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Waithera HW, Ndumwa HP, Njiro BJ, Chande-Mallya R, Julius W, Swahn M, Staton CA, Francis JM. Alcohol use disorders among healthcare professionals: a call for action. Health Promot Int 2024; 39:daae121. [PMID: 39397748 DOI: 10.1093/heapro/daae121] [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] [Indexed: 10/15/2024] Open
Abstract
Alcohol consumption and harmful and hazardous drinking are significant contributors to the global burden of disease, accounting for about 3 million deaths each year globally. Owing to their stressful work environment, healthcare professionals are at a high risk of experiencing physical and mental health problems, particularly alcohol use disorders. Alcohol use disorder among healthcare professionals is of concern as it is associated with decreased work productivity and performance and associated ill health and cognitive impairment. This review, therefore, aimed to gather evidence on the prevalence and associated factors for alcohol use disorders among healthcare professionals. The findings revealed a high prevalence of alcohol use disorders among healthcare professionals, which were worsened during the COVID-19 pandemic. Additionally, there was a glaring dearth of studies conducted in low- and middle-income countries. Urgent interventions and support systems are therefore needed to address these issues. A comprehensive approach, considering individual and organizational factors, alongside evidence-based interventions, training and support programs, can promote workforce well-being and improve the quality of patient care. It is imperative to integrate alcohol use screening, preventive and treatment interventions with primary healthcare and psychiatry services. This will help ensure early diagnosis and timely initiation of preventive and therapeutic measures, reducing the risk of missed opportunities. Furthermore, offering effective human resource management support services to healthcare professionals would significantly enhance their well-being and help prevent alcohol use disorders.
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Affiliation(s)
- Hannah W Waithera
- Department of Research, Gertrude's Children's Hospital, 34 Muthaiga Road, 00100, Nairobi, Kenya
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Harrieth P Ndumwa
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Belinda J Njiro
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rehema Chande-Mallya
- Directorate of Library Services, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - William Julius
- Directorate of Library Services, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Monica Swahn
- Wellstar College of Health and Human Services, Kennesaw, GA, USA
| | - Catherine A Staton
- Department of Emergency Medicine, Duke School of Medicine/Global Emergency Medicine Innovation and Implementation Research Center, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Joel M Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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2
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Wang B, Bai Y, Wu S, Lin W, Guo J. Association between occupational burnout and psychological symptoms among Chinese medical staff: moderating role of social support. PSYCHOL HEALTH MED 2024; 29:1265-1280. [PMID: 38166576 DOI: 10.1080/13548506.2023.2299666] [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: 03/25/2023] [Accepted: 12/18/2023] [Indexed: 01/04/2024]
Abstract
This study aimed to examine the association between occupational burnout and psychological symptoms among Chinese medical staff, assuming social support to play a moderating role in the aforementioned relationship. The survey was conducted online from May 1 to June 28, 2022, and the questionnaires were distributed and retrieved through a web-based platform. The final sample was comprised of 1461 Chinese medical staff in this cross-sectional study. Several multiple linear regressions were performed to analyze the data. After controlling for potential confounding factors, all three dimensions of occupational burnout were associated with poorer psychological symptoms. Emotional exhaustion (β = 0.33; 95% confidence interval [CI], 1.018, 1.479) had the strongest association with psychological symptoms, followed by depersonalization and diminished personal accomplishment. Moreover, medical staff with higher levels of friend support (β = -0.11; 95% CI, -4.063, -0.573) and significant other support (β = -0.10; 95% CI, -3.965, -0.168) were less likely to suffer from psychological symptoms when faced with occupational burnout. The results suggested that interventions aimed at lessening occupational burnout and boosting social support can be an effective way to promote the psychological health of medical staff.
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Affiliation(s)
- Bingqian Wang
- Department of Health Policy and Manage, School of Public Health, Peking University, Beijing, China
| | - Yashuang Bai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Songmei Wu
- Nursing Department, Luoyang Orthopedic Hospital of Henan Province, Zhengzhou, China
| | - Wei Lin
- Department of Neurosurgery, Joint Logistics Support Unit No. 904 Hospital, School of Medicine, Anhui Medical University, Wuxi, China
| | - Jing Guo
- Department of Health Policy and Manage, School of Public Health, Peking University, Beijing, China
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Williams-Brown MY, Summey RM, Newtson A, Burke W, Turner T, Sabu P, Davidson BA, Glaser G. System-level recommendations for improved wellness for gynecologic oncologists: A Society of Gynecologic Oncology Review. Gynecol Oncol 2024; 183:85-92. [PMID: 38554478 DOI: 10.1016/j.ygyno.2024.03.019] [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: 01/04/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/01/2024]
Abstract
Burnout and its negative sequelae are a persistent problem in gynecologic oncology, threatening the health of our physician workforce. Individual-level interventions such as stress management training, physical activity, and sleep hygiene only partially address this widespread, systemic crisis rooted in the extended work hours and stressful situations associated with gynecologic oncology practice. There is an urgent need for systematic, institution-level changes to allow gynecologic oncologists to continue the crucial work of caring for people with gynecologic cancer. We present recommendations for institution-level changes which are grounded in the framework presented by the National Plan for Health Workforce Well-Being by the National Academy of Medicine. These are aimed at facilitating gynecologic oncologists' well-being and reduction of burnout. Recommendations include efforts to create a more positive and inclusive work environment, decrease administrative barriers, promote mental health, optimize electronic medical record use, and support a diverse workforce. Implementation and regular evaluation of these interventions, with specific attention to at-risk groups, is an important next step.
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Affiliation(s)
- M Y Williams-Brown
- Department of Women's Health, Dell Medical School at The University of Texas at Austin, Austin, TX, United States of America.
| | - R M Summey
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - A Newtson
- Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - W Burke
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook University Cancer Center, Stony Brook, NY, United States of America
| | - T Turner
- St. Luke's Cancer Institute, Boise, ID, United States of America
| | - P Sabu
- Division of Gynecologic Oncology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - B A Davidson
- Division of Gynecologic Oncology, Duke University, Durham, NC, United States of America
| | - G Glaser
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
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Martinez-Calderon J, Infante-Cano M, Casuso-Holgado MJ, García-Muñoz C. The prevalence of burnout in oncology professionals: an overview of systematic reviews with meta-analyses including more than 90 distinct studies. Support Care Cancer 2024; 32:196. [PMID: 38411784 DOI: 10.1007/s00520-024-08400-x] [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: 10/10/2023] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE This overview of reviews aimed to summarize the prevalence of burnout and the dimensions of burnout (emotional exhaustion, depersonalization, and personal accomplishment) in oncology professionals around the world. METHODS The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to September 13, 2023. AMSTAR 2 was used to assess the quality of reviews. The overlap between reviews was calculated. RESULTS Twelve reviews were included. Overall, reviews showed that burnout was prevalent in oncologists and oncology nurses. On the other hand, no reviews meta-analyzed the prevalence of burnout in oncology radiation therapists. In addition, the dimensions of burnout, high emotional exhaustion, high depersonalization, and low personal accomplishment were highly prevalent across reviews in oncologists, oncology nurses, and oncology radiation therapists. In oncologists, the Americas (specifically Canada) showed the highest prevalence rates for high emotional exhaustion, whereas high depersonalization and low personal accomplishment were mainly prevalent in Europe and Asia, respectively. In oncology nurses, high emotional exhaustion and high depersonalization were mainly prevalent in Asia, whereas low personal accomplishment was more prevalent in the Americas (specifically Canada). The prevalence of overall levels of burnout was not meta-analyzed by continents. CONCLUSION Some methodological improvements may help to make more robust the findings of this overview (e.g., specific subgroup meta-analyses by oncology specialties), which may help readers reach more precise, direct, and consistent findings. PROTOCOL REGISTRATION https://doi.org/10.17605/OSF.IO/QPWG5 .
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Affiliation(s)
- Javier Martinez-Calderon
- Departamento de Fisioterapia, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Calle Avenzoar, 6, 41009, Seville, IBiS, Seville, Spain.
- CTS 1110: Understanding Movement and Self in Health From Science (UMSS) Research Group, Andalusia, Spain.
| | - Marta Infante-Cano
- CTS 1110: Understanding Movement and Self in Health From Science (UMSS) Research Group, Andalusia, Spain
| | - Maria Jesus Casuso-Holgado
- Departamento de Fisioterapia, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Calle Avenzoar, 6, 41009, Seville, IBiS, Seville, Spain
- CTS 1110: Understanding Movement and Self in Health From Science (UMSS) Research Group, Andalusia, Spain
| | - Cristina García-Muñoz
- CTS 1110: Understanding Movement and Self in Health From Science (UMSS) Research Group, Andalusia, Spain
- Departamento de Ciencias de La Salud y Biomédicas, Universidad Loyola de Andalucía, Seville, Spain
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Hernández FA, Loaiza DR, Marulanda E. "Here, I am More than Just Symptoms Combined": Mental Health Services from the Perspective of Community Rehabilitation Groups. J Patient Exp 2024; 11:23743735231224266. [PMID: 38223208 PMCID: PMC10785710 DOI: 10.1177/23743735231224266] [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] [Indexed: 01/16/2024] Open
Abstract
In response to the rise in mental disorders, psychosocial and community approaches have been proposed, complementing traditional clinical services. The present research aimed to understand the perception of individuals attending community-based strategies regarding mental health services as part of the approach to mental disorders in Colombia. Two workshops were conducted with 30 individuals with mental disorders (depression, anxiety and bipolar disorder), who were members of community strategies. A thematic analysis was conducted. The theme resulting from the analysis shows Community mental health within the healthcare system, which consisted of categories such as Group Amplifying Actions for Health and Groups as Complementary to Other Forms of Care. It is emphasized that the healthcare system should establish bridges with community mental health strategies and actively engage in their strengthening processes to enhance the outcomes of pharmacological interventions and even psychotherapeutic interventions. Bidirectional learning approach is proposed between community-based mental health services and clinical settings within the healthcare system. Community strategies can make an important contribution to complex processes in the health system.
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Affiliation(s)
| | - Daniela Rojas Loaiza
- Faculty of Medicine, Department of Psychiatry, Universidad de los Andes, Bogotá, Colombia
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Esparza-Reig J, Julián M. Association between suicidal ideation and burnout: A meta-analysis. DEATH STUDIES 2024; 48:1085-1096. [PMID: 38180020 DOI: 10.1080/07481187.2023.2300064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Approximately 700,000 people die by suicide annually worldwide. Researchers have explored a spectrum of experiences that involve stress in academic or work environments and potentially intensify suicidal thoughts or behaviors. However, no meta-analysis has examined the relationship between suicidal ideation (SI) and burnout. This study consisted of a meta-analysis to examine the association between SI and burnout syndrome, utilizing the WoS Core Collection, Scopus, PubMed, PsycINFO, DIALNET, and Google Scholar databases. Twenty-one samples met the study's eligibility criteria for inclusion in the analysis. The results revealed a significant relationship between SI and burnout, with the type of burnout (occupational, academic, and parental) emerging as the most significant moderating variable. Occupational burnout exhibited the lowest correlation, followed by academic and parental burnout. These findings suggest the importance of developing tools to assess SI within the context of the work environment, parenting and academics, and psychoeducational programs for managing stress.
