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Physical Activity, Quality of Life, and Burnout Among Physician Trainees: The Effect of a Team-Based, Incentivized Exercise Program
Abstract
To prospectively study the effects of an incentivized exercise program on physical activity (PA), quality of life (QOL), and burnout among residents and fellows (RFs) in a large academic medical center.
In January 2011, all RFs at Mayo Clinic in Rochester, Minnesota (N=1060), were invited to participate in an elective, team-based, 12-week, incentivized exercise program. Both participants and nonparticipants had access to the same institutional exercise facilities. Regardless of participation, all RFs were invited to complete baseline and follow-up (3-month) assessments of PA, QOL, and burnout.
Of the 628 RFs who completed the baseline survey (59%), only 194 (31%) met the US Department of Health and Human Services recommendations for PA. Median reported QOL was 70 on a scale of 1 to 100, and 182 (29%) reported at least weekly burnout symptoms. A total of 245 individuals (23%) enrolled in the exercise program. No significant differences were found between program participants and nonparticipants with regard to baseline demographic characteristics, medical training level, PA, QOL, or burnout. At study completion, program participants were more likely than nonparticipants to meet the Department of Health and Human Services recommendations for exercise (48% vs 23%; P<.001). Quality of life was higher in program participants than in nonparticipants (median, 75 vs 68; P<.001). Burnout was lower in participants than in nonparticipants, although the difference was not statistically significant (24% vs 29%; P=.17).
A team-based, incentivized exercise program engaged 23% of RFs at our institution. After the program, participants had higher PA and QOL than nonparticipants who had equal exercise facility access. Residents and fellows may be much more sedentary than previously reported.
... Finally, the selection of articles according to the exclusion criteria resulted in the inclusion of 16 studies in this literature review ( Figure 1). [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Study characteristics, interventions, and follow-up results are presented in Table 1. ...
... Burnout prevention strategies may be focused on organizational changes or individual aspects. Of the selected studies, five were focused on the organization of the workplace, 7,14,15,18,19 11 were individualfocused, 8,9,[11][12][13]16,17,[20][21][22] and only one was focused on both interventions concurrently. 10 Fourteen studies were clinical trials consisting of intervention and control groups. ...
... 10 Fourteen studies were clinical trials consisting of intervention and control groups. Control groups did not receive any intervention in seven studies, 8,13,15,17,18,21,22 on the wait list in three studies. 9,10,20 The shift schedule differed between the control and intervention groups in three studies. ...
Burnout syndrome is a response to occupational stress that consists of emotional exhaustion, depersonalization, and reduced personal fulfillment. It may affect health care professionals, requiring due attention and the development of preventive mechanisms. The objective of this study was to identify possible ways to prevent the onset of burnout among physicians. A literature review was conducted in PubMed and SciELO databases. The search resulted in 16 articles on the subject, of which 11 conducted individual-focused interventions, four focused on the work environment, and one focused on both aspects. In conclusion, reducing burnout levels may benefit both physicians and patients, and conducting approaches focused on both the individual and the work environment is essential. However, further research on physician burnout prevention is needed.
... Twenty-eight programs [11][12][13]15,39,40 were longitudinal in nature, consisting of a series of recurring lectures or activities. However, most of these were 1 year or less in duration. ...
... A summary of the included studies can be found in Tables 1 through 4, classified by burnout program effectiveness. Two studies 11,12 were published prior to 2015, and 28 studies 13-40 were published in 2015 or later. Twenty-eight studies [11][12][13][14][15][16][17][18][19][20][21][22][24][25][26][28][29][30][31][32][33][34][35][36][37][38][39][40] were conducted in the United States and 2 studies 23,27 in Canada. ...
... Two studies 11,12 were published prior to 2015, and 28 studies 13-40 were published in 2015 or later. Twenty-eight studies [11][12][13][14][15][16][17][18][19][20][21][22][24][25][26][28][29][30][31][32][33][34][35][36][37][38][39][40] were conducted in the United States and 2 studies 23,27 in Canada. The studies included a variety more than 70% of program participants involved in program evaluation, with the median number of evaluation participants being 25.5. ...
Context.—:
Physicians face a high rate of burnout, especially during the residency training period when trainees often experience a rapid increase in professional responsibilities and expectations. Effective burnout prevention programs for resident physicians are needed to address this significant issue.
Objective.—:
To examine the content, format, and effectiveness of resident burnout interventions published in the last 10 years.
Design.—:
The literature search was conducted on the MEDLINE database with the following keywords: internship, residency, health promotion, wellness, occupational stress, burnout, program evaluation, and program. Only studies published in English between 2010 and 2020 were included. Exclusion criteria were studies on interventions related to the coronavirus disease 2019 (COVID-19) pandemic, studies on duty hour restrictions, and studies without assessment of resident well-being postintervention.
Results.—:
Thirty studies were included, with 2 randomized controlled trials, 3 case-control studies, 20 pretest and posttest studies, and 5 case reports. Of the 23 studies that used a validated well-being assessment tool, 10 reported improvements postintervention. These effective burnout interventions were longitudinal and included wellness training (7 of 10), physical activities (4 of 10), healthy dietary habits (2 of 10), social activities (1 of 10), formal mentorship programs (1 of 10), and health checkups (1 of 10). Combinations of burnout interventions, low numbers of program participants with high dropout rates, lack of a control group, and lack of standardized well-being assessment are the limitations identified.
