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Chen WY, Lin FL. 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. Risk Manag Healthc Policy 2023; 16:2291-2307. [PMID: 37953809 PMCID: PMC10638657 DOI: 10.2147/rmhp.s429516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
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.
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Affiliation(s)
- Wen-Yi Chen
- Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung City, Taiwan
| | - Feng-Li Lin
- Department of Accounting, Chaoyang University of Technology, Taichung City, Taiwan
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Nosanov L, Elseth AJ, Maxwell J, Alimi YR, Giri O, Millar JK, Cannada L, Sulciner ML, Weaver JL. The things we carry: The scope and impact of second victim syndrome. Am J Surg 2023; 226:726-728. [PMID: 37451938 DOI: 10.1016/j.amjsurg.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Lauren Nosanov
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Anna J Elseth
- Dwight D Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | | | | | - Oviya Giri
- P.S.G Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Jessica K Millar
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Lisa Cannada
- University of North Carolina Department of Orthopaedics, Charlotte, NC, USA
| | - Megan L Sulciner
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Zeng Z, Wang H, Zhou Y, Lu Z, Ci R, Lin Y, Zeng X, Huang L. The prevalence and factors associated with posttraumatic growth after 3-years outbreak of COVID-19 among resident physicians in China: a cross-sectional study. Front Psychiatry 2023; 14:1228259. [PMID: 37753265 PMCID: PMC10518389 DOI: 10.3389/fpsyt.2023.1228259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
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.
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Affiliation(s)
- Zixuan Zeng
- Department of Psychiatry, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Huan Wang
- Clinical Research Center, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yaxing Zhou
- Department of Medical Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhanghong Lu
- Teaching Office, Renmin Hospital of Wuhan University, Wuhan, China
| | - Renyangcuo Ci
- Department of Medical Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yezhe Lin
- Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Xiaoping Zeng
- Department of Medical Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Huang
- Department of Psychiatry, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Medical Education, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Wang S, Li L, Jin Y, Liao R, Chuang YC, Zhu Z. Identifying Key Factors for Burnout Among Orthopedic Surgeons Using the Analytic Hierarchy Process Method. Int J Public Health 2023; 68:1605719. [PMID: 37206094 PMCID: PMC10188929 DOI: 10.3389/ijph.2023.1605719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives: To develop an evaluation model for, and identify key factors contributing to, burnout in orthopedic surgeons, providing a reference for the management of burnout among orthopedic surgeons in hospitals. Methods: We developed an analytic hierarchy process (AHP) model with 3 dimensions and 10 sub-criteria based on an extensive literature review and expert assessment. We used expert and purposive sampling and 17 orthopedic surgeons were selected as research subjects. The AHP process was then used to obtain the weights and to prioritize the dimensions and criteria for burnout in orthopedic surgeons. Results: The dimension of C 1 (personal/family) was the key factor affecting burnout in orthopedic surgeons, and in the sub-criteria, the top four sub-criteria were C 11 (little time for family), C 31 (anxiety about clinical competence), C 12 (work-family conflict), and C 22 (heavy work load). Conclusion: This model was effective in analyzing the key factors contributing to job burnout risk, and the results can inform improved management of the levels of burnout affecting orthopedic surgeons in hospitals.
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Affiliation(s)
- Shiqian Wang
- Business School, Dongguan City University, Dongguan, China
| | - Lin Li
- Business School, Dongguan City University, Dongguan, China
| | - Yanjun Jin
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Rui Liao
- Business College, Taizhou University, Taizhou, Zhejiang, China
| | - Yen-Ching Chuang
- Business College, Taizhou University, Taizhou, Zhejiang, China
- Institute of Public Health and Emergency Management, Taizhou University, Taizhou, Zhejiang, China
- Key Laboratory of Evidence-Based Radiology of Taizhou, Linhai, Zhejiang, China
- *Correspondence: Yen-Ching Chuang, ; Zhong Zhu,
| | - Zhong Zhu
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
- *Correspondence: Yen-Ching Chuang, ; Zhong Zhu,
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Alahmari MA, Al Moaleem MM, Hamdi BA, Hamzi MA, Aljadaani AT, Khormi FA, Darraj MA, Shrwani RJ, AlOmar AA, Tahhah MK, Alyousefy MA, Al Sanabanei FA. Prevalence of Burnout in Healthcare Specialties: A Systematic Review Using Copenhagen and Maslach Burnout Inventories. Med Sci Monit 2022; 28:e938798. [PMID: 36536586 PMCID: PMC9789675 DOI: 10.12659/msm.938798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This systematic review used the Copenhagen (CBI) and the Maslach (MBI) Burnout Inventories and its scales to assess and compare studies that involved students and workers in all medical specialties. MATERIAL AND METHODS PubMed, ScienceDirect, Scopus, Wiley Library, and Web of Science databases were searched using keywords and Medical Subject Headings. Identified studies were in English, published between 2008 and 2022, measured the burnout of healthcare workers and students by using CBI and MBI, and observed adverse patient outcomes. RESULTS A total of 38 studies were included in the current review. All included studies assessed and evaluated subjects and participants by observing clinical measures, personal and demographic data, countries where the study was conducted, and study type used. Fifty percent of CBI papers were conducted in Saudi Arabia and other Arab countries, whereas the majority of MBI papers (10) were conducted in Europe, followed by 9 studies conducted in Saudi Arabia and other Arab countries and 6 studies conducted in the USA and Canada. The overall percentage of burnout in CBI studies (53%) was higher than that in MBI studies (35%). Also, the types and domains in CBI were marginally higher than those in MBI. CONCLUSIONS Studies that used CBI scales recorded higher burnout compared with studies that used MBI. Females, higher education levels, and marriage status of the tested subjects showed higher CBI and MBI scale scores in comparison to their counterparts. Higher significant differences percentages in burnout types and genders were recorded in CBI than in MBI.