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Affiliation(s)
| | - Martín Julián
- Department of Psychology, Universidad Europea de Valencia, Valencia, Spain
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Khosravi M. Factors affecting medical students’ academic burnout: a moderation analysis. ITALIAN JOURNAL OF MEDICINE 2023; 17. [DOI: 10.4081/itjm.2023.1659] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024] Open
Abstract
Background. Burnout syndrome may threaten medical students’ professional life through negative effects on their academic work and personal life. Therefore, it is very important to identify the risk and protective factors of burnout syndrome in this group of subjects. The present study aimed to determine the association of socio-demographic characteristics, current substance/medication abuse, and personality dimensions with academic burnout among medical students, and examine physical activity as a potential moderator of the personality dimensions-academic burnout relationship. Materials and Methods. In this cross-sectional study, a total of 400 medical students from the four courses of basic sciences, physiopathology, stagers, and internship (100 people at each course) in Zahedan, Iran, in 2018, were selected by stratified sampling method and evaluated using the socio-demographic information form, Baecke physical activity questionnaire, Temperament and character inventory, and Breso’s academic burnout questionnaire. Finally, descriptive statistical methods, the Kruskal-Wallis test, Spearman’s rank correlation coefficient, and hierarchical linear regression were implemented for data analysis. Results. The participants included 156 men and 244 women. The overall frequencies for current substance/medication abuse, exhaustion, cynicism, inefficacy, and academic burnout were reported to be 27.5, 10.3, 12.3, 6.5, and 25.8 percent, respectively. The study results showed that physical activity, persistence, and cooperativeness were negative, and the years in medical school, current substance/medication abuse, and novelty seeking were positively associated with academic burnout. Also, the regression analysis results revealed the moderating effect of physical activity in the novelty-seeking-academic burnout link. Conclusions. These findings are an important contribution to the current literature on academic burnout as they can provide a meaningful guide to integrating treatment protocols designed to reduce both frequency and severity of this syndrome among medical students. However, the etiology of academic burnout among this highly sensitive group should be further investigated in depth.
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8
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Holzgang SA, Princip M, Pazhenkottil AP, Auschra B, von Känel R. Underutilization of effective coping styles in male physicians with burnout. PLoS One 2023; 18:e0291380. [PMID: 37682966 PMCID: PMC10490954 DOI: 10.1371/journal.pone.0291380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Ineffective coping is a risk factor for burnout among physicians, in whom the prevalence of burnout is high and has also increased in recent years. We examined in a cross-sectional study whether physicians with burnout show different coping styles compared with healthy controls. Male physicians (n = 60) were recruited into two groups (burnout vs. healthy). The Coping Inventory for Stressful Situations (CISS) and the Maslach Burnout Inventory (MBI) were applied. Wilcoxon rank-sum test showed group differences in two of the three coping styles, task-oriented and emotion-oriented, and also in one of the two subscales of the avoidance-oriented coping: social-diversion-oriented coping. Multiple binomial logistic regression, controlling for age, showed that lower task-oriented coping (OR = 0.38 (0.13 - 0.93), p = 0.048, d = 0.534) and lower social-diversion-oriented coping (OR = 0.33 (0.11 - 0.80), p = 0.024, d = 0.611) significantly predicted the burnout group. The findings suggest that male physicians with burnout differ from healthy controls in terms of less frequent utilization of effective coping styles. These findings could be explored for their utility in preventing burnout in future studies.
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Affiliation(s)
- Sarah A. Holzgang
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Aju P. Pazhenkottil
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Bianca Auschra
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Naert MN, Pruitt C, Sarosi A, Berkin J, Stone J, Weintraub AS. A cross-sectional analysis of compassion fatigue, burnout, and compassion satisfaction in maternal-fetal medicine physicians in the United States. Am J Obstet Gynecol MFM 2023; 5:100989. [PMID: 37127208 DOI: 10.1016/j.ajogmf.2023.100989] [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: 02/23/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Compassion fatigue is secondary traumatic distress experienced by providers from ongoing contact with patients who are suffering. Compassion satisfaction is emotional fulfillment from caring for others. Burnout is distress related to dissonance between job demands and available resources. Although burnout is well-studied, compassion satisfaction and compassion fatigue are neglected components of physician well-being. Because of recurrent exposure to adverse outcomes, maternal-fetal medicine providers may be at particular risk for compassion fatigue. OBJECTIVE This study aimed to better characterize both clinical and nonclinical drivers of work-related distress vs satisfaction. STUDY DESIGN The modified Compassion Fatigue and Satisfaction Self-Test and a questionnaire of professional and personal characteristics were distributed electronically to maternal-fetal medicine providers nationally. Multivariable regression models were constructed for compassion fatigue, burnout, and compassion satisfaction as a function of potential predictors. RESULTS The survey response rate was 24% (n=366), primarily consisting of White physicians working in academic medical centers. Significant predictors of lower burnout scores included employment at 1 institution for >20 years, discussing work-related distress with friends, and having one's most recent involvement in decision-making for a periviable fetus >6 months ago; distress because of coworkers and personal factors predicted higher scores. Female sex, self-report of significant emotional depletion, use of mental health services, and having other maternal-fetal medicine physicians as part of the care team for a fetus with severe anomalies were significant predictors of higher compassion fatigue scores, whereas White race and having social work as part of the care team for a maternal mortality predicted lower scores. Personal spiritual practice was a significant predictor of higher compassion satisfaction score, whereas employment at current institution for <5 years predicted lower scores. CONCLUSION Compassion fatigue, compassion satisfaction, and burnout are associated with several modifiable risk factors, such as practice type, having a multidisciplinary team, and emotional support outside of the workplace; these are potential targets for intervention.
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Affiliation(s)
- Mackenzie N Naert
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Naert, Berkin, and Stone); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr Naert).
| | - Cassandra Pruitt
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Pruitt, Sarosi, and Weintraub); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr Pruitt)
| | - Alex Sarosi
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Pruitt, Sarosi, and Weintraub); Division of Plastic Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY (Dr Sarosi)
| | - Jill Berkin
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Naert, Berkin, and Stone)
| | - Joanne Stone
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Naert, Berkin, and Stone)
| | - Andrea S Weintraub
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY (Drs Pruitt, Sarosi, and Weintraub)
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Ryan E, Hore K, Power J, Jackson T. The relationship between physician burnout and depression, anxiety, suicidality and substance abuse: A mixed methods systematic review. Front Public Health 2023; 11:1133484. [PMID: 37064688 PMCID: PMC10098100 DOI: 10.3389/fpubh.2023.1133484] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/09/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction The World Health Organization defines burnout as a problem associated with employment, a category distinct from psychological disorders such as depression, anxiety, suicidality and disorders of substance abuse. Evaluating the association between burnout as an occupational exposure and psychological morbidity may indicate that burnout can act as an occupational risk factor for mental ill-health. The systematic review explores this relationship in physicians due to the increased risk in this population and the implications for healthcare delivery. Methods A mixed methods systematic review of the literature was conducted across Medline, Cinahl Plus, PsycInfo, Web of Science and The Cochrane Library. Databases were systematically searched using keywords relating to physician burnout and depression, anxiety, suicidality and substance abuse. Identified articles were screened for eligibility by two independent researchers. Data extraction was performed and studies assessed for risk of bias. Quantitative and qualitative results were integrated using a convergent segregated approach and results portrayed as a narrative synthesis. Results Sixty-one articles were included in the review. There was notable heterogeneity in the measurement and criteria used to define burnout limiting the assimilation of results. Despite this, all studies that measured the association between depression and burnout reported a significant association. Studies that reported association between burnout and anxiety were similarly uniformly consistent. Most studies that reported the association between burnout and suicidality indicated that a significant association exists however difficulty in measurement of suicidality may have influenced variability of results. The reported association between substance abuse and burnout was more variable, suggesting that any association is likely to be weak or influenced by other variables. Qualitative studies described the manifestations of chronic workplace stress as well as perceived links with psychological morbidity. These included lack of time for work-life balance, the contribution of professional relationships and a culture of invulnerability that exists among physicians. Conclusion The systematic review cannot conclude causality but suggests that physician burnout is associated with depression, anxiety and suicidality. Qualitative data provides insight into the nature of this association. The review indicates the need for longitudinal research and provides considerations for intervention strategies to prevent the development and progression of burnout. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172938, identifier: CRD42020172938.
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Affiliation(s)
- Emer Ryan
- Department of Cardiothoracic Anaesthesia, Auckland City Hospital, Auckland, New Zealand
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
- College of Anaesthesiologists of Ireland, Dublin, Ireland
| | - Kevin Hore
- College of Anaesthesiologists of Ireland, Dublin, Ireland
- Department of Anaesthesia, Great Ormonde Street Children's Hospital, London, United Kingdom
| | - Jessica Power
- Centre for Global Health, Trinity College, Dublin, Ireland
| | - Tracy Jackson
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
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Getahun M, Oboke EN, Ogolla BA, Kinyua J, Ongeri L, Sterling M, Oluoch I, Lyndon A, Afulani PA. Sources of stress and coping mechanisms: Experiences of maternal health care providers in Western Kenya. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001341. [PMID: 36962929 PMCID: PMC10022275 DOI: 10.1371/journal.pgph.0001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/11/2023] [Indexed: 02/12/2023]
Abstract
The dynamic and complex nature of care provision predisposes healthcare workers to stress, including physical, emotional, or psychological fatigue due to individual, interpersonal, or organizational factors. We conducted a convergent mixed-methods study with maternity providers to understand their sources of stress and coping mechanisms they adopt. Data were collected in Migori County in western Kenya utilizing quantitative surveys with n = 101 maternity providers and in-depth interviews with a subset of n = 31 providers. We conducted descriptive analyses for the quantitative data. For qualitative data, we conducted thematic analysis, where codes were deductively developed from interview guides, iteratively refined based on emergent data, and applied by a team of five researchers using Dedoose software. Code queries were then analysed to identify themes and organized using the socioecological (SE) framework to present findings at the individual, interpersonal, and organizational levels. Providers reported stress due to high workloads (61%); lack of supplies (37%), poor salary (32%), attitudes of colleagues and superiors (25%), attitudes of patients (21%), and adverse outcomes (16%). Themes from the qualitative analysis mirrored the quantitative analysis with more detailed information on the factors contributing to each and how these sources of stress affect providers and patient outcomes. Coping mechanisms adopted by providers are captured under three themes: addressing stress by oneself, reaching out to others, and seeking help from a higher power. Findings underscore the need to address organizational, interpersonal, and individual level stressors. Strategies are needed to support staff retention, provide adequate resources and incentives for providers, and ultimately improve patient outcomes. Interventions should support and leverage the positive coping mechanisms identified.
