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DePierro JM, Chan CC, Mohamed N, Starkweather S, Ripp J, Peccoralo LA. Determinants of Staff Intent to Leave Health Care During the COVID-19 Pandemic. Am J Public Health 2024; 114:200-203. [PMID: 38354356 PMCID: PMC10916731 DOI: 10.2105/ajph.2024.307574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/16/2024]
Abstract
Objectives. To identify potential drivers of health care worker attrition. Methods. We conducted a survey of 1083 nonphysician health care workers in a large urban health system in New York City from September to October 2022. Results. The results of a multivariable logistic regression analysis revealed that higher odds of intending to leave health care were significantly associated with male gender, registered nurse profession, burnout, self-perceived mental health service need, and verbal abuse from patients or visitors, whereas lower odds were seen among those reporting greater emotional well-being and a better workplace culture. A relative importance analysis indicated that burnout was the strongest correlate of intention to leave (22.5% relative variance explained [RVE]), followed by subjective emotional well-being (16.7% RVE), being a registered nurse (12.3% RVE), poorer perceived workplace culture (9.5% RVE), and male gender (5.9% RVE). Conclusions. Overall, our findings suggest the need for well-coordinated interventions that address both individual- and system-level factors in an effort to improve retention. Public Health Implications. Our results indicate a need for interventions targeting workplace culture, staff burnout, and mental health service provision. (Am J Public Health. 2024;114(S2):S200-S203. https://doi.org/10.2105/AJPH.2024.307574).
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Affiliation(s)
- Jonathan M DePierro
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chi C Chan
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nihal Mohamed
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sydney Starkweather
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan Ripp
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lauren A Peccoralo
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
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He C, Igwe N, Damian C, Feder A, Feingold J, Ripp J, Pietrzak R, Peccoralo L, Hurtado A, Chan C. Racial & ethnic differences in mental health outcomes and risk factors among frontline healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry 2023; 85:1-7. [PMID: 37716020 DOI: 10.1016/j.genhosppsych.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/06/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To examine racial/ethnic differences in mental health outcomes and risk factors during the COVID-19 pandemic among frontline healthcare workers (FHCWs). METHODS A survey was conducted on FHCWs at a large metropolitan hospital during winter 2021. Depression, anxiety, and post-traumatic stress symptoms, demographic characteristics, and COVID-19-related occupational factors were assessed. Multivariable logistic regression examined factors associated with screening positive for psychiatric symptoms and their interactions with race/ethnicity. RESULTS Of 1437 FHCWs, 762 (53.0%) self-identified as white, 451 (31.4%) as Asian, 118 (8.2%) as Black, and 106 (7.4%) as Latinx. Black FHCWs had a higher prevalence of screening positive for depression (18.6%) than other groups (6.6%-11.7%, p < .05). Significant risk factors by race/ethnicity interactions indicated that having cared for patients who died from COVID-19 increased risk of psychiatric symptoms among white and Black individuals, having to make difficult decisions prioritizing patients increased risk most significantly among white and Asian individuals, and working more hours increased risk most significantly among Latinx individuals. CONCLUSION Results suggest that occupational stressors may have differential impacts on mental health among racial/ethnic groups of FHCWs. Findings provide insight on subgroups with increased vulnerability to certain risk factors and inform interventions to improve mental health in diverse FHCWs.
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Affiliation(s)
- Celestine He
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA.
| | - Nnamdi Igwe
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA
| | - Candida Damian
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Jordyn Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Jonathan Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1087, NY, NY 10029, USA
| | - Robert Pietrzak
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Lauren Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1087, NY, NY 10029, USA
| | - Alicia Hurtado
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, NY, NY 10029, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
| | - Chi Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1230, NY, NY 10029, USA
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Ripp J. Politicization and the Role of Societal-Level Drivers Affecting Health Care Workforce Well-Being. Mayo Clin Proc 2023; 98:1593-1595. [PMID: 37923517 DOI: 10.1016/j.mayocp.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Jonathan Ripp
- Icahn School of Medicine at Mount Sinai, New York, NY
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Starkweather S, DePierro JM, Akhtar S, de Guillebon E, Kaplan C, Kaplan S, Ripp J, Peccoralo L, Feingold J, Feder A, Murrough JW, Pietrzak RH. Predictors of Mental Health Service Utilization among Frontline Healthcare Workers during the COVID-19 Pandemic. Int J Environ Res Public Health 2023; 20:5326. [PMID: 37047942 PMCID: PMC10094311 DOI: 10.3390/ijerph20075326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
(1) Background: This study examined the prevalence and correlates of factors associated with self-reported mental health service use in a longitudinal cohort of frontline health care workers (FHCWs) providing care to patients with COVID-19 throughout 2020. (2) Methods: The study comprised a two-wave survey (n = 780) administered in April-May 2020 (T1) and November 2020-January 2021 (T2) to faculty, staff, and trainees in a large urban medical center. Factors associated with initiation, cessation, or continuation of mental health care over time were examined. (3) Results: A total of 19.1% of FHCWs endorsed currently utilizing mental health services, with 11.4% continuing, 4.2% initiating, and 3.5% ceasing services between T1 and T2. Predisposing and need-related factors, most notably a history of a mental health diagnosis and distress related to systemic racism, predicted service initiation and continuation. Among FHCWs with a prior mental health history, those with greater perceived resilience were less likely to initiate treatment at T2. Descriptive data highlighted the importance of services around basic and safety needs (e.g., reliable access to personal protective equipment) relative to mental health support in the acute phase of the pandemic. (4) Conclusions: Results may be helpful in identifying FHCWs who may benefit from mental health services.
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Affiliation(s)
- Sydney Starkweather
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Jonathan M. DePierro
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Saadia Akhtar
- Departments of Emergency Medicine and Graduate Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Eleanore de Guillebon
- Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Carly Kaplan
- Departments of Emergency Medicine and Graduate Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Sabrina Kaplan
- Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Jonathan Ripp
- Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Lauren Peccoralo
- Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Jordyn Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - James W. Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Robert H. Pietrzak
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
- U.S. Department of Veterans Affairs National Center for PTSD, West Haven, CT 06516, USA
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA
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Stanislawski ER, Saali A, Magill EB, Deshpande R, Kumar V, Chan C, Hurtado A, Charney DS, Ripp J, Katz CL. Longitudinal Mental Health Outcomes of Third-year Medical Students Rotating Through the Wards During COVID-19. Psychiatry Res 2023; 320:115030. [PMID: 36623426 PMCID: PMC9791716 DOI: 10.1016/j.psychres.2022.115030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 12/27/2022]
Abstract
This study investigated third year medical students' psychological well-being during clinical rotations at Mount Sinai hospitals in New York City during the COVID-19 pandemic. All students (n = 147) starting rotations (psychiatry, surgery, obstetrics-gynecology, neurology, pediatrics, and medicine) could participate in quarterly, online, anonymous surveys comprised of validated screeners for: psychological symptoms, risk, coping, and protective factors, demographics, COVID-19 worries, and stressful clerkship-related events. Associations between variables were examined with Chi-squared, Fisher's exact, t-, Wilcoxon Rank Sum, one-way ANOVA, and McNemar tests. Significant univariate predictors of psychological distress were included in stepwise multivariable linear regression models. The baseline survey was completed by 110 (74.8%) students; ninety-two (62.6%) completed at least one other survey. During the year, 68 (73.9%) students screened positive for depression, anxiety, or PTSD. The prevalence of psychiatric symptoms peaked in June 2020 without significant changes in average scores over time. COVID-19 worries decreased over time but did not influence psychological symptoms at year-end. Eighty-three students (90.2%) experienced stressful clerkship-related events, which were traumatic and/or COVID-19-related for 26 (28.3%) and 22 students (24.0%), respectively. Baseline psychological distress, childhood emotional abuse, and resilience predicted depression, anxiety, and/or PTSD by year-end. This study highlights the importance of recognizing psychological distress and implementing interventions to support students' well-being.
