Burnout and patient care in junior doctors in Mexico City

Junior doctors' workplace well-being and the determinants based on ability-motivation-opportunity (AMO) theory: Educational and managerial implications from a three-year longitudinal observation after graduation

PURPOSE

Junior doctors function as trainees from an educational perspective and as employees from a human resource management perspective. Employing the ability-motivation-opportunity (AMO) theory as a conceptual framework, this study longitudinally investigated the factors affecting the workplace well-being and career progression of junior doctors over a 3-year period following their graduation from medical schools.

MATERIALS AND METHODS

This 3-year prospective cohort study enrolled junior doctors who graduated from 2 medical schools in June 2019 in Taiwan. This study collected data by implementing web-based, self-administered structured questionnaires at 3-month intervals between September 2019 and July 2022. The collected data encompassed ability indicators (i.e. academic performance and perceived preparedness for clinical practice), motivation indicators (i.e. educational and clinical supervision), opportunity indicators (i.e. clinical unit cultures), and workplace well-being indicators (i.e. burnout, compassion satisfaction, and job performance). A total of 107 junior doctors participated, providing 926 total responses. The data were analysed using univariate analyses and structural equation modelling with path analysis.

RESULTS

Over the 3-year period following graduation, the junior doctors' confidence in their preparedness for clinical practice and the educational and clinical supervision had varying degrees of influence on the junior doctors' workplace well-being. The influence of clinical unit cultures, which can provide opportunities for junior doctors, became evident starting from the second year postgraduation; notably, unit cultures that emphasised flexibility and discretion played positive and critical roles in enhancing the junior doctors' workplace well-being lasted to the third year.

CONCLUSIONS

Our findings provide insights into the distinct critical factors that affect the socialisation of junior doctors within workplace environments over 3 consecutive years. These findings can provide guidance for medical educators and healthcare managers, helping them understand and support the progressive integration of junior doctors into their work environments.

Prevalence of burnout and associated factors among midwives, 2023: institution-based cross-sectional study

Background

One of the main characteristics of the mental health condition known as burnout syndrome is an overwhelming feeling of physical and emotional tiredness, particularly with regard to one's work. Midwives are the group most prone to burnout because they work in emergency situations to save two lives at a time, share the stress of laboring women, and put in extra hours without enough payment. Besides this, there is little information on burnout among Ethiopian midwives.

Objectives

To assess burnout and associated factors among midwives working in public health facilities in West Arsi Zone, Ethiopia.

Methods and materials

A census method cross-sectional study was conducted among all 467 midwives working in public health facilities found in the West Arsi Zone, Ethiopia, from September 1 and 30, 2023. A pretested, validated face-to-face interviewer-administered structured questionnaire was used to collect data. Then, binary logistic regression was used for analysis. Bi-variable and multivariable logistic regression analyses were employed to identify factors associated with burnout. The level of statistical significance was declared at p < 0.05 with a 95% CI.

Results

Overall, the prevalence of burnout among midwives was 47.10% (95% CI: 42.55, 51.75%). Marital status not in union 2.03 (95% CI: 1.32-3.13), working more than 40 h per week 2.00 (95% CI: 1.29-3.08), conflict with their metron 2.33 (95% CI: 1.54-3.54), not satisfied with their current job 2.39 (95% CI: 1.56-3.66) and having depression symptoms 1.71 (95% CI: 1.06-2.74) were factors significantly associated with burnout.

Conclusion

This study found that in the study area, almost half of the midwives experienced burnout. Thus, it is recommended that midwives should develop respectful interactions with both their mentors and colleagues. Secondly, we suggest that zonal health offices set up systems that by shortening working hours and boost job satisfaction by creating conducive working environment, provide opportunities for career advancement and increase employee engagement.

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

The relationship between physician burnout and depression, anxiety, suicidality and substance abuse: A mixed methods systematic review

Introduction

The World Health Organization defines burnout as a problem associated with employment, a category distinct from psychological disorders such as depression, anxiety, suicidality and disorders of substance abuse. Evaluating the association between burnout as an occupational exposure and psychological morbidity may indicate that burnout can act as an occupational risk factor for mental ill-health. The systematic review explores this relationship in physicians due to the increased risk in this population and the implications for healthcare delivery.

Methods

A mixed methods systematic review of the literature was conducted across Medline, Cinahl Plus, PsycInfo, Web of Science and The Cochrane Library. Databases were systematically searched using keywords relating to physician burnout and depression, anxiety, suicidality and substance abuse. Identified articles were screened for eligibility by two independent researchers. Data extraction was performed and studies assessed for risk of bias. Quantitative and qualitative results were integrated using a convergent segregated approach and results portrayed as a narrative synthesis.