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Affiliation(s)
- Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | | | | | | | | | - Mona Sterling
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | | | - Audrey Lyndon
- NYU Rory Meyers College of Nursing, New York, NY, United States of America
| | - Patience A. Afulani
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
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12
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Wolf AV, Hedrick KN, Begerowski SR, Wiper DW, Carter DR, Shuffler ML. Making Every Meeting Count: A Qualitative Investigation of Multiteam Meeting Events and Their Role in Supporting Coordinated Cancer Care Delivery. JCO Oncol Pract 2023; 19:e53-e66. [PMID: 36356278 DOI: 10.1200/op.22.00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This research considers how cross-disciplinary cancer care meetings can facilitate coordination within the multiteam systems (MTSs) that provide inpatient hospital care. We conducted a series of interviews and observations with members of a single cancer care MTS to address the following research questions: (1) what are the key characteristics of MTS cancer care meetings (with regard to composition, focus, and structure)? and (2) how is cross-team coordination acknowledged and addressed during these meetings? METHODS In this single-site case study of a MTS operating to provide gynecologic oncology care within a teaching hospital, two types of meetings, called rounds and huddles, were held consistently. We used qualitative methods, including interviews with health care professional subject matter experts and 30 hours of observations of cancer care meetings, and analyzed the data in three stages of qualitative coding. RESULTS Our analyses resulted in a thematic framework detailing key processes, and subprocesses, identified as central to the activities of observed cancer care meetings. Key processes include information sharing, gaining clarity, strategizing, and pedagogy. Discussions and explanations of this framework showcase the ways in which MTS meetings can bolster cross-team coordination and facilitate MTS activities. CONCLUSION Inpatient cancer care meetings provide opportunities to facilitate MTS coordination in several ways, yet doing so does not come without challenges. Considering these results together with insights from meeting science and MTS research, this article concludes by putting forward practical recommendations for leveraging opportunities and overcoming challenges to use cancer care meetings as tools to support cross-team coordination.
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Trends in Surgeon Burnout in the US and Canada: Systematic Review and Meta-Regression Analysis. J Am Coll Surg 2023; 236:253-265. [PMID: 36519921 DOI: 10.1097/xcs.0000000000000402] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Burnout among surgeons is increasingly recognized as a crisis. However, little is known about changes in burnout prevalence over time. We evaluated temporal trends in burnout among surgeons and surgical trainees of all specialties in the US and Canada. STUDY DESIGN We systematically reviewed MEDLINE, Embase, and PsycINFO for studies assessing surgeon burnout from January 1981 through September 2021. Changes in dichotomized Maslach Burnout Inventory scores and mean subscale scores over time were assessed using multivariable random-effects meta-regression. RESULTS Of 3,575 studies screened, 103 studies representing 63,587 individuals met inclusion criteria. Publication dates ranged from 1996 through 2021. Overall, 41% of surgeons met criteria for burnout. Trainees were more affected than attending surgeons (46% vs 36%, p = 0.012). Prevalence remained stable over the study period (-4.8% per decade, 95% CI -13.2% to 3.5%). Mean scores for emotional exhaustion declined and depersonalization declined over time (-4.1 per decade, 95% CI -7.4 to -0.8 and -1.4 per decade, 95% CI -3.0 to -0.2). Personal accomplishment scores remained unchanged. A high degree of heterogeneity was noted in all analyses despite adjustment for training status, specialty, practice setting, and study quality. CONCLUSIONS Contrary to popular perceptions, we found no evidence of rising surgeon burnout in published literature. Rather, emotional exhaustion and depersonalization may be decreasing. Nonetheless, burnout levels remain unacceptably high, indicating a need for meaningful interventions across training levels and specialties. Future research should be deliberately designed to support longitudinal integration through prospective meta-regression to facilitate monitoring of trends in surgeon burnout.
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Wilson J, Tanuseputro P, Myran DT, Dhaliwal S, Hussain J, Tang P, Noor S, Roberts RL, Solmi M, Sood MM. Characterization of Problematic Alcohol Use Among Physicians: A Systematic Review. JAMA Netw Open 2022; 5:e2244679. [PMID: 36484992 PMCID: PMC9856419 DOI: 10.1001/jamanetworkopen.2022.44679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Problematic alcohol use in physicians poses a serious concern to physicians' health and their ability to provide care. Understanding the extent and characteristics of physicians with problematic alcohol use will help inform interventions. OBJECTIVE To estimate the extent of problematic alcohol use in physicians and how it differs by physician sex, age, medical specialty, and career stage (eg, residency vs practicing physician). EVIDENCE REVIEW Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020-compliant systematic review, searching Medline, Embase, and PsychInfo from January 2006 to March 2020. Search terms included Medical Subject Headings terms and keywords related to physicians as the population and problematic alcohol use as the primary outcome. The quality of studies was assessed using the Newcastle-Ottawa Scale. We included articles where problematic alcohol use was measured by a validated tool (ie, Alcohol Use Disorders Identification Test [AUDIT], AUDIT Version C [AUDIT-C], or CAGE [Cut down, Annoyed, Guilty, and Eye-opener] questionnaire) in practicing physicians (ie, residents, fellows, or staff physicians). FINDINGS Thirty-one studies involving 51 680 participants in 17 countries published between January 2006 and March 2020 were included. All study designs were cross-sectional, self-reported surveys. Problematic alcohol use varied widely regardless of measurement method (0 to 34% with AUDIT; 9% to 35% with AUDIT-C; 4% to 22% with CAGE). Reported problematic alcohol use increased over time from 16.3% in 2006 to 2010 to 26.8% in 2017 to 2020. The extent of problematic use by sex was examined in 19 studies, by age in 12 studies, by specialty in 7 studies, and by career stage in 5 studies. Seven of 19 studies (37%) identified that problematic alcohol use was more common in males than females. Based on the wide heterogeneity of methods for included studies, limited conclusions can be made on how problematic alcohol use varies based on physician age, sex, specialty, and career stage. CONCLUSIONS AND RELEVANCE Studies about problematic alcohol use in physicians demonstrate a high degree of heterogeneity in terms of methods of measurement, definitions for problematic alcohol use, and cohorts assessed. Most studies are primarily self-reported, precluding the ability to determine the true prevalence among the profession. Few studies provide relevant comparisons to aid in identifying key risk groups for targeted interventions.
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Affiliation(s)
- Janet Wilson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Daniel T. Myran
- ICES, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shan Dhaliwal
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Junayd Hussain
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Patrick Tang
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Salmi Noor
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Marco Solmi
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ontario, Canada
- Deptartment of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Manish M. Sood
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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Barton MA, Lall MD, Johnston MM, Lu DW, Nelson LS, Bilimoria KY, Reisdorff EJ. Reliability and validity support for an abbreviated Copenhagen burnout inventory using exploratory and confirmatory factor analysis. J Am Coll Emerg Physicians Open 2022; 3:e12797. [PMID: 35949274 PMCID: PMC9358756 DOI: 10.1002/emp2.12797] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/07/2022] [Accepted: 07/14/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The Copenhagen Burnout Inventory (CBI) is an open-access, valid, and reliable instrument measuring burnout that includes 19 items distributed across the following 3 domains (factors): personal burnout, work burnout, and patient burnout. The primary objective of this study was to determine the validity and reliability of an abbreviated CBI to assess burnout in emergency medicine residents. Methods This cross-sectional study used data from the CBI that followed the 2021 American Board of Emergency Medicine In-training Examination. Exploratory factor analysis (EFA) was followed by confirmatory factor analysis (CFA). Results Of the 8491 eligible residents, 7225 (85.1%) completed the survey; the EFA cohort included 3613 residents and the CFA cohort included 3612 residents. EFA showed 2 eigenvalues ≥1, an internal factor and an external factor. There were 6 CBI items that contributed to the 2 factors. The first factor was related to personal burnout and work-related burnout and the second factor was related to working with patients. There were 4 CBI items that contributed to the internal factor and 2 CBI items that contributed to the external factor. Using the abbreviated CBI, the incidence of a resident having 1 or both types of burnout was 34.1%. Conclusions This study provides validity evidence and reliability support for the use of a 6-item, 2-factor abbreviated CBI. A shorter, reliable, valid, and publicly accessible burnout inventory provides numerous advantages for burnout research in emergency medicine.
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Affiliation(s)
| | - Michelle D. Lall
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | | | - Dave W. Lu
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Lewis S. Nelson
- Department of Emergency MedicineRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
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Al-Ghunaim T, Johnson J, Biyani CS, O'Connor DB. Burnout in surgeons: A qualitative investigation into contributors and potential solutions. Int J Surg 2022; 101:106613. [PMID: 35421612 DOI: 10.1016/j.ijsu.2022.106613] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/04/2022] [Accepted: 04/07/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Poor wellbeing affects the performance of all types of workers. Surgeons are particularly at risk of suffering from burnout, but minimal qualitative research has examined the causes of burnout and potential solutions in this group. Understanding this could inform the development of future burnout interventions. PURPOSE This study aimed to explore the main factors that lead to surgeon burnout and to examine how surgeons cope with burnout at work. SETTING Surgical departments in the United Kingdom's National Health Service (NHS). MATERIALS Telephone interview and face-to-face interview. METHODS This qualitative study was conducted using semi-structured interviews with 14 surgeons from diverse specialisations. The interview consisted of two sections. The first addressed the main reasons for burnout. The second explored how surgeons manage burnout. RESULTS A thematic analysis identified several factors that can lead to surgeon burnout, captured in the themes of: rising to the challenge of surgical work; interpersonal conflict at work; greater demands than resources; the challenge of work-life balance; and the devastating impact of errors and poor patient outcomes. The study also revealed various strategies that surgeons employed to cope with burnout, namely: cognitive restructuring; seeking social support; stepping aside or down from the job; and prioritising personal health. Additionally, the study found some surgeons used maladaptive coping. CONCLUSION Healthcare organisations, surgeons, and psychological experts should work together to provide more and improved interventions to help surgeons, which might lead to a reduction in the number of surgeons who leave the profession and help improve patient outcomes.
