Surgical Resident Burnout and Job Satisfaction: The Role of Workplace Climate and Perceived Support

The role of a team psychological safety feeling in teamwork in the classroom

Active cooperation is expected from the student in the education center, which is associated with fears of expressing their opinions, because a possible mistake may result in a negative reaction from the environment. In our research, we investigated the impact of team psychological safety feelings on students' willingness to engage in active learning. 244 students aged 18 and 19 participated in the research. A mixed methods approach was used to obtain the necessary data. By data analysis, we revealed three separate dimensions in respondents' answers to questionnaire items. According to our findings, students' involvement in active learning is strongly supported by their internal motivation to acquire new knowledge and trust in the class collective. A sense of psychological team safety has an important place in encouraging the student to engage in common activities. At the same time, we found that the teacher has a decisive influence on building the student's trust in the class team.

Identifying Novel Inhibitors of Workplace Support and the Importance of Value Congruence and Feeling Valued in General Surgery Residency Training

OBJECTIVE

To explore residents' perceptions of workplace support inhibitors and their relationship to resident wellbeing. We aim to provide evidence-based targets to inform future work operationalizing support in surgical training.

DESIGN

This is a 2-part mixed-methods cross-sectional study. Part 1 analyzed qualitative data from focus groups (April 2021-May 2022). Part 2 comprised an online survey (informed by findings in Part 1, May 2022) to assess the association between perceived workplace support (e.g. feeling valued and value congruence) and poor individual global wellbeing (e.g. languishing).

SETTING

National multi-center study including 16 ACGME-accredited academic programs.

PARTICIPANTS

General surgery residents at all training levels, both clinical and research years.

RESULTS

28 residents participated in the focus groups which revealed three major themes around perceived inhibitors of workplace support: lack of trust in residency program (e.g. ulterior motives), poor communication from leadership (e.g. lack of transparency, ineffective dialogue), and unfair systems in residency training (e.g. exploitation of residents, paternal leave policies). These themes emphasized the importance of feeling valued and value congruence, with the latter reflected in the form of trust and communication with leadership, a key element of worker-workplace alignment. 251 residents responded to the survey (response rate 31%, 50.6% women) which revealed that a lower sense of feeling valued and lower perceived value congruence were significantly associated with languishing.

CONCLUSIONS

Our findings suggest feeling valued and value congruence (specifically, having trust and communication with leadership) are important targets for increasing workplace support in surgical training, offering evidence-based targets for future work to operationalize support in surgical training.

Investigating Workplace Support and the Importance of Psychological Safety in General Surgery Residency Training

OBJECTIVE

Workplace interventions that increase support can mitigate burnout, improve workplace satisfaction, and increase well-being. Our aim is to provide evidence-based targets to inform future work for operationalizing support in general surgery residency.

DESIGN

This is a 2-part mixed-methods cross-sectional study. Part 1 analyzed qualitative data from focus groups (April 2021-May 2022). Part 2 comprised an online survey (informed by findings in Part 1) in May 2022 to assess the association between perceived psychological safety (PS) and flourishing, as well as PS and languishing.

SETTING

National multi-center study including 16 ACGME-accredited academic programs.

PARTICIPANTS

General surgery residents at various training levels, in both clinical and research.

RESULTS

A total of 28 residents participated in the focus groups which revealed both enhancers and inhibitors of support pertaining to PS in the workplace. Enhancers of support included those currently implemented (i.e., allyship of mentors) and those proposed by residents (i.e., nonpunitive analysis of mistakes). Inhibitors of support included both systems (i.e., wellness initiatives as a 'band-aid' for systems issues) and culture (i.e., indefatigability, stoicism). About 251 residents (31%) responded to the survey which revealed higher perception of PS was significantly associated with flourishing at the level of residency program and departmental leadership. Lower perception of PS was significantly associated with languishing at the level of residency program leadership only.

CONCLUSION

Our findings highlight the promotion of PS, such as expansion of mentorship to include advocacy (advocating on a resident's behalf, recognition when mistreated) and affirmation (i.e., soliciting opinions on controversial social matters/events, recognizing different life experiences), cultural acceptance of asking for help (without being perceived as weak), formal help navigating interpersonal dynamics (i.e., guidance from senior residents), and leadership presentations and modeling to destigmatize asking for help, as a means of operationalizing workplace support to increase flourishing and decrease languishing.

Applying augmented reality in teaching of surgical residents-telementoring, a "stress-free" way to surgical autonomy?

BACKGROUND

Achieving surgical autonomy can be considered the ultimate goal of surgical training. Innovative head-mounted augmented reality (AR) devices enable visualization of the operating field and teaching from remote. Therefore, utilization of AR glasses may be a novel approach to achieve autonomy. The aim of this pilot study is to analyze the feasibility of AR application in surgical training and to assess its impact on intraoperative stress.

METHODS

A head-mounted RealWear Navigator® 500 glasses and the TeamViewer software were used. Initial "dry lab" testing of AR glasses was performed in combination with the Symbionix LAP Mentor™. Subsequently, residents performed various stage-adapted surgical procedures semi-autonomously (SA) (on-demand consultation of senior surgeon, who is in theatre but not scrubbed) versus permanent remote supervision (senior surgeon not present) via augmented reality (AR) glasses, worn by the resident in theatre. Stress was measured by intraoperative heart rate (Polar® pulse belt) and State-Trait Anxiety Inventory (STAI) questionnaire.

RESULTS

After "dry lab" testing, N = 5 senior residents performed equally N = 25 procedures SA and with AR glasses. For both, open and laparoscopic procedure AR remote assistance showed satisfactory applicability. Utilization of AR significantly reduced intraoperative peak pulse rate from 131 to 119 bpm (p = 0.004), as compared with the semi-autonomous group. Likewise, subjectively perceived stress according to STAI was significantly lower in the AR group (p = 0.011).

CONCLUSION

AR can be applied in surgical training and may help to reduce stress in theatre. In the future, AR has a huge potential to become a stepping stone to surgical autonomy.

Medical Students' Perspectives on Family Planning and Impact on Specialty Choice

Importance

Physicians are known to delay childbearing compared with nonphysicians and to experience higher rates of age-related pregnancy complications. Delay of childbearing is more pronounced in surgical specialties, and family planning and building goals may influence specialty choice.

Objective

To assess medical students' perspectives on the development of family planning goals and the timing of family building within a medical career to elucidate how these perceptions impact their choice of specialty.

Design, Setting, and Participants

This qualitative study included fourth-year medical students at the University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada, and was conducted between May and August 2021. Participants were purposively sampled to maximize diversity of gender and specialty choice. Interviews were conducted via videoconferencing software that were recorded, transcribed verbatim, and verified for accuracy. Thematic analysis was completed independently by 2 researchers and consensus on final themes was reached through discussion among study investigators. Data were analyzed between September and December 2021.

Main Outcomes and Measures

Participants were asked to share their perceptions of personal family planning goals, support currently in place, family planning education in medicine and factors contributing to their choice of specialty and program. Thematic analysis was completed.

Results

A total of 34 fourth-year medical students (median [range] age, 26 [24-33] years; 23 females [67.6%]) were interviewed. Four main themes were identified: (1) there is no ideal time to family build in a medical career, (2) family planning is a taboo topic, (3) surgical specialties offer less support for family building, and (4) residents who have children are perceived to place a burden on their colleagues. Medical students considered their family planning while deliberating among specialty choices and their experiences were highly influential in shaping their specialty selection.

Conclusions and Relevance

Results of this qualitative study suggest that medical students perceive that family building during training may have unfavorable implications for team dynamics and relationships with colleagues, and these perceptions may affect specialty choice and family planning goals. Integration of family planning discussions and support for family building into medical curricula is needed along with efforts to improve culture by supporting team dynamics and workload when students take parental leave.

Perceived and Received Support by Academic Medicine Faculty During the COVID-19 Pandemic: A Single Institution Study

OBJECTIVE

The COVID-19 pandemic negatively impacted healthcare worker well-being, leading to increased burnout and decreased workplace engagement. To combat expected stressors from the pandemic, our mid-sized academic health center implemented numerous institutional support, such as town halls, and virtual support groups. This study aimed to evaluate faculty utilization of institutional support, its association with perceived organizational support, received organizational support, and burnout.

METHODS

A retrospective, cross-sectional survey was distributed to 630 faculty employed at our institution in September 2020, assessing participant demographics, institutional support utilized, perceived organizational support, and burnout, through a combination of self-report measures and qualitative responses.

RESULTS

A total of 79 (12.5%) faculty provided complete responses and were included in the analysis. Qualitative analysis identified 4 primary themes: (1) flexibility and adjusted expectations, (2) direct communication, (3) sense of community, and (4) no support felt, with additional subthemes within each larger theme. Increased utilization of institutional support was associated with decreased odds of experiencing burnout.

CONCLUSION

Flexibility, communication, and sense of community emerged as important strategies for maintaining faculty well-being and engagement during the early stages of the COVID-19 pandemic. This study suggests that utilization of workplace support is protective against burnout. Perceived support was not beneficial.

