Association of Pediatric Resident Physician Depression and Burnout With Harmful Medical Errors on Inpatient Services

Continuing the conversation: a cross-sectional study about the effects of work-related adverse events on the mental health of Dutch (resident) obstetrician-gynaecologists (ObGyns)

BACKGROUND

Obstetrician-Gynaecologists (ObGyns) frequently face work-related adverse events such as severe obstetric complications and maternal or neonatal deaths. In 2014, the WATER-1 study showed that ObGyns are at risk of developing work-related posttraumatic stress disorder (PTSD), while many hospitals lacked a professional support system. The aim of the present study is to evaluate the current prevalence of work-related traumatic events and mental health problems among Dutch ObGyns, as well as to examine the current and desired support.

METHODS

In 2022, an online questionnaire was sent to all members of the Dutch Society of Obstetrics and Gynaecology (NVOG), including resident and attending ObGyns. The survey included questions about experienced work-related events, current and desired coping strategies, and three validated screening questionnaires for anxiety, depression, and PTSD (HADS, TSQ, and PCL-5).

RESULTS

The response rate was 18.8% and 343 questionnaires were included in the analysis. Of the respondents, 93.9% had experienced at least one work-related adverse event, 20.1% had faced a complaint from the national disciplinary board, and 49.4% had considered leaving the profession at any moment in their career. The prevalence rates of clinically relevant anxiety, depression, and psychological distress were 14.3, 4.4, and 15.7%, respectively. The prevalence of work-related PTSD was 0.9% according to DSM-IV and 1.2% according to DSM-5. More than half of the respondents (61.3%) reported the presence of a structured support protocol or approach in their department or hospital, and almost all respondents (92.6%) rated it as sufficient.

CONCLUSIONS

The percentages of anxiety, depression, psychological distress and PTSD are comparable to the similar study performed in 2014. Most Dutch ObGyns experience adverse events at work, which can be perceived as traumatic and, in certain cases, may lead to the development of PTSD. Structured support after adverse work-related events is now available in almost two-thirds of workplaces, and was mostly experienced as good. Despite substantial improvements in the availability and satisfaction of professional support after work-related adverse events, the prevalence rates of mental problems remain considerable, and it is imperative to sustain conversation about the mental well-being of ObGyns.

The paradox of the resident experiencing depression: Higher depression, less favorable help-seeking outcome expectations, and lower help-seeking intentions

BACKGROUND

Medical residents experiencing depression can cause life-threatening harm to themselves and their patients. Treatment is available, but many do not seek help.

METHODS

The current set of three studies investigated whether depressive symptomatology in and of itself served as a help-seeking barrier-and whether expectations of help-seeking benefits provided insight into why this occurred. Nine waves of cross-sectional data were collected from medical residents across several different hospitals in the United States.

RESULTS

There was a large negative association between levels of depressive symptomatology and help-seeking intentions (H1) in Studies 1 and 3. In Study 2, this association was significant for one of the two help-seeking measures. For all analyses, studies, and measures, there was a large negative association between residents' levels of depressive symptomatology and agreement that seeking help will lead to positive outcomes (H2). Likewise, there was a moderately large indirect effect for all analyses, studies, and measures such that the association between levels of depressive symptomatology and help-seeking intentions occurred through less favorable expectations of help-seeking benefits (H3). Lower agreement of the benefits associated with help-seeking explained between 43 and 65% of depressive symptomatology's negative association with help-seeking intentions across studies.

CONCLUSIONS

The current findings indicate that depressive symptomatology itself represents a help-seeking barrier and underscore the importance of help-seeking expectations in explaining why this occurs. If future studies reveal a causal relationship between the perceived benefits of help-seeking and help-seeking intentions, then increasing such expectations could offer a potential path for increasing resident help-seeking.

The moderating role of resilience in the association between workload and depressive symptoms among radiology residents in China: results from a nationwide cross-sectional study

OBJECTIVES

The current study aimed to explore the moderating role of psychological resilience in the association between workload and depressive symptoms among radiology residents during standardized residency training (SRT) in China.

METHODS

A nationwide cross-sectional online survey was conducted among radiology residents in China. Workload was measured by working hours per week and the frequency of frontline nightwork in the last month. Resilience was assessed by the 2-item Connor-Davidson Resilience Scale. Depressive symptoms were measured by the Depression Anxiety Stress Scales. The hierarchical regression and simple slope analyses were performed to examine the moderating effect of resilience.

RESULTS

Among 3666 radiology residents, the mean age was 27.3 years (SD = 2.6) and 58% were female. About 24.4% of the participants reported medium to severe depressive symptoms. The hierarchical regression showed that working hours (ba = 0.11, 95%CI: 0.08, 0.14) and having frontline nightwork more than once (ba = 1.22, 95%CI: 0.67, 1.78) were positively associated with depressive symptoms; the moderating effect of resilience was significant in the association of depressive symptoms with working hours (ba =  - 0.02, 95%CI: - 0.03, - 0.01) and having frontline nightwork more than once (ba =  - 0.28, 95%CI: - 0.49, - 0.07). The simple slope test showed the association between workload-related variables and depressive symptoms was only significant in those with a relatively lower level of resilience.

CONCLUSIONS

The study found that resilience was an important modifier buffering the positive association between workload and depressive symptoms among radiology residents in China. Future medical training programs are suggested to include effective intervention components to increase personal resilience.

CLINICAL RELEVANCE STATEMENT

Heavy workload in clinical setting may pose adverse effect on mental health and job performance of radiology residents. The study investigated whether psychological resilience would mitigate the association between workload and depressive symptoms among Chinese radiology residents.

KEY POINTS

• Radiology residents with a heavier workload presented a higher level of depressive symptoms in China. • Psychological resilience mitigated the positive association between workload and depressive symptoms. • The association between workload and depressive symptoms was only statistically significant in radiology residents with a relatively lower level of resilience.

Prevalence of Depression and Burnout among Family Medicine Residents in Riyadh City, Saudi Arabia

Background

The mental health of healthcare workers, particularly family medicine residents, is an area of growing concern, more so in the context of the COVID-19 pandemic. High levels of burnout and depression among these professionals can affect their well-being and patients' quality of care.

Objectives

The study aimed to determine the prevalence of depression and burnout among family medicine residents in Riyadh, Saudi Arabia.

Materials and Methods

A cross-sectional study was conducted among 213 family medicine residents, using a self-administered survey. The survey included the Maslach Burnout Inventory and the Patient Health Questionnaire (PHQ)-9 to assess burnout and depression. Descriptive statistics were used to summarize participants' characteristics, and regression model was developed to explore predictors of burnout and depression.

Results

The mean age of participants was 26.85±1.42 years, and 53.3% were males. The study found a high prevalence of emotional exhaustion (EE) and depersonalization (DP) among participants, with mean scores of 21.10±9.38 and 15.44±7.69, respectively, indicating moderate to high levels. Similarly, a high level of personal accomplishment (PA) was reported, with a mean score of 11.46±6.33. Around 10% of participants reported moderately severe and severe depression, with a mean PHQ-9 scale score of 6.03±5.10. Gender and depression severity were significantly associated with burnout (p=0.001 and p<0.001, respectively).

