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1.
J Pediatr Hematol Oncol. 2019 Jun 27. doi: 10.1097/MPH.0000000000001548. [Epub ahead of print]

A Cross-sectional Analysis of Compassion Fatigue, Burnout, and Compassion Satisfaction in Pediatric Hematology-Oncology Physicians in the United States.

Author information

1
Department of Pediatrics, Division of Newborn Medicine, Kravis Children's Hospital, Mount Sinai Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY.
2
Division of Palliative Care, Lurie Children's Hospital of Chicago, Chicago, IL.

Abstract

Compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS) are interrelated phenomena that impact personal and professional performance. The CF and Satisfaction Self-Test and a demographic questionnaire were distributed electronically to pediatric hematology-oncology physicians nationally. Linear regression models for CF, BO, and CS as a function of potential predictors were constructed. Survey response rate was 28%. Female sex, BO score, distress about a "clinical situation," and "teaching" were associated with higher CF scores. "Administrative activities" were associated with lower CF scores. CF score, and distress about "administrative burden/academic stress" and "coworkers" were associated with higher BO scores. CS score and "socializing" were associated with lower BO scores. "Exercise," "socializing," and "talking with partner" were associated with higher CS scores. CF and BO scores, emotional depletion, and distress about the "work environment" and "administrative/academic burden" were associated with lower CS scores. Our data highlights the importance of strong social connections at work and at home to decrease BO and enhance CS. Professional development in leadership, communication, and conflict resolution, as well as "team building" events may perpetuate coworker relationships. Education about the importance of connectedness and self-care should begin early in medical education to cultivate robust coping mechanisms in trainees.

2.
Acad Emerg Med. 2019 Jul;26(7):732-743. doi: 10.1111/acem.13670. Epub 2019 Jun 17.

A Cross-sectional Analysis of Compassion Fatigue, Burnout, and Compassion Satisfaction in Pediatric Emergency Medicine Physicians in the United States.

Author information

1
Division of Newborn Medicine and Department of Pediatrics, Kravis Children's Hospital, Mount Sinai Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY.
2
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
3
Division of Palliative Care, Lurie Children's Hospital of Chicago, Chicago, IL.

Abstract

OBJECTIVES:

The objective was to determine the prevalence of compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS) and identify potential personal and professional predictors of these phenomena in pediatric emergency medicine (PEM) physicians.

METHODS:

A modified Compassion Fatigue and Satisfaction Self-Test for Helpers and a questionnaire of personal and professional characteristics were distributed electronically to PEM physicians nationally. The prevalence of these phenomena was calculated. Hierarchical linear regression models for CF, BO, and CS as a function of potential risk factors were constructed.

RESULTS:

The final analyzable survey rate represented 22.7% of the physicians invited to participate. The prevalences of CF, BO, and CS were 16.4, 21.5, and 18.5%, respectively. BO score, distress about a "clinical situation," "physical work environment," and engaging in prayer/meditation were each significant determinants of higher CF scores, whereas "socializing with family/friends" was significantly associated with lower CF scores. CF score, emotional depletion, and distress due to "coworkers" were each significant determinants of higher BO scores, whereas CS score and "talking with a family member" as a means of self-care were significantly associated with lower BO scores. Socializing with family/friends and >20 years as PEM provider were each significant determinants of higher CS scores, whereas BO score, emotional depletion, distress about the physical work environment and "administrative issues," 10% to 24% of time spent caring for pediatric patients, and "talking with life partner" about work-related distress were each significant determinants of lower CS scores. We acknowledge that the generalizability of our findings is limited by the sample size and by the fact that participants were largely female, Caucasian, and junior faculty and worked in academic medical centers.

CONCLUSIONS:

PEM physicians are at risk for developing CF, BO, and low CS. Proactive awareness of these phenomena and their predictors may allow providers to better manage the unique challenges and emotional stressors of the pediatric ED to enhance personal well-being and professional performance.

3.
Semin Pediatr Surg. 2019 Jun;28(3):189-194. doi: 10.1053/j.sempedsurg.2019.04.011. Epub 2019 Apr 26.

The unmeasured quality metric: Burn out and the second victim syndrome in healthcare.

Author information

1
Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Rd NE, Atlanta GA 30322, United States.
2
Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Rd NE, Atlanta GA 30322, United States. Electronic address: Matthew.clifton@choa.org.

Abstract

Physician Burn Out has become endemic as Healthcare has become increasingly complex and challenging to physicians who provide care to critically ill patients. Physicians are more prone to make errors when burnt out. Most Healthcare institutions have not been responsive to support physicians when burned out or when disturbing outcomes occur. Peer support has evolved as the preferred way to help a physician recover after the loss of a patient or a medical error. Best practices are evolving as awareness increases and better research questions arise. Individuals providers, surgical leaders and institutions can all be influential as we address this problem.

KEYWORDS:

Medical error; Peer support; Physician wellness; Second victim syndrome

4.
West J Emerg Med. 2019 May;20(3):485-494. doi: 10.5811/westjem.2019.4.40970. Epub 2019 Apr 23.

Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part I.

