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Clay TL, Mabachi NM, Callen EF. Building physician wellness into the culture: evaluating a family physician well-being programme using the physician wellness inventory. Fam Pract 2024:cmae024. [PMID: 38648190 DOI: 10.1093/fampra/cmae024] [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] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Family physicians have a higher incidence of burnout, dissatisfaction, and disengagement compared to other medical specialties. Addressing burnout on the individual and systemic level is important to promoting wellness and preventing deleterious effects on physicians and patients. We used the Physician Wellness Inventory (PWI) to assess the effects of a wellness programme designed to equip family physicians with skills to address burnout. METHODS The PWI is a fourteen-item 5-point Likert scale broken down into 3 scores; (i) career purpose, (ii) cognitive flexibility, and (iii) distress. The PWI was distributed to a cohort of n = 111 family physician scholars at 3 time points: January 2021, May-June 2021, and October 2021. The response rate was 96.4% at baseline, and 72.1% overall. Demographic information was collected to assess differences. The survey was distributed online through Qualtrics (Provo, UT). RESULTS Cognitive Flexibility scores at the endpoint were higher for POC scholars than white scholars (P = 0.024). Distress scores for all groups decreased over time. Female scholars were more nervous, and anxious at the start than male scholars (P = 0.012), which decreased over time (P = 0.022). New career scholars were more likely than later career scholars to be distressed (P = 0.007), but both groups' distress decreased over time (P = 0.003). Later career scholars' feelings of being bothered by little interest or pleasure in doing things decreased more than new career scholars (endpoint: P = 0.022; overall: P = 0.023). CONCLUSIONS The wellness programme shows improvement in PWI scores, indicating the programme content should be evaluated further for system level improvements.
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Affiliation(s)
- Tarin L Clay
- Analytics, DARTNet Institute, Aurora, CO, United States
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Babal JC, Lelkes E, Kloster H, Zwemer E, Lien ER, Sklansky D, Coller RJ, Moreno MA, Schultz R, Webber S. Pediatric Resident Well-being: A Group Concept Mapping Study. Acad Pediatr 2024; 24:535-543. [PMID: 38215904 DOI: 10.1016/j.acap.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/11/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Pediatric residency programs invest substantial resources in supporting resident well-being. However, no pediatric resident well-being conceptual model exists to guide interventions. This study aimed to understand how a diverse stakeholder sample conceptualized well-being. METHODS We used group concept mapping methodology. We sent a brainstorming survey to pediatric residents and program leaders at 24 US residencies with the prompt, "The experience of well-being for resident physicians includes…" Participants at 4 residencies sorted well-being ideas conceptually and rated idea importance. We performed multidimensional scaling and hierarchical cluster analysis to develop cluster maps. Using participant feedback and a consensus-driven process, we determined best cluster representation. We used pattern matching to compare domain ratings between subgroups. RESULTS In brainstorming, 136 residents and 22 program leaders from 22 residency programs generated 97 unique ideas. Ideas were sorted and rated by 33 residents, 14 program leaders. Eight domains aligning with 4 resident roles were identified. Domains were: 1) positive, safe, and diverse culture; 2) unity and connection; 3) professional fulfillment and mindset; 4) personal health and life satisfaction; 5) professional development and recognition; 6) schedule protections and downtime; 7) work systems and benefits; 8) proactive and compassionate leadership. Domains aligned with the following roles: 1) individual, 2) colleague, 3) employee, 4) emerging pediatrician. Residents placed higher value on schedule protections and downtime than program leaders, P < .05. CONCLUSIONS Pediatric resident well-being may be conceptualized as inter-related domains corresponding with various resident roles. Participants aligned on many well-being priorities but differed regarding work schedules.
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Affiliation(s)
- Jessica C Babal
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Efrat Lelkes
- Department of Pediatrics (E Lelkes), University of California San Francisco.
| | - Heidi Kloster
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Eric Zwemer
- Department of Pediatrics (E Zwemer), University of North Carolina, Chapel Hill.
| | | | - Daniel Sklansky
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Ryan J Coller
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Megan A Moreno
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Roger Schultz
- Department of Neurobiology (R Schultz), University of Wisconsin, Madison.
| | - Sarah Webber
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
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Mena Lora AJ, Knodle R, Borgetti S, Matt B, Osorio G, Sundareshan V, Rojas-Moreno C, Bartash R, Van Schooneveld TC, Reece R, Chow B, Prakash K, Butt S, Lastinger A. Meeting the Consultation Surge: A Nationwide Survey of Consult Volume and Mitigation Strategies in Infectious Diseases Fellowship Programs. Open Forum Infect Dis 2024; 11:ofae123. [PMID: 38567198 PMCID: PMC10986853 DOI: 10.1093/ofid/ofae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
High patient volume in fellowship programs can affect learning, wellness, and patient outcomes. Training programs must find ways to mitigate high consultation volume to protect the learning environment. This survey describes average new consults and average censuses for infectious diseases training programs and strategies implemented to mitigate high volume.
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Affiliation(s)
- Alfredo J Mena Lora
- Department of Medicine, Division of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ryan Knodle
- Department of Medicine, Division of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Scott Borgetti
- Department of Medicine, Division of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Brionna Matt
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Vidya Sundareshan
- Southern Illinois University School of Medicine, Carbondale, IL, USA
| | | | - Rachel Bartash
- Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | | | - Rebecca Reece
- Albert Einstein College of Medicine, New York, NY, USA
| | - Brian Chow
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Katya Prakash
- University of Maryland School of Medicine, Baltimore, MA, USA
| | - Saira Butt
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Allison Lastinger
- Division of Infectious Diseases, West Virginia University School of Medicine, Morgantown, WV, USA
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Maben J, Taylor C, Jagosh J, Carrieri D, Briscoe S, Klepacz N, Mattick K. Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-171. [PMID: 38662367 DOI: 10.3310/twdu4109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves. Aim To improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions. Methods Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards' reporting guidelines. Data sources First round database searching in Medical Literature Analysis and Retrieval System Online Database ALL (via Ovid), cumulative index to nursing and allied health literature database (via EBSCO) and health management information consortium database (via Ovid), was undertaken between February and March 2021, followed by supplementary searching strategies (e.g. hand searching, expert solicitation of key papers). Reverse chronology screening was applied, aimed at retaining 30 relevant papers in each profession. Round two database searches (December 2021) targeted COVID-19-specific literature and literature reviews. No date limits were applied. Results We built on seven key reports and included 75 papers in the first round (26 nursing, 26 midwifery, 23 paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. Through the realist synthesis we surfaced 14 key tensions in the literature and identified five key findings, supported by 26 context mechanism and outcome configurations. The key findings identified the following: (1) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; (2) it is difficult to promote staff psychological wellness where there is a blame culture; (3) the needs of the system often override staff well-being at work ('serve and sacrifice'); (4) there are unintended personal costs of upholding and implementing values at work; and (5) it is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors. Conclusions Our realist synthesis strongly suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological well-being. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Healthcare organisations need to (1) rebalance the working environment to enable healthcare professionals to recover and thrive; (2) invest in multi-level system approaches to promote staff psychological well-being; and use an organisational diagnostic framework, such as the NHS England and NHS Improvement Health and Wellbeing framework, to self-assess and implement a systems approach to staff well-being. Future work Future research should implement, refine and evaluate systemic interventional strategies. Interventions and evaluations should be co-designed with front-line staff and staff experts by experience, and tailored where possible to local, organisational and workforce needs. Limitations The literature was not equivalent in size and quality across the three professions and we did not carry out citation searches using hand searching and stakeholder/expert suggestions to augment our sample. Study registration This study is registered as PROSPERO CRD42020172420. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172420. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129528) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Justin Jagosh
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Daniele Carrieri
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Simon Briscoe
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Naomi Klepacz
- School of Health Sciences, University of Surrey, Guildford, UK
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Karen Mattick
- University of Exeter Medical School, University of Exeter, Exeter, UK
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Hu JS, Pangaro LN, Gloria Andrada BM, Ceasar RC, Phillips JL. Physician Leadership and Burnout: The Need for Agency; a Qualitative Study of an Academic Institution. J Healthc Leadersh 2024; 16:121-130. [PMID: 38449510 PMCID: PMC10914963 DOI: 10.2147/jhl.s419203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/18/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose Organizational approaches to physician burnout are limited. Training physician leaders to influence the organizational environment is a growing area of study. This study explored perceived physician leadership behaviors in response to burnout from the viewpoint of faculty physicians not in formal leadership positions. Understanding physician leadership behaviors from the viewpoint of those faculty being led can inform organizational strategy and leadership training to address physician burnout. Subjects and Methods Interview requests were sent to 70 randomly identified faculty physicians from a roster containing all 1145 physician faculty that excluded the Pediatric Department, at an academic health care institution in Southern California. The first ten respondents were asked to participate in a 30-to-40-minute semi-structured virtual interview via Zoom. The interviewees were asked two questions pertaining to burnout and their perception of how leadership responded. The two questions were "What has leadership done to address burnout?" and "If you had five minutes to advise your leaders on burnout, what would you say?" The recorded interviews were transcribed, redacted, and then sent to two reviewers. Thematic analysis through iterative coding was completed, and categories were constructed that aligned with the two interview questions. Results Overall, five themes were identified. These themes were organized according to the interview questions and broadly categorized as physician leadership behaviors observed that corresponded to the interview question of what leadership had done to address burnout and physician leadership behaviors desired corresponding to the second interview question of what advice should be given. Leadership behaviors observed in the context of burnout included three themes; referral to individual wellness programs, increased number of meetings and events, and a lack of agency in addressing wellness issues. The two themes of leadership behaviors desired were the obtainment of more resources and the granting of greater appreciation and recognition for work done through enhanced communication. Conclusion This small study of faculty physician perceptions of leadership behaviors identified several themes that had been identified in previous studies of leadership and burnout; need for relationship building through communication, need for resources to address work issues, and referral to wellness programs. However, the identification of a lack of agency in addressing factors in the wellness environment has not been identified in the previous burnout and physician leadership literature. Further study into the causes of this perceived lack of agency should be explored. Understanding the root causes of physician leaders' lack of agency can further inform physician leadership education as an organizational approach to burnout.
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Affiliation(s)
- James S Hu
- Department of Medicine – MD, EdD, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Louis N Pangaro
- Department of Medicine – MD, F. Edward Hébert School of Medicine of the Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Rachel C Ceasar
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jennifer L Phillips
- USC Rossier School of Education – DLS, University of Southern California, Los Angeles, CA, USA
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Paton MW, Kalemtzaki E, Stoewen D, Hameedunisha T, Yang H, Donlin J, Endenburg N. WSAVA professional wellness guidelines. J Small Anim Pract 2024; 65:153-175. [PMID: 38179606 DOI: 10.1111/jsap.13689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 01/06/2024]
Affiliation(s)
- M W Paton
- 31 Clipson Crescent, Mundaring, WA, 6073, Australia
| | | | - D Stoewen
- Independent Wellness Consultant, Ayr, ON, N0B 1E0, Canada
| | - T Hameedunisha
- Caspers Healing Paws, Neuro Rehabilitation Service, 3rd cross, HBR layout, Bangalore, Karnataka, 560054, India
| | - H Yang
- Unusual Pet Vets, Osborne Park, WA, 6017, Australia
| | - J Donlin
- 1931 N. Meacham Road, Schaumburg, IL, 60173, USA
| | - N Endenburg
- One Welfare Group, Section Animals in Science and Society, and Animal Behaviour Clinic, Department Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Merlo G, Bachtel G, Sugden SG. Gut microbiota, nutrition, and mental health. Front Nutr 2024; 11:1337889. [PMID: 38406183 PMCID: PMC10884323 DOI: 10.3389/fnut.2024.1337889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
The human brain remains one of the greatest challenges for modern medicine, yet it is one of the most integral and sometimes overlooked aspects of medicine. The human brain consists of roughly 100 billion neurons, 100 trillion neuronal connections and consumes about 20-25% of the body's energy. Emerging evidence highlights that insufficient or inadequate nutrition is linked to an increased risk of brain health, mental health, and psychological functioning compromise. A core component of this relationship includes the intricate dynamics of the brain-gut-microbiota (BGM) system, which is a progressively recognized factor in the sphere of mental/brain health. The bidirectional relationship between the brain, gut, and gut microbiota along the BGM system not only affects nutrient absorption and utilization, but also it exerts substantial influence on cognitive processes, mood regulation, neuroplasticity, and other indices of mental/brain health. Neuroplasticity is the brain's capacity for adaptation and neural regeneration in response to stimuli. Understanding neuroplasticity and considering interventions that enhance the remarkable ability of the brain to change through experience constitutes a burgeoning area of research that has substantial potential for improving well-being, resilience, and overall brain health through optimal nutrition and lifestyle interventions. The nexus of lifestyle interventions and both academic and clinical perspectives of nutritional neuroscience emerges as a potent tool to enhance patient outcomes, proactively mitigate mental/brain health challenges, and improve the management and treatment of existing mental/brain health conditions by championing health-promoting dietary patterns, rectifying nutritional deficiencies, and seamlessly integrating nutrition-centered strategies into clinical care.
