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Muteshi C, Ochola E, Kamya D. Burnout among medical residents, coping mechanisms and the perceived impact on patient care in a low/ middle income country. BMC MEDICAL EDUCATION 2024; 24:828. [PMID: 39085854 DOI: 10.1186/s12909-024-05832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/29/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Burnout is a syndrome that result from chronic workplace stress and it characterized by emotional exhaustion, depersonalization and low personal accomplishments. Studies report higher burnout levels in medical personnel compared to the general population. Workplace burnout has been directly linked to medical errors and negative coping strategies such as substance abuse. The aims of this study were to assess the level of burnout in medical residents, evaluate their impressions about coping mechanisms and assess perceived impact on patient care in a low/ middle income country setting. METHODS This was a cross sectional, mixed methods survey carried out at Aga Khan University, Nairobi Kenya. The Maslach Burnout Inventory - Human Services Survey was used to assess the level of burnout. High-risk scores for each subscale are defined as > 27 in emotional exhaustion, > 10 in depersonalization, and < 33 in personal accomplishment. Overall high risk of burnout was defined as high-risk scores in 2 or more of the 3 categories. Categorical variables were analysed using descriptive statistics and reported as frequency counts and corresponding percentages. Chi-square test was applied to test for association of burnout and the categorical variables. P value of < 0.05 was considered statistically significant. To assess the impressions on patient care and evaluate the coping mechanisms employed in the context of burnout residents participated in four focus group discussions reaching thematic saturation. RESULTS 95 out of 120 residents consented to participate in the study, 47.3% of whom had a high risk of burnout. A significant association was found between gender and burnout risk with more female residents having high risk of burnout compared to their male counterparts; 58.0% and 35.6% respectively (P value 0.029). Residents in paediatrics and child health had the greatest risk of burnout (8 out of 10) compared to those in other programmes (P value of 0.01). Thematic analysis from focus group discussions revealed that main sources of stress included departmental conflict and struggle to balance work and other aspects of life. All focus group discussions revealed that burnout and stress are associated with negative coping mechanisms. Respondents reported that when under stress, they felt more likely to make medical errors. CONCLUSION This study reported high risk of burnout among post graduate residents which is consistent with other global studies. The sources of stress cited by residents were mostly related to the workplace and many perceived sub-optimal patients care resulted from burnout. This highlights a need for preventive measures such as wellness programs within the training programmes. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Charles Muteshi
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya.
| | - Elizabeth Ochola
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
| | - Dorothy Kamya
- Department of Anaesthesiology, Aga Khan University Hospital, Nairobi, Kenya
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Alwatban L, Alageel MS, Alshehri LA, Alfehaid NS, Albahlal RA, Almazrou NH, Almubarak R. The Stigma of Burnout Impeding Formal Help: A Qualitative Study Exploring Residents' Experiences During Training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:333-342. [PMID: 38646001 PMCID: PMC11032676 DOI: 10.2147/amep.s453564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/02/2024] [Indexed: 04/23/2024]
Abstract
Purpose Burnout is an occupational stress syndrome that gives rise to emotional exhaustion (EE) depersonalization (DP) and reduced personal accomplishment (PA). Increasing rates of burnout among health care professionals has been reported globally. Saudi Arabia appears to be among the highest in prevalence with reports of higher than 70%. Medical residents in training are the highest group at risk. The literature has repeatedly linked burnout among residents with poor academic performance on training exams, impaired quality of life, career choice regret and intentions to abandon medicine. In this study, we explore the factors that contribute to resident burnout, their experiences with burnout and how they choose to mitigate it. Methods A qualitative design was used to conduct this study in the city of Riyadh, Saudi Arabia. A total of 14 residents from surgical and non-surgical programs were interviewed through in-depth interviews. Interpretive thematic analysis was used in coding and generated coding templates. Categories were repetitively reviewed and revised, expanding to include new data as it emerged and collapsing to remove redundant codes. Categories were organized into the final themes and sub-themes. Results All participants demonstrated a shared thread of shame in reaching the level of burnout. Three main interlinked themes were identified: Burnout stigma cycle, amalgamated causes of burnout and self-coping with burnout. One of the concerning findings in our study is the participants' pursuit of self-coping strategies and the avoidance of formal help, creating a cycle of suffering in silence. Conclusion The literature has repeatedly reported high levels of burnout among residents in training. This study has added another dimension to those findings through the exploration of residents actual accounts and appears to link burnout with suboptimal training and working conditions. We have highlighted the pivotal role stigma and shame play in completely preventing residents from seeking professional help.
