Burnout, wellbeing and how they relate: A qualitative study in general practice trainees

An Analysis of Students' Perceptions of Strategies to Improve Well-Being in Dentistry

INTRODUCTION

A number of papers have reported on stressors to students in the dental curriculum. This paper analyses perceptions of strategies to improve well-being among final-year dental students in a dental curriculum.

METHODS

A literature review was performed to create a question guide to explore issues of wellness and stress in a dental curriculum. Final-year dental students were invited to an interview using random sampling and issues related to strategies for well-being were analysed by an inductive-deductive approach.

RESULTS

Fourteen interviews were conducted, yielding three themes under the overarching domain of strategies to improve dental student well-being. Under the theme of well-being management, students wished for training on stress reduction for their personal well-being and guidance on communication, referral and mental health support to manage the well-being of colleagues and patients. The second theme, mentoring, covered peer support in the form of a 'buddy system' and sharing from recent graduates to help students gain practical and career advice about post-graduation challenges. Finally, suggestions for institutional support included providing in-house counsellors in the dental hospital with specialised knowledge about the unique concerns of dental students and clear leave of absence policies that treat mental and physical health equally to encourage help-seeking and reduce the fear of disclosure.

CONCLUSION

The experiences of final-year dental students were sampled to explore potential approaches to improve well-being in the dental school environment. Guided by these student perspectives, specific strategies have been implemented and recommended to improve the wellness support provided by the faculty for dental students.

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.

Transformational and Abusive Leaders and Their Influence on Employee Physical Ill-being: A Multilevel Longitudinal Study Exploring Negative Motivational-Affective Mechanisms

While research on leadership and employee physical ill-being is burgeoning, the short- and long-term mechanisms through which leadership influences employee physical ill-being remain underexplored. This research, grounded in leadership theories and the Job Demand-Resource (JD-R) theory, examines how transformational and abusive leadership behaviors influence employee physical ill-being through two conflict-related negative motivational mechanisms (negative work-home interactions and job role conflict) and two negative affective mechanisms representing short-term (negative affect) and long-term (burnout) mechanisms. Employing a three-wave longitudinal design over 6 months (N = 234), our findings from a multilevel path analysis revealed that transformational and abusive leadership had respectful, negative and positive effects on employee physical ill-being via conflict-related negative motivational mechanisms and short- and long-term affective mechanisms. Notably, the influence of leadership behaviors on employee physical ill-being was more pronounced through the short-term affective mechanism (negative affect) than the long-term affective mechanism (burnout). Our findings provide a nuanced understanding of how leadership behaviors affect employee physical ill-being over time, shedding light on the dynamic interplay of motivational and affective pathways in this relationship.

A Qualitative Analysis of Students' Perceptions and Experiences of Stressors and Well-Being in Dentistry

INTRODUCTION

Well-being is increasingly regarded as an integral component of a graduating dentist's professional responsibility, yet studies demonstrate significant levels of stress and poor mental health in the dental student population. The aim of this qualitative study was to explore final-year dental students' perceptions of stressors in dentistry and their experiences of managing their individual well-being and supporting the well-being of their colleagues and patients.

METHODS

A literature search was performed to guide the development of an interview framework which included questions centred around three higher domains based on self, peers and patients. Participants were randomly sampled and the interviews audio recorded and transcribed verbatim. An inductive-deductive approach was adopted for thematic analysis of the results.

RESULTS

Fourteen interviews were conducted, revealing four themes and 15 subthemes. Students were acutely aware of poor well-being symptoms amongst themselves and their peers. Treating dental patients with mental illness was common but some students expressed uncertainties in managing these patients. The key stressors were assessments and clinical stress. Students frequently sought support from peers and half had received professional help. Barriers to approaching faculty staff were identified. The role of stigma in preventing students from openly sharing their well-being experiences was discussed.

