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Vaisman A, Guiloff R, Contreras M, Casas-Cordero JP, Calvo R, Figueroa D. Over 50% of self-reported burnout among Latin American orthopaedic surgeons: A cross-sectional survey on prevalence and risk factors. J ISAKOS 2024; 9:128-134. [PMID: 38036044 DOI: 10.1016/j.jisako.2023.11.008] [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: 05/26/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Assess the prevalence of self-reported burnout and identify risk and protective factors based on demographic and life quality aspects, among Latin American orthopaedic surgeons. METHODS This study employed a cross-sectional analytical design. An original design survey was developed using multiple-choice and Likert-scale questions to gather self-reported burnout, demographic, work-related, social, personal, and mood-related data. The survey was electronically distributed to the Chilean Orthopaedic Surgery Society and the Latin American Society of Arthroscopy, Knee Surgery, and Sports Medicine members. Statistical analysis included Chi-square and Fisher's exact tests to determine associations between self-reported burnout and other variables. Subsequently, a multivariate logistic regression was carried out to identify key risk and protective factors (p < 0.05). RESULTS The survey's response rate was 20 % (n = 358) out of the 1779 invitations that were sent. The most representative age range was 41-60 years (50 %) and 94 % were men. Of those surveyed, 50 % reported a burnout episode more than once per year, 60 % depersonalization when treating patients at least yearly, 13 % anhedonia, 11 % a depressive mood more than half of the month or almost every day, and 61 % weariness at the end of a working day. Burnout was statistically associated with age under 40 years old (p = 0.012), fewer years as a specialist (p = 0.037), fear of lawsuits (p < 0.001), a non-healthy diet (p = 0.003), non-doing recreational activities (p = 0.004), depersonalization when treating their patients (p < 0.001), weariness (p < 0.001), anhedonia (p < 0.001), depressive mood (p < 0.001), and career dissatisfaction (p < 0.001). The logistic regression demonstrated that fear of lawsuits (p < 0.001), weariness at the end of a workday (p = 0.016), and anhedonia (p = 0.019) were those variables with stronger direct associations with self-reported burnout. A healthy diet was the strongest protective variable (p < 0.001). CONCLUSION Over 50 % of the Latin American orthopaedic surgeons who participated in the survey reported experiencing burnout episodes more than once a year, along with depersonalization when treating their patients at least once a year. Additionally, nearly 10 % of respondents experienced weekly depressive symptoms. Among the noteworthy risk factors for self-reported burnout were fear of lawsuits, weariness at the end of the workday, and anhedonia. Conversely, maintaining a healthy diet emerged as the most potent protective factor. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Alex Vaisman
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile
| | - Rodrigo Guiloff
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile.
| | - Martín Contreras
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Av. Plaza 680, 7610658, Las Condes, Santiago, Chile
| | - Juan Pablo Casas-Cordero
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Av. Plaza 680, 7610658, Las Condes, Santiago, Chile
| | - Rafael Calvo
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile
| | - David Figueroa
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile
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Al-Ghunaim T, Johnson J, Biyani CS, O'Connor DB. How UK surgeons experience burnout and the link between burnout and patient care: A qualitative investigation. Scott Med J 2022; 67:197-206. [PMID: 36069048 PMCID: PMC9643814 DOI: 10.1177/00369330221122348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background and Aims Poor well-being affects the performance of all kinds of workers, including
surgeons. This study aimed to answer two questions: (1) how does burnout
affect surgeons personally, and what is their burnout experience like? (2)
How does burnout affect the care that surgeons provide in the United Kingdom
(UK)? Method This study conducted thematic analysis of semi-structured interviews with 14
surgeons recruited from the UK National Health Service (NHS). Result The study found three themes in surgeons’ experiences of burnout: first,
burnout is common but frequently not recognised nor understood; second,
burnout is a personal crisis; and third, burnout creates vulnerability at
work. The study also revealed four themes related to burnout's effect on
patient care: first, burnout reduces the quality of surgeon-patient
relationships; second, burnout affects patient safety; third, burnout
impairs staff relationships; and fourth, burnout makes surgeons less
motivated to improve. Conclusion Burnout is common but not well recognised in surgeons. Improving
understanding and treatment of burnout could have benefits for both surgeons
themselves and the care they provide to patients.
