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Al Alawi M, Al Ghailani A. Understanding physician burnout in Oman: current status, cultural influences and future directions. BJPsych Int 2024; 21:38-39. [PMID: 38693953 PMCID: PMC11035967 DOI: 10.1192/bji.2024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 12/08/2023] [Accepted: 01/07/2024] [Indexed: 05/03/2024] Open
Abstract
Amidst the current global surge in physician burnout, a compelling need arises for precisely targeted research and interventions that cater to specific contexts, illuminating a path towards professional well-being. This brief communication analyses recent studies on physician burnout in Oman, critically evaluating the findings, cultural factors, methodological limitations and future growth opportunities. Distinct elements of Omani culture, encompassing attitudes towards mental illness, gender roles and patient expectations, can distinctly influence how burnout presents in this population. Advanced mixed-methods research integrating cultural insights, biomarkers and longitudinal tracking is needed to characterise burnout in Omani physicians. The findings can play a significant role in developing comprehensive interventions, at both a systemic and an individual level, that promote well-being of physicians while specifically aligning with the cultural values of Oman.
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Affiliation(s)
- Mohammed Al Alawi
- MD, MRCPsych, Consultant Liaison Psychiatrist, Department of Behavioral Medicine, Sultan Qaboos University, Al-khod, Oman
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2
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Bianchi R, Verkuilen J, Sowden JF, Schonfeld IS. Towards a new approach to job-related distress: A three-sample study of the Occupational Depression Inventory. Stress Health 2023; 39:137-153. [PMID: 35700982 PMCID: PMC10084211 DOI: 10.1002/smi.3177] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 02/05/2023]
Abstract
The Occupational Depression Inventory (ODI) was recently developed to assess depressive symptoms that individuals specifically attribute to their work. One purpose of the ODI is to respond to limitations of current assessments of job-related distress, most notably, assessments relying on the burnout construct. In this study, we conducted a thorough examination of the psychometric and structural properties of the ODI using exploratory structural equation modelling bifactor analysis and Mokken scale analysis. The study involved three samples of employed individuals, recruited in France (N = 3454), Switzerland (N = 1971), and Australia (N = 1485). Results were consistent across the three samples. The ODI exhibited essential unidimensionality and excellent total-score reliability-as indexed by McDonald's omega, Cronbach's alpha, Guttman's lambda-2, and the Molenaar-Sijtsma statistic. We found evidence for measurement invariance across sexes, age groups, and samples. Mokken scale analysis revealed that the ODI's scalability was strong. No monotonicity violation was detected. Invariant item ordering showed sufficient accuracy. In all three samples, suicidal ideation was the least commonly endorsed item-thus acting as a sentinel item-and fatigue/loss of energy was the most commonly endorsed item. The ODI exhibits excellent psychometric and structural properties, suggesting that occupational health specialists can effectively employ the instrument.
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Affiliation(s)
- Renzo Bianchi
- University of Neuchâtel, Neuchâtel, Switzerland.,Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jay Verkuilen
- City University of New York, New York City, New York, USA
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McClafferty HH, Hubbard DK, Foradori D, Brown ML, Profit J, Tawfik DS. Physician Health and Wellness. Pediatrics 2022; 150:189767. [PMID: 36278292 DOI: 10.1542/peds.2022-059665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.
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Affiliation(s)
- Hilary H McClafferty
- Department of Pediatrics, Section Chief, Pediatric Emergency Medicine, Tucson Medical Center, Tucson, Arizona
| | - Dena K Hubbard
- Children's Mercy Kansas City, School of Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Dana Foradori
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Melanie L Brown
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel S Tawfik
- Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Wang Y, Xiao B, Tao Y, Li Y. The Relationship between Mindfulness and Job Burnout of Chinese Preschool Teachers: The Mediating Effects of Emotional Intelligence and Coping Style. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127129. [PMID: 35742377 PMCID: PMC9222807 DOI: 10.3390/ijerph19127129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
Preschool teachers’ job burnout has many adverse effects on their career development; although some studies have examined the influencing factors of teachers’ burnout, less were explored from the perspective of individual factors. This study aimed to examine the relationship between mindfulness and job burnout of preschool teachers, and the mediating effects of emotional intelligence and coping style. A total of 394 preschool teachers in China filled in questionnaires measuring mindfulness, emotional intelligence, coping style, and job burnout. The findings suggested that: (1) mindfulness was negatively related to job burnout; (2) emotional intelligence and negative coping style played independent mediating effects between mindfulness and job burnout; and (3) emotional intelligence and positive coping style played a chain mediating effect between mindfulness and job burnout. The results revealed the mechanism of mindfulness on preschool teachers’ job burnout, which is of great significance for the psychological intervention of preschool teachers in the future.