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Affiliation(s)
- Emma R. Stanislawski
- Department of Psychiatry, 22 Bramhall Street, Maine Medical Center, Portland, ME, United States of America,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America,Correspondence author
| | - Alexandra Saali
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Elizabeth B. Magill
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Richa Deshpande
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Vedika Kumar
- Department of Psychiatry, Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, New York, United States of America
| | - Chi Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America,Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY, United States of America
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Dennis S. Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Jonathan Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
| | - Craig L. Katz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, United States of America
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Kiely SC, Parisi S, Farley H, Ripp J. Lessons From the Northeast COVID-19 Surge: Well-Being of the Health Care Workforce. Am J Med Qual 2023; 38:57-62. [PMID: 36515258 PMCID: PMC9797118 DOI: 10.1097/jmq.0000000000000096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic has had an unprecedented impact on the US health care system which was already experiencing higher levels of personal burnout among health care workers than the average US worker. Well-being efforts to support the workforce have become a critical countermeasure during the pandemic. This work was presented at the Thomas Jefferson University, College of Population Health Seminar Series: Clinical Lessons from the Northeast Surge, COVID-19: Spread the Science, not the Virus, held August 18, 2020. The entire series was held virtually from July 21 to September 29, 2020. The authors describe issues impacting health care workers during this early period of the pandemic with two examples of concrete strategies to approach well-being at the organizational level and lessons learned.
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Affiliation(s)
- Sharon C. Kiely
- Internal Medicine, Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT
| | - Susan Parisi
- Nuvance Learning Institute, Nuvance Health, Poughkeepsie, NY
| | - Heather Farley
- ChristianaCare – Center for WorkLife Wellbeing, Newark, DE
| | - Jonathan Ripp
- Icahn School of Medicine at Mount Sinai, New York, NY
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7
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Cohen B, DePierro J, Chan CC, Tolan E, Deshpande R, Feder A, Feingold JH, Peccoralo L, Pietrzak RH, Ripp J. Factors Associated With Burnout Among Nurses Providing Direct Patient Care During the COVID-19 Pandemic. J Nurs Adm 2022; 52:598-607. [PMID: 36301869 PMCID: PMC10624218 DOI: 10.1097/nna.0000000000001216] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to identify factors associated with burnout in nurses and nurses' opinions regarding interventions to promote well-being during crisis conditions such as those experienced during the COVID-19 pandemic. BACKGROUND Burnout among nurses is prevalent under usual conditions and may increase during crises such as COVID-19. METHODS Researchers conducted a survey of 1103 frontline nurses in a single New York City hospital during the first (spring 2020) and second (fall 2020/winter 2021) local waves of COVID-19. RESULTS Burnout prevalence increased from 45% to 52% between the first and second wave. Younger age, female gender, posttraumatic stress, anxiety or depressive symptoms, history of burnout, feeling less valued by hospital leadership, less informed of responsibilities, less certain about duration of enhanced workload, and prepared by prepandemic experience were predictive of burnout in multivariable analyses. CONCLUSIONS Although some identified risk factors for burnout were nonmodifiable, others may be modifiable by hospital leadership.
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Affiliation(s)
- Bevin Cohen
- Author Affiliations: Associate Professor, Department of Geriatric and Palliative Medicine, and Director, Center for Nursing Research and Innovation (Dr Cohen); Assistant Professor, Department of Psychiatry, and Director, Center for Stress, Resilience and Personal Growth (Dr DePierro); Assistant Professor, Department of Psychiatry (Dr Chan); Nurse Practitioner, Vascular Surgery, The Mount Sinai Hospital (Ms Tolan); Biostatistician, Center for Biostatistics (Ms Deshpande); Associate Professor, Department of Psychiatry, and Director, Trauma and Resilience Program (Dr Feder); Psychiatry Resident, Department of Psychiatry (Dr Feingold); Associate Professor, Department of Medicine, and Senior Associate Dean of Faculty Well-being and Development (Dr Peccoralo); and Chief Wellness Officer (Dr Ripp), Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York; and Professor of Psychiatry, Yale School of Medicine, Professor of Public Health, Department of Social and Behavioral Sciences, Yale School of Public Health, and Director, Translational Psychiatric Epidemiology Laboratory Clinical Neurosciences Division, National Center for PTSD, VA Connecticut Healthcare System, New Haven (Dr Pietrzak)
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8
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Kachadourian L, Murrough J, Kaplan C, Kaplan S, Feingold J, Feder A, Charney D, Southwick S, Peccoralo L, DePierro J, Ripp J, Pietrzak R. A prospective study of transdiagnostic psychiatric symptoms associated with burnout and functional difficulties in COVID-19 frontline healthcare workers. J Psychiatr Res 2022; 152:219-224. [PMID: 35753241 PMCID: PMC9181632 DOI: 10.1016/j.jpsychires.2022.05.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/21/2022] [Accepted: 05/20/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Frontline healthcare workers (FHCWs) responding to the COVID-19 pandemic develop posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms. Such symptoms are associated with burnout, occupational and relational difficulties. In the current study, we examined the prospective association between acute transdiagnostic COVID-19-related PTSD, MDD, and GAD symptoms at pandemic outset, and burnout and functional difficulties several months later in FHCWs in New York City. METHODS Wave 1 symptoms of COVID-19-related PTSD, MDD, and GAD, were assessed in 787 FHCWs from April 14 to May 11th, 2020. Burnout and occupational difficulties were assessed at wave 1 and wave 2, approximately 7 months later. RESULTS After adjusting for wave 1 burnout, wave 1 MDD symptoms, particularly sleep difficulties, loss of interest, and feeling tired/having little energy, collectively explained 42% incremental variance in this outcome. After adjusting for wave 1 work difficulties, MDD and PTSD symptoms, particularly feeling tired/having little energy, loss of interest, and negative expectations of self/world, collectively explained 42% incremental variance in this outcome. After adjusting for wave 1 relationship difficulties, MDD, GAD, and PTSD symptoms, particularly depressed mood, irritability, and appetite disturbance, explained 26% incremental variance in this outcome. CONCLUSIONS Results highlight psychiatric symptoms assessed during the acute phase of the COVID-19 pandemic that may help predict burnout and work and relationship difficulties in FHCWs. Early interventions aimed at ameliorating transdiagnostic symptoms of MDD, PTSD, and GAD may help mitigate risk for burnout and functional difficulties in this population.
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Affiliation(s)
| | - James Murrough
- Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, United States
| | - Carly Kaplan
- Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, United States
| | - Sabrina Kaplan
- Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, United States
| | - Jordyn Feingold
- Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, United States
| | - Adriana Feder
- Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, United States
| | - Dennis Charney
- Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, United States
| | | | - Lauren Peccoralo
- Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, United States
| | - Jonathan DePierro
- Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, United States
| | - Jonathan Ripp
- Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, United States
| | - Robert Pietrzak
- Yale School of Medicine, Yale University School of Medicine, United States
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Saali A, Stanislawski ER, Kumar V, Chan C, Hurtado A, Pietrzak RH, Charney DS, Ripp J, Katz CL. The Psychiatric Burden on Medical Students in New York City Entering Clinical Clerkships During the COVID-19 Pandemic. Psychiatr Q 2022; 93:419-434. [PMID: 34618278 PMCID: PMC8495188 DOI: 10.1007/s11126-021-09955-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 01/20/2023]
Abstract
For medical students first entering the clinical space in July 2020, the unique challenges related to the coronavirus pandemic threatened to amplify the psychological distress associated with clerkship rotations. This study aimed to characterize the mental health of third-year medical students starting clinical clerkships in the midst of a pandemic by assessing symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) as well as risk, coping, and protective factors associated with psychological outcomes. Of 147 third-year medical students at the Icahn School of Medicine at Mount Sinai in New York City, 110 (75%) participated in this prospective survey-based study with 108 included in the final analysis. 43 (39.8%) respondents screened positive for symptoms of either MDD, GAD, or PTSD. Multiple regression analyses revealed that greater overall symptom severity was associated with more avoidant coping, more traumatic events witnessed, poorer student and leisure functioning, lower trait emotional stability, and lower social support. Worries related to COVID-19 did not significantly influence outcome variables. To better understand the role of the pandemic on psychological outcomes in third-year medical students, additional research should focus on the trajectory of these outcomes over the year during the coronavirus pandemic.
