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

Psychosocial risk factors and perceived health of medical residents

BACKGROUND

Several investigations have shown that residents are especially vulnerable to work stress, with the greatest relevance placed on psychosocial factors.

AIMS

To investigate the relationship between psychosocial risk factors and general, mental and vitality perceived health and job satisfaction among residents in a teaching hospital for a preventive intervention program.

METHODS

This is a retrospective cross-sectional study. Data on psychosocial factors (F-PSICO-INSHT-4.0), perceived general, mental and vitality health (36-item Short Form Survey questionnaire), and overall job satisfaction were collected from an anonymous, online survey (2018). Univariate and multivariate analysis was done.

RESULTS

The survey was answered by 107 residents (31% response rate). Female residents had worse perceived mental health than males (P < 0.05). Residents showed a worsening of vitality from the second year to the residency end (P < 0.05). No gender or year of residency differences were found related to general health. Job satisfaction worsened during years of residency (P < 0.01), with no gender differences. The psychosocial factors identified as potential risk factors were workload, emotional demands, participation/supervision and role performance. Multivariate linear regression models showed that compensation and role clarity explain 18% of the variation in general health score (adjusted-R2 = 0.183); role clarity, emotional demands, interpersonal conflicts and difficulty at work the 32% of the variation in mental health outcome (adjusted-R2 = 0.315); and compensation, time pressure, gender and supervision the 32% of the variability of vitality outcome (adjusted-R2 = 0.320).

CONCLUSIONS

These findings highlight the importance of psychosocial risk factors in perceived health, and overall satisfaction in medical residents during their specialist training.

Wellbeing interventions in family medicine and general practice trainees: a preliminary meta-analysis

BACKGROUND

Medical trainees experience occupational stress, prompting increasing research to explore wellbeing interventions. To date, few meta-analyses have evaluated intervention effects, and none have focused on trainees in family medicine or general practice (FM/GP), specifically. Aim: To synthesise available literature on psychosocial interventions to promote wellbeing, and subsequently reduce ill-being or burnout, among FM/GP specialty trainees.

METHODS

Preferred Reporting Items for Systematic Review and Meta-Analysis were followed and online databases (Embase, Medline, PsycINFO, ProQuest, Scopus) systematically searched (no date limits) for published studies and dissertations. The methodological quality of included studies was reviewed (Mixed Methods Appraisal tool, GRADE assessment), and pre-post changes (Hedges' g) pooled using random effects modelling.

RESULTS

Eleven independent studies, involving 182 FM/GP trainees, were included in this review. Evaluated studies varied in their design and the results were characterised by imprecision. Interventions differed in their content, delivery, and length. The data did not favour a single type of intervention, although supporting individuals to monitor their wellbeing did produce significant, positive effects.

CONCLUSIONS

There is a lack of evidence about the best ways to promote wellbeing in FM/GP trainees. Both the methodology and design of training and educational initiatives for FM/GP need careful consideration in order to progress this research.

Vascular Surgeon Burnout in Chile: A Cross-Sectional National Study

BACKGROUND

The purpose of the study is to describe burnout in vascular surgeons (VS) in Chile and to determine their associated factors.

METHODS

Between April and June 2023, accredited Chilean VS were electronically surveyed. The results were analyzed with bivariate analysis and multivariate logistic regression, considering P value <0.05 as significant.

RESULTS

Of the 129 accredited VS in Chile, 113 (87.6%) responded, and after excluding 4 retired surgeons and 1 incomplete survey, 108 responses were analyzed representing 83.7% of those invited to participate. Mean age was 49.1 ± 9.9 years, most were male (85.2%), married/had a partner (83.0%) and had at least 1 child (82.4%). Overall, 62 (57.4%) of respondents had at least 1 symptom of burnout, 25 (23.1%) were at risk for depression, 11 (10.2%) screened positive for depression, and 5 (4.6%) had considered suicide in the last 12 months. In bivariate analysis, factors significantly associated with burnout were younger age, fewer years in practice, recent work-life conflict, degree of fatigue, job satisfaction, with or at risk for depression, sleep problems, lack of vacation time and the specific stressors. In the multivariate analysis, the significant factors were degree of fatigue, degree of resilience, desire for their children to pursue the same career as them, lack of sports or routine exercise, amount of vacation time, and adversities to perform the work at the hospital or clinic.

CONCLUSION

Burnout is highly prevalent in VS in Chile. Risk factors are like those described in the United States and Europe, the most relevant and distinctive being stress generated by work difficulties in hospitals.

Understanding the Medical Education Experiences of Low-Income Students Through a Maslow's Hierarchy of Needs Lens: An Exploratory Qualitative Study

BACKGROUND

Diversity in the physician workforce is critical for quality patient care. Students from low-income backgrounds represent an increasing proportion of medical school matriculants, yet little research has addressed their medical school experiences.

OBJECTIVE

To explore the medical school experiences of students from low-income backgrounds using a modified version of Maslow's Hierarchy of Needs (physiologic, safety, love/belonging, esteem, and self-actualization) as a theoretical framework.

DESIGN

We conducted an exploratory qualitative study through in-depth, semi-structured interviews.

PARTICIPANTS

Forty-two low-income medical students attending US-based MD or DO degree-granting institutions.

APPROACH

We conducted a content analysis of interview transcripts using deductive and inductive coding. We discussed our independent analyses to reach consensus and shared findings with a subgroup of participants for member checking.

RESULTS

Participants described substantial challenges in meeting their basic needs. Unmet physiologic needs included food insecurity, lack of adequate sleep/rest, and poor mental health. Unmet safety needs included lack of reliable transportation and safe housing; threats to financial safety included debt and an inability to cover both medical education-related and non-medical education-related expenses. Unmet belonging needs included difficulty connecting with peers or participating in financially inaccessible social activities. Unmet respect/esteem needs stemmed from bias from peers, teachers, and institutions. Unmet self-actualization needs were uncommon. Participants felt pride in their medical journey; however, some perceived that their financial struggles hindered them from realizing their full potential.

CONCLUSIONS

Previously reported attrition and adverse academic outcomes among low-income students may be linked to challenges they experience trying to more fully meet important human needs. This finding underscores the need to approach wellness holistically and ensure students do not exist in a prolonged state of unmet needs. Recommendations that accreditation bodies and medical schools could implement to promote tailored support for low-income and other marginalized learners are provided.

Burnout among medical residents in Haiti: a mixed-methods study

OBJECTIVES

To investigate the prevalence and risk factors associated with burnout among residents and to explain their experiences with burnout.

DESIGN

Mixed-methods convergent parallel study with an explanatory follow-up.

SETTINGS

One tertiary hospital in Mirebalais and one community hospital in Saint-Marc.

PARTICIPANTS

Of the 127 registered residents in both settings, 26 were excluded because they were on leave. Therefore, 101 were asked to participate. We received responses from 98 residents (response rate 97.02%).

INTERVENTIONS

Data collection took part in two stages: quantitative data collection was first made over a 2-week period in July 2023 using a questionnaire which included the Maslach Burnout Inventory. We simultaneously conducted a qualitative analysis based on three questions around which stress factors were related to work, personal fulfilment and social issues in the questionnaire. Second, following preliminary data results, one focus group was held with the seven chief residents to bring an in-depth understanding of the quantitative data analysis from the study questionnaire.

PRIMARY AND SECONDARY OUTCOMES

Sociodemographic and clinical factors linked to burnout for quantitative data. The themes explored for qualitative data were stress factors related to work, personal fulfilment and social issues. One focus group held with the chief residents explained, based on preliminary results, the main causes of burnout among medical residents, influencing factors, coping strategies and perspectives.

RESULTS

Five major findings emerged from the quantitative data, including the following: (a) burnout prevalence was 79.59%; (b) 43% of the residents estimated working more than 80 hours/week; (c) the group with the highest burnout rates were the second-year postgraduate residents (p=0.01); (d) paediatrics and family medicine residents had the highest mean score of emotional exhaustion (p=0.01); (e) general surgery/orthopaedics and paediatrics had the highest mean score of depersonalisation (p<0.01). For the qualitative data, five categories were linked to burnout: the residents' quality of life, their feelings of ineffectiveness, their regrets for choosing to do residency in Haiti, the hospital's admission policy and social factors.

CONCLUSIONS

Burnout prevalence was significantly high. The medical education department needs to implement initiatives that improve patient healthcare, boost the residents' morale and comply with accreditation standards. A cohort study or quality improvement project investigating the impact of interventions might also be suitable, or a study at different times of the academic year and in a less volatile period of time in Haiti might provide a more complete picture of the onset of this syndrome.

From Wilderness to the Bedside: Creating Adventurous and Mindful Physicians Entering Residency (CAMPER) by Residents for Residents to Foster Belongingness

OBJECTIVE

Determine whether a preresidency overnight outdoor experience can positively impact incoming resident's comfort, preparedness and sense of support before starting residency. Outdoor education trips have been shown to positively impact participants in many other settings but have not been examined in the transition to residency.

