Factors associated with burnout among US neurosurgery residents: a nationwide survey

The work environment and hospitalist work well-being and burnout

BACKGROUND

Hospital medicine is the largest growing specialty in the United States. It is important to understand factors that are related to burnout and work well-being (WWB), both predictors of workforce retention.

OBJECTIVE

To examine the relationship between work environment factors and hospitalist burnout and WWB.

METHODS

An online cross-sectional survey was completed by hospitalists in July-October 2020. Burnout was assessed using the Mini-Z burnout scale and the Abbreviated Maslach Burnout Inventory. WWB was assessed using the Work Well-Being Scale. Work structure variables included hours worked per week, frustration at work, safety level of clinical workload, lack of control over schedule, lack of control over daily work, continuity of patient care, and ability to optimize license. The current desire to practice medicine was also examined.

RESULTS

Eight-eight hospitalists participated. There were statistically significant differences between levels of safety of workload (F(2,85) = 9.70, p ≤.005), frustration at work (F(2,85) = 12.29, p ≤.005), control over schedule (F(2,85) = 3.17, p = .04), control over daily work (F(2,85) = 6.17, p = .003), and desire to practice medicine (F(2,85) = 42.34, p = <.005) with WWB. There were statistically significant associations between the presence of burnout and the safety of workload (χ2 = 8.167, p = .017), frustration at work (χ2 = 15.29, p = .005), control over daily work (χ2 = 12.48, p = .002), and desire to practice medicine (χ2 = 7.12, p = .03). WWB was positively associated with years as a hospitalist (r = .249, p = .02).

CONCLUSION

Work environment factors are associated with WWB and burnout. Modifiable work environment factors may offer a point of intervention for reducing burnout and enhancing WWB among hospitalists.

A national study of burnout, psychosocial work environment, and moral distress among neurosurgical doctors in Denmark

BACKGROUND

Burnout is a condition of mental, emotional, and physical enervation affecting personnel working in human services and has been reported high among neurosurgical doctors. However, previous burnout reports are based on low response rates and measured by the Maslach Burnout inventory, which for several reasons has proven problematic. Burnout has not previously been investigated among neurosurgical doctors in Denmark. With this study we measure the prevalence of burnout among neurosurgical doctors in Denmark with sustainable methodology and a clinically relevant burnout interpretation.

METHODS

Burnout was measured among neurosurgical doctors in Denmark using the Copenhagen Burnout Inventory (CBI) consisting of three subscales measuring personal burnout, work-related burnout and patient-related burnout. To gain better understanding of factors contributing to burnout, the psychosocial working conditions and moral distress was measured using the Danish Psychosocial Work Environment Questionnaire (DPQ) and a questionnaire of eight items previously used to assess moral distress.

RESULTS

With 73 responders and a response rate of 90.1%, clinically relevant burnout was reported in 27.4% in personal burnout, 16.5% in work-related burnout and 5.5% in patient-related burnout. Cohort members with children living at home experienced a significant higher degree of burnout regarding work-related burnout and patient-related burnout. Within the DPQ domains of 'Demands at work' and 'Work organization and job content', several moderate to strong correlations were observed between specific sub-dimensions and both personal and work-related burnout. Higher levels of the domain 'Interpersonal relations' was moderately correlated with lower levels of both personal and work-related burnout. In the testing of moral distress, only 2 responders (2.7%) scored as 'somewhat injured'.

CONCLUSION

Neurosurgical doctors in Denmark report relatively low prevalence of clinically relevant burnout. However, doctors with children living at home exhibited higher levels of work- and patient-related burnout. Our findings highlight the psychosocial work environment as a significant factor contributing to burnout, while moral distress appears to have a limited impact on the development of burnout in the study population.

Towards a National System-Level Intervention: Characterization of Burnout Among Trainees of Saudi Postgraduate Healthcare Professions Programs

BACKGROUND/OBJECTIVES

High levels of burnout among healthcare professionals and trainees represent a global problem with identified profound impacts. The collection of national data for better characterization of this problem can guide more needs-sensitive targeted interventions. We aimed to identify the prevalence of burnout, the associated factors, and their impacts among trainees of Saudi postgraduate healthcare professions training programs.

METHODS

We conducted an anonymous, cross-sectional survey of 11,500 Saudi Commission for Health Specialties trainees from February to May 2019. The survey included items for socio-demographic data, physical health, and work-related items. We used validated instruments to measure burnout (Maslach Burnout Inventory), stress (Perceived Stress Scale), and depression (Patient Health Questionnaire-9).

RESULTS

A total of 6606 postgraduate trainees from different healthcare professions responded (mean age of 28.8 ± 3 years). Fifty-six percent reported burnout symptoms. Burnout was lower among female trainees (aOR, 0.73; 95% CI, 0.65-0.82) and higher in trainees working ≥40 h/week (aOR, 1.19; 95% CI, 1.03-1.37) and doing ≥six on-call shifts/month (aOR, 1.18; 95% CI, 1.03-1.37). Harassment and discrimination increased the risk of burnout by 57% and 60% (aOR = 1.57, 95% CI: 1.36-1.80 and aOR, 1.60; 95% CI, 1.38-1.86), respectively. Burnout trainees had 3.57 adjusted odds to report major depression (95% CI 3.11-4.09), were 1.25 times more likely to report major stress (95% CI 1.36-1.80), and were 1.8 times more likely to complain of sleep disorders (95% CI 1.60-2.04).

CONCLUSION

This study identified several personal and work-related risk factors and impacts of burnout among our postgraduate trainees. The findings were helpful in guiding the expansion of the national Da'em well-being and prevention of burnout program efforts to a targeted system-level intervention.

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.

The relationship between self-determination and burnout: Mental health outcomes in medical residents

BACKGROUND

Burnout is a pervasively increasing threat to personal and professional wellbeing and performance. It is yet understudied in relation to basic psychological needs (BPN), especially in at-risk population such as medical residents. This study intends to explore the differential relationship between various aspects of burnout including depersonalization (DP), emotional exhaustion (EE) and lack of personal achievement (PA) and subsets of BPN satisfaction or frustration namely autonomy, relatedness, and competence, with the framework of the Self-Determination Theory (SDT) in healthcare.

MATERIALS

A total of 110 medical residents in various Lebanese hospitals were included. Demographics and standardized scales were used to measure basic psychological need satisfaction and frustration (BPNSFS), burnout (MBI), depression and anxiety (PHQ-4). Residents were also asked about subjective evaluation of academic training and level of impact by ongoing crises (COVID-19 pandemic, Beirut port explosion and financial breakdown).

RESULTS

Result point to alarming prevalence of burnout and mental distress in our sample. It also indicates a differential correlation between gender, financial security and various subsets of burnout. It lastly points to association of DP with overall satisfaction scale (Beta = 0.342, p = 0.001) and PHQ-4 scores (Beta = -0.234, p = 0.017), while feeling burdened to attend lectures and having been physically affected by the Beirut blast correlated with a sense of PA (Beta = 0.332, p = 0.010, Beta = 0.187, p = 0.041 respectively) and PHQ-4 (Beta = 0.341, p = 0.000), interacting with COVID-19 patients (Beta = 0.168, p = 0.020) and feeling protected in the working environment (Beta = -.231, p = 0.002) showed a significant association with EE.

DISCUSSION

Within the SDT framework, this study highlights the complex interplay between collective crises, subjective evaluations or work conditions and other demographics with aspects of burnout in medical residents. It mostly points to the need address this at an individual but also an institutional level to buffer distress in future healthcare providers.

Residency Wellness: A Historical Narrative Review

INTRODUCTION

The structure of medical residency in the United States has experienced significant changes, paralleling advances in medical science and education. While these changes have enhanced medical training, they have introduced challenges, particularly in resident wellness. The well-being of residents is critical for patient care and the healthcare system. This review aims to provide an overview of the historical trends in medical residency, focusing on the evolution of resident wellness and its associated challenges.

METHODS

A narrative review was conducted, examining the evolution and challenges of medical residency with an emphasis on resident wellness. An exhaustive literature search on January 25, 2024 was conducted across PubMed, Web of Science, and Google Scholar. The search utilized keywords related to medical residency, wellness, and educational reforms. Articles were selected based on relevance and robust evidence, and information was organized into thematic categories for narrative synthesis.

RESULTS

The search yielded 57 publications that met the inclusion criteria. Historical trends revealed a shift from an apprenticeship model to formalized training programs, with each phase bringing unique challenges to resident wellness. The Flexner Report's influence on standardizing medical education, the rise of modern residency programs, and the recognition of burnout as a significant issue were key developments. Policy changes, technological impacts, and the COVID-19 pandemic have further shaped residency training and wellness. Studies highlight the need for interventions addressing burnout and promoting wellness, with varied approaches across specialties and institutions.