Results

Sixty-one articles were included in the review. There was notable heterogeneity in the measurement and criteria used to define burnout limiting the assimilation of results. Despite this, all studies that measured the association between depression and burnout reported a significant association. Studies that reported association between burnout and anxiety were similarly uniformly consistent. Most studies that reported the association between burnout and suicidality indicated that a significant association exists however difficulty in measurement of suicidality may have influenced variability of results. The reported association between substance abuse and burnout was more variable, suggesting that any association is likely to be weak or influenced by other variables. Qualitative studies described the manifestations of chronic workplace stress as well as perceived links with psychological morbidity. These included lack of time for work-life balance, the contribution of professional relationships and a culture of invulnerability that exists among physicians.

Conclusion

The systematic review cannot conclude causality but suggests that physician burnout is associated with depression, anxiety and suicidality. Qualitative data provides insight into the nature of this association. The review indicates the need for longitudinal research and provides considerations for intervention strategies to prevent the development and progression of burnout.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172938, identifier: CRD42020172938.

Association Between Physician Burnout and Self-reported Errors: Meta-analysis

OBJECTIVES

Burnout among physicians is an increasingly recognized phenomenon affecting different aspects of patient care and safety. This meta-analysis quantifies association of burnout and its subscales with self-reported medical errors among physicians.

METHODS

This meta-analysis followed the principles formulated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies. The MEDLINE, PubMed, Web of Science, PsycInfo, and Eric databases were searched until February 5, 2019, using various combinations of key terms without any language restrictions: burnout, physicians, error, safety, and quality. Reference lists of selected studies were hand searched. Data were extracted from published reports. All quantitative studies reporting prevalence of burnout and its association with self-reported errors among physicians were considered. The analyses of heterogeneity (Cochran Q, I2), publication bias (Begg-Mazumdar and Egger), three subgroups, and sensitivity were performed. The effect of overall burnout and Maslach Burnout Inventory subscales on self-reported errors was calculated as odds ratios with 95% confidence interval.

RESULTS

Thirteen studies on 20,643 physicians and residents were included. The overall burnout among participants was associated with a significantly increased risk of self-reported errors (odds ratio = 2.72, 95% confidence interval = 2.19-3.37). Emotional exhaustion, depersonalization, and personal accomplishment were all independently predicting factors of self-reported errors. Cochran Q test and inconsistency index I2 were as follows: Q = 27.2; P = 0.0013, I2 = 67% (36%-83%).

CONCLUSIONS

The results provide evidence that not only overall burnout but also its subscales independently are to be associated with a significantly increased risk of self-reported errors among physicians. As self-reported errors may translate into different types of adverse events, this strong and unequivocal association should be of major concern to healthcare organizations.

Identifying Risk Factors for Self-reported Mental Health Problems in Psychiatry Trainees and Psychiatrists in Mexico

OBJECTIVE

The objective was to determine and compare demographic features, professional activities and adversities, physical health conditions, and self-care behaviors related to the most frequently self-reported mental health problems among psychiatrists and psychiatry trainees.

METHODS

A cross-sectional, retrospective, comparative study was conducted on a total of 330 (48.2%) psychiatry trainees and 355 (51.8%) psychiatrists from Mexico through an online survey. Demographic features, professional activities and adversities, physical and mental health problems, self-care behaviors, and social support were examined. Comparative analyses and multiple logistic regression models were performed.

RESULTS

Major depression, anxiety, and burnout were the most common mental health problems reported with a higher frequency of anxiety disorders in psychiatry trainees. Being a woman, having a physical health problem, and lack of restful sleep were the main risk factors in both groups. Consultation in the government sector and having patients with severe suicidal ideation affected more psychiatry trainees. Perceived discrimination and inadequate eating schedules were risk factors for mental health problems for psychiatrists.

CONCLUSION

Psychiatry trainees constitute a vulnerable group for anxiety disorders. Particular attention should be paid to how students cope with the training experience to determine whether additional support is required. These professionals face major stressors leading to a high prevalence of depression, burnout, and anxiety. Encouraging psychiatrists to have better health habits is a step in the right direction, which must be accompanied by tangible organizational avenues to do so and creating a culture that truly promotes self-care.

The prevalence of hazardous and harmful alcohol use across trauma-exposed occupations: A meta-analysis and meta-regression

BACKGROUND

Trauma exposure is associated with hazardous and/or harmful alcohol use. Occupational groups frequently exposed to trauma may be at risk of alcohol harm. This meta-analysis determined the prevalence of hazardous and harmful alcohol use across trauma-exposed occupations and meta-regressions explored the impact of pre-defined covariates on the variance in prevalence estimates.

METHOD

Literature was searched from 2000 to March 2020, using Scopus, Web of Science and PsycINFO. Studies were included in the meta-analysis if they used a standardized measure of alcohol use (e.g., Alcohol Use Disorder Identification Test (AUDIT)). Studies were excluded if they measured alcohol use following an isolated sentinel event (e.g., 9/11). The following occupations were included: first responders, health care workers, Armed Forces, war journalists and train drivers.

RESULTS

1882 studies were identified; 55 studies were eligible. The pooled prevalence of hazardous use was 22% (95% Confidence Intervals [CI]: 17%-27%) and 11% (95% CI: 8%-14%) for harmful use. Hazardous alcohol use was significantly lower in health care workers (13%; 95% CI: 10%-16%) than first responders (26%; 95% CI: 20%-32%) and Armed Forces (34%; 95% CI: 18%-52%). There was marked heterogeneity across studies and higher prevalence rates in low-quality studies. The meta-regression identified higher proportion of males and younger mean age as predictors of variance.

