Vocation and avocation: leisure activities correlate with professional engagement, but not burnout, in a cross-sectional survey of UK doctors

Hobbies, Distractions, Obsessions, and Addictions

A career in cardiothoracic surgery takes a psychological and emotional toll, which is likely increased by recent changes in our health care environment. The benefits of leisure pursuits are severalfold, one of which includes supporting physician wellness. However, we are at risk of relying on unhealthy mechanisms to provide relief. The incidence of addiction and substance abuse is high, particularly among women surgeons. There are a variety of opportunities to help ourselves and support our colleagues. We need to promote healthy activities outside of our profession for the long-term well-being of cardiothoracic surgeons and our specialty.

Analysis of hospitalization expenses and influencing factors for elderly cancer patients in a tertiary hospital in Dalian, China: a five‑year retrospective study

BACKGROUND

Because the proportion of elderly individuals and the incidence of cancer worldwide are continually increasing, medical costs for elderly inpatients with cancer are being significantly increasing, which puts tremendous financial pressure on their families and society. The current study described the actual direct medical costs of elderly inpatients with cancer and analyzed the influencing factors for the costs to provide advice on the prevention and control of the high medical costs of elderly patients with cancer.

METHOD

A retrospective descriptive analysis was performed on the hospitalization expense data of 11,399 elderly inpatients with cancer at a tier-3 hospital in Dalian between June 2016 and June 2020. The differences between different groups were analyzed using univariate analysis, and the influencing factors of hospitalization expenses were explored by multiple linear regression analysis.

RESULTS

The hospitalization cost of elderly cancer patients showed a decreasing trend from 2016 to 2020. Specifically, the top 3 hospitalization costs were material costs, drug costs and surgery costs, which accounted for greater than 10% of all cancers according to the classification: colorectal (23.96%), lung (21.74%), breast (12.34%) and stomach cancer (12.07%). Multiple linear regression analysis indicated that cancer type, surgery, year and length of stay (LOS) had a common impact on the four types of hospitalization costs (P < 0.05).

CONCLUSION

There were significant differences in the four types of hospitalization costs for elderly cancer patients according to the LOS, surgery, year and type of cancer. The study results suggest that the health administration department should enhance the supervision of hospital costs and elderly cancer patient treatment. Measures should be taken by relying on the hospital information system to strengthen the cost management of cancer diseases and departments, optimize the internal management system, shorten elderly cancer patients LOS, and reasonably control the costs of disease diagnosis, treatment and department operation to effectively reduce the economic burden of elderly cancer patients.

World Psychiatric Association-Asian Journal of Psychiatry Commission on the Mental Health and Wellbeing of International Medical Graduates

Historically, doctors have migrated for a range of personal, educational, economic, and political reasons. Likewise, medical students from many countries have moved abroad to complete their training and education and may or may not return to their country of origin. Within this context, globalisation has had a major impact on medical education and healthcare workforces, contributing to recent migration trends. Globalisation is a complex phenomenon with positive and negative outcomes. For example, lower-income countries are regularly losing doctors to higher-income areas, thereby exacerbating strains on existing services. Across various national healthcare settings, migrating International Medical Graduates (IMGs) can face socioenvironmental and psychosocial pressures, which can lead to lower mental wellbeing and undermine their contributions to clinical care. Rates of stress and burnout are generally increasing for doctors and medical students. For IMGs, stressors related to migration, acculturation, and adjustment are not dissimilar to other migrants but may carry with them specific nuances. Accordingly, this Commission will explore the history of IMG trends and the challenges faced by IMGs, proposing recommendations and solutions to support their mental health and wellbeing.

Are Richard Wagner's operas a potential tool to teach medical students and young doctors humanities?

There is an increasing interest in using poems and novels as a powerful resource to teach medical students ethical and professional behavior, virtues, and to illustrate the complexity of the doctor-patient relationship. This approach as part of a narrative medicine provides a framework for approaching a patient's problems more holistically and also offers a method for addressing existential inner qualities such as grief, hope, and despair that are part of illnesses. Occasionally, operas (mainly Italian) have also been used for this purpose. I however, propose that medical students may learn a lot from a deeper confrontation with the operas from the German composer Richard Wagner (1813-1883). Certainly, Wagner had a rather self-centered personality, also known for his notorious nationalistic and anti-Semitic essays, but his complete Gesamtkunstwerk (total work of art) encompasses almost every human feeling, conflict, and psychological problem including suffering, compassion, redemption, etc. Wagner's opera somewhat reflected his unsteady life. Wagner was convinced that his art could fill the void left by the retreat of traditional religion, suggesting that humanity may achieve freedom through the perception of beauty uniting communities through shared aesthetic experience. Not a very modest approach and not a very likable character, but a great composer. After a short biography, I will provide some (because of the complexity of the subject, naturally limited) arguments on what medical students can learn from Wagner operas, even though I am convinced that Wagner and his music are not easy to digest, even for experienced opera lovers.