CONCLUSION

A range of curricular and clinical stressors, and potential sources of support to manage these stressors, have been explored from the perspectives of final-year dental students. From these experiences, action points have been proposed to address knowledge gaps and enhance faculty-level wellness support for dental students.

Organisational factors associated with burnout among emergency and internal medicine physicians: a qualitative study

OBJECTIVE

To identify physician perspectives on factors associated with physician burnout, protective factors against burnout, and to seek potential solutions for this pervasive problem.

DESIGN

A qualitative study with semistructured focus group interviews using a systematic framework analysis.

SETTING AND PARTICIPANTS

Physicians from general internal medicine (GIM) and the emergency department (ED) at two urban tertiary care hospitals in Vancouver, Canada, were recruited. Separate GIM and ED physician focus groups were conducted virtually from July 2021 to December 2022, led by an independent facilitator. Audio recordings from focus group sessions were then transcribed for analysis.

RESULTS

41 physicians (29 GIM and 12 ED) participated in the focus groups. The dominant themes for organisational factors attributed to burnout that were highlighted by both groups included heavy workload and scheduling, frequent interruptions, interdepartmental conflict and feeling undervalued by leadership. Other contributing factors that were only emphasised by GIM physicians were pressure to work out-of-scope of their practice, pressure to admit and discharge patients quickly, as well as sexism in the workplace. Factors unique to ED physicians included experiencing violence in the workplace and having to assess patients in waiting rooms. Protective organisational factors included time to build rapport with patients, staff collegiality, working within their scope of practice, and feeling rewarded and valued by leadership. Interventions suggested by physicians included improving channels of communication between staff, increasing flexibility in scheduling and strengthening hospitalists' services.

CONCLUSIONS

Most organisational factors driving burnout were common to both GIM and ED physicians, including heavy workload and scheduling, frequent interruptions, interdepartmental conflict and feeling undervalued by leadership. Leveraging protective factors and intervening on organisational factors attributed to burnout such as improving communication and enhancing support services may be effective in addressing the physician burnout epidemic.

An Interpretative Phenomenological Analysis That Seeks to Describe and Understand the Personal Experience of Burnout in General Practitioners

Minimal research has explored the personal experience of burnout in doctors from any medical speciality. Consequently, we aimed to provide a relatable description and understanding of this globally recognised problem. We employed an interpretative phenomenological analysis (IPA) of face-to-face interviews with seven general practitioners (GPs) in Northern Ireland, having selected interviewees best able to speak about burnout. We sought to understand how these GPs understood their burnout experiences. Our participants' continuous work involved more than their busy weekdays and also working on supposedly off evenings and weekends. In addition, draining intrusive thoughts of work filled most, if not all, of their other waking moments. There was no respite. Work was 'always there.' Being constantly busy, they had no time to think or attend to patients as doctors. Instead, participants were going through the motions like GP automatons. Their effectiveness, efficiency, and caring were failing, while their interactions with patients had changed as they tried to conserve their now-drained energy and empathy. There was no time left for their families or themselves. They now "existed" to continuously work rather than "living" their previous, more balanced lives that at one time included enjoying being a doctor. Worryingly, participants were struggling, isolated, and vulnerable, yet unwilling to speak to someone they trusted. We intend our burnout narrative to promote discussion between medical colleagues and assist in its recognition by GPs and other doctors. Our findings warn against working excessively, prioritising work ahead of family and oneself, and self-isolation rather than seeking necessary support.

"Hey, can I go home?": a qualitative case study of wellbeing and the work environment in surgical training

PURPOSE

Surgical trainees are at high risk of burnout and poor wellbeing during their training. A range of workplace factors have been linked to poor wellbeing, including excessive work hours, lack of support networks, and training program demands. However, little is understood about the individual experiences of Australian trainees and their perceptions of the impact of the work environment on wellbeing. The aim of this study was to explore the experiences of Australian surgical trainees regarding their wellbeing in the surgical learning environment.