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Affiliation(s)
- Tmam Al-Ghunaim
- School of Psychology University of Leeds, Leeds, LS2 9JT, UK.
| | - Judith Johnson
- School of Psychology University of Leeds, Leeds, LS2 9JT, UK; Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, BD96RJ, UK; School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Chandra Shekhar Biyani
- Department of Urology, St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
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Sekine M, Nishijima K, Nakagawa S, Suzuki Y, Murakami T, Kato Y, Umazume T, Tanaka H, Komatsu H, Doi K, Miura K, Kudo Y, Unno N, Kimura T, Enomoto T. Challenges facing workstyle reform for Japanese obstetricians and gynecologists revealed from time studies. J Obstet Gynaecol Res 2022; 48:1580-1590. [PMID: 35388575 DOI: 10.1111/jog.15230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
AIM We aimed to grasp the actual working hours of Japanese obstetricians and gynecologists (OB/GYN doctors) as accurately as possible, using the same method of the Ministry of Health, Labour, and Welfare (MHLW). METHODS The time study targeted OB/GYN doctors working at 10 universities nationwide including Niigata University and 21 institutions which take a role of perinatal care in Niigata prefecture. Working hours per week were calculated based on the following categories: regular and overtime work inside the hospital, work outside the hospital, self-improvement, education, research, and others. Data on weekly working hours were converted to yearly data for analyses. RESULTS A time study of 10 universities nationwide revealed that 30% of doctors work overtime for more than 1860 h even if they do not include on-call shifts in their working hours. In 21 institutions in Niigata, physicians in Niigata University worked more overtime than other hospitals. It became clear that community health care was supported by dispatching physicians working at university. Furthermore, the results of simulations predicted the pessimistic situation of perinatal medical care in Niigata. CONCLUSIONS Our study showed the possibility to exist much more OB/GYN doctors who work more than 1860 h of overtime work per year than the data presented by the MHLW based on nation-wide survey in 2019. The fact that the working hours at the side jobs had a great influence on the increase in overtime work of physicians in University was the same result as the report of MHLW published in 2021.
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Affiliation(s)
- Masayuki Sekine
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koji Nishijima
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Satoshi Nakagawa
- Departments of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukio Suzuki
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Yasuhito Kato
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Japan
| | - Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Koutaro Doi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kiyonori Miura
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshiki Kudo
- Department of Obstetrics and Gynecology, Hiroshima University, Hiroshima, Japan
| | - Nobuya Unno
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tadashi Kimura
- Departments of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Creating work environments where people of all genders in gynecologic oncology can thrive: An SGO evidence-based review. Gynecol Oncol 2022; 164:473-480. [PMID: 35000796 PMCID: PMC9465952 DOI: 10.1016/j.ygyno.2021.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/14/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023]
Abstract
Equality, equity, and parity in the workplace are necessary to optimize patient care across all aspects of medicine. Gender-based inequities remain an obstacle to quality of care, including within the now majority women subspecialty of gynecologic oncology. The results of the 2020 SGO State of the Society Survey prompted this evidence-based review. Evidence related to relevant aspects of the clinical care model by which women with malignancies are cared for is summarized. Recommendations are made that include ways to create work environments where all members of a gynecologic oncology clinical care team, regardless of gender, can thrive. These recommendations aim to improve equality and equity within the specialty and, in doing so, elevate the care that our patients receive.
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Yuan Z, Yu D, Zhao H, Wang Y, Jiang W, Chen D, Liu X, Li X. Burnout of Healthcare Workers Based on the Effort-Reward Imbalance Model: A Cross-Sectional Study in China. Int J Public Health 2021; 66:599831. [PMID: 34744566 PMCID: PMC8565289 DOI: 10.3389/ijph.2021.599831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The effort-reward imbalance (ERI) model is widely used in job stress research. However, few studies using this model have been conducted in developing countries. This study tested the extrinsic and intrinsic hypotheses regarding the burnout of healthcare workers in China with the ERI model. Method: Job stress was assessed by Siegrist’s ERI questionnaire, and burnout was evaluated by the Maslach Burnout Inventory-General Survey (MBI-GS). A total of 1,505 effective respondents were included in the final study. Multiple and hierarchical linear regression was used to analyze the association between components in the ERI model and burnout. Results: Emotional exhaustion and cynicism were positively correlated with ERI and overcommitment. Professional efficacy was positively related to ERI but not to overcommitment. ERI was the determining factor of emotional exhaustion and cynicism. Overcommitment moderated the relationship between ERI and emotional exhaustion and between ERI and cynicism. Conclusion: Changing workplace conditions and increasing personal resilience might alleviate burnout among hospital workers in China. The links between professional efficacy and stressful work environment need further exploration.
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Affiliation(s)
- Zhipei Yuan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Dan Yu
- Hunan Prevention and Treatment Institute for Occupational Diseases, Changsha, China
| | | | - Yanli Wang
- Tangshan Union Hospital, Tangshan, China
| | - Wen Jiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Dan Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xuan Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xingli Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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20
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Al-Humadi S, Bronson B, Muhlrad S, Paulus M, Hong H, Cáceda R. Depression, Suicidal Thoughts, and Burnout Among Physicians During the COVID-19 Pandemic: a Survey-Based Cross-Sectional Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:557-565. [PMID: 34128193 PMCID: PMC8202962 DOI: 10.1007/s40596-021-01490-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/13/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Frontline workers have been a bulwark in the fight against COVID-19, while being subject to major unexpected stressors. These include conflicting news, evolving guidelines, perceived inadequate personal protective equipment, overflow of patients with rising death counts, absence of disaster training, and limitations in the implementation of social distancing. This study investigates the incidence and associated factors of depression, suicidal thoughts, and burnout among physicians during the COVID-19 pandemic. METHODS In a cross-sectional survey-based study of resident, fellow, and attending physicians from a tertiary university hospital during the height of the COVID-19 pandemic in New York from April 24 to May 15, 2020, demographics and practice specialty, attending vs. resident/fellow status, call frequency, emotional exhaustion, depersonalization, and depression severity were examined. RESULTS Two hundred twenty-five subjects completed the survey (response rate of 16.3%), with rates of 6.2% depression, 6.6% suicidal ideation, and 19.6% burnout. Depression, suicidal ideation, and burnout were all associated with history of prior depression/anxiety and frequency of on call. Suicidal ideation and burnout were also associated with younger age. There was no difference in rates of depression, suicidal ideation, or burnout between attending and resident physicians. Female physicians reported less work-life balance and more burnout. CONCLUSIONS These findings highlight the importance of considering physician mental health during times of peak stress, such as natural or man-made disasters. The prominence of premorbid depression/anxiety as a relevant factor underscores the need to further understand physician mental health and provide early screening and treatment.
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Affiliation(s)
| | | | | | | | - Houlin Hong
- Stony Brook University, Stony Brook, NY, USA
| | - Ricardo Cáceda
- Stony Brook University, Stony Brook, NY, USA.
- Northport Veteran Administration Medical Center, Northport, NY, USA.
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21
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Al-Humadi SM, Cáceda R, Bronson B, Paulus M, Hong H, Muhlrad S. Orthopaedic Surgeon Mental Health During the COVID-19 Pandemic. Geriatr Orthop Surg Rehabil 2021; 12:21514593211035230. [PMID: 34395046 PMCID: PMC8361516 DOI: 10.1177/21514593211035230] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 07/07/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: This study compares rates of depression, suicidal
ideation, and burnout among resident/fellow and attending physicians in
orthopaedic surgery to other specialties during height/end of the first wave of
the coronavirus disease 2019 (COVID-19) pandemic at our institution. Main
outcomes and measures included suicidal ideation, Patient Health Questionnaire
for Depression (PHQ-9) scores for depression, and 2 single-item measures for
emotional exhaustion and depersonalization. This study provides valuable
information regarding orthopaedic surgeon mental health during world crises.
Methods: This is a cross-sectional survey-based study of
resident, fellow, and attending physicians from 26 specialties during and after
the first wave of the COVID-19 pandemic at our institution from April 24, 2020
to May 15, 2020. The survey contained 22 items. This includes consent,
demographics and general data, 2 single-item questions of emotional exhaustion
and depersonalization, and the PHQ-9. Subjects were eligible if they were a
resident/fellow or attending physician at our institution. Results:
The response rate for the study was 16.31%. Across all specialties rates were
6.2% depression, 19.6% burnout, and 6.6% suicidal ideation. The results for
orthopaedic surgeons are as follows: 0% tentative diagnosis of depression, 3.8%
suicidal ideation, and 4% burnout. Anesthesiology had the highest rate of
depression (14.3%). Internal medicine and other non-surgical specialties had the
highest rate of suicidal ideation (10.2%). Orthopaedic surgeons were
significantly more likely to achieve work–life balance and experience less
burnout than anesthesiologists and pediatricians. Discussion:
Depression, suicidal ideation, and burnout continue to affect physicians across
all specialties. These issues are amplified in light of crisis. Job satisfaction
and rigorous training may be protective factors that allow orthopaedic surgeons
to adapt to novel clinical settings under stress when compared to
anesthesiologists and pediatricians. Resilience training and stress management
strategies should continue to be investigated to better prepare physicians for
world crises.
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Affiliation(s)
- Samer M Al-Humadi
- Department of Orthopaedic Surgery, SUNY Stony Brook University Hospital, Stony Brook, NY, USA
| | - Ricardo Cáceda
- Department of Psychiatry, SUNY Stony Brook University Hospital, Stony Brook, NY, USA
| | - Brian Bronson
- Department of Psychiatry, SUNY Stony Brook University Hospital, Stony Brook, NY, USA
| | - Megan Paulus
- Department of Orthopaedic Surgery, SUNY Stony Brook University Hospital, Stony Brook, NY, USA
| | - Houlin Hong
- Public Health Program, SUNY Stony Brook University, Stony Brook, NY, USA
| | - Samantha Muhlrad
- Department of Orthopaedic Surgery, SUNY Stony Brook University Hospital, Stony Brook, NY, USA
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22
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Smith RP, Rayburn WF. Burnout in Obstetricians-Gynecologists: Its Prevalence, Identification, Prevention, and Reversal. Obstet Gynecol Clin North Am 2021; 48:231-245. [PMID: 33573788 DOI: 10.1016/j.ogc.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Studies indicate that burnout rates among obstetricians-gynecologists range from 40% to more than 75%, which is in the middle to upper one-third of medical specialties. Symptoms range from feelings of underappreciation and unresolved fatigue, to cynicism, depression, physical symptoms, and illness. Burnout is associated with poor job satisfaction, questioning career choices, and dropping out of practice, impacting workforce concerns and patient access. Awareness of the symptoms and some simple stress and fatigue reduction techniques can decrease the risk of being trapped in the downward spiral of burnout. Successful interventions range from more sleep, to hobbies and vacations, to skilled counseling.
