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Gonzales PA, Coopersmith AS, Kaushik D, Lebares C, Malotte M, Taylor JM, Pierorazio PM. A mindful approach to complications: Brief review of the literature and practical guide for the surgeon. Urol Oncol 2024; 42:302-309. [PMID: 38845297 DOI: 10.1016/j.urolonc.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/18/2024] [Indexed: 07/27/2024]
Abstract
Patient complications and adverse outcomes are inherent to surgical practice and training. In addition to the impact on patients, there are profound and well-documented impacts of complications on surgeons, surgical trainees, and surgical teams. This manuscript reviews the literature regarding mindfulness-based practices and the associated mitigation of the adverse impact of complications. These mindfulness-based practices prepare surgeons for complications by improving mental and cognitive resilience facilitating more effective management of complications that avoids undue psychological and emotional stress. Practical recommendations are provided for the practicing surgeon from providers experienced in mindfulness-based training and preparation.
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Affiliation(s)
- Paul Adam Gonzales
- Department of Surgery, University of California San Francisco (UCSF), 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790; UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Ari S Coopersmith
- Department of Surgery, University of California San Francisco (UCSF), 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790; UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Dharam Kaushik
- Department of Urology, Houston Methodist, 6560 Fannin St # 2100, Houston, TX 77030
| | - Carter Lebares
- Department of Surgery, University of California San Francisco (UCSF), 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790; UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Michael Malotte
- UCSF Center for Mindfulness in Surgery, 513 Parnassus Avenue, HSW 1601, San Francisco, California, 94143 - 0790
| | - Jennifer M Taylor
- Department of Urology, Baylor College of Medicine, 7200 Cambridge St Ste 10B, Houston TX 7703
| | - Phillip M Pierorazio
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Penn Medicine, 51 N. 39th Street, Suite 300 MOB, Philadelphia PA 19104.
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Mehdorn M, Danker H, Mehdorn AS. The psychological burden of major surgical complications in visceral surgery. Langenbecks Arch Surg 2024; 409:255. [PMID: 39162875 PMCID: PMC11335847 DOI: 10.1007/s00423-024-03447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 08/13/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Complications are common after major visceral surgery. Besides the patients, also surgeons may experience negative feelings by the patients suffering. Some studies have evaluated the mental burden caused by complications, mainly focusing on residents in different surgical specialties. No evidence exists on the mental burden of board-qualified visceral surgeons in Germany. MATERIALS AND METHODS A point prevalence study was conducted using an online questionnaire. For the inclusion of participants, all departments of visceral surgery at German university hospitals were addressed. The objective of the online questionnaire was to elaborate the perception of complications and the coping mechanisms used by the surgeons with the aim to characterize the mental burden and possible improvement strategies. RESULTS A total of 113 questionnaires were answered, 98 being complete. 73.2% of the participants were male, 46.9% were consultants and had a working experience of 11-20 years. Most common specialties were colorectal and general surgery and 91.7% claimed to have caused complications Clavien-Dindo grade IV or V. Subsequently, predominant feelings were anger, grief, self-doubt and guilt. The fear of being blamed by colleagues or to lose reputation were high. Especially female and younger surgeons showed those fears. Coping mechanisms used to overcome those negative feelings were interaction with friends and family (60.6%) or proactive training (59.6%). Only 17.2% of the institutions offered professional support. In institutions where no support was offered, 71.6% of the surgeons asked for support. CONCLUSION Surgical complications cause major psychological burden in surgeons in German university hospitals. Main coping mechanisms are communication with friends and families and professional education. Vulnerable subgroups, such as younger surgeons, may be at risk of suffering more from perceived mental distress. Nonetheless, the majority did not receive but asked for professional counselling. Thus, structured institutional support may ameliorate care for both surgeon and patient.
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Affiliation(s)
- Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Helge Danker
- Department of Medical Psychology and Sociology, University of Leipzig, Leipzig, Germany
| | - Anne-Sophie Mehdorn
- Department of General, Abdominal, Transplantation, Thoracic and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Tan AF, Patel P. Reporting Mistreatment in Medical School. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:706. [PMID: 38574202 DOI: 10.1097/acm.0000000000005727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
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Pearson A, Carrieri D, Melvin A, Bramwell C, Scott J, Hancock J, Papoutsi C, Pearson M, Wong G, Mattick K. Developing a typology of interventions to support doctors' mental health and wellbeing. BMC Health Serv Res 2024; 24:573. [PMID: 38702774 PMCID: PMC11067176 DOI: 10.1186/s12913-024-10884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/20/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The problem of mental ill-health in doctors is complex, accentuated by the COVID-19 pandemic, and impacts on healthcare provision and broader organisational performance. There are many interventions to address the problem but currently no systematic way to categorise them, which makes it hard to describe and compare interventions. As a result, implementation tends to be unfocussed and fall short of the standards developed for implementing complex healthcare interventions. This study aims to develop: 1) a conceptual typology of workplace mental health and wellbeing interventions and 2) a mapping tool to apply the typology within research and practice. METHODS Typology development was based on iterative cycles of analysis of published and in-practice interventions, incorporation of relevant theories and frameworks, and team and stakeholder group discussions. RESULTS The newly developed typology and mapping tool enable interventions to be conceptualised and/or mapped into different categories, for example whether they are designed to be largely preventative (by either improving the workplace or increasing personal resources) or to resolve problems after they have arisen. Interventions may be mapped across more than one category to reflect the nuance and complexity in many mental health and wellbeing interventions. Mapping of interventions indicated that most publications have not clarified their underlying assumptions about what causes outcomes or the theoretical basis for the intervention. CONCLUSION The conceptual typology and mapping tool aims to raise the quality of future research and promote clear thinking about the nature and purpose of interventions, In doing so it aims to support future research and practice in planning interventions to improve the mental health and wellbeing of doctors.