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Affiliation(s)
- Alexandra Saali
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma R Stanislawski
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Psychiatry, Maine Medical Center, Portland, ME, USA.
| | - Vedika Kumar
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital, New York, NY, USA
| | - Chi Chan
- Mental Illness Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Dennis S Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Ripp
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Craig L Katz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Ratcliffe TA, Jasti H, Ortiz J, Curren C, Onumah C, Ripp J, Pincavage AT. Finding Meaning: Internal Medicine Clerkship Director Burnout and Professional Fulfillment. Am J Med 2022; 135:654-660.e3. [PMID: 35108501 DOI: 10.1016/j.amjmed.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/24/2022] [Indexed: 11/01/2022]
Affiliation(s)
| | - Harish Jasti
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jordan Ortiz
- Alliance for Academic Internal Medicine, Alexandria, Va
| | | | - Chavon Onumah
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jonathan Ripp
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amber T Pincavage
- University of Chicago Division of the Biological Sciences, Pritzker School of Medicine, Chicago, Ill
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11
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Fischer IC, Norman SB, Feder A, Feingold JH, Peccoralo L, Ripp J, Pietrzak RH. Downstream consequences of moral distress in COVID-19 frontline healthcare workers: Longitudinal associations with moral injury-related guilt. Gen Hosp Psychiatry 2022; 79:158-161. [PMID: 36403350 PMCID: PMC9664834 DOI: 10.1016/j.genhosppsych.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the longitudinal associations between dimensions of COVID-19 pandemic-related moral distress (MD) and moral injury (MI)-related guilt in a large sample of frontline COVID-19 healthcare workers (FHCWs). METHODS Data from a diverse occupational cohort of 786 COVID-19 FHCWs were collected during the initial peak of the COVID-19 pandemic in New York City and again 7 months later. Baseline MD and MI-related guilt at follow-up were assessed in three domains: family-, work-, and infection-related. Social support was evaluated as a potential moderator of associations between MD and MI-related guilt. RESULTS A total of 66.8% of FHCWs reported moderate-or-greater levels of MI-related guilt, the most prevalent of which were family (59.9%) or work-related (29.4%). MD was robustly predictive of guilt in a domain-specific manner. Further, among FHCWs with high levels of work-related MD, those with greater perceptions of supervisor support were less likely to develop work-related guilt 7 months later. DISCUSSION MD was found to be highly prevalent in FHCWs during the initial wave of the COVID-19 pandemic and was linked to the development of MI-related guilt over time. Prevention and early intervention efforts to mitigate MD and bolster supervisor support may help reduce risk for MI-related guilt in this population.
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Affiliation(s)
- Ian C. Fischer
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Corresponding author at: US Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA
| | - Sonya B. Norman
- US Department of Veterans Affairs National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, USA,Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordyn H. Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert H. Pietrzak
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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12
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Feingold JH, Hurtado A, Feder A, Peccoralo L, Southwick SM, Ripp J, Pietrzak RH. Posttraumatic growth among health care workers on the frontlines of the COVID-19 pandemic. J Affect Disord 2022; 296:35-40. [PMID: 34587547 PMCID: PMC8526329 DOI: 10.1016/j.jad.2021.09.032] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/31/2021] [Accepted: 09/12/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to significant mental health consequences for frontline health care workers (FHCWs). However, no known study has examined the prevalence, determinants, or correlates of posttraumatic growth (PTG) in this population. METHODS Data were analyzed from a prospective cohort of FHCWs at an urban tertiary care hospital in New York City (NYC). Assessments were conducted during the spring 2020 pandemic peak (Wave 1) and seven months later (Wave 2). Multivariable logistic regression analyses were conducted to identify Wave 1 sociodemographic, occupational, and psychosocial factors associated with PTG at Wave 2, and the association between aspects of PTG with burnout and pandemic-related PTSD symptoms at Wave 2. RESULTS A total 76.8% of FHCWs endorsed moderate or greater PTG; the most prevalent domains were increased appreciation of life (67.0%), improved relationships (48.7%), and greater personal strength (44.1%). Non-White race/ethnicity, greater levels of positive emotions, pandemic-related PTSD symptoms, dispositional gratitude, and feelings of inspiration were independently associated with PTG. At Wave 2, endorsement of spiritual growth during the pandemic was associated with 52% and 44% lower odds of screening positive for pandemic-related PTSD symptoms and burnout, respectively; greater improvement in relationships was associated with 36% lower odds of screening positive for burnout. LIMITATIONS Single institution study and use of self-report instruments. CONCLUSIONS Nearly 4-of-5 FHCWs report pandemic-related PTG, driven largely by salutogenic factors assessed during the pandemic surge. Interventions to bolster these factors may help promote PTG and mitigate risk for burnout and pandemic-related PTSD symptoms in this population.
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Affiliation(s)
- Jordyn H. Feingold
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, United States,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States,Corresponding author at: One Gustave L. Levy Place, Box 1002, New York, NY 10029, United States
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Lauren Peccoralo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Steven M. Southwick
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States
| | - Jonathan Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States,U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut, United States,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States
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13
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Gorbenko K, Franzosa E, Masse S, Brody A, Ripp J, Ornstein K, Federman A. The Psychological Impact of COVID-19 on Home Based Primary Care Providers in New York: A Qualitative Study. Innov Aging 2021. [PMCID: PMC8679756 DOI: 10.1093/geroni/igab046.1477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in the New York including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.
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Affiliation(s)
- Ksenia Gorbenko
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Emily Franzosa
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Sybil Masse
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Abraham Brody
- NYU Hartford Institute for Geriatric Nursing, New York, New York, United States
| | - Jonathan Ripp
- Mount Sinai Health System, New York, New York, United States
| | - Katherine Ornstein
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Alex Federman
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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14
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Kaplan CA, Chan CC, Feingold JH, Kaye-Kauderer H, Pietrzak RH, Peccoralo L, Feder A, Southwick S, Charney D, Burka L, Basist M, Ripp J, Akhtar S. Psychological Consequences Among Residents and Fellows During the COVID-19 Pandemic in New York City: Implications for Targeted Interventions. Acad Med 2021; 96:1722-1731. [PMID: 34380941 PMCID: PMC8603436 DOI: 10.1097/acm.0000000000004362] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To examine the psychological impact of the COVID-19 pandemic on medical trainees (residents and fellows) working at Mount Sinai Hospital (MSH) in New York City (NYC), the initial epicenter of the United States pandemic. METHOD The authors administered a survey to 991 trainees in frontline specialties working at MSH in NYC between April and May 2020. The instrument assessed symptoms of major depressive disorder, generalized anxiety disorder, COVID-19-related posttraumatic stress disorder, and burnout. Psychiatric screens were aggregated into 1 composite measure, and meeting criteria on any of the 3 scales was considered a positive screen for psychiatric symptoms. The survey also assessed COVID-19-related exposures, worries, coping strategies, and desired interventions. Multivariable logistic regressions were conducted to identify factors associated with psychiatric symptoms and burnout. RESULTS Of the 560 respondents (56.6% response rate), 29.7% screened positive for psychiatric symptoms and 35.8% screened positive for burnout. History of a mental illness, COVID-19-related duties and personal/career worries, and coping by substance use were associated with increased likelihood of screening positive for psychiatric symptoms. Positive emotion-focused coping and feeling valued by supervisors were associated with decreased likelihood. Internal medicine and surgical specialties, a history of mental illness, increased duty hours, duty-related worries, personal/career worries, coping via self-blame and venting, and coping via substance use were associated with higher odds of burnout. Feeling valued by supervisors was associated with decreased burnout odds. The most common crisis-related needs included access to personal protective equipment, food provisions, and financial support. CONCLUSIONS Psychological distress and burnout affected approximately one-third of trainees sampled during the height of the pandemic in NYC. As the pandemic surged beyond NYC, these findings suggest that interventions should include addressing basic needs, promoting leadership affirmation, moderating duty hours, supporting trainees financially, and enhancing mental health support.
