'Intern life': a longitudinal study of burnout, empathy, and coping strategies used by French GPs in training

How are French pediatric orthopedic surgeons affected by burnout? Results of a nationwide survey

INTRODUCTION

Burnout is a syndrome that adversely affects those who work in roles designed to assist and aid others, such as healthcare professionals. There is a paucity of data available on this topic among French pediatric orthopedic surgeons, registrars and interns. Therefore, we conducted a national survey to: (1) assess the prevalence of burnout syndrome among French pediatric orthopedic surgeons; (2) determine the risks and protective factors associated with this syndrome.

HYPOTHESIS

The prevalence of burnout among French pediatric orthopedic surgeons is at least as high as in other medical and surgical specialties.

MATERIALS AND METHODS

We conducted a nationwide survey during the months of June and July 2022 by distributing a digitized questionnaire by e-mail. The burnout syndrome was assessed by the MBI (Maslach Burnout Inventory) score. Demographic and professional practice data were also collected.

RESULTS

Thirty-eight interns and 65 pediatric orthopedic registrars took part in the survey, i.e. a participation rate estimated at 65.5% and 44.4% respectively. Twenty-six percent (n=10) of interns and 13.9% (n=9) of registrars had MBI scores suggestive of moderate or severe burnout. Respectively 20.8% (n=9) and 9.2% (n=6) of interns and registrars reported suicidal thoughts in the past year. After statistical analysis, medical errors (OR: 3.4336; 95% CI: 1.7164-6.869; p<0.001) and suicidal ideation (OR: 2.3075; 95% CI: 1.0480-5.081; p=0.038) were associated with severe burnout. Having children (OR: 0.495; 95% CI: 0.2491-0.983; p=0.044) emerged as a protective factor.

DISCUSSION

With a high participation rate, this study reveals a high burnout rate among French pediatric orthopedic interns and registrars, even if slightly lower than those found in other surgical specialties. Interns seem more exposed to this risk than their seniors. The consequences of burnout are diverse but can be significant. These results necessitate a vigilant approach to the occurrence of burnout among health professionals, and the appropriate management of it.

LEVEL OF EVIDENCE

III; descriptive cross-sectional study without a control group.

'We were treated like we are nobody': a mixed-methods study of medical doctors' internship experiences in Kenya and Uganda

OBJECTIVE

Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for learning and assessment, which is worse in countries with resource constraints. In this study, we provide an overview of medical doctors' internship experiences in Kenya and Uganda.

METHODS

Using a convergent mixed-methods approach, we collected data from a survey of 854 medical interns and junior doctors and semistructured interviews with 54 junior doctors and 14 consultants. Data collection and analysis were guided by major themes identified from a previous global scoping review (well-being, educational environment and working environment and condition), using descriptive analysis and thematic analysis respectively for quantitative and qualitative data.

FINDINGS

Most medical interns are satisfied with their job but many reported suffering from stress, depression and burn-out, and working unreasonable hours due to staff shortages. They are also being affected by the challenging working environment characterised by a lack of adequate resources and a poor safety climate. Although the survey data suggested that most interns were satisfied with the supervision received, interviews revealed nuances where many interns faced challenging scenarios, for example, poor supervision, insufficient support due to consultants not being available or being 'treated like we are nobody'.

CONCLUSION

We highlight challenges experienced by Kenyan and Ugandan medical interns spanning from burn-out, stress, challenging working environment, inadequate support and poor quality of supervision. We recommend that regulators, educators and hospital administrators should improve the resource availability and capacity of internship hospitals, prioritise individual doctors' well-being and provide standardised supervision, support systems and conducive learning environments.

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

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

Assessment of inflammatory bowel disease educational videos for increasing patient engagement and family and friends' levels of understanding

OBJECTIVE

We developed five educational videos through a user-centered approach for patients with inflammatory bowel diseases (IBD) and their families and friends. Here, we assessed if IBD patient activation and family and friends' abilities to understand IBD patients' thoughts, feelings, and behaviors (i.e., perspective taking) changed after watching the videos.

METHODS

Through a pre-post survey, we assessed patient activation and perspective taking levels in people with a self-reported IBD diagnosis and their family and friends, respectively, before and after watching one of the videos.

