Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population

Mental health differences in medical students based on curriculum and gender

BACKGROUND

The prevalence of mental health struggles among students in medical school is widely reported; however, little is known about how it is impacted by the medical school curriculum. This study aimed to evaluate differences in anxiety, depression, and emotional exhaustion in medical students based on gender, class year, and curriculum.

METHODS

An anonymous online survey consisting of questions from established, validated questionnaires about demographics, anxiety, depression, emotional exhaustion, and personal health behaviors was sent to 817 medical students who attended Rowan-Virtua School of Osteopathic Medicine during the Spring of 2021. When applying to this school, each of these students had the option to choose either the problem-based learning (PBL) or lecture-based learning (LBL) curriculum track.

RESULTS

The survey was completed by 222 students. Females experienced higher levels of anxiety, depression, and emotional exhaustion than males. Students in the PBL had lower levels of emotional exhaustion than their peers in the LBL. Increase in emotional exhaustion was most pronounced between 1st and 2nd year students. Emotional exhaustion was inversely correlated with sleep and exercise.

CONCLUSIONS

On average, students who were either male or in the PBL curriculum experienced less mental distress in the form of anxiety, depression, and emotional exhaustion than their peers. While gender continues to be an established factor in how mental distress is experienced, the reduced levels of emotional exhaustion in PBL students is a novel finding that can potentially shed light on how to better optimize medical education. Despite the inherent selection bias and lower number of PBL students, to our knowledge, this is the first study comparing two different curricula within a single institution. This finding along with a focus on good sleep and exercise habits may provide a path for improving mental health in medical students.

Moderating role of family functioning and resource support in the relationship between career calling and academic burnout among Chinese medical students during the controlled COVID-19 pandemic: a cross-sectional study

PURPOSE

This cross-sectional study aims to assess the level of academic burnout among Chinese medical students during the controlled COVID-19 pandemic and identify the potential demographic factors affecting academic burnout. It also explored the relationship between career calling, family functioning, resource support, and academic burnout, as well as investigated whether family functioning and resource support could moderate the relationship between career calling and academic burnout among Chinese medical students.

METHODS

The study was conducted in five Chinese cities in 2021. A total of 3614 valid questionnaires were collected to assess the relationship between academic burnout, career calling, family functioning, and resource support, and determine whether demographic factors contribute to academic burnout. Hierarchical multiple regression analysis was used to explore factors correlated with academic burnout and test the moderating effect of family functioning and resource support on the relationship between career calling and academic burnout.

RESULTS

The mean academic burnout score was 3.29 ± 1.17. Sex, major, academic performance ranking, monthly living expenses, physical health, and sleep quality significantly affected academic burnout (p < 0.05). Academic burnout was negatively correlated with career calling, resource support, and family functioning. Family functioning and resource support moderated the relationship between career calling and academic burnout. Simple slope analysis revealed that high family functioning and resource support strengthened the impact of career calling on academic burnout.

CONCLUSIONS

Most medical students in China experienced relatively high levels of academic burnout during the controlled COVID-19 pandemic. Furthermore, specific demographic factors contribute to academic burnout. Family functioning and resource support moderate the relationship between career calling and academic burnout. These findings emphasize the importance of implementing career-calling education, supplementing family functioning in the form of school support, and providing sufficient smart learning resources among medical students in the post-pandemic era.

Impostor phenomenon and burnout syndrome among emergency physicians: a cross-sectional study

INTRODUCTION

This study examined emergency physicians across the country in terms of Impostor Phenomenon (IP) and Burnout Syndrome (BoS). We aimed to evaluate the possible relationship between IP and BoS and determine which demographic characteristics pose a risk for IP and BoS.

METHODS

This quantitative cross-sectional study consists of Clance Impostor Phenomenon Scale (CIPS) and Maslach Burnout Inventory (MBI) which were filled out online by the participants. A total of 389 volunteers participated in the study.

RESULTS

The median age of participants was 30 years (Q1-Q3=27-35) and 57.3% (223) of them were male. The frequency of significant/intense IP was higher in women (28.9%) than in men (17%) (p=0.020). High emotional exhaustion and low personal accomplishment were more common in women than in men (71.7% vs 60.6% and 50% vs 31%, respectively). The median age of participants classified as none to mild IP was 34 years. It was 28 years in significant/intense IP. It was detected that the severity of IP increased as the participants got younger (p<0.001). Significant/intense IP was most common in residents (29%). The residents also had the highest frequency of depersonalization (73.5%). The frequency of moderate to intense IP was the least in participants who worked at a university hospital (74.6%).

CONCLUSION

The results of this study indicated that IP and BoS are more common in residency. The increased frequency of IP and BoS in young female physicians may be attributed to hierarchical working arrangements and worry about academic performance. Experienced physicians with high levels of academic self-consciousness exhibited a low frequency of IP. Additionally, this study identified a moderate correlation between IP and BoS.

Incidence and factors associated with burnout in radiologists: A systematic review

Rationale and objectives

Burnout among physicians has a prevalence rate exceeding 50%. The radiology department is not immune to the burnout epidemic. Understanding and addressing burnout among radiologists has been a subject of recent interest. Thus, our study aims to systematically review studies reporting the prevalence of burnout in physicians in the radiology department while providing an overview of the factors associated with burnout among radiologists.

Materials and methods

The search was conducted from inception until November 13th, 2022, in PubMed, Embase, Education Resources Information Center, PsycINFO, and psycArticles. Studies reporting the prevalence of burnout or any subdimensions among radiology physicians, including residents, fellows, consultants, and attendings, were included. Data on study characteristics and estimates of burnout syndrome or any of its subdimensions were collected and summarized.

Results

After screening 6379 studies, 23 studies from seven countries were eligible. The number of participants ranged from 26 to 460 (median, 162; interquartile range, 91-264). In all, 18 studies (78.3%) employed a form of the Maslach Burnout Inventory. In comparison, four studies (17.4%) used the Stanford Professional Fulfillment Index, and one study (4.3%) used a single-item measure derived from the Zero Burnout Program survey. Overall burnout prevalence estimates were reported by 14 studies (60.9%) and varied from 33% to 88%. High burnout prevalence estimates were reported by only five studies (21.7%) and ranged from 5% to 62%. Emotional exhaustion and depersonalization prevalence estimates were reported by 16 studies (69.6%) and ranged from 11%-100% and 4%-97%, respectively. Furthermore, 15 studies (65.2%) reported low personal accomplishment prevalence, ranging from 14.7% to 84%. There were at least seven definitions for overall burnout and high burnout among the included studies, and there was high heterogeneity among the cutoff scores used for the burnout subdimensions.

Conclusion

Burnout in radiology is increasing globally, with prevalence estimates reaching 88% and 62% for overall and high burnout, respectively. A myriad of factors has been identified as contributing to the increased prevalence. Our data demonstrated significant variability in burnout prevalence estimates among radiologists and major disparities in burnout criteria, instrument tools, and study quality.

Assessment of burnout syndrome and associated factors among medical students during the COVID-19 pandemic

Background: Overwhelming requirements, a high degree of work, and prolonged exposure to emotionally demanding circumstances in work and life settings can lead to burnout syndrome. The purpose of the study is to assess burnout syndrome and its associated factors among medical students during the COVID-19 pandemic. Methods: A cross-sectional, prospective, descriptive study was conducted in a Mexican medical school during the last week of the spring semester of 2021 using the Maslach Burnout Inventory-Student Survey (MBI-SS) and an associated factors survey. Results: Based on the MBI-SS definition, most students (54.2%, n = 332) had burnout symptoms and high emotional exhaustion (79.6%, n = 448), high cynicism (57.3%, n = 351), and low academic effectiveness (36.4%, n = 223). After adjusting the associated factors, a significant correlation between the school year and the presence of burnout was identified (OR 1.127, 95% CI [1.023-1.241], p<0.05). Regarding the current pandemic, the death of a family member by COVID-19 also put students at risk of developing burnout (OR 1.598*, 95% CI [1.080-2.363, p<0.05]). Limitations: The main limitation of this study was the lack of a control group (before the pandemic); therefore, the high prevalence of burnout can only be hypothesized due to the pandemic but cannot be objectively evidenced. A prospective study after the pandemic is needed to resolve this question. Conclusion: The coronavirus pandemic represents a challenge to the academic and psychological stability of students. It essential to continue assessing burnout levels in medical students and the general population to treat them in time and improve mental health.

