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Yupanqui-Lorenzo DE, Caycho-Rodríguez T, Baños-Chaparro J, Arauco-Lozada T, Palao-Loayza L, Rivera MEL, Barrios I, Torales J. Mapping of the network connection between sleep quality symptoms, depression, generalized anxiety, and burnout in the general population of Peru and El Salvador. PSICOLOGIA-REFLEXAO E CRITICA 2024; 37:27. [PMID: 39009857 PMCID: PMC11250734 DOI: 10.1186/s41155-024-00312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND A meta-analysis of randomized controlled trials has suggested a bidirectional relationship between sleep problems and mental health issues. Despite these findings, there is limited conclusive evidence on the relationship between sleep quality, depression, anxiety, and burnout. OBJECTIVE The current study aimed to evaluate the relationships between sleep quality symptoms, anxiety, depression, and burnout in samples of adult individuals from two Latin American countries, Peru and El Salvador, through network analysis and to identify key symptoms that reinforce the correlation and intensify the syndromes. METHODS A total of 1012 individuals from El Salvador and Peru participated, with an average age of 26.5 years (SD = 9.1). Symptom networks were constructed for both countries based on data from the Jenkins Sleep Scale, Patient Health Questionnaire-2, General Anxiety Disorder-2, and a single burnout item. RESULTS The results indicated that Depressed Mood, Difficulty Falling Asleep, and Nervousness were the most central symptoms in a network in the participating countries. The strongest conditional associations were found between symptoms belonging to the same construct, which were similar in both countries. Thus, there is a relationship between Nervousness and Uncontrollable Worry, Anhedonia and Depressed Mood, and Nighttime Awakenings and Difficulty in Staying Asleep. It was observed that burnout is a bridge symptom between both countries and presents stronger conditional associations with Tiredness on Awakening, Depressed Mood, and Uncontrollable Worry. Other bridge symptoms include a Depressed Mood and Nervousness. The network structure did not differ between the participants from Peru and El Salvador. CONCLUSION The networks formed by sleep quality, anxiety, depression, and burnout symptoms play a prominent role in the comorbidity of mental health problems among the general populations of Peru and El Salvador. The symptom-based analytical approach highlights the different diagnostic weights of these symptoms. Treatments or interventions should focus on identifying central and bridge symptoms.
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Affiliation(s)
| | - Tomás Caycho-Rodríguez
- Universidad Científica del Sur, Facultad de Psicología, Campus Villa II, Ctra. Panamericana S 19, Villa El Salvador, Lima, Perú.
| | - Jonatan Baños-Chaparro
- Universidad Científica del Sur, Facultad de Psicología, Campus Villa II, Ctra. Panamericana S 19, Villa El Salvador, Lima, Perú
| | | | | | | | - Iván Barrios
- Universidad Sudamericana, Facultad de Ciencias de la Salud, Salto del Guairá, Paraguay
- Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Filial Santa Rosa del Aguaray, Cátedra de Bioestadística, Santa Rosa del Aguaray, Paraguay
| | - Julio Torales
- Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Cátedra de Psicología Médica, San Lorenzo, Paraguay
- Universidad Sudamericana, Facultad de Ciencias de la Salud, Salto del Guairá, Paraguay
- Universidad Nacional de Caaguazú, Instituto Regional de Investigación en Salud, Coronel Oviedo, Paraguay
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Elliott J, Hodges C, Boots M, Pattinson R, Gillen E, Whybrow D, Bundy C. Mixed shift rotations, sleep, burnout and well-being in professions similar to radiographers: A systematic review. Radiography (Lond) 2024; 30:1194-1200. [PMID: 38901073 DOI: 10.1016/j.radi.2024.05.016] [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: 03/06/2024] [Revised: 05/23/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Delivering 24 h healthcare requires rotational shift work from doctors and the medical imaging team, while contributing to safe and timely care of patients. Additional service pressure and staff shortfall leads to workload pressures, adjusted shift patterns and risk of burnout. Evidence should be sought to the effects of this work on staff. METHODS This systematic review followed PRISMA reporting guidelines, using a convergent mixed methods approach according to Guidance from Joanna Briggs International. Quantitative trends and results were qualified in order to thematically analyse in conjunction with qualitative data and discussed together in context. Following initial searching, returned articles were screened by title and abstract. A team of 3 reviewers undertook blinded critical appraisal of those suitable, with quality assurance from a 4th team member. Papers passing a threshold of 75% on JBI appraisal tools were accepted for synthesis. Data extraction of appropriate articles retrieved was undertaken in parallel. RESULTS Following screening and critical appraisal, 13 studies were returned focusing exclusively on Non Consultant Doctors. No studies investigated diagnostic radiographers. 85% (n = 11) reported negative association between shift work and the three themes of sleep/fatigue, burnout and wellbeing: including after the introduction of shift pattern control or adjusted shift patterns. The remainder showed no change, or any improvement nullified by countermeasures to maintain service delivery. CONCLUSION Current working practices and shift plans in the target population showed detrimental effects on the participants - this can be suggested that Diagnostic Radiographers may suffer fatigue, burnout and poor mental health from stretched shift working patterns. IMPLICATIONS FOR PRACTICE Further study into the effects of shift work on Diagnostic Radiographers and other allied health professionals is indicated - relating to the above themes in the context of errors and patient safety. Additional research into Non Consultant Doctors, shift work effects and the context of wider service delivery required; with suitable interventions and education to maximise understanding of legal working practices, monitoring and self-management of symptoms.
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Barac M, Scaletty S, Hassett LC, Stillwell A, Croarkin PE, Chauhan M, Chesak S, Bobo WV, Athreya AP, Dyrbye LN. Wearable Technologies for Detecting Burnout and Well-Being in Health Care Professionals: Scoping Review. J Med Internet Res 2024; 26:e50253. [PMID: 38916948 PMCID: PMC11234055 DOI: 10.2196/50253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 01/01/2024] [Accepted: 03/20/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND The occupational burnout epidemic is a growing issue, and in the United States, up to 60% of medical students, residents, physicians, and registered nurses experience symptoms. Wearable technologies may provide an opportunity to predict the onset of burnout and other forms of distress using physiological markers. OBJECTIVE This study aims to identify physiological biomarkers of burnout, and establish what gaps are currently present in the use of wearable technologies for burnout prediction among health care professionals (HCPs). METHODS A comprehensive search of several databases was performed on June 7, 2022. No date limits were set for the search. The databases were Ovid: MEDLINE(R), Embase, Healthstar, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection via Clarivate Analytics, Scopus via Elsevier, EBSCOhost: Academic Search Premier, CINAHL with Full Text, and Business Source Premier. Studies observing anxiety, burnout, stress, and depression using a wearable device worn by an HCP were included, with HCP defined as medical students, residents, physicians, and nurses. Bias was assessed using the Newcastle Ottawa Quality Assessment Form for Cohort Studies. RESULTS The initial search yielded 505 papers, from which 10 (1.95%) studies were included in this review. The majority (n=9) used wrist-worn biosensors and described observational cohort studies (n=8), with a low risk of bias. While no physiological measures were reliably associated with burnout or anxiety, step count and time in bed were associated with depressive symptoms, and heart rate and heart rate variability were associated with acute stress. Studies were limited with long-term observations (eg, ≥12 months) and large sample sizes, with limited integration of wearable data with system-level information (eg, acuity) to predict burnout. Reporting standards were also insufficient, particularly in device adherence and sampling frequency used for physiological measurements. CONCLUSIONS With wearables offering promise for digital health assessments of human functioning, it is possible to see wearables as a frontier for predicting burnout. Future digital health studies exploring the utility of wearable technologies for burnout prediction should address the limitations of data standardization and strategies to improve adherence and inclusivity in study participation.
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Affiliation(s)
- Milica Barac
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
| | - Samantha Scaletty
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
| | - Leslie C Hassett
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
| | - Ashley Stillwell
- Department of Family Medicine, Mayo Clinic, Phoenix, AZ, United States
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Mohit Chauhan
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States
| | - Sherry Chesak
- Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States
| | - Arjun P Athreya
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Liselotte N Dyrbye
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Frija J, Mullaert J, Abensur Vuillaume L, Grajoszex M, Wanono R, Benzaquen H, Kerzabi F, Geoffroy PA, Matrot B, Trioux T, Penzel T, d'Ortho MP. Metrology of two wearable sleep trackers against polysomnography in patients with sleep complaints. J Sleep Res 2024:e14235. [PMID: 38873908 DOI: 10.1111/jsr.14235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 06/15/2024]
Abstract
Sleep trackers are used widely by patients with sleep complaints, however their metrological validation is often poor and relies on healthy subjects. We assessed the metrological validity of two commercially available sleep trackers (Withings Activité/Fitbit Alta HR) through a prospective observational monocentric study, in adult patients referred for polysomnography (PSG). We compared the total sleep time (TST), REM time, REM latency, nonREM1 + 2 time, nonREM3 time, and wake after sleep onset (WASO). We report absolute and relative errors, Bland-Altman representations, and a contingency table of times spent in sleep stages with respect to PSG. Sixty-five patients were included (final sample size 58 for Withings and 52 for Fitbit). Both devices gave a relatively accurate sleep start time with a median absolute error of 5 (IQR -43; 27) min for Withings and -2.0 (-12.5; 4.2) min for Fitbit but both overestimated TST. Withings tended to underestimate WASO with a median absolute error of -25.0 (-61.5; -8.5) min, while Fitbit tended to overestimate it (median absolute error 10 (-18; 43) min. Withings underestimated light sleep and overestimated deep sleep, while Fitbit overestimated light and REM sleep and underestimated deep sleep. The overall kappas for concordance of each epoch between PSG and devices were low: 0.12 (95%CI 0.117-0.121) for Withings and VPSG indications 0.07 (95%CI 0.067-0.071) for Fitbit, as well as kappas for each VPSG indication 0.07 (95%CI 0.067-0.071). Thus, commercially available sleep trackers are not reliable for sleep architecture in patients with sleep complaints/pathologies and should not replace actigraphy and/or PSG.
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Affiliation(s)
- Justine Frija
- Explorations Fonctionnelles et Centre du Sommeil- Département de Physiologie Clinique, APHP, Hôpital Bichat, Paris, France
- Université de Paris, NeuroDiderot, Inserm U1141, Paris, France
- Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU Neurosciences, APHP, Hôpital Bichat Claude Bernard, Paris, France
| | - Jimmy Mullaert
- AP-HP, Hôpital Bichat, DEBRC, Paris, France
- Université de Paris, IAME, INSERM, Paris, France
| | | | - Mathieu Grajoszex
- Explorations Fonctionnelles et Centre du Sommeil- Département de Physiologie Clinique, APHP, Hôpital Bichat, Paris, France
- Digital Medical Hub SAS, Assistance Publique Hôpitaux de Paris AP-HP, Hotel Dieu, Place du Parvis Notre Dame, Paris, France
| | - Ruben Wanono
- Explorations Fonctionnelles et Centre du Sommeil- Département de Physiologie Clinique, APHP, Hôpital Bichat, Paris, France
| | - Hélène Benzaquen
- Explorations Fonctionnelles et Centre du Sommeil- Département de Physiologie Clinique, APHP, Hôpital Bichat, Paris, France
| | - Fedja Kerzabi
- Explorations Fonctionnelles et Centre du Sommeil- Département de Physiologie Clinique, APHP, Hôpital Bichat, Paris, France
| | - Pierre Alexis Geoffroy
- Université de Paris, NeuroDiderot, Inserm U1141, Paris, France
- Département de psychiatrie et d'addictologie, GHU Paris Nord, DMU Neurosciences, APHP, Hôpital Bichat Claude Bernard, Paris, France
| | - Boris Matrot
- Université de Paris, NeuroDiderot, Inserm U1141, Paris, France
| | | | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marie-Pia d'Ortho
- Explorations Fonctionnelles et Centre du Sommeil- Département de Physiologie Clinique, APHP, Hôpital Bichat, Paris, France
- Université de Paris, NeuroDiderot, Inserm U1141, Paris, France
- Digital Medical Hub SAS, Assistance Publique Hôpitaux de Paris AP-HP, Hotel Dieu, Place du Parvis Notre Dame, Paris, France
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Abdelmageed S, Horak VJ, Virtanen PS, Lam SK, Burchiel KJ, Raskin JS. A Well-Being Well-Check for Neurosurgery: Evidence-Based Suggestions for Our Specialty Based on a Systematic Review. World Neurosurg 2024; 185:351-358.e2. [PMID: 38403016 DOI: 10.1016/j.wneu.2024.02.093] [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: 12/23/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The path through neurosurgery is rigorous. Many neurosurgeons may experience burnout, depression, or suicide throughout training and practice. We review the literature to help foster a culture of awareness and self-care and arm trainees with coping skills to reduce burnout and, thus, suicidality during all phases of their medical careers. METHODS A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 4 databases. 7 studies were included. RESULTS Overlying themes of interventions were to increase balance, mindfulness, and physical fitness. The most common interventions included in programs were educational and physical activity. We suggest a comprehensive wellness program emphasizing interventions from 4 wellness dimensions-physical, spiritual, mental, and emotional. CONCLUSIONS Many neurosurgeons experience burnout, leading to a lack of satisfaction and early retirement; this necessitates a discipline-wide acknowledgment of endemic burnout among neurosurgeons. Systemic changes are needed to refine the training process and prioritize physician well-being- this cannot be left to chance.
