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Stojanović A, Fris DAH, Solms L, van Hooft EAJ, De Hoog M, de Pagter APJ. Lifelong development in medicine: a thematic analysis of coaching goals throughout medical careers. BMJ Open 2024; 14:e081139. [PMID: 38772887 PMCID: PMC11110559 DOI: 10.1136/bmjopen-2023-081139] [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: 10/20/2023] [Accepted: 04/21/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES Healthcare grapples with staff shortages and rising burnout rates for medical students, residents and specialists. To prioritise both their well-being and the delivery of high-quality patient care, it becomes imperative to deepen our understanding of physicians' developmental aims and needs. Our first aim is, therefore, to gain comprehensive insights into the specific developmental aims physicians prioritise by examining the coaching goals they set at the beginning of coaching. Since physicians face distinct roles as they advance in their careers, our second aim is to highlight similarities and differences in developmental aims and needs among individuals at various medical career stages. DESIGN We conducted a qualitative analysis of 2571 coaching goals. We performed an inductive thematic analysis to code one-half of coaching goals and a codebook thematic analysis for the other half. Our interpretation of the findings was grounded in a critical realist approach. SETTING Sixteen hospitals in the Netherlands. PARTICIPANTS A total of 341 medical clerkship students, 336 medical residents, 122 early-career specialists, 82 mid-career specialists and 57 late-career specialists provided their coaching goals at the start of coaching. RESULTS The findings revealed that coachees commonly set goals about their career and future, current job and tasks, interpersonal work relations, self-insight and development, health and well-being, nonwork aspects and the coaching process. Furthermore, the findings illustrate how the diversity of coaching goals increases as physicians advance in their careers. CONCLUSIONS Our findings underscore the significance of recognising distinct challenges at various career stages and the necessity for tailoring holistic support for physicians. This insight holds great relevance for healthcare organisations, enabling them to better align system interventions with physicians' needs and enhance support. Moreover, our classification of coaching goals serves as a valuable foundation for future research, facilitating a deeper exploration of how these goals influence coaching outcomes.
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Affiliation(s)
- Ana Stojanović
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Daan A H Fris
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Lara Solms
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Edwin A J van Hooft
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthijs De Hoog
- Department of Neonatal & Pediatric Intensive Care/Division of Pediatric Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anne P J de Pagter
- Department of Quality and Patient Safety, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Quality and Patient Safety, Leiden University Medical Center, Leiden, The Netherlands
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Kiser SB, Sterns JD, Lai PY, Horick NK, Palamara K. Physician Coaching by Professionally Trained Peers for Burnout and Well-Being: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e245645. [PMID: 38607628 PMCID: PMC11015346 DOI: 10.1001/jamanetworkopen.2024.5645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/11/2024] [Indexed: 04/13/2024] Open
Abstract
Importance Physician burnout is problematic despite existing interventions. More evidence-based approaches are needed. Objective To explore the effect of individualized coaching by professionally trained peers on burnout and well-being in physicians. Design, Setting, and Participants This randomized clinical trial involved Mass General Physician Organization physicians who volunteered for coaching from August 5 through December 1, 2021. The data analysis was performed from February through October 2022. Interventions Participants were randomized to 6 coaching sessions facilitated by a peer coach over 3 months or a control condition using standard institutional resources for burnout and wellness. Main Outcomes and Measures The primary outcome was burnout as measured by the Stanford Professional Fulfillment Index. Secondary outcomes included professional fulfillment, effect of work on personal relationships, quality of life, work engagement, and self-valuation. Analysis was performed on a modified intention-to-treat basis. Results Of 138 physicians enrolled, 67 were randomly allocated to the coaching intervention and 71 to the control group. Most participants were aged 31 to 60 years (128 [93.0%]), women (109 [79.0%]), married (108 [78.3%]), and in their early to mid career (mean [SD], 12.0 [9.7] years in practice); 39 (28.3%) were Asian, 3 (<0.1%) were Black, 9 (<0.1%) were Hispanic, 93 were (67.4%) White, and 6 (<0.1%) were of other race or ethnicity. In the intervention group, 52 participants underwent coaching and were included in the analysis. Statistically significant improvements in burnout, interpersonal disengagement, professional fulfillment, and work engagement were observed after 3 months of coaching compared with no intervention. Mean scores for interpersonal disengagement decreased by 30.1% in the intervention group and increased by 4.1% in the control group (absolute difference, -0.94 poimys [95% CI, -1.48 to -0.41 points; P = .001), while mean scores for overall burnout decreased by 21.6% in the intervention group and increased by 2.5% in the control group (absolute difference, -0.79 points; 95% CI, -1.27 to -0.32 points; P = .001). Professional fulfillment increased by 10.7% in the intervention group compared with no change in the control group (absolute difference, 0.59 points; 95% CI, 0.01-1.16 points; P = .046). Work engagement increased by 6.3% in the intervention group and decreased by 2.2% in the control group (absolute difference, 0.33 points; 95% CI, 0.02-0.65 points; P = .04). Self-valuation increased in both groups, but not significantly. Conclusions and Relevance The findings of this hospital-sponsored program show that individualized coaching by professionally trained peers is an effective strategy for reducing physician burnout and interpersonal disengagement while improving their professional fulfillment and work engagement. Trial Registration ClinicalTrials.gov Identifier: NCT05036993.
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Affiliation(s)
- Stephanie B. Kiser
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - J. David Sterns
- Department of Occupational Medicine, Naval Medical Readiness and Training Command New England, US Navy, Portsmouth, New Hampshire
| | - Po Ying Lai
- Department of Biostatistics, Massachusetts General Hospital, Boston
| | - Nora K. Horick
- Department of Biostatistics, Massachusetts General Hospital, Boston
| | - Kerri Palamara
- Center for Physician Well-Being, Department of Medicine, Massachusetts General Hospital, Boston
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Hinrichs LA, Seidler KJ, Morrison K, Coats H. "We're not broken. We're human." A qualitative meta-synthesis of health-care providers' experiences participating in well-being programs. Physiother Theory Pract 2024; 40:65-90. [PMID: 35876152 DOI: 10.1080/09593985.2022.2103052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Protecting health-care provider (HCP) well-being is imperative to preserve health-care workforce capital, performance, and patient care quality. Limited evidence exists for the long-term effectiveness of HCP well-being programs, with less known about physiotherapists specifically. PURPOSE To review and synthesize qualitative research describing experiences of HCP, generate lessons learned from the greater population of HCP participating in workplace well-being programs, and then to inform programs and policies for optimizing psychological well-being in an understudied population of physiotherapists. METHODS This qualitative meta-synthesis included a systematic literature search conducted in September 2020; critical appraisal of results; and data reduction, re-categorizing, and thematic extraction (reciprocal translation) with interpretive triangulation. RESULTS Twenty-five papers met the inclusion criteria. Participants included physicians, nurses, and allied health providers. All programs targeted the individual provider and included psychoeducational offerings, supervision groups, coaching, and complementary therapies. Four themes were constructed: 1) beneficial outcomes across a range of programs; 2) facilitators of program success; 3) barriers to program success; and 4) unmet needs driving recommendations. CONCLUSIONS The findings enhance our understanding of diverse individual-level programs to address HCP well-being. Beneficial outcomes were achieved across program types with system-level support proving critical; however, HCP described barriers to program success (HCP characteristics, off-site programs, institutional culture) and remaining needs (resources, ethical dissonance) left unaddressed. Organizations should offer individual-level programs to support physiotherapists in the short term while pursuing long-term, system-level change to address drivers of well-being.
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Affiliation(s)
- Lauren A Hinrichs
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Colorado, Aurora
| | - Katie J Seidler
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Colorado, Aurora
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center Rocky Mountain Regional VA Medical Center, Aurora, USA
| | - Katherine Morrison
- Palliative Medicine Inpatient Service, Department of Medicine, University of Colorado, Colorado, Aurora
| | - Heather Coats
- Office of Research and Scholarship, College of Nursing, University of Colorado, Colorado, Aurora
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Breslin L, Dyrbye L, Chelf C, West C. Effects of coaching on medical student well-being and distress: a systematic review protocol. BMJ Open 2023; 13:e073214. [PMID: 37591650 PMCID: PMC10441055 DOI: 10.1136/bmjopen-2023-073214] [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: 02/26/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Medical students experience higher rates of distress and burnout compared with their age-similar peers overall. Coaching has been proposed as one means of combating distress and burnout within the medical profession. The purpose of this systematic review is to synthesise the current evidence on the effects of coaching interventions on medical student well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms. METHODS AND ANALYSIS We will conduct a systematic review of interventional and observational comparative studies that assess the effects of coaching interventions on well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms among undergraduate medical students internationally. We will search PubMed (MEDLINE), Embase (OVID), PsycINFO (OVID), Scopus, ERIC, Cochrane Database of Systematic Reviews (OVID) and Cochrane Central Register of Controlled Trials (OVID) from their respective inception dates using the following search terms: (medical students OR medical student OR undergraduate medical education) AND (coach OR coaching OR coaches). Studies in any language will be eligible. Studies that report one or more outcomes of distress or well-being among medical students who receive a coaching intervention will be included. Data on participant and intervention characteristics, outcomes and instruments used will be collected as well as quality/risk of bias assessments. Two reviewers will screen studies against the inclusion criteria and perform data extraction. We will conduct a narrative synthesis, with meta-analysis if evidence permits quantitative pooling of results. Heterogeneity of results across studies according to study design, learner level and study risk of bias will be evaluated, as well as publication bias. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Results will be disseminated by publication in a scientific journal. PROSPERO REGISTRATION NUMBER CRD42022322503.