Conclusions.—:
Longitudinal wellness training and other interventions appear effective in reducing resident burnout. However, the validity and generalizability of the results are limited by the study designs.
... Financial knowledge is found to be a strong predictor of self-efficacy and confidence in students' financial management, leading to financial optimism and potentially alleviating debt stress [10][11][12]. Numerous studies list mindfulness practices, exercise, and connecting with loved ones as activities that promote well-being and reduce generalized stress among students [13][14][15]. However, to date, no studies have examined whether these types of stress-reducing activities, by alleviating generalized stress, reduce debt-related stress. ...
... In our exploration of potential protective factors against the effects of debt-related stress, our survey analysis found that the two variables measured (high mental health resource utilization and meeting with a counselor) did not have any impact on reducing debt-related stress. This finding is inconsistent with the literature, which considers these activities to promote general well-being among students but has never been studied in the context of debt-related stress [13][14][15]. A potential explanation is that the survey questions that assessed these activities were imperfect. ...
Background
Nearly three in four U.S. medical students graduate with debt in six-figure dollar amounts which impairs students emotionally and academically and impacts their career choices and lives long after graduation. Schools have yet to develop systems-level solutions to address the impact of debt on students’ well-being. The objectives of this study were to identify students at highest risk for debt-related stress, define the impact on medical students’ well-being, and to identify opportunities for intervention.
Methods
This was a mixed methods, cross-sectional study that used quantitative survey analysis and human-centered design (HCD). We performed a secondary analysis on a national multi-institutional survey on medical student wellbeing, including univariate and multivariate logistic regression, a comparison of logistic regression models with interaction terms, and analysis of free text responses. We also conducted semi-structured interviews with a sample of medical student respondents and non-student stakeholders to develop insights and design opportunities.
Results
Independent risk factors for high debt-related stress included pre-clinical year (OR 1.75), underrepresented minority (OR 1.40), debt 100K (OR 13.22), private school (OR 1.45), West Coast region (OR 1.57), and consideration of a leave of absence for wellbeing (OR 1.48). Mental health resource utilization (p = 0.968) and counselors (p = 0.640) were not protective factors against debt-related stress. HCD analysis produced 6 key insights providing additional context to the quantitative findings, and associated opportunities for intervention.
Conclusions
We used an innovative combination of quantitative survey analysis and in-depth HCD exploration to develop a multi-dimensional understanding of debt-related stress among medical students. This approach allowed us to identify significant risk factors impacting medical students experiencing debt-related stress, while providing context through stakeholder voices to identify opportunities for system-level solutions.
... In medical students specifically, physical activity has been found to be negatively correlated with burnout and positively correlated with improved quality of life [17][18][19]. In residents and fellows at one institution, increased physical activity through an incentivized exercise program was correlated with increased reported quality of life [20]. Other studies have shown that increased physical activity is associated with higher professional efficacy, and decreased exercise frequency was correlated with lower professional efficacy [2,21]. ...
... Exercise satisfaction correlated positively with reported hours exercised per week, intensity of exercise, increased exercise habits compared to before medical school, and satisfaction with academic performance, social life, and personal relationships. These findings could be due to the positive effects of exercise, which have been correlated with increased reported quality of life and shown to provide distraction from negative thoughts, increase self-esteem, and encourage social engagement [15,[17][18][19][20]30]. However, if exercise increases self-esteem, perhaps increased satisfaction with performance in medical school, social life, and personal relationships could be due to increased self-confidence and therefore a difference in perception of satisfaction, not observable improvements in these three areas. ...
Medical students report higher stress and increased mental illness than peers of similar age. Burnout and depression among medical students and physicians have also been correlated with increased risk of medical errors and decreased importance of altruistic values, such as providing care to medically underserved populations. This study works to analyze the effects of exercise, nutrition, sleep, and other factors affecting wellness and performance of medical students, as well as identifying barriers to exercise and possible solutions. A survey was distributed to medical students in the Midwest to evaluate exercise habits, dietary intake, sleep, and other factors affecting wellness. An investigation of the correlation of variables and comparison of year in school for the variables was conducted. Satisfaction with social relationship and performance in school correlated with exercise, stress, and sleep variables. Several variables, including satisfaction with exercise, social life, and performance in school, showed significant differences based on year in school. No significant findings were noted between students from the various medical institutions at which the survey was distributed regarding satisfaction with exercise, academic performance, social life, personal relationships, hours spent in clerkship/class, hours spent studying, and stress. Students tended to have higher satisfaction with school and social relationships if they engaged in exercise more often, exercised with greater intensity, and slept better. Students identified barriers to exercise including cost, availability, and lack of time. Potential solutions include a workout facility in school buildings/hospitals, allocated wellness periods for exercise, and a more consistent schedule.
... 11,12 Furthermore, there is evidence that physically active physicians have better quality of life, higher resilience, and less burnout. 13,14 Physical Activity and the Risk of Chronic Disease Physical activity has been well studied and documented to reduce morbidity and mortality risks of chronic diseases. [3][4][5] For these reasons, the Department of Health and Human Services (DHHS) has recommended physical activity guidelines to support a healthy lifestyle. ...
... Physical activity is promoted for residents and physicians to increase resilience and reduce burnout, but the influence of physical activity level or increasing physical activity on burnout is equivocal. 13,67 There are several systematic reviews on interventions to reduce burnout, but few of them included studies with exercise or physical activity interventions. A small study from Europe assessed the ability of physical activity to influence physician burnout during the COVID-19 pandemic. ...
