A systematic review of burnout among doctors in China: a cultural perspective

The mediating effect of resilience on the relationship between alarm fatigue and burnout among critical care nurses

BACKGROUND

Burnout is a common problem in intensive care units and may be related to exposure to high levels of alarms.

OBJECTIVES

The aims of this study were to identify factors influencing burnout among critical care nurses and to examine the role of resilience in mediating the relationship between alarm fatigue and burnout.

METHODS

A cross-sectional correlational design was used with 306 critical care nurses in critical and intensive care units in Ha'il City, Saudi Arabia's public hospitals from June to August 2024. A path analysis was conducted using the AMOS 23.0 software.

RESULTS

Multiple linear regression analysis revealed that being Saudi (p = 0.033), having more years of experience (p = 0.020), and having a higher alarm fatigue score or lower resilience were significant predictors of higher emotional exhaustion. Having more years of experience (p < 0.001), higher alarm fatigue scores (p = 0.001), and lower resilience (p < 0.001) were significant predictors of higher depersonalisation. Alarm fatigue had an indirect impact on emotional exhaustion and depersonalisation (β = 0.12, p < 0.001 and β = 0.09, p < 0.001, respectively). Furthermore, alarm fatigue had a significant positive direct effect on emotional exhaustion and depersonalisation (β = 0.31, p < 0.001 and β = 0.19, p = 0.011, respectively) and a negative direct effect on resilience and personal achievement (β = -0.32, p < 0.001 and β = -0.25, p < 0.001, respectively). In addition, alarm fatigue had a total positive effect on emotional exhaustion and depersonalisation (β = 0.43, p < 0.001 and β = 0.28, p = 0.001, respectively) and a negative effect on personal achievement (β = -0.28, p < 0.001). Resilience had a direct negative effect on emotional exhaustion and depersonalisation (β = -0.37, p < 0.001 and β = -0.28, p < 0.001, respectively).

CONCLUSION

The findings revealed a high prevalence of emotional exhaustion and depersonalisation coupled with low levels of personal accomplishment. Resilience partially mediates the relationship between alarm fatigue, emotional exhaustion, and depersonalisation. Healthcare institutions must initiate proper alarm systems and training programs to help mitigate unnecessary alarms and empower resilience among nurses.

Analysing the effect of social jetlag on burnout among shift nurse using a chained mediation model

The purpose of the present research is to explore the relationship between social jetlag and burnout among Chinese shift nurses. Furthermore, we seek to demonstrate how perceived stress and sleep quality play as chain mediators in this relationship. A cross-sectional study. There are 429 Chinese shift nurses data records included through one-on-one format using the subjects' sociodemographic information, the Munich Chronotype Questionnaire for shift workers (MCTQshift), the Chinese version of the 14-item Perceived Stress Scale (CPSS-14), the Pittsburgh Sleep Quality Index (PSQI), and the Chinese version of Maslach Burnout Inventory-General Survey. The positive correlations are found between social jetlag and burnout among Chinese shift nurses; perceived stress and sleep quality, respectively, play a partial mediating role in this relationship. Furthermore, perceived stress and sleep quality play a chain mediating role between social jetlag and burnout. These findings contribute to understanding the impact mechanism of social jetlag on shift nurses' burnout and provide a theoretical foundation for nurses managers to develop programs designed for reducing the burnout that affects shift nurses.

Health Care Professionals' Engagement With Digital Mental Health Interventions in the United Kingdom and China: Mixed Methods Study on Engagement Factors and Design Implications

Background

Mental health issues like occupational stress and burnout, compounded with the after-effects of COVID-19, have affected health care professionals (HCPs) around the world. Digital mental health interventions (DMHIs) can be accessible and effective in supporting well-being among HCPs. However, low engagement rates of DMHIs are frequently reported, limiting the potential effectiveness. More evidence is needed to reveal the factors that impact HCPs' decision to adopt and engage with DMHIs.

Objective

This study aims to explore HCPs' motivation to engage with DMHIs and identify key factors affecting their engagement. Amongst these, we include cultural factors impacting DMHI perception and engagement among HCPs.

Methods

We used a mixed method approach, with a cross-sectional survey (n=438) and semistructured interviews (n=25) with HCPs from the United Kingdom and China. Participants were recruited from one major public hospital in each country.

Results

Our results demonstrated a generally low engagement rate with DMHIs among HCPs from the 2 countries. Several key factors that affect DMHI engagement were identified, including belonging to underrepresented cultural and ethnic groups, limited mental health knowledge, low perceived need, lack of time, needs for relevance and personal-based support, and cultural elements like self-stigma. The results support recommendations for DMHIs for HCPs.

Conclusions

Although DMHIs can be an ideal alternative mental health support for HCPs, engagement rates among HCPs in China and the United Kingdom are still low due to multiple factors and barriers. More research is needed to develop and evaluate tailored DMHIs with unique designs and content that HCPs can engage from various cultural backgrounds.

Perceived doctor-patient relationship, authentic leadership and organizational climate on physician burnout: job satisfaction as a mediator

BACKGROUND

This study aims to investigate the direct associations among perceived doctor-patient relationship, authentic leadership, organizational climate, and job burnout, as well as the indirect pathways through job satisfaction, with the aim of offering potential preventive strategies at the organizational level.

METHODS

A total of 399 physicians from six tertiary hospitals in Anhui Province were enrolled by purposive sampling method. Structural equation modeling was performed to examine the proposed model.

RESULTS

The average score of the participants' job burnout was 35.22 (SD: 12.14), and the burnout rate was found to be 55.7%. Perceived doctor-patient relationship, organizational climate directly influenced job burnout. Perceived doctor-patient relationship, authentic leadership and organizational climate also indirectly influenced burnout through job satisfaction.

CONCLUSIONS

The present study underscores the significant influence of the perceived doctor-patient relationship, authentic leadership and organizational climate in mitigating burnout, and further reveals that job satisfaction serves to alleviate burnout. It is crucial to emphasize the importance of both internal and external psychosocial and organizational environmental factors. Additionally, the study highlights the pivotal role of job satisfaction in influencing physician burnout.

Job Satisfaction Among Faculty in Standardized Residency Training Programs in Heilongjiang Province, China: A Cross-Sectional Study

Purpose

Job satisfaction among faculty in standardized residency training programs has been underexplored. The objective of this study is to investigate job satisfaction among these faculty members and identify associated determinants.

Methods

An online cross-sectional survey was conducted with 4581 teachers in Heilongjiang Province from 18 to 30 May 2022, using a census method. The survey collected demographic information and assessed satisfaction using the Minnesota Satisfaction Questionnaire-Short Form. Predictors of job satisfaction were identified using multiple linear regression analysis in SPSS 24.0.

Results

The survey achieved a 91.12% response rate (4174/4581). The average satisfaction score of the respondents teachers was 4.30±0.70. The top three items with the highest satisfaction scores were "the chance to work alone on the job" (4.46±0.68), "the way my job provides for steady employment" (4.45±0.68), and "the freedom to use my own judgment" (4.43±0.69). The lowest-scoring items "the chances for advancement on this job" (4.02±1.03), "my pay and the amount of work I do" (4.08±0.96), and "the praise I get for doing a good job" (4.10±0.93). Multiple linear regression analysis revealed that geographical area, registered general subjects, age, administrative position, monthly income, daily working hours, and overtime frequency were significant factors influencing job satisfaction (P < 0.05).

Conclusion

The level of job satisfaction among standardized residency training faculty in Heilongjiang Province was generally high. High satisfaction was associated with residing in economically developed areas, having registered general subjects, holding administrative positions, earning high income, working shorter few hours daily and having a low frequency of overtime.

Empathy fatigue among physicians and its influencing factors: a cross-sectional survey from Southwest China

BACKGROUND

Empathy fatigue refers to the excessive empathy required of medical staff in the process of helping patients, which can produce traumatic experiences and emotional exhaustion. Severe empathy fatigue can even lead to medical disputes and errors, exacerbating increasingly tense doctor-patient relationships. Most studies on empathy fatigue focus on nurses, with few studies on physicians.

METHODS

A cross-sectional questionnaire was used to assess empathy fatigue among physicians in public tertiary general hospitals in southwest China using convenience sampling.

RESULTS

A total of 562 physicians participated in the survey; average empathy satisfaction scores were 32.1 ± 6.85, 28.2 ± 5.30, and 26.2 ± 6.04 for empathy satisfaction disorder, job burnout, and secondary traumatic stress domains, respectively. We identified 291 (51.8%) physicians with severe empathy fatigue. Working two or three night shifts per week was associated with severe empathy fatigue. In total, 424 (75.4%) physicians had thoughts of resigning. Weekly rest time, empathic satisfaction disorder, job burnout, and secondary traumatic stress disorder influenced thoughts of resigning.

CONCLUSIONS

The majority of hospital physicians experience empathy fatigue and have considered resigning; this study provides reference data that demonstrate the extent of this issue. Efforts are urgently needed to address empathy fatigue in physicians and, therefore, increase physician retention.