CONCLUSIONS

Male-dominated occupations, such as police officers and military personnel, showed higher levels of hazardous and harmful alcohol use, indicating that interventions tailored specifically for these occupational groups may be needed.

Burnout en profesionales de la salud en contexto de pandemia: una propuesta metodológica para la detección de patrones basada en inteligencia artificial

Aunque las tasas de desgaste profesional o burnout pueden variar en función de contextos organizacionales y diversos tipos de trabajadores, varias investigaciones reportan tasas de prevalencia superiores en la población médica y profesionales de la salud en comparación con otras poblaciones (Adán, Jiménez y Herrra, 2004; Hernández, 2003; Toral-Villanueva, Aguilar-Madrid y Juárez-Pérez, 2009; Breilh, 1993). Por esta razón, se implementó una propuesta, basada en inteligencia artificial, para identificar patrones en variables de tipo sociodemográficas, de carga laboral y de nivel de burnout con el objetivo de ofrecer intervenciones o recomendaciones personalizadas. Para ello, se aplicaron un total de 724 formularios en línea a profesionales de la salud de México, los cuales contenían el inventario de Maslach adaptado a población mexicana (Aranda, Pando y Salazar, 2016) así como preguntas adicionales relacionadas a variables sociodemográficas y carga laboral. Posteriormente se implementó el algoritmo de clusterización Kamila para formar grupos de profesionales con el mayor parecido entre ellos (tomando en cuenta los resultados del inventario de Maslach y el resto de variables) finalmente se entrenó un modelo de clasificación utilizando un algoritmo de SVM (Support Vector Machine) con kernel gaussiano para clasificar nuevas observaciones en algún grupo resultado de la etapa clusterización, el cual tuvo una precisión de .92. La aplicación de algoritmos basados en inteligencia artificial puede servir para realizar intervenciones grupales lo más especializadas posibles o crear plataformas que puedan arrojar recomendaciones psicológicas personalizadas.

Why COVID-19 pandemic builds a convincing case for investing in 'Young Physician Leaders (YPL)'

There are pressing issues that are plaguing healthcare systems across the world (especially in the lower-middle-income countries), which comprise low-quality care, affordability, accessibility, poor infrastructure, violence against healthcare personnel, deficiency of physicians and healthcare staff. COVID-19 has put an immense physical and mental strain on the young physicians who are at the forefront in fighting this pandemic. This has lead to an increase in incidences of burnout among young doctors, which adversely impacts the quality of healthcare, patient well-being and satisfaction. The present-day medical training typically creates solo medical experts; but, modern-day management of patients and organisations require team-work and leadership. To profoundly alter the way the young physicians work and for creating physician leaders for the future, leadership training ought to commence during the medical school.

Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression

BACKGROUND

Burnout among postgraduate medical trainees (PMTs) is increasingly being recognized as a crisis in the medical profession. We aimed to establish the prevalence of burnout among PMTs, identify risk and protective factors, and assess whether burnout varied by country of training, year of study and specialty of practice.

METHODS

We systematically searched MEDLINE, Embase, PsycINFO, the Cochrane Database of Systematic Reviews, Web of Science and Education Resources Information Center from their inception to Aug. 21, 2018, for studies of burnout among PMTs. The primary objective was to identify the global prevalence of burnout among PMTs. Our secondary objective was to evaluate the association between burnout and country of training, year of study, specialty of training and other sociodemographic factors commonly thought to be related to burnout. We employed random-effects meta-analysis and meta-regression techniques to estimate a pooled prevalence and conduct secondary analyses.

RESULTS

In total, 8505 published studies were screened, 196 met eligibility and 114 were included in the meta-analysis. The pooled prevalence of burnout was 47.3% (95% confidence interval 43.1% to 51.5%), based on studies published over 20 years involving 31 210 PMTs from 47 countries. The prevalence of burnout remained unchanged over the past 2 decades. Burnout varied by region, with PMTs of European countries experiencing the lowest level. Burnout rates among medical and surgical PMTs were similar.

INTERPRETATION

Current wellness efforts and policies have not changed the prevalence of burnout worldwide. Future research should focus on understanding systemic factors and leveraging these findings to design interventions to combat burnout.

STUDY REGISTRATION

PROSPERO no. CRD42018108774.