Rural health care worker wellness during COVID-19: Compassion fatigue, compassion satisfaction & utilization of wellness resources

OBJECTIVE

The goal of this study was to identify factors associated with compassion fatigue (CF) and compassion satisfaction (CS) among rural health care workers (HCWs) during the COVID-19 pandemic. The secondary purpose was to assess utilization of wellness resources and preferences for new resources.

METHODS

A survey was distributed (October-December 2020) and completed by faculty, clinicians and staff (n = 406) at a rural university. Measures included a modified version of the Professional Quality of Life Scale (PROQOL-21), the Patient Health Questionnaire-4 and the Brief Resilience Coping Scale. Respondents reported their use of wellness resources and their preferences for new resources.

RESULTS

The mean CF score was 21.1, the mean CS score was 26.8 and 42.0% screened positive for depression or anxiety. Few of the existing wellness resources were utilized and respondents' preferences for new wellness resources included time off (70.7%), onsite food trucks (43.0%) and support animals (36.5%). Younger age, depression and anxiety were associated with higher CF. Older age, better mental health and resilience were associated with higher CS.

CONCLUSIONS

Rural HCWs have high CF, yet few utilize wellness resources. Rural health care organizations may foster wellness by providing time off for self-care, expanding mental health services and building resilience.

Supervision, scheduling, satisfaction and shared working: how experiences of junior doctors relate to excess mortality within the NHS

BACKGROUND

We sought to explore associations between trainee doctor perception and excess patient mortality.

METHODS

Data from two publicly available databases reflecting mortality and components of trainee satisfaction within 81 NHS healthcare institutions between the years 2012 and 2019 were analysed. Pearson's correlation coefficients were calculated.

RESULTS

All domains of trainee perception were correlated with excess mortality. Clinical supervision out of hours (R=-0.44; p<0.0001), teamwork (R=-0.36; p<0.0001) and clinical supervision at any time (R=-0.35; p<0.0001) were most strongly correlated. Most associations remained consistent year on year.

CONCLUSION

Trainee doctor perceptions of clinical supervision, rota design and teamwork within the NHS are consistently correlated with excess patient mortality. Further exploration of these associations could identify opportunities for interventions to reduce excess patient mortality. Given the clinical significance of our findings, organisations should consider rapid implementation of evidence-based interventions where they exist.

A questionnaire for quality control in postgraduate medical education in Switzerland

BACKGROUND

To ensure high qualification standards in medical institutions, a questionnaire has been developed to evaluate the postgraduate medical education in Switzerland.

AIM

This article describes the development and longitudinal analysis of a questionnaire using eight scales to assess the quality of postgraduate medical education.

METHOD

The questionnaire has been administered to all residents every year since 2003. In 2020, 8,745 residents returned the questionnaire, resulting in a response rate of 70%. In addition, a survey is conducted annually among the directors of medical institutions.

RESULTS

We present results of the directors' survey and the resident evaluation from 2020, as well as longitudinal data over 16 years. The mean values of the eight scales remained stable or increased slightly over the years. The decision-making culture scale is generally rated best by the residents, while the evidence-based medicine scale is rated as the least good. The most important drivers of residents' satisfaction with a training site are the work environment and leadership culture scales. The directors perceive the evaluation to be fair and useful.

CONCLUSIONS

The questionnaire represents a reliable and useful tool for the quality control in postgraduate medical training. It provides yearly feedback to the directors regarding how the residents perceive their training giving insights for improvments.

Satisfaction and attrition in Canadian surgical training program leadership: a survey of program directors

BACKGROUND

Surgical program directors (PDs) play an integral role in the well-being and success of postgraduate trainees. Although studies about medical specialties have documented factors contributing to PD burnout, early attrition rates and contributory factors among surgical PDs have not yet been described. We aimed to evaluate Canadian surgical PD satisfaction, stressors in the role and areas institutions could target to improve PD support.

METHODS

We administered a cross-sectional survey of postgraduate Canadian surgical PDs from all Royal College of Physicians and Surgeons of Canada accredited surgical specialties. Domains we assessed included PD demographics and compensation, availability of administrative support, satisfaction with the PD role and factors contributing to PD challenges and burnout.

RESULTS

Sixty percent of eligible surgical PDs (81 out of 134) from all 12 surgical specialties responded to the survey. We found significant heterogeneity in PD tenure, compensation models and available administrative support. All respondents reported exceeding their weekly protected time for the PD position, and 66% received less than 0.8 full-time equivalent of administrative support. One-third of respondents were satisfied with overall compensation, whereas 43% were unhappy with compensatory models. Most respondents (70%) enjoyed many aspects of the PD role, including relationships with trainees and shaping the education of future surgeons. Significant stressors included insufficient administrative support, complexities in resident remediation and inadequate compensation, which contributed to 37% of PDs having considered leaving the post prematurely.

INTERPRETATION

Most surgical PDs enjoyed the role. However, intersecting factors such as disproportionate time demands, lack of administrative support and inadequate compensation for the role contributed to significant stress and risk of early attrition.

Navigating the Ophthalmology & Urology Match with a Significant Other

OBJECTIVE

Medical students with a significant other in medical school face challenges when applying for residency as they attempt to match in proximity to their partner. The National Resident Matching Program (NRMP) offers a Couples Match to aid such applicants. This system is not available for ophthalmology and urology because these specialties utilize match systems outside the NRMP and have an early match timeline. The purpose of this study is to analyze usage of the Couples Match and assess ophthalmology and urology applicant viewpoints on the Couples Match system.

DESIGN & SETTING

First, NRMP data on the Couples Match from 1987 to 2021 was reviewed. Second, an online survey was sent to 559 ophthalmology and 321 urology applicants to The Johns Hopkins University School of Medicine in the 2021 match cycle.

PARTICIPANTS

342 ophthalmology and urology applicants (39% response rate).

RESULTS

There is increased usage of the Couples Match over time. In response to the survey, 89% of participants agreed that a Couples Match should be implemented in their specialty. 107 (31%) had a significant other in medicine. 78% of 68 respondents whose significant other also applied in 2021 reported that they would have used the Couples Match had it been available. 21% of those with a significant other considered not applying to ophthalmology or urology because there was no Couples Match. There are mixed responses regarding whether the early match timeline is beneficial to couples. Female applicants were more likely to report hesitancy about mentioning a significant other during the application process.

CONCLUSIONS

The Couples Match is highly desired by applicants to ophthalmology and urology, and the lack of such a system is a deterrent to pursuing these fields. Future studies will help elucidate how the match system can be leveraged to aid individuals applying with a significant other.

Structural equation modelling analysis on relationships of job demands and resources with work engagement, burnout and work ability: an observational study among physicians in Dutch hospitals

OBJECTIVE

To investigate to what extent work engagement mediates the relationships of job resources with work ability, and to what extent burnout mediates the relationships of job demands and resources with work ability.

DESIGN

Multicentre observational study.

SETTING

Academic and non-academic hospitals in the Netherlands.

PARTICIPANTS

Physicians (n=385) participated in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

We measured work ability with selected items from the validated Questionnaire of Experience and Evaluation of Work 2.0 (QEEW V.2.0), work engagement with the Utrecht Work Engagement Scale and burnout with the exhaustion subscale of the Oldenburg Burnout Inventory. The job demand 'workload' and job resources 'development opportunities', 'participation in decision-making', 'inspirational leadership' and 'relationships with colleagues' were measured using the QEEW V.2.0. The job demand 'bureaucratic burden' was measured with the Three Item Red Tape scale. A structural equation model was built to answer our research question.

RESULTS

Work engagement mediated relationships of job resources with physicians' work ability, and burnout mediated relationships of job resources and demands with work ability. Development opportunities (β=0.39, SE=0.12, p<0.001), participation in decision-making (β=0.18, SE=0.08, p=0.028) and relationships with colleagues (β=0.19, SE=0.19, p=0.002) were positively related to work engagement. Development opportunities (β=-0.20, SE=0.08, p=0.004) were negatively related and workload (β=0.51, SE=0.19, p<0.001) was positively related to burnout. Work engagement (β=0.22, SE=0.04, p<0.001) was positively related and burnout (β=-0.56, SE=0.06, p<0.001) was negatively related to work ability.

CONCLUSIONS

Physicians' work engagement and burnout mediated the relationships of various job demands and resources with their work ability. More work-engaged and less burned-out physicians reported better work ability. Hospitals may attenuate excessive workloads and facilitate development opportunities, participation in decision-making and good collegial relationships to enhance physicians' occupational well-being and performance.

Assessing burnout among Obstetrics & Gynecology residents during night float versus day float in a large academic hospital

BACKGROUND

The prevalence estimates of burnout among residents vary widely. Resident physicians working overnight have additional stressors and therefore, may be at higher risk of developing burnout.

OBJECTIVE

To determine the rates of burnout among residents working night rotations versus day rotations.

METHODS

This is a prospective, cross sectional, survey-based assessment of the prevalence of burnout among Obstetrics and Gynecology (OBGYN) residents on nights versus days rotations conducted at a large academic residency program that spans two separate hospitals in New York. All residents in the residency program were asked to complete the Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS (MP)) after the first rotation of the academic year in 2018, 2019, and 2020. The results for each of the three aspects of the MBI-HSS (MP): emotional exhaustion, depersonalization, and personal accomplishment, were then compared for those on nights versus day rotations using students t-test.

