Empathy and burnout: a study on residents from a Singapore institution

Prevalence of personal, work-related and patient-related burnout during the COVID-19 pandemic and its associated factors among healthcare workers in health clinics in the district of Manjung, Perak: A cross-sectional study

Introduction

Burnout is a syndrome characterised by physical, emotional and mental exhaustion that results from a long period of involvement in an overwhelming work condition. It is prevalent among frontline workers. This study aimed to identify the prevalence of burnout among primary healthcare workers in the district of Manjung, Perak and determine the factors associated with burnout.

Methods

This cross-sectional study was conducted among healthcare workers in seven health clinics located in the district from August to September 2022. The self-administered validated Malay version of the Copenhagen Burnout Inventory and the Malay version of the Multidimensional Scale of Perceived Social Support were used. These instruments consisted of 31 questions rated on a 5-point Likert scale. The scores were then summed up to determine the burnout level. Data were analysed using SPSS version 20. Simple logistic regression analysis was performed. Thereafter, multiple logistic regression analysis was conducted to determine the factors associated with burnout.

Results

A total of 224 participants were included. Among them, 61.6% were nurses; 21.4%, doctors; and 17.0%, assistant medical officers. The prevalence of personal burnout was 31.3%; work-related burnout, 16.5%; and patient-related burnout, 5.4%. The factors associated with burnout were the highest educational level, financial difficulties and low perceived social support from friends and significant others.

Conclusion

Healthcare workers in Manjung health clinics have a higher prevalence of personal burnout than work- and patient-related burnout. The findings of this study provide early insights and guidance for possible interventions.

The Association Between Well-Being and Empathy in Medical Residents: A Cross-Sectional Survey

Objective: To evaluate the extent to which personal well-being may be associated with empathy, while controlling for potential confounders. Settings/Location: Residency programs throughout the United States. Subjects: A total of 407 medical residents from residencies including general medicine, surgery, specialized and diagnostic medicine participated in this study. Outcome Measures: Well-being was measured using the modified existential well-being subscale of the spiritual well-being scale. Empathy was measured using the Jefferson Scale of Empathy. Results: Well-being was found to be positively correlated with empathy when adjusted for possible confounders (p < 0.001). In addition to well-being, other factors noted to be statistically significant contributors to higher empathy scores while controlling for the others included age, gender, year in residency, specialty, and work-hours (p < 0.05 for each). After controlling for these factors, a resident's year in residency was not found to be a statistically significant contributor to empathy score. Conclusions: In this study, well-being was associated with empathy in medical and surgical residents. Empathy is a fundamental component of physician competency, and its development is an essential aspect of medical training. These findings suggest that efforts to increase well-being may promote empathy among medical residents.

Association between burnout and empathy in medical residents

BACKGROUND

Burnout is a work-related syndrome that can affect physicians' performance. Empathy is one of the clinical competencies in whose formation many factors play a role. Empathy and burnout are important topics of research in medical sciences, and both are related to the communication between the patient and the physician. This study investigated the relationship between occupational burnout and empathy among medical residents.

METHOD

This cross-sectional study was conducted on 297 medical residents in Ahvaz Jundishapur University of Medical Sciences from January to March 2021. The data collection tools were the Jefferson Scale of Empathy (JSE) and the Maslach Burnout Inventory (MBI). The reliability of the instruments was measured by calculating Cronbach's alpha. Data were analyzed by SPSS-18, using the Pearson correlation test and linear regression models.

RESULTS

The average age of the study population was 33.06 ±4.7 years, with more than half being females (57.6%) and married (51.9%). The residents' mean scores of empathy and overall burnout were 102.87 out of 140 and 55.90 out of 132, respectively. The burnout scores showed an inverse correlation with the overall empathy scores (r = -0.123, P = 0.035), and the score of standing in the patient's shoes (r = -0.165, P = 0.004). Linear regression test was used to detect which dimension of empathy was a better predictor for the reduction of burnout scores. Results showed that the best predictor was standing in the patient's shoes (P = 0.014).

CONCLUSION

The findings showed a negative association between empathy and burnout among medical residents, which suggests the need for adjustment of the existing burnout management at the institutional level. Therefore, residents should be supported by managers to reduce burnout and improve their empathic behavior.

The relationship between Empathy and listening styles is complex: implications for doctors in training

BACKGROUND

Effective communication is the key to a successful relationship between doctors and their patients. Empathy facilitates effective communication, but physicians vary in their ability to empathize with patients. Listening styles are a potential source of this difference. We aimed to assess empathy and listening styles among medical students and whether students with certain listening styles are more empathetic.

METHODS

In this cross-sectional study, 97 medical students completed the Jefferson scale of Empathy (JSE) and the revised version of the Listening Styles Profile (LSP-R). The relationship between empathy and listening styles was assessed by comparing JSE scores across different listening styles using ANOVA in SPSS software. A p-value less than 0.05 was considered significant.

RESULTS

Overall, the students showed a mean empathy score of 103 ± 14 on JSE. Empathy scores were lower among clinical students compared to preclinical students. Most of the medical students preferred the analytical listening style. The proportion of students who preferred the relational listening style was lower among clinical students compared to preclinical students. There was no significant relationship between any of the listening styles with empathy.

CONCLUSION

Our results do not support an association between any particular listening style with medical students' empathic ability. We propose that students who have better empathetic skills might shift between listening styles flexibly rather than sticking to a specific listening style.

Empathy Levels Among Healthcare Professionals: An Asian Multi-professional Cross-Sectional Study

BACKGROUND

The aim of the study was to measure empathy in healthcare professionals in Singapore and to compare the scores between the different professions: doctors, nurses, and allied health professionals.

METHODS

An online survey questionnaire was conducted using the Jefferson Scale of Empathy (JSE) from July 2019 to January 2020. The total JSE score was calculated and compared among the different groups. Multiple linear regression was performed to assess predictors of total empathy scores for groups with statistically lower scores.

RESULTS

The survey was completed by 4,188 healthcare professionals (doctors (n=569, 13.6%), nurses (n=3032, 72.4%), and allied health professionals (n=587, 14.0%)) out of the 9,348-strong survey population, with a response rate of 44.8%. The study revealed a mean empathy score (SD) of 103.6 (15.6) for the cohort. The mean empathy score (SD) was 112.3 (14.7), 101.3 (15.2), and 107.0 (15.0), respectively for doctors, nurses, and allied health professionals. These were statistically significantly different among the groups (p< 0.0001), with nurses scoring significantly lower than either doctors (p< 0.0001) or allied health professionals (p< 0.0001). Multiple linear regression showed that age < 30 years old, male gender, Malay ethnicity, and working in a hospital setting were associated with significantly lower empathy scores in the nursing group.

CONCLUSION

Nurses in Singapore had significantly lower empathy scores compared to doctors and allied health professionals. Further research on the underlying causes should be undertaken and measures to improve empathy among Singapore nursing staff should be explored and implemented.

Longitudinal Assessment of Empathy and Burnout Across a Single Pharmacy Class Cohort

OBJECTIVE

This is a final analysis of longitudinal evaluation of burnout and empathy among a cohort of Doctor of Pharmacy students throughout their 4-year enrollment.

METHODS

The class of 2021 received sequential Qualtrics (Qualtrics, Provo, UT) surveys containing 2 validated survey instruments, the Jefferson Scale of Empathy and the Maslach Burnout Inventory. Surveys were disseminated at the start of the program (PY1start) and the end of each academic year (PY1end, PY2, PY3, PY4). Linear mixed models accounting for repeated measures, Generalized Estimating Equation, and Cochran's Q statistic were used to evaluate longitudinal change in the Jefferson Scale of Empathy and Maslach Burnout Inventory survey scores, categorized subscales, and burnout.

RESULTS

Matched survey responses were included for 91 students (85.8% response rate). Across all years, a decrease in empathy and professional efficacy and an increase in exhaustion and cynicism was seen. High categorical levels of exhaustion and cynicism indicated evidence of burnout throughout the program. Year-to-year analysis indicated statistically significant increases in exhaustion and cynicism between PY1start and all subsequent assessments, a decrease in professional efficacy from PY1start to PY1end and PY2, and a decrease in empathy for PY1start to PY1end.

CONCLUSION

Students reported trends of decreasing empathy and professional efficacy, with a simultaneous increase in exhaustion and cynicism. Further evaluation of the impact of COVID-19 on these results, as well as additional methods to support overall student wellness, is needed.