METHODS

Eleven semi-structured interviews were conducted with Australian surgical trainees at the start of their training and 18 months later, exploring their perspectives of wellbeing in the workplace. Results were analyzed thematically using the Job Demands-Resources model as a scaffold.

RESULTS

Seven themes emerged: (1) relationships with colleagues, (2) work hours and workload, (3) the learning environment and supervision, (4) training program requirements, (5) moving around, (6) hospital and team administration, and (7) hospital facilities and programs. Participant experiences between training commencement and 18 months follow-up did not change.

CONCLUSION

Trainees have unique experiences of wellbeing in the workplace. Some workplace factors, such as relationships with colleagues, can be demands or resources depending on their nature. Effective leadership and administrative practices, mentorship, and proactive rostering act as resources for trainees to balance workplace demands, and these should be prioritized by hospitals and training institutions to improve and protect trainee wellbeing.

Process Groups for Supporting Resident Wellbeing: Factors Influencing Resident Wellness amid the COVID-19 Pandemic

Background: Burnout is a well-recognized problem among resident physicians. The COVID-19 pandemic impacted the dynamics of the patient/resident relationship and introduced new stressors for medical trainees, such as new restrictions in the hospital, increased patient death, and uncertainty around safety. There is limited research on the implementation of group therapy for residents to address issues of wellbeing and burnout during the pandemic. Method: In response to perceived burnout amongst internal medicine residents, a university-based internal medicine residency program in the Northeast United States implemented process groups, a form of group therapy, in the curriculum. These sessions were held hourly once every five weeks for each cohort of twelve residents during the academic year. We sought to measure resident burnout and identify themes that impacted wellbeing to facilitate the intervention of process groups during the pandemic. In 2021 and 2022, internal medicine residents were invited to complete the Maslach Burnout Inventory (MBI) and answer two open-ended questions about the factors that most negatively and positively influenced their wellness. Results: Of the 134 participants, 82% had high emotional exhaustion or depersonalization. The most prevalent themes hindering wellness were negative personal interactions at work, most notably rude behavior by patients, unsupportive attendings, residency program expectations, and work intensity. Findings unique to the pandemic include social isolation from family, distress from poor outcomes, and fear of contracting or spreading the virus. The most prevalent themes for supporting wellness were personal life, camaraderie, professional satisfaction, and program structured support. Conclusions: Our findings suggest that programs can tailor structured support to improve wellness, despite the presence of significant stressors.

General practice trainee, supervisor and educator perspectives on the transitions in postgraduate training: a scoping review

Transitions are a period and a process, through which there is a longitudinal adaptation in response to changing circumstances in clinical practice and responsibilities. While the experience of the transition in medical student learning and in hospital-based specialty training programmes are well described and researched, the experience of the transition in community-based postgraduate general practitioner (GP) training has not been described comprehensively.

OBJECTIVE

We aimed to identify, and categorise, the formative experiences of transitions in GP training and their impacts on personal and professional development.

DESIGN

We adopted Levac et al's scoping review methodology. Of 1543 retrieved records, 76 were selected for data extraction. Based on a combined model of the socioecological and multiple and multi-dimensional theories of transitions, data relating to the experiences of transitions were organised into contextual themes: being physical, psychosocial, organisational culture and chronological.

ELIGIBILITY CRITERIA

Empirical studies focused on general practice trainees or training, that discussed the transitions experienced in general practice training and that were published in English were included.

INFORMATION SOURCES

PubMed, MEDLINE and Web of Science databases were searched in January 2024 with no date limits for empirical studies on the transition experiences of GP into, and through, training.

RESULTS

Our findings describe context-dependent formative experiences which advance, or impede, learning and development. Time is a significant modulator of the factors contributing to more negative experiences, with some initially adverse experiences becoming more positive. Identification of the inflection point that represents a shift from initially adverse to more positive experiences of transitions may help moderate expectations for learning and performance at different stages of training.

