Exploring burnout and the association with the educational climate in pediatric residents in Thailand

Burnout and Quality of Work Life among Physicians during Internships in Public Hospitals in Thailand

Physicians are exposed to occupational stress and burnout, which have been identified as contributing to a decrease in the quality of work life (QWL). Thailand's medical education program, consisting of a six-year curriculum with government tuition support followed by three years of internships, provides the context for this investigation. This study aimed to assess the QWL among intern physicians (IPs) in public hospitals and investigated the association between burnout and QWL. A cross-sectional study was conducted among 241 IPs in public hospitals in Thailand utilizing an online self-administered questionnaire. The questionnaire included a Thai version of a 25-item QWL scale and the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. Data analysis was performed using multivariable logistic regression. A significant proportion of IPs experienced low to moderate QWL (72.6%), with low levels of home-work interface (39.4%) and employee engagement (38.6%). In the exploratory model, after adjusting for sex and age, IPs with high depersonalization and low personal accomplishment demonstrated an association with low QWL (adjusted OR, aOR 2.08, 95% CI 1.01 to 4.31; aOR 2.74, 95% CI 1.40 to 5.39). Healthcare organizations should regularly assess intern physicians' QWL and burnout, prioritizing interventions; ensure reasonable work hours, schedule adjustments, and open communication; and develop support systems for cost-effective interventions. Further research on the dynamic relationship between burnout and QWL is crucial for targeted and culturally sensitive interventions.

Mistreatment in paediatric residency programs in Thailand: a national survey

BACKGROUND AND AIMS

Mistreatment in the learning environment is associated with adverse outcomes for residents. Most studies with that regard have been performed in western countries which may have different socio-cultural background and educational and training systems than the non-Western Asian countries. This study aimed (1) to determine the national prevalence of mistreatment in Thai paediatric residents and a correlation with the risk for burnout and other factors and (2) to launch a mistreatment awareness program (MAP) in our training program.

METHODS

The study was divided into two phases. Phase 1, an online survey of mistreatment-related questions, was sent to current paediatric residents across the country. Burnout and depression were also self-evaluated by formal screening questions. The results were categorized by the Negative Acts Questionnaire-Revised into five domains of mistreatment: workplace learning-related bullying (WLRB), person-related bullying (PRB), physically intimidating bullying, sexual harassment, and ethnic harassment. Frequent mistreated exposure was defined as if mistreatment occurred >1/week. Phase 2, MAP was conducted by distributing the results of the first phase with some examples of mistreatment events and mistreatment-related videos. After 3 months, at our centre, the survey was resent to evaluate mistreatment.

RESULTS

The response rate was 27% (n = 140). We found that 91% experienced ≥1 mistreated situation in the prior 6 months. Most mistreatment domains were WLRB and PRB, and residents were commonly instigated by clinical faculty and nurses. Most (84%) mistreated residents did not report the events. An association between frequent mistreated exposure and burnout was also found (P < 0.001). For Phase 2, the mistreated situations especially the WLRB and PRB domains dropped after the launch of MAP.

CONCLUSIONS

Thai paediatric residents frequently perceive mistreatment in their learning environment. Specific aspects of mistreatment, such as WLRB and PRB, should be carefully explored and managed through particular groups of instigators.

Factors affecting residents' internal motivation, grit, and well-being

BACKGROUND

Residents completing competency-based medical education for postgraduate training face many challenging situations that may compromise their well-being or result in exhaustion or burnout. Factors described in self-determination theory and grit are important for residents' achievement of learning outcomes and well-being. This study explored the relationships among internal motivation, grit, well-being, and related factors among non-Western Asian residents.

METHODS

We conducted an explanatory sequential mixed-methods survey-based study to explore correlations among satisfaction with basic psychological needs, grit, and well-being from September to November 2021 among residents at Ramathibodi Hospital, Mahidol University, Thailand. Data were collected with the Basic Psychological Needs Scale, Short Grit Scale, and World Health Organization-Five Well-Being Index. Next, participants with the highest and lowest scores for each scale were purposively invited to participate in semi-structured interviews. Interview data underwent thematic analysis and data collection continued until saturation was reached.

RESULTS

In total, 245 residents (51% major ward, 65% female) completed the survey. There were strong associations between internal motivation, grit, and well-being (r = 0.46-0.90). Female residents had higher autonomy and relatedness scores than males (p = 0.04 and p = 0.01, respectively), and residents with less family responsibility had higher relatedness scores than other residents (p = 0.01). Residents who got more sleep had higher autonomy, relatedness, and well-being scores than those that slept less (p < 0.05). Residents who exercised > 5 times/week had higher well-being scores than other residents (p < 0.01). Thirty residents completed interviews. The thematic analysis revealed internal motivation, grit, and well-being were promoted by a supportive learning environment, a well-designed curriculum, actions and personalities of faculty members, and good personal factors.

CONCLUSION

Internal motivation is significantly correlated with residents' grit, well-being, gender, family burdens, exercise, and sleep hours. Priority should be given to promoting internal motivation, grit, and well-being among residents by enhancing a positive learning environment, creating well-designed curricula, fostering good characteristics and actions among faculty members, and supporting residents' personal lives.