Conclusion

The study underscores a significant prevalence of burnout and depression among family medicine residents in Riyadh, with notable variations across different demographic and professional characteristics. This necessitates tailored mental health interventions for this population, especially in challenging times like the ongoing pandemic.

Association between Grit and depressive symptoms at the timing of job start among medical residents during the COVID-19 pandemic in Japan: a cross-sectional study

INTRODUCTION

The COVID-19 pandemic had an additional negative impact on the mental health of healthcare workers, including residents. Previous studies revealed that grit, which is an individual trait to achieve long-term goals unrelated to intelligence quotient, is not only positively associated with academic achievement and career success but also negatively correlated with depression. This study aimed to examine the association between grit and depressive symptoms among residents at the time of job start during the coronavirus disease 2019 (COVID-19) pandemic in Japan.

MATERIALS AND METHODS

This cross-sectional study used data from all post-graduate year 1 residents from March 2020 to April 2022 at Tokyo Medical and Dental University, Tokyo, Japan. Grit was measured by the Japanese version of Grit-S. The resident's depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. The association of interest was examined using logistic regression analysis.

RESULTS

Among 221 residents, 28 (12.7%) have depressive symptoms. One unit increase in Grit-S score after adjusting for age, sex, graduated university, and sleeping hours was associated with lower odds of having depressive symptoms by 63% (odds ratio [OR]: 0.37; 95% confidence interval [CI]: 0.19-0.74). Further, the perseverance of effort subscale score was associated with lower odds of having depressive symptoms after covariate adjustment (OR: 0.43; 95% CI: 0.22-0.84).

CONCLUSIONS

Higher grit scores were associated with lower odds of having depressive symptoms among residents at the timing of job start during the COVID-19 pandemic. Regular mental health assessment is particularly important for residents with low grit scores at entry.

On the Asymmetric Relationship Between Physician Mental Health Disorders on Quality of Healthcare Under the COVID-19 Pandemic in Taiwan: Quantile on Quantile Regression Analyses

Purpose

When examining the nexus of physician mental health disorders and healthcare quality from the empirical perspective, mental health disorders are frequently associated with cyclical patterns corresponding to cyclic seasonality, mood swings, emission of air pollution and business cycles, the potential asymmetric effects of physician mental health disorders on healthcare quality have not received adequate attention from researchers. Therefore, the purpose of this study is to explore the asymmetric relationship between physician mental health disorders and healthcare quality during the pandemic outbreak in Taiwan.

Methods

Daily data for care quality indicators and physician mental health disorders were collected from the National Insurance Research Database in Taiwan, and the quantile-on-quantile regression model was applied to proceed with our analyses.

Results

Our results indicated that the overall aggregate effects of each quantile of physician mental health disorders on the cumulative quantiles of healthcare quality are negative (positive) for the 14-day readmission rate (preventable hospitalization rate and non-urgent ED-visit rate). Positively (negatively) cumulative effects of each quantile of physician mental health disorders were detected in the middle (low and high) quantiles of the preventable hospitalization rate. The cumulative effects of each quantile of physician mental health disorders on the high (low and middle) quantiles of the 14-day readmission rate are negative (positive), but the cumulative effects on various quantiles of the non-urgent ED-visit rate exhibit the opposite pattern.

Conclusion

The observed variation in the relationship between physician mental health disorders and different quantiles of healthcare quality suggests the need for tailored strategic interventions based on distinct levels of healthcare quality when addressing the higher risk of physician mental health disorders during the pandemic outbreak conditions.

The prevalence and factors associated with posttraumatic growth after 3-years outbreak of COVID-19 among resident physicians in China: a cross-sectional study

Introduction

The Coronavirus disease 2019 (COVID-19) pandemic is a global traumatic event that has profoundly struck individuals' mental health. However, this might potentially promote positive transformation such as posttraumatic growth (PTG). Studies have indicated that the COVID-19 pandemic negatively affected the well-being of resident physicians, but little is known about PTG among this vulnerable population in China. Therefore, this study investigated the prevalence and associated factors of PTG among Chinese resident physicians after 3-years outbreak of COVID-19.

Methods

An online survey was conducted from 9 March to 20 March in 2023. PTG was assessed using the 10-item Posttraumatic Growth Inventory-Short Form (PTGI-SF). Scores ≥30 implied moderate-to-high PTG. We also collected possible associated factors for PTG, including socio-demographic and psychological variables. Data was analyzed by applying descriptive statistics, univariable and multivariable logistic regression models.

Results

In total, 2267 Chinese resident physicians provided validated data. 38.7% of them reported moderate-to-high PTG. In the multivariable logistic regression models, age (odds ratio, OR = 1.039; 95% confidence interval, 95%CI = 1.008-1.070), female (OR = 1.383, 95%CI = 1.151-1.662), satisfied or neutral with annual income (OR = 2.078, 95%CI = 1.524-2.832; OR = 1.416, 95%CI = 1.157-1.732), sufficient support at work (OR = 1.432, 95%CI = 1.171-1.751) and resilience (OR = 1.171, 95%CI = 1.096-1.252) were significantly positively associated with moderate-to-high PTG. On the contrary, burnout (OR = 0.653, 95%CI = 0.525-0.812), depression symptoms (OR = 0.700, 95%CI = 0.552-0.889), and stress (OR = 0.757, 95%CI = 0.604-0.949) were significantly negatively associated with moderate-to-high PTG.

Discussion

Overall, resident physicians in China experienced relatively high prevalence of PTG that could be associated with several psychosocial factors. Findings may provide evidence to develop interventions for resident physicians to systematically and constructively process traumatic events related to the pandemic and foster their PTG.

Resident Physician Perspectives on Mindfulness Education in Residency: A Multispecialty Qualitative Assessment of Clinical Care Impact

Background

Mindfulness training positively influences residents personally and professionally. Routine integration into residency may be impacted by limited understanding of the ways in which mindfulness training enhances clinical care.

Objective

We explored residents' direct experience and personal application of mindfulness in their clinical work following 10 hours of mindfulness training.

Methods

Mindfulness training sessions were facilitated between 2017 and 2019 for 5 groups of residents: pediatrics, ophthalmology, postgraduate year (PGY)-1 anesthesiology, and 2 different years of PGY-1 family medicine residents. Training was integrated into resident protected didactic time and attendance was expected, although not mandated, with the exception of pediatrics, in which the department mandated the training. Qualitative evaluation was conducted using a voluntary, semi-structured, de-identified phone interview within 2 months post-training. Reviewers independently coded the transcripts and then dialogued to reach consensus around emergent themes.

Results

Thirty-six of 72 residents (50%) who participated in the training completed interviews. Themes were similar across specialties. All residents acknowledged the potential usefulness of mindfulness training during residency. Six residents (17%) reported they had not applied the mindfulness training to their daily work by the end of the course. There were 4 emergent themes related to clinical application of mindfulness training: integrating brief moments of mindfulness practice, self-awareness, relational presence with patients, and maintaining perspective during clinical encounters and residency training as a whole.

Conclusions

After completing a 10-hour mindfulness training program, residents reported enhanced perspective-taking and relationship-building with themselves and their patients in clinical settings across medical and procedural specialties.