CONCLUSION

Residency burnout has been a growing concern since the 1970s, exacerbated by advancements in medicine, technology, and recent global events like the COVID-19 pandemic. Although awareness has increased, the need remains to address burnout and promote wellness during residency. Further research is warranted to develop effective interventions and adapt training to meet the evolving needs of residents.

Contemporary Evaluation of Work-Life Integration and Well-Being in US Surgical Residents: A National Mixed-Methods Study

BACKGROUND

The demands of surgical training present challenges for work-life integration (WLI). We sought to identify factors associated with work-life conflicts and to understand how programs support WLI.

STUDY DESIGN

A cross-sectional national survey conducted after the 2020 American Board of Surgery In-Training Examination queried 4 WLI items. Multivariable regression models evaluated factors associated with (1) work-life conflicts and (2) well-being (career dissatisfaction, burnout, thoughts of attrition, and suicidality). Semistructured interviews conducted with faculty and residents from 15 general surgery programs were analyzed to identify strategies for supporting WLI.

RESULTS

Of 7,233 residents (85.5% response rate), 5,133 had data available on work-life conflicts. A total of 44.3% reported completing noneducational task work at home, 37.6% were dissatisfied with time for personal life (eg hobbies), 51.6% with maintaining healthy habits (eg exercise), and 48.0% with performing routine health maintenance (eg dentist). In multivariable analysis, parents and female residents were more likely to report work-life conflicts (all p < 0.05). After adjusting for other risk factors (eg duty-hour violations and mistreatment), residents with work-life conflicts remained at increased risk for career dissatisfaction, burnout, thoughts of attrition, and suicidality (all p < 0.05). Qualitative analysis revealed interventions for supporting WLI including (1) protecting time for health maintenance (eg therapy), (2) explicitly supporting life outside of work (eg prioritizing time with family), and (3) allowing meaningful autonomy in scheduling (eg planning for major life events).

CONCLUSIONS

Work-life conflicts are common among surgical residents and are associated with poor resident well-being. Well-designed program-level interventions have the potential to support WLI in surgical residency.

Effects of Mentorship on Surgery Residents' Burnout and Well-Being: A Scoping Review

BACKGROUND

In surgical training, a mentor is a more senior and experienced surgeon who guides a surgical trainee to meet personal, professional, and educational goals. Although mentorship is widely assumed to positively affect surgical residents' professional development, a more nuanced understanding of mentorship's impact is lacking and urgently needed as burnout rates among residents increase. This study aims to summarize the current literature on the effects of mentorship on surgical residents' burnout and well-being.

METHODS

A comprehensive literature review was performed with key terms related to "surgical resident" and "mentor" using Pubmed, Embase, and ProQuest databases for primary studies published in the United States or Canada from January 1, 2010 to December 9, 2022 that measured outcomes related to burnout and well-being. Multiple reviewers screened titles and abstracts for relevance, then full-text articles for eligibility.

RESULTS

Initial search resulted in 1,468 unique articles, and 19 articles were included after review. Only one article was a randomized controlled trial. Twelve studies described a decrease in burnout rates or in outcomes related to burnout. In contrast, 4 studies identified negative outcomes related to burnout. Six studies showed improved well-being or related outcomes. One study was not able to show a change in self-valuation between coached and noncoached residents.

CONCLUSION

High quality mentorship can be associated with improved well-being and decreased burnout in surgical residents, but the key elements of effective and helpful mentorship remain poorly characterized. This summary highlights the importance of making mentorship accessible to surgical residents, and training faculty to be effective mentors.

Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis

BACKGROUND

Burnout among resident physicians during training has been prevalent, prompting training centers to introduce interventions at the individual or organizational level. However, empirical evidence is crucial before implementing such programs in practice.

METHODS

A systematic review and meta-analysis was carried out to evaluate the effectiveness of individual and organizational interventions in reducing burnout among resident physicians. Searching was done across five databases-PubMed, Scopus, ScienceDirect, Embase, and Cochrane Library from 1 December 2023 to 26 August 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for our reporting of study selection process. Eligibility criteria were randomized or non-randomized designs, with prospective intervention, with a comparator group focused on individual or organizational interventions reducing burnout, in any language and publication date. The Maslach Burnout Inventory scores for emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were the three outcome measures. Two investigators independently extracted the data. The risk of bias was evaluated using Cochrane risk-of-bias tool for randomized trials (RoB2) and non-randomized studies of interventions (ROBINS-I). Cohen's d and heterogeneity was estimated using a random-effects DerSimonian-Laird model and visualized by forest plots. Sensitivity analyses were carried out by leave-one-out meta-analysis.

RESULTS

We identified 33 eligible studies (n = 2536), comprising 25 (75.8%) individual intervention studies and 8 (24.2%) organizational intervention studies. Cohen's d for individual intervention versus control were as follows: EE -0.25 (95% CI -0.40 to -0.11, p < 0.01, I2 = 49.3%), and DP -0.17 (95% CI -0.32 to -0.03, p = 0.02, I2 = 50.0%). The organizational intervention showed no significant association with any domain. Sensitivity analyses were robust in all outcomes, with differences in intervention description and design identified as potential contributors to heterogeneity.

CONCLUSIONS

Various interventions, including individual coaching, meditation, and organization interventions, have been implemented to improve resident burnout. The effectiveness of intervention demonstrated none to small practical significance in improving burnout. Data inconsistency and high risk of bias across studies limited the validity of the pooled results. Further studies should focus on a combined approach.

REGISTRATION

The study was registered on PROSPERO, under PROSPERO registration number CRD42022349698.

Family medicine and general practitioner supervisor wellbeing: a literature review

BACKGROUND

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

AIM

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

DESIGN & SETTING

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

METHOD

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

RESULTS

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

CONCLUSION

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

Challenges and aspirations of neurosurgery residents in Germany: Insights from a questionnaire-based survey

OBJECTIVE

Neurosurgery residents in Germany face numerous challenges including receiving comprehensive surgical training with adequate learning opportunities, achieving balanced work life equilibrium, maintaining a positive work environment and navigating career prospects. The objectives of this study are to assess overall satisfaction with the training program, identify factors contributing to dissatisfaction, explore various dimensions of the training program, evaluate the psychological well-being of residents, and ascertain their preferences for future subspecialties.

METHODS

A questionnaire-based survey was conducted anonymously among neurosurgery residents from various training hospitals, nationwide. The survey utilized a quantitative questionnaire as data collection tool. The data collection took place from June 2021 to January 2023.

RESULTS

The survey encompassed 120 neurosurgery residents, with a gender distribution of 55 % male and 45 % female. The respondents were primarily from university hospitals (53 %), followed by community hospitals (38 %) and private hospitals (9 %). In terms of training program satisfaction, 37 % reported moderate satisfaction, 39 % indicated below-moderate satisfaction, and 28 % experienced above-moderate satisfaction. The predominant causes of dissatisfaction identified were insufficient surgical exposure (reported by 39 % of respondents), suboptimal educational content (38 %), and inadequate research opportunities (32 %). Additionally, 24 % of respondents highlighted psychological stress, and 36 % reported frequent experiences of burnout. A majority (63 %) indicated a workload of 60-80 h weekly. About half of the residents indicated a future specialization interest in neurosurgical oncology.

CONCLUSION

The results of the survey findings provide valuable insights into the challenges and aspirations of neurosurgery trainees in Germany. These results serve as a basis for improving the training system, enhancing the working environment, and guiding future planning in this field. To optimize the training of residents, it is important to address issues such as limited surgical and research opportunities and psychological well-being. The expressed interest in subspecializing offers guidance for shaping the training program's future direction.

Associations between workplace social capital, well-being, and work engagement in medical residents: a multicenter cross-sectional study

BACKGROUND

Workplace social capital (WSC), a social resource available within work or occupational environments, has been identified as an important factor for employees' health in fields other than medical education. However, little is known about whether WSC is associated with well-being and work engagement among medical residents. The aim of this study was to examine the relationships between WSC, well-being, and work engagement specifically among medical residents.

METHODS

This cross-sectional study was conducted at 32 hospitals in Japan, assessing WSC with the Japanese medical resident version of the Workplace Social Capital (JMR-WSC) scale. Well-being and work engagement were measured as the primary and secondary outcomes using the Subjective Well-Being Scale and the Japanese version of the Utrecht Work Engagement Scale.

RESULTS

We analyzed data from 276 residents. Adjusting for possible confounders, the JMR-WSC Scale scores were associated with well-being in a dose-dependent manner (adjusted mean difference 6.55, 95% CI 4.96-8.15 for the WSC highest score quartile, compared with the lowest score quartile). The WSC Scale scores demonstrated a dose-dependent association with work engagement (adjusted mean difference 15.12, 95% CI 11.66-18.57 for the WSC highest score quartile, compared with the lowest score quartile).

CONCLUSIONS

This study showed that WSC was linked to enhanced well-being and work engagement among residents. Our findings offer insights for developing interventions to prevent resident burnout and create an environment conducive to residents' well-being and engagement.