The effect of work-family conflict on employee well-being among physicians: the mediating role of job satisfaction and work engagement

BACKGROUND

Work-family conflict among physicians has many adverse consequences, like reduced work engagement and impaired well-being. However, relatively little research has been conducted on the impact of work-family conflict on specific pathways of physician well-being. The aim of this study was to determine the relationship between work-family conflict and employee well-being among physicians and to explore the mediating role of job satisfaction and work engagement in this relationship.

METHODS

Using data from a cross-sectional survey of 2,480 physicians in Jilin Province, China, partial least squares structural equation modeling (PLS-SEM) was applied in this study to examine the direct and indirect effects of work-family conflict on employee well-being and to assess the mediating roles of job satisfaction and work engagement therein.

RESULTS

The employee well-being score of physicians in Jilin Province was 5.16 ± 1.20. The univariate analysis results indicated significant disparities in employee well-being scores across different age groups, marital statuses, and professional titles. Work-family conflict was significantly negatively associated with employee well-being, while job satisfaction and work engagement were significantly positively associated with employee well-being. In addition, job satisfaction and work engagement were found to mediate the association between work-family conflict and employee well-being, and work engagement was considered to mediate the association between job satisfaction and employee well-being.

CONCLUSIONS

Our study confirms that work-family conflict negatively affects physicians' employee well-being. Moreover, our investigation revealed that the association between work-family conflict and employee well-being is influenced by both job satisfaction and work engagement and that work engagement plays a mediating role in the link between job satisfaction and employee well-being. Therefore, we propose that hospital administrators should rationally allocate organizational resources and develop manageable schedules to enhance physicians' employee well-being.

The Prevalence and Predictors of Burnout Among Resident Doctors in Enugu State, South East Nigeria: A Mixed Method Study

BACKGROUND

Burnout in the health care industry is a potential hazard that has reached epidemic proportions mostly among doctors in practice and training. Burnout has enormous consequences on doctors, patients, and health care institutions.

AIM

This study aimed to determine the prevalence and predictors of burnout among resident doctors in Enugu State, Nigeria.

METHODS

This was a mixed-method study of 420 resident doctors in tertiary hospitals in Enugu State, Nigeria. Data were collected using Oldenburg Burnout Inventory and in-depth interviews of chief resident doctors of selected departments. Data were analyzed using IBM statistical package 23.0 and Nvivo 11. Test of significance was set at 0.05.

RESULTS

The mean age of participants was 34.11 ± 5.08 years. The prevalence of burnout groups among resident doctors was 84.3% in the burnout group, 4.8% in the disengagement group, 6.9% in the exhaustion group, and 4.0% in the non-burnout group. Gender (OR = 1.861, C.I = 1.079-3.212), duration of training (OR = 1.740, C.I = 1.008-3.005), and working hours (OR = 2.982, C.I = 1.621-5.487) were the predictors of burnout; only working hours (OR = 0.279, C.I = 0.091-0.0862) was the predictor of disengagement; and gender (OR = 0.248, C.I = 0.107-0.579) was the predictor of exhaustion. Heavy workloads, long working hours, migration, poor working environment, job insecurity, poor remuneration, and management style were identified factors of burnout.

CONCLUSION

There was high prevalence of burnout among resident doctors, predicted by gender, duration of training, and working hours. Interventions are needed to reduce burnout, prevent the "brain drain", and improve resident doctors' overall well-being.

Associations of clinical context-specific ambiguity tolerance with burnout and work engagement among Japanese physicians: a nationwide cross-sectional study

PURPOSE

Ambiguity tolerance specific to the clinical context - in contrast to ambiguity tolerance as a personality trait - may vary with experience and has received considerable attention. Although this tolerance appears to be related to burnout and work engagement, few studies have examined this association among physicians. Thus, we aimed to examine the relationships between clinical context-specific ambiguity tolerance, burnout, and work engagement among physicians in Japan.

METHODS

We conducted a nationwide cross-sectional study in Japan. We invited family physicians from 14 family medicine residency programs and physicians with specialties other than family medicine from monitors of an Internet survey company to participate in the study. We measured ambiguity tolerance in the clinical context using the Japanese version of the Tolerance of Ambiguity in Medical Students and Doctors (J-TAMSAD) scale, burnout using the Japanese version of the Burnout Assessment Scale (BAT-J), and work engagement using the Utrecht Work Engagement Scale (UWES). We performed a multivariable linear regression analysis to determine whether the J-TAMSAD scale score was associated with the BAT-J and UWES scores.

RESULTS

383 respondents were included in the analysis. After adjustment for possible confounders, clinical context-specific ambiguity tolerance showed a dose-dependent negative association with burnout (adjusted mean difference  -0.39, 95% confidence interval (CI) -0.56 to -0.22 for the highest J-TAMSAD score quartile compared with the lowest). Ambiguity tolerance in the clinical context also showed a dose-dependent positive association with work engagement (adjusted mean difference 0.83, 95% CI 0.49 to 1.16 for the highest J-TAMSAD score quartile compared with the lowest).

CONCLUSIONS

Our study showed that tolerance for ambiguity in the clinical context was negatively associated with burnout, and positively associated with work engagement. These findings will be useful in developing interventions aimed at preventing burnout and promoting work engagement among physicians.

Cross-sectional study of the association between burnout and work overload and work-life imbalance among medical personnel in Liaoning, China: role of specialty

OBJECTIVES

Burnout is common among medical personnel in China and may be related to excessive and persistent work-related stressors by different specialties. The aims of this study were to assess the prevalence of burnout, work overload and work-life imbalance according to different specialties and to explore the effect of specialty, work overload and work-life imbalance on burnout among medical personnel.

DESIGN

A cross-sectional study.

SETTING

This study was conducted in 1 tertiary general public hospital, 2 secondary general hospitals and 10 community health service stations in Liaoning, China.

PARTICIPANTS

A total of 3299 medical personnel participated in the study.

METHODS

We used the 15-item Chinese version of the Maslach Burnout Inventory General Survey (MBI-GS) to measure burnout. Multivariable logistic regression models were used to explore the association between medical specialty, work overload, work-life imbalance and burnout.

RESULTS

3299 medical personnel were included in this study. The prevalence of burnout, severe burnout, work overload and work-life imbalance were 88.7%, 13.6%, 23.4% and 23.2%, respectively. Compared with medical personnel in internal medicine, working in obstetrics and gynaecology (OR=0.61, 95% CI 0.38, 0.99) and management (OR=0.45, 95% CI 0.28, 0.72) was significantly associated with burnout, and working in ICU （Intensive Care Unit）(OR=2.48, 95% CI 1.07, 5.73), surgery (OR=1.66, 95% CI 1.18, 2.35) and paediatrics (OR=0.24, 95% CI 0.07, 0.81) was significantly associated with severe burnout. Work overload and work-life imbalance were associated with higher ORs for burnout (OR=1.64, 95% CI 1.16, 2.32; OR=2.79, 95% CI 1.84, 4.24) and severe burnout (OR=4.33, 95% CI 3.43, 5.46; OR=3.35, 95% CI 2.64, 4.24).

CONCLUSIONS

Burnout, work overload and work-life imbalance were prevalent among Chinese medical personnel but varied considerably by clinical specialty. Burnout may be reduced by decreasing work overload and promoting work-life balance across different specialties.

The effectiveness of e-mental health interventions on stress, anxiety, and depression among healthcare professionals: a systematic review and meta-analysis

BACKGROUND

Many healthcare professionals are experiencing psychological distress. Electronic mental health (e-mental health) interventions are convenient and multifunctional. This review aimed to examine the effectiveness of e-mental health interventions in enhancing the well-being of healthcare professionals and to identify moderating factors.

METHODS

A comprehensive and systematic retrieval of randomized controlled trial (RCT) studies was conducted across eight databases. Population, intervention, comparison, and outcome (PICO) were used to define eligibility criteria. Stress, anxiety, and depression were included as the main outcomes. The overall effect was calculated based on the random effect model, and the effect size was presented using the standardized mean difference. The characteristics of the research design, intervention object, and intervention design were further selected as potential moderating factors for subgroup analysis. Meta-regression analyses were finally performed, incorporating intervention duration and sample size as independent variables.

RESULTS

A total of 20 studies were included in the systematic review, and 17 were included in the meta-analysis. A large effect on relieving stress and anxiety and a small-to-medium effect on reducing depression were observed. Subgroup analyses showed that features including mindfulness approaches, online courses, computer use, group interventions, and professional guidance were more favorable in the design of services. Meta-regression revealed that intervention duration only affected anxiety symptoms. Caution should be exercised, as some subgroups had fewer studies and higher heterogeneity. For the secondary outcomes, a large effect on emotional exhaustion and a small-to-medium effect on well-being were observed.

CONCLUSION

In general, e-mental health interventions significantly improve the psychological health of healthcare staff. Future high-quality, large-scale studies targeting healthcare professionals and specific intervention scenarios are warranted.

Job burnout among primary healthcare workers during COVID-19 pandemic: cross-sectional study in China

Objective

This study evaluated job burnout among primary healthcare workers (PHCWs) in China during the COVID-19 pandemic, explored its influencing factors, and examined PHCWs' preferences for reducing job burnout.

