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1.
Orthop Traumatol Surg Res. 2019 Nov 15. pii: S1877-0568(19)30324-X. doi: 10.1016/j.otsr.2019.04.029. [Epub ahead of print]

Burnout in orthopedic surgeons.

Author information

1
Clinique les Lauriers, 147, avenue Jean-Giono, 83600 Fréjus, France. Electronic address: travers_vincent@yahoo.fr.

Abstract

Burnout corresponds to a state of exhaustion (emotional, physical, mental) that can result in complete psychological and/or physical breakdown. Burnout is a result of how our society has evolved. A recent phenomenon, it affects all strata of society, all corporations, and all countries. Physicians are not immune to it, whether they are in public or private practice and whether they are residents in training or seasoned practitioners. The orthopedic world is particularly affected because of multiple risk factors such as sustained work demands, increased malpractice lawsuits, patients no longer placing physicians on a pedestal, greater bureaucratic demands from hospitals and large practices, institutional control policies, reduced autonomy and aggressive media. This is a highly topical issue, hence this study. We sought to answer the following questions: What is burnout? Burnout has three components: emotional exhaustion, depersonalization, loss of personal accomplishment. Its manifestations are psychological, emotional and also physical. Six psychosocial risk factors have been described. The most relevant to our specialty are the intensity and complexity of the work, and the substantial emotional requirements. What is the frequency of burnout and the risk factors in the medical field? Burnout affects the healthcare sector, especially surgeons with a mean of 40% rate. All age groups, all types of practices and all countries are impacted. The mean suicide rate among surgeons (13.3%) is double that of the general population. The primary risk factors are physical and emotional overload, growing bureaucracy, the burden of malpractice lawsuits and regulatory bodies. How does burnout impact orthopedic and trauma surgery specifically? The burnout rate has been reported to be 30% to 40%, and greater than 50% in residents. The stress level is graded at more than 8/10 in 31% of us, with 40% of practitioners deeming this current stress level unacceptable. Administrative factors and the regulatory burden are said to be the most difficult to handle; consequently, orthopedic surgeons feel the best when they are operating. How can burnout be prevented and treated? The main elements of individual and collective prevention appear to be stress management seminars where surgeons can share their experiences, hear from others in the same situation and adjust their practices. We believe the priority should be placed on managing the work time and number of patients.

KEYWORDS:

Burn out; Orthopedics; Work-related stress

Publication type

Publication type

2.
Eur Rev Med Pharmacol Sci. 2019 Oct;23(20):9058-9065. doi: 10.26355/eurrev_201910_19308.

Burnout syndrome among emergency medicine physicians: an update on its prevalence and risk factors.

Author information

1
Department of Respiratory Medicine, "G. Papanikolaou" Hospital, Thessaloniki, Greece. afboutou@yahoo.com.

Abstract

OBJECTIVE:

Training in and practising emergency medicine are very stressful conditions that pose a significant emotional burden on physicians, placing them at high risk of developing burnout. The purpose of the current manuscript is to review the published literature on burnout prevalence among emergency medicine physicians and to identify the risk factors associated with its occurrence.

MATERIALS AND METHODS:

A search of MEDLINE (January 1980-March 2019) was conducted using the terms "burnout", "emergency", "physicians", "emotional exhaustion", "depersonalization" in various combinations. All studies, which assessed burnout prevalence (as primary or secondary outcome) among emergency medicine physicians and were published as full-text articles in English, were included in the review.

RESULTS:

Twenty-seven studies met eligibility criteria. Although the prevalence of burnout among emergency medicine physicians is high, the exact incidence widely varies ranging between 25% and 77.8%, because of the unique characteristics of each population under study, and also due to the different definitions, tools, and cut-offs used for burnout diagnosis. Several work-related parameters (heavy work-load, low job satisfaction, a problematic co-workers relationship, and difficulty in balancing personal with professional life), personality traits and stress-copying methods, life-style parameters, and other mental disorders (such as stress and sleep disorders) are associated with the establishment of burnout.

CONCLUSIONS:

Emergency medicine physicians are of a high risk of burnout, although further agreement is needed regarding the use of the Maslach Burnout Inventory as a diagnostic tool. Furthermore, the identification of the potential risk factors for this disorder is crucial so that high-risk groups could be early identified and properly addressed.

3.
Med J Islam Repub Iran. 2019 Jul 31;33:77. doi: 10.34171/mjiri.33.77. eCollection 2019.

Interventions on reducing burnout in physicians and nurses: A systematic review.

Author information

1
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
2
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
3
Department of Health Management and Economics, School of Public Health and Research Center for Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
4
Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
5
Iranian Social Security Organization, Zanjan Province Health Administration, Zanjan, Iran.

