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Alwatban L, Alageel MS, Alshehri LA, Alfehaid NS, Albahlal RA, Almazrou NH, Almubarak R. The Stigma of Burnout Impeding Formal Help: A Qualitative Study Exploring Residents' Experiences During Training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:333-342. [PMID: 38646001 PMCID: PMC11032676 DOI: 10.2147/amep.s453564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/02/2024] [Indexed: 04/23/2024]
Abstract
Purpose Burnout is an occupational stress syndrome that gives rise to emotional exhaustion (EE) depersonalization (DP) and reduced personal accomplishment (PA). Increasing rates of burnout among health care professionals has been reported globally. Saudi Arabia appears to be among the highest in prevalence with reports of higher than 70%. Medical residents in training are the highest group at risk. The literature has repeatedly linked burnout among residents with poor academic performance on training exams, impaired quality of life, career choice regret and intentions to abandon medicine. In this study, we explore the factors that contribute to resident burnout, their experiences with burnout and how they choose to mitigate it. Methods A qualitative design was used to conduct this study in the city of Riyadh, Saudi Arabia. A total of 14 residents from surgical and non-surgical programs were interviewed through in-depth interviews. Interpretive thematic analysis was used in coding and generated coding templates. Categories were repetitively reviewed and revised, expanding to include new data as it emerged and collapsing to remove redundant codes. Categories were organized into the final themes and sub-themes. Results All participants demonstrated a shared thread of shame in reaching the level of burnout. Three main interlinked themes were identified: Burnout stigma cycle, amalgamated causes of burnout and self-coping with burnout. One of the concerning findings in our study is the participants' pursuit of self-coping strategies and the avoidance of formal help, creating a cycle of suffering in silence. Conclusion The literature has repeatedly reported high levels of burnout among residents in training. This study has added another dimension to those findings through the exploration of residents actual accounts and appears to link burnout with suboptimal training and working conditions. We have highlighted the pivotal role stigma and shame play in completely preventing residents from seeking professional help.
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Affiliation(s)
- Lemmese Alwatban
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- University Family Medicine Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mai S Alageel
- Department of Family Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Lina A Alshehri
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Batheja A, Lalwani N. A National Survey Evaluating Burnout and Wellness During Radiology Residency. Acad Radiol 2024:S1076-6332(24)00137-5. [PMID: 38508933 DOI: 10.1016/j.acra.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
RATIONALE AND OBJECTIVES Burnout is a serious problem during medical residency and can contribute to poorer resident and patient health. A thorough understanding of factors associated with burnout can provide insight into supporting resident well-being. The purpose of this study is to assess the prevalence of burnout and ascertain its associated factors among radiology residents in the U.S. MATERIALS AND METHODS This cross-sectional study involved sending an anonymous survey to radiology program directors, coordinators, and residents across the U.S. Data regarding demographics, burnout levels, and burnout-associated factors were collected in the month of August 2023. Multivariable linear regression models evaluated the association of demographic and burnout-associated variables with burnout scores in the dimensions of Emotional Exhaustion, Depersonalization, and Personal Accomplishment. Chi-square analyses with Bonferroni correction and Kruskal-Wallis analyses were used to assess associations between program types and burnout as well as between program type and program effectiveness in managing burnout. Resident suggestions on addressing burnout were qualitatively assessed. RESULTS 147 radiology residents responded to the survey. Emotional Exhaustion was positively associated with seeking social support (p = .03) and negatively associated with perceived program effectiveness in addressing burnout (p < .001). Respondents who identified as male experienced greater Depersonalization (p = .02). Increased frequency of physical activity was associated with higher Personal Accomplishment scores (p = .04). The most common resident suggestions related to Work Burden, Program Support, and Protected Wellness Time. CONCLUSION Radiology programs should consider designing interventions addressing burnout, such as enhancing avenues for feedback and tailoring resident training based on individual preferences for remote work. Understanding the unique challenges faced by radiology residents is essential to tackle burnout and improve wellness.
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Affiliation(s)
- Aashish Batheja
- Department of Radiology, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, Box 980470, Richmond, Virginia 23298, USA
| | - Neeraj Lalwani
- Department of Radiology, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, Box 980470, Richmond, Virginia 23298, USA.
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Bailey JG, Mossenson AI, Whynot S, Nyirigira G, Gower S, Livingston P. A Mixed-Methods Cohort Study Evaluating the Impact of a One-Day Well-Being Course for Anesthesia Providers Working in Low-Resource Settings. Anesth Analg 2024:00000539-990000000-00730. [PMID: 38306670 DOI: 10.1213/ane.0000000000006870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
BACKGROUND Burnout, depression, and anxiety are increasingly recognized as common among health care providers. Risks for these conditions are exacerbated in low-resource settings by excessive workload, high disease burden, resource shortage, and stigma against mental health issues. Based on discussions and requests to learn more about burnout during the Vital Anaesthesia Simulation Training (VAST), our team developed VAST Wellbeing, a 1-day course for health care providers in low-resource settings to recognize and mitigate burnout and to promote personal and professional well-being. METHODS This mixed-methods study used quantitative pre- and postcourse surveys using validated mental health measures and qualitative semistructured interviews to explore participants' experience of VAST Wellbeing during and after the course. Quantitative outcomes included burnout and professional fulfillment as measured by the Professional Fulfillment Index and general well-being as measured by the Warwick-Edinburgh Mental Wellbeing Scale. RESULTS Twenty-six participants from 9 countries completed the study. In the immediate postcourse survey, study participants rated the course overall as "very good" (60.7%) and "excellent" (28.6%). Quantitative analysis showed no statistical differences in levels of work exhaustion, interpersonal disengagement, burnout, professional fulfillment, or general mental well-being 2 months after the course. Five themes on the impact of VAST Wellbeing were identified during qualitative analysis: (1) raising awareness, breaking taboos; (2) not feeling alone; (3) permission and capacity for personal well-being; (4) workplace empowerment; and (5) VAST Wellbeing was relevant, authentic, and needed. CONCLUSIONS Causes of burnout are complex and multidimensional. VAST Wellbeing did not change measures of burnout and fulfillment 2 months postcourse but did have a meaningful impact by raising awareness, reducing stigma, fostering connection, providing skills to prioritize personal well-being, and empowering people to seek workplace change.