Prevalência da Síndrome de Burnout entre Médicos Residentes

Resumo Médicos residentes estão expostos aos estressores relacionados ao ensino e ao exercício profissional. Nesta pesquisa, objetivamos identificar a prevalência da síndrome de burnout entre os médicos residentes do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) e explorar sua relação com aspectos sociodemográficos e ocupacionais. Dos médicos residentes, 273 responderam uma ficha sociodemográfica e ocupacional e o Inventário de Burnout de Maslach (MBI), desses, entrevistamos 13. Submetemos as respostas dos questionários à análise estatística e das entrevistas à análise de conteúdo. Encontramos alta exaustão emocional (68,1%), moderado ou alto cinismo (41,7%) e moderada ou alta ineficácia profissional (40,6%). Identificamos a presença de síndrome de burnout em 25,64% dos médicos residentes, além disso, encontramos relações de baixo poder explicativo com as variáveis sociodemográficas e ocupacionais. Os resultados fortaleceram a necessidade de questionarmos as condições de trabalho dos médicos residentes, o papel das variáveis sociodemográficas e ocupacionais, da religiosidade e do processo de socialização organizacional no desenvolvimento da síndrome de burnout.

A cross-sectional study of United States family medicine residency programme director burnout: implications for mitigation efforts and future research

BACKGROUND

Academic physician burnout is concerning. Too little is known about factors associated with residency programme director burnout. Continued uncertainty risks adverse outcomes including graduate medical education leadership turnover and negative impact on recruiting and retaining under-represented minority residency programme directors.

OBJECTIVE

This study assessed symptoms of burnout (emotional exhaustion, depersonalization) and depression along with evidence-based individual and environmental risk factors in a U.S. sample of family medicine residency programme directors.

METHODS

The omnibus 2018 Council of Academic Family Medicine Education Research Alliance survey was used to contact programme directors at all Accreditation Council for Graduate Medical Education accredited U.S. family medicine residency programmes via email. Descriptive data included programme director and programme characteristics, Areas of Worklife (workload, values and control), loneliness (lack companionship, feel left out and feel isolated), burnout (emotional exhaustion, depersonalization) and depressive symptoms. Chi-square tests contrasted descriptive variables with burnout and depressive symptoms. Logistic regression (LR) modelled associations between significant descriptive variables and burnout and depressive symptoms.

RESULTS

The survey response rate was 45.2% (268/590). Programme directors reported: emotional exhaustion (25.0%), depersonalization (10.3%) and depressive symptoms (25.3%). LR models found significant associations with emotional exhaustion (Workload: lacking time and other work-related resources); lack of companionship, depersonalization (North West Central residency region; Workload and lack of companionship) and depressive symptoms (Black/African American ethnicity).

CONCLUSIONS

One-quarter of U.S. programme directors report burnout or depressive symptoms. Future research should consider associated variables as possible intervention targets to reduce programme director distress and turnover.

Burnout Levels and Patterns in Postgraduate Medical Trainees: A Systematic Review and Meta-Analysis

PURPOSE

Postgraduate medical trainees experience high rates of burnout; however, inconsistencies in definitions of burnout characterize this literature. The authors conducted a systematic review and meta-analysis examining burnout levels and patterns in postgraduate medical trainees, using a continuous conceptualization of burnout, consistent with the Maslach Burnout Inventory (MBI) framework.

METHOD

The authors searched 5 electronic databases (Cochrane Library, Embase, ERIC, Ovid MEDLINE, Ovid PsycINFO) between January 1981 and July 2019 for studies reporting postgraduate medical trainees' burnout levels using the MBI-Human Services Survey. They examined study reporting quality using the QualSyst quality appraisal tool and calculated standardized mean differences (Hedges' g), comparing trainees' data with MBI norms for medicine and the overall population using a random effects model. They explored between-study heterogeneity using subgroup analyses (i.e., by training level and specialty). Finally, they studied the combined contribution of these 2 variables (and year of study publication) to burnout levels, using meta-regression.

RESULTS

The authors identified 2,978 citations and included 89 independent studies in their review. They pooled the data for the 18,509 postgraduate trainees included in these studies for the meta-analyses. Reporting quality was generally high across the included studies. The meta-analyses revealed higher burnout levels among trainees compared with medicine and overall population norms, particularly for the depersonalization subscale. The authors also identified statistically significant differences between nonsurgical and surgical registrars (specialty trainees), with trainees from 12 individual specialties exhibiting unique burnout patterns.

CONCLUSIONS

There is a need to reduce and prevent burnout early in medical training. Given the differences in burnout levels and patterns across specialties, interventions must focus on the unique patterns exhibited by each specialty in the target population using a multidimensional approach. Standardizing the definition of burnout in accordance with the MBI framework will facilitate progression of this work.

Factors Associated With Burnout and Stress in Trainee Physicians: A Systematic Review and Meta-analysis

Importance

Evidence suggests that physicians experience high levels of burnout and stress and that trainee physicians are a particularly high-risk group. Multiple workplace- and non-workplace-related factors have been identified in trainee physicians, but it is unclear which factors are most important in association with burnout and stress. Better understanding of the most critical factors could help inform the development of targeted interventions to reduce burnout and stress.

Objective

To estimate the association between different stressors and burnout/stress among physicians engaged in standard postgraduate training (ie, trainee physicians).

Data Sources

Medline, Embase, PsycINFO, and Cochrane Database of Systematic reviews from inception until April 30, 2019. Search terms included trainee, foundation year, registrar, resident, and intern.