Author information

1
Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.
2
University of Massachusetts Medical School-Baystate Health, Department of Emergency Medicine, Springfield, Massachusetts.

Abstract

Each year more than 400 physicians take their lives, likely related to increasing depression and burnout. Burnout-a psychological syndrome featuring emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment-is a disturbingly and increasingly prevalent phenomenon in healthcare, and emergency medicine (EM) in particular. As self-care based solutions have proven unsuccessful, more system-based causes, beyond the control of the individual physicians, have been identified. Such system-based causes include limitations of the electronic health record, long work hours and substantial educational debt, all in a culture of "no mistakes allowed." Blame and isolation in the face of medical errors and poor outcomes may lead to physician emotional injury, the so-called "second victim" syndrome, which is both a contributor to and consequence of burnout. In addition, emergency physicians (EP) are also particularly affected by the intensity of clinical practice, the higher risk of litigation, and the chronic fatigue of circadian rhythm disruption. Burnout has widespread consequences, including poor quality of care, increased medical errors, patient and provider dissatisfaction, and attrition from medical practice, exacerbating the shortage and maldistribution of EPs. Burned-out physicians are unlikely to seek professional treatment and may attempt to deal with substance abuse, depression and suicidal thoughts alone. This paper reviews the scope of burnout, contributors, and consequences both for medicine in general and for EM in particular.

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Publication type

Publication type

5.
Cureus. 2019 Mar 6;11(3):e4186. doi: 10.7759/cureus.4186.

Curated Collection for Educators: Five Key Papers About Second Victim Syndrome.

Author information

1
Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, USA.
2
Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
3
Emergency Medicine, New York University Langone Medical Center, New York, USA.
4
Emergency Medicine, Thomas Jefferson University Hospitals, Philadelphia, USA.

Abstract

Second victim syndrome (SVS) is defined as the psychological or emotional suffering of healthcare workers as a result of a patient adverse, or near miss, event. Initially thought to be related to medical error, we now recognize that SVS can result from a much wider range of circumstances including adverse pediatric patient events, unanticipated deaths, or patients well known to the provider. Residents are particularly susceptible to SVS yet relatively little is written about this topic targeted at their educators. Since educators are positioned to help recognize and guide learners through the experience, this paper targets that reader audience. In this article, we identify and summarize five key papers relevant to educators interested in learning more about SVS as it relates to learners. We identified an extensive list of papers relevant to SVS via online discussions within the Academic Life in Emergency Medicine (ALiEM) Faculty Incubator. The Faculty Incubator is a digital community of practice providing professional development for educators. This list was augmented by an open call on Twitter seen by over 2000 people and yielding a list of 31 papers. We then conducted a three-round modified Delphi process within the authorship group, which included both junior and senior clinician educators, to identify the most impactful papers for educators interested in SVS. The three-round modified Delphi process ranked all papers submitted for review and used iterative rounds to select the five highest-rated papers for inclusion in this article. The group then summarized each of the five papers with specific consideration for junior faculty educators and faculty developers with an interest in SVS in learners. The five papers featured in this article serve as a key reading list for educators across specialties interested in SVS and our commentary provides context for medical educators using the articles.

KEYWORDS:

curated collection; faculty development; junior educators; medical education; modified delphi; resilience; second victim syndrome; wellness

Conflict of interest statement

The authors have declared that no competing interests exist.

Publication type

Publication type

6.
Acad Med. 2019 Aug;94(8):1150-1156. doi: 10.1097/ACM.0000000000002778.

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

Author information

1
K.A. Brunsberg is pediatric hospitalist, Children's Hospitals and Clinics of Minnesota, Minneapolis and St. Paul, Minnesota, and adjunct assistant professor, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota. C.P. Landrigan is professor of pediatrics, Harvard Medical School, chief of general pediatrics, Boston Children's Hospital, and director of the sleep and patient safety program, Brigham and Women's Hospital, Boston, Massachusetts. B.M. Garcia is a second-year medical student, University of California, San Francisco School of Medicine, San Francisco, California. C.R. Petty is a biostatistician, Boston Children's Hospital, Boston, Massachusetts. T.C. Sectish is professor of pediatrics, Harvard Medical School, vice chair for education, Department of Pediatrics, Harvard Medical School, and program director, Boston Combined Residency Program, Boston Children's Hospital, Boston, Massachusetts. A.L. Simpkin is associate director, Center for Educational Innovation and Scholarship, Massachusetts General Hospital, associate program director, Education and Curriculum, Internal Medicine Residency, Massachusetts General Hospital, and instructor in medicine, Harvard Medical School, Boston, Massachusetts. N.D. Spector is professor of pediatrics and associate dean of faculty development, Drexel University College of Medicine, Philadelphia, Pennsylvania, and executive director, Executive Leadership in Academic Medicine, Philadelphia, Pennsylvania. A.J. Starmer is assistant professor of pediatrics, Harvard Medical School, and associate medical director of quality, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts. D.C. West is professor of pediatrics, University of California, San Francisco School of Medicine, and UCSF Benioff Children's Hospital, San Francisco, California. S. Calaman is professor of pediatrics and director of the pediatric residency program, Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.

