The predictors of depression and burnout among surgical residents: A cross-sectional study from Kuwait

A survey on mental health among resident physicians: psychological resilience as a mediator

BACKGROUND

Sleep disturbances (SD) among resident physicians have been shown to negatively impact their mental health, potentially leading to suicidal ideation (SI) and reduced life satisfaction (LS). Psychological resilience (PR) is thought to buffer the negative effects of stressors, including SD, and may play a mediating role in this relationship. However, the specific mechanisms linking SD, PR, SI, and LS remain underexplored. This study aimed to examine the mediating role of PR in the relationship between SD, SI, and LS among resident physicians in China, building upon existing theories of resilience and stress in medical professionals.

METHODS

An anonymous four-part survey was conducted with 453 resident physicians training in tertiary hospital in China. Descriptive statistics and correlation analyses were performed using the Statistical Package for the Social Sciences software (version 27.0). The study employed structural equation modeling(SEM) to examine the interplay of variables and conducted a multiple-group analysis using Analysis of Moment Structure (version 23.0).

RESULTS

Based on a hypothetical model, SEM revealed that PR played a partial mediating role in the relationship between SD and SI (52.10% of the total effect of SD on SI was direct, and 47.90% of the total effect was mediated by PR). Moreover, in the relationship between SD and LS, PR also acted as a partial mediator, accounting for 79.00% of the direct effect of SD on LS and 21.00% of the effect mediated by PR. The multiple-group analysis further revealed that individuals over 25 years exercise more PR to enhance LS (t = 2.703, p < 0.01), and those with normal weight were less affected by SD in terms of LS (t = - 2.322, p = 0.02).

CONCLUSIONS

PR serves as a significant mediator in the relationship between SD and both SI and LS. These findings highlight the importance of fostering PR in resident physicians to mitigate the adverse effects of SD on their mental health and well-being. Policymakers and medical institutions should prioritize interventions aimed at improving sleep quality and supporting mental health to enhance the overall well-being of resident physicians.

The journey of female surgeons in the arab region: A scoping review

BACKGROUND

In the Arab region, there's a dearth of research on female surgeons' experiences and challenges. To address this gap, a scoping review aims to map existing literature. It seeks to understand the hurdles faced by female surgeons in Arab countries and examine any gender biases in public preferences for surgeons. No previous reviews were conducted on female surgeons in the Arab region. By identifying systemic barriers, the review aims to promote inclusivity and support for female surgeons in the Arab medical community.

METHODS

A scoping review was performed and reported using the PRISMA extension for scoping reviews. Five databases were searched which include PubMed, Web of Science, Scopus, Embase, and ProQuest. The search strategy included three main strings that are "Women" AND "Surgeons" AND "Arab Country". A priori-identified spreadsheet was used for data extraction.

RESULTS

A total number of 23 studies were included in this review. The findings were categorized under several headings, such as the general public's preferred gender of surgeon and well-being, challenges, and experiences of female surgeons as well as career perspectives, choices, and satisfaction.

CONCLUSIONS

This scoping review explores experiences and challenges faced by female surgeons in the Arab region, emphasizing the need to address systemic barriers and promote inclusivity.

Stress and Burnout among Medical Specialists in Romania: A Comparative Study of Clinical and Surgical Physicians

This study, which focuses on 227 participants (196 females and 31 males) comprising 187 clinical specialists and 40 surgical physicians, examines the prevalence of burnout in medical specialists. We investigate the effects of the emotional exhaustion (EE), Depersonalization (D), and personal accomplishment (PA) dimensions on professional satisfaction and plans to change careers using the modified licensed Maslach Burnout Inventory-Human Services Survey (MBI-HSS (MP)). High emotional exhaustion is reported by 52.63% of men and 71.28% of women in the clinical medicine group (n = 188). In the surgical specialties (n = 39), scores are significantly higher, with 75% of men and 77.77% of women reporting EE. In our sample group, 71.36% express high levels of emotional exhaustion, with similar patterns across specialization and gender. Clinical medicine respondents report high degrees of depersonalization in 33.13% of females and 21.05% of males, while surgical specialty respondents report high levels in 33.33% of females and 50% of males. Across genders and specializations, 33.03% of all respondents show high levels of depersonalization. Clinical medicine participants report high levels of personal accomplishment (42.60% of females and 42.10% of males), whereas surgical specialties report 44.44% of females and 66.66% of male on the PA dimension. Of the total number of respondents, 44.05% report having a high level of personal accomplishment; differences exist depending on specialty and gender. In addition, questions regarding professional fulfilment and intention to change careers were presented to the participants. A total of 53.40% (16 male and 105 female) of the clinical medicine respondents said they intended to change careers, while 33 participants (9 male, 34 female) doubted if they would remain in the same specialization. Furthermore, 86 individuals (9 male and 77 female) in the surgical specialties said they would never choose to work in healthcare again. Regression analysis suggests that being male, higher in age, and working in surgical specialties with lower job satisfaction and a higher intention to change profession are associated with higher levels of EE. Age and work satisfaction are significant predictors of depersonalization, and higher career satisfaction is associated with increased levels of PA.