Prevalence and Risk Factors of Burnout Syndrome during COVID-19 Pandemic among Healthcare Providers in Thailand

Objective

To study prevalence, risk factors, and consequences of the COVID-19 pandemic related to Burnout syndrome (BOS) among Thai healthcare providers (HCPs) during the COVID-19 pandemic.

Methods

We performed a cross-sectional study among HCPs, involved in caring for patients during the pandemic in two periods (1st period, May-Jun 2021, and 2nd period, Sep-Oct 2021). Data were distributed using electronic questionnaires. BOS was defined if respondents exhibited a high level of at least one domain in the Maslach Burnout Inventory criteria. The primary outcome was prevalence of BOS.

Results

Altogether, 2,027 and 1,146 respondents were enrolled in the 1st and 2nd periods, respectively. Most respondents were female (73.3, 68.2%). The top three job positions were physicians (49.2, 58.9%), nurses (41.2, 30.6%), and nursing assistants (4.8, 6.5%), respectively. No difference was found in overall prevalence of Burnout syndrome during the 1st and 2nd periods (73 vs. 73.5%, p=0.80). Using multivariate analysis, significant risk factors for Burnout syndrome in both periods were (1) living with family (odds ratio (OR) 1.3 and 1.5), (2) tertiary care hospital (OR 1.92 and 2.13), (3) nurse (OR 1.38 and 2.29), (4) nursing assistant (OR 0.92 and 4.81), (5) salary ≤40,000 THB (OR 1.53 and 1.53), (6) >20 patients per shift (OR 1.55 and 1.88), (7) >6 shifts after hours monthly (OR 1.26 and 1.49), and (8) ≤1 rest day weekly (OR 1.3 and 1.4).

Conclusion

We found a high prevalence of Burnout syndrome among Thai HCPs during the pandemic. Knowing those risk factors may provide a strategy to BOS during the pandemic.

Association between social supports and negative emotions among pediatric residents in China: The chain-mediating role of psychological resilience and burnout

Background

Chinese pediatricians are facing challenges, and there is a need to examine the issue of negative emotions, namely, stress, anxiety and depression, among front-line pediatric residents in clinical settings. Understanding the current situation and influencing factors of negative emotions among pediatric residents in China and exploring the formation mechanism can lay a foundation for psychological interventions.

Methods

A total of 138 pediatric residents in the Children's Hospital, Zhejiang University School of Medicine, China, were surveyed using the Depression Anxiety Stress Scale-21 (DASS-21), Social Support Rating Scale (SSRS), Connor-Davidson Resilience Scale (CD-RISC), and Maslach Burnout Inventory-General Survey (MBI-GS).

Results

(1) The incidence of abnormal stress, anxiety, and depression among pediatric residents was 18.8%, 47.8%, and 47.8% respectively. (2) Negative emotions were significantly negatively correlated with social supports and psychological resilience, and positively correlated with burnout. (3) The chain-mediating effect of resilience and burnout between social supports and negative emotions was significant.

Conclusion

Psychological resilience and burnout played a chain-mediating role between social supports and negative emotions. Measures should be taken to improve the mental health of Chinese pediatric residents.

Current status and problems of orthopaedic residents in Thailand and Myanmar

Background: There is no research about current experiences of orthopaedic residents in Thailand and Myanmar.

Methods: A questionnaire survey was distributed among Thai and Myanmar orthopaedic residents to assess their current experiences. This study included a total of 168 participants, comprising 92 orthopaedic residents in Thailand, and 76 in Myanmar who answered the questionnaire. The survey comprised nine questions about issues such as the contents of residency training programs, current training satisfaction, and future careers. The survey was administered anonymously between October 2020 and January 2021.

Results: Regarding training content, 24 residents (14.3%) reported being "very satisfied", 103  (61.3%) were "satisfied", 37 (22.0%) were "moderately satisfied", and four (2.4%) were "dissatisfied", and respondents spent a mean of 3.1 h/day reading textbooks and research papers. As for salary, five (3.0%) residents answered "satisfied", 46 (27.4%) responded "moderately satisfied", and 117 (69.6%) were "dissatisfied".

Conclusions: Many orthopedic residents in Thailand and Myanmar were enthusiastic about and satisfied with their training. Their only problem was that the salary was low.

Graduate medical education-led continuous assessment of burnout and learning environments to improve residents' wellbeing

BACKGROUND

Promoting residents' wellbeing and decreasing burnout is a focus of Graduate Medical Education (GME). A supportive clinical learning environment is required to optimize residents' wellness and learning.

OBJECTIVE

To determine if longitudinal assessments of burnout and learning environment as perceived by residents combined with applying continuous quality Model for Improvement and serial Plan, Do, Study, Act (PDSA) cycles to test interventions would improve residents' burnout.