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Affiliation(s)
| | - Judith Johnson
- School of Psychology, 4468University of Leeds, Leeds, UK.,Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Sauder M, Zagales I, Zagales R, Das S, Sen-Crowe B, Bilski T, Kornblith L, Elkbuli A. Comprehensive Assessment of Burnout Among Surgical Trainees and Practicing Surgeons: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2022; 79:1188-1205. [PMID: 35624025 DOI: 10.1016/j.jsurg.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Surgeon burnout has received increasing attention due to evidence of high prevalence across specialties. We aimed to (1) systematically characterize existing definitions of burnout, (2) evaluate tools to measure burnout, and (3) determine risk factors of surgical burnout. DESIGN PubMed, Google Scholar, and Embase databases were searched to identify burnout rates and tools used to measure the quality of life (QoL) published from January 2000-December 2021. PARTICIPANTS Surgical Trainees and Practicing Surgeons. RESULTS We identified 39 studies that defined surgical burnout, with 9 separate tools used to measure QoL. Surgeon burnout rates were found to be highest among general surgery trainees (20%-95%). Burnout among general surgery attendings ranged from 25% to 44%. Those most likely to experience burnout were younger and female. High rates of surgeon burnout were reported among all surgical specialties; however, these rates were lower than those of general surgeons. CONCLUSION Definitions of burnout vary throughout the surgical literature, but are consistently characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. The most utilized tool to measure surgical burnout has been the Maslach Burnout Inventory. Across specialties, there are high rates of burnout in both surgical trainees and attendings, indicating that this is a systemic issue within the field of surgery. Given the wide-scale nature of the problem, it is recommended that institutions provide support to surgical trainees and attending surgeons and that individual surgeons take steps toward mitigating burnout.
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Affiliation(s)
- Matthew Sauder
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Israel Zagales
- Universidad Iberoamericana (UNIBE) Escuela de Medicina, Santo Domingo, Dominican Republic
| | - Ruth Zagales
- Florida International University, Miami, Florida
| | - Snigdha Das
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Brendon Sen-Crowe
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Lucy Kornblith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital, San Francisco, California; University of San Francisco, San Francisco, California
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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Al-Ghunaim T, Johnson J, Biyani CS, O'Connor DB. Burnout in surgeons: A qualitative investigation into contributors and potential solutions. Int J Surg 2022; 101:106613. [PMID: 35421612 DOI: 10.1016/j.ijsu.2022.106613] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/04/2022] [Accepted: 04/07/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Poor wellbeing affects the performance of all types of workers. Surgeons are particularly at risk of suffering from burnout, but minimal qualitative research has examined the causes of burnout and potential solutions in this group. Understanding this could inform the development of future burnout interventions. PURPOSE This study aimed to explore the main factors that lead to surgeon burnout and to examine how surgeons cope with burnout at work. SETTING Surgical departments in the United Kingdom's National Health Service (NHS). MATERIALS Telephone interview and face-to-face interview. METHODS This qualitative study was conducted using semi-structured interviews with 14 surgeons from diverse specialisations. The interview consisted of two sections. The first addressed the main reasons for burnout. The second explored how surgeons manage burnout. RESULTS A thematic analysis identified several factors that can lead to surgeon burnout, captured in the themes of: rising to the challenge of surgical work; interpersonal conflict at work; greater demands than resources; the challenge of work-life balance; and the devastating impact of errors and poor patient outcomes. The study also revealed various strategies that surgeons employed to cope with burnout, namely: cognitive restructuring; seeking social support; stepping aside or down from the job; and prioritising personal health. Additionally, the study found some surgeons used maladaptive coping. CONCLUSION Healthcare organisations, surgeons, and psychological experts should work together to provide more and improved interventions to help surgeons, which might lead to a reduction in the number of surgeons who leave the profession and help improve patient outcomes.