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Affiliation(s)
- Jonathan G Bailey
- From the Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
| | - Adam I Mossenson
- From the Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
- St John of God Midland Public and Private Hospitals, Perth, Australia
- Curtin Medical School, Curtin University, Perth, Australia
| | - Sara Whynot
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Gaston Nyirigira
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda; and
| | - Shelley Gower
- Curtin School of Nursing, Curtin University, Perth, Australia
| | - Patricia Livingston
- From the Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
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Alkhawashki S, Alasiri R, Ruetalo M, Maggi J. The double whammy: Advanced medical training and parenting. Medicine (Baltimore) 2024; 103:e36697. [PMID: 38181276 PMCID: PMC10766316 DOI: 10.1097/md.0000000000036697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024] Open
Abstract
Clinicians may become parents during their clinical training and may be exposed to several challenges in career development, burnout and work-life balance. Previous research findings have reported that stressors facing trainees with children warrant greater attention from graduate medical institutions. Additionally, parenting-related information and considerations about the needs of trainees with children across clinical specialties are needed to inform institutional and national policies. A quantitative approach was used to examine clinical trainees' perceptions and experiences of parenting in relation to different specialties, sociodemographic traits, levels of support, and other potential factors influencing their residency and fellowship training and well-being. We used a survey that was distributed to all University of Toronto medical trainees (2214) via email correspondence and social media platforms. The trainees were asked to base their answers on their experience during the academic year of 2019 to 2020 (before the Coronavirus Disease 2019-related shutdown). Our study revealed that clearly, burnout is a concern for physicians who are raising children while in training. Notably, it was higher among younger aged trainees and those beginning their training journey including, first-year fellows and second-year residents, in addition to parents with toddlers. Moreover, female residents and male fellows showed higher burnout than their counterparts. Institutional support was associated with lower rates of burnout, evidenced by access to opportunities, allowing time to breastfeed/express milk and having access to medical care. We found multiple independent and significant factors affecting their rate of burnout including limited access to opportunities, lack of a self-care routine and absence of social community outside of work. The results show the importance of creating a positive learning experience for trainees juggling parenting and training needs, especially those starting their training both as residents and as fellows and those with younger children. Interventions can be categorized into those targeted at the individual and family levels, and institutional levels, with the overarching goal of balancing training and parenting. This can be achieved by fostering learning environments that prevent and decrease burnout and enhance the well-being of trainees and their families, which can start with ensuring trainees are aware of available resources and possible accommodations.
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Affiliation(s)
- Samah Alkhawashki
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rahaf Alasiri
- Department of Medicine, King Saud Bin Abdulaziz, University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mariela Ruetalo
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Julie Maggi
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Ishizuka K, Shikino K, Kuriyama A, Nishimura Y, Tanaka E, Nonaka S, Sadohara M, Moriya M, Yamamoto N, Wada Y, Makiishi T. A proposal for coping strategies on burnout among Japanese resident physicians. J Gen Fam Med 2024; 25:83-84. [PMID: 38239993 PMCID: PMC10792311 DOI: 10.1002/jgf2.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/22/2024] Open
Affiliation(s)
- Kosuke Ishizuka
- Department of General MedicineYokohama City University School of MedicineYokohamaJapan
| | - Kiyoshi Shikino
- Department of Community‐oriented Medical EducationChiba University Graduate School of MedicineChibaJapan
- Department of General MedicineChiba University HospitalChibaJapan
| | - Akira Kuriyama
- Department of Primary Care & Emergency MedicineKyoto University HospitalKyotoJapan
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of MedicineUniversity of Hawai'iHonoluluHawaiiUSA
| | - Emiri Tanaka
- The Jikei University School of MedicineMinato‐kuJapan
| | - Saori Nonaka
- Department of General MedicineTaito HospitalTaito‐kuJapan
| | - Michito Sadohara
- Department of Community, Family, and General MedicineKumamoto University HospitalKumamotoJapan
| | - Mitsuru Moriya
- Department of Psychosomatic Internal MedicineHealth Sciences University of HokkaidoIshikari‐gunJapan
| | | | - Yohnosuke Wada
- Department of Cardiovascular SurgeryJichi Medical University Saitama Medical CenterSaitamaJapan
| | - Tetsuya Makiishi
- Department of General MedicineShimane University HospitalIzumoJapan
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Aljuwaiser S, Brazzelli M, Arain I, Poobalan A. Common mental health problems in medical students and junior doctors - an overview of systematic reviews. J Ment Health 2023:1-37. [PMID: 37933550 DOI: 10.1080/09638237.2023.2278095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 09/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Common mental health problems (CMHP) are prevalent among junior doctors and medical students, and the COVID-19 pandemic has brought challenging situations with education disruptions, early graduations, and front-line work. CMHPs can have detrimental consequences on clinical safety and healthcare colleagues; thus, it is vital to assess the overall prevalence and available interventions to provide institutional-level support. AIMS This overview summarises the prevalence of CMHPs from existing published systematic reviews and informs public health prevention and early intervention practice. METHODS Four electronic databases were searched from 2012 to identify systematic reviews on the prevalence of CMHPs and/or interventions to tackle them. RESULTS Thirty-six reviews were included: 25 assessing prevalence and 11 assessing interventions. Across systematic reviews, the prevalence of anxiety ranged from 7.04 to 88.30%, burnout from 7.0 to 86.0%, depression from 11.0 to 66.5%, stress from 29.6 to 49.9%, suicidal ideation from 3.0 to 53.9% and one obsessive-compulsive disorder review reported a prevalence of 3.8%. Mindfulness-based interventions were included in all reviews, with mixed findings for each CMHP. CONCLUSIONS The prevalence of CMHPs is high among junior doctors and medical students, with anxiety remaining relatively stable and depression slightly increasing during the COVID-19 pandemic. Future research on mindfulness-based interventions is required for a resilient and healthy future workforce. PRISMA/PROSPERO the researchers have followed PRISMA guidance. This overview was not registered with PROSPERO as it was conducted as part of an MSc research project.
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Affiliation(s)
- Sameera Aljuwaiser
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Imran Arain
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Amudha Poobalan
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Watanabe S, Uemura T, Iwata Y, Yagasaki H, Itakura J, Suzuki T. Psychological distress among early medical residents: A 2-year longitudinal cohort study over seven years in Japan. Compr Psychiatry 2023; 127:152425. [PMID: 37774551 DOI: 10.1016/j.comppsych.2023.152425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/09/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Early medical residents are expected to have a higher prevalence of burnout due to physical and psychological stressors. However psychological distress associated with burnout has not been adequately investigated in a longitudinal manner. We therefore examined the longitudinal trajectory of depression and its associated factors among early medical residents. METHODS In this cohort study, medical residents (n = 215) who started rotation at the University of Yamanashi Hospital during 2012 to 2018 were recruited and asked to complete the Brief Job Stress Questionnaire (BJSQ), Center for Epidemiologic Studies Depression Scale (CESD), Brief Scale for Coping Profile (BSCP) and Athens Insomnia Scale (AIS) at the time of exit from each clinical department for up to two years over seven years. Factors associated with the CES-D scores were statistically explored, with a cutoff score of 16 to denote depression. RESULTS The CES-D was completed by 205 residents. The average CES-D score was 10.3 ± 8.0 and the scores were lower in the 2nd versus 1st year of residency (11.3 ± 6.7 versus 9.2 ± 7.0). Multiple regression analysis of BJSQ/BSCP/AIS on CES-D revealed that insomnia had a significant impact on the CES-D scores. Apart from insomnia, avoidance and suppression and peer support had significant effects. Resilient residents, who showed the maximum CES-D score of under 16 consistently throughout the residency, was better in terms of changing a point of view, active solution and changing mood. Women were more likely to express emotions to others, while they reported more job control in the first year. CONCLUSIONS Our results have high clinical relevance to challenge psychological burnout among early medical residents, offering some possible clues for prevention such as reduced burden, more flexibility during the first year and strengthening coworker support. Insomnia exerted moderate to strong effects on depression and monitoring of sleep appears indispensable in this specific population.
