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Heymann EP, Romann V, Lim R, Van Aarsen K, Khatib N, Sauter T, Schild B, Mueller S. Physician wellbeing and burnout in emergency medicine in Switzerland. Swiss Med Wkly 2024; 154:3421. [PMID: 38753467 DOI: 10.57187/s.3421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Emergency physicians are the most at-risk medical specialist group for burnout. Given its consequences for patient care and physician health and its resulting increased attrition rates, ensuring the wellbeing of emergency physicians is vital for preserving the integrity of the safety net for the healthcare system that is emergency medicine. In an effort to understand the current state of practicing physicians, this study reviews the results of the first national e-survey on physician wellbeing and burnout in emergency medicine in Switzerland. Addressed to all emergency physicians between March and April 2023, it received 611 complete responses. More than half of respondents met at least one criterion for burnout according to the Maslach Burnout Inventory - Human Services Survey (59.2%) and the Copenhagen Burnout Inventory (54.1%). In addition, more than half reported symptoms suggestive of mild to severe depression, with close to 20% screening positively for moderate to severe depression, nearly 4 times the incidence in the general population, according to the Patient Health Questionnaire-9. We found that 10.8% of respondents reported having considered suicide at some point in their career, with nearly half having considered this in the previous 12 months. The resulting high attrition rates (40.6% of respondents had considered leaving emergency medicine because of their working conditions) call into question the sustainability of the system. Coinciding with trends observed in other international studies on burnout in emergency medicine, this study reinforces the fact that certain factors associated with wellbeing are intrinsic to emergency medicine working conditions.
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Affiliation(s)
- Eric P Heymann
- Swiss Society of Emergency and Rescue Medicine, Switzerland
- Department of Emergency Medicine, Cantonal Hospital of Neuchâtel, Neuchâtel, Switzerland
- Department of Emergency Medicine, Faculty of Medicine, University of Bern, Switzerland
| | - Valerie Romann
- Swiss Society of Emergency and Rescue Medicine, Switzerland
- Department of Emergency Medicine, Tiefenau Hospital, Bern, Switzerland
| | - Rod Lim
- Canadian Association of Emergency Physicians, Canada
- Department of Paediatric Emergency Medicine, London Health Sciences Centre, Ontario, Canada
| | - Kristine Van Aarsen
- Department of Paediatric Emergency Medicine, London Health Sciences Centre, Ontario, Canada
| | - Nour Khatib
- Canadian Association of Emergency Physicians, Canada
- University of Toronto, Faculty of Medicine, Toronto, Canada
| | - Thomas Sauter
- Swiss Society of Emergency and Rescue Medicine, Switzerland
- Department of Emergency Medicine, Faculty of Medicine, University of Bern, Switzerland
- Department of Emergency Medicine, Bern University Hospital, Bern, Switzerland
| | - Barbara Schild
- Swiss Society of Emergency and Rescue Medicine, Switzerland
- Croce verde Bellinzona e di Tre Valli, Bellinzona, Switzerland
| | - Stefan Mueller
- Swiss Society of Emergency and Rescue Medicine, Switzerland
- Department of Anaesthesiology, Stadtspital, Zurich, Switzerland
- Schutz und Rettung Zürich, Zürich
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Kraege V, Gavin A, Norambuena J, Stiefel F, Méan M, Bourquin C. Core stories of physicians on a Swiss internal medicine ward during the first COVID-19 wave: a qualitative exploration. Swiss Med Wkly 2024; 154:3760. [PMID: 38642026 DOI: 10.57187/s.3760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION The first COVID-19 wave (2020), W1, will remain extraordinary due to its novelty and the uncertainty on how to handle the pandemic. To understand what physicians went through, we collected narratives of frontline physicians working in a Swiss university hospital during W1. METHODS Physicians in the Division of Internal Medicine of Lausanne University Hospital (CHUV) were invited to send anonymous narratives to an online platform, between 28 April and 30 June 2020. The analysed material consisted of 13 written texts and one audio record. They were examined by means of a narrative analysis based on a holistic content approach, attempting to identify narrative highlights, referred to as foci, in the texts. RESULTS Five main foci were identified: danger and threats, acquisition of knowledge and practices, adaptation to a changing context, commitment to the profession, and sense of belonging to the medical staff. In physicians' narratives, danger designated a variety of rather negative feelings and emotions, whereas threats were experienced as being dangerous for others, but also for oneself. The acquisition of knowledge and practices focus referred to the different types of acquisition that took place during W1. The narratives that focused on adaptation reflected how physicians coped with W1 and private or professional upheavals. COVID-19 W1 contributed to revealing a natural commitment (or not) of physicians towards the profession and patients, accompanied by the concern of offering the best possible care to all. Lastly, sense of belonging referred to the team and its reconfiguration during W1. CONCLUSIONS Our study deepens the understanding of how physicians experienced the pandemic both in their professional and personal settings. It offers insights into how they prepared and reacted to a pandemic. The foci reflect topics that are inherent to a physician's profession, whatever the context. During a pandemic, these foundational elements are particularly challenged. Strikingly, these topics are not studied in medical school, thus raising the general question of how students are prepared for the medical profession.