RESULTS

Among 767 participants with IBD, patient activation scores increased significantly after watching each video. In regression analyses, patient activation levels were less likely to increase in biologic-naïve participants after viewing the coping video. Among 232 people who knew someone with IBD, perspective taking scores increased significantly in 8/9 domains, which was more likely to occur among women.

CONCLUSIONS

Educational videos developed through a user-centered approach were associated with higher self-reported IBD patient activation scores and perspective taking levels among family and friends.

PRACTICE IMPLICATIONS

These videos, which are now widely disseminated on social media, serve as a model for how to create educational materials for improving patient activation and empathy in the social media era.

Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review

BACKGROUND

A variety of stressors throughout medical education have contributed to a burnout epidemic at both the undergraduate medical education (UGME) and postgraduate medical education (PGME) levels. In response, UGME and PGME programs have recently begun to explore resilience-based interventions. As these interventions are in their infancy, little is known about their efficacy in promoting trainee resilience. This systematic review aims to synthesize the available research evidence on the efficacy of resilience curricula in UGME and PGME.

METHODS

We performed a comprehensive search of the literature using MEDLINE, EMBASE, PsycINFO, Educational Resources Information Centre (ERIC), and Education Source from their inception to June 2020. Studies reporting the effect of resilience curricula in UGME and PGME settings were included. A qualitative analysis of the available studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the ROBINS-I Tool.

RESULTS

Twenty-one studies met the inclusion criteria. Thirteen were single-arm studies, 6 quasi-experiments, and 2 RCTs. Thirty-eight percent (8/21; n = 598) were implemented in UGME, while 62 % (13/21, n = 778) were in PGME. There was significant heterogeneity in the duration, delivery, and curricular topics and only two studies implemented the same training model. Similarly, there was considerable variation in curricula outcome measures, with the majority reporting modest improvement in resilience, while three studies reported worsening of resilience upon completion of training. Overall assessment of risk of bias was moderate and only few curricula were previously validated by other research groups.

CONCLUSIONS

Findings suggest that resilience curricula may be of benefit to medical trainees. Resilience training is an emerging area of medical education that merits further investigation. Additional research is needed to construct optimal methods to foster resilience in medical education.

Factors Associated With Burnout and Stress in Trainee Physicians: A Systematic Review and Meta-analysis

Importance

Evidence suggests that physicians experience high levels of burnout and stress and that trainee physicians are a particularly high-risk group. Multiple workplace- and non-workplace-related factors have been identified in trainee physicians, but it is unclear which factors are most important in association with burnout and stress. Better understanding of the most critical factors could help inform the development of targeted interventions to reduce burnout and stress.

Objective

To estimate the association between different stressors and burnout/stress among physicians engaged in standard postgraduate training (ie, trainee physicians).

Data Sources

Medline, Embase, PsycINFO, and Cochrane Database of Systematic reviews from inception until April 30, 2019. Search terms included trainee, foundation year, registrar, resident, and intern.

Study Selection

Studies that reported associations between stressors and burnout/stress in trainee physicians.

Data Extraction and Synthesis

Two independent reviewers extracted the data and assessed the quality of the evidence. The main meta-analysis was followed by sensitivity analyses. All analyses were performed using random-effects models, and heterogeneity was quantified using the I2 statistic.

Main Outcome and Measures

The main outcome was the association between burnout/stress and workplace- or non-workplace-related factors reported as odds ratios (ORs) and their 95% CIs.

Results

Forty-eight studies were included in the meta-analysis (n = 36 266, median age, 29 years [range, 24.6-35.7 years]). One study did not specify participants' sex; of the total population, 18 781 participants (52%) were men. In particular, work demands of a trainee physician were associated with a nearly 3-fold increased odds for burnout/stress (OR, 2.84; 95% CI, 2.26-3.59), followed by concerns about patient care (OR, 2.35; 95% CI, 1.58-3.50), poor work environment (OR, 2.06; 95% CI, 1.57-2.70), and poor work-life balance (OR, 1.93; 95% CI, 1.53-2.44). Perceived/reported poor mental or physical health (OR, 2.41; 95% CI, 1.76-3.31), female sex (OR, 1.34; 95% CI, 1.20-1.50), financial worries (OR, 1.35; 95% CI, 1.07-1.72), and low self-efficacy (OR, 2.13; 95% CI, 1.31-3.46) were associated with increased odds for burnout/stress, whereas younger age and a more junior grade were not significantly associated.