... Health-related stressors include sleep disorders, attending multiple classes, nutrition, exercise, quality of university food, physical illness, smoking, and substance abuse [16]. Moreover, sufficient sleep and regular exercise have increased the life quality of residents and fellowships [19], while poor sleep patterns [20] and low activity [21] are associated with mental conditions such as anxiety and depression. ...
... 3,5,10,13,16,17,21,24,26,31,34, 37, 38, and 42 for depression sub-scale;Questions 4,2,7,9,15,19,20,23,25,28,30, 36, 40, and 41 for anxiety sub-scale; and Questions 1,6,8,11,12,14,18,22,27,29,32,33,35, and 39 for stress sub-scale.The scores related to the items of each scale are summed for interpretation. Total scores are interpreted as follows:Depression: 0-9 normal, 10-13 mild, 14-20 moderate, 21-27 severe, and 28 + extremely severe; Anxiety: 0-7 normal, 8-9 mild, 10-14 moderate, 15-19 severe, and 20 + extremely severe; and Stress: 0-14 normal, 15-18 mild, 19-25 moderate, 26-33 severe, and 34 + extremely severe. ...
Background: Psychological disorders have negative consequences on students' learning and academic performance. In addition, academic burnout is one of the common challenges that affects students' motivation and academic eagerness; however, the determinant is not clear. Medical students, meanwhile, demand special attention due to their professional responsibilities. In this regard, this study is conducted to investigate the academic burnout, rate of depression, anxiety and stress as well as related factors among undergraduate medical students at the Tehran Medical Sciences Islamic Azad University. Methods: This cross-sectional and descriptive study was performed on medical students of Islamic Azad University of Tehran in 2017. In phase I, conducted on all stager students, Maslach Burnout questionnaire was used. In phase II, the DASS-42 questionnaire was provided for 123 students, 120 of whom met the inclusion criteria. In addition, another questionnaire including gender, age, lifestyle, marital and financial status, nutrition style, vitamin D deficiency, smoking, study hours per week, work efficiency and distance from the place of residence to the teaching hospital was used. Finally, the data extracted by SPSS version 23 was analyzed at the significance level of 0.05. Results: In phase I of the study, 17 subjects showed academic burnout (16.3%). Out of all, 76.5% of students with academic burnout did not focus on the study and students' academic burnout was associated with a decrease in their focus (P < 0.05). However, the relationship between academic burnout and other factors was not significant. In phase II, the prevalence of depression, anxiety and stress was 37.5, 41.1 and 30.3%, respectively. The prevalence of severe and very severe degrees that required psychiatric follow-up were 10.5, 10.5 and 7% for depression, anxiety and stress, respectively. According to statistical analyzes, there is a significant direct relationship between anxiety and the distance from the place of residence to the teaching hospital (P = 0.040). Conclusion: The present study estimated the prevalence of academic burnout to be between 9.2 and 23.4%, considering the 5% error in the calculation, and the level of anxiety was related to the distance from the place of residence to the hospital.
... [49] , [50] , [51] , [51][52][53][54][55] Of the physician-directed interventions five studies utilized mindfulness exercises, [56][57][58][59][60] six utilized some types of group activities such as debriefing sessions, [61] group discussion, [57,62,63] and team-based. [64] Eight studies involved some sort of individualized practice in reducing burnout or to enhance well-being including exercise, [57,64] role-play, [63] self-care activities, [65][66][67], and communication skill training. [52,68] Of ten studies demonstrating favorable outcome (statistically significant findings benefiting the intervention group), six were system-directed intervention, and four were physician-direct intervention. ...
... [49] , [50] , [51] , [51][52][53][54][55] Of the physician-directed interventions five studies utilized mindfulness exercises, [56][57][58][59][60] six utilized some types of group activities such as debriefing sessions, [61] group discussion, [57,62,63] and team-based. [64] Eight studies involved some sort of individualized practice in reducing burnout or to enhance well-being including exercise, [57,64] role-play, [63] self-care activities, [65][66][67], and communication skill training. [52,68] Of ten studies demonstrating favorable outcome (statistically significant findings benefiting the intervention group), six were system-directed intervention, and four were physician-direct intervention. ...
Background
The PERMA Model, as a positive psychology conceptual framework, has increased our understanding of the role of Positive emotion, Engagement, Relationships, Meaning, and Achievements in enhancing human potentials, performance and wellbeing. We aimed to assess the utility of PERMA as a multidimensional model of positive psychology in reducing physician burnout and improving their well-being.
Methods
Eligible studies include peer-reviewed English language studies of randomized control trials and non-randomized design. Attending physicians, residents, and fellows of any specialty in the primary, secondary, or intensive care setting comprised the study population. Eligible studies also involved positive psychology interventions designed to enhance physician well-being or reduce physician burnout. Using free text and the medical subject headings we searched CINAHL, Ovid PsychINFO, MEDLINE, and Google Scholar (GS) electronic bibliographic databases from 2000 until March 2020. We use keywords for a combination of three general or block of terms (Health Personnel OR Health Professionals OR Physician OR Internship and Residency OR Medical Staff Or Fellow) AND (Burnout) AND (Positive Psychology OR PERMA OR Wellbeing Intervention OR Well-being Model OR Wellbeing Theory).
