Physician wellness: a missing quality indicator

Ability and utility of the Physician Well-Being Index to identify distress among Chinese physicians

BACKGROUND

Despite the high prevalence of mental stress among physicians, reliable screening tools are scarce. This study aimed to evaluate the capability of the Physician Well-Being Index (PWBI) in identifying distress and adverse consequences among Chinese physicians.

METHODS

This cross-sectional online survey recruited 2803 physicians from Southern Mainland China via snowball sampling between October and December 2020. Data on socio-demographic characteristics, the PWBI, mental distress (including quality of life [QOL], burnout, sleepiness, fatigue and suicidal ideation) and adverse outcomes (medical errors and turnover intention) were collected. Chi-square tests and logistic regression were used for data analysis.

RESULTS

Seven items of the PWBI (emotional exhaustion, depression, stress, poor mental and physical QOL, low work meaning and dissatisfaction with work-life integration) were independently associated with low QOL (all p < 0.05). Physicians with lower QOL were more likely to endorse each item (OR: 1.76-5.86) and less likely to have favourable index scores (all p < 0.001). Assuming a prevalence of 29.2% for low QOL, the PWBI could reduce the post-test probability to 6.9% or increase it to 70.8%. Physicians scoring ≥4 on the PWBI were at increased risk (likelihood ratio >1) for experiencing various mental distress, with sensitivity exceeding 80% in detecting burnout, depression, high stress and anxiety. Additionally, the PWBI score helped stratify physicians' likelihood of reporting medical errors and turnover intention.

CONCLUSIONS

This study provides preliminary insights into the validity and utility of the 9-item PWBI as a screening tool for assessing distress and well-being among Chinese physicians, helping identify those at higher risk of medical errors or turnover. However, these findings should be interpreted with caution due to the limited sample size.

Mortality Risks of U.S. Healthcare Workers

INTRODUCTION

Physicians and nurses have lower annual mortality rates than the general population. One explanation for the low mortality rates of these healthcare workers emphasizes their specialized medical knowledge and greater access to healthcare while a second emphasizes their generally higher level of education. This study evaluated the extent to which general educational level accounts for the lower all-cause mortality rates of U.S. healthcare than non-healthcare workers. It also compared cause-specific mortality risks of healthcare and non-healthcare workers.

METHODS

A nationally representative sample of healthcare workers (n=176,000) and non-healthcare workers (n=1,662,000) from the 2008 American Community Survey (n=3,310,000) was followed through 2019 for mortality. Cox models estimated hazard ratios of all-cause and cause-specific mortality for 6 healthcare worker groups. Analyses were performed in 2024.

RESULTS

Age- and sex-standardized all-cause death rates per 100,000 were lower for healthcare (370.7; 95% CI=361.5, 379.9) than non-healthcare (442.2; 95% CI=439.2, 445.2) workers (p<0.001). However, this difference was not evident after additionally adjusting for level of education (aHR=1.00; 0.97, 1.02). In fully adjusted models, hazards of mortality were lower for healthcare than non-healthcare workers for cardiovascular disease (aHR=0.94; 0.89, 0.99) and lung cancer (aHR=0.89; 0.81, 0.98), but higher for pancreatic cancer (aHR=1.21; 1.05, 1.39) and external causes of death (aHR=1.20; 1.10, 1.30).

CONCLUSIONS

Higher educational attainment accounted for the longer life expectancy of U.S. healthcare workers than other workers. Nevertheless, healthcare work relative to non-healthcare work was associated with lower hazards of deaths due to cardiovascular diseases and lung cancer, but higher hazards of deaths due to external causes.

Factors related to resilience for mid- to late-career-stage veterinarians: a qualitative study

BACKGROUND

This study aimed to explore how resilience in mid- to late-career stage veterinarians in Australia is shaped by interactions between job demands, personal and contextual resources, strategies and outcomes.

METHODS

Semistructured interviews with 17 mid- to late-career stage veterinarians were conducted with questions modelled on prior research investigating veterinarians' experiences, teacher well-being and resilience. The Job Demands-Resources model guided thematic analysis.

RESULTS

Mid- to late-career stage veterinarians described how resilience is shaped by interactions between (1) demands of the job, (2) resources available, (3) strategies used and (4) resilience outcomes. Job demands and job resources categories were sub-divided into four and seven themes respectively according to whether characteristics were based on personal or contextual factors. Strategies were grouped into seven themes representing intentional ways that veterinarians made effective use of resources. Three themes in the Outcomes category represented positive outcomes that were enabled through dynamic interaction between demands, resources and strategies undertaken to realise outcomes.

LIMITATIONS

This study did not explore relationships between perceptions of resilience and veterinary work type, practice location, age or gender. Interviews were conducted before the global COVID-19 pandemic, and results do not reflect any associated psychological impacts from that event.

CONCLUSION

Resilience in mid- to late-career veterinarians is a dynamic process driven by the interplay of demands, resources, intentional actions and outcomes. Although personal resources can be developed over time, job demands are largely contextual. Effective management practices can mitigate challenges and foster resilience.

Work-life conflict and its health effects on Moroccan gastroenterologists: a cross-sectional study

Background

Gastroenterologists are exposed to various health-related risks due to their diverse professional roles, including endoscopy, clinical care, and academic responsibilities.

Objectives

This study aims to assess the work-life balance (WLB), the prevalence of work-related physical and mental symptoms among gastroenterologists practicing in Morocco, and the effects of WLB on their health.

Design

Survey study.

Methods

A total of 152 gastroenterologists from various Moroccan cities participated in an anonymous electronic questionnaire regarding their daily activities and symptoms. A WLB ratio was calculated, and musculoskeletal, gastrointestinal, and mental symptoms were recorded. The Maslach Burnout Inventory (MBI) was used to measure the burnout score. Data were analyzed using JAMOVI 2.5 software. The reporting of this study conforms to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) statement.

Results

This study included 152 gastroenterologists (72.4% female; sex ratio = 0.38) with a median age of 31 years (range: 26-64). Among participants, 61.8% were married, and 70.2% were married to physicians. The average working hours were 50.2 ± 12.7 h/week. Health-related symptoms were common: 86.8% reported musculoskeletal disorders, and 71.1% reported digestive disorders. Regarding mental symptoms, 23.7% reported anxiety, and 46.1% reported depression, with 21.1% experiencing both. The median WLB ratio was 0.42 (range: 0.32-0.55). In univariate analysis, the ratio was correlated with age (p < 0.001) and mental symptoms (depression, p < 0.001; anxiety, p = 0.007). Multivariate analysis revealed age as the only significant associated factor (beta = -0.24 (95% confidence interval: -0.46 to -0.013)). Using the MBI scale, 72.4% of respondents experienced burnout, which correlated with the WLB ratio (p = 0.04). In addition, depersonalization (DP) showed a moderate negative correlation with age (p = 0.002, r = -0.32), while personal accomplishment (PA) showed a moderate positive correlation with age (p = 0.003, r = 0.31).

Conclusion

Moroccan gastroenterologists suffer from musculoskeletal, digestive, and mental symptoms, and are prone to burnout likely due to long and labor-intensive. Our study found that younger individuals worked more and were more likely to experience burnout, particularly with increased DP toward patients and diminished PA. The mechanisms behind this observation may be linked to higher workloads, less autonomy, and limited coping strategies, factors that should be explored further.

Striking the right balance between accountability and quality improvement: a discharge summary timeliness tale

BACKGROUND

The timely distribution of discharge summaries within 48 hours can play an important role in ensuring safe patient care transitions and reducing readmission. Like other academic centres, we struggled with achieving a regulator mandated outcome of discharge summary authentication within 48 hours.

STUDY AIM

To increase the percentage of discharge summaries authenticated within 48 hours from a baseline of 62% to 75% over 1 year on six acute medicine teams.

METHODS

The model for improvement guided this quality improvement (QI) initiative. Outcome measures included the percentage of discharge summaries authenticated within 48 hours, and the average time from discharge to authentication. Balancing measures were a high-level process measure related to quality; editing behaviours before authentication. Data were analysed using a pre-post design and represented via statistical process control charts, P chart and XbarS charts.

RESULTS

While the primary aim was achieved, it was not sustained. By contrast, the time to authentication decreased from 53 hours to 38 hours and was sustained. The percentage of editing of summaries also exhibited significant variability. The 38% who demonstrated considerable improvement in time to authentication had decreased rates of consultant and trainee editing. In contrast, those who edited before authentication took longer to authenticate with a median difference of 5 hours (p<2.2e-16) and were less likely to meet the 48-hour target (OR 0.67, 95% CI 0.6028, 0.7521).

DISCUSSION

Our findings are important for both regulators and QI practitioners and highlight the importance of defining clinically meaningful targets while also considering their impact on quality and education. While we cannot be certain that summary quality was compromised in those without editing, the association between time to authentication and editing behaviour is highly suggestive. Moreover, it was also associated with a decrease in trainee editing, which is concerning from an educational perspective.

Course of mental distress among psychotherapists throughout two years of the COVID- 19 pandemic: individual and inter-relational resources make a difference-cross-sectional and longitudinal results of the VOICE study

BACKGROUND

The COVID-19 pandemic has posed challenges to healthcare systems worldwide. For healthcare workers (HCW), an increased prevalence of mental distress and the impact of various resources have been identified. Psychotherapists specialise in helping people cope with stressful life events. At the same time, they are susceptible to mental distress, resulting from their work. Data on symptoms of depression and the role of resources during the COVID-19 pandemic are scarce for psychotherapists. Therefore, the present study aimed to evaluate the course of self-reported depression of psychotherapists throughout the COVID-19 pandemic. Additionally, the impact of resources on depression was evaluated.