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Affiliation(s)
- Shintaro Watanabe
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Takuji Uemura
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan; Child Psychotherapy Center Uguisu-no-Mori, Yamanashi, Japan
| | - Yusuke Iwata
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Hideaki Yagasaki
- Department of clinical education, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Jun Itakura
- Department of clinical education, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Takefumi Suzuki
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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McCormick AD, Lim HM, Strohacker CM, Yu S, Lowery R, Vitale C, Ligsay A, Aiyagari R, Schumacher KR, Fifer CG, Owens ST, Cousino MK. Paediatric cardiology training: burnout, fulfilment, and fears. Cardiol Young 2023; 33:2274-2281. [PMID: 36691819 DOI: 10.1017/s1047951123000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Burnout is well characterised in physicians and residents but not in paediatric cardiology fellows, and few studies follow burnout longitudinally. Training-specific fears have been described in paediatric cardiology fellows but also have not been studied at multiple time points. This study aimed to measure burnout, training-specific fears, and professional fulfilment in paediatric cardiology fellows with the attention to time of year and year-of-training. METHODS This survey-based study included the Professional Fulfillment Index and the Impact of Events Scale as well as an investigator-designed Fellow Fears Questionnaire. Surveys were distributed at three-time points during the academic year to paediatric cardiology fellows at a large Midwestern training programme. Fellow self-reported gender and year-of-training were collected. Descriptive analyses were performed. RESULTS 10/17 (59%) of fellows completed all surveys; 60% were female, 40% in the first-year class, 40% in the second-year class, and 20% in the third-year class. At least half of the fellows reported burnout at each survey time point, with lower mean professional fulfilment scores. The second-year class, who rotate primarily in the cardiac ICU, had higher proportions of burnout than the other two classes. At least half of fellows reported that they "often" or "always" worried about not having enough clinical knowledge or skills and about work-life balance. CONCLUSIONS Paediatric cardiology fellows exhibit high proportions of burnout and training-specific fears. Interventions to mitigate burnout should be targeted specifically to training needs, including during high-acuity rotations.
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Affiliation(s)
| | - Heang M Lim
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Sunkyung Yu
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Ray Lowery
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Carolyn Vitale
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Andrew Ligsay
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Ranjit Aiyagari
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Carlen G Fifer
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Sonal T Owens
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
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Neufeld A. Moving the Field Forward: Using Self-Determination Theory to Transform the Learning Environment in Medical Education. TEACHING AND LEARNING IN MEDICINE 2023:1-6. [PMID: 37450608 DOI: 10.1080/10401334.2023.2235331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
Issue: The learning environment (LE) is known to be the main determinant of physician distress, yet most wellness interventions continue to focus on the learner. Additionally, few wellness interventions that focus on the LE have derived from well-established theory. These limitations represent major barriers in our progress toward improving the LE and supporting medical learner wellness in an evidence-based, humanistic, and scalable way. Evidence: To remedy the situation, I highlight a cross-section of promising experimental research in self-determination theory (SDT) and its potential applications in medical education. Implications: I propose that we incorporate SDT-based faculty development workshops to improve leaders' awareness and motivating style with learners. These interventions are known to improve the LE and thus learners' engagement, performance, and wellness. SDT-trained personnel would be needed to train medical faculty, including about the reciprocal benefits of being autonomy-supportive.
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Affiliation(s)
- Adam Neufeld
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
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Letica-Kriegel AS, Connolly MR, Westfal ML, Treadway D, Post L, Mullen JT, Qadan M. Implementation, Feasibility, and Perception of Facilitated Process Groups in Surgical Residency. JOURNAL OF SURGICAL EDUCATION 2023; 80:987-993. [PMID: 37088574 DOI: 10.1016/j.jsurg.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/07/2023] [Accepted: 04/02/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Recent studies have demonstrated burnout in surgeons, with trainees affected at alarming levels. However, few studies have focused on specific wellbeing initiatives in surgical residency. We implemented facilitated process groups at our residency program and aimed to understand the feasibility and perception of this program. DESIGN We recruited a psychologist to conduct weekly process groups. Each postgraduate year (PGY) class was scheduled for a rotating 1-hour session every 6 weeks during protected didactic time. A presurvey was conducted shortly following program commencement for PGY1-5 residents (11/2020-1/2021) and a postsurvey conducted after 9 to 10 months of implementation for PGY2-5 residents. Surveys included demographics, a 2-item Maslach Burnout Inventory, and questions about stress, lifestyle, and perception of the process groups, including qualitative feedback. SETTING The study took place at within the General Surgery Residency at Massachusetts General Hospital, a tertiary-care institution in Boston, Massachusetts. PARTICIPANTS Participants in process groups were all General Surgery residents during the timeframe of the study. Participation in the presurvey and postsurvey was voluntary for residents. RESULTS A total of 32 and 35 residents completed the presurveys and postsurveys, respectively. Groups were similar with regards to gender and race. A total of 97% and 57% of postsurvey respondents attended ≥1 and ≥3 process groups, respectively, with 95% citing clinical/other obligations as the cause of missing sessions. Perception of process groups was highly positive and persisted across both surveys. There were no significant differences in perception or burnout questions, except for a slight decrease in "I think process groups might help me process personal challenges" on postsurvey. Of 15 qualitative postsurvey responses, 73% were positive and the remainder were neutral. CONCLUSIONS Based on current measures, it is feasible to implement facilitated process groups for surgical residents. Resident perception of these groups was persistently positive.