Results
Our search retrieved 1886 results (1804 through CINAHL, Ovid PsychINFO, MEDLINE, and 82 through GS) before duplicates were removed and 1723 after duplicates were removed. The final review included 21 studies. Studies represented eight countries, with the majority conducted in Spain ( n = 3), followed by the US ( n = 8), and Australia (n = 3). Except for one study that used a bio-psychosocial approach to guide the intervention, none of the other interventions in this review were based on a conceptual model, including PERMA. However, retrospectively, ten studies used strategies that resonate with the PERMA components.
Conclusion
Consideration of the utility of PERMA as a multidimensional model of positive psychology to guide interventions to reduce burnout and enhance well-being among physicians is missing in the literature. Nevertheless, the majority of the studies reported some level of positive outcome regarding reducing burnout or improving well-being by using a physician or a system-directed intervention. Albeit, we found more favorable outcomes in the system-directed intervention. Future studies are needed to evaluate if PERMA as a framework can be used to guide system-directed interventions in reducing physician burnout and improving their well-being.
... These interventions may include structured small-group sessions, stress management education, and self-care training [20][21][22][23][24][25][26]. Furthermore, interventions focusing on enhancing the quality of life outside the hospital, such as mindfulness practices and physical activity, have also shown promise [27,28]. ...
... As such, some authors point to the following as adaptive strategies for the individual: relaxation exercises, physical exercise, pleasurable activities linked to the humanities and meditation. 13,14 For centuries, the fields of the sciences and the humanities have been placed at opposite poles, initially, either because of the separation between science and art, or because of the skepticism with which the view of medicine sees knowledge in the humanities, as being slippery, non-metric and essentially incompatible with an "evidence-based" approach. The positive relationship between medicine and the humanities, however, has been demonstrated through a multi-institutional study, the results of which revealed that experiences linked to the humanities become elements of improved academic performance and are in fact associated with increased empathy, tolerance, avoidance of burnout, self-efficacy and spatial skills. ...
This article is experience report, about a intervention developed during research with medical students in the southwest region of Bahia. The main objective of creating and implementing an emotional regulation program for medical students, using dance as a therapeutic resource with a focus on preventing and coping with Burnout Syndrome. The “Movimente-se medburnout” Program was offered in group mode, with weekly meetings, for 8 weeks, permeated by music, dance and creative body movements. 13 students of both sexes participated in the meetings, with a good response and positive evaluation of the activities developed. The result of this work was constituted as a technical technological product that will be presented to the managers of the participating universities.
... There was no significant gender difference in levels of PLEs in our sample, in line with the lack of consistent gender patterning of PLEs in the general population (Staines et al., 2023). Lifestyle factors such as higher levels of digital media use, sleep disruptions and cannabis use have been identified as correlates of PLEs in the general population (Barton et al., 2018;Paquin et al., 2024a), lower levels of physical activity have been crosssectionally associated with greater likelihood of psychotic disorders (Stubbs et al., 2017), and these factors have also been linked to poorer mental health in resident physicians (Mansukhani et al., 2012;Mathew et al., 2022;Ueno et al., 2020;Weight et al., 2013). In our study, higher digital media use and poorer sleep were weakly associated with more PLEs, but these associations were not robust to adjustment with survey weights. ...
Aim
Medical residency training is associated with a range of sociodemographic, lifestyle and mental health factors that may confer higher risk for psychotic‐like experiences (PLEs) in residents, yet little research has examined this question. Thus, we aimed to document the prevalence and associated factors of PLEs among resident physicians.
Methods
Physicians enrolled in residency programmes in the Province of Québec, Canada (four universities) were recruited in Fall 2022 via their programme coordinators and social media. They completed an online questionnaire assessing PLEs in the past 3 months (the 15‐item Community Assessment of Psychic Experiences), as well as sociodemographic characteristics, lifestyle and mental health. Analyses included survey weights and gamma regressions.
Results
The sample included 502 residents (mean age, 27.6 years; 65.9% women). Only 1.3% (95% CI: 0.5%, 4.0%) of residents met the screening cut‐off for psychotic disorder. Factors associated with higher scores for PLEs included racialised minority status (relative difference: +7.5%; 95% CI: +2.2%, +13.2%) and English versus French as preferred language (relative difference: +7.9% 95% CI: +3.1%, +12.9%), as well as each additional point on scales of depression (relative difference: +0.8%; 95% CI: +0.3%, +1.3%) and anxiety (relative difference: +1.3%; 95% CI: +0.8%, +1.7%). In secondary analyses, racialised minority status was associated with persecutory items, but not with other PLEs. Gender, residency programmes and lifestyle variables were not associated with PLEs.
Conclusions
This study found low reports of PLEs in a sample of resident physicians. Associations of PLEs with minoritised status may reflect experiences of discrimination.
... A recent systematic review including only studies from US and Australia highlighted that intervention studies using psychosocial strategies to reduce the risk of suicide are relatively scarce among health care worker's population (73). Actions known to be effective in other countries (74)(75)(76)(77)(78), such as physician well-being promotion or legal protection against work overload, should be replicated in the national context. Non employers, as well as universities, must be directly involved in those preventive actions. ...
Objectives:
To report suicide planning and attempts' in a lifetime among Brazilian physicians and to explore associated risk factors.
Methods:
A nation-wide, online survey based on the Tool for the Assessment of Suicide Risk and Satisfaction with Life Scale was conducted among Brazilian physicians (January 2018 - January 2019). Multivariate explored associations of demographics, psychological, and work-related factors on suicide planning and attempts reports.