Study Selection

Studies that reported associations between stressors and burnout/stress in trainee physicians.

Data Extraction and Synthesis

Two independent reviewers extracted the data and assessed the quality of the evidence. The main meta-analysis was followed by sensitivity analyses. All analyses were performed using random-effects models, and heterogeneity was quantified using the I2 statistic.

Main Outcome and Measures

The main outcome was the association between burnout/stress and workplace- or non-workplace-related factors reported as odds ratios (ORs) and their 95% CIs.

Results

Forty-eight studies were included in the meta-analysis (n = 36 266, median age, 29 years [range, 24.6-35.7 years]). One study did not specify participants' sex; of the total population, 18 781 participants (52%) were men. In particular, work demands of a trainee physician were associated with a nearly 3-fold increased odds for burnout/stress (OR, 2.84; 95% CI, 2.26-3.59), followed by concerns about patient care (OR, 2.35; 95% CI, 1.58-3.50), poor work environment (OR, 2.06; 95% CI, 1.57-2.70), and poor work-life balance (OR, 1.93; 95% CI, 1.53-2.44). Perceived/reported poor mental or physical health (OR, 2.41; 95% CI, 1.76-3.31), female sex (OR, 1.34; 95% CI, 1.20-1.50), financial worries (OR, 1.35; 95% CI, 1.07-1.72), and low self-efficacy (OR, 2.13; 95% CI, 1.31-3.46) were associated with increased odds for burnout/stress, whereas younger age and a more junior grade were not significantly associated.

Conclusions and Relevance

The findings of this study suggest that the odds ratios for burnout and stress in trainee physicians are higher than those for work-related factors compared with nonmodifiable and non-work-related factors, such as age and grade. These findings support the need for organizational interventions to mitigate burnout in trainee physicians.

Prevalence of burnout syndrome in gastroenterologists and endoscopists: results of a national survey in Mexico

BACKGROUND

Burnout syndrome (BOS) is characterized by emotional exhaustion, depersonalization and reduced personal accomplishment. It affects doctors, patients and their inter-relationship. There is a lack of data on BOS in Mexico. The main objective of the present study is to evaluate the prevalence of BOS in physician members of the Mexican gastroenterological association (MGA) and Mexican association for gastrointestinal endoscopy (MAGE).

MATERIALS AND METHODS

Cross sectional, prospective study through anonymous electronic survey via e-mail, sent to members of the MGA (n = 1192) and MAGE (n = 600). The survey included questions about basic sociodemographic information, Maslach Burnout Inventory, and factors potentially associated with BOS. Continuous variables were summarized as means and ANOVA or Kruskal-Wallis test were used to compare groups. Nominal variables were summarized as proportions and Fisher's exact test or Χ2 test were used, as appropriate.

RESULTS

A total of 1792 e-mail invitations were delivered and 411 answers were received with a response rate of 22.9%. The prevalence of BOS according to the Maslach Burnout Inventory was 26.3% (108/411). The prevalence of BOS according to the single-item self-defined burnout question (SISDBOQ) was 32.6% (134/411). The Kappa coefficient for emotional exhaustion between the SISDBOQ and Maslach inventory was 0.48 (p = 0.0001). Factors associated with BOS included performing endoscopic procedures (OR 2.9 (1.2-6.6); p = 0.008), lack of support from colleagues upon complications (OR 0.2 (0.1-0.4); p = 0.0001), receiving frequent reprimands from superiors (OR 2.4 (1.5-3.8); p = 0.0001), work unrelated to medicine (OR 2.4 (1.4-3.9); p = 0.0001), work violence/harassment (OR 3.0 (1.9-4.9); p = 0.0001) and living in a big city (OR 1.9 (1.2-3); p = 0.005).

CONCLUSION

BOS is a frequent entity in Mexican gastroenterologists and endoscopists. There are potentially modifiable factors associated with BOS.

Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis

BACKGROUND

Whether health care provider burnout contributes to lower quality of patient care is unclear.

PURPOSE

To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship.

DATA SOURCES

MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science (Clarivate Analytics), with no language restrictions, from inception through 28 May 2019.

STUDY SELECTION

Peer-reviewed publications, in any language, quantifying health care provider burnout in relation to quality of patient care.

DATA EXTRACTION

2 reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias by using the Ioannidis (excess significance) and Egger (small-study effect) tests.

DATA SYNTHESIS

A total of 11 703 citations were identified, from which 123 publications with 142 study populations encompassing 241 553 health care providers were selected. Quality-of-care outcomes were grouped into 5 categories: best practices (n = 14), communication (n = 5), medical errors (n = 32), patient outcomes (n = 17), and quality and safety (n = 74). Relations between burnout and quality of care were highly heterogeneous (I2 = 93.4% to 98.8%). Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor-quality care, 6 indicated burnout related to high-quality care, and 50 showed no significant effect. Excess significance was apparent (73% of studies observed vs. 62% predicted to have statistically significant results; P = 0.011). This indicator of potential bias was most prominent for the least-rigorous quality measures of best practices and quality and safety.