Art is Patient: A Museum-Based Experience to Teach Trauma-Sensitive Engagement in Health Care

Psychological trauma is ubiquitous, an often hidden yet influential factor in care across clinical specialties. Interdisciplinary health professions education is mobilizing to address the importance of trauma-sensitive care. Given their attention to complex human realities, the health humanities are well-poised to shape healthcare learners' responses to trauma. Indeed, many such arts and humanities curricula propose narrative exercises to strengthen empathy, self-reflection, and sensitive communication. Trauma, however, is often unwordable, fragmentary, and physically encoded, incompatible with storying methods. This article presents a recent innovation, the Art is Patient seminar series, which focuses on aesthetic exercises to help learners access and share non-verbal, embodied, and relational responses to art. Based in an art museum context, it provides successive experiences of approaching, witnessing, and engaging with visual art as an analogue to developing trauma-sensitive relationships. Reflections on the process locate the seminar vis-à-vis health humanities practices, aesthetics, and trauma-informed approaches.

Backlog in ophthalmic surgeries associated with the COVID-19 pandemic in Ontario 2020

OBJECTIVE

To assess the volume of deferred ophthalmic surgeries in Ontario associated with the COVID-19 pandemic from March to December 2020 and suggest strategies and time required to clear the backlog.

DESIGN

Cross-sectional study.

PARTICIPANTS

Ontarians eligible for the Ontario Health Insurance Plan in 2017-2020.

METHODS

Backlog and clearance time for ophthalmic surgeries associated with the COVID-19 pandemic were estimated from time-series forecasting models and queuing theory.

RESULTS

From March 16 to December 31, 2020, the estimated ophthalmic surgical backlog needing operating rooms was 92,150 surgeries (95% prediction interval, 71,288-112,841). Roughly 90% of the delayed surgeries were cataract surgeries, and a concerning 4% were retinal detachment surgeries. Nearly half the provincial backlog (48%; 44,542 of 92,150) was in patients from the western health region. In addition, an estimated 23,755 (95% prediction interval, 14,656-32,497) anti-vascular endothelial growth factor injections were missed. Estimated provincial clearance time was 248 weeks (95% CI, 235-260) and 128 weeks (95% CI, 121-134) if 10% and 20% of operating room surgical capacity per week were added, respectively, based on the weekly ophthalmic surgical volume in 2019.

CONCLUSIONS

Ontario data demonstrate that the magnitude of the ophthalmic surgical backlog in 2020 alone raises serious concerns for meeting the ophthalmic surgical needs of patients. As the pandemic continues, the accrued backlog size is likely to increase. Planning and actions are needed urgently to better manage the collateral impacts of the pandemic on the ophthalmic surgical backlog.

A Multimethod Examination of Medical Students' Experiences With Bereavement and Complicated Grief

Few studies have examined grief in medical students. This study used a multimethod approach to describe how bereavement and CG may impact medical students' educational experience and their perspectives on grief support and training. One hundred three medical students completed an online survey with quantitative and qualitative methods. Seventy-three (71%) students reported experiencing bereavement, of which 12 (18%) screened positive for CG. Medical students who screened positive for CG reported significantly more emotional and behavioral challenges (M = 3.58 [SD = 2.64]) compared to medical students without CG (M = 0.93 [SD = 1.58], p < .001). Qualitative analyses revealed that bereaved and nonbereaved students wanted more grief education and bereavement support from medical institutions. Therefore, it is crucial for medical institutions, to acknowledge that grief and bereavement may impact students' performance due to multifactorial causes.

Burnout risks in Bangladeshi Physicians: A multicenter, cross-sectional study

Physician burnout is a global concern that can lead to exhaustion, ineffectiveness, and poor health outcomes. Burnout has been linked to a variety of societal and professional variables worldwide. This cross-sectional, multi-centered study was conducted by face-to-face interviews between April 2019 and December 2021 at sixty-two (62) tertiary level hospitals to identify potential risk factors for burnout among Bangladeshi physicians, which is essential for preventing adverse impact on their well-being, improving overall quality of life, and facilitating measures to manage stress and maintain a healthy work-life balance. A simple random sampling technique in conjunction with a structured questionnaire was used to collect a total of 1434 responses, assuming 20 % of the sample as non-responsive. Univariate, bivariate, and multinomial logistic regression statistical analyses were performed to determine the risk factors and associate the level of severity. The distribution of burnout status differs significantly at distinct covariate levels, such as working place, working hour, prevalence of potential interpersonal conflicts (subsequent increase of adjusted odds ratios i.e.; 6.52, 8.82, 11.41, and 37.07 is observed for physicians having interpersonal conflicts with both co-workers & family members), job dissatisfaction, annoyed feeling while dealing with patients (adjusted odds ratios are 529.68, 518.26,983.87 and 849.57 respectively) and some other significant factors of the physicians. This study also reveals that the female physicians, physicians with age 40-49, physicians with additional liabilities, physicians with job dissatisfaction, less salary compared to the workload, less flexibility and security at the job sector as well as obese physicians are at high risk of burnout. These results are statistically significant with a p value ≤ 0.05. To reduce burnout of Bangladeshi physicians, it is necessary to address the risk factors, create supportive workplaces, maintain a healthy work-life balance, provide opportunities for self-care, and promote mental health.

Factors in turnover intention of cardiothoracic surgery residents

Increasing numbers of cardiothoracic surgery residents are resigning, without completing their training. This study analyzes how their turnover intention is related to the training environment, and individual psychological factors. Responses by 57 Korean cardiothoracic surgery residents were analyzed. Their levels of depression, anxiety, grit, and empathy, working conditions, the effect of someone's presence to discuss their concerns with, burnout, and turnover intention were identified as the research variables. Descriptive statistical analysis, correlation analysis, and structural equation modeling were used for data analysis. Burnout has the most significant relationship with turnover intention. It has a mediating effect on the influence of depression, grit (sustained interest), and working conditions, over turnover intention. Empathy, and the presence of someone to discuss concerns with, also affect turnover intention directly. The study also confirmed that grit and work satisfaction affect turnover intention indirectly, through burnout. The study identified both individual- and systemic-level factors for an effective training environment, to reduce cardiothoracic surgery residents' tendencies of leaving the residency program, and supporting them for greater satisfaction with their career choice. In order to resolve negative emotions such as burnout and depression, and foster empathy, a human resource development program for the residents' psychological support must be prepared. The program director should be adequately educated to take charge of the training program, oversee the residents' education and welfare, and perform the roles of role-model and mentor.

A Pilot Study of Symptoms of Major Depressive Disorder in Medical Students at an Osteopathic Medical School Before and After High-Stakes Examinations

Background

Given the high prevalence of symptoms of major depressive disorder (MDD) in medical students, identifying factors that impact the development of such symptoms is important. Previous data suggest that medical students can experience symptoms of MDD after medical school exams. It is not known if medical students experience more symptoms of MDD directly before or after exams. The aim of the current study is to determine the prevalence of symptoms of MDD in first- and second-year medical students directly before and after high-stakes medical school examinations.

Methods

Two anonymous surveys were sent via REDCap to first- and second-year medical students at the University of New England College of Osteopathic Medicine. A pre-exam survey on the day of the exam asking about the past three days' MDD symptoms, and a post-exam survey sent three days after the exam asking about MDD symptoms experienced after the exam was sent out to a total of 391 students with a response rate of 23%.

Results

First- and second-year medical students regardless of gender experienced symptoms of MDD at higher rates before exams than afterwards. Female students experienced symptoms of MDD (as defined by the DSM-5) including sadness, sleep disturbances, and feelings of guilt or worthlessness at a greater rate compared to males before exams. After exams, females were more likely to experience sleep disturbances and decreased energy. Second-year male students were the least likely to experience symptoms of MDD.

Conclusion

First- and second-year medical students can experience symptoms of MDD surrounding exams. This study highlights the emotional burden that students may carry near exams. It underscores the importance of further research on this topic to evaluate the effect exams have on the mental health of medical students during their training.

Academic climate and psychopathological symptomatology in Spanish medical students

INTRODUCTION

Medical Education studies suggest that medical students experience depression, anxiety and psychopathological symptomatology in a proportion higher than in the rest of the population. In the present study, we aimed to conduct a nationwide analysis to describe student's perceptions of Educational Climate in Spanish medical schools, and its relationship with psychopathological symptomatology.

METHODS

The study was carried out in 2022 in all 44 medical schools in Spain, and analyses the academic climate, and psychopathological symptomatology among medical students (n = 4374). To measure these variables, we used the Dundee Ready Education Environment Measure (DREEM) for academic climate, and the SA-45 (Symptom Assessment-45 Questionnaire was used to assess psychopathological symptomatology.