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Affiliation(s)
- Yingjie Wang
- School of Teacher Education, Huzhou University, Huzhou 313000, China;
| | - Bowen Xiao
- Department of Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Ying Tao
- School of Early Childhood Education, Shanghai Normal University, Shanghai 200234, China;
| | - Yan Li
- School of Early Childhood Education, Shanghai Normal University, Shanghai 200234, China;
- Correspondence:
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Fadare O, Doucette WR, Gaither C, Schommer JC, Arya V, Bakken B, Kreling DH, Mott DA, Witry MJ. Exploring the moderating role of job resources in how job demands influence burnout and professional fulfillment among U.S. pharmacists. Res Social Adm Pharm 2022; 18:3821-3830. [DOI: 10.1016/j.sapharm.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/09/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
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Woodward R, Cheng T, Fromewick J, Galvin SL, Latessa R. What happy physicians have in common: A qualitative study of workplace perceptions of physicians with low burnout scores. SAGE Open Med 2022; 10:20503121221085841. [PMID: 35371480 PMCID: PMC8968974 DOI: 10.1177/20503121221085841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/17/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Burnout is a phenomenon in the medical field that adversely affects patient care, physician retention, and physician well-being. The preponderance of burnout research has primarily focused on exploring what parts of medical practice and individual characteristics contribute to burnout. Our research aims to add to the growing body of evidence exploring what physicians who love their work have in common. Methods: Physician participants in this qualitative study were recruited through their local medical society from those who indicated a willingness to share tips for joy in practice. Potential participants were then screened for low probability of burnout using a validated single-item burnout inventory. Nine primarily mid- to late-career physicians engaged in semi-structured interviews and thematic analysis was used to analyze data. Of the interviewed physicians, five were practicing in the primary care specialties of family or internal medicine and four in specialties outside of primary care. Results: Six major themes arose from the nine interviews and included variety in work, a sense of empowerment, connection with patients, visible impact of one’s work, feelings of community with coworkers and colleagues, and experiencing a sense of calling. Conclusion: While further research is needed to demonstrate the transferability of the themes from these interviews, an asset-rooted approach to physician wellness is a direction for research and intervention that deserves further attention. Focusing only on alleviating the factors that contribute to burnout is a worthy goal, but ignores the necessity of designing training systems and workplaces that are built to foster the elements of medicine that bring joy and fulfillment to practice.
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Affiliation(s)
| | - Tsaiwei Cheng
- Mountain Area Health Education Center, Asheville, NC, USA
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Shelley L Galvin
- Mountain Area Health Education Center, Asheville, NC, USA
- University of North Carolina School of Medicine, Asheville, NC, USA
| | - Robyn Latessa
- UNC Health Sciences at MAHEC, Asheville, NC, USA
- University of North Carolina School of Medicine, Asheville, NC, USA
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Tetzlaff ED, Hylton HM, Ruth KJ, Hasse Z, Hall MJ. Association of Organizational Context, Collaborative Practice Models, and Burnout Among Physician Assistants in Oncology. JCO Oncol Pract 2022; 18:e1306-e1319. [PMID: 35061507 PMCID: PMC9377690 DOI: 10.1200/op.21.00627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Despite an increase in the number of physician assistants (PAs) in the oncology workforce, their potential to meet anticipated demand for oncology services may be hindered by high rates of burnout. The aim of this study was to examine the association between organizational context (OC) and burnout among oncology PAs to better understand factors associated with burnout. METHODS: A national survey of oncology PAs was conducted to explore relationships between burnout and the OC in which the PA practiced. The Areas of Worklife Survey (AWS) assessed OC by examining six key workplace qualities (workload, control, reward, community, fairness, and values). Burnout was assessed using the Maslach Burnout Inventory. RESULTS: PAs demonstrating burnout scored significantly lower across all domains of the AWS than those without burnout ( P < .001 for each AWS subscale). The median score for each domain of the AWS and burnout (No v Yes) were as follows: workload (3.33 v 2.67), control (3.67 v 3.00), reward (4.00 v 3.67), community (4.00 v 3.67), fairness (3.33 v 2.67), and values (4.00 v 3.33). Multivariable analysis found that mismatches between the PA and their work environment in workload (odds ratio [OR] = 1.99; 95% CI, 1.32 to 3.02; P = .001), reward (OR = 1.89, 95% CI, 1.18 to 3.02; P = .008), and values (OR = 2.25; 95% CI, 1.31 to 3.88; P = .003) were more likely to report burnout. Differences in burnout in the context of workload were not explained by patient volume, practice structure, or professional autonomy. CONCLUSION: Workload, reward, and values were associated with greater odds of burnout, with workload being the most common mismatch in job fit. Sustainable workloads and consistency in rewards (financial, institutional, and social) for oncology PAs should be an employer's focus to help mitigate their risk of burnout.
