Describing the emotional exhaustion, depersonalization, and low personal accomplishment symptoms associated with Maslach Burnout Inventory subscale scores in US physicians: an item response theory analysis

The relationship between job stress and job burnout of preschool teachers during the COVID-19: The moderation of perceived organizational support

BACKGROUND

COVID-19 poses great challenges for preschool teachers in China, which will increase the level of job stress and job burnout, and have an impact on the relationship between job stress, job burnout, and perceived organizational support (POS). However, few studies have examined trilateral relationships, especially the role of POS concerning job stress and job burnout of preschool teachers.

OBJECTIVE

This study aimed to investigate the relationship among the three variables of job burnout, job stress, and POS, as well as explore the moderating effects of POS between job stress and job burnout.

METHODS

A cross-sectional study was conducted among preschool teachers in six provinces of China. A total of 408 preschool teachers completed a self-report questionnaire, including three scales that measured job burnout, job stress, and POS respectively. The Pearson correlation coefficient and regression analysis were used to examine the relationship among variables.

RESULTS

The results showed that job burnout among Chinese preschool teachers was at a medium level during the COVID-19 pandemic. Job stress was positively related to job burnout, and the POS was negatively related to job burnout. Additionally, POS moderated the relationship between job stress and job burnout and alleviated the adverse effects of job stress on the job burnout of preschool teachers.

CONCLUSION

POS can play a moderating role between job stress and job burnout of Chinese preschool teachers during the COVID-19 pandemic.

National Comparison of Burnout for a Cohort of Surgical and Nonsurgical Female Trainees

INTRODUCTION

Studies have shown that female physician trainees have an increased risk of burnout. We describe the current state of surgical and nonsurgical female trainee well-being and examine differences between surgical and nonsurgical specialties.

METHODS

Survey responses were received from 1017 female identifying trainees from 26 graduate medical education institutions across the United States. These survey responses included demographic data and well-being measures. Specifically, burnout was assessed using the Maslach Burnout Inventory. Data were analyzed using Wilcoxon rank sum test, Fisher's exact test, and Pearson's Chi-squared test data with significance defined as a P < 0.05. This survey was reported in line with strengthening the reporting of cohort studies in surgery criteria.

RESULTS

Nine-hundred ninety-nine participants completed the demographic and well-being section of the surveys and were included in analysis. Demographic data between the surgical versus nonsurgical group were similar, aside from surgeons being slightly older. Burnout was prevalent among all surveyed trainees with 63% scoring positive. Trainees also scored high in imposter syndrome and moral injury with low levels of self-compassion, although respondents also reported themselves flourishing. Surgical trainees scored higher than nonsurgical trainees in the personal accomplishment domain of burnout (P < 0.048). There was no difference between surgical and nonsurgical trainees in measures of the emotional exhaustion or depersonalization domains of burnout, or in impostor syndrome, self-compassion, moral injury, or flourishing.

CONCLUSIONS

While personal accomplishment was noted to be higher in surgical trainees as compared to nonsurgical trainees, overall rates of burnout are high among both groups. Targeted interventions for well-being, such as coaching, can help decrease the levels of burnout experienced by female physician trainees and do not need to be specialty specific.

Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among doctors and nurses in Bangladesh? A cross-sectional survey study

INTRODUCTION

COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic.

METHODS

We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI).

RESULTS

Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p<0.01). Anxiety, depression and burnout scores were statistically worse in COVID-19 active staff compared with those not working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although mean burnout scores were within the normal range for each institution, a high proportion of staff (almost 20% in some instances) were shown to be classified as experiencing burnout by their EE, DP and PA scores.

CONCLUSION

We identified a high prevalence of perceived anxiety, depression and burnout among doctors and nurses during the COVID-19 pandemic. This was worse in staff engaged in COVID-19-related activities. These findings could help healthcare organisations to plan for future similar events.

Resident Burnout on the Internal Medicine Ward

BACKGROUND

Burnout is common among medical trainees. Whether brief periods of training on the internal medicine ward leads to resident burnout is unknown.

METHODS

A survey-based study was conducted at a single academic institution. Medical residents undertaking four-week rotations on the internal medicine ward were included. Burnout was measured at the beginning and end of each rotation using the Maslach Burnout Inventory - Human Services Survey. Burnout was defined as either an emotional exhaustion score of ≥ 27 or a depersonalization score of ≥ 10. Self-reported workplace conditions, behaviors and attitudes were recorded.

RESULTS

The survey response rate was 71% and included 148 participants. The overall prevalence of burnout was 17% higher at the end of the rotation compared to the beginning of the rotation (71% vs. 54%; P < 0.001). Forty-three percent of residents without pre-rotation burnout developed post-rotation burnout. Residents with post-rotation burnout were more likely to report at least one suboptimal behavior or attitude related to patient care or professionalism (84% vs. 35%; P < 0.001). Respondents with new onset burnout were less likely to report being appreciated for their work, having their role as a learner emphasized, and receiving satisfactory support from allied healthcare professionals. New onset burnout was inversely associated with completing a second consecutive internal medicine ward rotation (adjusted OR 0.19; 95% CI, 0.04-0.90; P = 0.04).