RESULTS

A total of 76 responses were received, 13 from residents on night rotations and 63 from residents on day rotations with a response rate of 61.8%. Comparing resident responses for a night versus day rotation, the residents averaged a low level of emotional exhaustion (a score of 17 ± 9) on day shift, compared to a moderate level of emotional exhaustion (a score of 18 ± 14) on nights (p = 0.37). Similarly, 55.6% of respondents reports low personal accomplishment on days, compared to 76.9% while on nights.

CONCLUSIONS

Emotional exhaustion scores were lower for residents on daytime rotations (mean score 17, SD 9), compared to those on nights rotations (mean 18, SD 14). Although there was no difference in depersonalization when comparing the day and night shift, 45% of the responses indicated high levels of depersonalization regardless of the type of shift. These results highlight the need to continue efforts to minimize burnout in medical training.

Invisible Work: Advanced Practice Providers' Role in the Education of Surgeons

OBJECTIVE

As the composition and work of surgical teams evolve, the role of advanced practice providers (APPs) has expanded. We explored how APPs influence the training experience of surgeons from the perspectives of faculty, residents, and APPs.

DESIGN

Qualitative data were obtained from semi-structured open-ended interviews. A codebook was developed blending deductive and inductive logics. Dyads independently coded the transcripts using a constant comparative approach; differences were reconciled by consensus.

RESULTS

During 2-day site visits to 15 general surgery programs, 393 individual and small focus group interviews were conducted with residents, faculty, staff, and program leadership. Forty transcripts representing 51 interviewees (15 APPs, 23 residents, 13 faculty) were collected. We identified 4 major themes:¹ APP as Educator: APPs play a significant role in resident education to ensure seamless patient care while allowing trainees room for clinical growth.² Canary in the Coal Mine: APPs often are the first to notice a surgical trainee's mood and provide support to improve wellness.³ Division of Labor: Distribution of clinical workload has a direct impact on surgical trainees' educational experience and APP job satisfaction.⁴ Second-Class Citizen: APPs described experiences in which their expertise was disrespected, and their contributions were unrecognized.

CONCLUSIONS

APPs have an active and essential role in the well-being and education of surgeons during training. Surgical residency programs and hospitals have an opportunity to decrease the "invisibility" of the work of APPs through increased recognition of these roles and elevation of APP expertise through formal career development pathways.

Educational Experience Impacts Wellness More than Hours Worked

OBJECTIVE

The Accreditation Council for Graduate Medical Education has focused its interests on resident wellbeing and the clinical work environment in recent years. Concerns regarding both duty hours as well as service obligations versus education resulted in programs nationwide receiving citations, including ours. This study aimed to evaluate the impact of those 2 factors on surgical residents' general wellbeing, hypothesizing that service obligations would be a stronger predictor.

DESIGN

We have previously reported on the use of a "Fuel Gauge" tool developed at our institution for monitoring resident wellbeing. We performed a retrospective comparison of prospectively collected cross-sectional survey data comparing the Fuel Gauge to a bimonthly "Service Versus Education" (SVE) report. This report used similar scaling and allowed residents to provide feedback on the balance of the educational quality of their current rotation in comparison to their perception of service obligation. Pearson's correlation was then used to compare those scores with duty hour logs to determine if a relationship could be identified between the 3 measurements.

SETTING

Academic institution of the University of Texas Southwestern in Dallas, Texas.

PARTICIPANTS

Active general surgery residents (n = 73).

RESULTS

During the study period, 73 residents filled out both a Fuel Gauge assessment and a SVE assessment at least once, with 273 complete data points available for analysis. Our program's Fuel Gauge median was 4, and our program's median SVE score was 4. Fuel Gauge assessment scores demonstrated a moderate positive correlation with SVE (r = 0.65, p < 0.001), while only a weakly negative association with increasing hours worked (r = -0.15, p = 0.015). SVE also demonstrated a weak negative correlation with hours logged (r = -0.225, p = 0.001).

CONCLUSIONS

While the Accreditation Council for Graduate Medical Education recognizes that multiple factors contribute to resident wellbeing issues, early efforts were focused on limiting excessive duty hours. Examining our institutional data regarding the previously understudied factor of SVE, we indeed found a stronger correlation with resident perception of low educational value rather than excessive work hours contributing to lower Fuel Gauge scores. These data, if verified, should guide program directors in identifying other institutional factors that may more strongly contribute to their own culture of resident wellness.

Learning Environment is the Prevailing Factor in Surgical Residents' Favorite Rotations

OBJECTIVE

Understand the characteristics of residents' favorite rotations to improve the ability of educators to maximize positive learning experiences.

DESIGN

Novel cross-sectional survey developed through thematic analysis of focus groups with residents using 4-point Likert scales ranked from "Not at all important" to "Extremely important."

SETTING

Single university-affiliated urban hospital PARTICIPANTS: Clinical surgical residents BACKGROUND: Resident assessments of learning experiences vary between rotations leading to the development of "favorite" rotations.

MATERIALS AND METHODS

A novel survey instrument containing 31 characteristics divided into 4 thematic categories was developed following analysis of surgical resident focus groups. Clinical surgical residents were asked how important each characteristic was for determining their favorite rotation on a 4-point Likert Scale from "not at all important" to "extremely important." Two-sided independent sample T-tests were used.

RESULTS

The response rate was 59% (33/56) with proportional representation of postgraduate levels. Overall, 67% (22/33) of residents reported their favorite rotation was in their preferred specialty, 70% (23/33) reported their favorite rotation required >70 hours per week in the hospital, and 97% (32/33) of residents reported their favorite rotation required <2 days of clinic. Overall, the average ranking of the categories from most to least important was content (mean = 2.84, SD = 0.48), learning environment (mean = 2.67, SD = 0.57), working environment (mean = 2.38, SD = 0.56), and accomplishment (mean = 2.31, SD = 0.57). The only category with a statistically significant difference between junior and senior resident was content with seniors ranking it most important (mean = 3.35, SD = 0.93) compared to junior residents who ranked it least important (mean = 2.21, SD = 1.25), p = 0.01. Personal characteristics such as "Attendings cared about my learning" (mean = 3.56, SD = 0.50) and "I felt good at my job" (mean = 3.45, SD = 0.67), tended to be more important than structural characteristics such as "call schedule" (mean = 2.71, SD = 0.86), "formal didactics" (mean = 2.67, SD = 1.04), and "work-life balance" (mean = 2.70, SD = 0.99).

CONCLUSIONS

This study demonstrates a novel understanding of the factors that contribute to resident preferences for certain rotations. Junior and senior residents attribute importance differently, which may provide the basis for level-appropriate improvements. Personal factors tended to be more contributory than structural factors, highlighting additional dimensions to examine when considering how to optimize certain rotations.

A National Mixed-Methods Evaluation of General Surgery Residency Program Responsiveness and the Association with Resident Wellness

INTRODUCTION

Resident burnout is highly prevalent in general surgery. Burnout is increasingly recognized as a symptom of an unsupportive workplace. The objectives of this study were to describe resident perceptions of program responsiveness and to identify associated factors.

METHODS

We used a convergent mixed-methods design. A cross-sectional survey was administered to all U.S. general surgery residents following the 2020 ABSITE, querying resident perceptions of their learning environment (including program responsiveness), burnout, thoughts of attrition and suicide, and career satisfaction. Multivariable logistic regression models adjusting for program/resident characteristics assessed associations of program responsiveness with aspects of the learning environment and resident wellness. 366 interviews and 27 focus groups with residents and faculty were conducted during in-person visits to 15 residency programs. Transcripts were analyzed thematically using inductive and deductive logics until thematic saturation was achieved.

RESULTS

Of the 7233 clinically active residents from 323 programs who completed the survey (85.5% response rate), 5256 had data available for all outcomes of interest. 72.1% (n = 3791) reported satisfaction with program responsiveness. These residents were significantly less likely to report 80-hour workweek violations (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.18-0.26), burnout (OR 0.47, 95% CI 0.41-0.53), thoughts of attrition (OR 0.32, 95% CI 0.27-0.38), and suicidality (OR 0.52, 95% CI 0.41-0.65). They were significantly more likely to report satisfaction with career choice, personal life, and work-life balance (all p < 0.001). Factors associated with improved perception of program responsiveness included larger program size (50+ vs. <23 residents; OR 1.48, 95% CI 1.01-2.19), having faculty mentorship (OR 2.64, 95% CI 2.22-3.14), having meaningful input into call and vacation schedules (OR 3.31, 95% CI 2.74-4.00), and feeling comfortable speaking up (OR 4.20, 95% CI 3.47-5.09). We conducted a qualitative analysis to identify the following components of program responsiveness: (1) core values reflecting a shared understanding of the importance of resident voice in shaping the training experience and the program, including mutual trust and respect between residents and faculty, transparency and communication, resident unity, and resident participation in and ownership of program improvement; (2) structural constructs that reflect and support responsiveness; (3) mechanisms for supporting resident agency, including resources and leadership support, faculty advocacy, and resident leadership opportunities.