DESIGN

The Creating Adventurous and Mindful Physicians Entering Residency (CAMPER) program consists of a multi-day backpacking trip designed by residents and medical students for incoming residents. CAMPER trips were conducted between 2022 and 2023 for the Michigan Medicine Family Medicine and Stanford Healthcare Ophthalmology, Plastic Surgery, and General Surgery residency programs. Trip programming included hiking, team-building activities, and an overnight camping experience including all meals and gear. After each program, participants were asked to provide feedback and given surveys to assess how their experiences impacted their start to residency.

SETTING

Michigan Medicine Family Medicine and Stanford Healthcare Ophthalmology, Plastic Surgery, and General Surgery residency programs. Trips were held in Point Reyes National Seashore in California and Pinckney State Recreation Area in Michigan.

PARTICIPANTS

A total of 44 incoming residents, including: 8 incoming Stanford Healthcare Ophthalmology, Plastic Surgery, and General Surgery residents in 2022, 12 residents in 2023. 12 Incoming Michigan Medicine Family Medicine interns for 2022 and 11 residents 2023. Participants in the most recent, 2023 cohort were surveyed about their experiences.

RESULTS

65% of participants responded to the 1-week post-CAMPER survey (11 from Stanford Healthcare and 4 from Michigan Medicine) and 100% of the Michigan Medicine trip responded to the 6-month post-trip survey. 100% of participants selected an 8, 9, or 10 when asked how likely they were to recommend CAMPER to a friend. 80% of participants in the 2023 cohort selected Agree or Strongly Agree to the question whether they felt more prepared to start residency than they did before participating in CAMPER. 73% of the CAMPERs endorsed bonding with their class as the biggest strength of the CAMPER experience.

CONCLUSIONS

Preresidency wilderness orientation trips conducted at 2 different institutions over multiple specialties have shown promise for helping residents feel more connected to their peers and programs and more prepared to begin their residencies. CAMPER can provide a model for fostering professional collaboration and development to build a true culture of support during a critical time in physician's training.

Under the covert norm: a qualitative study on the role of residency culture in burnout

PURPOSE

Burnout has become a major concern within healthcare. Medical residents comprise a notorious at-risk population in which approximately half of the population is affected. While previous work highlights the role of organizational risk factors as the main contributors to occupational burden, research on culture in medicine as a potential organizational risk factor is limited. The main objective of this qualitative study was to explore the expression of cultural norms from the medical resident perspective to establish the stage for future high-impact interventions.

METHODS

Data were gathered from 87 semistructured interviews with residents in Mexico City and analyzed through a grounded theory lens.

RESULTS

The analysis revealed harmful customary practices within medical residency culture. A distorted hierarchical system was responsible for promoting abusive power dynamics that fed into a 'covert norm' that continually infringed on formal regulations. This system is partly sustainable due to poor reporting mechanisms and self-perpetuating behaviors through normalization and violent enforcement.

CONCLUSION

The findings suggest that burnout was independently associated with and occurred in the context of covert conventions that defy guidelines. However, further studies are needed to assess proper organizational interventions that reject covert sociocultural normative conformity to support a more humanistic side of medical culture.

The Daily Fact Pile: Exploring Mutual Microlearning in Neurology Resident Education

Problem: A significant proportion of learning during residency takes place through informal channels. Spontaneous collaboration among medical learners significantly contributes to this informal learning and is increasingly recognized as a component of the hidden curriculum in medical education. Yet historically, a disproportionate emphasis in medical education has been placed on didactic, structured, and faculty-initiated methods, leaving an important force in medical education understudied and underutilized. We hypothesize that there is significant educational potential in studying and deploying targeted tools to facilitate collaboration among medical learners. Intervention: At our institution, neurology residents implemented the "Daily Fact Pile" (DFP), a resident-led, email-based collaboration that served as a platform to share clinical pearls in an informal, digital way. Participation was voluntary and participants were encouraged to share facts that were new to them and thought to be clinically relevant. Motivated by the positive collective experience, we conducted a retrospective examination of this phenomenon. In this context, we developed the concept of "mutual microlearning" to characterize this efficient, multidirectional exchange of information. Context: Thirty-six residents in a single neurology residency program utilized the DFP at a large university hospital in the USA between 2018 and 2019. After 21 months of spontaneous and voluntary participation, we assessed the feasibility of the DFP, its impact on the education and morale of neurology residents, and compared its mutual microlearning approach to traditional lectures. This was done through a survey of the DFP participants with a response rate of 80.7%, and analysis of the statistics of participation and interaction with the DFP. Impact: Most participants felt that the DFP was beneficial to their education and thought they often or always learned something new from reading the DFP. The impact of the DFP extended beyond education by improving interest in neurology, morale, and sense of teamwork. The DFP was feasible during neurology residency and participation was high, though participants were more likely to read facts than share them. Lessons learned: Mutual microlearning represents an opportunity to augment residents' education, and well-designed mutual microlearning tools hold promise for complementing traditional teaching methods. We learned that efficiency, ease of use, and a supportive, non-judgmental environment are all essential to the success of such tools. Future research should delve deeper into the underlying mechanisms of mutual microlearning to establish its position within the theoretical frameworks of medical education.

Towards precision well-being in medical education

Medical trainee well-being is often met with generalized solutions that overlook substantial individual variations in mental health predisposition and stress reactivity. Precision medicine leverages individual environmental, genetic, and lifestyle factors to tailor preventive and therapeutic interventions. In addition, an exclusive focus on clinical mental illness tends to disregard the importance of supporting the positive aspects of medical trainee well-being. We introduce a novel precision well-being framework for medical education that is built on a comprehensive and individualized view of mental health, combining measures from mental health and positive psychology in a unified, data-driven framework. Unsupervised machine learning techniques commonly used in precision medicine were applied to uncover patterns within multidimensional mental health data of medical students. Using data from 3,632 US medical students, clusters were formulated based on recognized metrics for depression, anxiety, and flourishing. The analysis identified three distinct clusters. Membership in the 'Healthy Flourishers' well-being phenotype was associated with no signs of anxiety or depression while simultaneously reporting high levels of flourishing. Students in the 'Getting By' cluster reported mild anxiety and depression and diminished flourishing. Membership in the 'At-Risk' cluster was associated with high anxiety and depression, languishing, and increased suicidality. Nearly half (49%) of the medical students surveyed were classified as 'Healthy Flourishers', whereas 36% were grouped into the 'Getting-By' cluster and 15% were identified as 'At-Risk'. Findings show that a substantial portion of medical students report diminished well-being during their studies, with a significant number struggling with mental health challenges. This novel precision well-being framework represents an integrated empirical model that classifies individual medical students into distinct and meaningful well-being phenotypes based on their holistic mental health. This approach has direct applicability to student support and can be used to evaluate the effectiveness of personalized intervention strategies stratified by cluster membership.

Imposter Syndrome Among Orthopaedic Surgery Residents is Extremely Common and Disproportionately Affects Female Residents

Introduction

Imposter syndrome is a psychological phenomenon in which individuals experience persistent self-doubt and feelings of inadequacy despite achieving objective measures of success. This phenomenon is associated with lower job satisfaction, increased rates of burnout, and reduced productivity. Therefore, the purpose of this study was to determine the prevalence of imposter syndrome among orthopaedic surgery residents and determine whether specific individual or residency characteristics predict higher rates of imposter syndrome.

Methods

An anonymous survey was distributed to residents at 7 ACGME-accredited orthopaedic surgery residencies. Respondents provided deidentified demographic data and completed the Clance Imposter Phenomenon Scale (CIPS) assessment. CIPS scores were used to categorize imposter syndrome severity as none to mild, moderate, significant, or intense. Differences were calculated and compared using t-test and χ2 analyses. Multivariable regression analysis was used to identify predictors of increased symptom severity.

Results

One hundred orthopaedic surgery residents completed the survey. Forty percent of respondents were female, and the mean age was 30.6 ± 2.8 years. The prevalence of significant or intense imposter syndrome was 73%. CIPS scores and significant or intense imposter syndrome did not vary by age, gender, sexual orientation, race/ethnicity, level of training, program region, research year, non-MD degrees, and Step 1, Step 2, or Orthopaedic In-Training Examination (OITE) scores on univariable analyses. On multivariable analysis, female residents were 5.64 (OR = 5.64 [1.04-30.63]) times more likely to have significant or intense imposter syndrome (p = 0.045). Residents at western programs were 0.13 (OR = 0.13 [0.02-0.90]) times as likely to experience significant or intense imposter syndrome (p = 0.039). In addition, women (estimate = 8.72 [1.41-16.04]; p = 0.0201) and those with OITE scores in the 0 to 25th (estimate = 11.92 [0.29-23.54]; p = 0.0446) and 51st-75th (estimate = 12.73 [2.79-22.67]; p = 0.0128) percentiles had higher CIPS scores.

