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Mangham W, Parikh KA, Motiwala M, Gienapp AJ, Roach J, Barats M, Lillard J, Khan N, Arthur A, Michael LM. A Scoping Review of Professionalism in Neurosurgery. Neurosurgery 2024; 94:435-443. [PMID: 37819083 DOI: 10.1227/neu.0000000000002711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/10/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Accreditation Council for Graduate Medical Education's Milestones provides a foundation for professionalism in residency training. Specific professionalism concepts from neurosurgery could augment and expand milestones for the specialty. We reviewed the current literature and identified professionalism concepts within the context of neurosurgical practice and training. METHODS We used a scoping review methodology to search PubMed/MEDLINE and Scopus and identify English-language articles with the search terms "professionalism" and "neurosurgery." We excluded articles that were not in English, not relevant to professionalism within neurosurgery, or could not be accessed. Non-peer-reviewed and qualitative publications, such as commentaries, were included in the review. RESULTS A total of 193 articles were included in the review. We identified 6 professionalism themes among these results: professional identity (n = 53), burnout and wellness (n = 51), professional development (n = 34), ethics and conflicts of interest (n = 27), diversity and gender (n = 19), and misconduct (n = 9). CONCLUSION These 6 concepts illustrate concerns that neurosurgeons have concerning professionalism. Diversity and gender, professional identity, and misconduct are not specifically addressed in the Accreditation Council for Graduate Medical Education's Milestones. This review could be used to aid the development of organizational policy statements on professionalism.
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Affiliation(s)
- William Mangham
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Kara A Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Mustafa Motiwala
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Andrew J Gienapp
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis , Tennessee , USA
| | - Jordan Roach
- College of Medicine, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Michael Barats
- College of Medicine, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Jock Lillard
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Nickalus Khan
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
| | - Adam Arthur
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
| | - L Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
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Anand A, Jensen R, Korndorffer JR. We Need to Do Better: A Scoping Review of Wellness Programs In Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2023; 80:1618-1640. [PMID: 37541937 DOI: 10.1016/j.jsurg.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/26/2023] [Accepted: 07/08/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE Burnout, depression, and fatigue are common among surgical residents. Most published wellness studies in surgery only focus on a cross-sectional view of attitudes and perceptions around wellness in training. While much of this literature calls for interventions and presents strategies for improving resident well-being, there is a paucity of published wellness initiatives, and even fewer with programmatic evaluation. DESIGN A scoping review was designed to address: (1) What wellness initiatives are used in surgery residency programs? (2) Which wellness domains do these programs address? and (3) How are program outcomes evaluated? A formal literature search was conducted using PubMed, Embase, and Scopus databases to identify English-language studies conducted in the United States that described wellness-focused initiatives for surgery residents. Two authors independently screened all abstracts and full texts for inclusion. Data were extracted including wellness domain(s) and outcomes evaluation methods with associated Kirkpatrick level(s) (1-reaction, 2-learning, 3-behavior, 4-results). Study quality was examined using the medical education research study quality index (MERSQI) score. RESULTS A total of 2237 abstracts were screened with 115 full texts reviewed for eligibility. Fifty-one studies were included in the final analysis, representing 39 distinct wellness programs. The most common domains of wellness addressed were emotional (19/39, 48.7%), occupational (17/39, 43.6%), and physical (16/39, 41.0%). Of the 51 studies reviewed, 8 (15.7%) did not conduct any program evaluation, 27 (52.9%) evaluated level 1, 30 (58.8%) evaluated level 2, 3 (5.9%) evaluated level 3, and none evaluated level 4 outcomes. The mean MERSQI score was 9.16 (SD 1.8). CONCLUSIONS Wellness is an established problem in surgical training. This review reveals a small number of published wellness interventions and even fewer that incorporate programmatic evaluation at the level of behavior and results change. Effective change will require rigorous and deliberate programming that addresses multiple domains and evaluation levels.