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Affiliation(s)
- Alison Pearson
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
| | - Daniele Carrieri
- Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Anna Melvin
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Charlotte Bramwell
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jessica Scott
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Pearson
- Institute of Clinical & Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karen Mattick
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Super J, Vinnicombe Z, Little M, Gunnee M, Anakwe R. The effect of socioeconomic status and training programmes on burnout in postgraduate trainees in the United Kingdom: a cross-sectional analysis. Postgrad Med J 2024; 100:305-308. [PMID: 38297961 DOI: 10.1093/postmj/qgad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 11/21/2023] [Accepted: 12/10/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE Burnout is described as a state of mental exhaustion caused by one's professional life and is characterised by three domains: emotional exhaustion, depersonalisation, and a reduced sense of accomplishment. The prevalence of stress is high amongst doctors and varies by specialty, gender, trainee level, and socioeconomic status. The authors set out to examine the scale of the problem, as well as to determine the influence of both socioeconomic status and chosen training programme on burnout amongst postgraduate trainees. This would identify at-risk groups and aid in future targeted interventions. METHODS Cross-sectional data were obtained, following approval from the General Medical Council, from The National Training Survey, completed annually by all trainees in the United Kingdom. Data were then anonymised and analysed. Burnout scores were derived from the Copenhagen Burnout Inventory and are positively framed (higher scores equal lower burnout). RESULTS The questionnaire was completed by 63 122 participants from 2019 to 2020. Mean burnout amongst all trainees was 52.4 (SD = 19.3). Burnout scores from the most deprived quintile was significantly lower compared with those from the least deprived quintile: 51.0 (SD = 20.6) versus 52.9 (SD = 18.9), respectively (P < 0.001). The highest levels of burnout were reported in Internal Medical Training, Emergency Medicine, Obstetrics and Gynaecology, and Core Surgical Training, respectively. CONCLUSION Postgraduates from lower socioeconomic backgrounds are more likely to encounter burnout during training. At-risk groups who may also benefit from targeted intervention have been identified, requiring further examination through future studies.
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Affiliation(s)
- Jonathan Super
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom
| | - Zak Vinnicombe
- Department of Plastic Surgery, St. George's Hospital, Blackshaw Road, Tooting, London SW17 0QT, United Kingdom
| | - Max Little
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, United Kingdom
| | - Matthew Gunnee
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, United Kingdom
| | - Raymond Anakwe
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, United Kingdom
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Kankam SB, Jalloh M, Habibzadeh A, Fakorede O. Combating burnout in neurosurgery: a monumental step to increasing prospects for future neurosurgery aspirants and patients. Neurosurg Rev 2024; 47:155. [PMID: 38609731 DOI: 10.1007/s10143-024-02373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Samuel Berchi Kankam
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
- Harvard T.H Chan School of Public Health, Harvard University, Boston, USA.
| | - Mohamed Jalloh
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | - Olayinka Fakorede
- Harvard T.H Chan School of Public Health, Harvard University, Boston, USA
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Donald N, Lindsay T. Surgical trainee experiences from 2013 to 2023 within the United Kingdom as reported by the General Medical Council National Training Survey. Surgeon 2024; 22:74-79. [PMID: 38081759 DOI: 10.1016/j.surge.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The General Medical Council (GMC) issues annual surveys to all doctors within the United Kingdom (UK) in a formal postgraduate training scheme. This facilitates the monitoring of experiences for quality assurance purposes. Low job satisfaction has been associated with heightened levels of burnout and staff turnover, alongside deteriorating clinical care and productivity levels. METHODS We gathered and extracted data from the publicly available online GMC reporting tool. Data ranged from 2013 to 2023 and spanned 12 postgraduate surgical training programmes across all 18 indicators available. In total, 198 individual metrics were recorded, in addition to burnout. We conducted trend analysis and yearly average mean scores for individual metrics, burnout and geographical differences for 141 individual training programmes within the 16 training regions. RESULTS Of the 198 metrics analysed, 83 (42 %) were found to have statistically significant negative trends (P < 0.05), in comparison to 24 (12 %) with positive trends. 5 specialities had over 50 % of metrics showing a significant negative trend. Overall satisfaction was negative in all 12 programmes, with eight reaching significance (P < 0.05). Of 141 individual training programmes, 29 % showed a significantly negative trend in overall satisfaction, with 1 % demonstrating a significant positive trend (P < 0.05). CONCLUSION Our study is the first to explore long-term trends in trainee reported surgical training experiences within the UK. Our data have revealed widespread worsening trainee reported experiences and dissatisfaction across multiple specialities and geographical regions, especially in key areas of overall satisfaction, self-development, and clinical supervision.
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Affiliation(s)
- Neil Donald
- Department of Surgery, Dartford and Gravesham NHS Trust, Darenth Wood Road, Dartford, DA2 8DA, UK.
| | - Tim Lindsay
- Department of Trauma and Orthopaedics, London North West University Hospitals NHS Trust, UK; Imperial College London, UK
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Bhachoo H, Glossop SC, Mattey LR, Pearson C, Hoade L, Cereceda-Monteoliva N, Scourfield L, Poacher AT. Undergraduate deficits in plastic surgery exposure and awareness of the specialty: a systematic review. Ann R Coll Surg Engl 2024. [PMID: 38362746 DOI: 10.1308/rcsann.2023.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Plastic surgery is an important specialty that involves widespread medical knowledge, some of which is taught in undergraduate curricula. The General Medical Council provides a well-defined plastic surgery curriculum for postgraduate training. However, there is no consensus on the provision for undergraduates in this specialty, potentially giving rise to a deficit in undergraduate medical education and a suboptimal basis for plastic surgery postgraduate training. Our aim was to identify the gap in undergraduate plastic surgery teaching and to understand student perceptions of the specialty as well as any trialled interventions. METHODS A prospectively registered systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The MEDLINE®, Embase™, PubMed® and Google Scholar™ databases were searched for literature relating to undergraduate exposure to plastic surgery and relevant teaching interventions. Ten studies were included in this review, categorised into three main themes: exposure during medical school, determining factors and perceptions for pursuing a plastic surgery career, and teaching interventions. RESULTS Surveys assessing medical student perceptions indicate a significant deficit in exposure to plastic surgery in the undergraduate curriculum. Medical students' interest in the specialty is affected by multiple factors, including the amount of surgical exposure in medical school. Interventions to address the deficit mostly involve one-day courses. CONCLUSIONS Although the literature is currently limited, studies are needed to effectively assess the outcomes of plastic surgery teaching methods in undergraduate training. Moreover, there is a need for consensus around the provision of undergraduate teaching in plastic surgery. This should be reflected in the latest undergraduate curricula in medical education.