Conclusions

Imposter syndrome is common among orthopaedic surgery residents, with 73% experiencing significant or intense symptoms. Female gender, lower OITE scores, and training in nonwestern regions predicted increased imposter syndrome severity. Targeted programs may help reduce burnout and improve career satisfaction and advancement.

Making housestaff feel at home: impact of workspace interventions on anatomic pathology trainee wellness

To improve trainee well-being in a healthcare setting, we implemented changes shown to significantly improve employee well-being in corporate settings in an anatomic pathology (AP) trainee workspace at one large academic program and measured changes in trainee stress and well-being. An IRB-approved survey was distributed to trainees before and after implementation of workspace modifications, which included deep cleaning of the physical space, making storage space for personal items, improving access to perishable and nonperishable foods, arranging equipment to facilitate ergonomic use, and providing real and artificial visuals of nature. The survey incorporated evidence-based scales including the Ambient Belonging Scale (ABS), the five-item WHO-5 Well-Being Index, the five-item modified Spielberger State and Trait Anxiety Scales, and the Growth Mindset Scale. Pre-intervention (n = 21) and post-intervention (n = 18) participants had scores consistent with a growth mindset, no significant anxiety state or trait, and above average sense of well-being. Compared with pre-intervention survey results, post-intervention AP residents who actively worked in the space had a significantly increased sense of belonging. Free-text feedback indicated that our efforts to improve the environment and to increase access to food positively impacted their well-being as AP trainees. We show that workspace interventions implemented at our institution significantly increased a sense of belonging for our trainees independent of their growth mindset, anxiety state or trait, and sense of well-being, which was high pre- and post-intervention. These simple and cost-effective workspace interventions can be implemented broadly to create a more supportive, inclusive environment for pathology trainees.

Physician and Medical Student Burnout, a Narrative Literature Review: Challenges, Strategies, and a Call to Action

Background: Burnout is a state of emotional, physical, and mental exhaustion produced by excessive and prolonged professional stress. Its prevalence is unclear, and figures from 2 to 81% have been reported, although studies focused on this issue are scarce and inconsistent definitions and the absence of validated measurement tools make comparisons difficult. Methods: Our narrative review's purpose was to explore physician and medical student burnout across medical specialties and in specific subgroups, including young doctors, researchers, and female physicians. We also assess burnout effects in medical students and patients and the possible strategies to prevent and reverse it. Results: Burnout affects doctors, medical students, and patients. It impacts significantly on physicians mental health and can be the trigger for depression, substance abuse, and suicide attempts. Moreover, this psychological and physical exhaustion can also increase the risk of systemic conditions such as cardiovascular disease. Physician burnout increases the risk of medical errors, reduces professional efficacy, and might compromise patients' safety. Strategies focusing on mental, physical, social, and occupational well-being can help to prevent and treat burnout. These include resilience training, self-care, exercise, work-life balance, and institutional changes, such as reducing administrative burdens and improving electronic health record systems. Medical students' burnout might be triggered by specific problems related to their young age, economic situation, exam stress and workload, high academic expectations, lack of support, and others. Conclusions: Burnout is common in physicians and medical students, negatively affecting mental health, professional/academic efficacy, and patient outcomes. Addressing burnout requires a multifaceted approach, including individual strategies and systemic changes within institutions.

Loneliness and mental burden among German medical students during the fading COVID-19 pandemic: a mixed-methods approach

Introduction

Medical students experience significantly more mental burdens compared to the general public. This circumstance was further exacerbated by the pandemic, particularly with regard to loneliness. While previous studies have identified risk factors for loneliness among students of different subjects, recent data focusing on medical students during the late stages of the pandemic remain insufficient. This study aims to address this gap.

Methods

We performed a cross-sectional study at a German Medical School, consisting of two online surveys conducted in winter 2021/22 and summer 2022. The study sample, composed of 283 undergraduate students in winter 2021/22 (231 in summer 2022), answered five well-established scales for measuring loneliness (R-UCLA3), distress (DT-NCCN), anxiety (GAD-2), depression (PHQ-2), and perceived stress (PPS-4). Additionally, we evaluated burdensome aspects of students' current situation through qualitative analysis. Longitudinal analyses were conducted for 80 medical students who participated in both surveys.

Results

Around 20% of all students responded to each survey. In winter 2021/22, 55.1% of students reported loneliness above the cut-off (M = 5.77 [2.02]; decreasing to 45.0% by summer 2022 (M = 5.22 [1.90]). Lonely students reported significantly higher levels of depression, anxiety, and self-perceived stress in both survey periods. Overall distress increased substantially throughout our study (Cohen's d = -0.54). Binary regression models indicated a shift in loneliness risk factors: in winter 2021/22, being single, higher self-perceived stress levels, and decreased study motivation were associated with increased loneliness. Lower peer connectedness emerged as the sole significant factor associated with loneliness in summer 2022. While the pandemic-related burden on students' study motivation lessened, issues related to exam preparation and lack of study organization through the faculty increased, varying significantly depending on students' study year.

Conclusion

Our data suggest that loneliness among German medical students decreased in the late stages of the COVID-19 pandemic. However, other mental burdens persisted at high levels compared to other data in the general public and medical students. Students' responses underscore the need for improved academic support by eased study program structure, improved counseling, and tailored services for students of different study years.

The impostor phenomenon among surgeons and surgeons in training: a scoping review

BACKGROUND

The impostor phenomenon (IP), is a condition in which people think they are incapable of success and tend to attribute their success to external causes such as luck, error, or knowing the appropriate individuals. It has been confirmed as a contributor to burnout for practicing physicians, residents, and medical students. The purpose of this scoping review is to describe the prevalence and scope of IP among surgeons and surgeons in training, in order to determine gaps that can be addressed in future research.

METHODS

Searches were conducted in the following databases: Embase, PubMed, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, Web of Science, PsycINFO, Google Scholar, and ProQuest from inception to 30 June 2024. Two investigators independently assessed the articles based on the inclusion and exclusion criteria. All titles and abstracts meeting the inclusion criteria were carefully reviewed for the full text. The individual screening results were compared, and any discrepancies were discussed with a third investigator and a final consensus for further analysis.

RESULTS

The Clance Impostor Phenomenon Scale (CIPS) was used to assess the prevalence in the included studies. The prevalence of IP among surgeons and surgeons in training ranged from 27.5 to 100%. Women were more prone to suffer from IP when compared to their male counterparts. Most literature also showed that female surgeons reported statistically higher in IP scores than males. Level of education and academic achievements were also associated with IP.

CONCLUSIONS

This scoping review identified the published literature on IP among surgeons and surgeons in training and focused on the existing research objects to discover the gaps in the current research. Future directions may focus on early interventions aimed at identifying and managing IP.

Development and validation of a school satisfaction scale for medical students

OBJECTIVE

There is currently no widely accepted multidimensional School Satisfaction Scale (SSS) for Chinese medical students. To develop and validate the first SSS specifically for medical students in China. Our research sample is from China. This study was conducted in two parts: the first focused on scale development, validity and reliability verification, while the second focused on the analysis of factors influencing school satisfaction.

METHODS

The study was conducted in four stages: (a) item generation (a literature review; a pilot test, n = 35; two rounds of the Delphi method, n = 12); (b) exploratory factor analysis (EFA) and reliability measure, n = 237; (c) confirmatory factor analysis (CFA), n = 446; (d) test-retest reliability, n = 100; predictive validity, n = 290; measurement invariance, n = 444. The content validity was evaluated with Pearson correlation coefficients. Medical students (n = 897) completed a cross-sectional survey.

RESULTS

Fifteen questions and four SSS dimensions, including learning satisfaction, interpersonal relationship satisfaction, teaching satisfaction, and service satisfaction. The entire SSS has good reliability (Cronbach's α = 0.916) and validity (0.673-0.783). Logistic regression predictive effects of learning, interpersonal, teaching and service on school satisfaction. And the model has invariance at different majors (p > 0.05).

CONCLUSION

This study demonstrated that the SSS has good validity and reliability and is a reliable tool for assessing medical students' school satisfaction in China.

Evaluation of a pathology resident wellness initiative: Initial establishment and subsequent expansion through a time of high stress, the COVID-19 pandemic

OBJECTIVES

Recent studies have shown that the pathology workforce is at risk of decreased workplace well-being, which may lead to decreased job satisfaction, increased attrition, burnout, depression, anxiety, and suicidality, but there has been relatively little research on well-being initiatives designed for pathologists, pathology trainees, and laboratory professionals. Some studies have suggested that well-being initiatives may decrease burnout and increase workplace satisfaction and engagement.

METHODS

Here we describe the creation of a Pathology Wellness Committee in a large residency program. Interventions included emotional, social, and physical well-being interventions as well as system-based improvements. Additional initiatives were introduced in response to the increased stress, isolation, and social distancing guidelines during the height of the COVID-19 pandemic. The program's impact was measured by an annual House Staff Council Resident Wellness Survey over 4 years.

