Burnout and Perceptions of Stigma and Help-Seeking Behavior Among Pediatric Fellows

Learning from the past: medical school experiences, stigma, and help seeking for depression

Experiencing lower psychological safety during medical school is linked to higher levels of impostorism and a diminished sense of meaning in work among incoming resident physicians. Furthermore, perceptions of a harmful hidden curriculum in medical school are associated with elevated levels of impostorism. This study aimed to build on these findings by examining whether incoming residents' perceptions of psychological safety and hidden curriculum in medical school correlate with various forms of mental health stigma and residents' intentions to seek help for depression. The participants (n = 244), surveyed from June 2023 to July 2023, were incoming medical residents starting their residency in the fall of 2023 at a large hospital organization. Residents responded to items inquiring about their medical school's psychological safety and hidden curriculum, as well as items asking about mental health stigma (i.e. self-stigma, perceived stigma from other doctors, and the perceived career consequences associated with help seeking) and current intentions to seek help for depression. A series of correlations and path analyses were conducted to examine relationships between these variables. Lower perceptions of psychological safety and higher perceptions of a harmful hidden curriculum in medical school were significantly correlated with higher levels of perceived stigma from other doctors, greater agreement that seeking help would harm their career, and lower help-seeking intentions. Psychological safety, but not hidden curriculum, was significantly related to self-stigma. Moreover, self-stigma, perceived stigma from other doctors, and perceived career consequences mediated the positive association between psychological safety and help-seeking intentions, while only perceived career consequences were a significant mediator for the negative relationship between hidden curriculum and help-seeking intentions for depression. These findings have implications for both understanding and improving resident well-being.

Actionable Areas of Distress Among Pediatric Cardiology Fellows

OBJECTIVE

To quantify burnout and identify specific stressors among a national sample of pediatric cardiology fellows.

STUDY DESIGN

We invited program directors at all 61 Accreditation Council for Graduate Medical Education-accredited pediatric cardiology training programs to distribute a 40-item survey to their categorical (year 1-3) fellows from February to April 2023. The survey included the Stanford Professional Fulfillment Index and ratings of key stressors to understand levels of burnout and associated stressors.

RESULTS

In total, 67% (261/391) of contacted pediatric cardiology fellows completed the survey, representing 50% of all categorical fellows in the US. Of these, 42% reported symptoms of burnout. Fellows without children were found to have increased odds of experiencing burnout symptoms compared with those with children (OR 2.03). 13 of 15 stressors were associated with increased burnout scores, of which "excessive number of work hours," "challenges to prioritizing self-care," and "mistreatment from supervisors" were the top 3.

CONCLUSION

This national study of pediatric cardiology fellows shows a high prevalence of burnout. The modifiable stressors identified in this study offer opportunities to improve the well-being of this group of trainees.

Negotiating Safety: Facilitation of Return to Work for Individuals Employed in High-Risk Occupations

PURPOSE

Return-to-work (RTW) after absence due to a mental illness is a largely understudied area, especially in industries already struggling with retention like those posing unique and high risks for public or personal safety (i.e., pilots, police officers, and health professionals), otherwise known as safety-sensitive sectors. The goal of this paper is to examine how RTW coordinators work with individuals who took a leave of absence for mental illness in safety-sensitive occupations and navigate the RTW process.

METHODS

Qualitative methodology was utilized to explore the experiences of 47 RTW coordinators who had worked with individuals employed in safety-sensitive industries. The participants were recruited across Canada using convenience sampling to participate in semi-structured interviews. The interviews were transcribed, anonymized, uploaded to NVIVO 11, and coded using inductive thematic analysis.

RESULTS

Our analysis shows that despite the presumed rigidity of occupational health and safety standards for safety-sensitive positions, the notion of "safety" becomes ambiguous in navigating RTW processes, and concerns about safety are often interpreted as the potential risk workers may pose to themselves, other individuals, or the workplace image. Institutional constraints of safety-sensitive jobs shape the ability of RTW coordinators to advocate on behalf of the workers, ultimately placing the workers at a disadvantage by prioritizing safety concerns for organizations over employees' needs.

CONCLUSION

It is important to consider how to protect workers in safety-sensitive occupations during the RTW process after absence due to a mental illness to ensure effective integration to the workplace.