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Affiliation(s)
- Maram A. Alahmari
- Saudi Board Prosthodontic Resident, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Mohammed M. Al Moaleem
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, Saudi Arabia,Faculty of Dentistry, University of Ibn al-Nafis for Medical Sciences, Sana’a, Yemen
| | - Bassam A. Hamdi
- Dental Intern, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | | | | | - Fatima Ali Khormi
- Dental Intern, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Maram Ahmed Darraj
- Dental Intern, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | | | | | | | - Mohanad A. Alyousefy
- Department of Oral Medicine and Periodontology, College of Dentistry, Sana’a University, Sana’a, Yemen
| | - Fuad A. Al Sanabanei
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Dominguez-Espinosa ADC, Montes de Oca-Mayagoitia SI, Sáez-Jiménez AP, de la Fuente-Zepeda J, Monroy Ramírez de Arellano L. The moderating role of sociodemographic and work-related variables in burnout and mental health levels of Mexican medical residents. PLoS One 2022; 17:e0274322. [PMID: 36112642 PMCID: PMC9481024 DOI: 10.1371/journal.pone.0274322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To explore the moderating effects of sociodemographic and work-related variables on levels of burnout and mental health among medical residents. Method A cross-sectional online survey was administered at the beginning of the second wave of COVID-19 at different public teaching hospitals where medical residents practiced in Mexico City. A total of 201 medical residents of different years completed the survey. Results Different univariate inferential analyses on the level of burnout and mental health indices showed significant differences between sex, marital status, previous reports of physical illness or psychological conditions, and residency ranking. However, the effect sizes of those differences were of low to medium size. A predictive path analysis revealed that the three stages of burnout (emotional exhaustion, depersonalization, and achievement dissatisfaction) negatively affect psychological wellbeing and positively affect psychological distress. Finally, even though sociodemographic variables showed some significant variation, the effect sizes were small and did not moderate the direct effect of burnout on mental health indices. Conclusions Medical residents deling with every day medical situations, will be exposed to stressors that might increase the probability to experience emotional exhaustion. This would negatively affect levels of wellbeing and positively affect distress, despite their sociodemographic characteristics.
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Lou SS, Lew D, Harford DR, Lu C, Evanoff BA, Duncan JG, Kannampallil T. Temporal Associations Between EHR-Derived Workload, Burnout, and Errors: a Prospective Cohort Study. J Gen Intern Med 2022; 37:2165-2172. [PMID: 35710654 PMCID: PMC9296727 DOI: 10.1007/s11606-022-07620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Sunny S Lou
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | - Daphne Lew
- Division of Biostatistics, Washington University School of Medicine, St Louis, MO, USA
| | - Derek R Harford
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | - Chenyang Lu
- Department of Computer Science, Washington University in St Louis, St Louis, MO, USA
| | - Bradley A Evanoff
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Jennifer G Duncan
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA. .,Institute for Informatics, Washington University School of Medicine, St Louis, MO, USA.
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Abstract
OBJECTIVES Burnout among physicians is an increasingly recognized phenomenon affecting different aspects of patient care and safety. This meta-analysis quantifies association of burnout and its subscales with self-reported medical errors among physicians. METHODS This meta-analysis followed the principles formulated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies. The MEDLINE, PubMed, Web of Science, PsycInfo, and Eric databases were searched until February 5, 2019, using various combinations of key terms without any language restrictions: burnout, physicians, error, safety, and quality. Reference lists of selected studies were hand searched. Data were extracted from published reports. All quantitative studies reporting prevalence of burnout and its association with self-reported errors among physicians were considered. The analyses of heterogeneity (Cochran Q, I2), publication bias (Begg-Mazumdar and Egger), three subgroups, and sensitivity were performed. The effect of overall burnout and Maslach Burnout Inventory subscales on self-reported errors was calculated as odds ratios with 95% confidence interval. RESULTS Thirteen studies on 20,643 physicians and residents were included. The overall burnout among participants was associated with a significantly increased risk of self-reported errors (odds ratio = 2.72, 95% confidence interval = 2.19-3.37). Emotional exhaustion, depersonalization, and personal accomplishment were all independently predicting factors of self-reported errors. Cochran Q test and inconsistency index I2 were as follows: Q = 27.2; P = 0.0013, I2 = 67% (36%-83%). CONCLUSIONS The results provide evidence that not only overall burnout but also its subscales independently are to be associated with a significantly increased risk of self-reported errors among physicians. As self-reported errors may translate into different types of adverse events, this strong and unequivocal association should be of major concern to healthcare organizations.
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Affiliation(s)
- Jakub Owoc
- From the Department of Gerontology, Public Health and Didactics - National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw
| | - Małgorzata Mańczak
- From the Department of Gerontology, Public Health and Didactics - National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw
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Xu R, Duan C, He Q, Meng Z, Wang G, Liu S, Guo M, Chen X, Wang Y, Duan W, Zhang Q, Yang Q, Liang X, Bai Y. An observation of the peer-assisted learning (PAL) method in the clinical teaching of vertigo/dizziness-related diseases for standardized residency training (SRT) students in China: a randomized, controlled, multicenter study. BMC Med Educ 2021; 21:532. [PMID: 34649532 PMCID: PMC8518317 DOI: 10.1186/s12909-021-02969-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/16/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND Vertigo and dizziness (VD) are among the most frequently seen symptoms in clinics and are important for medical students, especially for those in Chinese standardized residency training (SRT). The aim of our study was to examine the PAL method's feasibility in the clinical teaching of VD-related diseases for SRT students in China. METHODS This is a randomized, controlled, multicenter study. A total of 228 residents were invited to participate in this study, of which 198 completed the program. The students were randomized into two groups, and VD-related diseases were taught using lecture-based learning (control group) or peer-assisted learning (PAL). An examination paper and a rating scale were used to evaluate students' performance in the mastery of VD-related theoretical knowledge and clinical skills, meanwhile students' perceptions, satisfaction, and risk of burnout were also analyzed using a questionnaire. Independent-samples t-test and chi-square analysis were performed to evaluate statistical significance for continuous variables and categorical variables, respectively, using SPSS 18.0 software. RESULTS The PAL group performed better in mastering theoretical knowledge and clinical skills than the control group. And more students believed that PAL could help improve their personal qualities such as teamwork skills. However, more students reported that PAL increased the risk of burnout. CONCLUSIONS PAL was a suitable and effective method in the clinical teaching of some specialized diseases, especially it was recommended for students who had gained initial knowledge and skills, such as Chinese SRT students. However, we should draw attention to the increased risk of burnout if PAL is intended to be widely used in clinical teaching. TRIAL REGISTRATION ISRCTN registry, ISRCTN53773239 , 05/07/2021, retrospectively registered.
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Affiliation(s)
- Rui Xu
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Chunmei Duan
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Qian He
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Zhaoyou Meng
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Gong Wang
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Shu Liu
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Meng Guo
- Department of Neurology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, China
| | - Xiaoyan Chen
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Yue Wang
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Wei Duan
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Qin Zhang
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Qingwu Yang
- Department of Neurology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.
| | - Xiaojun Liang
- Department of Otolaryngology, The Second Affiliated Hospital, Army Medical University, Chongqing, 400038, China.
| | - Yang Bai
- Department of Otolaryngology, The First Affiliated Hospital, Army Medical University, Chongqing, 400038, China.