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Affiliation(s)
| | - Margaret R Connolly
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Maggie L Westfal
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - David Treadway
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Lisa Post
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Neufeld A. Towards an autonomy-supportive model of wellness in Canadian medical education. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:143-151. [PMID: 37465740 PMCID: PMC10351625 DOI: 10.36834/cmej.75312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Purpose Learner distress is a huge problem in medicine today, and medical institutions have been called upon to help solve this issue. Unfortunately, the majority have responded not by addressing the system and culture that have long plagued the profession, but by creating individual-focused "wellness" interventions (IFWs). As a result, medical learners are routinely being forced to undergo training on resilience, mindfulness, and burnout. Approach Grounded in well-supported theory and empirical evidence, my central argument in this commentary is that IFWs are inappropriate, insulting, and psychologically harmful to learners, and that they need to stop. Contribution Extending prior work in this area, I first present three fundamental problems with IFWs. I then recommend a paradigm shift in how we are approaching "wellness" in medical education. Conclusion Finally, I provide an evidence-based roadmap, in self-determination theory, for how system-level improvements could be made in a timely, sustainable, and socially responsible way, that would benefit everyone in medicine-from leaders, to educators, to learners, to patients.
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Affiliation(s)
- Adam Neufeld
- Department of Family Medicine, University of Calgary, Alberta, Canada
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12
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Dabbagh R, Alwatban L, Alrubaiaan M, Alharbi S, Aldahkil S, AlMuteb M, Alsahli N, Almutairi R. Depression, stress, anxiety and burnout among undergraduate and postgraduate medical trainees in Saudi Arabia over two decades: A systematic review. MEDICAL TEACHER 2023; 45:499-509. [PMID: 36355388 DOI: 10.1080/0142159x.2022.2139669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Evidence suggests physicians have higher rates of mental distress than other professionals. Although multiple studies have been conducted among Saudi medical trainees to address this issue, no reviews assessed multiple psychological problems simultaneously. We aimed to examine the prevalence and trends of depression, anxiety, burnout and stress among Saudi medical trainees. METHODS A systematic review was conducted searching PubMed/Medline, OVID, Scopus, PsychInfo, EBSCOhost and the Directory of Open Access Journals (DOAJ) for studies addressing depression, burnout, stress and anxiety among Saudi medical trainees, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Joanna Briggs Critical Appraisal Checklist was used to evaluate quality. The main findings were summarised in tables. RESULTS We identified 57 records from 2001 to 2020. Overall (mild, moderate or severe) depression ranged from 28% to 70.6%, while stress ranged from 30.5% to 90.7%. Burnout was primarily assessed among residents with an overall prevalence reaching 85.5%. Overall anxiety ranged from 52.7% to 67%, and was only assessed among undergraduates. Higher levels of all four mental conditions were reported among females. CONCLUSION This review suggests high prevalence of depression, stress, burnout and anxiety among medical trainees, with higher estimates for females compared to males.
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Affiliation(s)
- Rufaidah Dabbagh
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Lemmese Alwatban
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Sultan Alharbi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Shahad Aldahkil
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mona AlMuteb
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nora Alsahli
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rahaf Almutairi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Rodriguez-Unda NA, Mehta I, Chopra S, Vicente-Ruiz M, Navia A, Fernandez-Diaz OF. Global Resilience in Plastic Surgery Study (GRIPS): Resilience is Associated with Lower Burnout Rates. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4889. [PMID: 37051210 PMCID: PMC10085483 DOI: 10.1097/gox.0000000000004889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/03/2023] [Indexed: 04/14/2023]
Abstract
Burnout has earned notoriety in medicine. It affects medical students, residents and surgeons, causing a decrease in career satisfaction, quality of life, and increased risk of depression and suicide. The effect of resilience against burnout is yet unknown in plastic surgery trainees. Methods A survey was sent via email to the members of plastic surgery societies (ICOPLAST) and the trainees from (ASPS) Resident Council from November 2021 through January 2022. The data included: demographics, training program characteristics, physician wellness resources, and single item Maslach-Burnout Inventory and Connor-Davidson Resilience Scale questionnaire. Results One-hundred seventy-five plastic surgery trainees responded to the survey. Of these, 119 (68%) trainees from 24 countries completed the full survey. Most respondents 110 (92%) had heard of physician burnout, and almost half of respondents (45%) had burnout. The average Connor-Davidson Resilience Scale score varied significantly amongst trainees self-reporting burnout and those who did not (28.6 versus 31.3, P = 0.008). Multivariate logistic regression demonstrated that increased work hours per week were associated with an increased risk of burnout (OR = 1.03, P = 0.04). Higher resilience score (OR = 0.92; P = 0.04) and access to wellness programs (OR = 0.60, P = 0.0004) were associated with lower risk of burnout. Conclusions Burnout is prevalent across plastic surgery trainees from diverse countries. Increased work hours were associated with burnout, whereas access to wellness programs and higher resilience scores were "protective." Our data suggest that efforts to build resilience may mitigate burnout in plastic surgery trainees.
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Affiliation(s)
| | - Ishan Mehta
- Division of Plastic Surgery Department of General Surgery, Baylor Scott-White, Texas A&M College of Medicine
| | - Shiv Chopra
- Global Trainee Representative to the International Confederation of Plastic Surgery Societies [ICOPLAST]
| | - Miriam Vicente-Ruiz
- Plastic, Reconstructive and Aesthetic Surgery Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Alfonso Navia
- Section of Plastic and Reconstructive Surgery, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Oscar F. Fernandez-Diaz
- Department of Clinical Sciences, Medical School University of Guadalajara, Guadalajara, Mexico
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14
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Islam R, Kralj B, Sweetman A. Physician workforce planning in Canada: the importance of accounting for population aging and changing physician hours of work. CMAJ 2023; 195:E335-E340. [PMID: 36878540 PMCID: PMC9987225 DOI: 10.1503/cmaj.221239] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Affiliation(s)
- Rabiul Islam
- Department of Economics (Islam, Kralj, Sweetman); Centre for Health Economics and Policy Analysis (CHEPA) (Kralj, Sweetman); Health Policy PhD program (Sweetman), McMaster University, Hamilton, Ont
| | - Boris Kralj
- Department of Economics (Islam, Kralj, Sweetman); Centre for Health Economics and Policy Analysis (CHEPA) (Kralj, Sweetman); Health Policy PhD program (Sweetman), McMaster University, Hamilton, Ont
| | - Arthur Sweetman
- Department of Economics (Islam, Kralj, Sweetman); Centre for Health Economics and Policy Analysis (CHEPA) (Kralj, Sweetman); Health Policy PhD program (Sweetman), McMaster University, Hamilton, Ont.