Abstract

Background: Burnout is one of the main factors in reducing the performance quality among hospital staff. Appropriate interventions can reduce burnout among physicians and nurses and result in promotion of the quality of services provided at hospitals. The present study aimed to provide a more comprehensive understanding of the interventions on burnout reduction among hospital physicians and nurses. Methods: Studies were searched from January 2000 to June 2017 in PubMed, Embase, Scopus, Cochrane, and Web of Science. Randomized clinical trials (RCTs) and pretest-posttest studies that had interventions to reduce the burnout of physicians and nurses were included. However, studies conducted on medical and nursing students and nonmedical providers or beyond hospitals were excluded. Results: Based on the study inclusion criteria, 12 RCTs and 6 pretest-posttest studies were included in the review. Most of the included studies were from Netherlands, the United States, and England. The interventions included team-based program, EMH-approach, and coping and communication skills training. Most of the interventions had a positive effect on burnout reduction. Nevertheless, some studies had no significant impact. Conclusion: The results showed that the most interventions used to improve burnout were improving communication skills, teamwork, participatory programs, and psychological interventions (Yoga, meditation, and mindfulness). The impact of these interventions can increase mental health in the long term. Burnout is a complicated problem and should be treated by combining interventions.

KEYWORDS:

Burnout; Hospital; Mental health; Nurses; Physicians; Systematic review

4.
J Clin Orthop Trauma. 2019 Oct;10(Suppl 1):S47-S52. doi: 10.1016/j.jcot.2019.01.028. Epub 2019 Feb 2.

Burnout in orthopaedic surgeons: A systematic review.

Author information

1
Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.

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.

KEYWORDS:

Orthopaedic surgeon; Orthopaedics; Professional burnout; Psychological stress

PMID:
31695259
PMCID:
PMC6823792
[Available on 2020-10-01]
DOI:
10.1016/j.jcot.2019.01.028
Icon for Elsevier Science

Publication type

Publication type

5.
Fam Med. 2019 Nov 4. doi: 10.22454/FamMed.2019.562297. [Epub ahead of print]

Awareness of Meaning in Life is Protective Against Burnout Among Family Physicians: A CERA Study.

Author information

1
HealthPartners Institute, 8170 33rd Avenue, Mail Stop 23301A, Minneapolis, MN 55425 952-967-5056. 952-967-5022.
2
Department of Family Medicine, Virtua Health System, Voorhees, NJ.
3
Department of Family Medicine and Community Health, University of Minnesota Twin Cities, Minneapolis, MN.

Abstract

BACKGROUND AND OBJECTIVES:

Burnout is considered a public health crisis among physicians and is related to poor quality of life, increased medical errors, and lower patient satisfaction. A recent literature review and conceptual model suggest that awareness of life meaning, or meaning salience, is related to improved stress and coping, and may also reduce experience of burnout. This study examined associations among meaning salience, burnout, fatigue, and quality of life among family medicine residency program directors.

METHODS:

Data were collected via an online survey administered by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA; n=268, response rate of 45.4%) in December 2018. Program directors completed measures of meaning salience, burnout, fatigue, and quality of life. Data were analyzed using Spearman correlations and path analysis.

RESULTS:

Program directors who reported greater experienced meaning salience also reported significantly less burnout (β=-.40, P<.001) and less fatigue (β=-.38, P<.001), which were then both significantly associated with greater quality of life (Ps<.001). Program directors who reported greater meaning salience also reported greater quality of life (β=.21, P<.001). Additionally, there were significant indirect associations between meaning salience and quality of life through less burnout and fatigue (β=.26, P<.001).

CONCLUSIONS:

The potential for increasing physicians' awareness of their sense of meaning as a means to prevent or decrease burnout is underresearched and warrants further study. Both preventive measures (eg, wellness curricula) and interventions with already-distressed physicians may encourage regular reflection on meaning in life, especially during busy workdays.

6.
Psychiatr Clin North Am. 2019 Dec;42(4):669-681. doi: 10.1016/j.psc.2019.08.005.

University of California Technology Wellness Index: A Physician-Centered Framework to Assess Technologies' Impact on Physician Well-Being.

Author information

1
Department of Psychiatry and Behavioral Sciences, UC Davis Health, 2230 Stockton Boulevard, Sacramento, CA 95817, USA. Electronic address: drknakagawa@ucdavis.edu.
2
Department of Psychiatry and Behavioral Sciences, UC Davis Health, 2230 Stockton Boulevard, Sacramento, CA 95817, USA.

Abstract

Technology is increasingly being incorporated into the everyday workflows of physicians. There are concerns that electronic medical records and other digital technologies will contribute to the growing epidemic of physician burnout. However, some technologies, such as telemedicine, have demonstrated positive effects on physician health by saving time, enhancing work-life balance, improving quality, and restoring more control and flexibility to their practices. Organizations often lack data to evaluate the impact of technologies on physician health. The University of California Technology Wellness Index is a framework that provides a fast, systematic, physician-centered method to assess the impact of technology on physician well-being.