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Affiliation(s)
- Sunny Abdelmageed
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Victoria Jane Horak
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Piiamaria S Virtanen
- Department of Neurological Surgery, Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kim J Burchiel
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey S Raskin
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Nagasaki K, Kobayashi H, Nishizaki Y, Kurihara M, Watari T, Shimizu T, Yamamoto Y, Shikino K, Fukui S, Nishiguchi S, Katayama K, Tokuda Y. Association of sleep quality with duty hours, mental health, and medical errors among Japanese postgraduate residents: a cross-sectional study. Sci Rep 2024; 14:1481. [PMID: 38233476 PMCID: PMC10794685 DOI: 10.1038/s41598-024-51353-8] [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: 08/08/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
Long duty hours (DH) impair sleep and negatively affect residents' health and medical safety. This cross-sectional study investigated the association among residents' DH, sleep duration, insomnia, sleep impairment, depressive symptoms, and self-reported medical errors among 5579 residents in Japan who completed the General Medicine In-Training Examination (2021) and participated in the training-environment survey. Weekly DH was classified under seven categories. Sleep duration and insomnia symptoms, from the Athens Insomnia Scale, were analysed to determine sleep impairment; depressive symptoms and medical errors were self-reported. Among 5095 residents, 15.5% slept < 5 h/day, and 26.7% had insomnia. In multivariable analysis, compared with ≥ 60 and < 70, DH ≥ 90 h/week associated with shorter sleep duration and worsen insomnia symptoms. Shorter durations of sleep and more intense symptoms of insomnia were associated with increased depressive symptoms. Medical errors increased only among residents with insomnia, but were not associated with sleep duration. DH > 90 h/week could lead to shorter sleep duration, worsen insomnia symptoms, and negatively impact well-being and medical safety. There was no significant association between sleep duration and medical errors; however, insomnia conferred an increased risk of medical errors. Limiting DH for residents to avoid excessive workload can help improve resident sleep, enhance resident well-being, and potentially reduce insomnia-associated medical errors.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, 3-2-7, Miyamachi, Mito, Ibaraki, 310-0015, Japan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, 3-2-7, Miyamachi, Mito, Ibaraki, 310-0015, Japan.
| | - Yuji Nishizaki
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Masaru Kurihara
- Department of Patient Safety, Nagoya University Hospital, Aichi, Japan
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Shimane, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Sho Fukui
- Department of Emergency and General Medicine, Kyorin University, Tokyo, Japan
| | - Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kohta Katayama
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa for Teaching Hospitals, Okinawa, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
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Saintila J, Soriano-Moreno AN, Ramos-Vera C, Oblitas-Guerrero SM, Calizaya-Milla YE. Association between sleep duration and burnout in healthcare professionals: a cross-sectional survey. Front Public Health 2024; 11:1268164. [PMID: 38269387 PMCID: PMC10806404 DOI: 10.3389/fpubh.2023.1268164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Background Short sleep duration in healthcare professionals is a recurring concern among researchers. On the other hand, the prevalence of burnout in this population group is experiencing exponential growth. Therefore, this study aimed to explore the association between sleep duration and burnout in healthcare professionals. Methods This is a cross-sectional study. Data were collected by applying a non-probabilistic convenience sampling, considering a sample of 300 healthcare professionals from the public sector in Peru. The association between variables was explored using multivariate logistic regression. Values of p < 0.05 were considered statistically significant. Results The results of the analysis in the crude models revealed that both men and women who slept < 7 h during workdays and days off were 8.33 (95% CI = 2.68-13.99, p = 0.004) and 17.18 (95% CI = 10.50-23.87, p < 0.001) times more likely to have burnout compared to those who reported ≥7 h, respectively. After adjusting for confounding variables, the association remained statistically significant. Conclusion The findings of this study underscore the critical importance of sleep duration in the incidence of burnout among healthcare professionals. In the context of the global challenges to the mental and physical health of these professionals, our results highlight the urgent need to implement strategies at the organizational and individual level. This includes promoting a better work-life balance, and effective stress management and improved sleep quality.
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Burt L, Clark L, Park C. Stronger together: learner reactions on a team-based, interprofessional first death simulation experience. J Interprof Care 2024; 38:95-103. [PMID: 37422861 DOI: 10.1080/13561820.2023.2232408] [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: 09/27/2022] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
Patient death is a common experience that may be traumatic for health care providers. Although current rates of burnout are high, evidence supports that interprofessional coping can improve clinician mental health. While health care simulation affords learners freedom of safety to participate in a variety of educational experiences, current application of simulation during patient death is limited to professional duties, without explicitly addressing learner emotional well-being. We designed a patient death simulation scenario within a supportive and reflective interprofessional environment to teach foundational coping and well-being strategies to preclinical nursing, medical, and pharmacy students. Sixty-one students participated in this team-based, First Death simulation experience. Debriefings were analyzed using qualitative inductive content analysis methodology. Students reacted to being part of an interprofessional team after having participated in simulation about the death of a patient as described by five categories: emotional awareness, communication insight, feeling stronger together, with role curiosity, and through reflections on support. Findings suggested that simulation is an effective teaching modality for mentoring interprofessional students on humanistic well-being strategies. Furthermore, the experience fostered reactions transcending interprofessional competencies, which are transferrable to future clinical practice.
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Affiliation(s)
- Leah Burt
- College of Nursing Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lou Clark
- M Simulation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christine Park
- College of Medicine, Simulation and Integrative Learning (SAIL) Institute, University of Illinois, Chicago, Illinois, USA
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Le Gal A, Barfield DM, Wignall RH, Cook SD. Outcome prediction in dogs admitted through the emergency room: Accuracy of staff prediction and comparison with an illness severity stratification system for hospitalized dogs. J Vet Emerg Crit Care (San Antonio) 2024; 34:69-75. [PMID: 37987140 DOI: 10.1111/vec.13350] [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: 04/28/2022] [Revised: 07/25/2022] [Accepted: 09/03/2022] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To determine whether emergency staff and students can predict patient outcome within 24 hours of admission, comparing the accuracy of clinician prognostication with outcome prediction by Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast scoring and identifying whether experience or mood would be associated with accuracy. DESIGN Prospective observational study between April 2020 and March 2021. SETTING University teaching hospital. ANIMALS One hundred and sixty-one dogs admitted through an Emergency Service were assessed. Where data were available, an APPLEfast score was calculated per patient. An APPLEfast score of >25 was deemed a predictor for mortality. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Emergency staff and students were asked to complete surveys about dogs admitted to the emergency room. All clinicopathological data were available for review, and the animals were available for examination. Data collected included opinions on whether the patient would be discharged from hospital, a mood score, position, and experience in Emergency and Critical Care. One-hundred and twenty-five dogs (77.6%) were discharged; 36 dogs (22.4%) died or were euthanized. Two hundred and sixty-six responses were obtained; 202 responses (75.9%) predicted the correct outcome. Students, interns, residents, faculty, and nurses predicted the correct outcome in 81.4%, 58.3%, 83.3%, 82.1%, and 65.5% of cases, respectively. Of 64 incorrect predictions, 43 (67.2%) predicted death in hospital. APPLEfast scores were obtained in 121 cases, predicting the correct outcome in 83 cases (68.6%). Of 38 cases in which APPLEfast was incorrect, 27 (71.1%) were dogs surviving to discharge. Mean APPLEfast score was 22.9 (± 6.2). There was no difference in outcome prediction accuracy between staff and APPLEfast scores (P = 0.13). Neither experience nor mood score was associated with outcome prediction ability (P = 0.55 and P = 0.74, respectively). CONCLUSIONS Outcome prediction accuracy by staff is not significantly different to APPLEfast scoring where a cutoff of >25 is used to predict mortality. When predictions were incorrect, they often predicted nonsurvival.
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Affiliation(s)
- Alice Le Gal
- Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
| | - Dominic Martin Barfield
- Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
| | - Roseanne Helen Wignall
- Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
| | - Simon David Cook
- Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
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Feng S, Davis JA, Chowdhary A, Lomazow W, Yi JS, Huang J, Ding L, Taravati P. The effect of mandatory post-call relief on sleep and wellness in ophthalmology residents. BMC MEDICAL EDUCATION 2023; 23:955. [PMID: 38093220 PMCID: PMC10720055 DOI: 10.1186/s12909-023-04947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Multiple duty hour reforms have been implemented to optimize resident wellness through increasing opportunities for sleep recovery, but few studies have recorded objectively measured sleep or shown direct sleep and wellness benefits from such interventions. This study seeks to determine whether mandatory post-call relief policies with a partial night float system improved resident sleep, activity, and burnout among ophthalmology residents taking home call. METHODS We conducted a two group cohort study of ophthalmology residents at the University Washington comparing post graduate year-2 (PGY-2) resident sleep, activity, and burnout between the optional post-call relief group from July 1, 2017 to June 30, 2019 to the mandatory post-call relief group from July 1, 2019 to June 30, 2021. RESULTS Of twenty total residents participating in the survey portion, 18 residents participated in the sleep and activity tracking portion of the study, 9 in in the optional post-call relief cohort, and 9 in the mandatory post-call relief cohort. The mandatory post-call relief group recorded longer total sleep on call than the optional post-call relief group (p < 0.001). There was no difference in overnight sleep recorded on call (median 3.4 h), but residents recorded more time napping in the mandatory post-call relief cohort (p < 0.001). There was no significant difference between cohorts in amount of sleep while not on call. Residents in the mandatory post-call relief cohort recorded higher average daily steps, higher exercise time, and lower sedentary time than residents in the optional post-call relief cohort (p < 0.001). They also recorded lower median emotional exhaustion on the Maslach Burnout Inventory and lower stress in the Depression and Anxiety Stress Scale in the mandatory post-call relief cohort (p = 0.008). CONCLUSIONS Implementation of mandatory post-call relief policies with a partial night-float system among PGY-2 residents was associated with more post-call naps with more overall physical activity, lower emotional exhaustion scores, and lower stress scores, despite no changes to overnight sleep on call or total sleep. Although sample size limits interpretation of data, implementation of mandatory post call relief could be considered to improve post-call sleep in programs with home call.