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Affiliation(s)
- Gia Merlo
- Department of Psychiatry, New York University Grossman School of Medicine and Rory Meyers College of Nursing, New York, NY, United States
| | | | - Steven G. Sugden
- Department of Psychiatry, The University of Utah School of Medicine, Salt Lake City, UT, United States
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Gomes Souza L, Bouba DA, Corôa RDC, Dofara SG, Robitaille V, Blanchette V, Kastner K, Bergeron F, Guay-Bélanger S, Izumi SS, Totten AM, Archambault P, Légaré F. The Impact of Advance Care Planning on Healthcare Professionals' Well-being: A Systematic Review. J Pain Symptom Manage 2024; 67:173-187. [PMID: 37827454 DOI: 10.1016/j.jpainsymman.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 10/14/2023]
Abstract
CONTEXT Advance care planning (ACP) improves care for patients with chronic illnesses and reduces family stress. However, the impact of ACP interventions on healthcare professionals' well-being remains unknown. OBJECTIVE To systematically review the literature evaluating the impact of ACP interventions on healthcare professionals' well-being. METHODS We followed the Joanna Briggs Institute methodology for systematic reviews and registered the protocol in PROSPERO (CRD42022346354). We included primary studies in all languages that assessed the well-being of healthcare professionals in ACP interventions. We excluded any studies on ACP in psychiatric care and in palliative care that did not address goals of care. Searches were conducted on April 4, 2022, and March 6, 2023 in Embase, CINAHL, Web of Science, and PubMed. We used the Mixed Methods Appraisal Tool for quality analysis. We present results as a narrative synthesis because of their heterogeneity. RESULTS We included 21 articles published in English between 1997 and 2021 with 17 published after 2019. All were conducted in high-income countries, and they involved a total of 1278 participants. Three reported an interprofessional intervention and two included patient partners. Studies had significant methodological flaws but most reported that ACP had a possible positive impact on healthcare professionals' well-being. CONCLUSION This review is the first to explore the impact of ACP interventions on healthcare professionals' well-being. ACP interventions appear to have a positive impact, but high-quality studies are scarce. Further research is needed, particularly using more rigorous and systematic methods to implement interventions and report results.
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Affiliation(s)
- Lucas Gomes Souza
- Department of Social and Preventive Medicine (L.G.S., D.A.B.), Faculty of Medicine, Université Laval, Québec, Canada, and VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Dalil Asmaou Bouba
- Department of Social and Preventive Medicine (L.G.S., D.A.B.), Faculty of Medicine, Université Laval, Québec, Canada, and VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Roberta de Carvalho Corôa
- Department of Family Medicine and Emergency Medicine (R.C.C.), VITAM, Centre de recherche en santé durable, Unité de soutien au système de santé apprenant, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Suélène Georgina Dofara
- VITAM, Centre de recherche en santé durable (S.G.B., S.G.D.), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Vincent Robitaille
- Faculty of Medicine, Université Laval (V.R.), VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine (V.B.), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | | | - Sabrina Guay-Bélanger
- VITAM, Centre de recherche en santé durable (S.G.B., S.G.D.), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | | | - Annette M Totten
- Department of Medical Informatics and Clinical Epidemiology (A.M.T.), School of Medicine, Oregon Health & Science University, Portland, OR
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine (P.A.), Faculty of Medicine, Université Laval, VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Québec, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine (F.L.), Faculty of Medicine, Université Laval, VITAM, Centre de recherche en santé durable, Researcher, Centre de recherche du CHU de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada.
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Maragha T, Garcia AP, Shuler C, von Bergmann H. The six-domain well-being framework in oral health sciences: A pathway from theory to practice. J Dent Educ 2024; 88:157-168. [PMID: 37904583 DOI: 10.1002/jdd.13401] [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: 05/14/2023] [Revised: 08/01/2023] [Accepted: 10/20/2023] [Indexed: 11/01/2023]
Abstract
OBJECTIVES Well-being is a complex and multifaceted construct that has gained popularity in oral health sciences education. Maintaining students' well-being is essential for their academic performance and quality of life. While many definitions and frameworks of well-being exist, their applicability to oral health sciences education remains unknown. This study aimed to evaluate the applicability of the Feeney and Collins's framework of well-being to oral health sciences education by exploring students' perceptions and experiences in the University of British Columbia METHODS: An Interpretive Description approach was used to conduct semi-structured interviews with dental and dental hygiene students. Interviews were transcribed, and transcripts were coded and analyzed with guidance from Feeney and Collins's well-being and thriving framework using content analysis. Domains were inductively developed within and beyond the organizing categories of the chosen framework. RESULTS Thirty-one oral health sciences students participated in the study. Study data can largely be explained by the five well-being domains suggested by Feeney and Collins: physical, psychological, eudaimonic, subjective, and social. Spirituality and gratitude emerged as an additional domain that contributes to students' well-being. Interdomain relationships were observed. The social domain seemed to contribute to all other well-being domains; while the subjective domain seemed to be shaped by all other domains CONCLUSIONS: Feeney and Collins's framework seemed to be useful to understand and conceptualize well-being in oral health sciences education but needed to be expanded to include spirituality and gratitude. Further evidence is needed to explore the applicability of this framework in other health professional education disciplines.
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Affiliation(s)
- Tala Maragha
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arnaldo Perez Garcia
- Educational Research and Scholarship Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, British Columbia, Canada
| | - Charles Shuler
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - HsingChi von Bergmann
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Webber S, Coller RJ, Schultz R, Rogers EE, Olson ME, Moreno MA, Babal JC. Eight Domains of Pediatrician Wellness: A Stakeholder Informed Model. Acad Pediatr 2024:S1876-2859(23)00480-1. [PMID: 38215902 DOI: 10.1016/j.acap.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Physician wellness is important to health care systems and quality patient care. There has been limited research clarifying the physician wellness construct. We aimed to develop a stakeholder-informed model of pediatrician wellness. METHODS We performed a group concept mapping (GCM) study to create a model of pediatrician wellness. We followed the four main steps of GCM and recruited pediatricians at multiple sites and on social media. During brainstorming, pediatricians individually responded to a prompt to generate ideas describing the concept of pediatrician wellness. Second, pediatricians sorted the list of brainstormed ideas into conceptually similar groups and rated them on importance. Sorted data were analyzed to create maps showing each idea as a point, with lines around groups of points to create clusters of wellness. Mean importance scores for each cluster were calculated and compared using pattern match. RESULTS Pediatricians in this study identified eight clusters of wellness: 1) Experiencing belonging and support at work, 2) Alignment in my purpose, my work, and my legacy, 3) Feelings of confidence and fulfillment at work, 4) Skills and mindset for emotional well-being, 5) Harmony in personal, professional, and community life, 6) Time and resources to support holistic sense of self, 7) Work boundaries and flexibility, and 8) Organizational culture of inclusion and trust. There were no significant differences in mean cluster rating score; the highest rated cluster was Harmony in personal, professional and community life (3.62). CONCLUSION Pediatricians identified eight domains of wellness, spanning professional and personal life, work, and individual factors.
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Affiliation(s)
- Sarah Webber
- Department of Pediatrics (S Webber, RJ Coller, R Schultz, MA Moreno, and JC Babal), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Ryan J Coller
- Department of Pediatrics (S Webber, RJ Coller, R Schultz, MA Moreno, and JC Babal), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Roger Schultz
- Department of Pediatrics (S Webber, RJ Coller, R Schultz, MA Moreno, and JC Babal), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Elizabeth E Rogers
- Department of Pediatrics (EE Rogers), University of California San Francisco
| | - Maren E Olson
- Department of Pediatrics (ME Olson), University of Minnesota, Minneapolis, Minn
| | - Megan A Moreno
- Department of Pediatrics (S Webber, RJ Coller, R Schultz, MA Moreno, and JC Babal), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Jessica C Babal
- Department of Pediatrics (S Webber, RJ Coller, R Schultz, MA Moreno, and JC Babal), University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Korkmaz A, Bernhardsen GP, Cirit B, Koprucu Suzer G, Kayan H, Biçmen H, Tahra M, Suner A, Lehto SM, Sag D, Saatcioglu F. Sudarshan Kriya Yoga Breathing and a Meditation Program for Burnout Among Physicians: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2353978. [PMID: 38294813 PMCID: PMC10831575 DOI: 10.1001/jamanetworkopen.2023.53978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024] Open
Abstract
Importance Physicians are exposed to high stress and strain that results in burnout, which affects them, their families, their patients, and the entire health care system; thus, there is an urgent need to develop methods to increase the resiliency of physicians. Sudarshan Kriya Yoga (SKY) is a comprehensive yoga breathing and meditation-based program that is a potential approach to mitigate physician burnout. Objective To determine whether SKY can reduce psychological distress and improve wellness in physicians. Design, Setting, and Participants This randomized clinical trial assessed the potential efficacy of SKY compared with a stress management education (SME) training as control. This study was conducted online from November 11, 2021, to March 14, 2022, and included physicians from Turkey, Germany, and Dubai. Both the SKY and the SME control groups received 1.5 hours of training for 3 consecutive days via a group video conference call. Participants were physicians willing to do some form of relaxation exercise everyday for 2 months. Exclusion criteria included presence of major illness and maintaining a regular mind-body program practice. Statistical analysis took place from March to November 2023. Interventions Participants were randomly assigned 1:1 into 2 groups-the SKY group or the SME (control) group-using a computer algorithm. After the 3-day instruction period, the participants in the SKY group practiced for approximately 30 minutes per day on their own and participated in a weekly 1-hour, group-based online follow-up practice. After the 3-day instruction period, participants in the SME group reviewed and applied the notes from stress management education training at their initiative and had a weekly 1-hour group-based online follow-up session. Main Outcomes and Measures The primary outcomes were stress and depression (measured by the 42-item Depression, Anxiety, and Stress Scale [DASS-42]) and insomnia measured by the Regensburg Insomnia Scale (RIS) with primary end point at 8 weeks. Secondary outcomes included anxiety (DASS-42); optimism (Life Orientation Test-Revised [LOT-R]); professional fulfillment, work exhaustion, interpersonal disengagement, and overall burnout (Professional Fulfillment Index [PFI]); and self-reported professional errors (Self-Reported Professional Error Questionnaire). Results This study included 129 participants (SME, 63 participants [48.9%]; SKY, 66 participants [51.1%]; 115 females [89.2%]; 14 males [10.8%]; mean [SD] age, 46.2 [9.0] years). Compared with the SME control group, participants in the SKY group had significantly decreased stress on the DASS-42 at posttraining (difference, -6.8 points; 95% CI, -9.6 to -4.1 points; P = .006) and at postintervention (difference, -6.0 points; 95% CI, -8.8 to -3.3 points; P = .03), significantly decreased depression at posttraining (difference, -5.7 points; 95% CI, -8.6 to -2.8 points; P < .001) and postintervention (difference, -5.4 points; 95% CI, -8.3 to -2.5 points; P < .001), and significantly decreased anxiety at postintervention. In addition, there was a significant decrease in insomnia from baseline to postintervention in the SKY group (difference, -0.3 points; 95% CI, -2.3 to 1.7 points; P = .01). The SKY group also showed significantly increased professional fulfillment as well as significant decreases in work exhaustion, interpersonal disengagement, and burnout. There was no effect on self-reported medical errors. Conclusions and Relevance In this randomized clinical trial, physicians who regularly practiced SKY throughout a 2-month period experienced improvements in wellness and decreased burnout. These data suggest that SKY may be an effective, practical, and safe strategy to increase wellness and mitigate burnout in physicians. Trial Registration ClinicalTrials.gov Identifier: NCT05956470.