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15
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Gil-Monte PR, Espejo B, Checa I, Gil-LaOrden P, Angeline J K, Carlotto MS, Converso D, Deroncele-Acosta Á, Figueiredo-Ferraz H, Galarza L, Gómez-Ortiz V, Grau-Alberola E, Labarthe J, Llorca-Pellicer M, Mekala V C, Misiolek-Marín A, Román-Cao E, Salas-Blas E, Schoenenberger S, Unda-Rojas S, Viotti S. Factor Structure and Measurement Invariance of the Spanish Burnout Inventory Among Professionals Across 17 Countries and Regions. APPLIED RESEARCH IN QUALITY OF LIFE 2022; 18:869-892. [PMID: 36345422 PMCID: PMC9631596 DOI: 10.1007/s11482-022-10108-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
Studies on the prevalence of burnout in professionals in service organizations who work in direct contact with the clients or users of the organization have concluded that burnout is a serious health disorder that has increased due to the COVID-19 pandemic. A significant advantage of the Spanish Burnout Inventory (SBI) over other instruments is that it provides a broader conceptualization of burnout by including feelings of guilt as a dimension of burnout to explain its development. However, the measurement invariance of the SBI across countries has not been investigated. The purpose of this study was to test the measurement invariance of the SBI among professionals across 17 countries and regions in Europe, Latin America, and Asia, and in different languages. All the countries showed a good fit to the four-factor model, except the Indian sample, which was excluded from the measurement invariance study. Using the alignment method, it was possible to verify the scalar measurement invariance of the four SBI factors across 15 countries and one Spanish region (16 samples). The comparison of estimated latent means indicates that France is the country with the lowest scores on the Enthusiasm factor and the highest scores on the negative factors (Exhaustion, Indolence, and Guilt). In contrast, the Andean countries, Colombia, Peru, and Ecuador, show the highest latent means on the Enthusiasm factor and the lowest means on the negative factors. These results support the validity of the SBI in the countries and regions in Europe and Latin America included in this study.
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Affiliation(s)
- Pedro R. Gil-Monte
- Unidad de Investigación Psicosocial de la Conducta Organizacional (UNIPSICO), Valencia, Spain
- Faculty of Psychology (Dep. Methodology of Behavioral Sciences), University of Valencia, Av. Blasco Ibáñez, 21; 46010, Valencia, Spain
| | - Begoña Espejo
- Faculty of Psychology (Dep. Methodology of Behavioral Sciences), University of Valencia, Av. Blasco Ibáñez, 21; 46010, Valencia, Spain
| | - Irene Checa
- Faculty of Psychology (Dep. Methodology of Behavioral Sciences), University of Valencia, Av. Blasco Ibáñez, 21; 46010, Valencia, Spain
| | - Pedro Gil-LaOrden
- Unidad de Investigación Psicosocial de la Conducta Organizacional (UNIPSICO), Valencia, Spain
- Faculty of Psychology (Dep. Methodology of Behavioral Sciences), University of Valencia, Av. Blasco Ibáñez, 21; 46010, Valencia, Spain
| | | | | | | | | | - Hugo Figueiredo-Ferraz
- Unidad de Investigación Psicosocial de la Conducta Organizacional (UNIPSICO), Valencia, Spain
- Universidad Internacional de Valencia (VIU), Valencia, Spain
| | | | | | - Ester Grau-Alberola
- Unidad de Investigación Psicosocial de la Conducta Organizacional (UNIPSICO), Valencia, Spain
- Universidad Internacional de La Rioja, Logroño, Spain
| | | | - Marta Llorca-Pellicer
- Unidad de Investigación Psicosocial de la Conducta Organizacional (UNIPSICO), Valencia, Spain
| | | | | | | | | | | | - Sara Unda-Rojas
- Universidad Nacional Autónoma de México, FES Zaragoza, Ciudad de Mexico, Mexico
| | - Sara Viotti
- Università degli Studi di Torino, Turin, Italy
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Chew QH, Cleland J, Sim K. Burn-out and relationship with the learning environment among psychiatry residents: a longitudinal study. BMJ Open 2022; 12:e060148. [PMID: 36123086 PMCID: PMC9486328 DOI: 10.1136/bmjopen-2021-060148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Recent research suggests that burn-out is high and appears to be rooted in system-level factors including the local learning environment (LE). While most studies on this topic have been cross-sectional, our aim was to explore the relationship between burn-out and the LE over time within psychiatry residents. We hypothesised that burn-out is a significant predictor of learner perception of overall and all subdomains of LE within residents. DESIGN This was a repeated measures questionnaire study. SETTING We surveyed psychiatry residents in Singapore between January 2016 and December 2019. PRIMARY AND SECONDARY OUTCOME MEASURES The Oldenburg Burnout Inventory and the Postgraduate Hospital Education Environment Measure (PHEEM) were used to assess burn-out and resident perception of the LE, respectively. Linear mixed modelling was used to examine changes in PHEEM scores over time while taking into account burn-out status. PARTICIPANTS Overall, 93 residents (response rate 89.4%) took part. RESULTS The average difference between initial PHEEM total scores for residents with and without burn-out was significant (p<0.001). Burn-out status was a significant predictor of lower overall and all subdomain PHEEM scores at baseline (all p<0.001). PHEEM Teaching scores showed a significant increase over time for all residents regardless of burn-out status (p<0.05). However, PHEEM Total, Role Autonomy, Social Support scores did not change significantly over time or change significantly between residents with or without burn-out. CONCLUSIONS Perceptions of LE among psychiatry residents at baseline are inversely associated with burn-out status. That only the Teaching subdomain score increased over time could be accounted for by the fact that it is a more tangible and visible aspect of the LE compared with perceived role autonomy or social support subdomains. Our findings underscore the importance of attending to the well-being and improving the LE of our residents so as to optimise learning during training.
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Affiliation(s)
| | - Jennifer Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kang Sim
- West Region, Woodbridge Hospital, Singapore
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Nelson A, Eliasz KL. Combining desirable difficulty learning strategies to address the amount-to-learn vs. time-to-learn imbalance in residency training. MEDICAL TEACHER 2022; 44:1037-1043. [PMID: 35430933 DOI: 10.1080/0142159x.2022.2058389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Residents have limited time and much to learn. Mounting evidence shows that Desirable Difficulty (DD) learning strategies can ease that imbalance, but few studies have specifically studied combinations of these strategies. METHODS We tested two different combinations of DD strategies: a double combination of distributed practice and retrieval practice and a triple combination additionally including interleaved practice. We compared residents' annual In-Training Exam (ITE) scores and graduates' board certification performance between both DD curricula and a historical baseline. RESULTS Average ITE scores rose from 149.06 in the historical baseline to 160.04 under the combined DD curricula (p < 0.001). Average ITE scores fell from 162.50 under the double combination to 155.11 under the triple combination (p = 0.03). There were no significant changes in graduates' board performance between any of the curricula. CONCLUSIONS These results add to the evidence that DD strategies can enhance residents' learning. The drop in ITE scores under the triple DD combination may suggest that it pushed learners past beneficial desirable difficulty into detrimental overwhelming difficulty. Further research should apply this framework in larger and more diverse settings to clarify how these DD strategies can be optimally used to enhance residents' learning.