METHODS

We investigated symptoms of depression using the Patient Health Questionnaire-2 (PHQ-2) at four time points (T1-T4) during the COVID-19 pandemic in Germany. The PHQ-2 scores and resources such as sense of coherence (SOC), general optimism and social support (ESSI-D) of the psychotherapists (N = 1733) were compared with those of a comparison sample of HCW (N = 8470). The impact of resources on PHQ-2 scores was examined using cross-sectional linear modelling and longitudinal linear mixed modelling with interactions and lagged predictors.

RESULTS

At T1-T4, psychotherapists showed lower mean PHQ-2 scores than the comparison sample (p < 0.001). Among psychotherapists, the PHQ-2 scores increased (T1-T2, and T1-T4, p < 0.050). Cross-sectionally, higher SOC was associated with lower PHQ-2 scores (p < 0.001), with the protective influence weakening over time (p = 0.033). Longitudinal analyses confirmed a protective effect of sense of coherence (stable over time) and general optimism (declining over time) on PHQ-2 scores. An exploratory lagged-predictor analysis suggested that higher social support was associated with lower PHQ-2 scores, whereas higher general optimism was linked to increasing PHQ-2 scores.

CONCLUSIONS

This study revealed lower levels of depression among psychotherapists compared with the comparison sample throughout the pandemic. Concurrently, the resource levels were mostly comparable and stable, with a protective impact of the sense of coherence (stable) and optimism (decreasing) and an association of high social support with low depression throughout the pandemic. Strengthening the sense of coherence and social support should be the focus of professional and policy attention to improve the ability of psychotherapists to cope with future crises.

Better Together? A Mediation Analysis of French General Practitioners' Performance in Multi Professional Group Practice

Background

Integrated primary care teams remain a debatable policy in family medicine that could be a convenient response to French shortages in medical density.

Objectives

To analyse how general practitioners (GPs) respond to insufficient GP supply in their practice area in terms of quantity and quality of care, and how this response is mediated by enrolment in integrated primary care teams - multi-professional group practices (MGPs).

Methods

We used structural equation modelling on 3 representative cross-sectional surveys (2019-2020) of 1209 French GPs. Quantity and quality of care were approximated by latent variables comprising respectively GPs' demand absorption capacity and frequencies of vaccine recommendations.

Results

In the absence of potential mediators, low GP density was negatively associated with quantity (-0.221, unstandardized direct effects), but not with the quality of care. In the presence of mediators, low GP density was associated with higher work-related stress (0.120), which was consecutively associated with deteriorated demand absorption capacity (-0.202). Higher use of e-health tools was associated with greater involvement in vaccine recommendations (0.357). GPs in MGPs tended to use more e-health tools than those practicing outside MGPs (0.032), with a favourable effect on vaccine recommendations.

Conclusion

Lower level of work-related stress is the key mediator in handling patients' requests. When correcting for self-selection into MGPs, we found no significant mediation effect of enrolment in MGPs on the quantity of care but rather an effect on the quality of care. Our results pinpoint an added value of an enrolment in an MGPs to care quality that advocates for its further development.

JEL Classification

I14, I18.

A Qualitative Study of Surgeon Mattering and Well-Being in an Expanding Health System

INTRODUCTION

Academic medical centers are undergoing significant growth which may influence surgeons' perceptions of their roles and value within these institutions. This study aimed to explore academic surgeons' perspectives on their roles and sense of value within an expanding academic medical center.

MATERIALS AND METHODS

We conducted semi-structured interviews with 39 surgeons at a single academic medical center. Using a qualitative descriptive approach, we analyzed data through iterative coding and theme development.

RESULTS

We identified three main themes: (1) Increased administrative responsibilities with inadequate support, (2) Perceived limited influence in organizational decision-making, and (3) Importance of support from health system administration and colleagues. Surgeons interpreted administrative workload and their level of involvement in institutional decisions as key indicators of their value to the organization. Collegial support played a vital role in countering feelings of disengagement and fostering a sense of belonging.

CONCLUSIONS

The organizational structure of academic medical centers impacts surgeons' perceptions of their value. Addressing administrative burdens, enhancing surgeon participation in governance, and fostering supportive professional networks are potential strategies to improve morale and job satisfaction during organizational growth. Future research should focus on developing interventions to address these areas.

Spousal Support and Physician Work-Life Integration and Burnout

Importance

Few studies have assessed whether factors outside the workplace, such as support from a spouse or partner, are associated with work-life integration (WLI) satisfaction and burnout among physicians. Evaluating such an association may help with developing novel strategies to address burnout and improve WLI satisfaction among this group.

Objectives

To compare spousal support among female and male physicians and explore associations of spousal support with WLI satisfaction and burnout.

Design, Setting, and Participants

This cross-sectional, multispecialty survey study was conducted among 661 faculty physicians employed at an academic medical center from March 26 to May 22, 2024.

Main Outcomes and Measures

Survey items measured spousal support (5 items), WLI satisfaction (1 item), and burnout (2 Maslach Burnout Inventory items). Associations of spousal support and gender with WLI and burnout were assessed using logistic regression analyses adjusting for age, race and ethnicity, weekly work hours, and weekly hours spent on household or childcare duties.

Results

Overall, 739 of 2103 faculty physicians (response rate, 35.1%) completed the survey, of whom 661 (89.4%) were currently married or partnered (359 of 661 men [54.3%]). In this subset, 322 of 351 male physicians (91.7%) and 276 of 298 of female physicians (92.6%) reported frequent career support (defined as often, most of the time, or always) over the last year from their spouse or partner. Physicians reporting high levels of career support from their spouse or partner had higher odds of WLI satisfaction (odds ratio [OR], 1.50 [95% CI, 1.22-1.86]; P < .001) and lower odds of burnout (OR, 0.73 [95% CI, 0.61-0.87]; P < .001), independent of gender and adjusted for age, race and ethnicity, weekly work hours, and weekly hours spent on household or childcare duties. Male physicians had higher odds of WLI satisfaction than female physicians (OR, 1.95 [95% CI, 1.32-2.90]; P < .001), even after adjusting for spousal career support and other covariates listed, whereas odds of burnout did not significantly differ by gender (OR, 0.84 [95% CI, 0.57-1.23]; P = .37).

Conclusions and Relevance

This study suggests that the level of career support from a spouse or partner is associated with WLI satisfaction and burnout among physicians, independent of gender. Future studies should explore whether interventions designed to enhance career support can improve WLI and well-being among physicians.

Mortality Among US Physicians and Other Health Care Workers

Importance

National estimates of mortality among physicians and other health care workers are lacking. It is also unknown if distinct patterns exist across sex, race, and ethnicity.

Objective

To compare all-cause and cause-specific mortality rates among physicians, health care workers, and non-health care workers by sex, race, and ethnicity.

Design, Setting, and Participants

The National Vital Statistics System, a population-based registry of US death certificates, was used to obtain data on deaths among adults aged 25 to 74 years from January 2020 to December 2022 by usual occupation. Data were analyzed from January 2024 to December 2024.

Exposures

Usual occupation, sex, race, and ethnicity.

Main Outcomes and Measures

Overall and cause-specific mortality rates were calculated for each occupation, as well as sex, race, and ethnicity subgroups, and compared using mortality rate ratios. Mortality estimates were age-adjusted and sex-adjusted, and health care occupations were compared with non-health care occupations with similar income levels (categorized as low income, medium income, and high income based on US Census income terciles).

Results

Most health care workers had lower age-adjusted and sex-adjusted annual mortality rates per 100 000 population than non-health care workers (eg, physicians [269.3], high-income non-health care workers [499.2], and non-health care workers overall [730.6]). While female individuals had lower mortality than male individuals in non-health care occupations overall (female to male ratio, 0.55; 95% CI, 0.55-0.55) and high-income non-health care occupations specifically (0.60; 95% CI, 0.60-0.60), this advantage was absent for several health care occupations, including physicians (0.97; 95% CI, 0.93-1.01). In particular, female physicians experienced higher mortality than male physicians of neoplasms and chronic lower respiratory diseases, despite lower mortality of these causes among female individuals in high-income non-health care occupations. Black workers had higher mortality than White workers across all occupations, although the Black to White mortality ratio was largest for physicians (2.13; 95% CI, 1.99-2.29), with the largest differences due to neoplasms, heart disease, and COVID-19. Black female physicians had higher mortality rates than all other physician subgroups and White female individuals in non-health care occupations. While Hispanic workers had lower mortality than White workers in non-health care occupations overall (Hispanic to White ratio, 0.83; 95% CI, 0.83-0.83) and high-income non-health care occupations specifically (0.90; 95% CI, 0.90-0.91), this pattern was reversed for several health care occupations, including physicians (1.18; 95% CI, 1.09-1.27).

Conclusions and Relevance

The results of this cross-sectional study suggest that although physicians and most health care workers experienced lower mortality rates compared with the general population, this benefit did not fully extend to female individuals or racial and ethnic minority groups. Renewed efforts are needed to address health inequities within the health care workforce.

Wise Exertion: Associating Stoic Thought with Stress, Well-Being, and Life Satisfaction in Physicians

Recognition of how physicians contemplate and approach their activities, positive or negative, may shed light into a more holistic depiction of physician well-being. The purpose of this work was to develop items to measure wise cognitive exertion, constructed with Stoic thought, and determine its association with physician stress, well-being, and life satisfaction. A survey was sent to physicians and university staff members. This pilot investigation found a relationship among focusing on a purposeful life, acknowledging locus of control, avoiding wasteful cognition, and taking (good or bad) life experiences for personal growth and superior life satisfaction, well-being and lower stress. A 13-Item Wise Exertion Scale was developed and had significant associations with stress, well-being, and life satisfaction. Each of the four factors from the 13-Item Wise Exertion Scale were significantly associated with each measure with the exception of Control Consciousness and life satisfaction. Within physicians (N = 59), the 13-Item Wise Exertion Scale was a significant predictor, after adjusting for demographics with stress, well-being, and life satisfaction. Physicians had significantly lower 13-Item Wise Exertion Scale scores compared to non-physicians (N = 126). Future inquiries are required to determine if physicians with a mindset assembled with these beliefs have superior well-being.