RESULTS

The annual surveys showed improvements in workplace and residency program satisfaction and emotional well-being following system-based improvements and well-being initiatives. Physical and social well-being showed slight but not statistically significant decreases over the 4-year period. Results from the annual Accreditation Council for Graduate Medical Education Survey were also evaluated.

CONCLUSIONS

We found that dedicated well-being initiatives in conjunction with system-based interventions may help improve overall well-being in pathology residents.

Associations between adverse childhood experiences and medical students' interest in careers: a single-setting study

Background

Adverse childhood experiences (ACEs) are pervasive across communities, including medical students and physicians. Exposure to childhood trauma influences career decisions, such as social workers and nurses. However, the impact of ACEs on medical students' career interests remains unexplored.

Methods

From August to October 2022, a survey was designed and administered to medical students at UT Health San Antonio School of Medicine (Texas, USA). Ten household-level and four community-level ACEs were assessed. Associations between ACE distribution and interest in medical specialties, academia, and primary care were analyzed by Mann-Whitney U test.

Results

Four hundred nineteen (47.0%) of 891 total students completed the survey, of which 310 (74.3%) reported at least one ACE and 107 (25.7%) reported four or more. The most common ACE was living with a household member with mental illness (154, 36.9%). Students interested in psychiatry (p<.01) or academic medicine (p=.02) had significantly higher ACE scores than those not interested in these fields. No associations were observed between ACEs and students' interest in primary care.

Discussion

The prevalence of medical students living with a household member with mental illness was approximately double than reported in population-based studies. Childhood trauma exposure may influence medical students' interests in psychiatry and academic medicine careers. Further research is needed to investigate how ACEs influence medical students' career considerations. Research exploring ACEs exposure in academic physicians and psychiatrists may further illuminate the associations found in this brief report. Importantly, advancements in trauma-informed approaches to medical education are necessary to facilitate safe learning environments.

The relationship between mindfulness and burnout in physicians

BACKGROUND

To investigate the relationship between mindfulness and burnout in physicians and its underlying mechanisms.

METHODS

Study 1 employed a multiverse-style analysis based on a large sample of 8,462 physicians to examine the robust relationship between mindfulness(MAAS) and burnout(MBIES). Study 2 conducted a 21-day intensive longitudinal assessment on 471 physicians to explore the internal mechanisms by which mindfulness affects burnout.

RESULTS

Study 1 found that the negative association between mindfulness and burnout is robust. Study 2 discovered that Perceived Organizational Support(POS) and Psychological Safety(PS) play a sequential mediating role in the effect of mindfulness on burnout.

CONCLUSIONS

These findings provide a theoretical basis for formulating interventions at the organizational level and have important practical and theoretical significance for optimizing physicians' work environments and improving the medical quality.

CLINICAL TRIAL NUMBER

Not applicable.

Daily physical activity habits influence surgeons' stress in the operating room: a prospective cohort study

BACKGROUND

Exercise training improves heart rate variability, and evidence suggests it can mitigate the detrimental effects of stress. This study aims to evaluate the relationship between surgeons' physical activity habits and their stress, assessed as heart rate variability, at the start of surgery.

MATERIALS AND METHODS

This multispecialty prospective cohort study included surgeons from fourteen cardiac, endocrine, digestive, gynecologic, orthopedic, thoracic, and urologic surgical departments of four university hospitals. Surgeons wore accelerometers 24/7 from 1 November 2020 to 31 December 2021 to quantify the mean daily step counts and daily sedentary time for 7 days prior to each operation. RMSSD, the root mean square of successive differences between normal heart beats, is a heart rate variability (HRV) metric that reflects cardiac vagal tone. We evaluated RMSSD during the first 5 minutes of surgeries performed over five 15-day periods. Data were analyzed using a multivariable linear mixed model with a random effect for surgeons.

RESULTS

We analyzed 722 surgeries performed by 37 surgeons (median age = 47 (IQR 42-55); 29 (78.4%) male). On average (SD), surgeons walked 9762 (2447) steps and were sedentary 391 (102) minutes daily. The model showed a positive relationship between steps and cardiac vagal tone, with an increase in lnRMSSD (0.028, 95% CI 0.003 to 0.053, P = 0.026) for every 1000 more steps per day, but not for sedentary behavior. Surgeon professors presented lower lnRMSSD (-0.437, -0.749 to -0.126, P = 0.006), as did surgeons who spent less total time operating over the study period (-0.337, -0.646 to -0.027, P = 0.033), compared to their counterparts.

CONCLUSIONS

Higher daily step counts the week before surgery were associated with increased cardiac vagal tone, indicating lower stress levels at the beginning of surgery. This relationship highlights the influence of physical activity on surgeons' stress in the operating room.

Psychiatry Resident Physicians Experience Personal and Professional Grief, Burnout and Depression: Results From a National Survey

BACKGROUND

Resident physicians experience personal and professional stressors throughout training. These experiences may increase levels of burnout, depression, and grief. Understanding how these stressors impact trainees is essential for improving wellbeing during residency.

OBJECTIVE

We examined the prevalence and associations between burnout, depression, and grief among a national sample of psychiatry resident physicians.

METHODS

A survey including validated scales for burnout (Modified Maslach Burnout Inventory-Health Services Survey [MBI]), depression (Patient Health Questionnaire-9 [PHQ-9]), and grief (Traumatic Grief Inventory Self Report [TGSIR]) was distributed to 296 psychiatry program directors in January 2023 for dispersal to their respective residents.

RESULTS

Fifty-seven participants completed the survey out of 245 participants who opened and started the survey (23.3%). All participants were current psychiatry residents. MBI scores averaged 21.2 (SD 6.5, range 11-40); 11 participants reported high levels of burnout (scores >27; 19.3%). PHQ-9 scores averaged 3.42 (SD 3.0, range 0-14), with 8 responses meeting the criteria for moderate depressive symptoms (scores >10-14; 14.0%). Suicidal ideation was reported by 5 of 57 participants (8.7%). TGISR scores averaged 12.2 (SD 11, range 0-43); no participants met the criteria for pathologic grief. TGISR scores were correlated with MBI (r = .30; P = .02) and PHQ-9 scores (r = .53; P < .0001). MBI scores were also correlated with PHQ-9 scores (r = .54; P < .0001).

CONCLUSIONS

Non-pathological grief was correlated with burnout and depression. 14% to 20% of psychiatry residents reported clinically significant levels of burnout and depression. Future studies should aim to further characterize burnout, depression, and grief in larger samples of trainees.

Effects of building resilience skills among undergraduate medical students in a multi-cultural, multi-ethnic setting in the United Arab Emirates: A convergent mixed methods study

INTRODUCTION

Although curricula teaching skills related to resilience are widely adopted, little is known about needs and attitudes regarding resilience training of undergraduate-medical-trainees in Middle-East-and-North-Africa-region. The purpose of this study is to investigate the value of an innovative curriculum developed through design-based-research to build resilience-skills among undergraduate-medical-trainees in the United-Arab-Emirates.

METHODS

Convergent-mixed-methods-study-design was utilized. Quantitative data collection was through controlled random group allocation conducted in one cohort of undergraduate medical students(n = 47). Students were randomly allocated into the respective resilience-skills-building-course(study-group) versus an unrelated curriculum(control-group). All students were tested at baseline(test-1), at end of 8-week course(test-2), and again 8 weeks after end of course(test-3). Then students crossed over to the opposite course and again tested at end of 8 weeks(test-4). Testing at four timepoints consisted of questionnaires related to burnout-Maslach-Burnout-Inventory; anxiety-General-Anxiety-Disorder-7; and resilience- Connor-Davidson-Resilience-Scale. Quantitative data were analysed descriptively and inferentially. Qualitative data, constituting of students' perception of their experience with the course, was captured using virtual-focus-group-sessions. Qualitative analysis was inductive. Generated primary inferences were merged using joint-display-analysis.

RESULTS

Significant proportion of the students, at baseline, seemed to be at risk for burnout and anxiety, and would benefit from developing their resilience. There appeared to be no statistical differences in measures of burnout, anxiety, and resilience related to course delivery. Overall risk for anxiety among students increased following the COVID-19 lockdown. Qualitative analysis generated the 'Resilience-Skills'-Building-around-Undergraduate-Medical-Education-Transitions' conceptual model of five themes: Transitions, Adaptation, Added Value of course, Sustainability of effects of course, and Opportunities for improving course. Merging of findings led to a thorough understanding of how the resilience-skills'-building-course affected students' adaptability.

CONCLUSION

This study indicates that a resilience-skills'-building-course may not instantly affect medical trainees' ratings of burnout, anxiety, and resilience. However, students likely engage with such an innovative course and its content to acquire and deploy skills to adapt to changes.