Quality of Life Among Residents of General Surgery Residency Training Program in Saudi Arabia: A Nationwide Study

Introduction The General Surgery Residency Training Program is known to be one of the most challenging programs, which greatly impacts the resident's quality of life (QoL) during their training years. Undertraining residents are usually the first providers of patients' healthcare in medical facilities. They often get exposed to continuous pressure and stress, especially during long working hours. Aim This study aims to evaluate the quality of life (QoL) of general surgery residents in Saudi Arabia and investigate the personal and workplace determinants associated with the level of quality of life. Subjects and methods This cross-sectional study was conducted among general surgery residents in Saudi Arabia. A self-administered online questionnaire was distributed among the target residents. The questionnaire includes sociodemographic characteristics (e.g., gender, region of the training center, and residency level) and Work-Related Quality of Life (WRQoL) scale to measure the residents' quality of life at work. Results Of the 239 residents, 64.9% were males, and 27.2% were resident level 1. Among WRQoL components, only home-work interface (HWI) (mean score: 9.87 out of 15 points) and general well-being (GWB) (mean score: 20.6 out of 30 points) had average ratings, while control at work (CAW), job and career satisfaction (JCS), stress at work (SAW), and working conditions (WCS) were classified as good. The overall WRQoL was deemed good (mean score: 81.3 out of 115 points). Being a female and practicing residency inside central region were the factors associated with better WRQoL. No significant differences were observed between WRQoL in terms of residency level, marital status, and previous visitation to a psychiatrist or psychologist (p>0.05). Conclusion Nearly one-third of the general surgery residents perceived their WRQoL as good. Female residents practicing in the central region demonstrated better quality of life as compared to the rest of the residents. Further research is needed to establish the level of WRQoL and its effect on general surgery residents during residency training.

The Association of Professional Burnout and Turnover Intentions Among Intensive Care Units Physicians: A Cross-Sectional Study

Intensive Care Units (ICU) workers work in highly stressful conditions that make them prone to professional burnout, which can lead to high turnover rates. This study explores professional burnout levels among ICU workers in Kuwait general governmental hospitals (GGHs), their turnover intentions, and the correlation factors. A cross-sectional self-administered survey study was conducted. Professional burnout level was measured using the Copenhagen Burnout Inventory (CBI), while turnover intention was measured using the Turnover Intention Scale (TIS-6). Data were analyzed using STATA software, and descriptive, correlative, and comparative analyses were performed. Eighty-nine ICU physicians filled out the questionnaire. Most of the participants were males, married, non-Kuwaiti nationals, with 10 to 20 years of experience, and the mean age of respondents was 39.2. The total professional burnout score was high was 54.7 (17.6). There were high total average scores for the personal and work-related domains. Participants who were younger than 35 years of age and graduated before 5 to 10 years had higher levels of professional burnout compared to other groups. More than half of the sample expressed their intention to leave their current job as an ICU physician. However, no association was found between turnover intentions and levels of burnout. High levels of professional burnout of turnover intentions were seen among ICU physicians in Kuwait. Policies should be adopted to reduce and mitigate professional burnout among ICU physicians and increase their retention. Future research should further investigate professional burnout among ICU staff, the associated factors, and its relation to their turnover intention.

