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Morgan HK, Banks E, Gressel GM, Winkel AF, Hammoud MM, Akingbola B, George K. Inequities at the Transition to Obstetrics and Gynecology Residency. J Surg Educ 2024:S1931-7204(24)00202-2. [PMID: 38705787 DOI: 10.1016/j.jsurg.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/01/2024] [Accepted: 04/13/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Although approximately one-fifth of obstetrics and gynecology (OBGYN) residents matriculate from osteopathic or international medical schools, most literature regarding the transition to residency focuses on allopathic medical school graduates. To create comprehensive interventions for this educational transition, we must understand the needs of all incoming residents. Our objective was to examine OBGYN residents' perceptions of their transition to residency, and to understand how residents' background and medical school environment influence their perceived sense of readiness. DESIGN A 16-item survey asked questions about demographics, the transition to residency, resident well-being, burnout, and the transition to fellowship. Perception of preparedness was assessed with the question "I felt that I was well-prepared for the first year of residency" (1=strongly agree, 5=strongly disagree). Chi-squared and Fisher's exact tests and logistic regression explored association of perceived preparedness with residents' backgrounds. SETTING Survey administered at time of the in-training examination in 2022. PARTICIPANTS All OBGYN residents. RESULTS Of 5761 eligible participants, 3741 (64.9%) provided consent and completed the survey. Of the 3687 participants who answered the question, 2441 (66.2%) either agreed or strongly agreed that they felt well-prepared. Fewer osteopathic graduates reported feeling prepared compared to allopathic graduates (379/610, 62.1% vs 1,924/2,766, 69.6%) (OR 0.72, 95%CI 0.60-0.86, p < 0.01). International medical school graduates were seven times less likely to report feeling prepared compared to those from allopathic institutions (137/304, 45.1% vs 1924/2776, 69.6%) (OR 0.60, 95%CI 0.53-0.68, p < 0.01). Respondents from underrepresented racial and ethnic backgrounds were less likely to report feeling prepared compared to White respondents (276/535, 51.6% vs 1738/2387, 72.8%) (OR 0.39, 95%CI 0.33-0.48, p < 0.01). CONCLUSIONS Differences in residents' perceptions of their transition to residency highlight the need to begin offsetting pervasive inequities with comprehensive and accessible resources.
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Affiliation(s)
- Helen Kang Morgan
- Departments of Obstetrics and Gynecology and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan.
| | - Erika Banks
- Department of Obstetrics and Gynecology at NYU Long Island School of Medicine, Mineola, New York
| | - Gregory M Gressel
- Spectrum Health Medical Group Gynecologic Oncology, Grand Rapids, Michigan
| | - Abigail Ford Winkel
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York
| | - Maya M Hammoud
- Departments of Obstetrics and Gynecology and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Bukky Akingbola
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Karen George
- Larner College of Medicine at University of Vermont, Burlington, Vermont
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Qedair J, Ezzi S, AlMadani R, Alsamin SI, Almeneif HA, Hakami AY, Alobaid A. Neurosurgery Residents' Satisfaction Toward Their Saudi Training Program: Insights from a National Survey. World Neurosurg 2024; 185:e867-e877. [PMID: 38447740 DOI: 10.1016/j.wneu.2024.02.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Given the high-stakes nature of their work, neurosurgery residents face constant pressure and require high-quality training to succeed. We aim to investigate the satisfaction levels of residents with their Saudi Neurosurgery Residency Training Program (SNRTP) and its influential factors. METHODS This is a nationwide, cross-sectional study that employed a questionnaire, structured based on the relevant literature, which was disseminated to neurosurgery residents, commencing from December 2021 and culminating in September 2022. RESULTS A total of 70 out of 143 neurosurgery residents were included, giving a response rate of 48.9%. Most participants (62.9%) aged 24-28 years old, 55.7% were males, and 40.0% were from the Central region of Saudi Arabia. The residents were further divided into juniors (R1-R3; 64.3%) and seniors (R4-R6; 35.7%). Approximately 13.3% of the juniors were satisfied with the SNRTP, whereas only 8.0% of the seniors were satisfied. Dissatisfaction rates over the SNRTP were significantly higher in the seniors (68.0%) compared to the juniors (28.9%; P = 0.006). The frequency of operating room sessions per week and presence of protected research time were the only 2 factors significantly associated with the junior and senior residents' satisfaction, respectively. CONCLUSIONS The SNRTP has a vision to provide the society with elite competent neurosurgeons. However, we found a degree of dissatisfaction among the residents, indicating a need for improving the SNRTP's policies. We recommend incorporating more hands-on training opportunities, implementing a mentorship model, setting tailored teaching sessions, and establishing resident wellness programs. We hope this study initiate dialogue on promoting residents' satisfaction and overall well-being.
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Affiliation(s)
- Jumanah Qedair
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia.
| | - Suzana Ezzi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
| | - Raghad AlMadani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
| | - Sarah I Alsamin
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hesham A Almeneif
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alqassem Y Hakami
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
| | - Abdullah Alobaid
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
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Abahuje E, Smith KS, Amortegui D, Eng JS, Philbin SE, Verma R, Dastoor JD, Schlick C, Ma M, Mackiewicz NI, Choi JN, Greenberg J, Johnson J, Bilimoria KY, Hu YY. See One, Do One, Improve One's Wellness: Resident Autonomy in US General Surgery Programs, A Mixed-methods Study. Ann Surg 2023; 278:1045-1052. [PMID: 37450707 DOI: 10.1097/sla.0000000000006002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE We sought to examine the factors associated with resident perceptions of autonomy and to characterize the relationship between resident autonomy and wellness. BACKGROUND Concerns exist that resident autonomy is decreasing, impacting competence. METHODS Quantitative data were collected through a cross-sectional survey administered after the 2020 ABSITE. Qualitative data were collected through interviews and focus groups with residents and faculty at 15 programs. RESULTS Seven thousand two hundred thirty-three residents (85.5% response rate) from 324 programs completed the survey. Of 5139 residents with complete data, 4424 (82.2%) reported appropriate autonomy, and these residents were less likely to experience burnout [odds ratio (OR) 0.69; 95% CI 0.58-0.83], suicidality (OR 0.69; 95% CI 0.54-0.89), and thoughts of leaving their programs (OR 0.45; 95% CI 0.37-0.54). Women were less likely to report appropriate autonomy (OR 0.81; 95% CI 0.68-0.97). Residents were more likely to report appropriate autonomy if they also reported satisfaction with their workload (OR 1.65; 95% CI 1.28-2.11), work-life balance (OR 2.01; 95% CI 1.57-2.58), faculty engagement (OR 3.55; 95% CI 2.86-4.35), resident camaraderie (OR 2.23; 95% CI, 1.78-2.79), and efficiency and resources (OR 2.37; 95% CI 1.95-2.88). Qualitative data revealed that (1) autonomy gives meaning to the clinical experience of residency, (2) multiple factors create barriers to autonomy, and (3) autonomy is not inherent to the training paradigm, requiring residents to learn behaviors to "earn" it. CONCLUSION Autonomy is not considered an inherent part of the training paradigm such that residents can assume that they will achieve it. Resources to function autonomously should be allocated equitably to support all residents' educational growth and wellness.