Risk of burnout and depression: A survey of veterinary anaesthesia specialists in-training during COVID-19

OBJECTIVE

To investigate risk, risk factors and effects on adherence to adequate clinical standards, of burnout and depression in veterinary anaesthesia residents.

STUDY DESIGN

Closed online cross-sectional survey study.

STUDY POPULATION

A sample of 89 residents registered to the European and/or the American Colleges of Veterinary An (ae)sthesia and Analgesia out of a total of 185.

METHODS

A link to access an online questionnaire, which included the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), the Harvard National Depression Screening Day Scale (HANDS) and 28 questions developed to assess adherence to adequate clinical standards, was sent by email to 185 residents. The three components of the MBI-HSS namely emotional exhaustion (EE), depersonalization and reduced personal accomplishment were analysed separately. Analysis of proportions and two-step regression statistical modelling were used for data analysis, and p values < 0.05 were considered statistically significant.

RESULTS

The response rate was 48%. Based on HANDS and MBI-HSS scores, 49% of the residents were at high risk of both depression and burnout. These residents expressed greater concern of delivering inadequate animal care (p < 0.001), of decreased quality of supervision during COVID-19 (p = 0.038) and of negative impact of the pandemic on their training programme (p = 0.002) than residents at low-to-moderate risk. Working in a clinical environment for ≥ 60 hours/week was a risk factor for both depression (p = 0.016) and EE (p = 0.022), while female sex was a risk factor for EE only (p = 0.018).

CONCLUSIONS AND CLINICAL RELEVANCE

A large proportion of residents is at high risk of depression and burnout, a scenario likely worsened by the pandemic. The findings of this study suggest that reducing the clinical workload and increasing the level of support and supervision may help to improve residents' mental health.

Predictors of posttraumatic stress symptoms, COVID-related functional impairment, and burnout among medical professionals during the COVID-19 pandemic

Physicians are particularly vulnerable to mental health symptoms during global stressors such as the COVID-19 pandemic. Such stressors can increase death anxiety, which is a vulnerability factor for psychological dysfunction. Thus, exposure to COVID-related death may play a unique role in physicians' mental health during the pandemic. This cross-sectional study collected self-reported data from 485 resident physicians and fellows. Participants reported mental health symptoms, including posttraumatic stress symptoms (PTSS), burnout, and functional impairment due to the pandemic. Participants also reported death anxiety, COVID-19 anxiety, cognitive accessibility of death-related thoughts (DTA), and workplace exposure to COVID-19. Death anxiety, COVID-19 anxiety, DTA, and workplace COVID-19 exposure all independently predicted PTSS. Furthermore, COVID-19 anxiety and DTA interacted to predict PTSS, such that high levels of COVID-19 anxiety predicted higher PTSS, regardless of DTA level. Death anxiety and COVID-19 workplace exposure interacted to predict PTSS as well, such that death anxiety predicted PTSS only when COVID-19 exposure was high. Burnout was predicted by COVID-19 anxiety and workplace exposure, and COVID-related functional impairment was predicted by death anxiety and COVID anxiety. These findings demonstrate that death-related and COVID-related concerns, independently and in interaction with each other, play an important role in psychological distress among physicians.

Breath-Body-Mind Core Techniques to Manage Medical Student Stress

Objectives

This pilot study evaluated the feasibility of a live, interactive, synchronous, online, manualized intervention, Breath-Body-Mind Introductory Course (BBM-IC), for medical students. BBM-IC includes breathing, movement, and attention-focus techniques for stress management and better emotion regulation, energy, sleep, and mental focus.

Methods

Medical students attending a 2-h BBM demonstration were invited to participate in the 12-h BBM-IC and weekly 45-min 6-week group practice. Measures were obtained using Survey Monkey: patient health questionnaire (PHQ9), generalized anxiety disorder-7 (GAD-7), exercise-induced feeling inventory (EFI), sleep quality scale (SQS), and body perception questionnaire-short form (BPQ-SF) at pre-BBM-IC (T1), post-BBM-IC (T2), and 6 weeks post (T3). Perceived stress scale (PSS) and meditation practices questionnaire (MPQ) were measured at baseline (T1) only.

Results

Twelve medical students participated in BBM-IC 4-h daily for 3 days. Six attended practice sessions and completed 6-week post-tests. Mean scores comparison identified two variable sets with significant improvements: EFI tranquility (p < .005) and supradiaphragmatic reactivity (p < .040). Two measures reached near significance: SQS (p ≤ .060) and PHQ9 (p ≤ .078).

Conclusion

This pilot study provided preliminary evidence that BBM-IC may reduce stress and anxiety symptoms while improving mood, energy, mental focus, and other correlates of psychophysiological state in medical students. Taking time for self-care is challenging for medical students, as reflected in the small study enrollment. Designating time for BBM as a requirement within the medical curriculum would probably enable more students to participate and acquire skills to reduce the effects of stress on their physical and psychological health, as well as the health of their patients.

Mental health status of mental health nurses in China: Results from a national survey

INTRODUCTION

It has been acknowledged in China that actions should be taken immediately to ease the critical shortage of psychiatric nurses. However, with national data lacking, little is known about nurses' mental health status.

AIM

To evaluate psychiatric nurses' mental health status by measuring their burnout, depression, anxiety and stress.

METHODS

All psychiatric nurses in the 41 selected hospitals in China were invited to participate in the survey. The Maslach Burnout Inventory-Human Service Survey and Depression Anxiety Stress Scale were used to assess variables of interest.

RESULTS

38.6% of psychiatric nurses met the criteria for burnout. The rates of depression, anxiety and stress were 26.3%, 36.4% and 12.5%, respectively. It was found that workplace region, educational level, working years, longer working hours and night shifts were associated with risk of burnout and DASS.

CONCLUSIONS

More than a quarter of psychiatric nurses are suffering from burnout, depression or anxiety in China. Policymakers and hospital administrators should design a flexible schedule and restrict working hours for psychiatric nurses to achieve work-life balance.

IMPLICATIONS FOR PRACTICE

The study informs policymakers and administrators on addressing the nursing shortage by identifying nurses immersed in negative emotions and preventing mental health problems.

Thematic analysis comparing stressors for pediatric residents and subspecialty fellows at a large children's hospital

INTRODUCTION

Pediatric residents and subspecialty fellows experience a significant number of stressors during training, but they have rarely been self-reported or compared between groups. This qualitative study aimed to identify and compare themes of stressors experienced by pediatric residents and subspecialty fellows at a single large children's hospital.

MATERIALS AND METHODS

Using an open-ended survey at single time point for each group, we asked residents and fellows to list the stressors they face in training. The survey data was iteratively analyzed using thematic analysis then quantified by its frequency in each group and compared using a chi-square distribution or a Fisher's exact test, as appropriate.

