Resilience in medical doctors: a systematic review

Factors influencing the resilience of clinical education in general medicine in Iran: a qualitative content analysis study

BACKGROUND

Clinical education is one of the key components of medical education and directly affects the efficiency, professional skills, and quality of future services graduates provide. Additionally, resilience plays an essential role in facing crises and forming medical students' professional identity. Strengthening resilience can accelerate this process. Therefore, this study was conducted to comprehensively understand the dimensions and factors affecting resilience in the clinical education of general medicine, based on the experiences of stakeholders, including professors and students present in clinical environments.

METHODOLOGY

This qualitative study was conducted based on purposive sampling among ten faculty members and six medical students. The data collection process was conducted from September 2023 to April 2024 through semi-structured interviews. Interviews were transcribed, and data analysis was accomplished according to the steps proposed by Graneheim and Lundman (2004).

RESULTS

Data analysis revealed three themes that reflected the factors influencing resilience in clinical education: Facilitators of resilient clinical education, Barriers of resilient clinical education, and Prerequisite factors of resilient clinical education.

CONCLUSION

According to the results, in order to create a resilient clinical education system, it is necessary to pay attention to factors such as the use of residents in teaching, cooperative learning, effective interaction, strong knowledge base, infrastructure development, and spreading the culture of learning from experiences. In the meantime, obstacles such as the loss of trust between community members and doctors, heavy workload, non-scientific management and treatment-oriented clinical training centers can prevent the realization of this goal. On the other hand, supporting faculty members with training programs and job promotion as well as paying attention to individual resilience are considered as facilitating factors in this direction.

The Association Between Anesthetist Leadership Styles and Their Resilience: A Single-Center Study

PURPOSE

To explore the association between the leadership styles and resilience of anesthetists in leadership roles.

METHODOLOGY

This prospective study of all anesthetists in leadership roles within a university teaching hospital in Melbourne, Australia, employed three validated, anonymous questionnaires (Multifactor Leadership Questionnaire, Authentic Leadership Questionnaire, and the Resilience Scale). Questionnaire data were summarized using descriptive statistics and presented as counts and proportions. Spearman's rank correlation was used to evaluate quantitative continuous variables to identify linear relationships.

RESULTS

Of the 14 anesthetists in leadership roles, 14 completed all three questionnaires (response rate 100%). Ten participants (71.5%) displayed behaviors consistent with transformational leadership. Three participants (21.4%) displayed behaviors typically associated with transactional leadership, and one (7.1%) exhibited characteristics consistent with passive-avoidant leadership. Anesthetists with transformational leadership styles exhibited significantly higher resilience scores than those with transactional or passive-avoidant leadership styles. Those with transformational leadership qualities also had increased job satisfaction overall.

CONCLUSION

Anesthetists who exhibit transformational and authentic leadership are likely to be more resilient than those with transactional or passive-avoidant leadership styles. Higher levels of resilience were also associated with greater role effectiveness and experiencing greater levels of job satisfaction.

Understanding the performance-related psychological characteristics and skills of doctors: A sport psychology perspective

INTRODUCTION

Doctors need to consistently maintain their clinical performance across a range of different situations by managing the stress response provoked by these situations. Six performance-related adaptive and maladaptive psychological characteristics and psychological skills can distinguish between how athletes manage their stress response and consistently maintain an optimal level of performance across a variety of situations. The aim of the study was to understand how the performance-related psychological characteristics and skills identified in athletes are applied by doctors.

METHODS

An exploratory qualitative study was conducted with semi-structured interviews. A purposive sample of 10 doctors were interviewed and the data were analysed by template analysis.

RESULTS

Doctors have similar performance-related psychological characteristics and skills as identified in athletes for managing their stress response to consistently maintain optimal clinical performance. The importance of maladaptive characteristics was also identified, especially in junior doctors.

CONCLUSIONS

The findings of this pilot study can be used for informing the design of performance-related educational interventions for doctors to manage their stress response for consistently maintaining optimal clinical performance. An important consideration will need to be a focus on specific groups in their career journey and the development of a multi-dimensional, reflective, and problem-solving approach.

Exploring resilience among hospital workers: a Bayesian approach

Background and importance

Healthcare professionals face significant workloads, as their roles are among the most demanding and stressful. Resilience serves as a crucial factor in helping them cope with the challenges encountered in their work environment and effectively manage stress. Assessing the level of resilience among healthcare workers and identifying potential variations across different groups is essential for effective public health management, preventing burnout, and ultimately enhancing patient care.

Objective

To assess the resilience of various categories of workers operating within a tertiary care multisite hospital and understanding if there are any differences in resilience, based on their characteristics, the type of department they work in, and personality traits.

Design setting and participants

This was a cross-sectional study conducted in January 2024 at EOC, a multi-site tertiary care hospital located in Southern Switzerland. 1,197 hospital workers answered an online survey which included: (1) an ad hoc questionnaire on personal and job characteristics, well-being-related activities, satisfaction level regarding communication, collaboration, support, and training opportunities in the workplace, (2) the Connor-Davidson Resilience Scale 10-Item on resilience, and (3) the Big Five Personality Inventory 10-item on personality traits.

Outcome measures and analysis

Proportion of resilient and highly resilient individuals within the various categories of workers were analyzed with Bayesian approach and Bayesian robust regression.

Main results

Being part of the hospitality staff, working as a doctor, and having a male sex were associated to the highest scores of resilience. Surgery and emergency departments had the highest proportion of highly resilient individuals. Male sex, older age, seniority, higher hierarchical rank, engagement in physical activities, relaxation or mindfulness practices, religiosity, perception of good collaboration, communication, support, and physical activity correlated with higher resilience skills.

Conclusion

This cross-sectional study found that physicians and hospitality staff within our multi-site Swiss hospital are more resilient compared to other categories of hospital workers, and among departments, those working in surgery and Emergency Medicine. Enhancing our comprehension of resilience is crucial for more precise management of healthcare systems and the development of employment policies aimed at sustaining the capacity of healthcare systems to serve patients effectively, while also mitigating shortages of healthcare professionals.

Mediation effect of perceived social support and psychological distress between psychological resilience and sleep quality among Chinese medical staff

Sleep quality is crucial for the personal well-being of healthcare professionals and the health outcomes of their patients. This study aims to explore the relationship between psychological resilience (PR), perceived social support (PSS), psychological distress (comprising anxiety,depression,and stress), and sleep quality. It also examines whether PSS and psychological distress function as chain mediators between PR and sleep quality. A cross-sectional online survey was conducted using a convenient sampling method, with 454 participants included. The survey instruments included the Connor and Davidson Resilience Scale, the Perceived Social Support Scale, the 21-item Depression Anxiety Stress Scale, and the Pittsburgh Sleep Quality Index. Structural equation modeling revealed that PR significantly predicted sleep quality of Chinese medical staff. Psychological distress was identified as a mediating factor between PR and sleep quality. However, PSS did not directly mediate the relationship between PR and sleep quality. Instead, PSS and psychological distress were found to play a chain mediating role in the relationship between PR and sleep quality. This study provides new insights into the impact of PR on sleep quality, highlights the importance of PSS and psychological distress, and suggests practical implications for enhancing sleep quality among medical staff.