KEYWORDS:

Burnout; Electronic medical record; Health technology; Physician health; Physician well-being; Technology; Wellness

Publication type

Publication type

7.
J Gen Intern Med. 2019 Oct 28. doi: 10.1007/s11606-019-05381-0. [Epub ahead of print]

Frontline Perspectives on Physician Burnout and Strategies to Improve Well-Being: Interviews with Physicians and Health System Leaders.

Author information

1
Center for Health Systems Research, Sutter Health , Palo Alto, CA, USA. dillone@sutterhealth.org.
2
Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA. dillone@sutterhealth.org.
3
University of California San Diego, San Diego, CA, USA.
4
Center for Health Systems Research, Sutter Health , Palo Alto, CA, USA.
5
Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
6
Palo Alto Foundation Medical Group, Palo Alto, CA, USA.

Abstract

BACKGROUND:

Nationally over 50% of physicians report symptoms of burnout.

OBJECTIVE:

To understand the perspectives of health system leaders and frontline physicians on contributors to physician burnout and strategies to improve well-being.

DESIGN:

We conducted in-depth interviews with health system leaders and frontline physicians at a large, predominantly fee-for-service, multispecialty group practice with approximately 1300 physicians.

PARTICIPANTS:

The 17 participants included 15 physicians, (12 Internal Medicine and Family Medicine physicians and 3 from other specialties), 11 individuals in leadership roles, and 11 women.

APPROACH:

Interviews included a review of factors associated with burnout at the organization, asking participants which factors they believed contributed to burnout, questions about experiences of burnout, and what specific changes would improve well-being.

KEY RESULTS:

All 17 participants agreed that organizational factors were key contributors to burnout, while only 9 mentioned the salience of individual factors: "It does not matter how resilient or positive you are, the work environment, especially in primary care will eventually be a problem." An increasing workload associated with the electronic health record (EHR) and a culture focused on productivity were cited as contributing to burnout, especially among physicians in Internal Medicine and Family Medicine (primary care) departments. Physicians in primary care, women, and leaders described multiple barriers to well-being. Participants described responding to increased workloads by reducing clinical work hours. Participants suggested reducing and compensating EHR work, expanding care teams/support staff, reducing use of metrics, providing more support to leaders, changing the business model, and increasing positivity and collegiality, as essential to improving well-being.

CONCLUSION:

Interviews reveal a variety of interacting factors contributing to physician burnout. Reducing clinical work hours has become a coping strategy. Changes recommended to improve physician well-being include increasing support staff, reducing EHR workload, changing revenue generation and compensation approaches, and shifting organizational culture to place more value on physician wellness.

KEYWORDS:

burnout; interviews; physician; qualitative; well-being

8.
Int Rev Psychiatry. 2019 Oct 24:1-12. doi: 10.1080/09540261.2019.1677220. [Epub ahead of print]

Mental health and wellbeing of medical students in Nigeria: a systematic review.

Author information

1
Department of Psychiatry, University of Ibadan , Ibadan , Nigeria.
2
Department of Psychiatry, University College Hospital , Ibadan , Nigeria.
3
Department of Medicine, University College Hospital , Ibadan , Nigeria.
4
Department of Radiation Oncology, University of Ibadan , Ibadan , Nigeria.

Abstract

In addition to the stresses common to medical school training, medical students in Nigeria face additional peculiar contemporary social problems due to income inequality, poverty, insecurity and political instability. These have a direct impact on their mental health and wellbeing. The aim of this study was to systematically review articles reporting on the epidemiology of psychiatric disorders among medical students in Nigeria. Studies were identified using MEDLINE, HINARI, African Journal Online (AJOL) and Google Scholar databases using search terms encompassing psychiatric morbidity amongst medical students. No date restrictions were applied to the search. The pooled prevalence estimate was calculated for each disorder. Psychological distress was present in 25.2% of the students, perceived stress in 60.5%, depression in 33.5% and anxiety in 28.8%. The current use of at least one psychoactive substance was present in up to 44.2%, while 35.5% of all the respondents had experienced one or more forms of abuse during their training as medical students. The prevalence of psychiatric disorders among medical students in Nigeria is high. Positive coping mechanisms such as religiosity, positive reframing and resilience which were identified in this review should be optimized to reduce the burden.

KEYWORDS:

Mental health and wellbeing; Nigeria; medical students; psychiatric disorders

9.
Curr Treat Options Pediatr. 2019 Mar;5(1):11-25. doi: 10.1007/s40746-019-00147-6. Epub 2019 Feb 9.

Organizational factors affecting physician well-being.

Author information

1
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
2
Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
3
California Perinatal Quality Care Collaborative, Palo Alto, CA.
4
Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
5
Department of Medicine, Stanford University School of Medicine, Stanford, CA.

Abstract

Purpose of review:

Symptoms of burnout affect approximately half of pediatricians and pediatric subspecialists at any given time, with similarly concerning prevalence of other aspects of physician distress, including fatigue, depressive symptoms, and suicidal ideation. Physician well-being affects quality of care, patient satisfaction, and physician turnover. Organizational factors influence well-being, stressing the need for organizations to address this epidemic.