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Affiliation(s)
- Ananya Anand
- Department of Surgery, Stanford University, Stanford, California.
| | - Rachel Jensen
- Department of Surgery, Stanford University, Stanford, California
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Lu FI, Ratnapalan S. Burnout Interventions for Resident Physicians: A Scoping Review of Their Content, Format, and Effectiveness. Arch Pathol Lab Med 2023; 147:227-235. [PMID: 35687790 DOI: 10.5858/arpa.2021-0115-ep] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Physicians face a high rate of burnout, especially during the residency training period when trainees often experience a rapid increase in professional responsibilities and expectations. Effective burnout prevention programs for resident physicians are needed to address this significant issue. OBJECTIVE.— To examine the content, format, and effectiveness of resident burnout interventions published in the last 10 years. DESIGN.— The literature search was conducted on the MEDLINE database with the following keywords: internship, residency, health promotion, wellness, occupational stress, burnout, program evaluation, and program. Only studies published in English between 2010 and 2020 were included. Exclusion criteria were studies on interventions related to the COVID-19 pandemic, studies on duty hour restrictions, and studies without assessment of resident well-being postintervention. RESULTS.— Thirty studies were included, with 2 randomized controlled trials, 3 case-control studies, 20 pretest and posttest studies, and 5 case reports. Of the 23 studies that used a validated well-being assessment tool, 10 reported improvements postintervention. These effective burnout interventions were longitudinal and included wellness training (7 of 10), physical activities (4 of 10), healthy dietary habits (2 of 10), social activities (1 of 10), formal mentorship programs (1 of 10), and health checkups (1 of 10). Combinations of burnout interventions, low numbers of program participants with high dropout rates, lack of a control group, and lack of standardized well-being assessment are the limitations identified. CONCLUSIONS.— Longitudinal wellness training and other interventions appear effective in reducing resident burnout. However, the validity and generalizability of the results are limited by the study designs.
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Affiliation(s)
- Fang-I Lu
- From the Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Lu).,From the Departments of Laboratory Medicine and Pathobiology (Lu), University of Toronto, Toronto, Ontario, Canada
| | - Savithiri Ratnapalan
- From the Department of Paediatrics (Ratnapalan), University of Toronto, Toronto, Ontario, Canada.,From the Dalla Lana School of Public Health (Ratnapalan), University of Toronto, Toronto, Ontario, Canada.,From the Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada (Ratnapalan)
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Ujjan BU, Hussain F, Nathani KR, Farhad A, Chaurasia B. Factors associated with risk of burnout in neurosurgeons: current status and risk factors. Acta Neurol Belg 2022; 122:1163-1168. [PMID: 35988123 PMCID: PMC9392991 DOI: 10.1007/s13760-022-02072-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/15/2022] [Indexed: 12/03/2022]
Abstract
Objective The study aimed to evaluate burnout and associated risk factors in neurosurgical residents and faculty members. Summary of background data Burnout is an occupational risk of emotional exhaustion, depersonalization, and reduced perception of personal accomplishment secondary to work stress. It burdens the individual with immense mental stress causing compromised professional performance. Healthcare workers, particularly surgeons, have been documented to be at high risk of developing burnout, considering the stressful routine and serious impact of their profession. Methods The modified Maslach Burnout Inventory was filled by fellow neurosurgical residents or consultants. The respondents were classified into burnout and non-burnout groups and then analyzed for the associated risk factors. The data were analyzed using SPSS v26. Results One hundred and thirty-eight neurosurgical healthcare workers, including 62 residents and 76 consultants, responded to the questionnaire. The burnout and non-burnout groups comprised 83 (60%) and 55 (39.9%) respondents. Female gender and few kids were observed as significant risk factors for the development of burnout (p = 0.013 and p = 0.006, respectively). Regardless of its year, residency was a risk factor for overall burnout, as well as in each subsection of the Maslach Inventory (p = 0.002). In consultants, recent qualifications and a high number of weekly calls were also associated with a significant risk of burnout (p = 0.012 and p = 0 .027, respectively). Marital status and national economic status did not reveal any influence on the status of burnout in neurosurgical healthcare workers. Conclusion Burnout syndrome is a prevalent and serious, yet overlooked, condition among neurosurgeons. Adequate assessment and steps should be encouraged to ensure physician and patient safety.