Psychological endurance: how grit, resilience, and related factors contribute to sustained effort despite adversity

Many concepts describe how individuals sustain effort despite challenging circumstances. For example, scholars and practitioners may incorporate discussions of grit, hardiness, self-control, and resilience into their ideas of performance under adversity. Although there are nuanced points underlying each construct capable of generating empirically sound propositions, the shared attributes make them difficult to differentiate. As a result, substantial confusion arises when debating how these related factors concomitantly contribute to success, especially when practitioners attempt to communicate these ideas in applied settings. The model proposed here-psychological endurance-is a unified theory to explore how multiple concepts contribute to sustained goal-directed behaviors and individual success. Central to this model is the metaphor of a psychological battery, which potentiates and sustains optimal performance despite adversity. Grit and hardiness are associated with the maximum charge of the psychological battery, or how long an individual could sustain effort. Self-control modulates energy management that augments effort required to sustain endurance, whereas resilience represents the ability to recharge. These factors are constrained by both psychological and physiological stressors in the environment that drain the psychology battery. Taken together, these ideas form a novel framework to discuss related psychological concepts, and ideally, optimize intervention to enhance psychological endurance.

ALS Health care provider wellness

BACKGROUND

Interest in health care provider (HCP) wellness and burnout is increasing; however, minimal literature explores HCP wellness in the context of Amyotrophic Lateral Sclerosis (ALS) care.

OBJECTIVES

We sought to determine rates of burnout and resiliency, as well as challenges and rewards in the provision of ALS care.

METHODS

A survey link was sent to physicians at all Canadian ALS centers for distribution to ALS HCPs in their network. The survey included demographics questions, and validated measures for resiliency and burnout; the Brief Resilient Coping Scale (BRCS) and the Single Item Burnout Score (SIBS). Participants were asked to describe challenges and rewards of ALS care, impact of COVID-19 pandemic, and how their workplace could better support them.

RESULTS

There were 85 respondents across multiple disciplines. The rate of burnout was 47%. Burnout for female respondents was significantly higher (p = 0.007), but not for age, role, or years in ALS clinic. Most participants were medium resilient copers n = 48 (56.5%), but resiliency was not related to burnout. Challenges included feeling helpless while patients relentlessly progressed to death, and emotionally charged interactions. Participants found fulfillment in providing care, and through relationships with patients and colleagues. There was a strongly expressed desire for increased resources, team building/debriefing, and formal training in emotional exhaustion and burnout.

CONCLUSIONS

The high rate of burnout and challenges of ALS care highlight the need for additional resources, team-building, and formal education around wellness.

A qualitative study of leaders' experiences of handling challenges and changes induced by the COVID-19 pandemic in rural nursing homes and homecare services

BACKGROUND

The COVID-19 pandemic had a major impact on healthcare services globally. In care settings such as small rural nursing homes and homes care services leaders were forced to confront, and adapt to, both new and ongoing challenges to protect their employees and patients and maintain their organization's operation. The aim of this study was to assess how healthcare leaders, working in rural primary healthcare services, led nursing homes and homecare services during the COVID-19 pandemic. Moreover, the study sought to explore how adaptations to changes and challenges induced by the pandemic were handled by leaders in rural nursing homes and homecare services.

METHODS

The study employed a qualitative explorative design with individual interviews. Nine leaders at different levels, working in small, rural nursing homes and homecare services in western Norway were included.

RESULTS

Three main themes emerged from the thematic analysis: "Navigating the role of a leader during the pandemic," "The aftermath - management of COVID-19 in rural primary healthcare services", and "The benefits and drawbacks of being small and rural during the pandemic."

CONCLUSIONS

Leaders in rural nursing homes and homecare services handled a multitude of immediate challenges and used a variety of adaptive strategies during the COVID-19 pandemic. While handling their own uncertainty and rapidly changing roles, they also coped with organizational challenges and adopted strategies to maintain good working conditions for their employees, as well as maintain sound healthcare management. The study results establish the intricate nature of resilient leadership, encompassing individual resilience, personality, governance, resource availability, and the capability to adjust to organizational and employee requirements, and how the rural context may affect these aspects.

Exploring Resilience in Care Home Nurses: An Online Survey

Resilience is considered a core capability for nurses in managing workplace challenges and adversity. The COVID-19 pandemic has brought care homes into the public consciousness; yet, little is known about the resilience of care home nurses and the attributes required to positively adapt in a job where pressure lies with individuals to affect whole systems. To address this gap, an online survey was undertaken to explore the levels of resilience and potential influencing factors in a sample of care home nurses in Northern Ireland between January and April 2022. The survey included the Connor-Davidson Resilience Scale, demographic questions and items relating to nursing practice and care home characteristics. Mean differences and key predictors of higher resilience were explored through statistical analysis. A moderate level of resilience was reported among the participants (n = 56). The key predictors of increased resilience were older age and higher levels of education. The pandemic has exposed systemic weakness but also the strengths and untapped potential of the care home sector. By linking the individual, family, community and organisation, care home nurses may have developed unique attributes, which could be explored and nurtured. With tailored support, which capitalises on assets, they can influence a much needed culture change, which ensures the contribution of this sector to society is recognised and valued.

Key predictors of psychological distress and wellbeing in Australian frontline healthcare workers during COVID-19 (Omicron wave)

Introduction

The COVID-19 pandemic has led to significant challenges for frontline healthcare workers' (FHW), raising many mental health and wellbeing concerns for this cohort. To facilitate identification of risk and protective factors to inform treatment and interventions, this study investigated key predictors of psychological distress and subjective wellbeing in FHWs.

Methods

During the Omicron wave of the COVID-19 pandemic (January 2022), Victorian (Australia) doctors, nurses, allied health and non-medical staff from Emergency Departments, Intensive Care units, Aged Care, Hospital In The Home, and COVID Wards completed a cross-sectional survey consisting of the Kessler 6 item (Psychological Distress), Personal Wellbeing Index (Subjective Wellbeing), Coronavirus Health Impact Survey tool (COVID-19 related factors) and occupational factors. Multivariable linear regressions were used to evaluate unadjusted and adjusted associations. Relative weight analysis was used to compare and identify key predictors.

Results

Out of 167 participants, 18.1% screened positive for a probable mental illness and a further 15.3% screened positive for low wellbeing. Key risk factors for greater psychological distress included COVID infection worries, relationship stress and younger age. For both psychological distress and lower wellbeing, health status and supervisor support were key protective factors, while infection risks were key risk factors. Only positive changes in relationship quality was protective of lower wellbeing.

Conclusion

This study highlights the significance of social determinants and individual level factors alongside work related factors, in influencing FHWs' mental health and wellbeing during public health crises, such as the COVID-19 pandemic. Findings suggest that future interventions and supports should take a more holistic approach that considers work, social and individual level factors when supporting FHWs' mental health and wellbeing.