KEY MESSAGES

Partner similarity and social cognitive traits predict social interaction success among strangers

Social interactions are a ubiquitous part of engaging in the world around us, and determining what makes an interaction successful is necessary for social well-being. This study examined the separate contributions of individual social cognitive ability and partner similarity to social interaction success among strangers, measured by a cooperative communication task and self-reported interaction quality. Sixty participants engaged in a 1-h virtual social interaction with an unfamiliar partner (a laboratory confederate) including a 30-min cooperative 'mind-reading' game and then completed several individual tasks and surveys. They then underwent a separate functional MRI session in which they passively viewed video clips that varied in content. The neural responses to these videos were correlated with those of their confederate interaction partners to yield a measure of pairwise neural similarity. We found that trait empathy (assessed by the interpersonal reactivity index) and neural similarity to partner both predicted communication success in the mind-reading game. In contrast, perceived similarity to partner and (to a much lesser extent) trait mind-reading motivation predicted self-reported interaction quality. These results highlight the importance of sharing perspectives in successful communication as well as differences between neurobiological similarity and perceived similarity in supporting different types of interaction success.

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.

Coping Distress through Harvesting Resilience Among Indian Physicians: Role of Mediating–Moderating Variables

The study proposes to understand the dynamics of work stress and turnover relationship of physicians in Indian context. It also intends to understand the mediating and moderating roles of burnout and resilience on the relationship between work stress and turnover intentions. The article has taken the support of conservation of resources (COR) theory to develop the conceptual framework. The study uses the survey method for data collection which was analysed using quantitative statistical methods like confirmatory factor analysis and mediated and moderated regression. The result showed a significant moderating effect of resilience on burnout and turnover intentions relationship and a strong mediating effect of burnout on the relationship between stress and turnover intentions. Physicians who are regarded as ‘saviours’ should be treated with respect. Certain activities dealing with work–life balance, engaging in leisure activities, getting support from family and friends may help the physician in coping with the demands of stress and thereby reducing the burnout. Future research can take into account other states of India as well as other countries for generalisation of results. The demographic differences among the physicians can also be a new area of research. Although there is lot of available research on the study variables, but none of the studies have taken into context resilience as a moderator between burnout and turnover intention specially in reference to Indian context. The results can add value to the prevailing studies on stress, burnout, resilience and turnover intention.

Psychological distress among hospital caregivers during and after the first wave of COVID-19: Individual factors involved in the severity of symptoms expression

Coronavirus disease 2019 has spread rapidly over the globe and has put an unprecedent psychological pressure on health care workers (HCWs). The present study aimed at quantifying the psychological consequences of the COVID-19 pandemic on HCWs during and after the first wave and identify sociodemographic, situational, and psychological risk/protective factors for symptoms severity. An online survey was sent by e-mail to all nurses and physicians employed by a teaching hospital in Brussels, Belgium. 542 (20,62%) completed the survey. 47%, 55%, 32% and 52% of participants reported posttraumatic stress, anxiety, depression and insomnia symptoms, respectively, during the peak. Two to three months later, posttraumatic symptoms emerged de novo in 54% of HCWs. It persisted in 89% of those presenting severe symptoms initially. Neuroticism was the strongest predictor of posttraumatic stress, anxiety, and insomnia. Work overload was the strongest predictor of depression and second predictor of posttraumatic stress, anxiety, and insomnia. Other significant predictors included being a nurse, the number of past traumatic experiences, avoidant coping style, and expressive suppression of emotions.

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.

A better way of life: The role of leisure activities on self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support in psychiatrists and psychiatry trainees in Mexico

BACKGROUND

Psychiatrists are at high risk of developing burnout and mental health problems mainly due to their emotionally demanding jobs, difficult working conditions, long working hours, and poor work-life balance. As leisure activities are associated with better physical and mental health, engaging in these activities has been recommended as a measure to improve the wellbeing of healthcare workers. However, it is unclear the extent of which psychiatrists and trainees are involved in leisure activities, what type of activities they prefer, or how these impact their self-perceived health, stress, confidence in stress management, and satisfaction with their social support.

OBJECTIVE

The aim of this study was to identify differences in self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support, between psychiatrists and trainees who engage in different leisure activities, compared with those who do not.

METHODS

This was a cross-sectional study, including Mexican psychiatrists (n = 355) and trainees (n = 330) who agreed to participate through an online survey.

RESULTS

73.1% of participants engaged in some leisure activity, being solitary-passive activities the most reported. Those who have a leisure activity reported lower stress, greater confidence in stress management, and more satisfaction with their social support. Passive-solitary activities were associated with less perceived stress and better confidence in stress management, while active-solitary and social activities were associated with better satisfaction with social support.