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Affiliation(s)
- Lauren Breslin
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Liselotte Dyrbye
- Depratment of Community & Behavioral Health, Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cynthia Chelf
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Colin West
- Division of General Internal Medicine, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, USA
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Bernstein DN, Bozic KJ. Coaching for the Orthopedic Surgery Leader. Clin Sports Med 2023; 42:209-217. [PMID: 36907619 DOI: 10.1016/j.csm.2022.12.002] [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: 03/12/2023]
Abstract
From the increase in telehealth to the expansion of private investors to the growth of transparency (both price and patient outcomes) and value-based care initiatives, health-care delivery is rapidly changing. At the same time, demand for musculoskeletal care continues to rapidly increase, with more than 1.7 billion people globally suffering from musculoskeletal conditions, yet burnout is a major concern and growing since the onset COVID-19 global pandemic. When taken together, these factors have a major impact on the health-care delivery environment and pose enormous challenges and increased stressors on orthopedic surgeons and their teams. Coaching can help.
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Affiliation(s)
- David N Bernstein
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, 1701 Trinity Street, Austin, TX 78712, USA.
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Coaching en Radiodiagnóstico. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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7
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Samora JB, Brown GA, Clohisy D, Weber K. Coaching, Separate from Mentoring, May Provide Skill Acquisition, Improved Well-Being, and Career Advancement in Orthopaedic Surgery: AOA Critical Issues. J Bone Joint Surg Am 2022; 104:e76. [PMID: 36069800 DOI: 10.2106/jbjs.21.01198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Coaching is separate from mentoring, and can include life coaching, skills coaching, and behavior coaching. Life coaching can focus on purpose, work-life balance, well-being, and career path. Skills coaching encourages mastery and promotes autonomy. Behavior coaching may be mandated for a disruptive surgeon. Coaching has been shown to reduce burnout and promote well-being and can potentially advance a surgeon's career trajectory and leadership skills.
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Affiliation(s)
- Julie Balch Samora
- Department of Orthopaedics, Nationwide Children's Hospital, Columbus, Ohio
| | - Gregory A Brown
- Williston Orthopedic Clinic, CHI St. Alexius Health, Williston, North Dakota
| | - Denis Clohisy
- Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Kristy Weber
- Division of Orthopaedic Oncology, Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
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Shao CC, Kennedy GE, Rentas CM, Chen H, Fazendin JM. Leadership Development Among Junior Surgery Residents: Communication and Perception. J Surg Res 2022; 277:A18-A24. [PMID: 35428484 PMCID: PMC9678243 DOI: 10.1016/j.jss.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Leadership is necessary for effective health care teams, particularly for surgeons. Trainees similarly must acquire foundational leadership skills to maximize effectiveness. However, surgical leadership is rarely formally assessed, particularly for junior trainees. We aimed to establish themes of communication, perception and engagement styles, as well as strengths and weaknesses among junior surgical residents at a single institution. METHODS The Data Dome Inc. (datadome.com) DISC personality assessment was administered in 2018-2021 to junior residents at an academic general surgery training program at a single institution. Resident demographics were recorded, and themes from deidentified reports were analyzed by year (PGY-1 and PGY-2) using JMP 16 Pro Text Explorer. RESULTS PGY-1 communication was most frequently described as "accomplished best by well-defined avenues" with "duties and responsibilities of others who will be involved explained" in "friendly terms." PGY-2 communication involved "deal [ing] with people," "strong feelings about a particular problem," and being "good at giving verbal and nonverbal feedback." In ideal environments, PGY-1s self-perceived as "good listener [s]," "good-natured," and "team player [s]." However, under stress, PGY-1s were perceived by others as "poor listener [s]," "self-promoter [s]," "detached," and "insensitive." In ideal environments, PGY-2s were also "good listener [s]," "good-natured," and "team player [s]." However, under stress, PGY-2 external perception was "overly confident," "poor listener [s]," and "self-promoter [s]." CONCLUSIONS Clear expectations, friendly work environments, and opportunities to succeed are key to effectively train junior surgical residents. In environments where time is often a limited resource, surgical simulation, stress training, and standardized teaching methods from attending surgeons are needed to develop competent trainees.
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Affiliation(s)
- Connie C Shao
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Grace E Kennedy
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Courtney M Rentas
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica M Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Technical skills in the operating room: Implications for perioperative leadership and patient outcomes. Best Pract Res Clin Anaesthesiol 2022; 36:237-245. [DOI: 10.1016/j.bpa.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 01/02/2023]
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10
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The disruptive radiologist. Clin Imaging 2022; 87:5-10. [DOI: 10.1016/j.clinimag.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022]
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Orthopaedic Surgeons Have a High Prevalence of Burnout, Depression, and Suicide: Review of Factors Which Contribute or Reduce Further Harm. J Am Acad Orthop Surg 2022; 30:e528-e535. [PMID: 35171879 DOI: 10.5435/jaaos-d-21-00299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/24/2021] [Indexed: 02/01/2023] Open
Abstract
Orthopaedic surgeons have the highest prevalence of death by suicide among all surgical subspecialties, comprising 28.2% of surgeon suicides from 2003 to 2017. There is a continuum of burnout, depression, and other mental health illnesses likely contributing to these numbers in our profession. Stigmatization in terms of medical licensing and professional development are currently barriers to seeking mental health treatment. Education on the risk and treatment of burnout, depression, and suicidal ideations should begin early in a surgeon's career. This review documents the issue of physician burnout and depression and makes recommendations regarding necessary changes to counteract mental illness in orthopaedic surgeons.
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Guck AJ, Buck K. Reducing clinician inefficiency and restoring meaning in practice: A professional coaching approach for family medicine residents. Int J Psychiatry Med 2021; 56:319-326. [PMID: 34325553 DOI: 10.1177/00912174211034624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Burnout is widespread among primary care physicians (PCPs). Several key drivers of burnout in this specialty that have been increasingly recognized are the growing complexity and work demands placed on PCPs by outpatient clinical work environments. These high demands, from the perspective of the physician, detract from other valued tasks which provide meaning in daily work such as relationship-building and fellowship with the medical team. Given these trends, we believe that a viable means to address burnout can be found in utilizing a performance coaching approach to equip resident physicians for the practical and emotional demands of the primary care work environment into which they are entering. Specifically, we recommend a focus on clinical efficiency as an area for coaching development due to its potential impact on resident physician well-being. In this brief review article, we provide a summary of evidence for coaching interventions, along with evidence supporting an expansion to these approaches in clinical efficiency in outpatient settings based on the connection between workflow and engagement in meaningful medical practice. Lastly, we outline a prospective coaching approach which targets common sources of clinic inefficiency for resident practitioners.
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Affiliation(s)
- Adam J Guck
- JPS Family Medicine Residency Program, Fort Worth, TX, USA
| | - Katherine Buck
- JPS Family Medicine Residency Program, Fort Worth, TX, USA
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Kokokyi S, Klest B, Anstey H. A patient-oriented research approach to assessing patients' and primary care physicians' opinions on trauma-informed care. PLoS One 2021; 16:e0254266. [PMID: 34242358 PMCID: PMC8270182 DOI: 10.1371/journal.pone.0254266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To gather patients' and primary care physicians' (PCP) opinions on trauma-informed Care (TIC) and to investigate the acceptability of recommendations developed by patient, family, and physician advisors. DESIGN Cross-sectional research survey design and patient engagement. SETTING Canada, 2017 to 2019. PARTICIPANTS English-speaking adults and licensed PCPs residing in Canada. MAIN OUTCOME MEASURES Participants were given a series of questionnaires including a list of physician actions and a list of recommendations consistent with TIC. RESULTS Patients and PCPs viewed TIC as important. Both patients and PCPs rated the following recommendations as helpful and likely to positively impact patient care: physician training, online trauma resource centres, information pamphlets, the ability to extend appointment times, and clinical pathways for responding to trauma. PCPs' responses were significantly more positive than patients' responses. CONCLUSION TIC is important to patients and PCPs. Patients and PCPs believe changes to physician training, patient engagement, and systemic factors would be helpful and likely to positively impact patient care. Future research needs to be conducted to investigate whether these recommendations improve patient care.