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Affiliation(s)
- Shu Feng
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA.
| | - John A Davis
- Oregon Health and Sciences University, Casey Eye Institute, Portland, USA
| | - Apoorva Chowdhary
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Whitney Lomazow
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Jonathan S Yi
- University of Miami Health System, Bascom Palmer Eye Institute, Miami, USA
| | - Johnson Huang
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Parisa Taravati
- Department of Ophthalmology, University of Washington School of Medicine, Campus Box 359608, 325 9th Avenue, Seattle, WA, 98104, USA
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Gupta S, Prithviraj M, Gangwar A, Rath RS. Impact of Sleep Duration, Quality, and Chronotype on Learning and Academic Performance: A Cross-Sectional Study Among First Year Medical Students of a Tertiary Care Institute. Cureus 2023; 15:e50413. [PMID: 38222241 PMCID: PMC10784715 DOI: 10.7759/cureus.50413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction The link between sleep and cognitive processes, such as memory and learning, continues to be one of the most intriguing and perplexing theories. Undergraduate medical students in their first year are particularly vulnerable to sleep disturbances. Academic achievement and learning have been linked to sleep patterns, which include not only the quantity and quality of sleep but also the timing of sleep in relation to the natural sleep onsets, or chronotypes. There have been conflicting reports on the outcomes of sleep and relatively fewer researches focused on the impact of chronotypes on learning and academic achievement among medical students. The current study thus sought to determine the chronotypes of medical students, evaluate the quantity and quality of sleep, and determine the impact of these factors on learning and academic performance. Methods The study was conducted in the Department of Physiology, All India Institute of Medical Sciences (AIIMS) Gorakhpur, India. Sleep health was assessed in 167 first-year medical students using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), morningness-eveningness questionnaire (MEQ), and sleep log books. Learning and memory assessment was performed using Raven's progressive matrices test. Grade point average (GPA) was used to assess their academic performance. The relationship of sleep scores with GPA and RPM scores were obtained by linear regression analysis. One-way analysis of variance (ANOVA) and unpaired t-test were used to investigate other comparisons among categories of chronotypes and those of mean GPA. A p-value of <0.05 was considered as significant. Results The mean GPA and RPM scores obtained in the groups with PSQI ≥ 5 (2.67 ± 1.1, 49.51 ± 6.24, respectively) and PSQI < 5 (3.15 ± 0.59, 54.73 ± 4.01, respectively) and those in the group with ESS ≥ 10 (2.72 ± 1.17, 50.97 ± 5.92, respectively) and ESS < 10 (3.15 ± 0.6, 54.18 ± 3.91, respectively) varied with statistically significant differences (p < 0.05). Statistically significant R-squared values for the relationship of PSQI and ESS scores with RPM and GPA scores were obtained. No correlation between academic grades and chronotype was found. Poor GPA scores were found to be associated with reduced mean sleep duration for one week before the exams. Conclusion Learning and academic performance are negatively impacted by poor sleep quality and daytime sleep dysfunction. No definite evidence for the association of sleep chronotypes with the learning and memory could be attained. Higher test performance is more closely linked to the average sleep length over a duration of time preceding the exams.
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Affiliation(s)
- Sangeeta Gupta
- Physiology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND
| | - Manoj Prithviraj
- Psychiatry, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND
| | - Anil Gangwar
- Physiology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND
| | - Rama S Rath
- Community Medicine, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND
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Yuan JH, Huang Y, Rosgen BK, Donnelly S, Lan X, Katz SJ. Burnout and fatigue amongst internal medicine residents: A cross-sectional study on the impact of alternative scheduling models on resident wellness. PLoS One 2023; 18:e0291457. [PMID: 37708198 PMCID: PMC10501672 DOI: 10.1371/journal.pone.0291457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Fatigue and burnout are prevalent among resident physicians across Canada. Shifts exceeding 24 hours are commonly purported as detrimental to resident health and performance. Residency training programs have employed strategies towards understanding and intervening upon the complex issue of resident fatigue, where alternative resident scheduling models have been an area of active investigation. This study sought to characterize drivers and outcomes of fatigue and burnout amongst internal medicine residents across different scheduling models. METHODS We conducted cross-sectional surveys were among internal medicine resident physicians at the University of Alberta. We collected anonymized socioeconomic demographics and medical education background, and estimated associations between demographic or work characteristics and fatigue and burnout outcomes. RESULTS Sixty-nine participants competed burnout questionnaires, and 165 fatigue questionnaires were completed (response rate of 48%). The overall prevalence of burnout was 58%. Lower burnout prevalence was noted among respondents with dependent(s) (p = 0.048), who identified as a racial minority (p = 0.018), or completed their medical degree internationally (p = 0.006). The 1-in-4 model was associated with the highest levels of fatigue, reported increased risk towards personal health (OR 4.98, 95%CI 1.77-13.99) and occupational or household harm (OR 5.69, 95%CI 1.87-17.3). Alternative scheduling models were not associated with these hazards. CONCLUSIONS The 1-in-4 scheduling model was associated with high rates of resident physician fatigue, and alternative scheduling models were associated with less fatigue. Protective factors against fatigue are best characterized as strong social supports outside the workplace. Further studies are needed to characterize the impacts of alternative scheduling models on resident education and patient safety.
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Affiliation(s)
- Jack H. Yuan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Yiming Huang
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brianna K. Rosgen
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Donnelly
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Xiaoyang Lan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven J. Katz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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13
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Munisteri M, Wong R, Loza L, Scott LLF, Keyser EA, Gonzalez-Brown V. Resident Trainee Access and Barriers to Routine Health Services in the Military Health System. JOURNAL OF SURGICAL EDUCATION 2023; 80:581-587. [PMID: 36933931 DOI: 10.1016/j.jsurg.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/05/2023] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Resident physician wellness has been a highly contentious topic in graduate medical education over the past 2 decades. Physicians, including residents and attending physicians, are more likely than other professionals to work through illness and delay necessary healthcare screening appointments. Potential reasons for underutilization of health care include-unpredictable work hours, limited time, concerns about confidentiality, poor support from training programs, and apprehension about the impact on their peers. The goal of this study was to evaluate access to health care amongst resident physicians within a large military training facility. DESIGN This is an observational study using Department of Defense approved software to distribute an anonymous ten question survey on routine health care practices of residents. The survey was distributed to a total of 240 active-duty military resident physicians at a large tertiary military medical center. RESULTS One hundred seventy-eight residents completed the survey with a 74% response rate. Residents from 15 specialty areas responded. Compared to male counterparts', female residents were more likely to miss routine scheduled health care appointments to include, behavioral health appointments (54.2% vs 28%, p < 0.01). Female residents were more likely to report that attitudes toward missing clinical duties for health care appointments impacted their decision to start or add to their family more than male coresidents (32.3% vs 18.3%, p = 0.03). Surgical residents are also more likely to miss routine screening appointments or scheduled follow ups than residents in nonsurgical training programs; (84.0-88% compared to 52.4%-62.8%) respectively. CONCLUSIONS Resident health and wellness have long been an issue, with resident physical and mental health being negatively impacted during residency. Our study notes that residents in the military system also face barriers accessing routine health care. Female surgical residents being the demographic most significantly impacted. Our survey highlights cultural attitudes in military graduate medical education regarding the prioritization of personal health, and the negative impact that can have on residents' utilization of care. Our survey also raises concerns particularly amongst female surgical residents, that these attitudes may impact career advancement, as well as influence their decision to start or add to their families.
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Affiliation(s)
- Meghan Munisteri
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas.
| | - Rebecca Wong
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas
| | - Lina Loza
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas
| | - Laura L F Scott
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas; Maternal-Fetal Medicine, Brooke Army Medical Center, San Antonio, Texas
| | - Erin A Keyser
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas
| | - Veronica Gonzalez-Brown
- Gynecological Surgery & Obstetrics, Brooke Army Medical Center, San Antonio, Texas; Maternal-Fetal Medicine, Brooke Army Medical Center, San Antonio, Texas
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14
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Ardizzone E, Lerchbaumer E, Heinzel JC, Winter N, Prahm C, Kolbenschlag J, Daigeler A, Lauer H. Insomnia-A Systematic Review and Comparison of Medical Resident's Average Off-Call Sleep Times. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4180. [PMID: 36901190 PMCID: PMC10002061 DOI: 10.3390/ijerph20054180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Sleep deprivation is known to have serious consequences, including a decrease in performance, attention and neurocognitive function. It seems common knowledge that medical residents are routinely sleep deprived, yet there is little objective research recording their average sleep times. To discern whether residents may be suffering from the abovementioned side effects, this review aimed to analyze their average sleep times. Thirty papers recording the average sleep time of medical residents were found via a literature search using the key words "resident" and "sleep". An analysis of the mean sleep times cited therein revealed a range of sleep from 4.2 to 8.6 h per night, the median being 6.2 h. A sub-analysis of papers from the USA showed barely any significant differences in sleep time between the specialties, but the mean sleep times were below 7 h. The only significant difference (p = 0.039) was between the mean sleep times of pediatric and urology residents, with the former achieving less sleep. The comparison of methods for data collection showed no significant difference in the sleep times collected. The results of this analysis imply that residents are regularly sleep deprived and may therefore suffer from the abovementioned consequences.
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Affiliation(s)
- Eve Ardizzone
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Emily Lerchbaumer
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Johannes C. Heinzel
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Natalie Winter
- Department of Neurology, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Cosima Prahm
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
| | - Henrik Lauer
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany
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Chen Z, Foo ZST, Tang JY, Sim MWC, Lim BL, Fong KY, Tan KH. Sleep quality and burnout: A Singapore study. Sleep Med 2023; 102:205-212. [PMID: 36706670 DOI: 10.1016/j.sleep.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/30/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Improved sleep hygiene is postulated to be protective against burnout. Previous studies assessing a potential association between poor sleep quality and burnout showed incongruent results. OBJECTIVE To investigate the relationship between sleep quality and burnout. DESIGN Setting and Participants: A survey was conducted in a large health care cluster in Singapore and included health care staff from different professions (N = 4777). The Maslach Burnout Inventory - Human Services Survey was used to measure burnout across 3 sub-scales: Emotional Exhaustion, Depersonalization and Personal Accomplishment, while the Pittsburgh Sleep Quality Index (PSQI) was used to gauge the participants' sleep quality. Multi-variable general linear model ANOVA was used for correlation analysis. RESULTS There is a strong correlation between sleep quality and all 3 burnout sub-scales. PSQI is associated with Emotional Exhaustion (F value = 90.65, P-value <.0001), Depersonalization (F value = 49.46, P-value <.0001) and Personal Accomplishment (F value = 12.29, P-value <.0001). PSQI shows a significant linear upward trend with Emotional Exhaustion (linear contrast = 957.06, P-value <.0001) and with Depersonalization (linear contrast = 521.92, P-value <.0001). With Personal Accomplishment, PSQI shows a significant linear downward trend (linear contrast = 123.61, P-value <.0001). CONCLUSION Poor sleep quality is progressively and linearly associated with burnout and its 3 sub-scales. Future studies that evaluate interventions which improve sleep quality among health care workers may be useful in reducing burnout and improving patient care.
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Affiliation(s)
- Zhengyong Chen
- Duke-NUS Medical School, Singapore; SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore.
| | - Zann Sue Ting Foo
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
| | - Joo Ying Tang
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
| | - Mabel Wan Chi Sim
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
| | - Boon Leng Lim
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Kok Yong Fong
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
| | - Kok Hian Tan
- SingHealth Duke-NUS Institute for Patient Safety & Quality, Singapore
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Pattanaik S, Fastring D, Bateman RC. A Longitudinal Pilot Study of Stress and Sleep in First-Year Osteopathic Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231179532. [PMID: 37324050 PMCID: PMC10265315 DOI: 10.1177/23821205231179532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Poor sleep quality is thought to be a contributor to medical student stress. The authors evaluated the effect of high and low periods of academic stress on sleep quality and quantity in first-year medical students. METHODS A group of 25 students in their first year of medical school were provided Fitbit Charge 3 activity trackers for continual use and were surveyed at 4 intervals to assess stress level, sleep quantity, and sleep quality. Fitbit data were collected through the Fitbit mobile app and uploaded to the Fitabase (Small Steps Labs, LLC) server. Data collection times were scheduled around the academic exam schedule. Weeks in which testing occurred were identified as high-stress periods. Results from assessments were compared to nontesting periods of low stress. RESULTS During stressful periods, students slept an average of one hour less per 24-h period, took more naps, and reported poorer sleep quality than during the low-stress periods. No significant change was seen in the 4 surveyed intervals in sleep efficiency or sleep stages. CONCLUSION Students slept less and had poorer quality sleep in their main sleep event during stressful periods but attempted to compensate with increased napping and weekend catchup sleep. The objective Fitbit activity tracker data were consistent with and validated the self-reported survey data. Activity trackers could potentially be used to optimize the efficiency and quality of both student napping and main sleep events as one component of a stress reduction program for medical students.