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Affiliation(s)
- Tmam Al-Ghunaim
- School of Psychology University of Leeds, Leeds, LS2 9JT, UK.
| | - Judith Johnson
- School of Psychology University of Leeds, Leeds, LS2 9JT, 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, West Yorkshire, LS9 7TF, UK
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Sreedharan S, Cleland H, Lo CH. Plastic surgical trainees' perspectives toward burn surgery in Australia and New Zealand: Changes in the last 17 years? Burns 2021; 47:1766-1772. [PMID: 34598834 DOI: 10.1016/j.burns.2021.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION An emerging amount of literature emphasises the ever-growing shortage of burn surgeons worldwide. Despite burn surgery being a fundamental competency in the Australia and New Zealand plastic and reconstructive surgery training curriculum, a perceived lack of interest amongst trainees exists. The aim of this study was to investigate Australasian plastic surgery trainees' interest in burn surgery as a career and compare with the Brown and Mills survey in 2004. METHODS An electronic survey was distributed to all Australian and New Zealand plastic and reconstructive surgery trainees during the March 2021 registrar trainee conference. This anonymous survey was adapted from the original survey conducted by Brown and Mills in 2004, with additional questions to determine the perceived importance of burns surgery as a subspecialty of plastic and reconstructive surgery, and to elicit possible solutions to the issue of workforce shortage. A reminder email was sent one month following the conference to improve the response rate. The survey was hosted by Survey Monkey (San Mateo, California, USA). RESULTS The survey was distributed to all 121 trainees and 71 (58.7%) responded. An increase in interest amongst trainees in pursuing a career in burn surgery was found, with 34 trainees (48.6% of respondents) interested, mostly on a half time or sessional basis. The three most common barriers to practising burn surgery remain unchanged, and were nature of burn operations, nature of burn care and on-call commitments; inadequacy of exposure or training ranked fourth. We found a strong overall response that burn surgery and burn care remained an important component of plastic and reconstructive surgery. DISCUSSION Inadequate exposure or training has evolved to present a bigger barrier in this study compared to a similar study conducted 17 years ago. Burn units and training bodies may offer additional job placements to address these feelings of insufficient exposure. Facilitating employment of burn surgeons on a half-time or sessional capacity is a sustainable model, and will arguably improve clinical service provision. Strong and early mentorship and allocation of commensurate resources and funding will help to address the high workload. CONCLUSIONS Interest in burn surgery has improved over the last 17 years and the most common deterrents persist, namely nature of burn operations, nature of burn care and on-call commitments. However, many of these issues are modifiable or amenable to change. The opportunity exists for relevant stakeholders to address some of these concerns raised, and thereby addressing the issue of burn surgeon shortage.
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Affiliation(s)
- S Sreedharan
- Victorian Adult Burns Service, The Alfred, 55 Commercial Rd, Melbourne, VIC 3004, Australia.
| | - H Cleland
- Victorian Adult Burns Service, The Alfred, 55 Commercial Rd, Melbourne, VIC 3004, Australia; Department of Surgery, Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia.
| | - C H Lo
- Victorian Adult Burns Service, The Alfred, 55 Commercial Rd, Melbourne, VIC 3004, Australia; Department of Surgery, Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia.