Recent findings:

Organizational characteristics, policies, and culture influence physician well-being, and specific strategies may support an environment where physicians thrive. We highlight four organizational opportunities to improve physician well-being: developing leaders, cultivating community and organizational culture, improving practice efficiency, and optimizing administrative policies. Leaders play a key role in aligning organizational and individual values, promoting professional fulfillment, and fostering a culture of collegiality and social support among physicians. Reducing documentation burden and improving practice efficiency may help balance job demands and resources. Finally, reforming administrative policies may reduce work-home conflict, support physician's efforts to attend to their own well-being, and normalize use of supportive resources.

Summary:

Physician well-being is critical to organizational success, sustainment of an adequate workforce, and optimal patient outcomes. Because burnout is primarily influenced by organizational factors, organizational interventions are key to promoting well-being. Developing supportive leadership, fostering a culture of wellness, optimizing practice efficiency, and improving administrative policies are worthy of organizational action and further research.

KEYWORDS:

Organizational factors; burnout; physician engagement; physician well-being

PMID:
31632895
PMCID:
PMC6801108
[Available on 2020-03-01]
DOI:
10.1007/s40746-019-00147-6

Conflict of interest statement

Conflict of Interest Sarah Webber declares no conflicts of interest.

10.
Curr Psychiatry Rep. 2019 Oct 15;21(11):108. doi: 10.1007/s11920-019-1100-6.

Update on Addressing Mental Health and Burnout in Physicians: What Is the Role for Psychiatry?

Author information

1
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10604, USA. danielcurtismcfarland@gmail.com.
2
Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
3
Department of Psychiatry, Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.

Abstract

PURPOSE OF REVIEW:

To highlight an emerging understanding of burnout and physician mental health. This review will provide a discussion of conceptual and diagnostic issues of the burnout syndrome with its relevance to psychiatry, and how psychiatry may interface with other medical disciplines to provide support in creating burnout prevention and treatment programs.

RECENT FINDINGS:

Descriptive data of burnout correlations and risk factors are available while an understanding of burnout best practices is lacking but growing. Two recent meta-analyses provide efficacy data along with key subgroup analyses that point to greater efficacy among systemic/organizational over individual level interventions. Among individual interventions, groups work better than individual therapy and the incorporation of Mindfulness-Based Stress Reduction and/or Cognitive Behavioral Therapy modalities provide greater efficacy over other therapies. Ultimately, addressing burnout will be an iterative process specific to institutional cultures and therefore should be thought of as quality improvement initiatives involving leadership to adopt the quadruple aim of physician wellness and to seek institution-specific collaboration and feedback. Psychiatry is uniquely positioned to help change institutional cultures regarding the burnout syndrome, which has been labeled a national crisis. Combinatorial strategies that combine efficacious individual-level interventions with systemic-level interventions that enhance workflow will likely provide the most sustainable model for preventing and treating burnout. Psychiatry should be involved, especially at the level of the liaison psychiatrist to assist with how these types of interventions may be best implemented in specific institutions.

KEYWORDS:

Burnout; Depression; Empathy; Physician mental health; Physicians; Psychiatry; Suicide

Publication type

Publication type

11.
Leadersh Health Serv (Bradf Engl). 2019 Sep 26;32(4):620-643. doi: 10.1108/LHS-03-2019-0017. Epub 2019 Oct 9.

The state-of-play in physician health systems leadership research.

Author information

1
University of Toronto , Toronto, Canada.
2
Department of Family and Community Medicine, University of Toronto , Toronto, Canada.

Abstract

PURPOSE:

This paper aims to review a decade of evidence on physician participation in health system leadership with the view to better understand the current state of scholarship on physician leadership activity in health systems. This includes examining the available evidence on both physicians' experiences of health systems leadership (HSL) and the impact of physician leadership on health system reform.

DESIGN/METHODOLOGY/APPROACH:

A state-of-the-art review of studies (between 2007 and 2017); 51 papers were identified, analyzed thematically and synthesized narratively.

FINDINGS:

Six main themes were identified in the literature as follows: (De)motivation for leadership, leadership readiness and career development, work demands and rewards, identity matters: acceptance of self (and other) as leader, leadership processes and relationships across health systems and leadership in relation to health system outcomes. There were seemingly contradictory findings across some studies, pointing to the influence of regional and cultural contextual variation on leadership practices as well entrenched paradoxical tensions in health system organizations.

RESEARCH LIMITATIONS/IMPLICATIONS:

Future research should examine the influence of varying structural and psychological empowerment on physician leadership practices. Empirical attention to paradoxical tensions (e.g. between empowerment and control) in HSL is needed, with specific attention to questions on how such tensions influence leaders' decision-making about system reform.