Prevalence of Depression and Anxiety Disorders Among Surgical Doctors in Public Hospitals in Makkah City, Saudi Arabia: An Analytical Cross-Sectional Study

Background Depression and anxiety are among the most prevalent illnesses worldwide. Although depression affects many individuals throughout their lives, physicians are at a heightened risk of developing the disorder due to their high-stress levels and enormous responsibilities. The study aimed to examine the prevalence of depression and anxiety disorders among surgical doctors in Makkah city hospitals as well as the risk factors. Methods Analytical cross-sectional research was performed at all public hospitals in Makkah city, Saudi Arabia. The Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used as the screening tool. Results Of the 153 surgeons, 47.1% were Saudis, 81.7% were men, and 46.7% were residents. A personal history of anxiety or depression was apparent among 11.8% of the surgeons, while 4.6% had a family history of a mental disorder. Based on the HADS questionnaire responses, the prevalence rate of anxiety was 30.7%, and 27.5% of the surgeons had depression. Based on the univariate regression analysis, anxiety was significantly linked with being a participant in the Saudi Board program (p=0.010), working for more than nine hours (p=0.020), and having work-related stress (p=0.011 for moderate stress and p=0.001 for severe stress) as well as related to those who were rarely or never satisfied with their income (p=0.016 and p=0.047, respectively) and who was rarely satisfied with their career (p=0.019). Depression among surgeons was significantly linked with the age of 50 to 59 (p=0.023) as well as related to those who were usually satisfied with their career (p=0.022) and those with moderate work-related stress (p=0.016). Conclusion Psychological disorders such as depression and anxiety are prevalent among surgeons. They should be appropriately evaluated at regular intervals throughout life, especially during residency programs, to ensure physical and mental well-being, appropriate training exposure, and patient safety.

Burnout among surgeons and surgical trainees: A systematic review and meta-analysis of the prevalence and associated factors

Introduction

The more effort is put into work, the greater the chances of burnout. This is common among surgical personnel. We carried out this review study to determine the overall and per-specialty prevalence of burnout, and to identify the factors that affect burnout positively and negatively.

Methods

All full-text articles reporting data related to burnout in surgery and surgical subspecialties using the Maslach Burnout Inventory (MBI) were included. The following bibliographic databases were searched PubMed, Embase and Google Scholar (First 500 pages). We extracted data on the characteristics of the articles including the burnout prevalence and factors.

Results

27 articles met the criteria. The studies involved 8617 surgeons cutting acrossvarious surgical specialties. The overall prevalence was 47%. The rate per specialty ranged between 15% and 77% with Ear, Nose and Throat (ENT) surgeons having the highest rates. Associated factors included work-related issues and poor work/life balance while protective factors included career advancement, increase in postgraduate years, and having good relationships with co-residents. Our findings are similar to findings from other studies; ENT is seen to have the highest burnout rate while pediatric surgery the lowest.

Conclusion

The high prevalence of burnout among surgeons is concerning and the identified factors responsible should be explored by surgeons, hospital management boards, training colleges, and all bodies concerned to see how it can be reduced.

Burnout and Online Medical Education: Romanian Students in Lockdown and Their Residency Choices

The primary aim of the study was to investigate the prevalence of burnout in Romanian medical students during the COVID-19 pandemic using the Maslach Burnout Inventory-General Survey for Students (MBI-GS(S)). The presence of burnout was assessed based on Exhaustion (EX), Cynicism (CY) and Professional Efficacy (PE) subscales. The secondary aim of the study was to identify the presence of intentional shift in medical specialty compared to their initial pursued choice within the population investigated. Data was collected online at the end of 2020 and beginning of 2021 through a licensed, customized MBI-GS(S) questionnaire from a sample of 126 Romanian medical students at the two leading medical schools in the country, Iasi (N = 56) and Cluj Napoca (N = 70). Descriptive statistics and bivariate correlations were also applied to describe the data set (age and gender of participants) and the relationship between variables (EX, CY, PE). Subsequently, the MBI-GS(S) group report revealed that 36.5% of the medical students in the sample (46) experienced burnout, with problematic results both in Exhaustion and Cynicism. Exhaustion and Cynicism, which contribute to burnout, showed high scores compared to the average scale (EX = 3.5/2.4; CY = 2.8/1.8), while the Professional Efficacy score was relatively high (PE = 3.8/4.4), showing a protective effect and burnout reduction. One of the main conclusions is that the consequences of burnout in medical students plays a significant role in shaping the future healthcare practitioners’ perception of the medical profession and of patients’ wellbeing. Exhaustion and Cynicism are mainly associated with depersonalization and disconnection from the patient. Another conclusion of the study is that about one third of the respondents (30% Cluj students and 37.5% Iasi students) considered changing residency options. The pandemic has also revealed the limitations of and challenges facing current medical education, and that further research is required to assess the trends in prevalence of burnout in medical students.