Conclusions and Relevance

The findings of this study suggest that the odds ratios for burnout and stress in trainee physicians are higher than those for work-related factors compared with nonmodifiable and non-work-related factors, such as age and grade. These findings support the need for organizational interventions to mitigate burnout in trainee physicians.

"Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew": Defining Autistic Burnout

Background: Although autistic adults often discuss experiencing "autistic burnout" and attribute serious negative outcomes to it, the concept is almost completely absent from the academic and clinical literature. Methods: We used a community-based participatory research approach to conduct a thematic analysis of 19 interviews and 19 public Internet sources to understand and characterize autistic burnout. Interview participants were autistic adults who identified as having been professionally diagnosed with an autism spectrum condition. We conducted a thematic analysis, using a hybrid inductive-deductive approach, at semantic and latent levels, through a critical paradigm. We addressed trustworthiness through multiple coders, peer debriefing, and examination of contradictions. Results: Autistic adults described the primary characteristics of autistic burnout as chronic exhaustion, loss of skills, and reduced tolerance to stimulus. They described burnout as happening because of life stressors that added to the cumulative load they experienced, and barriers to support that created an inability to obtain relief from the load. These pressures caused expectations to outweigh abilities resulting in autistic burnout. Autistic adults described negative impacts on their health, capacity for independent living, and quality of life, including suicidal behavior. They also discussed a lack of empathy from neurotypical people and described acceptance and social support, time off/reduced expectations, and doing things in an autistic way/unmasking as associated in their experiences with recovery from autistic burnout. Conclusions: Autistic burnout appears to be a phenomenon distinct from occupational burnout or clinical depression. Better understanding autistic burnout could lead to ways to recognize, relieve, or prevent it, including highlighting the potential dangers of teaching autistic people to mask or camouflage their autistic traits, and including burnout education in suicide prevention programs. These findings highlight the need to reduce discrimination and stigma related to autism and disability.

LAY SUMMARY

Why was this study done?: Autistic burnout is talked about a lot by autistic people but has not been formally addressed by researchers. It is an important issue for the autistic community because it is described as leading to distress; loss of work, school, health, and quality of life; and even suicidal behavior.What was the purpose of this study?: This study aimed to characterize autistic burnout, understand what it is like, what people think causes it, and what helps people recover from or prevent it. It is a first step in starting to understand autistic burnout well enough to address it.What did the researchers do?: Our research group-the Academic Autism Spectrum Partnership in Research and Education-used a community-based participatory research approach with the autistic community in all stages of the study. We analyzed 9 interviews from our study on employment, 10 interviews about autistic burnout, and 19 public Internet sources (five in-depth). We recruited in the United States by publicizing on social media, by word of mouth, and through community connections. When analyzing interviews, we took what people said at face value and in deeper social context, and looked for strong themes across data.What were the results of the study?: The primary characteristics of autistic burnout were chronic exhaustion, loss of skills, and reduced tolerance to stimulus. Participants described burnout as happening because of life stressors that added to the cumulative load they experienced, and barriers to support that created an inability to obtain relief from the load. These pressures caused expectations to outweigh abilities resulting in autistic burnout. From this we created a definition:Autistic burnout is a syndrome conceptualized as resulting from chronic life stress and a mismatch of expectations and abilities without adequate supports. It is characterized by pervasive, long-term (typically 3+ months) exhaustion, loss of function, and reduced tolerance to stimulus.Participants described negative impacts on their lives, including health, capacity for independent living, and quality of life, including suicidal behavior. They also discussed a lack of empathy from neurotypical people. People had ideas for recovering from autistic burnout including acceptance and social support, time off/reduced expectations, and doing things in an autistic way/unmasking.How do these findings add to what was already known?: We now have data that autistic burnout refers to a clear set of characteristics, and is different from workplace burnout and clinical depression. We have the start of a model for why autistic burnout might happen. We know that people have been able to recover from autistic burnout and have some insights into how.What are the potential weaknesses in the study?: This was a small exploratory study with a convenience sample. Although we were able to bring in some diversity by using three data sources, future work would benefit from interviewing a wider range of participants, especially those who are not white, have higher support needs, and have either very high or very low educational attainment. More research is needed to understand how to measure, prevent, and treat autistic burnout.How will these findings help autistic adults now or in the future?: These findings validate the experience of autistic adults. Understanding autistic burnout could lead to ways to help relieve it or prevent it. The findings may help therapists and other practitioners recognize autistic burnout, and the potential dangers of teaching autistic people to mask autistic traits. Suicide prevention programs should consider the potential role of burnout. These findings highlight the need to reduce discrimination and stigma around autism and disability.