RESULTS

The mean DREEM global score was low, 95.8 (SD 22.6). Worse perception of the academic climate has been found in females (t -2.21, p 0.027), in students of the clinical academic years (t 16.9, p < 0.001), and public medical schools ( t 15.6, p < 0.001). The SA45 general index score was high (p90) in 25.6% of participants. In respect of gender, female students presented higher levels of SA45 general index score, depression, interpersonal sensitivity, somatization, anxiety, obsession-compulsion, and phobic anxiety symptoms. Higher DREEM global and subscale scores corresponded to a higher SA-45 global index score and higher SA-45 subscale scores.

CONCLUSIONS

Our study suggests a correlation between a poor perception of academic climate, increased depression, anxiety, and other psychopathological symptoms, with a pattern that varies between different faculties. The perception of academic climate varied between medical schools, as did the psychopathological symptoms scores. Our finding suggests the prevalence of these variables in medical students is, at least in part, attributable to factors directly related to the learning atmosphere.

The relationship between a single-item measure of burnout and the Copenhagen Burnout Inventory in family medicine residents

OBJECTIVE

Burnout during residency education is a phenomenon which requires careful study. A single item for measuring burnout shows promise for its brevity and concordance with the most commonly used measure of burnout, the Maslach Burnout Inventory, but has not been compared to the Copenhagen Burnout Inventory. We compared the single-item measure of burnout question to the Copenhagen Burnout Inventory to assess the convergence between these two measures of burnout.

METHOD

Family Medicine residents (n = 32) from three residency programs completed the single-item measure of burnout question and the Copenhagen Burnout Inventory. We compared the single-item measure of burnout measure to the three scales of the Copenhagen Burnout Inventory.

RESULTS

Our analyses indicated that the single item measure is highly correlated with personal burnout (r = .76), moderately correlated with patient burnout (r = .58), and not correlated with work burnout (r = .18).

CONCLUSIONS

Because the single-item measure of burnout is particularly useful for identifying personal burnout, it may help to identify early signs of burnout amount physicians in training.

Burnout During the COVID-19 Pandemic: A Report on Pediatric Residents

BACKGROUND AND OBJECTIVE

The Pediatric Resident Burnout and Resilience Consortium (PRB-RSC) has described the epidemiology of burnout in pediatric residents since 2016. We hypothesized burnout rates during the pandemic would increase. We explored resident burnout during the COVID-19 pandemic and its relationship to resident perception of workload, training, personal life, and local COVID burden.

METHODS

Since 2016, PRB-RSC has sent an annual, confidential survey to over 30 pediatric and medicine-pediatrics residencies. In 2020 and 2021, seven questions were added to explore the relationship of COVID-19 and perceptions of workload, training, and personal life.

RESULTS

In 2019, 46 programs participated, 22 in 2020, and 45 in 2021. Response rates in 2020 (n = 1055, 68%) and 2021(n = 1702, 55%) were similar to those of previous years (P = .09). Burnout rates in 2020 were significantly lower than in 2019 (54% vs 66%, P < .001) but returned to pre-COVID levels in 2021 (65%, P = .90). In combined 2020-2021 data, higher rates of burnout were associated with reported increased workload (Adjusted Odds Ratio (AOR) 1.38, 95% CI 1.19-1.6) and concerns regarding the effect of COVID on training (AOR 1.35, 95% CI 1.2-1.53). Program-level county COVID burden in combined 2020-2021 data was not associated with burnout in this model (AOR=1.03, 95% CI 0.70-1.52).

CONCLUSIONS

Burnout rates within reporting programs decreased significantly in 2020 and returned to prepandemic levels in 2021. Increased burnout was associated with perceived increases in workload and concerns regarding effect of the pandemic on training. Given these findings, programs should consider further investigation into workload and training uncertainty on burnout.

Physicians as shock absorbers: The system of structural factors driving burnout and dissatisfaction in medicine

American physicians disproportionately suffer from burnout. Despite calls for systemic solutions, however, few studies have actually examined how 'the system' works-i.e. how structural factors intersect in real-time as a system to shape wellbeing. I borrow a systems theoretical approach, which explicitly recognizes the dynamic relationships and interdependencies between different actors and factors in healthcare, to examine how structural factors work together to shape physicians' wellbeing. Drawing on an eight-month ethnography in a pediatrics clinic, I show how respondents experienced pressures from multiple structural levels: societal (including broader social inequality and changing doctor-patient relationships); organizational (centralized decision-making, economic pressures, and unresponsive leadership); and professional (specialty cultures and unhealthy norms). I find that individual physicians effectively served as shock absorbers, routinely absorbing countless, interconnected structural demands ("shocks") and converting them into competent medical care, at significant cost to their mental health. In so doing, I intervene in sociological debates about the broader fate of the medical profession and conclude that if medicine remains resilient against threats to its dominance, it may well be at the expense of individual physicians' mental wellbeing.

Paediatric cardiology training: burnout, fulfilment, and fears

BACKGROUND

Burnout is well characterised in physicians and residents but not in paediatric cardiology fellows, and few studies follow burnout longitudinally. Training-specific fears have been described in paediatric cardiology fellows but also have not been studied at multiple time points. This study aimed to measure burnout, training-specific fears, and professional fulfilment in paediatric cardiology fellows with the attention to time of year and year-of-training.

METHODS

This survey-based study included the Professional Fulfillment Index and the Impact of Events Scale as well as an investigator-designed Fellow Fears Questionnaire. Surveys were distributed at three-time points during the academic year to paediatric cardiology fellows at a large Midwestern training programme. Fellow self-reported gender and year-of-training were collected. Descriptive analyses were performed.

RESULTS

10/17 (59%) of fellows completed all surveys; 60% were female, 40% in the first-year class, 40% in the second-year class, and 20% in the third-year class. At least half of the fellows reported burnout at each survey time point, with lower mean professional fulfilment scores. The second-year class, who rotate primarily in the cardiac ICU, had higher proportions of burnout than the other two classes. At least half of fellows reported that they "often" or "always" worried about not having enough clinical knowledge or skills and about work-life balance.

CONCLUSIONS

Paediatric cardiology fellows exhibit high proportions of burnout and training-specific fears. Interventions to mitigate burnout should be targeted specifically to training needs, including during high-acuity rotations.

Investigation of Health Behavior on Burnout Scores in Women Physicians who Self-Identify as Runners: A Cross-Sectional Survey Study

As the proportion of women in the physician workforce increases, burnout in this population warrants further investigation. Exercise is an often-proposed strategy to combat burnout. Evaluating physical activity across a cohort of women physicians can assess associations of health behaviors with burnout. Cross-sectional study of women attending physicians in the United States who are actively engaged in a social media group for runners. An electronic survey comprised of 60 questions covering demographics, health behaviors, and burnout was administered. A healthy lifestyle subgroup (HLS) was defined based on American Heart Association physical activity and nutrition recommendations. We determine the prevalence of burnout and investigate associations between health behavior factors and burnout. Of the 369 included surveys, most respondents were at least six years out from medical training (85.9%) and White (74.5%). Forty-two percent experienced burnout symptoms. Time exercising was significantly associated with fruit/vegetable consumption (P=.00002). There was no significant difference in burnout between the HLS compared to others (P = .37). This group of self-reported physically active women physicians was found to have a lower prevalence of burnout when compared to other women physicians. Exercise and nutrition may be protective against burnout in women physicians but deserve further investigation.

Perceived Stress, Grit, and Self-Care Behaviors in First-Year Medical Students

Medical students experience more stress than the general population, which over time can cause mental and physical disease, including burnout. Identifying factors impacting stress during early medical training could inform strategies to minimize its impacts throughout training and in clinical practice. This study surveyed 238 first-year osteopathic medical students to assess stress (Perceived Stress Scale; PSS), grit, sleep quality (Pittsburgh Sleep Quality Index; PSQI), physical activity (Godin-Shephard Leisure-Time Physical Activity Score; LTPA), and nutrition habits (Rapid Eating Assessment for Participants; REAP) within the first 2 weeks of starting medical school and again 10 weeks later. Incomplete responses were removed, leaving 204 study participants. We observed statistically significant decreases in grittiness (∆grit = -2.230%, P = .002) and physical activity (∆LTPA = -22.147%, P < .0001), while perceived stress (∆PSS = 34.548%, P < .0001) and poor sleep quality (∆PSQI% = 19.853, P < .0001) increased. Correlation analyses identified the strongest relationships were between ∆PSS vs ∆PSQI (r = .47, P < .0001) and ∆PSS vs ∆LTPA (r = -.20, P < .01). Multivariable linear regression analysis isolated ∆PSQI (P < .0001) and ∆LTPA (P = .012) as statistically significant predictors of ∆PSS. These results suggest early, repeated curricular interventions focused on physical activity and sleep hygiene may help students better manage stress during medical education.