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Affiliation(s)
| | - Danielle Fastring
- College of Osteopathic Medicine,
William Carey University, Hattiesburg, MS, USA
| | - Robert C. Bateman
- College of Osteopathic Medicine,
William Carey University, Hattiesburg, MS, USA
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17
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Trends in Surgeon Burnout in the US and Canada: Systematic Review and Meta-Regression Analysis. J Am Coll Surg 2023; 236:253-265. [PMID: 36519921 DOI: 10.1097/xcs.0000000000000402] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Burnout among surgeons is increasingly recognized as a crisis. However, little is known about changes in burnout prevalence over time. We evaluated temporal trends in burnout among surgeons and surgical trainees of all specialties in the US and Canada. STUDY DESIGN We systematically reviewed MEDLINE, Embase, and PsycINFO for studies assessing surgeon burnout from January 1981 through September 2021. Changes in dichotomized Maslach Burnout Inventory scores and mean subscale scores over time were assessed using multivariable random-effects meta-regression. RESULTS Of 3,575 studies screened, 103 studies representing 63,587 individuals met inclusion criteria. Publication dates ranged from 1996 through 2021. Overall, 41% of surgeons met criteria for burnout. Trainees were more affected than attending surgeons (46% vs 36%, p = 0.012). Prevalence remained stable over the study period (-4.8% per decade, 95% CI -13.2% to 3.5%). Mean scores for emotional exhaustion declined and depersonalization declined over time (-4.1 per decade, 95% CI -7.4 to -0.8 and -1.4 per decade, 95% CI -3.0 to -0.2). Personal accomplishment scores remained unchanged. A high degree of heterogeneity was noted in all analyses despite adjustment for training status, specialty, practice setting, and study quality. CONCLUSIONS Contrary to popular perceptions, we found no evidence of rising surgeon burnout in published literature. Rather, emotional exhaustion and depersonalization may be decreasing. Nonetheless, burnout levels remain unacceptably high, indicating a need for meaningful interventions across training levels and specialties. Future research should be deliberately designed to support longitudinal integration through prospective meta-regression to facilitate monitoring of trends in surgeon burnout.
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18
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Pham HC, Phan TTH, Le QH, Bui VH, Dang TTG, Tran MD. The Influence of Physical Activities on Job Satisfaction: Mediating Role of Self-efficacy, Self-esteem and Moderating Role of Stress Management. Am J Health Behav 2022; 46:794-808. [PMID: 36721292 DOI: 10.5993/ajhb.46.6.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: Job satisfaction has been an essential element for the success of any organization, which has drawn the attention of several recent studies and policymakers. The aim of the current study was to investigate the impact of physical activities, self-efficacy and self-esteem on job satisfaction in manufacturing companies in Vietnam. The mediating impact of self-efficacy and self-esteem among physical activities and job satisfaction was also investigated. As a novel element, the study also examined the moderating impact of stress management among physical activities and job satisfaction in manufacturing companies in Vietnam. Methods: The study used survey questionnaires to gather the primary data from the selected employees of leading manufacturing companies of Vietnam. Using the PLS-SEM and Smart-PLS packages, the study analyzed the linkages among all variables. Results: The results revealed that physical activities, self-efficacy and self-esteem have a positive linkage with job satisfaction in manufacturing companies in Vietnam. The findings also exposed that self-efficacy and self-esteem significantly mediate among physical activities and job satisfaction. Conclusion: The findings also expressed that stress management significantly moderated between physical activities and job satisfaction. These findings will provide useful guidance and assistance to the strategists and policy makers to design policies related to job satisfaction using self-efficacy, stress management and self-esteem.
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Affiliation(s)
- Hong Chuong Pham
- Hong Chuong Pham, Faculty of Tourism and Hospitality, National Economics University, Vietnam
| | - Thi Thu Hien Phan
- Thi Thu Hien Phan, Faculty of Accounting & Auditing, Foreign Trade University;,
| | - Quoc Hoi Le
- Quoc Hoi Le, National Economics University, Vietnam
| | - Van Hung Bui
- Van Hung Bui, National Economics University, Vietnam
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Brown KB, Cook A, Chen F, Martinelli SM. A Perspective on Wellness in Anesthesiology Residency Programs: A Multi-Strategy Approach. Anesthesiol Clin 2022; 40:257-274. [PMID: 35659399 DOI: 10.1016/j.anclin.2022.01.003] [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] [Indexed: 06/15/2023]
Abstract
Addressing resident wellness is an important topic given the high risk for burnout and depression in resident physicians compared with the general U.S. population. This article provides an overview of various approaches to help conceptualize and intervene on resident wellness, based on the 9-strategies framework to improve wellness laid out by Shanafelt and colleagues. This article outlines the most relevant literature in each strategy followed by the authors' experience within their anesthesiology residency program.
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Affiliation(s)
- Kenneth B Brown
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA.
| | - Arianna Cook
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Fei Chen
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, USA
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Sakamoto JT, Lee J, Lu DW, Sundaram V, Bird SB, Blomkalns AL, Alvarez A. Factors driving burnout and professional fulfillment among emergency medicine residents: A national wellness survey by the Society for Academic Emergency Medicine. AEM EDUCATION AND TRAINING 2022; 6:S5-S12. [PMID: 35783080 PMCID: PMC9222870 DOI: 10.1002/aet2.10746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 06/15/2023]
Abstract
Objectives This study aimed to identify rates of and contributors to burnout and professional fulfillment among emergency medicine (EM) resident physicians. Methods This was a cross-sectional, national survey of resident members of the Society for Academic Emergency Medicine (SAEM). Primary outcomes were burnout and professional fulfillment measured using a previously validated instrument with additional domains pertaining to the academic environment. The survey included question domains examining organizational factors (e.g., academic work environment, satisfaction with training, electronic health records, values alignment, and control over schedule) and individual factors (e.g., self-compassion, meaningfulness of clinical work, impact of work on health and personal relationships, perceived appreciation, thoughts of attrition, and expectations of the field of EM). Logistic regression was performed to determine the relationships between the primary outcomes and each domain. Results The survey was sent electronically to 2641 SAEM resident members. A total of 275 residents completed the survey with a response rate of 10.4%. A total of 151 (55%) respondents were male, and 210 (76%) were White. A total of 132 (48%) residents reported burnout, and 75 (28%) reported professional fulfillment. All organizational and individual factors were significantly associated with both primary outcomes. EM residents reported that meaningfulness of clinical work had the most significant positive association with professional fulfillment (adjusted odds ratio [OR] 2.2 [95% confidence interval {CI} 1.8-2.7]) and negative association with burnout (adjusted OR 0.46 [95% CI 0.37-0.56]). Thoughts of attrition from academics and accurate expectations of EM were also associated with both primary outcomes, with adjusted ORs (95% CIs) of 0.40 (0.21-0.72) and 5.6 (1.9-23.8) for professional fulfillment and 4.1 (2.5-7.1) and 0.19 (0.08-0.40) for burnout, respectively. Conclusions This study found a high prevalence of burnout and a low prevalence of professional fulfillment among EM residents. Multiple factors were significantly associated with each occupational phenomenon, with meaningfulness of clinical work demonstrating the strongest relationships with burnout and professional fulfillment.
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Affiliation(s)
| | - Justin Lee
- Stanford University School of MedicineStanfordCaliforniaUSA
| | - Dave W. Lu
- University of Washington School of MedicineSeattleWashingtonUSA
| | | | - Steven B. Bird
- UMassMemorial Healthcare and University of Massachusetts Medical School WorcesterWorcesterMassachusettsUSA
| | | | - Al'ai Alvarez
- Stanford University School of MedicineStanfordCaliforniaUSA
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21
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BURNOUT SYNDROME IN DENTISTS: WORK-RELATED FACTORS. J Dent 2022; 121:104143. [DOI: 10.1016/j.jdent.2022.104143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
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22
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Lonsdale H, Gray GM, Ahumada LM, Yates HM, Varughese A, Rehman MA. The Perioperative Human Digital Twin. Anesth Analg 2022; 134:885-892. [PMID: 35299215 DOI: 10.1213/ane.0000000000005916] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Hannah Lonsdale
- From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Luis M Ahumada
- Center for Pediatric Data Science and Analytics Methodology
| | - Hannah M Yates
- Department of Anesthesia and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Anna Varughese
- Department of Anesthesia and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Mohamed A Rehman
- Department of Anesthesia and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida
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23
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Huhn S, Axt M, Gunga HC, Maggioni MA, Munga S, Obor D, Sié A, Boudo V, Bunker A, Sauerborn R, Bärnighausen T, Barteit S. The Impact of Wearable Technologies in Health Research: Scoping Review. JMIR Mhealth Uhealth 2022; 10:e34384. [PMID: 35076409 PMCID: PMC8826148 DOI: 10.2196/34384] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background Wearable devices hold great promise, particularly for data generation for cutting-edge health research, and their demand has risen substantially in recent years. However, there is a shortage of aggregated insights into how wearables have been used in health research. Objective In this review, we aim to broadly overview and categorize the current research conducted with affordable wearable devices for health research. Methods We performed a scoping review to understand the use of affordable, consumer-grade wearables for health research from a population health perspective using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. A total of 7499 articles were found in 4 medical databases (PubMed, Ovid, Web of Science, and CINAHL). Studies were eligible if they used noninvasive wearables: worn on the wrist, arm, hip, and chest; measured vital signs; and analyzed the collected data quantitatively. We excluded studies that did not use wearables for outcome assessment and prototype studies, devices that cost >€500 (US $570), or obtrusive smart clothing. Results We included 179 studies using 189 wearable devices covering 10,835,733 participants. Most studies were observational (128/179, 71.5%), conducted in 2020 (56/179, 31.3%) and in North America (94/179, 52.5%), and 93% (10,104,217/10,835,733) of the participants were part of global health studies. The most popular wearables were fitness trackers (86/189, 45.5%) and accelerometer wearables, which primarily measure movement (49/189, 25.9%). Typical measurements included steps (95/179, 53.1%), heart rate (HR; 55/179, 30.7%), and sleep duration (51/179, 28.5%). Other devices measured blood pressure (3/179, 1.7%), skin temperature (3/179, 1.7%), oximetry (3/179, 1.7%), or respiratory rate (2/179, 1.1%). The wearables were mostly worn on the wrist (138/189, 73%) and cost <€200 (US $228; 120/189, 63.5%). The aims and approaches of all 179 studies revealed six prominent uses for wearables, comprising correlations—wearable and other physiological data (40/179, 22.3%), method evaluations (with subgroups; 40/179, 22.3%), population-based research (31/179, 17.3%), experimental outcome assessment (30/179, 16.8%), prognostic forecasting (28/179, 15.6%), and explorative analysis of big data sets (10/179, 5.6%). The most frequent strengths of affordable wearables were validation, accuracy, and clinical certification (104/179, 58.1%). Conclusions Wearables showed an increasingly diverse field of application such as COVID-19 prediction, fertility tracking, heat-related illness, drug effects, and psychological interventions; they also included underrepresented populations, such as individuals with rare diseases. There is a lack of research on wearable devices in low-resource contexts. Fueled by the COVID-19 pandemic, we see a shift toward more large-sized, web-based studies where wearables increased insights into the developing pandemic, including forecasting models and the effects of the pandemic. Some studies have indicated that big data extracted from wearables may potentially transform the understanding of population health dynamics and the ability to forecast health trends.
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Affiliation(s)
- Sophie Huhn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Miriam Axt
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Hanns-Christian Gunga
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment, Berlin, Germany
| | - Martina Anna Maggioni
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment, Berlin, Germany.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | - David Obor
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Ali Sié
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.,Centre de Recherche en Santé Nouna, Nouna, Burkina Faso
| | | | - Aditi Bunker
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.,Harvard Center for Population and Development Studies, Cambridge, MA, United States.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Sandra Barteit
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
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Mendelsohn D. Self in medicine: Determinants of physician well-being and future directions in improving wellness. MEDICAL EDUCATION 2022; 56:48-55. [PMID: 34559421 DOI: 10.1111/medu.14671] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Medicine, a profession dedicated to the wellness of patients, is struggling with a crisis of physician and trainee wellness. Physicians and trainees are burning out at alarming rates. Historically, medicine has been characterised by challenging working conditions and inattention to physician wellness and self-care. Healthy physicians are better at promoting wellness to their patients, and physicians who are suffering from burnout can deliver compromised patient care. DISCUSSION In recent years, research has increasingly focused on the causes of unwellness among doctors, and a broad range of health determinants have been identified. Studies of interventions for improving trainee and physician wellness have identified individual-focused and organisational approaches that can address the root causes of burnout. Insights from the corporate workplace may help guide interventions. Strategies for addressing physician burnout and improving wellness will involve innovative and multifaceted approaches. Despite a growing emphasis of physician wellness in the literature, implementation of wellness interventions is lagging, and quality improvement methods can address these challenges. CONCLUSION Physician wellness is a shared responsibility among doctors, health care organisations and governing bodies. Addressing burnout and improving physician wellness will require transformational change and the embracement of a culture of wellness in medicine. Quality improvement methods are the next step in identifying effective wellness interventions and the targeted groups of physicians and trainees who will most benefit.