Uniformed Medical Student Perspectives About Mental Health: Thematic Analysis of Written Reflections

INTRODUCTION

Medical students, including uniformed medical students, are at greater risk of depression, anxiety, and burnout compared to their age-matched peers, yet relatively few medical students choose to seek help from mental health professionals. This study aimed to evaluate medical students' reflective writings to identify common themes and attitudes around mental health-for both the medical students themselves and how they view their future patients.

MATERIALS AND METHODS

Written reflections on the topic of mental health were completed during a required pre-clerkship reflective practice course. Third- and fourth-year medical students were asked whether the reflections they had completed could be used for analysis. Qualitative analyses were conducted to identify themes. The study was deemed exempt by the USU Institutional Review Board.

RESULTS

Written reflections from 50 uniformed medical students were reviewed. Four themes were identified: Mental health is health, caring for the caregiver, defining bias, and mental health and the mission.

CONCLUSIONS

Written reflection created an opportunity for medical students to discover their own perspectives on mental health and potential barriers to accessing mental health care. Medical schools should seek opportunities to incorporate reflective writing into the curriculum.

The Moderating Effects of Moral Injury and Discrimination Trauma on Women Physician Trainees' Well-Being

BACKGROUND

Graduate medical trainees are positioned to experience high rates of negative well-being due to the demanding and hierarchical nature of this time in their careers. Focusing on the well-being of physician trainees is required to ensure a better future of medicine. A novel avenue of examining physician trainee well-being is through understanding the effects of moral injury and discrimination trauma in overall well-being.

OBJECTIVE

This secondary data analysis examines the moderating role of discrimination trauma and moral injury on six well-being metrics cross-sectionally at baseline and 4 months postcoaching intervention, respectively.

DESIGN

This is a secondary, cross-sectional analysis using survey data collected at two time points.

PARTICIPANTS

The participants in this study (n = 1017) are women physician trainees in the USA.

MAIN MEASURES

The predictor measures are as follows: Moral Injury Symptom Scale- Healthcare Providers and Trauma Symptoms of Discrimination Scale. The outcome measures are as follows: Maslach's Burnout Inventory, Young Impostor Scale, Self-Compassion Scale, and Secure Flourishing Index.

KEY RESULTS

At baseline, discrimination trauma moderates the relationship among moral injury with impostor syndrome and self-compassion. After the coaching intervention, moral injury moderates the effect of the intervention on impostor syndrome.

CONCLUSIONS

The results of this secondary analysis emphasize the role moral injury and discrimination play in overall well-being, specifically through the experiences of self-compassion and impostor syndrome. This study calls for early measurement and mitigation efforts of both moral injury and discrimination trauma, which may effect well-being for graduate medical trainees and lessen the impact of our coaching intervention.

Towards a National System-Level Intervention: Characterization of Burnout Among Trainees of Saudi Postgraduate Healthcare Professions Programs

BACKGROUND/OBJECTIVES

High levels of burnout among healthcare professionals and trainees represent a global problem with identified profound impacts. The collection of national data for better characterization of this problem can guide more needs-sensitive targeted interventions. We aimed to identify the prevalence of burnout, the associated factors, and their impacts among trainees of Saudi postgraduate healthcare professions training programs.

METHODS

We conducted an anonymous, cross-sectional survey of 11,500 Saudi Commission for Health Specialties trainees from February to May 2019. The survey included items for socio-demographic data, physical health, and work-related items. We used validated instruments to measure burnout (Maslach Burnout Inventory), stress (Perceived Stress Scale), and depression (Patient Health Questionnaire-9).

RESULTS

A total of 6606 postgraduate trainees from different healthcare professions responded (mean age of 28.8 ± 3 years). Fifty-six percent reported burnout symptoms. Burnout was lower among female trainees (aOR, 0.73; 95% CI, 0.65-0.82) and higher in trainees working ≥40 h/week (aOR, 1.19; 95% CI, 1.03-1.37) and doing ≥six on-call shifts/month (aOR, 1.18; 95% CI, 1.03-1.37). Harassment and discrimination increased the risk of burnout by 57% and 60% (aOR = 1.57, 95% CI: 1.36-1.80 and aOR, 1.60; 95% CI, 1.38-1.86), respectively. Burnout trainees had 3.57 adjusted odds to report major depression (95% CI 3.11-4.09), were 1.25 times more likely to report major stress (95% CI 1.36-1.80), and were 1.8 times more likely to complain of sleep disorders (95% CI 1.60-2.04).

CONCLUSION

This study identified several personal and work-related risk factors and impacts of burnout among our postgraduate trainees. The findings were helpful in guiding the expansion of the national Da'em well-being and prevention of burnout program efforts to a targeted system-level intervention.

Do we have a lost generation of junior doctors: Effects of the COVID-19 pandemic on junior doctors' resilience status, medical knowledge and medical skills

BACKGROUND

At the onset of the COVID-19 pandemic, strict measures suspended face-to-face teaching at German universities, posing significant challenges for medical education. Practical, patient-centered training couldn't be fully replaced by online formats, leading to skill deficits and increased stress among students. To date, no study has examined the impact of COVID-19 on the resilience and the competence of medical graduates so far. This study aims to address this knowledge gap by investigating the pandemic impact on resilience, medical competence, communication skills, and research competence of medical graduates.

METHODS

The study employed data from the "Bavarian Graduate Study of Medicine" (MediBAS), a cross-sectional evaluation survey conducted in cooperation with Bavarian universities and the Bavarian Institute for higher education research and planning. It targeted medical, dental, and veterinary graduates. The data were collected in two waves (2018/19 and 2022/23), with 1.114 human medicine graduates participating. The questionnaire assessed among others resilience, medical expertise, communication skills, and research competence. Statistical analysis involved descriptive statistics, correlation analysis, and Mann-Whitney-U tests due to non-normal data distribution.

RESULTS

The study analyzed self-assessed resilience, medical expertise, communication, and research skills of medical graduates from two waves. The findings demonstrated through descriptive statistics a decline in all competencies except research skills, which exhibited an increase. Correlation analysis revealed significant relationships between variables. Mann-Whitney-U tests revealed no significant differences between the waves in resilience (p =.079, r =.06), medical expertise (p =.117, r =.05), communication skills (p =.053, r =.07), or research competence (p =.106, r =.05).

CONCLUSION

The study examined the impact of COVID-19 on medical graduates' resilience, medical expertise, communication skills, and research competence. While there was a slight decline in resilience, medical expertise, and communication skills between the waves, there was an improvement in research competence. None of these changes were statistically significant. The findings suggest that the pandemic may have contributed to these trends by limiting practical experiences. No major negative impacts were found, suggesting no "lost generation" of doctors. The long-term effects of the changes remain uncertain due to the cross-sectional design and require further research.

Burnout in medical education: interventions from a co-creation process

INTRODUCTION

The high prevalence of burnout in medical education indicates an urgent need to develop and implement effective interventions at both the individual and organisational levels. Currently, there is a shortage of studies that include perspectives from multiple stakeholders, such as medical students, trainees and university staff. Our objective is to identify and discuss interventions from various stakeholders using a bottom-up approach to guide future implementation.

METHODS

A co-creation methodology was adopted, including workshops and a Delphi session, engaging 96 participants. The study included 12 workshops with medical students and trainees in Flanders (Belgium): first-year bachelor students (n = 12), first-year master students (n = 13), first-year General Practice (GP) trainees (n = 14) and first-year specialist trainees (n = 39). Additionally, one Delphi session was held with 18 other relevant stakeholders, including university staff. All workshops were transcribed verbatim and thematically analysed using NVivo.

RESULTS

Our results identified interventions to prevent and mitigate burnout among medical students and trainees. On the individual level, participants discussed personalized coaching, annual health assessments and training sessions. On the organisational level, a distinction was made between interventions intended for universities, and those for hospitals and GPs involved in medical training. Six interventions focused on preventing burnout in all contexts (i.e., onboarding programs); three were meant for universities only (i.e., pass-fail system), and six were tailored for hospitals and GPs (i.e., flexibility in scheduling).

CONCLUSION

Through an iterative multistakeholder co-creation process, this study identified interventions to prevent and mitigate burnout within medical education. These interventions span individual and organisational levels, targeting universities, hospitals and GPs. While organisational interventions are increasingly recognized as crucial to address burnout, individual-focused interventions remain predominant in current research. There is a pressing need to further investigate organisational interventions and their combination with individual-focused strategies.

The Imitation of Christ as a Model for Physician Wellness

Physician burnout, studied for over fifty years in scientific literature, has been shown to negatively affect physician health, patient care, and the healthcare system. While various commendable systemic and individualistic approaches have been described and actively implemented to minimize burnout, it is important to also consider approaches to maximize physician wellness. For the Catholic physician, the ultimate model of wellness is Jesus Christ, the Divine Physician. In this article, we propose that the physician can follow the spiritual progress model of wellness presented in The Imitation of Christ by Thomas à Kempis to address burnout.

Factors associated with mental health and quality of life among Brazilian medical students: a three-year longitudinal study

BACKGROUND

Despite several studies on the mental health of medical students, there is insufficient research on long-term follow-ups.