Abstract

PURPOSE:

To determine whether higher rates of medical errors were associated with positive screenings for depression or burnout among resident physicians.

METHOD:

The authors conducted a prospective cohort study from 2011 to 2013 in seven pediatric academic medical centers in the United States and Canada. Resident physicians were screened for burnout and depression using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS). A two-step surveillance methodology, involving a research nurse and two physician reviewers, was used to measure and categorize errors. Bivariate and mixed-effects regression models were used to evaluate the relationship between burnout, depression, and rates of harmful, nonharmful, and total errors.

RESULTS:

A total of 388/537 (72%) resident physicians completed the MBI-HSS and HANDS surveys. Seventy-six (20%) and 178 (46%) resident physicians screened positive for depression and burnout, respectively. Screening positive for depression was associated with a 3.0-fold higher rate of harmful errors (incidence rate ratio = 2.99 [95% CI 1.40-6.36], P = .005). However, there was no statistically significant association between depression and total or nonharmful errors or between burnout and harmful, nonharmful, or total errors.

CONCLUSIONS:

Resident physicians with a positive depression screen were three times more likely than those who screened negative to make harmful errors. This association suggests resident physician mental health could be an important component of patient safety. If further research confirms resident physician depression increases the risk of harmful errors, it will become imperative to determine what interventions might mitigate this risk.

PMID:
31045601
PMCID:
PMC6667283
[Available on 2020-08-01]
DOI:
10.1097/ACM.0000000000002778
Icon for Wolters Kluwer
7.
MedEdPORTAL. 2019 Feb 27;15:10809. doi: 10.15766/mep_2374-8265.10809.

Empowering Residents to Process Distressing Events: A Debriefing Workshop.

Author information

1
Pediatric Chief Resident, Department of Pediatrics, University of Michigan Medical School.
2
Clinical Assistant Professor, Department of Internal Medicine, University of Michigan Medical School.
3
Clinical Assistant Professor, Department of Pediatrics, University of Michigan Medical School.
4
Senior Statistician, Center for Human Growth and Development, University of Michigan School of Public Health.
5
Instructional Designer, Health Information Technology & Services, University of Michigan Medical School.
6
Clinical Assistant Professor, Department of Psychiatry, University of Michigan Medical School.

Abstract

Introduction:

Adverse events are common in medical training and practice, which can lead to distress among providers. One method of coping with distress is debriefing, which has been shown to improve participants' ability to manage their grief and has been associated with lower rates of burnout.

Methods:

We designed this 2-hour workshop to provide senior residents with the knowledge and skills to lead debriefing sessions within their teams. In this curriculum, we have included a workshop facilitator's guide, didactic information reviewing the components of effective debriefing, a video of a sample debriefing, two videos demonstrating potential debriefing challenges, small-group practice cases, a debriefing pocket card resource, and pre- and postworkshop survey evaluations.

Results:

Twenty second-year pediatric and medicine-pediatric residents were included in the pilot study of this workshop. They reported an average of 2.2 (SD = 2.4) distressing events in the preceding month. None of the residents had received previous training in debriefing, and only 10% had previously led a debriefing session. Pre- and postintervention surveys demonstrated significant increases in resident comfort in and likelihood of leading a debriefing session, as well as in recognition of personal distress.

Discussion:

This workshop serves as one model to enhance training and education regarding debriefing in residency training programs. The issue of distress is not unique to residents, and although this training was initially designed for that population, it could easily be adapted to reach a broader audience of medical trainees and providers.

KEYWORDS:

Burnout; Debriefing; Emotional Distress; Pediatric; Resilience; Trainee

8.
JAMA Surg. 2019 May 1;154(5):451-457. doi: 10.1001/jamasurg.2018.5640.

Potential Consequences of Patient Complications for Surgeon Well-being: A Systematic Review.

Author information

1
Upper Gastrointestinal Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand.
2
Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago on Wellington Harbor, Wellington, New Zealand.

Abstract

Importance:

Patient complications occur in all areas of surgery, and managing them is an important part of surgical practice. Several investigations have examined whether surgeon health affects patient outcomes; however, to date, whether adverse patient outcomes affect surgeon well-being has not been comprehensively examined.

Objective:

To examine how surgical complications in their patients affect the health of surgeons, in particular emotional outcomes, coping strategies, and support mechanisms.

Evidence Review:

A systematic literature review was conducted to identify studies evaluating how patient complications affect surgeons with the aim of determining emotional outcomes, coping strategies, and support mechanisms. Studies pertaining to burnout alone or not conducted in surgeons were excluded. The databases searched included MEDLINE, Embase, PubMed, Web of Science, and Google Scholar, with all literature available on these data sets until the search date of May 1, 2018; collected data were analyzed between May 2 and June 1, 2018. The reference lists of all included studies, as well as related review articles, were manually searched to identify further relevant studies. An inductive approach was used to identify common themes.

