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Lee JJ, Mathur S, Gerhart J, Glover CM, Ritz E, Basapur S, Greenberg JA. Written communication and the ICU team experience (WRITE): A pre-post intervention study. Intensive Crit Care Nurs 2024; 84:103753. [PMID: 38924848 DOI: 10.1016/j.iccn.2024.103753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/05/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Families of critically ill patients may benefit from receiving a written update of patient care each day. Our objective was to develop a system to facilitate care provider creation of written updates and to determine the effect of implementing this process on the care provider experience. DESIGN The experiences of ICU care providers (nurses, advanced practice providers, and physicians) were measured monthly during a 3-month pre-intervention and a 3-month intervention period. During the intervention period, written updates were sent to families each day and posted in the electronic medical record. Study investigators assisted by editing and distributing the written communication to families. SETTING An urban academic medical center in the United States. MAIN OUTCOME MEASURES Nurse-Physician Collaboration Scale (NPCS) and Maslach Burnout Inventory (MBI). RESULTS Over the 3-month intervention period, care providers created written communication for families of 152 patients (average 5 ICU days per family). NPCS scores among the 65 participating care providers were significantly lower, indicating greater collaboration during the intervention vs. pre-intervention period: 49.9 (95 % CI 46.4-53.6) vs. 55.4 (95 % CI 51.5-59.3), p = 0.002. MBI scores were similar during the intervention vs. pre-intervention periods. A subset of care providers participated in individual interviews. Care providers reported that the process of creating written communication was acceptable and had clear benefits for both families and the medical team. CONCLUSIONS Use of written communication as a supplement to verbal communication improves collaboration among ICU care providers without affecting symptoms of burnout. IMPLICATIONS FOR PRACTICE We created a system to facilitate written communication with ICU families that was acceptable to care providers and improved aspects of their experience. In the future, use of written communication can be enhanced with refinements to the process that reduce the time spent creating written updates while highlighting the benefits to families and care providers.
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Affiliation(s)
| | - Shubha Mathur
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, USA
| | - Crystal M Glover
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ethan Ritz
- Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, IL, USA
| | - Santosh Basapur
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jared A Greenberg
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
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Williams-Brown MY, Summey RM, Newtson A, Burke W, Turner T, Sabu P, Davidson BA, Glaser G. System-level recommendations for improved wellness for gynecologic oncologists: A Society of Gynecologic Oncology Review. Gynecol Oncol 2024; 183:85-92. [PMID: 38554478 DOI: 10.1016/j.ygyno.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/01/2024]
Abstract
Burnout and its negative sequelae are a persistent problem in gynecologic oncology, threatening the health of our physician workforce. Individual-level interventions such as stress management training, physical activity, and sleep hygiene only partially address this widespread, systemic crisis rooted in the extended work hours and stressful situations associated with gynecologic oncology practice. There is an urgent need for systematic, institution-level changes to allow gynecologic oncologists to continue the crucial work of caring for people with gynecologic cancer. We present recommendations for institution-level changes which are grounded in the framework presented by the National Plan for Health Workforce Well-Being by the National Academy of Medicine. These are aimed at facilitating gynecologic oncologists' well-being and reduction of burnout. Recommendations include efforts to create a more positive and inclusive work environment, decrease administrative barriers, promote mental health, optimize electronic medical record use, and support a diverse workforce. Implementation and regular evaluation of these interventions, with specific attention to at-risk groups, is an important next step.
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Affiliation(s)
- M Y Williams-Brown
- Department of Women's Health, Dell Medical School at The University of Texas at Austin, Austin, TX, United States of America.
| | - R M Summey
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - A Newtson
- Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - W Burke
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook University Cancer Center, Stony Brook, NY, United States of America
| | - T Turner
- St. Luke's Cancer Institute, Boise, ID, United States of America
| | - P Sabu
- Division of Gynecologic Oncology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - B A Davidson
- Division of Gynecologic Oncology, Duke University, Durham, NC, United States of America
| | - G Glaser
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
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Babal JC, Lelkes E, Kloster H, Zwemer E, Lien ER, Sklansky D, Coller RJ, Moreno MA, Schultz R, Webber S. Pediatric Resident Well-being: A Group Concept Mapping Study. Acad Pediatr 2024; 24:535-543. [PMID: 38215904 DOI: 10.1016/j.acap.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/11/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Pediatric residency programs invest substantial resources in supporting resident well-being. However, no pediatric resident well-being conceptual model exists to guide interventions. This study aimed to understand how a diverse stakeholder sample conceptualized well-being. METHODS We used group concept mapping methodology. We sent a brainstorming survey to pediatric residents and program leaders at 24 US residencies with the prompt, "The experience of well-being for resident physicians includes…" Participants at 4 residencies sorted well-being ideas conceptually and rated idea importance. We performed multidimensional scaling and hierarchical cluster analysis to develop cluster maps. Using participant feedback and a consensus-driven process, we determined best cluster representation. We used pattern matching to compare domain ratings between subgroups. RESULTS In brainstorming, 136 residents and 22 program leaders from 22 residency programs generated 97 unique ideas. Ideas were sorted and rated by 33 residents, 14 program leaders. Eight domains aligning with 4 resident roles were identified. Domains were: 1) positive, safe, and diverse culture; 2) unity and connection; 3) professional fulfillment and mindset; 4) personal health and life satisfaction; 5) professional development and recognition; 6) schedule protections and downtime; 7) work systems and benefits; 8) proactive and compassionate leadership. Domains aligned with the following roles: 1) individual, 2) colleague, 3) employee, 4) emerging pediatrician. Residents placed higher value on schedule protections and downtime than program leaders, P < .05. CONCLUSIONS Pediatric resident well-being may be conceptualized as inter-related domains corresponding with various resident roles. Participants aligned on many well-being priorities but differed regarding work schedules.
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Affiliation(s)
- Jessica C Babal
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Efrat Lelkes
- Department of Pediatrics (E Lelkes), University of California San Francisco.
| | - Heidi Kloster
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Eric Zwemer
- Department of Pediatrics (E Zwemer), University of North Carolina, Chapel Hill.
| | | | - Daniel Sklansky
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Ryan J Coller
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Megan A Moreno
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Roger Schultz
- Department of Neurobiology (R Schultz), University of Wisconsin, Madison.
| | - Sarah Webber
- Department of Pediatrics (JC Babal, H Kloster, D Sklansky, RJ Coller, MA Moreno, and S Webber), University of Wisconsin School of Medicine and Public Health, Madison.
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Nguyen MLT, Honcharov V, Ballard D, Satterwhite S, McDermott AM, Sarkar U. Primary Care Physicians' Experiences With and Adaptations to Time Constraints. JAMA Netw Open 2024; 7:e248827. [PMID: 38687477 PMCID: PMC11061766 DOI: 10.1001/jamanetworkopen.2024.8827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/29/2024] [Indexed: 05/02/2024] Open
Abstract
Importance The primary care workforce shortage is significant and persistent, with organizational and policy leaders urgently seeking interventions to enhance retention and recruitment. Time constraints are a valuable focus for action; however, designing effective interventions requires deeper understanding of how time constraints shape employees' experiences and outcomes of work. Objective To examine how time constraints affect primary care physicians' work experiences and careers. Design, Setting, and Participants Between May 1, 2021, and September 31, 2022, US-based primary care physicians who trained in family or internal medicine were interviewed. Using qualitative analysis of in-depth interviews, this study examined how participants experience and adapt to time constraints during a typical clinic day, taking account of their professional and personal responsibilities. It also incorporates physicians' reflections on implications for their careers. Main Outcomes and Measures Thematic analysis of in-depth interviews and a measure of well-being (American Medical Association Mini-Z survey). Results Interviews with 25 primary care physicians (14 [56%] female and 11 [44%] male; median [range] age, 43 [34-63] years) practicing in 11 US states were analyzed. Two physicians owned their own practice, whereas the rest worked as employees. The participants represented a wide range of years in practice (range, 1 to ≥21), with 11 participants (44%) in their first 5 years. Physicians described that the structure of their work hours did not match the work that was expected of them. This structural mismatch between time allocation and work expectations created a constant experience of time scarcity. Physicians described having to make tradeoffs between maintaining high-quality patient care and having their work overflow into their personal lives. These experiences led to feelings of guilt, disillusionment, and dissatisfaction. To attempt to sustain long-term careers in primary care, many sought ways to see fewer patients. Conclusions and Relevance These findings suggest that organizational leaders must align schedules with work expectations for primary care physicians to mitigate physicians' withdrawal from work as a coping mechanism. Specific strategies are needed to achieve this realignment, including incorporating more slack into schedules and establishing realistic work expectations for physicians.
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Affiliation(s)
| | - Vlad Honcharov
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Dawna Ballard
- Department of Communication Studies, University of Texas at Austin, Austin
| | - Shannon Satterwhite
- Department of Family and Community Medicine, UC Davis Health, Sacramento, California
| | - Aoife M. McDermott
- School of Public Health, University of California, Berkeley
- Aston Business School, Aston University, Birmingham, UK
| | - Urmimala Sarkar
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
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Al-Harrasi S, Sabei SA, Omari OA, Abrawi UA. Nurses' Job Burnout and Resilience in Neonatal Intensive Care Units. J Perinat Neonatal Nurs 2024; 38:201-211. [PMID: 38758275 DOI: 10.1097/jpn.0000000000000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
PURPOSE To assess the relationship between job burnout and resilience among nurses working in neonatal intensive care units (NICUs) in Oman. BACKGROUND NICUs induce a significant amount of stress that predisposes nurses to a substantial degree of burnout. Resilience can play a role in reducing the effects of job burnout. A limited number of studies have examined job burnout and resilience among NICU nurses. METHODS A cross-sectional survey design was utilized. The Maslach Burnout Inventory was used to assess burnout, and the Brief Resilience Scale was used to assess perceptions of resilience. Pearson correlation was used to assess the relationship between job burnout and resilience. RESULTS A total of 173 staff nurses participated. Participants reported low levels of emotional exhaustion and depersonalization but moderate levels on the personal accomplishment subscale. Nurses reported moderate levels of resilience. Emotional exhaustion and depersonalization were negatively correlated with resilience, while personal accomplishment was positively correlated with resilience. CONCLUSION This study demonstrated that enhancing resilience can reduce the effect of burnout among NICU nurses. IMPLICATIONS FOR PRACTICE AND RESEARCH Enhancing levels of resilience among NICU nurses, in addition to providing adequate managerial support and good collegial relations, is essential to reduce their perceived job burnout.