LIMITATION

Studies were primarily observational; neither causality nor directionality could be determined.

CONCLUSION

Burnout in health care professionals frequently is associated with poor-quality care in the published literature. The true effect size may be smaller than reported. Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates.

PRIMARY FUNDING SOURCE

Stanford Maternal and Child Health Research Institute.

Depressive symptoms and associated factors in medical interns at a tertiary hospital

BACKGROUND

It is known that medical doctors suffer from increased rates of depression with medical interns being most at risk. Despite this, little is known about the prevalence of depression in interns in South Africa.

OBJECTIVES

This study aimed to assess the prevalence of depressive symptoms in interns employed at Groote Schuur Hospital, a tertiary hospital in the Western Cape.

METHOD

The study was a cross-sectional study. All 91 interns were invited to participate in the study and consenting interns were required to complete a demographic and related questionnaire and the Beck Depression Inventory 2 (BDI-2).

RESULTS

Fifty-four (59.3%) of all invited interns participated in the study. Twenty-two interns (40.7%) reported a BDI-2 score of 14 or greater, indicating at least mild self-reported symptoms of depression. Features associated with a BDI-2 score of 14 or greater, included female gender, a previous diagnosis of depression, seeing a psychotherapist and previously being on antidepressant medication during internship. Other features also significantly associated with higher BDI-2 scores included suicidal ideation, thoughts of emigration, wanting to leave medicine and using substances to cope. The most significant associated feature of high BDI-2 scores was a subjective feeling of being 'burnt out'.

CONCLUSION

Interns had a higher prevalence of depressive symptoms when compared to the general population. The feeling of being 'burnt out' was the most significant factor associated with the severity of depressive symptoms. It is imperative that the mental health of both medical students and newly qualified doctors be prioritised, supported and monitored.

Prevalence and correlates of depression, anxiety, and stress in medical residents of a Brazilian academic health system

BACKGROUND

Several studies correlate medical residency with the occurrence of mental health disorders, Burnout Syndrome and quality of life impairment. It has been demonstrated that mental health disorders increase medical errors and lead to less effective patient care. Considering such context, this study aimed to evaluate the prevalence of anxiety, depression, stress and to identify its correlates with Burnout Syndrome and quality of life in a sample of medical residents and fellow physicians of the largest Brazilian academic health system.

METHODS

In 2017, 1648 participants were voluntarily and anonymously surveyed online about demographic characteristics, Burnout Syndrome, mental symptoms, and quality of life measured by validated questionnaires. Responses were captured through REDCap platform and multivariate statistical analyses were performed with STATA 15.

RESULTS

A total of 606 (36.8%) residents/fellows physicians completed the survey. Depression symptoms were present in 19%, anxiety symptoms in 16% and stress symptoms in 17.7% of the sample. Burnout Syndrome was present in 63% of the sample. Multivariate analysis showed a statistical significant positive correlation between Burnout Syndrome and depression, anxiety and stress symptoms and a negative correlation between mental symptoms and quality of life scores.

CONCLUSIONS

Mental health symptoms prevalence in this study is similar to other studies and their occurrence is positively correlated with Burnout Syndrome among medical residents/fellow physicians of the largest Brazilian academic health system. These results are relevant and must be confirmed by multicentric longitudinal studies. This study reinforces the importance of debating interventions to improve mental health among doctors in training.

[A GERCOR-AERIO national survey of oncology residents in France: Current setting and expectations regarding post-internship and research]

INTRODUCTION

The demographics of oncology residents has changed since 2010 with the increase in the size of promotions. The evolution of the residents' aspirations towards research and their future exercise in parallel with these demographic changes has not been assessed.

METHODS

A questionnaire was developed by a working group from GERCOR (cooperative group in oncology), involving clinicians, researchers, GERCOR members, and residents. It consisted of 62 questions divided into 7 sections: demographics, medical thesis, post-residency, mobility, publication activity, basic research, and clinical/translational research. The national survey was published online by the Association d'enseignement et de recherche des internes en oncologie (AERIO).

RESULTS

In total, 143 residents participated, of which 116 (81.1%) completed the questionnaire entirely. The population was representative of the current demographics, with a majority of women (65.0%), a median age of 28 years, and 39.7% of residents from Paris region. The unsupervised analysis revealed four profiles of residents, including one group strongly committed to research (16.8%), one group with moderate involvement (41.3%) and one group that did not seem interested in research (14.7%). Uncertainty about future position and lack of time and interaction with researchers appeared to be the main barriers to involvement of residents in research.

DISCUSSION

This national survey provided useful information about the residents' perspective to academic research. It may serve as a basis for proposing measures adapted to their expectations.

Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis

IMPORTANCE

Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified.

OBJECTIVE

To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction.

DATA SOURCES

MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched.

STUDY SELECTION

Quantitative observational studies.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed.

MAIN OUTCOMES AND MEASURES

The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs.

RESULTS

Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007).

CONCLUSIONS AND RELEVANCE

This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.