AIMS

To investigate the associated factors and changes in the quality of life and mental health of a group of medical students followed-up for three years.

METHODS

An observational, prospective cohort study was conducted. Four classes were followed during the first three years of the medical course. The study included sociodemographic data, mental health data using the DASS-21 scale, and quality-of-life data using the WHOQOL-BREF scale. Linear regression models were used for analysis.

RESULTS

A total of 201 (66.1%) medical students responded to both data collection waves after a three-year follow-up. Depressive symptoms(p < 0.001), anxiety(p = 0.037), and stress(p < 0.001) increased. Additionally, physical(p < 0.001), psychological(p < 0.001), and social(p = 0.003) quality of life decreased. Worse mental health at baseline and being a woman were associated with worse mental health after three years, while higher income at baseline was associated with better quality of life after three years.

CONCLUSIONS

The mental health and quality of life of the medical students worsened after three years, being influenced by gender, income, and mental health at baseline. Educators and managers must be aware of these factors to minimize suffering in medical schools.

Trigger warnings in medical student education: A scoping review

BACKGROUND

Medicine is recognised as a challenging course where exposure to potentially distressing content is inevitable. Some educators provide students with warnings before they encounter potentially upsetting content-trigger warnings. In this scoping review, we mapped the existing literature seeking to better understand how trigger warnings are implemented in medical schools and how they are influencing education within them.

METHODS

Bibliographic databases were searched to identify relevant literature, including searching for grey literature. Articles were included if they focussed on medical school education and were written in English. Data analysis was undertaken using both quantitative and qualitative approaches (thematic analysis).

FINDINGS

Searching generated 1284 potential records for inclusion. Articles not related to the primary research question were excluded. Abstracts of the remaining 841 articles were screened, and ultimately, 12 articles met criteria for full-text review. Of these, there were three empirical research studies. Qualitative analysis identified five main themes: purpose, implementation, student distress, responsibility and problems with terminology.

CONCLUSIONS

The use of trigger warnings within medical student education remains contentious. There is a lack of consensus as to their purpose and much diversity in how they are implemented. There was limited published empirical evidence to inform practice in this area.

Virtual Impressions: An Examination of OBGYN Programs' Online Presence in the Match Process: OBGYN Residency Program Websites and Social Media

BACKGROUND

The COVID pandemic led to the transition of residency applications to a virtual format and the expansion of residency programs' virtual presence.

OBJECTIVE

The objective is to understand what information Obstetrics and Gynecology Residency interviewees prioritize and how influential program websites and social media platforms are.

STUDY DESIGN

Electronic surveys were sent to fourth-year medical students and OBGYN residents and were available for 6 weeks in spring 2023. All responses were anonymous and voluntary.

RESULTS

There were 198 survey respondents. From our cohort, fourth-year medical students, PGY-1, and PGY-2 residents had virtual interviews (71.2%) while PGY-3 and PGY-4 residents had in-person interviews (28.8%). Both virtual and in-person interviewees reported that the most important residency website information they were interested in included current resident profiles, rotation schedule, application cycle information, postresidency employment or match, and salary and benefits. Virtual interviewees were more interested in current resident profiles, salary and benefits, and video tours. Program websites and social media platforms were used by most, with virtual applicants accessing social media platforms more than in-person applicants (p < 0.001). Of those that interviewed virtually, when compared to those who interviewed in-person, there were more interest in resident profiles, salary and benefits, and video tours. Websites and social media were influential for all respondents, most significantly for virtual applicants (p < 0.001).

CONCLUSIONS

The recent shift to virtual OBGYN interviews has placed emphasis on residency programs' virtual presence. Our findings suggest that programs must be vigilant in providing a comprehensive view of their program in order to remain relevant and competitive.

Generative artificial intelligence in graduate medical education

Generative artificial intelligence (GenAI) is rapidly transforming various sectors, including healthcare and education. This paper explores the potential opportunities and risks of GenAI in graduate medical education (GME). We review the existing literature and provide commentary on how GenAI could impact GME, including five key areas of opportunity: electronic health record (EHR) workload reduction, clinical simulation, individualized education, research and analytics support, and clinical decision support. We then discuss significant risks, including inaccuracy and overreliance on AI-generated content, challenges to authenticity and academic integrity, potential biases in AI outputs, and privacy concerns. As GenAI technology matures, it will likely come to have an important role in the future of GME, but its integration should be guided by a thorough understanding of both its benefits and limitations.

Unveiling the interplay of medical professionalism, mental well-being and coping in medical students: a qualitative phenomenological study

BACKGROUND

Medical students face significant stress and challenges that impact their professional development by affecting their levels of medical professionalism (MP), coping ability, and mental well-being (MWB). Given the high-stakes environment of medical education, understanding the interplay between these factors is crucial. This study aims to explore undergraduate medical students' lived experiences of MP, coping strategies (CSs), and MWB to inform the development of effective support systems.

METHODS

A qualitative phenomenological study was conducted using Focus Group Discussions (FGDs) to capture the lived experiences of 40 medical students from first, third, and fifth years of study. Participants, selected through purposive sampling, represented diverse backgrounds (with 27 females, 18 fifth-year students, and 30 Malays). Seven FGDs, each with 5-10 participants, were conducted via Zoom©, yielding comprehensive qualitative data. An inductive coding approach was applied through iterative transcript analysis to ensure robust findings.

RESULTS

Analysis revealed two themes related to MWB: 'mental well-being issues,' highlighting persistent mental health challenges, and 'happiness,' illustrating factors that sustain well-being. CSs were categorized into 'positive coping,' including seeking support, and 'negative coping,' such as denial. For MP, two themes emerged: 'inter-medical professionalism,' focusing on communication with others, and 'intra-medical professionalism,' emphasizing ethical self-conduct.

CONCLUSION

The interplay between CSs, MP, and MWB is complex and deeply intertwined. The findings highlight the importance of developing targeted interventions to support medical students in managing stress, maintaining professionalism, and enhancing their mental well-being throughout their training. Future research should further explore these themes to inform policy and curriculum development in medical education.

CLINICAL TRIAL NUMBER

Not applicable.

Suicide risk among residents and PhD students: A systematic review of the literature

Residents and PhD students (any discipline) are susceptible to various mental health issues, including suicidal thoughts and behaviors. This systematic review aimed to (1) estimate the prevalence of suicide-related outcomes among residents/PhD students and (2) assess the associated variables. PubMed, PsycINFO, and Scopus databases were searched for articles documenting quantitative information about suicide-related outcomes among residents and PhD students from inception until April 30, 2023. Sixty studies were included. Estimates of the current prevalence of the following suicide-related outcomes were: death wishes (DW), 9.1%; suicidal ideation (SI), 8.6%; suicidal planning (SP), 3.2%; non-suicidal self-injury (NSSI), 1.9%; suicide attempt(s) (SA), .8%. Additionally, estimates of the lifetime prevalence were: lifetime SI (L-SI), 25.9%; lifetime SP (L-SP), 10.0%; lifetime SA (L-SA), 3.1%. Depression, burnout, hopelessness, loneliness, low quality of the relationship with the supervisor and experiencing workplace mistreatment frequently co-occurred with the assessed outcomes. Many outcomes (DW, SI, SP, L-SI, L-SP, L-SA) had a higher prevalence compared to the general population, while some (SI, NSSI, SA) were lower compared to undergraduates. Interventions for individuals at risk in this population are vital together with the modification of the work environment and the promotion of a supportive academic and professional culture to reduce suicide risk.

Schwartz Rounds in Higher Education Settings: A Systematic Review of the Research with Recommendations

BACKGROUND

Higher education institutions (HEIs) have recently integrated Schwartz Rounds (Rounds) as innovative ways of supporting health professional students' reflective practice, interprofessional learning and compassionate care. Emerging evidence suggests that Rounds benefit students' shared sense of belonging and insight into emotional aspects of training and care, providing safe places to share experiences and reflect. Our review examines the current literature regarding health students' evaluation of Rounds in HEIs, exploring experiences and perceived benefits of participating. We consider methodological issues with the existing literature and propose ways of addressing these in future research.

METHODS

Systematic searches were conducted on EBSCO, PsycINFO, PubMed and ASSIA to identify available literature relating to Schwartz Rounds in higher education. Eight studies - six with a mixed method design and two qualitative - were included in the review. Study quality and risk of bias were assessed. Evaluation survey data and themes generated from qualitative responses were considered together and a narrative synthesis was constructed.

RESULTS

Despite challenges with differing measurements and scale usage, five themes were identified reflecting the experience and perceived benefits for students attending Rounds. Students highlighted the value of peer connection and communication; normalisation of emotions; collaborative reflection and self-awareness; and the relevance of Rounds in their daily work and patient care. Students also commented on barriers to participation including Rounds' multidisciplinary nature, their group size, and the presence of staff. The majority of students rated Rounds as excellent or exceptional and agreed they should be integrated into the curriculum.