The Impact of Race and Gender-Related Discrimination on the Psychological Distress Experienced by Junior Doctors in the UK: A Qualitative Secondary Data Analysis

Almost half of NHS doctors are junior doctors, while high proportions are women and/or Black, Asian, and Minority Ethnic (BAME) individuals. Discrimination against this population is associated with poorer career-related outcomes and unequal representation. We aimed to qualitatively explore junior doctors’ experience of workplace racial and gender-based discrimination, and its impact on their psychological distress (PD). In this study, we carried out a secondary analysis of data from a UK-based parent study about junior doctors’ working cultures and conditions. Interview data was examined using thematic analysis. Transcripts (n = 14) documenting experiences of race and/or gender-based discrimination were sampled and analysed from 21 in-depth interviews conducted with UK junior doctors. Four themes were generated about the experiences and perpetrators of discrimination, the psychological impact of discrimination, and organisational interventions that tackle discrimination. Discrimination in various forms was reported, from racially charged threats to subtle microaggressions. Participants experienced profoundly elevated levels of PD, feeling fearful, undermined, and under-confident. Discrimination is associated with elevated levels of PD, whilst negatively impacting workforce sustainability and retention. This reduces the opportunity for more diversity in NHS medical leadership. We encourage NHS hospitals to review their policies about discrimination and develop in-person workshops that focus on recognising, challenging, and reporting workplace discrimination.

The importance of developing meaningfulness and manageability for resilience in rural doctors

INTRODUCTION

Retention of rural doctors is a problem in many countries. A previous study has identified resilience as a factor associated with longer retention. However, this needs a deeper study to understand what local and personal factors are at play. Studies suggest resilience can be developed during training. We propose that a better understanding of factors associated with resilience might assist in training students for rural practice and increase retention.

AIM

This study aimed to understand the differences in resilience development between the more and the less resilient rural doctors. A secondary purpose was to identify how to assist this developmental process through health professional education.

METHODS

This study employed a mixed-method design and was part of a more extensive study aiming to develop rural doctors' resilience in a low-resource setting. A prior survey assessed rural doctors' resilience levels. This study sampled high-level and low-level resilience participants to be interviewed. A total of 22 rural doctors participated in the individual semi-structured interviews. The interviews were analyzed qualitatively based on Richardson's Resilience Model and the six resilience dimensions looking for factors that explained high or low resilience.

RESULTS

Two important themes emerged during the qualitative analysis: 'meaningfulness' and 'manageability.' The different responses of high and low-resilient participants can be explained through cases.

CONCLUSIONS

The participants' perceived meaningfulness and manageability of the stressor determine the responses. We suggest that teachers may better construct students' resilience by focussing on assisting them in finding meaning and developing a sense of manageability.

Demographic and work-related factors associated with burnout, resilience, and quality of life among healthcare workers during the COVID-19 pandemic: A cross sectional study from Malaysia

Introduction

The healthcare setting is a stressful and demanding work environment, and healthcare workers face a continuous expansion of their job roles and responsibilities. Past studies have shown that factors affecting burnout, resilience, and quality of life among healthcare workers merit further research, as there were inconsistent findings, especially with regards to the influence of demographic and work-related factors. Therefore, this study aims to determine whether demographic and work-related factors are associated with burnout, resilience, and quality of life among healthcare workers.

Method

This cross-sectional study was conducted between February 15, 2022 and March 15, 2022, among 394 healthcare workers from Putrajaya and Selangor hospitals, Malaysia. Maslach Burnout Inventory, World Health Organization Quality of Life-BREF 26 inventory, and Brief Resilience Scale were utilized to capture information on burnout, quality of life, and resilience, respectively.

Results

The mean score of physical health of participants who work more than 10 h (11.38) is lower than participants who work from 8 to 10 h (13.00) and participants who work 7 h daily (13.03), p-value < 0.001. Similarly, the mean score of psychological health of participants who work more than 10 h (12.35) is lower than participants who work from 8 to 10 h (13.72) and participants who work 7 h daily (13.68), p-value = 0.001. Higher income levels were associated with high resilience and quality of life.

Conclusion

It is imperative that healthcare practitioners and policy makers adopt and implement interventions to promote a healthy workplace environment, address ethical concerns, and prevent burnout among healthcare workers during the COVID-19 pandemic. Managing the issue of long working hours could possibly result in improved resilience, burnout, and quality of life among healthcare workers. Despite this study able to tickle out some policy specific areas where interventions are needed, identifying effective solutions and evaluating their efficiency will require larger and interventional studies.

The Mediation Chain Effect of Cognitive Crafting and Personal Resources on the Relationship between Role Ambiguity and Dentists' Emotional Exhaustion

Based on Job Demands-Resources (JD-R), Conservation of Resources (COR) and self-regulation theories integration, this study investigated the association between role ambiguity and emotional exhaustion among 191 Romanian dentists, as well as the chain mediating role of cognitive crafting and three personal resources (resilience, optimism, and self-efficacy). Three conceptual models which included, separately, the three personal resources were proposed. PROCESS macros were used to verify the hypotheses related to the testing of the path mediation models. The results indicated that role ambiguity was directly and positively associated with dentists' burnout. More importantly, the sequential indirect effect of role ambiguity on burnout via mediators in chains (cognitive crafting and resilience for the first model; cognitive crafting and optimism for the second model; cognitive crafting and self-efficacy for the third model) was significant. The findings provide a direction for dentists' health intervention because it reveals how the negative impact of role ambiguity on emotional exhaustion increasing can be buffered by the cumulative effect of cognitive crafting and different personal resources, as a result of their chain reinforcement.

Health Security, Quality of Life and Democracy during the COVID-19 Pandemic: Comparative Approach in the EU-27 Countries

The aim of this paper is to emphasize the role played by the social, economic and political variables in shaping models of sustainable healthcare systems and strategies able to support and improve the quality of life during and after the COVID-19 pandemic. The context of our research is represented by the medical and socioeconomic crises generated by the COVID-19 pandemic. The current pandemic negatively affects healthcare systems, quality of life and the global economy. In this respect, this paper aims to thoroughly scrutinize the effects of the COVID-19 pandemic on the social and healthcare systems of EU countries, to analyze the impact of human development in the field of the Global Health Security Index and to estimate the relation between resilience and quality of life during the COVID-19 pandemic. The research design is quantitative, resorting to the use of both descriptive and inferential statistics, against the background of a long-term comparative approach to the respective situations in the EU-27 countries. Empirical findings are relevant for emphasizing the fact that human development and social progress are predictors for the dynamics of health security measures. Moreover, the quality of the political regime, particularly in the case of full and flawed democracies, is strongly related to a high level of resilience and could influence the perception of quality of life. All of these empirical results could prove valuable for scholars interested in understanding the relationships between democracy, healthcare systems and quality of life, and for political decision makers involved in the effort of reducing the negative effects of COVID-19 in EU-27 countries.

Can resilience promote calling among Chinese nurses in intensive care units during the COVID-19 pandemic? The mediating role of thriving at work and moderating role of ethical leadership

Background

Nurses working in the intensive care unit (ICU) clung tenaciously to their job during the COVID-19 pandemic in spite of enduring stressed psychological and physical effects as a result of providing nursing care for the infected patients, which indicates that they possessed a high degree of professionalism and career calling. The aim of this study was to explain the associations between resilience, thriving at work, and ethical leadership influencing the calling of ICU nurses.

