Association Between Physician Burnout and Self-reported Errors: Meta-analysis

Online yoga programme for resident physicians in Québec: an evaluation of feasibility and impact on mental health

OBJECTIVES

To evaluate the feasibility of the Bali Yoga Programme for Residents (PYB-R), an 8-week virtual yoga-based intervention and determine its impact on the mental health of resident physicians.

DESIGN

Single-group repeated measures study.

SETTING

Associations from the four postgraduate medical education programmes in Québec, Canada.

PARTICIPANTS

Overall, 55 resident physicians were recruited to participate of which 53 (96.4%) completed the assessment pre-PYB-R. The postintervention assessment was completed by 43 residents (78.2%) and 39 (70.9%) completed all phases (including 3-month follow-up). Most were in their first year (43.4%) or second year (32.1%) of residency. The majority were female (81.1%) with a mean age of 28±3.6 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was feasibility as measured by participation in the PYB-R. Secondary outcome measures were psychological variables (anxiety, depression, burn-out, emotional exhaustion, compassion fatigue and compassion satisfaction) and satisfaction with the PYB-R. Residents were further subgrouped based on the quality of work life and a number of PYB-R sessions attended.

RESULTS

The attrition rate for programme completion was 19%. Of the 43 residents who completed the PYB-R, 90.6% attended between 6 and 8 sessions. Repeated-measures analysis of variances (ANOVAs) at three time points (baseline, PYB-R completion and 3-month follow-up) confirmed a decrease in scores for depression and anxiety, and an increase in scores for compassion satisfaction. No changes were observed in the other psychological variables evaluated. ANOVAs also confirmed that a better quality of life at work helps develop compassion satisfaction, a protective factor to compassion fatigue. Most participants (92.9%) indicated they were satisfied or very satisfied with the quality of the programme.

CONCLUSIONS

A virtual yoga-based programme is feasible and has lasting positive effects for up to 3 months on the mental health of resident physicians. Further research is warranted to validate these findings using a larger sample of residents with a control group.

Quality of Care and Quality of Life: Balancing Patient Safety and Physician Burnout

Since the publication of the Institute of Medicine's landmark report on medical errors in 2000, a large number of safety programs have been implemented in American hospitals. Concurrently, there has been a dramatic increase in the rate of burnout among physicians. Although there are many unrelated causes of burnout (eg, loss of autonomy), and multiple safety programs that are applauded by physicians (eg, The Safe Motherhood Initiative), other programs created in the name of safety improvements may be contributing to physician distress. In this piece, we review several of those programs, describe their limitations and costs to physician well-being, and discuss the manner in which they might be modified to retain their benefits while mitigating the burdens they place on physicians.

Neurosurgery Residents' Satisfaction Toward Their Saudi Training Program: Insights from a National Survey

BACKGROUND

Given the high-stakes nature of their work, neurosurgery residents face constant pressure and require high-quality training to succeed. We aim to investigate the satisfaction levels of residents with their Saudi Neurosurgery Residency Training Program (SNRTP) and its influential factors.

METHODS

This is a nationwide, cross-sectional study that employed a questionnaire, structured based on the relevant literature, which was disseminated to neurosurgery residents, commencing from December 2021 and culminating in September 2022.

RESULTS

A total of 70 out of 143 neurosurgery residents were included, giving a response rate of 48.9%. Most participants (62.9%) aged 24-28 years old, 55.7% were males, and 40.0% were from the Central region of Saudi Arabia. The residents were further divided into juniors (R1-R3; 64.3%) and seniors (R4-R6; 35.7%). Approximately 13.3% of the juniors were satisfied with the SNRTP, whereas only 8.0% of the seniors were satisfied. Dissatisfaction rates over the SNRTP were significantly higher in the seniors (68.0%) compared to the juniors (28.9%; P = 0.006). The frequency of operating room sessions per week and presence of protected research time were the only 2 factors significantly associated with the junior and senior residents' satisfaction, respectively.