Investigation of Nurses' Wellbeing towards Errors in Clinical Practice-The Role of Resilience

Background and Objectives: The fatigue, stress, and burnout of nurses lead to them frequently making mistakes, which have a negative impact not only on the safety of the patients but also on their psychology. The ability to bounce back from mistakes is crucial for nurses. Nursing staff members' physical and mental health, particularly their depression, is far from ideal, and this ill health is directly correlated with the frequency of self-reported medical errors. The nurses' mental and physical health are also positively correlated with their perception of wellness support at work. This cross-sectional study aimed to investigate the status of nurses' mental and physical health regarding clinical errors and the impact of resilience on coping with these situations. Materials and Methods: A total of 364 healthcare professionals participated in this research; 87.5% of them were females and 12.5% of them were males. Most of the participants were 22-35 years old. The median number of years of employment was nine. Clinical nurses anonymously and voluntarily completed a special structured questionnaire that included questions from different validated tools in order to assess their state of physical and mental wellbeing after events of stress and errors made during their practice. Results: In total, 49.4% of the nurses had made an error on their own, and 73.2% had witnessed an error that someone else had made. At the time of the error, 29.9% of the participants were in charge of more than 20 patients, while 28.9% were responsible for a maximum of three patients. Participants who were 36-45 years old had more resilience (p = 0.049) and experienced fewer negative emotions than participants who were 22-35 years old. The participants who mentioned more positive feelings according to their mental state had greater resilience (p > 0.001). Conclusions: Errors were likely to happen during clinical practice due to nurses' negative experiences. The level of resilience among the nursing population was found to play a very important role not only in making mistakes but also in coping with errors during their daily routine. Wellness and prevention must be given top priority in all healthcare systems across the country in order to promote nurses' optimal health and wellbeing, raise the standard of care, and reduce the likelihood of expensive, avoidable medical errors. Healthcare administrations should promote prevention programs for stress occurrence in order to support nurses' wellbeing maintenance.

Patterns in Physician Burnout in a Stable-Linked Cohort

Importance

Physician burnout is widely reported to be an increasing problem in the US. Although prior analyses suggest physician burnout is rising nationally, these analyses have substantial limitations, including different physicians joining and leaving clinical practice.

Objective

To examine the prevalence of burnout among physicians in a large multispecialty group over a 5-year period.

Design, Setting, and Participants

This survey study was conducted in 2017, 2019, and 2021 and involved physician faculty members of the Massachusetts General Physicians Organization. Participants represented different clinical specialties and a full range of career stages. The online survey instrument had 4 domains: physician career and compensation satisfaction, physician well-being, administrative workload on physicians, and leadership and diversity.

Exposure

Time.

Main Outcomes and Measures

Physician burnout, which was assessed with the Maslach Burnout Inventory. A binary burnout measure was used, which defined burnout as a high score in 2 of the 3 burnout subscales: Exhaustion, Cynicism, and Reduced Personal Efficacy.

Results

A total of 1373 physicians (72.9% of the original 2017 cohort) participated in all 3 surveys. The cohort included 690 (50.3%) male, 921 (67.1%) White, and 1189 (86.6%) non-Hispanic individuals. The response rates were 93.0% in 2017, 93.0% in 2019, and 92.0% in 2021. Concerning years of experience, the cohort was relatively well distributed, with the highest number and proportion of physicians (478 [34.8%]) reporting between 11 and 20 years of experience. Within this group, burnout declined from 44.4% (610 physicians) in 2017 to 41.9% (575) in 2019 (P = .18) before increasing to 50.4% (692) in 2021 (P < .001).

Conclusions and Relevance

Findings of this survey study suggest that the physician burnout rate in the US is increasing. This pattern represents a potential threat to the ability of the US health care system to care for patients and needs urgent solutions.

Prevalence and levels of burnout in nursing students: A systematic review with meta-analysis

AIM

The aim of this study was to analyze burnout levels and prevalence in nursing students and to estimate prevalence levels with meta-analyses.

BACKGROUND

Nurses are one of the healthcare professionals most affect by burnout, but nursing students, during their studies, can also suffer burnout.

DESIGN

a systematic review with meta-analysis was performed.

METHODS

The search equation used in Pubmed, CINAHL and Scopus databases was "burnout AND nursing students". Quantitative primary studies including information about burnout, emotional exhaustion, depersonalization, or personal accomplishment in nursing students were included. Four meta-analysis were performed.

RESULTS

the sample was of n = 34 studies, with n = 15 studies being included in the meta-analysis with n = 2744 nursing students. Burnout prevalence was 19% (95% CI 11-28%). Regarding burnout dimensions, the most affected was high emotional exhaustion with a prevalence of 41%(95% CI 23-61%; n = 2222) followed by 27% low personal accomplishment(95% CI 9-49%; n = 2096), 25% high depersonalization (95% CI 15-36%; n = 2096).

CONCLUSIONS

Prevalence of burnout and its dimensions vary from 19% to 41%, being emotional exhaustion the main problem in nursing students. This problem may affect their future as nursing professionals, and it would be of important to prevent and to treat burnout at university levels.

The Women in Cardiothoracic Anesthesiology Special Interest Group: What Can the Lessons of One Anesthesiology Affinity Group Tell Us About How to Build Impactful Professional Communities?

The Women In Cardiothoracic Anesthesiology (WICTA), a special interest group of the Society of Cardiovascular Anesthesiologists, has been highly successful in mobilizing WICTA, a historically underrepresented and marginalized group in the subspecialty, and in supporting real and meaningful change in the professional community. The experience of WICTA as a professional affinity group in impacting a professional organization to diversify, evolve, and become more responsive to a wider professional audience has important lessons for other professional organizations. This article discusses the recent history of affinity organizations in anesthesiology, the benefits they offer professional organizations, and the strategies that have been used to effectively motivate change in professional communities. These strategies include engaging a strong advisory board, identifying the need of constituents, creating additional opportunities for networking and membership, addressing gaps in professional development, and aligning goals with those of the larger national organization. WICTA is just one example of the potential opportunities that affinity groups offer to professional societies and organizations for expanding their reach, enhancing their impact on physicians in their target audience, and achieving organizational missions.

Association of physician burnout with perceived EHR work stress and potentially actionable factors

OBJECTIVE

Physicians of all specialties experienced unprecedented stressors during the COVID-19 pandemic, exacerbating preexisting burnout. We examine burnout's association with perceived and actionable electronic health record (EHR) workload factors and personal, professional, and organizational characteristics with the goal of identifying levers that can be targeted to address burnout.

MATERIALS AND METHODS

Survey of physicians of all specialties in an academic health center, using a standard measure of burnout, self-reported EHR work stress, and EHR-based work assessed by the number of messages regarding prescription reauthorization and use of a staff pool to triage messages. Descriptive and multivariable regression analyses examined the relationship among burnout, perceived EHR work stress, and actionable EHR work factors.

RESULTS

Of 1038 eligible physicians, 627 responded (60% response rate), 49.8% reported burnout symptoms. Logistic regression analysis suggests that higher odds of burnout are associated with physicians feeling higher level of EHR stress (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.07-1.25), having more prescription reauthorization messages (OR, 1.23; 95% CI, 1.04-1.47), not feeling valued (OR, 3.38; 95% CI, 1.69-7.22) or aligned in values with clinic leaders (OR, 2.81; 95% CI, 1.87-4.27), in medical practice for ≤15 years (OR, 2.57; 95% CI, 1.63-4.12), and sleeping for <6 h/night (OR, 1.73; 95% CI, 1.12-2.67).

DISCUSSION

Perceived EHR stress and prescription reauthorization messages are significantly associated with burnout, as are non-EHR factors such as not feeling valued or aligned in values with clinic leaders. Younger physicians need more support.

CONCLUSION

A multipronged approach targeting actionable levers and supporting young physicians is needed to implement sustainable improvements in physician well-being.

An Evaluation of Burnout Among US Rheumatology Fellows: A National Survey

OBJECTIVE

To evaluate levels of burnout and correlates of burnout among US rheumatology fellows.

METHODS

US rheumatology fellows were invited to complete an electronic survey in 2019. Burnout was assessed using the Maslach Burnout Inventory. Measures of depression, fatigue, quality of life, and training year were also collected. Open-ended questions about perceived factors to promote resiliency and factors leading to increased burnout were included. Bivariate and multivariate regression analyses were used to examine correlates of burnout. Open-ended responses were analyzed using thematic analysis.