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Affiliation(s)
- Carly A. Kaplan
- C.A. Kaplan is a medical student, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chi C. Chan
- C.C. Chan is assistant professor of psychiatry, Icahn School of Medicine at Mount Sinai, New York, and research health scientist, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Jordyn H. Feingold
- J.H. Feingold is a psychiatry resident, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Halley Kaye-Kauderer
- H. Kaye-Kauderer is a psychiatry resident, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert H. Pietrzak
- R.H. Pietrzak is associate professor of psychiatry and public health, Yale School of Medicine, New Haven, Connecticut, director, translational psychiatric epidemiology laboratory, Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD, West Haven, Connecticut, and adjunct professor of psychiatry and environmental medicine and public health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lauren Peccoralo
- L. Peccoralo is associate dean for faculty well-being and resilience and associate professor of medicine, general internal medicine, and medical education, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Adriana Feder
- A. Feder is director for research, Center for Stress, Resilience, and Personal Growth, co-director, Ehrenkranz Laboratory for the Study of Human Resilience, and associate professor of psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Steven Southwick
- S. Southwick is professor emeritus of psychiatry, Yale School of Medicine, New Haven, Connecticut, and adjunct professor of psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dennis Charney
- D. Charney is Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and president for academic affairs, Mount Sinai Health System, New York, New York
| | - Larissa Burka
- L. Burka is a registered nurse, Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Madeleine Basist
- M. Basist is a third-year internal medicine resident, Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Jonathan Ripp
- J. Ripp is senior associate dean for well-being and resilience, chief wellness officer, and professor of medicine, medical education and geriatrics and palliative medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Saadia Akhtar
- S. Akhtar is associate dean for trainee well-being and resilience and associate professor of emergency medicine and medical education, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
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15
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Norman SB, Feingold JH, Kaye‐Kauderer H, Kaplan CA, Hurtado A, Kachadourian L, Feder A, Murrough JW, Charney D, Southwick SM, Ripp J, Peccoralo L, Pietrzak RH. Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning. Depress Anxiety 2021; 38:1007-1017. [PMID: 34293236 PMCID: PMC8426909 DOI: 10.1002/da.23205] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/21/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Little is known about the relationship between moral distress and mental health problems. We examined moral distress in 2579 frontline healthcare workers (FHCWs) caring for coronavirus disease 2019 (COVID-19) patients during the height of the spring 2020 pandemic surge in New York City. The goals of the study were to identify common dimensions of COVID-19 moral distress; and to examine the relationship between moral distress, and positive screen for COVID-19-related posttraumatic stress disorder (PTSD) symptoms, burnout, and work and interpersonal functional difficulties. METHOD Data were collected in spring 2020, through an anonymous survey delivered to a purposively-selected sample of 6026 FHCWs at Mount Sinai Hospital; 2579 endorsed treating COVID-19 patients and provided complete survey responses. Physicians, house staff, nurses, physician assistants, social workers, chaplains, and clinical dietitians comprised the sample. RESULTS The majority of the sample (52.7%-87.8%) endorsed moral distress. Factor analyses revealed three dimensions of COVID-19 moral distress: negative impact on family, fear of infecting others, and work-related concerns. All three factors were significantly associated with severity and positive screen for COVID-19-related PTSD symptoms, burnout, and work and interpersonal difficulties. Relative importance analyses revealed that concerns about work competencies and personal relationships were most strongly related to all outcomes. CONCLUSION Moral distress is prevalent in FHCWs and includes family-, infection-, and work-related concerns. Prevention and treatment efforts to address moral distress during the acute phase of potentially morally injurious events may help mitigate risk for PTSD, burnout, and functional difficulties.
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Affiliation(s)
- Sonya B. Norman
- Executive DivisionU.S. Department of Veterans Affairs National Center for PTSDWasington, D.C.USA,Department of PsychiatryUniversity of California San Diego School of MedicineSan DiegoCaliforniaUSA
| | - Jordyn H. Feingold
- Department of Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Halley Kaye‐Kauderer
- Department of Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Carly A. Kaplan
- Department of Well‐Being and ResilienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Alicia Hurtado
- Department of Well‐Being and ResilienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Lorig Kachadourian
- Executive DivisionU.S. Department of Veterans Affairs National Center for PTSDWasington, D.C.USA,Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | - Adriana Feder
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - James W. Murrough
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of NeuroscienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Dennis Charney
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of NeuroscienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of Pharmacological SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Steven M. Southwick
- Executive DivisionU.S. Department of Veterans Affairs National Center for PTSDWasington, D.C.USA
| | - Jonathan Ripp
- Department of Well‐Being and ResilienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Lauren Peccoralo
- Department of Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of Well‐Being and ResilienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Robert H. Pietrzak
- Executive DivisionU.S. Department of Veterans Affairs National Center for PTSDWasington, D.C.USA,Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA,Department of Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticutUSA
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16
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Peccoralo L, Depierro J, Feingold JH, Feder A, Charney DS, Southwick SM, Ripp J, Pietrzak RH. Building Resilience and Well-Being in Health Care Workers in the COVID-19 Era: Lessons Learned and Next Steps-Reply to Modesto-Lowe et al. J Clin Psychiatry 2021; 82. [PMID: 34320695 DOI: 10.4088/jcp.21lr14035b] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lauren Peccoralo
- Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan Depierro
- Center for Stress, Resilience, and Personal Growth, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jordyn H Feingold
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dennis S Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Pharmacology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jonathan Ripp
- Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New York, New York.,US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut.,Corresponding author: Robert H. Pietrzak, PhD, MPH, Yale University School of Medicine, National Center for PTSD, 950 Campbell Ave, West Haven, CT 06516
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17
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Gorbenko K, Franzosa E, Masse S, Brody AA, Sheehan O, Kinosian B, Ritchie CS, Leff B, Ripp J, Ornstein KA, Federman AD. "I felt useless": a qualitative examination of COVID-19's impact on home-based primary care providers in New York. Home Health Care Serv Q 2021; 40:1-15. [PMID: 34301160 PMCID: PMC8783921 DOI: 10.1080/01621424.2021.1935383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in New York City including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call schedules, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.
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Affiliation(s)
- Ksenia Gorbenko
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute of Health Care Delivery Science, Mount Sinai Health System, New York, New York, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatrics Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, New York, USA
| | - Sybil Masse
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Abraham A Brody
- Hartford Institute of Geriatric Nursing, Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Orla Sheehan
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bruce Kinosian
- Center for Health Equity Research and Promotion, Corporal Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Geriatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatrics, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Katherine A. Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex D. Federman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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18
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Kachadourian LK, Feder A, Murrough JW, Feingold JH, Kaye-Kauderer H, Charney D, Southwick SM, Peccoralo L, Ripp J, Pietrzak RH. Transdiagnostic Psychiatric Symptoms, Burnout, and Functioning in Frontline Health Care Workers Responding to the COVID-19 Pandemic: A Symptomics Analysis. J Clin Psychiatry 2021; 82. [PMID: 34004095 DOI: 10.4088/jcp.20m13766] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has led to an increased risk of psychiatric symptoms among frontline health care workers (FHCWs). In the current study, a novel "symptomics" approach was employed to examine the association between acute transdiagnostic symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) and burnout and work and relationship difficulties in FHCWs at an urban tertiary care hospital in New York City. METHODS Symptoms of COVID-19-related PTSD (4-item PTSD Checklist-5), MDD (Patient Health Questionnaire-8), GAD (Generalized Anxiety Disorder-7), burnout (Single-Item Mini-Z Burnout Assessment), and functional difficulties (Brief Inventory of Psychosocial Functioning) were assessed. Relative importance analyses were conducted to identify PTSD, MDD, and GAD symptoms associated with burnout and functional difficulties. RESULTS The total number of eligible participants included 6,026 presumed FHCWs, of which 3,360 (55.8%) completed the survey and 2,579 (76.8%) of whom endorsed directly treating patients with COVID-19 and provided sufficient responses to our outcome variables for analysis. Feeling tired/having little energy, being easily annoyed or irritable, and feeling nervous, anxious, or on edge were most strongly associated with burnout; feeling tired/having little energy accounted for the greatest amount of explained variance (> 15%). Negative expectations of oneself or the world, trouble concentrating, and feeling easily annoyed or irritable were most strongly associated with work difficulties; negative expectations of oneself or the world accounted for the greatest amount of explained variance (> 9%). Feeling easily annoyed or irritable, negative expectations about oneself or the world, and feeling bad about oneself were most strongly associated with relationship difficulties; feeling easily annoyed or irritable accounted for the greatest amount of explained variance (> 10%). CONCLUSIONS Results of this study underscore the importance of a transdiagnostic, symptom-based approach when examining associations between acute psychopathology and burnout and functional difficulties in FHCWs. Further work is needed to determine if early interventions aimed at ameliorating specific psychiatric symptoms may help mitigate risk for peri- and posttraumatic burnout and functional difficulties in this population.
