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Wu Y, Wu M, Wang C, Lin J, Liu J, Liu S. Evaluating the Prevalence of Burnout Among Health Care Professionals Related to Electronic Health Record Use: Systematic Review and Meta-Analysis. JMIR Med Inform 2024; 12:e54811. [PMID: 38865188 DOI: 10.2196/54811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Burnout among health care professionals is a significant concern, with detrimental effects on health care service quality and patient outcomes. The use of the electronic health record (EHR) system has been identified as a significant contributor to burnout among health care professionals. OBJECTIVE This systematic review and meta-analysis aims to assess the prevalence of burnout among health care professionals associated with the use of the EHR system, thereby providing evidence to improve health information systems and develop strategies to measure and mitigate burnout. METHODS We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for English-language peer-reviewed articles published between January 1, 2009, and December 31, 2022. Two independent reviewers applied inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Meta-analyses were performed using R (version 4.1.3; R Foundation for Statistical Computing), with EndNote X7 (Clarivate) for reference management. RESULTS The review included 32 cross-sectional studies and 5 case-control studies with a total of 66,556 participants, mainly physicians and registered nurses. The pooled prevalence of burnout among health care professionals in cross-sectional studies was 40.4% (95% CI 37.5%-43.2%). Case-control studies indicated a higher likelihood of burnout among health care professionals who spent more time on EHR-related tasks outside work (odds ratio 2.43, 95% CI 2.31-2.57). CONCLUSIONS The findings highlight the association between the increased use of the EHR system and burnout among health care professionals. Potential solutions include optimizing EHR systems, implementing automated dictation or note-taking, employing scribes to reduce documentation burden, and leveraging artificial intelligence to enhance EHR system efficiency and reduce the risk of burnout. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021281173; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021281173.
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Affiliation(s)
- Yuxuan Wu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyue Wu
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Changyu Wang
- West China College of Stomatology, Sichuan University, Chengdu, China
| | - Jie Lin
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jialin Liu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Siru Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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Fogleman BM, Goldman M, Holland AB, Dyess G, Patel A. Charting Tomorrow's Healthcare: A Traditional Literature Review for an Artificial Intelligence-Driven Future. Cureus 2024; 16:e58032. [PMID: 38738104 PMCID: PMC11088287 DOI: 10.7759/cureus.58032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Electronic health record (EHR) systems have developed over time in parallel with general advancements in mainstream technology. As artificially intelligent (AI) systems rapidly impact multiple societal sectors, it has become apparent that medicine is not immune from the influences of this powerful technology. Particularly appealing is how AI may aid in improving healthcare efficiency with note-writing automation. This literature review explores the current state of EHR technologies in healthcare, specifically focusing on possibilities for addressing EHR challenges through the automation of dictation and note-writing processes with AI integration. This review offers a broad understanding of existing capabilities and potential advancements, emphasizing innovations such as voice-to-text dictation, wearable devices, and AI-assisted procedure note dictation. The primary objective is to provide researchers with valuable insights, enabling them to generate new technologies and advancements within the healthcare landscape. By exploring the benefits, challenges, and future of AI integration, this review encourages the development of innovative solutions, with the goal of enhancing patient care and healthcare delivery efficiency.
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Affiliation(s)
- Brody M Fogleman
- Internal Medicine, Edward Via College of Osteopathic Medicine - Carolinas, Spartanburg, USA
| | - Matthew Goldman
- Neurological Surgery, Houston Methodist Hospital, Houston, USA
| | - Alexander B Holland
- General Surgery, Edward Via College of Osteopathic Medicine - Carolinas, Spartanburg, USA
| | - Garrett Dyess
- Medicine, University of South Alabama College of Medicine, Mobile, USA
| | - Aashay Patel
- Neurological Surgery, University of Florida College of Medicine, Gainesville, USA
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3
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Nibbelink CW, Dunn Lopez K, Reeves JJ, Horman S, El-Kareh RE. Nurse and Physician Perceptions and Decision Making During Interdisciplinary Communication: Factors That Influence Communication Channel Selection. Comput Inform Nurs 2024; 42:267-276. [PMID: 38335993 DOI: 10.1097/cin.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Errors in decision making and communication play a key role in poor patient outcomes. Safe patient care requires effective decision making during interdisciplinary communication through communication channels. Research on factors that influence nurse and physician decision making during interdisciplinary communication is limited. Understanding influences on nurse and physician decision making during communication channel selection is needed to support effective communication and improved patient outcomes. The purpose of the study was to explore nurse and physician perceptions of and decision-making processes for selecting interruptive or noninterruptive interdisciplinary communication channels in medical-surgical and intermediate acute care settings. Twenty-six participants (10 RNs, 10 resident physicians, and six attending physicians) participated in semistructured interviews in two acute care metropolitan hospitals for this qualitative descriptive study. The Practice Primed Decision Model guided interview question development and early data analysis. Findings include a core category, Development of Trust in the Communication Process, supported by three main themes: (1) Understanding of Patient Status Drives Communication Decision Making; (2) Previous Interdisciplinary Communication Experience Guides Channel Selection; and (3) Perceived Usefulness Influences Communication Channel Selection. Findings from this study provide support for future design and research of communication channels within the EHR and clinical decision support systems.
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Affiliation(s)
- Christine W Nibbelink
- Author Affiliations: Hahn School of Nursing and Health Science, University of San Diego (Dr Nibbelink), CA; College of Nursing, The University of Iowa (Dr Dunn Lopez), Iowa City; University of California, San Diego; Department of Surgery (Dr Reeves), Division of Hospital Medicine (Dr Horman), and Clinical Professor, School of Medicine (Dr El-Kareh), La Jolla
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Gell NM, Smith PA, Wingood M. Physical Therapist and Patient Perspectives on Mobile Technology to Support Home Exercise Prescription for People With Arthritis: A Qualitative Study. Cureus 2024; 16:e55899. [PMID: 38601402 PMCID: PMC11006223 DOI: 10.7759/cureus.55899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Mobile applications (apps) for exercise prescription may enhance communication between healthcare providers and patients while addressing common barriers to exercise among people with osteoarthritis. However, little is known about preferences and barriers to the use of mobile apps by physical therapists or people aging with osteoarthritis. Therefore, we aimed to examine physical therapist and patient perspectives on mobile apps to support physical therapist-prescribed home exercise for people with osteoarthritis. Methods Eighteen physical therapists and 17 individuals with a history of physical therapy for osteoarthritis participated in the study. Focus groups (n = 6, three each with physical therapists and patients) were conducted to gather perspectives on three commercially available mobile apps designed for physical therapy exercise prescription. Semi-structured questions assessed feature preferences, ease of use, exercise completion support, clinical feasibility, and potential barriers and facilitators to using the apps. Recordings of the focus groups were transcribed verbatim. The study team iteratively coded transcripts using thematic analysis. Results Perspectives of patients and physical therapists intersected but differed on the mobile apps. All patients preferred video exercise prescription over traditional methods and both patients and therapists predicted challenges and opportunities with mobile communication. Four themes emerged: accountability, data-driven, communication boost, and duality of technology. Facilitators of home exercise through mobile apps included exercise tracking, feedback loop, personalization, and the potential for reduced in-person visits. Barriers included technological challenges, complex interface design, lack of universal applicability, and security concerns. Conclusion Mobile app technology has the potential to support exercise adherence for people with osteoarthritis. However, patients' and therapists' perspectives differ and highlight numerous challenges that limit the universal clinical adoption of this technology. While physical therapists acknowledged the potential to improve the rehabilitation experience with mobile apps, there was concern about reimbursement and time constraints in the current fee-for-service environment.
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Affiliation(s)
- Nancy M Gell
- Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Paula A Smith
- Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Mariana Wingood
- Implementation Science, Wake Forest University School of Medicine, Winston-Salem, USA
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Bernburg M, Tell A, Groneberg DA, Mache S. Digital stressors and resources perceived by emergency physicians and associations to their digital stress perception, mental health, job satisfaction and work engagement. BMC Emerg Med 2024; 24:31. [PMID: 38413900 PMCID: PMC10900642 DOI: 10.1186/s12873-024-00950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Digital technologies are increasingly being integrated into healthcare settings, including emergency departments, with the potential to improve efficiency and patient care. Although digitalisation promises many benefits, the use of digital technologies can also introduce new stressors and challenges among medical staff, which may result in the development of various negative work and health outcomes. Therefore, this study aims to identify existing digital stressors and resources among emergency physicians, examine associations with various work- and health-related parameters, and finally identify the potential need for preventive measures. METHODS In this quantitative cross-sectional study, an online questionnaire was used to examine the relationship between digital stressors (technostress creators), digital resources (technostress inhibitors), technostress perception as well as mental health, job satisfaction and work engagement among 204 physicians working in German emergency medicine departments. Data collection lasted from December 2022 to April 2023. Validated scales were used for the questionnaire (e.g. "Technostress"-scale and the Copenhagen Psychosocial Questionnaire (COPSOQ). Descriptive and multiple regression analyses were run to test explorative assumptions. RESULTS The study found medium levels of technostress perception among the participating emergency physicians as well as low levels of persisting technostress inhibitors. The queried physicians on average reported medium levels of exhaustion symptoms, high levels of work engagement and job satisfaction. Significant associations between digital stressors and work- as well as health-related outcomes were analyzed. CONCLUSION This study provides a preliminary assessment of the persistence of digital stressors, digital resources and technostress levels, and their potential impact on relevant health and work-related outcomes, among physicians working in German emergency departments. Understanding and mitigating these stressors is essential to promote the well-being of physicians and ensure optimal patient care. As digitisation processes will continue to increase, the need for preventive support measures in dealing with technology stressors is obvious and should be expanded accordingly in the clinics. By integrating such support into everyday hospital life, medical staff in emergency departments can better focus on patient care and mitigate potential stress factors associated with digital technologies.
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Affiliation(s)
- Monika Bernburg
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt, Germany
| | - Anika Tell
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg- Eppendorf (UKE), Seewartenstraße 10, 20459, Hamburg, Germany
| | - David A Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt, Germany
| | - Stefanie Mache
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt, Germany.
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg- Eppendorf (UKE), Seewartenstraße 10, 20459, Hamburg, Germany.