Findings:

Nine case series or cross-sectional studies from the United Kingdom or North America were found (8518 unique participants), with 1 study in surgical trainees. Across all studies, surgeons were affected emotionally after complications, with adverse consequences in their professional and personal lives. Four themes were identified within the literature: the adverse emotional influence of complications (anxiety, guilt, sadness, shame, interference with professional and leisure activities) after intraoperative adverse events; coping mechanisms used by surgeons and trainees (limited discussion with colleagues, exercise, artistic or creative outlets, alcohol and substance abuse); institutional support mechanisms and barriers to support (clinical conferences, discussion with mentors, a perception that emotional distress would be perceived as a constitutional weakness); and the consequences of complications in future clinical practice (changes in practice, introduction of protocols, education of staff members, and participating in root-cause analysis).

Conclusions and Relevance:

This study's findings suggest that complications affect surgeons adversely across multiple domains. Further efforts are required at a personal, departmental, institutional, and organizational level to provide effective support. This review highlights that the psychological consequences of patient complications seem to be an important occupational health issue for surgeons.

9.
Eur J Pediatr. 2019 May;178(5):681-693. doi: 10.1007/s00431-019-03334-7. Epub 2019 Feb 19.

Occupational well-being in pediatricians-a survey about work-related posttraumatic stress, depression, and anxiety.

Author information

1
Department of Obstetrics and Gynecology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands. m.e.vansteijn@olvg.nl.
2
Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. m.e.vansteijn@olvg.nl.
3
Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
4
Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
5
Arq Psychotrauma Expert Group, Diemen, The Netherlands.
6
Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands.
7
Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
8
Department of Obstetrics and Gynecology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.

Abstract

The objective of this study was to study mental health, coping, and support after work-related adverse events among pediatricians. Physicians are frequently exposed to adverse events. It makes them at risk for posttraumatic stress disorder (PTSD), depression, and anxiety disorders. Besides the personal impact, physicians could pose a threat towards patients, as mental health problems are associated with medical errors. A questionnaire was sent to all members of the Pediatric Association of The Netherlands in October 2016. The questionnaire focused on adverse events, coping, and support. The Hospital Anxiety and Depression Scale and the Trauma Screening Questionnaire were included for evaluation of anxiety, depression, and posttraumatic stress. Four hundred ten questionnaires (18.9%) were eligible for analysis. Seventy-nine % (n = 325) of the respondents experienced adverse events, with "missing a diagnosis" having the most emotional impact and "aggressive behavior" as the most common adverse event. Nine (2.2%) pediatricians scored above the cut-off value on the Trauma Screening Questionnaire, indicative of PTSD. In total, 7.3% (n = 30) and 14.1% (n = 58) scored above the cut-off values in the Hospital Anxiety and Depression Scale, indicative of depression and anxiety. Only 26.3% reported to have a peer support protocol available for emotional support following adverse events.Conclusion: Pediatricians experience a considerable amount of adverse and potentially traumatizing events associated with significantly higher mental health problems compared to the general high-income population. Aggression towards pediatricians seems to be a common problem. Protocolled (peer) support should be implemented. What is known: • Physicians are frequently exposed to adverse events. It makes physicians at risk for depression, anxiety, and posttraumatic stress. • Physicians who are affected by these events pose a threat towards patients, as mental health problems are associated with medical errors. What is new: • Pediatricians experience a considerable amount of adverse and potentially traumatizing events associated with significantly higher mental health problems. • It is advised that (peer) support after adverse events is protocolled and education on coping strategies is implemented, to improve mental well-being of pediatricians.

KEYWORDS:

Adverse events; Mental health; Occupational stress; Work-related anxiety; Work-related depression; Work-related posttraumatic stress disorder; Workplace aggression

PMID:
30783762
PMCID:
PMC6459799
DOI:
10.1007/s00431-019-03334-7
[Indexed for MEDLINE]
Free PMC Article
Icon for Springer Icon for PubMed Central
10.
J Pediatr Surg. 2019 May;54(5):891-894. doi: 10.1016/j.jpedsurg.2019.01.014. Epub 2019 Jan 31.

Canadian Association of Pediatric Surgeons' state of wellness.

Author information

1
Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada. Electronic address: bratu@ualberta.ca.
2
Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
3
Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
4
Department of Surgery, Queen's University School of Medicine, Kingston, ON, Canada.
5
Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
6
Department of Surgery, University of Toronto, Toronto, ON, Canada.

Abstract

The following is a summary of the fourth Ein Panel Debate Session from the 50th Annual Meeting of the Canadian Association of Pediatric Surgeons (CAPS) held in Toronto, ON, from September 26-29, 2018. The session focused on surgeon well-being at different stages of career: role of mentorship at the start of career, second victim syndrome, litigation stress syndrome, and retirement. Using Maslach Burnout Inventory Survey, CAPS members were presented their wellness scores as a group compared to other health care providers. The power of surgical culture in influencing decision making and judgment was explored. A culture shift toward vulnerability and transparency is possible and more suitable to expert practice and surgeon wellness.