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Affiliation(s)
| | - Kinga L Eliasz
- New York University Grossman School of Medicine, New York, NY, USA
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18
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Hasan F, Pabari R, Wilejto M. Training for Wellness in Pediatric Oncology: A Focus on Education and Hidden Curricula. Curr Oncol 2022; 29:5579-5584. [PMID: 36005178 PMCID: PMC9406305 DOI: 10.3390/curroncol29080440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Pediatric oncologists have the privilege of caring for children and families facing serious, often life-threatening, illnesses. Providing this care is emotionally demanding and associated with significant risks of stress and burnout for oncologists. Traditional approaches to physician burnout and wellbeing have not emphasized the potential roles of education and training in mitigating this stress. In this commentary, we discuss the contribution that education, particularly in the areas of palliative and psychosocial oncology, can make in preparing oncologists for the work that they do. We argue that by adequately providing oncologists with the skills they need for their work, we can reduce their risk of burning out. We also discuss the importance of paying attention to hidden and formal curricula to ensure that messages provided in formal education programs are supported by informal training experiences.
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Affiliation(s)
- Fyeza Hasan
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Correspondence:
| | - Reena Pabari
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Marta Wilejto
- Division of Hematology/Oncology, Department of Pediatrics, London Health Sciences Center, London, ON N6A 5W9, Canada
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Warm EJ, Carraccio C, Kelleher M, Kinnear B, Schumacher DJ, Santen S. The education passport: connecting programmatic assessment across learning and practice. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:82-91. [PMID: 36091737 PMCID: PMC9441115 DOI: 10.36834/cmej.73871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Competency-based medical education (CBME) shifts us from static assessment of learning to developmental assessment for learning. However, implementation challenges associated with CBME remain a major hurdle, especially after training and into practice. The full benefit of developmental assessment for learning over time requires collaboration, cooperation, and trust among learners, regulators, and the public that transcends each individual phase. The authors introduce the concept of an "Education Passport" that provides evidence of readiness to travel across the boundaries between undergraduate medical education, graduate medical education, and the expanse of practice. The Education Passport uses programmatic assessment, a process of collecting numerous low stakes assessments from multiple sources over time, judging these data using criterion-referencing, and enhancing this with coaching and competency committees to understand, process, and accelerate growth without end. Information in the Passport is housed on a cloud-based server controlled by the student/physician over the course of training and practice. These data are mapped to various educational frameworks such Entrustable Professional Activities or milestones for ease of longitudinal performance tracking. At each stage of education and practice the student/physician grants Passport access to all entities that can provide data on performance. Database managers use learning analytics to connect and display information over time that are then used by the student/physician, their assigned or chosen coaches, and review committees to maintain or improve performance. Global information is also collected and analyzed to improve the entire system of learning and care. Developing a true continuum that embraces performance and growth will be a long-term adaptive challenge across many organizations and jurisdictions and will require coordination from regulatory and national agencies. An Education Passport could also serve as an organizing tool and will require research and high-value communication strategies to maximize public trust in the work.
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Affiliation(s)
- Eric J Warm
- Department of Internal Medicine, University of Cincinnati College of Medicine, Ohio, USA
- Correspondence to: Eric J. Warm,
| | | | - Matthew Kelleher
- Department of Internal Medicine, University of Cincinnati College of Medicine, Ohio, USA
| | - Benjamin Kinnear
- Department of Pediatrics, University of Cincinnati College of Medicine, Ohio, USA
| | - Daniel J Schumacher
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio, USA
| | - Sally Santen
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio, USA
- Virginia Commonwealth University, Ohio, USA
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Abstract
BACKGROUND Resident burnout is associated with increased incidence of depression, suicide, and poor patient outcomes, yet identification of it is difficult. This study was designed to compare how well program directors (directors) and a resident's spouse or domestic partner (partner) can serve as a proxy to identify burnout in the resident. STUDY DESIGN An electronic survey, including the Maslach Burnout Inventory, was distributed to residents, their partners, and directors of all ACGME-accredited residencies at a single university-affiliated hospital. Burnout rates were compared with McNemar's test. Emotional exhaustion and depersonalization rates were compared with Spearman's correlation. RESULTS The response rate by respondent type was 33% (292 of 876) for residents, 48% (55 of 114) for partners, and 57% (13 of 23) for directors. Residents' self-reported burnout rate was 51% (148 of 292), while partners' proxy predicted burnout rate was 25% (14 of 55), and directors' was 5% (9 of 174). There was moderate correlation of partners' prediction of resident emotional exhaustion (ρ = 0.537, p < 0.01), depersonalization (ρ = 0.501, p < 0.01), and personal accomplishment (ρ = 0.416, p < 0.01). There was poor correlation of directors' prediction of residents' emotional exhaustion (ρ = 0.361, p < 0.01) and depersonalization (ρ = 0.223, p < 0.01). Partners had a 50% sensitivity, 94% specificity, 86% positive predictive value, and 71% negative predictive value in predicting resident burnout. Directors had a 6% sensitivity, 96% specificity, 56% positive predictive value, and 54% negative predictive value in predicting resident burnout. CONCLUSIONS Directors are not skilled in detecting burnout in their trainees. Partners are an underused group for detecting burnout and may represent an important target audience for awareness of available resources to benefit residents.
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Peabody J, Lucas A, Ziesmann MT, Gillman LM. A cross-sectional study evaluating the relationship between followership type and burnout amongst critical care followers. Intensive Crit Care Nurs 2022; 72:103275. [DOI: 10.1016/j.iccn.2022.103275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
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22
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Update on the Personal and Professional Well-Being of Surgical Residents in New England. J Am Coll Surg 2022; 235:510-518. [PMID: 35588528 DOI: 10.1097/xcs.0000000000000276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical culture has shifted to recognize the importance of resident wellbeing. This is the first study to longitudinally track regional surgical resident wellbeing over 5 years. STUDY DESIGN An anonymous cross-sectional, multi-institutional survey of New England general surgery residents using novel and published instruments to create three domains: health maintenance, burnout, and work environment. RESULTS Overall, 75% (15/20) of programs participated. The response rate was 44% (250/570) and 53% (133/250) were female, 94% (234/250) were 25-34 years old, and 71% (178/250) were in a relationship. For health maintenance, 57% (143/250) reported having a primary care provider, 26% (64/250) had not seen a primary care provider in 2 years, 59% (147/250) endorsed being up to date with age-appropriate health screening, however, only 44% (109/250) were found to actually be up to date. Only 14% (35/250) reported exercising greater than 150 minutes/week. The burnout rate was 19% (47/250), with 32% (81/250) and 25% (63/250) reporting high levels of emotional exhaustion and depersonalization, respectively. For both program directors and attendings, 90% of residents reported they cared about resident wellbeing. 87% of residents believe it was acceptable to take time off during the workday for a personal appointment, while only 49% reported they would personally take the time. CONCLUSIONS The personal health maintenance of general surgery residents has changed little over the past five years, despite an overwhelming majority of residents reporting attendings and program directors care about their wellbeing. Further study is needed to understand the barriers to improvement of resident wellbeing.