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Allen MR, Webb S, Mandvi A, Frieden M, Tai-Seale M, Kallenberg G. Navigating the doctor-patient-AI relationship - a mixed-methods study of physician attitudes toward artificial intelligence in primary care. BMC PRIMARY CARE 2024; 25:42. [PMID: 38281026 PMCID: PMC10821550 DOI: 10.1186/s12875-024-02282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Artificial intelligence (AI) is a rapidly advancing field that is beginning to enter the practice of medicine. Primary care is a cornerstone of medicine and deals with challenges such as physician shortage and burnout which impact patient care. AI and its application via digital health is increasingly presented as a possible solution. However, there is a scarcity of research focusing on primary care physician (PCP) attitudes toward AI. This study examines PCP views on AI in primary care. We explore its potential impact on topics pertinent to primary care such as the doctor-patient relationship and clinical workflow. By doing so, we aim to inform primary care stakeholders to encourage successful, equitable uptake of future AI tools. Our study is the first to our knowledge to explore PCP attitudes using specific primary care AI use cases rather than discussing AI in medicine in general terms. METHODS From June to August 2023, we conducted a survey among 47 primary care physicians affiliated with a large academic health system in Southern California. The survey quantified attitudes toward AI in general as well as concerning two specific AI use cases. Additionally, we conducted interviews with 15 survey respondents. RESULTS Our findings suggest that PCPs have largely positive views of AI. However, attitudes often hinged on the context of adoption. While some concerns reported by PCPs regarding AI in primary care focused on technology (accuracy, safety, bias), many focused on people-and-process factors (workflow, equity, reimbursement, doctor-patient relationship). CONCLUSION Our study offers nuanced insights into PCP attitudes towards AI in primary care and highlights the need for primary care stakeholder alignment on key issues raised by PCPs. AI initiatives that fail to address both the technological and people-and-process concerns raised by PCPs may struggle to make an impact.
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Affiliation(s)
- Matthew R Allen
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA.
- Division of Biomedical Informatics, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Sophie Webb
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ammar Mandvi
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Marshall Frieden
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ming Tai-Seale
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Gene Kallenberg
- Department of Family Medicine, University of California San Diego, La Jolla, CA, 92093, USA
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Underdahl L, Ditri M, Duthely LM. Physician Burnout: Evidence-Based Roadmaps to Prioritizing and Supporting Personal Wellbeing. J Healthc Leadersh 2024; 16:15-27. [PMID: 38192639 PMCID: PMC10773242 DOI: 10.2147/jhl.s389245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
Current literature validates the magnitude of physician burnout as a complex challenge affecting physicians, patients, and healthcare delivery that mandates science-informed intervention. Physician burnout affects both individual practitioners and patient care delivery. Interventions, defined as roadmaps, to prioritizing and supporting personal wellbeing encompass organizational, individual, and moral injury, with virtually no consensus on optimal approaches. The purpose of this conceptual review is to present evidence-based innovative insights on contributing factors, mitigation, and designing adaptive systems to combat and prevent burnout. Science-informed policy initiatives that support long-term organizational changes endorsed by both leadership and institutional stakeholders are keys to sustaining personal wellbeing and ending burnout.
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Affiliation(s)
- Louise Underdahl
- College of Doctoral Studies, University of Phoenix, Phoenix, AZ, USA
| | - Mary Ditri
- Community Health, New Jersey Hospital Association, Princeton, NJ, USA
| | - Lunthita M Duthely
- Obstetrics, Gynecology and Reproductive Sciences and the Department of Public Health Sciences, University of Miami Health System, Miami, FL, USA
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Fukami T. Patient engagement with psychological safety. DIALOGUES IN HEALTH 2023; 3:100153. [PMID: 38515810 PMCID: PMC10953965 DOI: 10.1016/j.dialog.2023.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 03/23/2024]
Abstract
Psychological safety is a multidimensional, dynamic phenomenon that concerns team members' perception of whether it is safe to take interpersonal risks at work. It is particularly important within health care teams who need to work interdependently to coordinate safe patient care within a highly complex, variable and high-stakes work environment. High levels of psychological safety have clear benefits for patient safety by improving the delivery of clinical care and promoting health care providers' job satisfaction and well-being. Feeling psychologically safe can enable team members to engage in speaking up behavior, such as asking questions, pointing out mistakes, or reporting errors. Several studies have explored psychological safety in health care teams and its impact on patient safety. These studies have highlighted the importance of psychological safety in health care organizations and provided strategies for promoting psychological safety. Psychological safety in health care involvement with patients can improve patient engagement.
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Affiliation(s)
- Tatsuya Fukami
- Patient Safety Division, Shimane University Hospital, 693-8501 Izumo, Japan
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9
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Bes I, Shoman Y, Al-Gobari M, Rousson V, Guseva Canu I. Organizational interventions and occupational burnout: a meta-analysis with focus on exhaustion. Int Arch Occup Environ Health 2023; 96:1211-1223. [PMID: 37758838 PMCID: PMC10560169 DOI: 10.1007/s00420-023-02009-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE To assess whether organizational interventions are effective to prevent or reduce exhaustion, the core dimension of occupational burnout. METHODS We searched in PubMed, EMBASE, PsycINFO, and Cochrane Library databases randomized and non-randomized controlled trials conducted among active workers and reporting the outcome as exhaustion score. We calculated the effect sizes using the pre-test-post-test control group design's estimate. We used the random effects model in meta-analysis and Cochrane collaboration's tool for interventions to assess the risk of bias. Overall quality of evidence was appraised using the GRADE. RESULTS From the 2425 identified records, we assessed 228 full texts for eligibility and included 11 original articles describing 13 studies, 11 on organizational interventions, and 2 on combined inventions. The interventions were participatory (n = 9), focused on workload (n = 2), or on work schedule (n = 2). The overall effect size was - 0.30 ((95% CI = - 0.42; - 0.18), I2 = 62.28%), corresponding to a small reduction in exhaustion with a very low quality of evidence. Combined interventions had a larger effect (- 0.54 (95% CI = - 0.76; - 0.32)) than organizational interventions. When split by type of intervention, both participatory interventions and interventions focused on workload had a benefic effect of exhaustion reduction, with an estimated effect size of - 0.34 (95% CI = - 0.47; - 0.20) and - 0.44 (95% CI = - 0.68, - 0.20), respectively. CONCLUSION Interventions at combined level in workplaces could be helpful in preventing exhaustion. However, the evidence is still limited, due to a high heterogeneity between studies, bias potential, and small number of eligible studies. This calls for further research, using workload interventions at organizational level, especially in sectors with high risk of job stress and exhaustion.
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Affiliation(s)
- Isabelle Bes
- Department of Occupational and Environmental Health, Center for Primary Cary and Public Health (Unisanté), University of Lausanne, Epalinges, Switzerland
| | - Yara Shoman
- Department of Occupational and Environmental Health, Center for Primary Cary and Public Health (Unisanté), University of Lausanne, Epalinges, Switzerland
| | - Muaamar Al-Gobari
- Department of Occupational and Environmental Health, Center for Primary Cary and Public Health (Unisanté), University of Lausanne, Epalinges, Switzerland
| | - Valentin Rousson
- Quantitative Research Secteur, Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Irina Guseva Canu
- Department of Occupational and Environmental Health, Center for Primary Cary and Public Health (Unisanté), University of Lausanne, Epalinges, Switzerland.
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Kheirkhah H, Hartfeld NMS, Widdifield J, Kulhawy-Wibe S, Roberts J, Yacyshyn EA, Lee JJY, Jilkine K, Jerome D, Kwok TSH, Burt J, Barber CEH. An Overview of Reviews to Inform Organization-Level Interventions to Address Burnout in Rheumatologists. J Rheumatol 2023; 50:1488-1502. [PMID: 37527857 DOI: 10.3899/jrheum.2023-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To identify organization-directed strategies that could be implemented to prevent burnout among rheumatologists. METHODS A search of English language articles published 2011 or later was conducted on Cochrane Database of Systematic Reviews, Embase, Medline, and PsycInfo on January 25, 2022. Included reviews had ≥ 1 primary studies with ≥ 10% of participants who were physicians, recorded burnout as an outcome, and described an organization-directed intervention to prevent burnout. Overlap of primary studies across reviews was assessed. The final review inclusion was determined by study quality, minimization of overlap, and maximization of intervention breadth. The A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 tool was used for quality assessment. Included studies and interventions were assessed by rheumatologists for their applicability to rheumatology. RESULTS A total of 17 reviews, including 15 systematic reviews, 1 realist review, and 1 umbrella review were included. AMSTAR 2 quality ratings classified 5 systematic reviews as low quality, 1 as moderate, and 9 as critically low. There was significant heterogeneity between and within reviews. Six conducted a metaanalysis and 11 provided a qualitative summary of findings. The following intervention types were identified as having possible applicability to rheumatology: physician workflow and organizational strategies; peer support and formal communication training; leadership support; and addressing stress, mental health, and mindfulness. Across interventions, mindfulness had the highest quality of evidence to support its effectiveness. CONCLUSION Although the quality of evidence for interventions to prevent burnout in physicians is low, promising strategies such as mindfulness have been identified.
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Affiliation(s)
- Hengameh Kheirkhah
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Nicole M S Hartfeld
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Jessica Widdifield
- J. Widdifield, PhD, Sunnybrook Research Institute, University of Toronto, ICES, Toronto, Ontario
| | - Stephanie Kulhawy-Wibe
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Janet Roberts
- J. Roberts, MD, Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Elaine A Yacyshyn
- E.A. Yacyshyn, MD, MScHQ, Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Jennifer J Y Lee
- J.J.Y. Lee, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Konstantin Jilkine
- K. Jilkine, MD, Section of Rheumatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Dana Jerome
- D. Jerome, MD, MEd, T.S.H. Kwok, MD, MSc, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Timothy S H Kwok
- D. Jerome, MD, MEd, T.S.H. Kwok, MD, MSc, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Jennifer Burt
- J. Burt, PT, ACPAC-trained ERP, Rheumatology Services, Eastern Health, St. John's, Newfoundland and Labrador
| | - Claire E H Barber
- C.E.H. Barber, MD, PhD, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada.
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Győrffy Z, Radó N, Pölczman L, Sükösd A, Boros J. Creating work-life balance among physicians in the age of digitalization: the role of self-consciousness and communication - a qualitative study. BMC Health Serv Res 2023; 23:1141. [PMID: 37875908 PMCID: PMC10594792 DOI: 10.1186/s12913-023-10101-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/01/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Besides the positive effects of using digital health solutions, digitalization can affect the healthcare worker burnout. The ability to coordinate different aspects of life (WLB) also plays a significant role in the development of burnout among medical workers. The aim of our study is to show, through qualitative interviews, the impact of digitalization on work-life balance in Hungarian physicians. METHODS 62 semi-structured interviews were conducted between October 2021 and June 2022, of which, a total of 31 interviews were used for the analysis, which were all related to the theme of work-life balance. Purposive sampling and inductive thematic approach were used to collect and analyse the data and identify patterns of the themes. RESULTS Based on this analysis, 5 main themes emerged: (1) the use of digital health tools, (2) Impact of digital tools on everyday work, (3) Work-life balance, (4) Setting and maintaining work-life boundaries, (5) Potential solutions. With the spread of digital communication, most of the respondents feel that their working hours increased even at the expense of their private life. The majority considers constant availability as a serious problem, however, several physicians indicated that as a result of a learning curve, they are able to change and set the necessary boundaries. Respondents were divided on whether or not they were successful in setting and maintaining boundaries. The 2 most important factors of establishing WLB in a digital age are self-consciousness and communication. However, these skills are not self-evident: the responses also show that in many cases there is a need for external support, but also for health professionals to actively reflect from time to time on their role as healers and their relationship with technology. CONCLUSION Basic principles and tools for establishing successful digital work-life balance in healthcare should be involved in the training curriculum of future physicians and healthcare professionals, while institutions should elaborate specific policies to include digital work-life balance in the institutional setting, as part of the preventive measures against burnout.