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Affiliation(s)
- Samhaa Al-Harrasi
- Author Affiliations: Sultan Qaboos University Hospital, Sultanate of Oman, Al-Khodh, Oman (Ms Al-Harrasi); Department of Fundamentals and Nursing Administration, College of Nursing, Sultan Qaboos University, Sultanate of Oman, Al-Khodh, Oman (Drs Al Sabei and Al Sabei); and Royal Hospital, Sultanate of Oman, Muscat, Oman (Ms Abrawi)
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Sánchez-Rosenberg G, Magnéli M, Barle N, Kontakis MG, Müller AM, Wittauer M, Gordon M, Brodén C. ChatGPT-4 generates orthopedic discharge documents faster than humans maintaining comparable quality: a pilot study of 6 cases. Acta Orthop 2024; 95:152-156. [PMID: 38597205 PMCID: PMC10959013 DOI: 10.2340/17453674.2024.40182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/28/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND AND PURPOSE Large language models like ChatGPT-4 have emerged. They hold the potential to reduce the administrative burden by generating everyday clinical documents, thus allowing the physician to spend more time with the patient. We aimed to assess both the quality and efficiency of discharge documents generated by ChatGPT-4 in comparison with those produced by physicians. PATIENTS AND METHODS To emulate real-world situations, the health records of 6 fictional orthopedic cases were created. Discharge documents for each case were generated by a junior attending orthopedic surgeon and an advanced orthopedic resident. ChatGPT-4 was then prompted to generate the discharge documents using the same health record information. The quality assessment was performed by an expert panel (n = 15) blinded to the source of the documents. As secondary outcome, the time required to generate the documents was compared, logging the duration of the creation of the discharge documents by the physician and by ChatGPT-4. RESULTS Overall, both ChatGPT-4 and physician-generated notes were comparable in quality. Notably, ChatGPT-4 generated discharge documents 10 times faster than the traditional method. 4 events of hallucinations were found in the ChatGPT-4-generated content, compared with 6 events in the human/physician produced notes. CONCLUSION ChatGPT-4 creates orthopedic discharge notes faster than physicians, with comparable quality. This shows it has great potential for making these documents more efficient in orthopedic care. ChatGPT-4 has the potential to significantly reduce the administrative burden on healthcare professionals.
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Affiliation(s)
| | - Martin Magnéli
- Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital, Stockholm; Sweden
| | - Niklas Barle
- Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital, Stockholm; Sweden
| | - Michael G Kontakis
- Department of Surgical Sciences, Orthopedics, Uppsala University Hospital, Uppsala, Sweden
| | - Andreas Marc Müller
- Department of Orthopedic and Trauma Surgery, University Hospital Basel, Switzerland
| | - Matthias Wittauer
- Department of Orthopedic and Trauma Surgery, University Hospital Basel, Switzerland
| | - Max Gordon
- Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital, Stockholm; Sweden
| | - Cyrus Brodén
- Department of Surgical Sciences, Orthopedics, Uppsala University Hospital, Uppsala, Sweden.
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Bentulila Y, Lev Shalem L, Cohen B, Adler L. Physical work environment and burnout among primary care physicians in Israel: a cross-sectional study. BMC PRIMARY CARE 2024; 25:74. [PMID: 38418978 PMCID: PMC10900697 DOI: 10.1186/s12875-024-02310-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Physician burnout remains a prevalent issue globally, negatively affecting work satisfaction and patient care. However, exploration of the physical work environments of physicians, a potential influencing factor for burnout, remains scarce. The physical work environment is everything that surrounds the physician, including the doctor's office, the clinic, the clinic's building, the waiting, and staff rooms. The aims of this study were to describe aspects of the physical work environment of primary care physicians (PCPs) and to explore the association between the physical work environment and burnout. METHODS In this cross-sectional study, we emailed questionnaires to an online community of PCPs in Israel in October 2021. We asked physicians about their satisfaction with their physical work environment, evaluated elements of the work environment, and assessed burnout status (with the Shirom-Melamed Burnout Measure, SMBM). We used the Chi-square and Mann-Witney tests to compare categorical and continuous variables and used logistic regression for the final model. RESULTS Two hundred twenty-one PCPs answered the questionnaire (27.6% response rate). Over a third (35.7%) of respondents reported high burnout. PCPs who were satisfied with their general physical environment had lower burnout rates than those who were unsatisfied (28.1% vs. 47.8%, p-value < 0.001). We found positive correlations between general satisfaction with the physical work environment and the scores achieved for the doctor's office, the clinic, the clinic's building, and the waiting room. In the multivariate analysis, high satisfaction with the general physical work environment was associated with decreased odds for burnout (OR-0.50, 95% CI 0.25-0.99, p-value-0.048). CONCLUSION The doctor's office, the clinic, the clinic's building, and the waiting room affected general satisfaction from the physical work environment. High satisfaction with the physical work environment reduced burnout rates. Future studies are needed to determine whether PCPs and managers should invest in the physical work environment to decrease burnout and increase satisfaction.
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Affiliation(s)
- Yaara Bentulila
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel
| | - Liat Lev Shalem
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel
| | - Bar Cohen
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel
| | - Limor Adler
- Health Division, Maccabi HealthCare Services, Tel Aviv-Jaffa, Israel.
- Faculty of Medicine, Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel.
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Singh AP, Xiao L, O'Brien BJ, Blondeau CE, Flowers CR, Bruera E, Morris VK, Shah AY. Association of Emotional Exhaustion With Career Burnout Among Early-Career Medical Oncologists: A Single-Institution Study. JCO Oncol Pract 2024; 20:137-144. [PMID: 37235818 DOI: 10.1200/op.22.00782] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/09/2023] [Accepted: 04/12/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Burnout is a psychological occupational syndrome defined by the Maslach Burnout Inventory (MBI) as emotional exhaustion, depersonalization, and a low sense of personal accomplishment. We sought to characterize the prevalence of burnout among early-career medical oncologists at The University of Texas MD Anderson Cancer Center (MDACC). METHODS For this institutional review board-approved study, an electronic survey was developed for Assistant Professors in the MDACC Division of Cancer Medicine. All participants were involved directly in patient care. Our survey included questions assessing self-reported burnout, nine questions validated in the abbreviated MBI, and 31 questions to assess potential contributors to burnout. Each question was scaled 1-5, with higher scores associated with higher burnout. Descriptive statistics were used to estimate the prevalence of burnout, and logistic regression analyses were performed to identify contributing factors. RESULTS Among 86 Assistant Professors, 56 (65%) responded to the survey. The mean duration on faculty was 3.1 years. The mean clinical effort was 67% (range, 19-95). Fifty-four percent of respondents self-reported symptoms of burnout including 21% indicating severe burnout. Using the MBI, sentiments of being emotionally drained (54%), fatigued facing another day on the job (45%), and becoming more callous (30%) were especially notable. Twenty-five percent of respondents exhibited severe emotional exhaustion, which was more prevalent (P < .0001) than depersonalization (6%) or lack of personal accomplishment (17%). CONCLUSION Burnout exists with high prevalence among early-career medical oncologists, with emotional exhaustion being the most common manifestation of burnout. Interventions focusing on reducing emotional exhaustion are needed to reduce burnout among early-career medical oncologists.
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Affiliation(s)
- Anmol P Singh
- Hematology/Oncology Fellowship Program, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- Division of Cancer Medicine, Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Barbara J O'Brien
- Division of Cancer Medicine, Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX
| | - Claire E Blondeau
- Administrative Office, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - Christopher R Flowers
- Division of Cancer Medicine, Department of Lymphoma-Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Division of Cancer Medicine, Department of Palliative, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX
| | - Van K Morris
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX
| | - Amishi Y Shah
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, Houston, TX
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Zhong J, Bradford V, Fernandez AM, Infosino A, Soneru CN, Staffa SJ, Raman VT, Cravero J, Zurakowski D, Meier PM. Continued challenges in pediatric anesthesia during COVID-19 in 2022: An international survey from the pediatric anesthesia COVID-19 collaborative. Paediatr Anaesth 2023; 33:1020-1028. [PMID: 37732382 DOI: 10.1111/pan.14762] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION This international survey explored the ongoing impact of COVID-19 on pediatric anesthesiology. It assessed COVID-19's impact on the practice of pediatric anesthesiology, staffing, job satisfaction, and retention at the beginning of 2022 and addressed what should be done to ameliorate COVID-19's impact and what initiatives hospitals had implemented. METHODS This survey focused on five major domains: equipment/medication, vaccination/testing, staffing, burnout, and economic repercussions. Pilot testing for questionnaire clarity was conducted by members of the Pediatric Anesthesia COVID-19 Collaborative. The survey was administered by e-mail to a representative of the 72 collaborative centers. Respondents were instructed to answer based on their institution's practice from February through April of 2022. Descriptive statistics with 95% confidence intervals are reported. RESULTS Seventy of seventy-two institutions participated in this survey (97% response rate). Fifty-nine (84%) were from the United States, and 11 (16%) included other countries. The majority experienced equipment (68%) and medication (60%) shortages. Many institutions reported staffing shortages in nursing (37%), perioperative staff (27%), and attending anesthesiologists (11%). Sixty-two institutions (89%) indicated burnout was a frequent topic of conversation among pediatric anesthesiologists. Forty-three institutions (61%) reported anesthesiologists leaving current practice and 37 (53%) early retirement. Twenty-eight institutions (40%) canceled elective cases. The major suggestions for improving job retention included improving financial compensation (76%), decreasing clinical time (67%), and increasing flexibility in scheduled clinical time (66%). Only a minority of institutions had implemented the following initiatives: improving financial compensation (19%), increased access to mental health/counseling services (30%), and assistance with child or elder care (7%). At the time of the survey, 34% of institutions had not made any changes. CONCLUSION Our study found that COVID-19 has continued to impact pediatric anesthesiology. There are major discrepancies between what anesthesiologists believe are important for job satisfaction and faculty retention compared to implemented initiatives. Data from this survey provide insight for institutions and departments for addressing these challenges.