CONCLUSION

Program responsiveness in surgical residency is associated with improved resident wellness. Programs should develop formal channels to elicit and concretely address resident concerns, provide opportunities for resident representation, and entrust residents with the flexibility and autonomy to make decisions that support their own education and wellness.

Comprehensive Assessment of Burnout Among Surgical Trainees and Practicing Surgeons: A Systematic Review

OBJECTIVE

Surgeon burnout has received increasing attention due to evidence of high prevalence across specialties. We aimed to (1) systematically characterize existing definitions of burnout, (2) evaluate tools to measure burnout, and (3) determine risk factors of surgical burnout.

DESIGN

PubMed, Google Scholar, and Embase databases were searched to identify burnout rates and tools used to measure the quality of life (QoL) published from January 2000-December 2021.

PARTICIPANTS

Surgical Trainees and Practicing Surgeons.

RESULTS

We identified 39 studies that defined surgical burnout, with 9 separate tools used to measure QoL. Surgeon burnout rates were found to be highest among general surgery trainees (20%-95%). Burnout among general surgery attendings ranged from 25% to 44%. Those most likely to experience burnout were younger and female. High rates of surgeon burnout were reported among all surgical specialties; however, these rates were lower than those of general surgeons.

CONCLUSION

Definitions of burnout vary throughout the surgical literature, but are consistently characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. The most utilized tool to measure surgical burnout has been the Maslach Burnout Inventory. Across specialties, there are high rates of burnout in both surgical trainees and attendings, indicating that this is a systemic issue within the field of surgery. Given the wide-scale nature of the problem, it is recommended that institutions provide support to surgical trainees and attending surgeons and that individual surgeons take steps toward mitigating burnout.

Associations between kindergarten climate and retention intention of kindergarten teachers: The chain mediating roles of perceived organizational support and psychological empowerment

Kindergarten climate has been reported to be closely associated with teachers' retention intention, yet the underlying mechanism of this association remains unclear in some ethnic minority areas in China. Based on the Personal-Environment Fit Theory and Organizational Support Theory, the research aims to examine the correlation between kindergarten climate and retention intention of Chinese kindergarten teachers in ethnic minority areas and the chain mediating role of perceived organizational support, as well as the psychological empowerment. In total, 1,199 Chinese kindergarten teachers were recruited from ethnic minority areas to complete the questionnaires. Based on their responses, the main findings of the study were listed as follows: (1) A supportive kindergarten climate has a positive correlation with perceived organizational support, psychological empowerment, and retention intention. (2) A positive kindergarten climate would increase the retention intention only through the indirect path of perceived organizational support, psychological empowerment, as well as the chain mediating path between these two variables. Taken together, these results further explained the interplay between kindergarten climate and teachers' retention intention. Implications for research on retention intention were discussed. Theoretically, it enriches the theoretical basis related to the external environmental resources and individual cognition. Practically, it means that educational policymakers will need to issue new guidelines to ensure that more kindergarten teachers are retained in China's ethnic minority areas.

Factors Associated With Burnout in Physical Medicine and Rehabilitation Residents in the United States

OBJECTIVES

The aims of the study were to determine the prevalence of burnout in physical medicine and rehabilitation residents in the United States and to identify the personal- and program-specific characteristics most strongly associated with residents reporting burnout.

DESIGN

This was a cross-sectional survey of US physical medicine and rehabilitation residents. Emotional exhaustion, depersonalization, and burnout were assessed using two validated items from the Maslach Burnout Inventory. Associations of burnout with demographics and personal factors, residency program characteristics, perceived program support, and work/life balance were evaluated.

RESULTS

The survey was completed by 296 residents (22.8%), with 35.8% of residents meeting the criteria for burnout. Residents' perception of not having adequate time for personal/family life was the factor most strongly associated with burnout (χ2 = 93.769, P < 0.001). Residents who reported inappropriate clerical burden and working more than 50 hrs/wk on inpatient rotations were most likely to report that they did not have adequate time for personal/family life. Faculty support (χ2 = 41.599, P < 0.001) and performing activities that led residents to choose physical medicine and rehabilitation as a specialty (χ2 = 93.082, P < 0.001) were protective against burnout.

CONCLUSIONS

Residents reporting having inadequate time for their personal/family life was most strongly associated with physical medicine and rehabilitation resident burnout, although many personal and program characteristics were associated with burnout.

Considerations for a Holistic Model in Evaluating Medical Students for Cardiothoracic Surgical Residency

Program directors are tasked with selecting whom they think will be the best fit for residency and the next leaders of the field. While numerical metrics have played a vital role in this process, recent changes to student evaluation are reducing the availability of these metrics. This poses unique challenges for both applicants and program directors. Here we discuss how this will likely shift the focus on other parts of the application and the consequences (good and bad) of doing so.

How Perceived Organizational Support, Identification with Organization and Work Engagement Influence Job Satisfaction: A Gender-Based Perspective

The main objective of this study is to analyze the effects of work engagement, identification with an organization and perceived organizational support on job satisfaction and how these issues vary with gender. Data were collected in a public higher education institution with a questionnaire applied to professors and support staff. The data collected from the 171 employees allowed the development of a structural equation model. The results suggest that work engagement constructs have a greater effect on job satisfaction for female employees, whereas the impact of perceived organizational support on job satisfaction is stronger for male workers. The analysis also revealed that identification with the organization does not influence job satisfaction differently in terms of gender. The findings of this study contribute to the body of empirical knowledge on how the influence of factors on job satisfaction, such as engagement at work, perceived organizational support and identification with the organization, varies by gender.

Supervisors' transformational leadership style and residents' job crafting in surgical training: the residents' views

Objectives

This study aims to explore the effects of three supervisors' leadership styles (transformational, transactional, and laissez-faire) on residents' job crafting.

Methods

Sequential explanatory mixed-methods. First, a purposive sample of residents rated the leadership style of their supervisors and their own job crafting on the Multifactor Leadership Questionnaire and the Dutch Job Crafting Scale. The effects were tested through linear mixed effects regression analysis. Thereafter we conducted semi-structured interviews with residents and conducted a thematic analysis.

Results

A total of 116 residents participated. A transformational style had a positive effect on residents' job crafting (b = .19, t(112) =3.76, p=. 009), whereas the transactional and laissez-faire styles did not. This could be explained by the fact that residents felt a positive influence of the supervisors with such style on the atmosphere for training, on the job resources available to them, and on their modelling function for how to handle the demands of the environment.

Conclusions

A transformational style of the supervisor has a positive effect on residents' job crafting. Future research should explore the supervisors' perspective, as well as the effectiveness of leadership training for supervisors with a focus on resident outcomes, such as job crafting.

Work-life enablers for job satisfaction in healthcare: moderating role of organization type

Purpose

This paper aims to examine how the quality of work-life (QWL) factors influence job satisfaction and tests if organization type moderates this relationship.

Design/methodology/approach

The study adopts a quantitative cross-sectional research design using survey administration among resident doctors used in the Indian health-care sector. Drawing on the person-environment fit theory, leader-member exchange theory and action learning theory, the authors discuss the results.

Findings

Results depicted that in addition to the direct relationship between QWL and job satisfaction, this association is moderated by organization type.

Practical implications

The study provides critical information for health-care managers to prioritize three QWL attributes, namely, meaningful development, supervision, working conditions to enhance job satisfaction among resident doctors.

Originality/value

The study contributes to the limited empirical scholarly research adding a deeper understanding of pertinent factors influencing resident doctor’s QWL-job satisfaction relationship.

BEST of Surgical Training: the pan-London Core Surgical Training induction programme: "There's no I in team, but there is a me."

BACKGROUND

In the UK, Core Surgical Training (CST) marks the start of a surgical career, but previous experience and skills vary widely. Whilst Individual hospital Trusts offer local inductions, these are generally of a generic, administrative nature rather than advising trainees on how best to harness training opportunities. We designed a regional induction programme, 'Building Excellence in Surgical Training' (BEST) to address this, develop essential technical and non-technical skills, and engender support networks.

METHODS

All incoming London Core Surgical Trainees (annual cohort size 90) were invited to participate, during the week prior to commencement of training. Trainees undertook 3 modules (portfolio, surgical skills and human factors-based simulation) and a research paper presentation day. We collected qualitative and quantitative data through a structured evaluation form, pre and post course Likert-scale scores and self-assessment utilising the non-technical skills for surgeons (NOTSS) framework.

RESULTS

972 CSTs have completed BEST over the past 12 years. In 2019, significant improvements were seen in: confidence for starting CST, 45% (n = 22/49)-83% (n = 33/40,p = 0.00045); feeling the core programme cared about them, 55% (n = 27/49)-98% (n = 41/42, p =< 0.00001); getting to know peers 16% (n = 8/49)-88% (n = 35/40, p =< 0.00001); understanding human factors 82% (n = 40/49)-95% (n = 36/38, p = 0.00427); gaining confidence of trainers, 49% (n = 23/47)-86% (n = 31/36, p = 0.00114), and ability to speak out over patient safety concerns, 78% (n = 38/49)-97% (n = 37/38,p = 0.00019). NOTSS assessments showed significant improvement across all 4 criteria (n = 142, p =< 0.00001).