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Affiliation(s)
- Lorig K Kachadourian
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut.,Corresponding author: Lorig K. Kachadourian, PhD, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James W Murrough
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York.,Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jordyn H Feingold
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Halley Kaye-Kauderer
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dennis Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven M Southwick
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lauren Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York jDepartment of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York *Corresponding author: Lorig K. Kachadourian, PhD, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516
| | - Jonathan Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
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Brower KJ, Brazeau CM, Kiely SC, Lawrence EC, Farley H, Berliner JI, Bird SB, Ripp J, Shanafelt T. The Evolving Role of the Chief Wellness Officer in the Management of Crises by Health Care Systems: Lessons from the Covid-19 Pandemic. NEJM Catalyst 2021. [PMCID: PMC8046263 DOI: 10.1056/cat.20.0612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Even before the onset of the Covid-19 pandemic, clinician burnout was a recognized occupational syndrome and a driver of suboptimal patient care. National calls for system-level interventions to improve clinician well-being led some health care organizations (HCOs) to appoint a Chief Wellness Officer (CWO). By incorporating CWOs into the emergency command structure, these HCOs were equipped to identify and address health care worker needs throughout the pandemic. CWOs learned important lessons regarding how HCOs can best address workforce well-being in the midst of a crisis. Key CWO contributions include identifying evolving sources of worker anxiety, deploying support resources, participating in operational decision-making, and assessing the impact of fluid pandemic protocols on clinician well-being. As HCOs seek to promote posttraumatic growth, attention to the well-being of the workforce should be incorporated into emergency management protocols with the goal of sustaining a resilient health care workforce.
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Affiliation(s)
- Kirk J. Brower
- Chief Wellness Officer and Professor of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Chantal M.L.R. Brazeau
- Chief Wellness Officer, Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
- Assistant Dean for Faculty Vitality, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Assistant Dean for Faculty Vitality, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sharon C. Kiely
- Vice President, Chief Wellness Officer, and Associate Chief Medical Officer, Hartford HealthCare, Hartford, Connecticut, USA
| | - Elizabeth C. Lawrence
- Professor, Department of Internal Medicine, and Chief Wellness Officer and Assistant Dean for Professional Well-Being, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Heather Farley
- Chief Wellness Officer, ChristianaCare, Wilmington, Delaware, USA
- Professor of Emergency Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Jennifer I. Berliner
- Medical Director of the Chief Medical and Scientific Office, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Clinical Assistant Professor of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven B. Bird
- Clinician Experience Officer and Professor, Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jonathan Ripp
- Chief Wellness Officer and Dean for Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tait Shanafelt
- Chief Wellness Officer, Stanford University School of Medicine, and Professor of Medicine, Stanford Department of Medicine, Stanford, California, USA
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20
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Feingold JH, Peccoralo L, Chan CC, Kaplan CA, Kaye-Kauderer H, Charney D, Verity J, Hurtado A, Burka L, Syed SA, Murrough JW, Feder A, Pietrzak RH, Ripp J. Psychological Impact of the COVID-19 Pandemic on Frontline Health Care Workers During the Pandemic Surge in New York City. ACTA ACUST UNITED AC 2021; 5:2470547020977891. [PMID: 33598592 PMCID: PMC7863176 DOI: 10.1177/2470547020977891] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022]
Abstract
Background This study sought to assess the magnitude of and factors associated with mental health outcomes among frontline health care workers (FHCWs) providing care during the Spring 2020 COVID-19 pandemic surge in New York City. Methods A cross-sectional, survey-based study over 4 weeks during the Spring 2020 pandemic surge was used to assess symptoms of COVID-19-related posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) in 2,579 FHCWs at the Mount Sinai Hospital. Participants were additionally asked about their occupational and personal exposures to COVID-19. Multivariable logistic regression and relative importance analyses were conducted to identify factors associated with these outcomes. Results A total of 3,360 of 6,026 individuals completed the survey (55.8% participation), with 2,579 (76.8%) analyzed based on endorsing frontline responsibilities and providing information related to the three outcomes. 1,005 (39.0%) met criteria for symptoms of COVID-19-related PTSD, MDD, or GAD. 599 (23.3%) screened positively for PTSD symptoms, 683 (26.6%) for MDD symptoms, and 642 (25.0%) for GAD symptoms. Multivariable analyses revealed that past-year burnout was associated with the highest risk of developing symptoms for COVID-19-related PTSD (odds ratio [OR] = 2.10), MDD (OR = 2.83), and GAD (OR = 2.68). Higher perceived support from hospital leadership was associated with a lowest risk of all outcomes [PTSD (OR = 0.75), MDD (OR = 0.72), and GAD (OR = 0.76). Conclusion In this large sample of FHCWs providing care during the 2020 NYC pandemic surge, 39% experienced symptoms of COVID-19-related PTSD, MDD, and/or GAD and pre-pandemic burnout as well as leadership support were identified as the most highly associated factors. These findings suggest that interventions aimed at reducing burnout and augmenting support from hospital leadership may be appropriate targets to mitigate the risk for developing further psychopathology in this population and others working in the midst of crisis.
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Affiliation(s)
- Jordyn H Feingold
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Chi C Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carly A Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Halley Kaye-Kauderer
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaclyn Verity
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Larissa Burka
- Department of nursing, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shumayl A Syed
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, Depression and Anxiety Center for Discovery and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,U.S. Department of Veterans Affairs National Center for PTSD, West Haven, CT, USA
| | - Jonathan Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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22
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Pietrzak RH, Feingold JH, Feder A, Charney D, Peccoralo L, Southwick S, Ripp J. Psychological Resilience in Frontline Health Care Workers During the Acute Phase of the COVID-19 Pandemic in New York City. J Clin Psychiatry 2020; 82:20l13749. [PMID: 33378141 PMCID: PMC8078485 DOI: 10.4088/jcp.20l13749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Jordyn H. Feingold
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dennis Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lauren Peccoralo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven Southwick
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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23
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Putrino D, Ripp J, Herrera JE, Cortes M, Kellner C, Rizk D, Dams-O'Connor K. Multisensory, Nature-Inspired Recharge Rooms Yield Short-Term Reductions in Perceived Stress Among Frontline Healthcare Workers. Front Psychol 2020; 11:560833. [PMID: 33329188 PMCID: PMC7714047 DOI: 10.3389/fpsyg.2020.560833] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022] Open
Abstract
We are currently facing global healthcare crisis that has placed unprecedented stress on healthcare workers as a result of the coronavirus disease 2019 (COVID-19). It is imperative that we develop novel tools to assist healthcare workers in dealing with the significant additional stress and trauma that has arisen as a result of the pandemic. Based in research on the effects of immersive environments on mood, a neuroscience research laboratory was rapidly repurposed using commercially available technologies and materials to create a nature-inspired relaxation space. Frontline healthcare workers were invited to book 15-min experiences in the Recharge Room before, during or after their shifts, where they were exposed to the immersive, multisensory experience 496 Recharge Room users (out of a total of 562) completed a short survey about their experience during an unselected, consecutive 14-day period. Average self-reported stress levels prior to entering the Recharge Room were 4.58/6 (±1.1). After a single 15-min experience in the Recharge Room, the average user-reported stress level was significantly reduced 1.85/6 (±1.2; p < 0.001; paired t-test). Net Promoter Score for the experience was 99.3%. Recharge Rooms such as those described here produce significant short-term reductions in perceived stress, and users find them highly enjoyable. These rooms may be of general utility in high-stress healthcare environments.