RESULTS

Twenty-eight of 159 residents (18%) and 38 of 180 fellows (21%) answered the survey question, and an average of 2.8 stressors were identified by each resident and fellow. Two major themes and five major subthemes were shared between both groups. The theme Stressors at Home included the subthemes Difficulty Maintaining Overall Health and External Stressors. The theme Stressors at Work encompassed the subthemes Clinical Stressors Innate to Patient Care, Demanding Workload and Schedule, and Stressors Related to Culture of Work Environment. Within the subthemes, there were differences in categories of stressors between the groups. While there was no statistically significant difference in the distribution of themes, subthemes, or categories of stressors mentioned between groups, in general residents identified stressors associated with lack of autonomy and control whereas fellows focused on clinical uncertainty and complex situations.

CONCLUSIONS

While residents and fellows shared similar themes and subthemes for stressors, there was variability between individual categories. This study identified individual self-reported stressors that can be used by programs to design interventions to improve trainee well-being, but it also implies that programmatic support at different levels of training should be tailored to the target group.KEY MESSAGEAt our hospital, we found that some self-reported stressors facing pediatric residents and fellows were common and some unique.Stressors included those that can be eliminated or diminished as well as those that cannot.With knowledge that these disparities exist, training programs should use unique strategies to provide support for the two groups and their stressors.

Toward Constructive Change After Making a Medical Error: Recovery From Situations of Error Theory as a Psychosocial Model for Clinician Recovery

BACKGROUND

Making a medical error is a uniquely challenging psychosocial experience for clinicians. Feelings of personal responsibility, coupled with distress regarding potential or actual patient harm resulting from a mistake, create a dual burden. Over the past 20 years, experiential accounts of making an error have provided evidence of the associated distress and impacts. However, theory-based psychosocial support interventions to improve both individual outcomes for the involved clinicians and system-level outcomes, such as patient safety and workforce retention, are lacking. There is a need for evidence-based ways to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts. Such interventions play a role within wider programs of health professional support. We sought to address this by developing a testable, psychosocial model of clinician recovery after error based on recent evidence.

METHODS

Systematic review methodology was used to identify studies published between January 2010 and June 2021 reporting experiences of direct involvement in medical errors and/or subsequent recovery. A narrative synthesis was produced from the resulting articles and used as the basis for a team-based qualitative approach to model building.

RESULTS

We identified 25 studies eligible for inclusion, reporting evidence primarily from experiences of doctors and nurses. The identified evidence indicates that coping approach, conversations (whether they occur and whether they are perceived to be helpful or unhelpful), and learning or development activities (helpful, unhelpful or absent) may influence the relationship between making an error and both individual clinician outcomes of emotional impact and resultant practice change. Our findings led to the development of the Recovery from Situations of Error Theory model, which provides a preliminary theoretical basis for intervention development and testing.

CONCLUSIONS

The Recovery from Situations of Error Theory model is the first testable psychosocial model of clinician recovery after making a medical error. Applying this model provides a basis to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts and to support the replication of interventions that work across services and health systems toward constructive change. Such interventions may be embedded into the growing body of peer support and employee support programs internationally that address a diverse range of stressful workplace experiences.

The concept of errors in medical education: a scoping review

The purpose of this scoping review was to explore how errors are conceptualized in medical education contexts by examining different error perspectives and practices. This review used a scoping methodology with a systematic search strategy to identify relevant studies, written in English, and published before January 2021. Four medical education journals (Medical Education, Advances in Health Science Education, Medical Teacher, and Academic Medicine) and four clinical journals (Journal of the American Medical Association, Journal of General Internal Medicine, Annals of Surgery, and British Medical Journal) were purposively selected. Data extraction was charted according to a data collection form. Of 1505 screened studies, 79 studies were included. Three overarching perspectives were identified: 'understanding errors') (n = 31), 'avoiding errors' (n = 25), 'learning from errors' (n = 23). Studies that aimed at'understanding errors' used qualitative methods (19/31, 61.3%) and took place in the clinical setting (19/31, 61.3%), whereas studies that aimed at 'avoiding errors' and 'learning from errors' used quantitative methods ('avoiding errors': 20/25, 80%, and 'learning from errors': 16/23, 69.6%, p = 0.007) and took place in pre-clinical (14/25, 56%) and simulated settings (10/23, 43.5%), respectively (p < 0.001). The three perspectives differed significantly in terms of inclusion of educational theory: 'Understanding errors' studies 16.1% (5/31),'avoiding errors' studies 48% (12/25), and 'learning from errors' studies 73.9% (17/23), p < 0.001. Errors in medical education and clinical practice are defined differently, which makes comparisons difficult. A uniform understanding is not necessarily a goal but improving transparency and clarity of how errors are currently conceptualized may improve our understanding of when, why, and how to use and learn from errors in the future.

Pediatric Schwartz Rounds: Influencing Provider Insights and Emotional Connectedness

BACKGROUND AND OBJECTIVES

Schwartz Rounds (SR) is an interdisciplinary program that focuses on compassionate care by allowing the formation of an interprofessional community around the human and emotional testimonies of caregivers. The purpose of this study was to examine the impact of implementing departmental SR on pediatric care providers at a tertiary care children's hospital in New York.

METHODS

We applied the logic outcomes model for program evaluation to examine the impact of SR on pediatric providers. The standard evaluation form provided by the Schwartz Center was used to collect data after every SR. Descriptive statistics and qualitative data content analysis methods were used to analyze the evaluation data from the SR.

RESULTS

A total of 820 standard evaluation forms were collected from 17 of the 23 SR sessions offered (response rate: 74.8%). Most participants felt that, during the SR sessions, challenging social and emotional aspects of patient care were discussed and that they gained better perspectives of their coworkers and their patients/families. They reported less isolation and more openness to express their feelings about patient care to their coworkers. The analysis of 299 written comments identified 5 themes: understanding other people's perspectives, the importance of communication, empathy and compassion, awareness of personal biases, and maintaining boundaries.

CONCLUSIONS

Schwartz Rounds can provide an effective venue for pediatric care providers to gain insights into coworker and patient/family perspectives and process emotional experiences while providing patient care in a variety of circumstances.

Temporal Associations Between EHR-Derived Workload, Burnout, and Errors: a Prospective Cohort Study

BACKGROUND

The temporal progression and workload-related causal contributors to physician burnout are not well-understood.

OBJECTIVE

To characterize burnout's time course and evaluate the effect of time-varying workload on burnout and medical errors.

DESIGN

Six-month longitudinal cohort study with measurements of burnout, workload, and wrong-patient orders every 4 weeks.

PARTICIPANTS

Seventy-five intern physicians in internal medicine, pediatrics, and anesthesiology at a large academic medical center.

MAIN MEASURES

Burnout was measured using the Professional Fulfillment Index survey. Workload was collected from electronic health record (EHR) audit logs and summarized as follows: total time spent on the EHR, after-hours EHR time, patient load, inbox time, chart review time, note-writing time, and number of orders. Wrong-patient orders were assessed using retract-and-reorder events.