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Affiliation(s)
- John Zhong
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Victoria Bradford
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, USA
| | - Allison M Fernandez
- Department of Anesthesia, Pain and Perioperative Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Andrew Infosino
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
| | - Codruta N Soneru
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vidya T Raman
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Joseph Cravero
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Petra M Meier
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Thomas MK, Conner SM, Maw A, Soni NJ. Point-counterpoint: Should point-of-care ultrasound be a required skill of hospitalists? J Hosp Med 2023; 18:1150-1155. [PMID: 37747100 DOI: 10.1002/jhm.13208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Meghan K Thomas
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie M Conner
- Division of Hospital Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anna Maw
- Division of Hospital Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Nilam J Soni
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Divisions of Hospital Medicine and Pulmonary Diseases and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
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Peine A, Gronholz M, Seidl-Rathkopf K, Wolfram T, Hallawa A, Reitz A, Celi LA, Marx G, Martin L. Standardized Comparison of Voice-Based Information and Documentation Systems to Established Systems in Intensive Care: Crossover Study. JMIR Med Inform 2023; 11:e44773. [PMID: 38015593 DOI: 10.2196/44773] [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: 12/02/2022] [Revised: 06/21/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The medical teams in intensive care units (ICUs) spend increasing amounts of time at computer systems for data processing, input, and interpretation purposes. As each patient creates about 1000 data points per hour, the available information is abundant, making the interpretation difficult and time-consuming. This data flood leads to a decrease in time for evidence-based, patient-centered care. Information systems, such as patient data management systems (PDMSs), are increasingly used at ICUs. However, they often create new challenges arising from the increasing documentation burden. OBJECTIVE New concepts, such as artificial intelligence (AI)-based assistant systems, are hence introduced to the workflow to cope with these challenges. However, there is a lack of standardized, published metrics in order to compare the various data input and management systems in the ICU setting. The objective of this study is to compare established documentation and retrieval processes with newer methods, such as PDMSs and voice information and documentation systems (VIDSs). METHODS In this crossover study, we compare traditional, paper-based documentation systems with PDMSs and newer AI-based VIDSs in terms of performance (required time), accuracy, mental workload, and user experience in an intensive care setting. Performance is assessed on a set of 6 standardized, typical ICU tasks, ranging from documentation to medical interpretation. RESULTS A total of 60 ICU-experienced medical professionals participated in the study. The VIDS showed a statistically significant advantage compared to the other 2 systems. The tasks were completed significantly faster with the VIDS than with the PDMS (1-tailed t59=12.48; Cohen d=1.61; P<.001) or paper documentation (t59=20.41; Cohen d=2.63; P<.001). Significantly fewer errors were made with VIDS than with the PDMS (t59=3.45; Cohen d=0.45; P=.03) and paper-based documentation (t59=11.2; Cohen d=1.45; P<.001). The analysis of the mental workload of VIDS and PDMS showed no statistically significant difference (P=.06). However, the analysis of subjective user perception showed a statistically significant perceived benefit of the VIDS compared to the PDMS (P<.001) and paper documentation (P<.001). CONCLUSIONS The results of this study show that the VIDS reduced error rate, documentation time, and mental workload regarding the set of 6 standardized typical ICU tasks. In conclusion, this indicates that AI-based systems such as the VIDS tested in this study have the potential to reduce this workload and improve evidence-based and safe patient care.
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Affiliation(s)
- Arne Peine
- Department of Intensive Care Medicine and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
- Clinomic Group GmbH, Aachen, Germany
| | | | | | | | - Ahmed Hallawa
- Department of Intensive Care Medicine and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Leo Anthony Celi
- Laboratory of Computational Physiology, Harvard-MIT Division of Health Sciences Technology, Cambridge, MA, United States
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Gernot Marx
- Department of Intensive Care Medicine and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Lukas Martin
- Department of Intensive Care Medicine and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
- Clinomic Group GmbH, Aachen, Germany
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Anderson C, Kaul M, Gullapalli N, Pitani S. Electronic health records and clinical documentation in medical residency programs: preparing residents to become master clinicians. J Am Med Inform Assoc 2023; 30:1965-1972. [PMID: 37573135 PMCID: PMC10654888 DOI: 10.1093/jamia/ocad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/29/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVE The ubiquity of electronic health records (EHRs) has made incorporating EHRs into medical practice an essential component of resident's training. Patient encounters, an important element of practice, are impacted by EHRs through factors that include increasing documentation requirements. This research sheds light on the role of EHRs on resident clinical skills development with emphasis on their role in patient encounters. MATERIALS AND METHODS We conducted qualitative semistructured interviews with 32 residents and 13 clinic personnel at an internal medicine residency program in a western US medical school focusing on the resident's clinic rotation. RESULTS Residents were learning to use the EHR to support and enhance their patient encounters, but one factor making that more challenging for many was the need to address quality measures. Quality measures could shift attention away from the primary reason for the encounter and addressing them consumed time that could have been spent diagnosing and treating the patient's chief complaint. A willingness to learn on-the-job by asking questions was important for resident development in using the EHR to support their work and improve their clinical skills. DISCUSSION Creating a culture where residents seek guidance on how to use the EHR and incorporate it into their work will support residents on their journey to become master clinicians. Shifting some documentation to the patient and other clinicians may also be necessary to keep from overburdening residents. CONCLUSION Residency programs must support residents as they develop their clinical skills to practice in a world where EHRs are ubiquitous.
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Affiliation(s)
- Chad Anderson
- Department of Information Systems & Analytics, Miami University, Oxford, OH 45056, United States
| | - Mala Kaul
- Department of Information Systems, University of Nevada Reno, Reno, NV 89557, United States
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89557, United States
| | - Sujatha Pitani
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89557, United States
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13
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Lewis S, Miranda L, Kurtz J, Brewer WJ, Papoutsakis C. Harnessing the Benefits of the Nutrition Care Process Quality Evaluation and Standardization Tool: A National Auditing Initiative to Improve Quality of Documentation. J Acad Nutr Diet 2023; 123:1662-1668. [PMID: 37422056 DOI: 10.1016/j.jand.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
The Nutrition Care Process Quality Standardization and Evaluation Tool (NCP QUEST) is a validated audit instrument assessing the quality of NCP documentation by registered dietitian nutritionists. The present quality improvement project describes change in documentation quality as measured by NCP QUEST and word count of notes after a monthly national digital training provided to Veterans Affairs registered dietitian nutritionists. The training and adoption of NCP QUEST was voluntary. Facilities were recruited among those that had participated during the design and validation study of NCP QUEST. The NCP QUEST score was calculated and the word count was determined for 52 documentation notes (28 from NCP QUEST nonuser facilities and 24 from NCP QUEST user facilities) before and after training. The mean pretraining NCP QUEST score for notes from NCP QUEST nonuser facilities was 13.71 and 13.88 for NCP QUEST user facilities. The mean posttraining total NCP QUEST score for nonuser facilities was 14.00 and 17.65 for user facilities, with no improvement for the nonuser facilities (P = 0.69). A significant improvement was identified for the NCP QUEST user facilities (P ≤ 0.001). All facilities experienced a significant reduction in the word count of assessment notes (P = 0.04). Use of the electronic NCP Terminology website increased 123-fold and was sustained after the training. NCP QUEST users reported that the audit tool is useful. The NCP QUEST should be at the center of registered dietitian nutritionists' training and more strategic effort is needed to engage practitioners in the optimal application of the NCP.
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Affiliation(s)
| | | | - Julie Kurtz
- Phoenix VA Health Care System, Phoenix, Arizona
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14
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Chau BL, LaGuardia JS, Kim S, Zhang SC, Pletcher E, Sanford NN, Raldow AC, Singer L, Gong J, Padda SK, Kamrava M, Cohen T, Mitra D, Atkins KM. Association of Parental Status and Gender With Burden of Multidisciplinary Tumor Boards Among Oncology Physicians. JAMA Netw Open 2023; 6:e2340663. [PMID: 37906191 PMCID: PMC10618838 DOI: 10.1001/jamanetworkopen.2023.40663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/19/2023] [Indexed: 11/02/2023] Open
Abstract
Importance Tumor boards are integral to the care of patients with cancer. However, data investigating the burden of tumor boards on physicians are limited. Objective To investigate what physician-related and tumor board-related factors are associated with higher tumor board burden among oncology physicians. Design, Setting, and Participants Tumor board burden was assessed by a cross-sectional convenience survey posted on social media and by email to Cedars-Sinai Medical Center cancer physicians between March 3 and April 3, 2022. Tumor board start times were independently collected by email from 22 top cancer centers. Main Outcomes and Measures Tumor board burden was measured on a 4-point scale (1, not at all burdensome; 2, slightly burdensome; 3, moderately burdensome; and 4, very burdensome). Univariable and multivariable probabilistic index (PI) models were performed. Results Surveys were completed by 111 physicians (median age, 42 years [IQR, 36-50 years]; 58 women [52.3%]; 60 non-Hispanic White [54.1%]). On multivariable analysis, factors associated with higher probability of tumor board burden included radiology or pathology specialty (PI, 0.68; 95% CI, 0.54-0.79; P = .02), attending 3 or more hours per week of tumor boards (PI, 0.68; 95% CI, 0.58-0.76; P < .001), and having 2 or more children (PI, 0.65; 95% CI, 0.52-0.77; P = .03). Early or late tumor boards (before 8 am or at 5 pm or after) were considered very burdensome by 33 respondents (29.7%). Parents frequently reported a negative burden on childcare (43 of 77 [55.8%]) and family dynamics (49 of 77 [63.6%]). On multivariable analysis, a higher level of burden from early or late tumor boards was independently associated with identifying as a woman (PI, 0.69; 95% CI, 0.57-0.78; P = .003) and having children (PI, 0.75; 95% CI, 0.62-0.84; P < .001). Independent assessment of 358 tumor boards from 22 institutions revealed the most common start time was before 8 am (88 [24.6%]). Conclusions and Relevance This survey study of tumor board burden suggests that identifying as a woman or parent was independently associated with a higher level of burden from early or late tumor boards. The burden of early or late tumor boards on childcare and family dynamics was commonly reported by parents. Having 2 or more children, attending 3 or more hours per week of tumor boards, and radiology or pathology specialty were associated with a significantly higher tumor board burden overall. Future strategies should aim to decrease the disparate burden on parents and women.
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Affiliation(s)
- Brittney L. Chau
- Department of Medicine, New York Medical College, New York, New York
| | - Jonnby S. LaGuardia
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Sungjin Kim
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Samuel C. Zhang
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric Pletcher
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nina N. Sanford
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Ann C. Raldow
- Department of Radiation Oncology, University of California Los Angeles Medical Center, Los Angeles
| | - Lisa Singer
- Department of Radiation Oncology, University of California San Francisco Medical Center, San Francisco
| | - Jun Gong
- Department of Medicine, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sukhmani K. Padda
- Department of Medicine, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Devarati Mitra
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Katelyn M. Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
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15
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Messinger A, Das S. Erosion of the 'ethical' doctor-patient relationship and the rise of physician burn-out. MEDICAL HUMANITIES 2023; 49:390-395. [PMID: 36526412 DOI: 10.1136/medhum-2022-012506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
This paper examines the topic of physician burn-out from a philosophical lens. We explore the question of how the rise of physician burn-out may be related to an underlying erosion of meaning in medicine, characterised by the breakdown of the intersubjective relationship between doctors and patients. We argue that while commonly cited strategies for addressing burnout-including promoting work-life integration, cultivating workplace community, and fostering resilience-are critical for enhancing physician well-being, the common thread linking these approaches is that each identifies the physician as the primary locus of intervention. We propose that physician-centric approaches alone may be insufficient in addressing burnout, as the work might also involve shifting our attention to the intersubjective space that exists between the physician and the patient. To further elucidate the connection between intersubjectivity and the creation of meaning in medicine, we call on twentieth-century philosopher Emmanuel Levinas. Applying Levinas's philosophy to the clinical context, we discuss the phenomenon of 'depersonalisation' and ask whether, rather than a mere consequence of burnout, depersonalisation might be a core cause of this condition. With these points we shed light on an idea that is relatively absent from the burn-out literature: that a person-oriented approach is vital not only for patient well-being but for physician wellness as well, as a process that 'de-personalizes' patients might result in a simultaneous dehumanisation of physicians themselves. Drawing inspiration from Levinas, we explore how a reorientation towards the intersubjective, dialogical dimension of the doctor-patient dyad could serve as one important ingredient in healing not only the patient, but the physician as well.