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Affiliation(s)
- Zsuzsa Győrffy
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Nagyvárad tér 4. 20th floor, Budapest, H-1089, Hungary.
| | - Nóra Radó
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Nagyvárad tér 4. 20th floor, Budapest, H-1089, Hungary
| | - Lea Pölczman
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Nagyvárad tér 4. 20th floor, Budapest, H-1089, Hungary
| | - Anikó Sükösd
- Eötvös Lorand University, Pázmány Péter sétány 1/A, Budapest, H-1117, Hungary
| | - Julianna Boros
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Nagyvárad tér 4. 20th floor, Budapest, H-1089, Hungary
- Hungarian Demographic Research Institute, Budapest, Hungary
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Wosny M, Strasser LM, Hastings J. Experience of Health Care Professionals Using Digital Tools in the Hospital: Qualitative Systematic Review. JMIR Hum Factors 2023; 10:e50357. [PMID: 37847535 PMCID: PMC10618886 DOI: 10.2196/50357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The digitalization of health care has many potential benefits, but it may also negatively impact health care professionals' well-being. Burnout can, in part, result from inefficient work processes related to the suboptimal implementation and use of health information technologies. Although strategies to reduce stress and mitigate clinician burnout typically involve individual-based interventions, emerging evidence suggests that improving the experience of using health information technologies can have a notable impact. OBJECTIVE The aim of this systematic review was to collect evidence of the benefits and challenges associated with the use of digital tools in hospital settings with a particular focus on the experiences of health care professionals using these tools. METHODS We conducted a systematic literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to explore the experience of health care professionals with digital tools in hospital settings. Using a rigorous selection process to ensure the methodological quality and validity of the study results, we included qualitative studies with distinct data that described the experiences of physicians and nurses. A panel of 3 independent researchers performed iterative data analysis and identified thematic constructs. RESULTS Of the 1175 unique primary studies, we identified 17 (1.45%) publications that focused on health care professionals' experiences with various digital tools in their day-to-day practice. Of the 17 studies, 10 (59%) focused on clinical decision support tools, followed by 6 (35%) studies focusing on electronic health records and 1 (6%) on a remote patient-monitoring tool. We propose a theoretical framework for understanding the complex interplay between the use of digital tools, experience, and outcomes. We identified 6 constructs that encompass the positive and negative experiences of health care professionals when using digital tools, along with moderators and outcomes. Positive experiences included feeling confident, responsible, and satisfied, whereas negative experiences included frustration, feeling overwhelmed, and feeling frightened. Positive moderators that may reinforce the use of digital tools included sufficient training and adequate workflow integration, whereas negative moderators comprised unfavorable social structures and the lack of training. Positive outcomes included improved patient care and increased workflow efficiency, whereas negative outcomes included increased workload, increased safety risks, and issues with information quality. CONCLUSIONS Although positive and negative outcomes and moderators that may affect the use of digital tools were commonly reported, the experiences of health care professionals, such as their thoughts and emotions, were less frequently discussed. On the basis of this finding, this study highlights the need for further research specifically targeting experiences as an important mediator of clinician well-being. It also emphasizes the importance of considering differences in the nature of specific tools as well as the profession and role of individual users. TRIAL REGISTRATION PROSPERO CRD42023393883; https://tinyurl.com/2htpzzxj.
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Affiliation(s)
- Marie Wosny
- School of Medicine, University of St Gallen (HSG), St Gallen, Switzerland
| | | | - Janna Hastings
- School of Medicine, University of St Gallen (HSG), St Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich (UZH), Zurich, Switzerland
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Bakker CJ, Wyatt TH, Breth MC, Gao G, Janeway LM, Lee MA, Martin CL, Tiase VL. Nurses' Roles in mHealth App Development: Scoping Review. JMIR Nurs 2023; 6:e46058. [PMID: 37847533 PMCID: PMC10618897 DOI: 10.2196/46058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Although mobile health (mHealth) apps for both health consumers and health care providers are increasingly common, their implementation is frequently unsuccessful when there is a misalignment between the needs of the user and the app's functionality. Nurses are well positioned to help address this challenge. However, nurses' engagement in mHealth app development remains unclear. OBJECTIVE This scoping review aims to determine the extent of the evidence of the role of nurses in app development, delineate developmental phases in which nurses are involved, and to characterize the type of mHealth apps nurses are involved in developing. METHODS We conducted a scoping review following the 6-stage methodology. We searched 14 databases to identify publications on the role of nurses in mHealth app development and hand searched the reference lists of relevant publications. Two independent researchers performed all screening and data extraction, and a third reviewer resolved any discrepancies. Data were synthesized and grouped by the Software Development Life Cycle phase, and the app functionality was described using the IMS Institute for Healthcare Informatics functionality scoring system. RESULTS The screening process resulted in 157 publications being included in our analysis. Nurses were involved in mHealth app development across all stages of the Software Development Life Cycle but most frequently participated in design and prototyping, requirements gathering, and testing. Nurses most often played the role of evaluators, followed by subject matter experts. Nurses infrequently participated in software development or planning, and participation as patient advocates, research experts, or nurse informaticists was rare. CONCLUSIONS Although nurses were represented throughout the preimplementation development process, nurses' involvement was concentrated in specific phases and roles.
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Affiliation(s)
- Caitlin J Bakker
- Dr John Archer Library, University of Regina, Regina, SK, Canada
| | - Tami H Wyatt
- College of Nursing, University of Tennessee Knoxville, Knoxville, TN, United States
| | - Melissa Cs Breth
- Clinical Quality Informatics, The Joint Commission, Oakbrook Terrace, IL, United States
| | - Grace Gao
- School of Nursing, St. Catherine University, St Paul, MN, United States
- National Veterans Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta Veterans Affairs Medical Center, Atlanta, GA, United States
| | - Lisa M Janeway
- Northwestern Medicine, Chicago, IL, United States
- Oak Point University, Oak Brook, IL, United States
| | - Mikyoung A Lee
- College of Nursing, Texas Woman's University, Dallas, TX, United States
| | - Christie L Martin
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | - Victoria L Tiase
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
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Abstract
Data science has the potential to greatly enhance efforts to translate evidence into practice in critical care. The intensive care unit is a data-rich environment enabling insight into both patient-level care patterns and clinician-level treatment patterns. By applying artificial intelligence to these novel data sources, implementation strategies can be tailored to individual patients, individual clinicians, and individual situations, revealing when evidence-based practices are missed and facilitating context-sensitive clinical decision support. To achieve these goals, technology developers should work closely with clinicians to create unbiased applications that are integrated into the clinical workflow.
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Affiliation(s)
- Andrew J King
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3500 Terrace Street, Suite 600, Pittsburgh, PA 15261, USA
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3500 Terrace Street, Suite 600, Pittsburgh, PA 15261, USA; Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA.
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15
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Silistraru I, Ciubară A, Olariu O, Ciureanu IA, Checheriță LE, Drugus D, Dănilă R, Roșca Ș. Burnout and Intention to Change Profession among Romanian Dentists during COVID-19: A Cross Sectional Study Using the Maslach Burnout Inventory. Healthcare (Basel) 2023; 11:2667. [PMID: 37830704 PMCID: PMC10573021 DOI: 10.3390/healthcare11192667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
This study aims to examine the relationship between burnout and dentists' intentions to change careers during the COVID-19 pandemic. The MBI-Human Services Survey for Medical Personnel-MBI-HSS (MP) was used to measure burnout levels and investigate how they relate to dentists' intentions to change their profession. The sample included 69 Romanian dentists, 56 of whom were women and 13 of whom were men. Self-reported questionnaires provided to the participants were used to collect the data. Female participants reported higher levels of emotional Exhaustion and Depersonalisation than males. However, there were no substantial differences in Personal Accomplishment levels between genders. As for the intentions to change careers, 41 expressed a clear intention to change their profession, 15 were still determining if they would choose the same speciality, and 28 indicated they would not choose the medical field. The study's findings provide insight into how dentists' thoughts about perceived burnout during the COVID-19 pandemic significantly influenced their attitudes regarding their career paths. The results suggest concerns regarding burnout in the dental field and emphasise the necessity for burnout interventions and support services, particularly during healthcare crises. Further research and interventions to mitigate burnout and promote well-being among dentists are needed to ensure the sustainability and quality of dental healthcare services in Romania.
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Affiliation(s)
- Ioana Silistraru
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, 550025 Sibiu, Romania;
| | - Anamaria Ciubară
- Clinical Medical Department, School of Medicine and Pharmacy, Dunărea de Jos University of Galați, 800008 Galati, Romania
| | - Oana Olariu
- Clinical Medical Department, School of Medicine and Pharmacy, Dunărea de Jos University of Galați, 800008 Galati, Romania
| | - Ioan-Adrian Ciureanu
- Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-A.C.); (L.-E.C.); (D.D.)
| | | | - Daniela Drugus
- Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-A.C.); (L.-E.C.); (D.D.)
| | - Radu Dănilă
- Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.-A.C.); (L.-E.C.); (D.D.)
| | - Ștefan Roșca
- Clinical Medical Department, School of Medicine and Pharmacy, Dunărea de Jos University of Galați, 800008 Galati, Romania
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Borges do Nascimento IJ, Abdulazeem H, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, Azzopardi-Muscat N, Zapata T, Novillo-Ortiz D. Barriers and facilitators to utilizing digital health technologies by healthcare professionals. NPJ Digit Med 2023; 6:161. [PMID: 37723240 PMCID: PMC10507089 DOI: 10.1038/s41746-023-00899-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/01/2023] [Indexed: 09/20/2023] Open
Abstract
Digital technologies change the healthcare environment, with several studies suggesting barriers and facilitators to using digital interventions by healthcare professionals (HPs). We consolidated the evidence from existing systematic reviews mentioning barriers and facilitators for the use of digital health technologies by HP. Electronic searches were performed in five databases (Cochrane Database of Systematic Reviews, Embase®, Epistemonikos, MEDLINE®, and Scopus) from inception to March 2023. We included reviews that reported barriers or facilitators factors to use technology solutions among HP. We performed data abstraction, methodological assessment, and certainty of the evidence appraisal by at least two authors. Overall, we included 108 reviews involving physicians, pharmacists, and nurses were included. High-quality evidence suggested that infrastructure and technical barriers (Relative Frequency Occurrence [RFO] 6.4% [95% CI 2.9-14.1]), psychological and personal issues (RFO 5.3% [95% CI 2.2-12.7]), and concerns of increasing working hours or workload (RFO 3.9% [95% CI 1.5-10.1]) were common concerns reported by HPs. Likewise, high-quality evidence supports that training/educational programs, multisector incentives, and the perception of technology effectiveness facilitate the adoption of digital technologies by HPs (RFO 3.8% [95% CI 1.8-7.9]). Our findings showed that infrastructure and technical issues, psychological barriers, and workload-related concerns are relevant barriers to comprehensively and holistically adopting digital health technologies by HPs. Conversely, deploying training, evaluating HP's perception of usefulness and willingness to use, and multi-stakeholders incentives are vital enablers to enhance the HP adoption of digital interventions.