A scoping review on the relationship between mental wellbeing and medical professionalism

BACKGROUND

Mental wellbeing issues among medical students are common, and their relationship to medical professionalism is debated. Few studies have attempted to link such issues with undergraduate medical education. This review aimed to advance the knowledge on this matter by exploring the relationship between mental wellbeing and medical professionalism in undergraduate medical education.

METHODS

We collected the literature about mental wellbeing and medical professionalism (published from 1 January 1986 to 31 March 2021) from the Web of Science, PubMed, Scopus and ScienceDirect databases using the search terms 'mental wellbeing' and 'medical professionalism'.We included all peer-reviewed articles in which mental wellbeing and medical professionalism in the undergraduate medical education context were the central topics regardless of the age range, nationality, race and gender of the participants.

RESULTS

From the 13,076 Iinitially found articles, 16 were included. These 16 articles were from nine countries in four different continents, which all together helped us find answer to our research question using extracted points relating to the main study themes (mental wellbeing and medical professionalism). Under theme 1 (mental wellbeing), six subthemes emerged: burnout, stress, depression, disappointment, depersonalisation and conscientiousness. Theme 2 (medical professionalism), on the other hand, had five subthemes: empathy, academic performance, compassion, unprofessional behaviour and professionalism. A significant inverse association was found between empathy and burnout. Academic performance was also related to burnout. At the same time, empathy was found to have a varied association with stress. Moreover, compassion was found to alleviate burnout and nurture professional gratification.

CONCLUSION

The medical professionalism attributes were found to deteriorate as the mental wellbeing issues grow. This can harm medical students' overall health, current learning abilities and future attitudes towards their patients. Explicit primary research is thus required to examine and intervene in the cause-effect relationship between medical professionalism and mental wellbeing.

Exploring the views of Singapore junior doctors on medical curricula for the digital age: A case study

This study aims to explore the perspectives of medical trainees on the impartation of digital competencies in Singapore's medical school curricula. It also considers how the medical school experience can be strengthened in order to bridge potential gaps in the integration of these competencies in the local curricula. Findings were drawn from individual interviews with 44 junior doctors from Singapore's public healthcare institutions including hospitals and national specialty centers. House officers and residents from different medical and surgical specialties were recruited using purposive sampling. Data was interpreted using qualitative thematic analysis. The doctors were in their first to tenth year of post-graduate training. Thirty of them graduated from the three local medical schools whereas 14 others were trained overseas. Overall, they felt insufficiently prepared to utilize digital technologies in view of their limited exposure to such technologies in medical school. Six key reasons were identified: lack of flexibility and dynamism within the curriculum, dated learning style, limited access to electronic health records, gradual uptake of digital technologies in the healthcare sector, lack of an ecosystem that promotes innovation, and lack of guidance from qualified and available mentors. Equipping medical students with skills relevant to the digital age would benefit from a concerted effort from multiple stakeholders: medical schools, medical educators and innovators, as well as the government. This study bears important implications for countries that seek to bridge the 'transformation gap' brought about by the digital age, which is defined as the sharp divergence between innovations that healthcare providers recognize as important but for which they feel insufficiently prepared.

What is the Link Between Different Components of Empathy and Burnout in Healthcare Professionals? A Systematic Review and Meta-Analysis

Research on healthcare shows that the relationship between empathy and burnout is complex. The aim of this systematic review and meta-analysis is to clarify the link between different empathic components and burnout components in healthcare professionals. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. The search strategy was applied in PubMed, PsycINFO, CINAHL, Scopus, and Medline, from January 1990 to January 2021. Population included nurses and doctors. Key inclusion criteria were articles addressing the relationship between different components of empathy and professional performance and wellbeing or burn out, or studies using burnout and empathy measures with validity support from commonly accepted sources of evidence. Risk of bias was assessed using the Mixed Methods Appraisal Tool. From 1159 references identified, 22 studies were included in the systematic review, and 5 studies in the meta-analysis. Empathic Concern was significantly correlated with Depersonalization and Personal Accomplishment. Moreover, the links between Perspective Taking, Depersonalization and Personal Accomplishment were statistically significant. In conclusion, exploring and understanding the complex links between empathy and burnout could help healthcare professionals as well as institutions to reduce the risk of suffering burnout.

Service quality in health care: empathy as a double-edged sword in the physician–patient relationship

Purpose

As one of the five major dimensions of service quality, empathy has been and continues to be regarded as a requirement for a successful service encounter. This paper focuses on the highly customer-centric service industry of health care. The purpose of this paper is to shed light on the potential negative effects of empathy on both the physician and the patient.

Design/methodology/approach

Building on an in-depth review of literature and well-established service quality models, the authors propose a new model for understanding the complex role of physician empathy in the physician–patient encounter. The trait, emotional intelligence (EI), is presented as a moderator for physician empathy levels.

Findings

The Health Care Optimal Physician Empathy (HOPE) model enables further characterization and analysis of the tradeoffs between patient satisfaction and physician burnout and determining when empathy optimally works to the benefit of both the physician and the patient to maximize service quality. The HOPE model provides a systematic way to understand and determine the appropriate level of physician empathy that results in optimal outcomes for both physicians and their patients by demonstrating the tradeoffs between physician burnout and patient satisfaction.

Originality/value

The authors highlight the potential detrimental effects on physicians themselves, and, in turn, on service quality. The theoretical and practical implications in this paper provide insights into the development and implementation of empathy-focused interventions and best practices to optimize service quality in the physician–patient interaction. The HOPE model is the first of its kind in shedding light on the manifestation of physician empathy.

A Quasi-experimental Study Measuring the Effectiveness of Two Empathy Enhancement Programs on Caregivers Working with Older Adults Living Alone

Objectives: This quasi-experimental study assessed the effectiveness of two empathy enhancement programs on direct care workers of older adults living alone in South Korea.Methods: A total of 104 direct care workers participated in either a simulation-based program or a lecture-based program. Data were collected prior to and 2 weeks after the program implementation using self-reported questionnaires.Results: The lecture-based group had significantly higher levels of empathy compared to the simulation-based group. Pretest-posttest differences were found in the lecture-based group only, including higher levels of empathy and caring efficacy and lower levels of secondary traumatic stress and burnout.Conclusions: More studies are needed to identify helpful components of empathy enhancement programs to direct care workers working with older adults living alone. Also, a further randomized controlled trial study is needed to assess programs' effectiveness on older adults living alone and direct care workers.Clinical implications: A lecture-based empathy enhancement program can increase levels of empathy and caring efficacy of direct care workers working with older adults and decrease care workers' levels of burnout and stress. Training for direct care workers of older adults is needed to improve the empathy of direct care workers while reducing their stress and burnout.

Empathy among Saudi Residents at a Tertiary Academic Center during the COVID-19 Pandemic and Its Association with Perceived Stress

Background and Objectives: Empathy is an important attribute of a healthy doctor−patient relationship. Although multiple studies have assessed empathy in different countries, little is known about its levels among Saudi residents and its association with perceived stress. Objectives: To assess the levels of empathy and to identify if there is an association with stress in general and across the demographic and training characteristics of residents. Materials and Methods: A cross-sectional questionnaire-based study was carried out from December 2020 to March 2021 among residents training at a tertiary academic center in Riyadh, Saudi Arabia. Empathy and perceived stress were measured using the Jefferson Scale of Empathy (JSE) and the Perceived Stress Scale (PSS). Results: A total of 229 residents participated. The mean JSE score was 105.25 ± 15.35. The mean JSE scores were significantly higher among residents training in pediatrics (mean difference (MD) = 17.35, p < 0.001), family medicine (MD = 12.24, p = 0.007), and medical specialties (MD = 11.11, p = 0.012) when compared with surgical specialties and anesthesia. In addition, residents who worked 1−4 on-calls per month had a higher mean JSE score (MD = 11.23, p = 0.028) compared with those who worked 7 or more on-calls. Lastly, no correlation between empathy and perceived stress was detected in the whole sample (r = −0.007, p = 0.913); however, there was a correlation among residents training in medical specialties (r = −0.245, p = 0.025). Conclusion: Residents in our study had empathy levels comparable with Asian but lower than Western residents. We recommend qualitative studies that explore potential factors that might affect empathy among residents and studying the association between empathy and perceived stress among medical residents. Postgraduate curricula should incorporate interventions that foster a more empathetic doctor−patient relationship.