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Affiliation(s)
- Egide Abahuje
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Kathryn S Smith
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Daniela Amortegui
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Sarah E Philbin
- Center for Education in Health Sciences, Northwestern University, Chicago, IL
| | - Rhea Verma
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Jehannaz Dinyar Dastoor
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Cary Schlick
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Meixi Ma
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Natalia I Mackiewicz
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | | | | | - Julie Johnson
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Yue-Yung Hu
- Northwestern QUality Improvement, Research, and Education in Surgery (NSQUIRES), Department of Surgery, Northwestern University, Chicago, IL
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL
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Mishra K, Kovoor JG, Gupta AK, Bacchi S, Lai CS, Stain SC, Maddern GJ. Evolving challenges of leadership in surgery to improve inclusivity, representation, and well-being. Br J Surg 2023; 110:1723-1729. [PMID: 37758505 DOI: 10.1093/bjs/znad274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/18/2023] [Accepted: 08/08/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Leadership is a complex and demanding process crucial to maintaining quality in surgical systems of care. Once an autocratic practice, modern-day surgical leaders must demonstrate inclusivity, flexibility, emotional competence, team-building, and a multidisciplinary approach. The complex healthcare environment challenges those in leadership positions. The aim of this narrative review was to consolidate the major challenges facing surgeons today and to suggest evidence-based strategies to support surgical leaders. METHODS Google Scholar, PubMed, MEDLINE, and Ovid databases were searched to review literature on the challenges faced by surgical leaders. The commonly identified areas that compromise inclusivity and productive leadership practices were consolidated into 10 main subheadings. Further research was conducted using the aforementioned databases to outline the importance of addressing such challenges, and to consolidate evidence-based strategies to resolve them. RESULTS The importance of increasing representation of marginalized groups in leadership positions, including women, ethnic groups, the queer community, and ageing professionals, has been identified by surgical colleges in many countries. Leaders must create a collegial environment with proactive, honest communication and robust reporting pathways for victims of workplace harassment. The retention of diverse, empowering, and educating leaders relies on equitable opportunities, salaries, recognition, and support. Thus, it is important to implement formal training and mentorship, burnout prevention, conflict management, and well-being advocacy. CONCLUSION There are two aspects to addressing challenges facing surgical leadership; improving advocacy by and for leaders. Systems must be designed to support surgical leaders through formal education and training, meaningful mentorship programmes, and well-being advocacy, thus enabling them to proactively and productively advocate and care for their patients, colleagues, and professional communities.
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Affiliation(s)
- Kritika Mishra
- Flinders University, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Christine S Lai
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Steven C Stain
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Guy J Maddern
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Chen WY, Lin FL. On the Asymmetric Relationship Between Physician Mental Health Disorders on Quality of Healthcare Under the COVID-19 Pandemic in Taiwan: Quantile on Quantile Regression Analyses. Risk Manag Healthc Policy 2023; 16:2291-2307. [PMID: 37953809 PMCID: PMC10638657 DOI: 10.2147/rmhp.s429516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose When examining the nexus of physician mental health disorders and healthcare quality from the empirical perspective, mental health disorders are frequently associated with cyclical patterns corresponding to cyclic seasonality, mood swings, emission of air pollution and business cycles, the potential asymmetric effects of physician mental health disorders on healthcare quality have not received adequate attention from researchers. Therefore, the purpose of this study is to explore the asymmetric relationship between physician mental health disorders and healthcare quality during the pandemic outbreak in Taiwan. Methods Daily data for care quality indicators and physician mental health disorders were collected from the National Insurance Research Database in Taiwan, and the quantile-on-quantile regression model was applied to proceed with our analyses. Results Our results indicated that the overall aggregate effects of each quantile of physician mental health disorders on the cumulative quantiles of healthcare quality are negative (positive) for the 14-day readmission rate (preventable hospitalization rate and non-urgent ED-visit rate). Positively (negatively) cumulative effects of each quantile of physician mental health disorders were detected in the middle (low and high) quantiles of the preventable hospitalization rate. The cumulative effects of each quantile of physician mental health disorders on the high (low and middle) quantiles of the 14-day readmission rate are negative (positive), but the cumulative effects on various quantiles of the non-urgent ED-visit rate exhibit the opposite pattern. Conclusion The observed variation in the relationship between physician mental health disorders and different quantiles of healthcare quality suggests the need for tailored strategic interventions based on distinct levels of healthcare quality when addressing the higher risk of physician mental health disorders during the pandemic outbreak conditions.
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Affiliation(s)
- Wen-Yi Chen
- Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung City, Taiwan
| | - Feng-Li Lin
- Department of Accounting, Chaoyang University of Technology, Taichung City, Taiwan
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Egan CE, Lee YJ, Stratigis JD, Ku J, Greenberg JA, Beninato T, Zarnegar R, Fahey TJ, Agrusa CJ, Finnerty BM. An Original Study: Is There an Optimal Time to Complete Dedicated Research During Surgical Residency? Twelve Years of Research Experience After PGY2 or PGY3. J Surg Educ 2023; 80:1207-1214. [PMID: 37442697 DOI: 10.1016/j.jsurg.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/01/2023] [Accepted: 06/11/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE We aimed to determine if there is an optimal time to complete dedicated research during surgical residency. BACKGROUND Research is an integral part of academic general surgical residency, and dedicated research usually occurs after the 2nd or 3rd post-graduate year (PGY). The timing of dedicated research and its association with resident productivity, self-assessed competency (including technical skills), and fellowship match is not known. METHODS PubMed was queried for publications resulting after dedicated research time for graduating surgical residents at a single institution from 2010 to 2021. Graduates were surveyed about their research experience and placed into 2 groups: research after PGY2 or PGY3. RESULTS Sixty-six of 91 (73%) graduating residents completed dedicated research (after PGY2, n=28; after PGY3, n=38). Median number of total and first author publications was similar between groups; however, research after PGY2 was associated with an increased number of basic science publications by fellowship application deadlines (PGY2: 1.0[0-13] vs PGY3: 0.0[0-6], p=0.02). With a 79% survey response rate, there were no differences in self-assessed competencies upon return from research between cohorts. Most surveyed residents matched at their top fellowship choice (PGY2:70% vs PGY3:62%, p=0.77). CONCLUSIONS Research after PGY2 or PGY3 had no association with residents' total number of publications, self-assessed competency, or rates of matching at first choice fellowship. As research after PGY2 had an increased number of basic science publications by time of fellowship application, surgical residents applying to fellowships that highly value basic science research may benefit from completing dedicated research after PGY2.