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Affiliation(s)
- Daniel Mendelsohn
- Lions Gate Hospital, Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
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Jorgensen A, Savage NM, Sun X, Domson G. Duty Hours Tracking - Is There an App for That? JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221096350. [PMID: 35509685 PMCID: PMC9058355 DOI: 10.1177/23821205221096350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/06/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND To monitor duty hour compliance residency programs have used self-report methods which can be skewed by recall bias and data falsification. The purpose of this study was to compare the accuracy of and resident attitudes towards two duty hours tracking tools within our Orthopedic residency. We compared our institution's current self-report method of duty hours tracking via New Innovations (NI) with an automated method utilizing Hours Tracker (HT), a smartphone application which automatically logs work hours via GPS coordinates. The primary outcome measures were number of duty hour violations and survey results on resident perceptions. METHODS The participants were 22 residents of our 25 resident Orthopedic program. Over four weeks, residents tracked duty hours through the standard, selfreport method (NI) and simultaneously through the automated app (HT). Residents also completed an anonymous survey at the end of the study related to perceptions of the methods. RESULTS There was no significant difference in overall number of violations between NI and HT. HT detected more violations of the 8 hours off requirement (12 vs. 5, p = 0.03). Survey data revealed residents found HT significantly easier to use (p = .004) and less burdensome (p < .001) but in greater violation of privacy (p = .001). Residents reported they were more likely to falsify their hours when using NI (p = .002) and that the results of NI would be more likely used against them (p = .042). When analyzing by training year, junior residents indicated HT was overall easier to use than senior residents (p = .048). CONCLUSIONS Our study showed NI and HT are at least equivalent in accuracy with the app being overall better received, particularly by junior level residents. Until we begin accurately tracking duty hours and engaging residents with an easy to use, well-received interface to which report hours, effective developmental program changes will be difficult to achieve. An app-based approach is a starting point for re-thinking duty hours tracking within this digital age.
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Affiliation(s)
- Alexis Jorgensen
- Virginia Commonwealth University Health System, Richmond, Virginia
- Alexis Jorgensen MD, Virginia Commonwealth University Health System, Richmond, Virginia.
| | | | - Xinxin Sun
- Virginia Commonwealth University, Richmond, Virginia
| | - Gregory Domson
- Virginia Commonwealth University Health System, Richmond, Virginia
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Drivers and sequelae of burnout in U.S. dermatology trainees. Int J Womens Dermatol 2021; 7:780-786. [PMID: 35028382 PMCID: PMC8714592 DOI: 10.1016/j.ijwd.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/18/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background Burnout is a health care epidemic. Although burnout has been shown to affect dermatologists in multispecialty studies, there are no such studies in dermatology trainees. Objective We conducted a survey-based study of burnout in U.S. dermatology trainees to identify its drivers and sequelae. Methods All residents enrolled in a U.S. dermatology training program were eligible. The 45-question survey included the Maslach Burnout Inventory, a validated quality of life index, and 31 questions based on known drivers of burnout and new research questions. No identifying data were collected. Results A total of 180 residents responded, for a response rate of 14.4%. Notably, an analysis of the cohort showed that our sample was not statistically different from the national complement of trainees based both on proportion of female respondents and mean age (p = .9449 and .2376, respectively). Of the respondents, 59% were female. The average age was 30.6 years. Sixty-nine percent of trainees (124 of 180) met the criteria for burnout. On univariate analysis, age, sex, training year, and relationship status were not associated with burnout. Good work–life balance (p = .032), autonomy in the workplace (p = .0027), intradisciplinary respect (p = .022), and increased work hours (p = .0110) were protective. On multivariate analysis, autonomy in the workplace (odds ratio: 3.580; confidence interval, 1.32–9.71; p = .012) and good work–life balance (odds ratio: 0.262; confidence interval, 0.095–0.722; p = .0097) remained significant. Conclusion Improving control over working environment, as evidenced by the impact of work–life balance and autonomy, may lessen burnout in trainees. Further studies analyzing regional and program-specific variations will help improve trainee experience.
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Niotis K, Saif N, Simonetto M, Wu X, Yan P, Lakis JP, Ariza IE, Buckholz AP, Sharma N, Fink ME, Isaacson RS. Feasibility of a wearable biosensor device to characterize exercise and sleep in neurology residents. Expert Rev Med Devices 2021; 18:1123-1131. [PMID: 34632903 DOI: 10.1080/17434440.2021.1990038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Research suggests optimizing sleep, exercise and work-life balance may improve resident physician burnout. Wearable biosensors may allow residents to detect and correct poor sleep and exercise habits before burnout develops. Our objectives were to evaluate the feasibility of a wearable biosensor to characterize exercise/sleep in neurology residents and examine its relationship to self-reported, validated survey measures. We also assessed the device's impact on well-being and barriers to use. METHODS This prospective cohort study evaluated the WHOOP Strap 2.0 in neurology residents. Participants completed regular online surveys, including self-reported hours of sleep/exercise, and validated sleep/exercise scales at 3-month intervals. Autonomic, exercise, and sleep measures were obtained from WHOOP. Changes were evaluated over time via linear regression. Survey and WHOOP metrics were compared using Pearson correlations. RESULTS Sixteen (72.7%) of 22 eligible participants enrolled. Eleven (68.8%) met the minimum usage requirement (6+ months) and were classified as 'consecutive wearers.' Significant increases were found in sleep duration and exercise intensity. Moderate-to-low correlations were found between survey responses and WHOOP measures. Most (73%) participants reported a positive impact on well-being. Barriers to use included 'Forgetting to wear' (20%) and 'not motivational' (23.3%). CONCLUSION Wearable biosensors may be a feasible tool to evaluate sleep/exercise in residents.
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Affiliation(s)
- Kellyann Niotis
- 2019-2020 McGraw Fellow in Neurology Research; Department of Neurology, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | - Nabeel Saif
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Marialaura Simonetto
- Departments of Internal Medicine and Neurology, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | - Xian Wu
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine and Department of Healthcare Policy & Research, New York-Presbyterian, New York, NY, USA
| | - Peter Yan
- Department of Neurology, Beth Israel Deaconess Hospital-Milton Center for Specialty Care, Milton, MA, USA
| | - Jessica P Lakis
- Office of Development, New York-Presbyterian, New York, NY, USA
| | | | - Adam P Buckholz
- Department of Internal Medicine, Weill Cornell Medicine and New York-Presbyterian, New York, NY, USA
| | | | - Matthew E Fink
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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Grossi NR, Batinic B, Moharitsch S. Sleep and health: examining the relation of sleep to burnout and well-being using a consumer fitness tracker. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-021-00603-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AbstractSleep is an essential requirement for both physiological and psychological functioning and has an impact on various health parameters. The present study aimed to examine how quantity and quality of sleep predicts burnout and well-being by using both self-reported and objectively collected sleep data. The participants were 104 white-collar workers who wore a fitness tracker for 14 consecutive days and filled out a questionnaire about sleep, burnout, and well-being. The results showed that self-reported sleep quality predicts burnout and well-being, but neither did self-reported nor objective sleep duration. We concluded that although measuring sleep duration with a consumer fitness tracker still needs to be improved, it is a useful addition to self-reported sleep measures. The study did solidify results from previous self-reported measures and point out the prominent role of sleep quality rather than hours of sleep.
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Rehder K, Adair KC, Sexton JB. The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being. Arch Pathol Lab Med 2021; 145:1095-1109. [PMID: 34459858 DOI: 10.5858/arpa.2020-0557-ra] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Problems with health care worker (HCW) well-being have become a leading concern in medicine given their severity and robust links to outcomes like medical error, mortality, and turnover. OBJECTIVE.— To describe the state of the science regarding HCW well-being, including how it is measured, what outcomes it predicts, and what institutional and individual interventions appear to reduce it. DATA SOURCES.— Peer review articles as well as multiple large data sets collected within our own research team are used to describe the nature of burnout, associations with institutional resources, and individual tools to improve well-being. CONCLUSIONS.— Rates of HCW burnout are alarmingly high, placing the health and safety of patients and HCWs at risk. To help address the urgent need to help HCWs, we summarize some of the most promising early interventions, and point toward future research that uses standardized metrics to evaluate interventions (with a focus on low-cost institutional and personal interventions).
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Affiliation(s)
- Kyle Rehder
- From the Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
| | - Kathryn C Adair
- From the Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
| | - J Bryan Sexton
- From the Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
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Whelehan DF, Alexander M, Connelly TM, McEvoy C, Ridgway PF. Sleepy Surgeons: A Multi-Method Assessment of Sleep Deprivation and Performance in Surgery. J Surg Res 2021; 268:145-157. [PMID: 34311296 DOI: 10.1016/j.jss.2021.06.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/11/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Minimum rest is mandated in high stake industries such as aviation. The current system of healthcare provision permits on-call surgeons to work in sleep deprived states when performing procedures. Fatigue has been demonstrated to negatively affect performance. This study aimed to explore measurements of sleep deprivation and their impact on simulated performance. METHODS This was a single site study conducted between September 2019 and February 2020. Surgical trainee and consultants were conveniently sampled from a single site. All testing was done between 7 AM and 9 AM. Participants completed electroencephalogram testing using a modified Multiple Sleep Latency Test testing for objective sleep measurement, the Pittsburgh Sleep Quality Index, Chalder Fatigue Scale and Epworth Sleepiness Scale for subjective sleep measurement. The Psychomotor Vigilance Task and the SIMENDO simulated tasks were used for standardized performance assessment. RESULTS Surgeons entered sleep in 6 min, on average pre-call. This significantly decreased to an average of 164 s post-call (P = 0.016). Pittsburgh Sleep Quality Index scoring was 5, indicating poor baseline sleep quality. There was higher self-reported fatigue and sleepiness in post-call states. Performance decrements were noted in cognitive performance reaction time and aspects of technical instrument proficiency. CONCLUSIONS Surgeons are objectively sleep deprived pre-call according to internationally recognized guidelines. This sleep deprivation increases significantly in post-call states. Tasks with higher cognitive demands showed greater levels of diminished performance compared to those with lower cognitive demands. Current models of provision of surgical on-call are not conducive to optimizing sleep in surgeons. Prioritization of workload in post-call states, focusing on preserving individuals cognitive resources and utilizing lower cognitively demanding aspects of work is likely to have positive impacts on performance outcomes.
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Affiliation(s)
- Dale F Whelehan
- Department of Surgery, School of Medicine, Trinity College Dublin, Department of Neurophysiology, Department of Surgery, Tallaght University Hospital, Dublin, Ireland.
| | - Michael Alexander
- Department of Surgery, School of Medicine, Trinity College Dublin, Department of Neurophysiology, Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Tara M Connelly
- Department of Surgery, School of Medicine, Trinity College Dublin, Department of Neurophysiology, Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Christine McEvoy
- Department of Surgery, School of Medicine, Trinity College Dublin, Department of Neurophysiology, Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Paul F Ridgway
- Department of Surgery, School of Medicine, Trinity College Dublin, Department of Neurophysiology, Department of Surgery, Tallaght University Hospital, Dublin, Ireland
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Muncey W, Jesse E, Loeb A, Thirumavalavan N. Infertility insurance: What coverage exists for physician trainees? Can Urol Assoc J 2021; 15:E350-E355. [PMID: 33382368 PMCID: PMC8279235 DOI: 10.5489/cuaj.6824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to describe infertility insurance coverage provided to male and female fellows working at institutions that offer advanced infertility training. METHODS Faculty and fellows working within U.S. and Canadian andrology or reproductive endocrinology and infertility (REI) programs were contacted and asked for a copy of their institutional health insurance summary of benefits. Documents were assessed for coverage of diagnosis and treatment, shared costs, and maximum lifetime coverage for infertility care. RESULTS Insurance policies from 24 institutions were reviewed; 16 of 24 (66%) institutions covered costs related to the diagnosis of infertility. Six institutions (25%) offered coverage for diagnosis but not treatment. There were 15 (62.5%) institutions that offered some amount of coverage for the treatment of infertility, and the average lifetime maximum was $16 100. Only six of 24 (25%) plans explicitly described a covered male-specific treatment, which included sperm extraction (12.5%), varicocele repair (4.2%), and sperm cryopreservation (8.3%). CONCLUSIONS For physician trainees, infertility insurance coverage is not universal, policies are not transparent, and treatment for male factor infertility is often omitted. With high costs of infertility treatment, variable insurance coverage, and debt and time constraints, residents and fellows are a particularly vulnerable population that may experience significant financial toxicity when faced with infertility.