Effectiveness of a multimodal training programme to improve general practitioners' burnout, job satisfaction and psychological well-being

BACKGROUND

The changes in the models of care for mental disorders towards a community focus and deinstitutionalisation might have risen General practitioners' (GPs) workload, increasing their mental health concerns and the need for solutions. Pragmatic research into improving GPs' work-related health and psychological well-being is limited by focusing mainly on stressors and through not providing systematic attention to the development of positive mental health via interventions that develop psychological resources and capacities. The aim of this study was twofold: a) to determine the effectiveness of an intensive multimodal training programme for GPs designed to improve their management of mental-health patients; and b) to ascertain if the program could be also useful to improve the GPs management of their own burnout, job satisfaction and psychological well-being.

METHOD

Eighteen GPs constituted a control group that underwent the routine clinical Mental health support programme for primary care. An experimental group (N = 20) additionally received a Multimodal training programme (MTP) with an Integrated Brief Systemic Therapy (IBST) approach. Through questionnaires and a clinical interview, level of burnout, professional satisfaction, psychopathological state and various indicators of the quality of administrative and healthcare management were analysed at baseline and 10 months after the programme.

RESULTS

In relation to government of mental-health patients indicators, on the one hand MTP group showed statistically significant improvements in certain administrative health parameters, but on the other it did not improve opinions and attitudes towards mental illness. Regarding GPs management of their own burnout, job satisfaction and psychological well-being assessments, the MTP presented better scores on global psychopathological state and better evolution of satisfaction at work; psychopharmacology use dropped in both groups; in contrast, the MTP did not improve burnout levels.

CONCLUSIONS

Findings of this preliminary study are promising for the MTP (with an IBST approach) practice in primary care. More research evidence is required from larger samples and randomized controlled trials to support both the hypothetical adoption of MTP (with an IBST approach) as a part of a continuing professional-training programme for GPs' management of mental-health patients and its positive effects on work-related health factors.

Work strain and burnout risk in postgraduate trainees in general practice: an overview

Primary care physicians (general practitioners (GPs)) are burdened for various reasons and are particularly affected by stress-related complaints and an increasing prevalence of burnout. Thus, the prevention of physician burnout has become a major interest for health care services. Although many studies have addressed this issue in recent years, little seems to be known about the work strain and burnout rates in GP trainees. Therefore the objective of this article is to review the psychosocial burden and relevant prevention strategies for GPs with a special emphasis on GP trainees. Regardless of the specialty, burnout is more prevalent among medical trainees and so-called 'early career' physicians than among the age-matched population. Accordingly, burnout seems to be frequent among GP trainees, although there is some evidence that there are fewer doctors working in general medicine who were already heavily burdened at the time of choosing their career. The sudden assumption of responsibility in patient care as well as the fear of showing imperfection in front of their supervisors, or lack of recognition from senior doctors, the medical team, or patients might be stressors typical to this career stage. GP trainees might also feel burdened by the new level of personal involvement and thus have to develop or increase their individual level of professionality to deal with the patients' medical and personal problems. In conclusion, interventions to promote physical and mental health of GP trainees are a necessity to ensure passionate GPs in the future and should therefore be integrated into any postgraduate training curriculum in general practice.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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