RESULTS

The response rate was 18% (105/582 pediatric and adult rheumatology fellows). Over one-third (38.5%) of postgraduate year (PGY) 4 and 16.7% of PGY5/6 fellows reported at least 1 symptom of burnout. Of PGY4 fellows, 12.8% met criteria for depression compared with 2.4% of PGY5/6 fellows. PGY4 fellows reported worse fatigue and poorer quality of life compared with PGY5/6. In multivariable models controlling for training year and gender, older age (> 31 years) was associated with lower odds of burnout. Thematic analysis of open-ended responses identified factors that help reduce burnout: exercise, family/friends, sleep, support at work, and hobbies. Factors contributing to burnout: pager, documentation, long hours, demands of patient care, and presentations and expectations.

CONCLUSION

This national survey of US rheumatology fellows reveals that early trainee level and younger age are associated with worse levels of fatigue, quality of life, and burnout. Although awareness of and strategies to reduce burnout are needed for all fellows, targeted interventions for younger fellows and those in their first year of training may be of highest yield.

Burnout and motivation to study medicine among students during the COVID-19 pandemic

AIM

To investigate medical students' burnout and motivation levels in each of the six years of their studies during the COVID-19 pandemic and identify independent predictors of burnout and motivation.

METHODS

An anonymous cross-sectional survey was sent to the students of all six years within our school. Burnout was measured with the adapted Oldenburg Burnout Inventory questionnaire (OLBI-S) and motivation with the updated Strength of Motivation for Medical School (SMMS-R) questionnaire. Univariate analysis was performed with the Kruskal-Wallis test and Spearman's correlation, while multivariable analysis with linear regression models.

RESULTS

A total of 333 medical students (52% of student body) responded. Higher burnout levels correlated with lower motivation to study medicine (rho = -0.30, p < 0.001). Burnout levels differed between the six years of medical studies, peaking in years two and four whereas being the lowest in year one (p = 0.01). Motivation levels differed significantly as well, peaking in years one and four whereas being the lowest in years five and six (p = 0.012). In the multivariable linear regression models, being a female (b = 2.22, p = 0.016), studying in the fourth year vs. first year (b = 2.54, p = 0.049), having a perceived beginner/intermediate vs. advanced/expert technology level (b = 2.05, p = 0.032) and a perceived poor school support system (b = 6.35, p < 0.001) were independently associated with higher burnout levels. Furthermore, studying in the fifth year vs. first year (b = -5.17, p = 0.019) and a perceived poor school support system (b = -3.09, p = 0.01) were independently associated with a reduced motivation to study medicine.

CONCLUSION

Our study highlighted potential areas for intervention to decrease the rate of burnout and low motivation among medical students. However, further research is needed to unravel the full effect of the pandemic on medical students.

Feeling like the enemy: the emotion management and alienation of hospital doctors

Introduction

Globally, an epidemic of psychological distress, burnout, and workforce attrition signify an acute deterioration in hospital doctors' relationship with their work-intensified by COVID-19. This deterioration is more complicated than individual responses to workplace stress, as it is heavily regulated by social, professional, and organizational structures. Moving past burnout as a discrete "outcome," we draw on theories of emotion management and alienation to analyze the strategies through which hospital doctors continue to provide care in the face of resource-constraints and psychological strain.

Methods

We used Mobile Instant Messaging Ethnography (MIME), a novel form of remote ethnography comprising a long-term exchange of digital messages to elicit "live" reflections on work-life experiences and feelings.

Results

The results delineate two primary emotion-management strategies-acquiescence and depersonalization-used by the hospital doctors to suppress negative feelings and emotions (e.g., anger, frustration, and guilt) stemming from the disconnect between professional norms of expertise and self-sacrifice, and organizational realities of impotence and self-preservation.

Discussion

Illustrating the continued relevant of alienation, extending its application to doctors who disconnect to survive, we show how the socio-cultural ideals of the medical profession (expertise and self-sacrifice) are experienced through the emotion-management and self-estrangement of hospital doctors. Practically, the deterioration of hospital doctors' relationship with work is a threat to health systems and organizations. The paper highlights the importance of understanding the social structures and disconnects that shape this deteriorating relationship and the broad futility of self-care interventions embedded in work contexts of unrealized professional ideals, organizational resource deficits and unhappy doctors, patients, and families.

Effects of coaching on medical student well-being and distress: a systematic review protocol

INTRODUCTION

Medical students experience higher rates of distress and burnout compared with their age-similar peers overall. Coaching has been proposed as one means of combating distress and burnout within the medical profession. The purpose of this systematic review is to synthesise the current evidence on the effects of coaching interventions on medical student well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms.

METHODS AND ANALYSIS

We will conduct a systematic review of interventional and observational comparative studies that assess the effects of coaching interventions on well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms among undergraduate medical students internationally. We will search PubMed (MEDLINE), Embase (OVID), PsycINFO (OVID), Scopus, ERIC, Cochrane Database of Systematic Reviews (OVID) and Cochrane Central Register of Controlled Trials (OVID) from their respective inception dates using the following search terms: (medical students OR medical student OR undergraduate medical education) AND (coach OR coaching OR coaches). Studies in any language will be eligible. Studies that report one or more outcomes of distress or well-being among medical students who receive a coaching intervention will be included. Data on participant and intervention characteristics, outcomes and instruments used will be collected as well as quality/risk of bias assessments. Two reviewers will screen studies against the inclusion criteria and perform data extraction. We will conduct a narrative synthesis, with meta-analysis if evidence permits quantitative pooling of results. Heterogeneity of results across studies according to study design, learner level and study risk of bias will be evaluated, as well as publication bias.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review. Results will be disseminated by publication in a scientific journal.

PROSPERO REGISTRATION NUMBER

CRD42022322503.

The Flipped Classroom Approach in a Pediatric Anesthesiology Fellowship Curriculum

Background The flipped classroom approach is well documented to enhance medical education outcomes. Additionally, both the need for online learning materials and the increased demand for medical professionals during the COVID-19 pandemic has made this approach more relevant. The pediatric anesthesiology fellowship curriculum at one institution transitioned from a traditional classroom model to a flipped classroom approach to optimize the educational experience and support learner well-being. Approach Utilizing the American Board of Anesthesiology (ABA) and Accreditation Council for Graduate Medical Education (ACGME) content outlines, a novel, comprehensive curriculum was developed focusing on core clinical material and board review with the goal of providing structured learning while alleviating the burden of completing board review independently to improve work-life balance and reduce the potential for burnout. Evaluation Graduates of the program from 2017 to 2021 evaluated the flipped classroom structure and its perceived impact on their educational outcomes, wellness, and career development via a one-time, voluntary survey. Results indicated improved participation rates and educational benefits with the flipped classroom structure compared to the traditional structure. Fellows preferred the flipped classroom approach to the traditional lecture approach (72.2% vs. 27%), and they preferred custom-made prework material to traditional textbooks and articles. Fellows benefited from having more time for personal activities and other scholarly work, as evidenced by open-ended responses. Implications The flipped classroom structure was perceived as beneficial by pediatric anesthesiology fellows because of increased educational engagement, alleviation of academic burden, and improved wellness due to more time for non-academic activities. Further study is needed to optimize and correlate the new curriculum with objective educational outcomes.

Mental health throughout the medical career: A comparison of depression, anxiety, and stress levels among medical students, residents, and physicians

BACKGROUND

Different stages of a physician's career may be associated with different types of mental health impairment.

AIMS

This study aimed to compare symptoms of anxiety, depression, and stress and their associated factors among medical students, medical residents, and physicians.

METHODS

A cross-sectional study was conducted. Data collection included sociodemographic data, religiosity (Duke University Religion Index), and mental health (21-item Depression, Anxiety and Stress Scale - DASS-21) data. The comparison between the groups was performed using ANOVA, and the associated factors were evaluated via linear regression models.

RESULTS

The sample consisted of 1,417 participants: 778 medical students, 190 medical residents, and 468 established physicians. Medical students had significantly higher depression, anxiety, and stress scores as compared to medical residents and established physicians. However, regarding DASS 21 scores, no significant differences were found between established physicians and medical residents. The factors associated with mental health in the different groups showed that being married and male were associated with better mental health among physicians and medical residents, while the factors of male gender, being in later years of the course, and lower religious attendance were associated with better mental health in students.

CONCLUSION

Medical students had worse mental health outcomes when compared to residents and established physicians. Interventions are needed to minimize suffering during medical education and career.

Residents' Report of COVID-19 Associated Training Disruptions, Stressors, and Opportunities During the Pandemic-The Singapore Experience

Background

The COVID-19 pandemic has disrupted residency training. Several studies have been performed to investigate the impact of the pandemic on residency training in Accreditation Council for Graduate Medical Education-International (ACGME-I)-accredited institutions. However, these were either limited to certain specialties or failed to consider possible opportunities from the pandemic.