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Affiliation(s)
| | - Heather M. Hylton
- Association of Physician Assistants in Oncology, Altamonte Springs, FL
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Williamson K, Lank PM, Olson A, Cheema N, Lovell E. A Positive Depression Screen Is Associated with Emergency Medicine Resident Burnout and Is not Affected by the Implementation of a Wellness Curriculum. West J Emerg Med 2021; 22:1341-1346. [PMID: 34787560 PMCID: PMC8597694 DOI: 10.5811/westjem.2021.9.52016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/26/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction While burnout is occupation-specific, depression affects individuals comprehensively. Research on interventions for depression in emergency medicine (EM) residents is limited. Objectives We sought to obtain longitudinal data on positive depression screens in EM residents, assess their association with burnout, and determine whether implementation of a wellness curriculum affected the rate of positive screens. Methods In February 2017, we administered the Maslach Burnout Inventory and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire two-question depression screen at 10 EM residencies. At five intervention sites, a year-long wellness curriculum was then introduced while five control sites agreed not to introduce new wellness initiatives during the study period. Study instruments were re-administered in August 2017 and February 2018. Results Of 382 residents, 285 participated in February 2017; 40% screened positive for depression. In August 2017, 247/386 residents participated; 27.9% screened positive for depression. In February 2018, 228/386 residents participated; 36.2% screened positive. A positive depression screen was associated with higher burnout. There were similar rates of positive screens at the intervention and control sites. Conclusion Rates of positive depression screens in EM residents ranged between 27.9% and 40%. Residents with a positive screen reported higher levels of burnout. Rates of a positive screen were unaffected by introduction of a wellness curriculum.
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Affiliation(s)
- Kelly Williamson
- Northwestern University, Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Patrick M Lank
- Northwestern University, Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Adriana Olson
- University of Chicago, Pritzker School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Navneet Cheema
- University of Chicago, Pritzker School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Elise Lovell
- University of Illinois at Chicago, Advocate Christ Medical Center, Department of Emergency Medicine, Chicago, Illinois
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Dyrbye LN, West CP, Herrin J, Dovidio J, Cunningham B, Yeazel M, Lam V, Onyeador IN, Wittlin NM, Burke SE, Hayes SN, Phelan SM, van Ryn M. A Longitudinal Study Exploring Learning Environment Culture and Subsequent Risk of Burnout Among Resident Physicians Overall and by Gender. Mayo Clin Proc 2021; 96:2168-2183. [PMID: 34218879 DOI: 10.1016/j.mayocp.2020.12.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore the relationship between learning environment culture and the subsequent risk of developing burnout in a national sample of residents overall and by gender. METHODS From April 7 to August 2, 2016, and May 26 to August 5, 2017, we surveyed residents in their second (R2) and third (R3) postgraduate year. The survey included a negative interpersonal experiences scale (score range 1 to 7 points, higher being worse) assessing psychological safety and bias, inclusion, respect, and justice; an unfair treatment scale (score range 1 to 5 points, higher being worse), and two items from the Maslach Burnout Inventory. Individual responses to the R2 and R3 surveys were linked. RESULTS The R2 survey was completed by 3588 of 4696 (76.4%) residents; 3058 of 3726 (82.1%) residents completed the R3 survey; and 2888 residents completed both surveys. Women reported more negative interpersonal experiences (mean [SD], 3.00 [0.83] vs 2.90 [0.85], P<.001) and unfair treatment (66.5% vs. 58.7%, P<.001) than men at R2. On multivariable analysis, women at R3 were more likely than their male counterparts to have burnout (odds ratio, 1.23; 95% CI, 1.02 to 1.48; P=.03). Both men and women who reported more negative interpersonal experiences at R2 were more likely to have burnout at R3 (odds ratio, 1.32; 95% CI, 1.14 to 1.52; P<.001). The factors contributing to burnout did not vary in effect magnitude by gender. CONCLUSION These findings indicate women residents are more likely to have burnout relative to men in the third year of residency. Negative culture predicted subsequent burnout 1 year later among both men and women. Differences in burnout were at least partly due to differing levels of exposure to negative interactions for men versus women rather than a negative interaction having a differential impact on the well-being of men versus women.