PERANAN IKLIM UNIVERSITI SEBAGAI ‘MODERATOR OF THE MODERATOR’ PENCAPAIAN KENDIRI KE ATAS BURNOUT DAN LIBATSAMA BELAJAR HARIAN PELAJAR UNIVERSITI

Kajian ini bertujuan mengkaji peranan iklim universiti sebagai ‘moderator of the moderator’ terhadap pencapaian kendiri dalam meramalkan hubungan antara tuntutan belajar harian dengan sokongan belajar harian ke atas burnout harian dan libatsama belajar harian. Kajian menggunakan pendekatan diari kuantitatif pelbagai tahap (multilevel) yang melibatkan seramai 30 orang pelajar universiti yang dikutip bermula hari Ahad sehingga Rabu (30*4 = 120 data diari) dan data dianalisis dengan menggunakan perisian Hierarchical Linear Modeling (HLM) 8.0. Analisis mendapati bahawa terdapat kesan positif daripada pengalaman harian tuntutan belajar terhadap burnout harian dan sokongan belajar harian terhadap libatsama belajar harian dalam kalangan pelajar. Lebih penting lagi, kajian ini juga mendapati bahawa iklim universiti menjadi moderator hubungan interaksi antara pencapaian kendiri individu dengan tuntutan belajar harian dalam mengurangkan burnout harian. Pelajar mengalami burnout yang lebih tinggi dalam keadaan tuntutan belajar yang banyak. Walau bagaimanapun, kesan ini dapat dikurangkan apabila terdapatnya iklim persekitaran universiti yang baik dan pencapaian kendiri individu yang tinggi. Penemuan kajian ini menunjukkan bahawa kedua-dua faktor universiti (iklim universiti) dan faktor individu (pencapaian kendiri) memainkan peranan penting dalam usaha mengurangkan impak negatif tuntutan belajar, terutamanya ke atas burnout. Faktor persekitaran universiti dan ciri-ciri individu telah dianggap sebagai penentu utama yang mempengaruhi burnout dan libatsama belajar dalam kalangan pelajar, tetapi kesan secara serentak kedua-dua faktor masih belum lagi diterokai.

Prevalence of burnout among healthcare professionals in Singapore

INTRODUCTION

The aim was to study the prevalence of burnout among various groups of healthcare professionals in Singapore.

METHODS

An anonymous online survey questionnaire was conducted using the Maslach Burnout Inventory - Human Services to measure three categories of burnout: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) from July 2019 to January 2020 in a healthcare cluster in Singapore.

RESULTS

The survey was completed by 6,048 healthcare professionals out of a target survey population of 15,000 (response rate 40.3%). The study revealed 37.8% of respondents had high EE score ≥27, 29.7% of respondents had high DP score ≥10, and 55.3% of respondents had low PA score ≤33. Respondents with either high EE score or high DP score constituted 43.9% (n=2,654). The Allied Health group had the highest mean EE score, which was significantly higher than those of Medical, Nursing and Non-clinical groups (P<0.05). The Medical group had the highest mean DP score and this was significantly higher than the Nursing, Allied Health and Non-clinical groups (P<0.05). The Non-clinical group had the lowest PA, which was significantly lower than the Medical, Nursing and Allied Health groups (P<0.005).

CONCLUSION

There was high prevalence of burnout among healthcare professionals in Singapore, especially the allied health professionals. There were significant differences in the 3 categories of burnout (EE, DP and PA) among the different groups of healthcare professionals. There is an urgent need to address the high burnout rate.

Predictors of Physician Compassion, Empathy, and Related Constructs: a Systematic Review

BACKGROUND

Compassion in healthcare provides measurable benefits to patients, physicians, and healthcare systems. However, data regarding the factors that predict care (and a lack of care) are scattered. This study systematically reviews biomedical literature within the Transactional Model of Physician Compassion and synthesizes evidence regarding the predictors of physician empathy, compassion, and related constructs (ECRC).

METHODS

A systematic literature search was conducted in CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, OvidJournals, ProQuest, Web of Science, and Scopus using search terms relating to ECRC and its predictors. Eligible studies included physicians as participants. Methodological quality was assessed based on the Cochrane Handbook, using ROBINS-I risk of bias tool for quantitative and CASP for qualitative studies. Confidence in findings was evaluated according to GRADE-CERQual approach.

RESULTS

One hundred fifty-two included studies (74,866 physicians) highlighted the diversity of influences on compassion in healthcare (54 unique predictors). Physician-related predictors (88%) were gender, experience, values, emotions and coping strategies, quality of life, and burnout. Environmental predictors (38%) were organizational structure, resources, culture, and clinical environment and processes. Patient-related predictors (24%) were communication ease, and physicians' perceptions of patients' motives; compassion was also less forthcoming with lower SES and minority patients. Evidence related to clinical predictors (15%) was scarce; high acuity presentations predicted greater ECRC.

DISCUSSION

The growth of evidence in the recent years reflects ECRC's ongoing importance. However, evidence remains scattered, concentrates on physicians' factors that may not be amenable to interventions, lacks designs permitting causal commentary, and is limited by self-reported outcomes. Inconsistent findings in the direction of the predictors' effects indicate the need to study the relationships among predictors to better understand the mechanisms of ECRCs. The current review can guide future research and interventions.

Inter-relationships between burnout, personality and coping features in residents within an ACGME-I Accredited Psychiatry Residency Program

BACKGROUND

Burnout during residency training is associated with various factors. Within the context of stress/coping transactional model in which one's personality can influence stress appraisal and coping, there is limited evidence examining the relationship between burnout and personality factors amongst psychiatry residents.

OBJECTIVES

We aim to evaluate the prevalence of burnout within a cohort of psychiatry residents and its relationship with personality factors, demographic, work-related factors and coping features.

METHODS

We conducted a cross-sectional study involving 50 out of 77 eligible residents (response rate 64.9%) and administered the Oldenberg Burnout Inventory (OLBI), NEO-Five Factor Inventory (NEO-FFI) and Brief COPE Inventory. Burnout was defined as crossing the thresholds for exhaustion (≥2.25) and disengagement (≥2.1) scores. We compared the burnout vs nonburnout groups and examined the relationship between burnout, personality factors and coping strategies using correlational and mediational analyses.

RESULTS

Overall, 78% of our cohort met criteria for burnout. Burnout was correlated with hours of work per week (rs = .409, P = .008), neuroticism (OR 1.2, 95% CI 1.01-1.43, P = .041) and avoidance coping (OR 1.61, 95% CI 1.06-2.46, P = .025). Neuroticism was significantly correlated (all P < .001) with all coping domains (Seeking Social Support, rs = 0.40; Problem Solving, rs = 0.52; Avoidance, rs = 0.55; Positive thinking, rs = 0.41) and was a partial mediator between avoidance coping and burnout (β of indirect path = 0.168, [SE = 0.066]; P = .011).

CONCLUSIONS

We found a considerable burnout rate amongst psychiatry residents which was associated with neuroticism and avoidance coping, and suggest ways to better tackle occupational burnout during residency training.

The mediating role of social support in the relationship between physician burnout and professionalism behaviors

OBJECTIVE

Burnout poses as an understudied challenge to professionalism, and social support may explain their relationship. We sought to investigate the role of social support (moderating or mediating) in the association between physician burnout and professionalism (with four behavioral domains: respect, integrity, excellence, responsibility).

METHODS

We invited 4100 physicians from nine tertiary hospitals in Liaoning province, China, during February 2017, to participate in a cross-sectional survey. Professionalism, burnout, and social support were respectively assessed using three standardized tools. Descriptive statistics, multivariable linear regression, and ordinal logistic regression were used to analyze the data.

RESULTS

3506 physicians (85.5%) effectively completed the survey. After controlling for potential confounding factors, burnout was associated with lower professionalism (β = -0.65, SE = 0.07), particularly in respect (OR = 0.51, 95%CI: 0.41-0.64) and responsibility (OR=0.72, 95%CI: 0.57-0.90). However, there was no statistically significant association between burnout and integrity or excellence. Social support was associated with higher professionalism ((β = 0.24, SE = 0.02) and all of its behavioral domains and played a partial mediating effect on the association between burnout and professionalism.

CONCLUSION

Social support partially mediates the relationship between physician burnout and behavior-based professionalism.

PRACTICE IMPLICATIONS

Addressing burnout and promoting social support could be integral in fostering physician professionalism in the healthcare setting.