Method

We conducted a multicenter cross-sectional study in Heilongjiang, Sichuan, Anhui, Gansu, and Shandong Provinces. An electronic questionnaire survey was conducted through convenience sampling in communities from May to July 2022. We collected sociodemographic characteristics, job burnout level, job satisfaction, and preferred ways to reduce job burnout among PHCWs.

Results

The job burnout rate among PHCWs in China was 59.87% (937/1565). Scores for each dimension of job burnout were lower among PHCWs who had a better work environment (emotional exhaustion OR: 0.60; depersonalization OR: 0.73; personal accomplishment OR: 0.76) and higher professional pride (emotional exhaustion OR: 0.63; depersonalization OR: 0.70; personal accomplishment OR: 0.44). PHCWs with higher work intensity (emotional exhaustion OR: 2.37; depersonalization OR: 1.34; personal accomplishment OR: 1.19) had higher scores in all job burnout dimensions. Improving work environments and raising salaries were the preferred ways for PHCWs to reduce job burnout.

Conclusion

Strategies should be developed to improve job satisfaction among PHCWs, enhance their professional identity, and alleviate burnout to ensure the effective operation of the healthcare system, especially during periods of overwork.

Examining Medical Staff Well-Being through the Application and Extension of the Job Demands-Resources Model: A Cross-Sectional Study

For medical staff, job satisfaction is essential for advancement on an individual and organizational level. This study looked into the relationships between challenging job demands, job resources, personal resources, and well-being. Additionally, it examined the potential mediating effects of emotional exhaustion and work motivation within the framework of the job demands-resources (JD-R) model. Results from a cross-sectional study of 267 medical employees at a second-grade comprehensive hospital in Jiangsu, China's mainland, indicated that challenging job demands and job satisfaction were positively correlated and mediated via (decreasing) emotional exhaustion. The relationship between job resources and job satisfaction was found to be mediated via (decreasing) emotional exhaustion and (increasing) work motivation. The investigation also demonstrated that the two regulatory focuses serve different purposes. It was discovered that promotion focus had a favorable effect on work motivation but a negative effect on emotional exhaustion. Conversely, preventive focus only positively predicted emotional exhaustion. Thus, the JD-R model offers a valuable structure for clarifying the job satisfaction of health personnel. The implications for enhancing individual and job outcomes are discussed.

Burnout and Intention to Change Profession among Romanian Dentists during COVID-19: A Cross Sectional Study Using the Maslach Burnout Inventory

This study aims to examine the relationship between burnout and dentists' intentions to change careers during the COVID-19 pandemic. The MBI-Human Services Survey for Medical Personnel-MBI-HSS (MP) was used to measure burnout levels and investigate how they relate to dentists' intentions to change their profession. The sample included 69 Romanian dentists, 56 of whom were women and 13 of whom were men. Self-reported questionnaires provided to the participants were used to collect the data. Female participants reported higher levels of emotional Exhaustion and Depersonalisation than males. However, there were no substantial differences in Personal Accomplishment levels between genders. As for the intentions to change careers, 41 expressed a clear intention to change their profession, 15 were still determining if they would choose the same speciality, and 28 indicated they would not choose the medical field. The study's findings provide insight into how dentists' thoughts about perceived burnout during the COVID-19 pandemic significantly influenced their attitudes regarding their career paths. The results suggest concerns regarding burnout in the dental field and emphasise the necessity for burnout interventions and support services, particularly during healthcare crises. Further research and interventions to mitigate burnout and promote well-being among dentists are needed to ensure the sustainability and quality of dental healthcare services in Romania.

Job burnout on subjective wellbeing among clinicians in China: the mediating role of mental health

Background

Although job burnout and mental health difficulties are prevalent negative influences on clinicians' subjective wellbeing (SWB), there are few investigations into their relationships. This research investigates the mediating role of mental illness in the association between clinicians' SWB and job burnout in China.

Methods

This study used the data collected from a cross-sectional survey conducted in China. Using convenience sampling, we conducted a face-to-face questionnaire survey among clinicians in a tertiary hospital in Shandong Province from August to September 2019. The 22-item Maslach Burnout Inventory-Human Service Survey (Chinese version) and the Personal Wellbeing Index-Adult assessed job burnout and SWB. The Chinese short version of Depression, Anxiety and Stress Scale (DASS-C21) assessed mental health. We also collected data on participants' sociodemographic characteristics and job-related factors. Structural equation modeling (SEM) was applied to examine the associations between variables.

Results

Among the 422 participants, 80.8% of the participants reported at least one symptom of job burnout, whereas 5.7% reported all three symptoms of burnout. The prevalence rates of depression, anxiety, and stress were 40.3, 41.7, and 24.9%, respectively. Only 12.8% of the participants had high level of SWB. In mediation analysis, job burnout is positively associated with mental illness (β = 0.809, P < 0.001), mental illness had a significant negative association with SWB (β = -0.236, P = 0.013), and a negative association between job burnout and SWB was significant (β = -0.377, P = 0.002). Mental illness played a partially mediated role in the association between job burnout and SWB (indirect effect = -0.191, 95% CI: -0.361∼-0.017), and the mediating effect of mental illness can explain the 33.6% of the total effect of job burnout on SWB.

Conclusion

This study provides evidence that the effect of job burnout on SWB is partially mediated by mental illness among clinicians in China. Medical administration departments and hospital administrators should pay close attention to the job burnout and mental health of clinicians, so as to effectively improve the SWB of clinicians.

Technostress as source of physician burnout: An exploration of the associations between technology usage and physician burnout

BACKGROUND

The cause of physician burnout is multifactorial. Health care systems pressures, excessive workloads, fatigue, poor self-care, administrative burdens, work hours, technological advancements, and work-home life conflicts, are all prominent themes throughout the literature. To date, little is known about whether, and to what extent, stressors related to the use of information and communication technology (ICT) use, other than electronic health records, outside of working hours, contribute to physician burnout.

PURPOSE

The purpose of this study was to explore whether work related ICT use outside of working hours is associated with physician burnout.

METHOD

A cross-sectional survey delivered online using The Maslach Burnout Inventory (MBI), a Physician Technology Usage Scale (PTUS) (and 7 personal characteristics questions. Data were analyzed using bivariate correlations, analysis of variance (ANOVA) and t-tests, and multiple linear regression.

RESULTS

Of 2,108 participants invited to complete the survey, 403 responded to and completed the survey (19% response rate). Results identified two significant factors associated with physician burnout: work related technology use outside of working hours, and the number of years in practice.

CONCLUSION

This research highlights the need for additional in-depth research into areas such as: 1. work-home life issues and how the use of technology outside of work hours may affect or be affected by burnout; 2. physician age and experience and burnout; 3. The differences between specialties and whether and how specialty-specific factors are related to burnout.

Association of Job Characteristics and Burnout of Healthcare Workers in Different Positions in Rural China: A Cross-Sectional Study

Objectives: Health workers in rural primary care systems are at increased risk of job burnout, but their associations with different positions have received scant attention in the literature. Thus, this study aims to measure job burnout in different positions in rural China and to identify factors associated with it. Methods: A cross-sectional survey was conducted with a total of 15,627 participants from six provinces in China. And job burnout was measured using the Chinese version of the Maslach Burnout Inventory-General Scale (MBI-GS). Multilevel regression analyses were used in examining factors potentially associated with job burnout in different positions. Results: Overall, more than half of providers suffered from moderate burnout. The degree of job burnout varied among different positions. Middle managers showed higher levels personal stress, while general staff showed the lowest interpersonal and self-evaluation dimensions of burnout. Job duty, job capability, job treatment, and career advancement are potential factors affecting these results. Conclusion: Interventions aimed at providing appropriate training and development opportunities, developing relevant career planning and management strategies, and implementing reasonable staffing and job design may be promising strategies for alleviating burnout in different positions and improving health system performance.

Factors underlying burnout among rural village physicians in Southwestern China

Background

Primary healthcare doctors in China often experience problems with occupational burnout, a condition known to relate to high job stress and low wages. In China, many medical alliances have recently been established in rural areas, where village physicians work as healthcare gatekeepers. However, burnout in village physicians in the context of medical alliances remains underresearched.

Methods

This cross-sectional survey was conducted among 100 village physicians practicing at village clinics in Qiandongnan prefecture, Guizhou province, China. An online questionnaire was distributed to assess physicians' demographic characteristics and work situations. Burnout was measured using the Oldenburg Burnout Inventory (validated Chinese version). A multivariate linear model with stepwise procedure was used to estimate the effects of factors of interest on burnout, focusing particularly on actions within the medical alliance that involved respondents' clinics, such as training and support for village physicians provided by higher-level facilities.

Results

The overall response rate was 79%. The mean burnout score was 38.09 (standard deviation, 4.55; range, 25-47). The multivariate analysis showed that fewer working years and too much farming work were significantly related to exacerbation of burnout. Greater medical services in the total workload and greater support from higher-level facilities were associated with burnout alleviation.