CONCLUSION

Seven in ten residents are in a state of burnout after completing internal medicine ward rotations. Interventions to mitigate burnout development during periods of high intensity clinical training are needed.

Practitioner Burnout and Productivity Levels in Skilled Nursing and Assisted Living Facilities, Part 1: A Descriptive Quantitative Account

IMPORTANCE

Understanding burnout among practitioners in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) while considering contextual factors may lead to practices that enhance therapist and patient satisfaction as well as quality of care.

OBJECTIVE

To examine productivity standards and burnout in the context of setting and role, as reported by therapy practitioners in geriatric settings, and to explore relationships between productivity standards and perceived ethical pressures.

DESIGN

Cross-sectional online survey with descriptive data.

PARTICIPANTS

Practitioners (N = 366) included occupational therapists, physical therapists, speech-language pathologists, and occupational and physical therapy assistants working in SNFs and ALFs in the United States. A survey integrating the Maslach Burnout Inventory: Human Services Survey for Medical Personnel (MBI-HSS) and questions addressing demographics and contextual factors was distributed via social media.

RESULTS

Of 366 practitioners, 20.5% were burned out, exhibiting extreme scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) on the MBI-HSS. Significant relationships between productivity requirements and EE, DP, and PA, after accounting for covariates, were evident. Significant relationships between productivity standards and five of the six ethically questionable behaviors existed. Role affected productivity requirements, specifically between therapists and assistants, whereas setting did not.

CONCLUSIONS AND RELEVANCE

Productivity standards and related pressures are associated with concerning aspects of burnout among practitioners working in geriatric settings. Advocating for change in defining productivity and incorporating positive support in the work environment may assist in reducing burnout and turnover rates and improve patient satisfaction and care. Plain-Language Summary: This research highlights the prevalence of burnout and perceived pressures related to productivity requirements among occupational therapy practitioners working in skilled nursing and assisted living facilities.

Suicidal ideation, burnout, and their correlation among health care workers at the end of the fourth wave of the COVID-19 pandemic in Alborz Province, Iran

Background

During the COVID-19 pandemic, Health Care Workers (HCWs) were more vulnerable than ever to Burnout and Suicidal thoughts due to stressful work conditions. This study, investigated the level of Burnout and Suicidal thoughts among HCWs during the fourth wave of the pandemic in Alborz Province in Iran and compared it with the conditions at the beginning of the pandemic.

Methods

A total of 305 HCWs from 3 referral hospitals for COVID-19, including 155 men and 150 women, participated in the study. A cross-sectional study was carried out with a sample of HCWs dealing with COVID-19 patients using the available sampling method. The results of this online survey, which was conducted from June 7 to July 5, 2021 (at the end of the Fourth Wave of the COVID-19 Pandemic in Iran), have been compared with the conditions of the First Wave of the Pandemic (from February 24 to April 27, 2020). The participants were evaluated by the Beck Scale for Suicidal Ideations (BSSI) and Maslach Burnout Inventory (MBI).

Results

The mean age of the participants was 36.34 ± 7.37. The means of Suicide Index (SI), Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) scores were 0.76 ± 1.74, 19.94 ± 4.69, 4.92 ± 1.51, and 31.30 ± 5.88, respectively. SI and PA were significantly higher in workers other than nurses and physicians and EE was higher among workers with night shifts (p value<0.05 in all indices). Age had a significant and negative correlation with EE (p value<0.01) and DP (p value<0.05) and a significant and positive correlation with PA (p value<0.01).

Conclusion

This study showed a high level of SI and Burnout indices among HCWs in the fourth wave of the pandemic in Iran. Paying attention to the factors affecting the development of social capital and creating health policy changes may be effective in reducing Burnout indices and high Suicide index among HCWs.

Erosion of the 'ethical' doctor-patient relationship and the rise of physician burn-out

This paper examines the topic of physician burn-out from a philosophical lens. We explore the question of how the rise of physician burn-out may be related to an underlying erosion of meaning in medicine, characterised by the breakdown of the intersubjective relationship between doctors and patients. We argue that while commonly cited strategies for addressing burnout-including promoting work-life integration, cultivating workplace community, and fostering resilience-are critical for enhancing physician well-being, the common thread linking these approaches is that each identifies the physician as the primary locus of intervention. We propose that physician-centric approaches alone may be insufficient in addressing burnout, as the work might also involve shifting our attention to the intersubjective space that exists between the physician and the patient. To further elucidate the connection between intersubjectivity and the creation of meaning in medicine, we call on twentieth-century philosopher Emmanuel Levinas. Applying Levinas's philosophy to the clinical context, we discuss the phenomenon of 'depersonalisation' and ask whether, rather than a mere consequence of burnout, depersonalisation might be a core cause of this condition. With these points we shed light on an idea that is relatively absent from the burn-out literature: that a person-oriented approach is vital not only for patient well-being but for physician wellness as well, as a process that 'de-personalizes' patients might result in a simultaneous dehumanisation of physicians themselves. Drawing inspiration from Levinas, we explore how a reorientation towards the intersubjective, dialogical dimension of the doctor-patient dyad could serve as one important ingredient in healing not only the patient, but the physician as well.