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Mahmood SBZ, Zahid A, Nasir N, Tahir M, Ghouri U, Almas A. Triggering and protective factors of burnout in medical resident physicians in a lower-middle-income country: A cross-sectional study. Ann Med Surg (Lond) 2021; 67:102500. [PMID: 34188912 PMCID: PMC8219648 DOI: 10.1016/j.amsu.2021.102500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background Residents and interns are prone to emotional and physical exhaustion, also known as burnout. Burnout has not been studied much in physicians working in lower-middle income countries. We conducted this study to determine the burden of burnout among internal medicine residents and to identify triggering and protective factors associated with burnout. Materials and methods A cross-sectional study was conducted at two institutes in Karachi from 2018 to 2019. All residents registered in the internal medicine program for at least 6 months were invited to participate via an online survey. An abbreviated version of the Maslach Burnout scale was used to measure burnout, and protective and triggering factors were recorded according to known factors. Results A total of 71 out of 92 (77%) residents participated. The mean (SD) age of the participants was 28 (3.1) years, 51 (71.8%) were females and 51 (71.8%) were junior residents. A total of 33 (46.5%) residents had burnout. Burnout and emotional exhaustion were more in female residents (p < 0.05). None of the triggering factors attained statistical significance. The protective factors for burnout which showed significant association were good relationship with friends (OR 0.1–95% CI 0.0, 0.6), exercise and extra-curricular activities (OR 0.2–95% CI 0.0, 0.7), celebrating accomplishments (OR 0.2–95% CI 0.0, 0.7), having enough money (OR 0.2–95% CI 0.0, 0.4), and ability to plan for future (OR 0.1–95% CI 0.0, 0.6). Conclusion More than a third of medicine residents suffered from burnout. We need to focus on rejuvenating activities for medicine residents to decrease burnout among them. If not addressed adequately this may result in a compromise in the quality of care being provided to patients. More than a third of medicine residents suffered from burnout in our setup. We need to focus on rejuvenating activities to decrease burnout. Support of friends, celebrating accomplishment and enough money may reduce burnout. Burnout was more prevalent in women physicians compared to men physicians Level 2 physicians had higher burnout compared to the other levels of residency
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Affiliation(s)
| | - Aqusa Zahid
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Noreen Nasir
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Munaim Tahir
- Aziz Fatimah Medical, and Dental College, Pakistan
| | - Uzma Ghouri
- Department of Medicine, Ziauddin Hospital, Karachi, Pakistan
| | - Aysha Almas
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Mahajan A, Davalos L, Schneider L, Bailey M, Khan J, London Z. The impact of student debt on neurological practice. J Neurol Sci 2021; 427:117536. [PMID: 34139451 DOI: 10.1016/j.jns.2021.117536] [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: 02/18/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022]
Abstract
The median cost of attending medical school is rising annually, and with it, student debt. Neurology residents have stepped up during the pandemic to answer the call of a health system at its breaking point. In this article, we outline how this escalating problem of student debt affects the neurology pipeline, the wellbeing and career decisions of current neurology trainees and practicing neurologists and through it, and the gap in healthcare. We describe currently available options for loan repayment and call for advocacy and legislation to address this mounting burden as a means to improve neurological care in the United States.
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Affiliation(s)
- Abhimanyu Mahajan
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States.
| | - Long Davalos
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Logan Schneider
- Stanford University/Palo Alto VA Alzheimer's center, Palo Alto, CA, United States
| | - Meagan Bailey
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States.
| | - Jaffar Khan
- Department of Neurology, Emory University, Atlanta, GA, United States.
| | - Zachary London
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States.
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Feng S, Yi JS, Deitz G, Ding L, Van Gelder RN, Menda S. Relationships Between Sleep, Activity, and Burnout in Ophthalmology Residents. JOURNAL OF SURGICAL EDUCATION 2021; 78:1035-1040. [PMID: 32967802 DOI: 10.1016/j.jsurg.2020.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/01/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To objectively measure sleep and activity levels and examine their relationship to burnout, depression, anxiety, and stress in ophthalmology residents. DESIGN A cohort study of ophthalmology residents at the University of Washington from July 1, 2017 to June 30, 2018. SETTING Single-center academic institution. PARTICIPANTS Fourteen ophthalmology residents at the University of Washington enrolled between July 1, 2017 and June 30, 2018. RESULTS Data were collected from 14 residents, ages 27 to 34. Wrist actigraphy allowed for objective measurement of resident sleep and activity, though adherence to wrist actigraphy usage dropped significantly over time. Residents recorded significantly less sleep on call compared to when they were off call, with mean (SD) 3.6 (2.0) hours on primary call, 5.6 (1.8) hours on secondary call, and 6.7 (1.4) hours off call. Lower average sleep on call was associated with higher emotional exhaustion (r = -0.69, p = 0.04), lower personal accomplishment (r = 0.82, p = 0.007), higher anxiety (r = -0.90, p = 0.001), and higher stress (r = -0.75, p = 0.02). Higher daily activity was associated with higher sense of personal accomplishment (r = 0.57, p = 0.04). Average nightly sleep, average sleep while not on call, and daily sedentary time was not associated with any subset of burnout. CONCLUSIONS The association between objectively measured sleep while on call and burnout, depression, and anxiety are consistent with findings from prior studies which relied on subjective measures of sleep. The direction of causality - whether poor sleep caused burnout, burnout caused poor sleep, or both - could not be assessed in the present study. However, these results are consistent with the hypothesis that poor sleep on call contributes to resident burnout and that physical activity may reduce aspects of burnout. The use of wrist actigraphy to objectively measure sleep and activity patterns may help focus and evaluate interventions aimed at decreasing resident burnout.
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Affiliation(s)
- Shu Feng
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington.
| | - Jonathan S Yi
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington
| | - Galia Deitz
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington
| | - Leona Ding
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington
| | - Russell N Van Gelder
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington
| | - Shivali Menda
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington
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Sifrig B, Le RT, Chesire D, Hernandez M, Kee-Sampson J, Meyer TE. Exploration of the Relationship Between the Subcomponents of Burnout Throughout Radiology Training. J Am Coll Radiol 2021; 18:647-653. [DOI: 10.1016/j.jacr.2021.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
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Wu DTY, Xu C, Kim A, Bindhu S, Mah KE, Eckman MH. A Scoping Review of Health Information Technology in Clinician Burnout. Appl Clin Inform 2021; 12:597-620. [PMID: 34233369 PMCID: PMC8263130 DOI: 10.1055/s-0041-1731399] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinician burnout is a prevalent issue in healthcare, with detrimental implications in healthcare quality and medical costs due to errors. The inefficient use of health information technologies (HIT) is attributed to having a role in burnout. OBJECTIVE This paper seeks to review the literature with the following two goals: (1) characterize and extract HIT trends in burnout studies over time, and (2) examine the evidence and synthesize themes of HIT's roles in burnout studies. METHODS A scoping literature review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with two rounds of searches in PubMed, IEEE Xplore, ACM, and Google Scholar. The retrieved papers and their references were screened for eligibility by using developed inclusion and exclusion criteria. Data were extracted from included papers and summarized either statistically or qualitatively to demonstrate patterns. RESULTS After narrowing down the initial 945 papers, 36 papers were included. All papers were published between 2013 and 2020; nearly half of them focused on primary care (n = 16; 44.4%). The most commonly studied variable was electronic health record (EHR) practices (e.g., number of clicks). The most common study population was physicians. HIT played multiple roles in burnout studies: it can contribute to burnout; it can be used to measure burnout; or it can intervene and mitigate burnout levels. CONCLUSION This scoping review presents trends in HIT-centered burnout studies and synthesizes three roles for HIT in contributing to, measuring, and mitigating burnout. Four recommendations were generated accordingly for future burnout studies: (1) validate and standardize HIT burnout measures; (2) focus on EHR-based solutions to mitigate clinician burnout; (3) expand burnout studies to other specialties and types of healthcare providers, and (4) utilize mobile and tracking technology to study time efficiency.
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Affiliation(s)
- Danny T. Y. Wu
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Catherine Xu
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Medical Science Baccalaureate Program, University of Cincinnati College of Medicine, Ohio, United States
| | - Abraham Kim
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Medical Science Baccalaureate Program, University of Cincinnati College of Medicine, Ohio, United States
| | - Shwetha Bindhu
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Medical Science Baccalaureate Program, University of Cincinnati College of Medicine, Ohio, United States
| | - Kenneth E. Mah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Mark H. Eckman
- Division of General Internal Medicine, University of Cincinnati College of Medicine, Ohio, United States
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Le RT, Sifrig B, Hernandez M, Chesire D, Kee-Sampson J, Meyer TE. Predictors Between the Subcomponents of Burnout Among Radiology Trainees. J Am Coll Radiol 2021; 18:654-660. [DOI: 10.1016/j.jacr.2021.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 12/14/2022]
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Abstract
Objective We examined the prevalence of burnout among resident doctors and its relationship with specific stressors. Method We conducted a nationwide, online, cross-sectional survey in Japan with 604 resident doctors in 2018-2019. Materials Participants completed the Maslach Burnout Inventory-General Survey to evaluate burnout and provided details of their individual factors and working environmental factors. Chi-square tests and t-tests were conducted for categorical and continuous variables, respectively. The association between burnout and resident-reported causes of stress, ways of coping with stress, number of times patient-safety incidents were likely to occur, and individuals who provide support when in trouble was analyzed using logistic regression analyses after controlling for confounding variables. Results A total of 28% met the burnout criteria, 12.2% were exhausted, 2.8% were depressed, and 56.9% were healthy. After adjusting for sex, postgraduate years, type of residency program, marital status, number of inpatients under residents' care, number of working hours, number of night shifts, number of days off, and resident-reported causes of stress - excessive paperwork [odds ratio (OR): 2.24, 95% confidence interval (CI): 1.32-3.80], excessive working hours (OR: 2.75, 95% CI: 1.24-6.04), low autonomy (OR: 3.92, 95% CI: 2.01-7.65), communication problems at the workplace (OR: 2.24, 95% CI: 1.05-4.76), complaints from patients (OR: 6.62, 95% CI: 1.21-36.1), peer competition (OR: 2.22, 95% CI: 1.25-3.93), and anxiety about the future (OR: 2.13, 95% CI: 1.28-3.56) - were independently associated with burnout. The burnout group had more reported patient-safety incidents that were likely to occur per year (>10) (OR: 2.65, 95% CI: 1.01-6.95) and a lack of individuals who could provide support when in trouble (OR: 1.83, 95% CI: 1.01-3.34) than the non-burnout group. Conclusion This study described the prevalence of burnout among residents who responded to our survey. We detected an association between burnout and resident-reported causes of stress, patient-safety incidents, and a lack of individuals who provide support when in trouble. Further interventional studies targeting ways to reduce these concerns are warranted.