Psychosocial work characteristics, burnout, psychological morbidity symptoms and early retirement intentions: a cross-sectional study of NHS consultants in the UK

OBJECTIVES

The objectives of this study are twofold. First, to examine the direct effect of psychosocial work characteristics (as measured by job autonomy and work-related pressure) in relation to self-reported psychological morbidity symptoms and early retirement intentions among a sample of hospital consultants in the National Health Service (NHS). Second, to investigate burnout as mediating variable (ie, indirect effect) of these postulated associations.

DESIGN

A cross-sectional observational study.

PARTICIPANTS

593 NHS consultants (male=63.1%) from hospitals in England, Scotland and Wales.

MEASURES

Self-reported online questionnaires on work-related pressure and job autonomy (Job Demands-Resources Questionnaire); emotional exhaustion and depersonalisation (Maslach Burnout Inventory); depressive and anxiety symptoms (State Trait Personality Inventory) and a single-item on early retirement intention.

RESULTS

This study observed high prevalence rates across all adverse health measures: emotional exhaustion (38.7%), depersonalisation (20.7%), anxiety symptoms (43.1%) and depressive symptoms (36.1%). Multiple linear regressions examined the postulated direct and indirect effects. Job autonomy had significant negative direct effects on the frequency of NHS consultants' anxiety and depressive symptoms, and their intention to retire early. Both emotional exhaustion and depersonalisation mediated the relationships that work-related pressure (full mediation) and job autonomy (partial mediation) had with self-reported symptoms of psychological morbidities. Only emotional exhaustion mediated the relationships where early retirement intention was the outcome. In terms of sociodemographic factors, age and years' experience predicted both burnout dimensions and psychological morbidity.

CONCLUSIONS

This is the first study to observe job autonomy to be associated with the number of self-reported psychological morbidity symptoms and early retirement intentions in a sample of NHS consultants. Burnout dimensions mediated these relationships, indicating that interventions need to focus on enhancing working conditions and addressing burnout among NHS consultants before more severe symptoms of psychological morbidity are reported. This study has implications for NHS policy makers and senior leadership.

The relationship between resident burnout and safety-related and acceptability-related quality of healthcare: a systematic literature review

BACKGROUND

There has been increasing interest in examining the relationship between physician wellbeing and quality of patient care. However, few reviews have specifically focused on resident burnout and quality of patient care. The purpose of this systematic literature review of the current scientific literature is to address the question, "How does resident burnout affect the quality of healthcare related to the dimensions of acceptability and safety?"

METHODS

This systematic literature review uses a multi-step screening process of publicly available peer-reviewed studies from five electronic databases: (1) Medline Current, (2) Medline In-process, (3) PsycINFO, (4) Embase, and (5) Web of Science.

RESULTS

The electronic literature search resulted in the identification of 4638 unique citations. Of these, 10 articles were included in the review. Studies were assessed for risk of bias. Of the 10 studies that met the inclusion criteria, eight were conducted in the US, one in The Netherlands, and one in Mexico. Eight of the 10 studies focused on patient safety. The results of these included studies suggest there is moderate evidence that burnout is associated with patient safety (i.e., resident self-perceived medical errors and sub-optimal care). There is less evidence that specific dimensions of burnout are related to acceptability (i.e., quality of care, communication with patients).

CONCLUSIONS

The results of this systematic literature review suggest a relationship between patient safety and burnout. These results potentially have important implications for the medical training milieu because residents are still in training and at the same time are asked to teach students. The results also indicate a need for more evidence-based interventions that support continued research examining quality of care measures, especially as they relate to acceptability.

Common mental disorders related to incidents and behaviour in physicians

BACKGROUND

Common mental disorders (CMD-burnout, stress, depression and anxiety disorders) are prevalent in physicians.

AIMS

To investigate the relationship between CMD and medical incidents and/or unprofessional behaviour in hospital physicians.

METHODS

PubMed was searched for all articles published between 2003 and 2013 that study a relationship between CMD and medical incidents and/or unprofessional behaviour in hospital physicians. The strength of evidence was assessed through five levels of evidence.

RESULTS

We included 15 studies. We found strong evidence for a significant association between burnout and the occurrence of medical incidents, based on two longitudinal and seven cross-sectional studies with a positive association [odds ratio (OR) 1.07-5.5]; one longitudinal study found a non-significant association (strong evidence). For the association between depression and medical incidents, four longitudinal studies and three cross-sectional studies found a significant positive association (strong evidence; OR 2.21-3.29). For the association between fatigue and medical incidents, one longitudinal study and one cross-sectional study showed a significant positive association, but one cross-sectional study showed a non-significant association (strong evidence; OR 1.37). For the association between sleepiness and medical incidents, one longitudinal study and two cross-sectional studies showed a significant positive association (strong evidence; OR 1.10-1.37). No significant association was found between burnout and unprofessional behaviour (inconsistent evidence). Nor was any evidence found for the association between unprofessional behaviour and depression, fatigue or sleepiness.

CONCLUSIONS

CMD in hospital physicians were associated with the occurrence of self-reported medical incidents, but there was inconsistent evidence for unprofessional behaviour.