Occupational stress among Norwegian physicians: A literature review of long-term prospective studies 2007-2019

AIMS

There are signs of increased stress at work among Norwegian physicians over the last decades, not least among general practitioners (GPs). In this review, we identify trends in both occupational stress and adverse work-related predictors of such stress and burnout in Norwegian physicians.

METHODS

We performed an extensive literature search using MEDLINE, Embase and PsycINFO. We included prospective and repeated cross-sectional studies of work stress among Norwegian physicians published in 2007-2019.

RESULTS

Nine studies with observation periods of 1-20 years were included. Occupational stress (global measure) among all doctors decreased gradually from medical school to 20 years later. The prevalence of an effort-reward imbalance increased fourfold among GPs during the period 2010-2019. Five studies reported higher levels of occupational stress among female physicians than among their male colleagues. Work-home conflict levels increased after graduation until 10 years after leaving medical school and plateaued thereafter. Physicians who graduated in a later cohort reported lower levels of work-home conflict and less workplace violence. Work-home conflict, low colleague support, number of work hours and workload/low autonomy were all independent predictors of occupational stress.

CONCLUSIONS

The reduction in occupational stress during the years after leaving medical school may result from increased competency in clinical work and decreased on-call work. The Co-ordination Act implemented in 2012 may explain the increase in occupational stress among GPs. These findings suggest that both reducing work-home conflict and increasing colleague support are important for doctors' well-being.

The Practice: A Leadership-Endorsed Workplace Intervention to Improve Well-being in Healthcare Professionals

BACKGROUND

Highly prevalent and worsened by the COVID-19 pandemic, burnout is associated with more frequent self-reported medical errors, suboptimal patient care, staff attrition, and lower professional fulfillment. There is a growing call for "wellness-centered leaders" who model, integrate, and prioritize well-being within the practice environment.  OBJECTIVE: Having piloted a novel intervention called "The Practice" in one work unit with promising outcomes, we set out to implement and prospectively study the intervention more broadly at our institution.

DESIGN

Departmental leaders were offered an opportunity for their team to participate. Within each interested departmental group, participants were trained in the core components of "The Practice": five daily well-being exercises taking less than 15 min. Biweekly facilitated group meetings to share challenges and successes of doing "The Practice" were integrated into departmental meetings for 3 months. Outcome measures included the WHO-5 Well-being Index, the Wong & Law Emotional Intelligence Scale (WLEIS), and the Professional Fulfillment Index (PFI), completed at baseline and months 3, 6, 9, and 12 after enrollment. Changes over time were analyzed using mixed models. Supplemental experience data were collected from a convenience sample and analyzed using the Framework approach.

PARTICIPANTS

From May 2021 through January 2022, 191 physicians and allied health staff from 14 clinical departments were enrolled. Participants were majority female (84%, n = 161) and White (83.2%, n = 159).

KEY RESULTS

We observed significant improvements in scores from baseline compared to month 3 that were sustained at later time points for WHO-5, WLEIS, and three of four PFI scales (p < 0.05). Experience data reflected feelings of gratitude that the institution was invested in their well-being, "humanization" of leaders, and increased awareness of coworker's feelings.

CONCLUSION

"The Practice" may be an effective, integrated, departmental wellness program by which healthcare organizations can support the well-being of their staff.

'I would have blamed myself, but coming back, I can see that it wasn't me': A qualitative, descriptive phenomenological analysis of doctors' reflective processes in recovery from burnout and mental crisis

Elimination of burnout and work-related mental illness in hospital doctors, at least in the short term, is unrealistic. Supporting doctors' recovery continues to be important. Despite this, the aftermath of work-related mental illness and burnout, is not well understood. Using a descriptive phenomenological method, we describe the experience of coming to terms with mental crisis perceived to be caused or exacerbated by work stress for six senior consultant hospital doctors. Findings show that, in the aftermath of crisis, doctors engaged in two types of reflection: 'situational sense-making' to make sense of their experiences and 'transformative self-reflection', reflection in a deeper way on the experience, themselves and their lives. Transformative self-reflection led to change and in some cases growth. Not all doctors engaged in transformative self-reflection, and the process of recovery was complicated by contextual factors and when support from employers was perceived as absent, poor or acrimonious.

The Prevalence and Associated Factors of Job Burnout Among Medical Workers at COVID-19 Vaccination Sites: A Cross-Sectional Study

Background: During the pandemic period of the COVID-19, temporary centralized vaccination sites were set up in each administrative district in Nanjing to efficiently manage the vaccination campaign. Medical workers at COVID-19 vaccination sites are exposed to burnout syndrome due to repetitive and overload vaccination work. The purpose of our study was to investigate the prevalence of burnout among these medical workers and to explore its associated factors. Methods: A cross-sectional study was conducted at COVID-19 vaccination sites in May 2021 in Nanjing, China. The online questionnaire included demographic, job and COVID-19-related characteristics, Chinese Maslach Burnout Inventory, and Social Support Rating Scale. The hierarchical multiple regression model was used to identify the risk factors for job burnout of medical workers. Results: Of the 425 respondents, 189 had job burnout. The overall prevalence of burnout symptoms among medical workers at COVID-19 vaccination sites was 44.5% with a breakdown in severity as follows: 122 (28.7%) mild, 53 (12.5%) moderate, and 14 (3.3%) severe cases. Hierarchical multiple linear regression analysis indicated that education level, job titles, self-reported increased work intensity, self-assessment risk of contracting COVID-19 during work, and social support were significantly related to job burnout (p < 0.05), which explained 28.2% of the variance of job burnout score (F = 14.879, p < 0.01). Conclusion: The burnout symptoms were relatively common among medical workers at COVID-19 vaccination sites. More attention should be paid to medical workers with master degree or higher, junior job titles, increased work intensity, high risk of contracting COVID-19 during work, and low level of social support. Interventions that aim to reduce workload and increase social support can be effective approaches to prevent job burnout among medical workers during controlled COVID-19 period.

The Surgeon Athlete? Analysis of the Nutritional Habits of Orthopaedic Surgery Residents

INTRODUCTION

Orthopaedic surgery residency requires physical stamina and mental acuity. Residents work long hours in demanding conditions like those faced by professional athletes. However, surgical residents often neglect their nutritional needs. This investigates dietary habits of orthopaedic surgery residents and explores strategies to improve nutritional status and performance of residents.

METHODS

A prospective survey created by a dietitian focused on performance nutrition was conducted among orthopaedic surgery residents at a large, tertiary, academic surgery residency program. Data were collected on demographics, nutritional habits, and perceptions of dietary practices.

RESULTS

The survey was completed by 30 orthopaedic surgery residents (19 M and 11 F; 29.8 ± 2.5 years). This cohort had inconsistent nutritional habits, characterized by irregular meal patterns, and frequently skipped meals. The most common barrier revolved around time constraints. Other barriers included stress/emotional eating and undesired weight changes. Male and female residents had similar demographics and outcomes, except that female residents more frequently reported having the highest energy level. Those who skipped meals had lower reported levels of nutritional knowledge and cited limited time to prepare or eat food compared with those who did not.

CONCLUSION

This study underscores the paradox of the "surgeon athlete," where despite facing physical demands like athletes, orthopaedic surgeons fail to prioritize their nutrition. This neglect can impair both performance and long-term health and may trickle down to worse patient care and outcomes. Addressing these issues requires a multifaceted approach. Institutional support is essential to improve access to healthy foods, nutrition education, and fostering a culture that values physician well being.

Burnout in modern-day health care: Where are we, and how can we markedly reduce it? A meta-narrative review from the EUREKA* project

BACKGROUND

Burnout is disrupting the health care workforce, threatening the livelihoods of health care workers and the probability of safe and effective patient care.

PURPOSES

The aims of this study were to describe the evolution and gaps in burnout research and identify next steps to advance the field and reduce burnout.

METHODOLOGY/APPROACH

We formed a learning community of burnout scholars and Chief Wellness Officers, sought recent review articles for a meta-narrative synthesis of themes on health care worker burnout, and conducted focus groups with learning community members.

RESULTS

In 1,425 systematic burnout studies found in a Medline database search of systematic reviews published since 2018, 68 were retained for analysis. Many focused on individual interventions (e.g., mindfulness), paying inconsistent attention to (a) what comprises burnout, (b) prevalence and contributors, (c) theories underlying it, (d) presence in marginalized populations, and (e) innovative research methods. There was consensus that burnout poses a global crisis, but there was no agreement on how to address it. Focus group participants noted that although burnout research is now "mainstream," health systems commit insufficient resources to addressing it. They proposed that emphasizing organizational finances and patient safety may make burnout a priority for health systems.

PRACTICE IMPLICATIONS

Despite burnout's progressing unabated, many organizations do not employ known burnout indicators (worker dissatisfaction or turnover) as wellness metrics. Research into organizational contributors to burnout, rigorous evaluation of interventions, and organizational adoption of research findings into systemic action are urgently needed. A well-supported international research agenda is required to quickly move the field ahead and reduce or ultimately eliminate burnout.

