Resident burnout in Taiwan Hospitals—and its relation to physician felt trust from patients

The joint impact of burnout and neurotic personality on career satisfaction and intention to leave among health workers during the first 2 years of COVID-19

PURPOSE

The purpose of the study is to examine the psychological impact of COVID-19 on health workers' career satisfaction and intention to leave the health profession, with neurotic personality type as a moderator.

DESIGN/METHODOLOGY/APPROACH

A total of 277 health workers in two public hospitals in Ghana were included in this study. Purposive and convenience sampling techniques were adopted for the study, focusing on eight departments that were involved in the management of COVID-19 cases. Validated instruments were used to measure burnout, intention to leave, neurotic personality and career satisfaction. Using AMOS and partial least squares structural equation modeling (PLS-SEM), various techniques were employed to analyze mediating and moderating mechanisms.

FINDINGS

The departments had staff sizes ranging from 19 to 40, with 67% female and 33% male, with an average age of 31. Nurses accounted for the majority of responses (67.8%), followed by physicians (13.9%), sonographers (0.9%), lab technicians (0.9%) and other respondents (16.5%). The study found that health workers' level of burnout during COVID-19 had a positive effect on their intention to leave the health profession. Career satisfaction does not mediate this relationship; however, career satisfaction negatively influences the intention to leave the health profession. A neurotic personality does not moderate this relationship.

ORIGINALITY/VALUE

This study provides validation of burnout and intention to leave among health workers in Ghana during COVID-19 and supports the proposition that threats to resources (burnout) and having a resource (career satisfaction) have effects on the intention to leave one's profession.

Effects of connection-based physician-patient relationships on perceptions of outcome: A vignette experiment

OBJECTIVES

To investigate the effects of media reports of medical outcomes and connection-based medicine on trust in physicians. In "connection-based medicine," people use personal connections to obtain better medical resources.

METHODS

Vignette experiments were used to investigate attitudes toward physicians among 230 cancer patients and their families (Sample 1) and a cross-validated sample of 280 employees from various industries (Sample 2).

RESULTS

For both samples, negative media reports were associated with lower trust in physicians; when the reports were positive, the participants generally perceived physicians as more competent and trustworthy. However, with negative reports, patients and families perceived connection-based physicians as less right and professional than non-connection-based physicians; the public (represented by the employee sample) perceived connection-based physicians as less right than non-connection-based physicians and negative outcomes to be caused more by connection-based physicians than non-connection-based physicians.

CONCLUSIONS

Medical reports can influence the perception of a physician's traits, which are important for trust. Positive reports promote evaluation of Rightness, Attribution, and Professionalism, whereas negative results may elicit the opposite effect, especially for connection-based physicians.

PRACTICAL IMPLICATIONS

Positive media images of physicians can help facilitate trust. Connection-based medical treatment should be reduced to improve access to medical resources in China.

Exploring Factors Associated With the Work Hours of Attending Physicians Working in Hospitals

BACKGROUND

Long work hours for physicians not only harm the health of physicians, but also endanger patient safety. Compared with resident physicians, attending physicians-especially hospital-employed attending physicians-assume more responsibilities but has not gotten enough attention. The purpose of this study was to explore whether a hospital's geographic location and emergency care responsibility might influence the number of hours worked.

METHODS

The respondents of 2365 attending physicians from 152 hospitals in the 2018 survey of Taiwan physician work hours were used as the data source. The total work hour per week and its components, the regular scheduled shift and three types of on-call shifts, were used as outcome variables. Hospital geographic location and emergency care responsibility were the independent variables. The multilevel random effect model was employed to examine the study objective after adjusting for clinical specialty, hospital teaching status, and ownership.

RESULTS

The average number of total working hours was 69.09 hours per week; the regular scheduled shift was account for 75% of total work hours. The results showed the total work hours were only varied by the level of hospital's emergency care responsibility. However, the results also demonstrated the hours of duty shifts were varied by hospital's geographic location and emergency care responsibility. The results of the multilevel random effect model revealed that the hospital's emergency care responsibility was the factor consistently associated with attending physician's work hour, no matter the total work hours or its composition.

CONCLUSION

In this study, we explored how a hospital's location and its level of emergency care responsibility were associated with physicians' work hours for each type of shift. Our findings offer an opportunity to review the rationality of physician workforce allocation, and financial incentives and administrative measures could be the next steps for balancing the work hours of attending physicians.

Choices of Specialties and Training Sites among Taiwanese Physicians Graduating from Polish Medical Schools

Taiwanese students who graduated from Polish medical schools (P-IMGs) accounted for the second-largest group of international medical graduates in Taiwan. In 2009, domestic medical students in Taiwan staged mass demonstrations against P-IMG’s exemption from the qualifying test before the licensing exam. Although medical circles in Taiwan might still hold prejudices against P-IMGs, little is known about their career development. This study will analyze P-IMGs’ choices of specialties and training sites from 2000 to 2020 using data from the membership section of the Taiwan Medical Journal, the monthly official publication of the Taiwan Medical Association. Of 372 P-IMGs, 34.2% chose internal medicine and 17.1% surgery. Although academic medical centers offered 76% of all available trainee positions in a year, only 49.3% of P-IMGs received training there. By contrast, 20.9% of P-IMGs were trained at nonmetropolitan hospitals that altogether accounted for only 5.8% of trainee positions. In conclusion, P-IMGs had their residency training at less favorable specialties and sites. Their long-term career development deserves further study.