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Hiver C, Villa A, Bellagamba G, Lehucher-Michel MP. Burnout prevalence among European physicians: a systematic review and meta-analysis. Int Arch Occup Environ Health 2021. [PMID: 34628517 DOI: 10.1007/s00420-021-01782-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Our objective was to assess burnout prevalence rates among physicians practicing in Europe (regardless of their specialty) taking into account the main approaches used to define burnout with the Maslach Burnout Inventory (MBI) tool. METHODS A systematic review was carried out from 2006 to 2018. A keyword request was obtained using the PubMed/Medline, Web of Science and Banque de Données en Santé Publique search engine. Studies written in English measuring burnout with the MBI tool among a population of practicing European physicians were selected. Data were extracted and classified according to burnout's definition provided by the authors. Three definitions using the MBI dimensions were considered: tri-, bi- and unidimensional definition. A meta-analysis was then performed on burnout prevalence rates according to the dimensional definition of burnout. RESULTS From 2378 search results, we selected 56 studies including from up to 41 European countries. Depending upon the study, physicians' burnout prevalence rates ranged from 2.5% to 72.0%. The pooled prevalence rate of burnout was estimated at 7.7% [5.3-10.4%] with the tridimensional definition, 19.7% [13.5-26.3%] with the bidimensional definition and 43.2% [29.0-57.6%] with the unidimensional definition. CONCLUSION Burnout pooled prevalence among physicians varies from single to fivefold depending on the method employed to assess burnout with the MBI tool. Medical community should determine a standardized method to assess burnout prevalence rates to best evaluate this phenomenon.
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Hewitt DB, Ellis RJ, Chung JW, Cheung EO, Moskowitz JT, Huang R, Merkow RP, Yang AD, Hu YY, Cohen ME, Ko CY, Hoyt DB, Bilimoria KY. Association of Surgical Resident Wellness With Medical Errors and Patient Outcomes. Ann Surg 2021; 274:396-402. [PMID: 32282379 DOI: 10.1097/sla.0000000000003909] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to: (1) measure the prevalence of self-reported medical error among general surgery trainees, (2) assess the association between general surgery resident wellness (ie, burnout and poor psychiatric well-being) and self-reported medical error, and (3) examine the association between program-level wellness and objectively measured patient outcomes. SUMMARY OF BACKGROUND DATA Poor wellness is prevalent among surgical trainees but the impact on medical error and objective patient outcomes (eg, morbidity or mortality) is unclear as existing studies are limited to physician and patient self-report of events and errors, small cohorts, or examine few outcomes. METHODS A cross-sectional survey was administered immediately following the January 2017 American Board of Surgery In-training Examination to clinically active general surgery residents to assess resident wellness and self-reported error. Postoperative patient outcomes were ascertained using a validated national clinical data registry. Associations were examined using multivariable logistic regression models. RESULTS Over a 6-month period, 22.5% of residents reported committing a near miss medical error, and 6.9% reported committing a harmful medical error. Residents were more likely to report a harmful medical error if they reported frequent burnout symptoms [odds ratio 2.71 (95% confidence interval 2.16-3.41)] or poor psychiatric well-being [odds ratio 2.36 (95% confidence interval 1.92-2.90)]. However, there were no significant associations between program-level resident wellness and any of the independently, objectively measured postoperative American College of Surgeons National Surgical Quality improvement Program outcomes examined. CONCLUSIONS Although surgical residents with poor wellness were more likely to self-report a harmful medical error, there was not a higher rate of objectively reported outcomes for surgical patients treated at hospitals with higher rates of burnout or poor psychiatric well-being.
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Affiliation(s)
- Daniel Brock Hewitt
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ryan J Ellis
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- American College of Surgeons, Chicago, IL
| | - Jeanette W Chung
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Elaine O Cheung
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Reiping Huang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- American College of Surgeons, Chicago, IL
| | - Anthony D Yang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL
- American College of Surgeons, Chicago, IL
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Mangory KY, Ali LY, Rø KI, Tyssen R. Effect of burnout among physicians on observed adverse patient outcomes: a literature review. BMC Health Serv Res 2021; 21:369. [PMID: 33879135 PMCID: PMC8057942 DOI: 10.1186/s12913-021-06371-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/09/2021] [Indexed: 12/11/2022] Open
Abstract
Background Physician burnout has potentially harmful effects for both physicians and their patients. Despite relationships between physician burnout and lowered patient satisfaction and clinician-rated adverse patient outcomes, there is scarce literature regarding effects on objective patient outcomes. This study aimed to examine the relationship between physician burnout and observed adverse patient outcomes via a review of the literature. Methods A search was performed on the MEDLINE, EMBASE and PsychINFO databases, using keywords and Medical Subject Headings. The identified studies were in English, published from 2007 to 2019, measured burnout among physicians using the Maslach Burnout Inventory (MBI), and included observed adverse patient outcomes. In total, 360 eligible articles were identified, and 11 were included in the final review. All included studies measured patient outcomes by observed clinical measures (e.g. quality of care and medical errors). Results Four studies found a clear significant relationship between physician burnout and observed adverse patient outcomes, while 6 did not. One study found a significant relationship with one of the MBI subscales. Burnout was, in contrast to depression, only partly associated with observed patient outcomes. Conclusions This review illustrates the need for a validation of physician burnout measured by MBI with respect to observed patient outcomes. Further studies are required to investigate the effects of physician burnout on observed quality of their patient care.
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Affiliation(s)
| | | | | | - Reidar Tyssen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Staples BB, Burke AE, Batra M, Kemper KJ, Schwartz A, Wilson PM, Schubert CJ, Mahan JD, Serwint JR. Burnout and Association With Resident Performance as Assessed by Pediatric Milestones: An Exploratory Study. Acad Pediatr 2021; 21:358-365. [PMID: 32795689 DOI: 10.1016/j.acap.2020.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 07/28/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Prior work demonstrating that burnout is associated with decreased performance in medical trainees has relied on self-report and/or single-site studies. We explored the relationship between burnout status and Milestones-based scores in pediatric residents nationally. METHODS In April to June 2016, we confidentially surveyed residents using the Maslach Burnout Inventory. Separately, programs submitted resident Milestones scores in June 2016. We examined the relationship between burnout and performance as assessed by Milestones scores for each domain of competence. We performed multivariate analysis to determine which components of burnout (depersonalization [DP], emotional exhaustion, and lack of personal accomplishment [PA]) were most impactful. RESULTS About 1494 of 2368 (63%) residents at 32 programs completed the Maslach Burnout Inventory and had Milestones scores submitted. Residents who scored positive for burnout scored lower in all Milestones domains. Subgroup analysis demonstrated that this association was only significant (P < .05) in the post-graduate year 1 (PGY1) categorical pediatric cohort. In the PGY1 residents (n = 442), those positive for burnout had lower Milestones scores in patient care (PC) (2.78 vs 2.98), systems-based practice (2.69 vs 2.87), practice-based learning and improvement (2.77 vs 2.93), professionalism (3.09 vs 3.24), and interpersonal and communication skills (2.95 vs 3.12), but not medical knowledge. Multivariate analysis demonstrated that, in PGY1 residents, lower PC score was associated with lower PA and higher DP. CONCLUSIONS Burnout is associated with decreased Milestones performance for pediatric PGY1 residents. DP and low PA were associated with lower PC scores in PGY1 residents. Future research should address whether strategies to mitigate burnout improve PGY1 performance.