METHODS

From November 2017 to January 2020, 271 GME residents in internal medicine, general surgery, psychiatry, emergency medicine, family medicine and obstetrics and gynecology, were assessed over five cycles by Maslach Burnout Inventory (MBI), and by clinical learning environment factors (which included personal/social relationships, self-defined burnout, program burnout support, program back-up support, clinical supervision by faculty, and sleep difficulties). The results of the MBI and clinical learning environment factors were observed and analyzed to determine and develop indicated Institutional and individual program interventions using a Plan, Do, Study, Act process with each of the five cycles.

RESULTS

The response rate was 78.34%. MBI parameters for all GME residents improved over time but were not statistically significant. Residents' positive perception of the clinical supervision by faculty was significantly and independently associated with improved MBI scores, while residents' self-defined burnout; and impaired personal relations perceptions were independently significantly associated with adverse MBI scores on liner regression. For all GME, significant improvements improved over time in residents' perception of impaired personal relationships (p < 0.001), self-defined burnout (p = 0.013), program burn-out support (p = 0.002) and program back-up support (p = 0.028). For the Internal Medicine Residency program, there were statistically significant improvements in all three MBI factors (p < 0.001) and in clinical learning environment measures (p = 0.006 to < 0.001). Interventions introduced during the PDSA cycles included organization-directed interventions (such as: faculty and administrative leadership recruitment, workflow interventions and residents' schedule optimization), and individual interventions (such as: selfcare, mentoring and resilience training).

CONCLUSION

In our study, for all GME residents, clinical learning environment factors in contrast to MBI factors showed significant improvements. Residents' positive perception of the clinical learning environment was associated with improved burnout measures. Residents in separate programs responded differently with one program reaching significance in all MBI and clinical learning environment factors measured. Continuous wellbeing assessment of all GME residents and introduction of Institutional and individual program interventions was accomplished.

Current status and problems of orthopaedic residents in Thailand and Myanmar

Background: There is no research about current experiences of orthopaedic residents in Thailand and Myanmar. Methods: A questionnaire survey was distributed among Thai and Myanmar orthopaedic residents to assess their current experiences. This study included a total of 168 participants, comprising 92 (94.8%) of 97 orthopaedic residents in Thailand, and 76 (97.4%) of 78 in Myanmar who answered the questionnaire. The survey comprised nine questions about issues such as the contents of residency training programs, current training satisfaction, and future careers. The survey was administered anonymously between October 2020 and January 2021. Results: Regarding training content, 24 residents reported being "very satisfied", 103 were "satisfied", 37 were "moderately satisfied", and four were "dissatisfied", and respondents spent a mean of 3.1 h/day reading textbooks and research papers. As for salary, five residents answered "satisfied", 46 responded "moderately satisfied", and 117 were "dissatisfied". Conclusions: Many orthopedic residents in Thailand and Myanmar were enthusiastic about and satisfied with their training. Their only problem was that the salary was low.

The Effect of the Educational Environment on the rate of Burnout among Postgraduate Medical Trainees - A Narrative Literature Review

BACKGROUND

Burnout among postgraduate medical trainees is common. It is a syndrome characterised by emotional exhaustion, depersonalisation and reduced personal accomplishment. Burnout is seen as an organisational problem rather than the result of an individual's ability to cope with the stress at work. The educational environment can play a pivotal role in the prevention of burnout among postgraduate medical trainees. This narrative literature review is aimed at assessing the effect of the educational environment on burnout in postgraduate doctors-in-training.

METHODS

A search of the databases Medline and PscyInfo for articles published between 2015 and 2020 was performed with the key words 'burnout' and 'educational environment' or 'clinical learning environment' or 'postgraduate medical education' or 'learning environment'.

RESULTS

A total of 27 studies were identified and reviewed by the author. The prevalence of burnout reported varied widely between studies, ranging from 10% to 62%. Many of the factors that contribute to burnout form part of the educational environment, for example, hours worked, mistreatment, harassment and perceptions of injustice. Residency itself is a stressful period wherein trainees have to balance their responsibilities towards their patients with their responsibilities at home, all while furthering their studies and taking on new responsibilities. Interventions to prevent burnout and tackle existing burnout are multiple but very little solid evidence exists to attest to their efficacy. More research is needed to identify the most effective ways to deal with burnout in postgraduate medical trainees.

The quality of life of family health professionals: a systematic review and meta-synthesis

ABSTRACT Objectives: to perform a systematic review and meta-synthesis of qualitative studies about the work-related quality of life of Family Health Strategy professionals. Methods: this systematic review was developed to answer the following PVO question: “Which factors (variables) are associated with the work-related quality of life (outcome) of Family Health Strategy professionals (population)?” The PubMed, Scopus, Embase, SciELO, Web of Science, LILACS, Science Direct, OpenThesis, OpenGrey, and OATD databases were selected. The meta-synthesis analyzed the main codes and secondary codes of all included studies. Results: the database search resulted in 1,744 reports; six were considered eligible for the meta-synthesis. Four factors were considered for the quality of work life: working conditions; work processes; interpersonal relationships; and personal aspects. Conclusions: although this study confirms the adequacy of aspects commonly related to the quality of work life, other factors are important in the case of FHS professionals, especially work context.

Correction to: Exploring burnout and the association with the educational climate in pediatric residents in Thailand

Following publication of the original article.