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Affiliation(s)
- Atara Messinger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sunit Das
- Division of Neurosurgery and Centre for Ethics, University of Toronto, Toronto, Ontario, Canada
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Lim HY, Ooi SBS. A systems thinking approach to tackle the national challenge of burnout among healthcare workers. Singapore Med J 2023:384048. [PMID: 37675675 DOI: 10.4103/singaporemedj.smj-2021-317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Huai Yang Lim
- National Preventive Medicine Residency Programme, National University Health System, Singapore
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Steinberg DP, Faurot KR, Thompson KL, Alexander JJ, Braza DW, Cuccurullo S, Herrera J, Sliwa J, Weiss L. Burnout and Wellness Strategies Used by Academic Physiatry Programs: An Analysis and Perspective From the AAP Chairs Council. Am J Phys Med Rehabil 2023; 102:728-735. [PMID: 37026874 DOI: 10.1097/phm.0000000000002245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
ABSTRACT Physiatrists are at elevated risk of burnout, a work-related exhaustion syndrome resulting from chronic stress associated with emotionally draining work demands. The high reported rate of burnout in physical medicine and rehabilitation led the Association of Academic Physiatrists Chair Council to convene a workgroup to address burnout among academic physical medicine and rehabilitation physicians. The council recognizes that leaders of departments are accountable for all organizational stakeholders, including faculty, trainees, and staff. Department leaders are expected to understand and effectively manage the drivers of burnout among stakeholders. The workgroup identified several opportunities, including identifying and disseminating effective burnout mitigation across US academic medical center physical medicine and rehabilitation programs. As a result, in 2019, a work group conducted a survey of US academic physical medicine and rehabilitation program leaders to ascertain the use of strategies for reducing physician burnout. With the aim of identifying, educating, and advancing the development of effective interventions to address burnout among academic physical medicine and rehabilitation departments, the Association of Academic Physiatrists Chair Council advocates for increased education and utilization of effective strategies aimed at promoting physician well-being across organizational levels (national, organizational, work unit, and individual).
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Affiliation(s)
- David P Steinberg
- From the Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah (DPS); Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, North Carolina (KRF, KLT, JJA); Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin (DWB); Department of Physical Medicine and Rehabilitation, Rutgers-Robert Wood Johnson Medical School, Rutgers, New Jersey (SC); Department of Rehabilitation and Human Performance, Mount Sinai Health System, New York, New York (JH); Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (JS); and Department of Rehabilitation Medicine, NYU LongIsland School of Medicine, Mineola, New York (LW)
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Sullivan AB, Davin SA, Lapin B, Schuster AT, Dweik RA, Murray KF, Rehm SJ, Machado AG. Effects of flexible scheduling and virtual visits on burnout for clinicians: 1- year follow-up. Mult Scler Relat Disord 2023; 75:104721. [PMID: 37178579 DOI: 10.1016/j.msard.2023.104721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/28/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023]
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Song HI, Yun JA, Ahn YS, Choi KS. Validating a Korean Version of the Single-Item Burnout Measure for Evaluating Burnout Among Doctors. Psychiatry Investig 2023; 20:681-688. [PMID: 37525618 PMCID: PMC10397769 DOI: 10.30773/pi.2022.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/23/2023] [Accepted: 05/24/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE It is essential to measure the effect of burnout on doctors because burnout can affect doctors' mental health as well as the functioning of medical practice. This study aims to validate a Korean version of the single-item burnout measure (SIBM), which was developed to quickly measure the level of burnout among doctors. METHODS Through an online survey, a self-report questionnaire was administered to 324 public health doctors in Korea. The Korean version of the SIBM was validated against the Maslach Burnout Inventory-General Survey (MBI-GS), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) screening tool, the Perceived Stress Scale (PSS), and the Vaccination Attitudes Examination (VAX) scale. Pearson correlation coefficients and analysis of variance (ANOVA) were used to determine the association between the SIBM and other scales. ANOVA was additionally used to determine the associations between the subscales of the MBI-GS and those of the SIBM. RESULTS The correlation coefficient between the SIBM and the MBI-GS, PHQ-9, GAD-7, and PSS was positive (p<0.01), and the correlation coefficient between the SIBM and the VAX scale was not significant. Therefore, convergent and discriminant validity was verified. Exhaustion and cynicism, which were correlated with the SIBM, with r2=0.43 (p<0.01) and 0.48 (p<0.01), yielded R2 scores of 0.27 (p<0.01) and 0.20 (p<0.01) in ANOVA. CONCLUSION The Korean version of the SIBM is an appropriate screening tool for burnout. It can be evaluated in a short time, thereby enhancing continuous follow-up observations and response rates to burnout.
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Affiliation(s)
- Hye-in Song
- Department of Neuropsychiatry, Eulji University School of Medicine, Daejeon, Republic of Korea
- Department of Psychiatry, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji-Ae Yun
- Department of Neuropsychiatry, Eulji University School of Medicine, Daejeon, Republic of Korea
- Department of Neuropsychiatry, Daejeon Eulji Medical Center, Eulji University, Daejeon, Republic of Korea
| | - Yeon-Soon Ahn
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Kyeong-Sook Choi
- Department of Neuropsychiatry, Eulji University School of Medicine, Daejeon, Republic of Korea
- Department of Neuropsychiatry, Daejeon Eulji Medical Center, Eulji University, Daejeon, Republic of Korea
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A qualitative study of the dark and bright sides of physicians' electronic health record work outside work hours. Health Care Manage Rev 2023; 48:140-149. [PMID: 36820608 DOI: 10.1097/hmr.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The introduction of electronic health records (EHRs) has contributed considerably to EHR work outside work (WOW) hours for physicians. Prior research has identified the pressures associated with stress resulting from EHR WOW, yet developing a nuanced understanding of how physicians appraise and respond to this stress, and the resulting impacts, remains absent from the literature. PURPOSE Grounded in the technostress model, this study takes a qualitative approach to explore both the pressures and opportunities associated with EHR WOW. METHODS Thematic analysis of data from semistructured interviews was utilized to examine the pressures and opportunities associated with EHR WOW among primary care pediatricians (n = 15) affiliated with a large Midwestern pediatric health system. RESULTS The physicians in this study regularly spent time working in the EHR outside work hours. They felt the EHR contributed to their documentation burden, which ultimately increased their EHR WOW, and reported a sense of burden from ubiquitous EHR availability. Conversely, they appreciated the flexibility the EHR provided in terms of work-life balance. Suggestions for improvement under the direct purview of practice management included enhanced EHR usability, improvements in workflow during work hours to free up time to document, and more training on both EHR documentation strategies and ongoing software upgrades. CONCLUSION Physicians perceive that the EHR exerts certain pressures while affording new opportunities and conveniences. This study provides evidence of both the pressures and opportunities of EHR WOW and their effect on physician well-being. PRACTICE IMPLICATIONS Specific opportunities are identified for health administrators to enable physicians to better manage EHR WOW.
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Solms L, van Vianen AEM, Koen J, Kan KJ, de Hoog M, de Pagter APJ. Physician exhaustion and work engagement during the COVID-19 pandemic: A longitudinal survey into the role of resources and support interventions. PLoS One 2023; 18:e0277489. [PMID: 36724165 PMCID: PMC9891506 DOI: 10.1371/journal.pone.0277489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/27/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Physicians increasingly show symptoms of burnout due to the high job demands they face, posing a risk for the quality and safety of care. Job and personal resources as well as support interventions may function as protective factors when demands are high, specifically in times of crisis such as the COVID-19 pandemic. Based on the Job Demands-Resources theory, this longitudinal study investigated how monthly fluctuations in job demands and job and personal resources relate to exhaustion and work engagement and how support interventions are associated with these outcomes over time. METHODS A longitudinal survey consisting of eight monthly measures in the period 2020-2021, completed by medical specialists and residents in the Netherlands. We used validated questionnaires to assess job demands (i.e., workload), job resources (e.g., job control), personal resources (e.g., psychological capital), emotional exhaustion, and work engagement. Additionally, we measured the use of specific support interventions (e.g., professional support). Multilevel modeling and longitudinal growth curve modeling were used to analyze the data. RESULTS 378 medical specialists and residents were included in the analysis (response rate: 79.08%). Workload was associated with exhaustion (γ = .383, p < .001). All job resources, as well as the personal resources psychological capital and self-judgement were associated with work engagement (γs ranging from -.093 to .345, all ps < .05). Job control and psychological capital attenuated the workload-exhaustion relationship while positive feedback and peer support strengthened it (all ps < .05). The use of professional support interventions (from a mental health expert or coach) was related to higher work engagement (estimate = .168, p = .032) over time. Participation in organized supportive group meetings was associated with higher exhaustion over time (estimate = .274, p = .006). CONCLUSIONS Job and personal resources can safeguard work engagement and mitigate the risk of emotional exhaustion. Professional support programs are associated with higher work engagement over time, whereas organized group support meetings are associated with higher exhaustion. Our results stress the importance of professional individual-level interventions to counteract a loss of work engagement in times of crisis.
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Affiliation(s)
- Lara Solms
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Annelies E. M. van Vianen
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jessie Koen
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Sustainable Productivity and Employability, Netherlands Organization for Applied Scientific Research, Leiden, The Netherlands
| | - Kees-Jan Kan
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthijs de Hoog
- Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne P. J. de Pagter
- Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
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Sullivan AB, Hersh CM, Rensel M, Benzil D. Leadership Inequity, Burnout, and Lower Engagement of Women in Medicine. JOURNAL OF HEALTH SERVICE PSYCHOLOGY 2023; 49:33-39. [PMID: 36718386 PMCID: PMC9879246 DOI: 10.1007/s42843-023-00078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Gender parity has been reached in graduation rates from medical school, yet women in medicine continue to face obstacles in promotion, compensation and opportunities, leading to leadership inequity, higher burnout and lower engagement. These complex issues with gender are just one aspect of the wide challenges related to diversity, equity and inclusion among medical professionals. While there are no "one size fits all" approaches, psychologists are well positioned to lead efforts related to promoting leadership equity, reducing burnout and raising engagement because of their training in communication skills, programmatic development and empathetic listening. This paper details several evidence-based efforts in which psychologists can lead in these ongoing issues for women in medicine.