Methods

From December 2020 to January 2021 during the COVID-19 pandemic, a cross-sectional survey of 15 provinces in China was conducted using an online questionnaire. A total of 340 ICU nurses (effective response rate: 64.89%) completed sufficient responses to be used in the study. Sociodemographic factors, job demographic factors, resilience, calling, thriving at work, and ethical leadership were assessed using the questionnaire. General linear modeling (GLM), hierarchical linear regression (HLR) analysis, and generalized additive model (GAM) were performed to examine all the considered research hypotheses.

Results

Resilience was positively and significantly associated with calling. Moreover, thriving at work partially mediated the relationship between resilience and calling. The indirect effect of resilience on calling was 0.204 (p < 0.0001), and the direct effect of resilience on calling through thriving at work was 0.215 (p < 0.0001). The total effect of resilience on calling was 0.419 (p < 0.0001). In addition, ethical leadership played a moderating role in the relationship between resilience and calling (β = 0.16, p < 0.05).

Conclusion

Greater resilience can positively predict increased calling among Chinese ICU nurses during the COVID-19 pandemic. Moreover, thriving at work is a mechanism that partly transmits the positive effects of resilience on calling. Overall, nurses possessing greater resilience tend to maintain thriving at work in the face of such adversity, further resulting in subsequently increased calling. Besides, findings suggest that there is stronger influence of resilience on calling among nurses working in an organization managed by an ethical leader. The current findings may offer two insights for nursing practitioners and policymakers in the postpandemic world. First, resilience training and intervention are necessary to foster nurses' sense of thriving at work in the nursing industry, further promoting career calling. Second, better training and effort on the development of ethical leadership for leaders in nursing practice are essential to encourage followers to engage in social learning of ethical behaviors and abiding by normatively appropriate conduct, further enacting prosocial values and expressing moral emotions.

Nurse leaders' resilience and their role in supporting nurses' resilience during the COVID-19 pandemic: A scoping review

AIM

To explore nurse leaders' resilience and their role in supporting nurses' resilience during the COVID-19 pandemic.

BACKGROUND

The COVID-19 pandemic has challenged health care systems on a global level. Nurse leaders are tasked with ensuring high-quality care, even during crises, which requires active problem-solving and confidence in the future-resilience from leaders.

METHOD

A scoping review was conducted using inductive thematic analysis and the PCC (Participants, Concept, Context) framework. The PubMed, Scopus, CINAHL, and PsycINFO databases, as well additional studies and grey literature, were searched from December 2019 to June 2021.

RESULTS

The review included 12 studies. Nurse leaders' self-awareness, self-reflection, and coping strategies described their resilience during the pandemic. A relational leadership style, supportive and safe work environment, and adequate communication were found to support nurses' resilience.

CONCLUSIONS

There is scarce research concerning nurse leaders' resilience during the COVID-19 pandemic. Future research needs to address nurse leaders' personal resilience due to the link with nurses' resilience.

IMPLICATIONS FOR NURSING MANAGEMENT

A healthy work environment is essential for nurses' resilience. During crises, nurse leaders should adopt relational leadership styles and actively interact with nursing staff.

Safety Culture and the Positive Association of Being a Primary Care Training Practice during COVID-19: The Results of the Multi-Country European PRICOV-19 Study

The day-to-day work of primary care (PC) was substantially changed by the COVID-19 pandemic. Teaching practices needed to adapt both clinical work and teaching in a way that enabled the teaching process to continue, while maintaining safe and high-quality care. Our study aims to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of PC practices. PRICOV-19 is a multi-country cross-sectional study that researches how PC practices were organized in 38 countries during the pandemic. Data was collected from November 2020 to December 2021. We categorized practices into training and non-training and selected outcomes relating to safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. Mixed-effects regression models were built to analyze the effect of being a training practice for each of the outcomes, while controlling for relevant confounders. Of the participating practices, 2886 (56%) were non-training practices and 2272 (44%) were training practices. Being a training practice was significantly associated with a lower risk for adverse mental health events (OR: 0.83; CI: 0.70-0.99), a higher number of safety measures related to patient flow (Beta: 0.17; CI: 0.07-0.28), a higher number of safety incidents reported (RR: 1.12; CI: 1.06-1.19) and more protected time for meetings (Beta: 0.08; CI: 0.01-0.15). No significant associations were found for outreach initiatives, availability of triage information, use of a phone protocol or infection prevention measures and equipment availability. Training practices were found to have a stronger safety culture than non-training practices. These results have important policy implications, since involving more PC practices in education may be an effective way to improve quality and safety in general practice.

Implementing mindfulness meditation in hand surgery training: a feasibility study

Background

Surgery can be stressful, requiring decision-making and performance under pressure. The COVID-19 pandemic has further challenged surgeons’ well-being and training. Excess stress adversely affects well-being, technical and non-technical performance, and, by extension, patient care. Little emphasis has been placed on interventions to improve individual surgeons’ stress resilience despite mindfulness training being robustly linked to resilience, well-being, and improved executive function and performance. This feasibility study aimed to evaluate the effect and acceptability of a mindfulness meditation session on a group of surgical trainees during a hand fracture fixation course.

Methods

All participants of a single-day hand fracture fixation course were invited to take part in the study, and randomised into two groups. The intervention group experienced a 10-min guided meditation session before their assessment, while the control group did not. Basic demographics, inherent ‘trait’ mindfulness, change in mood, and perceived acceptability were compared between the two groups.

Results

The 17 participants were demographically similar, as were their self-reported mood scores until after the meditation, where they diverged significantly (p < .01, t-test), with the meditation group feeling more relaxed and calm. Meditation as an intervention was considered largely acceptable.

Conclusions

Mindfulness meditation is established in improving stress resilience, relevant to surgeon well-being, performance, and patient care. This feasibility study suggests benefit and acceptability, and potential for further research in designing a targeted programme for surgeons, to reduce stress sensitivity, and improve performance, joy, and well-being within surgical training.

Level of evidence: Level III, Therapeutic study.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00238-022-01962-1.

Are orthopaedic surgeons tough as nails? A regional resilience study

BACKGROUND

Healthcare professionals require resilience in the workplace to cope with the high demands of the job. Resilience reduces anxiety and distress following an adverse event, which orthopaedic surgeons must be prepared for. This cross-sectional study aims to assess the resilience levels of orthopaedic surgeons in one region to determine whether there are any factors which enhance it.

METHODS

Data from one hundred orthopaedic surgeons of varying levels was collected and compared using a validated scoring questionnaire (Connor-Davidson resilience scale 25). Scores were assessed and compared to experience level and participant demographics such as age, sex and subspeciality. Data on extracurricular activities i.e. sport, meditation/prayer and crafts were also collected.

RESULTS

There was no significant difference between the scores between genders (p = 0.74). The highest scores were found in trust grade doctors, SHOs and senior consultants. Higher resilience trends were noted for those who performed regular meditation and participated in regular arts and crafts. Those who participated in daily sports had lower resilience levels than those who participated less frequently. A concerning 13% reported that they felt pandemic had negatively impacted their resilience.