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Zhu PP, Chen LY, Pan JH, Kang CJ, Ye XM, Ye JY, Li HY, Huang M, Li P, Tan HY. The symptoms and factors associated with post-traumatic stress disorder for burns nurses: a cross-sectional study from Guangdong province in China. J Burn Care Res 2021; 43:189-195. [PMID: 34232296 DOI: 10.1093/jbcr/irab121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The symptoms of post-traumatic stress disorder (PTSD) among medical staff has become a significant issue. Environments related to burns are highly stressful for nurses and can lead to PTSD, thus affecting their mental health. It is vital to consider that the quality of burns care, and the outcomes of such treatments, may be threatened if nurses experience PTSD. We evaluated PTSD symptoms in burns nurses and explored the correlations between demographic characteristics, work-related characteristics, professional identity, turnover intention, and PTSD symptoms. METHODS This was a cross-sectional study involving 273 nurses working in burns unit from Guangdong, China, between July and August 2019. Nurses were recruited from 30 hospitals and completed three validated psychological questionnaires: Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), Professional Identity Scale for Nurses (PIS), and Turnover Intention Questionnaire (TIQ). We also collated information relating to socio-demographic and work-related characteristics. RESULTS The cut-off point for the PCL-C was defined as 38 points; 17.22% (n=47) of participants scored higher than or equal to 38. The PCL-C score was negatively correlated with professional identity level (P < 0.01) and positively correlated with turnover intention (P < 0.01). The workplace, mean monthly income, experience of workplace violence, and professional identity level, were important factors and all associated with the severity of PTSD. CONCLUSION PTSD symptoms were common in burns nurses. Attention should be paid to the mental wellbeing of these staff. Screening processes need to be initiated to identify individuals suffering from PTSD and take appropriate early interventional action.
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Affiliation(s)
- Piao-Piao Zhu
- Department of Nursing, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Nursing, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, China
| | - Li-Ying Chen
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jian-Hua Pan
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, China
| | - Chan-Juan Kang
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xue-Mei Ye
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jie-Yu Ye
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hai-Yan Li
- Department of Nursing, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, China
| | - Miao Huang
- Department of Nursing, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ping Li
- Department of Nursing, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hui-Yi Tan
- Department of Nursing, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, China
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Kinslow K, Sutherland M, McKenney M, Elkbuli A. Reported burnout among U.S. general surgery residents: A survey of the association of program directors in surgery members. Ann Med Surg (Lond) 2020; 60:14-19. [PMID: 33072313 PMCID: PMC7556262 DOI: 10.1016/j.amsu.2020.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction The literature remains unclear on the development, consequences, and interventions for burnout in resident populations. We aim to identify the prevalence and nuances of reported burnout in general surgery resident physicians to better understand which factors contribute the greatest risk. Methods A 42-question anonymous online survey was distributed by the Association of Program Directors in Surgery (APDS) to general surgery resident physicians. ANOVA, chi-square and multinomial regression analyses were performed with significance defined as p < 0.05. This survey was reported in line with the STOCSS criteria. Results 81 survey responses were received. Burnout was reported by 89.5% of university-hospital affiliated respondents and 95.2% of community teaching hospital affiliated respondents. After adjustment, community respondents showed a nearly fifteen times greater likelihood of burnout (aOR = 14.735, 95% CI: 0.791,274.482). Females were 2.7 times as likely as males to report burnout (aOR = 2.749, 95% CI: 0.189,39.960) and nearly twice as likely to report contemplating suicide (aOR = 1.819, 95% CI: 0.380,8.715). Burnout rates by hours worked/week revealed that 100% of those working ≥80 h/week report experiencing burnout. Conclusion Overall burnout rates reported by surgical residents respondents were high. Community teaching hospital setting, female gender, and increased number of hours worked per week may be associated with higher rates of burnout. Both female and community-affiliated residents were at increased risk of reporting suicidal ideation. Targeted interventions are needed to adequately address program-specific causes for resident burnout and reduce its prevalence in high-risk cohorts. Burnout as self-reported by general surgery residents is exceptionally high. Risk factors associated with increased reporting of burnout include female gender, community affiliated teaching hospitals, and increased work hours. Residents reporting burnout are more likely to consider leaving the medical field altogether, report their burnout affects their ABSITE performance and aspects of daily life.
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Affiliation(s)
- Kyle Kinslow
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South FL, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
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