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Affiliation(s)
- Israel Júnior Borges do Nascimento
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226-3522, USA
| | - Hebatullah Abdulazeem
- Department of Sport and Health Science, Techanische Universität München, Munich, 80333, Germany
| | - Lenny Thinagaran Vasanthan
- Physical Medicine and Rehabilitation Department, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Edson Zangiacomi Martinez
- Department of Social Medicine and Biostatistics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Miriane Lucindo Zucoloto
- Department of Social Medicine and Biostatistics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Lasse Østengaard
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University Library of Southern Denmark, Odense, 5230, Denmark
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
| | - Tomas Zapata
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, 2100, Denmark.
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Bail C, Harth V, Mache S. Digitalization in Urology-A Multimethod Study of the Relationships between Physicians' Technostress, Burnout, Work Engagement and Job Satisfaction. Healthcare (Basel) 2023; 11:2255. [PMID: 37628451 PMCID: PMC10454488 DOI: 10.3390/healthcare11162255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
The potential influences of digitization on the mental health of personnel in the healthcare sector are increasingly coming into the scientific focus in the healthcare sector, especially in terms of the use of information and communication technologies. To date, there have been no German studies of the effects of technostress in healthcare. This cross-sectional study examined the relationships between technostress, burnout, work engagement, and job satisfaction among physicians in the field of urology. Data were collected via an online survey based on the job demands-resources model and the concept of technostress. The survey was sent to German urologists working in inpatient clinics. The participating physicians experienced moderate levels of technostress (M = 2.67, SD = 0.69). The results, based on a general linear model analysis, showed that technostress is significantly positively associated with burnout (β = 0.293; p < 0.001) and negatively associated with work engagement (β = -0.175; p < 0.001) and job satisfaction (β = -0.206; p < 0.001). This study also identified stress and strain factors associated with the use of ICT and assessed institutional support offers as coping mechanisms. The results of this study and its formulated practical implications can serve as a basis for discussing sustainable digitalization strategies in hospitals, taking into consideration technostress and its impact on physicians' burnout, work engagement and job satisfaction.
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Affiliation(s)
| | | | - Stefanie Mache
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (C.B.); (V.H.)
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18
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Gellert GA, Rasławska-Socha J, Marcjasz N, Price T, Heyduk A, Mlodawska A, Kuszczyński K, Jędruch A, Orzechowski P. The Role of Virtual Triage in Improving Clinician Experience and Satisfaction: A Narrative Review. TELEMEDICINE REPORTS 2023; 4:180-191. [PMID: 37529770 PMCID: PMC10389257 DOI: 10.1089/tmr.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 08/03/2023]
Abstract
Objective This review examines the literature on improving clinician satisfaction with a focus on what has been most effective in improving experience from the perspective of clinicians, and the potential role that virtual triage (VT) technology can play in delivering positive clinician experiences that improve clinical care, and bring value to health care delivery organizations (HDOs). Methods Review and synthesis of evidence on clinician satisfaction indicating a potential for VT to favorably impact clinician experience, sense of effectiveness, efficiency, and reduction of administrative task burden. Analysis considers how to conceptualize and the value of improving clinician experience, leading clinician dissatisfiers, and the potential role of VT in improving clinician experience/satisfaction. Results Contributors to poor clinician experience/satisfaction where VT could have a beneficial impact include better managing resource limitations, administrative workload, lack of care coordination, information overload, and payer interactions. VT can improve clinician experience through the technology's ability to leverage real-time actionable data clinicians can use, streamlining patient-clinician communications, personalizing care delivery, optimizing care coordination, and better aligning digital/virtual services with clinical practice. From an organizational perspective, improvements in clinician experience and satisfaction derive from establishing an effective digital back door, increasing the clinical impact of and satisfaction derived from telemedicine and virtual care, and enhancing clinician centricity. Conclusions By embracing digital transformation and implementing solutions such as VT that focus on improving patient and clinician experience, HDOs can address barriers to delivery of high-quality, efficient, and cost-effective care. VT is a digital health tool that can create a more streamlined and satisfying experience for clinicians and the patients they care for. VT is a technology solution that can help clinicians make faster more informed decisions, reduces avoidable care, improves communication with patients and within care teams, and lowers their administrative burden so they have more quality time to care for patients.
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Affiliation(s)
- George A. Gellert
- Evidence-Based Impact and Value Demonstration, Infermedica Inc., San Antonio, Texas, USA
| | - Joanna Rasławska-Socha
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
| | - Natalia Marcjasz
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
| | - Tim Price
- Product Development, Infermedica Inc., London, United Kingdom
| | - Alicja Heyduk
- Implementation and Customer Success, Infermedica Inc., Wrocław, Poland
| | - Agata Mlodawska
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
| | - Kacper Kuszczyński
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
| | - Aleksandra Jędruch
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
| | - Piotr Orzechowski
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
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19
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Tell A, Westenhöfer J, Harth V, Mache S. Stressors, Resources, and Strain Associated with Digitization Processes of Medical Staff Working in Neurosurgical and Vascular Surgical Hospital Wards: A Multimethod Study. Healthcare (Basel) 2023; 11:1988. [PMID: 37510429 PMCID: PMC10379129 DOI: 10.3390/healthcare11141988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
The digitization of German hospitals is proceeding continuously, leading to the implementation of new digital technologies, such as electronic health records (EHRs) or other technologies, used for the purpose of medical documentation tasks. Even though the replacement of paper documentation through digitized documentation in general promises to come along with plenty of benefits, the daily utilization of technologies might also lead to stresses and strains among the medical staff, eventually possibly leading to the development of different negative work and health-related outcomes. This study, therefore, aims at identifying persisting digitization-associated stressors and resources among medical hospital staff, examining their influences on different work and health-related outcomes, and finally, identifying potential needs for preventive measures. A quantitative study in the form of an online questionnaire survey was conducted among physicians working in the medical field of neuro- and vascular surgery in German hospitals. The study was carried out between June and October 2022 utilizing an online questionnaire based on several standardized scales, such as the technology acceptance model (TAM) and the technostress model, as well as on several scales from the Copenhagen Psychosocial Questionnaire (COPSOQ). The study found medium levels of technostress among the participating physicians (n = 114), as well as low to medium levels of persisting resources. The queried physicians, on average, reported low levels of burnout symptoms, generally described their health status as good, and were mostly satisfied with their job. Despite the prevalence of technostress and the low levels of resources among the surveyed physicians, there is little awareness of the problem of digital stress, and preventive measures have not been widely implemented yet in the clinics, indicating a needs gap and the necessity for the strategic and quality-guided implementation of measures to effectively prevent digital stress from developing.
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Affiliation(s)
- Anika Tell
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, 20459 Hamburg, Germany
| | - Joachim Westenhöfer
- Department Health Sciences, Faculty of Life Sciences, University of Applied Sciences (HAW), Ulmenliet 20, 21033 Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, 20459 Hamburg, Germany
| | - Stefanie Mache
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, 20459 Hamburg, Germany
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Shin P, Desai V, Hobbs J, Conte AH, Qiu C. Time Out: The Impact of Physician Burnout on Patient Care Quality and Safety in Perioperative Medicine. Perm J 2023; 27:160-168. [PMID: 37278062 PMCID: PMC10266854 DOI: 10.7812/tpp/23.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Perioperative care delivery is a patient-centered, multidisciplinary process. It relies heavily on synchronized teamwork from a well-coordinated team. Perioperative physicians-surgeons and anesthesiologists-face enormous challenges in surgical care delivery due to changing work environments, post-COVID consequences, shift work disorder, value conflict, escalating demands, regulatory complexity, and financial uncertainties. Physician burnout in this working environment has become increasingly prevalent. It is not only harmful to physicians' health and well-being, but it also affects the quality and safety of patient care. Additionally, the economic costs associated with physician burnout are untenable due to the high turnover rate, high recruitment expenses, and potential early permanent exit from medical practice. In this deteriorating environment of unbalanced physician supply/demand, recognizing, managing, and preventing physician burnout may help preserve the system's most valuable asset and contribute to higher quality and safety of patient care. Leaders in government agencies, health care systems, and organizations must work together to re-engineer the health care system for better physicians and patient care.
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Affiliation(s)
- Philip Shin
- Department of Anesthesiology, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Vimal Desai
- Department of Anesthesiology, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Janet Hobbs
- Department of Anesthesiology, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Antonio Hernandez Conte
- Department of Anesthesiology, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Chunyuan Qiu
- Department of Anesthesiology, Southern California Permanente Medical Group, Pasadena, CA, USA
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Ballart X, Ferraioli F, Iruela A. [Administrative burden, motivation and well-being among primary care physicians: comparison of management models]. GACETA SANITARIA 2023; 37:102306. [PMID: 37263124 DOI: 10.1016/j.gaceta.2023.102306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To analyze the relationship between administrative burden and intrinsic motivation and between administrative burden and professional well-being among family and community medicine physicians. To analyze the extent to which attention to three basic needs (autonomy, sense of competence and relationship capacity) that one of the main motivation theories identifies as a generator of intrinsic motivation compensates for the negative effect of the administrative burden. To compare management models. METHOD Data from a survey (542 valid questionnaires) carried out through the Catalan Society of Family and Community Medicine are used. Data analysis is based on multiple regression and ANOVA techniques. RESULTS The perception of administrative burden and "red tape" are clearly demotivating and reduce job satisfaction. On the contrary, individual autonomy, networking opportunities between professionals and performance feedback are motivating and feed the perception of professional well-being. The EBA (Association Based Entity) model presents results above the ICS (Catalan Health Institute) and OSI (Integrated Health Organizations) models both in controlling the negative effect of administrative burden and in the management of basic psychological needs. CONCLUSIONS The motivation and professional well-being of primary care physicians would benefit from reforms that limit the administrative burden of some procedures and red tape. At the primary health center level, greater attention to individual autonomy, improving relatedness between professionals and the sense of competence based on better information on individual performance can offset the negative effects of the administrative burden.
