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Singh V, Young JQ, Malhotra P, McCann-Pineo M, Rasul R, Corley SS, Yacht AC, Friedman K, Barone S, Schwartz RM. Evaluating burnout during the COVID-19 pandemic among physicians in a large health system in New York. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2022; 77:819-827. [PMID: 35000576 DOI: 10.1080/19338244.2021.2023084] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The COVID-19 pandemic has generated significant psychological distress among health care workers worldwide. New York State, particularly New York City and surrounding counties, were especially affected, and experienced over 430,000 COVID-19 cases and 25,000 deaths by mid-August 2020. We hypothesized that physicians and trainees (residents/fellows) who were redeployed outside of their specialty to treat COVID-19 inpatients would have higher burnout. METHODS We conducted a cross-sectional survey to assess burnout among attending and trainee physicians who provided patient care during the COVID-19 pandemic between March-May 2020 across a diverse health care system in New York. Separate multivariable logistic regressions were performed to determine the association between redeployment and measures of burnout: Emotional Exhaustion (EE) and Depersonalization. Burnout measures were also compared by physician vs trainee status. The differential association between redeployment and outcomes with respect to trainee status was also evaluated. RESULTS Redeployment was significantly associated with increased odds of EE {OR =1.53, 95% CI: 1.01-2.31} after adjusting for gender and Epidemic-Pandemic Impacts Inventory (EPII) score. Similarly, being a trainee, especially a junior level trainee, was associated with increased odds of EE {OR = 1.59, 95% CI: 1.01-2.51} after adjusting for gender and EPII scores. However, neither redeployment nor trainee status were significantly associated with Depersonalization. Interactions between redeployment and trainee status were not significant for any of the outcomes (p>.05). CONCLUSION Physicians who were redeployed to treat COVID-19 patients had higher reported measures of EE. Trainees, irrespective of redeployment status, had higher EE as compared with attendings. Additional research is needed to understand the long-term impact of redeployment on burnout among redeployed physicians. Programs to identify and address potential burnout among physicians, particularly trainees, during pandemics may be beneficial.
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Affiliation(s)
- Vansha Singh
- Infectious Disease Department, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - John Q Young
- Department of Psychiatry, Zucker Hillside Hospital at Northwell Health, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Prashant Malhotra
- Infectious Disease Department, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Molly McCann-Pineo
- Department of Occupational Medicine, Epidemiology and Prevention, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Rehana Rasul
- Biostatistics Unit, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Samantha S Corley
- Department of Occupational Medicine, Epidemiology and Prevention, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Andrew C Yacht
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Karen Friedman
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Stephen Barone
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Rebecca M Schwartz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Occupational Medicine, Epidemiology and Prevention, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
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Smida M, Khoodoruth MAS, Al‐Nuaimi SK, Al‐Salihy Z, Ghaffar A, Khoodoruth WNC, Mohammed MFH, Ouanes S. Coping strategies, optimism, and resilience factors associated with mental health outcomes among medical residents exposed to coronavirus disease 2019 in Qatar. Brain Behav 2021; 11:e2320. [PMID: 34342152 PMCID: PMC8413747 DOI: 10.1002/brb3.2320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/17/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The aim of this study is to examine the association between coping strategies, resilience, optimism and different mental health outcomes like stress, anxiety, and depression among the medical residents' during the COVID-19 pandemic, with consideration of different factors like seniority, frontliner, gender, and coping style. METHODS An electronic survey was sent to all medical residents in Qatar. Depression, anxiety, and stress were assessed by the DASS-21. Professional quality of life was measured by the ProQOL scale. The coping mechanisms were assessed with the Brief-COPE, and resilience was measured by the Brief Resilience Scale. RESULTS The most commonly used coping strategies were acceptance, religion, and active coping. The avoidant coping style scores were higher among junior residents (p = .032) and non-COVID-19 frontliners (p = .039). Optimism LOT-R score was higher in senior than in junior residents (p < .001). Lower avoidant coping scores, higher optimism, and higher resilience were associated with lower stress, anxiety, and depressive symptoms. CONCLUSION It seems that avoidant coping styles can exacerbate depressive, anxiety, and stress symptoms in medical residents amidst the COVID-19 pandemic. Strategies promoting optimism, resilience, and approach coping styles can decrease the mental health burden of the pandemic on medical residents.