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Affiliation(s)
- Asli Korkmaz
- Department of Genomic Sciences and Molecular Biotechnology, Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey
- Izmir Biomedicine and Genome Center, Izmir, Turkey
| | - Guro Pauck Bernhardsen
- Division of Mental Health Services, Department of Research and Development, Akershus University Hospital, Lørenskog, Norway
| | - Burcu Cirit
- University of Health Sciences, Ataturk Chest Diseases Education and Research Hospital, Ankara, Turkey
| | | | | | | | - Muratcan Tahra
- School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Asli Suner
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Soili Marianne Lehto
- Division of Mental Health Services, Department of Research and Development, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Duygu Sag
- Department of Genomic Sciences and Molecular Biotechnology, Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey
- Izmir Biomedicine and Genome Center, Izmir, Turkey
- Department of Medical Biology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Fahri Saatcioglu
- Department of Biosciences, University of Oslo, Oslo, Norway
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
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Kokubun CW, Anderson KM, Manders OC, Kalokhe AS, Sales JM. Providing Trauma-Informed Care During a Pandemic: How Health Care Workers at Ryan White-Funded Clinics in the Southeastern United States Responded to COVID-19 and Its Effects on Their Well-Being. J Int Assoc Provid AIDS Care 2024; 23:23259582241235779. [PMID: 38576400 PMCID: PMC10998491 DOI: 10.1177/23259582241235779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 04/06/2024] Open
Abstract
As HIV/AIDS health care workers (HCWs) deliver services during COVID-19 under difficult conditions, practicing trauma-informed care (TIC) may mitigate negative effects on mental health and well-being. This secondary qualitative analysis of a larger mixed methods study sought to understand the pandemic's impact on HCWs at Ryan White-funded clinics (RWCs) across the southeastern US and assess changes in prioritization of TIC. RWC administrators, providers, and staff were asked about impacts on clinic operations/culture, HCW well-being, institutional support for well-being, and prioritization of TIC. HCWs described strenuous work environments and decreased well-being (eg, increased stress, burnout, fear, and social isolation) due to COVID-19. RWCs initiated novel responses to disruptions of clinic operations and culture to encourage continuity in care and promote HCW well-being. Despite increased awareness of the need for TIC, prioritization remained variable. Implementing and institutionalizing trauma-informed practices could strengthen continuity in care and safeguard HCW well-being during public health emergencies.
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Affiliation(s)
- Caroline W. Kokubun
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Katherine M. Anderson
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Olivia C. Manders
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ameeta S. Kalokhe
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jessica M. Sales
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Li H, Upreti T, Do V, Dance E, Lewis M, Jacobson R, Goldberg A. Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints. MEDICAL TEACHER 2024; 46:82-101. [PMID: 37405740 DOI: 10.1080/0142159x.2023.2231625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
PURPOSE Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary. METHODS Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed. RESULTS 221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once. CONCLUSIONS Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.
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Affiliation(s)
- Henry Li
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tushar Upreti
- Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
| | - Victor Do
- Department of Pediatrics, Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Erica Dance
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Melanie Lewis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ryan Jacobson
- Office of Advocacy and Wellbeing, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
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14
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Kang C, Sarkar IN. Interventions to Reduce Electronic Health Record-Related Burnout: A Systematic Review. Appl Clin Inform 2024; 15:10-25. [PMID: 37923381 PMCID: PMC10764123 DOI: 10.1055/a-2203-3787] [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: 08/10/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Electronic health records are a significant contributing factor in clinician burnout, which negatively impacts patient care. OBJECTIVES To identify and appraise published solutions that aim to reduce EHR-related burnout in clinicians. METHODS A literature search strategy was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Six databases were searched for articles published between January 1950 and March 2023. The inclusion criteria were peer-reviewed, full-text, English language articles that described interventions targeting EHR-related burnout in any type of clinician, with reported outcomes related to burnout, wellness, EHR satisfaction, or documentation workload. Studies describing interventions without an explicit focus on reducing burnout or enhancing EHR-related satisfaction were excluded. RESULTS We identified 44 articles describing interventions to reduce EHR-related burnout. These interventions included the use of scribes, EHR training, and EHR modifications. These interventions were generally well received by the clinicians and patients, with subjective improvements in documentation time and EHR satisfaction, although objective data were limited. CONCLUSION The findings of this review underscore the potential benefits of interventions to reduce EHR-related burnout as well as the need for further research with more robust study designs involving randomized trials, control groups, longer study durations, and validated, objective outcome measurements.
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Affiliation(s)
- Chaerim Kang
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, United States
| | - Indra Neil Sarkar
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, United States
- Rhode Island Quality Institute, Providence, Rhode Island, United States
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Lagina M, Grum C, Sandhu G, Ruff AL. Sources of Joy in Medical Educators as Described by the PERMA Model. TEACHING AND LEARNING IN MEDICINE 2024; 36:53-60. [PMID: 36251799 DOI: 10.1080/10401334.2022.2131556] [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: 12/19/2021] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Phenomenon: Burnout is prevalent amongst long-practicing physicians. For medical educators, it has deleterious effects not only on the educator themselves, but also the students they are teaching. Though significant research has focused on factors associated with burnout, there is limited understanding of its counter: how physicians, particularly medical educators, derive joy from their work. Approach: This qualitative study included 15 highly-rated clinician educators in Internal Medicine who took part in individual semi-structured interviews. Participants were invited to discuss their sources of professional joy. After transcription, we used thematic content analysis: 50 themes were identified. Themes were then coded using the domains of the PERMA (Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment) model of positive psychology, assigning each theme a best fit domain. Forty-five themes were mapped into the PERMA model. Findings: When describing professional joy, highly-rated clinician educators displayed high levels of overlap with all domains of the PERMA model. Interaction with the learner was a prominent source of professional joy, particularly within Positive Emotion, Engagement, and Relationship domains. Insights: Our findings indicate that the PERMA model appropriately defines the sources of professional joy for these educators. Future research could employ this model to identify targets for interventions aimed at amplifying joy at work for this group.
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Affiliation(s)
- Madeline Lagina
- Department of Internal Medicine, Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Cyril Grum
- Department of Internal Medicine, Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gurjit Sandhu
- Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison L Ruff
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Soklaridis S, Zaheer R, Scully M, Shier R, Williams B, Dang L, Daniel SJ, Sockalingam S, Tremblay M. 'We are in for a culture change': continuing professional development leaders' perspectives on COVID-19, burn-out and structural inequities. BMJ LEADER 2023:leader-2023-000837. [PMID: 37739772 DOI: 10.1136/leader-2023-000837] [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: 04/25/2023] [Accepted: 09/09/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION The COVID-19 pandemic positioned healthcare systems in North America at the epicentre of the crisis, placing inordinate stress on clinicians. Concurrently, discussions about structural racism, social justice and health inequities permeated the field of medicine, and society more broadly. The confluence of these phenomena required rapid action from continuing professional development (CPD) leaders to respond to emerging needs and challenges. METHODS In this qualitative study, researchers conducted 23 virtual semistructured interviews with CPD leaders in Canada and the USA. Interview audiorecordings were transcribed, deidentified and thematically analysed. RESULTS This study revealed that the CPD leaders attributed the pandemic as illuminating and exacerbating problems related to clinician wellness; equity, diversity and inclusion; and health inequities already prevalent in the healthcare system and within CPD. Analysis generated two themes: (1) From heroes to humans: the shifting view of clinicians and (2) Melding of crises: an opportunity for systemic change in CPD. DISCUSSION The COVID-19 pandemic increased recognition of burn-out and health inequities creating momentum in the field to prioritise and restrategise to address these converging public health crises. There is an urgent need for CPD to move beyond mere discourse on these topics towards holistic and sustainable actionable measures.
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Affiliation(s)
- Sophie Soklaridis
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Rabia Zaheer
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michelle Scully
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rowen Shier
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Betsy Williams
- Department of Psychiatry, University of Kansas School of Medicine, Kansas City, Kansas, USA
- Professional Renewal Centre, Lawrence, Kansas, USA
| | - Linda Dang
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sam J Daniel
- Department of Pediatric Surgery, McGill University, Montreal, Québec, Canada
| | - Sanjeev Sockalingam
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Martin Tremblay
- Continuing Professional Development Department, Fédération des médecins spécialistes du Québec, Montreal, Québec, Canada
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Wilkie T, Tajirian T, Thakur A, Mistry S, Islam F, Stergiopoulos V. Evolution of a physician wellness, engagement and excellence strategy: lessons learnt in a mental health setting. BMJ LEADER 2023; 7:182-188. [PMID: 37200187 DOI: 10.1136/leader-2022-000595] [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: 01/25/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aims to evaluate the impact of several organisational initiatives implemented as part of a physician engagement, wellness and excellence strategy at a large mental health hospital. Interventions that were examined include: communities of practice, peer support programme, mentorship programme and leadership and management programme for physicians. METHODS A cross-sectional study, guided by the Reach, Effectiveness/Efficacy, Adoption, Implementation and Maintenance evaluation framework, was conducted with physicians at a large academic mental health hospital in Toronto, Canada. Physicians were invited to complete an online survey in April 2021, which composed of questions on the awareness, use and perceived impact of the organisational wellness initiatives and the two-item Maslach Burnout Inventory tool. The survey was analysed using descriptive statistics and a thematic analysis. RESULTS 103 survey responses (40.9% response rate) were gathered from physicians, with 39.8% of respondents reporting experiences of burn-out. Overall, there was variable reach and suboptimal use of the organisational interventions reported by physicians. Themes emerging from open-ended questions included the importance of addressing: workload and resource related factors; leadership and culture related factors; and factors related to the electronic medical record and virtual care. CONCLUSIONS Organisational strategies to address physician burn-out and support physician wellness require repeated evaluation of the impact and relevance of initiatives with physicians, taking into account organisational culture, external variables, emerging barriers to access and participation, and physician needs and interest over time. These findings will be embedded as part of ongoing review of our organisational framework to guide changes to our physician engagement, wellness and excellence strategy.
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Affiliation(s)
- Treena Wilkie
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Tania Tajirian
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Anupam Thakur
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Smit Mistry
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Faisal Islam
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Dennis AA, Colton L, Tewari P, Slavin S. Promoting Well-Being in Graduate Medical Education: Embracing Principles Rather Than "Recipe". ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023:10.1007/s40596-023-01827-0. [PMID: 37552402 DOI: 10.1007/s40596-023-01827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/06/2023] [Indexed: 08/09/2023]
Affiliation(s)
| | - Lara Colton
- Houston Methodist Medical Center, Houston, TX, USA
| | - Priti Tewari
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stuart Slavin
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
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Allan J, Olcon K, Everingham R, Fox M, Pai P, Mackay M, Keevers L. Leading wellness in healthcare: A qualitative study of leadership practices for wellness in hospital settings. PLoS One 2023; 18:e0285103. [PMID: 37467299 DOI: 10.1371/journal.pone.0285103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/14/2023] [Indexed: 07/21/2023] Open
Abstract
Ways of dealing with workplace stress and enhancing healthcare workers wellness are sought globally. The aim of this study was to explore healthcare leaders' practice in relation to the implementation of a workplace wellness program called SEED in the context of multiple crises (bushfires and COVID-19) affecting a local health district in New South Wales, Australia. Practice theory informed interviews (n = 23), focus groups (n = 2) and co-analysis reflexive discussions (n = 2) that were conducted with thirteen leaders and twenty healthcare workers. A pragmatic approach to program implementation for healthcare workers' wellness explored the process and actions that resulted from leadership practice in an inductive thematic analysis. Preliminary themes were presented in the co-analysis sessions to ensure the lived experiences of the SEED program were reflected and co-interpretation of the data was included in the analysis. Three key themes were identified. 1) Leading change-implementing a wellness program required leaders to try something new and be determined to make change happen. 2) Permission for wellness-implicit and explicit permission from leaders to engage in wellness activities during worktime was required. 3) Role-modelling wellness-leaders viewed SEED as a way to demonstrate leadership in supporting and caring for healthcare workers. SEED provided a platform for leaders who participated to demonstrate their leadership practices in supporting wellness activities. Leadership practices are critical to the implementation of healthcare wellness programs. The implementation of SEED at a time of unprecedented crisis gave leaders and healthcare workers opportunities to experience something new including leadership that was courageous, responsive and authentic. The study highlighted the need for workplace wellness programs to intentionally include leaders rather than only expect them to implement them. The practices documented in this study provide guidance to others developing, implementing and researching workplace wellness programs.