CONCLUSIONS

The SNRTP has a vision to provide the society with elite competent neurosurgeons. However, we found a degree of dissatisfaction among the residents, indicating a need for improving the SNRTP's policies. We recommend incorporating more hands-on training opportunities, implementing a mentorship model, setting tailored teaching sessions, and establishing resident wellness programs. We hope this study initiate dialogue on promoting residents' satisfaction and overall well-being.

Implementation of Well-Being for Cardiothoracic Surgeons

Well-being is a quality of positive physical, mental, social, and environmental experiences. Well-being enables thoracic surgeons to achieve their full potential across personal and work domains. Evidence-based guidelines to promote individual well-being include (1) progress toward a goal; (2) actions commensurate with experience, interest, mission; (3) interconnectivity with others; (4) social relatedness of the work one does; (5) safety; and (6) autonomy. Successful pursuit of well-being includes the development of individual skills of mindfulness, resilience, and connection with others. However, well-being among individuals cannot be achieved without support of workplace leaders and durable institutional infrastructure.

[Burnout in hospital-based surgeons. Approaches for prevention?]

BACKGROUND

Burnout among physicians is increasingly recognized as a public health issue including its scientific, political, and societal relevance. The effects of burnout go far beyond physician health as they affect the quality of care, patient safety, medical errors, and efficiency of health care.

OBJECTIVE

Assessment of the risk of burnout for hospital-based surgeons as well as associations between surgeon burnout and several work-related and person-related factors.

METHODS

From the representative Saxony physician survey from 2019, we utilized the subsample of 231 hospital-based surgeons. We conducted a regression analysis with workload, job satisfaction, work-life balance (WLB), resilience, inability to recover and health complaints as predictors of burnout (Maslach burnout inventory-General survey, MBI-GS).

RESULTS

Nearly half of the sample were female (49.4%), the average age was 42.0 years, 4.8% of participants exhibited burnout, 45.9% with some symptoms and 49.4% no burnout. Multivariate analysis showed significant positive associations between health complaints, inability to recover, a lack of job-based self-fulfillment and burnout. There were significant negative connections between WLB, the wish to remain in the job and burnout.

CONCLUSION

Burnout is a serious problem for surgeons. Preventive measures should focus on risk factors associated with the workplace and organization of work. Interventions targeted at the individual level should start at an early career stage.

Psychological distress among early medical residents: A 2-year longitudinal cohort study over seven years in Japan

BACKGROUND

Early medical residents are expected to have a higher prevalence of burnout due to physical and psychological stressors. However psychological distress associated with burnout has not been adequately investigated in a longitudinal manner. We therefore examined the longitudinal trajectory of depression and its associated factors among early medical residents.

METHODS

In this cohort study, medical residents (n = 215) who started rotation at the University of Yamanashi Hospital during 2012 to 2018 were recruited and asked to complete the Brief Job Stress Questionnaire (BJSQ), Center for Epidemiologic Studies Depression Scale (CESD), Brief Scale for Coping Profile (BSCP) and Athens Insomnia Scale (AIS) at the time of exit from each clinical department for up to two years over seven years. Factors associated with the CES-D scores were statistically explored, with a cutoff score of 16 to denote depression.

RESULTS

The CES-D was completed by 205 residents. The average CES-D score was 10.3 ± 8.0 and the scores were lower in the 2nd versus 1st year of residency (11.3 ± 6.7 versus 9.2 ± 7.0). Multiple regression analysis of BJSQ/BSCP/AIS on CES-D revealed that insomnia had a significant impact on the CES-D scores. Apart from insomnia, avoidance and suppression and peer support had significant effects. Resilient residents, who showed the maximum CES-D score of under 16 consistently throughout the residency, was better in terms of changing a point of view, active solution and changing mood. Women were more likely to express emotions to others, while they reported more job control in the first year.