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Affiliation(s)
- Malek Smida
- Department of PsychiatryHamad Medical CorporationDohaQatar
| | | | | | | | - Adeel Ghaffar
- Graduate Medical EducationHamad Medical CorporationDohaQatar
| | | | | | - Sami Ouanes
- Department of PsychiatryHamad Medical CorporationDohaQatar
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Kim KH, Jung JY, Park JW, Lee MS, Lee YH. Operating bedside cardiac ultrasound program in emergency medicine residency: A retrospective observation study from the perspective of performance improvement. PLoS One 2021; 16:e0248710. [PMID: 33798217 PMCID: PMC8018668 DOI: 10.1371/journal.pone.0248710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
Background Point-of-care ultrasound is one of useful diagnostic tools in emergency medicine practice and considerably depends on physician’s performance. This study was performed to evaluate performance improvements and favorable attitudes through structured cardiac ultrasound program for emergency medicine residents. Methods Retrospective observational study using the point-of-care ultrasound (PoCUS) database in one tertiary academic-teaching hospital emergency department has been conducted. Cardiac ultrasound education and rotation program has been implemented in emergency medicine residency program. Structured evaluation sheet for cardiac ultrasound and questionnaire toward PoCUS have been developed. An early-phase and a late-phase case were selected randomly for each participant. Two emergency medicine specialists with expertise in PoCUS evaluated saved images independently. We used a paired t-test to compare the performance score of each phase and the results of the questionnaire. Multivariable linear regression analysis was conducted to evaluate the association between the characteristics of participants and performance improvements. Results During the study period, a total of 1,652 bedside cardiac ultrasounds were administered. Forty-six examinations conducted by 23 emergency medicine residents were randomly selected for analysis. The performance score increased from 39.5 to 56.1 according to expert A and 45.3 to 62.9 according to expert B (p-value <0.01 for both). The average questionnaire score, which was analyzed for 17 participants, showed improvement from 18.9 to 20.7 (p-value <0.01). In multivariable linear regression analysis, younger age, higher early-phase score and higher confidence had a negative association with a greater improvement of performance, while the number of examinations had a positive association. Conclusions Bedside cardiac ultrasound performance and attitudes toward PoCUS have been improved through structured residency program.
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Affiliation(s)
- Ki Hong Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
- * E-mail:
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Min Sung Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yong Hee Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
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Abhary S, Botti M, Dhulia A, Tham C, Loh E, Catford J. Factors impacting health and well-being and the utilisation of supports among Australian doctors in medical specialty training. BMJ LEADER 2020. [DOI: 10.1136/leader-2020-000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PurposeTo explore factors impacting the health and well-being of doctors undertaking various specialty training programs, and attitudes towards and utilisation of supports during their training. This is a subset of data from a larger study exploring experiences of doctors in Australian specialty training—a qualitative study of enablers, stressors and supports.MethodsIn this qualitative study, registrars in specialist training programmes in Australia were invited and interviewed between August 2015 and August 2016. Semistructured open-ended questions were used to explore topics of relevance to their workplace, training, support service utilisation and personal lives. Interviews were transcribed verbatim, deidentified and content and thematic analysis undertaken. Recruitment was ceased when data saturation was reached and no new themes emerged. Emerging key themes are reported in this studyResults17 participants were recruited (including 1 Indigenous and 1 international medical graduate). A total of six specialty training programmes, across multiple states at various locations across Australia, were represented.Common themes impacting health and well-being regarding workplace and training stressors were identified, including poor supervision, shiftwork and on-call, inability to take sick leave, bullying and harassment, college-related factors, examination preparation and work–life imbalance. Several of these were identified as having actual and perceived negative impacts on patient outcomes and safety.The majority of participants underused existing supports and were unaware of the breadth of support services available to them. Barriers to accessing these services included concerns about their confidentiality and career repercussions.ConclusionsThis first Australian pilot study highlighted many stressors and enablers in the workplace, training and personal lives of registrars. The underutilisation and barriers to access of support services were discovered. Several multisystem strategies are required and discussed in this report to address these complex issues identified as affecting the health and well-being of junior doctors.