CONCLUSIONS

Our findings on Schwartz Rounds in higher education suggest they support student reflective practice and confidence in providing compassionate, high-quality patient care. However, the quality of research in this area is mixed, reflecting the relatively recent integration of Rounds in Higher education, and the challenges of implementing and evaluating new interventions in educational settings.

A Self-Monitoring Mobile App to Mitigate Risk Factors for Suicide and Self-Harm in Junior (Resident) Doctors: A Review, Thematic Analysis and Concept Proposal

Doctors, particularly those in training in the UK, are exposed to high levels of stress in their work, which can lead to burnout and mental health problems. According to the health and safety executive (HSE) Management UK standards, employers should recognise and minimise work-related stress for staff. Our review looks to examine if known risk factors for suicide and self-harm in doctors align with the themes of the HSE management standards on stress control i.e., demand, control, support, relationships, role, and change and if so, could this be used to build a self-awareness digital application. Four research databases were searched using combinations of text words and thesaurus terms and predefined inclusion/exclusion criteria for relevant article retrieval. A thematic analysis was undertaken, aligning articles to their respective HSE standards. Twenty-six articles met the full inclusion criteria. 96.2% (25/26 papers) mentioned or aligned at least one of the HSE management standards, with 44% discussing three or more. Work-related risk factors for self-harm and suicide in doctors link well to the HSE management standards. We conceptualise a self-monitoring digital well-being tool for doctors to monitor stress.

The Silhouettes Fatigue Scale: further validation in Spanish-speaking university students and adults with chronic pain

PURPOSE

The aim of this study was to evaluate the psychometric properties of the Silhouettes Fatigue Scale (SFS) when used to assess fatigue in undergraduates and middle-aged adults with chronic pain.

MATERIALS AND METHODS

A total of 426 undergraduates and 207 middle-aged individuals with chronic pain participated in this study. Participants were asked to respond to a survey including the SFS as well as another validated measure of fatigue, questionnaires about pain catastrophizing and pain interference, and questions about pain (i.e., location, duration, and intensity). Convergent, discriminant, criterion and known-groups validity were evaluated.

RESULTS

Convergent validity was supported by a strong association between the two scales measuring fatigue. Discriminant validity was supported by stronger associations between the two fatigue scales scores compared to those between the SFS and pain catastrophizing scores. Criterion validity was supported by moderate associations between the SFS and measures of pain intensity and pain interference. Finally, known-groups validity was supported by significant differences in the SFS scores between students without chronic pain, students with chronic pain, and middle-aged individuals with chronic pain.

CONCLUSIONS

The findings support the validity of the SFS scores when used to assess fatigue in undergraduates and middle-aged adults with chronic pain.

Should I Stay, or Should I Go? Emotional Exhaustion's Association with Intent to Leave in a National Sample of Female Physician Trainees

Background: Physician burnout disproportionately affects women and contributes to attrition from the workforce, a costly problem that likely begins in training. Female physicians leave the workforce significantly earlier than male counterparts. The association between burnout and attrition intent in women physician trainees is unknown. Methods: This is a cross-sectional analysis of baseline data from a national sample of female physician trainees in a randomized controlled trial testing a well-being program in 2022. Participants completed surveys on burnout and intent to leave. Associations were analyzed using chi-square testing and univariable linear regression. Results: A total of 1,017 trainees responded. The average standard deviation (SD) age was 30.8 (4.0) years, 959 (94.3%) self-identified as a woman, and 540 (53.1%) as White. One-fifth (207, 20.7%) were in postgraduate year (PGY)-1, 198 (19.8%) PGY-2, and 595 (59.5%) ≥ PGY-3. Most scored positively for burnout; 77.5% experienced high emotional exhaustion (EE). One-fifth (20.6%) reported some intent to leave their program before graduation, and 32.7% reported intent to leave their specialty within 2 years. There was a strong association between EE scores and intent to leave: trainees reporting a high likelihood to leave before graduation had a 22.27 higher EE point average than those reporting no likelihood (95% confidence interval [CI]: 7.80, 36.74, p = 0.003). Conclusions: Attrition intent was associated with burnout. Addressing burnout during training will not only benefit trainees but could impact the retention of women physicians.

Well-being interventions for rural health professionals: A scoping review

INTRODUCTION

The objective of this scoping review is to identify interventions to promote well-being that have been tried or proven effective to prevent or address burnout in rural health care professionals and trainees (HCPTs). Secondarily, we aimed to identify potentially applicable and feasible well-being interventions that could help rural HCPTs.

METHODS AND ANALYSIS

We used PRISMA guidelines to conduct a scoping review of peer-reviewed English language studies, from all countries, published in core health sciences databases. We focused on intervention studies for burnout and well-being in rural HCPTs published from July 2013 to January 2024. Searches identified 571 studies; 18 additional studies were identified from hand searches of websites, reviews, and bibliographies identified in the original search strategy. Two authors screened and extracted all data using Covidence.

FINDINGS

After deduplication, 507 studies were screened for inclusion, and 50 full-text studies were assessed for eligibility. After discussion and consensus, 30 studies were selected for inclusion. We included selected "applicable" studies, for example, online interventions. We excluded potentially applicable studies that would not be feasible in rural settings, that is, health system interventions requiring substantial personnel and infrastructure. Interventions included individual interventions (eg, mindfulness), increased support for professionals (eg, remote pharmacist assistance), and interventions to improve quality or teamwork.

CONCLUSIONS

Few interventional studies have been done to support well-being and prevent burnout in vulnerable rural HCPTs. While individual interventions, such as mindfulness, are most effective to date, studies replicating or extending these interventions, and to identify supports that address workload and systems issues are needed.

Is medical training solely to blame? Generational influences on the mental health of our medical trainees

INTRODUCTION

The negative impact of medical training on trainee mental health continues to be a concern. Situated within a sociocultural milieu, Generation Z and Generation Y, defined by their highly involved parents and the widespread use of technology, currently dominate undergraduate and graduate medical education respectively. It is necessary to explore medical trainees' generational characteristics and job-related factors related to stress, burnout, depression, and resilience. This might provide different perspectives and potential solutions to medical trainees' mental health.

METHODS

A cross-sectional study was conducted among medical trainees (students and residents) from two institutions in Qatar. A self-administered online survey included measures for trainees' social media overuse, their parent's parenting style, the educational support by the clinical teacher, job (demands, control, and support), and work-life balance and their relation with their stress, burnout, depression, and resilience. Relationships were tested with multiple linear regression analyses.

RESULTS

Of the 326 medical trainees who responded, 142 (44%) trainees - 93 students and 49 residents - completed all items and were included in the analysis. Social media overuse and inability to maintain a work-life balance were associated with higher levels of stress, depression, and student burnout. Higher levels of job support were associated with lower levels of stress, depression, and resident burnout, and a higher level of resilience. Job control was associated with lower burnout levels. Parenting style was unrelated to trainees' mental health.

DISCUSSION

The two generations 'Y' and 'Z' dominating current medical training showed more stress-related complaints when there is evidence of social media overuse and failure to maintain a work-life balance, while job support counterbalances this, whereas parenting style showed no effect. Measures to enhance medical trainees' mental health may include education about the wise use of social media, encouraging spending more quality social time, and enhancing job support and job control.

Problematic Internet use among resident physicians at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia

BACKGROUND

Problematic Internet use (PIU) is a growing concern in modern society. There is a limitation of epidemiologic data related to PIU. This is due to a lack of consensus on the definition and variability of assessment tools of PIU. PIU has been linked to a range of negative outcomes including depression, anxiety, social isolation, and poor academic or work performance. Resident physicians are at risk of exhibiting problematic internet use due to the high stress of academic demands, social isolation, long working hours, busy schedules, and internet access. There is limited research on this topic and targeting resident physicians in Ethiopia. This study aimed to determine the PIU prevalence and associated factors among resident physicians in SPHMMC, Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted from September 1, 2023, to November 25, 2023, at St. Paul's Hospital Millennium Medical College (SPHMMC). This study included 417 physician residents who were selected using multistage sampling techniques, and Young's Internet addiction test was used to assess PIU. To look for associations, logistic regression analysis, both binary and multivariable, was performed, and a p-value of < 0.05 was used to determine statistical significance.

RESULTS

414 participants were included in this study, with a response rate of 99.3%. The prevalence of PIU was 46.6%, with a 95% CI of 41.7-51.6%. The multivariable logistic regression model revealed that using the Internet for five or more hours per day (AOR: 1.84, 95% CI = 1.14, 2.99), having less than 7 h of actual sleep per night (AOR: 2.16, 95% CI = 1.03, 4.53), and having depression (AOR: 7.98, 95% CI = 2.47, 25.78) were significantly positively associated with PIU. In addition, factors such as being married (AOR: 0.42, 95% CI = 0.19, 0.91) and residents of the obstetrics and gynecology department (AOR: 0.32, 95% CI = 0.13, 0.81) were negatively associated with PIU.