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Affiliation(s)
- Xavier Ballart
- Departamento de Ciencia Política, Facultad de Ciencias Políticas y Sociología, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España.
| | - Francisco Ferraioli
- Departamento de Ciencia Política, Facultad de Ciencias Políticas y Sociología, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España
| | - Antoni Iruela
- CAP Vallcarca, Barcelona, España; Departamento y Facultad de Medicina, Universitat de Vic, Barcelona, España
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Boet S, Etherington C, Andreas C, Denis-LeBlanc M. Professional Coaching as a Continuing Professional Development Intervention to Address the Physician Distress Epidemic. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:126-132. [PMID: 37249344 DOI: 10.1097/ceh.0000000000000450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
ABSTRACT Physician distress and burnout are reaching epidemic proportions, threatening physicians' capacities to develop and maintain competencies in the face of the increasingly demanding and complex realities of medical practice in today's world. In this article, we suggest that coaching should be considered both a continuing professional development intervention as well as an integral part of a balanced and proactive solution to physician distress and burnout. Unlike other interventions, coaching is intended to help individuals gain clarity in their life, rather than to treat a mental health condition or to provide advice, support, guidance, or knowledge/skills. Certified coaches are trained to help individuals discover solutions to complex problems and facilitate decision-making about what is needed to build and maintain capacity and take action. Across many sectors, coaching has been shown to enhance performance and reduce vulnerability to distress and burnout, but it has yet to be systematically implemented in medicine. By empowering physicians to discover and implement solutions to challenges, regain control over their lives, and act according to their own values, coaching can position physicians to become leaders and advocates for system-level change, while simultaneously prioritizing their own well-being.
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Affiliation(s)
- Sylvain Boet
- Dr. Boet: Professor, Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada, Assistant Dean, Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada, Scientist, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada, Institut du Savoir Montfort, Ottawa, Ontario, Canada, and Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada. Dr: Etherington: Senior Research Associate, Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada, and Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada. Dr. Andreas: Associate Faculty, Crux Coaching, Cranbrook, British Columbia, Canada. Dr. Denis-LeBlanc: Vice Dean, Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada, Department of Family Medicine, Hôpital Montfort, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada, and Institut du Savoir Montfort, Ottawa, Ontario, Canada
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23
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Lloyd S, Long K, Probst Y, Di Donato J, Oshni Alvandi A, Roach J, Bain C. Medical and nursing clinician perspectives on the usability of the hospital electronic medical record: A qualitative analysis. HEALTH INF MANAG J 2023:18333583231154624. [PMID: 36866778 DOI: 10.1177/18333583231154624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Electronic medical records (EMRs) have been widely implemented in Australian hospitals. Their usability and design to support clinicians to effectively deliver and document care is essential, as is their impact on clinical workflow, safety and quality, communication, and collaboration across health systems. Perceptions of, and data about, usability of EMRs implemented in Australian hospitals are key to successful adoption. OBJECTIVE To explore perspectives of medical and nursing clinicians on EMR usability utilising free-text data collected in a survey. METHOD Qualitative analysis of one free-text optional question included in a web-based survey. Respondents included medical and nursing/midwifery professionals in Australian hospitals (85 doctors and 27 nurses), who commented on the usability of the main EMR used. RESULTS Themes identified related to the status of EMR implementation, system design, human factors, safety and risk, system response time, and stability, alerts, and supporting the collaboration between healthcare sectors. Positive factors included ability to view information from any location; ease of medication documentation; and capacity to access diagnostic test results. Usability concerns included lack of intuitiveness; complexity; difficulties communicating with primary and other care sectors; and time taken to perform clinical tasks. CONCLUSION If the benefits of EMRs are to be realised, there are good reasons to address the usability challenges identified by clinicians. Easy solutions that could improve the usability experience of hospital-based clinicians include resolving sign-on issues, use of templates, and more intelligent alerts and warnings to avoid errors. IMPLICATIONS These essential improvements to the usability of the EMR, which are the foundation of the digital health system, will enable hospital clinicians to deliver safer and more effective health care.
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Affiliation(s)
- Sheree Lloyd
- Australian Institute of Health Service Management, 3925University of Tasmania, Hobart, TAS, Australia
| | - Karrie Long
- 90134The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Yasmine Probst
- 8691University of Wollongong, Wollongong, NSW, Australia
| | - Josie Di Donato
- 1969Queensland University of Technology (QUT Online), Brisbane City, QLD, Australia
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McBride S, Alexander GL, Baernholdt M, Vugrin M, Epstein B. Scoping review: Positive and negative impact of technology on clinicians. Nurs Outlook 2023; 71:101918. [PMID: 36801609 DOI: 10.1016/j.outlook.2023.101918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/20/2022] [Accepted: 01/21/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Unnecessary electronic health record (EHRs) documentation burden and usability issues have negatively impacted clinician well-being (e.g., burnout and moral distress). PURPOSE This scoping review was conducted by members from three expert panels of the American Academy of Nurses to generate consensus on the evidence of both positive and negative impact of EHRs on clinicians. METHODS The scoping review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews guidelines. RESULTS The scoping review captured 1,886 publications screened against title and abstract 1,431 excluded, examined 448 in a full-text review, excluded 347 with 101 studies informing the final review. DISCUSSION Findings suggest few studies that have explored the positive impact of EHRs and more studies that have explored the clinician's satisfaction and work burden. Significant gaps were identified in associating distress to use of EHRs and minimal studies on EHRs' impact on nurses. CONCLUSION Examined the evidence of HIT's positive and negative impacts on clinician's practice, clinicians work environment, and if psychological impact differed among clinicians.
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Affiliation(s)
- Susan McBride
- School of Nursing, The University of Texas at Tyler, Tyler, TX.
| | | | | | | | - Beth Epstein
- University of Virginia School of Nursing, Charlottesville, VA
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Boet S, Etherington C, Dion PM, Desjardins C, Kaur M, Ly V, Denis-LeBlanc M, Andreas C, Sriharan A. Impact of coaching on physician wellness: A systematic review. PLoS One 2023; 18:e0281406. [PMID: 36749760 PMCID: PMC9904500 DOI: 10.1371/journal.pone.0281406] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023] Open
Abstract
Physician wellness is critical for patient safety and quality of care. Coaching has been successfully and widely applied across many industries to enhance well-being but has only recently been considered for physicians. This review aimed to summarize the existing evidence on the effect of coaching by trained coaches on physician well-being, distress and burnout. MEDLINE, Embase, ERIC, PsycINFO and Web of Science were searched without language restrictions to December 21, 2022. Studies of any design were included if they involved physicians of any specialty undergoing coaching by trained coaches and assessed at least one measure along the wellness continuum. Pairs of independent reviewers determined reference eligibility. Risk of bias was assessed using the Cochrane Risk of Bias Tools for Randomized Controlled Trials (RCTs) and for Non-randomized Studies of Interventions (ROBINS-I). Meta-analysis was not possible due to heterogeneity in study design and outcome measures as well as inconsistent reporting. The search retrieved 2531 references, of which 14 were included (5 RCTs, 2 non-randomized controlled studies, 4 before-and-after studies, 2 mixed-methods studies, 1 qualitative study). There were 1099 participants across all included studies. Risk of bias was moderate or serious for non-RCTs, while the 5 RCTs were of lower risk. All quantitative studies reported effectiveness of coaching for at least one outcome assessed. The included qualitative study reported a perceived positive impact of coaching by participants. Evidence from available RCTs suggests coaching for physicians can improve well-being and reduce distress/burnout. Non-randomized interventional studies have similar findings but face many limitations. Consistent reporting and standardized outcome measures are needed.
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Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology and Pain Medicine, Hyperbaric Medicine Unit, The Ottawa Hospital, Ottawa, Canada,Department of Innovation in Medical Education, The Ottawa Hospital, Ottawa, Canada,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada,Institut du Savoir Montfort, Ottawa, Canada,Faculty of Education, University of Ottawa, Ottawa, Canada,* E-mail:
| | - Cole Etherington
- Department of Anesthesiology and Pain Medicine, Hyperbaric Medicine Unit, The Ottawa Hospital, Ottawa, Canada,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Pierre-Marc Dion
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada,Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Chloé Desjardins
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Manvinder Kaur
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Valentina Ly
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | | | - Cecile Andreas
- Professional and Continuing Studies, Royal Roads University, Victoria, Canada
| | - Abi Sriharan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Tierney WM, Henning JM, Altillo BS, Rosenthal M, Nordquist E, Copelin K, Li J, Enriquez C, Lange J, Larson D, Burgermaster M. User-Centered Design of a Clinical Tool for Shared Decision-making About Diet in Primary Care. J Gen Intern Med 2023; 38:715-726. [PMID: 36127543 PMCID: PMC9971535 DOI: 10.1007/s11606-022-07804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Health information technology is a leading cause of clinician burnout and career dissatisfaction, often because it is poorly designed by nonclinicians who have limited knowledge of clinicians' information needs and health care workflow. OBJECTIVE Describe how we engaged primary care clinicians and their patients in an iterative design process for a software application to enhance clinician-patient diet discussions. DESIGN Descriptive study of the steps followed when involving clinicians and their at-risk patients in the design of the content, layout, and flow of an application for collaborative dietary goal setting. This began with individual clinician and patient interviews to detail the desired informational content of the screens displayed followed by iterative reviews of intermediate and final versions of the program and its outputs. PARTICIPANTS Primary care clinicians practicing in an urban federally qualified health center and two academic primary care clinics, and their patients who were overweight or obese with diet-sensitive conditions. MAIN MEASURES Descriptions of the content, format, and flow of information from pre-visit dietary history to the display of evidence-based, guideline-driven suggested goals to final display of dietary goals selected, with information on how the patient might reach them and patients' confidence in achieving them. KEY RESULTS Through three iterations of design and review, there was substantial evolution of the program's content, format, and flow of information. This involved "tuning" of the information desired: from too little, to too much, to the right amount displayed that both clinicians and patients believed would facilitate shared dietary goal setting. CONCLUSIONS Clinicians' well-founded criticisms of the design of health information technology can be mitigated by involving them and their patients in the design of such tools that clinicians may find useful, and use, in their everyday medical practice.