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Affiliation(s)
- Takahiro Matsuo
- Department of Infectious Diseases, St. Luke's International Hospital, Japan
| | - Osamu Takahashi
- Department of General Internal Medicine, St. Luke's International Hospital, Japan
- Graduate School of Public Health, St. Luke's International University, Japan
| | | | - Hiroko Arioka
- Department of General Internal Medicine, St. Luke's International Hospital, Japan
| | - Daiki Kobayashi
- Department of General Internal Medicine, St. Luke's International Hospital, Japan
- Graduate School of Public Health, St. Luke's International University, Japan
- Department of Community-Based Medicine, Fujita Health University, Japan
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Chartrand G, Soucisse M, Dubé P, Trépanier JS, Drolet P, Sideris L. Self-directed learning by video as a means to improve technical skills in surgery residents: a randomized controlled trial. BMC MEDICAL EDUCATION 2021; 21:91. [PMID: 33546679 PMCID: PMC7863545 DOI: 10.1186/s12909-021-02524-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND With their demanding schedules, surgical residents have limited time to practice techniques. The aim is to evaluate the pedagogic model of self-directed learning using video in surgery residents. METHODS Informed consent was obtained from all the participants. A randomized controlled trial was conducted in 2018 at Hôpital Maisonneuve-Rosemont (University of Montreal). Participants were general surgery residents. There were 27 eligible residents; 22 completed the study. They were filmed performing an intestinal anastomosis on cadaveric pig bowel. The self-directed learning by video (SDL-V) group was given an expert video, which demonstrated the technique performed by an experienced surgeon. The control group continued with their regular duties. Three weeks later, participants performed a second filmed anastomosis. Two attending surgeons evaluated the residents' filmed anastomosis using the Objective Structured Assessment of Technical Skills scale. After their second anastomosis, all participants had access to the expert video and completed a survey. RESULTS Score did not differ significantly between groups during the first (control: 23.6 (4.5) vs. SDL-V: 23.9 (4.5), p = 0.99, presented as mean (SD)) or second filmed anastomosis procedure (control: 27.1 (3.9) vs. SDL-V: 29.6 (3.4) p = 0.28). Both groups improved significantly from pre- to post-intervention (mean difference between the two anastomosis procedure with 95% CI for control: 3.5, [1.1; 5.9] and for SDL-V: 5.8, [3.4: 8.2]). Correlation between the evaluators for score was moderate (r = 0.6, 95% CI: [0.3: 0.8]). The pass/fail global evaluation exhibited poor inter-rater reliability (Kappa: 0.105, 95% CI: [- 0.2:0.4]). On the survey, all participants wanted more expert-made videos of specific surgical techniques. CONCLUSIONS Despite a higher final OSATS score for the intervention group, self-directed learning by video failed to produce a statistically significant difference on the overall OSATS scores between the two groups in this small cohort.
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Affiliation(s)
- Geneviève Chartrand
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada.
| | - Mikael Soucisse
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Pierre Dubé
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Jean-Sébastien Trépanier
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Pierre Drolet
- Centre d'acquisition des attitudes et habiletés cliniques, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Lucas Sideris
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boulevard l'Assomption, Montréal, Québec, H1T 2M4, Canada
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Singh R, Richter KR, Pollock JR, Haglin JM, Balli N, Catapano JS, Zimmerman RS, Patel NP. Trends in Neurosurgical Practice Size: Increased Consolidation 2014-2019. World Neurosurg 2021; 149:e714-e720. [PMID: 33540094 DOI: 10.1016/j.wneu.2021.01.112] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Practice consolidation in healthcare has widespread consequences for providers and patients. Although many studies describe this phenomenon in various medical specialties, no such analysis has been performed in neurosurgery specifically. The goal of this study was to assess the trends in the size of U.S. neurosurgery practices over a 5-year period. METHODS Neurosurgery practice characteristics were obtained from the Medicare Physician Compare database from March 2014 through October 2019 on the Centers for Medicare & Medicaid Services Website. Neurosurgeons were separated on the basis of their practice size. Group practice sizes ranged from solo practitioner practice to large multispecialty groups and health organizations. Eight groups were identified (1 or 2, 3-9, 10-24, 25-49, 50-99, 100-499, 500-999, and ≥1000 members). Additionally, neurosurgery practices were analyzed across the 4 U.S. geographical regions to understand changes in practice size and distribution. RESULTS The percentage of neurosurgeons in smaller practices of 1 or 2 members decreased, from 20.09% to 13.05%; 3-9 members, from 17.79% to 9.41%; and 10-24 members, from 10.53% to 8.0%. The largest increase was seen in health organizations of 1000 members or more, with an increase from 9.85% to 22.84%. CONCLUSIONS This study shows that over the past 5 years, a substantial trend toward increasing practice sizes has evolved. The effect of the differences in practice size should be examined to determine the large-scale impacts on patient care, payment models, and healthcare access, in addition to neurosurgeon compensation, and satisfaction.
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Affiliation(s)
- Rohin Singh
- Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale, Arizona, USA
| | - Kent R Richter
- Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale, Arizona, USA
| | - Jordan R Pollock
- Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale, Arizona, USA
| | - Jack M Haglin
- Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale, Arizona, USA
| | - Noel Balli
- A.T. Still University of Health Sciences, Mesa, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Richard S Zimmerman
- Department of Neurologic Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Naresh P Patel
- Department of Neurologic Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA.
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Choshen-Hillel S, Ishqer A, Mahameed F, Reiter J, Gozal D, Gileles-Hillel A, Berger I. Acute and chronic sleep deprivation in residents: Cognition and stress biomarkers. MEDICAL EDUCATION 2021; 55:174-184. [PMID: 32697336 PMCID: PMC7854866 DOI: 10.1111/medu.14296] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Insufficient sleep affects circadian hormonal profiles and inflammatory markers and may modulate attention, executive functioning and decision-making. Medical professionals and specifically resident physicians, who are involved in long-term nightshift schedules during their post-graduate training, are prone to acute and chronic sleep deprivation and disruption, putting them at risk for making medical errors. The aim of the study was to evaluate the impact of chronic and acute-on-chronic sleep deprivation and disruption among residents on selected physiological and cognitive measures. METHODS Thirty-three medical and surgical residents were evaluated twice - at baseline and after a 26-hour shift. Eighteen young attending physicians who did not engage in nightshift schedules served as controls and were evaluated once. Measures included morning cortisol and high-sensitivity C-reactive protein (hs-CRP), computerised tests of attention and behaviour, the Behaviour Rating Inventory of Executive Function, a risk-taking questionnaire and the Pittsburgh Sleep Quality Index. RESULTS Residents, but not attendings, reported chronic sleep disruption and deprivation. Residents at baseline exhibited reduced morning cortisol levels and elevated hs-CRP levels, compared to attendings. Residents at baseline had impaired global executive function compared to attendings. A nightshift with acute sleep deprivation further reduced residents' executive function. Residents at baseline and after a nightshift demonstrated increased impulsivity and slower processing time than attendings. Residents and attendings did not differ in risk-taking tendencies which were assessed in a separate cohort. CONCLUSIONS In a real-life setting, resident physicians exhibit increased low-grade systemic inflammation (hs-CRP) and impaired HPA-axis function. Their chronic sleep curtailment is associated with greater impulsivity, slower cognitive processing, and impaired executive function. Future research is warranted to understand how improving working schedule by increasing sleep duration may minimise the short-term and potential long-term risks to physicians in training.
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Affiliation(s)
- Shoham Choshen-Hillel
- School of Business Administration and the Federmann Center for the Study of Rationality, Hebrew University of Jerusalem
| | - Ahmad Ishqer
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
| | - Fadi Mahameed
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
| | - Joel Reiter
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
| | - David Gozal
- Department of Child Health, MU Women’s and Children’s Hospital, University of Missouri School of Medicine
| | - Alex Gileles-Hillel
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
- The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center
| | - Itai Berger
- Pediatric Neurology; Department of Pediatrics, Assuta-Ashdod University Medical Center
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva
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Lin R, Lin Y, Hsia Y, Kuo C. Long working hours and burnout in health care workers: Non-linear dose-response relationship and the effect mediated by sleeping hours-A cross-sectional study. J Occup Health 2021; 63:e12228. [PMID: 33957007 PMCID: PMC8101694 DOI: 10.1002/1348-9585.12228] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Burnout among health care workers is highly prevalent and has profound impact on quality of care. Hospital on-duty schedules lead to long working hours and short sleeping hours; both are common factors associated with burnout. We examined the dose-response relationship and the potential mediating role of sleeping hours on the association between working hours and burnout among health care workers. METHODS We collected data on the burnout status, using the Mandarin version of the Copenhagen Burnout Inventory (subscales measure work-related and personal burnouts), working hours, sleeping hours, and relevant measures for 2081 health care personnel who underwent a routine health examination in a medical center in Taiwan during 2016-2017. Four subgroups were compared: physicians (n = 369), nurses (n = 973), technicians (n = 391), and administrators (n = 348). RESULTS Average weekly working hours are associated with burnout scores in a non-linear dose-response manner. Compared with a work week of 40 hours, the odds ratio of work-related burnout doubled when hours exceeded 60, tripled when hours exceeded 74, and quadrupled when hours exceeded 84. Physicians' burnout is less susceptible to incremental increases in working hours, compared to the situations in other health care workers. The proportions eliminated by reducing sleeping hours were 25%-73% for physicians and 7%-29% for nurses respectively. CONCLUSIONS Our findings suggest that working hours are associated with burnout, and the association was partially mediated by sleeping hours.
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Affiliation(s)
- Ro‐Ting Lin
- Department of Occupational Safety and Health, College of Public HealthChina Medical UniversityTaichungTaiwan
| | - Yu‐Ting Lin
- Department of Medical ResearchChina Medical University HospitalTaichungTaiwan
- Big Data CenterChina Medical University HospitalTaichungTaiwan
| | - Ying‐Fang Hsia
- Big Data CenterChina Medical University HospitalTaichungTaiwan
| | - Chin‐Chi Kuo
- Division of NephrologyDepartment of Internal MedicineChina Medical University HospitalTaichungTaiwan
- School of MedicineChina Medical UniversityTaichungTaiwan
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Poku CA, Donkor E, Naab F. Determinants of emotional exhaustion among nursing workforce in urban Ghana: a cross-sectional study. BMC Nurs 2020; 19:116. [PMID: 33372600 PMCID: PMC7722335 DOI: 10.1186/s12912-020-00512-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The subject of emotional exhaustion organisations has become important because of the emerging trends in employment and its associated challenges. Unhealthy practice environment is a major threat in the incidence of emotional exhaustion among nurses; and any organisational culture that do not support its personnel has huge burnout costs. The study aimed at assessing rate of emotional exhaustion; determining factors that accounts for it and also ascertaining the coping strategies used by nurses to overcome it in the Ghanaian health care setting. METHODS A cross-sectional study with a proportionate stratified sampling was used to draw a sample from five health facilities. A standardized questionnaire of Professional Practice Environment Scale of Nursing Work Index, Maslach Burnout Inventory and Coping Scale were used to assess variables under study. The STROBE guidelines were followed in reporting this study. RESULTS Out of the 232 registered nurses studied, 91.1% of them reported experiencing moderate to high rate of emotional exhaustion. The practice environment of the nurses explained 39.6% of the variance in emotional exhaustion. Emotion-focused and problem-focused approaches were identified to be used by registered nurses to cope with emotional exhaustion. CONCLUSION When appropriate and effective intervention are employed, emotional exhaustion will be reduce and this will enrich the effectiveness of quality care delivery to patients.
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Affiliation(s)
- Collins Atta Poku
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Ernestina Donkor
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Florence Naab
- School of Nursing and Midwifery, University of Ghana, Legon-Accra, Ghana
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Williams AM, Reed B, Self MM, Robiner WN, Ward WL. Psychologists' Practices, Stressors, and Wellness in Academic Health Centers. J Clin Psychol Med Settings 2020; 27:818-829. [PMID: 31728882 PMCID: PMC7220835 DOI: 10.1007/s10880-019-09678-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Burnout has been identified as widely prevalent in physicians and other health professions. However, relatively little has been written about burnout in psychologists. The current study reviews the literature investigating professional wellness, sources of stress, and burnout in practicing psychologists. Based on a survey of members of the Association for Psychologists in Academic Health Centers' (n = 93), stress levels, burnout, and work satisfaction in health service psychologists in academic health centers (AHCs) were examined. Respondents indicated some level of burnout ranging from having no symptoms (8%) to being occasionally stressed (59%), symptoms won't go away (12%), definitely burning out (18%), or being completely burned out (3%). Most respondents described working at high levels, including "at full capacity" (41%) or being "over-extended" (39%). Despite these concerns, most respondents indicated satisfaction with their positions (42% "very satisfied," 44% "somewhat satisfied") and recommended careers as psychologists in medical settings (50% strongly; 34% moderately). Most commonly perceived sources of stress included clinical load, salary, insufficient protected time for research, teaching, education, and supervision, insufficient psychologists to meet the need, and non-billable clinical activities. Consistent with the physician literature, workload was associated with burnout and burnout was associated with decreased professional satisfaction. The current study narrows the gap in the literature on the stress psychologists experience in AHCs and explores findings within the broader literature about health professional burnout. Greater understanding is needed about factors that affect burnout in health service psychologists, identification and modification of risk factors, and prevention strategies.