Resilience, Mentalizing and Burnout Syndrome among Healthcare Workers during the COVID-19 Pandemic in Serbia

The aim of this study was to examine whether the capacity for mentalizing and resilience among healthcare workers (HCWs) explains the degree of burnout syndrome during the COVID-19 pandemic in Serbia. The research was conducted on a sample of 406 healthcare workers (141 doctors and 265 nurses), aged 19 to 65 years (M = 40.11, SD = 9.41)—203 worked on the COVID-19 frontline, and 203 in regular clinical conditions. The Maslach Burnout Inventory was used to measure the burnout syndrome. Capacity for mentalizing was examined using the Reflective Functioning Questionnaire. The Brief Resilience Scale was used to measure resilience. The results indicated that there were negative correlations between resilience and the dimensions of burnout—emotional exhaustion (r = −0.38; p < 0.01) and depersonalization (r = −0.11; p < 0.05), and a positive correlation between resilience and personal accomplishment (r = 0.27; p < 0.01), as was expected. The analyses of hierarchical linear regression showed that hypomentalizing was a significant positive predictor of emotional exhaustion (ß = 0.12; p < 005) and depersonalization (ß = 0.15; p < 0.05), resilience was a significant negative predictor of emotional exhaustion (ß = −0.28, p < 0.01) and positive predictor of personal accomplishment (ß = 0.20; p < 0.01), and that the degree of explained variance of burnout dimensions was higher when resilience and hypomentalizing were included in regression models, in addition to sociodemographic variables. The findings suggest that being a woman and working on the COVID-19 frontline implies a higher burnout, while the level of burnout decreases with better socioeconomic status and more children. Resilience, capacity for mentalizing, and burnout syndrome among HCWs are interrelated phenomena, which have important professional implications.

Individual Stress Burden and Mental Health in Health Care Workers during the COVID-19 Pandemic: Moderating and Mediating Effects of Resilience

Introduction: The COVID-19 pandemic generated a significant burden on the German health care system, affecting the mental health of health care workers (HCW) in particular. Resilience may serve as an essential protective factor for individuals’ well-being. Objective: Our objective was to identify demographic and work-related correlates of individual resilience and to investigate the association between pandemic-related stress, resilience and mental health using different resilience models. Methods: Our sample comprised 1034 German HCW in different medical professions who completed an online survey from 20 April to 1 July 2020. Resilience was assessed using the Resilience Scale-5 (RS-5). The pandemic-related self-reported stress burden was captured by a single item, while depression and anxiety symptoms were measured with the PHQ-2 and GAD-2, respectively. Additionally, various sociodemographic and work-related factors were assessed. Results: Overall, we found high levels of resilience in the sample compared to a German sample before the pandemic, which were significantly associated only with the older age of participants and having children in both univariate and multivariate analyses. Regarding mechanisms of resilience, moderation analysis revealed that low individual resilience and high pandemic-related stress burden independently contributed to both anxiety and depression symptoms while resilience additionally moderated the relationship between stress burden and anxiety symptoms. The link between self-reported stress burden and mental health symptoms was also partially mediated by individual resilience. Conclusion: Taken together, the findings based on the present sample during the COVID-19 pandemic suggest that resilience plays a central role in the mental health of healthcare workers and that resilience-building interventions should be expanded, especially with a focus on younger employees.

Anxiety in anesthesia providers during coronavirus disease 19 pandemic: Insights into perception of harm a cross-sectional study

Background

The influence of Coronavirus disease 2019 (COVID-19) pandemic on mental health has been widely studied; however, literature evaluating the mental health effects of the pandemic on small groups of people is scarce. We aim to evaluate the impact of the COVID-19 pandemic on anxiety levels of anesthesiology providers in an academic institution.

Materials and methods

We conducted a cross-sectional study including one hundred and five participants (Faculty anesthesiologists, anesthesia residents, certified registered and student nurse anesthetists). The generalized anxiety disorder questionnaire (GAD-7) was administered to participants.

Results

Approximately half of the 105 participants experienced various degrees of anxiety, with only 14.3% exhibiting moderate to severe symptoms of anxiety. Anxiety interfering with daily activities was reported in 54.9% of the participants. Anxiety-generating factors such as access to protective equipment and transmitting the disease to family members were identified.

Conclusion

The COVID-19 pandemic is associated with different degrees of anxiety. The prevalence of severe anxiety is relatively low, probably due to differential individual perceptions, feelings of invulnerability, and resilience of anesthesia providers.

Psychological Distress and Resilience among Italian Healthcare Workers of Geriatric Services during the COVID-19 Pandemic

The COVID-19 pandemic exposed healthcare workers (HW) to heavy workload and psychological distress. This study was aimed to investigate distress levels among Italian physicians, nurses, rehabilitation professionals and healthcare assistants working in geriatric and long-term care services, and to explore the potential role of resilience as a protective resource. The General Health Questionnaire-12, the Connor-Davidson Resilience Scale, and a demographic survey were completed by 708 Italian HWs. Distress and resilience levels were compared between professionals through ANOVA; the contribution of sex, age, professional role, and resilience to distress was explored through regression analyses. Physicians reported significantly higher resilience and distress levels than rehabilitation professionals and healthcare assistants respectively. Women, HWs aged above 45, physicians, and participants reporting low resilience levels were at higher risk for distress. Findings suggest the importance of supporting HW's resilience to counterbalance the pandemic related distress.

The effect of social support on work stress in health workers during the pandemic: The mediation role of resilience

Stressful experiences commonly increase among health workers during the coronavirus disease 2019 (COVID-19) pandemic. From this perspective, this study primarily aimed to examine the mediating role of resilience in the effect of perceived social support on work stress among health workers. The sample of the study consisted of 402 health workers. In the research, the "General Work Stress Scale," "Brief Resiliency Scale," and "Multidimensional Scale of Perceived Social Support" were used. There was a statistically significant negative correlation between work stress and social support (r = -0.223, p = 0.00) and resilience (r = -0.432, p = 0.00), and a statistically significant positive correlation between social support and resilience (r = 0.226, p = 0.00). Resilience mediates the relationship between perception of social support and work stress. When planning effective intervention strategies, it will be critical to reduce the risk of adverse mental health outcomes in health workers, who are fighting against the COVID-19 pandemic, by increasing social support and resilience and reducing work stress.

Global prevalence of resilience in healthcare professionals: A systematic review, meta-analysis, and meta-regression

AIMS

This review aims to examine the prevalence estimate of low resilience among healthcare professionals and identify the factors affecting the prevalence.

BACKGROUND

Healthcare professionals experience high levels of stress. Understanding the healthcare professionals' resilience may provide an insight into how they perform in a highly stressed environment. Evaluation A comprehensive search of 11 databases was conducted. Studies that provided prevalence rates for low resilience among healthcare professionals working in a healthcare setting were included. Meta-analyses, sensitivity, subgroup analyses and meta-regression were conducted.

KEY ISSUES

Among 27,720 studies, 41 studies (N = 17,073) across 16 countries were included. The prevalence of low resilience was 26% (95% CI: 20-32). Subgroup analyses indicated that types of resilience measures affect resilience prevalence significantly. A higher prevalence of low resilience was observed among allied health professions during the COVID-19 pandemic in the Middle East.

CONCLUSIONS

This review indicated the prevalence of low resilience and type of resilience measurement instruments that affected the prevalence.

IMPLICATIONS FOR NURSING MANAGEMENT

This review provides a roadmap to design tailored, discipline-specific, and sustainable resilience training for nurses. Nursing managers should monitor the working hours and workload of nursing staffing in order to provide a protective working environment.