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Affiliation(s)
- Liselotte N Dyrbye
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Colin P West
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jeph Herrin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | | | - Brooke Cunningham
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Mark Yeazel
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | | | - Ivuoma N Onyeador
- Department of Management and Organizations, Kellogg School of Management, Northwestern University, Kirkland, WA
| | | | - Sara E Burke
- Department of Psychology, Syracuse University, Syracuse, NY
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sean M Phelan
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN
| | - Michelle van Ryn
- School of Nursing, Oregon Health & Science University, Portland, OR
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The prevalence and correlates of burnout among Chinese preschool teachers. BMC Public Health 2020; 20:160. [PMID: 32013939 PMCID: PMC6998270 DOI: 10.1186/s12889-020-8287-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/27/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A series of studies have suggested that teachers are likely to experience professional burnout in various regions around the world. To date, no known research has been conducted to investigate the prevalence and correlates of burnout among preschool teachers in China. This study examined the level of self-reported burnout and correlates of burnout among Chinese preschool teachers. METHODS A cross-sectional study was conducted among1795 preschool teachers in Tianjin, China, during August 2018-October 2018. The validated Chinese version of the 15-item Maslach Burnout Inventory was used to assess burnout. A self-administered questionnaire collected the sociodemographic factors. The psychological factors were collected by the Chinese version of the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and the Perceived Stress Scale-14. RESULTS The prevalence of burnout in Chinese preschool teachers was 53.2% (95% CI:51%─56%). Burnout rate was significantly decreased in overweight (P = 0.001, OR = 0.58, 95% CI: 0.42-0.79) and obesity (P = 0.048, OR = 0.75, 95% CI: 0.56-1.00) teachers compared with teachers with normal weight. The type of school (P = 0.007, OR = 1.45, 95% CI: 1.11-1.91), income satisfaction (P = 0.001, OR = 0.67, 95% CI: 0.53-0.86), depression (P < 0.001, OR = 3.08, 95% CI: 2.34-4.05) and perceived stress (P < 0.001, OR = 1.15, 95%CI: 1.13-1.18) were significantly associated with burnout. CONCLUSIONS The prevalence of burnout among preschool teachers in Tianjin, China, is high. Burnout was significantly associated with BMI, the type of school, income satisfaction, depression and perceived stress among Chinese preschool teachers.
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Abstract
Tens (or hundreds) of thousands of Americans die each year as a result of preventable medical errors. Changes in the practice and business of medicine have caused some to question whether burnout among physicians and other healthcare providers may adversely affect patient outcomes. A clear consensus supports the contention that burnout affects patients, albeit with low-quality objective data. The psychological and physical impact on physicians and other providers is quite clear, however, and the impact on the physician workforce (where large shortages are projected) is yet another cause for concern. We have all heard the airplane safety announcement remind us to "Please put on your own oxygen mask first before assisting others." Unfortunately, like many airline passengers (very few of whom use oxygen masks correctly when they are needed), physicians often do not recognize symptoms of burnout or depression, and even less often do they seek help. We detail the causes and consequences of physician burnout and propose solutions to increase physician work satisfaction.