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Affiliation(s)
- Badar Uddin Ujjan
- Department of Neurosurgery, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan
| | - Farhad Hussain
- Department of Neurosurgery, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan.
| | - Karim Rizwan Nathani
- Department of Neurosurgery, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan
| | - Aisha Farhad
- Department of Internal Medicine, Liaquat National Hospital, Karachi, Pakistan
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Ahart ER, Gilmer L, Tenpenny K, Krase K. Improving resident well-being: a narrative review of wellness curricula. Postgrad Med J 2022:postgradmedj-2022-141541. [PMID: 35853712 DOI: 10.1136/postgradmedj-2022-141541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/14/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND To improve wellness among residents, many graduate medical education programs have implemented formal wellness curricula. Curricular development has recently shifted focus from drivers of burnout to promotion of wellness. The specific components of successful wellness curricula, however, are not yet well defined. OBJECTIVE To review the published literature assessing core components of wellness curricula in graduate medical education programs. METHODS Searches were conducted through June 2020 in PubMed, Education Resources Information Center, Google Scholar and Web of Science using the search terms wellness curricula, wellness programs, well-being and graduate medical education. Additional articles were identified from reference lists. Curricula from primarily undergraduate medical education, singular interventions, non-peer-reviewed studies and non-English language studies were excluded. RESULTS Eighteen articles were selected and reviewed by three authors. Critical drivers of success included support from program leadership and opportunities for resident involvement in the curriculum implementation. Most curricula included interventions related to both physical and mental health. Curricula including challenging components of professionalisation, such as critical conversations, medical errors and boundary setting, seemed to foster increased resident buy-in. The most frequently used curricular assessment tools were the Maslach Burnout Inventory and resident satisfaction surveys. CONCLUSIONS Different specialties have different wellness needs. A resource or 'toolbox' that includes a variety of general as well as specialty-specific wellness components might allow institutions and programs to select interventions that best suit their individual needs. Assessment of wellness curricula is still in its infancy and is largely limited to single institution experiences.
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Affiliation(s)
- Erin R Ahart
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lisa Gilmer
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kelsey Tenpenny
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kelli Krase
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Schmeusser B, Gauthier Z, Nagy K. Assessment of Resident Burnout After Formalization of Wellness Program. Mil Med 2022; 188:usac004. [PMID: 35043956 DOI: 10.1093/milmed/usac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/01/2021] [Accepted: 01/10/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Burnout has reached epidemic levels among resident physicians. Characterized by emotional exhaustion (EE), depersonalization, and feelings of inefficacy, burnout negatively affects patient outcomes, increases costs, and decreases physician quality of life. These negative outcomes catalyze leaders in graduate medical education to address burnout and reverse its trends. The primary aim of this project is to design a residency Wellness Program utilizing the facets of physician wellness, assess levels of burnout among resident physicians, and determine the program's effects on burnout. MATERIALS AND METHODS A Wellness Program was formalized at a Midwestern, military-civilian Obstetrics and Gynecology residency program for the 2019-2020 academic year. Resident wellness and perceptions were assessed at three time points (0, 6, and 12 months) through surveys consisting of free response, yes-no questions, and the Maslach Burnout Inventory Scales. RESULTS On average, 17 of 24 residents completed all three survey assessments. Perception of the residency program prioritization of wellness increased significantly from 52.9% to 94.4% (P = .007). Residents consistently demonstrated burnout throughout the year with low levels of EE, high levels of depersonalization, and moderate levels of personal achievement. Residents were consistently satisfied with their personal wellness (80%-92.9%) during the program. Residents wanted to see physical activity incorporated into the program. CONCLUSIONS This study assessed burnout during a formalization of a Wellness Program and insight on resident perceptions and wellness requests. Military medicine, graduate medical education, and other residency programs can utilize this research to better develop and study the implementation of wellness initiatives aimed at reducing burn out.
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Hardship and Humanity: A Closer Qualitative Look at Surgical Training and Its Effects on Trainees from the Perspectives of Loved Ones. Ann Surg 2021; 275:673-678. [PMID: 34596074 DOI: 10.1097/sla.0000000000005230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To obtain novel perspectives regarding the effects that surgical training has on the well-being of trainees. SUMMARY BACKGROUND DATA Improving trainee well-being is a national concern given high rates of burnout, depression, and suicide among physicians. Supporters of surgical trainees may offer new perspectives regarding the effects of surgical training and point to strategies to optimize trainee wellness. METHODS This qualitative study employs semi-structured interviews of 32 support persons of trainees at a single tertiary care center with multiple surgical training programs. Interviews focused on perspectives related to supporting a surgical trainee. Interview transcripts underwent qualitative analysis with semantic and conceptual coding. Themes related to effects of training on trainee wellness are reported. RESULTS Four themes were identified: (1)Who Can Endure the Most Hardship?-trainee attributes and programmatic factors contribute to trainees feeling the need to constantly endure the most hardship; (2)Consequences of Hardship-constantly enduring hardships has significant negative effects on wellness; (3)Trainees are Humans-trainees are people with basic human needs, especially the need for worth; (4)Research Time as Refuge-dedicated research time is treated as an oasis away from clinical hardships. CONCLUSIONS Perspectives from support persons can offer valuable insight into the wellness needs of surgical trainees. According to support persons, surgical training profoundly negatively impacts trainee wellness. Unlike during clinical training, dedicated research time is a period during which wellness can be prioritized. Programs should provide greater attention to mitigating the negative ramifications of surgical training and promoting wellness in a longitudinal fashion throughout training.
