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Mũrage A, Morgan R, Samji H, Smith J. Gendered and racial experiences of moral distress: A scoping review. J Adv Nurs 2024; 80:1283-1298. [PMID: 37849045 DOI: 10.1111/jan.15901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
AIM To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such research. DESIGN Scoping review. METHODS The PRISMA (Preferred Reporting Items for Systematic and Meta-Analysis) Extension for Scoping Reviews was adopted. DATA SOURCES Systematic literature search was conducted through PubMed, CINAHL and Web of Science databases. Boolean operators were used to identify moral distress literature which included gender and/or race data and published between 2012 and 2022. RESULTS After screening and full-text review, 73 articles reporting on original moral distress research were included. Analysis was conducted on how gender and race were incorporated in research and interpretation of moral distress experiences among healthcare professionals. IMPACT This study found that while there is an upward trend in including gender and race-disaggregated data in moral distress research, over half of such research did not conduct in-depth analysis of such data. Others only highlighted differential experiences such as moral distress levels of women vis-à-vis men. Only about 20% of publications interrogated how experiences of moral distress differed and/or explored factors behind their findings. CONCLUSION There is a need to not only collect disaggregated data in moral distress research but also engage this data through gender and race-based analysis. Particularly, we highlight the need for intersectional analysis, which can elucidate how social identities and categories (such as gender and race) and structural inequalities (such as those sustained by sexism and racism) interact to influence moral experiences. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Moral distress as experienced by healthcare professionals is increasingly recognized as an important area of research with significant policy implications in the healthcare sector. This study offers insights for nuanced and targeted policy approaches. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Alice Mũrage
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Pacific Institute on Pathogens, Pandemics, and Society, Burnaby, British Columbia, Canada
| | - Rosemary Morgan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasina Samji
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julia Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Pacific Institute on Pathogens, Pandemics, and Society, Burnaby, British Columbia, Canada
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Jones C, Mitzman J, Spencer S, Lo CB, Mahan JD, Stein D. Barriers and Facilitators to Pediatric Resident Education in the Emergency Department: A Qualitative Study. Cureus 2023; 15:e40142. [PMID: 37425526 PMCID: PMC10329485 DOI: 10.7759/cureus.40142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Local resident evaluations of the pediatric emergency department (ED) declined over the last five years. Sparse literature exists on resident perspectives of educational experiences. This study explored the barriers and facilitators to resident education in the Pediatric ED. Methods This qualitative study utilized focus groups at a large pediatric training hospital. Trained facilitators performed semi-structured interviews prompting discussion of resident experiences in the pediatric ED. One pilot and six focus groups (38 pediatric residents) achieved data saturation. Sessions were audio recorded, de-identified and transcribed by a professional service. Three authors (CJ, JM, SS) analyzed the transcripts independently using line-by-line coding. Following code agreement, authors identified central themes drawing on grounded theory. Results Six categories emerged: (1) ED environment, (2) consistent goals, expectations, and resources, (3) ED workflow, (4) preceptor accessibility, (5) resident growth and development, (6) ED preconceived notions. Residents value a respectful work environment despite the chaotic nature of the ED. They need clear goals and expectations with a strong orientation. Autonomy, open communication and shared decision-making allow residents to feel like team members. Residents gravitate toward welcoming, available preceptors that enthusiastically teach. More ED environment exposure increases comfort and efficiency and helps develop medical decision-making skills. Residents admit ED preconceptions and personality traits affect performance. Conclusion Residents self-identified barriers and facilitators to ED education. Educators must provide a safe and open learning environment, clear rotation expectations and goals, consistent positivity supporting shared decision making, and allow residents autonomy to build their practice styles.
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Affiliation(s)
| | - Jennifer Mitzman
- Emergency Medicine, Nationwide Children's Hospital, Columbus, USA
| | - Sandra Spencer
- Emergency Medicine, Colorado Children's Hospital, Aurora, USA
| | - Charmaine B Lo
- Emergency Medicine, Nationwide Children's Hospital, Columbus, USA
| | - John D Mahan
- Pediatric Nephrology, Nationwide Children's Hospital, The Ohio State University, Columbus, USA
| | - David Stein
- Educational Studies, The Ohio State University College of Education and Human Ecology, Columbus, USA
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Making the Financial Case for Surgical Resident Well-being: A Scoping Review. Ann Surg 2023; 277:397-404. [PMID: 36124776 DOI: 10.1097/sla.0000000000005719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To conduct a scoping review of literature on financial implications of surgical resident well-being. BACKGROUND Surgeon well-being affects clinical outcomes, patient experience, and health care economics. However, our understanding of the relationship between surgical resident well-being and organizational finances is limited. METHODS Authors searched PubMed, Web of Science, and Embase with no date or language restrictions. Searches of the gray literature included hand references of articles selected for data extraction and reviewing conference abstracts from Embase. Two reviewers screened articles for eligibility based on title and abstract then reviewed eligible articles in their entirety. Data were extracted and analyzed using conventional content analysis. RESULTS Twenty-five articles were included, 5 (20%) published between 2003 and 2010, 12 (48%) between 2011 and 2018, and 8 (32%) between 2019 and 2021. One (4%) had an aim directly related to the research question, but financial implications were not considered from the institutional perspective. All others explored factors impacting well-being or workplace sequelae of well-being, but the economics of these elements were not the primary focus. Analysis of content surrounding financial considerations of resident well-being revealed 5 categories; however, no articles provided a comprehensive business case for investing in resident well-being from the institutional perspective. CONCLUSIONS Although the number of publications identified through the present scoping review is relatively small, the emergence of publications referencing economic issues associated with surgical resident well-being may suggest a growing recognition of this area's importance. This scoping review highlights a gap in the literature, which should be addressed to drive the system-level change needed to improve surgical resident well-being.