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Affiliation(s)
- Seint Kokokyi
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bridget Klest
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Hannah Anstey
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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Kurebayashi Y. Self-compassion and nursing competency among Japanese psychiatric nurses. Perspect Psychiatr Care 2021; 57:1009-1018. [PMID: 33078412 DOI: 10.1111/ppc.12649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This study examined the association of self-focus and self-compassion with nursing competency. DESIGN AND METHODS Data of 433 psychiatric nurses comprising demographics, other-consciousness, self-compassion, self-focus, and nursing competency were analyzed using the Other-Consciousness Scale (OCS), Self-Compassion Scale (SCS), Japanese version of the Rumination-Reflection Questionnaire (RRQ), and Oriented Problem Solving Behavior (OPSN). FINDINGS Higher internal aspect and lower fantastic aspect in OCS, higher reflection in RRQ, and lower SCS negative subscales predicted a higher OPSN score. The account rate of variance was 12.5%. PRACTICE IMPLICATIONS Psychiatric nursing education should facilitate other-consciousness and reflection enhancement, and assuage uncompassionate attitude towards self.
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Affiliation(s)
- Yusuke Kurebayashi
- Department of Nursing, Faculty of Nursing, Niigata University of Health and Welfare, Niigata City, Niigata, Japan
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15
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Bernburg M, Groneberg D, Mache S. Professional training in mental health self-care for nurses starting work in hospital departments. Work 2021; 67:583-590. [PMID: 33185622 DOI: 10.3233/wor-203311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Nurses working in hospitals can suffer from occupational stress due to high workloads and low job and/or personal resources. This can lead to work-related stress, exhaustion, health problems, and low quality of care. OBJECTIVE The aim of the study was to evaluate the effectiveness of work-related self-care skill training for nurses. METHODS A pilot study was conducted with 94 nurses in hospital departments in Germany. Nurses were either assigned to the intervention group that received competence training or to a waitlist control group. The intervention took place in groups over a period of 12 weeks. Training content included i.e. work-related stress management training, problem-solving techniques, and solution-focused counselling. The outcomes studied were changes in work-related stress, emotional exhaustion, emotion regulation, and job satisfaction. Three follow-up assessments were arranged. RESULTS Nurses in the IG achieved a decrease in perceived job stress and emotional exhaustion as well as improvements with regard to enhanced emotion regulation skills. The intervention was evaluated with high satisfaction scores. CONCLUSIONS This study showed first indications that training of mental health self-care skills for junior nurses could be a supportive approach for nurses starting work in hospital departments. However, replication studies are needed to verify the results.
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Affiliation(s)
- Monika Bernburg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Germany
| | - David Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Germany
| | - Stefanie Mache
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Germany
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Randell KA, Patel AK, Talib HJ. Parenting Pressures Among Academic Pediatricians During the COVID-19 Pandemic. Pediatrics 2021; 147:peds.2020-033159. [PMID: 33627369 PMCID: PMC8015152 DOI: 10.1542/peds.2020-033159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kimberly A. Randell
- Division of Emergency Medicine, Children’s Mercy and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri;,School of Medicine, University of Kansas, Kansas City, Kansas
| | - Anita K. Patel
- Division of Critical Care Medicine, Children’s National Health System and School of Medicine and Health Sciences, George Washington University, Washington, DC; and
| | - Hina J. Talib
- Division of Adolescent Medicine, Children’s Hospital at Montefiore and Albert Einstein College of Medicine, New York, New York
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Fishman MDC, Reddy SP. Coaching: A Primer for the Radiologist. J Am Coll Radiol 2021; 18:1192-1197. [PMID: 33753069 DOI: 10.1016/j.jacr.2021.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 10/24/2022]
Abstract
The practice of coaching using positive psychology is an emerging and promising approach to address the radiologist burnout epidemic, with the focus on wellness even more urgent given the coronavirus disease 2019 pandemic and other recent stressful events. Coaching uses a strengths-based approach to help radiologists identify and achieve positive emotions, create meaningful relationships, increase engagement and purpose, and develop coping skills for personal and professional stressors, including communication, improving resilience, team building, and mindfulness. Health and wellness coaching promotes healthy behavior change as a means of averting or mitigating chronic lifestyle-related diseases and is a potential treatment for burnout and stress management. Coaches help clients enhance self-motivation, identify strengths, and implement a framework for change by applying psychological resources, including mindfulness, positive mind-set, resilience, self-efficacy, and self-awareness. The framework of coaching is built upon psychological safety, mindfulness, accountability, and the coach-client relationship. Coaches use the three fundamental skills of mindful listening, open-ended inquiry, and perceptive reflections to empower clients on their journeys to achieve their best selves.
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Affiliation(s)
- Michael D C Fishman
- Section Chief of Breast Imaging Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
| | - Syam P Reddy
- Department of Radiology, University of Chicago Medicine Ingalls, Harvey, Illinois; Clinical Chairman and Local Practice Board President, RP Chicago, Radiology Partners, Chicago, Illinois
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Schwartz JM, Wittkugel E, Markowitz SD, Lee JK, Deutsch N. Coaching for the pediatric anesthesiologist: Becoming our best selves. Paediatr Anaesth 2021; 31:85-91. [PMID: 33070377 DOI: 10.1111/pan.14041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 11/28/2022]
Abstract
Anesthesiologists must balance demanding clinical workloads with career development goals. Leadership, conflict management, and other skills can improve medical outcomes, reduce stress at work, and increase career satisfaction. However, Medicine in general and Anesthesiology in particular have not traditionally emphasized physician growth in these areas. Coaching utilizes concepts from psychology, adult learning, and adult development theory to support an individual in personal and professional growth through inquiry, reflection, and shared discovery. This manuscript reviews the history and evidence basis for coaching, differentiates coaching from traditional mentorship, and presents some constructs of coaching and working with a coach. An example of a successful pilot program to disseminate coaching skills and support leadership growth among anesthesiologists, the Women's Empowerment and Leadership Initiative within the Society for Pediatric Anesthesia, is described.
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Affiliation(s)
- Jamie McElrath Schwartz
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Eric Wittkugel
- Department of Anesthesiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Certified Leadership Development Coach, Hudson Institute of Coaching, Santa Barbara, CA, USA
| | - Scott D Markowitz
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.,Leadership for Innovative Team Science Program, Executive Leadership Coach, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer K Lee
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nina Deutsch
- Department of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Leiss U, Schiller A, Fries J, Voitl P, Peyrl A. Self-Care Strategies and Job Satisfaction in Pediatricians: What We Can Do to Prevent Burnout-Results of a Nationwide Survey. Front Pediatr 2021; 9:722356. [PMID: 34532304 PMCID: PMC8438418 DOI: 10.3389/fped.2021.722356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Working in the clinical field can be a demanding experience. While reports indicate escalating burnout rates among physicians, further investigation about what physicians can do to prevent burnout is necessary. Our objective was to assess self-care levels among pediatricians and the correlation with job satisfaction in order to subsequently identify protective factors. Methods: In this nationwide, cross-sectional study, a web-based survey was distributed to all Austrian pediatricians via a mailing list of the Austrian Society of Pediatrics. Self-care was measured with a modified Professional Self-Care Scale (PSCS), which consisted of nine items on a four-point Likert scale (from 1, "totally disagree," to 4, "totally agree"). Additional items addressed job satisfaction, peer support, and access to professional coaching. Results: The survey was distributed to 1,450 mailing list contacts, a total of 309 Austrian pediatricians completed the survey (21%). "Family" (M = 3.3) and "Friends" (M = 3.1) were the most highly rated self-care strategies. We found significant differences between pediatricians under 35 years and those aged 50 years and above (z = -4.21, p < 0.001). Peer support appeared to impact job satisfaction substantially. We found differences between pediatricians who frequently talk to colleagues about difficult situations, those who sometimes do so, and those who never do (p < 0.001), with a linear trend indicating increased job satisfaction with more frequent peer support (p < 0.001). Conclusions: Among all self-care strategies, a stable network of family and friends was highest rated, followed by balanced nutrition. Younger, male pediatricians working in hospital showed to be a vulnerable group with regard to overall self-care. Moreover, higher self-care values were found among those pediatricians who reported to receive peer support on a regular basis. We suggest combined organizational and individual interventions to promote pediatricians' well-being. Organizations should provide the possibility to select a well-balanced diet as well as space and time to consume food and cultivate a work environment that enables communication among peers and facilitates professional coaching. On the personal level, we want to encourage pediatricians to talk to trusted colleagues in challenging clinical situations and to consider working with a professional coach.