KEY RESULTS

Seventy-five of 104 interns enrolled (72.1%) in the study. A total of 337 surveys and 8,863,318 EHR-based actions were analyzed. Median burnout score across the cohort across all time points was 1.2 (IQR 0.7-1.7). Individual-level burnout was variable (median monthly change 0.3, IQR 0.1-0.6). In multivariable analysis, increased total EHR time (β=0.121 for an increase from 54.5 h per month (25th percentile) to 123.0 h per month (75th percentile), 95%CI=0.016-0.226), increased patient load (β=0.130 for an increase from 4.9 (25th percentile) to 7.1 (75th percentile) patients per day, 95%CI=0.053-0.207), and increased chart review time (β=0.096 for an increase from 0.39 (25th percentile) to 0.59 (75th percentile) hours per patient per day, 95%CI=0.015-0.177) were associated with an increased burnout score. After adjusting for the total number of ordering sessions, burnout was not statistically associated with an increased rate of wrong-patient orders (rate ratio=1.20, 95%CI=0.76-1.89).

CONCLUSIONS

Burnout and recovery were associated with recent clinical workload for a cohort of physician trainees, highlighting the elastic nature of burnout. Wellness interventions should focus on strategies to mitigate sustained elevations of work responsibilities.

The Best Gift You Could Give a Resident: A Qualitative Study of Well-Being Resources and Use Following Unwanted Outcomes

In recent years, there has been increasing focus on the well-being of resident physicians. Considering the persistent problem of burnout and attrition particularly among surgical trainees, this is a well-warranted and laudable area of focus. However, despite the widespread adoption of resources available to residents through individual institutions, there is little understanding of how and why these resources are engaged or not during particularly vulnerable moments, such as following an unwanted patient event including postoperative complications and deaths.

Methods

This qualitative study explored access to and usage of resources to promote well-being following an unwanted patient outcome through semi-structured interviews of 28 general surgery residents from 14 residency programs across the United States, including community, academic, and hybrid programs. A qualitative descriptive approach was used to analyze transcripts.

Results

Residents described 3 main types of institutional resources available to them to promote well-being, including counseling services, support from program leadership, and wellness committees. Residents also described important barriers to use for each of these resources, which limited their access and value of these resources. Finally, residents shared their recommendations for future initiatives, including additional protected time off during weekdays and regular usage of structured debrief sessions following adverse patient outcomes.

Conclusions

While institutional resources are commonly available to surgery residents, there remain important limitations and barriers to use, which may limit their effectiveness in supporting resident well-being in times of need. These barriers should be addressed at the program level to improve services and accessibility for residents.

Relationship Between Physician Burnout And The Quality And Cost Of Care For Medicare Beneficiaries Is Complex

Despite reports of a physician burnout epidemic, there is little research on the relationship between burnout and objective measures of care outcomes and no research on the relationship between burnout and costs of care. Linking survey data from 1,064 family physicians to Medicare claims, we found no consistent statistically significant relationship between seven categories of self-reported burnout and measures of ambulatory care-sensitive admissions, ambulatory care-sensitive emergency department visits, readmissions, or costs. The coefficients for ambulatory care-sensitive admissions and readmissions for all burnout levels, compared with never being burned out, were consistently negative (fewer ambulatory care-sensitive admissions and readmissions), suggesting that, counterintuitively, physicians who report burnout may nevertheless be able to create better outcomes for their patients. Even if true, this hypothesis should not indicate that physician burnout is beneficial or that efforts to reduce physician burnout are unimportant. Our findings suggest that the relationship between burnout and outcomes is complex and requires further investigation.

One-Year Prevalence of Perceived Medical Errors or Near Misses and Its Association with Depressive Symptoms among Chinese Medical Professionals: A Propensity Score Matching Analysis

Objective: Medical errors or near misses (MENM) may cause serious negative outcomes for the patients. However, medical professionals with MENM may also be secondary victims. Although the association between MENM and depression among medical professionals has been explored in several previous studies, the possible causal relationship has been explored less, especially in China. In this study, our first aim was to determine the prevalence of MENM among Chinese medical professionals. We also wanted to explore the causal effect of MENM on depressive symptoms based on a propensity-score matching analysis. Methods: A cross-sectional study was conducted among medical professionals in Chinese public general hospitals, and 3426 medical professionals were analyzed in this study. The Center for Epidemiologic Studies Depression (CES-D) scale was used to assess depressive symptoms. Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS). MENM, social-demographic variables, occupational characteristics, and physical disease were also evaluated in this study. Results: The one-year prevalence of perceived MENM was 2.9% among medical professionals in Chinese public general hospitals. The results of logistic regressions showed that working hours/week (OR = 1.02, p < 0.05) and depressive symptoms (OR = 1.05, p < 0.001) were associated with MENM. After propensity score matching, depressive symptoms were associated with MENM (OR = 1.05, p < 0.001) among medical professionals. The associations between occupational characteristics, physical disease, social support, and MENM were not supported by this study. Conclusions: The one-year prevalence of MENM was low in Chinese public general hospitals, and based on our propensity score matching analyses, the occurrence of MENM may cause depressive symptoms in medical professionals. A bigger effort by health systems and organizations may be helpful for reducing MENM.

High Levels of Self-Reported Depressive Symptoms Among Physical Therapists and Physical Therapist Students Are Associated With Musculoskeletal Pain: A Cross-Sectional Study

OBJECTIVE

Depressive symptoms and musculoskeletal (MSK) pain are 2 of the most common health conditions. Their relationship, however, remains unclear. As depressive symptoms in physical therapists have not been well assessed, the purpose of this work was to assess self-reported depressive symptoms and MSK pain prevalence-and their possible association-in physical therapists and physical therapist students.

METHODS

An online cross-sectional survey was used to gather data from 707 physical therapists and 116 physical therapist students from Israel. The Patient Health Questionnaire-9 was used to assess depressive symptoms, and the Extended Nordic Musculoskeletal Questionnaire was used to evaluate the prevalence and characteristics of MSK pain.

RESULTS

Overall, 108 participants (13.1%) scored in the moderate to severe depressive symptoms category (Patient Health Questionnaire-9 score >10), and 261 participants (31.7%) scored in the mild depressive symptoms category. In total, 84 physical therapists (11.9%) and 24 physical therapist students (20.7%) reported moderate to severe depressive symptoms during the last 2 weeks. Neck and back pain had the highest point prevalence (26.7%-35.3%) and lifetime prevalence (75.9%-78.5%), respectively. Mild depressive symptoms were associated with current pain (adjusted odds ratio [OR] = 1.58) and smoking (adjusted OR = 1.79-1.84). Current pain was also associated with severe depressive symptoms (adjusted OR = 2.76-3.07). Physical therapists with higher salaries were less likely to report severe depressive symptoms (adjusted OR = 0.11-0.36).

CONCLUSION

The prevalence estimates generated from this study sample imply that 11.9% of physical therapists and 20.7% of physical therapist students in Israel experienced moderate to severe depressive symptoms. Neck and back pain had the highest point and lifetime prevalence.

IMPACT

The prevalence of self-reported depressive symptoms in this sample places physical therapists and physical therapist students alongside physicians, nurses, and medical profession students who have been previously reported to have elevated depressive symptoms. Future studies should further explore the nature of the association between pain and depressive symptoms in these populations.