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Affiliation(s)
| | | | | | | | - L Hoade
- Cardiff and Vale University Health Board, UK
| | | | - L Scourfield
- King's College Hospital NHS Foundation Trust, UK
| | - A T Poacher
- Cardiff and Vale University Health Board, UK
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Thaventhiran A, McKnight G, Clements JM, Barlow E, Pegna V, Dovell G, Nally D, Burke J. The Association of Surgeons in Training (ASiT) Consensus Statement on Major Trauma Training in the UK. Ann R Coll Surg Engl 2024; 106:123-130. [PMID: 36748795 PMCID: PMC10830340 DOI: 10.1308/rcsann.2022.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Since the establishment of the Major Trauma Networks in 2012, it is estimated that an extra 1,600 lives have been saved across England. Although the delivery of trauma care has improved significantly, the provision of trauma training has not and remains fragmented. The Association of Surgeons in Training (ASiT), an independent organisation run by trainees, is dedicated to excellence in surgical training within the United Kingdom (UK) and Republic of Ireland (ROI). The aim of this study was to develop a consensus statement representing the views of the ASiT on the future of trauma surgery training. METHODS A modified nominal group technique was used in five stages: 1, scoping exercise; 2, virtual consultation; 3, nominal group consensus meeting; 4, virtual feedback from stakeholders; and 5, virtual confirmation by the ASiT Council. The design and reporting of the consensus followed best practice methodology for consensus research. RESULTS Overall, 62 participants gave 90 statements across stages 1-3. Eleven key themes were identified, all of which met the consensus of the ASiT Council. The key findings were widespread support for increased exposure to trauma for medical students and early surgical trainees as well as an increased use of simulation methods and improved focus on non-technical skills within trauma surgery. CONCLUSIONS This study sets out the position of the ASiT on the future of trauma surgery training and how training in major trauma surgery in the UK and ROI could be improved.
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Affiliation(s)
| | | | - JM Clements
- The Association of Surgeons in Training, Royal College of Surgeons of England, UK
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Navinés R, Olive V, Hidalgo-Mazzei D, Langohr K, Vieta E, Martin-Santos R. Burnout in residents during the first wave of the COVID-19 pandemic: a systematic review and meta-analysis. Front Psychiatry 2024; 14:1286101. [PMID: 38328517 PMCID: PMC10847582 DOI: 10.3389/fpsyt.2023.1286101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction The high prevalence of burnout in resident physicians is expected to have increased as a result of the expansion of the pandemic. We conducted a systematic review with a meta-analysis of studies conducted during the first wave of the COVID-19 pandemic on burnout in residents and potential associated risk factors. Methods The search was done in the Web of Science, MEDLINE, Scopus, and Lillac databases (April 2020-October 2021) using a priori protocol based on the PRISMA guidelines. The Newcastle Ottawa Scale was used to assess the risk of bias in the included studies. We estimated the pooled prevalence (95% CI) of burnout and the prevalence ratio (95% CI) of each risk factor associated. Results We included 23 studies from 451 potential initial articles and those written in the English language; all of the collected studies were cross-sectional with anonymous online surveys, involving 4,998 responders (34%), of which 53.2% were female responders, 51% were R1-2, and 71% were in direct contact with COVID-19 patients. Eighty-seven percent presented a low-to-moderate risk of bias. Publication bias was not shown. The estimated pooled prevalence of burnout was 40% (95% CI = 0.26 - 0.57). Burnout was associated with psychiatry history (PR = 4.60, 95% CI = 1.06 - 20.06). There were no differences by gender, civil status, children in-charge, year of residency, or time exposure to COVID-19. Discussion The overall prevalence of burnout in residents during the first wave of the pandemic was in line with the results described in this collective before the pandemic. The presence of a psychiatry history was a potential burnout risk factor, suggesting a high vulnerability during the peak of the stress period and the need to implement mental health surveillance for this subgroup.
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Affiliation(s)
- Ricard Navinés
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
| | - Victoria Olive
- Functional Unit of Psychiatry, Department of Medicine, Neuroscience Institute, University of Barcelona (UB), Barcelona, Spain
- Department of Occupational Risk and Prevention, Hospital Clinic, University of Barcelona (UB), Barcelona, Spain
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
| | - Klaus Langohr
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona Tech, Barcelona, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
- Functional Unit of Psychiatry, Department of Medicine, Neuroscience Institute, University of Barcelona (UB), Barcelona, Spain
| | - Rocio Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, Institut d Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en RED en Salud Mental (CIBERSAM), Barcelona, Spain
- Functional Unit of Psychiatry, Department of Medicine, Neuroscience Institute, University of Barcelona (UB), Barcelona, Spain
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Bedendo A, Papworth A, Taylor J, Beresford B, Mukherjee S, Fraser L, Ziegler L. Staff well-being in UK children's hospices: a national survey. BMJ Support Palliat Care 2024; 13:e1363-e1372. [PMID: 37643839 DOI: 10.1136/spcare-2022-004056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES Poor psychological well-being among healthcare workers can have numerous negative impacts, but evidence about levels of burnout in children's hospice care staff is limited. This study aimed to determine the prevalence of burnout and to explore the association between staff characteristics and support mechanisms with burnout among children's hospice care staff in the UK. METHODS Two national online surveys collecting data on hospice care staff psychological well-being and hospice organisational characteristics. All children's hospices in the UK were invited.Thirty-one hospices (out of 52) responded to the hospice survey and 583 staff responded to the staff survey. Data collection took place between May and December 2020 and measures included the Copenhagen Burnout Inventory, Work Engagement and the Health and Safety Executive Management Standards Indicator Tool. RESULTS Burnout prevalence was 11% and mean burnout score was 32.5 (SD: 13.1). Burnout levels were independent of working arrangements (eg, working from home or at the hospice) during the COVID-19 pandemic. Hospices performed well in most management standards, but poorly on the 'Control' domain. The average Work Engagement score for staff was 7.5 (SD: 1.5). CONCLUSIONS Burnout levels for staff in children's hospices in the UK were lower than in other healthcare settings, with this comparing to 17.3% among palliative care staff generally. Overall, hospices performed well in management standards and there was no indication of urgent action needed. Work Engagement in our sample was higher compared with other National Health Service workers during the COVID-19 pandemic.