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Mackel CE, Nelton EB, Reynolds RM, Fox WC, Spiotta AM, Stippler M. A Scoping Review of Burnout in Neurosurgery. Neurosurgery 2021; 88:942-954. [PMID: 33471896 DOI: 10.1093/neuros/nyaa564] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/04/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Burnout is a negative workplace syndrome of emotional exhaustion, cynicism, and perceived professional inefficacy that risks the patient-provider relationship, patient care, and physician well-being. OBJECTIVE To assimilate the neurosurgical burnout literature in order to classify burnout among domestic and international neurosurgeons and trainees, identify contributory factors, and appraise the impact of wellness programs. METHODS A scoping review identified the available literature, which was reviewed for key factors related to burnout among neurosurgeons. Two researchers queried PubMed, Embase, Google Scholar, Cochrane, and Web of Science for articles on burnout in neurosurgery and reduced 1610 results to 32 articles. RESULTS A total of 32 studies examined burnout in neurosurgery. A total of 26 studies examined prevalence and 8 studies detailed impact of wellness programs. All were published after 2011. Burnout prevalence was measured mostly through the Maslach Burnout Inventory (n = 21). In 4 studies, participants defined their own understanding of "burnout." Domestically, burnout prevalence was 11.2% to 67% among residents and 15% to 57% among attendings. Among trainees, poor operative experience, poor faculty relationships, and social stressors were burnout risks but not age, sex, or marital status. Among attendings, the literature identified financial or legal concerns, lack of intellectual stimulation, and poor work-life balance as risks. The impact of wellness programs on trainees is unclear but group exercises may offer the most benefit. CONCLUSION Noticeable methodological differences in studies on trainee and attending burnout contribute to a wide range of neurosurgery burnout estimates and yield significant knowledge gaps. Environment may have greater impact on trainee burnout than demographics. Wellness programs should emphasize solidarity.
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Affiliation(s)
- Charles E Mackel
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Emmalin B Nelton
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Renée M Reynolds
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | | | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Martina Stippler
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Pascual JSG, Ignacio KHD, Khu KJO. Paving the Path to Wellness: A Systematic Review of Wellness Programs for Neurosurgery Trainees. World Neurosurg 2021; 152:206-213.e5. [PMID: 34146737 DOI: 10.1016/j.wneu.2021.06.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neurosurgical trainees have a heavy workload and poor quality of life, resulting in high rates of burnout and attrition. Consequently, wellness programs have been used by various training institutions to combat this situation. OBJECTIVE We aimed to identify and describe wellness programs available for neurosurgical trainees in their training institutions, the outcome measures used to assess them, and their efficacy. METHODS A systematic review of the literature was made following PRISMA guidelines. RESULTS Six studies were included in the review, describing wellness programs from 9 institutions. All programs except 1 used exercise as the core component. The other components included physical and mental well-being lectures, team-building activities, and cultural excursions. Most institutions used piloted satisfaction and perception questionnaires to assess efficacy. Trainee perceptions of wellness programs were generally positive, but the responses on validated questionnaires and surveys were mixed. Barriers to the program included lack of institutional support, time constraints, fatigue, and feelings of guilt in prioritizing wellness over patient care. CONCLUSIONS There is a paucity of literature regarding trainee wellness in neurosurgery. A few training programs have instituted wellness initiatives for trainees, and the feedback was generally positive. However, objective measures of efficacy such as validated questionnaires and scales yielded mixed results.
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Affiliation(s)
- Juan Silvestre G Pascual
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Katrina Hannah D Ignacio
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines.