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Vasquez-Purí C, Plaza-Ccuno JNR, Soriano-Moreno AN, Calizaya-Milla YE, Saintila J. Burnout, Fat Intake, and Body Mass Index in Health Professionals Working in a Public Hospital: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231189601. [PMID: 37515358 PMCID: PMC10387774 DOI: 10.1177/00469580231189601] [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: 04/26/2022] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
Burnout can have a negative influence on dietary intake, promoting unhealthy eating behaviors in health care workers. This study determined the association between burnout, saturated fat intake, and body mass index (BMI) in a group of health care workers. A cross-sectional study was conducted in 300 health professionals residing in Rioja, Department of San Martin, Peru. Data were collected through an online and face-to-face survey. Burnout was assessed using a scale adapted and validated in the Peruvian population. Additionally, a validated food frequency questionnaire (FFQ) was used to assess habitual fat intake. Both instruments were validated and adapted to the Peruvian population. Data were analyzed using Pearson correlation coefficients and multivariate logistic regression. Values of P < .05 were considered statistically significant. In the adjusted model, it was found that, for each extra point on intake scale, an average of 1.10 (95% CI, 0.57-1.62, P < .001) points increased burnout scale; these results persisted when compared by gender, 1.17 0.49 1.85, and 1.08 0.16 2.00, respectively female male genders. there no association between bmi (P > .05). Future programs and interventions should be considered to minimize the effects of burnout on unhealthy food intake in health care workers in Peru to ensure better medical care by health care professionals on behalf of patients.
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Mohseni F, Mohammadi A, Mafinejad MK, Gruppen LD, Khajavirad N. Development and validation of conflict management attitude questionnaire for medical students. BMC MEDICAL EDUCATION 2022; 22:860. [PMID: 36510225 PMCID: PMC9746217 DOI: 10.1186/s12909-022-03928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Medical students should effectively manage conflicts in teamwork and communication with other team members. This study aimed to develop and validate a tool to evaluate attitude of medical students and physicians toward conflict management. METHOD A multi-step process was employed to develop and validate a Conflict Management Attitude Questionnaire (CMAQ) based on the steps recommended in AMEE Guide No. 87. First, the initial items were obtained from the literature review and focus group. After cognitive interviews with the medical students and revision of the questionnaire, content validity was performed by experts. The construct validity and reliability of the questionnaire were assessed using exploratory Factor Analysis (EFA) and Cronbach's alpha coefficient, respectively. RESULTS This multi-step process resulted in a 12-item, five-point Likert-type questionnaire with satisfactory construct validity. Exploratory factor analysis revealed three factors, comprising the four items from the "perceived interactions in conflict management" subscale loading on the first factor, and five items from the "perceived value of learning conflict management" subscale loading on the second factor, along with three items from the "perceived application of conflict management" subscale loading on the third factor. All subscales described 56.48% of the variance. Validation results showed that Content Validity Index (CVI) and Content Validity Ratio (CVR) were greater than 0.75. Cronbach's alpha coefficient was 0.791. CONCLUSION This study showed that CMAQ has valid evidence for assessing the attitude of medical students toward conflict management with favorable psychometric properties and strong evidence of construct validity. However, due to the lack of evidence on any specific questionnaire to evaluate the attitude towards conflict management, future studies should conduct a confirmatory investigation regarding other aspects of medical students' attitudes toward conflict management.
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Affiliation(s)
- Fatemeh Mohseni
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
- Education Development Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Aeen Mohammadi
- Department of E-Learning in Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Khabaz Mafinejad
- Health Professions Education Research Center, Education Development Center, Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran.
| | - Larry D Gruppen
- PhD, Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Nasim Khajavirad
- Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Baxter SL, Saseendrakumar BR, Cheung M, Savides TJ, Longhurst CA, Sinsky CA, Millen M, Tai-Seale M. Association of Electronic Health Record Inbasket Message Characteristics With Physician Burnout. JAMA Netw Open 2022; 5:e2244363. [PMID: 36449288 PMCID: PMC9713605 DOI: 10.1001/jamanetworkopen.2022.44363] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IMPORTANCE Physician burnout is an ongoing epidemic; electronic health record (EHR) use has been associated with burnout, and the burden of EHR inbasket messages has grown in the context of the COVID-19 pandemic. Understanding how EHR inbasket messages are associated with physician burnout may uncover new insights for intervention strategies. OBJECTIVE To evaluate associations between EHR inbasket message characteristics and physician burnout. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study in a single academic medical center involving physicians from multiple specialties. Data collection took place April to September 2020, and data were analyzed September to December 2020. EXPOSURES Physicians responded to a survey including the validated Mini-Z 5-point burnout scale. MAIN OUTCOMES AND MEASURES Physician burnout according to the self-reported burnout scale. A sentiment analysis model was used to calculate sentiment scores for EHR inbasket messages extracted for participating physicians. Multivariable modeling was used to model risk of physician burnout using factors such as message characteristics, physician demographics, and clinical practice characteristics. RESULTS Of 609 physicians who responded to the survey, 297 (48.8%) were women, 343 (56.3%) were White, 391 (64.2%) practiced in outpatient settings, and 428 (70.28%) had been in medical practice for 15 years or less. Half (307 [50.4%]) reported burnout (score of 3 or higher). A total of 1 453 245 inbasket messages were extracted, of which 630 828 (43.4%) were patient messages. Among negative messages, common words included medical conditions, expletives and/or profanity, and words related to violence. There were no significant associations between message characteristics (including sentiment scores) and burnout. Odds of burnout were significantly higher among Hispanic/Latino physicians (odds ratio [OR], 3.44; 95% CI, 1.18-10.61; P = .03) and women (OR, 1.60; 95% CI, 1.13-2.27; P = .01), and significantly lower among physicians in clinical practice for more than 15 years (OR, 0.46; 95% CI, 0.30-0.68; P < .001). CONCLUSIONS AND RELEVANCE In this cross-sectional study, message characteristics were not associated with physician burnout, but the presence of expletives and violent words represents an opportunity for improving patient engagement, EHR portal design, or filters. Natural language processing represents a novel approach to understanding potential associations between EHR inbasket messages and physician burnout and may also help inform quality improvement initiatives aimed at improving patient experience.
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Affiliation(s)
- Sally L Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
- Department of Medicine, University of California, San Diego, La Jolla
| | - Bharanidharan Radha Saseendrakumar
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| | - Michael Cheung
- Department of Family Medicine, University of California, San Diego, La Jolla
| | - Thomas J Savides
- Department of Medicine, University of California, San Diego, La Jolla
| | - Christopher A Longhurst
- Department of Medicine, University of California, San Diego, La Jolla
- Department of Pediatrics, University of California, San Diego, La Jolla
| | | | - Marlene Millen
- Department of Medicine, University of California, San Diego, La Jolla
| | - Ming Tai-Seale
- Department of Medicine, University of California, San Diego, La Jolla
- Department of Family Medicine, University of California, San Diego, La Jolla
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Chandrabhatla T, Asgedom H, Gaudiano ZP, de Avila L, Roach KL, Venkatesan C, Weinstein AA, Younossi ZM. Second victim experiences and moral injury as predictors of hospitalist burnout before and during the COVID-19 pandemic. PLoS One 2022; 17:e0275494. [PMID: 36194588 PMCID: PMC9531782 DOI: 10.1371/journal.pone.0275494] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background The increasing number of physicians leaving practice, especially hospitalists, has been well-documented. The most commonly examined factor associated with this exodus has been burnout. The COVID-19 pandemic has put a unique and unprecedented stress on hospitalists who have been at the front lines of patient care. Therefore, the investigation of burnout and its related factors in hospitalists is essential to preventing future physician shortages. Objective This study examined the relationship between burnout, second victim, and moral injury experiences before and during the COVID-19 pandemic among hospitalists. Methods Two anonymous cross-sectional surveys of hospitalists from a community hospital in the metropolitan Washington, DC area were conducted. One was conducted pre-COVID-19 (September-November 2019) and one was conducted during COVID-19 (July-August 2020). The surveys were sent to all full-time hospitalists via an online survey platform. A variety of areas were assessed including demographic (e.g., age, gender), work information (e.g., hours per week, years of experience), burnout, second victim experiences, well-being, and moral injury. Results Burnout rates among providers during these two time periods were similar. Second victim experiences remained prevalent in those who experienced burnout both pre and during COVID-19, but interestingly the prevalence increased in those without burnout during COVID-19. Moral injury was predictive of burnout during COVID-19. Conclusion While there were some factors that predicted burnout that were similar both pre- and during-pandemic, moral injury was unique to predicting burnout during COVID-19. With burnout as a contributing factor to future physician shortages, it is imperative that predictive factors in a variety of different environments are well understood to prevent future shortages. Hospitalists may be an excellent barometer of these factors given their presence on the front line during the pandemic, and their experiences need to be further explored so that targeted interventions aimed at addressing those factors may be created.
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Affiliation(s)
- Tejasri Chandrabhatla
- Department of Medicine, Inova Fairfax Hospital, Fairfax, VA, United States of America
| | - Henok Asgedom
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, United States of America
| | - Zehra P. Gaudiano
- Department of Medicine, Inova Fairfax Hospital, Fairfax, VA, United States of America
| | - Leyla de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States of America
| | - Kenneth L. Roach
- Department of Medicine, Inova Fairfax Hospital, Fairfax, VA, United States of America
| | - Chapy Venkatesan
- Department of Medicine, Inova Fairfax Hospital, Fairfax, VA, United States of America
| | - Ali A. Weinstein
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, United States of America
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States of America
- Center for the Advancement of Well-Being, George Mason University, Fairfax, VA, United States of America
- * E-mail:
| | - Zobair M. Younossi
- Department of Medicine, Inova Fairfax Hospital, Fairfax, VA, United States of America
- Center for the Advancement of Well-Being, George Mason University, Fairfax, VA, United States of America
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Dunbar TK, Olsen MK, Yang H, Kennedy D, Jackson LR, Thomas KL, Alkon A, Prose NS, Pollak KI. Characteristics Associated with Burnout among Cardiologists in an Academic Medical Setting: Baseline Survey Results from a Communication Coaching RCT. Behav Sci (Basel) 2022; 12:362. [PMID: 36285931 PMCID: PMC9598081 DOI: 10.3390/bs12100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Clinician burnout poses risks not just to clinicians but also to patients and the health system. Cardiologists might be especially prone to burnout due to performing high-risk procedures, having to discuss serious news, and treating diseases that incur significant morbidity and mortality. Few have attempted to examine which cardiologists might be at higher risk of burnout. Knowing at-risk cardiologists can help frame resilience interventions. METHODS We enrolled 41 cardiologists across five ambulatory cardiology clinics into a randomized controlled trial where we assessed the Maslach Burnout Inventory at baseline. We used bivariate analyses to assess associations between cardiologist demographics and burnout. RESULTS Cardiologists reported low burnout for depersonalization and personal accomplishment and moderate levels for emotional exhaustion. Female cardiologists reported emotional exhaustion scores in the "low" range (M = 12.3; SD = 10.06), compared to male cardiologists whose score was in the "moderate" range 19.6 (SD = 9.59; p = 0.113). Cardiologists who had greater than 15 years in practice reported higher mean scores of emotional exhaustion, indicating moderate burnout (M = 20.0, SD = 10.63), compared to those with less than 15 years in practice (M = 16.6, SD = 9.10; p = 0.271). CONCLUSIONS In this sample, unlike prior studies, male cardiologists reported more burnout. Consistent with prior work, mid-level cardiologists might be at highest risk of emotional exhaustion.