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Affiliation(s)
- Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Katarzyna Olcon
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ruth Everingham
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, Australia
| | - Mim Fox
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Padmini Pai
- Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, Australia
| | - Maria Mackay
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lynne Keevers
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
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Dodelzon K, Grimm LJ, Plimpton SR, Markovic D, Milch HS. Ongoing Impact of COVID-19 on Breast Radiologists' Wellness. JOURNAL OF BREAST IMAGING 2023; 5:287-296. [PMID: 38416885 DOI: 10.1093/jbi/wbac100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Assess the ongoing impact of COVID-19 on mental well-being of breast radiologists nationwide two years after the start of the pandemic and compared to early in the pandemic. METHODS A 27-question survey was distributed from December 2021 to January 2022 to physician members of the Society of Breast Imaging. Psychological distress and anxiety scores were calculated, and factors associated with them were identified with a multivariate logistic model. RESULTS A total of 550 surveys were completed (23% response rate); the mean respondent age was 50 +/- 10 years. Fifty percent (265/526) of respondents reported two or more psychological distress symptoms, down from 58% in 2020 (P = 0.002), whereas 70% (362/526) of respondents reported increased anxiety, down from 82% in 2020 (P < 0.001). As in 2020, reporting financial strain and childcare adversely affecting job ability were associated with worse psychological distress scores (OR 3.6, 95% CI: 1.6-8.3, P = 0.02 and OR 6.0, 95% CI: 2.5-14.4, P = 0.002, respectively). Less time spent consulting, educating, and discussing results with patients was associated with higher psychological distress (OR 5.3, 95% CI: 2.1-13.2, P = 0.036) and anxiety (OR 6.4, 95% CI: 2.3-17.5, P < 0.001). Diminished research collaboration was associated with higher anxiety (OR 1.8, 95% CI: 1.1-2.9, P = 0.019). CONCLUSION The COVID-19 pandemic continues to cause mental health symptoms in breast radiologists, especially for those with pandemic-specific childcare needs and financial distress. Pandemic-related decreased opportunities to connect with patients and colleagues negatively impacts radiologists' mental health.
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Affiliation(s)
- Katerina Dodelzon
- Weill Cornell Medicine at New York-Presbyterian, Department of Radiology, New York, NY, USA
| | - Lars J Grimm
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
| | - S Reed Plimpton
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA, USA
| | - Daniela Markovic
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA, USA
| | - Hannah S Milch
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA, USA
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Wesslund HM, Payne JS, Baxter JD, Westmark DM, Bartels K, Bailey KL, Krutsinger DC. Personal Financial Wellness Curricula for Medical Trainees: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:636-643. [PMID: 36608351 DOI: 10.1097/acm.0000000000005136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE Education debt, poor financial literacy, and a late start to retirement savings can cause financial stress among physicians. This systematic review identifies methods for curriculum development, methods for curriculum delivery, and outcome measures to evaluate the effectiveness of personal financial wellness curricula for medical students, residents, and fellows. METHOD The authors searched the Embase, MEDLINE (via EBSCO), Scopus, Education Resources Information Center (via EBSCO), and Cochrane Library databases and MedEdPORTAL (via PubMed) on July 28, 2022. Studies must have reported the outcome of at least 1 postcourse assessment to be included. RESULTS Of the 1,996 unique citations identified, 13 studies met the inclusion criteria. Three curricula (23.1%) were designed for medical students, 8 (61.5%) for residents, 1 (7.7%) for internal medicine fellows, and 1 (7.7%) for obstetrics-gynecology residents and fellows. The most frequently discussed personal finance topics included student loans, investment options, disability insurance, life insurance, retirement savings, budgeting, debt management, and general personal finance. A median (interquartile range) of 3.5 (1.4-7.0) hours was spent on personal finance topics. Eleven curricula (85.6%) relied on physicians to deliver the content. Four studies (30.8%) reported precourse and postcourse financial literacy evaluations, each showing improved financial literacy after the course. Four studies (30.8%) assessed actual or planned financial behavior changes, each credited with encouraging or assisting with financial behavioral changes. One study (7.7%) assessed participants' well-being using the Expanded Well-Being Index, which showed an improvement after the course. CONCLUSIONS Given the impact educational debt and other financial stressors can have on the wellness of medical trainees, institutions should consider investments in teaching financial literacy. Future studies should report more concrete outcome measures, including financial behavior change and validated measures of wellness.
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Affiliation(s)
- Hannah M Wesslund
- H.M. Wesslund is a medical student, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska
| | - Jeremy S Payne
- J.S. Payne is a resident, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jared D Baxter
- J.D. Baxter is a resident, Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Danielle M Westmark
- D.M. Westmark is assistant professor, Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, Nebraska
| | - Karsten Bartels
- K. Bartels is professor of medicine, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kristina L Bailey
- K.L. Bailey is associate professor, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Dustin C Krutsinger
- D.C. Krutsinger is assistant professor, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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22
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Nelson MN, Akpek E, Margolis DJ, Barg FK, Vittorio CC. A mixed methods study on factors that promote and ameliorate burnout in academic dermatologists. Arch Dermatol Res 2023; 315:859-868. [PMID: 36352151 PMCID: PMC9645749 DOI: 10.1007/s00403-022-02441-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022]
Abstract
The burnout literature is replete with burnout score results from quantitative surveys. There is a paucity of qualitative research that seeks to understand the impact of physician stressors on work-life balance and burnout. This study aimed to identify factors that support and disrupt work-life balance, drivers of burnout, and potential solutions among academic dermatologists. The objective was to better understand factors that promote wellness and ameliorate burnout. Concurrent explanatory mixed methods consisted of scores on the Abbreviated Maslach Burnout Inventory and open-ended semi-structured telephone interviews. The results were that positive factors, such as supportive home life and satisfaction derived from academic endeavors, compete with ongoing feelings of exhaustion, frustration, and apathy. Negative stressors include the electronic medical record, insufficient staffing, administrative and clinical task burden, and perceived lack of interest from mid-level and senior health system leadership in addressing clinicians' needs. This was a single-center academic study. As with all qualitative studies, these results may not be generalizable to all dermatologists. In addition, some participants were concerned about their anonymity. Modifiable root causes of burnout require institutional commitment to sustain the pace required by academic dermatologists.
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Affiliation(s)
- Maria N Nelson
- Mixed Methods Research Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Eda Akpek
- Mixed Methods Research Lab, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Division of Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Frances K Barg
- Division of Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, 3600 Spruce Street, 2 Maloney, Philadelphia, PA, 19104, USA
| | - Carmela C Vittorio
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
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James TT, Hudon R, Merrick T, Olson L, Hanes D, Scanlan JM. Creating a Comprehensive Pandemic Response to Decrease Hospitalist Burnout During COVID-19: Intervention vs Control Results in 2 Comparable Hospitals (HOSP-CPR). J Gen Intern Med 2023; 38:1256-1263. [PMID: 36764984 PMCID: PMC9918339 DOI: 10.1007/s11606-023-08041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/13/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Physician burnout increased during the COVID-19 pandemic. OBJECTIVE To evaluate the effectiveness of a multimodal workplace intervention designed to reduce hospitalist burnout. DESIGN Participants and setting: Our intervention group was composed of internal medicine hospitalists at Providence Portland Medical Center (64 providers including 58 physicians and 6 nurse practitioners). Our control was composed of internal medicine hospitalists at Providence St Vincent's Hospital (59 physicians and 6 nurse practitioners). MEASUREMENTS Two surveys were given during, before, and after a 12-month intervention period (October 2020 and again in October 2021). Surveys included demographics, job satisfaction, the Maslach Burnout Inventory, the Pandemic Experiences Survey, and 2 questions about leaving the job. INTERVENTIONS Three hospitalists designated as wellness warriors created weekly COVID group meetings, providing up-to-date information about COVID-19 infection rates, treatments, and work-flow changes. Discussions included coping and vaccine hesitancy, difficult case debriefs, and intensive care unit updates. Individual coaching was also offered. Meeting minutes were taken and sessions were recorded for asynchronous access. RESULTS No site differences in burnout or job satisfaction were evident pre-intervention. Post-intervention, the intervention group reported 32% burnout while controls reported 56% (p = .024). Forty-eight percent of the intervention group reported high wellness support vs. 0% of the controls (< .001). Intervention participants attributed 44% of wellness support to Providence alone, vs. controls at 12% (< .001). Regressions controlling sex, work hours, experience, race, and children in the home showed the intervention's positive effects on burnout and job satisfaction remained significant (all p < .02). LIMITATIONS For privacy reasons, all survey responses were anonymous, meaning that individual pre-post changes could not be tracked. CONCLUSION We believe the intervention resulted in substantial burnout prevention and is feasible for adoption in most hospitals and clinics.
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Affiliation(s)
- Tricia T James
- Department of Medical Education, Providence Portland Medical Center, 5050 NE Hoyt Suite 540, Portland, OR, 97213, USA.
| | - Robert Hudon
- Department of Hospital Medicine, Providence Portland Medical Center, Portland, OR, USA
| | - Todd Merrick
- Department of Hospital Medicine, Providence Portland Medical Center, Portland, OR, USA
| | - Lisa Olson
- Department of Hospital Medicine, Providence Portland Medical Center, Portland, OR, USA
| | - Douglas Hanes
- Center for Cardiovascular Analytics, Research + Data Science, Providence Research Network, Portland, OR, USA
| | - James M Scanlan
- Providence Health Research Accelerator (HRA), Seattle, WA, USA
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24
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Uys C, Carrieri D, Mattick K. The impact of shared social spaces on the wellness and learning of junior doctors: A scoping review. MEDICAL EDUCATION 2023; 57:315-330. [PMID: 36208301 DOI: 10.1111/medu.14946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/19/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Impaired wellness among junior doctors is a significant problem. Connectedness and sense of belonging may be important factors to prevent and reduce mental ill-health. Shared social spaces in which health care staff can meet informally are thought to improve connectedness; however, these spaces are in decline. It is unclear what is known about such spaces, how they are used, and their impact on wellness and learning. This study aims to identify and synthetise available literature that informs our current understanding of the nature of shared social spaces as an intervention impacting wellness and learning of junior doctors. METHODS A scoping review was conducted following the Arksey and O'Malley five-step framework. The review question is 'What is the evidence of the impact of shared social spaces on wellness and learning of junior doctors?' We searched five databases: MEDLINE, EMBASE, APA PsychINFO, APA PsychExtra, and ERIC. We conducted thorough supplementary searches in addition to the database search. RESULTS We included 41 articles. These were predominantly letters, commentaries, and editorials with only five primary research studies. We identified four significant common attributes of shared social spaces, which can be credited with positive impacts on wellness and learning: (1) Informal: fostering connectedness and belonging, trust and teamwork and offering access to informal help and support; (2) safe: allowing reflection, debrief and raising of concerns; (3) functional: there is planning of clinical care activity, sense of control and engagement from users and provision of refreshment; (4) legitimate: regular maintenance and use of shared social spaces affect role modelling, sustainability and wellness culture. DISCUSSION This review identified several ways in which shared social spaces impact positively on learning and wellness. There is little primary research in this area. Future research would be useful to further examine how and why this works.