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Ashraf J, Hassan M, Iqbal Q, Naseer M, Idrees S, Ali Khan M. Satisfaction Levels of Medical Attendants at a Pakistani Emergency Department. Cureus 2020; 12:e7696. [PMID: 32431975 PMCID: PMC7233496 DOI: 10.7759/cureus.7696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Healthcare services all over Pakistan are facing an ever-growing patient flow. Rapid urbanization and a population boom are mainly responsible for this phenomenon. This is most evident in the emergency department. Not only are the patients in dire need of medical management but they require it within a certain time frame lest it is too late. It is difficult in such situations to deliver satisfactory services. Many studies have analyzed satisfaction levels in doctors, nurses, postgraduates, and patients in the emergency department. But little data is available on the satisfaction levels of attendants that accompany the patients most of the time. Attendants are an integral part of the doctor-patient relationship and their perspective may offer some insight into the shortcomings and issues afflicting the system, especially with regards to emergency medicine. Aim To evaluate the satisfaction levels of attendants of patients treated at the emergency department. Materials and methods This is a cross-sectional study, held from January 1 to June 31, 2018. Patient and attendant confidentiality were ensured. Written consent was taken in all cases. Attendants of patients treated at the emergency department that followed up at four weeks were given a simple questionnaire to fill. There were 10 questions in it, with a simple “Yes” or “No” answer. A “Yes” answer carried one point while a “No” answer had zero points. Satisfaction levels were scored out of 10. Satisfaction levels were grouped as very satisfied (9-10 points), satisfied (7-8 points), partially satisfied/partially dissatisfied (5-6 points), dissatisfied (3-4 points), and very dissatisfied (0-2 points). Results A total of 688 patients followed up at four weeks, with their attendants willing to fill in the questionnaire. Mean satisfaction levels were 7.21 ± 4.59. Almost 60% of the attendants were either very satisfied or satisfied with their experience. Attendants were most satisfied with the cost, lab facilities, availability of medicines, and medical equipment. Time management was the most concerning factor for the attendants. Conclusions Attendants are mostly very satisfied or satisfied with their experience in the emergency department. About one-fifth are either very dissatisfied or dissatisfied.
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Affiliation(s)
- Jibran Ashraf
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Mujtaba Hassan
- Critical Care, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Qaiser Iqbal
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Momina Naseer
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | | | - M Ali Khan
- Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Ward S, Outram S, Heslop B. Perceived utility and relevance of intern well-being sessions. Intern Med J 2018; 48:645-650. [PMID: 29464835 DOI: 10.1111/imj.13769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIM We conducted a pilot project assessing the perceived utility and relevance of well-being sessions provided to interns at a large regional teaching hospital in Australia, with the aim of promoting intern well-being and fostering a nurturing and supportive learning and work hospital culture. METHODS Our intervention involved two separate 60-min lectures covering well-being topics and skills to approximately 50 interns within protected teaching time, along with emailed well-being resources. Participants were emailed an online survey asking questions about value and novelty of the sessions, and work satisfaction and stress, as well as open comments. A request for an additional interview to explore responses in more depth was included. RESULTS Fifty interns attended at least one of the sessions and 35 participated in the survey, six to an additional interview. Survey and interview data showed that the majority of interns perceived the sessions as valuable, relevant and useful and felt that ongoing sessions would benefit junior medical officers in future years. Feedback highlighted the importance of providing future sessions in person, incorporating an interactive approach and emphasised that work site factors and medical culture play a large causative role in their stress. CONCLUSIONS We conclude that well-being sessions are acceptable and useful to interns and should be incorporated into hospital teaching curricula, and evaluated. However, these programmes are unlikely to change the high stress experienced unless external and systemic stressors are addressed by all stakeholders.