CONCLUSION

BEST equips trainees with the fundamental skills and confidence to safely embark on surgical training and provides tools to navigate the challenges training presents. The ethos of collaboration and support will aid the development of more resilient and empowered surgeons, vital in this era.

A Scoping Review of Burnout in Neurosurgery

BACKGROUND

Burnout is a negative workplace syndrome of emotional exhaustion, cynicism, and perceived professional inefficacy that risks the patient-provider relationship, patient care, and physician well-being.

OBJECTIVE

To assimilate the neurosurgical burnout literature in order to classify burnout among domestic and international neurosurgeons and trainees, identify contributory factors, and appraise the impact of wellness programs.

METHODS

A scoping review identified the available literature, which was reviewed for key factors related to burnout among neurosurgeons. Two researchers queried PubMed, Embase, Google Scholar, Cochrane, and Web of Science for articles on burnout in neurosurgery and reduced 1610 results to 32 articles.

RESULTS

A total of 32 studies examined burnout in neurosurgery. A total of 26 studies examined prevalence and 8 studies detailed impact of wellness programs. All were published after 2011. Burnout prevalence was measured mostly through the Maslach Burnout Inventory (n = 21). In 4 studies, participants defined their own understanding of "burnout." Domestically, burnout prevalence was 11.2% to 67% among residents and 15% to 57% among attendings. Among trainees, poor operative experience, poor faculty relationships, and social stressors were burnout risks but not age, sex, or marital status. Among attendings, the literature identified financial or legal concerns, lack of intellectual stimulation, and poor work-life balance as risks. The impact of wellness programs on trainees is unclear but group exercises may offer the most benefit.

CONCLUSION

Noticeable methodological differences in studies on trainee and attending burnout contribute to a wide range of neurosurgery burnout estimates and yield significant knowledge gaps. Environment may have greater impact on trainee burnout than demographics. Wellness programs should emphasize solidarity.

Reliability and validity of Healthy Fitness Measurement Scale Version1.0 (HFMS V1.0) in Chinese elderly people

Purpose

We examined the reliability and validity of the Healthy Fitness Measurement Scale Version 1.0 (HFMS V1.0) specifically on elderly people in China.

Methods

We carried out a cross-sectional study in December 2020 and enrolled 800 elderly people through stratified sampling technique, including 777 valid samples (with a mean age of 71.81 ± 8.36 years), of which 382 cases (49.2%) were women. The level of healthy fitness was measured using the HFMS V1.0. The Cronbach’s alpha coefficient, split-half reliability, test-retest reliability, convergent and discriminant validity, exploratory factor and confirmatory factor were calculated for assessing the reliability and validity of HFMS V1.0.

Results

HFMS V1.0 consists of 8 dimensions and 38 items. The scale had acceptable reliability (Cronbach’s alpha = 0.920, split-half = 0.946, test-retest = 0.878). Exploratory factor analysis showed KMO value =0.927, and uncovered 10 factors with the cumulative contribution rate of 65.71% and all factor loads over 0.40. The item distribution was consistent with the initial expectation of the scale. The confirmatory factor analysis indicated good fit: CMIN/DF = 2.796, RMSEA = 0.048, IFI =0.914, TLI = 0.902, CFI = 0.913.

Conclusion

HFMS V1.0 was shown to have acceptable reliability and validity indices for this sample. Collectively, HFMS V1.0 is reliable and efficient to measure the healthy fitness of elderly people. It is recommended to use it among the elderly in other Chinese cities in the future to ensure uniformity and objectivity. This scale can be carried out to evaluate of the effectiveness of public health measures in improving the healthy fitness level of the elderly and optimizing public health policies.

The Role of Burnout in the Association between Work-Related Factors and Perceived Errors in Clinical Practice among Spanish Residents

This study aimed to evaluate the prevalence of burnout syndrome in a sample of residents from different specialties, to determine the influence of work-related factors on the development of burnout, and to examine the mediating role of burnout in the relation between such work factors and perceived errors in clinical practice. A total of 237 Spanish residents participated (M_age = 28.87, SD = 3.84; 73.8% females). The Maslach Burnout Inventory and an ad hoc questionnaire were administered to assess burnout and work-related factors. Comparison analyses and mediational models were conducted. Half of the residents reported high levels of burnout (48.9%). Burnout was significantly associated with perceived errors in clinical practice. Significant differences were found between residents with lower and higher burnout levels, showing that those with higher burnout were less satisfied with the working conditions. Burnout mediated the associations between adjustment of responsibility, support among residents, satisfaction with teaching and rotations, general satisfaction, and perceived errors in the clinical practice. Adjusted levels of responsibility and workload, enhanced supervision, and more social support from colleagues predict lower levels of burnout, which may result in fewer errors in clinical practice. Consequently, such work-related factors should be taken into account as a preventive strategy for burnout and errors in the clinical practice so adequate patient care, good mental health of future specialists, and, therefore, higher quality of public health care can be ensured.

Public Perceptions of General Surgery Residency Training

OBJECTIVE

Patients are integral to surgical training. Understanding our patients' perceptions of surgical training, resident involvement and autonomy is crucial to optimizing surgical education and thus patient care. In the modern, connected world many factors extrinsic to a patient's experience of healthcare may influence their opinion of our training systems (i.e., social media, television shows, and internet searches). The purpose of this article is to contextualize the literature investigating public perceptions of general surgery training to allow us to effect patient education initiatives to optimize both surgical training and patient safety.

DESIGN

This is a perspective including a literature review summarizing the current knowledge of public perceptions of general surgery training.

CONCLUSIONS

Little is published regarding patient and public perceptions of general surgery residency training and the role of residents within this. Current literature demonstrates that the majority of patients are willing to have residents participate in their care. Patients' attitude toward resident involvement in their operation is improved by utilizing educational materials and by ensuring a supervising attending is present within the operating room. These observations, coupled with future work to delve deeper into factors affecting public perceptions of surgical training and resident involvement within this, can guide strategies to improve surgical education.

Job Satisfaction Among Plastic Surgery Residents in Canada

Objective:

Resident wellness is a focus of medical training and is prioritized in both Canadian and American accreditation processes. Job satisfaction is an important component of wellness that is not examined in the literature. The purpose of this study was to analyze job satisfaction in a national sample of plastic surgery residents, and identify factors that influence satisfaction.

Methods:

We designed a cross-sectional survey adapted from existing instruments, with attention to thorough item generation and reduction as well as pilot and clinical sensibility testing. All plastic surgery residents at Canadian institutions were surveyed regarding overall job satisfaction as well as personal- and program-specific factors that may affect satisfaction. Predictors of satisfaction were identified using multivariable regression models.

Results:

The response rate was 40%. Median overall job satisfaction was 4.0 on a 5-point Likert scale. Operative experience was considered both the most important element of a training program, and the area in most need of improvement. Senior training year (P < .01), shorter commute time (P = .04), fewer duty hours (P = .02), fewer residents (P < .01), and more fellows (P < .01) were associated with significantly greater job satisfaction.

Conclusions:

This is the first study to gather cross-sectional data on job satisfaction from a national sample of plastic surgery residents. The results from this study can inform programs in making tangible changes tailored to their trainees’ needs. Moreover, our findings may be used to inform a prospectively studied targeted intervention to increase job satisfaction and resident wellness to address North American accreditation standards.

Gaps identification in Saudi anesthesia residency training during early time of pandemic: Trainee view

BACKGROUND

COVID-19 pandemic was declared a worldwide crisis, as a response the community established new protocols and clinical pathways to prepare the health system in adapting to the expected surge of cases.

OBJECTIVES

In this study, we aim to assess the effect of the pandemic on the anesthesia training program residents from their own view. Identification of gaps in training programs will help to overcome the challenge like pandemic in order to have competent anesthesia practitioners.

METHODS

We deployed an online survey in early May 2020 targeting the anesthesia residents in Saudi Arabia. We used mixed methods, containing both quantitative and qualitative questions. Our survey had 3 main sections: demographics, pandemic effect on the training, and pandemic effect on the trainees.

RESULTS

Our survey showed that in the first 2 months of the pandemic there was a vast decrease in educational activities and clinical activities. However, after that both the Saudi Commission for Health Speciality (SCFHS) and local hospitals employed alternative education methods like electronic learning and simulation to adopt these changes. We also found the average stress level among residents was 6.5 out of 10 with number one stressor is transmitting Covid-19 to family or self. Finally, Wellbeing resources were available to residents however were not used sufficiently by residents.

CONCLUSION

During times of pandemic, assessment and gap identification in postgraduate training programs are necessary to help overcome challenges of training anesthesiologists. Other than the clinical competency residents' wellbeing needs to be monitored and make available resources easy to reach for the residents.

Work environment, job satisfaction and burnout among Spanish dentists: a cross-sectional study

Background

The main aim of the present study was to examine the relationships among work environment, job satisfaction and burnout in dentists and to analyse the way in which certain sociodemographic variables, such as gender, professional experience and weekly working hours, predict the perception of the work environment.