CONCLUSION

Psychiatrists' and trainees' wellbeing benefits from engagement in leisure activities, which should be part of their daily schedules to reduce stress, and potentially improve their mental health.

The influence of personality, alexithymia and work engagement on burnout among village doctors in China: a cross-sectional study

BACKGROUND

In China, as the "gatekeepers"of rural residents' health, the primary-level village doctors, play a very crucial role in ensuring and serving the health level of rural residents. However, the burnout of village doctors is gravely threatening the stability of rural primary medical system step by step. This study systematically evaluated the effects of personality, work engagement and alexithymia on burnout of village doctors, and further measured and assessed the mediating effect of alexithymia and work engagement in the association between personality and burnout.

METHODS

The subjects were 2684 village doctors in Jining, Shandong Province, China, from May to June 2019. Sociodemographic characteristics, alexithymia, personality, work engagement and job burnout were quantitated by self-completed questionnaire and measured by Likert 5-7 scale. One-way ANOVA, Person correlation analysis, and Structural Equation Modelling (SEM) were used for statistical analysis and mediating effect evaluation.

RESULTS

2693 questionnaires were collected in total, of which 2684 were valid, with an effective rate of 96.2%. 65.2% of village doctors were diagnosed with burnout, and 54.3% showed moderate to severe emotional exhaustion, 61.6% showed moderate to severe low sense of personal achievement, and 33.9% showed moderate to severe depersonalization burnout. Personality had a direct positive effect on work engagement (β = 0.50, p < 0.001), a direct negative effect on alexithymia (β = - 0.52, p < 0.001) and burnout (β = - 0.50, p < 0.001) respectively. Work engagement had a direct negative effect on burnout (β = - 0.10, p < 0.001), while alexithymia had a direct positive effect on burnout (β = 0.16, p < 0.001). In the path between personality and burnout, both work engagement 95%CI:(- 0.17)-(- 0.08), and alexithymia 95%CI:(- 0.36)-(- 0.09), have significant mediating effects. These results strongly confirm that personality, alexithymia, and work engagement are early and powerful predicators of burnout.

CONCLUSION

According to the results, medical administrators should pay attention to the personality characteristics of village doctors in vocational training, practice selection and job assignment, encourage village doctors to reflect on their own personality actively, and to reduce job burnout by obtaining necessary social support, constructing reasonable achievable career expectations, improving time management ability, and participating in psychological counselling programs.

The Risk Factors for Chinese Medical Economic Burden of Aging: A Cross-Sectional Study Based on Guangdong Province

Background

The proportion of aging in China is increasing, which needs more healthcare recourses. To analyze the risk factors of the direct medical economic burden of aging in China and provide the strategies to control the cost of treatment, the information was collected based on Guangdong Province's regular health expenditure accounting data collection plan.

Methods

The multiple linear regression models were used to explore the risk factors of inpatient expenses of the elderly in Guangdong province.

Results

The results revealed that hospital day, age, male patients, and patients who suffer from malignant tumors are key factors to increase the direct medical economic burden of aging. Moreover, the medical insurance for urban employees can reduce the medical economic burden, comparing with the medical insurance for urban residents.

Conclusions

The basic medical insurance system and the serious illness insurance system should be improved. While striving to speed up the development of regional economy, the government should pay attention to the construction of basic medical institutions in economically backward areas, increase the allocation of health human resources, and facilitate the masses to seek medical treatment nearby.

Exploring the Impact of Primary Care Physician Burnout and Well-Being on Patient Care: A Focus Group Study

OBJECTIVES

The aims of the study were (1) to explore whether primary care physicians (general practitioners [GPs]) perceive burnout and well-being to impact on the quality and safety of patient care and (2) to determine potential mechanisms behind these associations.

METHOD

Five focus groups with 25 practicing GPs were conducted in England, either in the participants' practice or in a private meeting room outside of their workplace.An interview schedule with prompts was followed with questions asking how participants perceive GP burnout and poor well-being could impact on patient care delivery. Audio recordings were transcribed verbatim and analyzed using thematic analysis.

RESULTS

General practitioners believed that poor well-being and burnout affect the quality of care patients receive through reducing doctors' abilities to empathize, to display positive attitudes and listening skills, and by increasing the number of inappropriate referrals made. Participants also voiced that burnout and poor well-being can have negative consequences for patient safety, through a variety of mechanisms including reduced cognitive functioning and decision-making abilities, a lack of headspace, and fatigue. Furthermore, it was suggested that the relationship between well-being/burnout and mistakes is likely to be circular.

