or their success in fellowship matching.
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Affiliation(s)
- Eric L Singman
- General Eye Services, Wilmer Eye Institute, Johns Hopkins School Of Medicine, Wilmer B-29, 600 N. Wolfe St., Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
| | - Michael V Boland
- General Eye Services, Wilmer Eye Institute, Johns Hopkins School Of Medicine, Wilmer B-29, 600 N. Wolfe St., Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jing Tian
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Laura K Green
- Lifebridge Health Krieger Eye Institute, Baltimore, USA
| | - Divya Srikumaran
- General Eye Services, Wilmer Eye Institute, Johns Hopkins School Of Medicine, Wilmer B-29, 600 N. Wolfe St., Johns Hopkins Hospital, Baltimore, MD, 21287, USA
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Bustraan J, Dijkhuizen K, Velthuis S, van der Post R, Driessen E, van Lith JMM, de Beaufort AJ. Why do trainees leave hospital-based specialty training? A nationwide survey study investigating factors involved in attrition and subsequent career choices in the Netherlands. BMJ Open 2019; 9:e028631. [PMID: 31175199 PMCID: PMC6589009 DOI: 10.1136/bmjopen-2018-028631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To gain insight into factors involved in attrition from hospital-based medical specialty training and future career plans of trainees who prematurely left their specialty training programme. DESIGN Nationwide online survey study. SETTING Postgraduate education of all hospital-based specialties in the Netherlands. PARTICIPANTS 174 trainees who prematurely left hospital-based medical specialty training between January 2014 and September 2017. MAIN OUTCOME MEASURES Factors involved in trainees' decisions to leave specialty training and their subsequent career plans. RESULTS The response rate was 38%. Of the responders, 25% left their programme in the first training year, 50% in year 2-3 and 25% in year 4-6. The most frequently reported factors involved in attrition were: work-life balance, job content, workload and specialty culture. Of the leaving trainees, 66% switched to another specialty training programme, of whom two-thirds chose a non-hospital-based training programme. Twelve per cent continued their career in a non-clinical role and the remainder had no specific plans yet. CONCLUSIONS This study provides insight in factors involved in attrition and in future career paths. Based on our findings, possible interventions to reduce attrition are: (1) enable candidates to develop a realistic view on job characteristics and demands, prior to application; (2) provide individual guidance during specialty training, with emphasis on work-life balance and fit with specialty.
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Affiliation(s)
- Jacqueline Bustraan
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kirsten Dijkhuizen
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sophie Velthuis
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Erik Driessen
- Department of Education Development and Research, Maastricht University, Maastricht, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arnout Jan de Beaufort
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
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Zabar S, Hanley K, Horlick M, Cocks P, Altshuler L, Watsula-Morley A, Berman R, Hochberg M, Phillips D, Kalet A, Gillespie C. "I Cannot Take This Any More!": Preparing Interns to Identify and Help a Struggling Colleague. J Gen Intern Med 2019; 34:773-777. [PMID: 30993628 PMCID: PMC6502915 DOI: 10.1007/s11606-019-04886-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few programs train residents in recognizing and responding to distressed colleagues at risk for suicide. AIM To assess interns' ability to identify a struggling colleague, describe resources, and recognize that physicians can and should help colleagues in trouble. SETTING Residency programs at an academic medical center. PARTICIPANTS One hundred forty-five interns. PROGRAM DESIGN An OSCE case was designed to give interns practice and feedback on their skills in recognizing a colleague in distress and recommending the appropriate course of action. Embedded in a patient "sign-out" case, standardized health professionals (SHP) portrayed a resident with depressed mood and an underlying drinking problem. The SHP assessed intern skills in assessing symptoms and directing the resident to seek help. PROGRAM EVALUATION Interns appreciated the opportunity to practice addressing this situation. Debriefing the case led to productive conversations between faculty and residents on available resources. Interns' skills require further development: while 60% of interns asked about their colleague's emotional state, only one-third screened for depression and just under half explored suicidal ideation. Only 32% directed the colleague to specific resources for his depression (higher among those that checked his emotional state, 54%, or screened for depression, 80%). DISCUSSION This OSCE case identified varying intern skill levels for identifying and assessing a struggling colleague while also providing experiential learning and supporting a culture of addressing peer wellness.
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Affiliation(s)
- Sondra Zabar
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Kathleen Hanley
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Margaret Horlick
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Patrick Cocks
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Lisa Altshuler
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Amanda Watsula-Morley
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Russell Berman
- Department of Surgery, NYU School of Medicine, New York, NY, USA
| | - Mark Hochberg
- Department of Surgery, NYU School of Medicine, New York, NY, USA
| | - Donna Phillips
- Department of Orthopedic Surgery, NYU School of Medicine, New York, NY, USA
| | - Adina Kalet
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Colleen Gillespie
- Institute for Innovation in Medical Education, Division of Quality and Evaluation and Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
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50
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Mendoza D, Bertino FJ. Why Radiology Residents Experience Burnout and How to Fix It. Acad Radiol 2019; 26:555-558. [PMID: 30243891 DOI: 10.1016/j.acra.2018.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/29/2018] [Accepted: 08/06/2018] [Indexed: 11/26/2022]
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