Conclusion

Close connections and interactions across medical alliance member facilities could facilitate reduction in burnout for village physicians practicing as primary care gatekeepers.

Measuring and improving performance of clinicians: an application of patient-based records

BACKGOUND

Efforts to measure performance and identify its driving factors among clinicians are needed for building a high-quality clinician workforce. The availability of data is the most challenging thing. This paper presented a summary performance measure for clinicians and its application on examining factors that influence performance using routine patient-based records.

METHODS

Perfomance indicators and difficulty score were extracted from electronic medical records (EMRs). Difficulty adjustment and standardized processing were used to obtain indicators which were comparable between specialties. Principal component analysis (PCA) was used to estimate the summary performance measure. The performance measure was then used to examine the influence of person-job fit and burnout through a mediator effect model and cluster analysis.

RESULTS

A valid sample of 404 clinicians were included in this study, and 244 of them had valid response in the questionnaire. PCA explained 79.37% of the total variance presented by the four adjusted performance indicators. Non-performance attributes and performance driving factors help distinguish different clusters of clinicians. Burnout mediates the relationship between person-job fit and performance in a specific group of clinicians (β = 0.120, p = 0.008).

CONCLUSIONS

We demonstrated the analytical steps to estimate clinicians' performance and its practical application using EMRs. Our findings provide insight into personnel classified management. Such practice can be applied in countries where electronic medical record systems are relatively less developed to continuously improve the application of performance management.

The prevalence of professional burnout among dentists: a systematic review and meta-analysis

Professional burnout refers to mental weariness caused by occupational stress. However, there is a lack of systematic studies on the prevalence of professional burnout among dentists. The purpose of this study was to investigate the prevalence of professional burnout among dentists. Databases including PubMed, PsycINFO, Embase, Cochrane, and Web of Science were systematically searched from inception to 28 October 2021. The random-effects model and forest plots were used to assess the pooled prevalence of professional burnout among dentists. A total of 15 studies with a total of 6038 study subjects were included in the meta-analysis, and the overall professional burnout among dentists was 13% (95%CI: 6-23). Subgroup analysis suggested a high prevalence of burnout in Europe, and the least in the Americas. The pooled burnout prevalence in cross-sectional surveys was significantly lower than that in longitudinal studies. In addition, the overall burnout prevalence in the last decade was significantly lower than that of a decade ago. This meta-analysis demonstrated that the prevalence of burnout was relatively low among dentists, and there was a downward trend. Therefore, it is important to continue to pay close attention to the mental health of dentists and effectively prevent and treat professional burnout to better maintain the provision of health care services.

Are doctors feeling burnout? - Multicenter cross-sectional study on burnout syndrome and its determinants during the ongoing pandemic

Background

Though the concept of burnout has been around for long, its significance is increasing nowadays owing to the demanding nature of jobs. The latest ICD-11 also provides a detailed description of Burnout syndrome. Physicians are at high risk for experiencing burnout and this becomes especially relevant in the ongoing COVID-19 pandemic.

Aim

To determine the risk of burnout among medical faculty and its predictors, if any.

Materials and Methods

This was a multicentric cross-sectional study that included medical faculty from four tertiary care government teaching hospitals in north India. A survey was conducted during the current COVID-19 pandemic to assess burnout using a structured online questionnaire based on Burnout Assessment Tool. The questionnaire also included relevant socio-demographic, professional, health, and lifestyle-related details. Descriptive statistics, Mann-Whitney U Test/Kruskal Wallis Test, and Kendall's tau-b Test were used for statistical analysis.

Results

A total of 244 medical faculty completed the survey. 27.87% were at risk of burnout, out of which 11.89% were at a very high risk of burnout. Dissatisfaction with the job and dissatisfaction with sleep (P < 0.01 for both) were associated with greater burnout scores and a greater risk of burnout.

Conclusion

Faculty members are at high risk of burnout, regardless of sociodemographic and work-related factors.

Factors affecting physicians' attitudes towards patient-centred care: a cross-sectional survey in Beijing

OBJECTIVES

Patient-centred care has been raised as an important component in providing high-quality healthcare services. This research aims to measure physicians' attitudes towards patient-centred care in Chinese healthcare settings and to identify the sociodemographic predictors of their attitudes using an exploratory research design.

DESIGN

A cross-sectional survey.

SETTING

Twelve hospitals in Beijing, China.

PARTICIPANTS

1290 physicians from 12 hospitals in Beijing were invited to take part in the survey using snowball sampling methods. There was a response rate of 84% (n=1084), of which 1053 responses (82%) were valid and included in this research.

METHODS

This research used a survey containing a previously validated 6-point Likert scale called 'Chinese-revised Patient-Practitioner Orientation Scale' (CR-PPOS). Descriptive statistics and multivariable logistic regression analyses were performed to measure participants' attitudes and to identify the sociodemographic predictors of Chinese physicians' attitudes towards patient-centred care.

RESULTS

Gender, professional title (ie, seniority) and hospital type influence Chinese physicians' attitudes towards patient-centred care. Female physicians, physicians with intermediate titles and those who work in tertiary (ie, top-level) hospitals tend to have higher patient-centred attitudes (OR=1.532, 95% CI 1.160 to 2.022; OR=2.089, 95% CI 1.206 to 3.618; OR=2.198, 95% CI 1.465 to 3.297) than male physicians with other titles, and than those who work in first, secondary or private hospitals. Physicians working in non-surgical departments, those who have received training in doctor-patient communication, and those who are satisfied with their income obtained high patient-centred scores, both on the overall CR-PPOS and its two subscales.

CONCLUSIONS

This research identified sociodemographic predictors of Chinese physicians' attitudes towards patient-centred care. The findings contribute to knowledge of factors to be considered in reforming medical education and the Chinese healthcare system to improve physician-patient relationships and provide high-quality healthcare to patients. However, these findings are exploratory in nature and require further investigation to establish their validity and generalisability.

Burnout in South Asian rheumatologists in the COVID-19 pandemic: an online survey

Physician burnout is recognized as a global crisis and an epidemic. However, burnout in rheumatology is an understudied phenomenon. We explored the prevalence of physician burnout among rheumatologists from South Asia in the peri-pandemic period (2021-2022). Rheumatologists from Asian countries were invited to participate in an anonymized, validated, and pilot-tested e-survey via social media platforms from December 2021 to April 2022. Demographic information, social aspects (marital status, income, vacation time, daily exercise), substance abuse, EHR (electronic health record) use, and years in practice were obtained. In addition, burnout was estimated using Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS) in three domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), and intergroup comparisons were made using independent t test and one-way ANOVA using SPSS v27. Of 146 respondents who participated in the survey, 134 belonged to Asian nations. The highest number of respondents was from Pakistan (56/134, 38.36%), followed by India (49/134, 33.56%). Slightly more respondents were male, 75 (51.4%), than females, 71 (48.6%). Over two-thirds of our respondents (99/134, 67.8%) reported burnout in at least one domain. Notably, we found statistically significant increased depersonalization scores in males. (P < 0.05). Females scored significantly higher on the following items: #5 (I feel I treat some patients as if they were impersonal objects), item# 10 (I've become more insensitive toward people since I took this job and item#22 (I feel patients blame me for some of their problems) (P < 0.05). We found differences in monthly salaries among South Asian (1484 ± 2717 USD) and non-South Asian respondents (5672 ± 8874 USD) (P < 0.01). A substantial proportion of rheumatologists in our survey report burnout, suggesting a felt need to introduce organizational measures to prevent and mitigate burnout and preserve the rheumatology workforce.

Determinants Influencing the Adoption of Internet Health Care Technology Among Chinese Health Care Professionals: Extension of the Value-Based Adoption Model With Burnout Theory

BACKGROUND

The global COVID-19 pandemic has been widely regarded as a catalyst for adopting internet health care technology (IHT) in China. IHT consists of new health care technologies that are shaping health services and medical consultations. Health care professionals play a substantial role in the adoption of any IHT, but the consequences of doing so can often be challenging, particularly when employee burnout is prevalent. Few studies have explored whether employee burnout influences the adoption intention of IHT in health care professionals.

OBJECTIVE

This study aims to explain the determinants influencing the adoption of IHT from the perspective of health care professionals. To do so, the study extends the value-based adoption model (VAM) with consideration for employee burnout as a determining factor.

METHODS

A cross-sectional web-based survey using a sample of 12,031 health care professionals selected through multistage cluster sampling from 3 provinces in mainland China was conducted. The hypotheses of our research model were developed based on the VAM and employee burnout theory. Structural equation modeling was then used to test the research hypotheses.

RESULTS

The results indicate that perceived usefulness, perceived enjoyment, and perceived complexity positively correlate with perceived value (β=.131, P=.01; β=.638, P<.001; β=.198, P<.001, respectively). Perceived value had a positive direct effect on adoption intention (β=.725, P<.001), perceived risk negatively correlated with perceived value (β=-.083, P<.001), and perceived value negatively correlated with employee burnout (β=-.308, P<.001). In addition, employee burnout was negatively related to adoption intention (β=-.170, P<.001) and mediated the relationship between perceived value and adoption intention (β=.052, P<.001).