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Affiliation(s)
- Caitlin E Egan
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York.
| | - Yeon Joo Lee
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - John D Stratigis
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Joyce Ku
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Jacques A Greenberg
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Toni Beninato
- Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Christopher J Agrusa
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
| | - Brendan M Finnerty
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York
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Hopcraft MS, McGrath R, Stormon N, Parker G. Mental health, psychological distress and burnout in Australian dental practitioners. Aust Dent J 2023; 68:160-170. [PMID: 37199455 DOI: 10.1111/adj.12961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Dental practitioners are known to experience a high level of stress, but little is known about the mental health of Australian dental practitioners. The aim of this study was to investigate the prevalence of mental health conditions among Australian dental practitioners. METHODS A cross sectional survey of 1483 Australian dental practitioners was carried out from October to December 2021. Participants reported aspects of mental health including depression, anxiety disorder, burnout (Sydney Burnout Measure) and psychological distress (Kessler Psychological Distress Scale and General Health Questionnaire 12). RESULTS Self-reported psychological distress was high, with 32.0% rated as having moderate or severe psychological distress and 59.4% a high likelihood of minor (or more severe) psychological distress. One in four participants (24.8%) were classified as likely to be experiencing burnout, with 25.9% reporting ever having a diagnosis of depression, 11.4% a current diagnosis of depression, 23.1% ever having a diagnosis of anxiety disorder and 12.9% a current diagnosis of anxiety disorder. CONCLUSION Australian dental practitioners reported a high burden of psychological distress, burnout and mental health issues, suggesting a need for education and programmes to support their mental health and wellbeing. © 2023 Australian Dental Association.
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Affiliation(s)
- M S Hopcraft
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
- eviDent Foundation, Melbourne, Victoria, Australia
| | - R McGrath
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - N Stormon
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
- Queensland Health Metro North Hospital and Health Service, Community and Oral Health, Brisbane, Queensland, Australia
| | - G Parker
- Discipline of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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Hopcraft MS, McGrath R, Stormon N, Tavella G, Parker G. Australian dental practitioners experience of burnout. J Public Health Dent 2023; 83:397-407. [PMID: 38018025 DOI: 10.1111/jphd.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/27/2023] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The aim of this study was to investigate factors associated with burnout in Australian dental practitioners. METHODS A cross-sectional survey of 1483 Australian dental practitioners was conducted from Oct to Dec 2021. Participants reported burnout using the Sydney Burnout Measure, and aspects of mental health including psychological distress, depression, and anxiety disorders. Predictors of burnout were explored using a generalized linear model with a stepped approach including demographic, health and risk factor variables. RESULTS One in four participants were classified as likely to be experiencing burnout. Burnout was associated with working in a regional/rural location (β = 2.82, p < 0.001), an academic/non-clinical role (β = 5.01, p = 0.037), more years of experience as a dental practitioner (β = 0.08, p = 0.022), a current diagnosis of depression (β = 2.38, p = 0.049), moderate/severe psychological distress (β = 7.16, p < 0.001), poor self-rated physical health (β = 5.84, p < 0.001) and increasing alcohol consumption (β = 0.17, p = 0.020). Participants who scored high on resilience (β = -0.23, p = 0.002) or perfectionism (β = -0.24, p < 0.001) had lower burnout scores. CONCLUSION Australian dental practitioners appear to be at high risk of burnout which may impact on their health and wellbeing and ability to deliver patient care. There is a need for support services to manage burnout and education to address workplace and environmental factors that may contribute to burnout.
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Affiliation(s)
- M S Hopcraft
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
- eviDent Foundation, Melbourne, Victoria, Australia
| | - R McGrath
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - N Stormon
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
- Queensland Health Metro North Hospital and Health Service, Community and Oral Health, Brisbane, Queensland, Australia
| | - G Tavella
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - G Parker
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
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Chen S, Skidmore S, Ferrigno BN, Sade RM. The second victim of unanticipated adverse events. J Thorac Cardiovasc Surg 2023; 166:890-894. [PMID: 36202662 DOI: 10.1016/j.jtcvs.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Sarah Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Savannah Skidmore
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Brittany N Ferrigno
- Thought Leadership & Advancement, Human Trafficking Institute, Washington, DC
| | - Robert M Sade
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
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Ibrahim H, Vetter CJ, West K, Oyoun Alsoud L, Sorrell S. Interventions to support medical trainee well-being when dealing with patient death: a scoping review protocol. BMJ Open 2023; 13:e072530. [PMID: 37290946 PMCID: PMC10254774 DOI: 10.1136/bmjopen-2023-072530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Existing literature demonstrates that medical students and residents experience complex emotions and substantial grief after patient deaths. Over time, this can lead to burnout and depression and adversely impact patient care. In response, medical schools and training programmes worldwide have developed and implemented interventions to help medical trainees to better cope with patient deaths. This manuscript provides a scoping review protocol that aims to systematically identify and document the published research reporting on the implementation or delivery of interventions to support medical students and residents/fellows in dealing with patient death. METHODS AND ANALYSIS A scoping review will be conducted following the Arksey-O'Malley five-stage scoping review method and the Scoping Review Methods Manual by the Joanna Briggs Institute. English language interventional studies published through 21 February 2023, will be identified in the following databases: MEDLINE, Scopus, Embase, Psych Info, Cochrane Database of Systematic Reviews, CINAHL and ERIC. Two reviewers will screen titles and abstracts and then independently screen full-text articles for inclusion. Two reviewers will assess the methodological quality of included studies using the Medical Education Research Study Quality Instrument. After extraction, data will be narratively synthesised. Experts in the field will be consulted to ensure the feasibility and relevance of the findings. ETHICS AND DISSEMINATION Ethical approval is not required as all data will be collected from published literature. The study will be disseminated through publication in peer-reviewed journals and presentation at local and international conferences.