CONCLUSIONS

Further research is needed to ascertain the validity of these perceptions. If found, physicians, healthcare organizations, and policy makers should examine how they can improve physician well-being and prevent burnout, because this may be a route to ensure high-quality and safe patient care.

A real-time measurement of general practice workload in the Republic of Ireland: a prospective study

Background

Demand for GP services in the Republic of Ireland (RoI) is increasing, and the resultant escalation in workload demands is an issue of growing concern. Accordingly, the accurate measurement and description of GP workload is essential to inform future healthcare planning.

Aim

To provide a real-time measurement of GP workload with respect to hours worked and of proportional time expenditure on typical workload activities.

Design and setting

A prospective study among GPs in the RoI that took place from January 2019 to March 2019.

Method

Participants were invited to enrol in the study by direct email invitation and via notifications posted within GP-specific monthly journals; online forums; and a social media platform. Participants used a time-management software program to self-record workload activity in real time over 6 weeks.

Results

In total, 123 GPs were included for final analyses with a total of 8930 hours of activity recorded. The mean duration of a two-session day (excluding break-time) was 9.9 hours (95% confidence interval [CI] = 9.7 to 10.0; interquartile range [IQR] 7.9 to 13.9). Of this time, 64% was spent on clinical consultations. In total, 25.4% of activity was recorded outside the hours of 9.00 am and 5.00 pm. An average of 12.4 face-to-face consultations were completed per session of activity. The mean duration of a 10-session week was greatest for the partner (50.8 hours; 95% CI = 49.8 to 51.9) and >55-year-old (50.8 hours; 95% CI = 49.3 to 52.2) demographics, relative to their respective colleagues.

Conclusion

To the authors’ knowledge, this is the first study to provide an objective, accurate, and granular real-time measurement of GP workload in the RoI, demonstrating the significant volume and variety of work undertaken by GPs in the RoI.

Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review

Background

The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem.

Objectives

Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts.

Design

Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.

Data sources

Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites.

Review methods

We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations.

Results

A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective.

Limitations

Variable quality of included literature; limited UK-based studies.

Future work

Use this evidence synthesis to refine, implement and evaluate interventions.

Study registration

This study is registered as PROSPERO CRD42017069870.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.

Association of GP wellbeing and burnout with patient safety in UK primary care: a cross-sectional survey

BACKGROUND

GPs have particularly high levels of burnout and poor wellbeing. Although both are associated with poorer safety outcomes within secondary care, there have been no quantitative studies investigating this within primary care. Furthermore, little is known about how occupational demands, burnout and wellbeing, and patient safety are all associated.

AIM

To investigate whether occupational variables (demands and support) are associated with patient safety outcomes in general practice through their influence on GP burnout and wellbeing.

DESIGN AND SETTING

Cross-sectional survey in the UK between March 2016 and August 2017.

METHOD

A total of 232 practising GPs completed an online or paper survey measuring burnout, wellbeing, occupational demands and support, and patient safety.

RESULTS

In all, 93.8% of GPs were classed as likely to be suffering from a minor psychiatric disorder, 94.7% as suffering from mild (22.0%) or severe (72.7%) exhaustion, and 86.8% as having mild (37.9%) or severe (48.9%) disengagement. Structural equation modelling (SEM) analyses showed that spending a higher number of hours on administrative tasks and on call, and feeling less supported in their practice, was associated with lower wellbeing, which in turn was associated with a higher likelihood of having reported a near miss in the previous 3 months. A higher number of hours spent on administrative tasks, a higher number of patients seen per day, and feeling less supported were associated with higher burnout levels, which in turn was associated with worse perceptions of safety.

CONCLUSION

To improve patient safety within general practice changes could be made at both practice and individual levels to promote a healthier work environment for staff and patients.

Burnout and Engagement: Personality Profiles in Nursing Professionals

The burnout syndrome, which affects many healthcare workers, has recently attracted wide interest due to the severe repercussions related to its effects. Although job factors determine its development, not all individuals exposed to the same work conditions show burnout, which demonstrates the importance of individual variables, such as personality. The purpose of this study was to determine the personality characteristics of a sample of nursing professionals based on the Big Five model. After having determined the personality profiles, we aimed to analyze the differences in burnout and engagement based on those profiles. The sample was made up of 1236 nurses. An ad hoc questionnaire was prepared to collect the sociodemographic data and the Brief Burnout Questionnaire, the Utrecht Work Engagement Scale and the Big Five Inventory-10 were used. The results showed that the existence of burnout in this group of workers is associated negatively with extraversion, agreeableness, conscientiousness and openness to experience, and it is associated positively with the neuroticism personality trait. These personality factors showed the opposite patterns with regard to engagement. Three different personality profiles were also found in nursing personnel, in which professionals who had a profile marked by strong neuroticism and low scores on the rest of the personality traits were the most affected by burnout.