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Affiliation(s)
| | - William F Rayburn
- University of New Mexico School of Medicine, University of New Mexico, Building No. 2, MSC09 53701, Albuquerque, NM 87131, USA
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Bui S, Pelosi A, Mazzaschi G, Tommasi C, Rapacchi E, Camisa R, Binovi C, Leonardi F. Burnout and Oncology: an irreparable paradigm or a manageable condition? Prevention strategies to reduce Burnout in Oncology Health Care Professionals. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021091. [PMID: 34212933 PMCID: PMC8343755 DOI: 10.23750/abm.v92i3.9738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Burnout is a stress-induced occupational related syndrome, characterized by Emotional Exhaustion (EE), feeling of depersonalization (DP) and low sense of professional accomplishment (PA). The aim of this study is to analyse the effectiveness of interventions in decreasing health professionals Burnout as well as work and life-style risk factors. Methods: A survey in Medical Oncology Department in the University Hospital of Parma was conducted using the validated Maslach Burnout Inventory (MBI) and two additional questionnaires exploring lifestyle and work factors. An 8-months intervention involved fortnight meetings by facilitators, incorporated elements of reflection, shared experiences and managing emotions. Six months after the end of the intervention a second survey was performed among the participants using MBI and the same questionnaires mentioned above. Results: EE resulted the most problematic score in Day Hospital: after the 8-month intervention we described a significant decreasing in EE score especially for Day Hospital operators (from 16.7 to 10.9) and a considerable reduction in DP score. In the Oncology Ward a correlation between lack of collaboration among different health categories and DE score was detected; in the Day Hospital the absence of solid working teams was related to higher EE scores. Conclusion: The Oncology professional health care personnel are at the greatest risk of Burnout. Our study in Oncology Department shows that specific intervention should be used to prevent and reduce Burnout. Effective personal health care strategies should be incorporated into routine oncology care to prevent and treat Burnout.
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Affiliation(s)
- Simona Bui
- azienda ospedaliero universitario di Parma.
| | | | | | | | | | | | - Cinzia Binovi
- Medical Oncology Unit, University Hospital of Parma.
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Cochran KL, Doo K, Squires A, Shah T, Rinne S, Mealer M. Addressing Burnout Syndrome From a Critical Care Specialty Organization Perspective. AACN Adv Crit Care 2021; 31:158-166. [PMID: 32525998 DOI: 10.4037/aacnacc2020579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Health care specialty organizations are an important resource for their membership; however, it is not clear how specialty societies should approach combating stress and burnout on an organizational scale. OBJECTIVE To understand the prevalence of burnout syndrome in American Thoracic Society members, identify specialty-specific risk factors, and generate strategies for health care societies to combat burnout. METHODS Cross-sectional, mixed-methods survey in a sample of 2018 American Thoracic Society International Conference attendees to assess levels of burnout syndrome, work satisfaction, and stress. RESULTS Of the 130 respondents, 69% reported high stress, 38% met burnout criteria, and 20% confirmed chaotic work environments. Significant associations included sex and stress level; clinical time and at-home electronic health record work; and US practice and at-home electronic health record work. There were no significant associations between burnout syndrome and the selected demographics. Participants indicated patient care as the most meaningful aspect of work, whereas the highest contributors to burnout were workload and electronic health record documentation. Importantly, most respondents were unaware of available resources for burnout. CONCLUSIONS Health care specialty societies have access to each level of the health system, creating an opportunity to monitor trends, disseminate resources, and influence the direction of efforts to reduce workplace stress and enhance clinician well-being.
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Affiliation(s)
- Kathryn L Cochran
- Kathryn L. Cochran is Senior Behavioral Health Program Coordinator, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Rm 1201G, Aurora, CO 80045
| | - Kathleen Doo
- Kathleen Doo is Medical Doctor, Division of Pulmonary and Critical Care Medicine, The Permanente Medical Group, Oakland, California
| | - Allison Squires
- Allison Squires is Associate Professor, NYU Rory Meyers College of Nursing, New York University, New York, New York
| | - Tina Shah
- Tina Shah is Medical Director of Practice Improvement, WellStar Health System, Atlanta, Georgia
| | - Seppo Rinne
- Seppo Rinne is Assistant Professor, Boston University Pulmonary Center, Boston, Massachusetts
| | - Meredith Mealer
- Meredith Mealer is Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
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Addressing Physician Burnout and Ensuring High-Quality Care of the Physician Workforce. Obstet Gynecol 2021; 137:3-11. [PMID: 33278277 DOI: 10.1097/aog.0000000000004197] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
Burnout in health care is a public health crisis. Burnout is a triad of emotional exhaustion, depersonalization, and feelings of reduced personal accomplishment. More than half of practicing physicians and trainees experience burnout, and the rates are increasing. This review highlights the current prevalence of burnout among U.S. physicians, especially obstetrician-gynecologists. We review personal and systemic risk factors for burnout, consequences of burnout, and proven interventions, especially at the systems level, to treat and prevent burnout.
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Abstract
Physician burnout is an issue having an impact on all of medicine but having a significant impact on the field of urology. Burnout begins in medical school and worsens in residency. Increased workload leads to increased burnout both in residency and in practice. Issues with work-life balance, electronic medical record usage, decreasing reimbursements, and increased Centers for Medicare & Medicaid Services burden all have an impact on physician satisfaction with their practices. Burnout should be acknowledged, and measures for prevention should be taken by hospitals and residency programs to decrease and prevent physician burnout.
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Affiliation(s)
- Jennifer Nauheim
- Department of Urology, Montefiore Medical Center, 1250 Waters Place, Bronx, NY 10461, USA. https://twitter.com/JenniferNauheim
| | - Amanda C North
- Department of Urology, Montefiore Medical Center, 1250 Waters Place, Bronx, NY 10461, USA.
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Psychological and physiological stress and burnout among maternity providers in a rural county in Kenya: individual and situational predictors. BMC Public Health 2021; 21:453. [PMID: 33676479 PMCID: PMC7936594 DOI: 10.1186/s12889-021-10453-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/16/2021] [Indexed: 01/10/2023] Open
Abstract
Background Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported stress and burnout levels as well as stress-related physiologic measures of these providers, along with their potential predictors. Methods Participants included 101 maternity providers (62 nurses/midwives, 16 clinical officers/doctors, and 23 support staff) in western Kenya. Respondents completed Cohen’s Perceived Stress Scale, the Shirom-Melamed Burnout scale, and other sociodemographic, health, and work-related items. We also collected data on heart rate variability (HRV) and hair cortisol levels to assess stress-related physiologic responses to acute and chronic stress respectively. Multilevel linear regression models were computed to examine individual and work-related factors associated with stress, burnout, HRV, and cortisol level. Results 85% of providers reported moderate stress and 11.5% high stress. 65% experienced low burnout and 19.6% high burnout. Average HRV (measured as the root mean square of differences in intervals between successive heart beats: RMSSD) was 60.5 (SD = 33.0) and mean cortisol was mean cortisol was 44.2 pg/mg (SD = 60.88). Greater satisfaction with life accomplishments was associated with reduced stress (β = − 2.83; CI = -5.47; − 0.18), while motivation to work excessively (over commitment) was associated with both increased stress (β = 0.61 CI: 0.19, 1.03) and burnout (β = 2.05, CI = 0.91, 3.19). Female providers had higher burnout scores compared to male providers. Support staff had higher HRV than other providers and providers under 30 years of age had higher HRV than those 30 and above. Although no association between cortisol and any predictor was statistically significant, the direction of associations was consistent with those found for stress and burnout. Conclusions Most providers experienced moderate to high levels of stress and burnout. Individuals who were more driven to work excessively were particularly at risk for higher stress and burnout. Higher HRV of support staff and providers under age 30 suggest their more adaptive autonomic nervous system response to stress. Given its impact on provider wellbeing and quality of care, interventions to help providers manage stress are critical. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10453-0.
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Abusanad A, Bensalem A, Shash E, Mula-Hussain L, Benbrahim Z, Khatib S, Abdelhafiz N, Ansari J, Jradi H, Alkattan K, Jazieh AR. Burnout in oncology: Magnitude, risk factors and screening among professionals from Middle East and North Africa (BOMENA study). Psychooncology 2021; 30:736-746. [PMID: 33427352 DOI: 10.1002/pon.5624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Burnout (BO) among oncology professionals (OP) is increasingly being recognized. Early recognition and intervention can positively affect the quality of care and patient safety. This study investigated the prevalence, work and lifestyle factors affecting BO among OPs in the Middle East and North Africa (MENA). METHODS An online survey was conducted among MENA OPs between 10 February and 15 March 2020, using the validated Maslach Burnout Inventory of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA), including questions regarding demography/work-related factors and attitudes towards oncology. Data were analysed to measure BO prevalence and risk factors and explore a screening question for BO. RESULTS Of 1054 respondents, 1017 participants (64% medical oncologists, 77% aged less than 45 years, 55% female, 74% married, 67% with children and 40% practiced a hobby) were eligible. The BO prevalence was 68% with high levels of EE and DP (35% and 57% of participants, respectively) and low PA scores (49%). BO was significantly associated with age less than 44 years, administrative work greater than 25% per day and the thought of quitting oncology (TQ). Practising a hobby, enjoying oncology communication and appreciating oncology work-life balance were associated with a reduced BO score and prevalence. North African countries reported the highest BO prevalence. Lack of BO education/support was identified among 72% of participants and TQ-predicted burnout in 77%. CONCLUSIONS This is the largest BO study in MENA. The BO prevalence was high and several modifiable risk factors were identified, requiring urgent action. TQ is a simple and reliable screening tool for BO.