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Gómez C, Lamas A, Ramirez-Martinez FR, Blunk D, Leiner M. Rethinking Strategies and Programs to Improve Physical and Emotional Well-being Among Healthcare Professionals: Facing the New Normalcy. MEDICAL SCIENCE EDUCATOR 2021; 31:565-572. [PMID: 33649713 PMCID: PMC7904297 DOI: 10.1007/s40670-021-01214-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 05/02/2023]
Abstract
Background With the advent of coronavirus disease 2019 (COVID-19), a different perspective on the future of humanity has emerged that emphasizes the importance of building the capacities of healthcare providers in order to assist them with the heavy burden that these changes have placed on them both now and in the future. A reduction in the quality of life and the presence of prolonged fatigue are some of the most imminent problems that emerge among these professionals. Objective The aim of this study was to determine the effectiveness of a holistic intervention (workshop) for health science students aimed at developing skills that will enable them to obtain a better self-assessment of their quality of life, and prolonged fatigue. Methods Pre- and post-measures of quality of life, and prolonged fatigue were obtained from 130 health science students, including a group of 96 attendees (cases) of a 4-h wellness workshop and 34 students who did not attend (controls). Results Paired t tests indicated a significant improvement in nearly all dimensions related to quality of life, and prolonged fatigue in the case group who attended the workshop. Conclusions A comprehensive wellness strategy that utilizes a holistic approach can play an important role in improving and promoting essential skills to improve healthcare provider's self-assessment about the quality of life and reduce their prolonged fatigue. The critical importance of these needs has long been recognized, and this will also be crucial for addressing new challenges and emerging realities.
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Affiliation(s)
- Claudia Gómez
- Universidad Autonoma de Ciudad Juarez, Chihuahua, Mexico
| | - Aura Lamas
- Department of Pediatrics, Texas Tech University Health Science Center El Paso, El Paso, TX USA
| | | | - Dan Blunk
- Paul L. Foster School of Medicine, Texas Tech University Health Science Center El Paso, El Paso, TX USA
| | - Marie Leiner
- Department of Pediatrics, Texas Tech University Health Science Center El Paso, El Paso, TX USA
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Berardo L, Gerges C, Wright J, Stout A, Shah H, Papanastassiou A, Kimmell K. Assessment of burnout prevention and wellness programs for US-based neurosurgical faculty and residents: a systematic review of the literature. J Neurosurg 2020; 135:392-400. [PMID: 33126213 DOI: 10.3171/2020.6.jns201531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurosurgeon burnout is a serious and prevalent issue that has been shown to impact professionalism, physician health, and patient outcomes. Interventions targeting physician burnout primarily focus on improving physician wellness. Many academic neurosurgery programs have established wellness curricula to combat burnout and improve wellness. No official recommendations exist for establishing a wellness program that effectively targets sources of burnout. The aim of this review was to examine measures of burnout and report objective results of wellness interventions for neurosurgical faculty and residents. METHODS Two systematic literature reviews were performed in parallel, in accordance with PRISMA 2009 guidelines. Following removal of duplicates, a query of PubMed/MEDLINE, Scopus, Ovid, Cochrane, and EMBASE databases yielded 134 resident-related articles and 208 faculty-related articles for abstract screening. After abstract screening, 17 articles with a primary focus of resident wellness and 10 with a focus on faculty wellness met criteria for full-text screening. Of the total 27 screened articles, 9 (6 resident, 2 faculty, 1 both resident and faculty) met criteria and were included in the final analysis. Article quality was assessed using the Joanna Briggs Institute critical appraisal tools for cohort studies. RESULTS Included studies reported burnout rates for neurosurgery residents of 30%-67%. Work-life imbalance, imbalance of duties, inadequate operative exposure, and hostile faculty were contributors to burnout. The 2 included studies reported burnout rates for neurosurgery faculty members of 27% and 56.7%. Psychosocial stressors, relational stressors, and financial uncertainty were generally associated with increased feelings of burnout. Of the 4 studies reporting on outcomes of wellness initiatives included in this review, 3 reported a positive impact of the wellness interventions and 1 study reported no significant improvement after implementing a wellness initiative. CONCLUSIONS Burnout among neurosurgical faculty and residents is prevalent and permeates the daily lives of neurosurgeons, negatively affecting patient outcomes, career satisfaction, and quality of life. Many neurosurgery programs have instituted wellness programs to combat burnout, but few have published evidence of improvement after implementation. While studies have shown that residents and faculty recognize the importance of wellness and look favorably on such initiatives, very few studies have reported objective outcomes.