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Affiliation(s)
- Vanessa Kraege
- Division of Internal medicine, Medical Directorate and Innovation and Clinical Research Directorate, Lausanne University Hospital, Lausanne, Switzerland
| | - Amaelle Gavin
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Julieta Norambuena
- Division of Internal medicine, Lausanne University Hospital, Lausanne,Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - Marie Méan
- Division of Internal medicine, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
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Bretagne L, Mosimann S, Roten C, Perrig M, Genné D, Essig M, Mancinetti M, Méan M, Darbellay Farhoumand P, Huber LC, Weber E, Knoblauch C, Schoenenberger AW, Frick S, Wenemoser E, Ernst D, Bodmer M, Aujesky D, Baumgartner C. Association of part-time clinical work with well-being and mental health in General Internal Medicine: A survey among Swiss hospitalists. PLoS One 2023; 18:e0290407. [PMID: 37768911 PMCID: PMC10538797 DOI: 10.1371/journal.pone.0290407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/08/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Burnout and low job satisfaction are increasing among the General Internal Medicine (GIM) workforce. Whether part-time compared to full-time clinical employment is associated with better wellbeing, job satisfaction and health among hospitalists remains unclear. MATERIALS AND METHODS We conducted an anonymized cross-sectional survey among board-certified general internists (i.e. hospitalists) from GIM departments in 14 Swiss hospitals. Part-time clinical work was defined as employment of <100% as a clinician. The primary outcome was well-being, as measured by the extended Physician Well-Being Index (ePWBI), an ePWBI ≥3 indicating poor wellbeing. Secondary outcomes included depressive symptoms, mental and physical health, and job satisfaction. We compared outcomes in part-time and full time workers using propensity score-adjusted multivariate regression models. RESULTS Of 199 hospitalists invited, 137 (69%) responded to the survey, and 124 were eligible for analysis (57 full-time and 67 part-time clinicians). Full-time clinicians were more likely to have poor wellbeing compared to part-time clinicians (ePWBI ≥3 54% vs. 31%, p = 0.012). Part-time compared to full-time clinical work was associated with a lower risk of poor well-being in adjusted analyses (odds ratio 0.20, 95% confidence interval 0.07-0.59, p = 0.004). Compared to full-time clinicians, there were fewer depressive symptoms (3% vs. 18%, p = 0.006), and mental health was better (mean SF-8 Mental Component Summary score 47.2 vs. 43.2, p = 0.028) in part-time clinicians, without significant differences in physical health and job satisfaction. CONCLUSIONS Full-time clinical hospitalists in GIM have a high risk of poor well-being. Part-time compared to full-time clinical work is associated with better well-being and mental health, and fewer depressive symptoms.