The privilege and the pressure: judges' and magistrates' reflections on the sources and impacts of stress in judicial work

There is growing evidence that judges and magistrates experience both high stress and high satisfaction in their work; however, the subjective experience of judicial stress and the cultural and professional factors shaping that experience remain largely unexamined. This qualitative study builds upon earlier quantitative research with the Australian judiciary, by exploring judges' and magistrates' perceptions of the sources and impacts of judicial stress and their ideas for court responses. Thematic analysis of 59 in-depth interviews with judicial officers from five Australian courts revealed eight themes pertaining to the better understanding and management of occupational stress within the judiciary. Implications for courts and individual judicial officers are discussed.

The Stigma of Burnout Impeding Formal Help: A Qualitative Study Exploring Residents' Experiences During Training

Purpose

Burnout is an occupational stress syndrome that gives rise to emotional exhaustion (EE) depersonalization (DP) and reduced personal accomplishment (PA). Increasing rates of burnout among health care professionals has been reported globally. Saudi Arabia appears to be among the highest in prevalence with reports of higher than 70%. Medical residents in training are the highest group at risk. The literature has repeatedly linked burnout among residents with poor academic performance on training exams, impaired quality of life, career choice regret and intentions to abandon medicine. In this study, we explore the factors that contribute to resident burnout, their experiences with burnout and how they choose to mitigate it.

Methods

A qualitative design was used to conduct this study in the city of Riyadh, Saudi Arabia. A total of 14 residents from surgical and non-surgical programs were interviewed through in-depth interviews. Interpretive thematic analysis was used in coding and generated coding templates. Categories were repetitively reviewed and revised, expanding to include new data as it emerged and collapsing to remove redundant codes. Categories were organized into the final themes and sub-themes.

Results

All participants demonstrated a shared thread of shame in reaching the level of burnout. Three main interlinked themes were identified: Burnout stigma cycle, amalgamated causes of burnout and self-coping with burnout. One of the concerning findings in our study is the participants' pursuit of self-coping strategies and the avoidance of formal help, creating a cycle of suffering in silence.

Conclusion

The literature has repeatedly reported high levels of burnout among residents in training. This study has added another dimension to those findings through the exploration of residents actual accounts and appears to link burnout with suboptimal training and working conditions. We have highlighted the pivotal role stigma and shame play in completely preventing residents from seeking professional help.

Spanish validation of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and factors associated with physician burnout

OBJECTIVES

The aim of this study was to investigate the psychometric properties of the Spanish version of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and the factors associated with Physician Burnout in Paraguay.

METHODS

Participants included 747 Paraguayan healthcare workers, aged 24-77 years old, of both sexes. SOSS-D was translated into Spanish and validated through an exploratory and confirmatory factor analysis. Participants were also scored with the Oldenburg Burnout Inventory (OLBI), the CAGE questionnaire, and the stigma subscale of the Perceived Barriers to Psychological Treatment (PBPT) measure.

RESULTS

Three factors had a raw eigenvalue greater than 1, and explained 61.7% of total variance. The confirmatory analysis confirmed that the scale is three-dimensional. The model adjustment was good, according to all fit indices. OLBI results indicate clinically significant disengagement in 85.9% and clinically significant exhaustion in 91.6% of participants. Of the 747 participants, 57.6% reported alcoholic beverage consumption and among those, 19.3% had problematic alcohol consumption according to the CAGE questionnaire. The correlation between SOSS-D and the stigma subscale of the PBPT was statistically significant (r = 0.245, p < 0.001).

CONCLUSIONS

The Spanish version of the SOSS-D was found to have good psychometric properties and adequately reproduces the three-dimensional model of the original English version.

Child Health and the US Pediatric Subspecialty Workforce: Planning for the Future

This article opens a multi-article Pediatrics supplement that provides a rigorous analysis of the projected pediatric subspecialty workforce in the United States. Congenital variations, epigenetics, exposures, lifestyle, preventive care, and medical interventions from conception through young adulthood set the stage for health and wellbeing in adulthood. Although care provided by pediatric subspecialists is associated with better outcomes and lower costs compared with adult providers, the authors of recent articles in the lay and medical literature have questioned the capacity of pediatric subspecialists to meet children's health care needs. This article highlights that, despite numerous advances in prevention, diagnosis, and treatment, the last decade has witnessed increasing numbers of children with acute or chronic physical and mental health disorders, including medical complexity, obesity, type 2 diabetes, anxiety, depression, and suicidality, all of which are exacerbated by poverty, racism, and other social drivers of health. In this article, we then describe the variability in the demographics, practice characteristics, and geographic distribution of the 15 core pediatric subspecialties certified by the American Board of Pediatrics. We then discuss the rationale and approach to the development of a pediatric subspecialty workforce model that forecasts subspecialist supply from 2020 to 2040 for 14 subspecialties at the national and subnational levels (not including the newest subspecialty, pediatric hospital medicine), accounting for US Census Bureau child population projections. The model does not account for the unique physical and mental needs of individual children, nor does it address the increasingly precarious commitment to, and financing of, pediatric subspecialty care in the US health care system impacting market demand.