ORIGINALITY/VALUE:

This review provides a broad synthesis of diverse papers about physician participation in health system leadership. Thus, it offers a comprehensive empirical synthesis of contemporary concerns and identifies important avenues for future research.

KEYWORDS:

Doctors; Leadership

12.
PLoS One. 2019 Oct 11;14(10):e0223159. doi: 10.1371/journal.pone.0223159. eCollection 2019.

Does task delegation to non-physician health professionals improve quality of diabetes care? Results of a scoping review.

Author information

1
Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany.
2
Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany.
3
West-German Center of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany.
4
Department of General Practice, Faculty of Medicine, Ruhr-Universität Bochum, Gebäude MAFO 1/61, Bochum, Germany.
5
Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.

Abstract

OBJECTIVE:

As a result of unhealthy lifestyles, reduced numbers of healthcare providers are having to deal with an increasing number of diabetes patients. In light of this shortage of physicians and nursing staff, new concepts of care are needed. The aim of this scoping review is to review the literature and examine the effects of task delegation to non-physician health professionals, with a further emphasis on inter-professional care.

RESEARCH DESIGN AND METHODS:

Systematic searches were performed using the PubMed, Embase and Google Scholar databases to retrieve papers published between January 1994 and December 2017. Randomised/non-randomised controlled trials and studies with a before/after design that described the delegation of tasks from physicians to non-physicians in diabetes care were included in the search. This review is a subgroup analysis that further assesses all the studies conducted using a team-based approach.

RESULTS:

A total of 45 studies with 12,092 patients met the inclusion criteria. Most of the interventions were performed in an outpatient setting with type-2 diabetes mellitus patients. The non-physician healthcare professionals involved in the team were nurses, pharmacists, community health workers and dietitians. Most studies showed significant improvements in glycaemic control and high patient satisfaction, while there were no indications that the task delegation affected quality of life scores.

CONCLUSIONS:

The findings of the review suggest that task delegation can provide equivalent glycaemic control and potentially lead to an improvement in the quality of care. However, this review revealed a lack of clinical endpoints, as well as an inconsistency between the biochemical outcome parameters and the patient-centred outcome parameters. Given the vast differences between the individual healthcare systems used around the world, further high-quality research with an emphasis on long-term outcome effects and the expertise of non-physicians is needed.

Conflict of interest statement

The authors have declared that no competing interests exist.

13.
Aging Clin Exp Res. 2019 Oct 9. doi: 10.1007/s40520-019-01368-3. [Epub ahead of print]

Organizational strategies to reduce physician burnout: a systematic review and meta-analysis.

Author information

1
Institute for Research on Innovation and Services for Development, National Research Council of Italy, Via San Felice, Naples, Italy. s.desimone@iriss.cnr.it.
2
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini, Naples, Italy.

Abstract

BACKGROUND:

The growing "process" of burnout impair performance and quality of professional services, with consequences for physicians, healthcare care organization, and patient's outcomes.

AIMS:

We aim to evaluate which strategy of intervention, individual or organization directed, is more effective to reduce physician burnout and to provide management suggestions in terms of actual organizational strategies and intensity leading to reductions in physician burnout.

METHODS:

The meta analysis was conducted according to the PRISMA guidelines. We included physicians of any specialty in the primary, secondary, or intensive care setting, including residents and fellows. Eligible interventions were any intervention designed to relieve stress and/or improve the performance of physicians and reported burnout outcomes, including physician-directed interventions and organization-directed interventions. The electronic search strategy applied standard filters for identification of the different studies. Databases searched were the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (from inception to September 2018), and EMBASE (from beginning to September 2018). Meta analysis was performed with mixed random effect using DerSimonian and Laird method. The standardized mean difference (SMD) and 95% CI for each outcome were separately calculated for each trial pooling data when needed, according to an intention-to-treat principle.

RESULTS:

Pooled interventions were associated with small significant reductions in burnout (SMD = - 0.289; 95% CI, - 0.419 to - 0.159; I2 = 29%) (Fig. 2). Organization-directed interventions were associated with a medium reduction in burnout score (SMD = - 0.446; 95% CI, - 0.619 to - 0.274; I2 = 8%) while physician-directed interventions were associated with a moderate reduction in burnout score (SMD = - 0.178; 95% CI, - 0.322 to - 0.035; I2 = 11%).

DISCUSSION:

This systematic review and meta-analysis showed that (1) organization-directed interventions were associated with moderate reduction in burnout score, (2) physician-directed interventions were associated with small reduction in burnout score, (3) organization-directed interventions reduced more the depersonalization than physician-directed interventions, (4) organization-directed interventions were related to a more improvement of the personal accomplishment than physician-directed interventions.

CONCLUSIONS:

This meta analysis found that physicians could gain important benefits from interventions to reduce burnout, especially from organizational strategies, by viewing burnout rooted in issues related to the working environment and organizational culture.