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Affiliation(s)
- Susannah Ward
- Advanced Trainee Rehabilitation Medicine, Belmont Hospital, Belmont, New South Wales, Australia
| | - Sue Outram
- Discipline of Health Behaviour Sciences, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia
| | - Benjamin Heslop
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Poonja Z, O'Brien P, Cross E, Bryce R, Dance E, Jaggi P, Krentz J, Thoma B. Sleep and Exercise in Emergency Medicine Residents: An Observational Pilot Study Exploring the Utility of Wearable Activity Monitors for Monitoring Wellness. Cureus 2018; 10:e2973. [PMID: 30237937 PMCID: PMC6141139 DOI: 10.7759/cureus.2973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Burnout is well-documented in residents and emergency physicians. Wellness initiatives are becoming increasingly prevalent, but there is a lack of data supporting their efficacy. In some populations, a relationship between sleep, exercise, and wellness has been documented; however, this relationship has not been established in emergency medicine (EM) residents or physicians. We aim to determine whether a wearable activity monitor is a feasible method of evaluating exercise and sleep quality and quantity in emergency medicine residents and if these assessments are associated with greater perceived wellness. Methods Twenty EM residents from two training sites wore a wearable activity monitor (Fitbit ChargeTM, Fitbit, Inc., San Francisco, CA, USA) during a four-week EM rotation. The Fitbit recorded data on sleep quantity (minutes sleeping) and quality (sleep disruptions), as well as exercise quantity and quality (daily step count, daily active minutes performing activity of 3 - 6, and > 6 metabolic equivalents). Participants completed an end-of-rotation Perceived Wellness Survey (PWS), which provided information on six domains of personal wellness (psychological, emotional, social, physical, spiritual, and intellectual). PWS levels were compared between groups of subjects with higher or lower levels of activity and sleep (i.e., above and below the median subject-averaged values) using the Mann-Whitney U test. Other subject characteristics were similarly assessed for their association with PWS. When a possible confounding effect was seen, the data was stratified and reviewed using a scatterplot. Results Of the 28 eligible residents, 23 agreed to participate. Of these, 20 and 16 wore the device for at least 50% of the respective days and nights during the observation period. Two devices were lost. One PWS was not completed. There was no statistically significant correlation between resident perceived wellness survey scores, sleep interruptions, average daily sleep minutes, daily step count, or average daily active minutes for the sample overall. However, first-year residents and residents from years two to five reported different median PWS scores of 13.9 and 17.1, respectively. Further exploration by the training group suggested that step counts may correlate with wellness in participants in their first year of residency, while the quantity of sleep may have an association with wellness in participants in years two through five of their residency. Conclusion Using wearable activity monitor devices to capture sleep and exercise data among residents does not seem to be an effective approach. Our data does not support our hypothesis that overall resident wellness was associated with exercise and sleep quality and quantity as measured by such a device. These results are counterintuitive and may be complicated by several measurement-related limitations and the possibility that benefits depend on the stage of training.
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Affiliation(s)
- Zafrina Poonja
- Emergency Medicine, University of Alberta, Edmonton, CAN
| | - Preston O'Brien
- College of Medicine, University of Saskatchewan, Saskatoon, CAN
| | - Elfriede Cross
- Emergency Medicine, University of Alberta, Edmonton, CAN
| | - Rhonda Bryce
- Clinical Research Support Unit, University of Saskatchewan, Saskatoon, CAN
| | - Erica Dance
- Emergency Medicine, University of Alberta, Edmonton, CAN
| | - Priya Jaggi
- Emergency Medicine, University of Alberta, Edmonton, CAN
| | - Joel Krentz
- Physical Education, Brandon University, Brandon, CAN
| | - Brent Thoma
- Emergency Medicine, College of Medicine/University of Saskatchewan, Saskatoon, CAN
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Brady KJS, Trockel MT, Khan CT, Raj KS, Murphy ML, Bohman B, Frank E, Louie AK, Roberts LW. What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:94-108. [PMID: 28913621 DOI: 10.1007/s40596-017-0781-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Physician wellness (well-being) is recognized for its intrinsic importance and impact on patient care, but it is a construct that lacks conceptual clarity. The authors conducted a systematic review to characterize the conceptualization of physician wellness in the literature by synthesizing definitions and measures used to operationalize the construct. METHODS A total of 3057 references identified from PubMed, Web of Science, and a manual reference check were reviewed for studies that quantitatively assessed the "wellness" or "well-being" of physicians. Definitions of physician wellness were thematically synthesized. Measures of physician wellness were classified based on their dimensional, contextual, and valence attributes, and changes in the operationalization of physician wellness were assessed over time (1989-2015). RESULTS Only 14% of included papers (11/78) explicitly defined physician wellness. At least one measure of mental, social, physical, and integrated well-being was present in 89, 50, 49, and 37% of papers, respectively. The number of papers operationalizing physician wellness using integrated, general-life well-being measures (e.g., meaning in life) increased [X 2 = 5.08, p = 0.02] over time. Changes in measurement across mental, physical, and social domains remained stable over time. CONCLUSIONS Conceptualizations of physician wellness varied widely, with greatest emphasis on negative moods/emotions (e.g., burnout). Clarity and consensus regarding the conceptual definition of physician wellness is needed to advance the development of valid and reliable physician wellness measures, improve the consistency by which the construct is operationalized, and increase comparability of findings across studies. To guide future physician wellness assessments and interventions, the authors propose a holistic definition.