CONCLUSION

Challenges in training can either advance development and contribute positively to professional identity formation and clinical competency, or detract from learning and potentially contribute to burnout and attrition from training programmes. These findings will assist future research in identifying predictive factors of positive and adverse experiences of transitions and may strengthen existing and nascent GP training programmes. The findings are transferable to other community-based specialty training programmes.

Family medicine and general practitioner supervisor wellbeing: a literature review

BACKGROUND

Research examining general practice supervisor wellbeing has often been conducted within the context of trainee wellbeing and educational outcomes.

AIM

To consolidate the current literature regarding the wellbeing of GP supervisors through a 'supervisor-wellbeing' lens.

DESIGN & SETTING

Literature review of original research studies on Embase, Ovid MEDLINE, and Ovid PsycINFO from inception to December 2022.

METHOD

The Embase, Ovid MEDLINE, and Ovid PsycINFO databases were systematically searched from inception to December 2022. Original research studies were eligible if they explored any aspect of wellbeing or burnout (that is, construct conceptualisations, risk and protective factors, implications, or interventions) among GPs involved in educating GP trainees. Reporting quality of included studies was assessed using the QualSyst tool. Results from included studies were narratively synthesised.

RESULTS

Data from 26 independent samples were reviewed. Burnout was generally conceptualised using the Leiter and Maslach model. Wellbeing was poorly defined in the literature, largely being conceptualised in personal psychological terms and, to a lesser extent, professional satisfaction. Risk and protective factors were identified and grouped as individual (for example, satisfaction with capacity to teach) and external (for example, autonomy, collegial relationships, resource availability) factors. GP supervisors' wellbeing appeared to affect their job performance and retention. This review identified only two studies evaluating interventions to support GP supervisors' wellbeing.

CONCLUSION

The present review highlights a lack of conceptual clarity and research examining interventions for GP supervisor wellbeing. It provides guidance for future research designed to maximise the wellbeing of GP supervisors and support the wellbeing of trainees.

Strategies of Well-being Training and Resilience

As cardiothoracic surgeons, we face frequent challenges to our well-being and our ability to function as our best selves. Building personal resilience is an important way to help us manage these challenges. Here, the authors outline the scope of the problem, the consequences of burnout, and offer 4 strategies to train ourselves to be more resilient: (1) Pursuit of fulfillment, (2) Cultivation of community and belonging, (3) Mitigation of microstresses and avoiding feelings of overwhelm, and (4) Building a "resilience bank account."

Individual and organizational factors influencing well-being and burnout amongst healthcare assistants: A systematic review

Background

Increasing evidence suggests that clinician well-being influences patient, workforce, and organizational outcomes. Despite increasing attention to well-being among licensed clinicians (e.g., nurses and physicians), collective evidence about well-being among healthcare assistants, such as nursing and medical assistants, is limited. Healthcare assistants make up a substantial portion of the clinical workforce delivering direct patient care. The well-being of healthcare assistants is critical to ensure an ample workforce supply. The objective of this systematic review was to contribute a reproducible search, summary, appraisal, synthesis, and critique of the literature about well-being among healthcare assistants, including factors that induce or inhibit burnout, and to identify gaps in evidence that warrant future research.

Methods

We performed a literature search across 4 databases with keywords using BOOLEAN operators. After an initial title and abstract screen, a search of relevant reference lists, and full text review was peformed independently by 2 researchers. Study quality was evaluated using Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. We extracted study characteristics, results, and deductively analyzed each study's alignment with the United States National Academy of Medicine's Clinician Well-Being Model.

Results

We identified 28 articles meeting our inclusion criteria. Our synthesis indicated that most studies investigated personal factors (e.g., financial stressors or physical, emotional, and spiritual health) as opposed to organizational or policy factors (e.g., occupational policies or workplace culture) that may impact well-being. Younger workers and those with fewer years of experience appear to have higher burnout risk. Sleep health, improved unit-based culture (respect and increased decision-making with nurses), shorter shifts, and increased social support appear to be the most protective against burnout.