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Affiliation(s)
- Ulrike Leiss
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria.,Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andrea Schiller
- Department of Pediatrics and Neonatology, St. Josef Hospital Vienna, Vienna, Austria
| | - Jonathan Fries
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria.,Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.,Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Peter Voitl
- First Vienna Medical Care Center, Vienna, Austria
| | - Andreas Peyrl
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria.,Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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20
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Nituica C, Bota OA, Blebea J. Specialty differences in resident resilience and burnout - A national survey. Am J Surg 2020; 222:319-328. [PMID: 33431168 DOI: 10.1016/j.amjsurg.2020.12.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/21/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Burnout is widespread among resident physicians, but higher resilience is associated with lower burnout. This study characterizes the relationship between resilience and burnout in medical (MR) and surgical (SR) resident physicians. METHODS A cross-sectional survey was distributed to all ACGME-accredited residency programs with the Connor-Davidson Resilience Scale and Abbreviated Maslach Burnout Inventory. RESULTS Of the 682 respondents, both Medical and Surgical Residents with higher resilience had lower burnout. Higher resilience was seen in Surgical Residents who were men, had greater family support, more residency program support, and enjoyed greater autonomy. Burnout was greater in women, Caucasians, those in an academic setting, and with less autonomy and program support. Burnout was similar among the medical and surgical groups, but surgical trainees had higher resilience. Overall, family and institutional support was associated positively with high resilience and decreased burnout. CONCLUSIONS Increasing resilience and program support can decrease burnout, especially for high-risk subgroups.
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Affiliation(s)
- Cristina Nituica
- Department of Surgery, College of Medicine, Central Michigan University, 912 S Washington Ave, Suite #1, Saginaw, MI, 48601, USA.
| | - Oana Alina Bota
- Department of Psychology, Education and Teacher Training, Faculty of Psychology and Education Sciences, Transilvania University of Brasov, 29 Eroilor Bd, 500036, Brasov, Romania.
| | - John Blebea
- Department of Surgery, College of Medicine, Central Michigan University, 912 S Washington Ave, Suite #1, Saginaw, MI, 48601, USA.
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21
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Cordova MJ, Gimmler CE, Osterberg LG. Foster Well-being Throughout the Career Trajectory: A Developmental Model of Physician Resilience Training. Mayo Clin Proc 2020; 95:2719-2733. [PMID: 33276844 DOI: 10.1016/j.mayocp.2020.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/27/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Abstract
Physician burnout is common across specialties and largely driven by demands of the current health care industry. However, the obvious need for systems change does not address the unavoidable impact of providing care to those who suffer. An intentional, developmental, longitudinal approach to resiliency training would not distract from fixing a broken system or blame physicians for their distress. Existing models and approaches to resilience training are promising but limited in duration, scope, and depth. We call for and describe a career-long model, introduced early in undergraduate medical training, extending into graduate medical education, and integrated throughout professional training and continuing medical education, in intrapersonal and interpersonal skills that help physicians cope with the emotional, social, and physical impact of care provision.
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Affiliation(s)
- Matthew J Cordova
- Department of Psychology, Palo Alto University, Palo Alto, CA, and VA Northern California Health Care System, Martinez, CA.
| | - Christophe E Gimmler
- VA Palo Alto Health Care System, Palo Alto, CA, and Stanford University School of Medicine, Stanford, CA
| | - Lars G Osterberg
- VA Palo Alto Health Care System, Palo Alto, CA, and Stanford University School of Medicine, Stanford, CA
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22
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Song Y, Swendiman RA, Shannon AB, Torres-Landa S, Khan FN, Williams NN, Dumon KR, Brooks AD, DeMatteo RP, Aarons CB. Can We Coach Resilience? An Evaluation of Professional Resilience Coaching as a Well-Being Initiative for Surgical Interns. JOURNAL OF SURGICAL EDUCATION 2020; 77:1481-1489. [PMID: 32446771 DOI: 10.1016/j.jsurg.2020.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/05/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the use of a professionally trained, resilience coach for surgical interns. DESIGN Mixed-methods study with pre- and postcoaching quantitative surveys measuring burnout and resilience factors and semistructured interviews. SETTING General, Vascular, Cardiac, Plastic, and Urologic Surgery residencies at a tertiary academic center. PARTICIPANTS Categorical and preliminary interns (N = 25) participated in a year-long, 8-session resilience coaching program for the academic year 2018 to 2019. RESULTS Program participants included 17 (68%) men and 8 (32%) women. The precoaching survey administered to interns before the start of the program identified 60% at risk of burnout as measured by the Abbreviated Maslach Burnout Inventory. The mean (standard deviation) Brief Resilience Scale score was 3.8 (0.8), with a trend toward a higher score (greater resilience) among men compared to women (4.1 [0.7] vs 3.4 [1.0], p = 0.10). Following the completion of the coaching program, the mean (standard deviation) Brief Resilience Scale score increased significantly from 3.8 [0.8] to 4.2 [0.7] p = 0.002). There were no changes in other parameters measuring burnout, satisfaction with life, or positive/negative affect. In semistructured interviews (N = 16/25 participants), most interns believed the coaching experience provided useful skills, but expressed concern about the durability of a 1-year intervention. Additionally, leadership-driven wellness at work, including optimizing team dynamics and purpose-driven engagement, were emphasized. CONCLUSIONS About 60% of new interns at our institution were at risk of burnout. The coaching program was viewed positively and was effective in improving resilience. While this intervention was a useful first step, it should be incorporated into a longitudinal wellness program for the duration of surgical training.
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Affiliation(s)
- Yun Song
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robert A Swendiman
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Adrienne B Shannon
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Samuel Torres-Landa
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Faisal N Khan
- University of Pennsylvania, Master of Applied Positive Psychology Program, Philadelphia, Pennsylvania; 1ExtraordinaryLife, LLC, Philadelphia, Pennsylvania
| | - Noel N Williams
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ari D Brooks
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ronald P DeMatteo
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Cary B Aarons
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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23
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Junker S, Pömmer M, Traut-Mattausch E. The impact of cognitive-behavioural stress management coaching on changes in cognitive appraisal and the stress response: a field experiment. COACHING: AN INTERNATIONAL JOURNAL OF THEORY, RESEARCH AND PRACTICE 2020. [DOI: 10.1080/17521882.2020.1831563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sabine Junker
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Martin Pömmer
- Department of Psychology, University of Salzburg, Salzburg, Austria
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Aboalshamat K, Al-Zaidi D, Jawa D, Al-Harbi H, Alharbi R, Al-Otaibi S. The effect of life coaching on psychological distress among dental students: interventional study. BMC Psychol 2020; 8:106. [PMID: 33054836 PMCID: PMC7557064 DOI: 10.1186/s40359-020-00475-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/05/2020] [Indexed: 01/22/2023] Open
Abstract
Background Depression, stress, and anxiety are common psychological conditions among dental students in many countries around the world. A number of researchers have found life coaching to be effective at reducing psychological distress. The aim of this study was to assess the effect of a life coaching program on dental students’ psychological status. Methods A quasi-experiment study with two arms was conducted on 88 female dental students at Umm Al-Qura University (study group = 44; control group = 44). The psychological status was assessed by questionnaire before and after intervention. The questionnaire was composed of the Depression and Anxiety Stress Scale (DASS-21), Resilience Scale (RS-14), the Psychological Well-Being Scale–Short (PWB-S), and goal approach questions. The study group received a coaching program comprising one lecture for 1 h and five phone coaching sessions over 5 weeks, while the control group received no intervention. Results The study group showed a significant reduction in depression, anxiety, stress, resilience, and self-acceptance according to the PWB-S scale. Also, goal approach was significantly improved. On the other hand, the control group showed a significant reduction on the RS-14 only. The differences in the tested scales between the study group and the control group from pre-intervention (T1) to post-intervention (T2) showed significant differences in depression, stress, self-acceptance, and goal approach measurements per t-test. Conclusion The study’s findings showed that life coaching had the effect of reducing psychological distress, which encouraged the implementation of coaching practice in the daily life of dental students.