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Affiliation(s)
- Travia Kayla Dunbar
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Maren K. Olsen
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC 27705, USA
| | - Hongqiu Yang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, USA
| | | | - Larry R. Jackson
- Division of Cardiology, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27705, USA
| | - Kevin L. Thomas
- Division of Cardiology, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27705, USA
| | - Aviel Alkon
- Department of General Internal Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Neil S. Prose
- Department of Dermatology and Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA
| | - Kathryn I. Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Cancer Research Institute, Durham, NC 27710, USA
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Smaggus A, Long JC, Ellis LA, Clay-Williams R, Braithwaite J. Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada. Int J Health Policy Manag 2022; 11:1682-1694. [PMID: 34273936 PMCID: PMC9808212 DOI: 10.34172/ijhpm.2021.67] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/08/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Resilience, a system's ability to maintain a desired level of performance when circumstances disturb its functioning, is an increasingly important concept in healthcare. However, empirical investigations of resilience in healthcare (RiH) remain uncommon, particularly those that examine how government actions contribute to the capacity for resilient performance in the healthcare setting. We sought to investigate how governmental actions during the coronavirus disease 2019 (COVID-19) pandemic related to the concept of resilience, how these actions contributed to the potential for resilient performance in healthcare, and what opportunities exist for governments to foster resilience within healthcare systems. METHODS We conducted case studies of government actions pertaining to the COVID-19 pandemic in New South Wales, Australia and Ontario, Canada. Using media releases issued by each government between December 2019 and August 2020, we performed qualitative content analysis to identify themes relevant to the resilience potentials (anticipate, monitor, respond, learn) and RiH. RESULTS Direct references to the term 'resilience' appeared in the media releases of both governments. However, these references focused on the reactive aspects of resilience. While actions that constitute the resilience potentials were evident, the media releases also revealed opportunities to enhance learning (eg, a need to capitalize on opportunities for double-loop learning and identify strategies appropriate for complex systems) and anticipating (eg, incorporating the concept of hedging into frameworks of RiH). CONCLUSION Though fostering RiH through government action remains a challenge, this study suggests opportunities to realize this goal. Articulating a proactive vision of resilience and recognizing the complex nature of current systems could enhance governments' ability to coordinate resilient performance in healthcare. Reflection on how anticipation relates to resilience appears necessary at both the practical and conceptual levels to further develop the capacity for RiH.
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Affiliation(s)
| | - Janet C. Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Louise A. Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Hasan F, Pabari R, Wilejto M. Training for Wellness in Pediatric Oncology: A Focus on Education and Hidden Curricula. Curr Oncol 2022; 29:5579-5584. [PMID: 36005178 PMCID: PMC9406305 DOI: 10.3390/curroncol29080440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Pediatric oncologists have the privilege of caring for children and families facing serious, often life-threatening, illnesses. Providing this care is emotionally demanding and associated with significant risks of stress and burnout for oncologists. Traditional approaches to physician burnout and wellbeing have not emphasized the potential roles of education and training in mitigating this stress. In this commentary, we discuss the contribution that education, particularly in the areas of palliative and psychosocial oncology, can make in preparing oncologists for the work that they do. We argue that by adequately providing oncologists with the skills they need for their work, we can reduce their risk of burning out. We also discuss the importance of paying attention to hidden and formal curricula to ensure that messages provided in formal education programs are supported by informal training experiences.
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Affiliation(s)
- Fyeza Hasan
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Correspondence:
| | - Reena Pabari
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Marta Wilejto
- Division of Hematology/Oncology, Department of Pediatrics, London Health Sciences Center, London, ON N6A 5W9, Canada
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Yeluru H, Newton HL, Kapoor R. Physician Burnout Through the Female Lens: A Silent Crisis. Front Public Health 2022; 10:880061. [PMID: 35685758 PMCID: PMC9171323 DOI: 10.3389/fpubh.2022.880061] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Physician burnout, the emotional exhaustion and depersonalization that arises from job fatigue and dissatisfaction, is a rapidly growing problem. Although burnout has been a recognized problem for decades, our healthcare system has yet to devise a sustainable solution. Additionally, burnout does not affect all physicians in the same way- women physicians have disproportionately higher rates of burnout than male physicians. Burnout poses a tremendous risk to our public's health with its severe and debilitating effects on both physician and patient health alike. We must intervene as early as medical school and residency at both the systemic and individual levels to combat burnout. Clinical leadership training might be one sustainable approach to begin addressing burnout in female physicians.
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Affiliation(s)
| | - Heather L. Newton
- Eastern Virginia Medical School, Norfolk, VA, United States
- *Correspondence: Heather L. Newton
| | - Rupa Kapoor
- Eastern Virginia Medical School, Norfolk, VA, United States
- Children's Hospital of the King's Daughters, Norfolk, VA, United States
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Velazquez AI, Gilligan TD, Kiel LL, Graff J, Duma N. Microaggressions, Bias, and Equity in the Workplace: Why Does It Matter, and What Can Oncologists Do? Am Soc Clin Oncol Educ Book 2022; 42:1-12. [PMID: 35649205 DOI: 10.1200/edbk_350691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite efforts to embrace diversity, women and members of racial, ethnic, and gender minority groups continue to experience bias, inequities, microaggressions, and unwelcoming atmospheres in the workplace. Specifically, women in oncology have lower promotion rates and less financial support and mentorship, and they are less likely to hold leadership positions. These experiences are exceedingly likely at the intersection of identities, leading to decreased satisfaction, increased burnout, and a higher probability of leaving the workforce. Microaggressions have also been associated with depression, suicidal thoughts, and other health and safety issues. Greater workplace diversity and equity are associated with improved financial performance; greater productivity, satisfaction, and retention; improved health care delivery; and higher-quality research. In this article, we provide tools and steps to promote equity in the oncology workplace and achieve cultural change. We propose the use of tailored approaches and tools, such as active listening, for individuals to become microaggression upstanders; we also propose the implementation of education, evaluation, and transparent policies to promote a culture of equity and diversity in the oncology workplace.
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Affiliation(s)
- Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | | | - Julie Graff
- Veterans Affairs Portland Health Care System, Portland, OR
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
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Casalino LP, Li J, Peterson LE, Rittenhouse DR, Zhang M, O’Donnell EM, Phillips RL. Relationship Between Physician Burnout And The Quality And Cost Of Care For Medicare Beneficiaries Is Complex. Health Aff (Millwood) 2022; 41:549-556. [PMID: 35377764 PMCID: PMC9934398 DOI: 10.1377/hlthaff.2021.00440] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite reports of a physician burnout epidemic, there is little research on the relationship between burnout and objective measures of care outcomes and no research on the relationship between burnout and costs of care. Linking survey data from 1,064 family physicians to Medicare claims, we found no consistent statistically significant relationship between seven categories of self-reported burnout and measures of ambulatory care-sensitive admissions, ambulatory care-sensitive emergency department visits, readmissions, or costs. The coefficients for ambulatory care-sensitive admissions and readmissions for all burnout levels, compared with never being burned out, were consistently negative (fewer ambulatory care-sensitive admissions and readmissions), suggesting that, counterintuitively, physicians who report burnout may nevertheless be able to create better outcomes for their patients. Even if true, this hypothesis should not indicate that physician burnout is beneficial or that efforts to reduce physician burnout are unimportant. Our findings suggest that the relationship between burnout and outcomes is complex and requires further investigation.
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Affiliation(s)
| | - Jing Li
- Weill Cornell Medical College
| | - Lars E. Peterson
- American Board of Family Medicine, Washington, D.C., and University of Kentucky, Lexington, Kentucky
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Apathy NC, Hare AJ, Fendrich S, Cross DA. Early Changes in Billing and Notes After Evaluation and Management Guideline Change. Ann Intern Med 2022; 175:499-504. [PMID: 35188791 DOI: 10.7326/m21-4402] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The American Medical Association updated guidance in 2021 for frequently used billing codes for outpatient evaluation and management (E/M) visits. The intent was to account for provider time outside of face-to-face encounters and to reduce onerous documentation requirements. OBJECTIVE To analyze E/M visit use, documentation length, and time spent in the electronic health record (EHR) before and after the guideline change. DESIGN Observational, retrospective, pre-post study. SETTING U.S.-based ambulatory practices using the Epic Systems EHR. PARTICIPANTS 303 547 advanced practice providers and physicians across 389 organizations. MEASUREMENTS Data from September 2020 through April 2021 containing weekly provider-level E/M code and EHR use metadata were extracted from the Epic Signal database. We descriptively analyzed overall and specialty-specific changes in E/M visit use, note length, and time spent in the EHR before and after the new guidelines using provider-level paired t tests. RESULTS Following the new guidelines, level 3 visits decreased by 2.41 percentage points (95% CI, -2.48 to -2.34 percentage points) to 38.5% of all E/M visits, a 5.9% relative decrease from fall 2020. Level 4 visits increased by 0.89 percentage points (CI, 0.82 to 0.96 percentage points) to 40.9% of E/M visits, a 2.2% relative increase. Level 5 visits (the highest acuity level) increased by 1.85 percentage points (CI, 1.81 to 1.89 percentage points) to 10.1% of E/M visits, a 22.6% relative increase. These changes varied by specialty. We found no meaningful changes in measures of note length or time spent in the EHR. LIMITATION The Epic ambulatory client base may underrepresent smaller and independent practices. CONCLUSION Immediate changes in E/M coding contrast with null findings for changes in both note length and EHR time. Provider organizations are positioned to respond more rapidly to billing process changes than to changes in care delivery and associated EHR use behaviors. Fully realizing the intended benefits of this guideline change will require more time, facilitation, and scaling of best practices that more directly address EHR documentation practices and associated burden. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Nate C Apathy
- Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, and Regenstrief Institute, Indianapolis, Indiana (N.C.A.)
| | - Allison J Hare
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (A.J.H., S.F.)
| | - Sarah Fendrich
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (A.J.H., S.F.)
| | - Dori A Cross
- Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (D.A.C.)