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Affiliation(s)
- Lisa Bretagne
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefanie Mosimann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Christine Roten
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Perrig
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Genné
- Department of Internal Medicine, Hospital of Biel-Bienne, Bienne, Switzerland
| | - Manfred Essig
- Department of General Internal Medicine, Tiefenau Hospital, Bern, Switzerland
| | - Marco Mancinetti
- Department of Medicine, University and Hospital of Fribourg, Fribourg, Switzerland
| | - Marie Méan
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | | | - Lars C Huber
- Department of General Internal Medicine, Stadtspital Zürich Triemli, Zürich, Switzerland
| | - Elisabeth Weber
- Department of General Internal Medicine, Stadtspital Zürich Waid, Zürich, Switzerland
| | - Christoph Knoblauch
- Department of General Internal Medicine, Hospital of Nidwalden, Stans, Switzerland
| | - Andreas W Schoenenberger
- Department of General Internal Medicine, Cantonal Hospital of Münsterlingen, Münsterlingen, Switzerland
| | - Sonia Frick
- Department of General Internal Medicine, Hospital of Limmattal, Schlieren, Switzerland
| | - Eliane Wenemoser
- Department of General Internal Medicine, Hospital Region of Oberaargau, Langenthal, Switzerland
| | - Daniel Ernst
- Department of General Internal Medicine, Hospital of Thun, Thun, Switzerland
| | - Michael Bodmer
- Department of General Internal Medicine, Cantonal Hospital of Zug, Baar, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Martínez-Fernández MC, Castiñeiras-Martín S, Liébana-Presa C, Fernández-Martínez E, Gomes L, Marques-Sanchez P. SBAR Method for Improving Well-Being in the Internal Medicine Unit: Quasi-Experimental Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16813. [PMID: 36554696 PMCID: PMC9778833 DOI: 10.3390/ijerph192416813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
SBAR (Situation, Background, Assessment, Recommendation) is a tool for standardizing and improving interprofessional communication. This study aims to explore the impact of SBAR in healthcare professionals' wellbeing, through concepts such as job satisfaction, engagement, resilience, and job performance, in the internal medicine unit of a university hospital in the province of León (Spain). This is an observational, descriptive, longitudinal case study with a pre- and post-intervention approach. Questionnaires were distributed to a group of doctors, nurses, and healthcare assistants before and after the implementation of the SBAR tool in the ward. The use of SBAR was monitored to ensure staff compliance. Data statistical analysis was performed using the SPSS program. Resilience levels increased significantly post-intervention. Job satisfaction and engagement levels remained neutral, slightly decreasing post-intervention. Besides' being a useful tool to improve communication, SBAR was effective in improving resilience among staff. Several aspects related to hospital management may have had an impact on job satisfaction and engagement results.
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Affiliation(s)
| | | | - Cristina Liébana-Presa
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, 24401 León, Spain
| | | | - Lisa Gomes
- Nursing School, Minho University, 4704-553 Braga, Portugal
| | - Pilar Marques-Sanchez
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, 24401 León, Spain
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Sun X, Zhang M, Lu Z, Zhang Z, Zheng JC, Cheng L, Zeng L, Qian Y, Huang L. Turnover intention and related factors among resident physicians in China under the standardised residency training programme: a cross-sectional survey. BMJ Open 2022; 12:e061922. [PMID: 35410941 PMCID: PMC9003615 DOI: 10.1136/bmjopen-2022-061922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This study aimed at examining the extent of turnover intention among the Chinese resident physicians who entered the newly established national standardised residency training programme (SRTP), and exploring factors associated with their turnover intention. DESIGN Cross-sectional survey. SETTING Ten institutions from five geographical areas in China. METHODS 1414 residents were surveyed using paper-based questionnaires and scales regarding their demographics, work situation, attitudes towards SRTP, job satisfaction, psychological resilience, burnout and turnover intention in 2017. The turnover intention was described and compared between categorical groups. Linear regressions were used to select the factors associated with turnover intention. The structural equation model was used to capture the potential mediating effects. RESULTS The mean turnover intention score was 12.45 (SD=4.47). Nearly half (47.87%) of the residents had a high and very high level of turnover intention. Psychological resilience (β=0.066), burnout (β=0.141) and job satisfaction (β=0.022) were positively associated with turnover intention, while specialty (β=-0.135), year of training (β=-0.687), career in medicine (β=-2.191), necessity of training (β=-0.695) and satisfaction with income (β=-1.215) had negative associations with turnover intention. Working hours and nightshift interval indirectly were associated with turnover intention through the mediating effects of burnout. Career in medicine, necessity of training, satisfaction with income, and psychological resilience showed direct effects and indirect effects on turnover intention through burnout and job satisfaction as mediators. CONCLUSIONS The turnover intention among Chinese residents was prevalent and unignorable. Burnout was the major contributing factor, while year of training and positive attitudes towards training were protective factors. Burnout and job satisfaction also served as mediators. Interventions targeting these factors should be incorporated in the training programmes to keep a prosperous physician workforce.