The worthless remains of a physician's calling: Max Weber, William Osler, and the last virtue of physicians

On the centenary of Max Weber's "Science as a Vocation," his essay still performs interpretative work. In it, Weber argues that the vocation of a scientist is to produce specialized, rationalized knowledge that will be superseded. Weber says this vocation is a rationalized version of the Protestant conception of calling or vocation (Beruf), tragically disenchanting the world and leaving the idea of calling as a worthless remains (caput mortuum). A similar trajectory can be seen in the physician William Osler's writings, especially his essay "Internal Medicine as a Vocation," in which the calling of a physician is described as both rational and noble. While Osler's conception of the physician's vocation has been formative for contemporary medicine, physicians are reporting burnout and leaving medical practice at escalating rates. As physicians abandon their noble vocations, an alternative conception of a physician's vocation is needed. From the worthless remains of the physician's rational and noble vocation, the labor of a physician can find grounding in humility.

Measuring a state of mind indicative of thriving using the Student Pharmacist Inventory of Professional Engagement (S-PIPE)

BACKGROUND

Professional engagement has importance to the professional of pharmacy, and in particular the growth of student pharmacists. Measurement of this construct would allow investigation of factors that may increase or decrease professional engagement.

OBJECTIVES

To describe the development of the Student Pharmacist Inventory of Professional Engagement (S-PIPE), assess the factor structure and convergent validity, and test for differences in professional engagement based upon demographic and background factors.

METHODS

Potential items for the S-PIPE were developed iteratively through inductive and deductive item-writing, 2 pilot administrations, expert review of items, and assessment of the content validity index, and cognitive interviews with students. The S-PIPE was administered to a cohort of 164 first year student pharmacists at University of Minnesota, along with items querying types and level of involvement in professional experiences and activities. An exploratory factor analysis was conducted using principal axis factoring extraction and Promax rotation. The number of factors to retain was based upon eigenvalues, examination of the scree plot, and a parallel analysis. Factors of the S-PIPE were compared to self-rated level of involvement and other demographic factors.

RESULTS

Three factors were retained accounting for 70.7% of the variance, and named Belonging (α = 0.942, 9 items), Connectedness (α = 0.864, 3 items), and Meaningful Experience (α = 0.760, 4 items). All 3 factors were significantly correlated to self-rated involvement (r = 0.291 to 0.370). Level of professional engagement differed in this study by gender, and pharmacy work experience.

CONCLUSIONS

This study lays the foundation for quantitative research in professional engagement among student pharmacists. Future work is needed to further validate and extend these findings.

Burnout and psychiatric morbidity among doctors in the UK: a systematic literature review of prevalence and associated factors

Aims and method To systematically review the prevalence and associated factors of burnout and stress-related psychiatric disorders among UK doctors. An extensive search was conducted of PubMed, EBSCOhost and British medical journals for studies published over a 20-year span measuring the prevalence of psychiatric morbidity (using the General Health Questionnaire) and burnout (using the Maslach Burnout Inventory). Results Prevalence of psychiatric morbidity ranged from 17 to 52%. Burnout scores for emotional exhaustion ranged from 31 to 54.3%, depersonalisation 17.4 to 44.5% and low personal accomplishment 6 to 39.6%. General practitioners and consultants had the highest scores. Factors significantly associated with increase in the prevalence of burnout and psychiatric morbidity include low job satisfaction, overload, increased hours worked and neuroticism. Clinical implications The results indicate a worryingly high rate of burnout and psychiatric morbidity among UK doctors, which could have a huge negative impact on healthcare provision in general. Factors at personal and organisational levels contribute to burnout and psychiatric morbidity, and so efforts made to counter these problems should target both levels.

Burnout syndrome in health-care professionals in a university hospital

OBJECTIVE:

To evaluate professional achievement and factors associated with occupational burnout among health professionals.

METHODS:

An institution-based cross-sectional study was conducted on 436 healthcare providers, consisting of 101 nurses, 81 doctors and 254 nursing technicians, all meeting pre-established inclusion criteria. Occupational burnout was detected using the Maslach occupational burnout inventory tool. Data were collected by self-administered questionnaires comprising questions concerning socio-demographics, education and training, and the Maslach occupational burnout inventory was used to identify levels of emotional exhaustion, depersonalization and professional achievement.

RESULTS:

Emotional exhaustion was associated with education level and work place for nursing technicians. Depersonalization was associated with gender in nursing technicians. For nurses, depersonalization showed a significant association with education level, whereas this factor was associated with number of jobs for doctors. Lower levels of professional achievement were observed for unspecialized doctors compared to those with further training. Higher levels of professional achievement were associated with professionals with postgraduate training compared to those without.