Survey Research Among Neurosurgeons: A Bibliometric Review of the Characteristics, Quality, and Citation Predictors of the Top 50 Most-Influential Publications in the Neurosurgical Literature

Survey research enables the gathering of information on individual perspectives in a large cohort. It can be epidemiological, attitude or knowledge focussed. Assessment of survey studies sampling neurosurgeons is currently lacking in the literature. This study aimed to highlight the characteristics, quality, and citation predictors of the most influential survey research studies published in the neurosurgical literature. Using PubMed and Google Scholar, the 50 most cited survey research publications were identified and reviewed. Data relating to the characteristics of the articles, participants and questionnaires were retrieved. The studies' quality and citation patterns were assessed. The median articles' age and publishing journal impact factor (IF) were 15.5 years and 2.82, respectively. Thirty-two (64%) articles were first authored by researchers from the USA while 28(56%) studies were focussed on specific disease management. The median number of participants and response rates were 222 and 51%, respectively. A full version of the questionnaire was provided in 18 (36%) articles. Only four (8%) articles reported validation of the questionnaire. The overall quality of reporting of the surveys was considered fair (based on good grading in five parameters, fair grading in one parameter, and poor grading in four parameters). The median citation number was 111. The citation analysis showed that the participant number, article age (≥15.5 years), and questionnaire category (surgical complications) were significant predictors of citation numbers. The citation rates were not influenced by the response rates or the journal's IF. In conclusion, high-impact survey publications in the neurosurgical literature were moderately cited and of fair quality. Their citation numbers were not affected by response rates but were positively influenced by the publication age, number of participants, and by novel data or the questions raised in the survey category. Surveys are valuable forms of research that require extensive planning, time, and effort in order to produce meaningful results. Increasing awareness of the factors that could affect citations may be useful to those who wish to undertake survey research.

How We Do It: Surgery IMPACT - Integrated Mentorship Program for Advancing Clinical Training

OBJECTIVE

Effective mentorship plays a crucial role in the professional development of surgical residents by providing guidance, support, networking, and facilitating personal, and career growth. This is particularly significant for female and underrepresented minority residents who often encounter additional challenges due to discrimination and historical lack of representation. Our objective is to present a framework for structuring a progressive and inclusive formal mentorship program- Surgery IMPACT- which embodies a panoramic perspective of surgery residency.

DESIGN

A holistic mentorship program was created through the conceptualization of WISE Domains (Work-Life Balance, Interpersonal and cultural proficiency, Scholarly and career advancement, Effective learning and study techniques). Mentor-Mentee partnerships were created between current surgical faculty and general surgery residents. The foundation of the program is built upon four essential mentor roles: Core faculty mentor, research mentor, fellowship mentor, alongside a concurrent incorporation of peer mentorship. Over the academic year, we encouraged at least 3 formal mentorship meeting prefaced by a reflective exercise by the residents.

CONCLUSIONS

The implementation of Surgery IMPACT has been successful in formalizing mentorship opportunities at our institution. By incorporating WISE domains, structured meeting centered on well-defined objectives, we have effectively created an all-inclusive mentorship program to foster resident growth and equal opportunities. Our ongoing commitment is to further refine and expand this innovative program with the aspiration of galvanizing similar mentorship models across diverse surgical programs.

A survey of surveys: an evaluation of the quality of published surveys in neurosurgery

PURPOSE

Surveys generate valuable data in epidemiologic and qualitative clinical research. The quality of a survey depends on its design, the number of responses it receives, and the reporting of the results. In this study, we aimed to assess the quality of surveys in neurosurgery.

METHODS

Neurosurgical surveys published between 2000 and 2020 (inclusive) were identified from PubMed. Various datapoints regarding the surveys were collated. The number of citations received by the papers was determined from Google Scholar. A 6-dimensional quality assessment tool was applied to the surveys. Parameters from this tool were combined with the number of responses received to create the survey quality score (SQS).

RESULTS

A total of 618 surveys were included for analysis. The target sample size correlated with the number of responses received. The response rate correlated positively with the target sample size and the number of reminders sent and negatively with the number of questions in the survey. The median number of authors on neurosurgery survey papers was 6. The number of authors correlated with the SQS and the number of citations received by published survey papers. The median normalized SQS for neurosurgical surveys was 65%. The nSQS independently predicted the citations received per year by surveys.

CONCLUSIONS

The modifiable factors that correlated with improvements in survey design were optimizing the number of questions, maximizing the target sample size, and incorporating reminders in the survey design. Increasing the number of contributing authors led to improvements in survey quality. The SQS was validated and correlated well with the citations received by surveys.

A Scoping Review of Professionalism in Neurosurgery

BACKGROUND AND OBJECTIVES

The Accreditation Council for Graduate Medical Education's Milestones provides a foundation for professionalism in residency training. Specific professionalism concepts from neurosurgery could augment and expand milestones for the specialty. We reviewed the current literature and identified professionalism concepts within the context of neurosurgical practice and training.

METHODS

We used a scoping review methodology to search PubMed/MEDLINE and Scopus and identify English-language articles with the search terms "professionalism" and "neurosurgery." We excluded articles that were not in English, not relevant to professionalism within neurosurgery, or could not be accessed. Non-peer-reviewed and qualitative publications, such as commentaries, were included in the review.

RESULTS

A total of 193 articles were included in the review. We identified 6 professionalism themes among these results: professional identity (n = 53), burnout and wellness (n = 51), professional development (n = 34), ethics and conflicts of interest (n = 27), diversity and gender (n = 19), and misconduct (n = 9).

CONCLUSION

These 6 concepts illustrate concerns that neurosurgeons have concerning professionalism. Diversity and gender, professional identity, and misconduct are not specifically addressed in the Accreditation Council for Graduate Medical Education's Milestones. This review could be used to aid the development of organizational policy statements on professionalism.

How are French pediatric orthopedic surgeons affected by burnout? Results of a nationwide survey

INTRODUCTION

Burnout is a syndrome that adversely affects those who work in roles designed to assist and aid others, such as healthcare professionals. There is a paucity of data available on this topic among French pediatric orthopedic surgeons, registrars and interns. Therefore, we conducted a national survey to: (1) assess the prevalence of burnout syndrome among French pediatric orthopedic surgeons; (2) determine the risks and protective factors associated with this syndrome.

HYPOTHESIS

The prevalence of burnout among French pediatric orthopedic surgeons is at least as high as in other medical and surgical specialties.

MATERIALS AND METHODS

We conducted a nationwide survey during the months of June and July 2022 by distributing a digitized questionnaire by e-mail. The burnout syndrome was assessed by the MBI (Maslach Burnout Inventory) score. Demographic and professional practice data were also collected.

RESULTS

Thirty-eight interns and 65 pediatric orthopedic registrars took part in the survey, i.e. a participation rate estimated at 65.5% and 44.4% respectively. Twenty-six percent (n=10) of interns and 13.9% (n=9) of registrars had MBI scores suggestive of moderate or severe burnout. Respectively 20.8% (n=9) and 9.2% (n=6) of interns and registrars reported suicidal thoughts in the past year. After statistical analysis, medical errors (OR: 3.4336; 95% CI: 1.7164-6.869; p<0.001) and suicidal ideation (OR: 2.3075; 95% CI: 1.0480-5.081; p=0.038) were associated with severe burnout. Having children (OR: 0.495; 95% CI: 0.2491-0.983; p=0.044) emerged as a protective factor.

DISCUSSION

With a high participation rate, this study reveals a high burnout rate among French pediatric orthopedic interns and registrars, even if slightly lower than those found in other surgical specialties. Interns seem more exposed to this risk than their seniors. The consequences of burnout are diverse but can be significant. These results necessitate a vigilant approach to the occurrence of burnout among health professionals, and the appropriate management of it.

LEVEL OF EVIDENCE

III; descriptive cross-sectional study without a control group.

The influence of perceived stress of Chinese healthcare workers after the opening of COVID-19: the bidirectional mediation between mental health and job burnout

Objective

To explore the current status and interaction of perceived stress, job burnout and mental health among healthcare workers after the opening of COVID-19 which occurred in December 2022.

Methods

A cross-sectional study of 792 healthcare workers from three tertiary hospitals in Wuxi was conducted from January 2023 to February 2023. Sociodemographic questionnaire, Perceived Stress Scale, Burnout Scale and Mental Health Self-Assessment Questionnaire were used for investigation. SPSS 26.0 was used to conduct data analysis. The significance of mediation was determined by the PROCESS macro using a bootstrap method.

Results

The results showed that (1) The average scores of the participants for perceived stress, mental health and job burnout were 22.65 (7.67), 3.85 (4.21) and 1.88 (1.03), respectively. (2) The perceived stress score, mental health score and job burnout score of healthcare workers were positively correlated (r = 0.543-0.699, p < 0.05). (3) Mental health partially mediated the relationship between perceived stress and job burnout with a mediating effect of 17.17% of the total effect. Job burnout partially mediated the correlation between perceived stress and mental health with a mediating effect of 31.73% of the total effect.