Mindfulness Applications: Can They Serve as a Stress, Anxiety, and Burnout Reduction Tool in Orthopaedic Surgery Training? A Randomized Control Trial

Stress and burnout are prevalent within the orthopaedic surgery community. Mindfulness techniques have been shown to improve wellness, yet traditional courses are generally time-intensive with low surgeon utilization. We sought to determine whether the introduction of a simple mindfulness-based phone application would help decrease stress, anxiety, and burnout in orthopaedic surgery residents.

Methods

Twenty-four residents participated in this prospective, randomized controlled trial. After simple 1:1 randomization, the treatment group received access to a mindfulness-based phone application for 2 months while the control group did not receive access. All participants completed the Perceived Stress Scale, Generalized Anxiety Disorder-7, and Maslach Burnout Inventory with emotional exhaustion (EE), depersonalization (DP), and personal accomplishment subscores to measure stress, anxiety, and burnout at baseline and after 2 months. Paired t tests were used to compare baseline scores and conclusion scores for both groups.

Results

There was no difference in baseline burnout scores between groups, but the treatment group had higher stress and anxiety scores at baseline. On average, the treatment group spent approximately 8 minutes per day, 2 days per week using the mindfulness application. After 2 months, the treatment group had significantly decreased stress (mean = -7.42, p = 0.002), anxiety (mean = -6.16, p = 0.01), EE (mean = -10.83 ± 10.72, p = 0.005), and DP (mean = -5.17 ± 5.51, p = 0.01). The control group did not have any significant differences in stress, anxiety, or burnout subscores.

Conclusions

Use of a mindfulness-based phone app for 2 months led to significant reductions in stress, anxiety, and burnout scores in orthopaedic surgery residents. Our results support the use of a mindfulness-based app to help decrease orthopaedic resident stress, anxiety, and burnout. Benefits were seen with only modest use, suggesting that intensive mindfulness training programs may not be necessary to effect a change in well-being. The higher baseline stress and anxiety in the treatment group may suggest that mindfulness techniques are particularly effective in those who perceive residency to be more stressful.

Level of Evidence

I.

Relationships Between Burnout and Resilience: Experiences of Physical Therapists and Occupational Therapists During the COVID-19 Pandemic

OBJECTIVE

Research on burnout among physical therapists and occupational therapists in the context of the coronavirus disease 2019 (COVID-19) pandemic is limited. Resilience may be important for reducing burnout and promoting well-being among rehabilitation specialists, especially during periods of elevated occupational demand and stress. The purpose of this study was to investigate experiences of burnout, COVID-19 pandemic-related distress, and resilience among physical therapists and occupational therapists during the first year of the COVID-19 pandemic.

METHODS

Physical therapists and occupational therapists working in a university-affiliated health system were invited to complete an online survey assessing burnout, COVID-19 pandemic-related distress, state- and trait-like resilience, physical activity, sleep disturbance, and financial concerns. Multiple linear regressions were used to examine variables associated with burnout as well as the contribution of specific aspects of resilience to burnout.

RESULTS

Greater COVID-19 pandemic-related distress was associated with greater emotional exhaustion and depersonalization, whereas state-like resilience at work was associated with lower emotional exhaustion, greater personal accomplishment, and lower depersonalization. Analyses examining the impact of specific components of resilience at work suggested that several components are associated with less burnout, with finding one's calling being particularly relevant for all 3 domains of burnout.

CONCLUSION

Symptoms of burnout were reported by many physical therapists and occupational therapists. COVID-19-related distress and state-like resilience at work, particularly the perception of finding one's calling, emerged as consistently being associated with burnout in the context of the COVID-19 pandemic.

IMPACT

These findings can inform the development of interventions to reduce burnout among physical therapists and occupational therapists amid the continuing COVID-19 pandemic.

Prevalence of Burnout in Healthcare Workers of Tertiary-Care Hospitals during the COVID-19 Pandemic: A Cross-Sectional Survey from Two Central European Countries

COVID-19 has led to an unprecedented strain on healthcare workers (HCWs). This study aimed to determine the prevalence of burnout in hospital employees during a prolonged pandemic-induced burden on healthcare systems. An online survey among employees of a Czech and Slovak university hospital was conducted between November 2021 and January 2022, approximately when the incidence rates peaked in both countries. The Maslach Burnout Inventory-Human Services Survey was applied. We obtained 807 completed questionnaires (75.1% from Czech employees, 91.2% from HCWs, 76.2% from women; mean age of 42.1 ± 11 years). Burnout in emotional exhaustion (EE) was found in 53.2%, depersonalization (DP) in 33%, and personal accomplishment (PA) in 47.8% of respondents. In total, 148 (18.3%) participants showed burnout in all dimensions, 184 (22.8%) in two, and 269 (33.3%) in at least one dimension. Burnout in EE and DP (65% and 43.7%) prevailed in physicians compared to other HCWs (48.6% and 28.8%). Respondents from COVID-19-dedicated units achieved burnout in the EE and DP dimensions with higher rates than non-frontline HCWs (58.1% and 40.9% vs. 49.9% and 27.7%). Almost two years of the previous overloading of healthcare services, caused by the COVID-19 pandemic, resulted in the relatively high prevalence of burnout in HCWs, especially in physicians and frontline HCWs.