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Bianchi R, Schonfeld IS, Verkuilen J. A five-sample confirmatory factor analytic study of burnout-depression overlap. J Clin Psychol 2020; 76:801-821. [PMID: 31926025 DOI: 10.1002/jclp.22927] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It has been asserted that burnout-a condition ascribed to unresolvable job stress-should not be mistaken for a depressive syndrome. In this confirmatory factor analytic study, the validity of this assertion was examined. METHODS Five samples of employed individuals, recruited in Switzerland and France, were mobilized for this study (N = 3,113). Burnout symptoms were assessed with the Shirom-Melamed Burnout Measure, the Maslach Burnout Inventory (MBI)-General Survey, and the MBI for Educators. Depressive symptoms were measured with the PHQ-9. RESULTS In all five samples, the latent factors pertaining to burnout's components correlated on average more highly with the latent Depression factor than with each other, even with fatigue-related items removed from the PHQ-9. Second-order factor analyses indicated that the latent Depression factor and the latent factors pertaining to burnout's components were reflective of the same overarching factor. CONCLUSIONS This study suggests that the burnout-depression distinction is artificial.
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Affiliation(s)
- Renzo Bianchi
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, NE, Switzerland
| | - Irvin Sam Schonfeld
- Department of Psychology, The City College of the City University of New York, New York City, New York
| | - Jay Verkuilen
- Department of Educational Psychology, The Graduate Center of the City University of New York, New York City, New York
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Hillert A, Albrecht A, Voderholzer U. The Burnout Phenomenon: A Résumé After More Than 15,000 Scientific Publications. Front Psychiatry 2020; 11:519237. [PMID: 33424648 PMCID: PMC7793987 DOI: 10.3389/fpsyt.2020.519237] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022] Open
Abstract
The "burnout" phenomenon, supposedly caused by work related stress, is a challenge for academic psychiatry both conceptually and professionally. Since the first description of burnout in 1974 until today, more than 140 definitions have been suggested. Burnout-symptomatology's main characteristic, the experience of exhaustion, is unspecific. Different development-models of burnout were proposed, assumed to depict a quasi-natural process. These could not be confirmed empirically. An expert consensus on the diagnostic criteria and the conceptual location, whether as an independent disorder or as a risk, could not be agreed on. Nevertheless, the phenomenon of burnout in the ICD-11 is considered to be categorized as a work-related disorder. Psychiatric research on the burnout-phenomenon ignores problems of definition resulting from different perspectives: It may meet societal expectations, but does not fulfill scientific criteria, and therefore is not suitable to establish an objective diagnosis and treatment. Parallel detection of ICD/DSM diagnoses from an expert perspective and subjective perturbation models are considered appropriate.
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Affiliation(s)
| | - Arnd Albrecht
- Munich Business School, München/Munich Business Coaching Institute, München, Germany
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Oquendo MA, Bernstein CA, Mayer LES. A Key Differential Diagnosis for Physicians-Major Depression or Burnout? JAMA Psychiatry 2019; 76:1111-1112. [PMID: 31314066 DOI: 10.1001/jamapsychiatry.2019.1332] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Carol A Bernstein
- New York University School of Medicine, New York.,now with Montefiore Medical Center; Albert Einstein College of Medicine, New York, New York
| | - Laurel E S Mayer
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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15
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Abstract
In this article we address the concept of burnout, first in the medical student setting, and then in the residency setting. We will review the prevalence followed by a discussion of risk factors, consequences, and finally thoughts on prevention and intervention.