KEYWORDS:

Meta-analysis; Organizational-directed interventions; Physician burnout; Systematic review; Wellbeing

Publication type

Publication type

14.
Curr Probl Pediatr Adolesc Health Care. 2019 Oct 4:100664. doi: 10.1016/j.cppeds.2019.100664. [Epub ahead of print]

Organizational strategies to reduce physician burnout and improve professional fulfillment.

Author information

1
Yale School of Medicine, Yale New Haven Health, 20 York Street, New Haven, CT 06510, United States. Electronic address: kristine.olson@yale.edu.
2
Medstar Health, Georgetown University School of Medicine, Washington, DC, United States.
3
Christiana Care Health System, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, United States.
4
University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
5
University of New Mexico School of Medicine, Albuquerque, NM, United States.
6
Department of Psychiatry and Behavioral Sciences, Stanford Medicine WellMD Center, Stanford University, Stanford, CA, United States.
7
Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
8
The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
9
Wake Forest Baptist Health, Winston-Salem, NC, United States.

Abstract

Burnout is highly prevalent among physicians and has been associated with negative outcomes for physicians, patients, staff, and health-care organizations. Reducing physician burnout and increasing physician well-being is a priority. Systematic reviews suggest that organization-based interventions are more effective in reducing physician burnout than interventions targeted at individual physicians. This consensus review by leaders in the field across multiple institutions presents emerging trends and exemplary evidence-based strategies to improve professional fulfillment and reduce physician burnout using Stanford's tripartite model of physician professional fulfillment as an organizing framework: practice efficiency, culture, and personal resilience to support physician well-being. These strategies include leadership traits, latitude of control and autonomy, collegiality, diversity, teamwork, top-of-license workflows, electronic health record (EHR) usability, peer support, confidential mental health services, work-life integration and reducing barriers to practicing a healthy lifestyle. The review concludes with evidence-based recommendations on establishing an effective physician wellness program.

15.
Harefuah. 2019 Oct;158(10):664-668.

[METHODS FOR BURNOUT PREVENTION AND THEIR IMPLEMENTATION IN THE COURSE FOR FAMILY MEDICINE RESIDENTS IN BEN-GURION UNIVERSITY OF THE NEGEV].

[Article in Hebrew]

Author information

1
Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Abstract

Professional burnout of physicians is common and culminates in the residency period. Burnout affects the doctor's health and quality of life, and it is associated with worse patient outcomes and an increase in the incidence of medical errors. The Israeli Ministry of Health recently conducted a survey on the burnout of health professionals in Israel and showed the extent of the phenomena, calling on health organizations to provide actions in order to reduce or prevent it. In the Department of Family Medicine at Ben-Gurion University of the Negev, there is a four-year course for family medicine residents in which we teach various clinical and psychosocial topics essential for the family medicine profession. As part of this course, we set up a program to prevent burnout. Four "mini-courses" were chosen and integrated into the course curriculum for family medicine residents: "Healers' art™", "meaning in medicine ", narrative medicine and reflective writing, mindfulness, meditation and relaxation techniques. In addition, the Balint groups continued to exist during the 3rd and 4th year of residence. Health institutions and organizations are committed, as part of the interventions to improve medical quality and patient safety, to detect and monitor the burnout of doctors and to offer changes in the work environment and interventions to prevent burnout. Although it is difficult to examine the long-term effects of these courses, the residents were very satisfied with the burnout prevention courses. There is a need to step up interventions and build a research and follow-up program to assess the short and long-term outcomes of these experiences on the physicians' well-being and patients' safety.

PMID:
31576714
[Indexed for MEDLINE]
16.
Postgrad Med. 2019 Oct 16:1-10. doi: 10.1080/00325481.2019.1675361. [Epub ahead of print]

Work strain and burnout risk in postgraduate trainees in general practice: an overview.

Author information

1
Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg , Heidelberg , Germany.
2
Institute of General Practice and Interprofessional Care, University Hospital Tuebingen , Tuebingen , Germany.
3
Department of General Practice and Health Services Research, University Hospital Heidelberg , Heidelberg , Germany.

Abstract

Primary care physicians (general practitioners (GPs)) are burdened for various reasons and are particularly affected by stress-related complaints and an increasing prevalence of burnout. Thus, the prevention of physician burnout has become a major interest for health care services. Although many studies have addressed this issue in recent years, little seems to be known about the work strain and burnout rates in GP trainees. Therefore the objective of this article is to review the psychosocial burden and relevant prevention strategies for GPs with a special emphasis on GP trainees. Regardless of the specialty, burnout is more prevalent among medical trainees and so-called 'early career' physicians than among the age-matched population. Accordingly, burnout seems to be frequent among GP trainees, although there is some evidence that there are fewer doctors working in general medicine who were already heavily burdened at the time of choosing their career. The sudden assumption of responsibility in patient care as well as the fear of showing imperfection in front of their supervisors, or lack of recognition from senior doctors, the medical team, or patients might be stressors typical to this career stage. GP trainees might also feel burdened by the new level of personal involvement and thus have to develop or increase their individual level of professionality to deal with the patients' medical and personal problems. In conclusion, interventions to promote physical and mental health of GP trainees are a necessity to ensure passionate GPs in the future and should therefore be integrated into any postgraduate training curriculum in general practice.