The Prevalence of Burnout and Its Associated Factors Among Surgical Specialists in Kuwait Ministry of Health Hospitals

Background

Workplace burnout is a state of emotional exhaustion (EE), depersonalization of others (DP), and low personal accomplishment (PA) owing to workplace stressors. This study aimed to assess the prevalence of burnout and its associated factors among surgical specialists in Kuwait.

Methods

This cross-sectional study assessed the prevalence of burnout among 489 surgeons in practice at Kuwait Ministry of Health (MOH). Data were collected using a self-administered questionnaire. Burnout was assessed using the Maslach Burnout Inventory, which defines burnout as having a high score of EE or DP, or a low score of PA; with severe burnout involving all. The associations between burnout or severe burnout with sociodemographic and occupational characteristics were assessed using multivariate binary logistic regression to adjust for potential confounders.

Results

Prevalence estimates for burnout and severe burnout were 76.9% (95% Confidence Interval = 72.9–80.7%) and 14.0% (11.0–17.5%), respectively. The prevalence estimates for high EE, high DP, and low PA scores were 44.7, 43.1, and 47.2%, respectively. The prevalence of burnout and severe burnout was highest among neurosurgeons. Burnout was lowest among otolaryngology surgeons and severe burnout was lowest among cardiothoracic surgeons. After adjustment, burnout was associated with younger age, lower income, and more on-calls per month. The four most common sources of stress included less family time, verbal assault, case overload, and highly complicated cases.

Conclusion

The prevalence of burnout among surgeons in Kuwait MOH hospitals is high. Occupational health programs should use these findings to design and implement interventions that can treat and prevent burnout in this population.

Burnout, Discrimination, Abuse and Mistreatment in Latin America Neurosurgical Training During the COVID-19 Pandemic

BACKGROUND

Discrimination, abuse and mistreatment are prevailing problems reported in neurosurgical-training programs globally. Moreover, the current COVID-19-pandemic may also display a negative impact on burnout levels in neurosurgery-residents. This study aims to evaluate burnout, discrimination and mistreatment in neurosurgical-residents training in Latin-America during the SARS-CoV-2 era.

METHODS

A 33-item electronic survey was sent to neurosurgery-residents from Latin-America from May-10 to May-25, 2021. Statistical analysis was made using IBM-SPSS-25.

RESULTS

111 neurosurgery residents responded the survey. Mean age was 29.39±2.37 years; 22.5% were female and 36% were training in Mexico. Residents who reported suffering from discrimination for testing positive to COVID-19 had the highest levels of depersonalization (66.7%, p=0.043) and emotional-exhaustion (75%, p= 0.023). Female respondents presented higher rates of gender discrimination (80%vs.1.2%, p=0.001), abuse (84%vs.58.1%, p<0.005) and sexual-harassment (24%vs.0%, p<0.001) than male respondents. Residents training in Mexico presented lower rates of emotional or verbal abuse (59.2%vs.32.5%, p=0.007) and bullying (p<0.005) than other countries in Latin-America. Older-age was a protective factor for high depersonalization scores (OR 0.133, 95%CI 0.035-0.500). Suffering from discrimination represented a risk factor for presenting high emotional-exhaustion scores (OR 3.019, 95%CI 1.057-8.629). High levels of depersonalization were associated with a 7-fold increased risk of presenting suicidal ideation (OR 7.869, 95%CI 1.266-48.88).

CONCLUSION

The COVID-19 pandemic has been a significant burden on several aspects of healthcare workers' lives. Our results provide a broad overview of its impact on burnout, discrimination and mistreatment as experienced by neurosurgery residents training in Latin-America, laying the groundwork for future studies and potential interventions.