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Al-Alawi M, Al-Sinawi H, Al-Qubtan A, Al-Lawati J, Al-Habsi A, Al-Shuraiqi M, Al-Adawi S, Panchatcharam SM. Prevalence and determinants of burnout Syndrome and Depression among medical students at Sultan Qaboos University: A cross-sectional analytical study from Oman. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2019; 74:130-139. [PMID: 29116906 DOI: 10.1080/19338244.2017.1400941] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study investigated the prevalence and determinants of Burnout Syndrome and Depressive Symptoms among medical students in Oman. Then, it explored whether the three-dimensional aspects of Burnout Syndrome (High Emotional Exhaustion, High Cynicism and Low Academic Efficacy) would predict the presence of Depressive Symptoms in a logistic regression model. A cross-sectional study was conducted among a random sample of medical students of Sultan Qaboos University. 662 students participated in the study with a response rate of 98%. The prevalence of Burnout Syndrome and Depressive Symptoms were; 7.4% and 24.5% respectively. Preclinical students reported high levels of both Burnout Syndrome (Odds Ratio-OR 2.83, 95% Confidence Interval CI 1.45-5.54) and Depressive Symptoms (OR 2. 72, 95% CI 1.07-6.89). The three-dimensional aspects of Burnout Syndrome(High Emotional Exhaustion, High Cynicism, low Professional efficacy) were statistically significant predictors of the presence of Depressive Symptoms; OR 3.52 (95% CI: 2.21-5.60), OR 3.33 (95% CI:2.10-5.28) and OR 2.07(95%CI:1.32-3.24) respectively. This study indicates that Burnout Syndrome and Depressive Symptoms are common among medical students, particularly in preclinical grade. Furthermore, the presence of high occupational burnout elevates the risk of depression.
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Affiliation(s)
- Mohammed Al-Alawi
- a Psychiatry Residency Training Program, Oman Medical Specialty Board , Muscat , Oman
- b Department of Behavioral Medicine , Sultan Qaboos University Hospital , Muscat , Oman
| | - Hamed Al-Sinawi
- a Psychiatry Residency Training Program, Oman Medical Specialty Board , Muscat , Oman
- b Department of Behavioral Medicine , Sultan Qaboos University Hospital , Muscat , Oman
| | - Ali Al-Qubtan
- c Department of Behavioral Medicine , College of Medicine and Health Science, Sultan Qaboos University , Muscat , Oman
| | - Jaber Al-Lawati
- c Department of Behavioral Medicine , College of Medicine and Health Science, Sultan Qaboos University , Muscat , Oman
| | - Assad Al-Habsi
- c Department of Behavioral Medicine , College of Medicine and Health Science, Sultan Qaboos University , Muscat , Oman
| | - Mohammed Al-Shuraiqi
- c Department of Behavioral Medicine , College of Medicine and Health Science, Sultan Qaboos University , Muscat , Oman
| | - Samir Al-Adawi
- c Department of Behavioral Medicine , College of Medicine and Health Science, Sultan Qaboos University , Muscat , Oman
| | - Sathiya Murthi Panchatcharam
- d Department of Behavioral Medicine , Studies and Research Section, Oman Medical Specialty Board , Muscat , Oman
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Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, Mata DA. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA 2018; 320:1131-1150. [PMID: 30326495 PMCID: PMC6233645 DOI: 10.1001/jama.2018.12777] [Citation(s) in RCA: 947] [Impact Index Per Article: 157.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022]
Abstract
Importance Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown. Objective To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout. Data Sources and Study Selection Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018. Data Extraction and Synthesis Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively. Main Outcomes and Measures Point or period prevalence of burnout assessed by questionnaire. Results Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined. Conclusions and Relevance In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.
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Affiliation(s)
- Lisa S. Rotenstein
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Brigham Education Institute, Boston, Massachusetts
| | - Matthew Torre
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Marco A. Ramos
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Rachael C. Rosales
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor
| | - Douglas A. Mata
- Harvard Medical School, Boston, Massachusetts
- Brigham Education Institute, Boston, Massachusetts
- Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
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Yuguero O, Melnick ER, Marsal JR, Esquerda M, Soler-Gonzalez J. Cross-sectional study of the association between healthcare professionals' empathy and burnout and the number of annual primary care visits per patient under their care in Spain. BMJ Open 2018; 8:e020949. [PMID: 30061437 PMCID: PMC6067329 DOI: 10.1136/bmjopen-2017-020949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the association between physician and nurse self-reported empathy and burnout and the number of annual primary care visits per patient under their care. METHODS Design: A cross-sectional survey study was conducted from January 2013 to July 2014. Site: The 22 primary care centres of the Lleida Health Region in Spain. MAIN OUTCOME MEASURES The Jefferson Scale of Physician Empathy and the Maslach Burnout Inventory were used to measure empathy and burnout, respectively. The number of visits and the number of diagnoses coded per visit were obtained through the Region's electronic health record. RESULTS Two hundred and sixty-seven healthcare professionals (physicians and nurses, 52.6% participation of the total in the region) with 301 657 patients under their care. Healthcare professionals' degree of burnout and empathy was associated with the number of annual visits per patient under their care. Burned out nurses and physicians received fewer visits (4.5vs3.7 in nurses and 18.1vs18.9 in physicians), whereas more empathic physicians received more visits per patient (19.4vs17.2, p<0.05) and documented more diagnoses per visit (10.2vs9.7, p=0.001). Less burned out and less empathic nurses documented more diagnoses per visit (10.2vs10.0 and 8.2vs9.9, p<0.05). CONCLUSIONS The number of annual primary care visits per patient that healthcare professionals receive is closely associated with healthcare professionals' empathy and burnout. These results should serve to promote empathic skills and establish organisational changes that promote efficiency in the practice and, in turn, reduce the degree of burnout of healthcare professionals.