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Millstein JH. Rescuing Empathy. J Patient Exp 2022; 9:23743735221079135. [PMID: 35155756 PMCID: PMC8829714 DOI: 10.1177/23743735221079135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Effects of Flexible Scheduling and Virtual Visits on Burnout for Clinicians. Mult Scler Relat Disord 2022; 60:103705. [DOI: 10.1016/j.msard.2022.103705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/09/2022] [Accepted: 02/19/2022] [Indexed: 11/23/2022]
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Rubanovich CK, Zisook S, Bloss CS. Associations Between Privacy-Related Constructs and Depression and Suicide Risk in Health Care Professionals, Trainees, and Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:239-246. [PMID: 34789664 DOI: 10.1097/acm.0000000000004513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The University of California, San Diego screens health care professionals, trainees, and students for depression and suicide risk. Individuals complete a voluntary, anonymous online screening tool and choose whether to provide personal demographic information. This study assessed the relationship between privacy-related constructs and self-rated depression and suicide risk. METHOD The authors analyzed responses to the screening tool collected from January 2018 to December 2019. Measures of depression, suicidal ideation and behaviors, and worry about stigma for seeking mental health services (i.e., privacy-related concern) were gathered. The number of demographic item nonresponses (i.e., age, gender, ethnicity/race, professional position) was operationalized as privacy-related behavior. Linear and logistic regression models were used to determine associations between privacy-related constructs (concern and behavior) and depression and suicide measures. RESULTS A total of 1,224 respondents were included. On average, respondents reported mild depression (mean = 9.12, standard deviation = 5.94), but 43% (524/1,224) reported at least moderate depression. One in 5 respondents (248/1,224) reported worry about stigma for seeking mental health services, and more than 17% (212/1,224) skipped at least 1 demographic question. Privacy-related concern was statistically significantly and positively associated with recent depression and suicidal ideation and behaviors (odds ratios [ORs] = 3.13-7.02; 95% confidence interval [CI], 2.23-19.20; P's < .001) and with lifetime suicide attempts (OR = 1.76; 95% CI, 1.08-2.86; P = .02). Privacy-related behavior was statistically significantly and positively associated with suicide action (OR = 2.23; 95% CI, 1.24-4.02; P = .008). CONCLUSIONS Privacy-related constructs may be meaningful correlates of mental health as respondents who endorsed these constructs had increased odds of worse depression and suicidal ideation and behaviors. Considering privacy-related constructs may be useful for identifying health care professionals, trainees, and students experiencing distress and in need of imminent mental health resources.
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Affiliation(s)
- Caryn Kseniya Rubanovich
- C.K. Rubanovich is a doctoral student, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, California; ORCID: https://orcid.org/0000-0002-0975-6416
| | - Sidney Zisook
- S. Zisook is distinguished professor, Department of Psychiatry, and director, Healer Education Assessment and Referral (HEAR) program, University of California, San Diego, La Jolla, California; ORCID: https://orcid.org/0000-0003-3341-9185
| | - Cinnamon S Bloss
- C.S. Bloss is professor, Herbert Wertheim School of Public Health and Human Longevity Science, director, Center for Empathy and Technology, and associate director, T. Denny Sanford Institute for Empathy and Compassion, University of California, San Diego, La Jolla, California; ORCID: https://orcid.org/0000-0003-1315-8387
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Cawyer CR, Blanchard C, Kim KH. Financial Literacy and Physician Wellness: Can a Financial Curriculum Improve an Obstetrician/Gynecologist Resident and Fellow's Well-Being? AJP Rep 2022; 12:e64-e68. [PMID: 35141038 PMCID: PMC8816634 DOI: 10.1055/s-0041-1742268] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to evaluate the effects of a financial literacy curriculum on resident and fellow's sense of well-being and financial stress. Study Design This single institution pilot study prospectively enrolled obstetrician/gynecologist (OB/GYN) medical trainees (residents and fellows) to take part in a five-part personal financial literacy curriculum during the 2019 to 2020 academic year. Topics covered included the following: financial education and its relationship to personal well-being, overview of financial terms and principles, budgeting, debt planning, and investing and giving. Primary outcomes were the improvement in well-being as measured by the Expanded Well-Being Index (E-WBI) and financial stress as measured by the Financial Stress Scale-College Version (FSS-CV) survey. Results Of the 35 residents and fellows who participated in the study, 21 (60%) completed the postintervention survey. After course completion, there was significant improvement in the individual's E-WBI ( p < 0.05) and no significant improvement in their FSS-CV ( p = 0.06). After completing the course, trainees agreed that financial literacy improved their sense of well-being ( p = 0.018). Conclusion Cultivating financial literacy is associated with an improvement in the sense of well-being in residents and fellows and should be considered for inclusion in other graduate medical education (GME) programs.
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Affiliation(s)
- Chase R Cawyer
- Division of Maternal Fetal Medicine, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina Blanchard
- Statistician I, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth H Kim
- Division of Gynecology Oncology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
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Attipoe S, Hoffman J, Rust S, Huang Y, Barnard JA, Schweikhart S, Hefner JL, Walker DM, Linwood S. Characterization of Electronic Health Record Use Outside Scheduled Clinic Hours among Primary Care Pediatricians: A Retrospective Descriptive Task Analysis of Electronic Health Record Access Log Data (Preprint). JMIR Med Inform 2021; 10:e34787. [PMID: 35551055 PMCID: PMC9136654 DOI: 10.2196/34787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/01/2022] [Accepted: 03/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many of the benefits of electronic health records (EHRs) have not been achieved at expected levels because of a variety of unintended negative consequences such as documentation burden. Previous studies have characterized EHR use during and outside work hours, with many reporting that physicians spend considerable time on documentation-related tasks. These studies characterized EHR use during and outside work hours using clock time versus actual physician clinic schedules to define the outside work time. Objective This study aimed to characterize EHR work outside scheduled clinic hours among primary care pediatricians using a retrospective descriptive task analysis of EHR access log data and actual physician clinic schedules to define work time. Methods We conducted a retrospective, exploratory, descriptive task analysis of EHR access log data from primary care pediatricians in September 2019 at a large Midwestern pediatric health center to quantify and identify actions completed outside scheduled clinic hours. Mixed-effects statistical modeling was used to investigate the effects of age, sex, clinical full-time equivalent status, and EHR work during scheduled clinic hours on the use of EHRs outside scheduled clinic hours. Results Primary care pediatricians (n=56) in this study generated 1,523,872 access log data points (across 1069 physician workdays) and spent an average of 4.4 (SD 2.0) hours and 0.8 (SD 0.8) hours per physician per workday engaged in EHRs during and outside scheduled clinic hours, respectively. Approximately three-quarters of the time working in EHR during or outside scheduled clinic hours was spent reviewing data and reports. Mixed-effects regression revealed no associations of age, sex, or clinical full-time equivalent status with EHR use during or outside scheduled clinic hours. Conclusions For every hour primary care pediatricians spent engaged with the EHR during scheduled clinic hours, they spent approximately 10 minutes interacting with the EHR outside scheduled clinic hours. Most of their time (during and outside scheduled clinic hours) was spent reviewing data, records, and other information in EHR.
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Affiliation(s)
- Selasi Attipoe
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Jeffrey Hoffman
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Steve Rust
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Yungui Huang
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - John A Barnard
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Sharon Schweikhart
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Jennifer L Hefner
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Daniel M Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Simon Linwood
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
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Oben P. The Missing Piece in the Current Patient Experience Movement in Healthcare. J Patient Exp 2021; 8:23743735211060615. [PMID: 34869841 PMCID: PMC8640300 DOI: 10.1177/23743735211060615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Patrick Oben
- Patient Experience, MercyOne Des Moines, Des Moines, IA, USA
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Sales PMG, Arshed A, Cosmo C, Li P, Garrett M, Cohen MA. Burnout and Moral Injury Among Consultation-Liaison Psychiatry Trainees. Psychodyn Psychiatry 2021; 49:543-561. [PMID: 34870461 DOI: 10.1521/pdps.2021.49.4.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Burnout and moral injury within medicine have steadily increased over the last decades, especially among those providing care during the COVID-19 pandemic. The term burnout has been used to describe clinician distress and a syndrome of emotional exhaustion, a diminished sense of personal accomplishment, and depersonalization. Burnout has a significant impact on both job performance and patient care. Moral injury occurs when external circumstances interact with a person's cherished beliefs and standards. When the tension between them cannot be reconciled, the felt integrity of the individual is disrupted and the person experiences distress. The consultative aspect in consultation-liaison psychiatry (CLP) presents challenges that may predispose the young clinician to burnout and moral injury, especially during fellowship training. CLP psychiatrists also have a liaison role that could catalyze systemlevel change to enhance the mental well-being of their colleagues. This article reviews clinically relevant psychodynamic aspects of burnout and moral injury during CLP training. In addition, the authors propose strategies to enhance career growth and prevent and address moral injury during training to generate fulfilling professional development.
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Affiliation(s)
- Paulo M G Sales
- An Assistant Professor of Psychiatry at the University of Alabama, Birmingham
| | - Arslaan Arshed
- A Clinical Assistant Professor of Psychiatry at the NYU Grossman School of Medicine, New York
| | - Camila Cosmo
- A Psychiatry Resident at the Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, and VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA, Providence, Rhode Island
| | - Paula Li
- A medical student at The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael Garrett
- A Clinical Professor of Psychiatry at SUNY Downstate, New York
| | - Mary Ann Cohen
- A Clinical Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, New York
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Predictors of Burnout in Hospital Health Workers during the COVID-19 Outbreak in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111720. [PMID: 34770231 PMCID: PMC8582777 DOI: 10.3390/ijerph182111720] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/24/2021] [Accepted: 11/03/2021] [Indexed: 01/01/2023]
Abstract
This study aimed to identify the factors that influence the components of burnout—emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA)—among hospital health workers, including doctors and nurses, during the COVID-19 pandemic. We analyzed 200 healthcare workers’ responses to the Employee Health Promotion Survey conducted at a general hospital in Seoul with over 200 hospital beds. The questionnaire included items about COVID-19-related burnout and its influencing factors. We performed three different multiple regression analyses using EE, DP, and PA as the dependent variables. The results show that sex, marital status, workload of treating suspected COVID-19 patients, fear of COVID-19 infection, anxiety, and depression predicted EE. The predictors of DP were job category, consecutive months of work in the current department, satisfaction with work environment, anxiety, and depression. The predictors of PA were the workload of directly interacting with patients, socioeconomic status, and job stress. For EE and DP, burnout was found to be worse in doctors and nurses than in other health workers; moreover, burnout was worse among nurses than among doctors across all three aspects of burnout. The findings can be used to establish tailored policies to address each burnout component.
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Abstract
BACKGROUND Professional identity formation (PIF) in medical students is a multifactorial phenomenon, shaped by ways that clinical and non-clinical experiences, expectations and environmental factors merge with individual values, beliefs and obligations. The relationship between students' evolving professional identity and self-identity or personhood remains ill-defined, making it challenging for medical schools to support PIF systematically and strategically. Primarily, to capture prevailing literature on PIF in medical school education, and secondarily, to ascertain how PIF influences on medical students may be viewed through the lens of the ring theory of personhood (RToP) and to identify ways that medical schools support PIF. METHODS A systematic scoping review was conducted using the systematic evidence-based approach. Articles published between 1 January 2000 and 1 July 2020 related to PIF in medical students were searched using PubMed, Embase, PsycINFO, ERIC and Scopus. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. Concurrent thematic and directed content analyses were used to evaluate the data. RESULTS A total of 10443 abstracts were identified, 272 full-text articles evaluated, and 76 articles included. Thematic and directed content analyses revealed similar themes and categories as follows: characteristics of PIF in relation to professionalism, role of socialization in PIF, PIF enablers and barriers, and medical school approaches to supporting PIF. DISCUSSION PIF involves iterative construction, deconstruction and inculcation of professional beliefs, values and behaviours into a pre-existent identity. Through the lens of RToP, factors were elucidated that promote or hinder students' identity development on individual, relational or societal levels. If inadequately or inappropriately supported, enabling factors become barriers to PIF. Medical schools employ an all-encompassing approach to support PIF, illuminating the need for distinct and deliberate longitudinal monitoring and mentoring to foster students' balanced integration of personal and professional identities over time.