CONCLUSIONS

Perceived value, perceived enjoyment, and employee burnout were the most important determinants of IHT adoption intention by health care professionals. In addition, while employee burnout was negatively related to adoption intention, perceived value inhibited employee burnout. Therefore, this study finds that it is necessary to develop strategies to improve the perceived value and reduce employee burnout, which will benefit the promotion of the adoption intention of IHT in health care professionals. This study supports the use of the VAM and employee burnout in explaining health care professionals' adoption intention regarding IHT.

Impact of work-family support on job burnout among primary health workers and the mediating role of career identity: A cross-sectional study

Objective

In China, medical workers in the primary sector shoulder the task of providing people with the basic medical and public health services, and are the "gatekeepers" of the public health. This study aims to analyze the current situation of job burnout among primary health workers of China, and shed light on the effect of work-family support and career identity on job burnout among them and their relationships. This may provide a new perspective for primary health care institutions and health administrative departments so as to formulate policies to "attract, retain and stabilize" primary health workers.

Methods

A multi-stage sampling method was adopted to select 8,135 primary health workers from 320 primary health care institutions in a province of central China. A descriptive statistical analysis, univariate analysis, Pearson correlation analysis, and mediation effect analysis were applied to analyze the effects of work-family support and career identity on job burnout among primary health workers as well as the mediating role of career identity.

Results

Among 8,135 primary health workers, 4,911 (60.4%) participants had mild to moderate levels of job burnout, 181 (2.2%) participants had severe job burnout, and the burnout detection rate is 62.6%. Work-family support was negatively correlated with job burnout (r = -0.46, p < 0.01) and positively correlated with career identity (r = 0.42, p < 0.01). Work-family support (β = -0.346, p < 0.01) and career identity (β = -0.574, p < 0.01) were negative predictors of job burnout respectively. In addition, career identity had a mediating effect between work-family support and job burnout, with the mediating effect contributing 33.7% to the overall effect.

Conclusions

The findings of this study demonstrate that work-family support is a protective factor against job burnout in primary health workers and reveal that career identity is a critical mediating mechanism linking work-family support to burnout. We propose to reduce job burnout by strengthening work-family support (especially work support), enhancing career identity, increasing the number of primary health workers and reducing the workload of existing incumbents, which can provide important practical implications for the future prevention and intervention programs.

Job security among healthcare workers in Guangdong, China

Objective

The objective of this study was to explore the sense of job security and its influencing factors among healthcare workers in Guangdong, China.

Methods

This cross-sectional study used stratified random sampling to enroll healthcare workers employed by hospitals across Guangdong province between September 2020 and October 2020.

Results

A total of 4,173 questionnaires were distributed, and 4,076 were returned for an effective recovery rate of 97.68%. The overall score for the sense of security was 64.85 ± 20.09, and the item means score was 2.95 ± 0.91. Multiple-linear regression analysis showed that work experience (years), education level, job position, specialty unit, employment type, marital status, job satisfaction, WPV frequency, daily sleep duration, weekly overtime hours, average monthly earnings (RMB), hospital level, and region were significantly associated with senses of poor security among healthcare workers (all P < 0.05).

Conclusions

Hospital workers in Guangdong reported relatively low levels of job security. Levels of job security were significantly associated with multiple factors which could be addressed by hospital practices to improve the sense of job security among healthcare workers.

Translation and validation of the techno-stress questionnaire in Brazil

OBJECTIVE

The aim of this study was to translate the techno-stress questionnaire proposed by Ragu Nathan et al into Brazilian Portuguese and to culturally adapt and validate it. For this, 4 of the 11 original questionnaires' domains were used.

METHODS

The questionnaires' domains translated and adapted were as follows: techno-overload, techno-invasion, techno-complexity, and job satisfaction. Initially, the techno-stress questionnaire was translated into Brazilian Portuguese language according to international standards, followed by cultural adaptations. Validation for feasibility and psychometric properties of translated questionnaire was performed on 138 gynecologists and obstetricians who use message applications to communicate with patients. The physicians were divided into groups according to the weekly messaging application usage time for communication with patients: <2 h (GI, n=89), 2-5 h (GII, n=29), and >5 h (GIII, n=23). The questionnaire was applied to all participants twice on the same day, overseen by two different interviewers, at a 15-min interval. After 15 days, it was readministered. The discriminant validity and reliability were calculated to validate the instrument.

RESULTS

Techno-stress subscales showed statistically significant differences between the groups. The Cronbach's alpha coefficient for the techno-stress questionnaire was >0.80, showing good internal consistency. No differences were observed in the test-retest comparison of the techno-stress questionnaire, and the intraclass correlation coefficient results showed excellent reproducibility (³0.75).

CONCLUSION

The techno-stress questionnaire was adequately translated into Brazilian Portuguese, with good discriminant validity, good internal consistency, and adequate test-retest results.

Association between high burn-out and workplace violence among healthcare workers in China: a WeChat-based survey

OBJECTIVES

This study is conducted to examine whether overall workplace violence (WPV) and its five types are associated with high burn-out among healthcare workers in China.

DESIGN

A WeChat-based cross-sectional survey. Snowball sampling was used in this study.

PARTICIPANTS

Front-line healthcare workers (N=3706) from 149 cities across 23 provinces in China responded to the survey, and 22 questionnaires were excluded because of incomplete data.

PRIMARY AND SECONDARY OUTCOME MEASURES

(1) The Chinese Maslach Burnout Inventory-General Survey was used to measure high burn-out. (2) WPV was assessed using the Chinese version of the Workplace Violence Scale. (3) An anonymous self-designed web-based questionnaire consisting of demographic, behavioural and occupational information was used to identify covariates.

RESULTS

A total of 3684 front-line healthcare workers (934 physicians and 2750 nurses) were included. Of all participants, 13.3% (491/3193) experienced high burn-out. Adjusted logistic regression revealed that experience of WPV in the past year was associated with high burn-out (OR 2.10, 95% CI 1.69 to 2.62). Healthcare workers who had suffered emotional abuse, threat or verbal sexual harassment were more vulnerable to high burn-out.

CONCLUSION

This study finds that healthcare workers with WPV, especially emotional abuse, threat and verbal sexual harassment, are more likely to experience burn-out. These types of WPV should be considered in interventions to reduce and prevent burn-out for healthcare workers.

Message applications in the doctor-patient relationship as a stressor

OBJECTIVE:

The aim of this study was to assess the use of smartphones’ messaging apps as a stressor affecting the well-being of gynecologists who use this tool to communicate with patients.

METHODS:

A cross-sectional study was conducted with gynecologists who use message applications to communicate with patients. Participants answered the WhatsApp Stress Scale, Oldenburg Burnout Inventory, and the techno-stress questionnaire. The population sample consisted of gynecologists and obstetricians selected by convenience.

RESULTS:

Physicians who spent more time using WhatsApp to communicate with patients had higher levels of stress (p=0.010), Burnout (p<0.001), and techno-invasion score (p<0.05).

CONCLUSIONS:

A positive association was found between the high frequency of WhatsApp usage for communication with patients and doctor's Burnout and stress, negatively influencing professional's well-being.

Optimizing the Practice Environment for Medical Staff in the Post-pandemic Era: A Discrete Choice Experiment

Objective

This study aimed to elicit the stated job preferences of Chinese medical staff in the post-pandemic era and identify the relative importance of different factors in the practice environment.

Methods

We used an online discrete choice experiment (DCE) survey instrument to elicit the job preferences of medical staff (doctors and nurses) in tertiary hospitals in Anhui, China. Attributes and levels were generated using qualitative methods, and four attributes were considered: career development, workload, respect from society, and monthly income. A set of profiles was created using a D-efficient design. The data were analyzed considering potential preference heterogeneity, using the conditional logit model and the latent class logit (LCL) model.

Results

A total of 789 valid questionnaires were included in the analysis, with an effective response rate of 73.33%. Career development, workload, respect from society, and monthly income were significant factors that influenced job preferences. Three classes were identified based on the LCL model, and preference heterogeneity among different medical staff was demonstrated. Class 1 (16.17%) and Class 2 (43.51%) valued respect from society most, whereas Class 3 (40.32%) prioritized monthly income. We found that when respect from society was raised to a satisfactory level (50–75% positive reviews), the probability of medical staff choosing a certain job increased by 69.9%.

Conclusion

Respect from society was the most preferred attribute, while workload, monthly income, and career development were all key factors in the medical staff's job choices. The heterogeneity of the medical professionals' preferences shows that effective policy interventions should be customized to accommodate these drive preferences.

Burnout among doctors in China through 2020: A systematic review and meta-analysis

Objective

To analyze surveys measuring the prevalence of burnout among Chinese doctors and reveal the overall prevalence, characteristics, timeline, and factors related to burnout.