Methods

A battery of online questionnaires was sent to 3876 dentists officially registered in the triple-province region of Valencia; the battery included the Survey of Organizational Attributes for Dental Care, the Warr–Cook–Wall Overall Job Satisfaction Scale, the Maslach Burnout Inventory and a series of sociodemographic questions formulated for the specific purpose of this study. To assess the relations with the independent variables, we calculated the Pearson correlation coefficient, the Z-scores were calculated to make effect sizes comparable, and the associations between the scales and the sociodemographic variables were investigated by adjusted multiple regression analysis.

Results

A total of 336 participants (9.4%) correctly completed the survey in this study. The mean (M) age was 37.6 years old (standard deviation (SD) = 9.6, median (M_e) = 34). Participants reported high scores on the work environment and job satisfaction scales, with only limited experiences of burnout (3.8%). Work environment and burnout were significantly and positively predicted by years of professional experience (β = .078; p = .000 and β = .107; p = .004, respectively), and job satisfaction was significantly and positively predicted by weekly hours of work (β = .022; p = .001), without significant differences according to gender.

Conclusions

Dentists who work over 20 hours a week and have more years of professional experience report having better perceptions of well-being at work, with no significant difference according to gender. It is important to highlight the aspects that improve well-being in dentistry to reduce burnout, which would lead to greater work engagement and better attention to patients.

Faculty and Peer Support During Pediatric Residency: Association With Performance Outcomes, Race, and Gender

PURPOSE

To examine the association of resident perception of colleague and faculty support with performance, as measured by milestones-based competency scores, exploring associations between race and gender and perception of support and milestone scoring.

METHODS

Resident satisfaction was measured using an annual survey of residents at 49 pediatric residency programs in 2016, 2017, and 2018. Satisfaction with colleague and faculty support was measured using Likert scale survey questions. Pediatric Milestone Competency scores were obtained from the Association of Pediatric Program Directors' Longitudinal Educational Assessment Research Network. Analysis included linear fixed-effects models to examine the relationship between support satisfaction, race, gender, and spring milestone scores.

RESULTS

Over 60% of eligible residents responded to the survey. The majority of residents were satisfied with colleague and faculty support, with those identifying as Asian or underrepresented in medicine (URM) reporting lower rates of satisfaction than White peers. Residents satisfied with colleague support had higher milestone scores compared to those with a neutral degree of satisfaction. Residents reporting dissatisfaction with colleague and faculty support had lower milestone scores in most competency domains. Residents identifying as URM had lower milestone scores than White residents, which was partially mediated by lower rates of support satisfaction.

CONCLUSIONS

Resident satisfaction with colleague and faculty support correlates with milestone performance. In particular, dissatisfied residents have lower scores than those who are neutral or satisfied. Racial inequities in resident milestone scores may be partially driven by lower rates of support satisfaction among underrepresented residents.

Characteristics and Attitudes of Aspiring Cardiothoracic Surgeons: A Survey Study

BACKGROUND

Although recruiting highly qualified, diverse applicants into cardiothoracic surgery remains a national priority, their characteristics remain unknown. This study aims to describe current and future applicants in cardiothoracic surgery.

METHODS

Aspiring cardiothoracic surgeons (students interested in matriculating in a North American training program) were voluntarily enrolled in the study through Twitter and email outreach. A 33-question survey evaluated their backgrounds, research experiences, attitudes, and interests within cardiothoracic surgery. Standard descriptive statistics were used.

RESULTS

There were 111 participants, 40 of whom were female (36.0%) and 27 of whom identified as an underrepresented minority (24.3%). Of the total, 63 belonged to an institution with a cardiothoracic surgery training program (56.8%). A total of 91 students envisioned having a mostly operative career (82.0%) and 75 envisioned pursuing educational roles (67.6%). The most popular surgical specialties were heart transplantation (50.5%) and aortic surgery (47.8%). Participants selected having a high-intensity operative environment (81.2%) and an innovative academic environment (58.8%) as the most attractive qualities. Perceived lack of work-life balance (46%) and toxic training or work environment (28%) were the greatest deterrents. Finances during the application process were perceived as a potential barrier by 41 students (36.9%). Approximately 75% of students (83 of 111) had faculty as mentors; 46.8% (56 of 111) thought that cardiothoracic surgery faculty were approachable but had limited time for mentorship.

CONCLUSIONS

This survey study characterized a nationally selected pool of aspiring cardiothoracic surgeons using social media. Future studies involving larger and more diverse cohorts are warranted to find areas for improvement in recruitment, retention, and diversity.

How Do Areas of Work Life Drive Burnout in Orthopaedic Attending Surgeons, Fellows, and Residents?

BACKGROUND

Concerning levels of burnout have been reported among orthopaedic surgeons and residents. Defined as emotional exhaustion and depersonalization, physician burnout is associated with decreased productivity, increased medical errors, and increased risk of suicidal ideation. At the center of burnout research, person-centered approaches focusing on individual characteristics and coping strategies have largely been ineffective in solving this critical issue. They have failed to capture and address important institutional and organizational factors contributing to physician burnout. Similarly, little is known about the relationship between burnout and the working environments in which orthopaedic physicians practice, and on how orthopaedic surgeons at different career stages experience and perceive factors relevant to burnout.

QUESTIONS/PURPOSES

(1) How does burnout differ among orthopaedic attending surgeons, fellows, and residents? (2) What specific areas of work life are problematic at each of these career stages? (3) What specific areas of work life correlate most strongly with burnout at each of these career stages?

METHODS

Two hundred orthopaedic surgeons (residents, fellows, and attending physicians) at a single institution were invited to complete an electronic survey. Seventy-four percent (148 of 200) of them responded; specifically, 43 of 46 residents evenly distributed among training years, 18 of 36 fellows, and 87 of 118 attending physicians. Eighty-three percent (123 of 148) were men and 17% (25 of 148) were women. Two validated questionnaires were used. The Maslach Burnout Inventory was used to assess burnout, measuring emotional exhaustion and depersonalization. The Areas of Worklife Survey was used to measure congruency between participants and their work environment in six domains: workload, control, reward, community, fairness, and values. Participants were invited to openly share their experiences and suggest ways to improve burnout and specific work life domains. The main outcome measures were Maslach Burnout Inventory subdomains of emotional exhaustion and depersonalization, and Areas of Worklife Survey subdomains of workload, control, reward, community, fairness and values. We compared outcome measures of burnout and work life between groups. Simple linear regression models were used to report correlations between subscales. Stratified analyses were used to identify which group demonstrated higher correlations. All open comments were analyzed and coded to fully understand which areas of work life were problematic and how they were perceived in our population.

RESULTS

Nine percent (7 of 80) of attending surgeons, 6% (1 of 16) of fellows, and 34% (14 of 41) of residents reported high levels of depersonalization on the Maslach Burnout Inventory (p < 0.001). Mean depersonalization scores were higher (worse) in residents followed by attending surgeons, then fellows (10 ± 6, 5 ± 5, 4 ± 4 respectively; p < 0.001). Sixteen percent (13 of 80) of attending surgeons, 31% (5 of 16) of fellows, and 34% (14 of 41) of residents reported high levels of emotional exhaustion (p = 0.07). Mean emotional exhaustion scores were highest (worse) in residents followed by attending surgeons then fellows (21 ± 12, 17 ± 10, 16 ± 14 respectively; p = 0.11). Workload was the most problematic work life area across all stages of orthopaedic career. Scores in the Areas of Worklife Survey were the lowest (worse) in the workload domain for all subgroups: residents (2.6 ± 0.4), fellows (3.0 ± 0.6), and attending surgeons (2.8 ± 0.7); p = 0.08. Five problematic work life categories were found through open comment analysis: workload, resources, interactions, environment, and self-care. Workload was similarly the most concerning to participants. Specific workload issues identified included administrative load (limited job control, excessive tasks and expectations), technology (electronic medical platform, email overload), workflow (operating room time, patient load distribution), and conflicts between personal, clinical, and academic roles. Overall, worsening emotional exhaustion and depersonalization were most strongly associated with increasing workload (r = - 0.50; p < 0.001; and r = - 0.32; p < 0.001, respectively) and decreasing job control (r = - 0.50; p < 0.001, and r = - 0.41; p < 0.001, respectively). Specifically, in residents, worsening emotional exhaustion and depersonalization most strongly correlated with increasing workload (r = - 0.65; p < 0.001; and r = - 0.53; p < 0.001, respectively) and decreasing job control (r = - 0.49; p = 0.001; and r = - 0.51; p = 0.001, respectively). In attending surgeons, worsening emotional exhaustion was most strongly correlated with increasing workload (r = - 0.50; p < 0.001), and decreasing job control (r = - 0.44; p < 0.001). Among attending surgeons, worsening depersonalization was only correlated with increasing workload (r = - 0.23; p = 0.04). Among orthopaedic fellows, worsening emotional exhaustion and depersonalization were most strongly correlated with decreasing sense of fairness (r = - 0.76; p = 0.001; and r = - 0.87; p < 0.001, respectively), and poorer sense of community (r = - 0.72; p = 0.002; and r = - 0.65; p = 0.01, respectively).

CONCLUSIONS

We found higher levels of burnout among orthopaedic residents compared to attending surgeons and fellows. We detected strong distinct correlations between emotional exhaustion, depersonalization, and areas of work life across stages of orthopaedic career. Burnout was most strongly associated with workload and job control in orthopaedic residents and attending surgeons and with fairness and community in orthopaedic fellows.