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Affiliation(s)
- Ciska Uys
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Daniele Carrieri
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Karen Mattick
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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25
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Saxena A, Desanghere L. A framework for residents' pursuit of excellence based upon non-cognitive and cognitive attributes. Postgrad Med J 2023; 99:17-24. [PMID: 36947425 DOI: 10.1093/postmj/qgac001] [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: 03/11/2022] [Revised: 08/16/2022] [Accepted: 09/25/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Excellence, although variably conceptualized, is commonly used in medicine and the resident excellence literature is limited. Both cognitive attributes (CAs) and non-cognitive attributes (NCAs) are essential for academic and clinical performance; however, the latter are difficult to evaluate. Undergirded by an inclusive and non-competitive approach and utilizing CAs and NCAs, we propose a criterion-referenced behavioral framework of resident excellence. METHODS Perceptions of multiple stakeholders (educational administrators, faculty, and residents), gathered by survey (n = 218), document analysis (n = 52), and focus group (n = 23), were analyzed. Inductive thematic analysis was followed by deductive interpretation and categorization using sensitizing concepts for excellence, NCAs, and CAs. Chi-squared tests were used to determine stakeholder perception differences. RESULTS All stakeholders had similar perceptions (P > .05) and 13 behavioral attributes in 6 themes undergirded by insight and conscientiousness were identified. The NCAs included: interpersonal skills (works with others, available, humble), professional (compassionate, trustworthy), commitment to profession (visible, volunteers), commitment to learn (proactively seeks feedback, creates learning opportunities), and work-life balance/integration (calm demeanor, inspirational). The CA (medical knowledge and intellect) included: applies knowledge to gain expertise and improves program's caliber. CONCLUSION Resident excellence is posited as a pursuit. The attributes are non-competitive, inclusionary, potentially achievable by all, and do not negatively affect freedom of choice. However, contextual and cultural differences are likely and these need validation across societal equity segments. There are implications for learners (adaptive reflection and learning goal orientation), faculty (reduced bias and whole-person feedback), and system leaders (enhancing culture and learning environments) to foster excellence.
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Affiliation(s)
- Anurag Saxena
- Postgraduate Medical Education Office, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, S7N 5E5
| | - Loni Desanghere
- Postgraduate Medical Education Office, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, S7N 5E5
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26
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Kase J, Doolittle B. Job and life satisfaction among emergency physicians: A qualitative study. PLoS One 2023; 18:e0279425. [PMID: 36827313 PMCID: PMC9955602 DOI: 10.1371/journal.pone.0279425] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 12/07/2022] [Indexed: 02/25/2023] Open
Abstract
The prevalence of burnout among emergency physicians is among the highest of any specialty. Multiple studies have described factors that contribute to physician burnout, such as age, institutional support, and the electronic medical record (EMR). However, there have been few studies that investigate those physicians who are satisfied with their career and their personal lives. This qualitative study evaluated emergency physicians who were satisfied with both their career and personal lives to propose a model for physician well-being. Physicians were recruited using email solicitation and referral by their peers from June-September 2020. Inclusion criteria involved those physicians who were satisfied with their life and their job and did not meet the criteria for burnout. A qualitative, non-structured interview with open-ended questions was performed with each participant. Emergent themes were identified using standard practice for qualitative studies. Twenty-three physicians participated with a mean age of 45.4 years old (range 32-65), 17 (73.9%) were men, 13 (56.5%) were Caucasian, 6 (26.0%) were Asian/South Asian, 1 (4.3%) were Latino, and 3 (13.0%) were another ethnicity. Several important themes emerged. Physicians satisfied with their lives and their jobs tended to be personally resilient, socially connected, with significant outside interests. These physicians self-identified their personality type as having both introverted and extroverted features. Threats to thriving included ineffective leadership and the EMR. This project proposes a model for job and life satisfaction among emergency physicians. Encouraging these qualities, while fostering supportive leadership, and optimizing the EMR, may improve satisfaction among physicians experiencing burnout.
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Affiliation(s)
- Jesse Kase
- Yale Program for Medicine, Spirituality and Religion, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Benjamin Doolittle
- Internal Medicine & Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
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27
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Boet S, Etherington C, Dion PM, Desjardins C, Kaur M, Ly V, Denis-LeBlanc M, Andreas C, Sriharan A. Impact of coaching on physician wellness: A systematic review. PLoS One 2023; 18:e0281406. [PMID: 36749760 PMCID: PMC9904500 DOI: 10.1371/journal.pone.0281406] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023] Open
Abstract
Physician wellness is critical for patient safety and quality of care. Coaching has been successfully and widely applied across many industries to enhance well-being but has only recently been considered for physicians. This review aimed to summarize the existing evidence on the effect of coaching by trained coaches on physician well-being, distress and burnout. MEDLINE, Embase, ERIC, PsycINFO and Web of Science were searched without language restrictions to December 21, 2022. Studies of any design were included if they involved physicians of any specialty undergoing coaching by trained coaches and assessed at least one measure along the wellness continuum. Pairs of independent reviewers determined reference eligibility. Risk of bias was assessed using the Cochrane Risk of Bias Tools for Randomized Controlled Trials (RCTs) and for Non-randomized Studies of Interventions (ROBINS-I). Meta-analysis was not possible due to heterogeneity in study design and outcome measures as well as inconsistent reporting. The search retrieved 2531 references, of which 14 were included (5 RCTs, 2 non-randomized controlled studies, 4 before-and-after studies, 2 mixed-methods studies, 1 qualitative study). There were 1099 participants across all included studies. Risk of bias was moderate or serious for non-RCTs, while the 5 RCTs were of lower risk. All quantitative studies reported effectiveness of coaching for at least one outcome assessed. The included qualitative study reported a perceived positive impact of coaching by participants. Evidence from available RCTs suggests coaching for physicians can improve well-being and reduce distress/burnout. Non-randomized interventional studies have similar findings but face many limitations. Consistent reporting and standardized outcome measures are needed.
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Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology and Pain Medicine, Hyperbaric Medicine Unit, The Ottawa Hospital, Ottawa, Canada,Department of Innovation in Medical Education, The Ottawa Hospital, Ottawa, Canada,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada,Institut du Savoir Montfort, Ottawa, Canada,Faculty of Education, University of Ottawa, Ottawa, Canada,* E-mail:
| | - Cole Etherington
- Department of Anesthesiology and Pain Medicine, Hyperbaric Medicine Unit, The Ottawa Hospital, Ottawa, Canada,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Pierre-Marc Dion
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada,Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Chloé Desjardins
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Manvinder Kaur
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Valentina Ly
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | | | - Cecile Andreas
- Professional and Continuing Studies, Royal Roads University, Victoria, Canada
| | - Abi Sriharan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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28
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Tremblay MF, Leblanc F, Laroche É, Blanchette V, Brousseau-Foley M. Provision of Compassionate and Empathic Care as a Well-Being Preservation Tool for Emergency Physicians: A Scoping Review. Open Access Emerg Med 2023; 15:37-45. [PMID: 36700005 PMCID: PMC9869903 DOI: 10.2147/oaem.s391189] [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: 09/25/2022] [Accepted: 01/07/2023] [Indexed: 01/20/2023] Open
Abstract
Objective Compassion and physician well-being are two key components related to quality care in health including emergency medicine. The objective of this study was to explore the impact of compassion in care on the well-being of emergency physicians. We conducted a scoping review to explore the impact of provision of compassionate care by emergency physicians on their well-being and subconcepts. Methods Four electronic databases and grey literature were searched to find evidence related to compassion, empathy, self-compassion, and their impact on emergency physicians' well-being. Following title and abstract review, two reviewers independently screened full-text articles, and extracted data. Data were presented using descriptive statistics and a narrative analysis. Results A total of 803 reports were identified in databases. Three articles met eligibility criteria for data extraction. None directly examined compassion and well-being. Included studies addressed empathy and burnout in emergency medicine professionals. Conclusion No high-quality evidence could be found on the topic in the population of interest. Literature related to the topic of compassion in physicians, especially in emergency physicians, a field known for its high demand and stress levels, is currently scarce and additional evidence is needed to better describe and understand the association between physicians' compassion and well-being.
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Affiliation(s)
- Marie-Frédéric Tremblay
- Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec affiliated to Université de Montréal Faculty of Medicine, Trois-Rivières, Québec, Canada
| | - Frédéric Leblanc
- Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec affiliated to Université de Montréal Faculty of Medicine, Trois-Rivières, Québec, Canada
| | - Étienne Laroche
- Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec affiliated to Université de Montréal Faculty of Medicine, Trois-Rivières, Québec, Canada
| | - Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada,VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Magali Brousseau-Foley
- Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec affiliated to Université de Montréal Faculty of Medicine, Trois-Rivières, Québec, Canada,Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada,Correspondence: Magali Brousseau-Foley, Groupe de médecine familiale universitaire de Trois-Rivières, 731 Rue Sainte-Julie 2e étage, Trois-Rivières, QC, G9A 1X9, Canada, Email
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29
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Khalil MT, Rathore FA, Dy R. Wellness in residency: Addressing the neglected need in lower middle-income countries. J Pediatr Rehabil Med 2023; 16:457-462. [PMID: 37694319 PMCID: PMC10578206 DOI: 10.3233/prm-230031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
The concept of wellness incorporates many domains, including mental, physical, social, and integrated well-being. However, it is not well understood in most lower middle-income countries (LMIC). The significance of practicing wellness during residency, focusing on the context of LMIC, is described here. Based on the authors' experiences of working in LMIC, the challenges faced during residency and the importance of prioritizing self-care and well-being is highlighted. Physician burnout is a global concern having a negative impact on patient care quality, patient satisfaction, and professionalism. Interventions to address wellness can be individual and organization-based. Individual interventions include mindfulness training, behavioral interventions, self-care practices, and support networks. Organizational interventions involve the establishment of wellness committees, introduction of wellness curricula, optimization of workflows, and creation of shared social spaces. There is a need for implementing wellness practices within residency programs in LMIC. By focusing on wellness, physicians can mitigate burnout, enhance their well-being, and improve patient care outcomes.
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Affiliation(s)
| | | | - Rochelle Dy
- Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA
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30
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O'Neill A, Baldwin D, Cortese S, Sinclair J. Impact of intrawork rest breaks on doctors' performance and well-being: systematic review. BMJ Open 2022; 12:e062469. [PMID: 36517098 PMCID: PMC9756173 DOI: 10.1136/bmjopen-2022-062469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To summarise evidence on intrawork breaks and their associated effect on doctors' well-being and/or performance at work. DESIGN Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement guidelines DATA SOURCES: Embase, PubMed, Web of Science (Core Collection) and PsychINFO were systematically searched on 6 June 2021. ELIGIBILITY CRITERIA No restrictions were placed on language, study design or date of publication. DATA EXTRACTION AND ANALYSIS Methodological quality was appraised using Cochrane's Risk of Bias (ROB-2), Cochrane's Risk of Bias in Non-randomised Studies (ROBINS-I), and the Johanna Briggs Institute (JBI) checklists for cross-sectional, cohort and qualitative studies. Quantitative synthesis was not undertaken due to substantial heterogeneity of design and outcomes. Results are presented narratively. RESULTS Database searches returned 10 557 results and searches of other sources returned two additional records. Thirty-two papers were included in the systematic review, comprised of 29 unique studies, participants and topics and 3 follow-up studies. A variety of well-being and performance outcome measures were used. Overall, findings indicate that intrawork breaks improved some measures of well-being and/or work performance. However, methodological quality was judged to be low with a high risk of bias in most included studies. DISCUSSION Using existing evidence, it is not possible to conclude with confidence whether intrawork breaks improve well-being and/or work performance in doctors. There is much inconsistency regarding how breaks are defined, measured and the outcomes used to assess effectiveness. Future research should seek to: (a) define and standardise the measurement of breaks, (b) use valid, reliable outcome measures to evaluate their impact on well-being and performance and (c) minimise the risk of bias in studies where possible. PROSPERO REGISTRATION NUMBER CRD42020156924; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=156924.