KEYWORDS:

Burnout; Litigation stress syndrome; Maslach burnout inventory; Mentorship; Pediatric surgery; Retirement; Second victim; Surgeon well-being

PMID:
30782439
DOI:
10.1016/j.jpedsurg.2019.01.014
[Indexed for MEDLINE]
Icon for Elsevier Science
12.
BMC Health Serv Res. 2019 Feb 6;19(1):100. doi: 10.1186/s12913-019-3936-1.

Experiences and responses of second victims of patient safety incidents in Korea: a qualitative study.

Author information

1
Asian Institute for Bioethics and Health Law, Seoul, Republic of Korea.
2
Department of Medical Humanities and Social Sciences, Division of Medical Law and Bioethics, Yonsei University College of Medicine, Seoul, Republic of Korea.
3
Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44055, Republic of Korea.
4
Doctoral Program in Medical Law and Ethics, Yonsei University, Seoul, Republic of Korea.
5
Office of Research Planning and Coordination Department, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
6
Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44055, Republic of Korea. ohohoms@naver.com.

Abstract

BACKGROUND:

Healthcare professionals who experience trauma due to patient safety incidents can be considered second victims, and they also suffer from various difficulties. In order to support second victims, it is necessary to determine the circumstances of the incidents in question, along with the symptoms that the victims are experiencing and the support they require. A qualitative study on healthcare professionals of various occupations, such as physicians and nurses working in Korea, was conducted, and the experiences and response methods and processes of second victims were examined.

METHODS:

In-depth interviews were conducted with 16 healthcare professionals (six physicians, eight nurses, and two pharmacists) who had experienced a patient safety incident. All interviews were recorded and transcribed, and the data analysis was conducted in accordance with Strauss and Corbin's grounded theory. Both open coding and axial coding were performed. Consolidated criteria for reporting qualitative research (COREQ) were applied in this study.

RESULTS:

The results of the open coding demonstrated that the experiences of second victims can be categorized into "the reactions of the first victim and surrounding people after the incident," "Influence of factors aside from the incident," "the initial complex responses of the participants to the incident," "open discussion of the incident," "the culture in medical institutions regarding early-stage incident response," "the coping responses of the participants after incidents," and "living with the incident." Then, the seven categories in the open coding stage were rearranged according to the paradigm model, and the reaction process of the second victims was analyzed through process analysis, being divided into the "entanglement stage," "agitating stage," "struggling stage," "managing stage," and "indurating stage."

CONCLUSIONS:

This research is significant because it provides a comprehensive understanding of second victims' experiences in the eastern region of Korea, by obtaining data using a qualitative research method. The findings of the study also highlight the five stages of the second victim response process, and can be used to design a specialized second victim support program in Korea.

KEYWORDS:

Emotional distress; Grounded theory; Medical litigation; Patient safety; Qualitative research; Republic of Korea; Second victims

PMID:
30728008
PMCID:
PMC6366082
DOI:
10.1186/s12913-019-3936-1
[Indexed for MEDLINE]
Free PMC Article
Icon for BioMed Central Icon for PubMed Central
14.
Educ Prim Care. 2019 Mar;30(2):96-101. doi: 10.1080/14739879.2018.1563502. Epub 2019 Jan 17.

Supporting trainees in challenging learning environments - is there a way?

Author information

1
a Post CCT GP fellow , Health Education East Midlands , Nottingham , UK.
2
b Salaried GP , Clare House Surgery , Tiverton , UK.
3
c The Research Unit for and Department of General Practice, Department of Public Health, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark.
4
d St. Edmund's College , Cambridge University , Cambridge , UK.

Abstract

The working and learning environment within the NHS is challenging. 46% of GPs report emotional exhaustion, and trainees experience burn-out with higher prevalence than expected. Attending Balint groups (BGs) has been suggested to prevent burnout and compassion fatigue, helping GPs to thrive in their jobs. For this pilot service evaluation of BGs for GP trainees we used qualitative research methodology including surveys, participant observation, and semi-structured interviews. Fonagy's concept of resilience was used as the theoretical frame of reference. The data-led analysis identified trainees having burn-out sensations: un-met expectations for their training; their need for more support and the value of attending the BGs. Trainees experienced BG as a safe place, allowing open discussions and honest accounts of anxieties, facilitating clinical learning and learning skills of reflection as an important supplement to normal training. The theory-led analysis showed that BG sessions taught trainees new approaches to improve elements that are assessed as key in the selection process for GP training and as Fonagy described as characteristic for people with resilience. As a result of this project, a number of trainees expressed interest in continuing Balint group work. Trainees were recruited to an ongoing monthly BG, within the GP training scheme. However, due to budget restraints, difficulties with new interest and failing to find a non-training GP facilitator in the local area, the group has floundered.