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Affiliation(s)
- Halah Ibrahim
- Department of Medicine, Khalifa University College of Medicine And Health Sciences, Abu Dhabi, UAE
| | - Cecelia J Vetter
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kelsey West
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leen Oyoun Alsoud
- Department of Medicine, Khalifa University College of Medicine And Health Sciences, Abu Dhabi, UAE
| | - Sara Sorrell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Siu M, Tashjian DB, Fernandez GL, Isotti J, Seymour NE. Routine Assessment of Surgical Resident Wellness-Related Concerns During Biannual Review. J Am Coll Surg 2023; 236:1148-1154. [PMID: 36448702 DOI: 10.1097/xcs.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Surgery residency confers stress burdens on trainees. To monitor and mitigate areas of concerns, our education team implemented a 6-item biannual survey querying potential stressors. We reviewed the initial 5-year experience to assess for trends and improve efforts in maintaining resident well-being. STUDY DESIGN Surgery residents from all postgraduate years were asked to complete a survey of common concerns, prioritizing them in order of importance. The items to be ranked were: needs of family/friends; nonwork time for study; financial concerns; personal well-being needs; concerns for clinical performance; and administrative demands. Changes in ranking were trended across 10 review periods. Results were analyzed using a Kruskal-Wallis test. RESULTS A completion rate of 96.5% was rendered from the completion of 333 surveys. Rankings changed significantly for nonwork time for study (p = 0.04), personal well-being needs (p = 0.03) and concerns for clinical performance (p = 0.004). Nonwork time for study and concerns on clinical performance were consistently ranked as top two stressors over study period, except for spring 2020. Personal well-being needs ranked highest in spring 2020; 41% of residents placed this as top 2 rankings. A decrease in concerns for clinical performance was observed in spring 2020, corresponding to the coronavirus disease 2019 (COVID-19) pandemic emergency declaration. CONCLUSIONS Surgery residents generally prioritized time for study and concerns for assessment of clinical performance as highest areas of concern. With the occurrence of a pandemic, increased prioritization of personal well-being was observed. Used routinely with biannual reviews, the survey was able to identify plausible changes in resident concerns. Determination of levels of actual stress and actual association with the pandemic requires additional study.
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Affiliation(s)
- Margaret Siu
- From the Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, MA
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12
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Teo R, Grosser R, Thuppal H, Statter MB. "Sip & Share": Building Resilience in Surgery Residency Through Moral Distress Rounds. J Surg Educ 2023; 80:556-562. [PMID: 36526538 PMCID: PMC9750891 DOI: 10.1016/j.jsurg.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Resident moral distress rounds were instituted during the COVID-19 pandemic to provide a safe zone for discussion, reflection, and the identification of the ethical challenges contributing to moral distress. The sessions, entitled "Sip & Share," also served to foster connectedness and build resilience. DESIGN A baseline needs assessment was performed and only 36% of general surgery residents in the program were satisfied with the current non-technical skills curriculum. Only 62% were comfortable with navigating ethical issues in surgery. About 72% were comfortable with leading a goals-of-care discussion, and 63% of residents were comfortable with offering surgical palliative care options. Case-based discussions over video conferencing were organized monthly. Each session was structured based on the eight-step methodology described by Morley and Shashidhara. Participation was voluntary. The sessions explored moral distress, and the ethical tensions between patient autonomy and beneficence, and beneficence and non-maleficence. SETTING Large general surgery residency in an urban tertiary medical center. PARTICIPANTS General surgery residents. RESULTS A post-intervention survey was performed with improvement in the satisfaction with the non-technical skills curriculum (70% from 36%). The proportion of residents feeling comfortable with navigating ethical issues in surgery increased from 62% to 72%. A survey was performed to assess the efficacy of the moral distress rounds after eight Sip & Share sessions over ten months. All thirteen respondents agreed that the discussions provided them with the vocabulary to discuss ethical dilemmas and define the ethical principles contributing to their moral distress. 93% were able to apply the templates learned to their practice, 77% felt that the discussions helped mitigate stress. All respondents recommended attending the sessions to other residents. CONCLUSIONS Moral distress rounds provide a structured safe zone for residents to share and process morally distressing experiences. These gatherings mitigate isolation, promote a sense of community, and provide a support network within the residency. In addition, residents are equipped with the vocabulary to identify the ethical principles being challenged and are provided practical take-aways to avoid similar conflicts in the future.
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Affiliation(s)
- Richard Teo
- Department of Surgery, Montefiore Medical Center, Bronx, New York; Division of Pediatric Surgery, Department of Surgery, Children's Hospital at Montefiore, Bronx, New York
| | - Rachel Grosser
- Department of Surgery, Montefiore Medical Center, Bronx, New York; Division of Pediatric Surgery, Department of Surgery, Children's Hospital at Montefiore, Bronx, New York
| | - Hayavadhan Thuppal
- Department of Surgery, Montefiore Medical Center, Bronx, New York; Division of Pediatric Surgery, Department of Surgery, Children's Hospital at Montefiore, Bronx, New York
| | - Mindy B Statter
- Department of Surgery, Montefiore Medical Center, Bronx, New York; Division of Pediatric Surgery, Department of Surgery, Children's Hospital at Montefiore, Bronx, New York.
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13
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Hess A, Porter M, Byerly S. Environmental Factors Impacting Wellness in the Trauma Provider. Curr Trauma Rep 2023; 9:10-17. [PMID: 36591543 PMCID: PMC9791636 DOI: 10.1007/s40719-022-00246-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/27/2022]
Abstract
Purpose of Review The purpose of this review is to evaluate the recent literature on environmental factors impacting wellness for the acute care surgeon. This includes factors influencing physical, mental, and emotional well-being. Recent Findings Recent studies have identified challenges to surgeon wellness including increased incidence of sleep deprivation, musculoskeletal pain and injuries, pregnancy complications, moral injury, posttraumatic stress disorder (PTSD), and burnout. Qualitative studies have characterized the surgeon's emotional response to occupational stress, adverse events, and surgical complications. Further descriptive studies offer interventions to prevent moral injury after adverse events and to improve surgeon work environment. Summary Acute care surgeons are at increased risk of sleep deprivation, musculoskeletal pain and injury, pregnancy complications, moral injury, PTSD, and burnout. Surgeons experience feelings of isolation and personal devaluation after adverse events or complications, and this may lead to practice limitation and progression to PTSD and/or burnout. Interventions to provide mentorship, peer support, and education may help surgeons recover after adverse events. Further study is necessary to evaluate institution-driven interventional opportunities to improve surgeon well-being and to foster an inclusive and supportive environment.