Association between burnout and PTSD, and perceived stress in the workplace among healthcare workers in the intensive care unit: a PsyCOVID-ICU substudy

The COVID-19 pandemic exposed intensive care unit (ICU) healthcare workers (HCWs) to acute stress (e.g. unpredictability, fear, helplessness) and chronic stress (e.g. prolonged crisis with recurring waves). While the psychological impact has been documented, few studies explore the overlap of these stressors. One year after the pandemic's first peak, we aimed to assess the psychotraumatic impact and burnout among ICU HCW and to examine the relationship between these disorders, and perceived workplace stressors. This study was conducted in 77 ICUs in France between June and July 2021. The online questionnaire included measures of perceived stress, burnout, and symptoms of post-traumatic stress disorder (PTSD). Descriptive analyses investigating the co-occurrence of PTSD/burnout symptoms were conducted and multinomial logistic regression was used to predict membership in these groupings from current perceived stress and a range of relevant demographic variables. Among 1108 hCW included, 318 (28.7%) exhibited only burnout, 34 (3.07%) exhibited only PTSD, and 182 (16.42%) exhibited both conditions simultaneously. These categories of professionals, particularly those with concurrent PTSD and burnout, perceived higher work-related stress than those without burnout and PTSD. These results can be used to provide personalized support for the specific psychological disorders present (burnout or PTSD), with a view to providing HCW with a work environment that is more conducive to their psychological recovery.Clinical trial registrationNCT04944394.

Sustainable benefits of mindfulness training in health professions education

BACKGROUND

Healthcare work and even studies towards a healthcare profession is associated with a high prevalence of distress. According to recent meta-analyses, half of the medical students worldwide suffer from burn out prior to residency, and 34% of nursing students suffer from depression. The aim of this study was to investigate healthcare students' long-term experiences of mindfulness training, and whether, how and why students were continuing their mindfulness practice after graduation. Further, to assess if background characteristics were associated with continuing mindfulness practice.

METHODS

A mixed method survey study based on predetermined and open-ended questions. Qualitative and quantitative data were analysed concurrently to assess effects on, and a deepened understanding of stress management, use of mindfulness in relation to patients, oneself and others, and continued practice of mindfulness.

RESULTS

Two hundred one of the 380 (52,8%) students completing the mindfulness based stress management course (MBSM) answered the questionnaire. Of all, 175 (87,1%) students also answered free text questions. The qualitative analysis identified five themes: "Positive" Experiences, "Negative" Experiences, "Origin and development of interest in mindfulness" and "Continuing practice of mindfulness". A considerable proportion of the participants experienced increased acceptance, relaxation, ability to face difficulties, self-compassion and better interaction with patients, but some participants also experienced negative experiences such as aversiveness and ineffectiveness of the course. Those continuing to practice mindfulness after graduation were more likely (85.3%) to say that the gained competence helped in their relationship with patients, compared to those who did not continue to practice (57.1%); (chi2 = 18.13; df = 2; p < 0.001). Among those who had previous mindfulness or similar experience, 84% continue to practice mindfulness after the course, compared to 50% of those who had no previous experience (chi2 = 26; df = 1; p < 0.001).

CONCLUSION

The long-term follow-up of mindfulness training for healthcare students shows that participants maintain a sustained capability to handle stressful work situations in their professional practice and develop a more compassionate relationship with themselves. We argue that skills to care for one's inner environment, such as learning mindfulness as a student, can contribute to a sustainable future professional life. However, further research is needed to confirm the transferability of the results.

Changes in provider responsibilities and associated outcomes for cirrhotic patients with telehealth: A single-center, retrospective study

BackgroundStudies show satisfaction with telemedicine, but there is limited data regarding changes in provider practices and clinical outcomes. We sought to evaluate the impact of telehealth on patient-provider communications between visits and clinical outcomes in patients with cirrhosis during the COVID-19 pandemic.MethodsSingle-center retrospective study of cirrhotic patients seen outpatient in 2019 and 2020 was conducted. Clinical characteristics, provider practices, and clinical outcomes were obtained. Provider practices included medication adjustments, labs ordered, and patient communication. Clinical outcomes included ED visits, hospitalizations, and mortality.ResultsTotally, 1395 patients were included with a mean age of 61, 51% female, and 73% Caucasian. The median baseline model for end-stage liver disease (MELD-Na) score was 10. During 2019 there were no telehealth visits. In 2020, 37% of clinic visits were telehealth and 64% of patients had at least one telehealth visit. The rate of medication changes significantly decreased in 2020. There was no significant difference in number of clinic visits, labs ordered, emergency department visits, hospitalizations, or intensive care unit (ICU) stays between 2019 and 2020. In 2020, the rate of telephone contacts and patient messages significantly increased. Compared to 2019, the odds of death were 2.6 times higher in 2020.ConclusionWhen a majority of cirrhotic patients had a telehealth visit, patients had similar rates of emergency department visits, hospitalizations, and ICU stays, but a higher rate of mortality compared to patients with in-person visits. Telehealth was associated with more patient contact between visits, increasing communication demands on providers.

Physician Leadership and Its Effect on Physician Burnout and Satisfaction During the COVID-19 Pandemic

Purpose

Physician burnout is a global issue associated with low job satisfaction, decreased quality of patient care, reduced productivity, and early retirement from clinical practice. We sought to evaluate the impact of the leadership qualities of direct physician supervisors on the burnout and professional satisfaction of the physicians they supervise.

Methods

An online survey was distributed by Email to all staff physicians practicing at a large Canadian academic tertiary care hospital. The primary outcome was the prevalence of burnout and professional satisfaction, assessed using the 2-item Maslach Burnout Inventory and a single item 5-point Likert scale rating, respectively. The secondary outcome was the relationship between composite leadership score and burnout/satisfaction, with leadership assessed by the 12-item Mayo Clinic Participatory Management Leadership Index.

Results

Out of the 1176 physicians surveyed, 383 (32.6%) responded (51.2% male; 41.5% female). Overall, 41.7% of physicians reported at least one symptom of burnout (40.0% reported high emotional exhaustion; 15.3% reported high depersonalization). 40.1% of physicians reported being satisfied with the organization, 26.3% were neutral, and 33.6% were dissatisfied. On multivariate analysis adjusting for age, sex, duration of employment at the institution, and specialty, each one-point increase in composite leadership score was associated with a 3.1% decrease in the likelihood of burnout (p = 0.0017), and a 6.6% increase in the likelihood of satisfaction (p < 0.0001).

Conclusion

Physician burnout is prevalent and positive leadership qualities of direct supervisors decreases the likelihood of burnout in physicians and increases the likelihood of their satisfaction with the organization.

Trial Registration

ClinicalTrials.gov; Identifier: NCT04896307.

Impact of a multimodal intervention on junior and senior hospital physicians' job satisfaction and wellbeing: a matched pre- and post-intervention study

BACKGROUND

Physician wellbeing has a direct impact on patient care. Meta-analyses have concluded that interventions are moderately effective at reducing physician burnout, but new studies are needed to target populations at higher risk (e.g. young physicians) and determine which interventions might be most effective.   METHOD: Using matched questionnaires, we conducted a cross-sectional pre-post study of a multimodal intervention to promote physician wellbeing. The intervention involved a change in institutional culture, information on occupational wellbeing, and the organisation of undisturbed lunch breaks and short breaks during the day. The primary outcome was the proportion of physicians satisfied with their job (scoring >3 points  on the Work-Related Quality of Life [WRQoL] scale). Secondary outcomes were overall WRQoL score, WRQoL subscale scores, number of short breaks taken during the working day, number of lunch breaks taken, physicians' likeliness of recommending their job to peers, monthly overtime hours worked and monthly sick days. Subgroup analyses included women vs men, residents vs chief residents/senior physicians, and participants with vs without children. We also explored potential factors influencing WRQoL in the pre-intervention population.

RESULTS

Pre- and post-intervention questionnaires were returned by 134 (63%) and 87 (42%) physicians, respectively, with 75 responding to both (matched). The intervention significantly increased the proportion of physicians satisfied with their job (from 49/75 [65%] to 58/75 [77%], p = 0.02), median overall WRQoL score (from 3.3 [IQR: 2.8-3.8] to 3.5 [IQR: 3.1-3.8], p <0.01), median Home-Work Interface subscale score (from 2.7 [IQR: 2.0-3.3] to 3.0 [IQR: 2.3-3.7], p = 0.01) and median General Well-Being subscale score (from 3.4 [IQR: 2.6-4.0] to 3.6 [IQR: 3.0-4.0], p <0.01). Residents showed a greater increase in overall WRQoL median score (from 3.2 [IQR: 2.7-3.6] to 3.5 [IQR: 3.3-3.8]) than chief residents/senior physicians (3.3 [IQR: 2.9-3.9] to 3.4 [IQR: 3.0-3.8], p <0.01 for group difference). No significant differences were seen in other subgroups or secondary outcomes in the matched population. Among the 134 participants in the pre-intervention period, those taking a daily lunch break, sleeping 7 hours or more or self-reporting doing sports activities on weekdays had higher overall WRQoL scores.

CONCLUSIONS

This wellbeing intervention increased physicians' WRQoL scores. However, the difference was small and its relevance remains uncertain.