A Novel Mindful-Compassion Art-Based Therapy for Reducing Burnout and Promoting Resilience Among Healthcare Workers: Findings From a Waitlist Randomized Control Trial

Protecting the mental health of healthcare workers is an urgent global public health priority. Healthcare workers, especially those immersed in palliative care, are prone to burnout due to the intense emotions associated with end-of-life caregiving. This study examines the efficacy of a novel, multimodal, and group-based Mindful-Compassion Art-based Therapy (MCAT) that integrates reflective self-awareness with creative emotional expression for protecting healthcare workers' mental health. A dual-arm open-label waitlist randomized controlled trial was conducted. A total of 56 healthcare workers were recruited from the largest homecare hospice in Singapore and randomized to the immediate-treatment condition of a standardized 6-week, 18-hours MCAT intervention (n=29), or the waitlist-control condition (n=27). Self-administered outcome measures on burnout, resilience, emotional regulation, self-compassion, death attitudes, and quality of life were collected at baseline, post-intervention/second-baseline at 6weeks, and follow-up/post-intervention at 12weeks. Results from mixed model ANOVAs reveal that treatment group participants experienced significant reduction in mental exhaustion, as well as significant improvements in overall emotional regulation, nonreactivity to intrusive thoughts, approach acceptance of death, and afterlife belief as compared to waitlist-control immediately after MCAT completion. Effect sizes of these impacts ranged from medium to large (η 2=0.65 to 0.170). Results from one-way ANOVAs further reveal that the treatment gains of reduced mental exhaustion and increased emotional regulation were maintained among treatment group participants at 12-weeks follow-up compared to baseline, with new benefits identified. These include increased ability to observe and describe one's experiences, elevated overall self-compassion, greater mindful awareness, enhanced common humanity, and better quality of life. Effect sizes of these impacts were large (η 2=0.128 to 0.298). These findings reflect the robust effectiveness and positive residual effects of MCAT for reducing burnout, building resilience, nurturing compassion, fostering collegial support, and promoting mental wellness among healthcare workers. The clinical model and applicability of MCAT in larger and more diverse caregiving contexts, such as family dementia care, are discussed. Clinical Trial Registration: ClinicalTrials.gov # NCT03440606, #NCT04548089.

Oncology workload in a tertiary hospital during the COVID-19 pandemic

Introduction

Workload in oncology during a pandemic is expected to increase as manpower is shunted to other areas of need in combating the pandemic. This increased workload, coupled with the high care needs of cancer patients, can have negative effects on both healthcare providers and their patients.

Methods

This study aims to quantify the workload of medical oncologists compared to internal medicine physicians and general surgeons during the current COVID-19 pandemic, as well as the previous H1N1 pandemic in 2009.

Results

Our data showed decrease in inpatient and outpatient workload across all three specialties, but the decrease was least in medical oncology (medical oncology −18.5% inpatient and −3.8% outpatient, internal medicine −5.7% inpatient and −24.4% outpatient, general surgery −17.6% inpatient, and −39.1% outpatient). The decrease in general surgery workload was statistically significant. The proportion of emergency department admissions to medical oncology increased during the COVID-19 pandemic. Furthermore, the study compared the workload during COVID-19 with the prior H1N1 pandemic in 2009 and showed a more drastic decrease in patient numbers across all three specialties during COVID-19.

Discussion

We conclude that inpatient and outpatient workload in medical oncology remains high despite an ongoing COVID-19 pandemic. The inpatient medical oncology workload is largely contributed by the stable number of emergency department admissions, as patients who require urgent care will present to a healthcare facility, pandemic or not. Healthcare systems should maintain manpower in medical oncology to manage this vulnerable group of patients in light of the prolonged COVID-19 pandemic.

Finding Echoes: An Exploration of Empathy Among Physiotherapists and Physiotherapy Students in Singapore

Background

Empathy is an essential antecedent in motivating healthcare professionals to treat and care for their patients with compassion – few studies had explored empathy on healthcare workers. Currently, no data reported empathy amongst physiotherapists and physiotherapy students in Singapore.

Objectives

This study aims to: 1) measure and explore within- and between-group differences in empathy scores amongst physiotherapists and physiotherapy students in Singapore, and 2) compare the results with similar studies locally and overseas.

Methods

This cross-sectional survey recruited 187 participants (37 physiotherapists and 150 physiotherapy students) via convenience sampling. Participants completed the Jefferson Scale of Empathy (JSE) Health Professions (JSE-HP) and the JSE-Health Professions Students (JSE-HPS), correspondingly. The 20-item JSE-HP and JSE-HPS are validated self-reported questionnaires that measure clinical empathy using a 7-point Likert scale. Summed scores range from 20 to 140, with higher scores suggesting a higher level of empathy. Statistical analysis included descriptive statistics, independent-sample t-tests and one-way analyses of variance.

Results

The mean score of JSE-HP and JSE-HPS was 110.89±11.37 and 112.43±10.73, respectively. No statistically significant differences found between gender, physiotherapists and physiotherapy students, and years of study. However, physiotherapists scored significantly higher [5.08±1.24 (95% CI 4.67–5.49) vs 4.01±1.36 (95% CI 3.79–4.23), p < .001 ] in the JSE components ‘Walking in Patient's Shoes’.

Conclusion

Physiotherapists and physiotherapy students in Singapore have similar empathy scores to their counterparts locally and internationally. No statistically significant differences in empathy scores were found. However, physiotherapy students were less able to understand patients' perspectives. This warrants further exploration in developing this vital attribute amongst students.

Burnout and resilience among pharmacy technicians: A Singapore study

BACKGROUND

Burnout describes emotional exhaustion (EE), depersonalization (DP), and low personal achievement caused by work and is known to bring about negative consequences to practitioners, patients, and health systems. Various organizational and personal factors, such as organizational strategies and resilience, have been associated with this phenomenon. However, there is a paucity of data describing the prevalence of burnout among pharmacy staff within Singapore and Asia, especially in the pharmacy technician (PT) population.

OBJECTIVES

This study aimed to (1) quantify burnout in PTs in patient-care sectors in Singapore and (2) explore factors that may be associated with burnout.

METHODS

A cross-sectional survey among PTs in patient-care areas in Singapore, which includes hospitals, primary and secondary care institutions, and retail pharmacies, across both public and private sectors was conducted from February to April 2020. The Maslach Burnout Inventory - Human Services Survey and Brief Resilience Scale were used to assess burnout and resilience among participants. Demographic, employment, and well-being information were also collected and summarized. Univariate analysis and multivariate logistic regression were used to assess associations between burnout and potential risk and impact factors.

RESULTS

Slightly more than half (52.0%) of PTs reported burnout (EE score ≥ 27 or DP ≥ 10 or both). Statistically significant factors associated with burnout include resilience, age, years of experience, ethnicity, marital status, nationality, highest qualifications, pharmacy-related certification, full-time employment status, and work hours. Impact associated with burnout includes intent for job change, job satisfaction, sleep, and presence of mental conditions. Statistically significant reported reasons for burnout and ways to build resilience were also elucidated.

CONCLUSION

Burnout affects most PTs in Singapore and is primarily driven by workload and nature of their work, low resilience, and poor social support structures. National and organizational efforts are needed to arrest the vicious cycle that propagates burnout in PTs.

Questionnaire Survey of Burnout Amongst Dentists in Singapore

Background

Burnout results from ongoing, unsuccessfully managed workplace stress, resulting in feelings of exhaustion, increased mental distance from one's job, and reduced professional efficacy.

Method

This research used a cross-sectional questionnaire survey design. Graduated dentists in Singapore completed an online questionnaire comprising 5 sections: (a) demographics (3 items); (b) working conditions and experience (12 items); (c) the Copenhagen Burnout Inventory (CBI) (19 items); (d) supplementary questions assessing causes and outcomes of stress and burnout (15 items); and (e) other outcomes (3 items).

Results

Overall, low to moderate levels of burnout were reported by the 210 survey respondents. Average CBI scale scores (out of 100) were as follows: personal burnout = 49.14, work-related burnout = 46.41, and patient-related burnout = 37.72. High to severe levels of burnout were self-reported by 24 individuals (11.3%) for personal burnout, 17 individuals (8.0%) for work-related burnout, and 9 individuals (4.2%) for patient-related burnout.

Conclusions

Levels of burnout were generally low to moderate in this sample, with a small proportion of dentists experiencing high levels of burnout. Further research is required to gain clarity on stress and burnout levels across different occupational designations and dentistry settings in Singapore.

A systematic scoping review of approaches to teaching and assessing empathy in medicine

BACKGROUND

Empathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed.

METHODS

This systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data.