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Affiliation(s)
- Alexis Hess
- grid.267301.10000 0004 0386 9246Department of General Surgery, University of Tennessee Health Science Center, 920 Madison Avenue, Memphis, TN 38163 USA
| | - Maddison Porter
- grid.267301.10000 0004 0386 9246Department of General Surgery, University of Tennessee Health Science Center, 920 Madison Avenue, Memphis, TN 38163 USA
| | - Saskya Byerly
- grid.267301.10000 0004 0386 9246Department of General Surgery, University of Tennessee Health Science Center, 920 Madison Avenue, Memphis, TN 38163 USA
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14
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Etheridge JC, Evans D, Zhao L, Ibrahim N, Wick EC, Freischlag JA, Brownstein MR. Trends in Surgeon Burnout in the US and Canada: Systematic Review and Meta-Regression Analysis. J Am Coll Surg 2023; 236:253-265. [PMID: 36519921 DOI: 10.1097/xcs.0000000000000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Burnout among surgeons is increasingly recognized as a crisis. However, little is known about changes in burnout prevalence over time. We evaluated temporal trends in burnout among surgeons and surgical trainees of all specialties in the US and Canada. STUDY DESIGN We systematically reviewed MEDLINE, Embase, and PsycINFO for studies assessing surgeon burnout from January 1981 through September 2021. Changes in dichotomized Maslach Burnout Inventory scores and mean subscale scores over time were assessed using multivariable random-effects meta-regression. RESULTS Of 3,575 studies screened, 103 studies representing 63,587 individuals met inclusion criteria. Publication dates ranged from 1996 through 2021. Overall, 41% of surgeons met criteria for burnout. Trainees were more affected than attending surgeons (46% vs 36%, p = 0.012). Prevalence remained stable over the study period (-4.8% per decade, 95% CI -13.2% to 3.5%). Mean scores for emotional exhaustion declined and depersonalization declined over time (-4.1 per decade, 95% CI -7.4 to -0.8 and -1.4 per decade, 95% CI -3.0 to -0.2). Personal accomplishment scores remained unchanged. A high degree of heterogeneity was noted in all analyses despite adjustment for training status, specialty, practice setting, and study quality. CONCLUSIONS Contrary to popular perceptions, we found no evidence of rising surgeon burnout in published literature. Rather, emotional exhaustion and depersonalization may be decreasing. Nonetheless, burnout levels remain unacceptably high, indicating a need for meaningful interventions across training levels and specialties. Future research should be deliberately designed to support longitudinal integration through prospective meta-regression to facilitate monitoring of trends in surgeon burnout.
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15
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Barone MA, Bienstock JL, Lovell E, Gimpel JR, Lin GL, Swails J, Mejicano GC. How the Quadruple Aim Widens the Lens on the Transition to Residency. J Grad Med Educ 2022; 14:634-638. [PMID: 36591427 PMCID: PMC9765900 DOI: 10.4300/jgme-d-22-00026.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michael A. Barone
- Michael A. Barone, MD, MPH, is Vice President, Competency-Based Assessment, National Board of Medical Examiners, and Adjunct Associate Professor of Pediatrics, Johns Hopkins University School of Medicine
| | - Jessica L. Bienstock
- Jessica L. Bienstock, MD, MPH, is Professor of Gynecology and Obstetrics, Senior Associate Dean for Graduate Medical Education, and Designated Institutional Official, Johns Hopkins University School of Medicine
| | - Elise Lovell
- Elise Lovell, MD, is Residency Program Director, Department of Emergency Medicine, Advocate Christ Medical Center, and Clinical Professor, University of Illinois at Chicago
| | - John R. Gimpel
- John R. Gimpel, DO, MEd, is President and CEO, National Board of Osteopathic Medical Examiners
| | - Grant L. Lin
- Grant L. Lin, MD, PhD, is a Resident Physician, Child Neurology, Stanford Health Care/Lucille Packard Children's Hospital
| | - Jennifer Swails
- Jennifer Swails, MD, is Residency Program Director, Co-Director of Interprofessional Education, and Associate Professor, Department of Medicine, McGovern Medical School, University of Texas Health Science Center
| | - George C. Mejicano
- George C. Mejicano, MD, MS, is Associate Dean for Academic Affairs, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign
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16
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Al-Ghunaim T, Johnson J, Biyani CS, O'Connor DB. How UK surgeons experience burnout and the link between burnout and patient care: A qualitative investigation. Scott Med J 2022; 67:197-206. [PMID: 36069048 PMCID: PMC9643814 DOI: 10.1177/00369330221122348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background and Aims Poor well-being affects the performance of all kinds of workers, including
surgeons. This study aimed to answer two questions: (1) how does burnout
affect surgeons personally, and what is their burnout experience like? (2)
How does burnout affect the care that surgeons provide in the United Kingdom
(UK)? Method This study conducted thematic analysis of semi-structured interviews with 14
surgeons recruited from the UK National Health Service (NHS). Result The study found three themes in surgeons’ experiences of burnout: first,
burnout is common but frequently not recognised nor understood; second,
burnout is a personal crisis; and third, burnout creates vulnerability at
work. The study also revealed four themes related to burnout's effect on
patient care: first, burnout reduces the quality of surgeon-patient
relationships; second, burnout affects patient safety; third, burnout
impairs staff relationships; and fourth, burnout makes surgeons less
motivated to improve. Conclusion Burnout is common but not well recognised in surgeons. Improving
understanding and treatment of burnout could have benefits for both surgeons
themselves and the care they provide to patients.
