Improving and Expanding Research on Burnout and Stress in the Academy

Scoping Review of Programmatic Well-Being Interventions and Outcomes to Support Pharmacy Students

OBJECTIVES

Recent literature highlights various well-being initiatives implemented across pharmacy programs; however, there is much heterogeneity in their implementation and limited studies assessing the impact and success of these initiatives on pharmacy students' well-being. The purpose of this scoping review was to identify the effectiveness of strategies implemented by pharmacy schools to improve the well-being of pharmacy students.

FINDINGS

In total, 23 studies were included, and well-being strategies were categorized into 3 groups: organizational wellness programs, curriculum design and educational course activities, and specific relaxation or meditation activities. Strategies included yoga meditation, structured mindfulness courses, and self-directed mindfulness with digital smartphone applications. The majority of studies assessed outcomes of stress, burnout, and mindfulness, though other well-being domains such as resilience and belonging emerged. Some also assessed perceptions and acceptability of the interventions through qualitative approaches.

SUMMARY

Despite the heterogeneity of interventions and outcome measures, this review provides a comprehensive scope of well-being domains, assessment tools, interventions, and approaches targeted at pharmacy students and highlights the strongest evidence for interventions on reducing stress. Pharmacy programs can benefit from approaches at both the organization level and those fostering individual accountability by exposing students to a variety of self-help well-being strategies that develop protective factors and motivate them to sustain well-being practices themselves as a shared approach. This scoping review addresses a critical gap by gaining an understanding of the current landscape of well-being initiatives and their effectiveness to better guide pharmacy programs on strategies that are most likely to improve student well-being.

Longitudinal Assessment of Empathy and Burnout Across a Single Pharmacy Class Cohort

OBJECTIVE

This is a final analysis of longitudinal evaluation of burnout and empathy among a cohort of Doctor of Pharmacy students throughout their 4-year enrollment.

METHODS

The class of 2021 received sequential Qualtrics (Qualtrics, Provo, UT) surveys containing 2 validated survey instruments, the Jefferson Scale of Empathy and the Maslach Burnout Inventory. Surveys were disseminated at the start of the program (PY1start) and the end of each academic year (PY1end, PY2, PY3, PY4). Linear mixed models accounting for repeated measures, Generalized Estimating Equation, and Cochran's Q statistic were used to evaluate longitudinal change in the Jefferson Scale of Empathy and Maslach Burnout Inventory survey scores, categorized subscales, and burnout.

RESULTS

Matched survey responses were included for 91 students (85.8% response rate). Across all years, a decrease in empathy and professional efficacy and an increase in exhaustion and cynicism was seen. High categorical levels of exhaustion and cynicism indicated evidence of burnout throughout the program. Year-to-year analysis indicated statistically significant increases in exhaustion and cynicism between PY1start and all subsequent assessments, a decrease in professional efficacy from PY1start to PY1end and PY2, and a decrease in empathy for PY1start to PY1end.

CONCLUSION

Students reported trends of decreasing empathy and professional efficacy, with a simultaneous increase in exhaustion and cynicism. Further evaluation of the impact of COVID-19 on these results, as well as additional methods to support overall student wellness, is needed.

Evaluation of Student Peer- and Self-Grading in an Integrated Pharmacotherapy Course

OBJECTIVE

To determine if student peer- and self-grades correlate with faculty grades on case vignettes.

METHODS

This study involved first professional-year students enrolled in an Integrated Pharmacotherapy course. The course included three modified team-based learning (TBL) activities (each consisting of individual and team readiness assurance tests, followed by three open-note case vignettes completed in teams). Each student uploaded completed case vignettes to the learning management system and was assigned to complete a self- and a random, anonymous peer-grade using a provided key. Peer- and self-grades were compared to faculty grades using a null multilevel model to determine the intraclass correlation coefficient (ICC). Faculty time spent grading was captured, and students were surveyed to determine the perceived value of peer- and self-grading.

RESULTS

Faculty- and peer-grades had a slightly higher correlation than faculty- and self-grades (ICC = 0.75 vs 0.73, respectively). The ICC between all three grader groups was 0.74. Faculty spent an average of 2.5 h grading the cases after each TBL session. Students reported spending a median of 36 min on the peer- and self-grades for each TBL session. Overall, students agreed that both the self- and peer-grading activities helped identify gaps in knowledge (90% and 56%, respectively). A total of 78% of students agreed that self-grading was beneficial for their learning.

CONCLUSION

There was a moderate-to-good correlation between peer-, self-, and faculty- grades for case vignettes. Faculty time may be saved through student self- or peer-grading.

Moral Distress and Moral Injury in Pharmacy and Why the Academy Needs to Care

Pharmacists and other pharmacy personnel are experiencing job stress and burnout, and in some instances, suicidal ideation and death by suicide. However, the described lived experiences of pharmacists and other pharmacy personnel are not defined by burnout. Thus, consideration of and research about whether pharmacy personnel are possibly experiencing moral distress or moral injury is necessary and urgent. The pharmacy academy is served by considering workplace conditions and lived experiences of pharmacists because of the potential, negative impact on prospective student recruitment, quality of experiential sites and preceptors, sites for clinical faculty placement, and the well-being of alumni. Understanding phenomena occurring for pharmacy personnel and determining how they impact the pharmacy academy can lend itself to the future development of solutions.

Burnout in healthcare - the Emperor's New Clothes

Burnout is common among physicians; it severely alters their health and has a negative impact on functioning of healthcare systems. Hypertension, increased cortisol levels, maladaptive behaviors with negative social consequences, and suboptimal quality of care have been associated with healthcare providers' burnout. As the number of patients with cancers, psychiatric and neurodegenerative disorders will rise, we need new solutions to maintain physicians' health and, therefore, quality of care. Coping strategies before the COVID-19 pandemic seem ineffective in scaling all the deficits of the global healthcare systems. Examples of new initiatives include new collaborative projects, such as COH-FIT (The Collaborative Outcomes study on Health and Functioning during Infection Times - https://www.coh-fit.com), which aims to collect global data and understand the impact of the COVID-19 pandemic on physical and mental health in order to identify various coping strategies for patients and healthcare workers during infection times, or MEMO (Minimizing Error, Maximizing Outcome), funded by the Agency of Healthcare Research and Quality (AHRQ). Others: i) Rome Foundation GastroPsych undertake efforts dedicated to the science and practice of psychogastroenterology, a burgeoning field with roots in behavioral intervention, cognitive science and experimental psychology focused on fostering the professional growth and collaboration of those engaged in medical practices, or ii) World Gastroenterology Organisation (WGO), Train The Trainers (TTT) program including a new topic of the impact of burnout on career longevity in order to foster strategies for staying healthy and increasing career satisfaction. There is a need for continuous development of digital technologies (e.g. training simulators, telemedicine, robots and artificial intelligence). Their implementation into medical practice is inevitable. Now more than ever, there is a need for a new spirit in healthcare. Together with others in the field, we believe this article is a desperate call for maximizing the use of novel technologies supported by collaborative interactions among healthcare providers and medical professionals of diverse medical fields.