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Affiliation(s)
- Aimee O'Neill
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Samuele Cortese
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Julia Sinclair
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Ungar P, Schindler AK, Polujanski S, Rotthoff T. Online programs to strengthen the mental health of medical students: A systematic review of the literature. MEDICAL EDUCATION ONLINE 2022; 27:2082909. [PMID: 35642839 PMCID: PMC9176341 DOI: 10.1080/10872981.2022.2082909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/28/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Medical students have been shown to be vulnerable to mental stress. Strengthening individual protective characteristics can be one cornerstone for promoting medical students' mental health and thereby preventing mental disorders. Online programs are an opportunity to provide appropriate options that have the advantage of being accessible from anywhere, at any time, and with a low entry threshold. This review provides a literature overview of current online programs for medical students. The findings can serve as a point of reference for designing effective online programs for mental health-promotion and mental disorder-prevention in medical curricula. We applied a systematic literature search in PubMed, ERIC, Cochrane, and Web of Science. Programs offered had to be web-based, and the addressed group had to be medical students. Protective individual characteristics for mental health and information on the programs' effectiveness were included in the search. As outcomes, we included mental health, burnout, symptoms of depression, anxiety, and well-being. The search yielded 723 articles; of them, 11 met the inclusion criteria. Programs found were grouped according to their focus: mental health literacy, mindfulness, based on Cognitive Behavioral Therapy, or peer support. Two studies showed significant reductions in perceived stress; one study indicated reduced burnout levels. One program had significant immediate effects on mindfulness, empathy, and resilience; two studies indicated strengthening coping strategies. Two programs were qualitatively assessed as helpful; two studies are ongoing. Nine studies lacked control groups; two randomized controlled trials were ongoing. Only a few online programs with limited evidence of effectiveness were found. They addressed protective individual characteristics, highlighting their importance for mental health. Thus, more health-promoting and mental disorder-preventing programs with high-quality effectiveness studies are necessary. An integration of such programs into curricula would allow for greater utilization and could give greater emphasis to and prioritize mental health in medical education.
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Affiliation(s)
- Patrizia Ungar
- Department of Medical Education (DEMEDA), University of Augsburg, Augsburg, Germany
| | | | - Sabine Polujanski
- Department of Medical Education (DEMEDA), University of Augsburg, Augsburg, Germany
| | - Thomas Rotthoff
- Department of Medical Education (DEMEDA), University of Augsburg, Augsburg, Germany
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Zangeneh Soroush M, Tahvilian P, Koohestani S, Maghooli K, Jafarnia Dabanloo N, Sarhangi Kadijani M, Jahantigh S, Zangeneh Soroush M, Saliani A. Effects of COVID-19-related psychological distress and anxiety on quality of sleep and life in healthcare workers in Iran and three European countries. Front Public Health 2022; 10:997626. [PMID: 36504977 PMCID: PMC9732084 DOI: 10.3389/fpubh.2022.997626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction The COVID-19 pandemic has considerably affected human beings most of whom are healthcare workers (HCWs) combating the disease in the front line. Methods This cross-sectional study aims to explore the effects of stress and anxiety caused by COVID-19 on the quality of sleep and life in HCWs, including physicians, nurses, and other healthcare staff. In this global study, we asked 1,210 HCWs (620 and 590 volunteers from Iran and European countries, including Germany, the Netherlands, and Italy, respectively), who age 21-70, to participate in the test. Several measures of COVID-related stress, anxiety, sleep, and life quality, including the 12-item General Health Questionnaire (GHQ-12), Fear of COVID-19 scale (FCV-19S), Beck Anxiety Inventory (BAI), the Pittsburgh Sleep Quality Index (PSQI), and World Health Organization Quality of Life-BREF (WHOQOL-BREF) are recorded. Results Volunteers reported high rates of stress and anxiety and poor sleep quality as well as lower quality of life. The correlation analysis between the measures is reported. According to the results, regardless of the location, HCWs, predominantly female nurses, developed anxiety and stress symptoms which consequently resulted in lower sleep and life quality. Both for Iranian and the European HCWs, significant differences existed between nurses and the other two groups, with the p-values equal to 0.0357 and 0.0429 for GHQ-12, 0.0368, and 0.714 for BAI measure. Even though nurses reported the most stress, anxiety, fear of COVID-19, lower quality of life and sleep in both countries, and also an increase in other measures as well, there existed no statistically significant difference in FCV-19S, PSQI, and WHOQOL-BREF. Discussion This study helps to expand our knowledge the effects of pandemics on HCWs and also for healthcare management to predict HCW's mental health conditions in similar situations.
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Affiliation(s)
- Morteza Zangeneh Soroush
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Bio-Intelligence Research Unit, Electrical Engineering Department, Sharif University of Technology, Tehran, Iran
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
- Engineering Research Center in Medicine and Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Parisa Tahvilian
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
- Engineering Research Center in Medicine and Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Sepideh Koohestani
- Department of Electrical Engineering, Islamic Azad University, Qazvin Branch, Qazvin, Iran
| | - Keivan Maghooli
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
- Engineering Research Center in Medicine and Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Nader Jafarnia Dabanloo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
- Engineering Research Center in Medicine and Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | - Sepehr Jahantigh
- Department Chemical Engineering, Sahand University of Technology, Tabriz, Iran
| | | | - Amitis Saliani
- Department of Genomic Medicine, Queen Mary University of London, London, United Kingdom
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McClafferty HH, Hubbard DK, Foradori D, Brown ML, Profit J, Tawfik DS. Physician Health and Wellness. Pediatrics 2022; 150:189767. [PMID: 36278292 DOI: 10.1542/peds.2022-059665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.
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Affiliation(s)
- Hilary H McClafferty
- Department of Pediatrics, Section Chief, Pediatric Emergency Medicine, Tucson Medical Center, Tucson, Arizona
| | - Dena K Hubbard
- Children's Mercy Kansas City, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Dana Foradori
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Melanie L Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel S Tawfik
- Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Adnan NBB, Dafny HA, Baldwin C, Jakimowitz S, Chalmers D, Aroury AMA, Chamberlain D. What are the solutions for well-being and burn-out for healthcare professionals? An umbrella realist review of learnings of individual-focused interventions for critical care. BMJ Open 2022; 12:e060973. [PMID: 36691206 PMCID: PMC9462087 DOI: 10.1136/bmjopen-2022-060973] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To determine what, how, for whom and under what conditions individual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals. DESIGN This study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme. RESULTS A total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive-behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions' interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience. CONCLUSIONS These findings provide realistic and reliable reporting of outcomes to better support implementation within the 'real world'. Future research such as seeking validation using expert opinions can provide further in depth understanding of hidden contextual factors, mechanisms and their interactions to provide a greater depth of knowledge ready for application with the critical care population.
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Affiliation(s)
- Nurul Bahirah Binte Adnan
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Hila Ariela Dafny
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Claire Baldwin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Samantha Jakimowitz
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Ammar Moh'd Ahmad Aroury
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
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Farahmand S, Rad EM, Keshmiri F. Exploring the effective elements on the personal and professional development among health-care providers: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:256. [PMID: 36325227 PMCID: PMC9621364 DOI: 10.4103/jehp.jehp_1405_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/10/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND A new domain of "personal and professional development" was introduced as a core competency of health-care providers. This study aimed to explore the experiences of learners and faculty members about what competencies or skills were essential for the professional development and success of health-care providers. MATERIALS AND METHODS This is a qualitative study using an inductive content analysis approach in 2019-2020. In the present study, 58 academic faculty members participated by purposeful sampling including ten associate professors (17.24%) and 24 assistance professors (41.37%), in addition to 23-year medical residents (20.65%) and 4th-year nursing students (20.65%). Individual and group interviews were conducted. Data were analyzed by the inductive content analysis approach introduced by Graneheim and Lundman. RESULTS The qualitative data were classified in 953 open codes and eight categories, which were further divided into four main categories: "socio-emotional skills," "life-long learning skills," "coping skills," and "well-being strategies." CONCLUSIONS The present results showed socioemotional and coping skills affect interpersonal and professional interactions that contributed to their improved health-care providers' capabilities. Participants also considered lifelong learning as influential in developing professional capabilities and keeping their knowledge and skills up-to-date for accountability to duties. Moreover, using well-being strategies protects the mental and physical health of health-care providers. These skills are synergistic, and their combination can have a significant role in improving the personal and professional capabilities.
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Affiliation(s)
- Shervin Farahmand
- Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Malakan Rad
- Department of Pediatric Cardiology, Children's Hospital Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Keshmiri
- Department of Medical Education, Education Development Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Shreffler J, Shreffler M, Thomas A, Huecker M. Wise Exertion: Associating Stoic Thought with Stress, Well-Being, and Life Satisfaction in Physicians. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221120785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recognition of how physicians contemplate and approach their activities, positive or negative, may shed light into a more holistic depiction of physician well-being. The purpose of this work was to develop items to measure wise cognitive exertion, constructed with Stoic thought, and determine its association with physician stress, well-being, and life satisfaction. A survey was sent to physicians and university staff members. This pilot investigation found a relationship among focusing on a purposeful life, acknowledging locus of control, avoiding wasteful cognition, and taking (good or bad) life experiences for personal growth and superior life satisfaction, well-being and lower stress. A 13-Item Wise Exertion Scale was developed and had significant associations with stress, well-being, and life satisfaction. Each of the four factors from the 13-Item Wise Exertion Scale were significantly associated with each measure with the exception of Control Consciousness and life satisfaction. Within physicians (N = 59), the 13-Item Wise Exertion Scale was a significant predictor, after adjusting for demographics with stress, well-being, and life satisfaction. Physicians had significantly lower 13-Item Wise Exertion Scale scores compared to non-physicians (N = 126). Future inquiries are required to determine if physicians with a mindset assembled with these beliefs have superior well-being.
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Affiliation(s)
- Jacob Shreffler
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (JS, AT, MH); and Department of Health and Sports Sciences, University of Louisville, Louisville, KY, USA (MS)
| | - Megan Shreffler
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (JS, AT, MH); and Department of Health and Sports Sciences, University of Louisville, Louisville, KY, USA (MS)
| | - Alyssa Thomas
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (JS, AT, MH); and Department of Health and Sports Sciences, University of Louisville, Louisville, KY, USA (MS)
| | - Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (JS, AT, MH); and Department of Health and Sports Sciences, University of Louisville, Louisville, KY, USA (MS)
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Sizemore R, Huecker M, Shreffler J, Zaino M, Thomas A, Kelley J. Physician Path to Wellness. A Qualitative Investigation of Self-Reported Strategies to Shift from Detrimental Health to Optimal Wellness. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221114314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: A healthy physician performs better clinically and provides superior care to patients than a physician struggling with burnout. Objective: The purpose of this study is to assess the physician perception of “health” and “burnout,” to identify successful wellness-promoting behaviors, and to build a model characterizing the successful transition from poor health to wellness. Methods: Utilizing a qualitative approach, the team conducted one-on-one, in-depth, semi-structured interviews with physicians from different specialties. Questions focused on behaviors, beliefs, and system changes that facilitated their transition from poor health/burnout to wellness. Interviews were recorded and responses qualitatively coded from a set of definitions of wellness and burnout. These coded responses were quantified, and code prevalence was analyzed. Results: Fourteen physicians completed interviews. The codebook consisted of 74 total themes, with nine occurring in more than 10 (71%) of the interviews. Most themes yielded to categories of Wellness, Unwell, and Burnout, with several themes related to individual agency in facilitating wellness. Highly prevalent themes included support systems, nutrition, exercise, and cognitive health. Subjects generally described comprehensive approaches to successfully transitioning to wellness. Conclusion: This study describes strategies for the successful transition to wellness: physician-level factors such as a healthy support system, maintaining a healthy lifestyle, and developing consistent daily routines. These findings support the importance of physician autonomy and individual-level wellness-promoting strategies for a physician’s transition to wellness. More research should investigate the overall effect of individual-level strategies versus system-level interventions.