RESULTS

In total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum.

CONCLUSIONS

Nurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one's professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.

Depression, Stress, and Perceived Medical Errors in Singapore Psychiatry Residents

OBJECTIVE

Doctors in training, especially psychiatrists, are at high risk of depression and burnout, which have been linked to increased medical errors. This study looks at prevalence and risk factors of depression and perceived stress among psychiatry residents in Singapore.

METHODS

An anonymous online questionnaire was completed by 65.3% (47/72) of residents, which included the Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale (PSS), and 2 burnout screening questions. They were asked if they were concerned about making a medical error.

RESULTS

Majority of residents (70.2%) slept 6-8 h/night, while 55.3% worked < 60 h/week. Based on PHQ-9 score ≥ 10, 38.3% had depression. Depression was associated with sleeping < 6 h/night (OR 13.62, 2.96-62.6; p = 0.0008) and working ≥ 60 h/week (OR 3.8, 1.096-13.18; p = 0.035). Six residents (12.8%) endorsed suicidal ideation. The mean score on the PSS scale was 23.89 ± 1.95. Higher PSS scores were associated with sleeping < 6 h/night (OR 4.92, 1.51-8.33; p = 0.007). One third of residents (34%) reported feeling burnt out fairly or very often. Residents who slept < 6 h/night were more likely to report feeling burnt out (OR 6.69, 1.69-26.45; p = 0.0068). PHQ scores correlated highly with PSS scores and burnout measures. Self-perceived medical errors were associated with depressive symptoms, suicidal thoughts, and < 6 h/night of sleep.

CONCLUSIONS

Less sleep and longer working hours were associated with higher risk of depression, suicidality, stress, and perceived medical errors in Singapore psychiatry residents. It is important to address depression and stress as it can affect physician well-being and patient care.

A Simulation-Based Empathy Enhancement Program for Non-Medical Care Providers of Older Adults: A Mixed-Methods Study

OBJECTIVE

Studies using simulation-based programs for empathy enhancement have been conducted mostly for health profession students and medical care providers in Western countries. No empirical research has been conducted for non-medical care providers of older adults in community settings in Asian countries. The purposes of this mixed-methods study were: to explore experiences and perceived usability of non-medical care providers of older adults in a simulation-based empathy enhancement program; and to examine if the program is effective in improving empathy and relevant outcomes.

METHODS

104 non-medical care providers of older adults in South Korea participated in a simulation-based empathy enhancement program in 2018. Data were collected using self-reported questionnaires for effectiveness testing, a program evaluation questionnaire, and individual interviews and analyzed using statistical tests and thematic analysis.

RESULTS

Care providers showed higher levels of empathy and lower levels of stress and burnout after the program participation (p<0.05). Qualitative findings supported the improved attitude and care strategies, increased empathy towards older adults, preparing for their own aging, and restoration of emotional stability through the participation in the program.

CONCLUSION

This study suggests that the simulation-based program is useful in promoting empathic responses of non-medical care providers working with older adults.

Factors associated with self-reported burnout level in allied healthcare professionals in a tertiary hospital in Singapore

BACKGROUND

Burnout has adverse implications in healthcare settings, compromising patient care. Allied health professionals (AHPs) are defined as individuals who work collaboratively to deliver routine and essential healthcare services, excluding physicians and nurses. There is a lack of studies on burnout among AHPs in Singapore. This study explored factors associated with a self-reported burnout level and barriers to seeking psychological help among AHPs in Singapore.

METHODS

We conducted a cross-sectional study in a sample of AHPs in a tertiary hospital from October to December 2019. We emailed a four-component survey to 1127 eligible participants. The survey comprised four components: (1) sociodemographic characteristics, (2) Maslach Burnout Inventory (MBI-HSS), (3) Areas of Worklife Survey, and (4) Perceived Barriers to Psychological Treatment (PBPT). We performed a multiple logistic regression analysis to identify factors associated with burnout. Adjusted odds ratios (AORs) and associated 95% confidence intervals (CIs) were computed.

RESULTS

In total, 328 participants completed the questionnaire. The self-reported burnout level (emotional exhaustion>27 and/or depersonalization>10) was 67.4%. The majority of the respondents were female (83.9%), Singaporean (73.5%), aged 40 years and below (84.2%), and Chinese ethnicity (79.9%). In the multiple logistic regression model, high burnout level was negatively associated with being in the age groups of 31 to 40 (AOR 0.39, 95% CI 0.16-0.93) and 40 years and older (AOR 0.30, 95% CI 0.10-0.87) and a low self-reported workload (AOR 0.35, 95% CI 0.23-0.52). High burnout level was positively associated with a work experience of three to five years (AOR 5.27, 95% CI 1.44-20.93) and more than five years (AOR 4.24; 95% CI 1.16-16.79. One hundred and ninety participants completed the PBPT component. The most frequently cited barriers to seeking psychological help by participants with burnout (n = 130) were 'negative evaluation of therapy' and 'time constraints.'

CONCLUSIONS

This study shows a high self-reported burnout level and identifies its associated factors among AHPs in a tertiary hospital. The findings revealed the urgency of addressing burnout in AHPs and the need for effective interventions to reduce burnout. Concurrently, proper consideration of the barriers to seeking help is warranted to improve AHPs' mental well-being.

Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression

BACKGROUND

Burnout among postgraduate medical trainees (PMTs) is increasingly being recognized as a crisis in the medical profession. We aimed to establish the prevalence of burnout among PMTs, identify risk and protective factors, and assess whether burnout varied by country of training, year of study and specialty of practice.

METHODS

We systematically searched MEDLINE, Embase, PsycINFO, the Cochrane Database of Systematic Reviews, Web of Science and Education Resources Information Center from their inception to Aug. 21, 2018, for studies of burnout among PMTs. The primary objective was to identify the global prevalence of burnout among PMTs. Our secondary objective was to evaluate the association between burnout and country of training, year of study, specialty of training and other sociodemographic factors commonly thought to be related to burnout. We employed random-effects meta-analysis and meta-regression techniques to estimate a pooled prevalence and conduct secondary analyses.

RESULTS

In total, 8505 published studies were screened, 196 met eligibility and 114 were included in the meta-analysis. The pooled prevalence of burnout was 47.3% (95% confidence interval 43.1% to 51.5%), based on studies published over 20 years involving 31 210 PMTs from 47 countries. The prevalence of burnout remained unchanged over the past 2 decades. Burnout varied by region, with PMTs of European countries experiencing the lowest level. Burnout rates among medical and surgical PMTs were similar.

INTERPRETATION

Current wellness efforts and policies have not changed the prevalence of burnout worldwide. Future research should focus on understanding systemic factors and leveraging these findings to design interventions to combat burnout.

STUDY REGISTRATION

PROSPERO no. CRD42018108774.

Risk and protective factors for burnout among physicians from standardized residency training programs in Shanghai: a cross-sectional study

Background

High burnout has been reported in physician populations. Although the standardized residency training (SRT) in China includes components that might put residents at a higher risk for burnout, the burnout of Chinese medical residents is unknown. This study aimed to evaluate the prevalence of burnout and the associated risk and protective factors for medical residents in the SRT program in Shanghai, China.

Methods

This study was a prospective cross-sectional design. A random sampling strategy was used to recruit 330 resident physicians from four SRT sites in Shanghai, and 318 completed questionnaires were returned. Respondents completed a self-made questionnaire including demographic and work characteristics, four burnout and wellness-specific surveys. Bivariate analyses and hierarchical multiple regression models were used to analyze factors associated with three sub-scales of burn out separately.

Results

The overall burnout rate was 71.4%. Low level rate of personal accomplishment (PA) was extremely high at 69.5%. Night shift experience, high occupational stress, and low social support were significant predictors, which explained 49.1% variance of emotional exhaustion (EE) (F = 26.528, P < 0.01). Factors that significantly predicted depersonalization (DP) included male gender, senior residents, night shift experience, high occupational stress, and low psychological empathy, which explained 51.5% variance totally (F = 29.004, P < 0.01). Senior residents, high income, low occupational stress, and high empathy were also significant predictors of decreased personal achievement (PA), which explained 18.4% variance totally (F = 12.897, P < 0.01).

Conclusions

There was a high burnout rate among SRT residents in Shanghai. Occupational stress and several work-related factors were significant and strong risk factors for burnout, while empathy and social support were mild protective factors. Decreased work-related demands and increased access to resources could assist residents in reducing their work stress and improving their well-being.