Burnout among intensivists and critical care fellows in South Korea: Current status and associated factors

Burnout among critical care physicians is an important issue that affects patient care and staff well-being. This study, conducted by the Korean Society of Critical Care Medicine, aimed to investigate the prevalence and associated factors of burnout among intensivists and critical care fellows in South Korea. From May to July 2019, a cross-sectional survey was conducted in 51 hospitals and 79 intensive care units offering subspecialty training in critical care medicine. Invitations were sent by email and text, and responses were collected using NownSurvey and Google Forms. Of the 502 invited participants, 253 responded (response rate: 50.4%). Significant contributing factors of burnout included being in an intensivist position (assistant professor/fellow) (odds ratio [OR], 3.916; 95% confidence interval [CI], 1.485-10.327; p = 0.006), working in a medical ICU (OR, 4.557; 95% CI, 1.745-11.900; p = 0.002), the number of stay-home night calls per month (OR, 1.070; 95% CI, 1.005-1.139; p = 0.034), and recent conflicts with colleagues (OR, 5.344; 95% CI, 1.140-25.051; p = 0.033). Similar factors were found to influence severe levels of burnout. This nationwide study indicates that a significant proportion of critical care physicians in South Korea experience burnout. Strategies to reduce overtime and workplace conflict are imperative to reduce burnout among these physicians and protect their mental health. Future research should explore targeted interventions for these specific factors.

Economic evaluation of resilience training for medical students: A cohort state-transition model

BACKGROUND

Resilience training shows moderate effect in combatting burnout, yet little is known about its cost-effectiveness. This study analyzes the cost-effectiveness of offering resilience training to medical students with elevated stress from a Dutch university medical center (payer) perspective compared to mental health support as usual.

METHODS

We constructed a state-transition cohort (Markov) model to estimate quality-adjusted lifeyears and associated costs of offering resilience training to a cohort of 410 first-year medical students over a 6-year timeframe. Utility values were obtained through baseline data from the DEcrease STress through RESilience training for Students (DESTRESS) study. Data on transition probabilities and the effect of resilience training were based on the best available literature. We resampled all data to generate 10,000 simulations of incremental costs and effects in a probabilistic analysis.

RESULTS

On average students gained 0.15 QALYs (95%CI 0.09, 0.20) at a cost-saving of €1076 (95%CI 412, 2008), making resilience training the dominant strategy. These savings resulted from an assumed reduction in study delay due to a reduction in symptoms of stress and burnout. For every euro the university invests in resilience training, we estimatea return of investment of €2.79.

CONCLUSIONS

This study provides evidence that offering resilience training to medical students is cost-effective and cost-saving.

Burnout in Practicing Neurologists: A Systematic Review and Meta-Analysis

Purpose of Review

Burnout is a context-dependent, global issue among physicians in the medical field who often face job-related stressors, high workloads, and limited or lack of social support or autonomy. Within medicine, neurology is a specialty with high levels of burnout and low levels of work-life satisfaction. We, therefore, conducted this study to evaluate burnout rates among neurologists globally and identify the tools used to evaluate it.

Recent Findings

Among the 14 articles analyzed, the mean burnout prevalence rate among neurologists ranged from 18.1% to 94% (N = 8,735) across 6 countries (the United States, China, Philippines, Spain, Greece, and Brazil). Assessment of burnout using the Maslach Burnout Inventory (MBI) revealed that almost two-thirds (65.9%) of neurologists (N = 7,816) report experiencing burnout. Ten studies (71.4%) assessed burnout by using the MBI; the other 4 studies used the Copenhagen Burnout Inventory, a survey questionnaire generated by the American Academy of Neurology Stroke Practice Resources Workgroup, the Mini-Z survey, and a single question from the Physician Work Life Study. Among the 5 studies that used the same tool for measuring burnout (22-item MBI) and burnout criteria cutoff (emotional exhaustion [EE] ≥ 27 and/or depersonalization (DP) ≥ 10 subscale), the mean burnout rate ranged from 45% to 67% (p < 0.05, N = 7,816) across 3 countries (China, the United States, and Brazil). Of the studies that used the MBI and reported the 3 subscales of EE, DP, and personal accomplishment (PA), only the mean EE score was statistically different between studies. There were no significant differences detected in burnout rates among residents, among attending physicians, or residents compared with attendings.

Summary

This meta-analysis of burnout among practicing neurologists reveals that available published data span different levels of training, different sample sizes, and different survey tools with different cutoffs used for burnout within the same tool. Although burnout rates among neurologists were found to differ by country, it is evident from this systematic review that a great deal of neurology physicians are experiencing burnout across the globe. This systematic review may inform future approaches to reduce burnout among neurologists.

Navigating the Boundaries of Health and Identity: Medical Students' Perspectives

BACKGROUND

Medical professionals do not always manage their own health in an optimal way. Research conducted on medical students' response to illness is limited; however, some studies suggest they choose to self-manage and seek advice outside of the traditional pathways of care. This study aims to understand how medical students perceive and manage their health as they transition through medical school.

METHODS

Individual semistructured interviews with 10 medical students from one institution in England were conducted. Interviews explored students' experiences of managing their own physical and mental health and the health of family and friends, and how they could be better supported at medical school. Thematic analysis was conducted.

RESULTS

Four themes were described reflecting: the different sources of learning that students used to construct their notion of health and how these changed during their training; how these notions of health influenced the practices that students used for good and bad self-care; how they held multiple identities of a lay person and somebody with medical status that could result in conflicts and tensions; finally, students suggested supportive practices including creating a safe space for reflection and the discussion of conflict.

DISCUSSION

Becoming a doctor can result in many tensions as students develop increasingly medicalised notions of health that may lead to poor self-care. Creating spaces within the curriculum to discuss the privileges and tensions that arise from training to be a doctor may yield future benefits for the medical profession and patient care.

What about physician wellness? Impact of a quality improvement intervention

BACKGROUND

Emergency department (ED) consultations with general internal medicine (GIM) are required when patients need admission, assistance with safe disposition or evaluation and management of complex or acute medical needs. GIM physicians often balance responsibilities between hospital wards and the ED, which can lead to delayed ED consultations, difficulty balancing workload and potential burn-out. To address this issue, a quality improvement (QI) initiative was trialled, establishing a dedicated GIM ED consultation service to manage these duties independently. This study aimed to evaluate the impact of this intervention on physician wellness.

METHODS

A pre-post design was used, with two questionnaires adapted from the validated Mini Z version 2.0 (Zero Burnout Program) Worklife measure for clinicians. These were distributed via Google Forms to collect feedback from participating GIM physicians before and after the intervention. Data were analysed using descriptive statistics and the Mini Z outcome measurement scale.

RESULTS

13 physicians completed the surveys. Applying the Mini Z scale, the GIM ED consultation service had no impact on physician well-being or burn-out. There was a minor increase in satisfaction (1 point) and stress levels (2 points), and the working environment worsened slightly (1 point). Comparing preintervention and postintervention survey responses, job satisfaction improved (36%), while reports of 'burn-out' (23%) and 'beginning to burn out' (8%) decreased. Postintervention, physicians reported decreased time for documentation (23%), a perception of a more chaotic work environment (23%) and an increase in work encroaching on personal time (15%) when on the ED consultation service. Additionally, there was a 23% reduction in the likelihood of needing to reduce clinical teaching unit service weeks.

CONCLUSION

When conducting QI initiatives, consider measuring the wellness of physicians and other healthcare providers. Proactively integrating wellness strategies into interventions requires further exploration which may enhance participant experience and initiative sustainability.

Close to the border-Resilience in healthcare in a European border region: Findings of a needs analysis

OBJECTIVES

Promoting resilience, the ability to withstand and overcome challenging situations, is crucial for maintaining the performance of healthcare systems. Unique challenges faced by healthcare facilities in border regions render them particularly vulnerable during crises, emphasizing the need to promote resilience in these areas. The current study evaluated the state and needs of resilience in healthcare professionals in a representative European border region.

METHODS

All hospitals and emergency medical care services in the Euregio Meuse-Rhine (Germany, Belgium, the Netherlands) were approached to participate via an online-survey. Behavioral data on psychological distress (Patient Health Questionnaire-4), work-related stressors, individual resilience (Brief Resilience Scale, Resilience at Work scale), and organizational resilience (Benchmark Resilience Tool-short) were collected.

RESULTS

2233 participants initiated the survey with 500 responses included in the analysis. 46% of the participants indicated clinically significant psychological distress. Most challenging stressors were staff availability, available time, and workload. On average, individual resilience was in the normal range, yet 15.6% showed below average resilience. At the organizational level, healthcare institutions can particularly enhance resilience in the domains of Internal resources, Situation Awareness, and Unity of purpose. Compared to their neighbor countries, German healthcare professionals indicated higher levels of depressive symptoms, were more burdened by work-related stressors, and reported lower levels of organizational resilience.

CONCLUSION

Findings highlight that healthcare institutions not only need to promote the resilience of the individual employee particularly in border regions, healthcare institutions, must also act to be better prepared for potential threats and crises while considering each country's unique needs.

Perspectives and Practices of Healthcare Leaders in Supporting Healthcare Worker Well-Being: A Reality Check

Introduction

The well-being of healthcare workers (HCWs) is a critical concern. While healthcare leaders can play a crucial role in influencing employees' well-being, it remains unclear how leaders are leveraging this influence. This study aims to unravel the current perspectives and practices of healthcare leaders in supporting HCW well-being.

Methods

Semi-structured interviews were conducted with healthcare leaders at various levels within a university medical center. The interviews focused on exploring three key topics: factors influencing HCW well-being, data sources utilized for information gathering, and strategies leaders employ to influence HCW well-being. Our study design was grounded in constructionist epistemology and adopted a phenomenological approach. The methodology primarily involved a data driven, inductive thematic analysis to discern patterns and themes from the collected data.

Results

Fifteen interviews with healthcare leaders revealed a multitude of factors influencing HCW well-being, categorized into three domains: personal, socioeconomic, and work-related factors. Leaders reported a variety of data sources, including "contact data", data derived from regular and sporadic interpersonal interactions, and "investigation data", entailing formal inquiries conducted within the healthcare organization. Interestingly, while leaders acknowledge their potential to positively influence well-being, particularly in work-related aspects, there was a notable trend of deflecting responsibility, often redirecting it towards other leaders or placing it back on the individual employee.