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Affiliation(s)
- William M Tierney
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA.
- The Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
| | - Jacqueline M Henning
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Brandon S Altillo
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA
- The Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Lone Star Circle of Care, Georgetown, TX, USA
| | - Madalyn Rosenthal
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Eric Nordquist
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | - Ken Copelin
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | - Jiaxin Li
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | | | - Jordan Lange
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Dagny Larson
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Marissa Burgermaster
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
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Mano MS. If you can't kill the beast, tame it: Tips for surviving WhatsApp® in medical practice. Clinics (Sao Paulo) 2023; 78:100156. [PMID: 36669425 PMCID: PMC9868886 DOI: 10.1016/j.clinsp.2022.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Max S Mano
- Breast Cancer Group Leader, Grupo Oncoclínicas; Faculty ‒ ESMO Breast Cancer Group; Faculty ‒ Academy of Leadership Sciences Switzerland (ALSS); Vice-chair, LACOG Breast Cancer Group, São Paulo, SP, Brazil.
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Montgomery A, Lainidi O. Creating healthy workplaces in healthcare: Are we delaying progress by focusing on what we can do rather than what we should do? Front Public Health 2023; 11:1105009. [PMID: 36935666 PMCID: PMC10016614 DOI: 10.3389/fpubh.2023.1105009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/09/2023] [Indexed: 03/05/2023] Open
Abstract
All the available evidence points to the fact that healthcare is under considerable stress, and while change is urgently needed there is no quick fix; systemic and sustained changes in organizational cultures within healthcare are required. Moreover, the fragility of healthcare systems globally has been starkly exposed by the Coronavirus 2019 pandemic. We have gathered enough evidence to know what is driving poor wellbeing, and how these processes impact on quality of care and patient safety. Indeed, we have a good idea of what we need to do to improve the situation. Therefore, this begs a simpler question; If we know how to create healthy workplaces, why is it so difficult to achieve this in healthcare? In the following perspective paper, we will argue that we can do better if we address the following three issues: (1) we are ignoring the real problems, (2) limited successes that we are achieving are moving us further from tackling the real problems, (3) culture change is accepted as crucial, but we are not accepting what the evidence is telling us about healthcare culture. Tackling burnout is useful and necessary, but we must increase dignity among healthcare employees. Moreover, we need to train line managers to recognize and facilitate the need of employees to feel competent and be appreciated by others, while helping them set wellbeing boundaries.
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Affiliation(s)
- Anthony Montgomery
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
- *Correspondence: Anthony Montgomery
| | - Olga Lainidi
- School of Psychology, University of Leeds, Leeds, United Kingdom
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Azizi S, Hier DB, Wunsch II DC. Enhanced neurologic concept recognition using a named entity recognition model based on transformers. Front Digit Health 2022; 4:1065581. [PMID: 36569804 PMCID: PMC9772022 DOI: 10.3389/fdgth.2022.1065581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Although deep learning has been applied to the recognition of diseases and drugs in electronic health records and the biomedical literature, relatively little study has been devoted to the utility of deep learning for the recognition of signs and symptoms. The recognition of signs and symptoms is critical to the success of deep phenotyping and precision medicine. We have developed a named entity recognition model that uses deep learning to identify text spans containing neurological signs and symptoms and then maps these text spans to the clinical concepts of a neuro-ontology. We compared a model based on convolutional neural networks to one based on bidirectional encoder representation from transformers. Models were evaluated for accuracy of text span identification on three text corpora: physician notes from an electronic health record, case histories from neurologic textbooks, and clinical synopses from an online database of genetic diseases. Both models performed best on the professionally-written clinical synopses and worst on the physician-written clinical notes. Both models performed better when signs and symptoms were represented as shorter text spans. Consistent with prior studies that examined the recognition of diseases and drugs, the model based on bidirectional encoder representations from transformers outperformed the model based on convolutional neural networks for recognizing signs and symptoms. Recall for signs and symptoms ranged from 59.5% to 82.0% and precision ranged from 61.7% to 80.4%. With further advances in NLP, fully automated recognition of signs and symptoms in electronic health records and the medical literature should be feasible.
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Affiliation(s)
- Sima Azizi
- Applied Computational Intelligence Laboratory, Department of Electrical & Computer Engineering, Missouri University of Science & Technology, Rolla, MO, United States
| | - Daniel B. Hier
- Applied Computational Intelligence Laboratory, Department of Electrical & Computer Engineering, Missouri University of Science & Technology, Rolla, MO, United States
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, United States
| | - Donald C. Wunsch II
- Applied Computational Intelligence Laboratory, Department of Electrical & Computer Engineering, Missouri University of Science & Technology, Rolla, MO, United States
- National Science Foundation, ECCS Division, Arlington, VA, United States
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Monfries N, Sandhu N, Millar K. A Smartphone App to Reduce Burnout in the Emergency Department: A Pilot Randomized Controlled Trial. Workplace Health Saf 2022; 71:181-187. [PMID: 36373628 PMCID: PMC10080362 DOI: 10.1177/21650799221123261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Burnout is a significant concern among health care professionals, particularly those working in the emergency department (ED). Given the negative personal and professional consequences that burnout can have on all health care professionals, multidisciplinary solutions are needed to address burnout. Our objective was to evaluate the feasibility and potential impact of resilience training delivered through a smartphone application on burnout among health care professionals working at a tertiary-care pediatric ED. Methods: We conducted a single-center pilot randomized controlled study enrolling multidisciplinary health care professionals working in our ED. Participants assigned to the intervention group received self-driven access to a smartphone application that provided a structured resilience curriculum for a period of 3 months. The participants completed psychometric assessments both prior to and following the invention period. Changes in psychometric measures of the intervention group were then compared with a waitlist-control group. Results: Following the intervention period, a total of 20 participants were included in the final analysis. The change in participant scores on psychometric measures prior to and following the intervention period was calculated. A statistically significant mean decrease in burnout measure (emotional exhaustion subscale of Maslach-Burnout Inventory mean score −5.88, p < .001) and increase in mindfulness measure (Mindful Attention Awareness Scale mean score 0.51, p < .001) was observed among the intervention group participants. Conclusions/Application to Practice: Our study suggests that a resilience training program delivered using a smartphone application can be an effective intervention in reducing burnout and increasing mindfulness skills. Our study also demonstrated the potential feasibility of a randomized controlled study of burnout within a multidisciplinary group of health care professionals.
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Gajjar J, Pullen N, Li Y, Weir S, Wright JG. Impact of the COVID-19 pandemic upon self-reported physician burnout in Ontario, Canada: evidence from a repeated cross-sectional survey. BMJ Open 2022; 12:e060138. [PMID: 36130759 PMCID: PMC9490300 DOI: 10.1136/bmjopen-2021-060138] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To estimate the impact of the SARS-CoV-2 (COVID-19) pandemic on levels of burnout among physicians in Ontario, Canada, and to understand physician perceptions of the contributors and solutions to burnout. DESIGN Repeated cross-sectional survey. SETTING Active and retired physicians, residents and medical students in Canada's largest province were invited to participate in an online survey via an email newsletter. PARTICIPANTS In the first survey wave (March 2020), 1400 members responded (representing 76.3% of those who could be confirmed to have received the survey and 3.1% of total membership). In the second wave (March 2021), 2638 responded (75.9% of confirmed survey recipients and 5.8% of membership). KEY OUTCOME MEASURE Level of burnout was assessed using a validated, single-item, self-defined burnout measure where options ranged from 1 (no symptoms of burnout) to 5 (completely burned out). RESULTS The overall rate of high levels of burnout (self-reported levels 4-5) increased from 28.0% in 2020 (99% CI: 24.3% to 31.7%) to 34.7% in 2021 (99% CI: 31.8% to 37.7%), a 1-year increase of 6.8 percentage points (p<0.01). After a full year of practising during the COVID-19 pandemic, respondents ranked 'patient expectations/patient accountability', 'reporting and administrative obligations' and 'practice environment' as the three factors that contributed most to burnout. Respondents ranked 'streamline and reduce required documentation/administrative work', 'provide fair compensation' and 'improve work-life balance' as the three most important solutions. CONCLUSIONS During the first 12 months of the COVID-19 pandemic in Ontario, prevalence of high levels of burnout had significantly increased. The contributors and solutions ranked highest by physicians were system-level or organisational in nature.
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Affiliation(s)
- Jainita Gajjar
- Economics, Policy & Research, Ontario Medical Association, Toronto, Ontario, Canada
| | - Naomi Pullen
- Economics, Policy & Research, Ontario Medical Association, Toronto, Ontario, Canada
| | - Yin Li
- Economics, Policy & Research, Ontario Medical Association, Toronto, Ontario, Canada
| | - Sharada Weir
- Economics, Policy & Research, Ontario Medical Association, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, University of Toronto, Toronto, Ontario, Canada
| | - James G Wright
- Economics, Policy & Research, Ontario Medical Association, Toronto, Ontario, Canada
- Botnar Research Centre, Oxford, UK
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Yan X, Husby H, Mudiganti S, Gbotoe M, Delatorre-Reimer J, Knobel K, Hudnut A, Jones JB. Evaluating the Impact of a Point-of-Care Cardiometabolic Clinical Decision Support Tool on Clinical Efficiency Using Electronic Health Record Audit Log Data: Algorithm Development and Validation. JMIR Med Inform 2022; 10:e38385. [PMID: 36066940 PMCID: PMC9490545 DOI: 10.2196/38385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/10/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Electronic health record (EHR) systems are becoming increasingly complicated, leading to concerns about rising physician burnout, particularly for primary care physicians (PCPs). Managing the most common cardiometabolic chronic conditions by PCPs during a limited clinical time with a patient is challenging. Objective This study aimed to evaluate a Cardiometabolic Sutter Health Advanced Reengineered Encounter (CM-SHARE), a web-based application to visualize key EHR data, on the EHR use efficiency. Methods We developed algorithms to identify key clinic workflow measures (eg, total encounter time, total physician time in the examination room, and physician EHR time in the examination room) using audit data, and we validated and calibrated the measures with time-motion data. We used a pre-post parallel design to identify propensity score–matched CM-SHARE users (cases), nonusers (controls), and nested-matched patients. Cardiometabolic encounters from matched case and control patients were used for the workflow evaluation. Outcome measures were compared between the cases and controls. We applied this approach separately to both the CM-SHARE pilot and spread phases. Results Time-motion observation was conducted on 101 primary care encounters for 9 PCPs in 3 clinics. There was little difference (<0.8 minutes) between the audit data–derived workflow measures and the time-motion observation. Two key unobservable times from audit data, physician entry into and exiting the examination room, were imputed based on time-motion studies. CM-SHARE was launched with 6 pilot PCPs in April 2016. During the prestudy period (April 1, 2015, to April 1, 2016), 870 control patients with 2845 encounters were matched with 870 case patients and encounters, and 727 case patients with 852 encounters were matched with 727 control patients and 3754 encounters in the poststudy period (June 1, 2016, to June 30, 2017). Total encounter time was slightly shorter (mean −2.7, SD 1.4 minutes, 95% CI −4.7 to −0.9; mean –1.6, SD 1.1 minutes, 95% CI −3.2 to −0.1) for cases than controls for both periods. CM-SHARE saves physicians approximately 2 minutes EHR time in the examination room (mean −2.0, SD 1.3, 95% CI −3.4 to −0.9) compared with prestudy period and poststudy period controls (mean −1.9, SD 0.9, 95% CI −3.8 to −0.5). In the spread phase, 48 CM-SHARE spread PCPs were matched with 84 control PCPs and 1272 cases with 3412 control patients, having 1119 and 4240 encounters, respectively. A significant reduction in total encounter time for the CM-SHARE group was observed for short appointments (≤20 minutes; 5.3-minute reduction on average) only. Total physician EHR time was significantly reduced for both longer and shorter appointments (17%-33% reductions). Conclusions Combining EHR audit log files and clinical information, our approach offers an innovative and scalable method and new measures that can be used to evaluate clinical EHR efficiency of digital tools used in clinical settings.