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Affiliation(s)
- Ross Sizemore
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
| | - Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
| | - Jacob Shreffler
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
| | - Mallory Zaino
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
| | - Alyssa Thomas
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
| | - Justin Kelley
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA (RS, MH, JS, AT); Internal Medicine, University of Louisville, Louisville, KY, USA (MZ); and Undergraduate Medical Education, Louisville, University of Louisville, KY, USA (JK)
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Abstract
BACKGROUND While a great deal of research has brought attention to the issue of physician burnout in recent years, and resident physician burnout in particular, the topics of physician well-being, and by extension physician thriving, have been relatively understudied. Consequently, we propose a model of resident physician thriving. Objective To understand what factors contribute to a subjective sense of thriving among resident physicians. DESIGN In this study, we conducted in-depth interviews from May 2020 through February 2021 with resident physicians to determine what factors have contributed to their sense of thriving in their careers as well as in their lives more generally. We used a snowball sampling technique to recruit participants. Validated instruments were used to quantify the participant's subjective level of job and life satisfaction as well as their level of career burnout. To derive our conclusions, we employed thematic content analysis using a grounded theory-based approach. PARTICIPANTS Resident physicians in the internal medicine, pediatrics, and combined internal medicine-pediatrics residency programs at a single university-affiliated institution. APPROACH We interviewed those residents with high life, career, and residency satisfaction who did not meet criteria for burnout to explore those factors that contribute to their sense of thriving. KEY RESULTS Thirty-seven screening interviews were conducted. Twenty-four participants met criteria for life, career, and residency satisfaction while also not meeting criteria for burnout. The six key themes contributing to resident thriving that we identified during the course of our analysis included program leadership, learning climate, connectedness, joy in medicine, life balance, and intrinsic factors. CONCLUSIONS This project proposes a model of resident thriving that can potentially inform program structure, culture, and values.
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Affiliation(s)
- Joshua H Hyman
- Yale University School of Medicine, 1074 LMP, PO Box 8030, New Haven, CT, 06520-8030, USA.
| | - Benjamin Doolittle
- Internal Medicine & Pediatrics Residency Program, Yale University School of Medicine, New Haven, CT, USA
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Fosnot L, Jones CD, Keniston A, Burden M, Indovina KA, Patel H. Hospitalists' perspectives on challenging patient encounters and physician well-being: A qualitative study. PATIENT EDUCATION AND COUNSELING 2022; 105:1209-1215. [PMID: 34511284 DOI: 10.1016/j.pec.2021.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/29/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Challenging patient encounters contribute to physician burnout, though little is known about how these impact hospitalists specifically. This study explores how hospitalists characterize challenging patient encounters and their impact on hospitalist well-being to inform organizational efforts. METHODS We conducted a qualitative, descriptive study with 15 physician hospitalist faculty at two locations, a tertiary academic and safety-net hospital, utilizing a conceptual framework based on the Stanford Wellness Framework for physician resilience around challenging patient encounters. RESULTS Two themes emerged: feelings of helplessness and time-consuming encounters. Helplessness was associated with systems issues, misaligned patient/provider goals, and violence. Time-consuming encounters were due to systems issues, misaligned goals requiring prolonged conversations, and patient factors. These factors were found to negatively impact hospitalist well-being. Resilience strategies included developing and teaching empathy and seeking expert/colleague opinion through debriefing, peer-to-peer interactions, and external resources. CONCLUSIONS Organizational strategies to support hospitalists in the context of challenging patient encounters require a multifaceted approach: improved system processes, fostering a local culture of empathy-building, and supporting peer-to-peer relationships and debriefing mechanisms. PRACTICE IMPLICATIONS Enhanced communication around system process improvements and culture of wellness, in addition to communication skills and mindfulness, could improve hospitalist well-being.
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Affiliation(s)
- Lisa Fosnot
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Christine D Jones
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Kimberly A Indovina
- Division of Hospital Medicine, University of Colorado, Denver Health, Denver, CO, USA.
| | - Hemali Patel
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
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Prentice S, Benson J, Dorstyn D, Elliott T. Promoting Wellbeing among Family Medicine Trainees: A Hermeneutic Review of Intervention Mechanisms of Change and their Delivery Methods. TEACHING AND LEARNING IN MEDICINE 2022:1-12. [PMID: 35465799 DOI: 10.1080/10401334.2022.2048833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
PHENOMENON Efforts to promote wellbeing and reduce burnout amongst postgraduate medical trainees have been hampered by little consideration of interventions' underlying mechanisms, as well as how interventions are delivered. The critical role of trainee specialty has also been overlooked, despite the unique personal and work-based stressors faced among subgroups - such as those completing Family Medicine/General Practice. A consolidation of intervention research can help to guide the design, implementation and evaluation of future targeted programs and potentially enhance their effectiveness. The present hermeneutic literature review addresses this gap. APPROACH The Embase, Ovid Medline, and Ovid PsycINFO databases were searched for articles exploring wellbeing and related concepts of burnout and stress amongst Family Medicine/General Practice trainees. Thirty-one studies were identified through seven iterative rounds, with articles that offered novel insights and/or addressed knowledge gaps identified in each round and analyzed, followed by refinement of the overarching coding structure. Thematic analysis was conducted by two researchers. FINDINGS Proposed and enacted wellbeing interventions typically involved a combination of individualistic (e.g., self-awareness), organizational (e.g., increasing policy flexibility), and cultural (e.g., leadership) strategies. Change mechanisms were interpersonal (e.g., comradery) and, to a greater extent, intrapersonal (e.g., normalizing and accepting feelings of insecurity). Key delivery methods included the need to ingrain trainee wellness into daily work life and the importance of contextualizing interventions to increase their relevance, acceptance, and effectiveness. INSIGHTS The present review identifies and consolidates key mechanisms of change intrinsic to wellbeing-promotion interventions, alongside delivery methods. These findings provide guidance for practice and research to identify these attributes of interventions in the design and evaluation stages. This, in turn, will enhance the clarity of what is being evaluated, facilitating more informed comparisons between evaluations.
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Affiliation(s)
- Shaun Prentice
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jill Benson
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- GPEx Ltd, Adelaide, South Australia, Australia
| | - Diana Dorstyn
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Risk factors associated with student distress in medical school: Associations with faculty support and availability of wellbeing resources. PLoS One 2022; 17:e0265869. [PMID: 35395007 PMCID: PMC8992977 DOI: 10.1371/journal.pone.0265869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background
It is estimated that over half of medical students experience severe distress, a condition that correlates with low mental quality-of-life, suicidal ideation and serious thoughts of dropping out. While several risk factors for the development of severe distress have been identified, most focus on individual student characteristics. Currently, little is known about the impact medical schools have on student wellbeing.
Methods
Prospective, observational survey study from 2019–2020 from a national cohort of US medical students. Student wellbeing, school characteristics, and wellbeing resource availability was measured with a 30-question electronic survey. Medical student distress was defined as a Medical Student Wellbeing Index (MS-WBI) of ≥4. Risk factors for the development of severe distress were evaluated in a multivariate logistic regression model. The impact of the number of wellbeing resources available on student wellbeing was measured along multiple wellbeing domains. Independent reviewers categorized free text analysis of survey responses about desired wellbeing resources into themes.
Results
A total of 2,984 responses were included in the study, representing 45 unique medical schools. Medical school characteristics independently associated with severe distress included low faculty support (OR 4.24); the absence of mentorship resources (OR 1.63) and the absence of community building programs (OR 1.45) in a multivariate model. Increased availability of wellbeing resources was associated with lower average MS-WBI (4.58 vs. 3.19, p<0;05) and a smaller percentage of students who had taken or considered taking a leave of absence (40% vs. 16%, p<0.05). The resources most desired by students were mental health services and scheduling adjustments.
Conclusions
The majority of medical school characteristic that contribute to student distress are modifiable. Improving faculty support and offering more and varied wellbeing resources may help to mitigate medical student distress. Student feedback is insightful and should be routinely incorporated by schools to guide wellbeing strategies.
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Wellness in Graduate Surgical Medical Education. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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The global prevalence of depression and anxiety among doctors during the covid-19 pandemic: Systematic review and meta-analysis. J Affect Disord 2022; 298:431-441. [PMID: 34785264 PMCID: PMC8596335 DOI: 10.1016/j.jad.2021.11.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND This review provides an estimate of the global prevalence of depression and anxiety symptoms among doctors, based on analysis of evidence from the first year of the COVID-19 pandemic. METHODS A systematic review was conducted to identify suitable studies. Final searches were conducted on 3rd March 2021. Papers were initially screened by title and abstract, based on pre-agreed inclusion criteria, followed by full-text review of eligible studies. Risk of bias was assessed using the Joanna Briggs Checklist for Prevalence Studies. Data from studies rated as low or medium risk of bias were pooled using a random-effects meta-analysis. Sensitivity and subgroup analyses were conducted to explore heterogeneity. RESULTS Fifty-five studies were included after full-text review. Of these, thirty studies were assessed as low or medium risk of bias and were included in primary analyses. These comprised twenty-six studies of depression (31,447 participants) and thirty studies of anxiety (33,281 participants). Pooled prevalence of depression and anxiety was 20.5% (95% CI 16.0%-25.3%) and 25.8% (95% CI 20.4%-31.5%) respectively. INTERPRETATION Evidence from the first year of the pandemic suggests that a significant proportion of doctors are experiencing high levels of symptoms of depression and anxiety, although not conclusively more so than pre-pandemic levels. Differences in study methodology and variation in job demands may account for some of the observed heterogeneity. LIMITATIONS Findings must be interpreted with caution due to the high heterogeneity and moderate risk of bias evident in the majority of included studies.
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Mendelsohn D. Self in medicine: Determinants of physician well-being and future directions in improving wellness. MEDICAL EDUCATION 2022; 56:48-55. [PMID: 34559421 DOI: 10.1111/medu.14671] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Medicine, a profession dedicated to the wellness of patients, is struggling with a crisis of physician and trainee wellness. Physicians and trainees are burning out at alarming rates. Historically, medicine has been characterised by challenging working conditions and inattention to physician wellness and self-care. Healthy physicians are better at promoting wellness to their patients, and physicians who are suffering from burnout can deliver compromised patient care. DISCUSSION In recent years, research has increasingly focused on the causes of unwellness among doctors, and a broad range of health determinants have been identified. Studies of interventions for improving trainee and physician wellness have identified individual-focused and organisational approaches that can address the root causes of burnout. Insights from the corporate workplace may help guide interventions. Strategies for addressing physician burnout and improving wellness will involve innovative and multifaceted approaches. Despite a growing emphasis of physician wellness in the literature, implementation of wellness interventions is lagging, and quality improvement methods can address these challenges. CONCLUSION Physician wellness is a shared responsibility among doctors, health care organisations and governing bodies. Addressing burnout and improving physician wellness will require transformational change and the embracement of a culture of wellness in medicine. Quality improvement methods are the next step in identifying effective wellness interventions and the targeted groups of physicians and trainees who will most benefit.
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Affiliation(s)
- Daniel Mendelsohn
- Lions Gate Hospital, Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
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Dillon EC, Stults CD, Deng S, Martinez M, Szwerinski N, Koenig PT, Gregg L, Cobb JK, Mahler E, Frosch DL, Le Sieur S, Hanley M, Pertsch S. Women, Younger Clinicians', and Caregivers' Experiences of Burnout and Well-being During COVID-19 in a US Healthcare System. J Gen Intern Med 2022; 37:145-153. [PMID: 34729697 PMCID: PMC8562379 DOI: 10.1007/s11606-021-07134-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic brought rapid changes to the work and personal lives of clinicians. OBJECTIVE To assess clinician burnout and well-being during the COVID-19 pandemic and guide healthcare system improvement efforts. DESIGN A survey asking about clinician burnout, well-being, and work experiences. PARTICIPANTS Surveys distributed to 8141 clinicians from June to August 2020 in 9 medical groups and 17 hospitals at Sutter Health, a large healthcare system in Northern California. MAIN MEASURES Burnout was the primary outcome, and other indicators of well-being and work experience were also measured. Descriptive statistics and multivariate logistic regression analyses were performed. All statistical inferences were based on weighted estimates adjusting for response bias. KEY RESULTS A total of 3176 clinicians (39.0%) responded to the survey. Weighted results showed 29.2% reported burnout, and burnout was more common among women than among men (39.0% vs. 22.7%, p<0.01). In multivariate models, being a woman was associated with increased odds of reporting burnout (OR=2.19, 95% CI: 1.51-3.17) and being 55+ years old with lower odds (OR=0.54, 95% CI: 0.34-0.87). More women than men reported that childcare/caregiving was impacting work (32.9% vs. 19.0%, p<0.01). Even after controlling for age and gender, clinicians who reported childcare/caregiving responsibilities impacted their work had substantially higher odds of reporting burnout (OR=2.19, 95% CI: 1.54-3.11). Other factors associated with higher burnout included worrying about safety at work, being given additional work tasks, concern about losing one's job, and working in emergency medicine or radiology. Protective factors included believing one's concerns will be acted upon and feeling highly valued. CONCLUSIONS This large survey found the pandemic disproportionally impacted women, younger clinicians, and those whose caregiving responsibilities impacted their work. These results highlight the need for a holistic and targeted strategy for improving clinician well-being that addresses the needs of women, younger clinicians, and those with caregiving responsibilities.