CONCLUSIONS:

High levels of emotional exhaustion were found in professionals from the maternity unit as well as in professionals with lower educational levels. Depersonalization was higher in physicians with several jobs and in female nurses. Low professional achievement was found in unspecialized doctors, while high professional achievement was associated with postgraduate training.

Compassion Fatigue Among Palliative Care Clinicians: Findings on Personality Factors and Years of Service

Objectives:

Palliative medicine is a rewarding field, but providers encounter patient trauma on a routine basis. Compassion fatigue, marked by burnout, secondary traumatic stress, and low satisfaction may result. However, professionals differ markedly in how they respond to patient trauma. The objective of the current study was to determine whether personality traits of neuroticism and agreeableness relate to aspects of compassion fatigue, after accounting for time spent working in the field.

Methods:

Sixty-six palliative medicine physicians, nurses, social workers, and chaplains completed validated measures of personality traits, compassion fatigue, and work background.

Results:

Providers who had worked longer reported higher levels of satisfaction and lower levels of burnout. Neuroticism demonstrated strong significant associations with secondary traumatic stress and burnout ( Ps < .001). Agreeableness was significantly and strongly associated with compassion satisfaction ( P < .001). These associations held after accounting for years spent working in the field.

Significance of Results:

Personality traits of neuroticism and agreeableness may convey risk and resilience, respectively, for palliative care professionals. More research is needed to determine if assessing personality traits can help identify providers at risk for adverse reactions to patient trauma.

Psychometric properties of WLEIS as a measure of emotional intelligence in the Portuguese and Spanish medical students

The psychometric properties of Wong and Law's (2002) Emotional Intelligence Scale (WLEIS) were analyzed. Participants were 954 medical students: 481 from the University of Extremadura (Spain) and 473 from the University of Lisbon (Portugal). Following Messicks' validation framework, we analyzed the scale's response process, internal structure and relationship with other variables (i.e., engagement). Descriptive statistics, scale reliability, item characteristics, and exploratory and confirmatory analyses supported the distribution of the sixteen items across four factors. Convergent validity analyzed through the ρvc (η) index showed that all the factors were in the 50% criterion. The factors shared, on average, 23% of the variance showing adequate discriminant validity. Furthermore, the correlations among EI dimensions and engagement were all positive and significant. Overall, the WLEIS demonstrated good psychometric properties. Thus, this study ensures that WLEIS is a valid instrument in Portugal and Spain to evaluate EI in medical students.

Burnout Syndrome Among Medical Practitioners Across India: A Questionnaire-Based Survey

BACKGROUND AND OBJECTIVES

Excessive and prolonged work-related stress has always been a cause for burnout among healthcare professionals. This has led to emotional, mental, and physical exhaustion. This survey was conducted to assess the burnout among medical practitioners using the abbreviated Maslach Burnout Inventory (aMBI) and Burnout Clinical Subtype Questionnaire (BCSQ-12) scales.

MATERIALS AND METHODS

A cross-sectional survey was conducted among 482 registered medical practitioners across India. A questionnaire consisting of 25 socio-demographic and occupational questions related to aMBI and BCSQ-12 scales was used to assess the burnout. The distribution of responses for each variable was examined using frequencies and percentages among the subgroups to find out the burnout levels of various components of the scales.

RESULTS

High burnout levels were uniformly recorded for the entire population. For the aMBI, 45.02% (n = 217) and 65.98% (n = 318) of the participants scored high on the emotional exhaustion and depersonalization scales, respectively, whereas 87.14% (n = 420) scored low on the personal accomplishment scale and 62.86% (n = 303) and 11.41% (n = 55) had medium and low scores on the satisfaction with the medical practice scale. The BCSQ-12 scale showed the mean values of 15.89, 11.56, and 10.28 on a scale of 28 for overload, lack of development, and neglect subtypes, respectively, whereas, satisfaction with the financial compensation item showed a mean value of 3.79 on a scale of seven. All these values indicate high levels of burnout.

CONCLUSION

The results suggest high levels of burnout in all domains of aMBI and BCSQ-12 scales in all the occupational and socio-demographic groups of medical practitioners and warrant immediate actions to address this issue.

Rethinking the medical in the medical humanities

To clinicians there are a number of striking features of the ever-evolving field of the medical humanities. The first is a perception of a predominantly unidirectional relationship between medicine and the humanities, generally in terms of what the arts and humanities have to offer medicine. The second is the portrayal of medical practice in terms of problems and negativities for which the medical humanities are seen to pose the solution rather than viewing medicine as an active and positive contributor to an interdisciplinary project. Paradigms that fail to recognise the contributions of medicine and its practitioners (including students) to the medical humanities, this paper argues, will continue to struggle with definition and acceptance. This paper explores the possibilities for advancing the medical humanities through recognition of the contribution of medicine to the humanities and the importance of engaging with the arts, culture and leisure pursuits of doctors and medical students. Our research shows the richness of cultural engagement of medical students, their broad range of cultural interests and their ability to contribute to research and scholarship in the medical humanities. Mutual recognition of strengths, weaknesses and differences of scholarly approach is critical to successful development of the enterprise. Recognising and building on the interests, sympathies and contributions of medicine and its practitioners to the medical humanities is a fundamental component of this task. Future directions might include introductory courses for humanities scholars in aspects of healthcare and medicine.