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Affiliation(s)
- Andre Bedendo
- Department of Health Sciences, University of York, York, UK
| | | | - Johanna Taylor
- Department of Health Sciences, University of York, York, UK
| | | | | | - Lorna Fraser
- Cicely Saunders Institute and Dept of Women's and Children's Health, King's College London, London, UK
| | - Lucy Ziegler
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Houdmont J, Daliya P, Adiamah A, Theophilidou E, Hassard J, Lobo DN. Management standards and burnout among surgeons in the United Kingdom. Occup Med (Lond) 2023; 73:484-491. [PMID: 37802910 PMCID: PMC10756657 DOI: 10.1093/occmed/kqad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Burnout arising from chronic work-related stress is endemic among surgeons in the UK. Identification of contributory and modifiable psychosocial work characteristics could inform risk reduction activities. AIMS We aimed to assess the extent to which surgeons' psychosocial working conditions met aspirational Management Standards delineated by the UK Health and Safety Executive, draw comparisons with national general workforce benchmarks and explore associations with burnout. METHODS Surgeons (N = 536) completed the Management Standards Indicator Tool and a single-item measure of burnout. Descriptive data were computed for each Standard, independent t-tests were used to examine differences between trainees and consultants, and hierarchical linear regression was applied to explore relations between psychosocial work environment quality and burnout. RESULTS Psychosocial work environment quality fell short of each Management Standard. Trainee surgeons (n = 214) reported significantly poorer psychosocial working conditions than consultant surgeons (n = 322) on the control, peer support and change Standards. When compared with UK workforce benchmarks, trainees' psychosocial working conditions fell below the 10th percentile on four Standards and below the 50th percentile on the remainder. Consultant surgeons were below the 50th percentile on five of the seven Standards. Psychosocial working conditions accounted for 35% of the variance in burnout over that accounted for by socio- and occupational-demographic characteristics. CONCLUSIONS Surgeons' psychosocial working conditions were poor in comparison with benchmark data and associated with burnout. These findings suggest that risk management activities based on the Management Standards approach involving modification of psychosocial working conditions would help to reduce burnout in this population.
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Affiliation(s)
- J Houdmont
- School of Medicine, University of Nottingham, Nottingham NG8 1BB, UK
| | - P Daliya
- East Midlands Surgical Academic Network, Queen’s Medical Centre, Nottingham NG7 2UH, UK
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - A Adiamah
- East Midlands Surgical Academic Network, Queen’s Medical Centre, Nottingham NG7 2UH, UK
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - E Theophilidou
- East Midlands Surgical Academic Network, Queen’s Medical Centre, Nottingham NG7 2UH, UK
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - J Hassard
- School of Medicine, University of Nottingham, Nottingham NG8 1BB, UK
- Management School, Queen’s University of Belfast, Belfast, BT9 5EE, UK
| | - D N Lobo
- School of Medicine, University of Nottingham, Nottingham NG8 1BB, UK
- East Midlands Surgical Academic Network, Queen’s Medical Centre, Nottingham NG7 2UH, UK
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK
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Brennan JN, Hall AJ, Baird EJ. Online case-based educational meetings can increase knowledge, skills, and widen access to surgical training:The nationwideVirtualTrauma & Orthopaedic Meetingseries. Surgeon 2023; 21:e263-e270. [PMID: 36914519 DOI: 10.1016/j.surge.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Access to surgical training is challenging for undergraduate and early postgraduate trainees due to a greater focus on developing generic knowledge and skills, and a drive to recruit greater numbers into internal medicine and primary care. COVID-19 accelerated the declining access to surgical training environments. Our aims were to: 1) establish the feasibility of an online, specialty-specific, case-based surgical training series, and 2) evaluate its suitability for meeting the needs of trainees. METHODS A nationwide audience of undergraduate and early postgraduate trainees were invited to a series of bespoke online case-based educational meetings in Trauma & Orthopaedics (T&O) over a six month period. The six sessions, which simulated real-world clinical meetings, were constructed by Consultant sub-specialists and involved the presentation of cases by registrars, followed by structured discussion of basic principles, radiological interpretation, and management strategies. Mixed qualitative and quantitative analyses were conducted. RESULTS There were 131 participants (59.5% male), consisting mostly of doctors in training (58%) and medical students (37.4%). The mean quality rating was 9.0/10 (SD 1.06), further supported by qualitative analysis. 98% enjoyed the sessions, 97% reported improved knowledge of T&O, and 94% reported a direct benefit to clinical practice. There was a significant improvement in knowledge of T&O conditions, management plans, and radiological interpretation (p = <0.05). CONCLUSION Structured virtual meetings, underpinned by bespoke clinical cases, may widen access to T&O training, increase flexibility and robustness of learning opportunities, and mitigate the effects of reduced exposure on preparation for surgical careers and recruitment.