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Affiliation(s)
- Betty B Staples
- Department of Pediatrics, Pediatric Residency Program, Duke University Medical Center (BB Staples), Durham, NC.
| | - Ann E Burke
- Department of Pediatrics, Pediatric Residency Program, Wright State University Boonshoft SOM and Dayton Children's Hospital (AE Burke), Dayton, Ohio
| | - Maneesh Batra
- Department of Pediatrics, Pediatric Residency Program, Seattle Children's Hospital and the University of Washington (M Batra), Seattle, Wash
| | - Kathi J Kemper
- Department of Pediatrics, College of Medicine, the Ohio State University (KJ Kemper), Columbus, Ohio
| | - Alan Schwartz
- The Michael Reese Endowed Professor of Medical Education and Research Professor, Pediatrics, University of Illinois College of Medicine (A Schwartz), Chicago, Ill; Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN) (A Schwartz), Chicago, Ill
| | - Paria M Wilson
- Division of Emergency Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center (PM Wilson), Pittsburgh, Pa
| | - Charles J Schubert
- Cincinnati Children's Hospital Medical Center at the University of Cincinnati (CJ Schubert), Cincinnati, Ohio
| | - John D Mahan
- Center for Faculty Development, Nationwide Children's Hospital (JD Mahan), Columbus, OH; Department of Pediatrics, the Ohio State University (JD Mahan), Columbus, Ohio
| | - Janet R Serwint
- Johns Hopkins University School of Medicine, Bloomberg Children's Center (JR Serwint), Baltimore, Md. Dr Wilson is now with Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center at the University of Cincinnati, Cincinnati, Ohio
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Guillou P, Pelaccia T, Bacqué MF, Lorenzo M. Does burnout affect clinical reasoning? An observational study among residents in general practice. BMC Med Educ 2021; 21:35. [PMID: 33413369 PMCID: PMC7792007 DOI: 10.1186/s12909-020-02457-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Philippe Guillou
- Departement of General Practice, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France
| | - Thierry Pelaccia
- Center for Training and Research in Health Sciences Education, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France
- Prehospital Emergency Care Service, Strasbourg University Hospital, University of Strasbourg, 1, place de l'hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Marie-Frédérique Bacqué
- EA3071, Psychology Faculty, University of Strasbourg, 12, rue Goethe, 67000, Strasbourg, France
| | - Mathieu Lorenzo
- Departement of General Practice, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France.
- Center for Training and Research in Health Sciences Education, Medicine Campus, University of Strasbourg, 4, rue Kirschleger, 67085, Strasbourg Cedex, France.
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15
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Naji L, Singh B, Shah A, Naji F, Dennis B, Kavanagh O, Banfield L, Alyass A, Razak F, Samaan Z, Profetto J, Thabane L, Sohani ZN. Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression. CMAJ Open 2021; 9:E189-E200. [PMID: 33688027 PMCID: PMC8034324 DOI: 10.9778/cmajo.20200068] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Burnout among postgraduate medical trainees (PMTs) is increasingly being recognized as a crisis in the medical profession. We aimed to establish the prevalence of burnout among PMTs, identify risk and protective factors, and assess whether burnout varied by country of training, year of study and specialty of practice. METHODS We systematically searched MEDLINE, Embase, PsycINFO, the Cochrane Database of Systematic Reviews, Web of Science and Education Resources Information Center from their inception to Aug. 21, 2018, for studies of burnout among PMTs. The primary objective was to identify the global prevalence of burnout among PMTs. Our secondary objective was to evaluate the association between burnout and country of training, year of study, specialty of training and other sociodemographic factors commonly thought to be related to burnout. We employed random-effects meta-analysis and meta-regression techniques to estimate a pooled prevalence and conduct secondary analyses. RESULTS In total, 8505 published studies were screened, 196 met eligibility and 114 were included in the meta-analysis. The pooled prevalence of burnout was 47.3% (95% confidence interval 43.1% to 51.5%), based on studies published over 20 years involving 31 210 PMTs from 47 countries. The prevalence of burnout remained unchanged over the past 2 decades. Burnout varied by region, with PMTs of European countries experiencing the lowest level. Burnout rates among medical and surgical PMTs were similar. INTERPRETATION Current wellness efforts and policies have not changed the prevalence of burnout worldwide. Future research should focus on understanding systemic factors and leveraging these findings to design interventions to combat burnout. STUDY REGISTRATION PROSPERO no. CRD42018108774.
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Affiliation(s)
- Leen Naji
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
| | - Brendan Singh
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Ajay Shah
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Faysal Naji
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Brittany Dennis
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Owen Kavanagh
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Laura Banfield
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Akram Alyass
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Fahad Razak
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Zainab Samaan
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Jason Profetto
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Lehana Thabane
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que
| | - Zahra N Sohani
- Departments of Family Medicine (Naji, Singh, Kavanagh, Profetto) and of Health Research Methods, Evidence and Impact (Naji, Alyass, Samaan, Thabane), McMaster University; Michael G. DeGroote School of Medicine (Shah); Departments of Vascular Surgery (Naji) and Medicine (Dennis); Health Sciences Library (Banfield), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry and Behavioural Neurosciences (Samaan), McMaster University, Hamilton, Ont.; Biostatistics Unit, St. Joseph's Healthcare - Hamilton (Thabane), Hamilton, Ont.; Faculty of Medicine (Sohani), University of Toronto, Toronto, Ont.; Department of Internal Medicine (Sohani), McGill University, Montréal, Que.