Increased Cardiovascular Risk Using Atherogenic Index Measurement Among Healthcare Workers

BACKGROUND AND AIMS

Cardiovascular diseases are one of the leading causes of death worldwide. This burden of disease is particularly high among healthcare workers. The aim of the study was to identify determinants that increase atherogenic index among healthcare workers.

METHODS

In 1,678 healthcare workers, cardiovascular risk factors were analyzed: body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. Atherogenic index was calculated and determinants were identified.

RESULTS

Mean (SD) age was 41.2 (8.4) years; body mass index 28.4 (4.8); waist-hip-ratio 0.88 (0.07); glucose 96.6 (22.2) μg/dL; TC 195.3 (50.3) mg/dL; HDL 49.0 (16.3) mg/dL; LDL 112.7 (35.0) mg/dL; triglycerides 171.7 (121.2) mg/dL; and atherogenic index 3.3 (1.5). Overweight and obesity prevalence was 77.2%. In the multiple linear regression model, the coefficients for AI were being a physician β = 0.381, male gender = 0.443, BMI β = 0.35, waist-to-hip ratio β = 2.15, age = 0.014, and triglycerides β = 0.915.

CONCLUSIONS

The main contributors to atherogenic index increase were male sex, increased age, waist-to-hip ratio increase, overweight and obesity, high triglyceride levels and working as a physician. Although waist-to-hip ratio was the most powerful determinant, the physician occupational category added risk factors such as stress and adverse psychosocial working conditions, which may potentiate cardiovascular diseases.

The mediating role of feelings of guilt in the relationship between burnout and the consumption of tobacco and alcohol

Earlier studies have shown that feelings of guilt appear to be involved in the burnout process. However, the exact nature of the relationship between burnout, feelings of guilt, and tobacco and alcohol use is unclear. The purpose of this study was to analyze the role of feelings of guilt in the relationship between burnout and the consumption of tobacco and alcohol. Role conflict, Role clarity, and Feedback were included as predictors of burnout. The sample of this cross‐sectional study consisted of 260 Chilean administration and customer service workers. Hypotheses were tested using a path model. The hypothesized model (i.e., Indolence to guilt to tobacco/alcohol use) showed an adequate data fit, including a mediator role of feelings of guilt in the relationship between burnout and alcohol use. The results of this study recommending taking into consideration the evaluation of feelings of guilt as a symptom of burnout in order to develop a more reliable diagnosis of burnout syndrome and its consequences.

High rates of burnout among maternal health staff at a referral hospital in Malawi: A cross-sectional study

Background

Burnout among maternal healthcare workers in sub-Saharan Africa may have a negative effect on services provided and efforts to mitigate high maternal mortality rates. In Malawi, research on burnout is limited and no empirical research has been conducted specifically among maternal health staff. Therefore, the aims of the study were to examine the prevalence and degree of burnout reported by healthcare workers who provide antenatal, intrapartum, and postnatal services in a district referral hospital in Malawi; and, to explore factors that may influence the level of burnout healthcare workers experience.

Methods

In the current cross-sectional study, levels of burnout among staff working in obstetrics and gynaecology at a referral hospital in Malawi were examined, in addition to individual and job characteristics that may be associated with burnout.

Results

In terms of the three dimensions of burnout, of the 101 participants, nearly three quarters (72%) reported emotional exhaustion, over one third (43%) reported depersonalization while almost three quarters (74%) experienced reduced personal accomplishment.

Conclusions

Based on these findings, burnout appears to be common among participating maternal health staff and they experienced more burnout than their colleagues working in other medical settings and countries. Further research is needed to identify factors specific to Malawi that contribute to burnout in order to inform the development of prevention and treatment within the maternal health setting.

Burnout and perceived quality of care among German clinicians in surgery

OBJECTIVE

Burnout is highly prevalent among clinicians but there is not much known about the association between burnout and quality of care. In this paper, burnout, perceived quality of care and medical errors among German clinicians in surgery are explored.

DESIGN

Data were collected during 2008 by a cross-sectional, standardized mail survey.

PARTICIPANTS

and

SETTING

A total of 1311 clinicians in surgery in 489 German hospitals. Measure(s) Burnout was measured by using the Copenhagen Burnout Inventory (CBI). The measurement of self-rated patient care was based on a 13 item instrument (Chirurgisches Qualitätssiegel) and two questions assessing the frequency of medical errors.

RESULTS

About 48.7% of the clinicians meet the criteria for burnout according to the CBI. Moreover, in multivariate logistic regression analyses, burnout is significantly associated with perceived quality of care among male (odds ratios vary from 1.5 to 2.6) but not among female surgeons (odds ratios vary from 1.3 to 1.5).

CONCLUSIONS

The high prevalence of burnout in our study corresponds with former studies of burnout among physicians. Furthermore, the results of the study suggest a relationship between burnout and perceived quality of care among men. Thus, reducing burnout among surgeons could not only improve their health and well-being but also the quality of care.