CONCLUSIONS

Our results have high clinical relevance to challenge psychological burnout among early medical residents, offering some possible clues for prevention such as reduced burden, more flexibility during the first year and strengthening coworker support. Insomnia exerted moderate to strong effects on depression and monitoring of sleep appears indispensable in this specific population.

The State of Health, Burnout, Healthy Behaviors, Workplace Wellness Support, and Concerns of Medication Errors in Pharmacists During the COVID-19 Pandemic

OBJECTIVES

The aims of the study were to describe the well-being and lifestyle behaviors of health-system pharmacists during the COVID-19 pandemic and to determine the relationships among well-being, perceptions of workplace wellness support, and self-reported concern of having made a medication error.

METHODS

Pharmacist ( N = 10,445) were randomly sampled for a health and well-being survey. Multiple logistic regression assessed associations with wellness support and concerns of medication error.

RESULTS

The response rate was 6.4% ( N = 665). Pharmacists whose workplaces very much supported wellness were 3× more likely to have no depression, anxiety, and stress; 10× more likely to have no burnout; and 15× more likely to have a higher professional quality of life. Those with burnout had double the concern of having made a medication error in the last 3 months.

CONCLUSIONS

Healthcare leadership must fix system issues that cause burnout and actualize wellness cultures to improve pharmacist well-being.

LGBTQ+ Identity and Ophthalmologist Burnout

PURPOSE

To evaluate lesbian, gay, bisexual, transgender, questioning, and other sexual/gender minority (LGBTQ+) orientation as a burnout risk factor among an international ophthalmologist cohort.

METHODS

An anonymous, cross-sectional electronic survey was distributed via an Internet platform to characterize the relationship among demographic factors, including LGBTQ+ orientation, and burnout as measured by the Copenhagen Burnout Inventory (CBI). Univariable data analysis (linear) by sexual orientation was performed and variables with an association with a P value of <0.15 in univariable analysis were included in the multiple linear regression modeling.

RESULTS

A total of 403 ophthalmologists participated in the survey. The majority self-identified as "White" (69.2%), were from North America (72.0% United States, 18.6% Canada) and were evenly distributed between age of 30 and 65 years. Overall, 13.2% of participants identified as LGBTQ+ and 98.2% as cisgender. Approximately 12% had witnessed or experienced LGBTQ+-related workplace discrimination or harassment. The personal and work-related burnout scores and confidence limits of persons identified as LGBTQ+ were higher and nonoverlapping compared with those reported as non-LGBTQ+. Multivariable analysis identified significant risk factors for higher personal and work-related burnout scores: LGBTQ+ (11.8 and 11.1, P = .0005 and .0023), female gender (5.36 and 4.83, P = .0153 and .0434), older age (19.1 and 19.2, P = .0173 and .0273). and caretaker stress (6.42 and 5.97, P = .0085 and .0239).

CONCLUSIONS

LGBTQ+ orientation is a burnout risk factor among ophthalmologists, and LGBTQ+ workplace discrimination may be a contributing factor. Support from ophthalmology organizations to address LGBTQ+-, gender-, and age-related workplace discrimination may decrease burnout. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Incidence of Burnout Syndrome among Anesthesiologists and Intensivists in France: The REPAR Study

BACKGROUND

Burnout syndrome (BOS) impacts health workers and has become a real public health issue. The primary objective of this observational study was to re-evaluate the incidence of BOS among anesthesiologists and intensivists (AI) in France, ten years after the SESMAT study, a French Physician Health Survey carried out among burnout salaried AI. The secondary objective was to investigate risks factors.

METHODS

The REPAR survey is an observational study carried in France among AI, residents, and seniors, whatever their main mode of practice, in the framework of a self-questionnaire distributed on the Internet from 11 April 2018 to 1 July 2018. BOS was assessed using the Copenhagen Burnout Inventory (CBI). A score above 50% on two of the dimensions (personal burnout and work-related burnout) indicated BOS, as a main criterion. In order to investigate risks factors, questions were about sociodemographic characteristics, professional and extraprofessional environments, personality and mood using the Major Depression Inventory (MDI). A significance threshold of p < 0.05 was retained.