KEYWORDS:

Mental health promotion; burnout; general practice trainees; stress

17.
Curr Probl Pediatr Adolesc Health Care. 2019 Sep 24:100662. doi: 10.1016/j.cppeds.2019.100662. [Epub ahead of print]

Selecting physician well-being measures to assess health system performance and screen for distress: Conceptual and methodological considerations.

Author information

1
Health Law, Policy and Management Department, Boston University School of Public Health, 715 Albany Street, Boston, MA 02218, United States. Electronic address: kjbrady@bu.edu.
2
Health Law, Policy and Management Department, Boston University School of Public Health, 715 Albany Street, Boston, MA 02218, United States.
3
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; Stanford Medicine WellMD Center, Stanford University, Stanford, CA, United States.

Abstract

Following national calls to address burnout among U.S. physicians, healthcare systems across the nation are integrating measures of physician well-being into institutional assessments. In this paper, we review important conceptual and methodological considerations for selecting self-reported physician well-being measures to monitor health system performance and to screen individual physicians for symptoms of distress. First, we discuss the importance of selecting any given measure of physician well-being based on the degree to which evidence supports the validity of the measure within the context of its intended use. Second, we present a conceptual model explaining the relationship between physician well-being and the larger healthcare context, to assist health systems in identifying the intended goals of physician well-being assessment. Well-being assessments are metrics of individual-level physician wellness/distress and may be indicators of system-level performance. We highlight proposed roles of physician well-being as a performance metric (i.e., as a downstream effect of the medical practice environment, as a predictor of health system outcomes, and as a mediator of the practice environment's effect on health system outcomes). Using this framework, we review the evidence supporting the validity of four of the most commonly used measures of well-being in U.S. physicians, identify gaps in the literature, and present practical recommendations for healthcare organizations' selection of appropriate measurement tools. We conclude by offering directions for future research to advance the measurement of physician well-being outcomes.

18.
Mil Med. 2019 Sep 27. pii: usz236. doi: 10.1093/milmed/usz236. [Epub ahead of print]

Burnout in Military Emergency Medicine Resident Physicians: A Cross-Sectional Study With Comparisons to Other Physician Groups.

Author information

1
Emergency Department, United States Naval Hospital Yokosuka, PSC 475 Box 1, FPO AP Yokosuka 96350-1600, Japan.
2
Emergency Medicine Department, Naval Medical Center, San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134.

Abstract

INTRODUCTION:

Physician burnout is of growing concern in the medical community and in emergency medicine (EM) in particular. It is unclear whether higher levels of burnout are associated with poorer academic or clinical performance. EM residency in military environments compared to civilian residencies has unique considerations related to additional military-specific training and operational requirements, which may contribute to burnout. The prevalence and effects of burnout on military EM resident physicians have not been investigated.

METHODS:

In this institutional review board-approved cross-sectional study, the prevalence of burnout and its effect on academic performance of 30 EM residents in a single 4-year military EM training program was examined. The primary instrument utilized to assess for burnout was the Maslach Burnout Inventory Health Services Survey (MBI-HSS). The primary definition of burnout utilized was a high score in both emotional exhaustion (EE) and depersonalization (DP), and a low score in personal achievement (PA). Additionally, at risk for burnout was defined as moderate or high scores in both EE and DP and low scores in PA. A secondary definition of burnout utilized was any high score in EE or DP, or a low score in PA. The findings in this cohort were compared with published reports of burnout in civilian EM resident and attending physicians as well as military orthopedic physicians. The annual American Board of Emergency Medicine In-Training Exam (ABEM-ITE) percentile ranks for each volunteer in that same academic year were collected as a measure of academic achievement.

RESULTS:

Thirty of the 40 eligible resident physicians consented to participate in this research project (75%). All 30 completed the MBI-HSS and ABEM-ITE. Burnout, using the primary definition, was found in 10% of residents with an additional 13% at risk for burnout. Using the secondary definition of burnout, 73% of residents demonstrated burnout. The prevalence of burnout as measured by the MBI-HSS was similar to that reported in civilian EM resident and practicing physician groups but 2.7 times the burnout rates found in a military orthopedic resident group. We found no relationship between any individual burnout measure in the MBI-HSS and the annual ABEM-ITE percentile scores.

CONCLUSION:

In a small study of military EM resident physicians, level of burnout as measured by the MBI-HSS is similar to other EM populations including civilian residents and practicing physicians, though it was much higher than that of military orthopedic residents. No relationship between presence or absence of burnout and academic performance as measured by the ABEM-ITE was found.