Application of mentorship program for another aspect of surgical residency training: The importance of academia in surgical training

Traditionally, surgical residency training is more focused on obtaining surgical skills through a well-established coaching system worldwide. However, constant advances in medical science require surgeons to learn not only surgical skills but also the ability of scientific research to improve clinical practice and future professional development. The study aims to emphasize that professional education in terms of scientific research is also significant for surgical residency training.All residents who had been recruited in a medical center for the surgery residency program between years 2006 and 2015 were evaluated in the study. Generally, every resident is assigned to a mentor since the first year of residency. Then, the mentor would help the resident qualify a 2-step evaluation in terms of scientific research during the residency training program.A total of 193 residents were evaluated in the study. All of them had completed the first step regarding oral presentation of their designated research, and the majority of residents obtained 80 to 90 points that were rated by referees. Overall, 102 residents (52.8%) had completed the second step with the publication of a research manuscript. The percentage of residents who had fulfilled the criteria of this 2-step assessment ranged from 35.3% to 81.8% by year.The continuing education for surgical residents should not be limited in coaching clinical practice. Scientific research is also essential for current surgical residency training, and a formal mentorship program may be beneficial for the future professional development of surgical residents. However, the success of the 2-step evaluation could possibly depend on the career choices of the residents instead of the mentorship program.

The number and composition of work hours for attending physicians in Taiwan

Long work hours among physicians is a worldwide issue in the healthcare arena. Previous studies have largely focused on the work hours of resident physicians rather than those of attending physicians. The purpose of this study was to investigate total work hours and the composition of those work hours for attending physicians across different hospital settings and across different medical specialties through a nationwide survey. This included examining differences in physician workload and its composition with respect to different hospital characteristics, and grouping medical specialties according to the work similarities. A cross-sectional self-reported nationwide survey was conducted from June to September of 2018, and the two questionnaires were distributed to all accredited hospitals in Taiwan. The number of physician work hours in different types of duty shifts were answered by medical specialty in each surveyed hospital. Each medical specialty in a hospital filled only one response for its attending physicians. The findings reveal that the average total work hours per week of an attending physician is around 69.1 h, but the total work hours and their composition of different duty shifts varied among hospital accreditation levels, geographic locations, emergency care responsibilities, and medical specialties. Because of the variance in the number and composition of attending physicians' work hours, adjusting physician work hours to a reasonable level will be a major challenge for health authority and hospital managers.

Provider burnout: Implications for our perinatal patients

OBJECTIVE

To describe the syndrome of physician burnout within neonatology, its relation to neonatal quality of care, and outline potential solutions.

FINDINGS

Burnout affects up to half of physicians, including up to one-third of neonatologists, at any given time. It is linked to suicidality, substance abuse, and intent to leave practice, and it is strongly associated with reduced quality of care in the published literature. Resilience and mindfulness interventions rooted in positive psychology may reduce burnout among individual providers. Because burnout is largely driven by organizational factors, system-level attention to leadership, teamwork, and practice efficiency can reduce burnout at the level of the organization.

CONCLUSIONS

Burnout is common among neonatologists and consistently relates to decreased quality of patient care in a variety of dimensions. Personal resilience training and system-wide organizational interventions are needed to reverse burnout and promote high-quality neonatal care.

Workplace and community social capital and burnout among professionals of health and welfare services for the seniors: A multilevel analysis in Japan

OBJECTIVE

Despite the potential of the social capital approach in preventing burnout, there is sparse evidence of its contextual effect. This study aimed to reveal the contextual association of workplace and community social capital on burnout among professionals of health and welfare services for seniors in Japan.

METHODS

We collected data from a cross-sectional questionnaire survey for all health and welfare professionals working in Community Comprehensive Support Centers (CCSCs) in the central Tokyo area in 2015. We assessed burnout using the Japanese version of the Maslach Burnout Inventory, which consists of three subscales: emotional exhaustion, depersonalization, and reduced personal accomplishment. We prepared social capital items regarding workplace (the CCSC the participants belonged to) and community (the current catchment area of the CCSC). We aggregated individual responses of workplace and community social capital within each CCSC to create group-level workplace and community social capital indicators.

RESULTS

Among the 1771 questionnaires distributed, we analyzed 1110 from 211 CCSCs. Multilevel analysis showed that higher group-level workplace social capital was significantly associated with lower scores of all three subscales after adjusting for covariates. Moreover, we found a significant association between greater group-level community social capital and lower scores of depersonalization and reduced personal accomplishment.

CONCLUSION

Working in workplaces and communities with higher social capital is related to lower burnout. The findings suggest that strategies to enhance the social capital of their workplace and community would be beneficial in the prevention of burnout among professionals in the field of health and social welfare.