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Huang L, Caspari JH, Sun X, Thai J, Li Y, Chen FZ, Zhao XD. Risk and protective factors for burnout among physicians from standardized residency training programs in Shanghai: a cross-sectional study. BMC Health Serv Res 2020; 20:965. [PMID: 33087121 PMCID: PMC7576715 DOI: 10.1186/s12913-020-05816-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/12/2020] [Indexed: 12/23/2022] Open
Abstract
Background High burnout has been reported in physician populations. Although the standardized residency training (SRT) in China includes components that might put residents at a higher risk for burnout, the burnout of Chinese medical residents is unknown. This study aimed to evaluate the prevalence of burnout and the associated risk and protective factors for medical residents in the SRT program in Shanghai, China. Methods This study was a prospective cross-sectional design. A random sampling strategy was used to recruit 330 resident physicians from four SRT sites in Shanghai, and 318 completed questionnaires were returned. Respondents completed a self-made questionnaire including demographic and work characteristics, four burnout and wellness-specific surveys. Bivariate analyses and hierarchical multiple regression models were used to analyze factors associated with three sub-scales of burn out separately. Results The overall burnout rate was 71.4%. Low level rate of personal accomplishment (PA) was extremely high at 69.5%. Night shift experience, high occupational stress, and low social support were significant predictors, which explained 49.1% variance of emotional exhaustion (EE) (F = 26.528, P < 0.01). Factors that significantly predicted depersonalization (DP) included male gender, senior residents, night shift experience, high occupational stress, and low psychological empathy, which explained 51.5% variance totally (F = 29.004, P < 0.01). Senior residents, high income, low occupational stress, and high empathy were also significant predictors of decreased personal achievement (PA), which explained 18.4% variance totally (F = 12.897, P < 0.01). Conclusions There was a high burnout rate among SRT residents in Shanghai. Occupational stress and several work-related factors were significant and strong risk factors for burnout, while empathy and social support were mild protective factors. Decreased work-related demands and increased access to resources could assist residents in reducing their work stress and improving their well-being.
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Affiliation(s)
- Lei Huang
- Medical Education Division & Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Tongji University School of Medicine, Shanghai, China
| | | | - Xiaoting Sun
- Tongji University School of Medicine, Shanghai, China
| | - Jessica Thai
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yaxi Li
- Tongji University School of Medicine, Shanghai, China
| | - Fa-Zhan Chen
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China.
| | - Xu-Dong Zhao
- Tongji University School of Medicine, Shanghai, China. .,Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China. .,Shanghai East Hospital Affiliated to Tongji University, Shanghai, China.
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Crowe RP, Fernandez AR, Pepe PE, Cash RE, Rivard MK, Wronski R, Anderson SE, Hogan TH, Andridge RR, Panchal AR, Ferketich AK. The association of job demands and resources with burnout among emergency medical services professionals. J Am Coll Emerg Physicians Open 2020; 1:6-16. [PMID: 33000008 PMCID: PMC7493511 DOI: 10.1002/emp2.12014] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Although burnout has been linked to negative workplace-level effects, prior studies have primarily focused on individuals rather than job-related characteristics. This study sought to evaluate variation in burnout between agencies and to quantify the relationship between burnout and job-related demands/resources among emergency medical services (EMS) professionals. METHODS An electronic questionnaire was sent to all licensed, practicing EMS professionals in South Carolina. Work-related burnout was measured using the Copenhagen Burnout Inventory. Multivariable generalized estimating equations were used to estimate odds ratios (ORs) for specific job demands and resources while adjusting for confounding variables. Composite scores were used to simultaneously assess the relationship between burnout and job-related demands and resources. RESULTS Among 1271 EMS professionals working at 248 EMS agencies, the median agency-level burnout was 35% (interquartile range [IQR]: 13% to 50%). Job-related demands, including time pressure, were associated with increased burnout. Traditional job-related resources, including pay and benefits, were associated with reduced burnout. Less tangible job resources, including autonomy, clinical performance feedback, social support, and adequate training demonstrated strong associations with reduced burnout. EMS professionals facing high job demands and low job resources demonstrated nearly a 10-fold increase in odds of burnout compared with those exposed to low demands and high resources (adjusted OR [aOR]: 9.50, 95% confidence interval [CI]: 6.39-14.10). High job resources attenuated the impact of high job demands. CONCLUSION The proportion of EMS professionals experiencing burnout varied substantially across EMS agencies. Job resources, including those reflective of organizational culture, were associated with reduced burnout. Collectively, these findings suggest an opportunity to address burnout at the EMS agency level.
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Affiliation(s)
| | - Antonio R. Fernandez
- ESO IncAustinTexasUSA
- Department of Emergency MedicineSchool of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Paul E. Pepe
- Metropolitan EMS Medical Directors Global CoalitionFort LauderdaleFloridaUSA
| | - Rebecca E. Cash
- The National Registry of EMTsColumbusOhioUSA
- College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Madison K. Rivard
- The National Registry of EMTsColumbusOhioUSA
- College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Robert Wronski
- South Carolina Department of Health and Environmental ControlBureau of EMSColumbiaSouth CarolinaUSA
| | | | - Tory H. Hogan
- College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | | | - Ashish R. Panchal
- The National Registry of EMTsColumbusOhioUSA
- Wexner Medical CenterThe Ohio State UniversityColumbusOhioUSA
| | - Amy K. Ferketich
- College of Public HealthThe Ohio State UniversityColumbusOhioUSA
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Abstract
Background: Globally, burnout is an increasingly prevalent problem amongst young medical professionals. This review aims to understand the factors related to burnout in the early-career stage of medicine. Drawing on the widely used Job Demands-Resources Model, the antecedents of burnout were distinguished from its outcomes.Methods: The review adopted the PRISMA guidelines. Using specific search terms, peer-reviewed articles were obtained from a range of databases and assessed against selection criteria. To meet inclusion requirements, the study had to be published between 2000 and 2018, include a validated measure of burnout, and undertake empirical assessment of factors related to burnout in medical students and/or junior medical officers/residents. Additional studies were obtained and reviewed from the reference lists of selected articles.Results: Out of the 3796 studies that were initially found, 585 were assessed against the eligibility criteria leaving 113 studies for review. These studies highlighted the negative consequences of burnout in the early medical career. Also identified were work-specific and person-specific demands that likely lead to burnout and, work and person resources that appear to reduce burnout.Conclusion: This review provides a framework to explain the growing problem of burnout amongst early-career medical professionals. However, further research is necessary to overcome the current reliance on cross-sectional designs and small sample sizes.
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Affiliation(s)
| | - Barbara Griffin
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
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Yuguero O, Marsal JR, Esquerda M, Galvan L, Soler-González J. Cross-sectional study of the association between empathy and burnout and drug prescribing quality in primary care. Prim Health Care Res Dev 2019; 20:e145. [PMID: 31663492 DOI: 10.1017/S1463423619000793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: The aim of this study was to assess whether burnout and empathy levels among general practitioners (GPs) might influence prescribing performance assessed using pharmaceutical prescription quality standard indicators. Design and Setting: Cross-sectional descriptive study of 108 GPs from 22 primary care centers in Lleida, Spain, and of centralized data corresponding to 183 600 patients under their care. The study was conducted between May and July 2014. Main Outcome Measures: Burnout and empathy were measured using the Spanish versions of the Maslach Burnout Inventory and the Jefferson Scale for Physician Empathy, and prescribing quality was measured using the Catalan Pharmaceutical Prescription Quality Standard (EQPF). Normal distribution of scores was verified using the Chi-square and Kolmogorov–Smirnov–Lilliefors tests. The effect of each of the variables was evaluated using crude odds ratios. Results: Older GPs scored significantly higher in the EQPF (P < 0.05). High empathy scores were positively associated with high EQPF scores. GPs with low burnout also performed better in the EQPF. Conclusions: More empathic, less burned-out, older GPs showed better prescribing performance according to quality indicators. However, further studies are needed to evaluate other factors influencing prescribing habits. The promotion of communication skills may increase empathy and reduce burnout, thus benefiting patients.