A national study of burnout and spiritual health in UK general practitioners during the COVID-19 pandemic

OBJECTIVES

To quantify the burnout and spiritual health of general practitioners (GPs) in the United Kingdom (UK) who worked during the Covid-19 Pandemic.

DESIGN

Online survey, April/May 2021, distributed via emails to general practices, Clinical Commissioning Groups (CCGs), Health boards, Clinical Research Networks, professional groups, social media GP groups and networks.

SETTING

United Kingdom.

PARTICIPANTS

1318 GPs who had worked in the National Health Service (NHS) during the COVID-19 pandemic (March 2020 -May 2021).

MAIN OUTCOME MEASURES

Burnout scores, measured by the Maslach Burnout Inventory (MBI) for Medical Personnel; spiritual health, measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Non-Illness (FACIT-SP-NI).

RESULTS

19% of surveyed GPs were at the highest risk for burnout, using accepted MBI 'cut off' levels. There was no evidence of a difference in burnout by gender, ethnicity, or length of service. GP burnout was associated with GP spiritual health, regardless of identification with a religion. GPs with low spiritual health were five times more likely to be in the highest risk group for burnout.

CONCLUSIONS

Burnout is at crisis levels amongst GPs in the UK NHS. A comprehensive response is required, identifying protective and precipitating factors for burnout. The potentially protective impact of spiritual health merits further investigation.

Physician Health and Wellness

Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.

Characteristics Associated with Burnout among Cardiologists in an Academic Medical Setting: Baseline Survey Results from a Communication Coaching RCT

OBJECTIVES

Clinician burnout poses risks not just to clinicians but also to patients and the health system. Cardiologists might be especially prone to burnout due to performing high-risk procedures, having to discuss serious news, and treating diseases that incur significant morbidity and mortality. Few have attempted to examine which cardiologists might be at higher risk of burnout. Knowing at-risk cardiologists can help frame resilience interventions.

METHODS

We enrolled 41 cardiologists across five ambulatory cardiology clinics into a randomized controlled trial where we assessed the Maslach Burnout Inventory at baseline. We used bivariate analyses to assess associations between cardiologist demographics and burnout.

RESULTS

Cardiologists reported low burnout for depersonalization and personal accomplishment and moderate levels for emotional exhaustion. Female cardiologists reported emotional exhaustion scores in the "low" range (M = 12.3; SD = 10.06), compared to male cardiologists whose score was in the "moderate" range 19.6 (SD = 9.59; p = 0.113). Cardiologists who had greater than 15 years in practice reported higher mean scores of emotional exhaustion, indicating moderate burnout (M = 20.0, SD = 10.63), compared to those with less than 15 years in practice (M = 16.6, SD = 9.10; p = 0.271).

CONCLUSIONS

In this sample, unlike prior studies, male cardiologists reported more burnout. Consistent with prior work, mid-level cardiologists might be at highest risk of emotional exhaustion.

Burnout Syndrome among Otorhinolaryngologists during the COVID-19 Pandemic

Background and Objectives: To determine the prevalence of burnout syndrome among otorhinolaryngologists in Lithuania and investigate associations with sociodemographic and professional factors during the COVID-19 pandemic. Materials and Methods: Burnout was measured using the validated Lithuanian version of the Maslach Burnout Inventory. Demographic characteristics and professional characteristics were collected utilizing an anonymous questionnaire. Results: Eighty otorhinolaryngologists (ORL group) and 30 information technology professionals (the control group) were enrolled in this study. A high level of professional burnout in at least one of the subscales was observed in 82.5% of the ORL group subjects. Depersonalization and burnout syndrome were more frequently detected with increasing age in the ORL group (r = 0.2, p < 0.04). Greater satisfaction with salary and working environment resulted in a lower burnout incidence (r = 0.31, p = 0.001). Conclusions: During the COVID-19 pandemic, the incidence of burnout syndrome has been high among Lithuanian otorhinolaryngologists. Demographic and professional characteristics are significantly related to burnout syndrome among Lithuanian otorhinolaryngologists.

Implementation of a Novel Pediatric Behavioral Health Integration Initiative

This study explores healthcare professionals' perspectives about the impact of behavioral health integration (BHI) on pediatric primary care delivery in community health centers (CHCs). A concurrent, qualitative-dominant mixed methods empirical study design was utilized, applying semi-structured interviews with healthcare professionals at the end of the implementation phase of a 3-year co-development, implementation, and evaluation process. Surveys were also administered at three time points. Via thematic analysis, emergent qualitative themes were mapped onto the Relational Coordination (RC) conceptual framework to triangulate and complement final qualitative results with quantitative results. Interview findings reveal five emergent themes aligning with RC domains. Survey results show that healthcare professionals reported increased behavioral healthcare integration into clinic practice (p = 0.0002) and increased clinic readiness to address behavioral health needs (p = 0.0010). Effective pediatric BHI and care delivery at CHCs may rely on strong professional relationships and communication. Additional research from the patient/caregiver perspective is needed.