Results:
Among 4,148 respondents, 1,946 (53.5%) were male, 2,527 (60.9%) were 30-60 years old, 2,675 (64.5%) had 2-4 work-contracts and 1,725 (41.6%) reported a weekly workload of 40-60 hours. Overall prevalence of suicide plans was 8.8% (n=364) and suicide attempts were reported by 3.2% (n=133) of respondents. Daily (AdjOR=7.857;95%CI 2.282-27.051, p=0.002) or weekly emotional exhaustion (AdjOR=7.953; 95%CI 2.403-26.324, p=0.001), daily frustration with work (AdjOR=3.093;95%CI 1.711-5.588, p<0.001), and being bisexual (AdjOR=5.083;95%CI 2.544-10.158, p<0.001) were significantly associated with higher odds of reports. Among extremely dissatisfied professionals 38.3% reported having made suicide planning and attempts, while among extremely satisfied only 2.8% reported it (p<0.001).
Conclusions:
Brazilian physicians with a lifetime history of suicide planning and attempts presented a higher association with emotional exhaustion and frustration with work. Urgent actions are needed to promote professional protection policies and resilience.
... [2] The contrast between QOL and HRQOL is more important than just an academic exercise. [3] A recent evaluation of HRQOL measures used in clinical trials found that methods commonly failed to distinguish between general QOL and HRQOL. It is obvious that a survey that asks about global QOL without mentioning health specifically would not provide any information on the estimate's health-related component. ...
It is generally accepted that health-related quality of life (HRQOL) refers to “an evaluation of one’s wellbeing based on consideration of physical, mental, social, and general health status.” In this review, we provide information from current studies on the main and most used QOL measures for both adults and children with epilepsy. Measurement of HRQOL aims at capturing such patient centered effects of therapy. Different epilepsy-specific instruments such as QOLIE-89, quality of life in epilepsy inventory (QOLIE-31), QOLIE-10, quality of life in epilepsy inventory for adolescent (QOLIE-AD48), epilepsy surgery inventory (ESI55), side effects and life satisfaction, Liverpool HRQOL Battery, and Washington psychosocial seizure inventory (WPSI) are used to determine QOL. This concludes that there were instruments that should be preferred for future use. The WPSI will be used for the mental and social measures, ESI-55 for surgery, QOL in Epilepsy QOLIE-31 used for adults, Liverpool QOL Batteries used for frequency and intensity of seizure, and QOLIE-AD-48 used for adults.
... Stage 3 requires enhanced support to be put in place. In addition to interventions necessary in stages 1 and 2, team building, team-wide, and team-participation programs can be helpful [45]. During this stage, other self-care and resilience-building programs, including support groups, mindfulness, meditation, tai chi, and yoga, can be helpful to improve the sense of helplessness [46,47]. ...
The impact of burnout is significant on individuals and the organization. It is important to understand the progressive evolution of burnout symptoms to ensure that intervention is appropriate for the burnout stage that the person may be in. A timely intervention appropriate for the stage of burnout has the potential to ensure that necessary support is made available to the individual to stop the further evolution of burnout symptoms. Moreover, understanding the experiences of an individual provides an opportunity to address organizational systems and processes that may be contributing to burnout.
... Developing resilience is relevant since it can be an important factor in the difference in individual vulnerability to presenting PTSS and those who do not. Protective factors such as self-care, physical activation, and sleep hygiene have shown promising effects in decreasing rates of burnout, improving quality of life, and promoting resilience in HCW [52,53]. ...
During the health emergency caused by the COVID-19 pandemic, one of the most affected sectors was the healthcare workers (HCWs), since it is a population group with a high risk of developing post-traumatic stress disorder (PTSD), anxiety, or depression. Resilience is one of the abilities that can favor a greater adaptation to adverse circumstances. Therefore, the aim of the present research was to know the association between resilience and PTSD in HCWs during the COVID-19 outbreak, which contributes to the development of preventive strategies and therapeutic interventions for this debilitating mental disorder. The study was prospective ex post facto, cross-sectional; it had a non-probabilistic sample of 613 Mexican HCWs. Data was collected through the platform www.personalcovid.com. The results obtained showed that resilience is negatively related to PTSD, with nurses being the most at-risk group among HCWs.
... Furthermore, an increasing number of studies have been conducted to examine the relationship between physical activity and HRQoL (47,84,85). It was evidently demonstrated that physical activity improved HRQoL and well-being when compared with minimal or no-treatment controls for adults aged 18-65 years (86). ...
Background
Primary health care (PHC) serves as the gatekeeper of health system and PHC physicians take on significant obligations to provide health care services in the pursuit of Universal Health Coverage (UHC). PHC physicians' health-related quality of life (HRQoL) can have a strong impact on patients, physicians and the health care system. Lifestyle interventions are found to be effective to improve HRQoL. The purpose of this study was to evaluate the association between lifestyle behaviors and HRQoL among PHC physicians, so that lifestyle intervention can be tailored by policy makers for health promotion.
Methods
A survey covering 31 provinces and administrative regions in China was conducted in 2020 using a stratified sampling strategy. Data on sociodemographic characteristics lifestyle behaviors and HRQoL were collected by a self-administered questionnaire. HRQoL was measured through EuroQol-five dimension-five level (EQ-5D-5L) instrument. A Tobit regression model was performed to evaluate the association between sociodemographic characteristics, lifestyle behaviors and HRQoL.