KEYWORDS:

Balint groups (BG's); Burnout; GP trainees; general practice (GP); resilience

PMID:
30652934
DOI:
10.1080/14739879.2018.1563502
[Indexed for MEDLINE]
Icon for Taylor & Francis
15.
Cureus. 2018 Oct 5;10(10):e3416. doi: 10.7759/cureus.3416.

Compassion Satisfaction, Burnout, and Compassion Fatigue in Cardiac Physicians Working in Tertiary Care Cardiac Hospitals in Pakistan.

Author information

1
Internal Medicine, Shifa College of Medicine, Islamabad, PAK.
2
Epidemiology and Public Health, Combined Military Hospital, Peshawar, PAK.
3
Cardiology, Punjab Institute of Cardiology, Lahore, PAK.
4
Cardiac/thoracic/vascular Surgery, Shaikh Zayed Hospital, Lahore, PAK.

Abstract

Introduction The purpose of this study is to determine the prevalence and risk factors of compassion satisfaction, compassion fatigue, and burnout among cardiac physicians working in tertiary care cardiac hospitals in Pakistan. Materials and methods We performed a cross-sectional study in four tertiary care cardiac hospitals located in Rawalpindi and Lahore, Pakistan from June 2017 to January 2018. The study comprised of three stages. The first stage involved administration of the Professional Quality of Life Scale (ProQOL-5) questionnaire in order to assess the prevalence of compassion satisfaction, compassion fatigue, and burnout in cardiac physicians. In the second stage, cardiac physicians were divided into two groups according to their compassion fatigue level. In the third stage, 50 participants were selected via convenience sampling to participate in a 15-minute interview regarding compassion fatigue and risk factors. The data obtained was analyzed using the Statistical Package for the Social Sciences (SPSS), version 21.0 (IBM, Armonk, NY). Results The mean age of the participants was found to be 39.2 ± 6.3 years. Out of the 200 participants, 110 (55.0%) were males while 90 (45.0%) were females. The mean score in the compassion satisfaction category was 39.13 ± 5.54 while the mean score of burnout category was 24.7 ± 4.28 and that of secondary traumatic stress (compassion fatigue) was 25.97 ± 6.39. Participants whose age was less than 40 years had a higher score in Burnout (p < 0.001) and secondary traumatic stress category (p < 0.05). Conclusions In Pakistan compassion fatigue, despite being reported as a negative phenomenon, has received little or no attention. There is a dire need to increase awareness about compassion fatigue and burnout among cardiac care physicians in Pakistan.

KEYWORDS:

burnout; cardiac caregiver; compassion fatigue; compassion satisfaction; secondary traumatic stress

Conflict of interest statement

The authors have declared that no competing interests exist.

16.
Pediatr Crit Care Med. 2019 Mar;20(3):213-222. doi: 10.1097/PCC.0000000000001803.

A Cross-Sectional Analysis of Compassion Fatigue, Burnout, and Compassion Satisfaction in Pediatric Critical Care Physicians in the United States.

Author information

1
Division of Newborn Medicine and Department of Pediatrics, Kravis Children's Hospital, Mount Sinai Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY.
2
Division of Palliative Care, Lurie Children's Hospital of Chicago, Chicago, IL.

Abstract

OBJECTIVES:

To determine the prevalence of compassion fatigue, burnout, and compassion satisfaction and identify potential personal and professional predictors of these phenomena in pediatric critical care providers.

DESIGN:

Cross-sectional, online survey.

SETTING:

Pediatric critical care practices in the United States.

SUBJECTS:

Pediatric critical care fellows and attending physicians.

INTERVENTIONS:

None.

MEASUREMENT AND MAIN RESULTS:

A modified Compassion Fatigue and Satisfaction Self-Test for Helpers and a questionnaire of personal and professional characteristics were distributed electronically to pediatric critical care physicians nationally. Prevalence of these phenomena was calculated. Hierarchical linear regression models for compassion fatigue, burnout, and compassion satisfaction as a function of potential risk factors were constructed. The survey response rate was 35.7%. The prevalence of compassion fatigue, burnout, and compassion satisfaction was 25.7%, 23.2%, 16.8%, respectively. Burnout score, emotional depletion, and distress about a patient and/or the physical work environment were each significant determinants of higher Compassion Fatigue scores. Preparing for didactics, Compassion Fatigue score, distress about administrative issues and/or coworkers, and "self-care is not a priority" were each significant determinants of higher burnout scores, whereas female sex, Compassion Satisfaction score, and distress about the physical work environment were each significant determinants of lower burnout scores. Prayer/meditation, talking with colleagues, senior faculty level, and student and/or chaplain involvement when delivering bad news were each significant predictors of higher Compassion Satisfaction scores, whereas female sex, burnout score, emotional depletion, and distress about coworkers were each significant predictors of lower Compassion Satisfaction scores.