Methods

A comprehensive search was conducted on China National Knowledge Infrastructure, WANFANG, PubMed, EMBASE, PsycINFO and Cochrane Library databases from their inception to 28 February 2021. Random-effects meta-analyses, meta-regression and planned subgroup analyses were performed, and the standardized mean difference was adopted for comparisons between subgroups. Egger’s and Begg’s tests were performed to evaluate publication bias. Heterogeneity across the studies was tested using the I² statistic. The study protocol was registered on PROSPERO (CRD42018104249).

Results

In total, 3,210 records were reviewed; 64 studies including 48,638 Chinese doctors were eligible for meta-analysis. The prevalence of burnout increased continuously from 2008 to 2017 and decreased significantly from 2018 to 2020, a little increase from 2020 to 2021. The overall prevalence of burnout was 75.48% (95% CI, 69.20 to 81.26; I² = 99.23%, P < 0.001), and high burnout was 9.37% (95% CI, 4.91 to 15.05, I² = 98.88%, P < 0.001). The prevalence of emotional exhaustion was 48.64% (95% CI, 38.73 to 58.59; I² = 99.53%, P < 0.001), depersonalization was 54.67% (95% CI, 46.95 to 62.27; I² = 99.20%, P < 0.001), and reduced personal accomplishment was 66.53% (95% CI, 58.13 to 74.44; I² = 99.37%, P < 0.001). Gender, marriage, professional title and specialty all influenced burnout.

Conclusions

The results showed that the total prevalence of doctor burnout in China is very high. The prevalence of burnout varies by location. Gender, marital status and professional title all affect burnout scores.

Teamwork quality and health workers burnout nexus: a new insight from canonical correlation analysis

BACKGROUND

Burnout is evidenced to have  adverse effect on the well-being of health workers. Although several risk factors of burnout have been found, only a hand full of studies have examined the role of teamwork quality. This study therefore sought to explore the relationship between the sub-dimensions of burnout and teamwork quality.

METHOD

This is an empirical study involving health workers who have practising certificate from the National Health Commission of the People's Republic of China. Relying on the study's target population, a sample of 939 healthworkers complied to partake in the survey. Data were obtained from the administration of a well-structured electronic questionnaire containing the Maslach Burnout Inventory together with Healthy and Resilient Organization (HERO) scales correspondingly. The scales were then analysed using the canonical correlation approach (CCA).

RESULTS

The results unveiled a statistically significant correlation between teamwork quality and health worker burnout indicating that teamwork quality and burnout are canonically correlated. Further, examination on the relationship existing between the dimensions of teamwork quality and burnout unveiled that with the exception of personal accomplishment and teamwork dedication, teamwork quality sub-scales (teamwork vigour and teamwork absorption) were negatively related to emotional exhaustion and depersonalization as sub-scales of burnout, respectively.

CONCLUSION

The study concluded that, surge in teamwork quality leads to reduced emotional exhaustion and reduced depersonalization while simultaneously increasing professional accomplishment. Therefore, this study presents a solid foundation for decreasing burnout syndrome in healthcare that can be implemented by successfully increasing levels of teamwork quality.

Turnover intention and related factors among resident physicians in China under the standardised residency training programme: a cross-sectional survey

OBJECTIVES

This study aimed at examining the extent of turnover intention among the Chinese resident physicians who entered the newly established national standardised residency training programme (SRTP), and exploring factors associated with their turnover intention.

DESIGN

Cross-sectional survey.

SETTING

Ten institutions from five geographical areas in China.

METHODS

1414 residents were surveyed using paper-based questionnaires and scales regarding their demographics, work situation, attitudes towards SRTP, job satisfaction, psychological resilience, burnout and turnover intention in 2017. The turnover intention was described and compared between categorical groups. Linear regressions were used to select the factors associated with turnover intention. The structural equation model was used to capture the potential mediating effects.

RESULTS

The mean turnover intention score was 12.45 (SD=4.47). Nearly half (47.87%) of the residents had a high and very high level of turnover intention. Psychological resilience (β=0.066), burnout (β=0.141) and job satisfaction (β=0.022) were positively associated with turnover intention, while specialty (β=-0.135), year of training (β=-0.687), career in medicine (β=-2.191), necessity of training (β=-0.695) and satisfaction with income (β=-1.215) had negative associations with turnover intention. Working hours and nightshift interval indirectly were associated with turnover intention through the mediating effects of burnout. Career in medicine, necessity of training, satisfaction with income, and psychological resilience showed direct effects and indirect effects on turnover intention through burnout and job satisfaction as mediators.

CONCLUSIONS

The turnover intention among Chinese residents was prevalent and unignorable. Burnout was the major contributing factor, while year of training and positive attitudes towards training were protective factors. Burnout and job satisfaction also served as mediators. Interventions targeting these factors should be incorporated in the training programmes to keep a prosperous physician workforce.

Are We in Control of Our Demons?: Understanding Compassion Satisfaction, Compassion Fatigue and Burnout in an Asian Pediatric Emergency Department in a Pandemic

BACKGROUND

The medical profession, with its remarkable physical and emotional demands, predisposes physicians to compassion fatigue (CF) and burnout (BO). Although these conditions have been studied individually, little attention has been paid to how pediatric emergency physicians experience these conditions in the context of an Asian emergency setting especially during a global pandemic In our study, we aim to understand the experiences of individual physicians and describe the potential triggers or protective factors of compassion satisfaction, BO, and compassion satisfaction among physicians in an Asian pediatric emergency department during a pandemic.

METHODS

A qualitative, individual interview methodology was used. From March to April 2020, we enrolled 20 physicians involved in frontline care during the coronavirus disease 2019 (COVID-19) pandemic in the pediatric emergency department to participate. Semistructured interviews were conducted, audiotaped, and transcribed in verbatim, with identifiers removed. Themes were identified, and data were analyzed using qualitative data analysis and iterative data analysis.

RESULTS

We recruited 20 physicians. Three themes emerged from data analysis. First, we showed how workplace conditions are protective, including work morale, leadership and management, and social support received. Second, workload affected participants emotionally and in terms of its heavier quantity and longer hours. Finally, intrinsic factors that were protective in developing CF or BO include having professional autonomy, experience, work-life balance, and having emotional resilience to develop self-care. Cultural influences affect emotional regulation and can lead to negative coping with negative peer pressure. In general, participants quantified their levels of satisfaction at work as average to above average. However, they highlighted experiencing greater stress during COVID-19 with the underlying fear of contagion and infection.

CONCLUSIONS

Being a pediatric emergency physician puts one at greater risk of experiencing CF and BO because of work and nonwork stressors, especially during a global pandemic, influenced by sociocultural factors. A positive and supportive work environment should be created while providing culturally adapted strategies to improve individual physician resilience to maintain their well-being.

Attitudes of medical professionals towards patient-centredness: a cross-sectional study in H City, China

OBJECTIVES

Patient-centred communication improves patient experiences and patient care outcomes. This study aimed to assess the preference of medical professionals in China towards patient-centred communication under the context of the deteriorating doctor-patient relationship.

METHODS

A cross-sectional survey of medical professionals was conducted in January and February 2018 in H City of Heilongjiang province, the northeast of China. The Chinese-Revised Patient-Practitioner Orientation Scale (CR-PPOS) was adopted to measure the individual preference of respondents towards patient-centredness in clinical communication. Multivariate logistic regression models were established to identify the sociodemographic (gender, age, marital status and educational attainment) and work experience (years of working, seniority, satisfaction with income, daily workload and perceived doctor-patient relationship) predictors of the preference towards patient-centredness.

PATIENT AND PUBLIC INVOLVEMENT

Not applicable.

RESULTS

A total of 618 valid questionnaires were returned. The CR-PPOS demonstrated acceptable reliability and validity. Overall, a low level of preference towards patient-centredness in clinical communication was found. Relatively higher scores on 'caring for patients' (20.42±4.42) was found compared with those on 'information/responsibility sharing' (15.26±4.21). Younger age, higher educational attainment, lower daily workload and a perception of harmonious doctor-patient relationship were associated with a higher preference towards patient-centredness in clinical communication.

CONCLUSIONS

A low level of preference towards patient-centredness in clinical communication was found in medical professionals in the northeast of China, which may further jeopardise the efforts to improve doctor-patient relationship.

Burnout and Well-Being Among Medical Professionals in China: A National Cross-Sectional Study

Objective

To determine the profile of Chinese medical professionals with burnout symptoms at the national level and identify the association between capability well-being and burnout.

Design and Setting

A cross-sectional study in a nonrandom national sample of medical staff from 6 provinces across western, central and eastern China.

Participants

Physicians, medical laboratory scientists, nurses, and general practitioners aged 18 years or above who submitted a completed online questionnaire from June 2019 to January 2020 successfully (N = 25,120).

Main Outcome Measures

The prevalence of burnout symptoms was assessed by the 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which consists of three domains: emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). The overall high burnout was defined as EE score ≥27 or DP score ≥10. The capability well-being was measured by the Investigating Choice Experiments Capability Measure for Adults (ICECAP-A) and the overall ICECAP-A score was calculated using the UK value set, ranging from a score of 0–1. Multivariable logistic regression analysis was used to identify the association between well-being and the overall high burnout.