Discussion

There remains a scarcity of evidence about factors impacting well-being among healthcare assistants. Existing literature focuses on individual, as opposed to external or organizational, contributory factors to burnout or well-being risk. Future studies should use specific methods to define and measure healthcare assistant roles, isolate harmful individual and organizational factors, and measure more specific sub-concepts of well-being such as depression. Such studies can contribute greatly to the overall understanding of healthcare assistant health and wellness, which subsequently may promote optimal patient and organizational outcomes.

Tweetable abstract

The hidden workforce: Systematic review demonstrates gaps in evidence about wellbeing and burnout among healthcare assistants and aides.

Insights into the Impact of Organizational Factors and Burnout on the Employees of a For-Profit Psychiatric Hospital during the Third Wave of the COVID-19 Pandemic

In this paper, we provide insights into the interplay among the organizational, job, and attitudinal factors and employees' intentions to resign during the third wave of the COVID-19 pandemic at a mental health hospital. We point out shortcomings in the relationship dynamics between executive administration and operational staff and propose a pathway to develop more effective leadership frameworks to increase job satisfaction. We integrate qualitative data from case information and open-ended questions posed to employees at a mental health hospital and quantitative data from a small-scale survey (n = 19). We highlight that the ability to achieve objectives, work autonomy, burnout, affective commitment, distributive and procedural justice, and job satisfaction are critical in determining individuals' intentions to resign. Individuals identified disconnectedness and moral distress as critical aspects, while highlighting empathy, compassion, satisfaction, and confidence as pivotal elements. Mental healthcare settings could benefit from enhancing the staff's ability to achieve objectives, work autonomy, affective commitment, and both distributive and procedural justice. Addressing burnout and implementing measures to increase job satisfaction are equally vital. Efficiently restructuring dynamics between various leadership levels and staff can significantly improve employee retention.

Building workforce capacity to address substance use in primary health care: preliminary results from a mixed-methods pilot program

BACKGROUND

Primary health care is critical to the prevention of alcohol, tobacco and other drug-related harms. Scaling-up screening, brief intervention and referral to treatment (SBIRT) within primary health care can reduce the burden of substance-related diseases, and improve downstream healthcare services. Building knowledge, skills and confidence among general practitioners (GPs), particularly in rural, regional and remote areas, to deliver SBIRT is an essential step. Therefore, this study aimed to pilot test a skills-based training program for GPs designed to build capacity for SBIRT delivery.

METHODS

This pilot study investigated the acceptability of a structured, educational skills-based training program among GPs, as well as its preliminary effectiveness in inducing changes in confidence to deliver SBIRT, and in increasing knowledge about low-risk alcohol guidance. The training package was designed by experts in addiction medicine and public health, and involved a series of online webinars and in-person workshops at four locations across the South Eastern NSW Primary Healthcare Network catchment.

RESULTS

A total of 18 GPs registered for the training, with six completing the final webinar. The GPs who completed all sessions demonstrated increases in confidence to deliver SBIRT and alcohol guidance knowledge from baseline. Qualitative feedback found the program acceptable, and GPs were able to successfully implement learnings into practice, and promote to colleagues.

CONCLUSIONS

The results indicated the potential of this program at a national level, but highlighted the need for a range of additional incentives to encourage uptake and ongoing implementation.

'A sense of self, empowerment and purposefulness': professional diversification and wellbeing in Australian general practitioners

BACKGROUND

Burnout and workforce shortages comprise a vicious cycle in medicine, particularly for Australian general practitioners (GPs). Professional diversification, whereby individuals work multiple roles across their week, may help address this problem, but this strategy is under-studied.

METHODS

We surveyed 1157 Australian GPs using qualitative and quantitative questions examining professional diversification, values, autonomy, and wellbeing. Quantitative data were analysed using inferential statistics, whilst qualitative data were analysed using inductive thematic analysis. We triangulated the data by using the qualitative findings to inform further quantitative testing.