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Affiliation(s)
- Atlal Abusanad
- Department of Medical Oncology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Assia Bensalem
- Oncology Department, CHU Dr Benbadis, Constantine, Algeria
| | - Emad Shash
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Layth Mula-Hussain
- Radiation Oncology Department, University of Ottawa, Ottawa, Ontario, Canada
| | - Zineb Benbrahim
- Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah
| | - Sami Khatib
- Department of Oncology, Private Sector, Amman, Jordan
| | - Nafisa Abdelhafiz
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Jawaher Ansari
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Hoda Jradi
- Public Health Faculty, Department of public health, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khaled Alkattan
- Thoracic surgery department, King Faisal Specialist Hospital and Research Center (KFSH-RC), Alfaisal University, Riyadh, Saudi Arabia
| | - Abdul R Jazieh
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Professional Burnout Survey for Practicing Female Pelvic Medicine and Reconstructive Surgeons: A Cross-sectional Study. Female Pelvic Med Reconstr Surg 2021; 27:e326-e332. [PMID: 32740467 DOI: 10.1097/spv.0000000000000920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to determine the prevalence of burnout among active practicing members of the American Urogynecologic Society (AUGS). METHODS This was an anonymous electronic survey of AUGS nontrainee physician members. Basic demographic, personal, and professional characteristics were collected. Levels of emotional exhaustion, depersonalization and personal accomplishment, as defined by the Maslach Burnout Inventory-Human Services Survey, were utilized to categorize participants into burnout profiles and to determine 2 alternative burnout definitions. Descriptive statistics and models were used to summarize provider characteristics and to explore differences among the burnout profiles. RESULTS Of the 1039 active members of AUGS, 280 (26.9%) responded to the survey. Burnout profiles were delineated using the Maslach Burnout Inventory-Human Services Survey. Forty-three percent fit the Engaged profile, whereas 13% fit the Burnout profile. Significant differences were seen in the distribution of the burnout profiles for physicians who take call (P=0.015), have a current mentor (P=0.016), screen positive for major depression (P < 0.001), experience suicidal ideation (P=0.018), have a feeling of control regarding their schedule (P < 0.001) and those who would become a physician again (P < 0.001). The overall rate of burnout in female pelvic medicine and reconstructive surgery providers was significantly different depending on the definition utilized (P < 0.01) and ranged from as low as 6.5% to as high as 51.9%. CONCLUSIONS There were some differences in respondent characteristics seen among the burnout profiles. The chosen definition of burnout significantly affected the purported rate of burnout, complicating comparisons among provider populations.
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Prevalence of burnout among healthcare professionals at the Serbian National Cancer Center. Int Arch Occup Environ Health 2021; 94:669-677. [PMID: 33387030 DOI: 10.1007/s00420-020-01621-7] [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: 05/26/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the level of burnout and identify who is at highest risk among healthcare professionals (HCPs) working at the largest referent national institution. METHODS A cross-sectional survey was conducted at the Institute of Oncology and Radiology of Serbia from May 2019 to July 2019, evaluating the level of burnout, depression, fatigue, socio-demographic, behavioral and professional characteristics, and quality of life among healthcare professionals. Of the 576 distributed questionnaires among physicians, nurses/technicians and healthcare coworkers, 432 participants returned their questionnaires (75%). All instruments used in our study had been validated and cross-culturally adapted to Serbian language. RESULTS The overall prevalence of burnout was 42.4%, with the greatest proportion of burned out in emotional exhaustion domain (66.9%). The multivariable-adjusted model analysis showed that nurses/technicians had a 1.41 times greater chance of experiencing burnout, compared to physicians (OR = 1.41, 95% CI 1.16-7.10), and that with each year of work experience, the chance of burnout increased by about 2% (OR = 1.02, 95% CI 1.00-1.92). Furthermore, it was shown that, with each point in the PHQ-9 score for depression, probability of burnout increased by 14% (OR = 1.14, 95% CI 1.07-1.94). Finally, after controlling all these potential confounders, the Mental Composite Score of SF-36 score showed an independent prognostic value in exploring the burnout presence among HCPs (OR = 1.17, 95% CI 1.03-2.47). CONCLUSION Our research showed a significant level of burnout among healthcare professionals working in oncology, especially among nurses/technicians. The development of effective interventions at both individual and organizational level toward specific risk groups is needed.
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Dong M, Zhou FC, Xu SW, Zhang Q, Ng CH, Ungvari GS, Xiang YT. Prevalence of suicide-related behaviors among physicians: A systematic review and meta-analysis. Suicide Life Threat Behav 2020; 50:1264-1275. [PMID: 33025630 DOI: 10.1111/sltb.12690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Suicide is a major cause of premature death among physicians, but the prevalence of suicide-related behaviors (including suicidal ideation, SI and suicide attempt, SA) is inconsistent across studies. This meta-analysis aimed to estimate the prevalence of suicide-related behaviors among physicians and its associated factors. METHODS PubMed, EMBASE, PsycINFO, and Cochrane library databases were systematically searched from commencement date to August 14, 2018. Eligible studies on the prevalence of suicide-related behaviors among physicians were included. RESULTS Thirty-five eligible studies with 70,368 physicians were included. The lifetime prevalence of SI was 17.4% (95% CI: 13.8%-21.8%), while the 1-year prevalence was 8.6% (95% CI: 7.1%-10.3%), 6-month prevalence was 11.9% (95% CI: 2.7%-39.2%), and 1-month prevalence was 8.6% (95% CI: 5.6%-13.0%). The lifetime prevalence of SA was 1.8% (95% CI: 0.9%-3.7%), while the 1-year prevalence was 0.3% (95% CI: 0.1%-0.8%). Subgroup analyses revealed that geographic region was significantly associated with lifetime and 1-year prevalence of SI, while sample size was significantly associated with 1-month prevalence of SI. CONCLUSIONS This meta-analysis found a relatively high prevalence of suicide-related behaviors, particularly lifetime SI, among physicians. Appropriate preventive and treatment measures should be implemented to reduce the risk of suicide-related behaviors in this population.
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Affiliation(s)
- Min Dong
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fu-Chun Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Shi-Wei Xu
- The First Clinical College, Changsha Medical University, Changsha, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Vic., Australia
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, WA, Australia.,University of Notre Dame Australia, Fremantle, WA, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, SAR, China.,Center for Cognition and Brain Sciences, University of Macau, Macao, SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, SAR, China
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An increase in multi-site practices: The shifting paradigm for gynecologic cancer care delivery. Gynecol Oncol 2020; 160:3-9. [PMID: 33243442 DOI: 10.1016/j.ygyno.2020.10.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/26/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess whether the number of practice sites per gynecologic oncologist (GO) and geographic access to GOs has changed over time. METHODS This is a retrospective repeated cross-sectional study using the 2015-2019 Physician Compare National File. All GOs in the 50 United States and Washington, DC, who had completed at least one year of practice were included in the study. All practice sites with complete addresses were included. Linear regression analyses estimated trends in GOs' number of practice sites and geographic dispersion of practice sites. Secondary analyses assessed temporal trends in the number of geographic areas served by at least one GO. RESULTS Although there was no significant change in the number of GOs from 2015 to 2019 (n = 1328), there was a significant increase in the number of practice sites (881 to 1416, p = 0.03), zip codes (642 to 984, p = 0.03), HSAs (404 to 536, p = 0.04), and HRRs (218 to 230, p = 0.03) containing a GO practice. The mean number of practice sites (1.64 versus 2.13, p < 0.001) and dispersion of practice sites (0.03 versus 0.43 miles, p = 0.049) per GO increased significantly. CONCLUSIONS Between 2015 and 2019, an increasing number of GOs have multi-site practices, and more geographic regions contain a GO practice. Improvements in geographic access to GOs may represent improved access to care for many women in the US, but its effect on patients, physicians, and geographic disparities is unknown.
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Gibson C, O'Connor M, White R, Baxi S, Halkett G. Burnout or Fade Away; experiences of health professionals caring for patients with head and neck cancer. Eur J Oncol Nurs 2020; 50:101881. [PMID: 33340842 DOI: 10.1016/j.ejon.2020.101881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/11/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The oncology workforce has been found to have high risk of burnout; however, limited research has explored the experiences of health professionals working with head and neck cancer patients. The objective of this qualitative study was to explore the experiences of health professionals who work directly with patients diagnosed with head and neck cancers, with a focus on work-life balance, mental health and wellbeing. METHOD A total of 21 in-depth semi-structured interviews were conducted with health professionals including radiation oncologists, medical oncologists, nurses, and associated medical and allied health professionals. A qualitative research approach based on social constructionist theory was used. Thematic analysis was used to identify and code themes. RESULTS Five main themes emerged: 1. Conscientiousness; 2. Empathy; 3. Challenges; 4. Coping; and 5. Burnout or Fade Away. Challenges included sub-themes of Time & Resource Constraints, Work-Life Imbalance, Patients with Complex Needs, and Lack of Self-Care. CONCLUSION It is vital to the sustainability of head and neck oncology services that this highly skilled workforce is retained. The development of interventions that will reduce the risk of burnout and improve retention and capacity of health professionals may include advanced communication skills training, trauma sensitivity training, self-compassion and stress management skills.
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Affiliation(s)
- Chandrika Gibson
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia.
| | - Moira O'Connor
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Rohen White
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Georgia Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
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Ferriss JS, Rose S, Rungruang B, Urban R, Spencer R, Uppal S, Sinno AK, Duska L, Walsh C. Society of Gynecologic Oncology recommendations for fellowship education during the COVID-19 pandemic and beyond: Innovating programs to optimize trainee success. Gynecol Oncol 2020; 160:271-278. [PMID: 33077260 PMCID: PMC7568037 DOI: 10.1016/j.ygyno.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
In approximately ten months' time, the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has infected over 34 million people and caused over one million deaths worldwide. The impact of this virus on our health, relationships, and careers is difficult to overstate. As the economic realities for academic medical centers come into focus, we must recommit to our core missions of patient care, education, and research. Fellowship education programs in gynecologic oncology have quickly adapted to the “new normal” of social distancing using video conferencing platforms to continue clinical and didactic teaching. United in a time of crisis, we have embraced systemic change by developing and delivering collaborative educational content, overcoming the limitations imposed by institutional silos. Additional innovations are needed in order to overcome the losses in program surgical volume and research opportunities. With the end of the viral pandemic nowhere in sight, program directors can rethink how education is best delivered and potentially overhaul aspects of fellowship curriculum and content. Similarly, restrictions on travel and the need for social distancing has transformed the 2020 fellowship interview season from an in-person to a virtual experience. During this time of unprecedented and rapid change, program directors should be particularly mindful of the needs and health of their trainees and consider tailoring their educational experiences accordingly. The novel coronavirus pandemic has disrupted medical education at all levels. Fellowship programs must adapt to the realities of social distancing, workforce redeployments, and laboratory closures. The integration of teleconferencing into clinical practice and learning provides both challenges and growth opportunities. Program directors should be aware of new stressors our fellows, particularly underrepresented minorities, are facing. Programs should take advantage of the opportunity to rethink fellowship education and the needs of our recent graduates.