Objective

To determine the stressors on residents as well as the opportunities that arose from the COVID-19 pandemic across multiple specialities in Singapore.

Methods

A cross-sectional survey among SingHealth residents was conducted between July and September 2020. The survey assessed the balance between service and training during hospital postings, the pandemic's influence on examination and teaching, the psychological impact of the pandemic, the level of burnout, and the effect on morale of residents during the pandemic.

Results

The response rate was 27.1% (253 of 934). Out of the 253 residents, 136 (53.8%) felt stressed during the pandemic. Concerns about family's health and safety pertaining to potential COVID-19 infection, progression in training, and completion of examinations were the top 3 stressors. One-hundred and three residents (40.7%) had their training disrupted either by being placed in an interim posting not part of their residency requirements or being deployed to care for patients with COVID-19. Although administrative support and information for virtual teaching were sufficient, only 108 (42.7%) agreed it had the same value as face-to-face sessions. Despite the challenges, 179 (70.8%) thought that experiencing this crisis provided more meaning in their career.

Conclusions

The COVID-19 pandemic has brought about challenges and learning opportunities for residents.

Behavioral and psychosocial factors related to mental distress among medical students

Introduction

Physicians die by suicide at rates higher than the general population, with the increased risk beginning in medical school. To better understand why, this study examined the prevalence of mental distress (e.g., depressive symptoms and suicide risk) and behavioral and psychosocial risk factors for distress, as well as the associations between mental distress and risk factors among a sample of medical students in a pre-COVID-19-era.

Methods

Students enrolled in a large California medical school in 2018-2019 (N = 134; 52% female) completed questionnaires assessing sociodemographic characteristics, depression and suicide family history, health behaviors, and psychosocial wellbeing. Assessment scores indexing mental distress (e.g., depressive symptoms, thoughts of suicide in the past 12 months, suicide risk, and history of suicidality) and risk factors (e.g., stress, subjective sleep quality, alcohol use, impostor feelings, and bill payment difficulty) were compared across biological sex using chi-squared tests, and associations between mental distress and risk factors were determined through logistic regression.

Results

Elevated mental distress indicators were observed relative to the general public (e.g., 16% positive depression screen, 17% thought about suicide in previous 12 months, 10% positive suicide risk screen, and 34% history of suicidality), as well as elevated risk factors [e.g., 55% moderate or high stress, 95% at least moderate impostor feelings, 59% poor sleep quality, 50% screened positive for hazardous drinking (more likely in females), and 25% difficulty paying bills]. A positive depression screen was associated with higher stress, higher impostor feelings, poorer sleep quality, and difficulty paying bills. Suicidal ideation in the previous 12 months, suicide risk, and a history of suicidality were independently associated with higher levels of impostor feelings.

Discussion

Higher scores on assessments of depressive symptoms and suicidal thoughts and behaviors were related to several individual-level and potentially modifiable risk factors (e.g., stress, impostor feelings, sleep quality, and bill payment difficulties). Future research is needed to inform customized screening and resources for the wellbeing of the medical community. However, it is likely that the modification of individual-level risk factors is limited by the larger medical culture and systems, suggesting that successful interventions mitigate suicide risk for medical providers need to address multiple socio-ecological levels.

How do peer group reflection meetings support medical students' learning and personal development during clinical rotations?

BACKGROUND

Medical schools look to support students in coping with challenges and stressors related to clinical rotations. One potential approach is implementing Intervision Meetings (IM): a peer group reflection method during which students address challenging situations and personal development issues with peers, guided by a coach. Its implementation and perceived effectiveness in undergraduate medical education has however not yet been widely studied and described. This study evaluates how students perceive the effect of a three-year IM-programme during their clinical rotations, and explores which processes and specific factors support students' personal development and learning during clinical rotations.

METHODS

Using an explanatory Mixed Methodology, medical students participating in IM were asked to evaluate their experiences through a questionnaire at three time points. Questionnaire results were further explored through three focus groups. Data were analysed using descriptive statistics and thematic analysis.

RESULTS

Three hundred fifty seven questionnaires were filled out by students across the three time points. Students perceived IM to contribute to their ability to cope with challenging situations during clinical rotations. Participants in the focus groups described how IM created an increase in self-awareness by active self-reflection supported by peers and the coach. Sharing and recognizing each other's' situations, stories or problems; as well as hearing alternative ways of coping, helped students to put things into perspective and try out alternative ways of thinking or behaving.

CONCLUSIONS

IM can help students to better deal with stressors during clinical rotations and approach challenges as learning opportunities under the right circumstances. It is a potential method medical schools can use to aid their students on their journey of personal and professional development.

Universal Brief Mental Health Screenings for First-Year Medical Students: A 6-Year Retrospective of the Keck Checks Program

Medical students are at elevated risk for mental health difficulties and may struggle to ask for help. Innovative outreach programs are warranted to reduce barriers and ensure that students receive the professional care they need and deserve. This article provides a 6-year retrospective of the Keck Checks program, a well-established initiative that offered universal 15-minute mental health screenings to every first-year medical student at the Keck School of Medicine of the University of Southern California from fall 2016 to fall 2022. This early detection program was designed to combat barriers to seeking mental health care by normalizing the concept of all students meeting with a psychologist early in their academic careers. The Keck Checks program showed promising feasibility, with a single full-time clinician successfully hosting appointments for entire classes of first-year medical students (mean of 189 students per class) during approximately 4 months, in addition to other work duties. Participation rates were high, with 715 eligible students (76.3%) choosing to attend their Keck Check. Students were frequently referred to follow-up services during the Keck Check, including mental health care (n = 360 [50.4%] referred), occupational therapy (n = 72 [10.1%] referred), and academic support services (n = 60 [8.4%] referred). Next steps include possible expansion of similar programs to medical students in years 2 to 4, residents, and physicians, as well as understanding the effect of brief mental health screenings on long-term help-seeking, adherence to mental health treatment plans, and general educational or professional success. Brief, universal mental health screenings are a relatively low-cost, high-impact approach for medical schools to consider in supporting the mental health of their student body.

Cultural adaptation and validation of Japanese medical resident version of the workplace social capital scale: a cross-sectional study

BACKGROUND

The Workplace Social Capital (WSC) Scale is the most frequently used tool for measuring social capital at work in Western countries. However, there are no corresponding tools for assessing WSC among medical trainees in Japan. Thus, this study was conducted to develop the Japanese medical resident version of the WSC (JMR-WSC) Scale and examine its validity and reliability.

METHODS

The Japanese version of the WSC Scale by Odagiri et al. was reviewed and the scale was partially modified for use in the Japanese context of postgraduate medical education. To verify the validity and reliability of the JMR-WSC Scale, a cross-sectional survey was performed in 32 hospitals across Japan. Postgraduate trainees (years 1-6) at the participating hospitals responded to the online questionnaire on a voluntary basis. We tested the structural validity through confirmatory factor analysis. We also examined criterion-related validity and internal consistency reliability of the JMR-WSC Scale.

RESULTS

In all, 289 trainees completed the questionnaire. The results of confirmatory factor analysis supported the JMR-WSC Scale's structural validity on the same two-factor model as that of the original WSC Scale. Logistic regression analysis showed that, after adjustment for gender and postgraduate years, trainees with good self-rated health had a significantly elevated odds ratio for good WSC. Cronbach's alpha coefficients showed acceptable internal consistency reliability.

CONCLUSIONS

We successfully developed the JMR-WSC Scale and examined its validity and reliability. Our scale could be used to measure social capital in postgraduate medical training settings in Japan to help prevent burnout and reduce patient safety incidents.

The impact of global health outreach experiences on medical student burnout

BACKGROUND

Student burnout during medical education is a prevalent and critical problem. Burnout has reaching consequences, including negative health outcomes for students, financial loss for schools, and worsened patient care as students transition to practice. Global Health Outreach Experiences (GHOEs), known to enhance cultural awareness and clinical knowledge among medical students, are offered in most programs. Prior studies document that GHOEs benefit physicians suffering from burnout, with effects demonstrating improvement over 6 months. No study, to our knowledge, has assessed the influence GHOEs may have on medical student burnout with a comparable control group. This study examines whether participation in a GHOE, compared to a standard break from school, has a positive effect on burnout.

METHODS

A case control study utilizing the Copenhagen Burnout Inventory was conducted on medical students. 41 students participated in a one-week, spring break GHOE and 252 were randomly selected as non-participating students in a control group. Assessments were gathered 1 week prior, 1 week after, and 10 weeks after spring break. Response across the surveys in chronological order included 22, 20, 19 GHOE and 70, 66, 50 control participants.