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Zuo KJ, Meng Y, Gordon L, Saun TJ, Mazine A, Ahuja CS, Lipsman N, Rutka JT, Fehlings MG. Navigating the Postgraduate Research Fellowship: A Roadmap for Surgical Residents. J Surg Res 2020; 256:282-289. [PMID: 32712442 DOI: 10.1016/j.jss.2020.06.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/03/2020] [Accepted: 06/16/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND To preserve the future of surgical innovation, opportunities for surgical residents to receive structured research training are paramount. The objective of this article is to help surgical residents navigate a research fellowship by overviewing key topics such as choosing an area of focus and supervisor, applying for external funding, transitioning away from clinical duties, managing intellectual property, integrating family planning, and incorporating research experience into independent career development. MATERIALS AND METHODS Using the framework of the University of Toronto's graduate degree-awarding Surgeon-Scientist Training Program, the authors outline key considerations, decisions, and pearls for surgical residents considering or currently enrolled in a full-time research fellowship training program. RESULTS Full-time research fellowships offer a unique opportunity for residents interested in an academic career. Such full-time research fellowships away from clinical duties allow surgical trainees to focus on developing key research competencies, including how to generate hypotheses, apply research methodology, gain experience presenting and publishing manuscripts, and ultimately apply these skills as independent investigators to improve patient and population health. Research fellowships may also be an opportunity to develop intellectual property or facilitate family planning. Practical tips are provided for the transition back into clinical training and how to effectively market one's research skills for career advancement. CONCLUSIONS The authors outline key considerations, decisions, and pearls for surgical residents considering or currently enrolled in a full-time research fellowship training program. By adhering to the principles highlighted in this article, residents will be able to successfully navigate a full-time research fellowship to optimize their intellectual development, maximize their academic productivity, and facilitate their transition into an independent investigator.
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Affiliation(s)
- Kevin J Zuo
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ying Meng
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Gordon
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; International Centre for Surgical Safety, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tomas J Saun
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Christopher S Ahuja
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Cell Biology, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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Pololi LH, Brennan RT, Civian JT, Shea S, Brennan-Wydra E, Evans AT. Us, Too. Sexual Harassment Within Academic Medicine in the United States. Am J Med 2020; 133:245-248. [PMID: 31301297 DOI: 10.1016/j.amjmed.2019.06.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We report on the extent of sexual harassment among residents and examine its relationship to specialty and program year and effects. METHODS Using the C-Change Resident Survey, we surveyed residents in 34 internal medicine, pediatrics, and general surgery programs in 14 academic medical centers (AMCs). A total of 1708 residents completed the survey (70% response-rate); 51% (n = 879) were women. Respondents reported unwanted sexual comments, attention, or advances by a superior or colleagues within the last 2 years. Measures of vitality and ethical or moral distress were included in the surveys. RESULTS Rates of sexual harassment reported by women differed across the 34 programs, with an interquartile range of 0%-11%. Residents in pediatrics had the lowest frequencies of sexual harassment (mean 2%, 95% confidence interval [CI] 0%, 4%). Residents in internal medicine had higher rates of sexual harassment (mean 7%, 95% CI 1%, 25%). Residents in surgery had the highest rates (mean 12%, 95% CI 2%, 33%). Sexual harassment was associated with lower levels of vitality and higher ethical or moral distress (both, P <0.05). CONCLUSIONS Sexual harassment is more common for women residents in Internal Medicine and Surgery programs. The adverse effects of sexual harassment on female residents detracts from an institution's professional workforce.