Results
Among 894 PHC physicians who completed the survey, Anxiety/Depression (AD) was the dimension with the most problems reported (18.1%). Regular daily routine (β = 0.025, 95%CI 0.004 to 0.045) and good sleep quality (β = 0.049, 95% CI = 0.029 to 0.069) were protective factors for HRQoL, while smoking (β = −0.027, 95% CI = −0.079 to −0.003) and frequency of eating breakfast (β = −0.041, 95%CI = −0.079 to −0.003) were negatively associated with HRQoL. Physical activity and alcohol drinking were not significantly associated with HRQoL.
Conclusion
These findings suggest that tailored interventions on daily routine, improving sleep quality, and tobacco control among PHC physicians may be effective strategies to improve their HRQoL.
... As an example, protective factors against surgeon burnout include spending time with a spouse, physical activity, and discussing concerns with family, coworkers, or friends. [13,14] Musculoskeletal pain among surgeons may be reduced through awareness of compromising procedural position, ergonomic optimization, exercise, stretching, and intraoperative breaks. [5,6] The benefits of regular exercise to the physical and mental health of orthopedic surgeons are well-documented. ...
Orthopedic surgeons face significant physical and psychosocial stressors during their training
as surgical residents and throughout their career. Aside from occupational hazards intrinsic to the
profession, two notable and treatable concerns are musculoskeletal pain and emotional burnout,
which have a reported prevalence as high as 97% and 56%, respectively, among orthopedic
residents. Management of musculoskeletal pain and burnout is essential for promoting surgeon well
being, education, and longevity as well as avoiding medical errors and compromises to patient care.
This perspective manuscript describes the occupational challenges faced by orthopedic surgeons
and promotes a habitual practice of yoga as an adjunct therapy for managing musculoskeletal pain
and emotional burnout, and furthermore, introduces the need to reconsider gendered perceptions
surrounding orthopedics and the practice of yoga in a profession largely comprised of men.
... These workshops are associated with short-term improvements in some components of burnout within-subjects [53], as well as potential long-term improvements [98], but the scalability of these sessions has not been assessed [14], and effects are mediated by continued adherence [69]. Lastly, self-interventions for burnout have focused on meditation and targeted behavior change [94,97]. ...
Recent research has explored computational tools to manage workplace stress via personal sensing, a measurement paradigm in which behavioral data streams are collected from technologies including smartphones, wearables, and personal computers. As these tools develop, they invite inquiry into how they can be appropriately implemented towards improving workers' well-being. In this study, we explored this proposition through formative interviews followed by a design provocation centered around measuring burnout in a U.S. resident physician program. Residents and their supervising attending physicians were presented with medium-fidelity mockups of a dashboard providing behavioral data on residents' sleep, activity and time working; self-reported data on residents' levels of burnout; and a free text box where residents could further contextualize their well-being. Our findings uncover tensions around how best to measure workplace well-being, who within a workplace is accountable for worker stress, and how the introduction of such tools remakes the boundaries of appropriate information flows between worker and workplace. We conclude by charting future work confronting these tensions, to ensure personal sensing is leveraged to truly improve worker well-being.
... Indeed, physical activity has been linked to improvement in all domains of QoL, 20 and an exercise programme in medical residents and fellows has been shown to significantly raise QoL. 21 Furthermore, a systematic review of multiple professions demonstrated a negative relationship between physical activity and the key component of burnout, emotional exhaustion. 22 To date, there has been no systematic review demonstrating the extent to which, if any, physical activity (including exercise) has an effect on burnout/QoL in medical students. ...
Background:
Medical students are at risk of burnout and reduced quality of life (QoL). The risk of burnout doubles from third to sixth year of medical school, and medical students have an 8%-11% lower QoL than nonmedical students. It is imperative to prevent this, as burnout and reduced QoL is independently associated with errors in practice. This systematic review aims to examine whether physical activity/exercise is associated with burnout and/or QoL in medical students.
Methods:
Articles were identified through database searches of Embase, Medline, PsycINFO, Scopus and Web of Science. Studies were included if both physical activity/exercise and burnout or QoL were measured and limited to those focussing on medical students. Risk of bias was assessed using accredited cohort and cross-sectional checklists. A narrative synthesis was conducted due to heterogeneity in the dataset.
Findings:
Eighteen studies were included, comprising 11,500 medical students across 13 countries. Physical activity was negatively associated with burnout and positively associated with QoL. Furthermore, the findings were suggestive of a dose-response effect of physical activity on both burnout and QoL; higher intensities and frequencies precipitated greater improvements in outcomes.
Conclusions:
This multinational review demonstrates that physical activity is associated with reduced burnout and improved QoL in medical students. It also identifies a paucity of research into the optimal intensity, frequency, volume and mode of physical activity. Further research, building on this review, is likely to inform the long overdue development of evidence-based, well-being curricula. This could involve incorporating physical activity into medical education which may improve well-being and better prepare students for the demands of medical practice.
... PA in general has been shown to improve anxiety, stress, depression, and overall mental wellbeing 8,9 . These benefits are seen in medical student populations as well, including a lower risk of student burnout 10,11 . ...