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Affiliation(s)
- Khalid Aboalshamat
- Dental Public Health Division, Preventative Dentistry Department, College of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Duha Al-Zaidi
- Dental Intern, College of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Duha Jawa
- Dental Intern, College of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hanouf Al-Harbi
- Dental Intern, College of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Raghad Alharbi
- Dental Intern, College of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Shahad Al-Otaibi
- Dental Intern, College of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
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25
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Rich A, Aly A, Cecchinato ME, Lascau L, Baker M, Viney R, Cox AL. Evaluation of a novel intervention to reduce burnout in doctors-in-training using self-care and digital wellbeing strategies: a mixed-methods pilot. BMC MEDICAL EDUCATION 2020; 20:294. [PMID: 32907573 PMCID: PMC7488166 DOI: 10.1186/s12909-020-02160-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Burnout for doctors-in-training is increasingly cause for concern. Our objectives were to assess the feasibility, acceptability and impact of a novel intervention to reduce burnout and improve wellbeing. This is the first wellbeing intervention for medical doctors to include strategies for work-life boundary management and digital wellbeing. METHODS Twenty-two doctors participated in face-to-face workshops which included group discussion of challenges experienced and strategies to enhance self-care and wellbeing. A pre-post-test mixed-methods evaluation was undertaken. Questionnaire measures were the Oldenburg Burnout Inventory, Warwick-Edinburgh Mental Wellbeing Scale and the boundary control subscale of the Work-Life Indicator (i.e., the degree of perception of control of the boundaries between work and personal life). Paired t-tests examined whether there were statistically significant differences. Eleven doctors also participated in post-intervention semi-structured interviews. Transcripts were analysed using thematic analysis. RESULTS The intervention was well-received, with all trainees finding the workshop useful and saying they would recommend it to others. At baseline most participants had scores indicative of burnout on both the disengagement (82%) and exhaustion (82%) subscales of the Oldenburg Burnout Inventory. One month post-intervention, participants had a statistically significant reduction in burnout (both disengagement and exhaustion) and improvement in boundary control. Wellbeing scores also improved, but differences were not statistically significant. Qualitative analysis indicated participants had welcomed a safe space to discuss stressors and many had implemented digital wellbeing strategies to manage their smartphone technology, and increased self-care such as mindfulness practice and walking in green space. CONCLUSIONS The intervention reduced burnout and improved boundary control. We suggest that having protected time for doctors to share personal experiences, adopt digital wellbeing and self-care strategies are effective tools to support doctors' wellbeing and should be investigated further.
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Affiliation(s)
- Antonia Rich
- Research Department of Medical Education, UCL Medical School, University College London, London, UK
| | - Amira Aly
- Research Department of Medical Education, UCL Medical School, University College London, London, UK
| | - Marta E Cecchinato
- Computer and Information Sciences Department, Northumbria University, Newcastle Upon Tyne, UK
| | - Laura Lascau
- UCL Interaction Centre, University College London, London, UK
| | - Magdalen Baker
- Research Department of Medical Education, UCL Medical School, University College London, London, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, University College London, London, UK
| | - Anna L Cox
- UCL Interaction Centre, University College London, London, UK.
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Abstract
BACKGROUND The members and leadership of the Pediatric Orthopaedic Society of North America (POSNA) continue to expand awareness of the impact of burnout on the delivery of care and on the health care professionals that are critical to delivering that care. Surgeon coaching, when appropriately defined, shows considerable promise as a method to create positive change in our team environment and practice, our organizational culture, and our own wellness. METHODS The surgeon coaching concepts shared are a mix of expert opinions, literature review, and personal experiences of the author. The literature review includes extensive experience in behavioral health, adult learning theory, and the evolution of best practices as they pertain to coaching techniques and skills. Early experiences in physician coaching highlight the challenges and successes when these concepts are applied to high performance professionals in our current health care environment. RESULTS Physician and surgeon coaching is more akin to executive coaching and self-directed learning for highly trained individuals and teams rather than a method of remediation or coercion into someone else's agenda. A methodology for performance improvement to those who have already achieved so much in their careers was shared as a structure for those struggling to organize the process, avoid blind spots, and leverage a growth/reward process rather than the traditional destructive/punitive process that includes shaming, guilting, and other negative techniques. Surgeon coaches and coaching skills are expected to be significant ingredients of performance improvement in team-based care, organizational culture, and physician wellness. DISCUSSION Coaching, the activity of bringing forth knowledge, wisdom, and insight through: asking open-ended questions, listening deeply, keenly observing, dedication to self-awareness, and commitment to learning can be particularly helpful in burnout management and surgeon wellness, and in surgical technique, team management, career advancement, and any leadership skill. What if your ability to improve at anything is unique to you? What if your ability to grow is most effective and efficient with a coach who can better understand your uniqueness and guide you in a sequence of deliberate practice and learning? What if the answer to reaching your goals or working through your challenges is coaching? If you and your coach are paying attention to longevity and sustainability, then you must pay attention to all areas of performance improvement, including mental, emotional, and physical practices. CONCLUSIONS High-performance surgeons engage in coaching to maintain or amplify that passion for performance improvement in anything and everything. It does not matter whether you are seeking coaching for juggling the many priorities in your life and practice; dealing with difficult outcomes, litigation, or personal stress; refining a technique or skill; addressing burnout; climbing to the next level of your career; training for or sustaining the marathon of a surgical career; implementing incremental steps or changes; or practicing wellness in your own way. Any way you look at it, coaching and coaching skills can be a positive influence and an avenue to even greater success for surgeons in their life and career.
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27
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Erlich M. Life coaching for doctors. Can J Ophthalmol 2020; 55:4-6. [DOI: 10.1016/j.jcjo.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Carrieri D, Pearson M, Mattick K, Papoutsi C, Briscoe S, Wong G, Jackson M. Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem.
Objectives
Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts.
Design
Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites.
Review methods
We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations.
Results
A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective.
Limitations
Variable quality of included literature; limited UK-based studies.
Future work
Use this evidence synthesis to refine, implement and evaluate interventions.
Study registration
This study is registered as PROSPERO CRD42017069870.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Daniele Carrieri
- College of Medicine and Health, University of Exeter, Exeter, UK
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, UK
| | - Karen Mattick
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Briscoe
- Exeter HSDR Evidence Synthesis Centre, Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Jackson
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
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29
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Chi BH, Belizan JM, Blas MM, Chuang A, Wilson MD, Chibwesha CJ, Farquhar C, Cohen CR, Raj T. Evaluating Academic Mentorship Programs in Low- and Middle-Income Country Institutions: Proposed Framework and Metrics. Am J Trop Med Hyg 2019; 100:36-41. [PMID: 30430978 PMCID: PMC6329356 DOI: 10.4269/ajtmh.18-0561] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A growing number of low- and middle-income country (LMIC) institutions have developed and implemented formal programs to support mentorship. Although the individual-level benefits of mentorship are well established, such activities can also sustainably build institutional capacity, bridge inequities in health care, and catalyze scientific advancement. To date, however, evaluation of these programs remains limited, representing an important gap in our understanding about the impact of mentoring. Without rigorous and ongoing evaluation, there may be missed opportunities for identifying best practices, iteratively improving program activities, and demonstrating the returns on investment in mentorship. In this report, we propose a framework for evaluating mentorship programs in LMIC settings where resources may be constrained. We identify six domains: 1) mentor–mentee relationship, 2) career guidance, 3) academic productivity, 4) networking, 5) wellness, and 6) organizational capacity. Within each, we describe specific metrics and how they may be considered as part of evaluation plans. We emphasize the role of measurement and evaluation at the institutional level, so that programs may enhance their mentoring capacity and optimize the management of their resources. Although we advocate for a comprehensive approach to evaluation, we recognize that—depending on stage and relative maturity—some domains may be prioritized to address short- and medium-term program goals.
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Affiliation(s)
- Benjamin H Chi
- University of North Carolina, Chapel Hill, North Carolina
| | - Jose M Belizan
- Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | | | - Alice Chuang
- University of North Carolina, Chapel Hill, North Carolina
| | - Michael D Wilson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | | | - Craig R Cohen
- University of California Global Health Institute, San Francisco, California.,University of California, San Francisco, San Francisco, California
| | - Tony Raj
- St. John's Research Institute, Bengaluru, India
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Radha Krishna LK, Renganathan Y, Tay KT, Tan BJX, Chong JY, Ching AH, Prakash K, Quek NWS, Peh RH, Chin AMC, Taylor DCM, Mason S, Kanesvaran R, Toh YP. Educational roles as a continuum of mentoring's role in medicine - a systematic review and thematic analysis of educational studies from 2000 to 2018. BMC MEDICAL EDUCATION 2019; 19:439. [PMID: 31775732 PMCID: PMC6882248 DOI: 10.1186/s12909-019-1872-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/13/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Recent studies have gone to great lengths to differentiate mentoring from teaching, tutoring, role modelling, coaching and supervision in efforts to better understand mentoring processes. This review seeks to evaluate the notion that teaching, tutoring, role modelling, coaching and supervision may in fact all be part of the mentoring process. To evaluate this theory, this review scrutinizes current literature on teaching, tutoring, role modelling, coaching and supervision to evaluate their commonalities with prevailing concepts of novice mentoring. METHODS A three staged approach is adopted to evaluate this premise. Stage one involves four systematic reviews on one-to-one learning interactions in teaching, tutoring, role modelling, coaching and supervision within Internal Medicine, published between 1st January 2000 and 31st December 2018. Braun and Clarke's (2006) approach to thematic analysis was used to identify key elements within these approaches and facilitate comparisons between them. Stage two provides an updated view of one-to-one mentoring between a senior physician and a medical student or junior doctor to contextualise the discussion. Stage three infuses mentoring into the findings delineated in stage one. RESULTS Seventeen thousand four hundred ninety-nine citations were reviewed, 235 full-text articles were reviewed, and 104 articles were thematically analysed. Four themes were identified - characteristics, processes, nature of relationship, and problems faced in each of the four educational roles. CONCLUSIONS Role modelling, teaching and tutoring, coaching and supervision lie within a mentoring spectrum of increasingly structured interactions, assisted by assessments, feedback and personalised support that culminate with a mentoring approach. Still requiring validation, these findings necessitate a reconceptualization of mentoring and changes to mentor training programs and how mentoring is assessed and supported.