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Affiliation(s)
- Keri J S Brady
- Boston University School of Public Health, Boston, MA, USA
| | | | | | - Kristin S Raj
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Bryan Bohman
- Stanford University School of Medicine, Stanford, CA, USA
| | - Erica Frank
- University of British Columbia, Vancouver, Canada
| | - Alan K Louie
- Stanford University School of Medicine, Stanford, CA, USA
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Schrager JD, Shayne P, Wolf S, Das S, Patzer RE, White M, Heron S. Assessing the Influence of a Fitbit Physical Activity Monitor on the Exercise Practices of Emergency Medicine Residents: A Pilot Study. JMIR Mhealth Uhealth 2017; 5:e2. [PMID: 28143805 PMCID: PMC5309436 DOI: 10.2196/mhealth.6239] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/07/2016] [Accepted: 12/17/2016] [Indexed: 11/13/2022] Open
Abstract
Background Targeted interventions have improved physical activity and wellness of medical residents. However, no exercise interventions have focused on emergency medicine residents. Objective This study aimed to measure the effectiveness of a wearable device for tracking physical activity on the exercise habits and wellness of this population, while also measuring barriers to adoption and continued use. Methods This pre-post cohort study enrolled 30 emergency medicine residents. Study duration was 6 months. Statistical comparisons were conducted for the primary end point and secondary exercise end points with nonparametric tests. Descriptive statistics were provided for subjective responses. Results The physical activity tracker did not increase the overall self-reported median number of days of physical activity per week within this population: baseline 2.5 days (interquartile range, IQR, 1.9) versus 2.8 days (IQR 1.5) at 1 month (P=.36). There was a significant increase in physical activity from baseline to 1 month among residents with median weekly physical activity level below that recommended by the Centers for Disease Control and Prevention at study start, that is, 1.5 days (IQR 0.9) versus 2.4 days (IQR 1.2; P=.04), to 2.0 days (IQR 2.0; P=.04) at 6 months. More than half (60%, 18/30) of participants reported a benefit to their overall wellness, and 53% (16/30) reported a benefit to their physical activity. Overall continued use of the device was 67% (20/30) at 1 month and 33% (10/30) at 6 months. Conclusions The wearable physical activity tracker did not change the overall physical activity levels among this population of emergency medicine residents. However, there was an improvement in physical activity among the residents with the lowest preintervention physical activity. Subjective improvements in overall wellness and physical activity were noted among the entire study population.
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Affiliation(s)
- Justin David Schrager
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Philip Shayne
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Sarah Wolf
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Shamie Das
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Melissa White
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Sheryl Heron
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
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Pan TY, Fan HS, Owen CA. The work environment of junior doctors: their perspectives and coping strategies. Postgrad Med J 2016; 93:414-419. [PMID: 27934629 DOI: 10.1136/postgradmedj-2016-134362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/14/2016] [Accepted: 11/15/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study explores the associations between psychological distress in junior doctors and their work environment and how they cope with work stressors. METHODS A cross-sectional survey designed by Health Education and Training Institute was delivered in 2014 to over 1900 junior doctors across 15 hospital networks through Australian Capital Territory and New South Wales. Psychological distress was evaluated using the Kessler Psychological Distress Scale-10 (K10). Numerous variables were assessed for associations with psychological distress to identify the strongest relationships and the coping strategies used. Potential associations between work demands, coping strategies and psychological distress were explored. RESULTS 540 responses were analysed. 414 (81%) thought their workload was reasonable, 376 (75%) were enjoying their current job and 446 (82.6%) were content with their work life. However, 85 (15.7%) reported that they would not study medicine if given their time again, and 146 (27%) reported workplace bullying. The mean K10 score was 17.2 (σ=6.3) and the prevalence of elevated psychological distress was between 63% and 80% higher than the general community. Variables most strongly associated with distress were: being discontented with workload, lack of enjoyment from current job, taking time off work and having experienced workplace bullying. There was a preference to use social activities as a method of coping but at higher levels of psychological distress there is a greater proportion who took time off work. CONCLUSIONS Psychologically distressed junior doctors need recognition, support and treatment. Future interventions should focus on improving work environment, job satisfaction, provision of supports, use of healthy coping strategies and improving work-related relationships. This could potentially reduce levels of psychological distress in junior doctors, optimise delivery of healthcare to patients and maximise workforce potential.