Aim Physical Activity (PA) and Mindfulness-Based Stress Reduction (MBSR) both have positive effects on medical student well-being. The 'MED-WELL' programme is a curricular intervention that combines PA and education on exercise as medicine. This trial evaluates whether there is a mean difference in outcomes of participants of an exercise intervention, the 'MED-WELL' programme, versus a control group which engages in a MBSR programme. Methods All second-year medical students were voluntarily allocated into the intervention or control group. Data on overall health and well-being, sleep quality, loneliness, current level of PA, and confidence in prescribing exercise as medicine was analysed from both groups at baseline and after eight weeks. Results Within groups the intervention and control groups showed statistically significant improvements in overall well-being (p=0.010, p=0.005 respectively) and in sleep quality (p<0.001, p=0.007 respectively). The intervention group had statistically significant improvements in levels of PA (p=0.003) and confidence in prescribing exercise (p<0.001). However, there were no statistically significant differences in changes in outcome measures between groups. Conclusion This study has shown that participants in an exercise intervention, the 'MED-WELL' programme, had similar improvements in overall wellbeing and sleep quality to those in a control group who participated in a MBSR programme of the same duration.
... It can cause symptoms such as fatigue, insomnia, forgetfulness, distraction, somatic complaints (palpitations, chest tightness, muscle pain, gastrointestinal disorders, etc.), frequent illness and mental reactions (easily irritable, depressed mood, lack of pleasure) [9] . Sedentariness brings burnout and poor quality of life [30,31] . Similarly, poor quality of life and burnout can bring inactivity. ...
... International PA guidelines recommend a minimum of 30 min of moderate to vigorous PA five days per week, or 150 min over a week to support physical and mental health [4]. Amongst medical students in particular, PA has a positive effect on mental and physical health, including reducing levels of anxiety, depression, and burnout [5][6][7]. ...
Background
The ‘MED-WELL’ programme is a combined exercise and educational intervention designed to promote well-being among medical students and educate students about prescribing exercise as medicine in clinical practice. Due to COVID-19 public health restrictions of social distancing the ‘MED-WELL’ programme was offered online instead of in-person in 2021. The aim of this study is to compare the experiences of participants in the ‘MED-WELL’ programme online to those that previously participated in the same programme in-person to understand the student experience and optimize programme delivery.
Methods
Purposive sampling was used to recruit 20 participants to a qualitative study using semi-structured interviews. Ten study participants took part in the ‘MED-WELL’ programme when it was offered in-person, and the other ten study participants took part in the programme when it was offered online. All interviews were audio-recorded and transcribed using Microsoft Teams. A combined inductive and deductive approach was used for analysis. An inductive thematic analysis was utilized to categorize data into higher order codes, themes, and overarching themes. The theory of online learning provided the theoretical framework for a deductive approach.
Results
Analysis of the data produced five overarching themes: ‘student-student’, ‘student-teacher’, ‘student-content’, ‘student-environment’, and ‘effects of a pandemic’. The first four themes detail distinct types of interaction that participants had with various entities of the ‘MED-WELL’ programme and the effects that these interactions had on participant experiences. ‘Effects of a pandemic’ refers to the context of delivering the ‘MED-WELL’ programme online during a pandemic and how this mode of delivery influenced participants and the programme.
Conclusions
Optimizing the ‘MED-WELL’ programme relies on an understanding of how participants interact with different entities of the programme and are motivated to attend and engage. Participants tended to favour an in-person mode of delivery, however certain advantages of delivering the programme online were also identified. The findings from this study can be used to inform similar experiential and educational exercise interventions, and may help plan for potential future restrictions on in-person educational and exercise-based programmes.
... Importantly, these health behaviors and health conditions were associated with student, faculty and staff burnout which in turn has been associated with increased medical errors, lower quality of care, reduced productivity, and increased turnover among other adverse outcomes [5,6]. The poor health behaviors and health found in the current study provide further need to help healthcare workers and medical students improve these behaviors [45][46][47]. Social media [48] or wearable technology [49] may be less costly interventions that have widespread reach among medical students and university hospital staff. While these efforts have indicated small success, a more systematic approach to improving healthcare and future healthcare workers well-being is needed. ...
Background and objectives
Health behaviors of physical activity and sleep are critical to the prevention of numerous chronic diseases. The health behaviors of healthcare professionals are even more critical, as healthcare providers who practice positive health behaviors are more likely to promote these healthy behaviors in their patients.
Aims
To assess the health status and health behaviors of medical students, faculty, and staff in an academic health center in the US, and examine the associations between behaviors, physical and mental health outcomes and burnout.
Methods
Students, faculty, residents and staff from a large university medical system completed an online survey between late-September and mid-November 2019. Associations were examined between health behaviors and health status including mental health outcomes with burnout.
Results
Participating in any leisure time physical activity and having a Pittsburgh Sleep Quality Index score < 5 were associated with fewer physical health conditions and lower odds of reporting pain at any site (n = 2060; students n = 242, residents n = 32, staff n = 1425, faculty n = 361). Leisure physical activity and fewer sleep symptoms were associated with fewer reported depressive, anxiety and stress-related symptoms. Participating in leisure physical activity and good-quality sleep were associated with lower odds of burnout.
Conclusions
The current study found high rates of physical inactivity and poor sleep among medical students, faculty and staff at an academic health center. These health behaviors were associated with poor mental health and high burnout. Programs and policies are needed improve these health behaviors to reduce burnout.
... An incentivized team-based exercise program was studied in a cohort of 245 residents and fellows and compared to a control group (n = 383). Those in the exercise program reported significantly higher QoL (p \ 0.001) at the conclusion of the program suggesting that some form of wellness contributed to the improved QoL whether it be physical activity, camaraderie, appreciation via incentives, or a combination of factors [29]. These studies show that wellness can be approached from several angles to reach the same goal. ...