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Affiliation(s)
| | - Judith Johnson
- School of Psychology, 4468University of Leeds, Leeds, UK.,Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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17
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Bamdad MC, Vitous CA, Rivard SJ, Anderson M, Lussiez A, De Roo AC, Englesbe MJ, Suwanabol PA. The Best Gift You Could Give a Resident: A Qualitative Study of Well-Being Resources and Use Following Unwanted Outcomes. Ann Surg Open 2022; 3:e139. [PMID: 36936721 PMCID: PMC10013169 DOI: 10.1097/as9.0000000000000139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/31/2022] [Indexed: 11/26/2022] Open
Abstract
In recent years, there has been increasing focus on the well-being of resident physicians. Considering the persistent problem of burnout and attrition particularly among surgical trainees, this is a well-warranted and laudable area of focus. However, despite the widespread adoption of resources available to residents through individual institutions, there is little understanding of how and why these resources are engaged or not during particularly vulnerable moments, such as following an unwanted patient event including postoperative complications and deaths. Methods This qualitative study explored access to and usage of resources to promote well-being following an unwanted patient outcome through semi-structured interviews of 28 general surgery residents from 14 residency programs across the United States, including community, academic, and hybrid programs. A qualitative descriptive approach was used to analyze transcripts. Results Residents described 3 main types of institutional resources available to them to promote well-being, including counseling services, support from program leadership, and wellness committees. Residents also described important barriers to use for each of these resources, which limited their access and value of these resources. Finally, residents shared their recommendations for future initiatives, including additional protected time off during weekdays and regular usage of structured debrief sessions following adverse patient outcomes. Conclusions While institutional resources are commonly available to surgery residents, there remain important limitations and barriers to use, which may limit their effectiveness in supporting resident well-being in times of need. These barriers should be addressed at the program level to improve services and accessibility for residents.
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Affiliation(s)
- Michaela C. Bamdad
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - C. Ann Vitous
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Samantha J. Rivard
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Maia Anderson
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Alisha Lussiez
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Ana C. De Roo
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Michael J. Englesbe
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Pasithorn A. Suwanabol
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
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18
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Xu M, Wang Y, Yao S, Shi R, Sun L. One-Year Prevalence of Perceived Medical Errors or Near Misses and Its Association with Depressive Symptoms among Chinese Medical Professionals: A Propensity Score Matching Analysis. Int J Environ Res Public Health 2022; 19. [PMID: 35328969 DOI: 10.3390/ijerph19063286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/10/2022]
Abstract
Objective: Medical errors or near misses (MENM) may cause serious negative outcomes for the patients. However, medical professionals with MENM may also be secondary victims. Although the association between MENM and depression among medical professionals has been explored in several previous studies, the possible causal relationship has been explored less, especially in China. In this study, our first aim was to determine the prevalence of MENM among Chinese medical professionals. We also wanted to explore the causal effect of MENM on depressive symptoms based on a propensity-score matching analysis. Methods: A cross-sectional study was conducted among medical professionals in Chinese public general hospitals, and 3426 medical professionals were analyzed in this study. The Center for Epidemiologic Studies Depression (CES-D) scale was used to assess depressive symptoms. Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS). MENM, social-demographic variables, occupational characteristics, and physical disease were also evaluated in this study. Results: The one-year prevalence of perceived MENM was 2.9% among medical professionals in Chinese public general hospitals. The results of logistic regressions showed that working hours/week (OR = 1.02, p < 0.05) and depressive symptoms (OR = 1.05, p < 0.001) were associated with MENM. After propensity score matching, depressive symptoms were associated with MENM (OR = 1.05, p < 0.001) among medical professionals. The associations between occupational characteristics, physical disease, social support, and MENM were not supported by this study. Conclusions: The one-year prevalence of MENM was low in Chinese public general hospitals, and based on our propensity score matching analyses, the occurrence of MENM may cause depressive symptoms in medical professionals. A bigger effort by health systems and organizations may be helpful for reducing MENM.
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Kemp MT, Evans J, Rivard SJ, Sharma SB, Williams AM, Coleman DM, Dimick J, Sandhu G. Hardship and Humanity: A Closer Qualitative Look at Surgical Training and Its Effects on Trainees from the Perspectives of Loved Ones. Ann Surg 2021. [PMID: 34596074 DOI: 10.1097/SLA.0000000000005230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To obtain novel perspectives regarding the effects that surgical training has on the well-being of trainees. SUMMARY BACKGROUND DATA Improving trainee well-being is a national concern given high rates of burnout, depression, and suicide among physicians. Supporters of surgical trainees may offer new perspectives regarding the effects of surgical training and point to strategies to optimize trainee wellness. METHODS This qualitative study employs semi-structured interviews of 32 support persons of trainees at a single tertiary care center with multiple surgical training programs. Interviews focused on perspectives related to supporting a surgical trainee. Interview transcripts underwent qualitative analysis with semantic and conceptual coding. Themes related to effects of training on trainee wellness are reported. RESULTS Four themes were identified: (1)Who Can Endure the Most Hardship?-trainee attributes and programmatic factors contribute to trainees feeling the need to constantly endure the most hardship; (2)Consequences of Hardship-constantly enduring hardships has significant negative effects on wellness; (3)Trainees are Humans-trainees are people with basic human needs, especially the need for worth; (4)Research Time as Refuge-dedicated research time is treated as an oasis away from clinical hardships. CONCLUSIONS Perspectives from support persons can offer valuable insight into the wellness needs of surgical trainees. According to support persons, surgical training profoundly negatively impacts trainee wellness. Unlike during clinical training, dedicated research time is a period during which wellness can be prioritized. Programs should provide greater attention to mitigating the negative ramifications of surgical training and promoting wellness in a longitudinal fashion throughout training.
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20
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Sarosi A, Coakley BA, Berman L, Mueller CM, Rialon KL, Brandt ML, Heiss K, Weintraub AS. A cross-sectional analysis of compassion fatigue, burnout, and compassion satisfaction in pediatric surgeons in the U.S. J Pediatr Surg 2021; 56:1276-1284. [PMID: 33589141 DOI: 10.1016/j.jpedsurg.2021.01.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND/PURPOSE To determine the prevalence of compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS) and identify potential predictors of these phenomena in pediatric surgeons. METHODS The Compassion Fatigue and Satisfaction Self-Test and a survey of personal/professional characteristics were distributed electronically to American Pediatric Surgical Association members. Linear regression models for CF, BO, and CS as a function of potential risk factors were constructed. RESULTS The analyzeable study response rate was 25.7%. The prevalence of CF, BO, and CS was 22%, 24% and 22, respectively, which were similar to prevalences previously identified in pediatric subspecialists. Higher CF scores were significantly associated with: higher BO scores; solo practice; compensation; ≥5 operating days/week; current distress about a 'clinical situation'; mental health-care for work-related distress; and history of childhood surgery. Lower CF scores were significantly associated with 'talking with a life partner' about work-related distress. Higher BO scores were significantly associated with: higher CF scores; current distress about 'coworkers'; and 'keeping lawsuits confidential'. Lower BO scores were significantly associated with higher CS scores. CONCLUSIONS CF, BO, and CS are distinct but highly related entities. Pediatric surgeons experience these phenomena at similar rates to other pediatric subspecialists. Establishing local channels for physician peer support may be particularly impactful.