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Affiliation(s)
- Tzong-Yang Pan
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Howard S Fan
- St George and Sutherland Clinical School, University of New South Wales, Sydney, Australian Capital Territory, Australia.,Department of Surgery, The Sutherland Hospital, Sydney, New South Wales, Australia
| | - Cathy A Owen
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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Abstract
BACKGROUND Rates of physician burnout have increased in recent years, and high burnout levels are reported by physicians in training. OBJECTIVE This review of the research on resident well-being seeks to identify factors associated with well-being, summarize well-being promotion interventions, and provide a framework for future research efforts. METHODS Keywords were used to search PubMed, PsycINFO, and MEDLINE. Studies included were conducted between 1989 and 2014. The search yielded 82 articles, 26 which met inclusion criteria, and were assessed using the Medical Education Research Study Quality Instrument. RESULTS Articles measured resident well-being and associated factors, predictors, effects, barriers, as well as interventions to improve well-being. Factors identified in psychological well-being research-autonomy, building of competence, and strong social relatedness-are associated with resident well-being. Sleep and time away from work are associated with greater resident well-being. Perseverance is predictive of well-being, and greater well-being is associated with increased empathy. Interventions focused on health and coping skills appear to improve well-being, although the 3 studies that examined interventions were limited by small samples and single site administration. CONCLUSIONS An important step in evolving research in this area entails the development of a clear definition of resident well-being and a scale for measuring the construct. The majority (n = 17, 65%) of existing studies are cross-sectional analyses of factors associated with well-being. The literature summarized in this review suggests future research should focus on factors identified in cross-sectional studies, including sleep, coping mechanisms, resident autonomy, building competence, and enhanced social relatedness.
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Affiliation(s)
- Kristin S. Raj
- Corresponding author: Kristin S. Raj, MD, Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305, 650.724.4652,
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Alosaimi FD, Kazim SN, Almufleh AS, Aladwani BS, Alsubaie AS. Prevalence of stress and its determinants among residents in Saudi Arabia. Saudi Med J 2016; 36:605-12. [PMID: 25935183 PMCID: PMC4436759 DOI: 10.15537/smj.2015.5.10814] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives: To examine perceived stress among residents in Saudi Arabia and its associated risk factors. Methods: A cross-sectional study of all residents registered at the Saudi Commission for Health Specialties, Riyadh, Saudi Arabia, was conducted between May and October 2012. We assessed the likelihood of stress using the perceived stress scale (PSS). Results: Out of the 4000 residents contacted, 1035 responded and 938 were included. The mean (±standard deviation) PSS score was 22.0±5.1 (median 22 and inter-quartile range of 18-25). With the exception of gender and nationality, no significant associations were found between stress and socio-demographic or behavioral factors. Stress was associated with higher workload, sleep deprivation, dissatisfaction with colleagues and the program, and harmful ideations. Stressors included work-related, academic, and homesickness stressors. In multivariate analysis, the following were independently associated with stress: Saudi nationality, facing homesick stressor, facing work-related stressor, dissatisfaction with relationships with colleagues, and frequent thoughts of quitting the medical profession. Conclusion: Residents in Saudi Arabia are at comparable or slightly higher risk of perceived stress than that reported among residents worldwide. Unfortunately, most of the participants never received stress management, which highlights the need for stress management programs during residency.
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Affiliation(s)
- Fahad D Alosaimi
- Department of Psychiatry, King Khalid University Hospital, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia. E-mail.
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Facey AD, Tallentire V, Selzer RM, Rotstein L. Understanding and reducing work-related psychological distress in interns: a systematic review. Intern Med J 2016; 45:995-1004. [PMID: 25871700 DOI: 10.1111/imj.12785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/05/2015] [Indexed: 11/29/2022]
Abstract
The aim of this study was to collate and evaluate studies investigating either the factors influencing work-related psychological distress in postgraduate year one (PGY1) doctors or the strategies designed to reduce it. This is a systematic review conducted in May 2014. The data sources were key databases (MEDLINE, PsycINFO and Embase) and manual searches of reference lists for relevant studies published in the last 15 years. This study is an empirical research designed either to elucidate the factors influencing work-related psychological distress in PGY1 doctors, or examine the effects of an intervention designed to reduce it. Key information was extracted into an electronic data extraction form, which incorporated elements of Murphy's model of work stress factors. A total of 21 studies was included in the review; 16 studies had examined the factors influencing work-related psychological distress, four studies had investigated strategies to reduce it, and a single study addressed both. Analysis of the findings of each individual study through the conceptual framework provided by Murphy's model revealed a discrepancy between the factors influencing work-related psychological distress and the focus of strategies designed to reduce it. Factors such as career progression and a PGY1 doctor's role within the organisation were not addressed in the interventions identified. Significant sources of psychological distress in PGY1 doctors remain overlooked by current interventions. Strategies designed to prevent or reduce psychological distress should be broad-based and grounded in both the literature exploring salient factors and existing theories of work-related stress.