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Affiliation(s)
- Xiaoting Sun
- Postdoctoral station, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Tongji University School of Medicine, Shanghai, China
| | | | - Zhanghong Lu
- Teaching office, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhaoyu Zhang
- Tongji University School of Medicine, Shanghai, China
| | | | - Liming Cheng
- Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lianhua Zeng
- Tongji University School of Medicine, Shanghai, China
| | - Yingli Qian
- Tongji University School of Medicine, Shanghai, China
| | - Lei Huang
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Holzer BM, Ramuz O, Minder CE, Zimmerli L. Motivation and personality factors of Generation Z high school students aspiring to study human medicine. BMC MEDICAL EDUCATION 2022; 22:31. [PMID: 35016664 PMCID: PMC8753872 DOI: 10.1186/s12909-021-03099-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 12/31/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND A new generation of medical students, Generation Z (Gen Z), is becoming the predominant population in medical schools and will join the workforce in a few years' time. Medicine has undergone serious changes in high-income countries recently. Therefore, it is unclear how attractive the medical profession still is for high school students of Gen Z. The aim of this study was to investigate what motivation leads Gen Z students in their choice to study human medicine, and how they see their professional future. Our study was guided by motivation theory and the influence of personality traits and other personal factors on students' choice of university major. METHODS In a cross-sectional online survey, we included third- and fourth-year high school students in Northern Switzerland. We examined the importance of criteria when choosing a university major: personality traits, career motivation, life goals, and other considerations influencing the choice of human medicine versus other fields of study. Results Of 1790 high school students, 456 (25.5%) participated in the survey (72.6% women, mean age 18.4 years); 32.7% of the respondents aspired to major in medicine at university. For all respondents, the foremost criterion for selecting a field of study was 'interest in the field,' followed by 'income' and 'job security.' High school students aiming to study human medicine attached high importance to 'meaningful work' as a criterion; supported by 36.2% of those students answering that helping and healing people was a core motivation to them. They also scored high on altruism (p < 0.001 against all groups compared) and intrinsic motivation (p < 0.001) and were highly performance- (p < 0.001) and career-minded (p < 0.001). In contrast, all the other groups except the law/economics group had higher scores on extraprofessional concerns. CONCLUSIONS Swiss Gen Z students aspiring to study human medicine show high intrinsic motivation, altruism, and willingness to perform, sharing many values with previous generations. Adequate work-life balance and job security are important issues for Gen Z. Regarding the current working conditions, the ongoing shortage of physicians, and recent findings on physicians' well-being, the potential for improvement and optimization is high.
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Affiliation(s)
- Barbara M Holzer
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Oriane Ramuz
- Department of Internal Medicine Cantonal Hospital Olten, Solothurner Spitäler AG, Olten, Switzerland
| | - Christoph E Minder
- Department of Internal Medicine Cantonal Hospital Olten, Solothurner Spitäler AG, Olten, Switzerland
| | - Lukas Zimmerli
- Department of Internal Medicine Cantonal Hospital Olten, Solothurner Spitäler AG, Olten, Switzerland.
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