CLINICAL RELEVANCE

Institutions wishing to better understand burnout may use this approach to identify specific work life drivers of burnout, and determine possible interventions targeted to orthopaedic surgeons at each stage of career. Based on our institutional experience, leadership should investigate strategies to decrease workload by increasing administrative support and improving workflow; improve sense of autonomy by consulting physicians in decision-making; and seek to improve the sense of control in residents and sense of community in fellows.

Enhancing Medical Student Education and Combating Mistreatment During a Surgery Clerkship With a Novel Educational Tool: A Pilot Study

BACKGROUND

Medical education changes dramatically from preclinical to clinical years, and the learning environment becomes key as students strive to develop clinical competence and informed career decisions. This change becomes heightened on a surgical clerkship where student mistreatment is often perceived, and the fast-paced nature of surgery can result in limited resident-student interactions and time for examination preparation.

OBJECTIVE

To evaluate medical student and resident perception of educational strategies during a surgical clerkship and to determine whether the addition of a novel educational tool would increase satisfaction with the surgical clerkship on examination preparation and team dynamics.

SETTING

University of North Carolina at Chapel Hill, Department of Surgery.

STUDY DESIGN

During the 2018-2019 academic year, a 10-item "Ask a Resident Topics" (ART) card of high yield general surgery topics was implemented as part of the third-year surgery clerkship curriculum. Students were asked to review a topic and then discuss it with a general surgery resident. They were expected to complete at least 6 of 10 topics by the end of the rotation for credit. At the end of the year, third-year medical students were administered a 23-item survey regarding their experience on the surgery clerkship and with the ART cards. Fourth-year medical students and those students at satellite sites who did not receive the ART cards were administered the same survey, minus specific questions about the ART card, and were used as a preintervention control. General surgery residents who participated in teaching were similarly surveyed.

RESULTS

Of those students that completed the ART cards, 84% felt it improved their understanding of general surgery and were more likely to report the surgery clerkship prepared them well for the NBME examination compared to those who did not (Χ² (1, N = 87) = 4.95, p = 0.03). They were also more likely to report residents were willing to discuss surgery topics with them (Χ² (1, N = 87) = 2.77, p = 0.10). Seventy-three percent of students thought the card did not add undue stress to their clerkship. Sixty-three percent of all students felt they were a productive member of the surgery team, and this did not vary by intervention group (Χ² (1, N = 87) = 0.03, p = 0.9). Students who completed the ART card were more likely to report being interested in surgery than those who did not (Χ² (1, N = 87) = 4.20, p = 0.04). Hundred percent of residents surveyed felt the ART card provided value for themselves as a teacher and for the student as a learner.

CONCLUSIONS

The ART card is mutually beneficial to both residents and medical students during the surgical clerkship. This tool is easy to implement, helps students improve their understanding of general surgery, increases camaraderie among the surgical team, and has a positive impact on students pursuing a career in surgery.

Dissecting a department of surgery: Exploring organizational culture and competency expectations

INTRODUCTION

In order to recruit high-potential trainees, surgery residency and fellowship programs must first understand what competencies and attributes are required for success in their respective programs. This study performed a systematic analysis to define organizational culture and competency expectations across training programs within one academic surgery department.

METHODS

Subject matter experts rated the importance and frequency of 22 competencies and completed a 44-item organizational culture inventory along 1 to 5 Likert-type scales.

RESULTS

Importance and frequency attributions of competencies varied significantly among programs (p < .05 by ANOVA), but there was substantial agreement on organizational culture; self-directed (x̄ = 3.8), perfectionist (x̄ = 3.7) and social (x̄ = 3.7) attributes were most representative of the program, while oppositional (x̄ = 1.8), competitive (x̄ = 2.5) and hierarchical (x̄ = 2.7) characteristics were least representative.

CONCLUSIONS

Residency and fellowship programs within the same department have shared perceptions of the culture and values of their institution, but seek different competencies among entering trainees.

Ideas and Innovations to Improve the Otolaryngology–Head and Neck Surgery Residency Application and Selection Process

Objective

To (1) summarize strategies proposed in the recent otolaryngology–head and neck surgery (OTO-HNS) literature for improving the residency application and selection process, (2) evaluate the effects of recently implemented changes to the OTO-HNS match, and (3) discuss recommendations for future changes to the OTO-HNS residency application and selection process.

Data Sources

PubMed, Medline Ovid database, and article reference lists.

Review Methods

A structured literature search was performed to identify current English language articles relating to the objectives of this study using the aforementioned data sources, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. The search was limited to submissions published between January 1, 2015, and January 1, 2020.

Conclusions

Numerous proposals have been made for improving the otolaryngology residency application and selection process and addressing the competitive nature of the Match. These proposals include but are not limited to mandating a secondary essay, implementing consortia and early match processes, using a signaling system, conducting regional and web-based interviews, offering early engagement with interest groups, instituting a hard cap on applications, increasing costs of applying, counseling self-restraint to prospective applicants, and creating application filters.

Implications for Practice

As the volume of literature surrounding the OTO-HNS Match continues to increase, this review aims to provide a summary of past proposals and serve as a guide for possible future innovations. We propose 3 initiatives that may improve the residency application and selection process for both program and resident, with minimal impact to the current National Resident Matching Program (NRMP) Match structure.

Well-being and education of urology residents during the COVID-19 pandemic: Results of an American National Survey

BACKGROUND

The rapid spread of COVID-19 has placed tremendous strain on the American healthcare system. Few prior studies have evaluated the well-being of or changes to training for American resident physicians during the COVID-19 pandemic. We aim to study predictors of trainee well-being and changes to clinical practice using an anonymous survey of American urology residents.

METHODS

An anonymous, voluntary, 47-question survey was sent to all ACGME-accredited urology programmes in the United States. We executed a cross-sectional analysis evaluating risk factors of perception of anxiety and depression both at work and home and educational outcomes. Multiple linear regressions models were used to estimate beta coefficients and 95% confidence intervals.

RESULTS

Among ~1800 urology residents in the USA, 356 (20%) responded. Among these respondents, 24 had missing data leaving a sample size of 332. Important risk factors of mental health outcomes included perception of access to PPE, local COVID-19 severity and perception of susceptible household members. Risk factors for declination of redeployment included current redeployment, having children and concerns regarding ability to reach case minimums. Risk factors for concern of achieving operative autonomy included cancellation of elective cases and higher level of training.

CONCLUSIONS

Several potential actions, which could be taken by urology residency programme directors and hospital administration, may optimise urology resident well-being, morale, and education. These include advocating for adequate access to PPE, providing support at both the residency programme and institutional levels, instituting telehealth education programmes, and fostering a sense of shared responsibility of COVID-19 patients.

An Analysis of Burnout among Military General Surgery Residents

OBJECTIVES

Resident burnout is an increasing issue in graduate medical education programs. Military graduate medical education is unique in numerous ways and may have different rates of burnout as well as different causes. This study aims to assess resident burnout rates and contributing factors among military general surgery residents.

DESIGN, SETTING, AND PARTICIPANTS

Using Department of Defense approved software, an anonymous survey was created and distributed to all general surgery residents (n = 180) in 6 US medical centers where there are general surgery residency programs. The survey contained an Abbreviated Maslach Burnout Index questionnaire, multiple choice questions including several military-specific questions, and 2 open ended questions. Rates of burnout and potential risk factors associated with burnout were analyzed.

RESULTS

After the collection period, 92 of 180 (51%) residents completed all Abbreviated Maslach Burnout Index questions, demographics, and military specific questions with an opportunity for written comments. Notable demographic findings of the respondents were that 64% were male, 65% were married or engaged, 40% had children, and 69% had no student loan debt. Overall, there was a 66% rate of burnout in any tertile. Variables found to be significant for overall burnout included the likelihood the resident plans to stay beyond their active duty service obligation and the perceived level of autonomy. Of the written responses, the most commonly cited contributing factor was the work burden from nonclinical and/or administrative tasks while the most common protective factor was resident camaraderie.

CONCLUSIONS

Overall, burnout rates are similar among military general surgery residents compared to published reports of civilians. The close association with resident burnout and anticipation of early withdrawal from military service demonstrates this topic is potentially important to retention of the military medical force. The topics of increased resident autonomy, decreased non-clinical duties, and efforts to increase resident camaraderie should be more closely evaluated.

We Orient Residents to Surgical Life: Why Not Their Families Too?

Surgical education requires more than time and commitment; it is a period of a professional development that relies on one's resilience and fortitude. While training programs makes substantial efforts to onboard learners and prepare them for the experiences to come, most are likely underutilizing one of the greatest resources available to learners: their personal communities. Every intern who enters residency brings with them the emotional bonds and benefits of family, friends, and/or other community members who may or may not understand the nature of surgical training and the professional journey ahead. In an effort to support our own learners and increase the awareness of resources available to them, we hosted an orientation for interns' friends and families. The programming allowed for residents and their personal supports to better understand residency culture, meet educational leadership, and discuss the experiences of more senior residents, faculty and their families over time. Additionally, some education was provided regarding the signs and symptoms of burnout and depression; our aim was to help residents' communities feel better able to recognize and respond to such symptoms. The preliminary feedback regarding the program is strong, encouraging its continued implementation.