Conclusion

The results of this study suggested that perceived stress had an impact on job burnout and mental health, either directly or indirectly. Healthcare managers should intervene to reduce perceived stress to protect healthcare workers' mental health, thereby alleviating burnout under the opening COVID-19 pandemic environment.

Promoting padawans: a survey examining the state of mentorship in neurosurgical training in the United Kingdom

BACKGROUND

Mentorship has long since been acknowledged as an integral part of Neurosurgical training. The authors sought to evaluate the state of mentorship in Neurosurgical training in the United Kingdom (UK).

METHODS

A 28-point questionnaire was sent to all neurosurgical trainees in the UK and Ireland via the British Neurosurgical Trainee's Association (BNTA), comprising 180 trainees.

RESULTS

There were 75 responses (180 trainees on the mailing list, 42% response rate). Despite all respondents reporting it to be at least somewhat important to have a mentor, 16% felt they had no mentors. The mean number of mentors was 2.91 with 72% of respondents having more than 1 mentor. In terms of the content of mentorship relationships, 63% were comfortable discussing career related topics with their mentor to a high or very high degree but only 29% felt comfortable discussing their general wellbeing. With regards to allocated educational supervisors, 43% thought this person to be a 'low' or 'very low' source of mentorship. The three most important traits of the ideal mentor as reported by respondents were: someone chosen by them (48%), working in the same hospital (44%) and having received formal mentorship training (36%).

CONCLUSIONS

The current perception of mentorship in Neurosurgery from the surveyed trainees is mixed. A healthy majority of trainees benefit from mentorship of some kind, whilst a significant minority feel underserved. The surveyed trainees feel mentorship is slanted more towards clinical and professional aspects of development than it is towards personal ones. Suggestions for future insight would be an evaluation of senior registrar and consultant sentiments towards mentorship, whilst exploration into more flexible models for establishing mentoring relationships may help to address the heavy importance of trainee choice which is voiced by this survey's results.

Making the Financial Case for Surgical Resident Well-being: A Scoping Review

OBJECTIVE

To conduct a scoping review of literature on financial implications of surgical resident well-being.

BACKGROUND

Surgeon well-being affects clinical outcomes, patient experience, and health care economics. However, our understanding of the relationship between surgical resident well-being and organizational finances is limited.

METHODS

Authors searched PubMed, Web of Science, and Embase with no date or language restrictions. Searches of the gray literature included hand references of articles selected for data extraction and reviewing conference abstracts from Embase. Two reviewers screened articles for eligibility based on title and abstract then reviewed eligible articles in their entirety. Data were extracted and analyzed using conventional content analysis.

RESULTS

Twenty-five articles were included, 5 (20%) published between 2003 and 2010, 12 (48%) between 2011 and 2018, and 8 (32%) between 2019 and 2021. One (4%) had an aim directly related to the research question, but financial implications were not considered from the institutional perspective. All others explored factors impacting well-being or workplace sequelae of well-being, but the economics of these elements were not the primary focus. Analysis of content surrounding financial considerations of resident well-being revealed 5 categories; however, no articles provided a comprehensive business case for investing in resident well-being from the institutional perspective.

CONCLUSIONS

Although the number of publications identified through the present scoping review is relatively small, the emergence of publications referencing economic issues associated with surgical resident well-being may suggest a growing recognition of this area's importance. This scoping review highlights a gap in the literature, which should be addressed to drive the system-level change needed to improve surgical resident well-being.

Burnout among Residents: Prevalence and Predictors of Depersonalization, Emotional Exhaustion and Professional Unfulfillment among Resident Doctors in Canada

BACKGROUND

Burnout in the medical profession has garnered a lot of attention over recent years. It has been reported across all specialties and all stages of medical education; however, resident doctors in particular are at risk for burnout throughout their years of training. This study was aimed at evaluating the prevalence and correlates of burnout among resident doctors in Alberta.

METHODS

Through a descriptive cross-sectional study design, a self-administered questionnaire was used to gather data from resident doctors at two medical schools in Alberta, Canada. The Maslach Burnout Inventory was used as the assessment tool. Chi-squared and multivariate binary logistic regression analyses were used.

RESULTS

Overall burnout prevalence among residents was 58.2%, and for professional fulfilment index, it was 56.7% for work exhaustion and interpersonal disengagement and 83.5% for lack of professional fulfillment. Working more than 80 h/week (OR = 16.437; 95% CI: 2.059-131.225), being dissatisfied (OR = 22.28; 95% CI: 1.75-283.278) or being neither satisfied nor dissatisfied with a career in medicine (OR = 23.81; 95% CI: 4.89-115.86) were significantly associated with high depersonalization. Dissatisfaction with efficiency and resources (OR = 10.83; CI: 1.66-70.32) or being neither satisfied nor dissatisfied with a career in medicine (OR = 5.14; CI: 1.33-19.94) were significantly associated with high emotional exhaustion. Working more than 80 h/week (OR = 5.36; CI: 1.08-26.42) and somewhat agreeing that the residency program has enough strategies aimed at resident well-being in place (OR = 3.70; CI: 1.10-12.46) were significantly associated factors with high work exhaustion and interpersonal disengagement. A young age of residents (≤30 years) (OR = 0.044; CI: 0.004-0.445) was significantly associated with low professional fulfillment.

CONCLUSION

Burnout is a serious occupational phenomenon that can degenerate into other conditions or disrupt one's professional performance. Significant correlates were associated with high rates of burnout. Leaders of medical schools and policymakers need to acknowledge, design, and implement various strategies capable of providing continuous effective mental health support to improve the psychological health of medical residents across Canada.

Mentoring novice NPs: Recommendations for navigating the transition to autonomous practice

ABSTRACT

The transition to professional practice is a challenging time for the novice NP. Mentorship is an effective strategy to ease this transition and increase success in the role. This article provides recommendations for best practice in mentoring the transitioning novice NP.

Resident Burnout and Well-being in Otolaryngology and Other Surgical Specialties: Strategies for Change

OBJECTIVE

To perform a literature review on burnout prevalence, factors that affect burnout and well-being, and solutions to address burnout in otolaryngology-head and neck surgery (OTO-HNS) residents and residents in other surgical specialties.

DATA SOURCES

Ovid Medline, Embase, and article reference lists.

REVIEW METHODS

A literature search was performed to identify articles on resident burnout, distress, wellness, well-being, and quality of life. Articles deemed outside the scope of the current work were excluded. Search was limited to the past 5 years.

CONCLUSIONS

Moderate to high burnout has been reported in 35% to 86% of OTO-HNS residents. Among other surgical specialties, resident burnout ranges between 58% and 66% in plastics, 11% and 67% in neurosurgery, 38% and 68% in urology, and 31% and 56% in orthopedics. Highest burnout rates were seen in postgraduate year 2 residents. Factors significantly associated with burnout included hours worked (>80 h/wk), level of autonomy, exercise, and program support. Reported resident work hours have steadily increased: 8% of OTO-HNS residents in 2005 vs 26% in 2019 reported averaging >80 h/wk. Practical implications of resident burnout include decreased empathy, moral distress and injury, poor health, decreased quality of life, increased attrition, decreased desire to pursue fellowship, and increased likelihood of medical errors. Structured mentorship programs, wellness initiatives, and increased ancillary support have been associated with lower burnout rates and improvements in resident well-being across specialties.

IMPLICATIONS FOR PRACTICE

Addressing burnout, which is prevalent in OTO-HNS residents, is critical to improving patient care and physician well-being. Surgical specialties can share strategies to effectively address resident burnout through institutional interventions, which can be essential quality improvement initiatives, to promote well-being.

Motivators of becoming and staying a neurosurgeon in the Netherlands: a survey and focus group

OBJECTIVE

The aim of this study was to gain insight in motivators and demotivators of the Dutch neurosurgical residents and neurosurgeons.

METHODS

A mixed method study was conducted. A survey was sent by the Dutch Neurosurgical Society to all Dutch neurosurgeons and residents in the framework of the yearly national quality conference. The focus groups were held during the Dutch national training days for neurosurgical residents. Baseline statistics were made of all survey data. Focus group recordings were transcribed verbatim and open coded in a constant comparative manner.

RESULTS

The survey yielded a response rate of 47.3% of neurosurgeons and 72.5% of residents. 42.5% of residents participated in the focus groups. Overall, motivators according to residents and neurosurgeons were divided between autonomous and controlled motivation. For residents, the motivators to become a neurosurgeon were mostly patient-centered. Neurosurgeons had the same general motivators as residents. Around one-third of neurosurgeons considered ending their career as a neurosurgeon. Among residents, 9.5% considered quitting residency. Neurosurgeons and residents indicated that no time for their family life, increased administrative burden and non-patient-related tasks were reasons to consider leaving the profession. Also, less perceived respect from patients and society was a reason to consider ending their career as a neurosurgeon.