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Affiliation(s)
- David Putrino
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jonathan Ripp
- Office of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph E Herrera
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mar Cortes
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Christopher Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Dahlia Rizk
- Division of Hospital Medicine, Mount Sinai Beth Israel, New York, NY, United States
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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24
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Shanafelt T, Farley H, Wang H, Ripp J. Responsibilities and Job Characteristics of Health Care Chief Wellness Officers in the United States. Mayo Clin Proc 2020; 95:2563-2566. [PMID: 33153644 DOI: 10.1016/j.mayocp.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/05/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Hanhan Wang
- Stanford University School of Medicine, Stanford, CA
| | - Jonathan Ripp
- Icahn School of Medicine at Mount Sinai, New York, NY
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25
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Ripp J, Shanafelt T. In Reply to Egener. Acad Med 2020; 95:1627-1628. [PMID: 33109963 DOI: 10.1097/acm.0000000000003668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jonathan Ripp
- Chief wellness officer, Mount Sinai Health System, and senior associate dean for well-being and resilience, Icahn School of Medicine at Mount Sinai, New York City, New York;
| | - Tait Shanafelt
- Chief wellness officer, Stanford Medicine, director, WellMD Center, Jeanie and Stewart Ritchie Professor of Medicine, and associate dean, Stanford School of Medicine, Stanford School of Medicine, Palo Alto, California
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Abstract
Occupational distress among clinicians and its impact on quality of care is a major threat to the health care delivery system. To address threats to clinician well-being, many institutions have introduced a new senior leadership position-the health care chief wellness officer (CWO). This role is distinct from CWOs or other wellness leadership positions that have historically existed outside of medicine. The health care CWO role was established to reduce widespread occupational distress in clinicians by improving the work environment rather than by promoting health behaviors to reduce health insurance costs. A complex array of system-level drivers has contributed to clinician distress. Developing and overseeing the execution of a strategy to address these challenges and working in partnership with other operational leaders to improve well-being require a correctly placed senior leader with the appropriate authority and resources, such as a CWO.Health care CWOs must focus primarily on improving their organizations' work environment and culture, not on developing individual-level interventions, such as personal resilience, mindfulness, and self-care offerings. The goal of this work is to address what is wrong with the practice environment, not to make individuals better able to tolerate a broken system. Metrics to evaluate organizational progress as well as the efficacy of the health care CWO and his or her team are discussed in this Perspective. Occupational distress in clinicians is widespread and has implications for quality of care. Vanguard organizations have begun to put into place the leaders, infrastructure, and improvement teams necessary to address this issue. The health care CWO plays a critical role in the effectiveness of these efforts.
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Affiliation(s)
- Jonathan Ripp
- J. Ripp is chief wellness officer, Mount Sinai Health System, professor of medicine, Departments of Medicine, Medical Education and Geriatrics and Palliative Medicine, and senior associate dean for well-being and resilience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tait Shanafelt
- T. Shanafelt is chief wellness officer, Stanford Medicine, Jeanie and Stewart Ritchie Professor of Medicine, and associate dean, Stanford School of Medicine, Stanford, California
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27
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Ripp J, Peccoralo L, Charney D. Attending to the Emotional Well-Being of the Health Care Workforce in a New York City Health System During the COVID-19 Pandemic. Acad Med 2020; 95:1136-1139. [PMID: 32282344 PMCID: PMC7176260 DOI: 10.1097/acm.0000000000003414] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The COVID-19 pandemic has placed an enormous strain on health care workers, and its potential impact has implications for the physical and emotional well-being of the workforce. As hospital systems run well over capacity, facing possible shortages of critical care medical resources and personal protective equipment as well as clinician deaths, the psychological stressors necessitate a strong well-being support model for staff. At the Mount Sinai Health System (MSHS) in New York City, health care workers have been heroically providing frontline care to COVID-19 patients while facing their own appropriate fears for their personal safety in the setting of contagion. This moral obligation cannot be burdened by unacceptable risks; the health system's full support is required to address the needs of its workforce.In this Invited Commentary, the authors describe how an MSHS Employee, Faculty, and Trainee Crisis Support Task Force-created in early March 2020 and composed of behavioral health, human resources, and well-being leaders from across the health system-used a rapid needs assessment model to capture the concerns of the workforce related to the COVID-19 pandemic. The task force identified 3 priority areas central to promoting and maintaining the well-being of the entire MSHS workforce during the pandemic: meeting basic daily needs; enhancing communications for delivery of current, reliable, and reassuring messages; and developing robust psychosocial and mental health support options. Using a work group strategy, the task force operationalized the rollout of support initiatives for each priority area. Attending to the emotional well-being of health care workers has emerged as a central element in the MSHS COVID-19 response, which continues to be committed to the physical and emotional needs of a workforce that courageously faces this crisis.
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Affiliation(s)
- Jonathan Ripp
- J. Ripp is senior associate dean for well-being and resilience, Icahn School of Medicine at Mount Sinai, and chief wellness officer, Mount Sinai Health System, New York, New York
| | - Lauren Peccoralo
- L. Peccoralo is associate dean for faculty well-being and resilience, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Dennis Charney
- D. Charney is Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and president for academic affairs, Mount Sinai Health System, New York, New York
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28
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Affiliation(s)
- Tait Shanafelt
- Stanford University School of Medicine, Stanford, California
| | - Jonathan Ripp
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mickey Trockel
- Stanford University School of Medicine, Stanford, California
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29
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Austin C, Berg E, Heuer L, Cushman L, Lindquist C, Ripp J. Public health and health professional education at a tribal college: a collaborative immersion program in rural North Dakota. Rural Remote Health 2019; 19:5020. [PMID: 31519109 DOI: 10.22605/rrh5020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Native Americans have some of the worst health outcomes of any minority group in the USA, and are severely under-represented in the health professional workforce. From 2009 to 2015, partners from a tribal college in rural North Dakota and academic institutions in New York collaborated to create a program wherein non-Native health professionals traveled to the reservation to teach a summer course to Native students. This study assessed the impact of the program on both the Native students who took the course and the non-Native health professionals who taught the course. METHODS Focus groups composed of former students in the program were held in Spirit Lake, North Dakota. Non-Native student teachers were surveyed using an online survey tool. Focus group data were analyzed using grounded theory methodology. Survey data were analyzed using descriptive statistics. RESULTS Fifteen former students participated in the focus groups. Participants stated that their experiences in the course increased interest in health professions and knowledge of public health issues. Participants also described barriers to entering health professionals for Native students and the benefits of close interaction with non-Native individuals. Eighty-six percent (24/28) of former course teachers responded to the survey. Survey respondents stated their experiences in North Dakota increased their understanding of underserved populations and their interest in working in rural areas. CONCLUSION This study assessed the successes and limitations of a collaborative, interprofessional immersion program in rural North Dakota. Similar programs may increase the number of Native Americans in health professions and increase non-Native health professional interest in and engagement with rural communities.