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Affiliation(s)
- A D Facey
- Alfred Hospital, Melbourne, Victoria, Australia
| | | | - R M Selzer
- Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Alfred Centre, Melbourne, Victoria, Australia
| | - L Rotstein
- Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Alfred Centre, Melbourne, Victoria, Australia
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Abstract
In this article, we discuss current perceptions of the model physician and how these perceptions conflict with stressful realities of training environments and contribute to the staggering rates of burnout and depression faced by medical students and residents. We suggest a multi-tiered interventional approach to address these problems, with innovations for individual trainees, programs, institutions, and the health care system. Finally, we discuss the medical community's ethical obligations to ensure that it is appropriately and thoughtfully investing in the wellness of medicine's next generations of practitioners.
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Affiliation(s)
- Kathryn Baker
- Clinical instructor in the Department of Psychiatry at the University of Michigan in Ann Arbor, and the director of the University of Michigan Medical Student Mental Health and House Officer Mental Health programs
| | - Srijan Sen
- Associate professor in the Department of Psychiatry and in the Molecular and Behavioral Neuroscience Institute at the University of Michigan in Ann Arbor, and the principal investigator of the Intern Health Study
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15
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Mason S, O'Keeffe C, Carter A, Stride C. A longitudinal study of well-being, confidence and competence in junior doctors and the impact of emergency medicine placements. Emerg Med J 2015; 33:91-8. [PMID: 26338523 PMCID: PMC4752645 DOI: 10.1136/emermed-2014-204514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 06/21/2015] [Indexed: 11/07/2022]
Abstract
Objectives To measure levels of, and change in junior doctor well-being, confidence and self-reported competence over their second postgraduate training year and the impact of emergency department (ED) placements on these outcomes. Design A longitudinal study using an online survey administered at four time points (2010–2011). Setting 28 Acute Hospital Trusts, drawn from nine participating Postgraduate Deaneries in England. Participants Junior doctors who had a placement in an ED as part of their second postgraduate training year. Main outcome measures Levels of anxiety, depression, motivation, job satisfaction, confidence and self-reported competence, collected at four time points spread over the period of the doctor's second training year (F2). Results 217 junior doctors were recruited to the study. Over the year there was a significant increase in their overall job satisfaction, confidence and self-reported competence. Junior doctors also reported significantly increased levels of motivation and anxiety, and significantly decreased levels of extrinsic job satisfaction when working in ED compared with other specialties. There were also significant increases in both junior doctor confidence and self-reported competence after their placement in ED relative to other specialties. Conclusions While elements of junior doctor well-being worsened in their ED placement compared with their time spent in other specialties, the increased levels of anxiety and reduced extrinsic job satisfaction were within the normal range for other healthcare workers. These deficits were also balanced by greater improvements in motivation, confidence in managing common acute clinical conditions and perceived competence in performing acute procedures compared with benefits offered by placements in other specialties.