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Affiliation(s)
- Joseph N Brennan
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew J Hall
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK; Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Edinburgh, Edinburgh, UK.
| | - Emily J Baird
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK; Royal Hospital for Children & Young People, Edinburgh, UK
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14
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Glossop SC, Bhachoo H, Murray TM, Cherif RA, Helo JY, Morgan E, Poacher AT. Undergraduate teaching of surgical skills in the UK: systematic review. BJS Open 2023; 7:zrad083. [PMID: 37819804 PMCID: PMC10566575 DOI: 10.1093/bjsopen/zrad083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/16/2023] [Accepted: 07/13/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Students must be proficient in surgical skills according to General Medical Council and Royal College of Surgeons of England guidelines. If these skills are not appropriately taught, there is a risk of an incoming junior workforce with inadequate surgical skills. This paper aimed to review the literature relating to undergraduate teaching of surgical skills in the UK and summarize future suggested training methods. METHODS The databases MEDLINE, Embase and SCOPUS were searched, and the existing literature relating to methodology of undergraduate teaching of surgical skills in the UK over the past 10 years was summarized. The Medical Education Research Quality Instrument was used to assess research quality. RESULTS A total of 19 papers were included. Cross-sectional evaluations and survey-based studies highlight a clear deficit in surgical skills teaching in the UK. Medical students are currently unable to fulfil their own learning needs and meet requirements set out by the General Medical Council. This lack of surgical teaching appears to negatively affect student desire to pursue a surgical career. The three main themes for improvement are extracurricular surgical skills days, near-peer teaching and simulation. Each method appeared to improve learning, although no studies utilized medium- to long-term follow-up to demonstrate efficacy and there lacks a clear consensus as to the 'standard' of undergraduate surgical skill education. There was also potential for selection bias and response shift bias in many of the studies assessing pre- and postintervention confidence and opinions. CONCLUSION There is a concerning lack of surgical skills teaching that has resulted in medical students and junior doctors not having the necessary surgical skills as per General Medical Council guidance and students feel that their own learning needs are not met. This failure to address the learning deficit may be responsible for the fall in surgical competition ratios. While surgical skills teaching must be improved urgently, more robust evidence is required to evaluate the optimal ways of approaching this issue.
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Affiliation(s)
- Sean C Glossop
- School of Medicine, Cardiff University, Cardiff, South Glamorgan, UK
| | - Hari Bhachoo
- School of Medicine, Cardiff University, Cardiff, South Glamorgan, UK
| | - Thomas M Murray
- School of Medicine, Cardiff University, Cardiff, South Glamorgan, UK
| | - Rayan A Cherif
- School of Medicine, Cardiff University, Cardiff, South Glamorgan, UK
| | - John Y Helo
- School of Medicine, Cardiff University, Cardiff, South Glamorgan, UK
| | - Evie Morgan
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Arwel T Poacher
- Department of Plastic Surgery, St Thomas’ Hospital, Guys and St Thomas’ Trust, London, UK
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15
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Whitehead IO, Moffatt S, Warwick S, Spiers GF, Kunonga TP, Tang E, Hanratty B. Systematic review of the relationship between burn-out and spiritual health in doctors. BMJ Open 2023; 13:e068402. [PMID: 37553194 PMCID: PMC10414094 DOI: 10.1136/bmjopen-2022-068402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/03/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE To investigate the relationship between burn-out and spiritual health among medical doctors. DESIGN Systematic literature review and narrative synthesis of cross-sectional studies. SETTING Any setting, worldwide. DATA SOURCES Five databases were searched from inception to March 2022, including Medline, Embase, PsycINFO, Scopus and Web of Science. ELIGIBILITY CRITERIA Any study design that involved medical doctors (and other healthcare staff if assessed alongside medical doctors), that measured (in any way) both burn-out (or similar) and spiritual health (or similar) medical doctors. DATA EXTRACTION AND SYNTHESIS All records were double screened. Data extraction was performed by one reviewer and a proportion (10%) checked by a second reviewer. Quality was assessed using the Appraisal of Cross-sectional Studies tool. Due to the heterogeneity of the included studies, a narrative review was undertaken without a meta-analysis. RESULTS Searches yielded 1049 studies. 40 studies met eligibility criteria and were included in this review. Low reported levels of spirituality were associated with high burn-out scores and vice versa. Religion was not significantly associated with lower levels of burn-out. Few studies reported statistically significant findings, few used validated spiritual scores and most were vulnerable to sampling bias. CONCLUSIONS Published research suggests that burn-out is linked to spiritual health in medical doctors but not to religion. Robust research is needed to confirm these findings and develop effective interventions. PROSPERO REGISTRATION NUMBER CRD42020200145.
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Affiliation(s)
| | - Suzanne Moffatt
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephanie Warwick
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma F Spiers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Eugene Tang
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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16
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Graham YNH, Mahawar K, Singhal R, Madhok B, Yang W, Riera M, Martinez‐Duartez P, Pouwels S, Sharma M, Hayes C. Bariatric surgeons' experiences of working in the first year of the pandemic. Obes Sci Pract 2023; 9:329-336. [PMID: 37546291 PMCID: PMC10399527 DOI: 10.1002/osp4.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 08/08/2023] Open
Abstract
Background The first year of the Covid-19 pandemic saw drastic changes to bariatric surgical practice, including postponement of procedures, altered patient care and impacting on the role of bariatric surgeons. The consequences of this both personally and professionally amongst bariatric surgeons has not as yet been explored. Aims The aim of this research was to understand bariatric surgeons' perspectives of working during the first year of the pandemic to explore the self-reported personal and professional impact. Methods Using a retrospective, two phased, study design with global participants recruited from closed, bariatric surgical units. The first phase used a qualitative thematic analytic framework to identify salient areas of importance to surgeons. Themes informed the construction of an on-line, confidential survey to test the potential generalizability of the interview findings with a larger representative population from the global bariatric surgical community. Findings Findings of the study revealed that the first year of the pandemic had a detrimental effect on bariatric surgeons both personally and professionally globally. Conclusion This study has identified the need to build resilience of bariatric surgeons so that the practice of self-care and the encouragement of help-seeking behaviors can potentially be normalized, which will in turn increase levels of mental health and wellbeing.