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Affiliation(s)
- Laura Berardo
- 1School of Medicine, University of Texas at San Antonio, Texas
| | - Christina Gerges
- 2School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - James Wright
- 2School of Medicine, Case Western Reserve University, Cleveland, Ohio
- 3Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Amber Stout
- 3Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Hamid Shah
- 4Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kristopher Kimmell
- 6Department of Neurosurgery, Rochester Regional Health and University of Rochester Medical Center, Rochester, New York
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Zaed I, Jaaiddane Y, Chibbaro S, Tinterri B. Burnout Among Neurosurgeons and Residents in Neurosurgery: A Systematic Review and Meta-Analysis of the Literature. World Neurosurg 2020; 143:e529-e534. [PMID: 32777406 PMCID: PMC7413160 DOI: 10.1016/j.wneu.2020.08.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 12/23/2022]
Abstract
Background Burnout syndrome (BS) is a common condition among medical professionals. It is composed of 3 different subdimensions: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). In the last years, interest in BS in the neurosurgical community has increased. Here we investigated burnout among neurosurgeons and residents in neurosurgery. Methods A systematic review with meta-analysis was performed following PRISMA guidelines. A search of bibliographic databases was conducted from study inception to February 2020. A total of 16,377 studies were found. Six articles were included in our final analysis. Their references were checked for additional studies, but none were found. Results From the initial 16,377 studies identified, only 6 met our inclusion criteria. These studies included a total of 3310 physicians. The general prevalence of BS was 48%. The prevalence in neurosurgeons was 51.1%, higher than that recorded in neurosurgical residents (45.4%). Regarding subdimensions, personal accomplishment seemed to be the most influential factor for burnout development among neurosurgeons (42.57%) and residents (51.56%) alike. Conclusions Neurosurgery is a rewarding career choice, but numerous challenges and stressors can lead to lower levels of satisfaction and dangerously increased levels of burnout. We hope that our results will generate discussion, raise awareness, stimulate further studies, and lead to programs designed to mitigate excessive stress and burnout in neurosurgeons.
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Affiliation(s)
- Ismail Zaed
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Youssef Jaaiddane
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Management Engineering, Polytechnic University of Milan, Milan, Italy
| | - Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospitals, Strasbourg, France
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Pennington Z, Lubelski D, Khalafallah AM, Ehresman J, Sciubba DM, Witham TF, Huang J. Letter to the Editor "Changes to Neurosurgery Resident Education Since Onset of the COVID-19 Pandemic". World Neurosurg 2020; 139:734-740. [PMID: 32450312 PMCID: PMC7243785 DOI: 10.1016/j.wneu.2020.05.139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adham M Khalafallah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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14
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Tang OY, Dunn KA, Yoon JS, Ponce FA, Sonntag VK, Lawton MT. Neurosurgery Resident Wellness and Recovery from Burnout: A 39-Year Single-Institution Experience. World Neurosurg 2020; 138:e72-e81. [DOI: 10.1016/j.wneu.2020.01.236] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
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15
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McNutt SE, Goss ML, Hallan DR, Bible JE. Factors in Residency Decision Making for Female Neurosurgery Applicants. World Neurosurg 2020; 140:e105-e111. [PMID: 32360735 DOI: 10.1016/j.wneu.2020.04.166] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Neurosurgery remains a specialty with one of the largest gender gaps in the United States. Neurosurgery residency programs are highly motivated to attract the best female candidates in an effort to improve their program diversity, but no studies currently exist that examine the factors of highest importance to female applicants for neurosurgery residency selection. The purpose of this study was to determine factors that female neurosurgery residents used when selecting their residency. METHODS A 2-part survey was sent to female neurosurgical residents by e-mails collected from the American Association of Neurological Surgeons directory and residency program websites. The survey asked participants to score 17 characteristics of residency programs in terms of importance and then asked them to rank their top 5 most influential factors when selecting a neurosurgery residency. RESULTS The most important factors included variety/number of cases, camaraderie and happiness of current residents, early surgical/clinical experience, and academic reputation. The least important factors included gender diversity of faculty and residents, number of female residents, number of female faculty, and attitudes toward maternity leave. CONCLUSIONS Efforts to increase female applicants in neurosurgery residency programs should focus on highlighting some more universal, non-gender-related factors, such as happiness and camaraderie among residents and anticipated clinical experiences, as opposed to showcasing features that would seemingly appeal to female applicants, such as maternity leave and number of current female faculty or residents.