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Hui RWH, Leung KC, Ge S, Hwang AC, Lai GGW, Leung AN, Leung JSL. Burnout in orthopaedic surgeons: A systematic review. J Clin Orthop Trauma 2019; 10:S47-S52. [PMID: 31695259 PMCID: PMC6823792 DOI: 10.1016/j.jcot.2019.01.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/06/2018] [Accepted: 01/30/2019] [Indexed: 10/27/2022] Open
Abstract
Occupational burnout is a syndrome composing of emotional exhaustion, depersonalisation and low sense of personal accomplishment. Burnout has been shown to negatively affect both the personal lives and professional performance of doctors. Orthopaedic surgery is a challenging specialty, and while burnout has been studied in orthopaedic surgeons, a comprehensive review article in this area is lacking. Hence we performed a systematic review to summarise the evidence regarding burnout in orthopaedic surgeons. We conducted a systematic literature review using the terms "orthopaedic surgeons" and "burnout" and related terms. Studies were reviewed by two independent reviewers. English articles that were (a) peer-reviewed original research articles; (b) measures burnout directly in study participants; (c) uses validated scales for burnout assessment; and (d) on orthopaedic surgeons, were included. Discrepancies between reviewers were resolved by panel discussion. 216 papers were identified and 14 papers were selected for qualitative synthesis. The prevalence of burnout varied considerably between orthopaedic surgeons from different centres and of different seniority. There is insufficient evidence to suggest that the burnout rate in orthopaedic surgeons is different from doctors in other specialties. A range of risk factors and protective factors associated with burnout were identified. Similar to prior studies in the general medical population, key determinants of burnout included personal, family, working environment and career factors. One paper identified an association between burnout and irritable behaviour during operation, yet no studies have assessed the effect of burnout on orthopaedic patient outcomes. We did not identify papers on the management of burnout in orthopaedic surgeons. To conclude, the evidence on burnout in orthopaedic surgeons is preliminary and key methodological limitations have been noted in the current studies. Large-scale prospective studies are warranted to better understand the determinants and effects of burnout in orthopaedic surgeons, in order to guide appropriate interventions against this occupational mental health hazard.
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Schwartz R, Haverfield MC, Brown-Johnson C, Maitra A, Tierney A, Bharadwaj S, Shaw JG, Azimpour F, Thadaney Israni S, Verghese A, Zulman DM. Transdisciplinary Strategies for Physician Wellness: Qualitative Insights from Diverse Fields. J Gen Intern Med 2019; 34:1251-1257. [PMID: 31037542 PMCID: PMC6614234 DOI: 10.1007/s11606-019-04913-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/24/2019] [Accepted: 02/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND While barriers to physician wellness have been well detailed, concrete solutions are lacking. OBJECTIVE We looked to professionals across diverse fields whose work requires engagement and interpersonal connection with clients. The goal was to identify effective strategies from non-medical fields that could be applied to preserve physician wellness. DESIGN We conducted semi-structured interviews with 30 professionals outside the field of clinical medicine whose work involves fostering effective connections with individuals. PARTICIPANTS Professionals from diverse professions, including the protective services (e.g., police officer, firefighter), business/finance (e.g., restaurateur, salesperson), management (e.g., CEO, school principal), education, art/design/entertainment (e.g., professional musician, documentary filmmaker), community/social services (e.g., social worker, chaplain), and personal care/services (e.g., massage therapist, yoga instructor). APPROACH Interviews covered strategies that professionals use to initiate and maintain relationships, practices that cultivate professional fulfillment and preserve wellness, and techniques that facilitate emotional presence during interactions. Data were coded using an inductive thematic analysis approach. KEY RESULTS Professionals identified self-care strategies at both institutional and individual levels that support wellness. Institutional-level strategies include scheduling that allows for self-care, protected time to connect with colleagues, and leadership support for debriefing after traumatic events. Individual strategies include emotionally protective distancing techniques and engagement in a bidirectional exchange that is central to interpersonal connection and professional fulfillment. LIMITATIONS In this exploratory study, the purposive sampling technique and single representative per occupation could limit the generalizability of findings. CONCLUSION Across diverse fields, professionals employ common institutional and personal wellness strategies that facilitate meaningful engagement, support collegiality, and encourage processing after intense events. The transdisciplinary nature of these wellness strategies highlights universal underpinnings that support wellbeing in those engaging in people-oriented professions.
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Affiliation(s)
- Rachel Schwartz
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA.
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Marie C Haverfield
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Cati Brown-Johnson
- Evaluation Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Amrapali Maitra
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Tierney
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Shreyas Bharadwaj
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sonoo Thadaney Israni
- Presence Center, Department of Medicine, Stanford University, Stanford University School of Medicine, Stanford, CA, USA
| | - Abraham Verghese
- Presence Center, Department of Medicine, Stanford University, Stanford University School of Medicine, Stanford, CA, USA
| | - Donna M Zulman
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Low ZX, Yeo KA, Sharma VK, Leung GK, McIntyre RS, Guerrero A, Lu B, Sin Fai Lam CC, Tran BX, Nguyen LH, Ho CS, Tam WW, Ho RC. Prevalence of Burnout in Medical and Surgical Residents: A Meta-Analysis. Int J Environ Res Public Health 2019; 16:ijerph16091479. [PMID: 31027333 PMCID: PMC6539366 DOI: 10.3390/ijerph16091479] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
The burnout syndrome is characterized by emotional exhaustion, depersonalization, and reduced personal achievement. Uncertainty exists about the prevalence of burnout among medical and surgical residents. Associations between burnout and gender, age, specialty, and geographical location of training are unclear. In this meta-analysis, we aimed to quantitatively summarize the global prevalence rates of burnout among residents, by specialty and its contributing factors. We searched PubMed, PsycINFO, Embase, and Web of Science to identify studies that examined the prevalence of burnout among residents from various specialties and countries. The primary outcome assessed was the aggregate prevalence of burnout among all residents. The random effects model was used to calculate the aggregate prevalence, and heterogeneity was assessed by I2 statistic and Cochran's Q statistic. We also performed meta-regression and subgroup analysis. The aggregate prevalence of burnout was 51.0% (95% CI: 45.0-57.0%, I2 = 97%) in 22,778 residents. Meta-regression found that the mean age (β = 0.34, 95% CI: 0.28-0.40, p < 0.001) and the proportion of males (β = 0.4, 95% CI = 0.10-0.69, p = 0.009) were significant moderators. Subgroup analysis by specialty showed that radiology (77.16%, 95% CI: 5.99-99.45), neurology (71.93%, 95% CI: 65.78-77.39), and general surgery (58.39%, 95% CI: 45.72-70.04) were the top three specialties with the highest prevalence of burnout. In contrast, psychiatry (42.05%, 95% CI: 33.09-51.58), oncology (38.36%, 95% CI: 32.69-44.37), and family medicine (35.97%, 95% CI: 13.89-66.18) had the lowest prevalence of burnout. Subgroup analysis also found that the prevalence of burnout in several Asian countries was 57.18% (95% CI: 45.8-67.85); in several European countries it was 27.72% (95% CI: 17.4-41.11) and in North America it was 51.64% (46.96-56.28). Our findings suggest a high prevalence of burnout among medical and surgical residents. Older and male residents suffered more than their respective counterparts.