Consequences of Medical Hierarchy on Medical Students, Residents, and Medical Education in Otolaryngology

Objective

To (1) review concepts of medical hierarchy; (2) examine the role of medical hierarchy in medical education and resident training; (3) discuss potential negative impacts of dysfunctional hierarchy in medical and surgical training programs, focusing on otolaryngology; and (4) investigate solutions to these issues.

Data Sources

Ovid Medline, Embase, GoogleScholar, JSTOR, Google, and article reference lists.

Review Methods

A literature search was performed to identify articles relating to the objectives of the study using the aforementioned data sources, with subsequent exclusion of articles believed to be outside the scope of the current work. The search was limited to the past 5 years.

Conclusions

Two types of hierarchies exist: “functional” and “dysfunctional.” While functional medical hierarchies aim to optimize patient care through clinical instruction, dysfunctional hierarchies have been linked to negative impacts by creating learning environments that discourage the voicing of concerns, legitimize trainee mistreatment, and create moral distress through ethical dilemmas. Such an environment endangers patient safety, undermines physician empathy, hampers learning, lowers training satisfaction, and amplifies stress, fatigue, and burnout. On the other hand, functional hierarchies may improve resident education and well-being, as well as patient safety.

Implications for Practice

Otolaryngology–head and neck surgery programs ought to work toward creating healthy systems of hierarchy that emphasize collaboration and improvement of workplace climate for trainees and faculty. The goal should be to identify aspects of dysfunctional hierarchy in one’s own environment with the ambition of rebuilding a functional hierarchy where learning, personal health, and patient safety are optimized.

The Influence of Perceived Organizational Support on Police Job Burnout: A Moderated Mediation Model

Objective

Based on the theory of perceived organizational support (POS), conservation of resource (COR) and job demands-resources (JD-R) model, this study establishes a moderated mediation model to test the role of job satisfaction in mediating the relationship between POS and job burnout, as well as the role of regulatory emotional self-efficacy (RES) in moderating the above mediating process.

Methods

A total of 784 police officers were surveyed with the POS Scale, the Job Burnout Questionnaire, the RES Scale, and the Minnesota Job Satisfaction Questionnaire.

Results

(1) After controlling for gender, seniority, age, police classification, education, and marital status, regression analysis showed a significant negative correlation between POS and burnout (r = −0.42, p < 0.01), and the former had a significant negative predictive effect on job burnout (β = −0.42, p < 0.001). (2) The mediating effect test shows that job satisfaction plays a partial role in mediating the relationship between POS and job burnout. (3) Through the analysis of the moderated mediation model test, RES moderates the first half of the path of “POS → job satisfaction → job burnout.”

Conclusion

POS not only directly affects police job burnout but also indirectly affects police job burnout through job satisfaction. RES enhances the influence of organizational support on job satisfaction. This study indicates the combined effect of POS, job satisfaction, and RES on job burnout and has certain guiding significance for alleviating police job burnout.

Are Vascular Surgery Trainees Satisfied and are They Using the Right Factors to Choose a Training Program?

BACKGROUND

Medical students and residents often evaluate training sites in vascular surgery with minimal exposure to those programs. We sought to identify factors associated with vascular surgery trainee satisfaction in relation to their current work environment and how they made their rank list.

METHODS

All integrated residents and fellows currently in United States vascular training programs were queried using an anonymous electronic survey for variables of their current training environment, factors that influenced their rank order list, and satisfaction. Questions were graded on a Likert scale. Continuous, ordinal, and categorical variables were respectively analyzed using the two-sample t-test, Mann-Whitney U-test/Wilcoxon rank sum test, and Fisher's exact test.

RESULTS

A total of 166 of 517 (32%) trainees completed the survey with equal distribution across postgraduate years. Respondents reported high rates of satisfaction with their training program overall (84%), including 88% (n = 83) of residents and 78% (n = 56) of fellows. Several work environment variables were associated with both resident and fellow satisfaction including program-funded trips for conferences and presentations (P = 0.027 for residents; P = 0.001 for fellows), diversity of operative cases (P = 0.024; P < 0.001), perception of a strong supportive social network at the hospital (P = 0.006; P = 0.001), and perception of appreciation by attending surgeons (P < 0.001; P < 0.001). Fellows who felt appreciated by nursing staff (P = 0.047), ancillary staff (P = 0.013), and patients were more likely to be satisfied (P = 0.011); however, this was not true for integrated residents. Social outings with nontrainee family and friends were associated with satisfaction for fellows (P = 0.002) but not integrated residents (P = 0.138), whereas social outings with vascular trainees were associated with satisfaction for integrated residents (P = 0.047) but not fellows (P = 0.375). Similarly, satisfied integrated residents were more likely to have close relationships with their vascular cotrainees (P = 0.035) than fellows (P = 0.349). No rank list factors were found to be predictive of current trainee satisfaction for integrated residents. Rank list factors associated with fellow satisfaction included recommendation of the institution from a mentor (P < 0.001), success of program graduates (P = 0.002), faculty (P = 0.014), perceived program prestige (P = 0.040), and amount of early operative exposure (P = 0.042).

CONCLUSIONS

Vascular surgery trainees report a high level of satisfaction with their training program. Fellow satisfaction was more dependent on the perception of their workplace peers than integrated residents. Satisfied integrated residents were more likely to have close relationships with their vascular cotrainees than fellows.

Exploring the relationship between burnout and grit during general surgery residency: A longitudinal, single-institution analysis

BACKGROUND

How burnout changes during general surgery residency remains unknown.

METHODS

From 2015 to 2018, general surgery residents completed the Maslach Burnout Inventory and Grit Scale. Statistical analyses were adjusted for repeated measures and compared to the incoming intern level.

RESULTS

Fifty-five residents participated in this study. Burnout rates varied by program level, with an increased risk occuring in the third clinical year (OR = 11.7, p = 0.03). Emotional exhaustion (EE) peaked during the first and third clinical years, depersonalization (DP) peaked during the first and second clinical years, and personal achievement (PA) reached a nadir during the third clinical year (all p < 0.05). Residents with burnout had lower grit scores compared to those without burnout (3.71 vs 4.02, p < 0.01). Increasing grit was linearly associated with decreasing EE, decreasing DP, and increasing PA (all p < 0.05).

CONCLUSIONS

Burnout varies throughout surgical residency, and grit is inversely related to burnout.

The workday of hospital surgeons: what they do, what makes them satisfied, and the role of core tasks and administrative tasks; a diary study

Background

Many surgeons report passion for their work, but not all tasks are likely to be satisfying. Little is known about how hospital surgeons spend their days, how they like specific tasks, and the role of core tasks (i.e. surgery-related tasks) versus tasks that may keep them from core tasks (e.g., administrative work). This study aimed at a more detailed picture of hospital surgeons’ daily work - how much time they spend with different tasks, how they like them, and associations with satisfaction.

Methods

Hospital surgeons (N = 105) responded to a general survey, and 81 of these provided up to five daily questionnaires concerning daily activities and their attractiveness, as well as their job satisfaction. The data were analyzed using t-tests, analysis of variance, as well as analysis of covariance and repeated measures analysis of variance for comparing means across tasks.

Results

Among 14 tasks, surgery-related tasks took 21.2%, patient-related tasks 21.7% of the surgeons’ time; 10.4% entailed meetings and communicating about patients, and 18.6% documentation and administration. The remaining time was spent with teaching, research, leadership and management, and not task-related activities (e.g. walking between rooms). Surgery was rated as most (4.25; SD = .66), administration as least attractive (2.63; SD = .78). A higher percentage of administration predicted lower perceived legitimacy; perceived legitimacy of administrative work predicted job satisfaction (r = .47). Residents were least satisfied; there were few gender differences.

Conclusions

Surgeons seem to thrive on their core tasks, most notably surgery. By contrast, administrative duties are likely perceived as keeping them from their core medical tasks. Increasing the percentage of medical tasks proper, notably surgery, and reducing administrative duties may contribute to hospital surgeons’ job satisfaction.

Electronic supplementary material

The online version of this article (10.1186/s12893-019-0570-0) contains supplementary material, which is available to authorized users.

Burnout and psychological distress between surgical and non-surgical residents

Surgical training is considered to be very stressful among residents and medical students choose less often surgery for their career. Our aim was to assess the prevalence of burnout and psychological distress in residents attending surgical specialties (SS) compared to non-surgical specialties (NSS). Residents from the University of Bologna were asked to participate in an anonymous online survey. The residents completed a set of questions regarding their training schedule and three standardized questionnaires: (1) the Maslach Burnout Inventory, assessing the three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA); (2) the Zung Self-Rating Depression Scale; (3) the Psychosomatic Problems Scale. One-hundred and ninety residents completed the survey. Overall, the prevalence of burnout was 73% in the SS group and 56.3% in the NSS group (P = 0.026). More specifically, SS reported higher levels of EE and DP compared to NSS. No significant differences between SS and NSS emerged for PA, depression, or somatic problems. The present findings indicate that burnout is more prevalent in surgical residents than in residents attending non-surgical specialties. ClinicalTrials.gov identifier: NCT03668080.