CONCLUSION

Neurosurgeons and residents in neurosurgery are mostly motivated by intrinsic motivators. Factors such as administrative burden, less perceived respect from patients and society, and increase in non-patient-related tasks are large demotivators for both neurosurgeons and residents.

Trends in Surgeon Burnout in the US and Canada: Systematic Review and Meta-Regression Analysis

BACKGROUND

Burnout among surgeons is increasingly recognized as a crisis. However, little is known about changes in burnout prevalence over time. We evaluated temporal trends in burnout among surgeons and surgical trainees of all specialties in the US and Canada.

STUDY DESIGN

We systematically reviewed MEDLINE, Embase, and PsycINFO for studies assessing surgeon burnout from January 1981 through September 2021. Changes in dichotomized Maslach Burnout Inventory scores and mean subscale scores over time were assessed using multivariable random-effects meta-regression.

RESULTS

Of 3,575 studies screened, 103 studies representing 63,587 individuals met inclusion criteria. Publication dates ranged from 1996 through 2021. Overall, 41% of surgeons met criteria for burnout. Trainees were more affected than attending surgeons (46% vs 36%, p = 0.012). Prevalence remained stable over the study period (-4.8% per decade, 95% CI -13.2% to 3.5%). Mean scores for emotional exhaustion declined and depersonalization declined over time (-4.1 per decade, 95% CI -7.4 to -0.8 and -1.4 per decade, 95% CI -3.0 to -0.2). Personal accomplishment scores remained unchanged. A high degree of heterogeneity was noted in all analyses despite adjustment for training status, specialty, practice setting, and study quality.

CONCLUSIONS

Contrary to popular perceptions, we found no evidence of rising surgeon burnout in published literature. Rather, emotional exhaustion and depersonalization may be decreasing. Nonetheless, burnout levels remain unacceptably high, indicating a need for meaningful interventions across training levels and specialties. Future research should be deliberately designed to support longitudinal integration through prospective meta-regression to facilitate monitoring of trends in surgeon burnout.

The neurosurgical marriage: evaluating the interplay of work life and home life from the perspective of partners of neurosurgical residents

OBJECTIVE

Burnout and work-life balance have been noted to be problems for residents across all fields of medicine, including neurosurgery. No studies to date have evaluated how these factors may contribute to issues outside of the hospital, specifically residents' home lives. This study aimed to evaluate the interplay between home life and work life of neurosurgical residents, specifically from the point of view of residents' significant others.

METHODS

Online surveys were distributed to the significant others of neurosurgical residents at 12 US neurosurgery residencies. Residents' partners were asked about relationship dynamics, their views on neurosurgery residency (work-life balance and burnout), and their views of neurosurgery as a career.

RESULTS

The majority of residents' significant others (84%) reported being satisfied with their relationship. Significant others who reported dissatisfaction with their relationship were more likely to report frustration with work-life balance and more likely to report their resident partner as having higher levels of burnout.

CONCLUSIONS

From the perspective of neurosurgery residents' significant others, higher perceived levels of burnout and lower satisfaction with work-life balance are correlated with lower levels of relationship satisfaction. These findings speak to the complex interplay of work life and home life and can be used to inform future interventions into improving the quality of life for both the resident and the significant other.

How We Do It: An Innovative General Surgery Mentoring Program

OBJECTIVE

The taxing nature of surgery residency is well-documented in the literature, with residents demonstrating high rates of burnout, depression, suicidal thoughts, sexual harassment, and racial discrimination. Mentoring has been shown to improve camaraderie, address challenges of underrepresentation in medicine, and be associated with lower burnout. However, existing formal mentoring programs tend to be career-focused and hierarchal without opportunity to discuss important sociocultural issues. An innovative approach is needed to address these cultural and anthropological issues in surgery residencies while creating camaraderie and learning alternative perspectives across different levels of training. We sought to describe the framework we used to fill these needs by creating and implementing a novel mentoring program.

DESIGN

A vertical, near-peer mentoring system of 7 groups was created consisting of the following members: 1 to 2 medical students, a PGY-1 general surgery resident, a PGY-4 research resident, and a faculty member. Meetings occur every 3 to 4 months in a casual setting with the first half of the meeting dedicated to intentional reflection and the second half focused on an evidence-based discussion regarding a specific topic in the context of surgery (i.e., burnout, discrimination, allyship, and finding purpose).

SETTING

Program implementation took place at the University of Michigan in Ann Arbor, MI.

PARTICIPANTS

Medical students, general surgery residents, and general surgery faculty were recruited.

CONCLUSIONS

We have successfully launched the pilot year of a cross-spectrum formal mentoring program in general surgery. This program emphasizes camaraderie throughout training while providing opportunities for evidence-based discussion regarding sociocultural topics. We have included increased opportunities for community inclusivity and mentoring while allowing trainees and faculty members to discuss sensitive topics in a supportive environment. We plan to continue developing the program with robust evaluation and to expand the program to other surgical specialties and to other institutions.

Burnout among surgeons and surgical trainees: A systematic review and meta-analysis of the prevalence and associated factors

Introduction

The more effort is put into work, the greater the chances of burnout. This is common among surgical personnel. We carried out this review study to determine the overall and per-specialty prevalence of burnout, and to identify the factors that affect burnout positively and negatively.

Methods

All full-text articles reporting data related to burnout in surgery and surgical subspecialties using the Maslach Burnout Inventory (MBI) were included. The following bibliographic databases were searched PubMed, Embase and Google Scholar (First 500 pages). We extracted data on the characteristics of the articles including the burnout prevalence and factors.

Results

27 articles met the criteria. The studies involved 8617 surgeons cutting acrossvarious surgical specialties. The overall prevalence was 47%. The rate per specialty ranged between 15% and 77% with Ear, Nose and Throat (ENT) surgeons having the highest rates. Associated factors included work-related issues and poor work/life balance while protective factors included career advancement, increase in postgraduate years, and having good relationships with co-residents. Our findings are similar to findings from other studies; ENT is seen to have the highest burnout rate while pediatric surgery the lowest.

Conclusion

The high prevalence of burnout among surgeons is concerning and the identified factors responsible should be explored by surgeons, hospital management boards, training colleges, and all bodies concerned to see how it can be reduced.

Factors associated with risk of burnout in neurosurgeons: current status and risk factors

Objective

The study aimed to evaluate burnout and associated risk factors in neurosurgical residents and faculty members.

Summary of background data

Burnout is an occupational risk of emotional exhaustion, depersonalization, and reduced perception of personal accomplishment secondary to work stress. It burdens the individual with immense mental stress causing compromised professional performance. Healthcare workers, particularly surgeons, have been documented to be at high risk of developing burnout, considering the stressful routine and serious impact of their profession.

Methods

The modified Maslach Burnout Inventory was filled by fellow neurosurgical residents or consultants. The respondents were classified into burnout and non-burnout groups and then analyzed for the associated risk factors. The data were analyzed using SPSS v26.

Results

One hundred and thirty-eight neurosurgical healthcare workers, including 62 residents and 76 consultants, responded to the questionnaire. The burnout and non-burnout groups comprised 83 (60%) and 55 (39.9%) respondents. Female gender and few kids were observed as significant risk factors for the development of burnout (p  =  0.013 and p  = 0.006, respectively). Regardless of its year, residency was a risk factor for overall burnout, as well as in each subsection of the Maslach Inventory (p  =  0.002). In consultants, recent qualifications and a high number of weekly calls were also associated with a significant risk of burnout (p =  0.012 and p  =  0 .027, respectively). Marital status and national economic status did not reveal any influence on the status of burnout in neurosurgical healthcare workers.

Conclusion

Burnout syndrome is a prevalent and serious, yet overlooked, condition among neurosurgeons. Adequate assessment and steps should be encouraged to ensure physician and patient safety.

Factors Associated with Burnout among Resident Physicians Responding to the COVID-19 Pandemic: A 2-Month Longitudinal Observation Study

BACKGROUND

Burnout during residency may be a function of intense professional demands and poor work/life balance. With the onset of the COVID-19 pandemic, NYC hospital systems were quickly overwhelmed, and trainees were required to perform beyond the usual clinical duties with less supervision and limited education.

OBJECTIVE

The present longitudinal study examined the effects of COVID-19 caseload over time on burnout experienced by resident physicians and explored the effects of demographic characteristics and organizational and personal factors as predictors of burnout severity.

METHODS

This study employed a prospective design with repeated measurements from April 2020 to June 2020. Participants were surveyed about their well-being every 5 days. Predictors included caseload, sociodemographic variables, self-efficacy, hospital support, perceived professional development, meaning in work, and postgraduate training level.

RESULTS

In total, 54 resident physicians were recruited, of whom 50% reported burnout on initial assessment. Periods of higher caseload were associated with higher burnout. PGY-3 residents reported more burnout initially but appeared to recover faster compared to PGY-1 residents. Examined individually, higher self-efficacy, professional development, meaningful work, and hospital support were associated with lower burnout. When all four predictors were entered simultaneously, only self-efficacy was associated with burnout. However, professional development, meaningful work, and hospital support were associated with self-efficacy.