Paediatric cardiology training: burnout, fulfilment, and fears

BACKGROUND

Burnout is well characterised in physicians and residents but not in paediatric cardiology fellows, and few studies follow burnout longitudinally. Training-specific fears have been described in paediatric cardiology fellows but also have not been studied at multiple time points. This study aimed to measure burnout, training-specific fears, and professional fulfilment in paediatric cardiology fellows with the attention to time of year and year-of-training.

METHODS

This survey-based study included the Professional Fulfillment Index and the Impact of Events Scale as well as an investigator-designed Fellow Fears Questionnaire. Surveys were distributed at three-time points during the academic year to paediatric cardiology fellows at a large Midwestern training programme. Fellow self-reported gender and year-of-training were collected. Descriptive analyses were performed.

RESULTS

10/17 (59%) of fellows completed all surveys; 60% were female, 40% in the first-year class, 40% in the second-year class, and 20% in the third-year class. At least half of the fellows reported burnout at each survey time point, with lower mean professional fulfilment scores. The second-year class, who rotate primarily in the cardiac ICU, had higher proportions of burnout than the other two classes. At least half of fellows reported that they "often" or "always" worried about not having enough clinical knowledge or skills and about work-life balance.

CONCLUSIONS

Paediatric cardiology fellows exhibit high proportions of burnout and training-specific fears. Interventions to mitigate burnout should be targeted specifically to training needs, including during high-acuity rotations.

An Evaluation of Burnout Among US Rheumatology Fellows: A National Survey

OBJECTIVE

To evaluate levels of burnout and correlates of burnout among US rheumatology fellows.

METHODS

US rheumatology fellows were invited to complete an electronic survey in 2019. Burnout was assessed using the Maslach Burnout Inventory. Measures of depression, fatigue, quality of life, and training year were also collected. Open-ended questions about perceived factors to promote resiliency and factors leading to increased burnout were included. Bivariate and multivariate regression analyses were used to examine correlates of burnout. Open-ended responses were analyzed using thematic analysis.

RESULTS

The response rate was 18% (105/582 pediatric and adult rheumatology fellows). Over one-third (38.5%) of postgraduate year (PGY) 4 and 16.7% of PGY5/6 fellows reported at least 1 symptom of burnout. Of PGY4 fellows, 12.8% met criteria for depression compared with 2.4% of PGY5/6 fellows. PGY4 fellows reported worse fatigue and poorer quality of life compared with PGY5/6. In multivariable models controlling for training year and gender, older age (> 31 years) was associated with lower odds of burnout. Thematic analysis of open-ended responses identified factors that help reduce burnout: exercise, family/friends, sleep, support at work, and hobbies. Factors contributing to burnout: pager, documentation, long hours, demands of patient care, and presentations and expectations.

CONCLUSION

This national survey of US rheumatology fellows reveals that early trainee level and younger age are associated with worse levels of fatigue, quality of life, and burnout. Although awareness of and strategies to reduce burnout are needed for all fellows, targeted interventions for younger fellows and those in their first year of training may be of highest yield.

A Noisy Theory of Asking for Help That Explains why Many Feel Underwhelmed With the Help They Receive

Employees often feel that the help they receive at work is inadequate. Whereas previous research explains this empirical finding by referencing stereotypes or poor communication, we suggest an alternative that does not rely on biased agents: disappointment with received help may arise due to self-selection and regression to the mean. Before asking for help, employees assess whether their co-workers have the time and ability to respond. Consistent with regression to the mean, extreme beliefs are often followed by less extreme outcomes. However, employees with inflated beliefs are more likely to ask for help than employees with low or modest beliefs. Therefore, the subset of employees who act will have overly optimistic expectations, expectations that are unlikely to be met once co-workers respond. Apart from challenging conventional wisdom, this article also integrates chance and self-selection perspectives into the ongoing dialogue of help-seeking. Implications for future research, theory, and practice are discussed.