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Affiliation(s)
- Zhi Xuan Low
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Keith A Yeo
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Vijay K Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Gilberto K Leung
- Department of Surgery, The University of Hong Kong, Hong Kong, China.
| | - Roger S McIntyre
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5G 2C4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada.
- Department of Toxicology and Pharmacology, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Anthony Guerrero
- Department of Psychiatry, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
| | - Brett Lu
- Department of Psychiatry, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
| | | | - Bach X Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
- Vietnam Young Physicians' Association, Hanoi 100000, Vietnam.
| | - Long H Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Cyrus S Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119228, Singapore.
| | - Wilson W Tam
- Alice Lee School of Nursing, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Biomedical Institute for Global Health Research and Technology, National University of Singapore, Singapore 119228, Singapore.
- Centre of Excellence in Behavioral Medicine, Nguyen Tat Thanh University (NTTU), Ho Chi Minh City 70000, Vietnam.
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Mendoza D, Bertino FJ. Why Radiology Residents Experience Burnout and How to Fix It. Acad Radiol 2019; 26:555-558. [PMID: 30243891 DOI: 10.1016/j.acra.2018.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/29/2018] [Accepted: 08/06/2018] [Indexed: 11/26/2022]
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Mendoza D, Holbrook A, Bertino F, Theriot D, Ho C. Using Wellness Days to Mitigate Resident Burnout. J Am Coll Radiol 2019; 16:221-3. [DOI: 10.1016/j.jacr.2018.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 11/19/2022]
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Huang L, Harsh J, Cui H, Wu J, Thai J, Zhang X, Cheng L, Wu W. A Randomized Controlled Trial of Balint Groups to Prevent Burnout Among Residents in China. Front Psychiatry 2019; 10:957. [PMID: 32116808 PMCID: PMC7026367 DOI: 10.3389/fpsyt.2019.00957] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/04/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Burnout is highly prevalent among residents and is associated with negative outcomes for patients, organizations, and physicians. Balint groups have been shown to be an effective strategy to alleviate physicians' burnout. The purpose of this study was to examine the effectiveness and feasibility of Balint groups in preventing burnout among residents in training programs in China. METHODS 36 resident physicians in their first year of residency at a comprehensive hospital in China were randomly assigned to two groups. Physicians in the intervention group participated in 2 lectures and 10 Balint sessions for 6 months, while participants in the control group were placed on a waitlist for future Balint sessions. All 36 participants completed burnout and job satisfaction measures pre and post-intervention. RESULTS The mean burnout subscale scores for EE and DP decreased, and the scores for PA and job satisfaction increased after Balint group participation. However, paired t-test results revealed there were no statistically significant differences between pre and post-test scores for EE (t = -1.323, p = 0.203), DP (t = -0.727, p = 0.477), PA (t = 0.716, p = 0.484, and job satisfaction (t = 0.282, p = 0.781) for the intervention group. For the control group, the burnout subscale scores for EE (t = 2.312, p = 0.034) and DP (t = 2.898, p = 0.019) increased, and there were statistically significant differences between pre and post-test. PA (t = -0.717, p = 0.483) and job satisfaction (t = -0.241, p = 0.812) scores decreased although there were no significant differences seen between the pre and post-test. Independent t-test results demonstrated statistically significant differences in scores for EE (t = -2.662, p = 0.013) and DP (t = -2.433, p = 0.020) between intervention and control group. However, there were not statistically significant differences between groups for scores in PA (t = 1.013, p = 0.318) and job satisfaction (t = 0.367, p = 0.716). All 18 participants in the intervention group reported that Balint groups were helpful and that they would be willing to attend future sessions. Overall satisfaction with the Balint group program was over 80%. CONCLUSION Balint groups are an efficacious, feasible, standardized method of preventing resident burnout. Residents in China may benefit from Balint group implementation in residency training programs.
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Affiliation(s)
- Lei Huang
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Medical Education Division, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jennifer Harsh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Haisong Cui
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiaxin Wu
- Tongji University School of Medicine, Shanghai, China
| | - Jessica Thai
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Xu Zhang
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liming Cheng
- Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenyuan Wu
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Perina DG, Marco CA, Smith-Coggins R, Kowalenko T, Johnston MM, Harvey A. Well-Being among Emergency Medicine Resident Physicians: Results from the ABEM Longitudinal Study of Emergency Medicine Residents. J Emerg Med 2018; 55:101-109.e2. [PMID: 29759656 DOI: 10.1016/j.jemermed.2018.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/10/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Longitudinal Study of Emergency Medicine Residents (LSEMR) conducted by the American Board of Emergency Medicine queries a randomized cohort of emergency medicine (EM) residents. It is designed to identify residents' perceptions of their training, sources of stress, well-being level, and career choice satisfaction over time. OBJECTIVES This study utilizes LSEMR to identify resident well-being levels, career satisfaction, factors producing stress, and whether a specific cohort is more stressed than the overall respondent group. METHODS Data from five longitudinal cohorts were analyzed using descriptive statistics to assess stressors, career satisfaction, and self-reported resident well-being. Participants' answers were reported on a 5-point Likert scale. RESULTS There were 766 residents who completed the survey in five cohorts. Respondents were 30 years old (median 29), male (66%), and predominantly White (79%). The most frequently encountered problems included "time devoted to documentation and bureaucratic issues," "knowing enough," and "crowding in the emergency department." In contrast, the least frequently reported problems included "gender discrimination," "EMS support," "minority discrimination," and "other residents." Respondents thought being an EM resident was fun and would select EM again. Less than 20% indicated they had seriously considered transferring to another EM program. Resident reports of health concerns changed over time, with fewer residents reporting they were exceptionally healthy in 2016. CONCLUSIONS Residents are, overall, happy with their career choice. However, concern was expressed regarding continued well-being in training. Sources of stress in training are identified. Strategies should be developed to decrease identified stressors and increase well-being among EM residents.