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Affiliation(s)
- Lalit Kumar Radha Krishna
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, North West Cancer Research Centre, Liverpool, UK.
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore.
- Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Yaazhini Renganathan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kuang Teck Tay
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Jia Yan Chong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ann Hui Ching
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kishore Prakash
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Wei Sheng Quek
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rachel Huidi Peh
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore, Singapore, Singapore
| | | | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, North West Cancer Research Centre, Liverpool, UK
| | - Ravindran Kanesvaran
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Ying Pin Toh
- Department of Family Medicine, National University Health System, Singapore, Singapore
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Schulte EE, Sikon AL, Love L, Simonsen K, Berry A, Agarwal G. Enhancing Physician Wellness Through Coaching: An Occupational Psychiatry Tool. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20191010-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical Trial. JAMA Intern Med 2019; 179:1406-1414. [PMID: 31380892 PMCID: PMC6686971 DOI: 10.1001/jamainternmed.2019.2425] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Burnout symptoms among physicians are common and have potentially serious ramifications for physicians and their patients. Randomized studies testing interventions to address burnout have been uncommon. OBJECTIVE To explore the effect of individualized coaching on the well-being of physicians. DESIGN, SETTING, AND PARTICIPANTS A pilot randomized clinical trial involving 88 practicing physicians in the departments of medicine, family medicine, and pediatrics who volunteered for coaching was conducted between October 9, 2017, and March 27, 2018, at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin. Statistical analysis was conducted from August 24, 2018, to March 25, 2019. INTERVENTIONS A total of 6 coaching sessions facilitated by a professional coach. MAIN OUTCOMES AND MEASURES Burnout, quality of life, resilience, job satisfaction, engagement, and meaning at work using established metrics. Analysis was performed on an intent-to-treat basis. RESULTS Among the 88 physicians in the study (48 women and 40 men), after 6 months of professional coaching, emotional exhaustion decreased by a mean (SD) of 5.2 (8.7) points in the intervention group compared with an increase of 1.5 (7.7) points in the control group by the end of the study (P < .001). Absolute rates of high emotional exhaustion at 5 months decreased by 19.5% in the intervention group and increased by 9.8% in the control group (-29.3% [95% CI, -34.0% to -24.6%]) (P < .001). Absolute rates of overall burnout at 5 months also decreased by 17.1% in the intervention group and increased by 4.9% in the control group (-22.0% [95% CI, -25.2% to -18.7%]) (P < .001). Quality of life improved by a mean (SD) of 1.2 (2.5) points in the intervention group compared with 0.1 (1.7) points in the control group (1.1 points [95% CI, 0.04-2.1 points]) (P = .005), and resilience scores improved by a mean (SD) of 1.3 (5.2) points in the intervention group compared with 0.6 (4.0) points in the control group (0.7 points [95% CI, 0.0-3.0 points]) (P = .04). No statistically significant differences in depersonalization, job satisfaction, engagement, or meaning in work were observed. CONCLUSIONS AND RELEVANCE Professional coaching may be an effective way to reduce emotional exhaustion and overall burnout as well as improve quality of life and resilience for some physicians. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03207581.
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Affiliation(s)
- Liselotte N Dyrbye
- Department of Medicine, Program on Physician Well-Being, Mayo Clinic, Rochester, Minnesota
| | - Tait D Shanafelt
- Department of Medicine, WellMD Center, Stanford School of Medicine, Stanford University, Palo Alto, California
| | | | - Daniel V Satele
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Colin P West
- Department of Medicine, Program on Physician Well-Being, Mayo Clinic, Rochester, Minnesota.,Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
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Sibeoni J, Bellon-Champel L, Mousty A, Manolios E, Verneuil L, Revah-Levy A. Physicians' Perspectives About Burnout: a Systematic Review and Metasynthesis. J Gen Intern Med 2019; 34:1578-1590. [PMID: 31147982 PMCID: PMC6667539 DOI: 10.1007/s11606-019-05062-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/11/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Doctors' burnout is a major public health issue with important harmful effects on both the healthcare system and physicians' mental health. Qualitative studies are relevant in this context, focusing as they do on the views of the physicians of how they live and understand burnout in their own professional field. OBJECTIVE To explore physicians' perspectives on burnout by applying a metasynthesis approach, including a systematic literature review and analysis of the qualitative studies. DATA SOURCES Medline, PsycINFO, EMBASE, and SSCI from the earliest available date to June 2018 REVIEW METHODS: This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting doctors' perspectives on burnout. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them. RESULTS Thirty-three articles were included, covering data from more than 1589 medical doctors (68 residents and 1521 physicians). Two themes emerged from the analysis: (1) stress factors promoting burnout-ranked as organizational, then contextual and relational, and finally individual-factors and (2) protective factors, which were above all individual but also relational and organizational. CONCLUSIONS The individual and organizational levels are abundantly described in the literature, as risk factors and interventions. Our results show that doctors identify numerous organizational factors as originators of potential burnout, but envision protecting themselves individually. Relational factors, in a mediate position, should be addressed as an original axis of protection and intervention for battling doctors' burnout.
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Affiliation(s)
- Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 rue du LTC Prud'hon, 95107, Argenteuil, France. .,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, 75010, Paris, France.
| | | | - Antoine Mousty
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 rue du LTC Prud'hon, 95107, Argenteuil, France
| | - Emilie Manolios
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, 75010, Paris, France.,Service de Psychologie et Psychiatrie de Liaison et d'Urgences, Hôpital Européen Georges Pompidou AP-HP, Hôpitaux Universitaires Paris Ouest, Paris, France
| | - Laurence Verneuil
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, 75010, Paris, France
| | - Anne Revah-Levy
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, 69 rue du LTC Prud'hon, 95107, Argenteuil, France.,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, 75010, Paris, France
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Aggarwal R, Kim K, O'Donohoe J, Kleinschmit K. Implementing Organizational Strategies for Resident Well-being: Practical Tips. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:400-404. [PMID: 30805860 DOI: 10.1007/s40596-019-01045-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/14/2019] [Indexed: 06/09/2023]
Affiliation(s)
| | - Kristen Kim
- Rutgers New Jersey Medical School, Newark, NJ, USA
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Locke R, Lees A. A literature review of interventions to reduce stress in doctors. Perspect Public Health 2019; 140:38-53. [DOI: 10.1177/1757913919833088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: Stress is prevalent among doctors, and interventions are offered, often as part of their continuing professional development, to help doctors learn in the workplace about the recognition, prevention and management of the harmful effects of stress. The aim of this review was to examine existing research to ascertain the features of successful educational interventions with practising doctors and any factors that may affect outcomes. Methods: We searched key databases for papers published between 1990 and 2017 on the themes of stress that included an education-based intervention and practising doctors. Using an inclusive approach to the review, a broad evaluation was made of the primary research using both quantitative and/or qualitative evidence where the study reported a positive outcome in terms of stress management. Results: Review criteria were met in 31 studies of 1,356 originally retrieved. Three broad categories of interventions emerged from the coding process: mindfulness-type ( n = 12), coping and solutions focused (CSF) ( n = 12) and reflective groups ( n = 7). There is evidence that these interventions can be successful to help doctors deal with stress. Based on the results from this review, an original guide is advanced to help educators choose an educational intervention. Conclusion: Although evidence for some interventions may be ‘hierarchically stronger’, it is misleading to assume that interventions can be imported as successfully into any context. Factors such as medical specialty and health care systems may affect which intervention can be used. The guide offers an evidence base on which further research can be built.