Plain Language Summary

This article presents a theory explaining the following empirical regularity: employees often feel let down with the help they receive at work. Prior research explains this effect by referencing errors in communication or cognition. We propose a simple, alternative mechanism, such that cognitive biases or communication mishaps need not be present for the pattern to emerge. Suppose employees ask for help based on a noisy signal of colleague potential—that is, a perception of whether co-workers have the motivation and ability to resolve the issue. Employees who believe potential is high will be more likely to ask for help than employees who believe potential is low. Due to regression to the mean, extreme beliefs will likely be followed by less extreme received help (in either direction). But not every employee asks for help. Only those with sufficiently high beliefs send a request—and it is those employees who have a greater chance of holding inflated assessments. Among those who ask, then, received help will appear underwhelming. Apart from challenging conventional wisdom, this article also integrates chance and self-selection perspectives into the ongoing dialogue of help-seeking. Implications for future research, theory, and practice are discussed.

Community-Based HIV and Viral Hepatitis Fellowship Evaluation: Results from a Qualitative Study

PURPOSE

The UMass Chan Medical School/New England AIDS Education and Training Center Community-Based HIV and Viral Hepatitis Fellowship was launched in 2014 to train physicians and nurse practitioners to become experts in outpatient management of HIV, hepatitis B and C, and latent tuberculosis. The purpose of this study was to identify areas of strength and improvement and understand fellows' perceptions of the program and its impact on their current positions and career trajectories.

METHODS

Qualitative study utilizing a semi-structured interview guide with (11) fellowship graduates (8 MDs; 3 NPs). 45 to 60 min interviews were conducted in April and May 2021, recorded and transcribed. Transcripts were analyzed for representative themes and general patterns in the data.

RESULTS

Results indicate high satisfaction with the fellowship, which left a positive and indelible impact on their careers and patient care. Fellows highlighted the program's commitment to health equity, its role in transforming them into leaders and advocates for HIV in primary care, and their ability to balance their work and training demands with their personal lives and needs. The fellowship motivated them to become more involved in public health initiatives, serve marginalized communities and reduce their health disparities. They expressed confidence in their ability to independently manage outpatient HIV, viral hepatitis B and C, and latent tuberculosis, and found areas of overlap with their work in primary care.

CONCLUSION

As the care of people with HIV becomes more commonplace in primary care clinics, it is imperative that primary care providers receive the necessary training and education to meet this need. Our study of 11 former fellows shows that the Community-Based HIV and Viral Hepatitis Fellowship offers such training, spreads it to other institutions, and can be a model for other programs nationwide.

The Sustained Psychological Impact of the COVID-19 Pandemic on Health Care Workers One Year after the Outbreak-A Repeated Cross-Sectional Survey in a Tertiary Hospital of North-East Italy

This study aimed to evaluate the mental health outcomes of health care workers (HCWs) of the Verona academic hospital trust (Italy) one year after the outbreak of COVID-19 and to identify predicted risk factors. A web-based survey was conducted from mid-April to mid-May 2021 on hospital workers one year after the first evaluation performed during the lock-down phase of the COVID-19 pandemic. Post-traumatic stress, general anxiety, depression, and burnout were assessed by using, respectively, the impact of event scale (IES-R), the self-rating anxiety scale (SAS), the patient health questionnaire (PHQ-9) and the Maslach burnout inventory-general survey (MBI-GS). Multivariate logistic regression analysis was performed to identify factors associated with each of the four mental health outcomes one year after the COVID-19 outbreak. A total of 1033 HCWs participated. The percentage of HCWs scoring above the cut-off increased from 2020 to 2021 in all of the outcome domains (anxiety, 50.1% vs. 55.7, p < 0.05; depression, 26.6% vs. 40.6%, p < 0.001; burnout, 28.6% vs. 40.6%, p < 0.001; chi-square test), with the exception of post-traumatic distress. There was also an increase when stratifying by occupation and workplace, with a greater increase for depression and burnout. Multivariate analysis revealed that, one year after the COVID-19 outbreak, nurses were at the greatest risk of anxiety and depression, whereas residents were at the greatest risk of burnout (in terms of low professional efficacy). Working in intensive care units was associated with an increased risk of developing severe emotional exhaustion and a cynical attitude towards work.