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Affiliation(s)
- Linda H Pololi
- Director, National Initiative on Gender, Culture and Leadership in Medicine: C-Change, Brandeis University, Waltham, Mass.
| | - Robert T Brennan
- Research Associate, Boston College, School of Social Work, Chestnut Hill, Mass
| | - Janet T Civian
- Senior Analyst, Brandeis University, Women's Studies Research Center, Waltham, Mass
| | - Sandra Shea
- Consultant, CIR Policy and Education Initiative, New York, NY
| | - Emma Brennan-Wydra
- Assessment Program Manager, Yale School of Medicine Teaching and Learning Center, New Haven, CT
| | - Arthur T Evans
- Professor of Medicine, Weill Cornell Medical College, New York, NY
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Hariharan TS, Griffin B. A review of the factors related to burnout at the early-career stage of medicine. MEDICAL TEACHER 2019; 41:1380-1391. [PMID: 31345077 DOI: 10.1080/0142159x.2019.1641189] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Background: Globally, burnout is an increasingly prevalent problem amongst young medical professionals. This review aims to understand the factors related to burnout in the early-career stage of medicine. Drawing on the widely used Job Demands-Resources Model, the antecedents of burnout were distinguished from its outcomes.Methods: The review adopted the PRISMA guidelines. Using specific search terms, peer-reviewed articles were obtained from a range of databases and assessed against selection criteria. To meet inclusion requirements, the study had to be published between 2000 and 2018, include a validated measure of burnout, and undertake empirical assessment of factors related to burnout in medical students and/or junior medical officers/residents. Additional studies were obtained and reviewed from the reference lists of selected articles.Results: Out of the 3796 studies that were initially found, 585 were assessed against the eligibility criteria leaving 113 studies for review. These studies highlighted the negative consequences of burnout in the early medical career. Also identified were work-specific and person-specific demands that likely lead to burnout and, work and person resources that appear to reduce burnout.Conclusion: This review provides a framework to explain the growing problem of burnout amongst early-career medical professionals. However, further research is necessary to overcome the current reliance on cross-sectional designs and small sample sizes.
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Affiliation(s)
| | - Barbara Griffin
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
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Summers SM, Nagy CJ, April MD, Kuiper BW, Rodriguez RG, Jones WS. The Prevalence of Faculty Physician Burnout in Military Graduate Medical Education Training Programs: A Cross-Sectional Study of Academic Physicians in the United States Department of Defense. Mil Med 2019; 184:e522-e530. [DOI: 10.1093/milmed/usz055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
In military populations, physician burnout has potential to adversely affect medical readiness to deploy in support of joint operations. Burnout among Graduate Medical Education (GME) faculty may further threaten the welfare of the medical force given the central role these officers have in training and developing junior physicians. The primary aim of this investigation was to estimate the prevalence of burnout among faculty physicians in United States (US) Army, Navy, and Air Force GME programs.
Materials and Methods
We conducted a cross-sectional study of faculty physicians at US military GME training programs between January 2018 and July 2018. Through direct coordination with Designated Institutional Officials, we administered the Maslach Burnout Inventory Health Services Survey (MBI-HSS) via online web link to faculty physicians listed in Accreditation Data System at each sponsoring institution. In addition to the MBI-HSS, we collected demographic data and queried physicians about common occupational stressors in order to assist institutional leaders with identifying at-risk physicians and developing future interventions to address burnout.
Results
Sixteen of 21 institutions that currently sponsor military GME programs agreed to distribute the MBI-HSS survey to core faculty. We received completed assessments from 622 of the 1,769 (35.1%) reported physician core faculty at these institutions. Of the 622 physician respondents, 162 demonstrated high levels of emotional exhaustion and depersonalization for an estimated 26% prevalence of burnout. We identified only one independent risk factor for burnout: increasing numbers of deployments (OR 1.38, 95% CI 1.07–1.77). Physicians in our cohort who reported a desire to stay beyond their initial active duty service obligation were less likely to be classified with burnout (OR 0.45, 95% CI 0.26–0.77). The most common drivers of occupational distress were cumbersome bureaucratic tasks, insufficient administrative support, and overemphasis on productivity metrics.
Conclusions
We estimate that 26% of physician faculty in military GME programs are experiencing burnout. No specialty, branch of service, or specific demographic was immune to burnout in our sample. Institutional leaders in the MHS should take action to address physician burnout and consider using our prevalence estimate to assess effectiveness of future interventions.
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Affiliation(s)
- Shane M Summers
- San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr., JBSA Fort Sam Houston, TX 78234
| | - Christopher J Nagy
- San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr., JBSA Fort Sam Houston, TX 78234
| | - Michael D April
- San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr., JBSA Fort Sam Houston, TX 78234
| | - Brandon W Kuiper
- San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr., JBSA Fort Sam Houston, TX 78234
| | - Rechell G Rodriguez
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Woodson S Jones
- University of Texas Health Sciences Center San Antonio, 8300 Floyd Curl Dr, San Antonio, TX 78229
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