RESULTS

Approximately 40% of the sample had diversified. Although diversifying was not significantly associated with wellbeing, the qualitative data indicated that diversification supported GPs' wellbeing by enhancing career sustainability, accomplished through various pathways (e.g. value fulfilment, autonomy, variety). Subsequent quantitative analyses provided evidence that these pathways mediated the relationship between diversification and wellbeing. To diversify, GPs needed particular personal qualities, external supports, flexibility, and serendipity. Barriers to diversifying mirrored these factors, spanning individual (e.g. skillset) and situational levels (e.g. autonomy, location).

CONCLUSIONS

Diversification can support GPs' wellbeing if it meets their needs. Organisations should focus on publicising opportunities and accommodating requests to diversify.

Feasibility and acceptability of a culturally adapted psychological first aid training intervention (Preparing Me) to support the mental health and well-being of front-line healthcare workers in China: a feasibility randomized controlled trial

Background: Psychological first aid (PFA) training helps to prepare healthcare workers (HCWs) to manage trauma and stress during healthcare emergencies, yet evidence regarding its effectiveness and implementation is lacking.Method: A two-arm feasibility randomized controlled trial design was conducted in a Chinese tertiary hospital. Participants were randomly allocated to receive either a culturally adapted PFA training (the intervention arm) or psychoeducation (the control arm). Feasibility indicators and selected outcomes were collected.Results: In total, 215 workers who expressed an interest in participating in the trial were screened for eligibility, resulting in 96 eligible participants being randomly allocated to the intervention arm (n = 48) and control arm (n = 48). There was a higher retention rate for the face-to-face PFA training session than for the four online group PFA sessions. Participants rated the PFA training as very helpful (86%), with a satisfaction rate of 74.25%, and 47% reported being able to apply their PFA skills in responding to public health emergencies or providing front-line clinical care. Positive outcome changes were observed in PFA knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth. Their scores on depression, anxiety, stress, and burnout measures all declined. Most of these changes were sustained over 3 months (p < .05). Repeated measures analysis of variance found statistically significant interaction effects on depression (F2,232 = 2.874, p = .046, η p 2  = .031) and burnout (F2,211 = 3.729, p = .018, η p 2  = .037), indicating a greater reduction in symptoms of depression and burnout with PFA compared to psychoeducation training.Conclusion: This culturally adapted PFA training intervention was highly acceptable among Chinese HCWs and was feasible in a front-line care setting. Preliminary findings indicated positive changes for the PFA training intervention on knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth, especially a reduction of depression and burnout. Further modifications are recommended and a fully powered evaluation of PFA training is warranted.

Stress, burnout, and parenting: a qualitative study of general practice registrars

BACKGROUND

Early career medical professionals experience stress and burnout at higher levels than the wider community. Burnout can arise with competing demands of life and career, which is evident in early career development, where family planning can coincide with specialty training. General practice may be seen as a family friendly career option; however, few studies examine the experience of general practice trainees with stress and burnout and the impact that parenting has on their experience. This study aims to explore the experience of stress and burnout in general practice registrars and the exacerbating and protective factors, with a focus on the experiences of two groups of registrars, those that have children, and those that do not.

METHODS

A qualitative study was conducted with 14 participants, who were interviewed with questions exploring experiences of stress and burnout. Participants were grouped into those with children and those without children. The transcripts were thematically analysed.

RESULTS

Themes were identified as those that contributed to stress and burnout (such as time, financial concerns and isolation) and those factors that reduced stress and burnout (such as support from others and being respected and valued within the workplace). Parenting was identified as both a factor that could contribute to and reduce stress and burnout.

CONCLUSIONS

Stress and burnout are important foci for future research and policy to ensure the sustainability of general practice. System based and individual focused policies, including individualising training to support parenting, are required to ensure that registrars are supported through their training years and beyond.

Well-being, burnout and value fulfilment: Let us situate individuals within systems

Bansal explores how systems‐based enquiry might productively shift focus from individual success or failure, to broader support of wellbeing and burnout prevention.