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McFarland DC, Hlubocky F. Therapeutic Strategies to Tackle Burnout and Emotional Exhaustion in Frontline Medical Staff: Narrative Review. Psychol Res Behav Manag 2021; 14:1429-1436. [PMID: 34552358 PMCID: PMC8450185 DOI: 10.2147/prbm.s256228] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
Burnout and emotional exhaustion in frontline healthcare workers and their implications for the health of patients, individual clinicians, and organizations are increasingly described among various healthcare settings. Yet therapeutic strategies to address burnout and other work-related conditions are outpaced by innumerable descriptions of burnout prevalence across healthcare disciplines. This review provides a framework that should be helpful in beginning the process of addressing burnout and its related conditions. It begins with an elucidation of key inter-related concepts of work-related conditions that should be considered in the differential diagnosis along with other mental health conditions that are concomitantly elevated in healthcare clinicians (eg, depression and substance abuse) but require a different approach to treatment. Factors that lead to increased resilience, engagement, and thriving in clinical workplaces are considered. While strategies are dichotomized between organizational level interventions and individual or personal interventions to address burnout, the idea of identifying and addressing root causes of burnout and related conditions is highlighted. The efficacy and feasibility of interventions that incorporate mindfulness-based stress reduction, cognitive behavioral strategies, meaning-centered therapy, and compassion training are highlighted as interventions with proven efficacy and durability that should be considered based on work-related stressors and appeal to clinicians.
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Affiliation(s)
- Daniel C McFarland
- Department of Medicine, Northwell Health Cancer Institute, Lenox Hill Hospital, New York, NY, USA
| | - Fay Hlubocky
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, MacLean Center for Clinical Medical Ethics, and the Cancer Research Center, Chicago, IL, USA
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Rediscovering Meaning and Purpose: An Approach to Burnout in the Time of COVID-19 and Beyond. Am J Med 2021; 134:1065-1067. [PMID: 33989605 PMCID: PMC9746258 DOI: 10.1016/j.amjmed.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022]
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Dymek C, Kim B, Melton GB, Payne TH, Singh H, Hsiao CJ. Building the evidence-base to reduce electronic health record-related clinician burden. J Am Med Inform Assoc 2021; 28:1057-1061. [PMID: 33340326 DOI: 10.1093/jamia/ocaa238] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/10/2020] [Indexed: 12/23/2022] Open
Abstract
Clinicians face competing pressures of being clinically productive while using imperfect electronic health record (EHR) systems and maximizing face-to-face time with patients. EHR use is increasingly associated with clinician burnout and underscores the need for interventions to improve clinicians' experiences. With an aim of addressing this need, we share evidence-based informatics approaches, pragmatic next steps, and future research directions to improve 3 of the highest contributors to EHR burden: (1) documentation, (2) chart review, and (3) inbox tasks. These approaches leverage speech recognition technologies, natural language processing, artificial intelligence, and redesign of EHR workflow and user interfaces. We also offer a perspective on how EHR vendors, healthcare system leaders, and policymakers all play an integral role while sharing responsibility in helping make evidence-based sociotechnical solutions available and easy to use.
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Affiliation(s)
- Christine Dymek
- Division of Digital Healthcare Research, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| | - Bryan Kim
- Healthcare Delivery and Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Genevieve B Melton
- Department of Surgery and Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Thomas H Payne
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Chun-Ju Hsiao
- Division of Digital Healthcare Research, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
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Nishi M, Yamano M, Matoba S. Prediction of well-being and insight into work-life integration among physicians using machine learning approach. PLoS One 2021; 16:e0254795. [PMID: 34265012 PMCID: PMC8282024 DOI: 10.1371/journal.pone.0254795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/03/2021] [Indexed: 11/19/2022] Open
Abstract
There has been increasing interest in examining physician well-being and its predictive factors. However, few studies have revealed the characteristics associated with physician well-being and work-life integration using a machine learning approach. To investigate predictive factors of well-being and obtain insights into work-life integration, the survey was conducted by letter mail in a sample of Japanese physicians. A total of 422 responses were collected from 846 physicians. The mean age was 47.9 years, males constituted 83.3% of the physicians, and 88.6% were considered to be well. The most accurate machine learning model showed a mean area under the curve of 0.72. The mean permutation importance of career satisfaction, work hours per week, existence of family support, gender, and existence of power harassment were 0.057, 0.022, 0.009, 0.01, and 0.006, respectively. Using a machine learning model, physician well-being could be predicted. It seems to be influenced by multiple factors, such as career satisfaction, work hours per week, family support, gender, and power harassment. Career satisfaction has the highest impact, while long work hours have a negative effect on well-being. These findings support the need for organizational interventions to promote physician well-being and improve the quality of medical care.
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Affiliation(s)
- Masahiro Nishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Cardiovascular Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Abstract
Background: Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. The aim of this study was to identify burnout incidence in pediatric residents and evaluate possible risk factors for burnout. Methods: Using a cross-sectional study design, we approached all pediatric residents in the Saudi Pediatrics Residency Program in Riyadh, Saudi Arabia (n=457) between January and March 2019. The Maslach Burnout Inventory-Human Services Survey was used to assess burnout incidence. In addition, demographic factors, schedule burden, career choice satisfaction, and work-life balance were assessed. Results: The response rate was 57.8% (264/457). Males represented 46.6%. Only 14% of the residents in the study were satisfied with their work-life balance, and 62% were satisfied with their career choice of pediatrics. The overall high burnout incidence was 15.9%, the high emotional exhaustion incidence was 63.6%, the high depersonalization incidence was 27.7%, and the low sense of personal accomplishment incidence was 48.5%. In the multivariate analysis, an increase in the average number of on-calls per month (odds ratio [OR]=1.66, 95% CI 1.12-2.46; P=0.012) and satisfaction with salary (OR=0.47, 95% CI 0.33-0.66; P<0.001) showed significant associations with high overall burnout. Conclusion: We found a high level of emotional exhaustion and a low sense of personal accomplishment among respondents. However, less than one-third of residents had feelings of depersonalization or overall high burnout. Residency program directors may need to make modifications in their programs to ensure a good work-life balance for residents that will help ensure that these physicians provide safe and sustained patient care.
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Pearl A, Mrozowski S, Shapiro D. Where There’s Smoke: Validating a Nonproprietary Single-Item Burnout-Impacting-Safety Scale. PATIENT SAFETY 2021. [DOI: 10.33940/culture/2021.6.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study aimed to assess the utility of a single survey item to predict the impact of burnout on safety and quality of healthcare providers as perceived by their colleagues. The primary objective is to determine if the item predicts the frequency of patient safety event reports within certain clinical departments. The secondary objective will be to determine if there is an acceptable cutoff score for the item which predicts low versus high numbers of safety events reported by healthcare providers in each clinical department. Participants were 424 healthcare providers in an academic medical center in the mid-Atlantic region of the United States. The item was designed to assess for the perception of the impact of burnout on work in terms of quality or safety using a 5-point
Likert scale. Data from a patient safety event reporting system was accessed for the year of survey completion (2017). A negative binomial regression was used to assess the ability of the item to predict reported patient safety event reports. The item was found
to significantly predict objective safety event data. Sensitivity and specificity, as well as receiver operating characteristic (ROC) curve analyses, were conducted to determine appropriateness of cutoff scores to identify low- and high-risk clinical departments. The
item was found to demonstrate adequate sensitivity (82%) using a cutoff score of 4 on the survey item. However, the area under the curves (AUCs) which assess diagnostic accuracy fell in the poor range. These results suggest that healthcare administrators
could deploy this single item as a brief pulse or screener of teams of individuals who are within a work unit and use a cutoff score of 4 as a means to assess for hot spots where healthcare provider burnout may be putting patients at high risk in terms of safety.
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Al-Ghamdi MA, Nahar S, Siddiqui AF, Al-Saleem SA. Burnout and its correlates in Saudi family medicine residents: An observational study from Aseer, Saudi Arabia. J Family Med Prim Care 2021; 10:1904-1911. [PMID: 34195123 PMCID: PMC8208182 DOI: 10.4103/jfmpc.jfmpc_2146_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/24/2020] [Accepted: 02/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Burnout is a workplace phenomenon and is high among healthcare workers, particularly physicians. It brings in significant negative impact on patient care and physicians. Considerable number of studies have highlighted burnout issues on residents of other specialties; however, scarcity of data exist on burnout among family medicine residents. Objectives: This study aimed to measure the prevalence of burnout, and its predictors amongst family medicine residents in Aseer region, Saudi Arabia. Methodology: This cross-sectional study was conducted among 133 family medicine residents using a custom-designed and validated Self administered questionnaire. The Maslach Burnout Inventory Human Services Survey (MBI-HSS) was used to measure the three dimensions of burnout: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Results: The overall prevalence of burnout was 84.2%. In terms of three dimensions of burnout, 29.3% of respondents scored high for EE burnout, 19.5% for DP and 79.7% for PA. High burnout in all three dimensions was found to be strongly associated with a number of variables under study. Male gender (aOR = 3.41, 95% CI 1.1-11.10; P = 0.042), married residents (aOR = 3.32, 95% CI 1.1-10.48) and use of anti-anxiety drugs (aOR = 3.75,95% CI = 2.0-21.26) were identified as predictors of high emotional exhaustion. A work schedule of more than 8 hours per day (aOR = 3.79, 95% CI 1.12-10.87) and young age (aOR = 2.6, 95% CI 1.12-10.87) were identified predictors for high depersonalisation and low personal accomplishment, respectively. Conclusions: Prevalence of burnout in this study exhibits that it is a common problem in family medicine residents. There is a need for a nationwide longitudinal study targeting the family medicine residents to study the effects of burnout on physician well-being and patient care.
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Affiliation(s)
- Malak Aziz Al-Ghamdi
- Family Medicine Resident, Joint Program of Family Medicine, Aseer Region, Abha, Saudi Arabia
| | - Shamsun Nahar
- Department of Family and Community Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Safar Abadi Al-Saleem
- Department of Family and Community Medicine, King Khalid University, Abha, Saudi Arabia
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Affiliation(s)
- Chaitra Jayadev
- Department of Uvea and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Srinivasan Sanjay
- Department of Uvea and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
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