Burnout and Associated Factors Among Health Care Workers in Singapore During the COVID-19 Pandemic

OBJECTIVES

The strain on health care systems due to the COVID-19 pandemic has led to increased psychological distress among health care workers (HCWs). As this global crisis continues with little signs of abatement, we examine burnout and associated factors among HCWs.

DESIGN

Cross-sectional survey study.

SETTING AND PARTICIPANTS

Doctors, nurses, allied health professionals, administrative, and support staff in 4 public hospitals and 1 primary care service in Singapore 3 months after COVID-19 was declared a global pandemic.

METHODS

Study questionnaire captured demographic and workplace environment information and comprised 3 validated instruments, namely the Oldenburg Burnout Inventory (OLBI), Safety Attitudes Questionnaire (SAQ), and Hospital Anxiety and Depression Scale (HADS). Multivariate mixed model regression analyses were used to evaluate independent associations of mean OLBI-Disengagement and -Exhaustion scores. Further subgroup analysis was performed among redeployed HCWs.

RESULTS

Among 11,286 invited HCWs, 3075 valid responses were received, giving an overall response rate of 27.2%. Mean OLBI scores were 2.38 and 2.50 for Disengagement and Exhaustion, respectively. Burnout thresholds in Disengagement and Exhaustion were met by 79.7% and 75.3% of respondents, respectively. On multivariate regression analysis, Chinese or Malay ethnicity, HADS anxiety or depression scores ≥8, shifts lasting ≥8 hours, and being redeployed were significantly associated with higher OLBI mean scores, whereas high SAQ scores were significantly associated with lower scores. Among redeployed HCWs, those redeployed to high-risk areas in a different facility (offsite) had lower burnout scores than those redeployed within their own work facility (onsite). A higher proportion of HCWs redeployed offsite assessed their training to be good or better compared with those redeployed onsite.

CONCLUSIONS AND IMPLICATIONS

Every level of the health care workforce is susceptible to high levels of burnout during this pandemic. Modifiable workplace factors include adequate training, avoiding prolonged shifts ≥8 hours, and promoting safe working environments. Mitigating strategies should target every level of the health care workforce, including frontline and nonfrontline staff. Addressing and ameliorating burnout among HCWs should be a key priority for the sustainment of efforts to care for patients in the face of a prolonged pandemic.

Relationship between level of empathy during residency training and perception of professionalism climate

BACKGROUND

Empathy is one of the vital personality attributes for all physicians. It is essential for establishing general interpersonal relationships among doctors and patients. Unfortunately, there is evidence for the decline of physician's empathy during the clinical training phase and is a major concern for medical educators worldwide. One of the major factors reported for the decline of this trait is an unprofessional learning environment.

OBJECTIVE

This study examines the relationship between empathy level and perception of climate of professionalism among residents.

METHOD

The study participants included 70 residents of Obstetrics & Gynecology and Pediatrics departments of a private sector tertiary care hospital in Karachi, Pakistan. Two self-administered internet based surveys - Jefferson Scale of Physician Empathy (JSPE) and "Professionalism Climate Instrument"(PCI) - were administered to assess the level of empathy among the participants and their perception of professionalism in the learning environment. The relationship between the level of empathy and professionalism was analyzed using Spearman rank correlation.

RESULTS

The overall response rate was 81.4% with mean empathy level of 103 ± 13. The internal consistency of each scale measured by Cronbach's coefficient α was 0.76 for JSPE and 0.65 for PCI. No significant difference was observed in the mean empathy scores between senior and junior residents of both specialties. Statistically significant difference in empathy scores existed between female and male residents (p = 0.012; 95% CI, 2.27 to 17.59). The mean PCI score was 106 + 8.88 with no significant difference among residents of two specialties. Professionalism score was not found to vary with either the year of residency or gender. Empathy score and professionalism climate were not found to be correlated (r_s = 0.56, p = 0.64).

CONCLUSION

The findings suggested that empathy is a relatively stable trait that remains unchanged during residency training programs. Female residents had higher empathic concern than the male trainees, however, the empathy level of the participants was not found to be influenced by the climate of professionalism.

Burnout level and associated factors in a sub-Saharan African medical setting: prospective cross-sectional survey

BACKGROUND

Burnout in the hospital environment is a problem that affects care and training. Often explored in the high-income medical context, burnout is poorly studied in low and middle-income countries characterized by a precarious hospital situation and a high stake linked to the Millennium Development Goals. The aim of our study was to determine in medical practitioners, in a sub-Saharan African country's medical context, the burnout level and associated factors.

METHODS

A prospective cross-sectional study by using a self-administered Likert-scale questionnaire addressed to doctors and doctoral medical students in Gabon. Maslach Burnout Inventory scale has been used. Burnout symptoms were defined by high level in at least one of the 3 dimensions. Severe burnout defined by high level in all dimensions. Explored factors: socio-demographic and psychometric. Multiple logistic regression has been performed.

RESULTS

Among 104 participants, severe burnout prevailed at 1.9% (95% CI: 0.2-6.8%) and burnout symptoms at 34.6% (95% CI: 25, 6-44.6%). The associated factors with burnout symptoms: age (OR = 0.86, p = 0.004), clinical activity in a university hospital center (OR = 5.19, p = 0.006), the easy access to the hospital (OR = 0.59, p = 0.012), number of elderly dependents living with the practitioner (OR = 0.54, p = 0.012), place of residence (same borough where the hospital is located: OR = 4.09, p = 0.039) and to be favorable to traditional medicine (OR = 1.82, p = 0.087). Nagelkerke's R-squared:53.1%.

CONCLUSION

In Gabon, middle-income country, almost one practitioner in two has burnout symptoms. The young age, the university hospital center, the difficulty to access to hospital and to live in the borough where the hospital is located increase the probability of burnout symptoms. These results must put question to relevant authorities regarding health and medical education, to set up: a public transport for practitioners, an optimal primary health care system, a regulation of medical tasks in hospitals, a training in clinical supervision.

Grit protects medical students from burnout: a longitudinal study

BACKGROUND

Burnout is a serious issue plaguing the medical profession with potential negative consequences on patient care. Burnout symptoms are observed as early as medical school. Based on a Job Demands-Resources model, this study aims to assess associations between specific job resources measured at the beginning of the first year of medical school with burnout symptoms occurring later in the first year.

METHODS

The specific job resources of grit, tolerance for ambiguity, social support and gender were measured in Duke-NUS Medical School students at the start of Year 1. Students were then surveyed for burnout symptoms at approximately quarterly intervals throughout the year. Using high ratings of cynicism and exhaustion as the definition of burnout, we investigated the associations of the occurrence of burnout with student job resources using multivariable logistic regression analysis.

RESULTS

Out of 59 students, 19 (32.2%) indicated evidence of burnout at some point across the first year of medical school. Stepwise multivariable logistic regression analysis identified grit as having a significant protective effect against experiencing burnout (Odds Ratio, 0.84; 95%CI 0.74 to 0.96). Using grit as a single predictor of burnout, area under the ROC curve was 0.76 (95%CI: 0.62 to 0.89).

CONCLUSIONS

Grit was identified as a protective factor against later burnout, suggesting that less gritty students are more susceptible to burnout. The results indicate that grit is a robust character trait which can prognosticate burnout in medical students. These students would potentially benefit from enhanced efforts to develop grit as a personal job resource.

Indicators Associated With Job Morale Among Physicians and Dentists in Low-Income and Middle-Income Countries: A Systematic Review and Meta-analysis

IMPORTANCE

Improving health care in low- and middle-income countries (LMICs) requires a workforce with positive job morale. However, the level of job morale in this population remains unclear.

OBJECTIVE

To analyze studies measuring the job morale of physicians and dentists working in LMICs, using levels of job burnout, job satisfaction, and job motivation as indicators of job morale.

DATA SOURCES

A comprehensive search of Scopus, PubMed, PsycINFO, EMBASE, Web of Science, and the Cochrane Library, from database inception to October 30, 2018, and gray literature was performed.

STUDY SELECTION

Studies were eligible if at least 50% of the sample were qualified physicians and/or dentists working in public health care settings in LMICs. Three indicators of job morale in this population were used: job burnout, job satisfaction, and job motivation. Of 12 324 records reviewed, 79 studies were included in the systematic review and 59 were eligible for the meta-analysis.

DATA EXTRACTION AND SYNTHESIS

Data were extracted independently by several investigators in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Random-effects meta-analyses, planned subgroup analyses, and metaregression were performed. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess bias.