RESULTS

Among 1519 questionnaires received, 1500 completed questionnaires were analyzed. There were 775 men (52%) and 721 women (48%), aged 23 to 74 years. Among those, 24% suffered from BOS, 9% showed depressive symptoms (MDI > 25) and 35% were considering changing jobs or stopping their studies. There was no significant difference with the SESMAT study for the general BOS score. After multivariate analysis, 12 variables were significantly associated with the main criterion.

CONCLUSIONS

Ten years after the SESMAT study, the incidence of BOS in AI has not decreased in the largest cohort of AI studied to date in France.

Physician burnout levels and associated factors in The Covid-19 pandemic

Introduction: Burnout, characterized by emotional exhaustion, depersonalization, and low personal accomplishment, is frequently observed in physicians. Aim: The purpose of this study was to determine burnout levels and associated factors in physicians during the pandemic. Material and Method: This cross-sectional study was performed online with 288 physicians from various fields in Erzurum. Sociodemographic questions and the Maslach Burnout Inventory represented the data collection tools. The data were collected online in May and June 2021. Statistical analysis: Descriptive statistics, Student's t and ANOVA tests And Multiple ordinal logistic regression analysis were used. p values <0.05 were regarded as significant. Analysis was performed on SPSS 22. Results: Physicians' mean emotional exhaustion, depersonalization, and personal accomplishment component scores were 20.1±8.3, 6.7±4.5, and 21.1±4.5, respectively. Analysis showed that 49.7% of physicians exhibited moderate-high emotional exhaustion, 35.8% high-moderate depersonalization, and 69.8% signs of low personal accomplishment. Job title, regret concerning selecting the medical profession, satisfaction with the working environment, number of additional monthly out-of-hours shifts worked, regular sporting activity, and assessment of the physical conditions in the working environment emerged as factors affecting burnout components at regression analysis. Conclusion: The participants' burnout levels were high. The planning of effective interventions addressing individual and work-related factors with a holistic approach is essential to halt this rapidly growing epidemic.

Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis

OBJECTIVE

To examine the association of physician burnout with the career engagement and the quality of patient care globally.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10.

RESULTS

4732 articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I²=97%, k=73 studies, n=146 980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I²=97%, k=16, n=33 871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I²=97%, k=25, n=32 271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I²=83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I²=0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I²=87%, k=35, n=41 059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I²=96%, k=40, n=32 321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I²=75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08).

CONCLUSIONS

This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO number CRD42021249492.

Factors Associated With Burnout in Physical Medicine and Rehabilitation Residents in the United States

OBJECTIVES

The aims of the study were to determine the prevalence of burnout in physical medicine and rehabilitation residents in the United States and to identify the personal- and program-specific characteristics most strongly associated with residents reporting burnout.

DESIGN

This was a cross-sectional survey of US physical medicine and rehabilitation residents. Emotional exhaustion, depersonalization, and burnout were assessed using two validated items from the Maslach Burnout Inventory. Associations of burnout with demographics and personal factors, residency program characteristics, perceived program support, and work/life balance were evaluated.

RESULTS

The survey was completed by 296 residents (22.8%), with 35.8% of residents meeting the criteria for burnout. Residents' perception of not having adequate time for personal/family life was the factor most strongly associated with burnout (χ2 = 93.769, P < 0.001). Residents who reported inappropriate clerical burden and working more than 50 hrs/wk on inpatient rotations were most likely to report that they did not have adequate time for personal/family life. Faculty support (χ2 = 41.599, P < 0.001) and performing activities that led residents to choose physical medicine and rehabilitation as a specialty (χ2 = 93.082, P < 0.001) were protective against burnout.

CONCLUSIONS

Residents reporting having inadequate time for their personal/family life was most strongly associated with physical medicine and rehabilitation resident burnout, although many personal and program characteristics were associated with burnout.