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Affiliation(s)
- Lemmese Alwatban
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- University Family Medicine Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mai S Alageel
- Department of Family Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Lina A Alshehri
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Kabunga A, Kigongo E, Okalo P, Udho S, Grace AA, Tumwesigye R, Akello AR, Musinguzi M, Acup W, Nabaziwa J, Shikanga EM, Namata H. Burnout and coping mechanisms among healthcare professionals in central Uganda. Front Psychiatry 2024; 15:1373743. [PMID: 38686129 PMCID: PMC11056560 DOI: 10.3389/fpsyt.2024.1373743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
Background The escalating global prevalence of burnout among healthcare professionals poses a serious health concern. Recent studies focus on prevalence and predictors of burnout among healthcare providers, emphasizing the need for well-being interventions. This study investigates burnout and coping mechanisms among healthcare professionals in central Uganda, addressing the dearth of knowledge about coping strategies specific to the region. Methods An analytical facility cross-sectional study was conducted in five healthcare facilities in central Uganda between June to July 2023. Participants included physicians, nurses, and technicians actively engaged in direct patient care. Data were collected using socio-demographic surveys, the Professional Quality of Life (ProQOL-5), and the Brief-COPE tools. Results The study revealed a high prevalence of burnout, with 39.8% of participants experiencing significant levels. Active coping, positive reframing, and denial were negatively correlated with low burnout levels. Dysfunctional coping, specifically self-distraction and denial, showed positive correlations with average and high burnout levels. Emotion-focused coping mechanisms were not employed across burnout levels. Conclusions The results emphasize the demanding nature of healthcare roles in the region and highlight the need for comprehensive, context-specific interventions to address burnout globally. While some healthcare professionals utilized adaptive strategies such as seeking social support, engaging in self-care activities, and utilizing problem-solving skills, others resorted to maladaptive coping mechanisms such as substance use and avoidance behaviors. This dichotomy highlights the need for targeted interventions to promote adaptive coping strategies and mitigate the negative impact of maladaptive behaviors on individual well-being and patient care.
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Affiliation(s)
- Amir Kabunga
- Department of Psychiatry, Faculty of Medicine, Lira University, Lira, Uganda
| | - Eustes Kigongo
- Department of Environmental Health and Disease Control, Faculty of Public Health, Lira University, Lira, Uganda
| | - Ponsiano Okalo
- Department of Psychiatry, Faculty of Medicine, Lira University, Lira, Uganda
| | - Samson Udho
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Anna Auma Grace
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Raymond Tumwesigye
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Anne Ruth Akello
- Department of Environmental Health and Disease Control, Faculty of Public Health, Lira University, Lira, Uganda
| | - Marvin Musinguzi
- Department of Community Health, Faculty of Public Health, Lira University, Lira, Uganda
| | - Walter Acup
- Department of Community Health, Faculty of Public Health, Lira University, Lira, Uganda
| | - Jannat Nabaziwa
- Department of Community Health, Faculty of Public Health, Lira University, Lira, Uganda
| | | | - Haliama Namata
- Department of Mental Health, Makerere University, Kampala, Uganda
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Doherty A, Prihodova L, Walsh G, Hayes B. How do they cope? A national cross-sectional study of coping in hospital doctors in Ireland. BMJ Open 2024; 14:e076218. [PMID: 38199629 PMCID: PMC10806734 DOI: 10.1136/bmjopen-2023-076218] [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: 05/31/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES To measure coping strategies and associated psychological distress, burnout and work ability in hospital doctors in Ireland. DESIGN National cross-sectional study of randomised sample of trainee and consultant hospital doctors. SETTING Irish publicly funded hospitals and residential institutions. PARTICIPANTS 1749 doctors returned surveys (55% response rate). OUTCOME MEASURES Dependent variables were psychological distress (measured using 12-item General Health Questionnaire), burnout (Maslach Burnout Inventory) and work ability (single-item measure). Adaptive and maladaptive coping strategies (Brief Coping Orientation to Problems Experienced) were covariates. RESULTS The coping mechanism most frequently reported by this cohort was the adaptive strategy of active planning. Increased mean hours worked (MHW) (OR 1.02; 95% CI 1.01 to 1.03), a low Work Ability Score (OR 3.23; 95% CI 2.47 to 4.23) and maladaptive coping strategies (OR 1.26; 95% CI 1.22 to 1.31) were significantly associated with psychological distress. Adaptive coping was associated with decreased psychological distress (OR 0.98; 95% CI 0.97 to 1.00). Increased MHW (OR 0.98; 95% CI 0.97 to 0.99), insufficient work ability (OR 0.62; 95% CI 0.48 to 0.80) and maladaptive coping (OR 0.87; 95% CI 0.85 to 0.89) were significantly associated with burnout. Increased MHW (OR 0.99; 95% CI 0.98 to 1.00) and maladaptive coping (OR 0.90, 95% CI 0.88 to 0.92) were significantly associated with insufficient work ability. CONCLUSIONS Adaptive coping is associated with decreased psychological distress but does not mitigate the effect of increased work hours, which are associated with burnout, distress and insufficient work ability, regardless of a doctor's coping style. The burden of psychological distress on doctors cannot be mitigated meaningfully unless workplace factors are addressed.
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Affiliation(s)
- Ailbhe Doherty
- Specialist Perinatal Mental Health Service, Rotunda Hospital, Dublin, Ireland
| | - Lucia Prihodova
- National Office for Research Ethics Committees, Dublin, Ireland
| | - Gillian Walsh
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Blánaid Hayes
- Royal College of Physicians of Ireland, Dublin, Ireland
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