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Affiliation(s)
- Ellis C Dillon
- Center for Health Systems Research, Sutter Health and Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA, 94301, USA.
| | - Cheryl D Stults
- Center for Health Systems Research, Sutter Health and Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA, 94301, USA
| | - Sien Deng
- Center for Health Systems Research, Sutter Health and Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA, 94301, USA
| | - Meghan Martinez
- Center for Health Systems Research, Sutter Health and Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA, 94301, USA
| | - Nina Szwerinski
- Center for Health Systems Research, Sutter Health and Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA, 94301, USA
| | - P T Koenig
- Sutter Medical Group, Sacramento, CA, USA
| | - Laurie Gregg
- Sutter Medical Center Sacramento and Sutter Independent Physicians, Sacramento, CA, USA
| | | | | | - Dominick L Frosch
- Center for Health Systems Research, Sutter Health and Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA, 94301, USA
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Prentice S, Benson J, Dorstyn D, Elliott T. Wellbeing Conceptualizations in Family Medicine Trainees: A Hermeneutic Review. TEACHING AND LEARNING IN MEDICINE 2022; 34:60-68. [PMID: 34126815 DOI: 10.1080/10401334.2021.1919519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PHENOMENON High levels of burnout have been widely reported among postgraduate medical trainees, however relatively little literature has examined what 'wellbeing' means for this group. Moreover, the literature that does exist has generally overlooked the potential role of specialty factors in influencing such conceptualizations. This is particularly true for family medicine and general practice trainees - a specialty considered to be unique due, in part, to its focus on community-based care. The present review sought to explore conceptualizations of wellbeing specifically within the context of family medicine and general practice training. APPROACH The Embase, Ovid Medline, and PsycINFO databases were searched from inception to November 2019 for literature examining wellbeing in family medicine and general practice trainees. Literature was iteratively thematically analyzed through the process of a hermeneutic cycle. In total, 36 articles were reviewed over seven rounds, at which point saturation was reached. FINDINGS The findings confirm the complex and multifaceted nature of wellbeing as experienced by family medicine and general practice trainees. An emphasis on psychological factors - including emotional intelligence, positive mental health, self-confidence and resilience - alongside positive interpersonal relationships, rewards, and balanced interactions between trainees' personal and professional demands were deemed critical elements. INSIGHTS A model of wellbeing that emphasizes rich connections between trainees' personal and professional life domains is proposed. Further qualitative research will help to extend current understanding of wellbeing among medical trainees, including the individuality of each specialty's experiences, with the potential to enhance interventional efforts.
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Affiliation(s)
- Shaun Prentice
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jill Benson
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- GPEx Ltd, Adelaide, South Australia, Australia
| | - Diana Dorstyn
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Thriving among Primary Care Physicians: a Qualitative Study. J Gen Intern Med 2021; 36:3759-3765. [PMID: 34047922 PMCID: PMC8642558 DOI: 10.1007/s11606-021-06883-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/03/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND Burnout is high in primary care physicians and negatively impacts the quality of patient care. While many studies have evaluated burnout, there have been few which investigate those physicians who are satisfied with their careers and life-a phenomenon we term "thriving." OBJECTIVE To identify factors contributing to both career and life satisfaction through qualitative interviews. PARTICIPANTS The subjects were primary care physicians. APPROACH Qualitative interviews were performed between July 2018 and March 2020. Physicians were identified by snowball sampling and were asked to complete validated instruments to identify job/life satisfaction and lack of burnout. Semi-structured interviews were conducted, focused on aspects of participants' career and life which contributed to their thriving, including work environment, social networks, family life, institutional support, coping strategies, and extracurricular activities. Transcripts were analyzed using thematic content analysis using a grounded theory approach. MAIN MEASURES Personal, professional, and life factors that contributed to achieving career and life satisfaction in primary care physicians and potential solutions for burnout. RESULTS Thirty-two physicians were interviewed (9.4% family physicians, 9.4% combined internists-pediatricians, 40.6% internists, and 40.6% pediatricians) with a mean age 54.7 years and 23.8 years in practice. No physicians included met the criteria for burnout. All met the criteria for career and life satisfaction. Five themes were identified as critical to thriving: an intrinsic love for the work, a rich social network, a fulfilling doctor-patient relationship, a value-oriented belief system, and agency in the work environment. CONCLUSIONS Several factors contribute to professional fulfillment and life satisfaction among primary care physicians, which we propose as a model for physicians thriving. Some factors were intrinsic, such as having value-oriented beliefs and inherent love for medicine, while others were extrinsic, such as having a fulfilling social network. Barriers and opportunities to apply these lessons for the wider physician community are discussed.
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Bazargan-Hejazi S, Shirazi A, Wang A, Shlobin NA, Karunungan K, Shulman J, Marzio R, Ebrahim G, Shay W, Slavin S. Contribution of a positive psychology-based conceptual framework in reducing physician burnout and improving well-being: a systematic review. BMC MEDICAL EDUCATION 2021; 21:593. [PMID: 34823509 PMCID: PMC8620251 DOI: 10.1186/s12909-021-03021-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The PERMA Model, as a positive psychology conceptual framework, has increased our understanding of the role of Positive emotion, Engagement, Relationships, Meaning, and Achievements in enhancing human potentials, performance and wellbeing. We aimed to assess the utility of PERMA as a multidimensional model of positive psychology in reducing physician burnout and improving their well-being. METHODS Eligible studies include peer-reviewed English language studies of randomized control trials and non-randomized design. Attending physicians, residents, and fellows of any specialty in the primary, secondary, or intensive care setting comprised the study population. Eligible studies also involved positive psychology interventions designed to enhance physician well-being or reduce physician burnout. Using free text and the medical subject headings we searched CINAHL, Ovid PsychINFO, MEDLINE, and Google Scholar (GS) electronic bibliographic databases from 2000 until March 2020. We use keywords for a combination of three general or block of terms (Health Personnel OR Health Professionals OR Physician OR Internship and Residency OR Medical Staff Or Fellow) AND (Burnout) AND (Positive Psychology OR PERMA OR Wellbeing Intervention OR Well-being Model OR Wellbeing Theory). RESULTS Our search retrieved 1886 results (1804 through CINAHL, Ovid PsychINFO, MEDLINE, and 82 through GS) before duplicates were removed and 1723 after duplicates were removed. The final review included 21 studies. Studies represented eight countries, with the majority conducted in Spain (n = 3), followed by the US (n = 8), and Australia (n = 3). Except for one study that used a bio-psychosocial approach to guide the intervention, none of the other interventions in this review were based on a conceptual model, including PERMA. However, retrospectively, ten studies used strategies that resonate with the PERMA components. CONCLUSION Consideration of the utility of PERMA as a multidimensional model of positive psychology to guide interventions to reduce burnout and enhance well-being among physicians is missing in the literature. Nevertheless, the majority of the studies reported some level of positive outcome regarding reducing burnout or improving well-being by using a physician or a system-directed intervention. Albeit, we found more favorable outcomes in the system-directed intervention. Future studies are needed to evaluate if PERMA as a framework can be used to guide system-directed interventions in reducing physician burnout and improving their well-being.
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Affiliation(s)
- Shahrzad Bazargan-Hejazi
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA.
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Anaheed Shirazi
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Andrew Wang
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nathan A Shlobin
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Krystal Karunungan
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Joshua Shulman
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
| | - Robert Marzio
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
| | - Gul Ebrahim
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
| | - William Shay
- College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, 90059, USA
| | - Stuart Slavin
- Accreditation Council for Graduate Medical Education, Chicago, USA
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Mir H, Downes K, Chen AF, Grewal R, Kelly DM, Lee MJ, Leucht P, Dulai SK. Physician wellness in orthopaedic surgery : a multinational survey study. Bone Jt Open 2021; 2:932-939. [PMID: 34766825 PMCID: PMC8636297 DOI: 10.1302/2633-1462.211.bjo-2021-0153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS Physician burnout and its consequences have been recognized as increasingly prevalent and important issues for both organizations and individuals involved in healthcare delivery. The purpose of this study was to describe and compare the patterns of self-reported wellness in orthopaedic surgeons and trainees from multiple nations with varying health systems. METHODS A cross-sectional survey of 774 orthopaedic surgeons and trainees in five countries (Australia, Canada, New Zealand, UK, and USA) was conducted in 2019. Respondents were asked to complete the Mayo Clinic Well-Being Index and the Stanford Professional Fulfillment Index in addition to 31 personal/demographic questions and 27 employment-related questions via an anonymous online survey. RESULTS A total of 684 participants from five countries (Australia (n = 74), Canada (n = 90), New Zealand (n = 69), UK (n = 105), and USA (n = 346)) completed both of the risk assessment questionnaires (Mayo and Stanford). Of these, 42.8% (n = 293) were trainees and 57.2% (n = 391) were attending surgeons. On the Mayo Clinic Well-Being Index, 58.6% of the overall sample reported feeling burned out (n = 401). Significant differences were found between nations with regards to the proportion categorized as being at risk for poor outcomes (27.5% for New Zealand (19/69) vs 54.4% for Canada (49/90) ; p = 0.001). On the Stanford Professional Fulfillment Index, 38.9% of the respondents were classified as being burned out (266/684). Prevalence of burnout ranged from 27% for Australia (20/74 up to 47.8% for Canadian respondents (43/90; p = 0.010). Younger age groups (20 to 29: RR 2.52 (95% confidence interval (CI) 1.39 to 4.58; p = 0.002); 30 to 39: RR 2.40 (95% CI 1.36 to 4.24; p = 0.003); 40 to 49: RR 2.30 (95% CI 1.35 to 3.9; p = 0.002)) and trainee status (RR 1.53 (95% CI 1.15 to 2.03 p = 0.004)) were independently associated with increased relative risk of having a 'at-risk' or 'burnout' score. CONCLUSIONS The rate of self-reported burnout and risk for poor outcomes among orthopaedic surgeons and trainees varies between countries but remains unacceptably high throughout. Both individual and health system characteristics contribute to physician wellness and should be considered in the development of strategies to improve surgeon wellbeing. Level of Evidence: III Cite this article: Bone Jt Open 2021;2(11):932-939.
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Affiliation(s)
- Hassan Mir
- Florida Orthopedic Institute, Tampa, Florida, USA
| | | | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ruby Grewal
- Roth McFarlane Hand and Upper Limb Cente, University of Western Ontario, London, Canada
| | - Derek M Kelly
- Campbell Clinic Orthopaedics, Memphis, Tennessee, USA
| | - Michael J Lee
- Department of Orthopaedics, University of Chicago, Chicago, Illinois, USA
| | - Philipp Leucht
- Ortho Surgery & Cell Biology, NYU Langone Health, New York, New York, USA
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Impact of COVID-19 on Dermatology Residency. Dermatol Clin 2021; 39:609-618. [PMID: 34556250 PMCID: PMC8320344 DOI: 10.1016/j.det.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
COVID-19 has created challenges across medicine, including in medical education, with deeply rooted impacts in the dermatology residency experience. Its effects are both acute and chronic, including: shifts to virtual education and conferences, skewed clinical experiences, negatively impacted wellness, and uncertainty in the future. As educators and mentors, it is important to recognize and address these issues so that we may remain transparent, adaptable, and engaged as we continue to build a better tomorrow for our resident trainees.
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