Conclusion

Healthcare leaders show a comprehensive understanding of factors affecting employee well-being. However, healthcare leaders have a predominantly reactive approach to managing employees' well-being. Data collection is often sporadic, lacking consistency, and there is a tendency to redirect responsibility for well-being, revealing a discrepancy between acknowledgement of influence and its actual implementation. We argue that it is essential for leaders at all hierarchical levels to assume responsibility actively and collectively for employee well-being, transitioning to a proactive approach in promoting and safeguarding the well-being of HCWs.

Effects of Department Type and Disability Status on Medical School Faculty Wellbeing

Purpose

Faculty wellbeing impacts student learning and is a priority among medical schools, especially as a counterbalance to growing burnout. Previous researchers found differences in burnout by sex and race among clinicians, but not for faculty with disabilities. Accordingly, the purpose was to test the association between faculty's wellbeing, burnout, and control over workload and investigate differences in wellbeing attributed to department type and ability status.

Method

The authors developed and administered a comprehensive wellbeing survey to University of Minnesota Medical School faculty, of whom 703 provided complete responses. The authors conducted two-way ANOVA followed by a post hoc analysis to test for differences in faculty wellbeing domains due to department type (basic sciences, nonsurgical, surgical, and two large departments of Medicine and Pediatrics) and disability status (yes, no). The authors also fitted a two-way ordinal model since burnout frequency and control over workload were assessed by one ordinal item each.

Results

Wellbeing domains were positively correlated with control over workload but negatively associated with burnout. Faculty with disabilities reported less support from their work environment and meeting of their basic needs. Department type had a statistically significant impact on faculty's sense of basic needs, respect, and contribution. Multiple comparisons revealed faculty in basic sciences departments had higher scores within basic needs compared to the departments of Medicine, Pediatrics, and surgical departments, who reported lower levels of respect as well. Results revealed department type and disability status affected the frequency of burnout, as faculty in basic sciences departments reported lower levels of burnout compared to other departments.

Conclusions

Results support disaggregating wellbeing by department and ability status for targeted interventions due to differences- notably among faculty with disabilities and surgical departments- in their assessment of basic needs, work environment, respect, and contribution. Results suggest revisiting interventions in these domains to account for lower reported wellbeing.

Promoting Wellness Among Orthopaedic Surgeons

» Wellness encompasses multiple dimensions of well-being, including physical, mental, emotional, social, and spiritual health. Prioritizing physician wellness is crucial for ensuring high-quality patient care and reducing the risks of burnout, depression, and other mental health issues. Poor wellness among physicians not only affects their personal and professional lives but also has a ripple effect on patient care. It is associated with higher rates of medical errors, lower patient satisfaction, and an increased risk of mental health disorders including anxiety, depression, substance abuse, and suicide. » Burnout is a significant issue among healthcare professionals, particularly physicians. It can lead to severe consequences like increased medical errors, job dissatisfaction, and a decline in both personal and professional well-being. Addressing burnout through coping mechanisms and better work-life balance is essential. Moral injury occurs when physicians are forced to act against their moral beliefs due to systemic flaws, leading to inner conflict. Unlike burnout, which is often attributed to individual resilience, moral injury points to issues within the medical system itself. » Anxiety and depressive disorders can alter an individual's ability to participate in work and daily function. Among orthopedic surgeons, burnout has been described as an occupational hazard associated with medical errors, as well as with physical and mental exhaustion. Orthopedic surgeons face a burnout rate ranging between 40% and 60%. Tragically, they also have the highest suicide rate, comprising 28.2% of surgeon suicides from 2007 to 2013. » More flexible work hours, adequate time off, and efficient workflow are methods that can be used to improve the work environment, as well as providing easy access to mental health counseling and confidential support groups. Research has shown that residents do not utilize employee assistance programs; however, programs with directors that regularly inquire about well-being has led to increased well-being and use of assistance programs and groups.

Relieving anxiety and depression symptoms through promoting organizational identity and mitigating family-work conflict among medical professionals in digital leadership

BACKGROUND

Digital leadership might be an innovative approach to decreasing the elevated rates of anxiety and depression symptoms among medical professionals, while also enhancing their psychological well-being. This emerging pathway may offer promising strategies to support the mental health of medical professionals. This study seeks to investigate the association among digital leadership, organizational identity, family-work conflict, and anxiety and depression symptoms, and further to uncover the underlying moderating mechanisms interplay.

METHODS

A cross-sectional online survey with 657 valid data were collected from four tertiary hospitals in Harbin, Heilongjiang Province, China, with a response rate of 69.3%. The statistical analysis was conducted employing IBM SPSS Statistics 22.0. Hierarchical regression analysis was performed to scrutinize the pertinent factors associated with anxiety and depression symptoms among medical professionals, while also evaluating the moderating influence of organizational identity and family-work conflict on the nexus among those.

RESULTS

The prevalence of anxiety and depression symptoms among medical professionals was 50.1%. Anxiety and depression symptoms were negatively correlated with digital leadership (r= -0.278, p < 0.01) and organizational identity (r = - 0.318, p < 0.01), and positively correlated with family-work conflict (r = 0.445, p < 0.01). Organizational identity (β = - 0.938, p < 0.05) and family-work conflict (β = 0.698, p < 0.05) moderate the relationship between digital leadership and anxiety and depression symptoms; The results of the simple slope analysis indicated that high organizational identity and low family-work conflict strengthened the effect of digital leadership on anxiety and depression symptoms among Chinese medical professionals.

CONCLUSIONS

The prevalence of anxiety and depression symptoms among medical professionals was noted to be high. This study posits that strengthening digital leadership could apparently improve anxiety and depression symptoms among medical professionals. Moreover, it highlights the moderating role of organizational identity and family-work conflict in the relationship between digital leadership and anxiety and depression symptoms. These discoveries underscore the significance of implementing support and interventions to enhance the mental well-being of medical professionals, encompassing the cultivation of organizational identity, reduction of family-work conflict, and acknowledgment of the potential role of digital leadership in addressing mental health challenges.

Validity evidence for a French version of the Stigma of Occupational Stress Scale for Doctors (SOSS-D)

OBJECTIVES

Physicians demonstrate low rates of help seeking for psychiatric disorders, occupational stress, and burnout due to perceived stigma. The Stigma of Occupational Stress Scale for Doctors (SOSS-D) is a brief standardized tool designed to measure stigma (personal, perceived other, and perceived structural) in physicians. The aim of this study was to gather validity evidence for a French version of the SOSS-D.

METHODS

The SOSS-D was translated into French and piloted with 12 physicians. The scale was administered to physicians at the Geneva University Hospitals. We computed descriptive statistics and internal consistency coefficients. Construct validity was analyzed using exploratory (EFA) and confirmatory factor (CFA) analyses.

RESULTS

In total, 323 physicians participated in the survey. The internal consistency coefficient for the French SOSS-D was 0.72, 0.55 for the personal stigma subscale, 0.66 for the perceived other stigma subscale, and 0.65 for the perceived structural stigma subscale. CFA indicated a marginal fit. EFA revealed three factors: personal, perceived other, and perceived structural stigma.

DISCUSSION

Our findings support the hypothesis that stigma is a multi-dimensional construct. However, the French version of the SOSS-D scale did demonstrate some differences when compared to its English version. Identifying stigmatization beliefs among physicians may allow for increased identification of physicians at risk, and increased communication concerning preventive actions. Moreover, being aware of and fighting stigma can reduce barriers to help seeking and increased access to care resources for burnt-out physicians.

CONCLUSION

The results provide evidence of the validity and reliability of the French version of the SOSS-D indicating its suitability for use in a French-speaking physician population.

Influence of Work-Life Balance on Mental Health Among Nurses: The Mediating Role of Psychological Capital and Job Satisfaction

Background

Nurses constitute the backbone of the healthcare sector, often confronting elevated levels of work-related stress and emotional demands that can profoundly impact their mental well-being. Mental health is critical to nursing practice as it directly influences job performance, patient care quality, and workforce sustainability. This study examines the effects of work-life balance on the mental health of nurses in Pakistan while examining the intermediary effects of psychological capital and job satisfaction.

Methods

A descriptive cross-sectional survey was conducted from twenty-seven public and private hospitals in Multan, Pakistan, between December 2023 and March 2024. The research employed meticulously validated measurement tools: Work-Life Balance (WLB) Scale, Psychological Capital Questionnaire 12 (PCQ-12), Job Satisfaction Survey (JSS), and General Health Questionnaire 12 (GHQ-12) to collect data on 578 participants. Statistical analysis was performed using SPSS and AMOS to investigate direct and indirect relationships among study constructs.

Results

The results indicated that work-life balance positively influences both psychological capital (β = 0.083, p < 0.05) and job satisfaction (β = 0.113, p < 0.01), which, in turn, significantly contributes to better mental health outcomes among nurses. Sequential mediation analysis confirmed that psychological capital and job satisfaction (Indirect effect=0.022, 95% CI: 0.01-0.037) mediate between work-life balance and mental health, suggesting that a healthy work-life balance enhances psychological resources and job satisfaction, thereby improving mental health.

Conclusion

The findings highlight the importance of fostering a supportive work environment within the nursing community that promotes work-life balance, enhances psychological resources, and improves job satisfaction to maintain nurses' overall mental health.

Practicing What They Preach: Do Medical Specialty and Subspecialty Conferences Incorporate Physician Wellness Into Their Programs?