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Affiliation(s)
- Alex Sarosi
- Department of Surgery, Mount Sinai Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian A Coakley
- Department of Surgery, Mount Sinai Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Loren Berman
- Department of Surgery, Nemours AI DuPont Hospital for Children, Wilmington, DE, USA; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Kristy L Rialon
- Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Mary L Brandt
- Department of Surgery, Children's Hospital of New Orleans, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kurt Heiss
- Department of Surgery, Children's Hospital of Atlanta, Emory University, Atlanta, GA, USA
| | - Andrea S Weintraub
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Box 1508, One Gustave L. Levy Place, New York, NY 10029, USA.
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21
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Johnson J, Al-Ghunaim TA, Biyani CS, Montgomery A, Morley R, O’Connor DB. Burnout in Surgical Trainees: a Narrative Review of Trends, Contributors, Consequences and Possible Interventions. Indian J Surg 2021; 84:35-44. [PMID: 34341627 PMCID: PMC8319710 DOI: 10.1007/s12262-021-03047-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 02/03/2023] Open
Abstract
Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.
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Affiliation(s)
- Judith Johnson
- School of Psychology, University of Leeds, Leeds, LS29JT UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, BD96RJ UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052 Australia
| | | | - Chandra Shekhar Biyani
- Department of Urology, St James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
- Cadaveric Simulation Programme, Anatomy Department, School of Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Anthony Montgomery
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Roland Morley
- Imperial College Healthcare NHS Trust, London, W2 1NY UK
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22
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Foote DC, Donkersloot JN, Sandhu G, Ziegler K, Lau J. Identifying institutional factors in general surgery resident wellness and burnout. Am J Surg 2021; 223:53-57. [PMID: 34332743 DOI: 10.1016/j.amjsurg.2021.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Effects of the institutional macrocosm on general surgery resident wellbeing have not been well studied. We sought to identify organizational factors that impact resident wellness and burnout. METHODS Using a modified Delphi technique, an open-ended survey and two subsequent iterations were distributed to wellness stakeholders at two institutions to identify and stratify institutional factors in six burnout domains. RESULTS Response rates for each survey round were 29/106 (27%), 30/46 (65%) and 21/30 (70%). Top factors identified in each domain were: CONCLUSION: A modified Delphi technique prioritized institutional wellness and burnout factors. Top factors identified were compensation, vacation time, and autonomy. These results can direct future scholarship of barriers/facilitators of resident wellbeing.
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Affiliation(s)
- Darci C Foote
- Beaumont Health, Department of Surgery, 3601 W. 13 Mile Road, Royal Oak, MI, 48073, USA; Michigan Medicine, Department of Surgery, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - John N Donkersloot
- Michigan Medicine, Department of Surgery, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Gurjit Sandhu
- Michigan Medicine, Department of Surgery, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Kathryn Ziegler
- Beaumont Health, Department of Surgery, 3601 W. 13 Mile Road, Royal Oak, MI, 48073, USA
| | - James Lau
- Loyola University, Department of Surgery, 2160 South 1st Avenue, Maywood, IL, 60153, USA.
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Aziz H, James T, Remulla D, Sher L, Genyk Y, Sullivan ME, Sheikh MR. Effect of COVID-19 on Surgical Training Across the United States: A National Survey of General Surgery Residents. J Surg Educ 2021; 78:431-439. [PMID: 32798154 PMCID: PMC7391955 DOI: 10.1016/j.jsurg.2020.07.037] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/13/2020] [Accepted: 07/25/2020] [Indexed: 05/11/2023]
Abstract
INTRODUCTION COVID-19 emerged as a global pandemic in 2020 and has affected millions of lives. Surgical training has also been significantly affected by this pandemic, but the exact effect remains unknown. We sought to perform a national survey of general surgery residents in the United States to assess the effect of COVID-19 on surgical resident training, education, and burnout. METHODS An anonymous online survey was created and distributed to general surgery residents across the United States. The survey aimed to assess changes to surgical residents' clinical schedules, operative volume, and educational curricula as a result of the COVID-19 pandemic. Additionally, we sought to assess the impact of COVID-19 on resident burnout. RESULTS One thousand one hundred and two general surgery residents completed the survey. Residents reported a significant decline in the number of cases performed during the pandemic. Educational curricula were largely shifted toward online didactics. The majority of residents reported spending more time on educational didactics than before the pandemic. The majority of residents feared contracting COVID-19 or transmitting it to their family during the pandemic. CONCLUSIONS COVID-19 has had significant impact on surgical training and education. One positive consequence of the pandemic is increased educational didactics. Online didactics should continue to be a part of surgical education in the post-COVID-19 era. Steps need to be taken to ensure that graduating surgical residents are adequately prepared for fellowship and independent practice despite the significantly decreased case volumes during this pandemic. Surgery training programs should focus on providing nontechnical clinical training and professional development during this time.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Tayler James
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Daphne Remulla
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Linda Sher
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Yuri Genyk
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Maura E Sullivan
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mohd Raashid Sheikh
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
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Mion G, Hamann P, Saleten M, Plaud B, Baillard C. Psychological impact of the COVID-19 pandemic and burnout severity in French residents: A national study. The European Journal of Psychiatry 2021. [DOI: 10.1016/j.ejpsy.2021.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Palacios Huatuco RM, Liaño JE, Moreno LB, Ponce Beti MS. Analysis of the impact of the pandemic on surgical residency programs during the first wave in Argentina: A cross - sectional study. Ann Med Surg (Lond) 2021; 62:455-459. [PMID: 33532065 PMCID: PMC7843101 DOI: 10.1016/j.amsu.2021.01.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction COVID – 19 emerged as a global pandemic in 2020 and affected the teaching methods at all levels. Surgical education has also been significantly affected by this pandemic, but the effect remains unknown. We developed a survey in order to obtain more information on how this pandemic affected the training and education of surgical residency programs. Material and methods Cross-sectional study. We surveyed 195 residents of various surgical programs, from August 20th to September 30th, 2020, in Córdoba, Argentina. The effect of the COVID – 19 pandemic was analyzed on surgical training, on the academic program, and professional burnout. Results The volume of surgical cases performed during the pandemic decreased dramatically, affecting mainly residents of lower years. Comparing the number of cases (>7) that residents carried out per week (Pre pandemic vs pandemic), we found that PGY – 1: 47% vs 9%; p = 0.01 and PGY – 2: 46% vs 8%; p = 0.03. 83.2% reported that the impact of the pandemic affected their surgical training negatively and 45% were not adequately trained to carry out their surgical activity in the residency program. On the other hand, 71.3% affirmed that this health emergency allowed them to dedicate more time to the development of their academic training. Conclusion This is the first cross – sectional survey study that shows the impact of the pandemic on surgical residences during the first wave in Argentina. Surgical training performed by residents had a negative impact. First cross-sectional survey study showing the impact of the pandemic on surgical residences in Argentina. The effect on surgical training, academic program, and professional exhaustion was evaluated. The majority of residents considered a negative impact on their surgical training. The impact of COVID-19 was positive in the educational program.