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Affiliation(s)
- Yitka N. H. Graham
- Faculty of Health Sciences and WellbeingSchool of Nursing and Health SciencesHelen McArdle Nursing and Care Research InstituteUniversity of SunderlandSunderlandUK
- Bariatric Surgical UnitSouth Tyneside and Sunderland NHS Foundation TrustSunderlandUK
- Faculty of PsychologyUniversity of Anahuac MexicoNaucalpanMexico
| | - Kamal Mahawar
- Faculty of Health Sciences and WellbeingSchool of Nursing and Health SciencesHelen McArdle Nursing and Care Research InstituteUniversity of SunderlandSunderlandUK
- Bariatric Surgical UnitSouth Tyneside and Sunderland NHS Foundation TrustSunderlandUK
| | - Rishi Singhal
- Upper GI UnitUniversity Hospital Birmingham NHS Foundation TrustBirminghamUK
| | - Brij Madhok
- East Midlands Bariatric and Metabolic InstituteUniversity Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
| | - Wah Yang
- Department of Metabolic and Bariatric SurgeryThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Manel Riera
- Bariatric Surgical UnitThe Shrewsbury and Telford Hospitals NHS TrustShrewsburyUK
| | | | - Sjaak Pouwels
- Department of Intensive Care MedicineElisabeth Tweesteden HospitalTilburgThe Netherlands
- Department of SurgeryAgaplesion Bethanien KrankenhausFrankfurt Am MainHessenGermany
| | - Mitesh Sharma
- Bariatric Surgical UnitSouth Tyneside and Sunderland NHS Foundation TrustSunderlandUK
| | - Catherine Hayes
- Faculty of Health Sciences and WellbeingSchool of Nursing and Health SciencesHelen McArdle Nursing and Care Research InstituteUniversity of SunderlandSunderlandUK
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17
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Le HD, Wolinska JM, Baertschiger RM, Himidan SA. Complication Is Inevitable, but Suffering is Optional-Psychological Aspects of Dealing with Complications in Surgery. Eur J Pediatr Surg 2023; 33:181-190. [PMID: 36948212 DOI: 10.1055/s-0043-1767830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Surgical complications remain common in health care and constitute a significant challenge for hospitals, surgeons, and patients. While they cause significant physical, financial, and psychological harm to patients and their families, they also heavily burden the involved physicians. This phenomenon, known as the "second victim," results in negative short and long-term physical, cognitive, and psychological consequences on the surgeon. In this review, we explored the intricate connections between the surgeons' emotional response to adverse events concerning the patient outcome, perceived peer reaction, and existing social and institutional support systems. Using a selective literature review coupled with personal experiences, we propose a model of this complex interaction and suggest specific interventions to ameliorate the severity of response within this framework. The institution of the proposed interventions may improve the psychological well-being of surgeons facing complications and promote a cultural shift to better support physicians when they occur.
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Affiliation(s)
- Hau D Le
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Justyna M Wolinska
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharifa A Himidan
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, Humber River Hospital, Toronto, Ontario, Canada
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18
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Kiernan A, Boland F, Harkin DW, Alzayyat S, Ryan Á, Renton S, Wales L, Imray C. Vascular Surgery Workforce: Evaluation and Estimation of Future Demand in the United Kingdom. Ann Vasc Surg 2023; 89:153-160. [PMID: 36126835 DOI: 10.1016/j.avsg.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/03/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Vascular disease is a common cause of death and disability in our growing elderly population and the demand for vascular procedures is increasing worldwide. Workforce planning is essential to meet future demand and provide safe vascular services. Our aim was to evaluate the current workforce in the United Kingdom and estimate future demand for vascular surgeons. METHODS From November 2020 to January 2021, we surveyed UK vascular surgeons for information on their work patterns. We estimated current vascular surgery (VS) workforce using the National Vascular Registry (NVR) data and population data from the Office for National Statistics. To estimate future demand, we interrogated Hospital Episode Statistic (HES) data using Hospital Admitted Patient Care Activity (HAPCA) and linear trend analysis. RESULTS NVR data estimate that currently there are 518 consultant VS in the United Kingdom, or 1 per 128,951 population, lower than international comparisons. HAPCA data (2012-2020) suggests VS Finished Consultant Episodes (FCE), admissions, and waiting lists are growing by approximately 2% per year, and we estimate the workforce will need to grow by more than 50% over the next 10 years to meet this demand and Vascular Society of Great Britain and Ireland recommendation. CONCLUSIONS The UK has a shortage of vascular surgeons at a time when vascular activity is increasing. The VS workforce, both VS consultant and vascular surgeons in training numbers need to expand to address the ongoing shortage and maintain a safe level of service.
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Affiliation(s)
- Aoife Kiernan
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Fiona Boland
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Denis W Harkin
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sarah Alzayyat
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Áine Ryan
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sophie Renton
- North West London Hospitals National Health Service Trust, London, UK
| | - Lucy Wales
- Northern Vascular Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Christopher Imray
- Department of Vascular Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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19
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Baryeh K, Bradley A, Cotzias C. The recovery of training and education post-COVID-19: the importance of supporting the consultant workforce. Br J Hosp Med (Lond) 2023; 84:1-9. [PMID: 36708341 DOI: 10.12968/hmed.2022.0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIMS Since the COVID-19 pandemic began, training and education have been significantly disrupted, causing an incalculable effect on trainees. However, the consultant workforce is crucial to the success of training recovery. The motivation of the consultant workforce to assist in training recovery, in a context of significant workload and increasing pressures on resources, is currently unknown. METHODS This survey gathered the consultant workforce's views on assisting training recovery at one site of a large NHS foundation trust. RESULTS There was reduced motivation to engage in training and education when compared to pre-pandemic levels, widespread indicators of burnout, and changes in attitude towards reducing their working hours and early retirement. CONCLUSIONS These findings demonstrate a worrying trend that is likely to be replicated nationwide, which highlights the need to support consultants to avoid further disruption to training recovery.