Burnout, Professional Fulfillment, Intention to Leave, and Sleep-Related Impairment among Radiology Trainees across the United States (US): A Multisite Epidemiologic Study

OBJECTIVE

To examine the prevalence of burnout among radiology trainees in the United States, and to study the relationships between burnout and professional fulfillment (PF), intent-to-leave (ITL), sleep-related impairment and self-compassion by gender.

METHODS

This cross-sectional study was conducted via an anonymous electronic survey sent to 11 large academic medical centers (Physician Wellness Academic Consortium) between January 2017 and September 2018. The survey included the Professional Fulfillment Index (PFI) and an abbreviated form of the PROMIS Sleep-related impairment (SRI) scale. Two-sample t-tests and chi-square exact tests were used for analysis (p < 0.05).

RESULTS

Two hundred forty-seven radiology residents responded to the survey. Out of these, 36.2% reported burnout, 37.4% endorsed PF, 64.8% reported sleep-related impairment, 7.6% expressed ITL. There were no significant differences between genders. Burnout was associated with reduced PF, increased sleep-impairment (p < 0.001 for both) and increased ITL (p = 0.02). Lower PF, peer support, perceived appreciation for and meaningfulness in work, alignment of organizational and personal values, self-compassion, and higher sleep impairment were associated with burnout (p < 0.001 for all). Burnout was associated with perceptions of less support from department leaders (p = 0.003), control over schedules (p = 0.001) and helpfulness of electronic health record systems (p = 0.01). ITL was associated with reduced PF, perceived work appreciation, and leadership support (p = 0.03, p = 0.04, and p = 0.007, respectively).

DISCUSSION

Burnout is prevalent among radiology residents. Many demonstrate sleep-impairment and reduced professional fulfillment, with a lesser fraction desiring to leave their institution. Key factors to burnout included peer and organizational support, electronic health record systems helpfulness, and personal factors like self-compassion and work appreciation.

Hopelessness in Police Officers and Its Association with Depression and Burnout: A Pilot Study

Hopelessness is a particularly critical condition and a risk factor for suicide. Many studies have reported that this condition is common in some occupations and is associated with high stress that is not properly managed. This study examined the prevalence of hopeless status (HS) in a sample of police officers (POs) and the association of hopelessness with depression, burnout, and suicidality. In total, 127 out of 231 POs participated in the survey; they were assessed with the Beck Hopelessness Scale, the Beck Depression Scale, and the Maslach Burnout Inventory. A total of 26.5% of POs reported hopelessness, and a significant association was found with depression and burnout; in individual cases, these conditions were associated with suicidal thoughts. In a multivariate logistic regression model adjusted for confounding variables, depression, emotional exhaustion, and reduction of personal accomplishment were significantly associated with HP status. Depression (OR = 3.02, 95% CI: 1–9.12) and emotional exhaustion (OR = 1.88, 95% CI: 1.06–3.32) significantly increased the risk of hopelessness, while personal accomplishment (OR = 0.57, 95% CI: 0.32–1) was a protective factor. Hopelessness appears to be a very important factor to consider when assessing POs’ mental health.

Establishing Crosswalks Between Common Measures of Burnout in US Physicians

BACKGROUND

Physician burnout is often assessed by healthcare organizations. Yet, scores from different burnout measures cannot currently be directly compared, limiting the interpretation of results across organizations or studies.

OBJECTIVE

To link common measures of burnout to a single metric in psychometric analyses such that group-level scores from different assessments can be compared.

DESIGN

Cross-sectional survey.

SETTING

US practices.

PARTICIPANTS

A total of 1355 physicians sampled from the American Medical Association Physician Masterfile.

MAIN MEASURES

We linked the Stanford Professional Fulfillment Index (PFI) and Mini-Z Single-Item Burnout (MZSIB) scale to the Maslach Burnout Inventory (MBI) in item response theory (IRT) fixed-calibration and equipercentile analyses and created crosswalks mapping PFI and MZSIB scores to corresponding MBI scores. We evaluated the accuracy of the results by comparing physicians' actual MBI scores to those predicted by linking and described the closest cut-point equivalencies across scales linked to the same MBI subscale using the resulting crosswalks.

KEY RESULTS

IRT linking produced the most accurate results and was used to create crosswalks mapping (1) PFI Work Exhaustion (PFI-WE) and MZSIB scores to MBI Emotional Exhaustion (MBI-EE) scores and (2) PFI Interpersonal Disengagement (PFI-ID) scores to MBI Depersonalization (MBI-DP) scores. The commonly used MBI-EE raw score cut-point of ≥27 corresponded most closely with respective PFI-WE and MZSIB raw score cut-points of ≥7 and ≥3. The commonly used MBI-DP raw score cut-point of ≥10 corresponded most closely with a PFI-ID raw score cut-point of ≥9.