BACKGROUND

Depending upon their organization and content, medical conferences can enhance wellness or create additional stress for physician attendees. The objective of our study was to examine the degree to which major medical specialty and subspecialty conferences incorporate wellness into their meeting programs.

METHODS

We performed a cross-sectional study of major medical conferences occurring in 2023 representing specialties and subspecialties with the greatest number of active physicians. Meeting programs and agendas were reviewed for conference timing including if scheduled on a weekend and/or United States Federal or major religious holiday, availability of childcare, and wellness-themed activities and sessions. Sessions were categorized across seven wellness domains, including emotional, environmental, financial, occupational, physical, social, and spiritual.

RESULTS

Programing was available for 39 of the 41 conferences. The median conference length was five days. Approximately 97% (38/39) of conferences were held over all or part of a weekend and 21% (8/39) were scheduled over a Federal or religious holiday. Only one in 10 meetings advertised childcare. Fifty-four percent of conferences included a wellness activity such as a fun run, yoga, meditation, or city tour. The majority of agendas included sessions across multiple wellness domains, most commonly social (n=427), occupational (n=356), and emotional (n=140).

CONCLUSION

 Most major medical specialty and subspecialty conferences incorporate wellness-themed activities and sessions into their agendas; however, opportunities exist to improve the availability of childcare, optimize scheduling, and offer more expansive programing across wellness domains.

Clinical laboratory shadowing- an elective program in undergraduate health professions training: perception, strengths and challenges

BACKGROUND

The authors aim to evaluate the perception, strengths, and challenges in the implementation of "Clinical Laboratory Shadowing" as an elective module for third-year professional medical students.

METHODS

Clinical Laboratory shadowing is an elective module designed by the faculty of Biochemistry for Phase III part-2 medical students. The elective comprises modules explaining the functioning of the Biochemistry Laboratory in a hospital. The students are provided insights into the different processes involved in laboratory testing. They are taught about total quality management of the Biochemistry Laboratory. Thirteen students from Batch 2019 and eight students from Batch 2020 volunteered to attend the elective. Students' feedback regarding the learning was analyzed with the help of a questionnaire. Pre-test and post-test questions were evaluated to test the knowledge gained during the elective. Two focus group discussions were conducted regarding the benefits and areas for improvement for the elective.

RESULTS

Following the elective module there was a significant improvement in the test score compared to baseline. A majority (84-95%) of students perceived that the shadowing elective was well planned, and materials were well prepared, there was appropriate engagement with the facilitators, gained knowledge on the principles of total quality management, good laboratory practices, disease process, and diagnosis. Most (53-74%) of the students felt that this elective was not monotonous and not difficult. Around 84-95% of students felt that this elective module enhanced the importance of interprofessional communication and teamwork. Moreover, through focused group discussions, several recurring themes emerged. Among these, the scope for improvement within the module is profound. The faculties were of the opinion that the shift from conventional training to competency-based learning was effectively embraced by the students, underscoring the importance of consistent small group activities in the module to enhance the skills of Good laboratory practices. The students expressed a desire for additional clinical correlation and interpretation classes in the elective module, showing their preference for student-centred clinically oriented learning.

CONCLUSION

The current study concludes that including an elective module on Clinical laboratory shadowing is an overall positive experience for medical students in enhancing their knowledge of basic sciences and application of the concepts in diagnosing cases. This elective may be desirable to adopt in other medical colleges in India.

Why is it so hard to improve physicians' health? A qualitative interview study with senior physicians on mechanisms inherent in professional identity

Objectives

Current research increasingly describes physicians' health as endangered. Interventions to improve physicians' health show inconsistent results. In order to investigate possible causes for weak long-term effects, we examined senior physicians' perceptions about the relevance of their own health and analyzed whether and how these might affect the difficulty to improve physicians' health.

Method

The authors conducted 19 semi-structured interviews with senior physicians from different medical disciplines, analyzed the data and developed theory using the grounded theory method.

Results

Based on the interviews, we developed a conceptual model which identifies reinforcing factors for physicians' hesitancy in self-care as well as barriers to change. Participants regarded their own health needs as low and equated health with performance. These perceptions were described as being part of their professional identity and mirrored by the hospital culture they work in. Mechanisms as part of the collective professional identity (CPI) of physicians help to stabilize the status quo through early socialization and pride in exceptional performance. In addition, the tabooing of weakness and illness among colleagues, and dissociation from patients as well as sick doctors were identified as stabilizing mechanisms.

Conclusion

Findings support the assumption that one cause of physicians' health problems might lie in a CPI that includes tendencies to rate one's health as secondary or irrelevant. Identified mechanisms against change are, according to Social Identity Theory, typical group strategies which ensure the stability of CPI and make existing attitudes and beliefs difficult to change. However, barriers against change could possibly be overcome by addressing these underlying mechanisms and by a change process that is supported by experienced and competent members of the in-group for the benefit of both physicians and patients.

Long-Term Impact of an Online Physician Group-Coaching Program to Improve Burnout and Self-Compassion in Trainees

GOAL

To evaluate long-term outcomes of Better Together Physician Coaching, a digital life-coaching program to improve resident well-being.

METHODS

We performed a secondary analysis of survey data from the pilot program implementation between January 2021 and June 2022. An intention-to-treat analysis was completed for baseline versus post-6 months and baseline versus post-12 months for all outcome measures.

PRINCIPAL FINDINGS

Of 101 participants, 95 completed a baseline survey (94%), 66 completed a 6-month survey (65%) and 36 completed a 12-month survey (35%). There were no significant differences in burnout scale scores between baseline to 6 or 12 months. Self-compassion scores (i.e., means) improved after 6 months, from 33.2 to 38.2 (p < .001) and remained improved after 12 months at 36.7 (p = .020). Impostor syndrome score means decreased after 6 months, from 5.41 to 4.38 (p = .005) but were not sustained after 12 months (4.66, p = .081). Moral injury score means decreased from baseline to 6 months from 41.2 to 37.0 (p = .018), but reductions were not sustained at 12 months (38.1, p = .166).

PRACTICAL APPLICATIONS

This study showed significant, sustained improvement in self-compassion for coaching program participants.

Mental Health Status Profiles of Dentists in South Korea: A Latent Profile Analysis Approach

OBJECTIVE

Dentists encounter unique occupational challenges, including stress, depression, and anxiety, that can impact their mental well-being. Therefore, it is essential to identify dentists' mental health statuses and the factors influencing them. Understanding the heterogeneity in dentists' mental health is crucial for tailored interventions. To investigate different mental health profiles within the dentist population and understand the characteristics of each type.

METHODS

In this cross-sectional study, we surveyed 261 Korean dentists from a sample of 1,520. Using latent profile analysis, participants were classified into distinct mental health profiles based on self-reported stress, depressive symptoms, anxiety, and sleep quality. Demographic and occupational variables were analyzed to explore their association with mental health profiles.

RESULTS

Three distinct mental health profiles were identified: high, moderate, and low. Factors such as drinking frequency, socioeconomic status, income, and work hours significantly influenced profile classification. Significant differences in job satisfaction were observed among the profiles.

CONCLUSION

This study underscores the importance of personalized interventions to address the specific needs of each mental health profile, aiming to improve job satisfaction and overall mental health in the dental profession.

The effect of work-family conflict on employee well-being among physicians: the mediating role of job satisfaction and work engagement

BACKGROUND

Work-family conflict among physicians has many adverse consequences, like reduced work engagement and impaired well-being. However, relatively little research has been conducted on the impact of work-family conflict on specific pathways of physician well-being. The aim of this study was to determine the relationship between work-family conflict and employee well-being among physicians and to explore the mediating role of job satisfaction and work engagement in this relationship.

METHODS

Using data from a cross-sectional survey of 2,480 physicians in Jilin Province, China, partial least squares structural equation modeling (PLS-SEM) was applied in this study to examine the direct and indirect effects of work-family conflict on employee well-being and to assess the mediating roles of job satisfaction and work engagement therein.

RESULTS

The employee well-being score of physicians in Jilin Province was 5.16 ± 1.20. The univariate analysis results indicated significant disparities in employee well-being scores across different age groups, marital statuses, and professional titles. Work-family conflict was significantly negatively associated with employee well-being, while job satisfaction and work engagement were significantly positively associated with employee well-being. In addition, job satisfaction and work engagement were found to mediate the association between work-family conflict and employee well-being, and work engagement was considered to mediate the association between job satisfaction and employee well-being.

CONCLUSIONS

Our study confirms that work-family conflict negatively affects physicians' employee well-being. Moreover, our investigation revealed that the association between work-family conflict and employee well-being is influenced by both job satisfaction and work engagement and that work engagement plays a mediating role in the link between job satisfaction and employee well-being. Therefore, we propose that hospital administrators should rationally allocate organizational resources and develop manageable schedules to enhance physicians' employee well-being.

Gender and work-life balance: Results of a national survey of pediatric hospitalists

In medicine, difficulty integrating work and home can lead to decreased job satisfaction, diminished well-being, and increased turnover. Understanding the experience of pediatric hospitalists can provide insights into building a stable, long-term workforce. We aim to examine gender differences in work-life balance and parental leave for physicians practicing Pediatric Hospital Medicine.

METHODS

This was a cross-sectional survey study of 1096 pediatric hospitalists. Responses were collected via an online survey platform and summarized using descriptive statistics, including frequency distributions and measures of central tendency. A multivariable logistic regression was used to examine associated variables and work-life balance satisfaction. We analyzed free responses on parental leave to provide nuance to quantitative survey data.