CONCLUSION

Burnout among residency is prevalent and may have implications for burnout during later stages of a physician's career. Self-efficacy is associated with lower burnout and interventions to increase self-efficacy and the interpersonal factors that promote self-efficacy may improve physician physical and emotional well-being.

A mentorship model for neurosurgical training: the Mayo Clinic experience

Neurosurgical education is a continually developing field with an aim of training competent and compassionate surgeons who can care for the needs of their patients. The Mayo Clinic utilizes a unique mentorship model for neurosurgical training. In this paper, the authors detail the historical roots as well as the logistical and experiential characteristics of this teaching model.

This model was first established in the late 1890s by the Mayo brothers and then adopted by the Mayo Clinic Department of Neurological Surgery at its inception in 1919. It has since been implemented enterprise-wide at the Minnesota, Florida, and Arizona residency programs. The mentorship model is focused on honing resident skills through individualized attention and guidance from an attending physician. Each resident is closely mentored by a consultant during a 2- or 3-month rotation, which allows for exposure to more complex cases early in their training.

In this model, residents take ownership of their patients’ care, following them longitudinally during their hospital course with guided oversight from their mentors. During the chief year, residents have their own clinic, operating room (OR) schedule, and OR team and service nurse. In this model, chief residents conduct themselves more in the manner of an attending physician than a trainee but continue to have oversight from staff to provide a “safety net.” The longitudinal care of patients provided by the residents under the mentorship model is not only beneficial for the trainee and the hospital, but also has a positive impact on patient satisfaction and safety. The Mayo Clinic Mentorship Model is one of many educational models that has demonstrated itself to be an excellent approach for resident education.

Determinants of satisfaction and self-perceived proficiency of trainees in surgical residency programs at a single institution

BACKGROUND

We aimed to identify factors contributing to training program satisfaction and self-perceived proficiency of residents in 5 integrated surgical residency programs within the same referral institution.

METHODS

We conducted a cross-sectional survey including all senior surgical residents in all integrated sub-specialty and general surgery residency programs at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. Training programs were assessed on 6 educational components including operative case volume and diversity, intra-operative hands-on training, morning teaching sessions, seminars, ward rounds, and research opportunities.

RESULTS

Of 82 eligible residents, 69 (84.1%) responded to the survey. Overall resident satisfaction (rated from 0-10) varied between the 5 training programs, from a mean of 6.03 to 7.89 (overall p = 0.03). The percentage of residents who agreed they would be proficient by the end of their training ranged from 44.2%-88.9%. General surgery residents had the lowest overall satisfaction score, and lowest scores in all educational components except seminar teaching. In multivariable analysis, operative case volume and diversity (AOR 3.67; 95% CI, 1.24-10.83; P = 0.019), and hands-on training (AOR 4.15; 95% CI, 1.27-13.5; P = 0.018) were significantly associated with overall resident satisfaction. In ordinal logistic regression, hands-on training (OR 3.94, 95% CI, 1.69-9.2; P = 0.001), and seminar sessions (OR 2.43, 95% CI, 1.11-5.33; P = 0.028) were significantly associated with self-perceived proficiency.

CONCLUSION

Different surgical residency training programs within the same institution had divergent resident satisfaction scores and proficiency scores. Operative case volume and diversity, and intraoperative hands-on training are the most important predictors of resident satisfaction while hands-on training and seminar sessions independently predicted self-perceived proficiency. Attention to these key components of resident education is likely to have a strong effect on training outcomes.

A career in neurosurgery: perceptions and the impact of a national SBNS/NANSIG neurosurgery careers day

OBJECTIVE

Entrance to neurosurgical training is highly competitive. Without proper advice, information and opportunities, talented individuals may be dissuaded from applying. The Neurology and Neurosurgery Interest Group (NANSIG) organises a Careers Day in Neurosurgery every year. Our objective was to assess the overall utility of a neurosurgery careers day and the perceived factors that attract and detract from the specialty, from attendees of the ninth annual neurosurgery careers day.

METHODS

Eighteen-item pre-conference and 19-item post-conference questionnaires were disseminated electronically to conference attendees. Questions aimed to capture: (i) baseline demographics; (ii) previous experience and exposure in neurosurgery; (iii) interest in neurosurgery; (iv) understanding training and a career in neurosurgery; (v) perceived factors of attraction and dissuasion of neurosurgery; and (vi) perceived value, quality and educational purpose of the conference.

RESULTS

In total, 77 delegates attended the careers day. Most did not have a formal neurosurgical rotation during medical school (24.7%, n = 19), but almost half had gained neurosurgical experience and presented research work. The careers day increased knowledge of the neurosurgical application process (median Likert score 3/5 to 4/5, p < 0.01), duration of training (72.7-88.3%), and desire to pursue a career in neurosurgery (75.3-81.8%). The most commonly reported factors attracting delegates to neurosurgery were interest in neuroanatomy (80.5%, n = 62), practical skills (64.9%, n = 50), and impact on patients (62.3%, n = 48). The most common dissuasive factors were competition to entry (64.9%, n = 50), long working hours (40.3%, n = 31), and other career interests (35.1%, n = 27). Almost all would recommend the event to a colleague (94.9%, n = 73).

CONCLUSIONS

Formal undergraduate exposure to neurosurgery is limited. Neurosurgery careers days increase awareness and understanding of the application process and improve interest in a selected cohort. The factors attracting applicants to neurosurgery remain practical links to neuroanatomy, opportunities in neurosurgery for innovation and research, and direct impact on patients.

Burnout and Associated Factors among Hospital-Based Nurses in Northern Uganda: A Cross-Sectional Survey

Background

Burnout is a public health problem that disproportionately affects nurses in sub-Saharan Africa because of the weak health systems that create an unconducive workplace environment. In Uganda, there is limited evidence on the burden of burnout among nurses in a manner that undermine advocacy and policy formulation. We aimed to assess the level of burnout and associated factors among nurses in northern Uganda.

Methods

This was a cross-sectional survey conducted among 375 randomly selected nurses from health facilities in northern Uganda. Data were collected using a self-administered questionnaire. Data analysis consisted of descriptive statistics and logistic regression at a 95% level of significance in SPSS version 25.

Results

Majority of the respondents were female 56.5% (n = 223). Nearly half, 49.1% (n = 194) of respondents had high levels of burnout, 36.2% (n = 143) reported average levels of burnout, and 14.7% (n = 58) reported low levels of burnout. Factors associated with burnout were age (AOR: 2.90; 95% CI: 1.28-6.58; p = 0.011), social support (AOR: 0.45; 95% CI: 0.22-0.94; p = 0.033), healthy eating (AOR: 0.06; 95% CI: 0.02-0.22; p < 0.001), workload (AOR: 0.31; 95% CI: 0.14-0.68; p = 0.004), and management responsibilities (AOR: 3.07; 95% CI: 1.54-6.12; p = 0.001).

Conclusion

Half of the nurses in northern Uganda experienced high levels of burnout. The Ministry of Health should consider recruiting more nurses to reduce workload and adjust working hours to prevent workplace-related burnout among nurses in the country.

Burnout, Discrimination, Abuse and Mistreatment in Latin America Neurosurgical Training During the COVID-19 Pandemic

BACKGROUND

Discrimination, abuse and mistreatment are prevailing problems reported in neurosurgical-training programs globally. Moreover, the current COVID-19-pandemic may also display a negative impact on burnout levels in neurosurgery-residents. This study aims to evaluate burnout, discrimination and mistreatment in neurosurgical-residents training in Latin-America during the SARS-CoV-2 era.

METHODS

A 33-item electronic survey was sent to neurosurgery-residents from Latin-America from May-10 to May-25, 2021. Statistical analysis was made using IBM-SPSS-25.

RESULTS

111 neurosurgery residents responded the survey. Mean age was 29.39±2.37 years; 22.5% were female and 36% were training in Mexico. Residents who reported suffering from discrimination for testing positive to COVID-19 had the highest levels of depersonalization (66.7%, p=0.043) and emotional-exhaustion (75%, p= 0.023). Female respondents presented higher rates of gender discrimination (80%vs.1.2%, p=0.001), abuse (84%vs.58.1%, p<0.005) and sexual-harassment (24%vs.0%, p<0.001) than male respondents. Residents training in Mexico presented lower rates of emotional or verbal abuse (59.2%vs.32.5%, p=0.007) and bullying (p<0.005) than other countries in Latin-America. Older-age was a protective factor for high depersonalization scores (OR 0.133, 95%CI 0.035-0.500). Suffering from discrimination represented a risk factor for presenting high emotional-exhaustion scores (OR 3.019, 95%CI 1.057-8.629). High levels of depersonalization were associated with a 7-fold increased risk of presenting suicidal ideation (OR 7.869, 95%CI 1.266-48.88).