Confirmation of Maslow's Hypothesis of Synergy: Developing an Acceptance of Selfishness at the Workplace Scale

This study aimed to develop a new Acceptance of Selfishness at the Workplace Scale (ASWS) and to confirm Maslow's hypothesis of synergy: if both a sense of contribution and acceptance of selfishness at the workplace are high, workers are psychologically healthy. In a cross-sectional study with employees of three Japanese companies, 656 workers answered a self-administered questionnaire on paper completely (response rate = 66.8%). Each questionnaire was submitted to us in a sealed envelope and analyzed. The ASWS indicated high internal consistency (Cronbach's alpha = 0.86). Significant (p < 0.001) positive moderate correlations between ASWS scores and job control scores support the ASWS's convergent and discriminant validity. Significant (p < 0.001) associations of ASWS scores with psychological distress and work engagement supported the ASWS's criterion validity. In short, ASWS was a psychometrically satisfactory measure. Significant (p < 0.05) interactions between a sense of contribution and acceptance of selfishness at the workplace in linear regression models showed that when those two factors are low, psychological distress becomes high. However, when a sense of contribution and acceptance of selfishness are high, work engagement also becomes high. Thus, Maslow's hypothesis of synergy was confirmed.

The Academic Backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors

BACKGROUND

Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades.

METHODS

Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register.

RESULTS

Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on measures of educational attainment, undergraduate, and post-graduate performance. Women performed better in assessments but were less likely to be on the Specialist Register. Non-white participants generally underperformed in undergraduate and post-graduate assessments, but were equally likely to be on the Specialist Register. There was a suggestion of smaller ethnicity effects in earlier studies.

CONCLUSIONS

The existence of the Academic Backbone concept is strongly supported, with attainment at secondary school predicting performance in undergraduate and post-graduate medical assessments, and the effects spanning many years. The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge ('cognitive capital' and 'medical capital'). The Academic Backbone provides strong support for using measures of educational attainment, particularly A-levels, in student selection.

Construct-level predictive validity of educational attainment and intellectual aptitude tests in medical student selection: meta-regression of six UK longitudinal studies

BACKGROUND

Measures used for medical student selection should predict future performance during training. A problem for any selection study is that predictor-outcome correlations are known only in those who have been selected, whereas selectors need to know how measures would predict in the entire pool of applicants. That problem of interpretation can be solved by calculating construct-level predictive validity, an estimate of true predictor-outcome correlation across the range of applicant abilities.

METHODS

Construct-level predictive validities were calculated in six cohort studies of medical student selection and training (student entry, 1972 to 2009) for a range of predictors, including A-levels, General Certificates of Secondary Education (GCSEs)/O-levels, and aptitude tests (AH5 and UK Clinical Aptitude Test (UKCAT)). Outcomes included undergraduate basic medical science and finals assessments, as well as postgraduate measures of Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) performance and entry in the Specialist Register. Construct-level predictive validity was calculated with the method of Hunter, Schmidt and Le (2006), adapted to correct for right-censorship of examination results due to grade inflation.

RESULTS

Meta-regression analyzed 57 separate predictor-outcome correlations (POCs) and construct-level predictive validities (CLPVs). Mean CLPVs are substantially higher (.450) than mean POCs (.171). Mean CLPVs for first-year examinations, were high for A-levels (.809; CI: .501 to .935), and lower for GCSEs/O-levels (.332; CI: .024 to .583) and UKCAT (mean = .245; CI: .207 to .276). A-levels had higher CLPVs for all undergraduate and postgraduate assessments than did GCSEs/O-levels and intellectual aptitude tests. CLPVs of educational attainment measures decline somewhat during training, but continue to predict postgraduate performance. Intellectual aptitude tests have lower CLPVs than A-levels or GCSEs/O-levels.

CONCLUSIONS

Educational attainment has strong CLPVs for undergraduate and postgraduate performance, accounting for perhaps 65% of true variance in first year performance. Such CLPVs justify the use of educational attainment measure in selection, but also raise a key theoretical question concerning the remaining 35% of variance (and measurement error, range restriction and right-censorship have been taken into account). Just as in astrophysics, 'dark matter' and 'dark energy' are posited to balance various theoretical equations, so medical student selection must also have its 'dark variance', whose nature is not yet properly characterized, but explains a third of the variation in performance during training. Some variance probably relates to factors which are unpredictable at selection, such as illness or other life events, but some is probably also associated with factors such as personality, motivation or study skills.