MAIN OUTCOMES AND MEASURES

Levels of job burnout, job satisfaction, and job motivation as indicators of job morale.

RESULTS

Overall, 12 324 records were identified. Of them, 80 records, representing 79 studies and involving 45 714 participants across 37 LMICs, met the inclusion criteria for the review; however, only 3 were from low-income countries. In 21 studies with 9092 participants working mainly in middle-income countries, 32% (95% CI, 27%-38%; I2 = 95.32%; P < .001) reported job burnout, and in 20 studies with 14 113 participants, 60% (95% CI, 53%-67%; I2 = 98.21%; P < .001) were satisfied with their job overall. Sufficient data were not available for a meta-analysis of job motivation.

CONCLUSIONS AND RELEVANCE

The findings suggest that, among physicians and dentists working mainly in middle-income countries, more than half reported having positive job morale. Positive job morale among physicians and dentists may help with recruitment and retention and thus support programs for improving health care in LMICs.

Outrunning Burnout in a GI Fellowship Program During the COVID-19 Pandemic

Many GI training programs have needed to adjust to the serious disruption to the training and education of fellows worldwide due to the COVID-19 pandemic. A silent problem that has arisen within programs is the issue of burnout among their trainees. Burnout is common among gastroenterologists, especially in fellows (Keswani et al. in Gastroenterology 147(1):11-14, 2014. https://doi.org/10.1053/j.gastro.2014.05.023 , Am J Gastroenterol 106(10):1734-1740, 2011. https://doi.org/10.1038/ajg.2011.148 ), with negative consequences to patient care and the safety of the trainees if not effectively dealt with. In this article, the author describes several additional factors potentially contributing to the intensifying burnout of the fellows in their home institution during this pandemic. Moreover, he describes specific practical interventions that the hospital and program have taken in order to address these factors.

The Abbreviated Maslach Burnout Inventory Can Overestimate Burnout: A Study of Anesthesiology Residents

The Maslach Burnout Inventory for healthcare professionals (MBI-HSS) and its abbreviated version (aMBI), are the most common tools to detect burnout in clinicians. A wide range in burnout prevalence is reported in anesthesiology, so this study aimed to ascertain which of these two tools most accurately detected burnout in our anesthesiology residents. The MBI-HSS and aMBI were distributed amongst 86 residents across three hospitals, with a total of 58 residents completing the survey (67.4% response rate; 17 male and 41 female). Maslach-recommended cut-offs for the MBI-HSS and the aMBI with standard cut-offs were used to estimate burnout prevalence, and actual prevalence was established clinically by a thorough review of multiple data sources. Burnout proportions reported by the MBI-HSS and aMBI were found to be significantly different; 22.4% vs. 62.1% respectively (p < 0.0001). Compared to the actual prevalence of burnout in our cohort, the MBI-HSS detected burnout most accurately; area under receiver operating characteristic of 0.99 (95% confidence interval (CI): 0.92–1.0). Although there was a good correlation between the MBI-HSS and aMBI subscale scores, the positive predictive value of the aMBI was poor; 33.3% (95% CI:27.5–39.8%), therefore caution and clinical correlation are advised when using the aMBI tool because of the high rates of false-positives.

Empathy, burnout, life satisfaction, correlations and associated socio-demographic factors among Chinese undergraduate medical students: an exploratory cross-sectional study

BACKGROUND

Medical education is widely known to be a demanding process that may cause various mental health problems, such as burnout, which can lead to lowered levels of life satisfaction among medical students. Research shows that empathy is negatively correlated with burnout, but there are few studies on the relationship among empathy, burnout and life satisfaction in medical students. The objective of the present study is to explore the correlations of empathy and burnout with life satisfaction and the associated socio-demographic factors among Chinese undergraduate medical students.

METHODS

In this cross-sectional study, 1271 undergraduate medical students (age 19.42 ± 1.34 years, 36% male) from 1st to 4th grades completed questionnaires including the Interpersonal Reactivity Index Chinese version (IRI-C), the Maslach Burnout Inventory Modified Chinese version (MBI-MC), the Satisfaction With Life Scale (SWLS) and socio-demographic characteristics. Statistical analyses included Student's t-test, one-way ANOVA, post hoc Bonferroni tests, hierarchical linear regression analysis and general linear model-univariate full factorial model.

RESULTS

Over four academic years, medical students' empathy levels declined, but their burnout levels almost plateaued and their life satisfaction levels witnessed an initial fall before a rebound. Empathy was correlated with students' age and grade, and burnout was associated with students' maternal education. Significant differences in life satisfaction were detected with regard to medical students' age, academic year, the number of children in the family, place of residence and parents' educational levels.

CONCLUSIONS

Empathy explained 0.6% of the variance in life satisfaction in contrast to 13.7% of the variance explained by burnout in life satisfaction. Although empathy did not have a main effect on life satisfaction, there was an interaction effect of empathy and burnout on life satisfaction among students of high and low empathy and burnout levels. Students with high levels of empathy and low levels of burnout were most satisfied with life. Medical institutions and related authorities need to find effective measures to enhance students' empathy levels and reduce burnout to improve their life satisfaction.

A cross-sectional study of burnout and its associations with learning environment and learner factors among psychiatry residents within a National Psychiatry Residency Programme

BACKGROUND

Multiple studies have reported high burnout rates among residents, including psychiatry. There is a paucity of studies examining the relationship between burnout and learning context, stress levels, resilience, stigma in healthcare providers and coping methods concurrently within the same cohort.

OBJECTIVE

We examined the rate of burnout among our psychiatry residents in a cross-sectional study and hypothesised that burnout is associated with poorer perception of learning environment, greater perceived stress, stigma levels, lower resilience and specific coping strategies during training.

METHODS

Ninety-three out of 104 psychiatry residents (89.4%) within our National Psychiatry Residency Programme participated in the study from June 2016 to June 2018. Relevant scales were administered to assess the perception of learning environment, burnout, stress, resilience, stigma levels and coping methods, respectively. We performed comparisons of the above measures between groups (burnout vs no burnout) and within-group correlations for these same measures.

RESULTS

Overall, 54.8% of the sample met criteria for burnout. Residents with burnout had poorer perception of the learning environment, greater stress levels (both p<0.001), were less willing to disclose/seek help and employed greater active-avoidance coping strategies. Within the burnout group, greater perceived stress was correlated with poorer perception of learning environment (r_s=-0.549) and greater use of active-avoidance coping (r_s=0.450) versus additional use of problem-focussed coping within the non-burnout group.

CONCLUSIONS

Burnout was related to both environment and learner factors. These findings viewed within the transactional, sequential and imbalance models of burnout suggest the need to address stressors, beef up coping, provide continual support and develop resilience among our learners.

Evaluating the educational environment in a residency programme in Singapore: can we help reduce burnout rates?

INTRODUCTION

The educational environment (EE) reflects the quality of a residency programme and has an association with burnout. Studying the EE allows for interventions to target specific weaknesses. We aimed to measure the EE of an internal medicine residency programme in Singapore, compare the perceptions between genders, residency grades and levels of work experience, and identify specific areas of weaknesses for intervention in hopes of reducing residency burnout rates in Singapore.

METHODS

This study took place between October and December 2017. We adopted a mixed methods approach, quantitatively using the Postgraduate Hospital Educational Environment Measure (PHEEM), and qualitative exploration using semi-structured focus group discussion.

RESULTS

A total of 136 (88.9%) out of 153 residents responded. Our total PHEEM scores (112.23 ± 16.71), along with the scores for all three subscales, were higher than those of institutions in previous studies. There were no differences in overall PHEEM and subscale scores between genders, residency grades or levels of work experience. However, there were differences for individual questions, which were explored in the focus group discussion. Senior residents juggling heavier workloads, responsibilities and examinations appeared to be most prone to burnout. We identified three recurring themes that contributed to a poor EE in our programme: excessive workload, poor faculty relationships and differing unmet needs.

CONCLUSION

Although our programme had a good EE, there were also areas of weaknesses revealed by specific questions, possibly contributing to burnout. We hope to implement interventions to these areas and subsequently assess for longitudinal changes in EE and burnout rates.

Using the Postgraduate Hospital Educational Environment Measure to Identify Areas for Improvement in a Singaporean Residency Program

BACKGROUND

Attributes of the clinical learning environment (CLE) are a measure of quality in postgraduate medical education, and assessing the CLE is a component of the New Accreditation System being introduced in Singapore by the Accreditation Council for Graduate Medical Education International. There is a dearth of published studies of CLE quality in Singapore.