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Affiliation(s)
- J Stuart Ferriss
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Steve Rose
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Bunja Rungruang
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Renata Urban
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ryan Spencer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Shitanshu Uppal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Abdulrahman K Sinno
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA
| | - Linda Duska
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| | - Christine Walsh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Hughes F, Francis AP, Sciscione AC. Physician Burnout among Members of the Society for Maternal-Fetal Medicine. Am J Perinatol 2020; 37:1115-1122. [PMID: 31170748 DOI: 10.1055/s-0039-1692185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to determine the rate of physician burnout among maternal-fetal medicine subspecialists and identify associated factors. STUDY DESIGN Noninternational members of the Society for Maternal-Fetal Medicine (SMFM) were surveyed regarding burnout using a validated tool specifically designed for health professionals (Maslach Burnout Inventory-Human Services Survey). Burnout was defined as exceeding established cutoffs for emotional exhaustion or depersonalization. Demographic information and potential contributors associated with the presence of burnout were also examined. RESULTS The survey was sent to 1,220 members and 44.1% of members completed the entire survey. The physician burnout rate was 56.5%. Factors associated with burnout included female gender, being 5 to 20 years in practice, self-perceived burnout, being somewhat or very dissatisfied with career or supervisor and charting for more than 4 hours per day. Factors associated with less burnout were being male, having some protected time for education and regular exercise. Women scored higher on emotional exhaustion and depersonalization and lower personal accomplishment compared with men. CONCLUSION Physician burnout among the SMFM members is higher than has been reported in other specialties. While some of these factors are modifiable, further study into why women have higher rates of burnout needs to be performed.
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Affiliation(s)
- Francine Hughes
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Antonia P Francis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, New York, New York
| | - Anthony C Sciscione
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Christiana Care Health Systems, Newark, Delaware
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Noronha J, Malik A, Bindhulakshmi P, Karimundackal G. Oncology Residency-a Burning Issue, Results of a Questionnaire-Based Survey on Psychological Well-being of Oncology Residents. Indian J Surg Oncol 2020; 11:387-393. [PMID: 33013115 DOI: 10.1007/s13193-020-01183-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/23/2020] [Indexed: 11/26/2022] Open
Abstract
Residency, in particular oncology residency, is a challenging time with extensive academic demands, long working hours, and uncertainty about the future. Our study aimed to evaluate the prevalence and factors associated with burnout, anxiety and depression among oncology residents at a tertiary cancer centre. An anonymised questionnaire-based study was conducted among medical, surgical, paediatric and radiation oncology resident doctors at a tertiary cancer centre in April 2019. We used Copenhagen Burnout Index (CBI) to assess burnout (which includes personal, work-related and patient-related burnout), Patient Health Questionnaire (PHQ9) for depression and Generalised Anxiety Disorder (GAD7) for anxiety. The questionnaire was served to 201 residents. The overall response rate was 70.6%. High personal, work-related and patient-related burnout was identified in 71.1%, 67.6% and 23.2% of the respondents respectively. Medical oncology residents had the highest rate of personal and work-related burnout (95% and 85%) while head and neck oncology residents had the highest rate of patient-related burnout (33.3%). 27.5% of participants were found to have high levels of anxiety on the GAD7 while 14.8% of participants were detected to have a high score on the PHQ9 for depression. High personal burnout and work-related burnout were associated with both high anxiety and depression scores (p < 0.05). There is a high prevalence of burnout, depression and anxiety among oncology residents. With an expected rise in cancer burden in the next decade, psychological issues in caregivers can be expected to increase. Further studies will be needed to determine interventions to reduce psychological distress.
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Affiliation(s)
- Jarin Noronha
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Akshat Malik
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Bindhulakshmi
- Advanced Centre for Women's Studies, Tata Institute of Social Sciences, Mumbai, India
| | - George Karimundackal
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Lee YG, Maeng CH, Kim DY, Kim BS. Perspectives on Professional Burnout and Occupational Stress among Medical Oncologists: A Cross-sectional Survey by Korean Society for Medical Oncology (KSMO). Cancer Res Treat 2020; 52:1002-1009. [PMID: 32683840 PMCID: PMC7577827 DOI: 10.4143/crt.2020.190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/09/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to investigate the prevalence and risk factors of burnout and occupational stress among medical oncologists in Korea. Materials and Methods A survey was conducted of medical oncologists who were members of Korean Society for Medical Oncology (KSMO) using the Korean Occupational Stress Scale, the validated Maslach Burnout Inventory (MBI) and supplemental questions about work and lifestyle factors. Results Among 220 active KSMO members, 111 responses were collected. The median age was 42 years (range, 32 to 63 years). Two-thirds of responders worked 6 days per week and half of them worked a total of 60-80 hours per week. Each medical oncologist treated a median of 90-120 patients per week in outpatient clinics and 20-30 patients per week in patient practices. MBI subscales indicated a high level of emotional exhaustion in 74%, a high level of depersonalization in 86%, and a low level of personal accomplishment in 65%: 68% had professional burnout according to high emotional exhaustion and high depersonalization scores. The risk of burnout was higher for medical oncologists aged from 30-39 than 40-49 years, and unmarried than married. Considering personal accomplishment, females had a higher risk of burnout. The median score of occupational stress was 63 (range, 43 to 88). Having night-duty call was the strongest risk factor on more stress. A higher stress score was associated with a higher prevalence of burnout. Conclusion Burnout and occupational stress are quite common amongst Korean medical oncologists. Achieving a healthy work-life balance, ensuring balanced workload distribution, and engaging in proper stress relief solutions are necessary.
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Affiliation(s)
- Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Hoon Maeng
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Bong-Seog Kim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
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Galaiya R, Kinross J, Arulampalam T. Factors associated with burnout syndrome in surgeons: a systematic review. Ann R Coll Surg Engl 2020; 102:401-407. [PMID: 32326734 PMCID: PMC7388944 DOI: 10.1308/rcsann.2020.0040] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION To date, studies have shown a high prevalence of burnout in surgeons. Various factors have been found to be associated with burnout, and it has significant consequences personally and systemically. Junior doctors are increasingly placing their own health and wellbeing as the most important factor in their decisions about training. Finding ways to reduce and prevent burnout is imperative to promote surgical specialties as attractive training pathways. METHODS The MEDLINE, PsychInfo and EMBASE databases were searched using the subject headings related to surgery and burnout. All full text articles that reported data related to burnout were eligible for inclusion. Articles which did not use the Maslach Burnout Inventory or included non-surgical groups were excluded; 62 articles fulfilled the criteria for inclusion. FINDINGS Younger age and female sex tended to be associated with higher levels of burnout. Those further in training had lower levels of burnout, while residents suffered more than their seniors. Burnout is associated with a lower personal quality of life, depression and alcohol misuse. Academic work and emotional intelligence may be protective of burnout. Certain personality types are less likely to be burnt out. Mentorship may reduce levels of burnout. CONCLUSIONS Workload and work environment are areas that could be looked at to reduce job demands that lead to burnout. Intervening in certain psychological factors such as emotional intelligence, resilience and mindfulness may help to reduce burnout. Promoting physical and mental health is important in alleviating burnout, and these factors likely have a complex interplay.
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Affiliation(s)
- R Galaiya
- Barnet, Enfield and Haringey Mental Health NHS Trust
| | - J Kinross
- Department of Surgery and Cancer, Imperial College London, UK
| | - T Arulampalam
- School of Medicine, Anglia Ruskin University, Chelmsford
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Abstract
Although there has been discussion of a shortage of surgical specialties including OB/GYN, consensus is difficult because of the multiple variables involved in estimating both supply and demand. In addition, burnout has become more recognized as a variable that has not been taken into account in estimating a shortage of OB/GYNs. We estimate OB/GYN physician shortages of 17%, 24%, and 31% by 2030, 2040, and 2050, respectively. Here, we examine the impact of burnout on the OB/GYN workforce. Specifically, we address the associations of burnout, reduction in clinical productivity as well as early retirement. We also discuss the implications of the substantial increase of female OB/GYNs to ∼66% of workforce over the next 10 years and how this may impact the impending OB/GYN shortage. Finally, we briefly consider possible solutions to workforce issues causing burnout.
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Okoli CTC, Seng S, Otachi JK, Higgins JT, Lawrence J, Lykins A, Bryant E. A cross-sectional examination of factors associated with compassion satisfaction and compassion fatigue across healthcare workers in an academic medical centre. Int J Ment Health Nurs 2020; 29:476-487. [PMID: 31808600 DOI: 10.1111/inm.12682] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 12/30/2022]
Abstract
Compassion satisfaction (CS) among healthcare professionals is a sense of gratification derived from caring for their suffering patients. In contrast, compassion fatigue, often a consequence of burnout (BO) and secondary traumatic stress (STS), is detrimental to healthcare professionals' productivity and patient care. While several studies have examined CS, BO, and STS among healthcare professionals, the majority have assessed samples in specific disciplines. However, the comparative differences in these factors by discipline or work setting are not well known. The aims of this study were to examine the differences in CS, BO, and STS by discipline and work setting, and to assess demographic, work-related, and behavioural factors associated with these outcomes. An electronic survey was administered (N = 764) at a large academic medical centre in the southeast United States. Questions elicited demographic variables, work-related factors, behavioural/lifestyle factors, experience with workplace violence, and the Professional Quality of Life Scale. Findings of the study determined that the rates of CS, BO, and STS vary across healthcare disciplines and work settings. Demographic, work-related, behavioural, and work setting (i.e., experience of workplace violence) factors were differentially associated with experiences of CS, BO, and STS. The results of the study suggest two potential areas for research, specifically workplace violence and sleep quality as a means of further understanding reduced CS and increased BO and STS among healthcare workers. These findings have important implications for future research and policy interventions to enhance healthcare workers' health and safety.
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Affiliation(s)
| | - Sarret Seng
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Janet K Otachi
- University of Kentucky College of Social Work, Lexington, Kentucky, USA
| | - Jacob T Higgins
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
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Turner TB, Kushner DM, Winkel AF, McGwin G, Blank SV, Fowler JM, Kim KH. The Society of Gynecologic Oncology wellness curriculum pilot: A groundbreaking initiative for fellowship training. Gynecol Oncol 2020; 156:710-714. [DOI: 10.1016/j.ygyno.2019.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 11/30/2022]
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Deng D, Naslund JA. Psychological Impact of COVID-19 Pandemic on Frontline Health Workers in Low- and Middle-Income Countries. HARVARD PUBLIC HEALTH REVIEW (CAMBRIDGE, MASS.) 2020; 28:http://harvardpublichealthreview.org/wp-content/uploads/2020/10/Deng-and-Naslund-2020-28.pdf. [PMID: 33409499 PMCID: PMC7785092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Healthcare systems in many countries have been overwhelmed by the coronavirus disease (COVID-19) pandemic, with increasing demands to contain and respond to the virus. The result has been increased pressure on frontline health workers. As the pandemic unfolds, the impact on health systems in low-income and middle-income countries (LMICs) is becoming apparent. In lower resource settings, the detrimental effects on frontline health workers will likely be significant due to fragmented infrastructure, low compensation, and significant shortages of necessary resources such as personal protective equipment. These high stress conditions, coupled with risk of infection and fears and anxieties among patients, can result in grave psychosocial consequences for frontline health workers, who play a vital role in delivering the bulk of primary care services in LMICs. In this narrative review, we consider the psychological impact of the COVID-19 pandemic on frontline health workers in LMICs. We describe the important role of frontline health workers, summarize existing literature on burnout and risks to mental health in this essential workforce, and consider how public health emergencies exacerbate these concerns to showcase their vulnerability to mental health impacts of COVID-19. We explore emerging research on the detrimental effects of the COVID-19 pandemic on health workers and consider possible approaches to mitigate these consequences. This review draws from existing studies and emerging evidence to highlight the critical need to consider the wellbeing of frontline health workers, and to address these challenges as health systems respond to the pandemic.