Construct-level predictive validity of educational attainment and intellectual aptitude tests in medical student selection: meta-regression of six UK longitudinal studies

BACKGROUND

Measures used for medical student selection should predict future performance during training. A problem for any selection study is that predictor-outcome correlations are known only in those who have been selected, whereas selectors need to know how measures would predict in the entire pool of applicants. That problem of interpretation can be solved by calculating construct-level predictive validity, an estimate of true predictor-outcome correlation across the range of applicant abilities.

METHODS

Construct-level predictive validities were calculated in six cohort studies of medical student selection and training (student entry, 1972 to 2009) for a range of predictors, including A-levels, General Certificates of Secondary Education (GCSEs)/O-levels, and aptitude tests (AH5 and UK Clinical Aptitude Test (UKCAT)). Outcomes included undergraduate basic medical science and finals assessments, as well as postgraduate measures of Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) performance and entry in the Specialist Register. Construct-level predictive validity was calculated with the method of Hunter, Schmidt and Le (2006), adapted to correct for right-censorship of examination results due to grade inflation.

RESULTS

Meta-regression analyzed 57 separate predictor-outcome correlations (POCs) and construct-level predictive validities (CLPVs). Mean CLPVs are substantially higher (.450) than mean POCs (.171). Mean CLPVs for first-year examinations, were high for A-levels (.809; CI: .501 to .935), and lower for GCSEs/O-levels (.332; CI: .024 to .583) and UKCAT (mean = .245; CI: .207 to .276). A-levels had higher CLPVs for all undergraduate and postgraduate assessments than did GCSEs/O-levels and intellectual aptitude tests. CLPVs of educational attainment measures decline somewhat during training, but continue to predict postgraduate performance. Intellectual aptitude tests have lower CLPVs than A-levels or GCSEs/O-levels.

CONCLUSIONS

Educational attainment has strong CLPVs for undergraduate and postgraduate performance, accounting for perhaps 65% of true variance in first year performance. Such CLPVs justify the use of educational attainment measure in selection, but also raise a key theoretical question concerning the remaining 35% of variance (and measurement error, range restriction and right-censorship have been taken into account). Just as in astrophysics, 'dark matter' and 'dark energy' are posited to balance various theoretical equations, so medical student selection must also have its 'dark variance', whose nature is not yet properly characterized, but explains a third of the variation in performance during training. Some variance probably relates to factors which are unpredictable at selection, such as illness or other life events, but some is probably also associated with factors such as personality, motivation or study skills.

Emotional burnout, perceived sources of job stress, professional fulfillment, and engagement among medical residents in Malaysia

This study was the first to explore factors associated with emotional burnout (EB) among medical residents in Malaysia. A cross-sectional study was conducted in a universal sample of 205 medical residents in a Malaysian general hospital. The self-administered questionnaire used consisted of questions on sociodemographics and work characteristics, sources of job stress, professional fulfillment, engagement, and EB. EB was measured using the emotional exhaustion subscale, the Maslach Burnout Inventory (MBI). Mean (±SD) age of the respondents was 26.5 (±1.6). The most common source of job stress was “fear of making mistakes.” Most of the participants were dissatisfied with the increase of residentship period from one year to two years. A high level of EB was reported by 36.6% of the respondents. In multivariate analysis, the most important correlates of EB were sources of job stress, professional fulfillment, and engagement. A high prevalence of EB was found among medical residents. Sociodemographic characteristics, performance pressure, and satisfaction with policies were significantly associated with EB. Although this study was limited by its cross-sectional design, its findings posit a sufficient foundation to relevant authorities to construct, amend, and amalgamate existing and future policies.

Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life—the poetry of the common place, of the common man, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their grief.

SirWilliam Osler, Aphorisms from the Student Life (Aequanimitas, 1952)

Investigating student pharmacist perceptions of professional engagement using a modified Delphi process

OBJECTIVE

To develop a definition of professional engagement, a list of professionally engaging and disengaging activities, and characteristics of those activities.

METHODS

A 2-round modified Delphi process was conducted using student pharmacists. The first round captured input while the second assessed agreement using a 5-point Likert scale.

RESULTS

A definition was created using the 3 items that reached consensus. All engaging characteristics reached consensus, and 25% (3/12) of the disengaging characteristics reached consensus. Lower rates of consensus were observed for activities, with 78% (7/9) of the professionally engaging and none of the disengaging activities reaching consensus.

CONCLUSION

The findings of this study have implications for creating professionally engaging learning experiences for student pharmacists and suggest that ensuring activities contain certain professionally engaging characteristics may be more important than the activities themselves.