CONCLUSIONS

Our findings allow healthcare organizations using the PFI or MZSIB to compare group-level scores to historical, regional, or national MBI scores (and vice-versa).

The effects of yoga and mindful meditation on elderly care worker's burnout: a CONSORT-compliant randomized controlled trial

Objectives: This study aims to investigate the effects of mindful meditation and yoga on reducing burnout and stress in care workers who assist elderly individuals. Knowing how to reduce burnout is important because that of care workers is associated with the quality of client care, worker productivity, and job turnover.

Patients and Methods: The participants included 44 care workers who worked for elderly care facilities in rural Fukuoka. They were randomly assigned to one of three intervention groups: control, yoga, or mindfulness. In the yoga intervention group, a certified yoga instructor taught a 60-minute yoga session each week for six weeks. In the mindfulness group, an experienced medical doctor instructed a mindful meditation program for the same length. Participants were asked to complete the Japanese Burnout Scale (JBS), and the research team collected the level of α-amylase in saliva using NIPRO: T-110-N pre- and post-interventions.

Results: MANOVA was performed with each intervention (control, yoga, mindfulness) as the independent variable on the three subscales of the JBS (emotional exhaustion, depersonalization, and personal achievement) and a biomarker of stress level (α-amylase). The results indicated a significant main effect of interventions, and a follow-up ANOVA showed a significant effect of interventions on emotional exhaustion and personal achievement.

Conclusion: The results indicate that practicing mindful meditation or yoga for 60 minutes once a week for six weeks can reduce care workers’ burnout. This study was notable because the biomarker of stress also improved. It is strongly recommended and encouraged that institutions caring for the elderly population provide mindful meditation or yoga intervention to reduce burnout, which benefits not only care workers but also their clients.

Exploring the Effect of the COVID-19 Pandemic on the Dental Team: Preparedness, Psychological Impacts and Emotional Reactions

Background: The COVID-19 pandemic has placed increased demands on clinical staff in primary dental care due to a variety of uncertainties. Current reports on staff responses have tended to be brief enquiries without some theoretical explanation supported by developed measurement systems.

Aim: To investigate features of health and well-being as an outcome of the uncertainties surrounding COVID-19 for dentists and dental health professionals in primary dental care and for those in training. In addition, the study examined the well-being indices with reference to normative values. Finally a theoretical model was explored to explain depressive symptoms and investigate its generalisability across dentists and dental health professionals in primary dental care and those in postgraduate training.

Methods: A cross-sectional survey of dental trainees and primary dental care staff in Scotland was conducted in June to October 2020. Assessment was through “Portal,” an online tool used for course bookings/management administered by NHS Education for Scotland. A non-probability convenience sample was employed to recruit participants. The questionnaire consisted of four multi-item scales including: preparedness (14 items of the DPPPS), burnout (the 9 item emotional exhaustion subscale and 5 items of the depersonalisation subscale of the MBI), the 22 item Impact of Event Scale-Revised, and depressive symptomatology using the Patient Health Questionnaire-2. Analysis was performed to compare the levels of these assessments between trainees and primary dental care staff and a theoretically based path model to explain depressive symptomology, utilising structural equation modelling.

Results: Approximately, 27% of all 329 respondents reported significant depressive symptomology and 55% of primary care staff rated themselves as emotionally exhausted. Primary care staff (n = 218) felt less prepared for managing their health, coping with uncertainty and financial insecurity compared with their trainee (n = 111) counterparts (all p's < 0.05). Depressive symptomology was rated higher than reported community samples (p < 0.05) The overall fit of the raw data applied to the theoretical model confirmed that preparedness (negative association) and trauma associated with COVID-19 (positive association) were significant factors predicting lowered mood (chi-square = 46.7, df = 21, p = 0.001; CFI = 0.98, RMSEA = 0.06, SRMR = 0.03). Burnout was indirectly implicated and a major path from trauma to burnout was found to be significant in primary care staff but absent in trainees (p < 0.002).

Conclusion: These initial findings demonstrate the possible benefit of resourcing staff support and interventions to assist dental staff to prepare during periods of high uncertainty resulting from the recent COVID-19 pandemic.

Evaluating burnout during the COVID-19 pandemic among physicians in a large health system in New York

PURPOSE

The COVID-19 pandemic has generated significant psychological distress among health care workers worldwide. New York State, particularly New York City and surrounding counties, were especially affected, and experienced over 430,000 COVID-19 cases and 25,000 deaths by mid-August 2020. We hypothesized that physicians and trainees (residents/fellows) who were redeployed outside of their specialty to treat COVID-19 inpatients would have higher burnout.

METHODS

We conducted a cross-sectional survey to assess burnout among attending and trainee physicians who provided patient care during the COVID-19 pandemic between March-May 2020 across a diverse health care system in New York. Separate multivariable logistic regressions were performed to determine the association between redeployment and measures of burnout: Emotional Exhaustion (EE) and Depersonalization. Burnout measures were also compared by physician vs trainee status. The differential association between redeployment and outcomes with respect to trainee status was also evaluated.