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Affiliation(s)
- Xiaowei Yan
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, United States
| | - Hannah Husby
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, United States
| | - Satish Mudiganti
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, United States
| | - Madina Gbotoe
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, United States
| | - Jake Delatorre-Reimer
- Department of Clinical Informatics, NorthBay Healthcare, Fairfield, CA, United States
| | - Kevin Knobel
- Sutter Gould Medical Foundation, Sutter Health, Modesto, CA, United States
| | - Andrew Hudnut
- Sutter Medical Group, Sutter Health, Sacramento, CA, United States
| | - J B Jones
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, United States
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Qamar S, Tekin A, Singh R, Surani S, Adhikari R, Bansal V, Sharma M, Bogojevic M, Deo N, Zec S, Valencia Morales DJ, Taji J, Kumar VK, Boman K, Khan SA, Domecq JP, Kashyap R. How do frontline healthcare workers learn from COVID-19 webinars during a pandemic? An online survey study. Hosp Pract (1995) 2022; 50:326-330. [PMID: 35982643 DOI: 10.1080/21548331.2022.2114741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES The COVID-19 pandemic severely restricted in-person learning. As a result, many educational institutions switched to online platforms to continue teaching. COVID-19 webinars have been useful for rapidly disseminating information to frontline healthcare workers. While conducting COVID-19 webinars through online platforms is a popular method to train medical professionals, their effectiveness has never been investigated. Our aim was to ascertain the usefulness of COVID-19 webinars during the pandemic. METHODS We conducted an online survey of about 400 frontline healthcare workers. 112 people responded to the survey (response rate = 28%). In it, we asked several questions to determine whether webinars had been a useful resource to help deal with COVID-19 patients. RESULTS We found that a majority of healthcare worker respondents had favourable opinions of online education during the pandemic as around 78% of respondents either agreed or highly agreed that webinars are a useful source of knowledge. A significant proportion (34%) did not participate in webinars and gave time constraints as their main reason for not participating. CONCLUSION Our results indicated that while online education is a great way to disseminate information quickly to a large amount of people, it also comes with its disadvantages. As we transition into a post-pandemic world, we need to make sure that online teaching is designed with the best interests of the healthcare workers in mind to ensure that we get the most out of it.
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Affiliation(s)
- Shahraz Qamar
- Post-baccalaureate Research Education Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Aysun Tekin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Romil Singh
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Salim Surani
- Department of Medicine, Texas A&M University, Corpus Christi, TX 78404, United States
| | - Ramesh Adhikari
- Department of Hospital Medicine, Franciscan Health, Lafayette, USA
| | - Vikas Bansal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mayank Sharma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marija Bogojevic
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Neha Deo
- Medical Student, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Simon Zec
- Department of Critical Care Medicine, Mayo Clinic, Rochester, USA
| | - Diana J Valencia Morales
- Departments of Anesthesiology and Perioperative Medicine, and Health Sciences Research, Rochester, MN, USA
| | - Jamil Taji
- Department of Intensive Care, Mayo Clinic Health System, Mankato, MN
| | | | - Karen Boman
- Society of Critical Care Medicine, Mount Prospect, IL
| | - Syed Anjum Khan
- Department of Intensive Care, Mayo Clinic Health System, Mankato, MN
| | - Juan Pablo Domecq
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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Valtchinov VI, Murphy SN, Lacson R, Ikonomov N, Zhai BK, Andriole K, Rousseau J, Hanson D, Kohane IS, Khorasani R. Analytics to monitor local impact of the Protecting Access to Medicare Act's imaging clinical decision support requirements. J Am Med Inform Assoc 2022; 29:1870-1878. [PMID: 35932187 PMCID: PMC9552289 DOI: 10.1093/jamia/ocac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/19/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed is to: (1) extend the Integrating the Biology and the Bedside (i2b2) data and application models to include medical imaging appropriate use criteria, enabling it to serve as a platform to monitor local impact of the Protecting Access to Medicare Act's (PAMA) imaging clinical decision support (CDS) requirements, and (2) validate the i2b2 extension using data from the Medicare Imaging Demonstration (MID) CDS implementation. MATERIALS AND METHODS This study provided a reference implementation and assessed its validity and reliability using data from the MID, the federal government's predecessor to PAMA's imaging CDS program. The Star Schema was extended to describe the interactions of imaging ordering providers with the CDS. New ontologies were added to enable mapping medical imaging appropriateness data to i2b2 schema. z-Ratio for testing the significance of the difference between 2 independent proportions was utilized. RESULTS The reference implementation used 26 327 orders for imaging examinations which were persisted to the modified i2b2 schema. As an illustration of the analytical capabilities of the Web Client, we report that 331/1192 or 28.1% of imaging orders were deemed appropriate by the CDS system at the end of the intervention period (September 2013), an increase from 162/1223 or 13.2% for the first month of the baseline period, December 2011 (P = .0212), consistent with previous studies. CONCLUSIONS The i2b2 platform can be extended to monitor local impact of PAMA's appropriateness of imaging ordering CDS requirements.
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Affiliation(s)
- Vladimir I Valtchinov
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Shawn N Murphy
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,i2b2 tranSMART Foundation, Wakefield, Massachusetts, USA
| | - Ronilda Lacson
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nikolay Ikonomov
- Institute of Mathematics and Informatics, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Bingxue K Zhai
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine Andriole
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin Rousseau
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Dick Hanson
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Isaac S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,i2b2 tranSMART Foundation, Wakefield, Massachusetts, USA
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Mano MS, Morgan G. Telehealth, Social Media, Patient Empowerment, and Physician Burnout: Seeking Middle Ground. Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35561300 DOI: 10.1200/edbk_100030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The digital revolution is an ongoing process that has nevertheless profoundly affected century-old medical practice. Digitalization has many facets, ranging from telehealth to social media and even new instant communication devices, each of which affect both patients' and physicians' realities. Although the benefits of developments such as telehealth and novel applications of social media to medicine are more easily perceived by all stakeholders, they still have their own hurdles and risks, such as coldness and impersonal treatment in telehealth, and misinformation on social media. The widespread digitalization of health records has greatly facilitated patient access to health information, becoming a major patient empowerment tool; however, some forms of unrestricted access, such as to test results-in particular, prior to consultations-have unclear benefits to patients with cancer and have also become a hurdle for care teams. In addition, the advent of instant messaging, which is revolutionizing personal communication in many cultures, is gradually affecting patient-physician communication and, combined with unrestricted patient access to test results, is creating new challenges for physicians. How these transformations are affecting patients themselves and physicians' well-being and mental health are matters addressed in this text. Last, to address potential biases in an article written by two oncologists, and in line with this year's ASCO presidential theme of including a diversity of voices, we decided to give voice to patients with cancer by collecting the opinions of high-profile patient advocates about the controversial topics addressed in this text.