CONCLUSION

The COVID-19 pandemic has been a significant burden on several aspects of healthcare workers' lives. Our results provide a broad overview of its impact on burnout, discrimination and mistreatment as experienced by neurosurgery residents training in Latin-America, laying the groundwork for future studies and potential interventions.

ACGME 2011 Duty Hours Restrictions and Their Effects on Surgical Residency Training and Patients Outcomes: A Systematic Review

OBJECTIVE

The ACGME instituted the 2011 residency duty-hour restrictions (DHR) to increase resident well-being and patient safety. However, its eventual remodeling came after patient care was deemed unaffected. We aimed to identify the effects of the ACGME 2011-DHR on (1) patient outcomes, (2) surgical resident case volume, and (3) surgical resident quality of life.

DESIGN

Literature search using Google Scholar, PubMed, Cochrane, and Embase for publications between 2010 and 2020, on the 2011-DHR effects on resident and patient outcomes. Studies containing the number of cases performed during training, quality of life, and surgical patients' outcomes were included.

RESULTS

Fifteen studies met inclusion criteria. There was no difference in complication rates for surgical patients post 2011-DHR (p = 0.561). 2011-DHR caused surgical caseload shifts from interns to senior residents reflected by decreased operative cases for interns (p = 0.005) with significantly more total cases performed by chief residents (p = 0.0006). Pre-2011-DHR had more work flexibility that led to higher resident well-being (p = 0.01). Only 25% of residents approved of the 2011-DHR while 87% felt these restrictions would have adverse effects.

CONCLUSION

Current literature supports that the 2011-DHR did not improve patient outcomes, decreased surgical experience for junior residents and shifted clinical responsibilities to senior residents. System wide regulations such as the 2011-DHR may unintentionally create professional and personal life imbalance and introduce stress over resident inability to perform clinical responsibilities. Future systemic interventions to address resident well-being should be made with caution and not solely limited to the number of hours they work in a single week or in a single shift.

Patterns of prophylactic anticonvulsant use in spontaneous intracerebral and subarachnoid hemorrhage: results of a practitioner survey

BACKGROUND

The use of prophylactic anti-seizure medications (ASMs) in the management of patients with spontaneous intracerebral hemorrhage (sICH) and aneurysmal subarachnoid hemorrhage (aSAH) is controversial.

OBJECTIVE

The purpose of this survey was to better characterize the current state of prophylactic ASM use in sICH and aSAH in North America.

METHODS

US and Canadian neurosurgeons, neurologists, and interventional neuroradiologists with an interest in or expertise in the management of neurovascular disease were surveyed using an electronic survey tool.

RESULTS

Seven hundred ninety-four survey requests were sent; responses were received from 103 (13%). The majority of respondents were neurosurgeons (84%). Thirty-eight percent of respondents self-identified as vascular neurosurgeons and 10% self-identified as neurocritical care specialists. Seventy-two percent were in academic practice. When asked their preference for ASM prophylaxis (aSAH, sICH, or both), the most common response was to use prophylaxis in both aSAH and sICH (43, 45%). Twenty-one (22%) did not use routine prophylaxis, while 22 (23%) used prophylaxis only in aSAH and 9 (9%) only in sICH. The majority of practitioners (35, 67%) who answered that they used ASM prophylaxis in sICH, used ASMs selectively. For aSAH, the vast majority (53, 82%) used prophylaxis for all patients. Respondents felt that they were more likely to use ASMs for sICH patients if the sICH was in a cortical location, supratentorial location, or was related to a structural abnormality (e.g., tumor, arteriovenous malformation) Levetiracetam (Keppra) was the most commonly used ASM (73, 99%). When asked whether the statement "Current AHA/ASA Guidelines recommend against the use of prophylactic anticonvulsants in spontaneous ICH" was true or false, 78 (83%) responded correctly that the recommendation is true. Only 24 respondents answered the question as to whether they would be willing to randomize sICH and/or aSAH patients to management with or without ASM prophylaxis. Of these, 13 (54%) said they would be willing to randomize sICH patients, while only 6 (25%) were willing to randomize aSAH patients. There were no statistically significant differences in responses to survey questions when analyzed by practice type (academic versus non-academic) or physician specialty (critical care versus non-critical care, or vascular neurology/neurosurgery versus other).

CONCLUSION

The use of ASMs for seizure prophylaxis after sICH and aSAH remains widespread despite the lack of any specific evidence-based guideline to support the practice. A large-scale randomized controlled trial is needed to add clarity to the practice of prophylactic ASM use in patients with spontaneous intracranial hemorrhage.

Burnout amongst neurosurgical trainees in the UK and Ireland

INTRODUCTION

Burnout is becoming an increasingly recognised phenomenon within the medical profession. This study aims to investigate the presence of burnout amongst neurosurgical trainees in the UK and Ireland as well as investigating potential exacerbating and protective factors.

METHOD

An online survey was sent to all neurosurgical trainees in the UK and Ireland via the British Neurosurgical Trainees' Association (BNTA) mailing list. Responding participants anonymously completed the Copenhagen Burnout Inventory (CBI) and answered questions about known risk factors for burnout including workplace environment, workplace bullying, time spent on leisure activities and sleep and reported likelihood of leaving neurosurgery. We also collated data on responders' demographics. We compared CBI scores for participants with and without risk factors to determine correlation with CBI.

RESULTS

There were 75 respondents (response rate 42%) from a range of ages and all training grades, 72% of whom were male. The median CBI score was 38.85 (IQR 17.76). Participants showed a higher degree of personal and workplace burnout (median CBIs of 47.02, IQR 25.00; and 49.14, IQR 19.64, respectively) compared with patient-related burnout (median CBI 18.67, IQR 25.00). Participants with the following self-reported risk factors were significantly more likely to have higher CBIs: workplace bullying (p = 0.01), getting on less well with colleagues (p < 0.05), working longer hours (p < 0.05) and insufficient sleep, exercise and leisure time (all p < 0.01). Those with higher CBI scores were more likely to consider leaving neurosurgical training (p = 0.01).

CONCLUSION

We identified a high burnout incidence in a cohort representative of UK neurosurgical trainees, although our results may have been skewed somewhat by selection bias. We determined potential risk factors for burnout related to specific workplace stressors and time for non-work activities. In the future, changes to training curricula should address these issues, aiming to improve training, enhance patient care and reduce attrition rates.

Assessment of burnout prevention and wellness programs for US-based neurosurgical faculty and residents: a systematic review of the literature

OBJECTIVE

Neurosurgeon burnout is a serious and prevalent issue that has been shown to impact professionalism, physician health, and patient outcomes. Interventions targeting physician burnout primarily focus on improving physician wellness. Many academic neurosurgery programs have established wellness curricula to combat burnout and improve wellness. No official recommendations exist for establishing a wellness program that effectively targets sources of burnout. The aim of this review was to examine measures of burnout and report objective results of wellness interventions for neurosurgical faculty and residents.

METHODS

Two systematic literature reviews were performed in parallel, in accordance with PRISMA 2009 guidelines. Following removal of duplicates, a query of PubMed/MEDLINE, Scopus, Ovid, Cochrane, and EMBASE databases yielded 134 resident-related articles and 208 faculty-related articles for abstract screening. After abstract screening, 17 articles with a primary focus of resident wellness and 10 with a focus on faculty wellness met criteria for full-text screening. Of the total 27 screened articles, 9 (6 resident, 2 faculty, 1 both resident and faculty) met criteria and were included in the final analysis. Article quality was assessed using the Joanna Briggs Institute critical appraisal tools for cohort studies.

RESULTS

Included studies reported burnout rates for neurosurgery residents of 30%-67%. Work-life imbalance, imbalance of duties, inadequate operative exposure, and hostile faculty were contributors to burnout. The 2 included studies reported burnout rates for neurosurgery faculty members of 27% and 56.7%. Psychosocial stressors, relational stressors, and financial uncertainty were generally associated with increased feelings of burnout. Of the 4 studies reporting on outcomes of wellness initiatives included in this review, 3 reported a positive impact of the wellness interventions and 1 study reported no significant improvement after implementing a wellness initiative.

CONCLUSIONS

Burnout among neurosurgical faculty and residents is prevalent and permeates the daily lives of neurosurgeons, negatively affecting patient outcomes, career satisfaction, and quality of life. Many neurosurgery programs have instituted wellness programs to combat burnout, but few have published evidence of improvement after implementation. While studies have shown that residents and faculty recognize the importance of wellness and look favorably on such initiatives, very few studies have reported objective outcomes.

'Every patient is like my child': pediatric neurosurgeons' relational and emotional bonds with their patients and families

PURPOSE

To explore the relational and emotional components of the surgeon-patient relationship from the perspective of practicing pediatric neurosurgeons in the field.

MATERIALS AND METHODS

The study utilized the Grounded Theory Method of data collection and analysis. 26 pediatric neurosurgeons from 12 countries were interviewed using video-conferencing technology.