RESULTS

Redeployment was significantly associated with increased odds of EE {OR =1.53, 95% CI: 1.01-2.31} after adjusting for gender and Epidemic-Pandemic Impacts Inventory (EPII) score. Similarly, being a trainee, especially a junior level trainee, was associated with increased odds of EE {OR = 1.59, 95% CI: 1.01-2.51} after adjusting for gender and EPII scores. However, neither redeployment nor trainee status were significantly associated with Depersonalization. Interactions between redeployment and trainee status were not significant for any of the outcomes (p>.05).

CONCLUSION

Physicians who were redeployed to treat COVID-19 patients had higher reported measures of EE. Trainees, irrespective of redeployment status, had higher EE as compared with attendings. Additional research is needed to understand the long-term impact of redeployment on burnout among redeployed physicians. Programs to identify and address potential burnout among physicians, particularly trainees, during pandemics may be beneficial.

Effect of Emotional Exhaustion and Knowledge Sharing on Depersonalization, Work Accomplishment, and Organizational Performance

The objective of the present study is to empirically investigate the relationship between emotional exhaustion and knowledge sharing of individual and organizational outcomes. Data was collected from 672 respondents from the information technology (IT) sector. The results from path analysis revealed that emotional exhaustion is (i) positively related to depersonalization, and (ii) negatively related to work accomplishment and organizational performance. The results also reveal that knowledge sharing is (i) negatively related to depersonalization, and (ii) positively related to work accomplishment and organizational performance. However, depersonalization is not negatively related to organizational performance. As predicted, work accomplishment is positively related to organizational performance. The diametrically opposite results of emotional exhaustion and knowledge sharing are particularly interesting. The implications for management and practicing mangers are discussed.

Burnout and the Sexual Assault Nurse Examiner: Who Is Experiencing Burnout and Why?

INTRODUCTION

A sexual assault nurse examiner role exemplifies the high-stress and highly emotional patient interactions that are often associated with burnout. The purpose of this study was to examine the frequency of burnout among sexual assault nurse examiners in North Carolina.

METHODS

This cross-sectional study was an anonymous survey of practicing sexual assault nurse examiners within North Carolina using the Maslach Burnout Inventory and additional demographics. Results were analyzed with odds ratios, confidence intervals, Fisher exact, chi-square, and Kruskal Wallis tests as appropriate.

RESULTS

Among 95 respondents, burnout was more frequent in sexual assault nurse examiners who stopped both emergency and nurse examiner work (55.6%, odds ratio 4.41, 95% confidence interval 1.07-18.06) and in dual function nurses (both emergency and nurse examiner work, 35.7%, odds ratio 2.71, 95% confidence interval 1.04-7.06). Sexual assault nurse examiners who had a high percentage of pediatric cases (above the median of 40%) were more likely to meet burnout thresholds for emotional exhaustion scores > 26 (48.78% vs 25.93%, χ² = 5.30, P = .02) and more likely to meet burnout thresholds for depersonalization scores > 9 (48.78% vs 24.07%, χ² = 6.28, P = .01).

DISCUSSION

Higher frequency of burnout threshold criteria was found in those people who worked concurrently as a sexual assault nurse examiner and an emergency nurse and in those who had retired from both specialties. We also found that sexual assault nurse examiners with a higher case mix of pediatric cases had higher emotional exhaustion scores and higher depersonalization scores.

Burnout among neurology residents during the COVID-19 pandemic: a national cross-sectional study

Background

Neurology residents are particularly vulnerable to burnout because of the novel logistical and clinical challenges brought about by the coronavirus disease 2019 (COVID-19) pandemic. Despite its implications, knowledge on burnout and its predictors among neurology residents is lacking. This study aimed to determine the prevalence of burnout among neurology residents during the pandemic, to compare burnout subscale scores and sociodemographic and work characteristics, and to explore residents’ perceptions on how to address burnout.

Methods

We conducted a cross-sectional survey among all 120 residents from the nine institutions in the Philippines offering neurology residency programs from March to August 2020. We obtained sociodemographic and work characteristics using questionnaire. We measured burnout using the Maslach Burnout Inventory. We performed an inductive thematic analysis to analyze perceptions on how to reduce burnout.

Results

The response rate was 71.67% (86/120). The mean age was 30.1 ± 3.1 years. Using predefined subscale critical boundaries, the prevalence of burnout was 94% (95% CI 89, 99). The lack of compensation and number of on-duty days influenced emotional exhaustion scores. The number of on-duty days influenced depersonalization scores. Thematic analysis revealed five themes: increasing manpower; self-care; reducing clerical tasks; improving work environment; and adequate compensation.

Conclusions

The prevalence of burnout among neurology residents during the COVID-19 pandemic was alarmingly high. Reforms in hiring policies, work-hour management, manpower organization, work environment, and logistics may be considered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10072-021-05675-4.

Physician Well-being 2.0: Where Are We and Where Are We Going?