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Affiliation(s)
- René M Palacios Huatuco
- General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Julián E Liaño
- General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Laura B Moreno
- General Surgery Service, Nuevo Hospital San Roque, Bajada Pucará 1900, Córdoba Capital, Argentina
| | - María S Ponce Beti
- General Surgery Service, Hospital Militar Regional Córdoba, Cruz Roja Argentina 1174, Córdoba Capital, Argentina
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Wong D, Kuprasertkul A, Khouri RK, Ganesan V, Kenigsberg AP, Lemack GE. Assessing the Female and Underrepresented Minority Medical Student Experience in the Urology Match: Where Do We Fall Short? Urology 2021; 147:57-63. [DOI: 10.1016/j.urology.2020.08.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 12/17/2022]
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Drake FT, Lyden ML, Kuo JH, Shen WT, Morris-Wiseman LF, Carty SE, Wang TS. Optimizing the fellowship interview process: Perspectives from applicants and program directors of the comprehensive endocrine surgery fellowship program. Surgery 2020; 169:488-495. [PMID: 32854969 DOI: 10.1016/j.surg.2020.06.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/21/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Approximately 80% of general surgery residents undertake some form of fellowship training. Our objective was to characterize goals and burdens of the interview process among applicants to Comprehensive Endocrine Surgery Fellowship programs. METHODS Participants included trainees from 2013 to 2019. Results for ranking questions are presented as a mean rank reported out of the total number of selections. RESULTS Response rate was 54% (n = 75). The most important goal for interviews was meeting the faculty (mean rank 2.4/9), followed by "behind the scenes information" and "make a good impression" (mean rank 3.6 and 3.7, respectively). The most substantial burden for the applicant was expense (mean rank 2.1/7), followed by time away from residency (mean rank 3.1/7). The economic burden of 51% of the applicants was $2,500 to $7,500. Geographic location and expense were the top 2 reasons applicants declined offers of interviews. Despite the process, 76% of respondents indicated that no improvements to the interview process are necessary. Alternative strategies such as videoconferencing or centralized interviews received little support (<10%). CONCLUSION Despite identifying several burdens, survey respondents believed that in-person interviews are an integral component of the fellowship application process. Indeed, 70% of applicants do not have a first-choice program before interviews, and meeting the faculty is ranked as the greatest priority goal. Our data illustrate the importance of individual specialties evaluating and optimizing their own processes for fellowship interviews.
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Affiliation(s)
- Frederick Thurston Drake
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA.
| | | | - Jennifer H Kuo
- Department of Surgery, Columbia University Medical Center, New York City, NY
| | - Wen T Shen
- Department of Surgery, University of California, San Francisco Medical Center, San Francisco, CA
| | | | - Sally E Carty
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
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Elhadi M, Msherghi A, Elgzairi M, Alhashimi A, Bouhuwaish A, Biala M, Abuelmeda S, Khel S, Khaled A, Alsoufi A, Elmabrouk A, Alshiteewi FB, Hamed TB, Alhadi B, Alhaddad S, Elhadi A, Zaid A. Burnout Syndrome Among Hospital Healthcare Workers During the COVID-19 Pandemic and Civil War: A Cross-Sectional Study. Front Psychiatry 2020; 11:579563. [PMID: 33362600 PMCID: PMC7759513 DOI: 10.3389/fpsyt.2020.579563] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022] Open
Abstract
Objective: We aimed to determine the prevalence of burnout among hospital healthcare workers in Libya during the coronavirus disease (COVID-19) pandemic and civil war. Methods: A cross-sectional study was conducted from April 18 to May 2, 2020 among Libyan healthcare workers. Data on participant characteristics were collected with a specifically designed questionnaire. Burnout was assessed with the abbreviated Maslach Burnout Inventory (aMBI) comprising three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), with each sub-scale score range from 0 to 18. For EE and DP, scores of 10 to 18 were regarded as "moderate to severe burnout." PA was scored inversely, where a score ≤ 10 indicated severe burnout. Results: The study yielded a sample size of 532 participants. Of these, 357 (67.1%) reported emotional exhaustion (EE Score ≥ 10), 252 (47.4%) reported depersonalization (DP score ≥ 10), and 121 (22.7%) reported a lower sense of personal accomplishment (PA score ≤ 10). Verbal abuse was experienced by 304 participants (57.1%) and physical abuse in 93 (17.5). Gender was associated with high emotional exhaustion and high depersonalization. Being 35 years or older was associated with high depersonalization. Professional specialty was significantly associated with high emotional exhaustion and depersonalization. Fear of COVID-19 infection was associated with high emotional exhaustion and high depersonalization. Conclusion: The rising prevalence of mental disorders and inadequate availability of health services facilities during the COVID-19 pandemic and civil war demonstrated the need for healthcare policies to address the well-being of healthcare workers to decrease the risk of loss, suicide, and medical negligence.
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Affiliation(s)
| | - Ahmed Msherghi
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Moutaz Elgzairi
- Faculty of Medicine, University of Benghazi, Benghazi, Libya
| | - Ayiman Alhashimi
- Faculty of Medicine, Al-Jabal Al Gharbi University, Gherian, Libya
| | | | - Marwa Biala
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Samer Khel
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Ala Khaled
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Ahmed Alsoufi
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Amna Elmabrouk
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | | | - Bushray Alhadi
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Sara Alhaddad
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Ahmed Elhadi
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Ahmed Zaid
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
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