Flourishing in Healthcare Trainees: Psychological Well-Being and the Conserved Transcriptional Response to Adversity

While much attention has been paid to healthcare provider and trainee burnout, less is known about provider well-being (i.e., flourishing) or about the effects of well-being on immune function. This study examined the demographic and psycho-social correlates of well-being among healthcare trainees (resident physicians and physician assistant (PA) trainees) and evaluated the association of well-being with the “conserved transcriptional response to adversity” (CTRA) characterized by up-regulated expression of pro-inflammatory genes and down-regulated expression of innate antiviral genes. Participants (n = 58) completed self-reported assessments of sleep disturbance, loneliness, depressive symptoms, anxiety, stress, and well-being (flourishing). Blood sample RNA profiles were analyzed by RNA sequencing to assess the CTRA. Slightly over half (n = 32; 55.2%) of healthcare trainees were categorized as flourishing. Flourishing was less prevalent among primary caregivers, and more prevalent among trainees who exercised more frequently and those with fewest days sick. Loneliness (AOR = 0.75; 95% CI = 0.61, 0.91; p = 0.003) and stress (AOR = 0.65; 95% CI = 0.45, 0.94; p = 0.02) were associated with decreased odds of flourishing when controlling for other variables. Flourishing was associated with down-regulated CTRA gene expression, whereas loneliness was associated with up-regulated CTRA gene expression (both p < 0.05). Assessing these relationships in a larger, multi-site study is of critical importance to inform policy, curricula, and interventions to bolster sustainable trainee well-being.

Depressive symptoms in helping professions: a systematic review of prevalence rates and work-related risk factors

OBJECTIVE

The aim of this study is twofold. Our first aim is to provide an overview of the prevalence rate of depression in a wide array of helping professions. Our second aim is to identify work organization conditions that seem to be associated with this depression risk.

METHODS

Four databases were searched (CINAHL, PsycInfo, PubMed, and Web of Science) yielding 87,626 records in total. We were interested in identifying depression prevalence rates and work-related variables that have been found to contribute to depression in helping professions.

RESULTS

In total, this systematic review included 17,437 workers in more than 29 countries. Depression prevalence rate varied between 2.5% and 91.30%. The two most frequently reported professions were nurses and doctors with 73.83% and 30.84% of studies including nurses and doctors in their sample. Work factors contributing to depression included: skill utilization, decision authority, psychological demands, physical demands, number of hours worked, work schedule (irregular or regular), work schedule (daytime or night time), social support from coworkers, social support from supervisor and the family, job insecurity, recognition, job promotion, and bullying.

CONCLUSION

The results of this study highlight alarmingly high rates of depression in helping professions and should serve as a reminder to pay close attention to the mental health of those workers. Investing in employees' mental health by preventing and reducing depression risk could prove to be a valuable investment from an employer's point of view, as it is likely to increase productivity and reduce absenteeism among a host of other positive outcomes.

The mediating role of social support in the relationship between physician burnout and professionalism behaviors

OBJECTIVE

Burnout poses as an understudied challenge to professionalism, and social support may explain their relationship. We sought to investigate the role of social support (moderating or mediating) in the association between physician burnout and professionalism (with four behavioral domains: respect, integrity, excellence, responsibility).

METHODS

We invited 4100 physicians from nine tertiary hospitals in Liaoning province, China, during February 2017, to participate in a cross-sectional survey. Professionalism, burnout, and social support were respectively assessed using three standardized tools. Descriptive statistics, multivariable linear regression, and ordinal logistic regression were used to analyze the data.

RESULTS

3506 physicians (85.5%) effectively completed the survey. After controlling for potential confounding factors, burnout was associated with lower professionalism (β = -0.65, SE = 0.07), particularly in respect (OR = 0.51, 95%CI: 0.41-0.64) and responsibility (OR=0.72, 95%CI: 0.57-0.90). However, there was no statistically significant association between burnout and integrity or excellence. Social support was associated with higher professionalism ((β = 0.24, SE = 0.02) and all of its behavioral domains and played a partial mediating effect on the association between burnout and professionalism.

CONCLUSION

Social support partially mediates the relationship between physician burnout and behavior-based professionalism.

PRACTICE IMPLICATIONS

Addressing burnout and promoting social support could be integral in fostering physician professionalism in the healthcare setting.

Prevalence of depressive symptoms and excessive daytime sleepiness in a cohort of Saudi doctors under training: A cross sectional study

Objectives

Recent studies have highlighted an increasing prevalence of depression and sleep problems among physicians during their residency training in the medical field. The study aims to explore the prevalence of depressive symptoms and sleepiness among the residents of different medical specialties in the two regions of KSA and describe the factors that potentially cause depression and sleepiness.

Methods

A survey was distributed to the residents of King Abdulaziz Medical City in the Riyadh province, and to the residents of King Fahad Specialist Hospital Buraidah and Maternity and Children's Hospital Buraidah in the Qassim province. The Patients' Health Questionnaire-2 was used to determine the prevalence of depression and the Epworth Sleepiness Scale was used to measure sleepiness.

Results

One hundred and eighty-one residents completed the survey. While depressive symptoms were prevalent among 93% of the residents, 49% of the residents reported excessive daytime sleepiness. Depressive symptoms were more common in the residents of King Abdulaziz Medical City, with the prevalence being 94.5%. There was a significant association between depressive symptoms and excessive sleepiness (p = 0.046).

Conclusion

Depressive symptoms and excessive sleepiness are highly prevalent in postgraduate trainees. Residents with depression were found to be sleepier during their work. Given the negative effect on patient safety, the high prevalence of both depressive symptoms and sleepiness is alarming. There is an urgent need to improve residents' wellness through well-structured well-being programs.

Emergency Medicine Resident Burnout and Examination Performance

OBJECTIVES

Burnout afflicts emergency physicians (EPs) to a significant degree. The impact of burnout spans from decreased clinical efficiency to increased medical errors to heightened risk of physician suicide. This large-scale study captures responses from emergency medicine (EM) residents regarding two burnout items and examines the correlation between in-training examination (ITE) scores and burnout risk as well as that between residency year and burnout risk.

METHODS

This was a prospective, mixed-methods, cross-sectional cohort study. All residents in U.S. categorical EM residents who took the 2019 ITE were included. At the end of the ITE, residents were invited to complete a voluntary survey that included two items from the Maslach Burnout Inventory (MBI) that have been found to be strongly indicative of burnout: one about self-perception of being burned out and one about feelings of callousness. Responses were on a 7-level Likert scale (1-7), ranging from very low frequency (1) to very high frequency (7). Measurements included the number of residents in each year-level of training (EM1-EM4), the MBI item ratings, and the ABEM ITE score. Performance, as measured by the scaled, equated score, was compared to the MBI item responses. A corrected Spearman's correlation coefficient (ρ) was used to compare continuous data (score) against a discrete ordinal variable (MBI Likert response).

RESULTS

There were 2,501 EM1 residents, 2,389 EM2 residents, 2,206 EM3 residents, and 616 EM4 residents in the study group. There were 7,206 (93.4%) physicians who completed the first MBI question about burnout; 7,172 (93%) completed the second MBI question about callousness. There was no statistically significant association between the burnout item response and ITE performance (ρ = -0.03; p = 0.015). There was a positive, statistically significant association between the callousness item response and higher ITE performance (ρ = 0.07; p < 0.001). There was a statistically significant association between the response to the burnout item and training level (ρ = 0.07; p <0.001). There was also a statistically significant association between the response to the callousness item and training level (ρ = 0.15; p < 0.001). The overall prevalence of burnout risk in various training levels were EM1, 28.2%; EM2, 39%; EM3, 41.1%; and EM4, 43.3%.