CONCLUSION

This study revealed high PIU use among resident physicians at SPHMMC. Factors such as using the Internet for five or more hours per day, having less than seven hours of actual sleep per night, and having depression were found to be risk factors for PIU. On the other hand, being married and residents of the obstetrics and gynecology department were protective factors. Thus, creating awareness among medical residents about healthy tech habits and involving policymakers to develop guidelines for healthy internet use and awareness campaigns to reduce the impact of PIU is recommended.

Gap Years-Unbridled Good or Unwarranted Cost?

This Viewpoint discusses the increasing popularity of taking a gap year between college and medical school and raises questions about the perceived necessity of this trend, its financial and other costs, and the potential disadvantage it may pose to underrepresented minority applicants.

Status quo and influencing factors of job burnout among residents in standardized training

Background

With the continuous progress and in-depth implementation of the reform of the medical and health care system, alongside the gradual enhancement of the standardized training framework for residents, such training has become a crucial avenue for cultivating high-level clinicians and improving medical quality. However, due to various constraints and limitations in their own capabilities, residents undergoing standardized training are often susceptible to job burnout during this process. Numerous factors contribute to job burnout, which is closely associated with depression and anxiety. To promote effective standardized training and develop high-quality resident personnel, it is essential to investigate the influencing factors of job burnout and implement strategies to mitigate its occurrence.

Objective

Explore the job burnout and its influencing factors among standardized training residents of Affiliated Hospital of Yan 'an University, and to provide favorable basis for effective prevention of job burnout.

Methods

An online questionnaire survey was conducted among all standardized training residents at the hospital from June 2020 to September 2022. The evaluation utilized a general situation questionnaire, the Job Burnout Inventory - General Survey (MBI-GS), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS).

Results

A total of 660 valid questionnaires were collected, and 315 people had positive reaction for job burnout, and the detection rate was 47.7%. Difference in gender, marital status, whether they held practicing certificates, participated in work before training, used sleep medication, age, grade, sleep state were the influencing factors of different dimensions of job burnout. 175 people were in a state of anxiety (26.5%), while 357 (54.1%) were depressed. Pearson correlation analysis showed that anxiety and depression were highly correlated with job burnout (p < 0.01). The results of multi-factor analysis showed that sleep status, whether to take sleep AIDS, anxiety and depression were the factors affecting the dimension of emotional exhaustion (p < 0.01). Income, sleep status, anxiety and depression scores were the influencing factors of job burnout dimension (p < 0.05). Sleep status and depression score were the factors affecting the dimension of reduced sense of achievement (p < 0.05).

Conclusion

Job burnout is prevalent among residents undergoing standardized training, and the factors influencing it are numerous and diverse. It is closely associated with various elements such as age, income, years of training, sleep quality, anxiety, and depression. Therefore, it is recommended to implement appropriate measures to mitigate the occurrence of job burnout and enhance the quality of standardized training for residents. Such measures may include formulating reasonable training policies and theoretical learning plans, as well as providing mental health interventions.

Impact of Working Conditions and Other Determinants on the Risk of Substance Misuse among Healthcare Residents: Results of a Cross-Sectional Study

INTRODUCTION

Substance misuse significantly impairs psychosocial functioning and correlates with many environmental factors, including working conditions. We investigated the influence of working conditions and other determinants on the risk of substance misuse among healthcare residents of Lyon, France.

METHODS

We conducted an online survey among medicine, dentistry and pharmacy residents of Lyon from May 30, 2022, to July 15, 2022. Participants reported their age, sex, residency specialty, and living conditions and completed the French Job Content Questionnaire, the Alcohol Use Disorder Identification Test - consumption, and questions exploring their current tobacco, alcohol, and illicit drug use. We constructed directed acyclic graphs to model the effect of working conditions on substance misuse and used them to perform multivariable logistic regressions.

RESULTS

Among the 1,936 residents of the Lyon subdivision, 904 (46.7%) completed the survey. Among these, 54.0% exhibited alcohol misuse, 23.7% reported tobacco misuse, and 34.5% reported illicit drug misuse. Working more than 48 h per week was not associated with any substance misuse. Low social support at work predicted the use of illicit drugs (aOR: 1.49, 95% CI: [1.04; 2.13]). Compared with general medicine residents, psychiatric residents had greater odds of reporting tobacco misuse (aOR: 2.28, 95% CI: [1.14; 4.58]) and illicit drug misuse (aOR: 2.51, 95% CI: [1.33; 4.74]). Pediatric and pharmacy residents had lower odds of reporting alcohol misuse (aOR: 0.42, 95% CI: [0.21; 0.84] and OR: 0.53, 95% CI: [0.28; 0.98], respectively).

CONCLUSIONS

Social support at work significantly impacts the risk of substance misuse among healthcare residents, as do other factors, such as residents' health specialty. These findings contribute to the development of appropriate institutional policies and support programs to improve the well-being of healthcare residents.

Turning the "Page" Again: Decreasing Inappropriate After-Hours Pages

OBJECTIVE

To decrease the number of inappropriate pages after-hours by 50%.

METHODS

Over 9 weeks, after-hours pages to the on-call resident at University of Minnesota Department of Urology were documented. Pages were deemed "appropriate" or "inappropriate" by 3 independent reviewers. The source of each page was reviewed and after several plan-do-study-act (PDSA) cycles, 3 separate interventions were created, directed at floor nursing, patient phone calls, and the call triage center. After a 6-week implementation period, data were re-collected for 9 weeks. Descriptive statistics were generated, and a Mann-Whitney U test was used to compare inappropriate pages pre- and post- interventions.

RESULTS

In phase I, 48 shifts were recorded. The mean number of pages per shift was 8.9 (range 1-27), with 52.7% of pages considered "inappropriate." Most pages came from the wards (48.9%) followed by the emergency department (20.4%), patient phone calls (19.4%), and the call center (2.6%). From these domains, the call center had the highest proportion of inappropriate pages (90.9%). In phase II, 39 shifts were recorded. The mean number of pages per shift decreased to 6.0 (range 1-20), and inappropriate pages per shift decreased by 68.4%, (P <.0001).

CONCLUSION

By improving communication to nurses, patients, and call center personnel, inappropriate after-hours pages decreased by 68.4%-exceeding our aim. Future studies are needed to assess if the impact was sustainable over time.

Resident perspectives on the impact of program leadership communication on well-being during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic introduced a myriad of changes that negatively impacted resident physicians' well-being. Communication from program leadership may mitigate resident stress during times of crisis, yet literature supporting this premise is scant, and best communication practices remain uncertain. This qualitative study aimed to identify stressors to residents and explore the influence of residency program leadership's communication on emotional stress during the COVID-19 pandemic.

METHODS

Informed by Kotter's 8-step management model to support resident well-being, this qualitative study used grounded theory methods to interview 25 residents from three training programs (Pediatrics, Internal Medicine, and Medicine-Pediatrics) on a single academic medical campus from May-September 2020. Four investigators coded the data using the constant comparative analysis. Sampling continued until reaching thematic saturation. Codes were built using an iterative approach and organized into themes. Discrepancies were resolved by consensus discussion among investigators.

RESULTS

Residents described increased stress levels, the all-consuming nature of COVID-19, mixed emotions about their role as healthcare providers, new coping mechanisms, and changes to their education and work environment that impacted stress. Communication from leadership to residents during the pandemic varied. Effective communication helped mitigate stress; perceived suboptimal communication exacerbated stress. Who was communicating, methods of communication, and content of communication influenced resident stress.

CONCLUSIONS

The COVID-19 pandemic introduced new stressors and challenges to residents. The perception of leadership communication played a critical role in mitigating or exacerbating resident stress. We propose a communication framework ("Who? What? Where? When? How?") that residency leadership can utilize during times of crisis.

Enhancing wellbeing in medical practice: Exploring interventions and effectiveness for improving the work lives of resident (junior) doctors: A systematic review and narrative synthesis

Introduction

Globally, resident doctors face challenges like long work hours, critical decision-making stress, and exposure to death and distress, prompting concern for their wellbeing. This study addresses the need for interventions to improve their working conditions, vital for enhancing quality of life, patient care and retaining a skilled workforce.

Methods

Following PRISMA guidelines, a systematic literature review until 3 January 2024 explored interventions for resident Ddoctors pre- and post-COVID-19. It evaluated intervention effectiveness, metrics and feasibility, excluding studies with high bias risk.

Results

The review identified diverse interventions, from mentoring to wellness resources, showing significant improvements in job satisfaction, mental health and professional growth among resident doctors. Due to methodological variations, a narrative synthesis was conducted.

Conclusion

Effective interventions addressing resident doctors' challenges can notably enhance their wellbeing and job satisfaction. Scaling such interventions is vital for fostering supportive work environments, sustaining the healthcare workforce and improving patient care quality.