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Maniuk T, Cheung WJ, Fischer L, Nemnom MJ, Eagles D. The relationship between empathy and the quality of the educational environment in Canadian emergency medicine residents. CAN J EMERG MED 2022; 24:493-497. [PMID: 35486367 PMCID: PMC9051016 DOI: 10.1007/s43678-022-00297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/15/2022] [Indexed: 12/03/2022]
Abstract
Purpose Empathy and quality of educational environment appear to be inversely correlated with burnout but the relationship between the two is largely unknown. Our primary objective was to examine the relationship between postgraduate educational environment and empathy. Secondary objectives included impact of gender, residency year and on- versus off-service context on levels of empathy and educational environment. Methods A modified Dillman approach was used to conduct an email survey of Canadian Royal College Emergency Medicine residents in June 2020. The survey instrument included: demographic data, Toronto Empathy Questionnaire (TEQ) and Scan of Postgraduate Educational Environment Domains (SPEED). Logistic and linear regressions evaluated the association between TEQ and SPEED, and mean SPEED scores and covariates, respectively. Results Response rate was 38% (138/363) with representation from all programs. Respondents were mean 30 years of age, 59% men and 25%, 20%, 18%, 24%, and 13% in postgraduate year (PGY) 1–5, respectively. There was no statistically significant association between high/low TEQ scores and mean SPEED score (p = 0.97). There were no statistically significant associations between any of the covariates and high/low TEQ scores (gender, p = 0.21; PGY, p = 0.58; on-versus off-service, p = 0.46) or mean SPEED score (gender, p = 0.95; PGY, p = 0.48; on- versus off-service, p = 0.07). Emergency medicine residents rated their educational environment on average 3.44 (+/- 0.43) out of four. 39 of 134 residents were found to have low empathy. Conclusion There was no association between empathy and educational environment. Further research is needed to elucidate modifiable factors contributing to the development of low empathy in emergency medicine residents.
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Affiliation(s)
- Tetyana Maniuk
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Fischer
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada. .,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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Sun X, Zhang M, Lu Z, Zhang Z, Zheng JC, Cheng L, Zeng L, Qian Y, Huang L. Turnover intention and related factors among resident physicians in China under the standardised residency training programme: a cross-sectional survey. BMJ Open 2022; 12:e061922. [PMID: 35410941 PMCID: PMC9003615 DOI: 10.1136/bmjopen-2022-061922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This study aimed at examining the extent of turnover intention among the Chinese resident physicians who entered the newly established national standardised residency training programme (SRTP), and exploring factors associated with their turnover intention. DESIGN Cross-sectional survey. SETTING Ten institutions from five geographical areas in China. METHODS 1414 residents were surveyed using paper-based questionnaires and scales regarding their demographics, work situation, attitudes towards SRTP, job satisfaction, psychological resilience, burnout and turnover intention in 2017. The turnover intention was described and compared between categorical groups. Linear regressions were used to select the factors associated with turnover intention. The structural equation model was used to capture the potential mediating effects. RESULTS The mean turnover intention score was 12.45 (SD=4.47). Nearly half (47.87%) of the residents had a high and very high level of turnover intention. Psychological resilience (β=0.066), burnout (β=0.141) and job satisfaction (β=0.022) were positively associated with turnover intention, while specialty (β=-0.135), year of training (β=-0.687), career in medicine (β=-2.191), necessity of training (β=-0.695) and satisfaction with income (β=-1.215) had negative associations with turnover intention. Working hours and nightshift interval indirectly were associated with turnover intention through the mediating effects of burnout. Career in medicine, necessity of training, satisfaction with income, and psychological resilience showed direct effects and indirect effects on turnover intention through burnout and job satisfaction as mediators. CONCLUSIONS The turnover intention among Chinese residents was prevalent and unignorable. Burnout was the major contributing factor, while year of training and positive attitudes towards training were protective factors. Burnout and job satisfaction also served as mediators. Interventions targeting these factors should be incorporated in the training programmes to keep a prosperous physician workforce.
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Affiliation(s)
- Xiaoting Sun
- Postdoctoral station, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Tongji University School of Medicine, Shanghai, China
| | | | - Zhanghong Lu
- Teaching office, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhaoyu Zhang
- Tongji University School of Medicine, Shanghai, China
| | | | - Liming Cheng
- Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lianhua Zeng
- Tongji University School of Medicine, Shanghai, China
| | - Yingli Qian
- Tongji University School of Medicine, Shanghai, China
| | - Lei Huang
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Shahi S, Paudel DR, Bhandari TR. Burnout among resident doctors: An observational study. Ann Med Surg (Lond) 2022; 76:103437. [PMID: 35308433 PMCID: PMC8927790 DOI: 10.1016/j.amsu.2022.103437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Burnout is a syndrome of emotional exhaustion and depersonalization that reduces efficiency at work. No studies have been reported focusing only on residency burnout and risk factors from our country until now. This study aimed to find out the impact and the association of specific demographic and practice characteristics with burnout among resident doctors. Methods A prospective cross-sectional survey of all resident doctors under training at that point of time in 2019 in the National Academy of Medical Sciences, Nepal in different specialties was done. We evaluated demographic variables, practice characteristics, and assessed burnout through validated Maslach burnout inventory (MBI) tools, and data were analyzed. Results A total 347 among 410 resident doctors (227 male) responded to the survey. Median age was 30 years (range 25–44). Overall, 147 (42.4%) of responding residents were burned out with high emotional exhaustion in 58 (16.6%), high depersonalization in 55 (15.9%), and low personal achievement in 34 (9.8). In regression analysis, out of independent variables gender, marital status, having children, specialty, hours of work per week and year of residency, specialties (general surgery odds ratio [OR]; 12.595, confidence interval [CI],[ 1.037–152.9], P; 0.047), obstetrics, and gynecology (odds ratio [OR]; 13.977, confidence interval [CI]; [1.324–147.5], P; 0.028), and anesthesiology (odds ratio [OR]; 11.54, confidence interval [CI]; [1.014–131.4], P; 0.049)) and hours of work per week (≥80 h) (odds ratio [OR]; 2.511, confidence interval [CI]; [1.128–5.589], P; 0.024), were significantly associated with high burnout. Conclusions Burnout is common among trainee resident doctors which is possibly preventable. Thus, the concern should be to prepare strategies to identify and minimize burnout from the individual, institutional, and societal sides. It is essential to preserve and promote the mental health of trainee residents to prevent serious consequences in the personal lives of resident doctors and as well as on patient outcomes. Burnout amongst resident doctors is extremely predominant which may be caused due to various reasons. We describe the impact of burnout among resident doctors and focus on identifying different risk factors for burnout. Preservation of mental health of resident doctors is essential to prevent serious consequences in their lives as well as on patient care.