CONCLUSIONS

Our study found no significant correlation between ITE score and burnout risk. There was a weakly positive correlation between ITE scores and callousness. Based on our study results, ITE scores may not be useful in prognosticating burnout risk for EM residents and, interestingly, higher ITE scores correlated to stronger feelings of callousness. Our study indicates that EM residents at higher levels of training reported stronger self-perceptions of burnout and callousness. Further investigation into why residents at higher levels of training may experience greater burnout risk is warranted.

Effect of Online Psychological Intervention on Burnout in Medical Residents From Different Majors: An Exploratory Study

Background: Work-related stress among healthcare professionals poses a serious economic and healthcare burden. This study aimed to investigate the prevalence of burnout as well as anxiety, depression, and stress in medical residents from different majors, and assess the effects of an online psychological intervention on the mental health status of medical residents with a high degree of burnout. Methods: We conducted an online survey that collected information on the demographics, mental health, and burnout conditions of medical residents from Shengjing Hospital. The mental health condition was assessed by the Depression, Anxiety, and Stress Scale (DASS)-21. Further, burnout was assessed by the Maslach Burnout Inventory (MBI). Medical residents with a total MBI score between 50 and 75 were selected to receive online psychological intervention for 3 months. Results: Two-hundred and ten medical residents completed the questionnaire, of whom, 63 residents with an MBI score between 50 and 75 received the 3-month online psychological intervention. Anesthesia residents showed the highest level of depression, anxiety, and stress, and presented with a lower sense of personal accomplishment, higher emotional exhaustion, and higher depersonalization. Furthermore, pediatric residents had the second highest DASS and MBI scores following anesthesia residents. Following the online psychological intervention, negative emotional states and burnout levels were significantly lower among anesthesia and pediatric residents. There were no differences in the level of stress and sense of personal accomplishment pre- and post-online psychological intervention among the different majors. Conclusion: Our findings revealed high levels of burnout, as well as depression, anxiety, and stress symptoms in medical residents, with marked differences among different majors. The online psychological intervention effectively improved emotional exhaustion, and depersonalization, and relieved the psychological problems such as anxiety and depression in medical residents.

Critical Care Nurses' Physical and Mental Health, Worksite Wellness Support, and Medical Errors

BACKGROUND

Critical care nurses experience higher rates of mental distress and poor health than other nurses, adversely affecting health care quality and safety. It is not known, however, how critical care nurses' overall health affects the occurrence of medical errors.

OBJECTIVE

To examine the associations among critical care nurses' physical and mental health, perception of workplace wellness support, and self-reported medical errors.

METHODS

This survey-based study used a cross-sectional, descriptive correlational design. A random sample of 2500 members of the American Association of Critical-Care Nurses was recruited to participate in the study. The outcomes of interest were level of overall health, symptoms of depression and anxiety, stress, burnout, perceived worksite wellness support, and medical errors.

RESULTS

A total of 771 critical care nurses participated in the study. Nurses in poor physical and mental health reported significantly more medical errors than nurses in better health (odds ratio [95% CI]: 1.31 [0.96-1.78] for physical health, 1.62 [1.17-2.29] for depressive symptoms). Nurses who perceived that their worksite was very supportive of their well-being were twice as likely to have better physical health (odds ratio [95% CI], 2.16 [1.33-3.52]; 55.8%).

CONCLUSION

Hospital leaders and health care systems need to prioritize the health of their nurses by resolving system issues, building wellness cultures, and providing evidence-based wellness support and programming, which will ultimately increase the quality of patient care and reduce the incidence of preventable medical errors.

The dual pandemics of COVID-19 and racism: impact on early childhood development and implications for physicians

PURPOSE OF REVIEW

The novel coronavirus (COVID-19) pandemic has highlighted healthcare and racial inequities. This article discusses recent literature documenting the impact of racism on early childhood development, disparities in access to developmental services and ways healthcare providers and health systems can promote physician well being during these difficult times.

RECENT FINDINGS

Exposure to racism begins prenatally, and early childhood experiences with racism are intimately tied to adverse physical and mental health outcomes. Early intervention is key to treating children with developmental delay, but disparities exist in accessing eligibility screening and in the provision of services. Paediatric providers are at risk of developing secondary traumatic stress and burnout, which may affect the care that they provide.

SUMMARY

New research has led to the development of resources that help paediatric providers address racism, access developmental resources in a novel manner and protect the paediatric workforce from trauma and burnout.

Does burnout affect clinical reasoning? An observational study among residents in general practice

BACKGROUND

Burnout results from excessive demands at work. Caregivers suffering from burnout show a state of emotional exhaustion, leading them to distance themselves from their patients and to become less efficient in their work. While some studies have shown a negative impact of burnout on physicians' clinical reasoning, others have failed to demonstrate any such impacts. To better understand the link between clinical reasoning and burnout, we carried out a study looking for an association between burnout and clinical reasoning in a population of general practice residents.

METHODS

We conducted a cross-sectional observational study among residents in general practice in 2017 and 2019. Clinical reasoning performance was assessed using a script concordance test (SCT). The Maslach Burnout Inventory for Human Services Survey (MBI-HSS) was used to determine burnout status in both original standards of Maslach's burnout inventory manual (conventional approach) and when individuals reported high emotional exhaustion in combination with high depersonalization or low personal accomplishment compared to a norm group ("emotional exhaustion +1" approach).

RESULTS

One hundred ninety-nine residents were included. The participants' mean SCT score was 76.44% (95% CI: 75.77-77.10). In the conventional approach, 126 residents (63.31%) had no burnout, 37 (18.59%) had mild burnout, 23 (11.56%) had moderate burnout, and 13 (6.53%) had severe burnout. In the "exhaustion + 1" approach, 38 residents had a burnout status (19.10%). We found no significant correlation between burnout status and SCT scores either for conventional or "exhaustion + 1" approaches.

CONCLUSIONS

Our data seem to indicate that burnout status has no significant impact on clinical reasoning. However, one speculation is that SCT mostly examines the clinical reasoning process's analytical dimension, whereas emotions are conventionally associated with the intuitive dimension. We think future research might aim to explore the impact of burnout on intuitive clinical reasoning processes.

Alive and Well: Encouraging Long Term Health Habits Through Implementation of Student Driven Wellness Programs in Medical Schools

Purpose

A lack of coping mechanisms has been linked to increased rates of anxiety, depression, and imposter syndrome among medical students. In response, schools have been searching for methods to negate these results through wellness programs focused on student life.

Methods

A survey comprised of three multiple choice questions was disseminated amongst first year basic science medical students to determine their current state of well-being and potential interest in an educational course focused on wellness. Questions inquired about students’ current coping strategies and their interest in engaging in wellness focused activities. Participants’ responses were then used to create a Well-being selective. The course design was centered around a small points reward system in order to promote autonomous decision making and encourage balance of body, mind, and spirit.