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Affiliation(s)
- Sarah E McNutt
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Madison L Goss
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - David R Hallan
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jesse E Bible
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
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16
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Weber AC, Henderson F, Santos JM, Spiotta AM. Letter: For Whom the Bell Tolls: Overcoming the Challenges of the COVID Pandemic as a Residency Program. Neurosurgery 2020; 87:E207. [PMID: 32335679 DOI: 10.1093/neuros/nyaa166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aimee C Weber
- Department of Neurosurgery The Medical University of South Carolina Charleston, South Carolina
| | - Fraser Henderson
- Department of Neurosurgery The Medical University of South Carolina Charleston, South Carolina
| | - Jaime Martinez Santos
- Department of Neurosurgery The Medical University of South Carolina Charleston, South Carolina
| | - Alejandro M Spiotta
- Department of Neurosurgery The Medical University of South Carolina Charleston, South Carolina
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17
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In Pursuit of Balance: The UPMC Neurosurgery Wellness Initiative. World Neurosurg 2019; 132:e704-e709. [DOI: 10.1016/j.wneu.2019.08.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/23/2022]
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18
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Khan NR, Derstine PL, Gienapp AJ, Klimo P, Barbaro NM. A Survey of Neurological Surgery Residency Program Mentorship Practices Compared to Accreditation Council for Graduate Medical Education Resident Outcome Data. Neurosurgery 2019; 87:E566-E572. [DOI: 10.1093/neuros/nyz479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/28/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Mentorship can be a powerful and life-altering experience during residency training, but there are few articles discussing mentorship models within neurosurgery. In this study, we surveyed US neurosurgical department mentorship practices and linked them to resident outcomes from the Accreditation Council for Graduate Medical Education (ACGME), including resident survey responses, board pass rates, and scholarly activity.
A 19-question survey was conducted from October to December 2017 with the assistance of the Society of Neurological Surgeons. De-identified data were then obtained from the ACGME and correlated to these results. Out of 110 programs, 80 (73%) responded to the survey and gave informed consent. The majority (65%) had a formal mentorship program and assigned mentor relationships based on subspecialty or research interest. Barriers to mentorship were identified as time and faculty/resident “buy-in.” Mentorship programs established for 5 or more years had superior resident ACGME outcomes, such as board pass rates, survey results, and scholarly activity. There was not a significant difference in ACGME outcomes among programs with formal or informal/no mentorship model (P = .17). Programs that self-identified as having an “unsuccessful” mentorship program had significant increases in overall negative resident evaluations (P = .02).
Programs with well-established mentorship programs were found to have superior ACGME resident survey results, board pass rates, and more scholarly activity. There was not a significant difference among outcomes and the different models of formal mentorship practices. Barriers to mentorship, such as time and faculty/resident “buy-in,” are identified.
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Affiliation(s)
- Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Review Committee for Neurological Surgery, Accreditation Council for Graduate Medical Education (ACGME)
| | - Pamela L Derstine
- Review Committee for Neurological Surgery, Accreditation Council for Graduate Medical Education (ACGME)
| | - Andrew J Gienapp
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
- Semmes-Murphey, Memphis, Tennessee
| | - Nicholas M Barbaro
- Review Committee for Neurological Surgery, Accreditation Council for Graduate Medical Education (ACGME)
- Department of Neurosurgery, Indiana University, Indianapolis, Indiana
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19
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Spiotta AM, Kalhorn SP, Patel SJ. Letter: How to Combat the Burnout Crisis in Neurosurgery? Cathedrals and Mentorship. Neurosurgery 2018; 84:E257-E258. [DOI: 10.1093/neuros/nyy611] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alejandro M Spiotta
- Medical University of South Carolina Department of Neurosurgery Charleston, South Carolina
| | - Stephen P Kalhorn
- Medical University of South Carolina Department of Neurosurgery Charleston, South Carolina
| | - Sunil J Patel
- Medical University of South Carolina Department of Neurosurgery Charleston, South Carolina
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