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Affiliation(s)
- Rachel Locke
- Senior Researcher, Health and Wellbeing Research Group, University of Winchester, SO22 4NR, Winchester, UK
| | - Amanda Lees
- Senior Researcher, Health and Wellbeing Research Group, University of Winchester, Winchester, UK
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Rosdahl JA, Kingsolver K. An eye center-wide burnout intervention: resilience program and burnout survey. Digit J Ophthalmol 2019; 25:5-11. [PMID: 31080370 DOI: 10.5693/djo.01.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose Burnout affects half of doctors in the United States. Programs to decrease burnout and foster resilience are needed to prevent loss of doctors in the workforce and maintain quality care. To ameliorate burnout at our eye center, we developed a resilience program and used a survey to identify additional groups with higher burnout for future interventions. Methods The eye center-wide resilience program consisted of the baseline burnout survey, short email wellness tips, a grand rounds presentation, short wellness presentations at faculty meetings, and a small group discussion series with clinical faculty. The anonymous burnout survey was performed prospectively online at the beginning of this program. The survey participants consisted of respondents at the Duke Eye Center, including all doctors, scientists, clinical and research staff, trainees, and administrative and educational staff, in June and July of 2017. The short, anonymous electronic survey consisted of 10 demographic questions, 2 validated burnout questions, and 1 validated work-life balance question. Results A total of 593 individuals were invited to participate, of whom 252 completed the survey. Overall, 37% of the respondents reported being emotionally exhausted, and 17% had experienced depersonalization. With regard to work-life balance, 43% of the respondents were satisfied and 34% were dissatisfied. Burnout was higher in respondents who participated in clinical care (P = 0.001), particularly among ophthalmic technicians (P = 0.044). Feedback from the doctors participating in the "Doctors Lounge" suggested perceived benefits, including enhanced collegiality, life skills, and improved self-management. Conclusions Our baseline burnout survey showed higher burnout in our clinical workers, particularly in our ophthalmic technicians. Planning for next year will include the providers identified in the survey.
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Affiliation(s)
- Jullia A Rosdahl
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Karen Kingsolver
- Department of Ophthalmology, Duke University, Durham, North Carolina
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Abstract
Aims and methodThe concept of personal resilience is relevant to physician well-being, recruitment and retention, and to delivering compassionate patient care. This systematic review aims to explore factors affecting personal resilience among psychiatrists, in particular, those that may impair well-being and those that facilitate resilience practice. A literature search was performed of the Ovid®, Embase®, CINAHL and PsycINFO databases, using keywords to identify empirical studies involving psychiatrists that examined resilience, stress and burnout from the past 15 years. RESULTS: Thirty-three international English language studies were included, showing that a combination of workplace, personal and non-workplace factors negatively and positively influenced well-being and resilience.Clinical implicationsGiven that workplace factors were the most commonly cited, it would appear that any resilience package that predominantly targets interventions at the workplace level would be particularly fruitful. Future research, however, needs to address the absence of a universal measurement of well-being and its moderators so that any potential interventions are better evaluated.Declaration of interestNone.
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Interventions to improve resilience in physicians who have completed training: A systematic review. PLoS One 2019; 14:e0210512. [PMID: 30653550 PMCID: PMC6336384 DOI: 10.1371/journal.pone.0210512] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/23/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Resilience is a contextual phenomenon where a complex and dynamic interplay exists between individual, environmental, and socio-cultural factors. With growing interest in enhancing resilience in physicians, given their high risk for experiencing prolonged or intense stress, effective strategies are necessary to improve resilience and reduce negative outcomes including burnout. The objective of this review was to identify effective interventions to improve resilience in physicians who have completed training, working in any setting. METHODS AND FINDINGS We included randomized controlled trials (RCT), and observational studies (including pilot studies) published in English, French, and Spanish that included an intervention to improve resilience in physicians who have completed training. We included studies that implemented interventions to reduce burnout, anxiety, and depression or to improve empathy to ultimately enhance resilience, rather than studies designed solely to reduce stress or trauma-induced stress. We performed a systematic search of Medline, EMBASE, PsychInfo, CINAHL and Cochrane Library with no publication year limit. The last search was conducted on March 29, 2017. We used random effect models to calculate pooled standardized mean differences. Resilience was the primary outcome measure using validated resilience scores. Secondary outcome measures included proxy measures of resilience such as burnout, empathy, anxiety and depression. Our search strategy identified 7,579 records;74 met the criteria for full-text review. Seventeen studies were included in the final review published between 1998 and 2016 of which 9 (4 RCT, 5 observational) had physician data extractable. Interventions varied greatly regarding their approach, duration, and follow-up. Two RCTs measured resilience using validated scales; both found a significant improvement. No meta-analysis for resilience was conducted due to the presence of high clinical and methodological heterogeneity. CONCLUSIONS Our systematic review demonstrates that there is weak evidence to support one intervention over another to improve resilience in physicians who have completed training. The quality of evidence for the outcomes ranged from very low to low. There is a need for a consensus on the definition of resilience and how it is measured. Longer follow-up is required to ensure any intervention effects are sustained over time.
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Oladeji LO, Ponce BA, Worley JR, Keeney JA. Mentorship in Orthopedics: A National Survey of Orthopedic Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2018; 75:1606-1614. [PMID: 29685787 DOI: 10.1016/j.jsurg.2018.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/19/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Mentorship is an important component of graduate medical education. It has been associated with numerous benefits including personal development, increased career satisfaction, and reduced stress and burnout. The purpose of this study was to assess orthopedic resident attitudes regarding mentorship and to determine if there were sociodemographic differences. DESIGN A total of 243 orthopedic surgery residents completed this 25-item mixed response questionnaire. RESULTS Nearly two-thirds of residents conveyed that their training program either had a formal or informal mentorship program, and 95.8% of residents indicated that they believed mentorship played an important role with respect to their development as an orthopedic resident. Minorities were more likely to have a mentor that was obtained while they were in medical school, less likely to have multiple mentors, and more likely to be dissatisfied with the quality of mentorship in residency. Females were more likely to pursue a mentor on their own. Overall, 31% of orthopedic residents were classified as experiencing burnout. There was no difference in the prevalence of mentorship in respondents experiencing burnout, but they were more likely to be unsatisfied with the quality of mentorship in residency. Finally, only two-thirds of residency programs have mentorship programs despite the fact that the vast majority of orthopedic residents believe that the mentorship plays an important role in their development as surgeons. RESULTS Given these findings, future work should focus on identifying and addressing race and sex-based mentorship disparities while simultaneously working to improve access to mentorship for all residents.
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Affiliation(s)
- Lasun O Oladeji
- Missouri Orthopaedic Institute, University of Missouri Columbia, Columbia, Missouri.
| | - Brent A Ponce
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - John R Worley
- Missouri Orthopaedic Institute, University of Missouri Columbia, Columbia, Missouri
| | - James A Keeney
- Missouri Orthopaedic Institute, University of Missouri Columbia, Columbia, Missouri
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Mental health promotion for junior physicians working in emergency medicine: evaluation of a pilot study. Eur J Emerg Med 2018; 25:191-198. [PMID: 27879536 DOI: 10.1097/mej.0000000000000434] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Work-related stress is highly prevalent among physicians working in emergency medicine. Mental health promotion interventions offer the chance to strengthen physicians' health, work ability, and performance. The aim of this study was to implement and evaluate a mental health promotion program for junior physicians working in emergency medicine. METHODS In total, 70 junior physicians working in emergency medicine were randomized to either the mental health promotion program (n=35) or a waitlist control arm (n=35). The training involved 90-min sessions over a time period of 3 months. The primary outcome was perceived stress. The secondary outcomes included emotional exhaustion, emotion regulation, work engagement, and job satisfaction. Self-report assessments for both groups were scheduled at baseline, after the training, after 12 weeks, and 6 months. RESULTS The intervention group showed a highly significant reduction in perceived stress and emotional exhaustion from baseline to all follow-up time points, with no similar effects found in the comparison group. The benefit of the mental health promotion program was also evident in terms of improved emotion regulation skills, job satisfaction, and work engagement. Participating physicians evaluated the training with high scores for design, content, received outcome, and overall satisfaction. CONCLUSION The results suggest that this health promotion program is a promising intervention to strengthen mental health and reduce perceived work stress. It is suitable for implementation as a group training program for junior physicians working in emergency medicine. Comparable interventions should be pursued further as a valuable supportive offer by hospital management.
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Dugani S, Afari H, Hirschhorn LR, Ratcliffe H, Veillard J, Martin G, Lagomarsino G, Basu L, Bitton A. Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review. Gates Open Res 2018; 2:4. [PMID: 29984356 PMCID: PMC6030396 DOI: 10.12688/gatesopenres.12779.3] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.