19.
JMIR Res Protoc. 2019 Sep 19;8(9):e14677. doi: 10.2196/14677.

Investigating the Relationship Between Resilience, Stress-Coping Strategies, and Learning Approaches to Predict Academic Performance in Undergraduate Medical Students: Protocol for a Proof-of-Concept Study.

Author information

1
College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
2
Center for Outcomes and Research in Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
3
Center for Medical Education, University of Dundee, Nethergate, Dundee, United Kingdom.
4
Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
5
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.

Abstract

BACKGROUND:

The evolution of an undergraduate medical student into an adept physician is perpetual, demanding, and stressful. Several studies have indicated medical students have a higher predominance of mental health problems than other student groups of the same age, where medical education acts as a stressor and may lead to unfavorable consequences such as depression, burnout, somatic complaints, decrease in empathy, dismal thoughts about quitting medical school, self harm and suicidal ideation, and poor academic performance. It is imperative to determine the association between important psychoeducational variables and academic performance in the context of medical education to comprehend the response to academic stress.

OBJECTIVE:

The aim of this proof-of-concept study is to determine the relationship between resilience, learning approaches, and stress-coping strategies and how they can collectively predict achievement in undergraduate medical students. The following research questions will be addressed: What is the correlation between the psychoeducational variables resilience, learning approaches, and stress-coping strategies? Can academic performance of undergraduate medical students be predicted through the construction of linear relationships between defined variables employing the principles of empirical modeling?

METHODS:

Study population will consist of 234 students registered for the MBBS (Bachelor of Medicine, Bachelor of Surgery) at Mohammed Bin Rashid University of Medicine and Health Sciences distributed over 4 cohorts. Newly registered MBBS students will be excluded from the study. Various psychoeducational variables will be assessed using prevalidated questionnaires. For learning approaches assessment, the Approaches and Study Skills Inventory for Students questionnaire will be employed. Resilience and stress-coping strategies will be evaluated using the Wagnild-Young resilience scale and a coping strategies scale derived from Holahan and Moos's Coping Strategies Scale, respectively. Independent variables (resilience, stress-coping strategies, and learning approaches) will be calculated. Scores will be tested for normality by using the Shapiro-Wilk test. An interitem correlational matrix of the dependent and independent variables to test pairwise correlation will be formed using Pearson bivariate correlation coefficients. Regression models will be used to answer our questions with type II analyses of variance in tests involving multiple predictors. Regression analyses will be checked for homogeneity of variance (Levine test) and normality of residuals and multicollinearity (variance inflation factor). Statistical significance will be set at 5% (alpha=.05). Effect sizes will be estimated with 95% CIs.

RESULTS:

Psychoeducational instruments in the form of validated questionnaire have been identified in relation to the objectives. These questionnaires have been formatted for integration into Google forms such that they can be electronically distributed to the consenting participants. We submitted the proposal to MBRU institutional review board (IRB) for which exemption has been awarded (application ID: MBRU-IRB-2019-013). There is no funding in place for this study and no anticipated start date. Total duration of the proposed research is 12 months.

CONCLUSIONS:

Psychoeducational instruments used in this study will correlate resilience, stress-coping strategies, and learning approaches to academic performance of undergradudate medical students. To the best of our knowledge, no study exploring the multidimensional association of key psychoeducational variables and academic performance in undergraduate medical students has been pursued. Investigated variables, resilience, learning approaches, and stress-coping strategies, are individual traits, however; students' learning history before they joined MBRU is unknown, so our research will not be able to address this specific aspect.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):

PRR1-10.2196/14677.

KEYWORDS:

coping behavior; learning; medical education; psychological resilience; psychological stress; resilience; undergraduate medical education

20.
Am J Med. 2019 Sep 11. pii: S0002-9343(19)30757-0. doi: 10.1016/j.amjmed.2019.08.034. [Epub ahead of print]

Physician Stress and Burnout.

Author information

1
Center for Executive Medicine, 6020 W. Parker Rd., Ste 420, Plano, TX 75093. Electronic address: swyates@texasmed.com.

Abstract

Tens (or hundreds) of thousands of Americans die each year as a result of preventable medical errors. Changes in the practice and business of medicine have caused some to question whether burnout among physicians and other healthcare providers may adversely affect patient outcomes. A clear consensus supports the contention that burnout affects patients, albeit with low quality objective data. The psychological and physical impact on physicians and other providers is quite clear however, and the impact on the physician workforce (where large shortages are projected) is yet another cause for concern. We have all heard the airplane safety announcement remind us to "please put on your own oxygen mask first before assisting others." But, like many airline passengers (very few of whom use oxygen masks correctly when they are needed), physicians often do not recognize symptoms of burnout or depression, and even less often do they seek help. We detail causes and consequences of physician burnout and propose solutions to increase physician work satisfaction.

KEYWORDS:

burnout; physician well-being; quality; workforce

PMID:
31520624
DOI:
10.1016/j.amjmed.2019.08.034
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