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Affiliation(s)
- Charlotte Austin
- Department of Surgery, Monmouth Medical Center, 200 2nd Avenue, Long Branch, NJ 07740, USA
| | - Elizabeth Berg
- Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, NYP/Columbia University Irving Medical Center, 622 W 168th St. PH 17-119, New York, NY 10032, USA
| | - Loretta Heuer
- Population and Family Health at Columbia University Medical Center, 60 Haven Avenue B-2, New York, NY 10032, USA
| | - Linda Cushman
- Cankdeska Cikana Community College, 214 1st Ave, Fort Totten, ND 58335, USA
| | - Cynthia Lindquist
- School of Nursing, North Dakota State University School of Nursing, NDSU Dept 2670, PO Box 6050, Fargo, ND 58102, USA
| | - Jonathan Ripp
- General Internal Medicine, Geriatrics and Palliative Medicine, Department of Medicine, Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA
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30
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Dyrbye LN, Meyers D, Ripp J, Dalal N, Bird SB, Sen S. A Pragmatic Approach for Organizations to Measure Health Care Professional Well-Being. NAM Perspect 2018. [DOI: 10.31478/201810b] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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31
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Ripp J, Bazari H, West CP. In Reply to Fortenberry et al. Acad Med 2018; 93:344. [PMID: 29485499 DOI: 10.1097/acm.0000000000002092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jonathan Ripp
- Associate professor, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; ORCID: http://orcid.org/0000-0001-8681-0095; e-mail: jonathan.ripp@mountsinaiorg. Program director emeritus, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-5703-0329. Professor, Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: http://orcid.org/0000-0003-1628-5023
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32
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Quinn MA, Bazari H, Ripp J, Block L, Chretien KC, Fried ED, Leiter RE, Pincavage AT, Spataro B, Trockel M, West CP. A Roadmap for Research on Resident Well-Being. Am J Med 2018; 131:323-328. [PMID: 29246867 DOI: 10.1016/j.amjmed.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/01/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Mariah A Quinn
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | | | - Jonathan Ripp
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lauren Block
- Hofstra Northwell School of Medicine, Hempstead, NY
| | - Katherine C Chretien
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ethan D Fried
- Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Richard E Leiter
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Mass
| | | | | | | | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, Minn.
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Arora G, Ripp J, Evert J, Rabin T, Tupesis JP, Hudspeth J. Taking it Global: Structuring Global Health Education in Residency Training. J Gen Intern Med 2017; 32:559-562. [PMID: 27530530 PMCID: PMC5400750 DOI: 10.1007/s11606-016-3843-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/12/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Abstract
To meet the demand by residents and to provide knowledge and skills important to the developing physician, global health (GH) training opportunities are increasingly being developed by United States (U.S.) residency training programs. However, many residency programs face common challenges of developing GH curricula, offering safe and mentored international rotations, and creating GH experiences that are of service to resource-limiting settings. Academic GH partnerships allow for the opportunity to collaborate on education and research and improve health care and health systems, but must ensure mutual benefit to U.S. and international partners. This article provides guidance for incorporating GH education into U.S. residency programs in an ethically sound and sustainable manner, and gives examples and solutions for common challenges encountered when developing GH education programs.
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Affiliation(s)
- Gitanjli Arora
- Department of Palliative Medicine, Kaiser Permanente Los Angeles, Los Angeles, CA, USA.
| | - Jonathan Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessica Evert
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Tracy Rabin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Janis P Tupesis
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Global Health Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - James Hudspeth
- Department of Internal Medicine, Boston University, Boston, MA, USA
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Abstract
BACKGROUND Burnout is a common issue in internal medicine residents, and its impact on medical errors and professionalism is an important subject of investigation. OBJECTIVE To evaluate differences in medical errors and professionalism in internal medicine residents with and without burnout. METHODS A single institution observational cohort study was conducted between June 2011 and July 2012. Burnout was measured using the Maslach Burnout Inventory to generate subscores for the following 3 domains: emotional exhaustion, depersonalization, and sense of personal accomplishment. By convention, burnout was defined as a high emotional exhaustion or depersonalization subscore. Medication prescription error rate was the chosen measure of medical errors. Professionalism was measured cumulatively through examining discharge summaries completed within 48 hours, outpatient charts completed within 72 hours, and the average time to review outpatient laboratory tests. RESULTS Of a total of 54 eligible first-year residents, 53 (98%) and 32 (59%) completed the initial and follow-up surveys, respectively. Residents with year-end burnout had a lower rate of medication prescription errors (0.553 versus 0.780, P = .007). Discharge summaries completed within 48 hours of discharge (83.8% versus 84.0%, P = .93), outpatient charts completed within 72 hours of encounter (93.7% versus 94.3%, P = .31), and time (minutes) to review outpatient laboratory test results (72.3 versus 26.9, P = .28) were similar between residents with and without year-end burnout. CONCLUSIONS This study found a small decrease in medical errors in residents with year-end burnout compared to burnout-free residents and no difference in selected measures of professionalism.
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Affiliation(s)
- Jason Kwah
- Corresponding author: Jason Kwah, MD, Northwestern Medical Group, 211 E Chicago Avenue, Suite 1050, Chicago, IL 60611, 312.695.8630, fax 312.694.1839,
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Truglio J, Graziano M, Vedanthan R, Hahn S, Rios C, Hendel-Paterson B, Ripp J. Global health and primary care: increasing burden of chronic diseases and need for integrated training. ACTA ACUST UNITED AC 2013; 79:464-74. [PMID: 22786735 DOI: 10.1002/msj.21327] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Noncommunicable diseases, including cardiovascular disease, chronic respiratory disease, diabetes, cancer, and mental illness, are the leading causes of death and disability worldwide. These diseases are chronic and often mediated predominantly by social determinants of health. Currently there exists a global-health workforce crisis and a subsequent disparity in the distribution of providers able to manage chronic noncommunicable diseases. Clinical competency in global health and primary care could provide practitioners with the knowledge and skills needed to address the global rise of noncommunicable diseases through an emphasis on these social determinants. The past decade has seen substantial growth in the number and quality of US global-health and primary-care training programs, in both undergraduate and graduate medical education. Despite their overlapping competencies, these 2 complementary fields are most often presented as distinct disciplines. Furthermore, many global-health training programs suffer from a lack of a formalized curriculum. At present, there are only a few examples of well-integrated US global-health and primary-care training programs. We call for universal acceptance of global health as a core component of medical education and greater integration of global-health and primary-care training programs in order to improve the quality of each and increase a global workforce prepared to manage noncommunicable diseases and their social mediators.
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Abstract
BACKGROUND Many physicians planning to work in global health lack adequate formal training. Globalized cities create opportunities to integrate global health training into residency programs, preparing clinicians for less supported experiences abroad. AIM To develop a clinical elective to advance residents' knowledge and skills in global health and fieldwork abroad. METHODS Two-week comprehensive elective was offered to PGY2 combined medicine-pediatrics residents. We incorporated clinical exposures and global health topics. Global health experts were involved as teachers and preceptors. Clinical exposure included: tropical medicine with laboratory sessions; travel medicine; tuberculosis; immigrant and continuity; and human rights clinics. Didactic components and supplemental readings included socio-political issues, global public health, and health challenges of populations from developing regions. We assessed resident satisfaction using questionnaires and focus groups. RESULTS Residents reported usefulness and relevance of sessions and topics as (4) very good (scale: (1) poor to (5) excellent), and quality of sessions and teaching as very good to excellent (4.2). Residents' baseline knowledge and understanding of global health issues improved by around 50%. CONCLUSION Our experience supports the feasibility and usefulness of clinical and didactic training in global health issues at home. A multidisciplinary approach, collaboration with academic and non-academic institutions, experienced faculty, and departmental commitment are vital.
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Affiliation(s)
- Ramin Asgary
- Department of Medical Education, Global Health Center, Mount Sinai School of Medicine, One Gustave L Levy Place, Box 1255, New York, NY 10029, USA.