RESULTS

A significant reduction in personal burnout (PB) (P = 0.0161), studies related burnout (SRB) (P = 0.0056), and colleagues related burnout (CRB) (P = 0.0357) was found among GHOE attendees compared to control participants at 10-weeks after spring break. When modeled with potential confounders, CRB and SRB reductions remained significant.

CONCLUSION

GHOEs may be a potential tool for institutions to combat burnout rates in their students. The benefits of GHOEs appear to enhance over time.

Meeting the Behavioral Health Needs of Health Care Workers During COVID-19 by Leveraging Chatbot Technology: Development and Usability Study

BACKGROUND

During the COVID-19 pandemic, health care systems were faced with the urgent need to implement strategies to address the behavioral health needs of health care workers. A primary concern of any large health care system is developing an easy-to-access, streamlined system of triage and support despite limited behavioral health resources.

OBJECTIVE

This study provides a detailed description of the design and implementation of a chatbot program designed to triage and facilitate access to behavioral health assessment and treatment for the workforce of a large academic medical center. The University of California, San Francisco (UCSF) Faculty, Staff, and Trainee Coping and Resiliency Program (UCSF Cope) aimed to provide timely access to a live telehealth navigator for triage and live telehealth assessment and treatment, curated web-based self-management tools, and nontreatment support groups for those experiencing stress related to their unique roles.

METHODS

In a public-private partnership, the UCSF Cope team built a chatbot to triage employees based on behavioral health needs. The chatbot is an algorithm-based, automated, and interactive artificial intelligence conversational tool that uses natural language understanding to engage users by presenting a series of questions with simple multiple-choice answers. The goal of each chatbot session was to guide users to services that were appropriate for their needs. Designers developed a chatbot data dashboard to identify and follow trends directly through the chatbot. Regarding other program elements, website user data were collected monthly and participant satisfaction was gathered for each nontreatment support group.

RESULTS

The UCSF Cope chatbot was rapidly developed and launched on April 20, 2020. As of May 31, 2022, a total of 10.88% (3785/34,790) of employees accessed the technology. Among those reporting any form of psychological distress, 39.7% (708/1783) of employees requested in-person services, including those who had an existing provider. UCSF employees responded positively to all program elements. As of May 31, 2022, the UCSF Cope website had 615,334 unique users, with 66,585 unique views of webinars and 601,471 unique views of video shorts. All units across UCSF were reached by UCSF Cope staff for special interventions, with >40 units requesting these services. Town halls were particularly well received, with >80% of attendees reporting the experience as helpful.

CONCLUSIONS

UCSF Cope used chatbot technology to incorporate individualized behavioral health triage, assessment, treatment, and general emotional support for an entire employee base (N=34,790). This level of triage for a population of this size would not have been possible without the use of chatbot technology. The UCSF Cope model has the potential to be scaled, adapted, and implemented across both academically and nonacademically affiliated medical settings.

Burnout among labor and birth providers in northern Tanzania: A mixed-method study

Burnout, characterized by emotional exhaustion, depersonalization, and a diminished sense of accomplishment, is a serious problem among healthcare workers. Burnout negatively impacts provider well-being, patient outcomes, and healthcare systems globally, and is especially worrisome in settings with a shortage of healthcare workers and resources. The goal of this study is to explore the experience of burnout in a population of labor and delivery (L&D) providers in Tanzania. We examined burnout using three data sources. A structured assessment of burnout was collected at four time points from a sample of 60 L&D providers in six clinics. The same providers participated in an interactive group activity from which we drew observational data on burnout prevalence. Finally, we conducted in-depth interviews (IDIs) with a subset of 15 providers to further explore their experience of burnout. At baseline, prior to any introduction to the concept, 18% of respondents met criteria for burnout. Immediately after a discussion and activity on burnout, 62% of providers met criteria. One- and three- months later, 29% and 33% of providers met criteria, respectively. In IDIs, participants saw the lack of understanding of burnout as the cause for low baseline rates and attributed the subsequent decrease in burnout to newly acquired coping strategies. The activity helped providers realize they were not alone in their experience of burnout. High patient load, low staffing, limited resources, and low pay emerged as contributing factors. Burnout was prevalent among a sample of L&D providers in northern Tanzania. However, a lack of exposure to the concept of burnout leads to providers being unaware of the issue as a collective burden. Therefore, burnout remains rarely discussed and not addressed, thus continuing to impact provider and patient health. Previously validated burnout measures cannot adequately assess burnout without a discussion of the context.

Hybrid Delivery of Mindfulness Meditation and Perceived Stress in Pediatric Resident Physicians: A Randomized Clinical Trial of In-Person and Digital Mindfulness Meditation

Physicians are experiencing epidemic levels of work-related stress and burnout. Determine efficacy of mindfulness meditation delivered as a hybrid (in-person and digital) format to reduce perceived stress in pediatric residents. Pediatric residents (n = 66) were block randomized to a hybrid Mindful Awareness Practices (MAPs) intervention, comprised of one in-person 60-min session and 6-week access to a digitally delivered MAPs curriculum (n = 27) or wait-list control (n = 39). Perceived Stress Scale (PSS) was administered at baseline and post-intervention as the primary outcome measure. A priori secondary outcomes were measured using the Abbreviated Maslach Burnout Inventory-9, Beck Depression Inventory, Beck Anxiety Inventory, UCLA Loneliness Scale, and Pittsburgh Sleep Quality Index. After the first session, 58% participated at least one digital session (M = 2.0; SD = 1.3). MAPs participants showed significant decrease in PSS compared to controls, with between-group mean difference of 2.20 (95% CI 0.47-3.93) at post-intervention (effect size 0.91; 0.19-1.62). No secondary outcome group differences were detected. Exposure to a hybrid mindfulness intervention was associated with improvement in perceived stress among pediatric residents.Trial Registration: NCT03613441.

High prevalence of mental disorder symptoms among medical and other health specialties residents during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic put healthcare professionals, including residents (postgraduate trainees of health professions), under intense physical and psychological stress, hence at risk for mental disorders. We evaluated the prevalence of mental disorders among healthcare residents during the pandemic.

METHODS

From July to September 2020, residents in medicine and other healthcare specialties in Brazil were recruited. The participants completed electronic forms with validated questionnaires (DASS-21, PHQ-9, BRCS) to screen for depression, anxiety, and stress, and to evaluate resilience. Data on potential predisposing factors for mental disorders were also collected. Descriptive statistics, chi-squared, students t, correlation and logistic regression models were applied. The study received ethical approval, and all participants provided informed consent.

RESULTS

We included 1313 participants (51.3% medical; 48.7% nonmedical) from 135 Brazilian hospitals; mean (SD) age: 27.8 (4.4) years; 78.2% females; 59.3% white race. Of all participants, 51.3%, 53.4% and 52.6% presented symptoms consistent with depression, anxiety, and stress, respectively; 61.9% showed low resilience. Nonmedical residents exhibited higher anxiety compared to medical residents (DASS-21 anxiety score, mean difference: 2.26; 95% CI: 1.15-3.37; p < 0.001). In multivariate analyses, having any pre-existent, nonpsychiatric chronic disease was associated with higher prevalence of symptoms indicative of depression (odds ratio, OR: 2.05; 95% CI: 1.47-2.85, on DASS-21 | OR: 2.26; 95% CI: 1.59-3.20, on PHQ-9), anxiety (OR: 2.07; 95% CI: 1.51-2.83, on DASS-21), and stress (OR: 1.53; 95% CI: 1.12-2.09, on DASS-21); other predisposing factors were identified; by contrast, high resilience (BRCS score) was protective against symptoms of depression (OR 0.82; 95% CI: 0.79-0.85, on DASS-21 | OR 0.85; 95% CI: 0.82-0.88, on PHQ-9), anxiety (OR 0.90; 95% CI: 0.87-0.93, on DASS-21), and stress (OR 0.88; 95% CI: 0.85-0.91, on DASS-21); p < 0.05 for all outcomes.

CONCLUSIONS

We found a high prevalence of mental disorder symptoms among healthcare residents during COVID-19 pandemic in Brazil. Nonmedical residents exhibited higher levels of anxiety than medical ones. Some predisposing factors for depression, anxiety and stress among residents were identified.

Well-being at a Military Medical School and Implications for Military Retention

INTRODUCTION

Physical and psychological well-being play a critical role in the academic and professional development of medical students and can alter the trajectory of a student's quality of personal and professional life. Military medical students, given their dual role as officer and student, experience unique stressors and issues that may play a role in their future intentions to continue military service, as well as practice medicine. As such, this study explores well-being across the 4 years of medical school at Uniformed Services University (USU) and how well-being relates to a student's likelihood to continue serving in the military and practicing medicine.