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Affiliation(s)
- Kwaku Baryeh
- Department of Medical Education, West Middlesex University Hospital, Isleworth, UK
| | - Anna Bradley
- Department of Medical Education, West Middlesex University Hospital, Isleworth, UK
| | - Christina Cotzias
- Department of Medical Education, West Middlesex University Hospital, Isleworth, UK
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20
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Houdmont J, Daliya P, Adiamah A, Theophilidou E, Hassard J, Lobo DN. Identification of Surgeon Burnout via a Single-Item Measure. Occup Med (Lond) 2022; 72:641-643. [PMID: 36314995 PMCID: PMC9805298 DOI: 10.1093/occmed/kqac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Burnout is endemic in surgeons in the UK and linked with poor patient safety and quality of care, mental health problems, and workforce sustainability. Mechanisms are required to facilitate the efficient identification of burnout in this population. Multi-item measures of burnout may be unsuitable for this purpose owing to assessment burden, expertise required for analysis, and cost. AIMS To determine whether surgeons in the UK reporting burnout on the 22-item Maslach Burnout Inventory (MBI) can be reliably identified by a single-item measure of burnout. METHODS Consultant (n = 333) and trainee (n = 217) surgeons completed the MBI and a single-item measure of burnout. We applied tests of discriminatory power to assess whether a report of high burnout on the single-item measure correctly classified MBI cases and non-cases. RESULTS The single-item measure demonstrated high discriminatory power on the emotional exhaustion burnout domain: the area under the curve was excellent for consultants and trainees (0.86 and 0.80), indicating high sensitivity and specificity. On the depersonalisation domain, discrimination was acceptable for consultants (0.76) and poor for trainees (0.69). In contrast, discrimination was acceptable for trainees (0.71) and poor for consultants (0.62) on the personal accomplishment domain. CONCLUSIONS A single-item measure of burnout is suitable for the efficient assessment of emotional exhaustion in consultant and trainee surgeons in the UK. Administered regularly, such a measure would facilitate the early identification of at-risk surgeons and swift intervention, as well as the monitoring of group-level temporal trends to inform resource allocation to coincide with peak periods.
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Affiliation(s)
- J Houdmont
- Centre for Organizational Health and Development, School of Medicine, University of Nottingham, Nottingham, UK
| | - P Daliya
- East Midlands Surgical Academic Network, Queen’s Medical Centre, Nottingham, UK
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - A Adiamah
- East Midlands Surgical Academic Network, Queen’s Medical Centre, Nottingham, UK
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - E Theophilidou
- East Midlands Surgical Academic Network, Queen’s Medical Centre, Nottingham, UK
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - J Hassard
- Centre for Organizational Health and Development, School of Medicine, University of Nottingham, Nottingham, UK
| | - D N Lobo
- East Midlands Surgical Academic Network, Queen’s Medical Centre, Nottingham, UK
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
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21
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Agha A, Basu A, Hanif W. Burnout in diabetes and endocrinology specialist registrars across England, Scotland and Wales in the pre-COVID era. Prim Care Diabetes 2022; 16:515-518. [PMID: 35667990 DOI: 10.1016/j.pcd.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/11/2022] [Accepted: 05/22/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Presence of either emotional exhaustion, depersonalization or lack of personal accomplishment define Burnout Syndrome which may lead to decreased workforce productivity, increased absenteeism, depression and medical errors as well as decreased patient satisfaction. OBJECTIVE The aim of this study was to assess the frequency of burnout syndrome among Diabetes Specialist Registrars across England, Scotland and Wales and to identify any self-reported factors which may be contributory to burnout. METHODS Over 430 Diabetes Specialist Registrars were invited to anonymously participate in an electronic survey which used Maslach Burnout Inventory and selfreporting questionnaire to identify burnout and contributory factors. RESULTS In this pre-pandemic times study, Burnout was identified in 61 (57.5%; n = 106) respondents using Maslach burnout cut-off scores. 45.2% (48/106) participants had scored high in Emotional Exhaustion, while lack of personal accomplishment and depersonalization was seen in 24.5% (26/106) and 21.6% (23/106) of the respondents respectively. The commonest self-reported stressors by participants were "General Internal Medicine workload" 60.4% (64/106) followed by "Lack of specialty training" 36.8% (39/106) and "Lack of audit/research/Continuing Professional Development time" 10.8% (11/106) CONCLUSION: Burnout syndrome is frequent among the participating Diabetes Specialist Registrars and urgent steps may be required address this problem nationally to ensure that these physicians remain physically and mentally healthy, especially after the pandemic.
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Affiliation(s)
- A Agha
- Queens Hospital Burton on Trent, University Hospitals of Derby and Burton, UK; College of Medicine & Health Sciences, United Arab Emirates University, United Arab Emirates.
| | - A Basu
- City and Sandwell Hospitals Birmingham, UK
| | - W Hanif
- Queen Elizabeth Hospital, University Hospitals Birmingham, UK
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22
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Al-Ghunaim T, Johnson J, Biyani CS, O'Connor DB. Burnout in surgeons: A qualitative investigation into contributors and potential solutions. Int J Surg 2022; 101:106613. [PMID: 35421612 DOI: 10.1016/j.ijsu.2022.106613] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/04/2022] [Accepted: 04/07/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Poor wellbeing affects the performance of all types of workers. Surgeons are particularly at risk of suffering from burnout, but minimal qualitative research has examined the causes of burnout and potential solutions in this group. Understanding this could inform the development of future burnout interventions. PURPOSE This study aimed to explore the main factors that lead to surgeon burnout and to examine how surgeons cope with burnout at work. SETTING Surgical departments in the United Kingdom's National Health Service (NHS). MATERIALS Telephone interview and face-to-face interview. METHODS This qualitative study was conducted using semi-structured interviews with 14 surgeons from diverse specialisations. The interview consisted of two sections. The first addressed the main reasons for burnout. The second explored how surgeons manage burnout. RESULTS A thematic analysis identified several factors that can lead to surgeon burnout, captured in the themes of: rising to the challenge of surgical work; interpersonal conflict at work; greater demands than resources; the challenge of work-life balance; and the devastating impact of errors and poor patient outcomes. The study also revealed various strategies that surgeons employed to cope with burnout, namely: cognitive restructuring; seeking social support; stepping aside or down from the job; and prioritising personal health. Additionally, the study found some surgeons used maladaptive coping. CONCLUSION Healthcare organisations, surgeons, and psychological experts should work together to provide more and improved interventions to help surgeons, which might lead to a reduction in the number of surgeons who leave the profession and help improve patient outcomes.