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Affiliation(s)
- Oriol Yuguero
- Faculty of Medicine, University of Lleida, Lleida, Spain
- Biomedical Research Institute of Lleida, IRBLLEIDA, Lleida, Spain
| | - Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Josep R. Marsal
- Research Support Unit, Primary Care Research Institute (IDIAP), Barcelona, Spain
- Epidemiology Unit, Cardiovascular Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Montserrat Esquerda
- Faculty of Medicine, University of Lleida, Lleida, Spain
- Direction, Borja Bioethics Institute, Barcelona, Spain
| | - Jorge Soler-Gonzalez
- Faculty of Medicine, University of Lleida, Lleida, Spain
- Biomedical Research Institute of Lleida, IRBLLEIDA, Lleida, Spain
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Fleurant M, Lasser KE, Quintiliani LM, Liebschutz J. Group Self-Reflection to Address Burnout: A Facilitator's Guide. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10663. [PMID: 30800863 PMCID: PMC6338134 DOI: 10.15766/mep_2374-8265.10663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/10/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Inadequately supported clinicians risk burnout, which is prevalent among them. Balint-like groups can be utilized to address clinician stressors and augment interpersonal skills by exploring the clinician-patient relationship. METHODS In January 2012, we initiated the Clinical Case Discussion Group (CCDG), based on Michael Balint's Balint group, at the Boston University School of Medicine Section of General Internal Medicine. The CCDG is an interprofessional group discussion founded on self-reflection of patient cases designed to tease out ethical, psychosocial, and medical issues that impact the clinician-patient relationship. The format consists of a facilitator-led small group session including 5-10 minutes of case discussion followed by open group discussion. In April 2014, we conducted a cross-sectional survey of clinicians who participated in the CCDG to evaluate the group's ability to foster skills in self-reflection, empathy, response to patient challenges, personal awareness, and tolerance of uncertainty, and to address clinicians' personal and professional stressors. RESULTS More than 75% of clinicians surveyed agreed that participation fostered skills in tolerating uncertainty, increasing empathy, and navigating difficult patient relationships. All respondents agreed the group developed skills in self-reflection. At least 40% of clinicians reported some degree of isolation, professional stress, and personal stress; group participation addressed these issues at least 70% of the time. DISCUSSION This self-reflection case discussion group, incorporated into academic clinical practice, supports the professional development of a broad cadre of clinicians and addresses both personal and professional stressors. Clinical departments should consider systematically implementing similar groups in practice.
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Affiliation(s)
- Marshall Fleurant
- Assistant Professor of Medicine, Grady Section, Department of General Medicine and Geriatrics, Emory University School of Medicine
- Assistant Professor of Medicine, Grady Memorial Hospital
| | - Karen E. Lasser
- Associate Professor of Medicine, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine
- Associate Professor of Medicine, Boston Medical Center
- Associate Professor of Medicine, Boston University School of Public Health
| | - Lisa M. Quintiliani
- Assistant Professor of Medicine, Department of Community Health Sciences, Boston University School of Public Health
| | - Jane Liebschutz
- Associate Professor of Medicine, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine
- Associate Professor of Medicine, Boston Medical Center
- Associate Professor of Medicine, Boston University School of Public Health
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