CONCLUSIONS:

In our population, chronic exposure to distress in patients and families puts pediatric critical care physicians at risk for compassion fatigue and low compassion satisfaction. Awareness of compassion fatigue, burnout, and compassion satisfaction and their predictors may benefit providers both personally and professionally by allowing them to proactively manage their distress.

Comment in

18.
J Healthc Qual Res. 2018 Sep - Oct;33(5):284-289. doi: 10.1016/j.jhqr.2018.06.002. Epub 2018 Oct 22.

Physicians as second victims after a malpractice claim: An important issue in need of attention.

Author information

1
Professional Liability Department, Barcelona's College of Physicians, Barcelona, Spain; Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain; Professional Liability and Legal Medicine Chair, Universitat Autònoma de Barcelona, Barcelona, Spain.
2
Professional Liability Department, Barcelona's College of Physicians, Barcelona, Spain; Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain.
3
Professional Liability Department, Barcelona's College of Physicians, Barcelona, Spain.
4
Professional Liability Department, Barcelona's College of Physicians, Barcelona, Spain; Professional Liability and Legal Medicine Chair, Universitat Autònoma de Barcelona, Barcelona, Spain; Legal Medicine Unit, Public Health Department, Universidad de Barcelona, Barcelona, Spain.

Abstract

OBJECTIVE:

Being sued for malpractice is extremely stressful and potentially traumatizing. We aim to identify claims' consequences on the physicians' well-being and medical practice.

MATERIAL AND METHODS:

We administered a confidential telephonic survey to those physicians with a claim closed during 2014, among those insured by the main professional liability insurance company in the region. The questionnaire addressed several topics: symptoms and well-being changes, needs, impairments and practice changes. We used descriptive statistics as well as Chi-square and T-Student tests.

RESULTS:

A total of 99 physicians responded to the questionnaire (response rate of 64.7%). Most of them (80.8%) acknowledged having suffered a significant emotional distress, no matter the claim's outcome (p=0.958) or the kind of procedure (p=0.928). Anger and mood cluster of symptoms were frequent, and the experience frequently affected their personal, family or social life and professional conduct. Practice changes correlated significantly and positively with the number of symptoms reported (p=0.010), but not with the outcome of the claim (p=0.338) or the kind of procedure (p=0.552).

CONCLUSIONS:

Most claimed physicians suffer a significant emotional distress after a malpractice claim, which affects their professional performance. According to our results, they should be assessed and assisted in order to minimize the negative consequences on their well-being and their praxis.

KEYWORDS:

Análisis de reclamaciones; Claims analysis; Claims review; Mala praxis; Malpractice; Post traumatic stress disorder; Professional liability; Responsabilidad profesional; Revisión de reclamaciones; Síndrome de estrés por mala praxis

PMID:
30361104
DOI:
10.1016/j.jhqr.2018.06.002
[Indexed for MEDLINE]
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19.
Cancer Radiother. 2018 Dec;22(8):784-789. doi: 10.1016/j.canrad.2018.02.005. Epub 2018 Oct 19.

Prevalence of burnout, depression and job satisfaction among French senior and resident radiation oncologists.

Author information

1
Département de radiothérapie, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France; CNRS, Laboratoire QuantIF, EA4108-Litis, FR UMR 3638, 1, rue d'Amiens, 76000 Rouen, France. Electronic address: ioana.lazarescu1@gmail.com.
2
Département de radiothérapie, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France; CNRS, Laboratoire QuantIF, EA4108-Litis, FR UMR 3638, 1, rue d'Amiens, 76000 Rouen, France.
3
Département de biostatistiques, centre hospitalier universitaire de Rouen, 1 rue de Germont, 76031 Rouen cedex, France.
4
Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
5
Société française de radiothérapie oncologique (SFRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS 80005, 84918 Avignon cedex 9, France.
6
Société française de radiothérapie oncologique (SFRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Service de radiothérapie, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Professeur-Jacques-Monod, 44805 Saint-Herblain, France.
7
Société française de radiothérapie oncologique (SFRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France; Département de radiothérapie oncologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; EMR 3738, université Claude-Bernard-Lyon-1, 69373 Lyon cedex 08, France.
8
Syndicat national des radiothérapeutes oncologues (SNRO), 168A, rue de Grenelle, 75007 Paris, France; Centre d'oncologie et de radiothérapie du Parc, rue des Sentiers, 71100 Chalon-sur-Saône, France.
9
Département de radiothérapie, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France; CNRS, Laboratoire QuantIF, EA4108-Litis, FR UMR 3638, 1, rue d'Amiens, 76000 Rouen, France; Société française des jeunes radiothérapeutes oncologues (SFjRO), centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France.

Abstract

PURPOSE:

Cancer caregivers are at high risk of burn-out, with potential severe consequences on professionals' health and on patients' care. We have investigated the prevalence of burn-out and its impact in terms of psychological morbidity among French radiation oncologists.

METHODS AND MATERIALS:

An anonymous online questionnaire was advertised in all French senior radiation oncologists and residents, including demographical data, job-related stress factors, drug use, the Maslach Burn-out Inventory (MBI) and the General Health Questionnaire (GHQ-12).