Results/Discussion

Initial survey data suggests student interest in the creation of a wellness centered selective. Students engaged in a diverse array of activities to support the whole of their being. By tracking student choices of activities to engage in and feedback sent to the selective director, the selective design is being adapted to fit the needs of the student body.

Conclusion

Through promotion of on and off-campus extracurricular activities, the Well-being selective offers a non-threatening and self-paced approach to a balanced mind, body, and spirit. In this selective, students participate in diverse activities that support health and life balance, ranging from sunset group yoga to local botany. Student feedback suggests that through the selective they have experienced increased community engagement and support during their basic sciences medical education.

The number and composition of work hours for attending physicians in Taiwan

Long work hours among physicians is a worldwide issue in the healthcare arena. Previous studies have largely focused on the work hours of resident physicians rather than those of attending physicians. The purpose of this study was to investigate total work hours and the composition of those work hours for attending physicians across different hospital settings and across different medical specialties through a nationwide survey. This included examining differences in physician workload and its composition with respect to different hospital characteristics, and grouping medical specialties according to the work similarities. A cross-sectional self-reported nationwide survey was conducted from June to September of 2018, and the two questionnaires were distributed to all accredited hospitals in Taiwan. The number of physician work hours in different types of duty shifts were answered by medical specialty in each surveyed hospital. Each medical specialty in a hospital filled only one response for its attending physicians. The findings reveal that the average total work hours per week of an attending physician is around 69.1 h, but the total work hours and their composition of different duty shifts varied among hospital accreditation levels, geographic locations, emergency care responsibilities, and medical specialties. Because of the variance in the number and composition of attending physicians' work hours, adjusting physician work hours to a reasonable level will be a major challenge for health authority and hospital managers.

Bullying, Discrimination, Sexual Harassment, and Physical Violence: Common and Associated With Burnout in Pediatric Residents

BACKGROUND

Many pediatric residents suffer from burnout. We aimed to describe the prevalence, source, and epidemiology of bullying, discrimination, harassment, and physical violence, and the relationship between these experiences and burnout.

METHODS

We analyzed data from the Spring, 2019 Pediatric Resident Burnout and Resilience Study Consortium's 72-item online survey. Surveys included screening questions about burnout; residents' characteristics and experiences, and attitudes about their learning environment.

RESULTS

Nineteen hundred fifty-six residents (66% of those eligible) from 46 programs participated; most (70%) were women and most (66%) were Caucasian. Overall 45% reported weekly or more frequent burnout symptoms; 33% reported 1 or more of these experiences ("mistreatment") during the past year: 19% reported experiencing bullying; 18% reported discrimination; 5% reported sexual harassment; and 1% reported physical violence. The most frequent sources of mistreatment were clinical staff (60%), patients' families (54%), and faculty (43%). Women were more likely than men to report mistreatment (36% vs 25%, P < .01) Residents who reported experiencing mistreatment were more likely than those who did not to report symptoms of burnout (adjusted odds ratio 1.98; 95% confidence interval, CI 1.62-2.42); they also reported higher stress levels, lower quality of life, and were less likely to agree that their program prioritized collaboration, education, or mentoring (P < .001 for all).

CONCLUSIONS

Mistreatment occurs frequently among pediatric residents, especially women; mistreatment is associated with burnout, stress, lower quality of life, and worse attitudes about the learning environment. Future studies could explore whether institutional efforts to improve workplace civility improves resident well-being and attitudes about training.

Resident physician burnout: insights from a Canadian multispecialty survey

BACKGROUND

Burnout results from chronic exposure to stress: comprising emotional exhaustion (EE), depersonalisation (DP) and a reduced sense of personal achievement (PA). Only a few studies have examined burnout in Canadian residents, and no multispecialty studies using the Maslach Burnout Inventory-Health Sciences Survey (MBI-HSS) exist. The purpose of our study is to identify burnout prevalence, contributory factors and solutions.

METHODS

A prospective 62-item survey, including the 22-item MBI-HSS, was sent to all Alberta residents, with a resident population of 1745. The association between burnout, EE, DP and PA with items in the survey was performed. Continuous data were evaluated using Student's t-test or analysis of variance. Ordinal data were evaluated using Spearman's correlation coefficient and Mann-Whitney U test. Nominal data were evaluated using χ² test.

RESULTS

Response rate was 41.1% (n=718), with burnout prevalence of 69.4%. 61.6% of residents demonstrated high EE, 47.8% high DP and 29.0% low PA. More hours worked, poor work-life balance, poor service-education balance, poor mental health support, experiencing intimidation/harassment and being unhappy with programme and with career choice were associated with higher burnout (p<0.001). 53.5% of residents experienced intimidation/harassment. Solutions to burnout included improved teaching, improved call/working hours, more wellness days and a change in medicine culture.

CONCLUSION

High prevalence of burnout in Canadian residents with contributory factors and solutions identified. We hope programmes across the world can use this information to improve the burden of burnout among residents.

Burning without burning out: A call to protect the calling of medicine

Physicians enter the field of medicine with a sense of calling to meet the needs of others. This sense of calling is a source of resilience and strength, inspiring physicians to defer their own needs in service to patients' needs. When this trade-off becomes chronic, as it does in dysfunctional work environments, burnout can result and both physicians and patients suffer negative consequences. Some of the sources of physician distress, like exposure to suffering and involvement in medical errors, are inherent to medical practice, while others are the product of workplace inefficiencies and flaws in how the health care system functions. Individual physicians can cultivate strategies to maintain resilience in the face of medicine's inherent challenges, while health care organizations work to reduce the systemic drivers of burnout and build cultures that support physicians to thrive. In this and next month's issues, we offer eight articles on aspects of physician well-being with the goal of inspiring and empowering individuals and organizations to take action to transform the health care system so that it can better meet the needs of physicians and their patients.

Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis

BACKGROUND

Whether health care provider burnout contributes to lower quality of patient care is unclear.

PURPOSE

To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship.

DATA SOURCES

MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science (Clarivate Analytics), with no language restrictions, from inception through 28 May 2019.

STUDY SELECTION

Peer-reviewed publications, in any language, quantifying health care provider burnout in relation to quality of patient care.

DATA EXTRACTION

2 reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias by using the Ioannidis (excess significance) and Egger (small-study effect) tests.

DATA SYNTHESIS

A total of 11 703 citations were identified, from which 123 publications with 142 study populations encompassing 241 553 health care providers were selected. Quality-of-care outcomes were grouped into 5 categories: best practices (n = 14), communication (n = 5), medical errors (n = 32), patient outcomes (n = 17), and quality and safety (n = 74). Relations between burnout and quality of care were highly heterogeneous (I2 = 93.4% to 98.8%). Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor-quality care, 6 indicated burnout related to high-quality care, and 50 showed no significant effect. Excess significance was apparent (73% of studies observed vs. 62% predicted to have statistically significant results; P = 0.011). This indicator of potential bias was most prominent for the least-rigorous quality measures of best practices and quality and safety.

LIMITATION

Studies were primarily observational; neither causality nor directionality could be determined.

CONCLUSION

Burnout in health care professionals frequently is associated with poor-quality care in the published literature. The true effect size may be smaller than reported. Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates.

PRIMARY FUNDING SOURCE

Stanford Maternal and Child Health Research Institute.