RESULTS

Pediatric neurosurgeons find meaning, joy and pleasure in the relationships they form with their patients and their families, while also experiencing difficult and painful emotions when these patients do not do well. Four themes emerged from the analysis that include having a relational attachment to patients, forming bonds with the parents/caregivers of these patients, dealing with patient suffering, death and complications, and communicating bad news to parents.

CONCLUSIONS

Pediatric neurosurgeons develop deep and enduring bonds with their patients and their families. These relationships are an integral part of what brings meaning and joy to their work, and simultaneously, are one of the most significant emotional challenges of their careers. . Training neurosurgical fellows should include pedagogical modules about the relational and emotional dimensions of their work, with a specific and dedicated focus on communicating bad news.

Residents' Perceptions of Faculty Behaviors and Resident Burnout: a Cross-Sectional Survey Study Across a Large Health Care Organization

BACKGROUND

Data suggests the learning environment factors influence resident well-being. The authors conducted an assessment of how residents' perceptions of faculty-resident relationships, faculty professional behaviors, and afforded autonomy related to resident burnout.

METHODS

All residents at one organization were surveyed in 2019 using two items from the Maslach Burnout Inventory and the faculty relationship subscale of the Johns Hopkins Learning Environment Scale (JHLES, range 6 to 30). Residents were also asked about faculty professional behaviors (range 0 to 30), and satisfaction with autonomy across various clinical settings.

RESULTS

A total of 762/1146 (66.5%) residents responded to the survey. After adjusting for age, gender, postgraduate year, and specialty, lower (less favorable) JHLES-faculty relationship subscale score (parameter estimate, - 3.08, 95% CI - 3.75, - 2.41, p < 0.0001), fewer observed faculty professional behaviors (parameter estimate, - 3.34, 95% CI - 4.02, - 2.67, p < 0.0001), and lower odds of satisfaction with autonomy in the intensive care settings (OR 0.46, 95% CI 0.30, 0.70, p = 0.001), but not other care settings, were reported by residents with burnout in comparison to those without. Similar relationships were observed when emotional exhaustion and depersonalization were analyzed separately as continuous variables.

CONCLUSION

In this cohort, resident perceptions of faculty relationships, faculty professional behaviors, and satisfaction with autonomy in the intensive care unit were associated with resident burnout. Additional longitudinal studies are needed to elucidate the direction of these relationships and determine if faculty development can reduce resident burnout.

COVID-19 Impact Among Spine Surgeons in Latin America

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

The aim of this study was to evaluate the impact of the COVID-19 outbreak in spine surgeons in Latin America.

METHODS

A questionnaire was sent to Latin American spine surgeons from April 4 to 6, 2020. Surgeon characteristics were recorded. The impact of COVID-19 on economic well-being, work, and mental health were also determined. All variables were compared and analyzed.

RESULTS

Two hundred four surgeons answered the complete survey; most of them were male (96.6%), the average age was 47.7 years; 58.8% (n = 120) were orthopedic surgeons and 41.2% (n = 84) were neurosurgeons. The majority of the respondents were from Argentina (59.8%, n = 122), followed by Brazil (17.2%, n = 35), Chile (6.4%, n = 13), and Mexico (5.9%, n = 12). Most of the surgeons reported performing emergency procedures only during the pandemic (76.5%, n = 156). Half used telemedicine or online consultation modalities (54.4%, n = 111). The average concern about the financial situation due to the pandemic was 7.53 in a scale of 1 to 10 (10 being the worst scenario). Twenty-two percent (n = 45) of the surgeons had a score over 10 in the Patient Health Questionnaire (PHQ-9; scores higher than 10 needs referral to confirm depression diagnosis). Young age and neurosurgery as a specialty were associated with higher PHQ-9 scores.

CONCLUSIONS

COVID-19 has an impact in the daily working practice and financial situation of spine surgeons in Latin America. The long-term psychological impact should be taken into consideration to avoid a heavier burden for health care providers.

A Scoping Review of Burnout in Neurosurgery

BACKGROUND

Burnout is a negative workplace syndrome of emotional exhaustion, cynicism, and perceived professional inefficacy that risks the patient-provider relationship, patient care, and physician well-being.

OBJECTIVE

To assimilate the neurosurgical burnout literature in order to classify burnout among domestic and international neurosurgeons and trainees, identify contributory factors, and appraise the impact of wellness programs.

METHODS

A scoping review identified the available literature, which was reviewed for key factors related to burnout among neurosurgeons. Two researchers queried PubMed, Embase, Google Scholar, Cochrane, and Web of Science for articles on burnout in neurosurgery and reduced 1610 results to 32 articles.

RESULTS

A total of 32 studies examined burnout in neurosurgery. A total of 26 studies examined prevalence and 8 studies detailed impact of wellness programs. All were published after 2011. Burnout prevalence was measured mostly through the Maslach Burnout Inventory (n = 21). In 4 studies, participants defined their own understanding of "burnout." Domestically, burnout prevalence was 11.2% to 67% among residents and 15% to 57% among attendings. Among trainees, poor operative experience, poor faculty relationships, and social stressors were burnout risks but not age, sex, or marital status. Among attendings, the literature identified financial or legal concerns, lack of intellectual stimulation, and poor work-life balance as risks. The impact of wellness programs on trainees is unclear but group exercises may offer the most benefit.

CONCLUSION

Noticeable methodological differences in studies on trainee and attending burnout contribute to a wide range of neurosurgery burnout estimates and yield significant knowledge gaps. Environment may have greater impact on trainee burnout than demographics. Wellness programs should emphasize solidarity.

Hemodialysis nurse burnout in 31 provinces in mainland China: A cross-sectional survey

INTRODUCTION

Job burnout is an occupational psychological syndrome with a high prevalence among nurses in China. Hemodialysis (HD) nursing work has the characteristics of high intensity, high technical content, and high risk. The aims of this study were to investigate the prevalence and level of job burnout among HD nurses in China and explore the potential factors associated with burnout among HD nurses.

METHODS

This was a cross-sectional study in 2019. Survey data were collected from 2738 HD centers in mainland China. Job burnout was measured by the Chinese version of the Maslach Burnout Inventory. The working atmosphere, interpersonal relationships with colleagues, and intention to leave were each assessed by a single question respectively. Multiple linear regression and structural equation modeling were used for the analysis.

FINDINGS

A total of 10,570 surveys were collected. A total of 1199 (11.34%) HD nurses reported a high level of emotional exhaustion, 782 (7.40%) reported a high level of depersonalization, and 6767 (64.02%) reported a low level of personal accomplishment. Job burnout in the Northeastern region of mainland China was higher than that in other regions (p < 0.05). The working atmosphere, interpersonal relationships, region, hospital level, educational level, career planning, age, and number of children were significantly associated with burnout among HD nurses (p < 0.001, adjusted R2 = 0.313). The working environment, individual factors, and specialist nurse training were significantly associated with HD nurse burnout and intention to leave (comparative fit index = 0.907; goodness of fit index = 0.930; root mean square error of approximation = 0.055).

DISCUSSION

There were notable regional differences in the burnout of HD nurses. This study contributes to the knowledge of the possible relationship of job burnout and intention to leave in HD nurses. It is suggested that improving the working atmosphere or interpersonal relationships and providing more training opportunities can alleviate job burnout in HD nurses.

Optimizing Surgeon Well-Being: A Review and Synthesis of Best Practices

Through a systematic review and mixed-methods meta-synthesis of the existing literature on surgeon well-being, we sought to identify the specific elements of surgeon well-being, examine factors associated with suboptimal well-being, and highlight opportunities to promote well-being.

Background

Suboptimal surgeon well-being has lasting and substantial impacts to the individual surgeon, patients, and to society as a whole. However, most of the existing literature focuses on only 1 aspect of well-being-burnout. While undoubtedly a crucial component of overall well-being, the mere absence of burnout does not fully consider the complexities of being a surgeon.

Methods

We performed a literature search within Ovid Medline, Elsevier Excerpta Medica dataBASE, EBSCOhost Cumulative Index to Nursing and Allied Health Literature, and Clarivate Web of Science from inception to May 7, 2020, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies with primary data examining surgeon well-being were included. Using a predetermined instrument, data were abstracted from each study and compared using thematic analysis.

Results

A total of 5369 abstracts were identified and screened, with 184 full articles (172 quantitative, 3 qualitative, 9 mixed methods) selected for analysis. Among these, 91 articles measured burnout, 82 examined career satisfaction, 95 examined work-related stressors, 44 explored relationships and families, and 85 assessed emotional and physical health. Thematic analysis revealed 4 themes: professional components, personal components, work-life balance, and impacts to well-being.

Conclusions

Surgeon well-being is complex and multifaceted. This nuanced examination of surgeon well-being highlights the critical need to develop and provide more long-term support to surgeons-with interventions being tailored based on individual, institutional, and systemic factors.