Although awareness of the importance of physician well-being has increased in recent years, the research that defined this issue, identified the contributing factors, and provided evidence on effective individual and system-level solutions has been maturing for several decades. During this interval, the field has evolved through several phases, each influenced not only by an expanding research base but also by changes in the demographic characteristics of the physician workforce and the evolution of the health care delivery system. This perspective summarizes the historical phase of this journey (the "era of distress"), the current state (Well-being 1.0), and the early contours of the next phase based on recent research and the experience of vanguard institutions (Well-being 2.0). The key characteristics and mindset of each phase are summarized to provide context for the current state, to illustrate how the field has evolved, and to help organizations and leaders advance from Well-being 1.0 to Well-being 2.0 thinking. Now that many of the lessons of the Well-being 1.0 phase have been internalized, the profession, organizations, leaders, and individual physicians should act to accelerate the transition to Well-being 2.0.

The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being

CONTEXT.—

Problems with health care worker (HCW) well-being have become a leading concern in medicine given their severity and robust links to outcomes like medical error, mortality, and turnover.

OBJECTIVE.—

To describe the state of the science regarding HCW well-being, including how it is measured, what outcomes it predicts, and what institutional and individual interventions appear to reduce it.

DATA SOURCES.—

Peer review articles as well as multiple large data sets collected within our own research team are used to describe the nature of burnout, associations with institutional resources, and individual tools to improve well-being.

CONCLUSIONS.—

Rates of HCW burnout are alarmingly high, placing the health and safety of patients and HCWs at risk. To help address the urgent need to help HCWs, we summarize some of the most promising early interventions, and point toward future research that uses standardized metrics to evaluate interventions (with a focus on low-cost institutional and personal interventions).

Prevalence and Factors Associated With Burnout of Frontline Healthcare Workers in Fighting Against the COVID-19 Pandemic: Evidence From China

OBJECTIVES

The sudden outbreak of the novel coronavirus disease (COVID-19) plunged healthcare workers (HCWs) into warfare. This study aimed to determine the prevalence of burnout and the factors associated with it among frontline HCWs fighting COVID-19.

METHODS

A cross-sectional survey was conducted among frontline HCWs fighting against the COVID-19 in Wuhan, Harbin, and Shenzhen during the period from February 18 to March 4. Finally, HCWs were recruited using cluster sampling, 1,163 HCWs were included in the final analysis. Burnout was measured using a 22-item Maslach Burnout Inventory scale (MBI scale).

RESULTS

Of the participants, 48.6% suffered from burnout, and 21.8% showed a high degree of burnout. Doctors (b = 3.954, P = 0.011) and nurses (b = 3.067, P = 0.042) showed higher emotional exhaustion (EE) than administrators. Participants who worked continuously for more than 8 h a day (b = 3.392, P = 0.000), those who were unable to eat three regular daily meals (b = 2.225, P = 0.008), whose daily water intake was no more than 800 ml (b = 3.007, P = 0.000), who slept for no more than 6 h (b = 1.609, P = 0.036), and who were infected or had colleagues who were infected with COVID-19 (b = 4.182, P = 0.000) experienced much higher levels of EE, while those who could adhere to infection control procedures (b = -5.992, P = 0.000), who were satisfied with their hospital's infection control measures(b = -3.709, P = 0.001), and who could receive sufficient psychological crisis intervention (b = -1.588, P = 0.039) reported lower levels of EE.

CONCLUSION

The study reveals that burnout is prevalent among frontline HCWs and that the known factors associated with burnout, such as workload, and the factors directly associated with COVID-19, such as having insufficient protection, can affect burnout symptoms in frontline HCWs. Synergized and comprehensive interventions should be targeted at reducing its occurrence among frontline HCWs fighting COVID-19.

Examining the measurement equivalence of the Maslach Burnout Inventory across age, gender, and specialty groups in US physicians

Background

Disparities in US physician burnout rates across age, gender, and specialty groups as measured by the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI) are well documented. We evaluated whether disparities in US physician burnout are explained by differences in the MBI’s functioning across physician age, gender, and specialty groups.

Methods

We assessed the measurement equivalence of the MBI across age, gender, and specialty groups in multi-group item response theory- (IRT-) based differential item functioning (DIF) analyses using secondary, cross-sectional survey data from US physicians (n = 6577). We detected DIF using two IRT-based methods and assessed its impact by estimating the overall average difference in groups’ subscale scores attributable to DIF. We assessed DIF’s practical significance by comparing differences in individuals’ subscale scores and burnout prevalence estimates from models unadjusted and adjusted for DIF.

Results

We detected statistically significant age-, gender-, and specialty- DIF in all but one MBI item. However, in all cases, average differences in expected subscale-level scores due to DIF were < 0.10 SD on each subscale. Differences in physicians’ individual-level subscale scores and burnout symptom prevalence estimates across DIF- adjusted and unadjusted IRT models were also small (in all cases, mean absolute differences in individual subscale scores were < 0.04 z-score units; prevalence estimates differed by < 0.70%).

Conclusions

Age-, gender-, and specialty-related disparities in US physician burnout are not explained by differences in the MBI’s functioning across these demographic groups. Our findings support the use of the MBI as a valid tool to assess age-, gender-, and specialty-related disparities in US physician burnout.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-021-00312-2.