Comparison of occupational burnout scores among medical residents and their correlation with dimensions of TCI questionnaire

Background: The present study was conducted to compare occupational burnout scores and determine their correlation with different dimensions of Temperament and Character Inventory (TCI) questionnaire among psychiatry, internal medicine, and surgery residents during the academic year 2013-14. Methods: In this cross sectional analytical study, 201 residents were recruited. Colinger's 125-item TCI and Maslach's Burnout Inventory were completed by residents. The mean severity of burnout and the mean scores in the subgroups of temperament and character were compared between the 3 groups of residents, and the correlations were calculated. Data were analyzed using SPSS software version 16. Also, A 2-sided p value of less than 0.05 was considered significant. Results: A significant positive correlation was found between severity of burnout and harm avoidance in internal medicine residents (r=0.7, p<0.001). Also, a significant correlation was found between severity of burnout and self-directedness in surgery residents (r=0.5, p=0.003), self-transcendence in internal medicine residents (r=0.04, p=0.009), and persistence in internal medicine (r=0.17, p=0.003) and surgery residents (r=0.10, p=0.004). A significant correlation was found between frequency of burnout and harm avoidance in internal medicine residents (r=0.6, p=0.001), self-directedness in surgery residents (r=0.9, p<0.001), persistence in surgery (r=0.14, p<0.001) and psychiatry residents (r=0.19, p<0.001), and finally self-transcendence in internal medicine residents (r=0.6, p<0.001). Conclusion: Dimensions of character were different among surgery, internal medicine, and psychiatry residents. Likewise, the severity of burnout was different among them according to personality traits. Occupational burnout appears to be less if personality traits match the chosen specialty.

Burnout among postgraduate doctors in Colombo: prevalence, associated factors and association with self-reported patient care

BACKGROUND

Postgraduate doctors are prone to burnout due to occupational and educational stressors. Sri Lankan situation is unknown. This study determines burnout among postgraduate doctors in Colombo: Prevalence, associated factors, and association with self-reported patient care.

METHODS

A cross-sectional study was conducted among 278 postgraduate doctors from eight specialties working in Colombo district, attached to the main postgraduate training institute for medical professionals. A self-administered questionnaire was used. It comprised of the Copenhagen Burnout Inventory and an author-developed questionnaire, which was used to assess, associated factors and self-reported patient care. Prevalence of burnout was calculated. Associations were analysed using chi-square and binary logistic regression.

RESULTS

The response rate was 88.1% (n = 245). The prevalence of personal, work-related and client-related burnout was 41.6% (95% CI = 35.5-47.8%), 30.6% (95% CI = 24.8-36.4%), 8.9% (95% CI = 5.4-12.5%) respectively. Personal burnout was positively associated with, the trainee being a female, having a chronic disease, being involved in frequent unhealthy habits, having doctor parents, having home-work demands and having emotional demands. It was negatively associated with, having frequent healthy habits, being satisfied with skill development opportunities, and frequent use of deep studying. Work-related burnout was positively associated with, female gender, being involved in frequent unhealthy habits, having home-work demands and having emotional demands. It was negatively associated with, frequent use of deep methods of studying. Client-related burnout was positively associated with having emotional demands and negatively associated with being satisfied with training. The frequent self-reported, suboptimal patient-care practices: poor communication, poor clinical practice, poor response to patient's needs and poor communication during handing over were associated positively with client-related burnout.

CONCLUSIONS

Most postgraduate doctors in Colombo have high personal and work-related burnout but client-related burnout is less. The factors associated with burnout need to be addressed by the programme managers of the postgraduate courses. Preventive measures should be introduced to reduce burnout among future postgraduate trainees of Colombo.

Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis

BACKGROUND

Whether health care provider burnout contributes to lower quality of patient care is unclear.

PURPOSE

To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship.

DATA SOURCES

MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science (Clarivate Analytics), with no language restrictions, from inception through 28 May 2019.

STUDY SELECTION

Peer-reviewed publications, in any language, quantifying health care provider burnout in relation to quality of patient care.

DATA EXTRACTION

2 reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias by using the Ioannidis (excess significance) and Egger (small-study effect) tests.

DATA SYNTHESIS

A total of 11 703 citations were identified, from which 123 publications with 142 study populations encompassing 241 553 health care providers were selected. Quality-of-care outcomes were grouped into 5 categories: best practices (n = 14), communication (n = 5), medical errors (n = 32), patient outcomes (n = 17), and quality and safety (n = 74). Relations between burnout and quality of care were highly heterogeneous (I2 = 93.4% to 98.8%). Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor-quality care, 6 indicated burnout related to high-quality care, and 50 showed no significant effect. Excess significance was apparent (73% of studies observed vs. 62% predicted to have statistically significant results; P = 0.011). This indicator of potential bias was most prominent for the least-rigorous quality measures of best practices and quality and safety.

LIMITATION

Studies were primarily observational; neither causality nor directionality could be determined.

CONCLUSION

Burnout in health care professionals frequently is associated with poor-quality care in the published literature. The true effect size may be smaller than reported. Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates.

PRIMARY FUNDING SOURCE

Stanford Maternal and Child Health Research Institute.