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Affiliation(s)
- Clive Brown
- *Address correspondence to Clive Brown, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS-E03, Atlanta, GA 30329. E-mail:
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Ripp J, Babyatsky M, Fallar R, Bazari H, Bellini L, Kapadia C, Katz JT, Pecker M, Korenstein D. The incidence and predictors of job burnout in first-year internal medicine residents: a five-institution study. Acad Med 2011; 86:1304-10. [PMID: 21869661 DOI: 10.1097/acm.0b013e31822c1236] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Job burnout is prevalent among U.S. internal medicine (IM) residents and may lead to depression, suboptimal patient care, and medical errors. This study sought to identify factors predicting new burnout to better identify at-risk residents. METHOD The authors administered surveys to first-year IM residents at five institutions twice between June 2008 and June 2009, linking individual pre- and postresponses. Surveys measured job burnout, sleepiness, personality traits, and other characteristics. Burnout was defined using the most commonly identified definition and another stricter definition. RESULTS Of 263 eligible residents, 185 (70%) completed both surveys. Among 114 residents who began free of burnout and completed both surveys, 86 (75%) developed burnout, with no differences across institutions. They were significantly more likely to report a disorganized personality style (9 versus 0; 11% versus 0%; P = .019) and less likely to report receiving regular performance feedback (34 versus 13; 63% versus 87%; P = .057). Using a stricter definition, 50% (78/156) of residents developed burnout. They were less likely to plan to pursue subspecialty training (49 versus 63; 78% versus 93%; P = .016) or have a calm personality style (59 versus 70; 77% versus 90%; P = .029). There were no significant associations between burnout incidence and duty hours, clinical rotation, demographics, social supports, loan debt, or psychiatric history. CONCLUSIONS This study identified a high burnout incidence. The associations observed between burnout incidence and personality style, lack of feedback, and career choice uncertainty may inform interventions to prevent burnout and associated hazards.
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Affiliation(s)
- Jonathan Ripp
- Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA.
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Landrigan PJ, Ripp J, Murphy RJC, Claudio L, Jao J, Hexom B, Bloom HG, Shirazian T, Elahi E, Koplan JP. New academic partnerships in global health: innovations at Mount Sinai School of Medicine. ACTA ACUST UNITED AC 2011; 78:470-82. [PMID: 21598272 DOI: 10.1002/msj.20257] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Global health has become an increasingly important focus of education, research, and clinical service in North American universities and academic health centers. Today there are at least 49 academically based global health programs in the United States and Canada, as compared with only one in 1999. A new academic society, the Consortium of Universities for Global Health, was established in 2008 and has grown significantly. This sharp expansion reflects convergence of 3 factors: (1) rapidly growing student and faculty interest in global health; (2) growing realization-powerfully catalyzed by the acquired immune deficiency syndrome epidemic, the emergence of other new infections, climate change, and globalization-that health problems are interconnected, cross national borders, and are global in nature; and (3) rapid expansion in resources for global health. This article examines the evolution of the concept of global health and describes the driving forces that have accelerated interest in the field. It traces the development of global health programs in academic health centers in the United States. It presents a blueprint for a new school-wide global health program at Mount Sinai School of Medicine. The mission of that program, Mount Sinai Global Health, is to enhance global health as an academic field of study within the Mount Sinai community and to improve the health of people around the world. Mount Sinai Global Health is uniting and building synergies among strong, existing global health programs within Mount Sinai; it is training the next generation of physicians and health scientists to be leaders in global health; it is making novel discoveries that translate into blueprints for improving health worldwide; and it builds on Mount Sinai's long and proud tradition of providing medical and surgical care in places where need is great and resources few.
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Affiliation(s)
- Philip J Landrigan
- Mount Sinai Global Health, Mount Sinai School of Medicine, New York, NY, USA.
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Mazurkiewicz R, Korenstein D, Fallar R, Ripp J. The prevalence and correlations of medical student burnout in the pre-clinical years: a cross-sectional study. PSYCHOL HEALTH MED 2011; 17:188-95. [PMID: 21781020 DOI: 10.1080/13548506.2011.597770] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Burnout is a psychological syndrome of emotional exhaustion, depersonalization, and impaired personal accomplishment induced by repeated workplace stressors. Current research suggests that physician burnout may have its origins in medical school. The consequences of medical student burnout include both personal and professional distress, loss of empathy, and poor health. We hypothesized that burnout occurs prior to the initiation of the clinical years of medical education. This was a cross-sectional survey administered to third-year medical students at the Mount Sinai School of Medicine (MSSM) in New York, New York (a traditional-style medical school with a marked division between pre-clinical and clinical training occurring at the beginning of the third year). Survey included an instrument used to measure job burnout, a sleep deprivation screen, and questions related to demographic information, current rotation, psychiatric history, time spent working/studying, participation in extracurricular activities, social support network, autonomy and isolation. Of the 86 medical students who participated, 71% met criteria for burnout. Burnt out students were significantly more likely to suffer from sleep deprivation (p = 0.0359). They were also more likely to disagree with the following statements: "I have control over my daily schedule" (p = 0.0286) and "I am confident that I will have the knowledge and skills necessary to become an intern when I graduate" (p = 0.0263). Our findings show that burnout is present at the beginning of the third year of medical school, prior to the initiation of the clinical years of medical training. Medical student burnout is quite common, and early efforts should be made to empower medical students to both build the knowledge and skills necessary to become capable physicians, as well as withstand the emotional, mental, and physical challenges inherent to medical school.
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Affiliation(s)
- Rebecca Mazurkiewicz
- Department of General Internal Medicine, The Mount Sinai School of Medicine, New York, NY, USA.
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Kazura JW, Ripp J, Milhous WK. Back to the future: the American Society of Tropical Medicine and Hygiene, its journal and the continuing commitment to global health. Am J Trop Med Hyg 2011; 84:3-4. [PMID: 21212193 PMCID: PMC3005509 DOI: 10.4269/ajtmh.2011.10-0666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- James W. Kazura
- *Address correspondence to James W. Kazura, Case Western Reserve University Medical School, W137, 10900 Euclid Avenue, Cleveland, OH 44106-4983. E-mail:
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Abstract
BACKGROUND Job burnout is characterized by emotional exhaustion, depersonalization, and feelings of decreased personal accomplishment, and it may be linked to depression and suboptimal patient care. Burnout among American internal medicine residents ranges between 55% and 76%. PURPOSE We aim to further characterize burnout prevalence at the start of residency. METHODS Between 2006 and 2007, all incoming internal medicine interns at Mount Sinai Hospital and Elmhurst Hospital Center were asked to complete a survey at orientation. The survey included an instrument to measure burnout, a sleep deprivation screen, a personality inventory and demographic information. Comparison tests were conducted to identify statistically significant differences. RESULTS The response rate was 94% (145/154). Overall burnout prevalence was 34% (50/145). Interns self-identifying as anxious (51% vs. 28%, p= .01) or disorganized (60% vs. 31%, p= .03) were more likely to have burnout. CONCLUSIONS Our study found higher levels of burnout among beginning medical interns than reported in the literature. Burnout correlated with some self-reported personality features.
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Anandaraja N, Hahn S, Hennig N, Murphy R, Ripp J. The design and implementation of a multidisciplinary global health residency track at the Mount Sinai School of Medicine. Acad Med 2008; 83:924-928. [PMID: 18820521 DOI: 10.1097/acm.0b013e3181850a3b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The Mount Sinai Global Health Center established a new multidisciplinary Global Health Residency Track (GHRT) in 2006. The goal of the GHRT is to provide participants with a foundation in global health issues and population-based health care, a chance to develop basic research and public health skills in the field, and guidance for career development. The authors describe how the GHRT was created, present its structure, and discuss their experience implementing this new program. Other selected global health residency training programs are also reviewed. The Mount Sinai GHRT is a two-year program that comprises a didactic curriculum, with participants required to take selected classes in the Master of Public Health Program of the Mount Sinai School of Medicine of New York University, and "field experience," which consists of a public health project that is implemented during a two-month elective period during the second year. Core competencies include (1) epidemiology and research skills, (2) health disparities, human rights, and cultural competency, (3) needs assessment and project development, (4) tropical medicine and infectious disease, and (5) reproductive, maternal, and child health. Nine residents were selected from four Mount Sinai residency programs to participate in the GHRT in its first year, and, during the winter of 2007, senior residents conducted public health projects in the Dominican Republic, India, Kenya, and East Harlem. All components of the track performed well in evaluations. An outcomes survey is ongoing to track career choices among graduates and to identify barriers to continuing involvement in global health.
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Affiliation(s)
- Natasha Anandaraja
- Department of Medical Education and Department of Pediatrics, Mount Sinai School of Medicine, New York, New York 10029, USA
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