Medical internship training during the COVID-19 pandemic – A case of ‘sacrificial pawns’ or not?

Background

Newly qualified medical practitioners in South Africa (SA) are part of the frontline health care workers who face Africa’s most severe coronavirus disease 2019 (COVID-19) pandemic. The experiences of interns during the pandemic reflect SA’s preparedness to respond in a crisis and inform strategies that could be adopted to balance training and service in resource-challenged contexts.

Aim

To explore the strengths, weaknesses, opportunities and threats posed during the first wave of the COVID-19 pandemic as reflected on by interns within the clinical training platforms in SA.

Setting

Public hospitals in KwaZulu-Natal.

Methods

An online questionnaire consisting of eight open-ended questions based on the SWOT framework related to personal and professional perspectives to clinical training during the COVID-19 pandemic was developed using SurveyMonkey. All data were collected remotely via social media platforms. Data were thematically analysed.

Results

Forty-six interns reflected on personal and systemic challenges as the major threats and weaknesses in intern training during the COVID-19 pandemic. Extrapolating on strengths and opportunities, there were three overarching learnings interns reflected on. These related to being a medical professional, communities of practice and the development and enhancement of clinical and non-clinical competencies. Existing challenges in the environment exacerbated the threats posed by COVID-19 and innovative strategies related to improving support, feedback, broadening the intern curriculum and online training.

Conclusion

Although the clinical environment where interns learn and work is often stressful and overpowered by high service burdens, there are unique opportunities to enhance self-directed learning and graduate competencies, even in the midst of the COVID-19 pandemic.

The professional resilience of mid-career GPs in the UK: a qualitative study

BACKGROUND

With a continued crisis of increasing workload and reduced workforce in general practice, supporting resilience is a key strategy for sustaining the profession into the future.

AIM

How do GPs perceive professional resilience, and what workplace factors influence it?

DESIGN AND SETTING

A UK-based qualitative study of the perspectives of GPs currently practicing in mainly urban locations across the UK with ≥5 years' experience after completion of GP training.

METHOD

Participants were recruited using convenience sampling, which included social media forums, and underwent semi-structured interviews undertaken in May and June 2020 (n = 27). Data were analysed using thematic analysis.

RESULTS

Participants offered definitions of and influences on resilience that largely fit with existing research, but in addition, may result in the perception that GPs are obstructive, or that resilience may be a 'surface act'. GPs agree that the current focus on methods of improving resilience does support them, but there is significantly more to be done in this field. Social media activity aiming at GP support may be counterproductive. Reduction of clinical working hours is a common strategy to improve resilience.

CONCLUSION

That GPs feel to improve resilience they need to work fewer clinical hours may have huge implications for a workforce already in crisis, and ultimately, for the health care of the UK population. Urgent research is needed to formulate a bespoke assessment for measuring GP resilience to assess potential interventions, and to identify GPs at risk of mental ill-health or leaving the profession.

Let's embed peer-support groups into the medical curriculum for all

Even before the COVID-19 pandemic, attending to the mental wellbeing of all doctors was high on the political agenda. The quality of patient care is also known to be related to doctors' wellbeing. Now, in the midst of a global pandemic, doctors are having to cope with ever more trauma and moral injury. Group-based peer support and regular reflective practice are interventions known to reduce clinician burnout and optimise wellbeing. Junior doctors are the most likely of all medical groups to be at a high risk of burnout. The NHS Staff and Learners' Mental Wellbeing Commission report advocates establishing explicit peer support mechanisms and the use of peer support as part of the first line of psychological first aid. Peer support is not addressed in the curriculum for the majority of medical specialties. We recommend that regular peer-support reflective groups are provided during protected time for all trainees.

The perceptions and experiences of doctors training in intensive care medicine on their personal resilience and strategies practiced to enhance resilience

Background

There is limited understanding of the meaning and conceptualisation of personal resilience in doctors training in intensive care medicine (ICM). This study aims to analyse the perceptions and experiences of doctors training in ICM to conceptualise personal resilience in ICM careers.

Methods

Semi-structured interviews were conducted of doctors training in ICM with a qualitative thematic analysis of their perceptions and experiences of personal resilience.

Results

The five major themes were identified: personal resilience is developed through experiences; resilient attitudes and behaviours are important; maintaining balance and harmony; maintaining cognisance; and understanding the professional environment and system challenges.Two overarching themes became apparent: personal resilience as a continuous process and self-awareness within an environment.

Conclusion

Doctors training in ICM perceive themselves to function at a high level of personal resilience. Personal resilience can be conceptualised as a continuous process, which is developed through experiences. Adaptive strategies such as maintaining balance and harmony, and upholding resilient attitudes and behaviours can be used to maintain an individual resilience equilibrium.

Medical resilience and morality: a survey study on the opinions and actions of exemplary family physicians

Background

Studies conducted to understand how family doctors develop resilience and deal with the challenges posed by work-related stress, usually have focused on identifying the elements that generate resilience from psychological perspectives and their impact on coping strategies. Few have explored the role that personal qualities and values that traditionally motivate family physicians can play as drivers of well-being and resilience.

Objectives

To explore attributes that exemplary family physicians (EFP) consider important for their work and the elements that, for them, are source of gratification and resources in the face of the adversities they encounter in their practice.

Methods

This is an exploratory study carried out by online survey. Eighty six doctors regarded as exemplary by their colleagues answered 7 close and 4 open-ended questions that explored their job satisfaction, the elements of their work that reward them, the difficulties and problems they usually encounter, the resources they use to cope with those problems, and the personal qualities they consider central to their work. Four researchers conducted a thematic (deductive and inductive) analysis of the free text responses received. Based on the results obtained, and through an iterative discussion process, the researchers proposed an integrated set of qualities at the core of their professionalism.

Results

88.4% (76) of the doctors said they were satisfied with their work. However, they face problems (202 comments), including demanding patients, insensitive managers with unshared interests/care goals, excessive paperwork, work overload, or time pressures. Sources of gratification point to personal identity; clinical, relational, and collaborative efficiency; a holistic and comprehensive practice (centred on individuals); and a continuous search for excellence (149) and the root of their resources (135). These elements, in turn, corresponded to the attributes considered essential for the practice of family medicine (131).

Conclusions

For EFPs, certain professional values give meaning to their clinical practice and are a source of well-being and resources. This central focus on professional values and qualities can help for better understand the burnout nature and expand the type of action that promotes resilience. Further studies using a less structured qualitative research will be needed to confirm/expand these results.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01555-0.

Investigating practice-level and individual factors of advanced practice registered nurses and physician assistants and their relationship to resilience

BACKGROUND

Gaps in research persist related to practitioners' resilience, although much has been written about the need for strategies to strengthen personal resilience.

PURPOSE

The study's purpose was to examine practice-level (quality of physician relationship, physician presence, and autonomy) and individual factors and how they affect resilience.

METHODOLOGY

An online survey invited advanced practice registered nurses (APRNs) and physician assistants (PAs) from four states to participate in a cross-sectional study. Hierarchical ordinary least squares regression was used to test the impact of main effect variables in the context of identified control variables.

SAMPLE

A sample of 1,138 APRNs and PAs completed the survey questions.