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Affiliation(s)
- Sagar Dugani
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA.,University of Toronto, Toronto, Canada.,Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Henrietta Afari
- Department of Medicine , Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | - Hannah Ratcliffe
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jeremy Veillard
- The World Bank Group, Washington, D.C., USA.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | | | | | - Lopa Basu
- Armstrong Institute for Patient Safety & Quality, Johns Hopkins University, Baltimore, USA
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA.,Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, USA.,Department of Health Care Policy, Harvard Medical School, Boston, USA
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Dugani S, Afari H, Hirschhorn LR, Ratcliffe H, Veillard J, Martin G, Lagomarsino G, Basu L, Bitton A. Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review. Gates Open Res 2018. [PMID: 29984356 DOI: 10.12688/gatesopenres.12779.1] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.
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Affiliation(s)
- Sagar Dugani
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA.,University of Toronto, Toronto, Canada.,Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Henrietta Afari
- Department of Medicine , Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | - Hannah Ratcliffe
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jeremy Veillard
- The World Bank Group, Washington, D.C., USA.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | | | | | - Lopa Basu
- Armstrong Institute for Patient Safety & Quality, Johns Hopkins University, Baltimore, USA
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA.,Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, USA.,Department of Health Care Policy, Harvard Medical School, Boston, USA
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Babyar JC. They did not start the fire: reviewing and resolving the issue of physician stress and burnout. J Health Organ Manag 2018; 31:410-417. [PMID: 28877620 DOI: 10.1108/jhom-11-2016-0212] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Physician stress and burnout is a serious and common concern in healthcare, with over half of physicians in the USA meeting at least one criterion for burnout. The paper aims to discuss these issues. Design/methodology/approach A review on current state of physician stress and burnout research, from 2008 to 2016, was undertaken. A subsequent perspective paper was shaped around these reviews. Findings Findings reveal research strength in prevalence and incidence with opportunities for stronger intervention studies. While descriptive studies on causes and consequences of physician burnout are available, studies on interventions and prevention of physician burnout are lacking. Future research on physician stress and burnout should incorporate intervention studies and take care to avoid limitations found in current research. Accountability and prevention of physician burnout is the responsibility of the healthcare industry as a whole, and organizational strategies must be emphasized in future research. Originality/value The value of this research comes in the original comprehensive review, international inclusion and succinct summary of physician burnout research and strategies.
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Dugani S, Afari H, Hirschhorn LR, Ratcliffe H, Veillard J, Martin G, Lagomarsino G, Basu L, Bitton A. Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review. Gates Open Res 2018; 2:4. [DOI: 10.12688/gatesopenres.12779.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.
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Lovell B. What do we know about coaching in medical education? A literature review. MEDICAL EDUCATION 2018; 52:376-390. [PMID: 29226349 DOI: 10.1111/medu.13482] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/07/2017] [Accepted: 09/18/2017] [Indexed: 05/26/2023]
Abstract
CONTEXT Coaching has been employed successfully in the competitive sports, professional music, and business and corporate worlds. It is now emerging as a training modality in medical education. OBJECTIVES This paper reviews the current evidence on coaching strategies for doctors and medical students. METHODS An applied literature search was conducted in PubMed, MEDLINE and Web of Science. Predetermined definitions of coaching interventions and their evaluations were used to narrow 993 papers down to 21, which were included in the final review. The 21 papers were critiqued with reference to validated scoring metrics. RESULTS There are many papers discussing the merits of coaching in the world of medicine, but few evaluations of coaching interventions. Existing coaching methodologies can be broadly summarised into three categories: coaching for doctor/student well-being and resilience; coaching for improved non-technical skills, and coaching for technical skills. Identification of suitable papers for inclusion is complicated by theoretical uncertainty regarding coaching: many papers use the term as a synonym for teaching or mentoring. The strongest evidence for coaching lies in the teaching of technical skills. CONCLUSIONS There is weak- to medium-strength evidence to support coaching as a method of improving doctor well-being and enhancing non-technical skills, although the evidence base is limited as a whole. This review identifies strong evidence to support coaching as a method to improve technical skills. There is great scope for further studies investigating the power of coaching in medical students and doctors.
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Affiliation(s)
- Ben Lovell
- Department of Acute Medicine, University College London Hospitals National Health Service (NHS) Foundation Trust, London, UK
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Noah TL, Tolleson-Rinehart S, Meltzer-Brody S, Jordan JM, Kelly KJ, Eimers KM, Burks AW. Application of Assessment Metrics for an Academic Department Faculty Development Program. J Pediatr 2018; 195:5-8.e1. [PMID: 29576182 DOI: 10.1016/j.jpeds.2018.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Sue Tolleson-Rinehart
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; Gillings School of Global Public Health, Chapel Hill, NC
| | - Samantha Meltzer-Brody
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Joanne M Jordan
- Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; Office of the Dean, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Kevin J Kelly
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Kathryn M Eimers
- Office of the Dean, University of North Carolina School of Medicine, Chapel Hill, NC
| | - A Wesley Burks
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; Office of the Dean, University of North Carolina School of Medicine, Chapel Hill, NC
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Niebuhr F, Wilfling D, Hahn K, Steinhäuser J. Coaching aus der Perspektive der Allgemeinmedizin. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2018. [DOI: 10.1007/s11553-017-0636-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Knudsen KB, Boisen KA, Katzenstein TL, Mortensen LH, Pressler T, Skov M, Jarden M. Living with cystic fibrosis - a qualitative study of a life coaching intervention. Patient Prefer Adherence 2018; 12:585-594. [PMID: 29720874 PMCID: PMC5916455 DOI: 10.2147/ppa.s159306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is a chronic, life-shortening disease with a significant treatment burden. To support young adults with CF in their everyday life, we previously conducted a life coaching feasibility trial (published elsewhere). The aim of the current study was to explore how life coaching was experienced by study participants within the context of their lives with CF. METHODS A qualitative study using individual interviews. Respondents (n=14) were recruited from the intervention group after participation in life coaching. Data were analyzed from a phenomenologic-hermeneutical perspective, inspired by Ricoeur's theory. FINDINGS Periodic exacerbations of CF led to worry about disease progression, and interrupted the respondents' ability to fulfill daily life roles satisfactory. The treatment burden demanded self-discipline and this was sometimes at the expense of social life or career. The young adults rarely spoke to others about their situation; therefore, they valued opening up to a professional coach about life and concerns. We identified three themes: 1) living an unpredictable life; 2) the conflict between freedom and the constraints of illness; and 3) the value of telling one's story. In relation to all three themes, coaching promoted reflection over life situations, reframed thoughts, and facilitated finding new ways to manage everyday life. CONCLUSION Life coaching is an intervention that is valued for those who feel challenged by their CF disease. Coaching programs should be designed to include the participants, when they feel a need for coaching and are open for change. Screening parameters to identify persons who will most likely benefit from life coaching are needed.
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Affiliation(s)
- Karin Bæk Knudsen
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
- Correspondence: Karin Bæk Knudsen, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark, Tel +45 3 545 7835, Fax +45 3 545 2975, Email
| | - Kirsten Arntz Boisen
- Department of Pediatric and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Terese Lea Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Tacjana Pressler
- Department of Pediatric and Adolescent Medicine, Cystic Fibrosis Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Skov
- Department of Pediatric and Adolescent Medicine, Cystic Fibrosis Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mary Jarden
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Shanafelt TD, Lightner DJ, Conley CR, Petrou SP, Richardson JW, Schroeder PJ, Brown WA. An Organization Model to Assist Individual Physicians, Scientists, and Senior Health Care Administrators With Personal and Professional Needs. Mayo Clin Proc 2017; 92:1688-1696. [PMID: 29101937 DOI: 10.1016/j.mayocp.2017.08.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/01/2017] [Accepted: 08/22/2017] [Indexed: 11/22/2022]
Abstract
Working as a physician, scientist, or senior health care administrator is a demanding career. Studies have demonstrated that burnout and other forms of distress are common among individuals in these professions, with potentially substantive personal and professional consequences. In addition to system-level interventions to promote well-being globally, health care organizations must provide robust support systems to assist individuals in distress. Here, we describe the 15-year experience of the Mayo Clinic Office of Staff Services (OSS) providing peer support to physicians, scientists, and senior administrators at one center. Resources for financial planning (retirement, tax services, college savings for children) and peer support to assist those experiencing distress are intentionally combined in the OSS to normalize the use of the Office and reduce the stigma associated with accessing peer support. The Office is heavily used, with approximately 75% of physicians, scientists, and senior administrators accessing the financial counseling and 5% to 7% accessing the peer support resources annually. Several critical structural characteristics of the OSS are specifically designed to minimize potential stigma and reduce barriers to seeking help. These aspects are described here with the hope that they may be informative to other medical practices considering how to create low-barrier access to help individuals deal with personal and professional challenges. We also detail the results of a recent pilot study designed to extend the activity of the OSS beyond the reactive provision of peer support to those seeking help by including regular, proactive check-ups for staff covering a range of topics intended to promote personal and professional well-being.
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