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Affiliation(s)
- Davy Deng
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Yeob KE, Kim SY, Park BR, Shin DW, Yang HK, Park K, Cho J, Park JH. Burnout Among oncologists in the Republic of Korea: A nationwide survey. Curr Probl Cancer 2019; 44:100535. [PMID: 31926648 DOI: 10.1016/j.currproblcancer.2019.100535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/04/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Burnout in oncologists negatively impacts patient care and health care system, as it is associated with poor patient satisfaction, medical errors, leaving current practice, and/or early retirement. Because the quality of life of oncologists is influenced by various factors and ultimately affects the patient's treatment and medical system, we aimed to investigate burnout among oncologists and to identify factors affecting burnout. MATERIALS AND METHODS A total of 130 oncologists recruited from 13 cancer centers participated in a nationwide survey. Professional Quality of Life scale used to evaluate burnout and multiple regression analysis was performed to identify factors affecting burnout. RESULTS A total of 144 oncologists were invited, 134 (93.1%) responded, and 130 (90.2%) of those completed the survey. Burnout score of all participants was 49.9, and males was 48.8, females was 53.9, females score was higher than males. According to the hours worked per session, the average burnout score increased with the hours worked per session. Multiple regression analysis showed that influencing or predictive factors in burnout were sex and hours worked per session. CONCLUSION To reduce burnout in oncologists, organization-directed interventions should be implemented to prevent work overload.
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Affiliation(s)
- Kyoung Eun Yeob
- College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - So Young Kim
- College of Medicine, Chungbuk National University, Cheongju, Republic of Korea; Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea; Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Bo Ram Park
- College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyung-Kook Yang
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Keeho Park
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Juhee Cho
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Health Sciences and Technology, Samsung Advanced institute of health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jong Hyock Park
- College of Medicine, Chungbuk National University, Cheongju, Republic of Korea; Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea; Division of Cancer Policy and Management, National Cancer Control Research Institute, National Cancer Center, Goyang, Republic of Korea; Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
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Dubale BW, Friedman LE, Chemali Z, Denninger JW, Mehta DH, Alem A, Fricchione GL, Dossett ML, Gelaye B. Systematic review of burnout among healthcare providers in sub-Saharan Africa. BMC Public Health 2019; 19:1247. [PMID: 31510975 PMCID: PMC6737653 DOI: 10.1186/s12889-019-7566-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/29/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Burnout is characterized by physical and emotional exhaustion from long-term exposure to emotionally demanding work. Burnout affects interpersonal skills, job performance, career satisfaction, and psychological health. However, little is known about the burden of burnout among healthcare providers in sub-Saharan Africa. METHODS Relevant articles were identified through a systematic review of PubMed, Web of Science (Thomson Reuters), and PsycINFO (EBSCO). Studies were selected for inclusion if they examined a quantitative measure of burnout among healthcare providers in sub-Saharan Africa. RESULTS A total of 65 articles met our inclusion criteria for this systematic review. Previous studies have examined burnout in sub-Saharan Africa among physicians (N = 12 articles), nurses (N = 26), combined populations of healthcare providers (N = 18), midwives (N = 2), and medical or nursing students (N = 7). The majority of studies assessed burnout using the Maslach Burnout Inventory. The highest levels of burnout were reported among nurses, although all healthcare providers showed high burnout. Burnout among healthcare providers is associated with their work environments, interpersonal and professional conflicts, emotional distress, and low social support. CONCLUSIONS Available studies on this topic are limited by several methodological challenges. More rigorously designed epidemiologic studies of burnout among healthcare providers are warranted. Health infrastructure improvements will eventually be essential, though difficult to achieve, in under-resourced settings. Programs aimed at raising awareness and coping with burnout symptoms through stress management and resilience enhancement trainings are also needed.
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Affiliation(s)
- Benyam W Dubale
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lauren E Friedman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Kresge 505, Boston, MA, 02115, USA
| | - Zeina Chemali
- The Chester M. Pierce, M.D. Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John W Denninger
- Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Darshan H Mehta
- Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Atalay Alem
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gregory L Fricchione
- The Chester M. Pierce, M.D. Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle L Dossett
- Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Kresge 505, Boston, MA, 02115, USA. .,The Chester M. Pierce, M.D. Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
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Hill EK, Stuckey A, Fiascone S, Raker C, Clark MA, Brown A, Gordinier M, Robison K. Gender and the Balance of Parenting and Professional Life among Gynecology Subspecialists. J Minim Invasive Gynecol 2019; 26:1088-1094. [DOI: 10.1016/j.jmig.2018.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
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47
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Littell RD, Kumar A, Einstein MH, Karam A, Bevis K. Advanced communication: A critical component of high quality gynecologic cancer care: A Society of Gynecologic Oncology evidence based review and guide. Gynecol Oncol 2019; 155:161-169. [PMID: 31422857 DOI: 10.1016/j.ygyno.2019.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/22/2019] [Accepted: 07/29/2019] [Indexed: 01/22/2023]
Abstract
Effective communication between gynecologic oncology providers and patients is vital to patient-centered care. Skilled communication improves the patient's knowledge retention, builds trust in providers, enhances shared decision-making, and alleviates anxiety of both patients and caregivers. Effective communication is also associated with reduced provider burnout due to improved comfort from possessing the skills to handle emotionally charged situations. Therefore, training in serious illness communication skills is critically important to gynecologic oncology practice and benefits patients, providers, and the healthcare system. Like surgical skills, communication skills can be learned and improved upon, particularly by making use of communication skills courses and other resources. While the purpose of each conversation will vary based on the medical setting, most communication roadmaps incorporate four basic components: 1) Assess patient knowledge and understanding, 2) inform patient in accordance with her communication preferences, 3) recognize and respond to emotion 4) elicit patient values, and create a plan that aligns with those values. Improved patient outcomes associated with addressing patient emotions underscore a critical need to recognize and address emotional cues during difficult conversations. We present strategies for delivering serious news, and for discussing prognosis and goals of care. In each strategy, we highlight skills for recognizing and responding to patient and family emotional cues.
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Affiliation(s)
- Ramey D Littell
- Kaiser Permanente Northern California Gynecologic Cancer Program, San Francisco, CA, United States of America
| | - Amanika Kumar
- Mayo Clinic, Rochester, MN, United States of America
| | - M Heather Einstein
- University of Connecticut Health Center School of Medicine, Hartford, CT, United States of America
| | - Amer Karam
- Stanford University, Palo Alto, CA, United States of America
| | - Kerri Bevis
- University of Alabama at Birmingham, Birmingham, AL, United States of America.
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Burnout and its relationship with perceived stress, self-efficacy, depression, social support, and programmatic factors in general surgery residents. Am J Surg 2019; 219:907-912. [PMID: 31307660 DOI: 10.1016/j.amjsurg.2019.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/03/2019] [Accepted: 07/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Burnout affects surgical residents' well-being. OBJECTIVE We sought to identify factors associated with burnout among surgery residents. METHODS An electronic/anonymous survey was sent to surgical residents at 18 programs, consisting of demographic/programmatic questions and validated scales for burnout, depression, perceived stress, self-efficacy, and social support. Residents were grouped into quartiles based off burnout, and predictors were assessed using univariate and multivariate analyses. RESULTS 42% of residents surveyed completed it. Burnout was associated with depression, higher perceived stress/debt, fewer weekends off, less programmatic social events, and residents were less likely to reconsider surgery if given the chance. Low burnout was associated with lower depression/stress, higher social support/self-efficacy, more weekends off per month, program mentorship, lower debt, and residents being more likely to choose surgery again if given the chance. On multivariate analysis, higher depression/perceived stress were associated with burnout, and lower burnout scores were associated with lower stress/higher self-efficacy. CONCLUSIONS Burnout in surgery residents is associated with higher levels of depression and perceived stress. The addition of programmatic social events, limiting weekend work, and formal mentoring programs may decrease burnout.
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Williams ES, Rathert C, Buttigieg SC. The Personal and Professional Consequences of Physician Burnout: A Systematic Review of the Literature. Med Care Res Rev 2019; 77:371-386. [DOI: 10.1177/1077558719856787] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The well-being of the health care workforce has emerged as both a major concern and as a component of the “quadruple aim” to enable the “triple aim” of improving patient experiences, reducing costs, and improving population health. Physician burnout is problematic given its effects on physicians, patients, health care organizations, and society. Using conservation of resources theory as a frame, we conducted a systematic review of the empirical literature on the relationship of physician burnout with physician personal and professional outcomes that includes 43 articles. Nine outcomes were organized into three categories illustrating burnout as a dynamic loss spiral rather than a static end-state. Findings show that emotional exhaustion had the greatest impact with the outcomes explored, while depersonalization and lack of professional accomplishment manifested fewer associations. The results suggest that burnout is a complex, dynamic phenomenon, which unfolds over time. Future research and implications of these results are discussed.
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Alcaraz-Mor R, Vigouroux A, Urcun A, Boyer L, Villa A, Lehucher-Michel MP. [Qualitative study on young hospital physicians: They remain satisfied…]. SANTE PUBLIQUE 2019; Vol. 31:113-123. [PMID: 31210507 DOI: 10.3917/spub.191.0113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Prevalence of depression, suicidal ideation and burnout are higher among physicians than in general population. Young physicians seem more concerned and the beginning of career seems to be a period of greater risks for hospital practitioners. While this may be the case, in France, few studies have specifically evaluated the quality of the working conditions of this population. The objective of this study is to identify stress factors related to the organization of work and to social relationships at work, as they are perceived by the young hospital physicians. METHODS A qualitative study through semi-structured interviews was conducted with hospital practitioners with less than 10 years of practice. Manual analysis of the interviews was carried out by three interviewers and supplemented by a computerized lexical analysis. RESULTS Eighteen physicians were interviewed. Five categories of psychosocial and organizational factors have been identified. Teamwork and communication are generally associated with positive feelings. The pace of work, professional status, organizational factors and material conditions are considered unsatisfactory. Young physicians, however, are satisfied with the content of their work, particularly because of scientific emulation and skills development. CONCLUSION The results of this study should help to better target prevention actions in order to improve the working conditions of young doctors. It seems a priority to reduce their workload or to regulate their working time, to offer greater stability to their work and to provide them with better material work conditions.
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