Results

Among the 25,120 participants, 60.8% of the participants reported at least one symptom of burnout, whereas 11.2% reported all three symptoms of burnout. In the adjusted model, ICECAP-A score was independently associated with high burnout (AOR = 0.018, 95% CI = 0.015–0.022). Medical staff who were males, with shorter working years, working in tertiary hospitals, and those with the specialties of psychiatry, intensive care, emergency medicine, internal medicine, oncology, and pediatrics were at higher risk of reporting burnout symptoms.

Conclusion

The burnout symptoms were relatively common among Chinese medical staff and they were found to be independently associated with capability well-being in health professionals. Interventions should be enhanced on vulnerable groups to reduce burnout and promote well-being in future studies.

The Frequency of Burnout among Iranian Orthopedic Surgeons and Residents

BACKGROUND

Burnout is an emotional, psychological, and physical exhaustion syndrome with feelings of negativism toward one's job and reduced attention to clients. This complication is caused by the lack of control over work-related stress. Physicians, especially surgeons, are at higher risk for burnout due to critical responsibility and heavy workload. Given the importance and consequences of this dilemma, the present study aimed to investigate the frequency of burnout among orthopedic surgeons and residents.

METHODS

The present cross-sectional, analytical study was conducted in 2019 in the cities of Tehran and Yazd, in Iran. A total of 180 orthopedic surgeons and residents participated in the study. A demographic characteristics form and the Maslach Burnout Inventory (MBI) were employed to assess burnout in the participants.

RESULTS

The mean age of the participants was 42.8 years, and 94.4%, 23.9%, 52.2%, and 23.9% of the participants were male, residents, general orthopedic specialists, and fellowship-trained orthopedics, respectively. Out of 180 participants, 90 (50%) cases were suffering from burnout, of whom 26.7%, 16.1%, and 7.2% got a pathological score in one, two, and three criteria. No significant relationship was observed between burnout and gender, marital status, years of experience, and the average number of surgeries per week. However, there was a significant association between burnout and younger age, lower academic rank or being a resident, working in the public sector, and spending less time in leisure and sports activities.

CONCLUSION

The prevalence of burnout (50%) among orthopedists was remarkable and worrying. The frequency of burnout was higher among residents and the ones working in the public sector. This study demonstrates that the issue of burnout and its related risk factors have to be addressed in Iranian orthopedic surgeons and residents.

Reflections from the forgotten frontline: 'The reality for children and staff in residential care' during COVID-19

Currently, 78,150 children are in care in England, with 11% of the most vulnerable living in 2,460 residential homes due to multitype traumas. These children require safe and secure trauma-informed therapeutic care. However, the children's residential care workforce delivering this vital care is an unrepresented, under-researched and largely unsupported professional group. The workforce undertakes physically and emotionally challenging work in difficult conditions, exacerbated by the COVID-19 pandemic. Practitioner wellbeing is directly associated with outcomes for children. Therefore, we sought to understand how experiences within the workforce could improve overall working conditions, and thus outcomes for staff and children. Thirty participants took part in a survey, providing feedback on their experiences and the situations they faced during the English lockdown April-June 2020. Two participants also opted to take part in a teleconference interview, rather than survey, although were asked the same questions. Data were analysed through thematic analysis. A stakeholder advisory board supported the project, including frontline staff, care leavers, service managers and policy researchers. The advisory board assisted in reflecting on the data from the survey and interviews to generate a complete analysis. Overall, staff require facilitated safe spaces for peer-support, reflective and emotionally supportive supervision. An organisational awareness that staff wellbeing is intrinsically connected to the wellbeing and therapeutic outcomes of the children they care for is essential. Further, staff require a sense of belongingness to feel safe and competent in their role due to a lack of external recognition and professional representation or validation. Based on the findings of the study and an iterative process with the stakeholder advisory board, we created a Wellbeing Charter for adoption within organisations to promote and protect the wellbeing of this vital workforce. The COVID-19 pandemic has exposed professional, financial and environmental inequalities that affect these frontline workers. Implementing organisational, statutory and policy-driven initiatives to prioritise their wellbeing are essential for the vulnerable children they care for.

A Scale to Measure the Joy in Work of Doctors: Development, Validity, and Reliability

Background: The aim of this study is to develop a scale and evaluate its' validity and reliability to measure the joy in work of doctors. Methods: Based on literature review and panel discussion, the scale framework and item pool were determined. Next, the items were modified by two rounds of expert consultation. Then the pre-investigation was applied and the formal version of scale was formed. Last, the reliability and validity of the scale were tested with 426 physicians. Results: The scale was composed of four dimensions: work autonomy needs, competency identification needs, competency perception needs and work relationship needs. Each dimension had 7 items, and both reliability and validity were acceptable. The Cronbach α coefficient and half-reliability coefficient of the whole scale were 0.954 (>0.9) and 0.974 (>0.9). The Spearman correlations of item-total score ranged from 0.556 to 0.749, indicating a good-item total score correlation. The χ 2/ df, RMSEA, RMR, GFI, CFI, and TLI, CFA of the maximum likelihood method supported a good fit with the model. Conclusions: Based on the self-determination theory, this study develops a scale to measure the joy in work of doctors. It has good validation and reliability, which is useful for doctors and medical institutions to take steps to improve happiness.

Medical disputes and patient satisfaction in China: How does hospital management matter?

OBJECTIVE

Satisfaction with healthcare may be captured by surveys of patients and staff, or in extreme cases, the number and severity of medical disputes. This study tries to investigate the relationship between satisfaction and hospital management as well as the role of good management in preventing medical disputes ex ante.

METHOD

We investigate this relationship using information on management practices collected from 510 hospitals in mainland China using the World Management Survey questionnaire and combined with medical malpractice litigation data and patient/staff satisfaction surveys. Multiple regression models were used to analyse the relationship between hospital management scores and medical litigation outcomes as well as patient and staff satisfaction during 2014-2016.

RESULTS

An increase of one standard deviation in the management score was related to 13.1% (p < 0.10) lower incidence of medical disputes, 12.4% (p < 0.05) fewer medical litigations, and 51.3% (p < 0.10) less compensation. Better management quality of hospitals was associated with higher inpatient satisfaction (p < 0.05) and staff well-being (p < 0.01).

CONCLUSION

Improving hospital management could reduce hospital costs generated by lawsuits, reduce potential harm to patients, and improve patient and staff satisfaction, thus leading to a better patient-physician relationship.

As if it weren't hard enough already: Breaking down hiring discrimination following burnout

Hiring discrimination towards (former) burnout patients has been extensively documented in the literature. To tackle this problem, it is important to understand the underlying mechanisms of such unequal hiring opportunities. Therefore, we conducted a vignette experiment with 425 genuine recruiters and jointly tested the potential stigma against job candidates with a history of burnout that were mentioned earlier in the literature. We found candidates revealing a history of burnout elicit perceptions of requiring work adaptations, likely having more unpleasant collaborations with others as well as diminished health, autonomy, ability to work under pressure, leadership capacity, manageability, and learning ability, when compared to candidates with a comparable gap in working history due to physical injury. Led by perceptions of a reduced ability to work under pressure, the tested perceptions jointly explained over 90 % of the effect of revealing burnout on the probability of being invited to a job interview. In addition, the negative effect on interview probability of revealing burnout was stronger when the job vacancy required higher stress tolerance. In contrast, the negative impact of revealing burnout on interview probability appeared weaker when recruiters were women and when recruiters had previously had personal encounters with burnout.

Stress of COVID-19, Anxiety, Economic Insecurity, and Mental Health Literacy: A Structural Equation Modeling Approach

The COVID-19 pandemic is currently a global health threat attributed to negatively affecting the mental health and well-being of people globally. The purpose of the current study is to examine the mediating roles of economic insecurity and mental health literacy in the relationship between stress about COVID-19 and anxiety. Results from the current study using a large sample of Chinese college students (N = 1,334) showed that stress of COVID-19 was positively associated with economic insecurity and anxiety while negatively associated with mental health literacy, which in turn was negatively associated with anxiety. These results elucidate our understanding of the role of mediators in stress about COVID-19 and anxiety. The findings are useful in terms of providing evidence for tailoring interventions and implementing preventative approaches to mitigate anxiety due to stress of COVID-19. Based on the present findings and within the context of COVID-19, the potential utility of promoting MHL to reduce the psychopathological consequences of COVID-19 is discussed.

Linking doctor-patient relationship to medical residents' work engagement: The influences of role overload and conflict avoidance

Background

Chinese residents’ practical work experiences are different from those described in Western studies. To explore potential mechanisms underlying the effects of doctor-patient relationships on medical residents’ work engagement, verifying a posited mediating effect of role overload, and moderating effect of conflict avoidance, in the Chinese context.

Methods

Based on the conservation of resources theory, a composite model was constructed. This study’s data were collected from four different Chinese tertiary hospitals; 195 residents undergoing regularization training took this survey. Hierarchical moderated and mediated regression analyses were utilized.