METHODS

In September 2019, 678 USU medical students were invited to complete a survey consisting of three sections-the Medical Student Well-being Index (MSWBI), a single-item burnout measure, and six questions regarding their likelihood of staying in the military and medical practice. Survey responses were analyzed using descriptive statistics, analysis of variance (ANOVA), and contingency table analysis. Additionally, thematic analysis was conducted on open-ended responses included as part of the likelihood questions.

RESULTS

Our MSWBI and burnout scores suggest that the overall state of well-being among medical students at USU is comparable to other studies of the medical student population. ANOVA revealed class differences among the four cohorts, highlighted by improved well-being scores as students transitioned from clerkships to their fourth-year curriculum. Fewer clinical students (MS3s and MS4s), compared to pre-clerkship students, indicated a desire to stay in the military. In contrast, a higher percentage of clinical students seemed to "reconsider" their medical career choice compared to their pre-clerkship student counterparts. "Medicine-oriented" likelihood questions were associated with four unique MSWBI items, whereas "military-oriented" likelihood questions were associated with one unique MSWBI item.

CONCLUSION

The present study found that the overall state of well-being in USU medical students is satisfactory, but opportunities for improvement exist. Medical student well-being seemed to have a stronger association with medicine-oriented likelihood items than with military-oriented likelihood items. To obtain and refine best practices for strengthening engagement and commitment, future research should examine if and how military and medical contexts converge and diverge throughout training. This may enhance the medical school and training experience and, ultimately, reinforce, or strengthen, the desire and commitment to practice and serve in military medicine.

Military Medical Students' Coping With Stress to Maintain Well-being

INTRODUCTION

Previous studies have shown that medical students experience a great level of burnout and poor well-being during their clinical training periods. In this study, we sought to understand how military medical students cope with stress to prevent burnout and support their well-being. We also investigated if these coping strategies are associated with military medical students' self-reported well-being, burnout, and depression levels. The findings could help inform programming, resources, and educational strategies to better support students to thrive in their careers long term.

METHODS

Using a cross-sectional research design, we surveyed military medical students and conducted content analysis on participant responses to the open-ended item by trained coders. Coding was based on the existing coping theory frameworks as well as categories that emerged inductively to represent the data.

RESULTS

The primary four strategies military medical students utilized included social connection (59.9%), exercise (58.3%), personal relaxation (36%), and work-life balance (15.7%). The use of work-life balance strategy was significantly associated with more positive well-being and lower depression compared to those who did not use this strategy. Three main coping typologies were further extracted, including personal care, connection, and cognitive strategies. Based on the typologies, 62% of students were recognized as multi-type copers (who combined more than two coping typologies), who reported significantly more positive well-being compared to students who relied on a single typology.

CONCLUSIONS

The findings demonstrate that certain coping strategies are more positively associated with a good state of well-being and less burnout, and that utilization of multiple types of coping strategies is more supportive. This study amplifies the voice of military medical students concerning the importance of prioritizing self-care and available resources given the unique pressures and demands of their dual military medical curriculum.

The Impact of the COVID-19 Surge Response on Motivation Among Anesthesiology Residents and Fellows: A discussion of findings from semi-structured interviews at Montefiore Medical Center and educational takeaways

Background

The American Board of Medical Specialties definition of medical professionalism cites the need to acquire, maintain, and advance a value system serving the patients' and public's interests above self-interests.4 Medical professionalism is a one of the core physician competencies assessed by both the ACGME training program evaluation and the ABA certification process. However, a growing concern for the decline of professionalism and altruism in medicine resulted in increased publications on the matter, citing various potential sources for the issue.

Methods

All residents and fellows (Focus Group 1) of the Anesthesiology Department of Montefiore Medical Center in Bronx, NY were invited to participate in a semi-structured interview via Zoom, held on two separate dates. A separate invitation was sent to the faculty of the department (Focus Group 2), held on one date. During the interview, guiding questions were provided by the 4 interviews to facilitate discussion. The interviewers, all members of the anesthesia faculty, took notes as the interviews progressed. The notes were reviewed for common themes as well as supporting and contradicting quotations.

Results

A total of 23 residents and fellows and a total of 25 faculty members within the Anesthesiology department at Montefiore Medical Center were interviewed. Amongst the findings, common discussions concerned motivating and demotivating factors contributing to the professionalism and altruism exhibited by the residents and fellows when caring for critical COVID-19 patients during the height of the pandemic. It was widely regarded that patient improvement, community and team support, as well as intrinsic desire to help greatly motivated the team while continuous patient deterioration, uncertainty in staffing and treatment, and concerns for personal and family safety were sources of discouragement. Overall, faculty perceived an increased demonstration of altruism amongst residents and fellows. The statements made by the residents and fellows during their interviews supported this observation.

Conclusions

The actions of the Montefiore Anesthesiology residents and fellows demonstrated that altruism and professionalism were readily available amongst physicians. Increased levels of empathy and responsibility contributed to a demonstration of professionalism that challenges previous views of a perceived decline of these attributes in the medical field. The findings of this study stress the importance of creating a curriculum and exercise that stress empathy-based care and altruism in order to improve resident satisfaction and decrease feelings of burnout. Additionally, curriculum additions to facilitate professionalism are proposed.

Prevalence and Determinants of Social Media Addiction among Medical Students in a Selected University in Saudi Arabia: A Cross-Sectional Study

Social media addiction has become a serious public health concern due to its adverse psychological effects. Therefore, the purpose of this study was to assess the prevalence and determinants of social media addiction among medical students in Saudi Arabia. A cross-sectional study was designed. Participants (n = 326) from King Khalid University in Saudi Arabia completed the sociodemographic information, patient health questionnaire-9 scale, and the generalized anxiety disorder-7 tool to measure explanatory variables. The Bergen social media addiction scale (BSMAS) was used to measure social media addiction. A multiple linear regression model was fitted to investigate the predictors of social media addiction. The prevalence of social media addiction among study participants was 55.2% (mean BSMAS score: 16.6). According to the adjusted linear regression, male students had higher social media addiction scores than their female counterparts (β = 4.52, p < 0.001). Students' academic performance was negatively associated with social media addiction scores. Moreover, students with symptoms of depression (β = 1.85, p = 0.005) or anxiety (β = 2.79, p = 0.003) had a higher BSMAS score compared to their counterparts. Further longitudinal studies are warranted to identify the causal factors of social media addiction, which would assist intervention initiatives by policymakers.

The mediating role of psychological flexibility in the association of autistic-like traits with burnout and depression in medical students during clinical clerkships in Japan: a university-based cross-sectional study

BACKGROUND

Burnout and depression among medical students is linked to serious problems that require appropriate solutions. Subthreshold autism traits or autistic-like traits (ALTs) may be possible factors associated with burnout and depression. The effectiveness of acceptance and commitment therapy (ACT) for burnout and depression has been widely reported. The treatment aims to improve psychological flexibility, a concept indicating engagement in personal value-based behaviors without avoiding uncomfortable private experiences. This study examined whether ALTs were associated with burnout or depression among medical students during clinical clerkships in Japan, and then investigated what psychological flexibility processes might mediate these associations.

METHODS

A cross-sectional survey was administered to 284 medical students at Nagoya City University School of Medical Sciences who had been in clinical clerkships for 10 months or longer. Linear multiple regressions were performed with each burnout factor or depression as the outcome variable using validated tools measuring burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), ALT (Autism-Spectrum Quotient Japanese version-21), and psychological flexibility processes (Cognitive Fusion Questionnaire-7 and Valuing Questionnaire). Additionally, a mediation analysis was conducted using structural equation modeling.

RESULTS

A linear multiple regression analysis that controlled for age and gender found that ALTs were significantly associated with lower personal accomplishment, a factor of burnout, and depression. Lower personal accomplishment was also associated with males and lower progress toward values of the psychological flexibility process. Depression was also associated with males and higher cognitive fusion, lower progress towards values, and higher obstruction to values of the psychological flexibility process. Surprisingly, emotional exhaustion and depersonalization were not significantly associated with ALTs. The mediation analysis revealed that the relationship between ALTs and personal accomplishment was partially mediated by a process of progress toward values, while the relationship between ALTs and depression was partially mediated by both processes of progress toward values and cognitive fusion.

CONCLUSIONS

ALTs were significantly associated with lower personal accomplishment of burnout and depression among medical students in clinical clerkships. Consideration should be given to the psychological flexibility processes that focus on interventions targeting psychological flexibility for medical students with ALTs to reduce burnout and depression.