RESULTS:

The response rates were 37% (76 out of 204) for radiation oncologists and 22% (166 out of 751) for residents. Sixty-four (84%) radiation oncology residents and 104 (63%) radiation oncologists met criteria for moderate/severe burn-out (odd ratio 2.1 [95% confidence interval 1.0-4.8], P=0.03). Radiation oncology residents were more prone to depersonalization (P<0.001) and lower personal accomplishment (P<0.001). Burn-out was more frequent in radiation oncologists working for public facilities. Symptoms of depression (GHQ-12≥4) were reported by 42% of residents and 36% of radiation oncologists (P=0.40). Psychological morbidity, suicidal ideation and anxiolytic consumption were more frequent in burnt out responders.

CONCLUSION:

Our figures are in the highest range of published data. Active screening and prevention of burn-out should be implemented and particularly aimed at radiation oncology residents.

KEYWORDS:

Burn out; Depression; Drug abuse; Dépression; General Health Questionnaire; Internes; Internship; Maslach Burnout Inventory; Oncology caregiver; Professional burnout; Radiation oncology; Radiothérapeutes; Residency; Syndrome d’épuisement professionnel des soignants

PMID:
30348608
DOI:
10.1016/j.canrad.2018.02.005
[Indexed for MEDLINE]
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20.
Orthop Traumatol Surg Res. 2018 Dec;104(8):1291-1295. doi: 10.1016/j.otsr.2018.08.016. Epub 2018 Oct 17.

Burnout syndrome in orthopaedic and trauma surgery residents in France: A nationwide survey.

Author information

1
Service de chirurgie orthopédique, département universitaire, CHU de Besançon, 3, boulevard Alexandre Fleming, 25000 Besançon, France. Electronic address: gr.faivre@gmail.com.
2
Service de chirurgie orthopédique, CHI de Vesoul, 2, rue René Heymes, 70000 Vesoul, France.
3
Service de chirurgie orthopédique, département universitaire, CHU de Besançon, 3, boulevard Alexandre Fleming, 25000 Besançon, France.

Abstract

BACKGROUND:

Burnout syndrome is one of the manifestations of distress in healthcare workers and is characterised by emotional exhaustion (EE), depersonalisation (DP), and a sense of low personal accomplishment (PA). The surgical residency is a period of intense training that imposes major challenges on future surgeons, who may therefore be at high risk for burnout syndrome. Nevertheless, no data on burnout syndrome in orthopaedic and trauma surgery (OTS) residents in France is available. Therefore we performed a prospective survey to: (1) evaluate the prevalence of burnout syndrome among OTS residents in France, (2) and to look for factors associated with a higher or lower risk of burnout syndrome in the survey respondents.

HYPOTHESIS:

Burnout syndrome is at least as prevalent among OTS residents in France as among residents in other medical and surgical specialities.

MATERIAL AND METHODS:

A nationwide prospective survey was conducted in France between February and April 2017 via a digital questionnaire sent by email. Burnout syndrome was evaluated using the Maslach Burnout Inventory (MBI) and symptoms of depression using the General Health Questionnaire (GHQ-12). Demographic data and information on relationships with partners and working modalities were collected.

RESULTS:

Of 480 OTS residents, 107 (22%) completed the questionnaire. Mean age was 27 years and 65% (n=70) were male. High EE was reported by 26% (n=28), high DP by 63% (n=68), and low PA by 33% (n=36) of respondents. The scores on two or all three of the MBI sub-scales were abnormal, indicating severe burnout syndrome, in 40% (n=43) of respondents. The GHQ-12 scores indicated symptoms of depression in 40% (n=43) of respondents. Furthermore, 61% (n=66) of respondents stated that they would not recommend OTS or any other area of medicine to their children as a career and 10% (n=11) reported suicidal ideation during the past year. The statistical analysis identified three risk factors for burnout syndrome: medical errors (odds ratio [OR], 8.8; 95% confidence interval [95%CI], 1.7-58.7; p=0.0121), symptoms of depression (OR, 19.3; 95%CI, 2.9-196.0; p=0.0048), and living single (OR, 4.7; 95%CI, 1.4-18.9; p=0.0173).

DISCUSSION:

Despite the 22% response rate, this study provides useful information on the prevalence of burnout syndrome among OTS residents in France, with severe burnout in 40% and suicidal ideation in 10%. These prevalences may be overestimations, however, as residents who felt under stress may have been more likely to respond to the survey. In published studies, burnout syndrome was associated with higher risks of medical error and suicidal behaviour. These data emphasise the importance of detecting and managing burnout syndrome in healthcare staff.

LEVEL OF EVIDENCE IV:

Prospective descriptive cross-sectional survey with no control group.

KEYWORDS:

Burnout; Maslach Burnout Inventory; Orthopaedic surgery; Residents; Suicide

PMID:
30341030
DOI:
10.1016/j.otsr.2018.08.016
[Indexed for MEDLINE]
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