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Affiliation(s)
- Amy M Williams
- Department of Otolaryngology - Head & Neck Surgery, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
| | - Bonney Reed
- School of Medicine, Emory University, 1400 Tullie Circle #8332, Atlanta, GA, 30329, USA
| | - Mariella M Self
- Psychiatry and Behavioral Sciences, College of Medicine, Texas Children's Hospital Psychology Service, Baylor University, 6701 Fannin St. Ste. 1600, Houston, TX, 77030, USA
| | - William N Robiner
- Division of General Internal Medicine, Department of Pediatrics, University of Minnesota, MMC 741, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Wendy L Ward
- Office of Interprofessional Education, College of Medicine, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-21, Little Rock, AR, 72202, USA
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Zhou Y, Gu W, Tao R, Chen C. The impact of gender and working hours on pulmonary physician burnout. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1166. [PMID: 33241015 PMCID: PMC7576023 DOI: 10.21037/atm-20-5827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Physician burnout has attracted an increasing amount of attention as a global public health problem. It is associated with negative clinical and organizational outcomes, including lower patient satisfaction, patient safety, and quality of care. The work of pulmonary physicians involves high levels of stress, putting them at higher risk of burnout. This study aimed to evaluate the personal and professional characteristics associated with burnout among pulmonary physicians. Methods Between March 2020 and May 2020, a survey to evaluate burnout and career satisfaction among pulmonary physicians was conducted in Shanghai Pulmonary Hospital. The survey collected information on physician characteristics, career satisfaction, and burnout. The Maslach Burnout Inventory (MBI), the gold standard tool for measuring burnout, was used to measure burnout symptoms. Self-reported professional satisfaction in relation to career, specialty, and work-life balance was recorded. Results Of 130 pulmonary physicians contacted, 125 (96.1%) completed full-length surveys. Ninety-one (72.8%) of these 125 physicians were female. The survey participants had a median age of 40 years. Of the respondents, 48.8% had at least one symptom of burnout according to high emotional exhaustion (EE) score and/or high depersonalization (DP) score. Univariable analysis showed female gender, the number hours worked per week, the number of nights on call per month, and the number of calls per night shift to be factors associated with burnout. Gender and hours worked per week were independent factors associated with burnout in multivariate analysis. Conclusions The MBI was able to characterize burnout experienced by pulmonary physicians in our hospital. Gender and the number of hours worked per week were the significant factors independently associated with burnout among the physicians in our study.
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Affiliation(s)
- Ying Zhou
- Department of Respiratory Medicine and Clinical Research Center, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Weiqing Gu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rong Tao
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Gleason F, Baker SJ, Wood T, Wood L, Hollis RH, Chu DI, Lindeman B. Emotional Intelligence and Burnout in Surgical Residents: A 5-Year Study. JOURNAL OF SURGICAL EDUCATION 2020; 77:e63-e70. [PMID: 32819871 DOI: 10.1016/j.jsurg.2020.07.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We sought to characterize the interactions of burnout with internal and external factors over the past 5 years for surgery residents at our institution. We hypothesized that burnout levels would be consistent among years, inversely related to emotional intelligence (EI) and job resources, and directly related to disruptive behaviors. DESIGN General surgery residents at a single institution were invited to complete a survey each year from 2015 to 2019 that included a combination of the 22-item Maslach-Burnout Inventory, 30-item trait EI questionnaire, as well as focused questions assessing disruptive behaviors (8 items), job resources (8 items), and demographic characteristics. Burnout was defined as scoring high in depersonalization (≥ 10 points) or emotional exhaustion (≥ 27 points). Student's t tests and Wilcoxon tests were used to compare continuous variables; chi-square and Fisher's exact tests were used to compare categorical variables, as appropriate. Spearman's rho was used to calculate correlation. A logistic regression and separate linear regression model were constructed to assess relation of variables to burnout. SETTING The general surgery residency program at the University of Alabama at Birmingham, Birmingham, Alabama, a large tertiary care academic center. RESULTS An average of 47 surveys were completed each year, for a total of 236 (response rate 81%). One hundred seventeen (58.5%) met criteria for burnout. Burnout rates each year ranged from 68% to 53%, with the lowest value occurring in 2019. Incidence of burnout was lowest among the postgraduate year (PGY) 1 class and highest among the PGY5 class (38% versus 64%, p = 0.02). Individuals without burnout had higher scores for EI overall (5.7 versus 5.3, p < 0.001) as well as in each of its 4 subcomponents (p < 0.001). Individuals who were subjected to disruptive behaviors, particularly others taking credit for work and public humiliation, were more likely to experience burnout (p = 0.02). Those with burnout also had significantly lower scores in each of the 4 domains of the Job Resources model (p < 0.01). On multivariate logistic regression, increasing PGY level remained a significant predictor of burnout risk. Each of the sub-domains of EI and jobs resources inversely corelated with burnout, while disruptive behaviors directly correlated with burnout. ON subsequent multivariable linear regression, resident well-being and professional development remained independent predictors of lower burnout scores. CONCLUSIONS Burnout is prevalent among trainees at our institution, but a trend toward improvement has been shown over 5 years. Burnout rates increase each year of surgical training beyond PGY2. Factors that mitigate burnout include resident well-being and professional development. Disruptive behaviors lead to increase burnout rates.
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Affiliation(s)
- Frank Gleason
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Tara Wood
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Lauren Wood
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Daniel I Chu
- University of Alabama at Birmingham, Birmingham, Alabama
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Prentice S, Dorstyn D, Benson J, Elliott T. Burnout Levels and Patterns in Postgraduate Medical Trainees: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1444-1454. [PMID: 32271234 DOI: 10.1097/acm.0000000000003379] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Postgraduate medical trainees experience high rates of burnout; however, inconsistencies in definitions of burnout characterize this literature. The authors conducted a systematic review and meta-analysis examining burnout levels and patterns in postgraduate medical trainees, using a continuous conceptualization of burnout, consistent with the Maslach Burnout Inventory (MBI) framework. METHOD The authors searched 5 electronic databases (Cochrane Library, Embase, ERIC, Ovid MEDLINE, Ovid PsycINFO) between January 1981 and July 2019 for studies reporting postgraduate medical trainees' burnout levels using the MBI-Human Services Survey. They examined study reporting quality using the QualSyst quality appraisal tool and calculated standardized mean differences (Hedges' g), comparing trainees' data with MBI norms for medicine and the overall population using a random effects model. They explored between-study heterogeneity using subgroup analyses (i.e., by training level and specialty). Finally, they studied the combined contribution of these 2 variables (and year of study publication) to burnout levels, using meta-regression. RESULTS The authors identified 2,978 citations and included 89 independent studies in their review. They pooled the data for the 18,509 postgraduate trainees included in these studies for the meta-analyses. Reporting quality was generally high across the included studies. The meta-analyses revealed higher burnout levels among trainees compared with medicine and overall population norms, particularly for the depersonalization subscale. The authors also identified statistically significant differences between nonsurgical and surgical registrars (specialty trainees), with trainees from 12 individual specialties exhibiting unique burnout patterns. CONCLUSIONS There is a need to reduce and prevent burnout early in medical training. Given the differences in burnout levels and patterns across specialties, interventions must focus on the unique patterns exhibited by each specialty in the target population using a multidimensional approach. Standardizing the definition of burnout in accordance with the MBI framework will facilitate progression of this work.
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Affiliation(s)
- Shaun Prentice
- S. Prentice is a Master of Psychology (Clinical) and PhD candidate, School of Psychology, University of Adelaide, and research support officer, GPEx, Adelaide, South Australia; ORCID: http://orcid.org/0000-0002-9403-7861
| | - Diana Dorstyn
- D. Dorstyn is senior lecturer, School of Psychology, University of Adelaide, Adelaide, South Australia; ORCID: http://orcid.org/0000-0002-7799-8177
| | - Jill Benson
- J. Benson is senior medical educator, GPEx, and director, Health in Human Diversity Unit, School of Medicine, University of Adelaide, Adelaide, South Australia
| | - Taryn Elliott
- T. Elliott is manager of quality & special projects, GPEx, Adelaide, South Australia
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Tang OY, Dunn KA, Yoon JS, Ponce FA, Sonntag VK, Lawton MT. Neurosurgery Resident Wellness and Recovery from Burnout: A 39-Year Single-Institution Experience. World Neurosurg 2020; 138:e72-e81. [DOI: 10.1016/j.wneu.2020.01.236] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
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Kancherla BS, Upender R, Collen JF, Rishi MA, Sullivan SS, Ahmed O, Berneking M, Flynn-Evans EE, Peters BR, Abbasi-Feinberg F, Aurora RN, Carden KA, Kirsch DB, Kristo DA, Malhotra RK, Martin JL, Olson EJ, Ramar K, Rosen CL, Rowley JA, Shelgikar AV, Gurubhagavatula I. Sleep, fatigue and burnout among physicians: an American Academy of Sleep Medicine position statement. J Clin Sleep Med 2020; 16:803-805. [PMID: 32108570 DOI: 10.5664/jcsm.8408] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
None Physician burnout is a serious and growing threat to the medical profession and may undermine efforts to maintain a sufficient physician workforce to care for the growing and aging patient population in the United States. Burnout involves a host of complex underlying associations and potential for risk. While prevalence is unknown, recent estimates of physician burnout are quite high, approaching 50% or more, with midcareer physicians at highest risk. Sleep deprivation due to shift-work schedules, high workload, long hours, sleep interruptions, and insufficient recovery sleep have been implicated in the genesis and perpetuation of burnout. Maladaptive attitudes regarding sleep and endurance also may increase the risk for sleep deprivation among attending physicians. While duty-hour restrictions have been instituted to protect sleep opportunity among trainees, virtually no such effort has been made for attending physicians who have completed their training or practicing physicians in nonacademic settings. It is the position of the American Academy of Sleep Medicine that a critical need exists to evaluate the roles of sleep disruption, sleep deprivation, and circadian misalignment in physician well-being and burnout. Such evaluation may pave the way for the development of effective countermeasures that promote healthy sleep, with the goal of reducing burnout and its negative impacts such as a shrinking physician workforce, poor physician health and functional outcomes, lower quality of care, and compromised patient safety.
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Affiliation(s)
- Binal S Kancherla
- Department of Pediatrics, Division of Pediatric Pulmonology, Texas Children's Hospital - Baylor College of Medicine, Houston, Texas
| | - Raghu Upender
- Department of Neurology, Division of Sleep Medicine, Vanderbilt Medical Center, Nashville, Tennessee
| | - Jacob F Collen
- Pulmonary, Critical Care and Sleep Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Muhammad Adeel Rishi
- Department of Pulmonology, Critical Care and Sleep Medicine, Mayo Clinic, Eau Claire, Wisconsin
| | | | - Omer Ahmed
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York
| | | | - Erin E Flynn-Evans
- Fatigue Countermeasures Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, California
| | - Brandon R Peters
- Sleep Disorders Center, Virginia Mason Medical Center, Seattle, Washington
| | | | - R Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kelly A Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | | | | | - Raman K Malhotra
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer L Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California.,David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
| | | | - Anita V Shelgikar
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
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50
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Wolfe SQ, Fargen KM. Burnout: Separating Fact from Fiction. World Neurosurg 2019; 130:555-556. [PMID: 31351937 DOI: 10.1016/j.wneu.2019.07.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Stacey Quintero Wolfe
- Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Kyle M Fargen
- Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
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