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Tawfik DS, Profit J, Morgenthaler TI, Satele DV, Sinsky CA, Dyrbye LN, Tutty MA, West CP, Shanafelt TD. Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Mayo Clin Proc 2018; 93:1571-1580. [PMID: 30001832 PMCID: PMC6258067 DOI: 10.1016/j.mayocp.2018.05.014] [Citation(s) in RCA: 343] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/04/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate physician burnout, well-being, and work unit safety grades in relationship to perceived major medical errors. PARTICIPANTS AND METHODS From August 28, 2014, to October 6, 2014, we conducted a population-based survey of US physicians in active practice regarding burnout, fatigue, suicidal ideation, work unit safety grade, and recent medical errors. Multivariate logistic regression and mixed-effects hierarchical models evaluated the associations among burnout, well-being measures, work unit safety grades, and medical errors. RESULTS Of 6695 responding physicians in active practice, 6586 provided information on the areas of interest: 3574 (54.3%) reported symptoms of burnout, 2163 (32.8%) reported excessive fatigue, and 427 (6.5%) reported recent suicidal ideation, with 255 of 6563 (3.9%) reporting a poor or failing patient safety grade in their primary work area and 691 of 6586 (10.5%) reporting a major medical error in the prior 3 months. Physicians reporting errors were more likely to have symptoms of burnout (77.6% vs 51.5%; P<.001), fatigue (46.6% vs 31.2%; P<.001), and recent suicidal ideation (12.7% vs 5.8%; P<.001). In multivariate modeling, perceived errors were independently more likely to be reported by physicians with burnout (odds ratio [OR], 2.22; 95% CI, 1.79-2.76) or fatigue (OR, 1.38; 95% CI, 1.15-1.65) and those with incrementally worse work unit safety grades (OR, 1.70; 95% CI, 1.36-2.12; OR, 1.92; 95% CI, 1.48-2.49; OR, 3.12; 95% CI, 2.13-4.58; and OR, 4.37; 95% CI, 2.06-9.28 for grades of B, C, D, and F, respectively), adjusted for demographic and clinical characteristics. CONCLUSION In this large national study, physician burnout, fatigue, and work unit safety grades were independently associated with major medical errors. Interventions to reduce rates of medical errors must address both physician well-being and work unit safety.
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Affiliation(s)
- Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Timothy I Morgenthaler
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Daniel V Satele
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | - Colin P West
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E, Chew-Graham C, Peters D, Hodkinson A, Riley R, Esmail A. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:1317-1331. [PMID: 30193239 PMCID: PMC6233757 DOI: 10.1001/jamainternmed.2018.3713] [Citation(s) in RCA: 562] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified. OBJECTIVE To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction. DATA SOURCES MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched. STUDY SELECTION Quantitative observational studies. DATA EXTRACTION AND SYNTHESIS Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed. MAIN OUTCOMES AND MEASURES The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs. RESULTS Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007). CONCLUSIONS AND RELEVANCE This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.
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Affiliation(s)
- Maria Panagioti
- National Institute for Health Research (NIHR) School for Primary Care Research, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Keith Geraghty
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Judith Johnson
- Bradford Institute for Health Research, University of Leeds, Leeds, United Kingdom
| | - Anli Zhou
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Efharis Panagopoulou
- Laboratory of Hygiene, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, Newcastle, United Kingdom
| | - David Peters
- Westminster Centre for Resilience, Faculty of Science and Technology, University of Westminster, London, United Kingdom
| | - Alexander Hodkinson
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Ruth Riley
- Institute of Applied Health Research College of Medical and Dental Sciences, Murray Learning Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Aneez Esmail
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Naghavi Alhosseini SS, Pourabbasi A. Earthquake in the city: using real life gamification model for teaching professional commitment in high school students. J Med Ethics Hist Med 2018; 11:12. [PMID: 31346389 PMCID: PMC6642457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/02/2018] [Indexed: 11/12/2022] Open
Abstract
Professional commitment plays a significant role in all professions. Moreover, schools are valuable fields for teaching the principles of these concepts especially through novel methods such as gamification. "Earthquake in the city" was implemented in a school in Tehran, Iran, and its effectiveness on learning the concepts of professional commitment was evaluated. "Earthquake in the city" was built based upon a fantasy scenario occurring in an imaginary city. Each student took on a role in the city (citizen or healthcare provider). After finishing the game, participants were asked about the concept of professional commitment. Their definition was scored by a group of medical ethics experts separately in terms of compliance with the actual definitions and compared with their peers in the control group who did not participate in the game. A group of 16-year-old teenagers studying in the 11th grade participated in this intervention. The average score of conformity with the actual concept of professional commitment among the case group participants was significantly higher than the average value for the control group (P < 0.05). The results of this study could provide insights to planners and educators engaged in the education system so that gamification can be incorporated as an influential tool to teach the concepts of professional commitment. This experience can also be generalized to other concepts, but designing the appropriate scenario will be the most important component of the intervention in these cases.
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Affiliation(s)
- Solmaz Sadat Naghavi Alhosseini
- Reseacher, Department of Idea Development and Innovation, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ata Pourabbasi
- Assistant Professor, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Ata Pourabbasi. Address: No. 10, Jalal Al-Ahmad St., next to Shariati Hospital, Chamran Hwy, Tehran, Iran. Tel: (+98) 21 88 63 12 97.
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Abstract
Errors are inherent in medicine due to the imperfectness of human nature. Health care providers may have a difficult time accepting their fallibility, acknowledging mistakes, and disclosing errors. Fear of litigation, shame, blame, and concern about reputation are just some of the barriers preventing physicians from being more candid with their patients, despite the supporting body of evidence that patients cite poor communication and lack of transparency as primary drivers to file a lawsuit in the wake of a medical complication. Proper error disclosure includes a timely explanation of what happened, who was involved, why the error occurred, and how it will be prevented in the future. Medical mistakes afford the opportunity for individuals and institutions to be candid about their weaknesses while improving patient care processes. When a physician takes the Hippocratic Oath they take on a tremendous sense of responsibility for the care of their patients, and often bear the burden of their mistakes in isolation. Physicians may struggle with guilt, shame, and a crisis of confidence, which may thwart efforts to identify areas for improvement that can lead to meaningful change. Coping strategies for providers include discussing the event with others, seeking professional counseling, and implementing quality improvement projects. Physicians and health care organizations need to find adaptive ways to deal with complications that will benefit patients, providers, and their institutions.
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Affiliation(s)
- Sevann Helo
- Division of Urology, Southern Illinois University, Springfield, IL, USA
| | - Carol-Anne E Moulton
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
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