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Affiliation(s)
- Sudha Shahi
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
- Corresponding author.
| | - Dhundi Raj Paudel
- Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Tika Ram Bhandari
- General Surgery, People's Dental College and Hospital, Kathmandu, Nepal
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van Dijk I, van Beek MHCT, Arts-de Jong M, Lucassen PLBJ, van Weel C, Speckens AEM. Experiences of Clinical Clerkship Students With Mindfulness-Based Stress Reduction: A Qualitative Study on Long-Term Effects. Front Psychol 2022; 13:785090. [PMID: 35432124 PMCID: PMC9009088 DOI: 10.3389/fpsyg.2022.785090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/21/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose To explore the mindfulness practice, its long-term effects, facilitators and barriers, in clinical clerkship students 2 years after participation in an 8-week mindfulness-based stress reduction (MBSR) training. Method A qualitative study was performed by semi-structured in-depth interviews with 16 clinical clerkship students selected by purposive sampling. Students had participated in a MBSR training 2 years before and were asked about their current mindfulness practice, and the long-term effects of the MBSR training. Thematic analysis was conducted using the constant comparison method. Data saturation was reached after 16 interviews. Results Most interviewees were still engaged in regular, predominantly informal, mindfulness practice, although some discontinued mindfulness practice and reported an “unchanged lifestyle.” Three main themes came forward; (1) “focused attention and open awareness” during daily activities as core elements of long-term mindfulness practice; (2) “changes in behavior and coping” that resulted from taking a pause, reflecting, recognizing automatic behavioral patterns and making space for a conscious response; (3) “integration in personal and professional life” by enhanced enjoyment of daily activities, improved work-life-balance and making different career choices. Barriers and facilitators in starting and maintaining mindfulness practice were (1) understanding and intention as “pre-conditions”; (2) practical, personal, and professional factors of students in maintaining practice. Conclusion Two years after participation in a MBSR training, many interviewees were still engaged in (mostly informal) mindfulness practice contributing to both personal and professional changes. In light of the high clerkship demands, MBSR training could be a valuable addition to medical curricula, supporting medical students in developing necessary competencies to become well-balanced professionals.
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Affiliation(s)
- Inge van Dijk
- Radboudumc Center of Mindfulness, Department of Psychiatry, Radboudumc, Nijmegen, Netherlands
| | | | - Marieke Arts-de Jong
- Radboudumc Center of Mindfulness, Department of Psychiatry, Radboudumc, Nijmegen, Netherlands
- *Correspondence: Marieke Arts-de Jong,
| | - Peter L. B. J. Lucassen
- Department of Primary and Community Care, Research Institute of Health Services, Radboudumc, Nijmegen, Netherlands
| | - Chris van Weel
- Department of Primary and Community Care, Research Institute of Health Services, Radboudumc, Nijmegen, Netherlands
- Department of Health Services Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Anne E. M. Speckens
- Radboudumc Center of Mindfulness, Department of Psychiatry, Radboudumc, Nijmegen, Netherlands
- Department of Psychiatry, Radboudumc, Nijmegen, Netherlands
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Ponsford MW, Bilszta JL, Olver J. Burnout in rehabilitation medicine trainees: a call for more research. Intern Med J 2022; 52:495-499. [DOI: 10.1111/imj.15709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Michael W. Ponsford
- Department of Rehabilitation Epworth HealthCare Melbourne Victoria Australia
| | - Justin L. Bilszta
- Department of Medical Education Melbourne Medical School, University of Melbourne Melbourne Victoria Australia
| | - John Olver
- Department of Rehabilitation Epworth HealthCare Melbourne Victoria Australia
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Ishikawa M. Relationships between overwork, burnout and suicidal ideation among resident physicians in hospitals in Japan with medical residency programmes: a nationwide questionnaire-based survey. BMJ Open 2022; 12:e056283. [PMID: 35273058 PMCID: PMC8915267 DOI: 10.1136/bmjopen-2021-056283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study examined the relationships between overwork, burnout and suicidal ideation among resident physicians working in hospitals throughout Japan. DESIGN A nationwide, questionnaire-based survey. SETTING Participating hospitals (n=416) were accredited by the Japanese Medical Specialty Board to offer medical residency programmes in 19 core specialties. Surveys were conducted in October 2020. PARTICIPANTS Valid responses were obtained from 4306 physicians (response rate: 49%). OUTCOME MEASURES Items pertaining to the Japanese Burnout Scale, depressive tendencies and suicidal ideation were included in questionnaires. Multiple regression analyses were performed: suicidal ideation was the response variable; sex, age, core specialty, marital status, income, weekly working hours and workplace (ownership, number of beds, number of full-time physicians and regional classification) were explanatory variables. RESULTS Regarding the Japanese Burnout Scale, the highest score was recorded for 'sense of personal accomplishment', followed by 'emotional exhaustion' and 'depersonalization'. Increased emotional exhaustion and depersonalisation were associated with longer working hours, but there was no such trend for sense of personal accomplishment. Depressive tendencies and suicidal ideation were noted in 24.1% and 5.6% of respondents, respectively. These percentages tended to increase when respondents worked longer hours. Several factors were significantly associated with suicidal ideation: female sex (reference: male, OR: 2.08, 95% CI: 1.56 to 2.77), ≥12 million yen income (reference: <2 million yen, OR: 0.21, 95% CI: 0.05 to 0.79), ≥100 working hours/week (reference:<40 hours/week, OR: 3.64, 95% CI: 1.88 to 7.04) and 600-799 hospital beds (reference: <200 beds, OR: 0.23, 95% CI: 0.07 to 0.82). CONCLUSIONS Many Japanese residents demonstrated a tendency to experience burnout and suicidal ideation. Female sex, low income, long working hours and insufficient hospital beds were associated with suicidal ideation. To ensure physicians' health and patients' safety, it is necessary to advance workstyle reform for physicians.
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Affiliation(s)
- Masatoshi Ishikawa
- Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Tokyo Healthcare University, Gotanda, Tokyo, Japan
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Naji L, Bhandari M. Cochrane in CORR®: Psychological Interventions to Foster Resilience in Healthcare Professionals. Clin Orthop Relat Res 2021; 479:1426-1432. [PMID: 34101672 PMCID: PMC8208430 DOI: 10.1097/corr.0000000000001809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Leen Naji
- Department of Health Research Methods, Evidence and Impact, and Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, and Centre for Evidence-Based Orthopaedics, Hamilton, ON, Canada
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