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Affiliation(s)
- Suzanne Mason
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Colin O'Keeffe
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Angela Carter
- Institute of Work Psychology (IWP), Sheffield University Management School, University of Sheffield, Sheffield, UK
| | - Chris Stride
- Institute of Work Psychology (IWP), Sheffield University Management School, University of Sheffield, Sheffield, UK
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Alosaimi FD, Almufleh A, Kazim S, Aladwani B. Stress-coping strategies among medical residents in Saudi Arabia: A cross-sectional national study. Pak J Med Sci 2015; 31:504-9. [PMID: 26150833 PMCID: PMC4485260 DOI: 10.12669/pjms.313.7490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 02/13/2015] [Accepted: 03/25/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Maladaptive stress-coping strategies have been linked to reduced quality of life, psychiatric disorders, and reduced work performance among residents or physicians. This study aimed to examine stress-coping strategies among medical residents in Saudi Arabia and their association with stress levels and important personal characteristics. METHODS This cross-sectional study was conducted between May and October 2012. Residents of different specialties were recruited from a national database. Stress-coping strategies were assessed using the 28-item brief coping scale (BCS), while stress was assessed using the perceived stress scale (PSS). RESULTS Nine hundred seventeen residents completed both BCS and PSS assessments. Almost 55% of participants were males, 88% were Saudi, 58% were married, and 15% had positive history of psychiatric disorders. The adaptive stress-coping strategy with the highest score was religion, followed by planning, acceptance, and active coping. The maladaptive stress-coping strategy with the highest score was self-blame, followed by self-distraction, and venting. Maladaptive stress-coping strategies were associated with high stress level, female gender, and history of psychiatric disorders. Stress-coping strategies were not correlated/associated with age, presence of major medical illnesses, or stress management education/training. CONCLUSION Adaptive stress-coping strategies were more frequently used among a sample of residents in Saudi Arabia than maladaptive stress-coping strategies, with higher use of religion in coping than previously reported. To avoid potential negative impact on resident well-being, future studies among residents should aim to identify the type of stress management program that most positively impacts stress-coping skills.
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Affiliation(s)
- Fahad D Alosaimi
- Fahad D Alosaimi, MD. Assistant Professor of King Saud University, Riyadh, KSA. Psychiatry & Psychosomatic Medicine Consultant, Psychiatry Dept. # 55, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Auroabah Almufleh
- Aroba Almufleh, Psychiatry Resident, Department of Psychiatry, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - Sana Kazim
- Sana Kazim, Psychiatry Resident, Department of Psychiatry, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - Bandar Aladwani
- Bandar Aladwani, Psychiatry Resident, Department of Psychiatry, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
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Abdulghani HM, Al-Harbi MM, Irshad M. Stress and its association with working efficiency of junior doctors during three postgraduate residency training programs. Neuropsychiatr Dis Treat 2015; 11:3023-9. [PMID: 26677329 PMCID: PMC4677768 DOI: 10.2147/ndt.s92408] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The residency training period in the medical profession is well known for physical and mental stress, which may affect cognitive function and practical life. The aims of this study were to assess prevalence of stress among the resident trainees of the three medical specialties of Saudi Commission for Health Specialties (SCHS) training programs, namely, Internal Medicine, Emergency Medicine, Family Medicine, and their association with training years, sex, and marital status. This study also aimed to correlate the stress levels with the working efficiency and self-perceived general health problems. PARTICIPANTS AND METHODS Resident trainee physicians of SCHS were invited to complete a stress inventory Kessler 10, which is used for stress measurement. Pearson's chi-square test (χ (2)) and odds ratios (ORs) were used to quantify the associations between categorical variables. A P-value of <0.05 was considered statistically significant. RESULTS A total of 318 (out of 389, with the response rate of 82%) resident trainees participated in this study. The mean (± standard deviation) age of the study population was 27.9 (±1.6) years. The results showed 70.4% of resident trainees had stressful conditions, which consisted of severe stress: 22.6%, moderate stress: 20.4%, and mild stress: 27.4%. During the 1st year (R-1), moderate stress (OR =5.87; 95% confidence interval =2.93-17.79; P=0.001) and severe stress (OR =11.15; 95% confidence interval =4.35-28.51; P=0.0001) levels were quite high. The highest stress level was found in Emergency Medicine (80.5%), followed by Internal Medicine (73.6%), and Family Medicine (63.2%) (χ (2)=6.42; P=0.04). The stress level decreased with the increase of years of training in Emergency Medicine (χ (2)=23.76; P<0.0001) and Internal Medicine (χ (2)=60.12; P<0.0001), whereas increased in Family Medicine (χ (2)=11.80; P=0.008). High stress level was significantly associated with absence from duty days (χ (2)=28.48, P<0.0001), inefficient day activities (χ (2)=39.15; P<0.0001), and general health problems (χ (2)=45.27; P<0.0001) of resident trainees. CONCLUSION We found significantly high levels of stress among the resident trainees of SCHS. High levels of stress may have an effect on their working efficiency and general physical health. The high stress level decreased efficient day activity and made the trainees absent from the workplace.
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Affiliation(s)
| | - Mohammed Meteb Al-Harbi
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad Irshad
- Department of Medical Education, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Hussain T. In this issue of Occupational Medicine. Occup Med (Lond) 2014; 64:1. [PMID: 24389898 DOI: 10.1093/occmed/kqt170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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