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Affiliation(s)
- Tmam Al-Ghunaim
- School of Psychology University of Leeds, Leeds, LS2 9JT, UK.
| | - Judith Johnson
- School of Psychology University of Leeds, Leeds, LS2 9JT, UK; Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, BD96RJ, UK; School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Chandra Shekhar Biyani
- Department of Urology, St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
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23
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Jesuyajolu D, Nicholas A, Okeke C, Obi C, Aremu G, Obiekwe K, Obinna I. BURNOUT AMONG SURGEONS AND SURGICAL TRAINEES: A Systematic Review and Meta-analysis of the prevalence and associated factors. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Selvaskandan H, Nimmo A, Savino M, Afuwape S, Brand S, Graham-Brown M, Medcalf J, Cockwell P, Beckwith H. Burnout and long COVID among the UK nephrology workforce: results from a national survey investigating the impact of COVID-19 on working lives. Clin Kidney J 2021; 15:517-526. [PMID: 35198158 PMCID: PMC8754810 DOI: 10.1093/ckj/sfab264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 11/14/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic is placing a significant strain on healthcare. We conducted a national survey of the UK nephrology workforce to understand its impacts on their working lives. Methods An online questionnaire incorporating the Maslach Burnout Inventory score was distributed between 31 March and 1 May 2021, with a focus on COVID-19 and long COVID incidence, vaccine uptake, burnout and working patterns. Data were analysed qualitatively and quantitatively; multivariable logistic regression was used to identify associations. Results A total of 423 responses were received. Of them, 29% had contracted COVID-19, which was more common among doctors and nurses {odds ratio [OR] 2.18 [95% confidence interval (CI) 1.13–4.22]} and those <55 years of age [OR 2.60 (95% CI 1.38–4.90)]. Of those who contracted COVID-19, 36% had symptoms of long COVID, which was more common among ethnicities other than White British [OR 2.57 (95% CI 1.09–6.05)]. A total of 57% had evidence of burnout, which was more common among younger respondents [OR 1.92 (95% CI 1.10–3.35)] and those with long COVID [OR 10.31 (95% CI 1.32–80.70)], and 59% with reconfigured job plans continued to work more hours. More of those working full-time wished to retire early. A total of 59% experienced remote working, with a majority preference for continuing this in the future. In terms of vaccination, 95% had received one dose of a COVID-19 vaccine and 86% had received two doses by May 2021. Conclusions Burnout and long COVID is prevalent with impacts on working lives. Some groups are more at risk. Vaccination uptake is high and remote and flexible working were well received. Institutional interventions are needed to prevent workforce attrition.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester
| | | | | | - Sarah Afuwape
- Kidney and Urology Department, Royal Free London NHS Foundation Trust
| | - Sarah Brand
- Department of Renal Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Graham-Brown
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester
| | - James Medcalf
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester
- UK Renal Registry, The Renal Association, Bristol, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, UK
| | - Hannah Beckwith
- Institute of Clinical Sciences, Imperial College London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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Magennis P, Begley A, Dhariwal DK, Smith A, Hutchison I. Oral and Maxillofacial Surgery (OMFS) Consultant Workforce in the UK: reducing consultant numbers resulting from recruitment issues, pension pressures, changing job-plans, and demographics when combined with the COVID backlog in elective surgery, requires urgent action. Br J Oral Maxillofac Surg 2021; 60:14-19. [PMID: 34844827 DOI: 10.1016/j.bjoms.2021.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022]
Abstract
Mean retirement age for UK doctors is 59.6 years, giving the average OMFS consultant approximately 20 years of practice. Current pension tax regulations, new consultant posts typically restricted to a maximum of 10 sessions (40 hours), increasing proportions of consultants working less than full time (LTFT), all combined with the backlog of elective care created by COVID-19 will create a significant gap between workforce capacity and clinical demand. The age of current OMFS consultants was estimated using the date of their primary medical/dental qualification. Changes in job plans were estimated using data from the BAOMS Workforce Census and from recently advertised posts. Reports of unfilled posts were collated by OMFS Regional Specialty Professional Advisors (RSPAs). First degree dates were identified for 476 OMFS substantive consultant posts. Estimated current average age of OMFS consultants was 52.7 years (minimum 35.9, maximum 72.1), 75th centile age 59.0 and 23% of the current consultant workforce above the average retirement age for doctors. The 10 sessions of new OMFS consultants posts is significantly less than existing consultants' average of 12.1 sessions (48.4 hours). Unfilled consultant posts in Great Britain are 13% of total compared to 20% in Northern Ireland and Ireland. Many (23%) of the OMFS consultant workforce are above average retirement age. Forty-hour contracts; new consultants working LTFT; and early loss of senior colleagues because of pension pressure will reduce NHS' capacity to treat OMFS disorders and injuries. This paper suggests increasing consultant posts, increasing trainee numbers, and actively retaining senior surgeons to maintain capacity.
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Affiliation(s)
- Patrick Magennis
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
| | - Anne Begley
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom.
| | | | - Austen Smith
- OMFS Surgeon, Sheffield and Barnsley Hospitals NHS Foundation Trust, United Kingdom.
| | - Iain Hutchison
- Institute of Dentistry, Barts and The London, United Kingdom.
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Rogers B. Shall not cease from exploration. Ann R Coll Surg Engl 2021; 103:463. [PMID: 34192494 DOI: 10.1308/rcsann.2021.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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