RESULTS

Findings from the covariate model (model 1) and the main effect model (model 2) show that both models were significant at the p < .01 level, with the adjusted R2 differing from 0.02 to 0.13, respectively. Regression results show a significant positive association between quality of the physician relationship and APRN/PA resilience (b = 0.09, p < .01). A negative association between the lack of autonomy and higher levels of resilience (b = -0.14, p < .01) was also demonstrated.

CONCLUSIONS

Advanced practice registered nurse/PA resilience is affected by both practice-level and personal factors, suggesting that workplace interventions could increase resilience.

IMPLICATIONS FOR PRACTICE

Work environments allowing APRNs and PAs to function autonomously and with professional support from physician colleagues are favorable contributors to their resilience. Future studies need to investigate the meaning of physician presence/availability and organizational interventions that extend beyond individual resilience.

Resilience and mindfulness in nurse training on an undergraduate curriculum

PURPOSE

The aim is to investigate what relationships exist between resilience and mindfulness in undergraduate nurse training and how these might contribute to well-being.

DESIGN AND METHODS

One hundred and six students participated in this cross-sectional study. Multivariate and bivariate procedures were utilized to assess the differences between students' demographics, academic resilience, and mindfulness.

FINDINGS

The findings suggested that acceptance and attention within mindfulness were important for resilience. Students who had higher levels of academic resilience also had higher indexes of mindfulness.

PRACTICE IMPLICATIONS

A key implication is that learning and practice areas should ensure that well-being, mindfulness, and resilience literacy are key issues for students in training. This is at a time when mental health support and staff retention are foremost in policymakers' minds.

Psychosocial Impact and Role of Resilience on Healthcare Workers during COVID-19 Pandemic

Italy was the first European country to be affected by the 2019 coronavirus epidemic (COVID-19). Several studies have shown the risk of developing depression, anxiety, and post-traumatic stress disorder in medical and paramedical staff. Causes included the high contagiousness of the virus, the fear of contracting it, the lack of adequate personal protective equipment, and physical and psychological fatigue. In this context, resilience represents a protective factor against adversity and stress burden. The aim of this research was to investigate if and how the resilience and personality profile is able to influence the response to stress and anxiety on a sample of Italian healthcare workers, during the COVID-19 outbreak. The sample consisted of 152 frontline healthcare workers, physicians, and paramedical professionals. Participants completed the online questionnaire measuring the Resilience Scale for Adults, the Big Five Inventory-10 Item, the State Anxiety Inventory, and the Perceived Stress Scale. Analyses of data aimed to show differences in the stress of healthcare workers due to gender and professional role, and at finding, by means of multidimensional scaling, the relations among anxiety, stress, resilience, and traits of personality. The findings gave some suggestions for implementing strategies useful to increase the resilience in healthcare workers and support them to cope with stressful events, typical of the pandemic emergency.

Sources of work-related psychological distress experienced by UK-wide foundation and junior doctors: a qualitative study

OBJECTIVES

This paper reports findings exploring work cultures, contexts and conditions associated with psychological distress in foundation and junior doctors.

DESIGN

Qualitative study using in-depth interviews with 21 junior doctor participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method.

SETTING

NHS in England.

PARTICIPANTS

A purposive sample of 16 female and five male junior doctor junior doctor participants who self-identified as having stress, distress, anxiety, depression and suicidal thoughts, or having attempted to kill themselves.

RESULTS

Analysis reported four key themes: (1) workload and working conditions; (2) toxic work cultures-including abuse and bullying, sexism and racism, culture of blaming and shaming; (3) lack of support; (4) stigma and a perceived need to appear invulnerable.

CONCLUSION

This study highlights the need for future solutions and interventions targeted at improving work cultures and conditions. There needs to be greater recognition of the components and cumulative effects of potentially toxic workplaces and stressors intrinsic to the work of junior doctors, such as the stress of managing high workloads and lack of access to clinical and emotional support. A cultural shift is needed within medicine to more supportive and compassionate leadership and work environments, and a zero-tolerance approach to bullying, harassment and discrimination.

Protective factors and sources of support in the workplace as experienced by UK foundation and junior doctors: a qualitative study

OBJECTIVES

This paper reports findings identifying foundation and junior doctors' experiences of occupational and psychological protective factors in the workplace and sources of effective support.

DESIGN

Interpretative, inductive, qualitative study involving in-depth interviews with 21 junior doctor participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method.

SETTING

National Health Service in the UK.

PARTICIPANTS

Participants were recruited from junior doctors through social media (eg, the British Medical Association (BMA) junior doctors' Facebook group, Twitter and the mental health research charity websites). A purposive sample of 16 females and 5 males, ethnically diverse, from a range of specialities, across the UK. Junior doctor participants self-identified as having stress, distress, anxiety, depression and suicidal thoughts or having attempted to kill themselves.

RESULTS

Analysis identified three main themes, with corresponding subthemes relating to protective work factors and facilitators of support: (1) support from work colleagues - help with managing workloads and emotional support; (2) supportive leadership strategies, including feeling valued and accepted, trust and communication, supportive learning environments, challenging stigma and normalising vulnerability; and (3) access to professional support - counselling, cognitive-behavioural therapy and medication through general practitioners, specialist support services for doctors and private therapy.

CONCLUSIONS

Findings show that supportive leadership, effective management practices, peer support and access to appropriate professional support can help mitigate the negative impact of working conditions and cultures experienced by junior doctors. Feeling connected, supported and valued by colleagues and consultants acts as an important buffer against emotional distress despite working under challenging working conditions.

Resilience interventions in physicians: A systematic review and meta-analysis

The aim of this review was to evaluate the effectiveness of interventions in promoting resilience among physicians. Previous reviews concerning resilience did not assess effectiveness in a systematic way using meta-analytic methods. PubMed, PsycINFO, and Cochrane Register of Controlled Trials were searched from inception to January 31, 2020. Randomized clinical trials, non-randomized clinical trials, and repeated-measures studies of intervention designs targeting at resilience in physicians were included. Eleven studies were included in the review (n = 580 physicians). Research findings suggest that interventions for resilience in physicians were associated with small but significant benefits. Subgroup analyses suggested small but significantly improved effects for emotional-supportive-coping interventions (Hedges's g = 0.242; 95% CI, 0.082-0.402, p = .003) compared with mindfulness-meditation-relaxation interventions (Hedges's g = 0.208; 95% CI, 0.131-0.285, p = .000). Interventions that were delivered for more than a week indicated higher effect (Hedges's g = 0.262; 95% CI, 0.169-0.355, p = .000) compared with interventions delivered for up to a week (Hedges's g = 0.172; 95% CI, -0.010 to 0.355, p = .064). Results were not influenced by the risk of bias ratings. Findings suggest that physicians can benefit in their personal levels of resilience from attending an intervention specifically designed for that reason for more than a week. Moreover, policy-makers should view current results as a significant source of redesigning healthcare systems and promoting attendance of resilience interventions by physicians. Future research should address the need for more higher-quality studies and improved study designs.

Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review

BACKGROUND

A variety of stressors throughout medical education have contributed to a burnout epidemic at both the undergraduate medical education (UGME) and postgraduate medical education (PGME) levels. In response, UGME and PGME programs have recently begun to explore resilience-based interventions. As these interventions are in their infancy, little is known about their efficacy in promoting trainee resilience. This systematic review aims to synthesize the available research evidence on the efficacy of resilience curricula in UGME and PGME.

METHODS

We performed a comprehensive search of the literature using MEDLINE, EMBASE, PsycINFO, Educational Resources Information Centre (ERIC), and Education Source from their inception to June 2020. Studies reporting the effect of resilience curricula in UGME and PGME settings were included. A qualitative analysis of the available studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the ROBINS-I Tool.

RESULTS

Twenty-one studies met the inclusion criteria. Thirteen were single-arm studies, 6 quasi-experiments, and 2 RCTs. Thirty-eight percent (8/21; n = 598) were implemented in UGME, while 62 % (13/21, n = 778) were in PGME. There was significant heterogeneity in the duration, delivery, and curricular topics and only two studies implemented the same training model. Similarly, there was considerable variation in curricula outcome measures, with the majority reporting modest improvement in resilience, while three studies reported worsening of resilience upon completion of training. Overall assessment of risk of bias was moderate and only few curricula were previously validated by other research groups.

CONCLUSIONS

Findings suggest that resilience curricula may be of benefit to medical trainees. Resilience training is an emerging area of medical education that merits further investigation. Additional research is needed to construct optimal methods to foster resilience in medical education.

Resilience Among Professional Health Workers in Emergency Services

INTRODUCTION

Although it seems logical to assume that working in an emergency service implies having a great capacity to face extreme situations, resilience in health care workers has been shown to be related not only to individual personality characteristics but also with external factors. The objective of this study was to determine the resilience of professional health workers in emergency services and its relationships with sociodemographic and working conditions.

METHODS

This cross-sectional study included emergency physicians, nurses, and nursing assistants. Sociodemographic variables and the Resilience Scale-25 were analyzed.

RESULTS

A total of 320 professionals participated. Their mean age was 43.5 years (SD 8.9), and 81.87% were women. The mean resilience score was 133.52 (SD 7.22), which corresponds to moderately low to moderate levels. An association was found between the highest resilience scores and being a physician (χ² 8.84; P = 0.01) and a higher capacity if working in emergency mobile units (χ² 6.29; P = 0.04). Working the day shift and being a nurse (beta = -5.71; P = 0.02) were associated with lower resilience scores. Age (odds ratio 1.095; P = 0.02; 95% confidence interval 1.015, 1.184), and not having a partner decreased resilience (being divorced odds ratio 5.17; P = 0.01; 95% confidence interval 1.503, 18.235 and being single odds ratio 3.371; P = 0.01; 95% confidence interval 1.259, 9.257). However, more work experience increased the resilience levels (odds ratio 0.906; P = 0.02; 95% confidence interval 0.833, 0.983).

DISCUSSION

Resilience in professional health workers was related to personal and working conditions. The scores of emergency staff were low and should be improved with specific strategies.

Hardiness, Stress and Secondary Trauma in Italian Healthcare and Emergency Workers during the COVID-19 Pandemic

Emergency situations such as the COVID-19 pandemic can lead healthcare and emergency workers to undergo severe stress reactions that increase the risk of developing secondary trauma. Hardiness is a protective factor that reduces the likelihood of negative outcomes such as secondary trauma. In this study, we analyzed the responses to physical, emotional, cognitive, organizational‒relational and COVID-19 stress of 140 healthcare and 96 emergency workers. Decision-making difficulties due to high uncertainty and the fear of contracting the virus and infecting others were also considered. We aimed to detect which stressors caused secondary trauma and to assess the protective power of hardiness. Participants completed the questionnaire online measuring stress, secondary trauma and resilience. We performed a t-test, correlational analysis and hierarchical regression. The healthcare workers had higher levels of stress and arousal than the emergency workers group and those involved in the treatment of COVID-19 were exposed to a large degree of stress and were at high risk of developing secondary trauma. Commitment is associated with high levels of stress, arousal and intrusion, while control shows a protective function. Stress and hardiness result in 37% and 17% of the variance of arousal and intrusion, respectively.

What the COVID-19 pandemic tells us about the need to develop resilience in the nursing workforce

Most research on resilience in healthcare systems such as the NHS is based on organisational crises, such as nurse shortages, an ageing workforce and financial restrictions. However, nursing can learn lessons from the past to consider how to become more resilient, particularly considering the 2020 COVID-19 pandemic. This article briefly looks at previous pandemics and disasters that have affected healthcare systems, as well as the 2020 COVID-19 pandemic, and considers how nurse leaders can support staff and show organisational resilience during such emergencies. The article also discusses how nurse leaders can develop their own resilience.

What are the factors affecting resilience in health professionals? A synthesis of systematic reviews

Introduction: Health professionals often have cumbersome responsibilities, performing their roles in complex environments under stressful circumstances. Resilience has been recognized as an enabler of thriving in such adversity and remains vague in the health profession literature.Aims: This paper aims to provide a synthesis of existing literature reviews of the evidence for resilience in health professionals, thematically integrating factors affecting resilience in health professionals.Methods: Electronic databases were searched systematically using inclusion and exclusion criteria to include literature reviews that explored resilience in health care professionals using purposive sampling of primary research studies.Results: Nine studies were identified. The definition of resilience varied across the studies. Four main themes of factors affecting resilience were found: (1) the influence of individual factors (e.g. individual traits, having a higher purpose, being self-determined), (2) environmental and organizational factors (e.g. workplace culture), (3) approaches that an individual takes when interacting with her/his professional circumstances (e.g. professional shielding and self-reflection), and (4) effective educational interventions (e.g. resilience workshops).Conclusions: Resilience is multidimensional and can be affected by multiple factors. Interventions to improve resilience should consider context and focus on improvement of adaptive abilities of health professionals in adversity. A more uniformed definition and measurement of resilience can further research in this field.

Challenges to well-being for general practice trainee doctors: a qualitative study of their experiences and coping strategies

PURPOSES OF THE STUDY

To identify the challenges to well-being experienced by general practice postgraduate trainees and to explore how the trainees respond to those challenges.

STUDY DESIGN

Qualitative focus group study with doctors in their final year of general practice training (n=16). The participants in the study were recruited from one training scheme in South West England. Data were thematically analysed.

RESULTS

Participants reported challenges to well-being relating to dysfunctional relationships with colleagues and patients, their workload, a perceived lack of support at work and also physical environmental challenges. They identified response strategies focused on cognitive processing, physical self-care, focusing on their professional purpose, building supportive relationships and adapting their working environment where possible. Additionally, there were factors that could support trainee well-being, including personal factors such as adaptability and self-awareness, but also external and organisational factors, such as culture, supportive colleagues and organisational adaptability in relation to workload management. The importance to trainees of the idea of being a 'good doctor' arose repeatedly in the data, as did the importance of the organisational environment. Participants reported finding their training placements in secondary care environments particularly challenging.

CONCLUSION

This research highlights the strategies that general practice trainees use in response to challenges, but also that the responsibility for maintaining well-being cannot be borne by individuals alone. This study identifies that supportive approaches by healthcare organisations and educators are vitally important to general practitioner trainees' well-being.