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Affiliation(s)
- Max S Mano
- Grupo Oncoclínicas, São Paulo, Brazil
- Academy of Leadership Sciences Switzerland, Zurich, Switzerland
| | - Gilberto Morgan
- Skåne University Hospital, Department of Clinical Oncology, Lund, Sweden
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Kruse CS, Mileski M, Dray G, Johnson Z, Shaw C, Shirodkar H. Physician Burnout and the Electronic Health Record Leading up to and During The First Year of COVID-19: A Systematic Review (Preprint). J Med Internet Res 2022; 24:e36200. [PMID: 35120019 PMCID: PMC9015762 DOI: 10.2196/36200] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background Physician burnout was first documented in 1974, and the electronic health record (EHR) has been known to contribute to the symptoms of physician burnout. Authors pondered the extent of this effect, recognizing the increased use of telemedicine during the first year of COVID-19. Objective The aim of this review was to objectively analyze the literature over the last 5 years for empirical evidence of burnout incident to the EHR and to identify barriers to, facilitators to, and associated patient satisfaction with using the EHR to improve symptoms of burnout. Methods No human participants were involved in this review; however, 100% of participants in studies analyzed were adult physicians. We queried 4 research databases and 1 targeted journal for studies commensurate with the objective statement from January 1, 2016 through January 31, 2021 (n=25). Results The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one’s schedule, cognitive fatigue, a general loss of autonomy, and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes as strategies to alleviate the administrative burden of the EHR and decrease symptoms of burnout. Conclusions The solutions provided in the literature only addressed 2 of the 3 factors (workflow and documentation time) but not the third factor (usability). Practitioners and administrators should focus on the former 2 factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify and improve the usability features with the greatest impact. Researchers should design experiments to explore solutions that address all 3 factors of the EHR that contribute to burnout. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020201820; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201820 International Registered Report Identifier (IRRID) RR2-10.2196/15490
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Michael Mileski
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Gevin Dray
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Zakia Johnson
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Cameron Shaw
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Harsha Shirodkar
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
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Davoudi A, Lee NS, Luong T, Delaney T, Asch E, Chaiyachati K, Mowery D. Identifying Medication-related Intents from a Bidirectional Text Messaging Platform for Hypertension Management: A Pilot Study using a Unsupervised Learning Approach (Preprint). J Med Internet Res 2022; 24:e36151. [PMID: 35767327 PMCID: PMC9280462 DOI: 10.2196/36151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/01/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background Free-text communication between patients and providers plays an increasing role in chronic disease management, through platforms varying from traditional health care portals to novel mobile messaging apps. These text data are rich resources for clinical purposes, but their sheer volume render them difficult to manage. Even automated approaches, such as natural language processing, require labor-intensive manual classification for developing training data sets. Automated approaches to organizing free-text data are necessary to facilitate use of free-text communication for clinical care. Objective The aim of this study was to apply unsupervised learning approaches to (1) understand the types of topics discussed and (2) learn medication-related intents from messages sent between patients and providers through a bidirectional text messaging system for managing participant blood pressure (BP). Methods This study was a secondary analysis of deidentified messages from a remote, mobile, text-based employee hypertension management program at an academic institution. We trained a latent Dirichlet allocation (LDA) model for each message type (ie, inbound patient messages and outbound provider messages) and identified the distribution of major topics and significant topics (probability >.20) across message types. Next, we annotated all medication-related messages with a single medication intent. Then, we trained a second medication-specific LDA (medLDA) model to assess how well the unsupervised method could identify more fine-grained medication intents. We encoded each medication message with n-grams (n=1-3 words) using spaCy, clinical named entities using Stanza, and medication categories using MedEx; we then applied chi-square feature selection to learn the most informative features associated with each medication intent. Results In total, 253 participants and 5 providers engaged in the program, generating 12,131 total messages: 46.90% (n=5689) patient messages and 53.10% (n=6442) provider messages. Most patient messages corresponded to BP reporting, BP encouragement, and appointment scheduling; most provider messages corresponded to BP reporting, medication adherence, and confirmatory statements. Most patient and provider messages contained 1 topic and few contained more than 3 topics identified using LDA. In total, 534 medication messages were annotated with a single medication intent. Of these, 282 (52.8%) were patient medication messages: most referred to the medication request intent (n=134, 47.5%). Most of the 252 (47.2%) provider medication messages referred to the medication question intent (n=173, 68.7%). Although the medLDA model could identify a majority intent within each topic, it could not distinguish medication intents with low prevalence within patient or provider messages. Richer feature engineering identified informative lexical-semantic patterns associated with each medication intent class. Conclusions LDA can be an effective method for generating subgroups of messages with similar term usage and facilitating the review of topics to inform annotations. However, few training cases and shared vocabulary between intents precludes the use of LDA for fully automated, deep, medication intent classification. International Registered Report Identifier (IRRID) RR2-10.1101/2021.12.23.21268061
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Affiliation(s)
- Anahita Davoudi
- Department of Biostatistics, Epidemiology, and Informatics, Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Natalie S Lee
- Division of General Internal Medicine, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - ThaiBinh Luong
- Penn Medicine Predictive Healthcare, University of Pennsylvania Health System, Philadelphia, PA, United States
| | - Timothy Delaney
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States
| | - Elizabeth Asch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Krisda Chaiyachati
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Danielle Mowery
- Department of Biostatistics, Epidemiology, and Informatics, Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, United States
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Nguyen OT, Turner K, Apathy NC, Magoc T, Hanna K, Merlo LJ, Harle CA, Thompson LA, Berner ES, Feldman SS. Primary care physicians' electronic health record proficiency and efficiency behaviors and time interacting with electronic health records: a quantile regression analysis. J Am Med Inform Assoc 2021; 29:461-471. [PMID: 34897493 PMCID: PMC8800512 DOI: 10.1093/jamia/ocab272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aimed to understand the association between primary care physician (PCP) proficiency with the electronic health record (EHR) system and time spent interacting with the EHR. MATERIALS AND METHODS We examined the use of EHR proficiency tools among PCPs at one large academic health system using EHR-derived measures of clinician EHR proficiency and efficiency. Our main predictors were the use of EHR proficiency tools and our outcomes focused on 4 measures assessing time spent in the EHR: (1) total time spent interacting with the EHR, (2) time spent outside scheduled clinical hours, (3) time spent documenting, and (4) time spent on inbox management. We conducted multivariable quantile regression models with fixed effects for physician-level factors and time in order to identify factors that were independently associated with time spent in the EHR. RESULTS Across 441 primary care physicians, we found mixed associations between certain EHR proficiency behaviors and time spent in the EHR. Across EHR activities studied, QuickActions, SmartPhrases, and documentation length were positively associated with increased time spent in the EHR. Models also showed a greater amount of help from team members in note writing was associated with less time spent in the EHR and documenting. DISCUSSION Examining the prevalence of EHR proficiency behaviors may suggest targeted areas for initial and ongoing EHR training. Although documentation behaviors are key areas for training, team-based models for documentation and inbox management require further study. CONCLUSIONS A nuanced association exists between physician EHR proficiency and time spent in the EHR.
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Affiliation(s)
- Oliver T Nguyen
- Corresponding Author: Oliver T. Nguyen, MSHI, Department of Community Health and Family Medicine, University of Florida, College of Medicine, PO Box 100211, Gainesville, FL 32610, USA;
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA,Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
| | - Nate C Apathy
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tanja Magoc
- Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA
| | - Karim Hanna
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Lisa J Merlo
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - Christopher A Harle
- Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA,Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Eta S Berner
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sue S Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Califf RM. The Ecosystem to Support People with Heart Failure. J Card Fail 2021; 28:650-658. [PMID: 34752906 DOI: 10.1016/j.cardfail.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 01/28/2023]
Affiliation(s)
- Robert M Califf
- Verily Life Sciences and Google Health (Alphabet), South San Francisco, California.
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40
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Almulhem JA, Aldekhyyel RN, Binkheder S, Temsah MH, Jamal A. Stress and Burnout Related to Electronic Health Record Use among Healthcare Providers during the COVID-19 Pandemic in Saudi Arabia: A Preliminary National Randomized Survey. Healthcare (Basel) 2021; 9:1367. [PMID: 34683047 PMCID: PMC8544434 DOI: 10.3390/healthcare9101367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023] Open
Abstract
Healthcare providers' burnout may potentially have a negative impact on patient care. The use of the electronic health record (EHR) increases the burden for healthcare providers (HCPs), particularly during the coronavirus disease-2019 (COVID-19) pandemic. This study assessed the stress and burnout related to the use of EHRs and health information technology (HIT) tools among HCPs during COVID-19 in Saudi Arabia. We used a self-developed survey tool. It consisted of five sections; demographics and professional data, experience using EHR, effects of EHR use, use of EHR and technology tools during COVID-19, and health and wellbeing. The survey link was emailed to a random sample of HCPs registered with a national scientific regulatory body. Univariate, bivariate, and multivariate analyses were performed to measure the association between burnout and study variables. A total of 182 participants completed the survey. 50.5% of participants reported a presence of HIT-related stress, and 40.1% reported a presence of burnout. The variables independently associated with burnout were providing tertiary level of care, working with COVID-19 suspected cases, dissatisfaction with EHRs, and agreement with the statement that using EHRs added frustration to the workday. Further research that explores possible solutions is warranted to minimize burnout among HCPs, especially during infectious outbreaks.
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Affiliation(s)
- Jwaher A. Almulhem
- Medical Informatics and E-learning Unit, Medical Education Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia; (R.N.A.); (S.B.)
| | - Raniah N. Aldekhyyel
- Medical Informatics and E-learning Unit, Medical Education Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia; (R.N.A.); (S.B.)
| | - Samar Binkheder
- Medical Informatics and E-learning Unit, Medical Education Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia; (R.N.A.); (S.B.)
| | - Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia;
| | - Amr Jamal
- Evidence-Based Health Care & Knowledge Translation Research Chair, King Saud University, Riyadh 11362, Saudi Arabia;
- Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
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Poon EG, Trent Rosenbloom S, Zheng K. Health information technology and clinician burnout: Current understanding, emerging solutions, and future directions. J Am Med Inform Assoc 2021; 28:895-898. [PMID: 33871016 DOI: 10.1093/jamia/ocab058] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/01/2023] Open
Affiliation(s)
- Eric G Poon
- Duke Health Technology Solutions, Duke University Health System, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Department of Pediatrics & Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kai Zheng
- Department of Informatics, University of California, Irvine, Irvine, California, USA
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42
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Pachamanova D, Glover W, Li Z, Docktor M, Gujral N. Identifying Patterns in Administrative Tasks through Structural Topic Modeling: A Study of Task Definitions, Prevalence, and Shifts in a Mental Health Practice's Operations during the COVID-19 Pandemic. J Am Med Inform Assoc 2021; 28:2707-2715. [PMID: 34390582 DOI: 10.1093/jamia/ocab185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This case study illustrates the use of natural language processing for identifying administrative task categories, prevalence and shifts necessitated by a major event (the COVID-19 pandemic) from user-generated data stored as free text in a task management system for a multi-site mental health practice with 40 clinicians and 13 administrative staff members. METHODS Structural topic modeling was applied on 7,079 task sequences from 13 administrative users of a HIPAA-compliant task management platform. Context was obtained through interviews with an expert panel. RESULTS 10 task definitions spanning three major categories were identified, and their prevalence estimated. Significant shifts in task prevalence due to the pandemic were detected for tasks like billing inquiries to insurers, appointment cancellations, patient balances and new patient follow-up. CONCLUSIONS Structural topic modeling effectively detects task categories, prevalence, and shifts, providing opportunities for healthcare providers to reconsider staff roles and to optimize workflows and resource allocation.
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Affiliation(s)
- Dessislava Pachamanova
- Professor and Zwerling Family Endowed Research Scholar, Mathematics & Science Division, Babson College, Wellesley, MA, USA.,Research Affiliate, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Wiljeana Glover
- Stephen C. and Carmella R Kletjian Foundation Distinguished Professor of Global Healthcare Entrepreneurship, Operations and Information Management Division, Babson College, Wellesley, MA, USA
| | - Zhi Li
- Lecturer, Operations and Information Management Division, Babson College, Wellesley, MA, USA
| | - Michael Docktor
- Attending, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Nitin Gujral
- Chief Technology Officer, Dock Health, Boston, MA, USA
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Johnson J, Al-Ghunaim TA, Biyani CS, Montgomery A, Morley R, O’Connor DB. Burnout in Surgical Trainees: a Narrative Review of Trends, Contributors, Consequences and Possible Interventions. Indian J Surg 2021; 84:35-44. [PMID: 34341627 PMCID: PMC8319710 DOI: 10.1007/s12262-021-03047-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 02/03/2023] Open
Abstract
Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.
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Affiliation(s)
- Judith Johnson
- School of Psychology, University of Leeds, Leeds, LS29JT UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, BD96RJ UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052 Australia
| | | | - Chandra Shekhar Biyani
- Department of Urology, St James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
- Cadaveric Simulation Programme, Anatomy Department, School of Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Anthony Montgomery
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Roland Morley
- Imperial College Healthcare NHS Trust, London, W2 1NY UK
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