OBJECTIVE

Our study had 3 aims: (1) to measure the CLE in 1 Singaporean residency program; (2) to compare trainee perceptions by sex, training level, and experience; and (3) to identify areas for improvement.

METHODS

Between October and December 2017, we conducted a mixed assessment of the CLE in an internal medicine program in Singapore, using the Postgraduate Hospital Educational Environment Measure (PHEEM) and qualitative exploration using a focus group.

RESULTS

Of 153 IM residents, 136 (89%) provided PHEEM responses and 8 participated in the focus group. Total PHEEM scores and scores for the 3 subscales were higher than published data on the use of the PHEEM in international settings. Exploration of selected PHEEM responses via a focus group identified attributes associated with negative perceptions of the CLE: excessive workload, inadequate faculty presence in the CLE, and unmet trainee needs. It also suggested senior residents' clinical workloads, greater responsibilities, and pending examinations may contribute to their less positive perceptions of the CLE.

CONCLUSIONS

Our analysis using the PHEEM showed overall positive perceptions of the CLE, along with areas for improvement amenable to interventions. Our approach has relevance to an accreditation model with ongoing evaluation of the CLE.

Burnout and associated factors in psychiatry residents: a systematic review

OBJECTIVES

This study aimed to systematically review extant data on the prevalence of burnout amongst psychiatry residents, examine the contributory factors, and consider potential ways to manage burnout.

METHODS

A systematic literature review was conducted on all relevant articles within Pubmed/OVID Medline and ScienceDirect digital databases from January 2000 till March 2019 that investigated burnout in psychiatry residents. Variables of interest included questionnaires used to assess burnout, the prevalence of burnout, and its clinical correlates. Articles were included if they were observational or experimental studies and involved a sample consisting solely of or a subsample of psychiatry residents. The data are summarised and presented as a narrative synthesis.

RESULTS

Twenty-two studies were included. The overall prevalence of burnout among psychiatry residents was 33.7%, which was associated with certain demographic (non-parental status), training (juniors years of training, lower priority of psychiatry as career choice, lack of clinical supervision, discontinuation from training), work (high workload, long hours, insufficient rest), and learner factors (more stressors, greater anxiety, and depressive symptoms, low self-efficacy, decreased empathic capacity, poor coping, self- medication, and use of mental health services).

CONCLUSIONS

These findings suggest that interventions such as refining candidate selection, enforcement of work hour limits, enhancement of support and supervision, and equipping of stress coping skills may ameliorate burnout related to training, work, and learner factors respectively. These findings and suggestions may apply to other residency programs. However, future studies should examine burnout longitudinally and evaluate the effectiveness of different interventions in reducing burnout within psychiatry residents.

Association Between Empathy and Burnout Among Emergency Medicine Physicians

Background

The association between physician self-reported empathy and burnout has been studied in the past with diverse findings. We aimed to determine the association between empathy and burnout among United States emergency medicine (EM) physicians using a novel combination of tools for validation.

Methods

This was a prospective single-center observational study. Data were collected from EM physicians. From December 1, 2018 to January 31, 2019, we used the Jefferson scale of empathy (JSE) to assess physician empathy and the Copenhagen burnout inventory (CBI) to assess burnout. We divided EM physicians into different groups (residents in each year of training, junior/senior attendings). Empathy, burnout scores and their association were analyzed and compared among these groups.

Results

A total of 33 attending physicians and 35 EM residents participated in this study. Median self-reported empathy scores were 113 (interquartile range (IQR): 105 - 117) in post-graduate year (PGY)-1, 112 (90 - 115) in PGY-2, 106 (93 - 118) in PGY-3 EM residents, 112 (105 - 116) in junior and 114 (101 - 125) in senior attending physicians. Overall burnout scores were 43 (33 - 50) in PGY-1, 51 (29 - 56) in PGY-2, 43 (42 - 53) in PGY-3 EM residents, 33 (24 - 47) in junior attending and 25 (22 - 53) in senior attending physicians separately. The Spearman correlation (ρ) was -0.11 and β-weight was -0.23 between empathy and patient-related burnout scores.

Conclusion

Self-reported empathy declines over the course of EM residency training and improves after graduation. Overall high burnout occurs among EM residents and improves after graduation. Our analysis showed a weak negative correlation between self-reported empathy and patient-related burnout among EM physicians.

Training residents in patient-centred communication and empathy: evaluation from patients, observers and residents

BACKGROUND

Patient-centred communication and empathy are key enablers for patient-centred care. However, several studies suggest a downward trend regarding the empathic communication skills of physicians during medical residency. It is known that communication training can have a positive effect on patient-centred communication, empathy and relational skills. Training residents in patient-centred communication and empathy can be an opportunity to improve the patient-centred care. To evaluate the training a tri-focal perspective will be used.

METHODS

A 3-day training was developed to improve residents' patient-centred communication and empathy skills at an academic medical health centre, in the Netherlands. The training included: (1) the basics of patient-centred communication and empathy (through presentations, scientific literature), (2) practicing with actors, and (3) reflecting on residents' video recorded consultations (by themselves and communication experts). A pilot study with a pre-post design was conducted to evaluate the training from patient and observer perspectives. Semi-structured interviews were used to get insight into residents' perspective. Nine residents from different specialities followed the training and enrolled in the pilot study. During two random days consultations between residents and patients were video recorded. Patients were asked to fill in two questionnaires, indicating their perspective on residents' empathy and communication skills before as well as after the consultation. All video recorded consultations were coded to rate residents' communication skills, empathy, computer use and agenda-setting. Statistical analysis were performed using multilevel analysis.

RESULTS

A total of 137 eligible patients took part in the pilot study. Trained residents showed significant improvement in patient-rated empathy scores. According to observers, residents' computer use improved significantly after the training. The communication skills of trained residents did not improve significantly. Agenda setting by residents showed a downward trend. Almost all residents were satisfied with the training, especially with the video-feedback.

CONCLUSIONS

A brief training significantly increased residents' empathy scores according to patients and significantly decreased residents' computer use according to observers. These findings indicate that the quality of patient-centred care can be improved by integrating patient-centred communication into residency programs, at an academic medical health centre. The ultimate goal is to structurally embed the training in residents' education program.

Burnout in French physicians: A systematic review and meta-analysis

BACKGROUND

Burnout syndrome is the consequence of chronic work-related stress exposure and is 2-3 times higher than in physicians than in other professions. Many studies exploring burnout in French physicians have been published with inconsistent data regarding its prevalence and associated factors.

OBJECTIVE

To assess the prevalence of burnout and associated factors in French physicians in a systematic review and meta-analysis.

MATERIAL AND METHODS

Studies assessing the prevalence of French physician's burnout and its three dimensions emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA) were selected in the following databases from 2000 to April 2017: MEDLINE, BIOSIS WEB OF SCIENCE, PASCAL ET FRANCIS, SCIENCES DIRECT, PSYCHinfo, and BDSP. Burnout was defined by one abnormal score in one or more of the 3 dimensions of the MBI scale (EE, DP or PA). Severe burnout was defined by the association of high scores of EE and DP, and low score of PA. High EE was defined by an EE score ≥27. High DP was defined by a score ≥10. Low PA was defined by a score ≤33.

RESULTS

A total of 37 studies and 15,183 French physicians were included in the present meta-analysis. The random effects pooled prevalence estimate was 49% (95% CI 45%-53%, P < 0.001, I² = 93.1%) for burnout, 5% (95% CI 4-7, P < 0.001, I²= 92.7%) for severe burnout, 21% (95% CI 19-24, P < 0.001, I² = 94.7%) for high EE, 29% (95% CI 25-33, P < 0.001, I² = 96.7%) for high DP, and 29% (95% CI 24-34, P < 0.001, I² = 97.7%) for low PA. Emergency physicians were found to have a trend to higher rates of burnout (P = 0.051), and significantly more severe burnout compared to other physicians (b = 0.05, se[b] = 0.02, P = 0.019). Junior residents were found to have higher rates of DP; junior residents, sample size, and monthly number of night shifts were associated with lower PA; and anesthesiologists were found to have lower rates of high EE and high DP.

CONCLUSION

Burnout is highly prevalent in French physicians. Some recommendations may be suggested to reduce this rate, including reducing the number or duration of night shifts to increase personal accomplishment and targeting emergency physicians and junior residents in priority. Other specialties should be explored in future studies.