Results

Doctor-patient relationship were found to be positively related to residents’ work engagement (β=0.31, p≤0.001). Role overload partially mediated the effect of these relationships on work engagement, and the moderating role of conflict avoidance in the relationship between doctor-patient relationship and conflict avoidance was negative.

Conclusion

Maintaining good doctor-patient relationship can prompt residents to increase their engagement in work in order to meet their patients’ needs. Furthermore, role overload has a particular influence in early career stages. Not only is it necessary for residents to gain a sense of recognition and support while they carry out their job responsibilities, especially while dealing with complex doctor-patient relationship, but it is also important to create work environments that can help residents shape their professional competency.

Anaesthesiology in China: A cross-sectional survey of the current status of anaesthesiology departments

Background

The discipline of anaesthesiology in China has undergone historical changes and development during the past century. However, nationwide comprehensive data on the current status of each hospital department providing anaesthesia care has been lacking since the discipline was first established in China. This information is essential for effective regulation of healthcare policies by both the professional associations and the government health ministry. Therefore, a nationwide survey was set up in 2018 to investigate the current status of Chinese anaesthesiology. This paper reports the findings of the survey.

Methods

We performed a cross-sectional nationwide census survey of the current status of each hospital department providing anaesthesia care in 31 provinces across the Chinese mainland. The content of the survey included general information of the department, the hospital level and scale, the volume of the anaesthesiology department, the characteristics of anaesthesiologists, and the caseload of the anaesthesiology departments. Face-to-face interviews were performed by trained interviewers. The Chinese Anaesthesiology Department Tracking Database (CADTD) was established during the survey. Data quality control was undertaken by the investigation committee throughout the survey process.

Findings

The nationwide census survey was completed by 11,432 hospital departments providing anaesthesia care throughout mainland China from June 1, 2018 to June 30, 2019. Among the 11,432 departments, 4591 (40•16%) belonged to specialised hospitals, while 6841 (59•84%) were affiliated to general hospitals. The proportion of independent anaesthesiology departments was 45•15% in mainland China. There was a total of 92,726 anaesthesiologists, or 6•7 per 100,000 of the population. Regions with better economic conditions had more anaesthesiologists per 100,000 of the population. From 2015 to 2017, the workload of anaesthesiologists has increased by 10%.

Interpretation

The discipline of anaesthesiology in China has entered a rapid development phase. However, the current status of anaesthesiology is not well defined, which makes it difficult to meet the needs of the increasing Chinese healthcare demand. The evidence from this survey offers valuable information for policy makers and anaesthesiology associations to monitor the development of the discipline and regulate healthcare policies effectively.

Funding

National Key Research and Development Program of China (Grant No. 2018YFC2001900).

Effect of the COVID-19 Pandemic on Medical Student Career Perceptions: Perspectives from Medical Students in China

Our aim was to examine perceived occupational turnover intentions among medical students and the associated factors. A cross-sectional study using a Web-based survey was conducted. A total of 2922 completed responses were received (response rate 55.7%). A total of 58.4% (95% CI 56.6-60.2) reported high turnover intention (score of 7-15). The odds of higher total turnover score among the fifth-year students was nearly four times that of first-year students (OR = 3.88, 95% CI 2.62-5.73). Perception of the medical profession as not being of high social status and reputation significantly influenced high turnover intention scores (OR = 2.26, 95% CI 1.90-2.68). All three dimensions of the multidimensional scale of perceived social support (MSPSS) significantly predict turnover intention. Lower scores in the support from Significant Other (OR = 1.47, 95% CI 1.17-1.84), Family (OR = 1.47, 95% CI 1.18-1.83) and Friend (OR = 1.42, 95% CI 1.14-1.77) subscales were associated with higher turnover intention. Low score in the Brief Resilience Scale (BRS) was also associated with higher turnover intention (OR = 1.44, 95% CI 1.17-1.77). The findings shed light on the importance of changing public attitudes towards respecting the medical profession and improving the implementation of policies to protect the well-being of people in the medical profession.

Depression and Suicidal Ideation in a Sample of Malaysian Healthcare Workers: A Preliminary Study During the COVID-19 Pandemic

Objective: The burden of suicidal behavior is anticipated to increase as a sequela of the COVID-19 pandemic. However, there is limited evidence on suicidal behavior among healthcare workers, an at-risk population. Our study aimed to investigate suicidal ideation in terms of the rate and associated factors in a sample of Malaysian healthcare workers during the early-phase of the COVID-19 pandemic. Methods: A subpopulation analysis (N = 171) was conducted within a larger, nation-wide cross-sectional study of Malaysian healthcare worker psychological distress from March 18-21, 2020. Current suicidal ideation was measured with item 9 of the Patient Health Questionnaire-9 (PHQ-9). The following independent variables were assessed: socio-demographic profile, occupation and service-related factors, health-anxiety (Health Anxiety Inventory, HAI), lifetime anxiety disorder and severity of depression (PHQ-9). Results: The proportion of healthcare workers with current suicidal ideation (19/171) and clinical depression (17/171) were 11.1 and 9.9%, respectively. Multivariable analysis showed that clinical depression was the most significant factor associated with current suicidal ideation (p < 0.001, OR = 55.983, 95% CI = 9.015-347.671) followed by mild (subthreshold) depression (p = 0.001, OR = 115.984, 95% CI = 2.977-85.804). Service duration of more than 10 years was associated with significantly less suicidal ideation (p = 0.049, OR = 0.072, 95% CI = 0.005-0.993). Conclusions: Depression (subthreshold and especially within the clinical range) and early-career status (<10 years in service) may be target areas of early intervention for reduction of suicidal ideation amongst healthcare workers who have served during the COVID-19 pandemic. Further research is warranted to elucidate specific occupational stressors related to COVID-19 work conditions to tailor appropriate suicide preventive strategies in this population.

Association of professional identity, job satisfaction and burnout with turnover intention among general practitioners in China: evidence from a national survey

Background

The complex interrelationships between professional identity, job satisfaction, burnout, and turnover intention among general practitioners (GPs) are insufficiently understood in China. This study aimed to investigate the interrelationships between professional identity, job satisfaction, burnout, and turnover intention in China, and to examine whether job satisfaction and burnout played mediating roles between professional identity and turnover intention.

Methods

A cross-sectional survey was conducted between October, 2017 and February, 2018 in China. The participants were selected using a multistage stratified random sampling method. Data were collected with a self-administered questionnaire from 3236 GPs (response rate, 99.8%) working in community health institutions in China. Professional identity was measured by the 13 items scale, and job satisfaction scale with an 11-item designed by Shi et al. was employed. Burnout was measured using a 22-item Maslach Burnout Inventory-Human Services Survey, and turnover intention was measured with a 6 items scale. Descriptive statistics were calculated and groups’ differences were estimated Student’s t-test and analyses of variance. Pearson’s correlation analysis was used to assess the degree of correlation among different dimensions of professional identity, job satisfaction, burnout, and turnover intention. Structural equation modeling analysis was applied to examine the interrelationships among these study variables based on the hypothesized model.

Results

The proposed model achieved a good model fit. Job satisfaction had a direct negative effect on turnover intention (β = − 0.38, P < 0.001), burnout had a direct positive effect on turnover intention (β = 0.37, P < 0.001), and professional identity had an indirect negative effect on turnover intention through the mediating effect of job satisfaction and burnout.

Conclusions

Our study elucidated the pathways linking professional identity, job satisfaction, and burnout to turnover intention of GPs. This revealed that turnover intention was significantly affected by job satisfaction and burnout, and the effects of professional identity on turnover intention can be mediated by job satisfaction and burnout.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06322-6.

Working Hours, Job Burnout, and Subjective Well-Being of Hospital Administrators: An Empirical Study Based on China's Tertiary Public Hospitals

(1) Purpose: To analyze the role of job burnout in connection with working hours and subjective well-being (SWB) among hospital administrators in China’s tertiary public hospitals. (2) Methods: A multi-stage, stratified, cluster random sampling method was used to select 443 hospital administrators in six tertiary public hospitals for study. The data were collected and analyzed using the working hours measuring scale, Maslach burnout, and the subjective well-being schedule. Pearson correlation, structural equation model, and bootstrap tests were conducted to examine the association between job burnout, working hours, and SWB. (3) Results: Among the 443 respondents, 330 worked more than 8 h per day on average (76.2%), 81 had the longest continuous working time more than 16 h (18.7%), and 362 worked overtime on weekends (82.2%). The prevalence of job burnout in hospital administrators was 62.8%, among which, 59.8% have mild burnout and 3.00% have severe burnout. In the dimension of emotional exhaustion, depersonalization, and reduced personal achievement, the proportion of people in high burnout was 21.0% (91/433), 15.0% (65/433), and 45.3% (196/433), respectively. Job burnout has a mediating effect between working hours and SWB, which accounted for 95.5% of the total effect. (4) Conclusion: Plagued by long working hours and severe job burnout, the hospital administrators in China’s tertiary public hospitals may have low SWB. Working hours have a negative direct impact on job burnout and SWB, and an indirect impact on SWB through job burnout as a mediator. Targeted strategies should be taken to adjust working hours to promote the physical and mental health of hospital administrators.