RESULTS

Five hundred and sixty-five respondents (52% response rate) completed the survey with 71% women. 343 (62%) prioritize work-life balance in career decision-making. Women report taking on more household responsibilities than their partners (41.4% vs. 8.4%; p < .001) including a larger percentage of caregiving and domestic tasks. Female gender and performing <50% caregiving were associated with decreased work-life balance satisfaction; performing <50% domestic tasks increased satisfaction. Median parental leaves were 4 weeks, with men taking significantly shorter leaves (3.5 vs. 6 weeks; p < .001) and more "paid back" time off.

CONCLUSION

Work-life balance is an important factor in career decisions for men and women. Women perceive carrying a larger load at home. Qualitative results suggest that parental leave may be inadequate in length and salary support for men and women. This study adds insights into work-life integration in PHM.

Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study

Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the "working conditions in the country" (OR: 1.89, 95% CI: 1.56-2.28) whereas the "social environment/lifestyle abroad" was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65). Insights: Although the percentage of those who want to emigrate "definitely" was at the same level as in the other developing countries, the tendency to migrate "permanently" was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.

Promotion or prevention: regulatory foci as moderators in the job demands-resources model

BACKGROUND

Building on the job demands-resources (JD-R) model and regulatory focus theory, this study examined how regulatory foci shaped the effects of different job demands and resources on both negative and positive workplace outcomes among medical staff.

METHODS

Two independent studies (NStudy 1 = 267; NStudy 2 = 350) were designed for cross-validation. Participants completed a battery of measures evaluating job demands (workload, emotional demands, interpersonal stress), job resources (psychological safety, perceived organizational support, servant leadership), and well-being (job burnout, affective commitment, job satisfaction).

RESULTS

Multiple linear regression analyses showed employees' well-being was affected by job demands and resources through energetic and motivational processes, respectively. The deleterious effect of emotional demands on job burnout was pronounced in individuals with weak prevention focus (B = 0.392, standard error [SE] = 0.069, p < .001). Psychological safety (Study 1) and servant leadership (Study 2) had stronger positive associations with motivational outcomes among individuals with weak promotion focus than those with strong promotion focus (B = 0.394, SE = 0.069, p < .001; B = 0.679, SE = 0.121, p < .001; and B = 0.476, SE = 0.072, p < .001, respectively).

CONCLUSION

We used two samples to examine and cross-validate the joint effects of job characteristics and personal traits on workplace well-being among Chinese medical staff. Although heterogenous, the results showed regulatory foci were especially important in determining the effects of job demands and resources on well-being when there was (autonomous) self-regulation in the workplace.

Role of medical regulators in physician wellness: leading or lagging? A brief report on physician wellness practices

BACKGROUND

Physician wellness remains a growing concern, not only affecting the physicians' quality of life but also the quality of care delivered. One of the core tasks of medical regulatory authorities (MRAs) is to supervise the quality and safety of care. This brief report aimed to evaluate the practices of MRAs regarding physician wellness and their views on residents as a high-risk group for decreased physician wellness.

METHODS

A questionnaire was sent to MRAs worldwide, related to four topics: the identification of physician wellness as a risk factor for quality of care, data collection, interventions and the identification of residents as high risk for poor physician wellness. 26 responses were included.

RESULTS

23 MRAs consider poor physician wellness a risk factor for quality of care, 10 collect data and 13 have instruments to improve physician wellness. Nine MRAs identify residents as a high-risk group for poor physician wellness. Seven MRAs feel no responsibility for physician wellness.

CONCLUSION

Although almost all MRAs see poor physician wellness as a risk factor, actively countering this risk does not yet appear to be common practice. Given their unique position within the healthcare regulatory framework, MRAs could help improve physician wellness.

Peer Support to Promote Surgeon Well-being: The APSA Program Experience

BACKGROUND

Peer support programs have evolved to train physicians to provide outreach and emotional first aid to their colleagues when they experience the inevitable challenge of a serious adverse event, whether or not it is related to a medical error. Most pediatric surgeons have experienced the trauma of a medical error, yet, in a survey of APSA membership, almost half said that no one reached out to them, and few were satisfied with their institution's response to the error. Thus, the APSA Wellness Committee developed an APSA-based peer support program to meet this need.

METHODS

Peer supporters were nominated by fellow APSA members, and the group was vetted to ensure diversity in demographics, practice setting, and seniority. Formal virtual training was conducted before the program went live in 2020. Trained supporters were surveyed 6 months after the program launched to evaluate their experiences with providing peer support.

RESULTS

15 referrals were made in the first year, 60 % of which were self-initiated. Most referrals were for distress related to adverse events or toxic work environments (33 % each). While only about 25 % of trained supporters had provided formal support through the APSA program, more than 80 % reported using the skills to support colleagues and trainees within their own institutions.

CONCLUSION

Our experience in the first year of the APSA peer support program demonstrates the feasibility of building and maintaining a national program to provide emotional first aid by a professional society to expand the safety net for surgeons who are suffering.

Obstetric Outcomes of Nighttime Versus Daytime Delivery with Labor Epidural: An Observational Retrospective Study

Background: Variability in obstetric outcomes in terms of the number and type of deliveries related to the day-night cycle has been described in previous studies. This 11-year retrospective analysis explores the effects of nighttime versus daytime delivery with labor epidural on obstetric outcomes. Methods: Data on deliveries performed between 1 October 2008 and 1 October 2019 were collected and differentiated into daytime, occurring from 8:00 a.m. to 7:59 p.m., and nighttime deliveries, occurring from 8:00 p.m. to 7:59 a.m. of the following day. The data collected included the patient history and maternal and neonatal outcomes. Results: A total of 29831 patients were included in the analysis. A positive and statistically significant correlation between the number of cesarean sections (Odds Ratio 1.35; 95% confidence interval = 1.26-1.44; p < 0.001) and the number of vaginal operative deliveries (Odds Ratio 1.21; 95% confidence interval = 1.01-1.44; p < 0.05) in patients who did not receive an epidural at nighttime was reported. Regarding the labor epidurals, a significantly greater incidence of accidental dural punctures with needles (0,4%; p < 0.05) in the nighttime versus daytime was reported. Conclusions: The absence of labor epidurals was associated with a significant increase in the number of cesarean sections and vaginal operative deliveries occurring at nighttime, without significant differences in labor duration. The incidence of anesthesiologic complications was greater in deliveries performed at nighttime.

Prioritising nurses' and doctors' health at work: a scoping review of monitoring instruments

OBJECTIVE

Nurses' and doctors' health at work is crucial for their overall performance and the quality of care they provide. The Jobs Demands Resources (JD-R) model offers a framework for health at work, encompassing 'job demands', 'job resources', 'personal resources', 'leadership', 'well-being' and 'outcomes'. While various instruments exist to measure health, an overview of instruments specifically designed for assessing nurses and doctors health is currently missing. This study provides a comprehensive overview of available health instruments specifically developed and validated for healthcare professionals in hospital care.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, Embase and CINAHL.

ELIGIBILITY CRITERIA

Studies assessing the health of nurses and/or doctors in hospitals using or evaluating instruments based on the JD-R model, published between January 2011 and January 2024, excluding student-exclusive samples.

DATA EXTRACTION AND SYNTHESIS

We extracted data on study and sample characteristics, as well as details of the measurement instruments, including main and subconstructs. Instruments were categorised based on the JD-R model domains. Descriptive analysis and data visualisation were performed using Excel and Python.

RESULTS

We included 1204 studies, reporting 986 unique instruments. We identified 32 comprehensive instruments suitable for broad health screening, measuring four or more of the JD-R model domains. Additionally, we identified instruments focusing on specific domains for targeted screening needs. Furthermore, we present frequently reported instruments assumed to be extensively evaluated, user-friendly, accessible and available in multiple languages.

CONCLUSIONS

Health at work cannot be determined by a single instrument alone, underscoring the multidimensional nature of workplace health. Alternatively, organisations should select instruments based on domains most relevant and applicable to their context. This approach ensures a more comprehensive assessment of health at work.

A Qualitative Study of Strategies to Improve Occupational Well-being in Physical Medicine and Rehabilitation Physicians

BACKGROUND

Physiatry is a specialty with high rates of burnout. Although organizational strategies to combat burnout are key, it is also important to understand strategies that individual physiatrists can use to address burnout.

OBJECTIVE

The aim of the study is to identify changes that resulted in improvement of occupational well-being of physiatrists over a 6- to 9-mo period.

DESIGN

We employed two quantitative surveys spaced 6-9 mos apart to identify physiatrists who experienced meaningful improvement in occupational burnout and/or professional fulfillment between the two survey time points. These physiatrists were subsequently recruited to participate in a qualitative study using semistructured interviews to identify changes that respondents felt contributed to improvements in burnout and professional fulfillment.

SETTING

Online surveys and interviews.

PARTICIPANTS

Physiatrists in the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Membership Masterfile.

MAIN OUTCOME MEASURE

Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index.

RESULTS

One hundred twelve physiatrists responded to the baseline and follow-up surveys. Of these, 35 were eligible for interviews based on improvements in the Stanford Professional Fulfillment Index, and 23 (64%) agreed to participate. Themes from the qualitative interviews highlighted the importance of personal lifestyle choices, approaches to improve professional satisfaction, and strategies to foster work-life harmony. Personal lifestyle strategies included investing in wellness and mental health. Efforts to improve professional satisfaction included decreasing work intensity, prioritizing meaningful aspects of work, and building relationships with colleagues. Fostering work-life harmony also included making trade-offs in both domains, setting boundaries at work, setting expectations at home, and overcoming personal challenges.

CONCLUSIONS

Our findings illustrate that in addition to organizational strategies demonstrated to be effective, there are actions that individual physiatrists can take to recover from burnout and foster professional fulfillment.