Purpose of Review
Burnout disproportionately affects healthcare providers and impacts patient care and providers’ quality of life (QoL). This review sought to define and dissect techniques used across the country to combat burnout during graduate surgical medical education.
Recent Findings
Growing literature exploring the effects of burnout interventions demonstrate the increased commitment and importance placed on these topics by residency programs and the Accreditation Council for Graduate Medical Education. Resiliency training, mindfulness teachings, mentorship, and other strategies have had measurable success on residents’ self-reported mental health and QoL. Resident-driven interventions such as improvements to their work environment have significantly improved measurements of stress, job satisfaction, emotional intelligence, emotional exhaustion, and life satisfaction.
Summary
While encouraged by the many wellness initiatives undertaken around the country, further work is needed to better identify, standardize, and compare wellness interventions to determine how to best serve this group of medical providers.
... Specifically, a randomized controlled trial assigning medical students to an exercise regimen would be able to measure the exact mental health benefits of physical activity and determine causality. While psychological benefits have not been identified in prior studies of exercise [53], these benefits may not have been detected because earlier studies relied upon the CDC guidelines that did not differentiate between HEPA and less intense forms of exercise. It therefore may be more appropriate for future wellbeing interventions to target and measure HEPA separately from moderate physical activity, as opposed to grouping them together in the category of 'compliant with CDC guidelines.' ...
Background
Physical activity may protect the mental health of medical students, yet it is unknown which types and intensities of physical activity have the greatest potential to improve medical student well-being.
Objective
We characterize the relationship between exercise intensity and stress levels of U.S. medical students, thereby informing the design of future well-being interventions.
Design
Two cross-sectional validated surveys assessing stress and physical activity were administered one year apart at the David Geffen School of Medicine at UCLA. A total of 1,046 out of 1,392 medical students responded (75%). An ordered logistic regression was used to determine the association between stress and each level of exercise intensity (inactivity, moderate-activity, and health-enhancing physical activity [HEPA]). These exercise intensity groupings were compared to the CDC guidelines for aerobic exercise.
Results
While achieving either moderate-activity or HEPA is compliant with the CDC guidelines for aerobic exercise, the additional intensity of exercise required to achieve HEPA was associated with a 26% increase in the probability of being in the lowest stress quartile and a 22% decrease in the probability of being in the highest stress quartile. Medical student physical activity levels were on-par with the national average per the CDC exercise guidelines (65% vs. 58%), but medical student HEPA levels were significantly lower than the national average (27% vs. 64%; OR 0.21; 95% CI 0.12–0.37).
Conclusions
There is a large disparity in rates of the highest intensity physical activity (HEPA) between medical students and the age-adjusted national average, which has previously been overlooked by the binary CDC exercise guidelines. The fact that HEPA levels are not optimized and more strongly associated with lower stress levels relative to less intense forms of exercise makes it a promising new target for future well-being interventions among medical trainees.
... It is vital that academic institutions provide an organizational culture of wellbeing by assessing challenges to self-care and by implementing institutional strategies and measures that encourage sound mental and physical health. Such initiatives can include online wellness platforms, support groups, increased access to mental health services, classes on yoga, mindfulness, sleep health, time management, nutrition and fitness, as well as longitudinal wellness index surveys (25)(26)(27). ...
Stress and burnout are serious and growing threats to the mental health of medical trainees. Recent estimates of burnout in medical students and residents are quite high, with more than half displaying signs of stress, anxiety and depression. The COVID-19 pandemic has only heightened the state of poor mental health in these student populations. It is the position of LSU Health Shreveport Office of Institutional Wellness that a critical need exists for academic institutions to evaluate challenges to self-care and wellbeing in medical trainees. Such evaluations may pave the way for the development of effective institutional wellness initiatives and strategies, with the goal of reducing barriers to self-care to promote better mental and physical health, and facilitate improved quality of life in medical students and residents.
... 47 In terms of organizational justice, reasonable distribution of work, 45,48 compliance with working hours, and effective communication are recommended. 45,49 By utilizing e-learning and video platforms, medical institutions can also engage in interventions to improve communication skills, case management, and troubleshooting strategies to solve any possible psychological problems that might arise when treating COVID-19 patients. 50 There are some limitations in this study. ...
Objective:
The aim of this study was to assess the psychosocial characteristics of the employees working at a university hospital and investigated the factors affecting their quality of life (QOL) under COVID-19.
Methods:
This study enrolled 1,191 healthcare workers from a university hospital, including doctors, nurses, administrative officer and technicians. Besides demographic information, depression, anxiety, somatization, insomnia, resilience, and QOL were assessed.
Results:
The nurses presented significantly higher scores for anxiety, depression and showed significantly higher insomnia scores and significantly lower resilience scores. The occupations showed significant differences in the QOL and sub-groups, including the overall quality of life and general health (F=4.774, p<0.001), psychological domain (F=6.230, p<0.001), and environment domain (F=5.254, p<0.001). There was a positive correlation between the QOL and resilience (r=0.608, p<0.01). However, depression (r=-0.502, p<0.01), anxiety (r=-0.425, p<0.01), somatization (r=-0.364, p<0.01), and insomnia (r=-0.385, p<0.01) showed negative correlations with the QOL. Resilience was the most important factor influencing the QOL.
Conclusion:
The results of this study showed that low resilience adversely affected the QOL and the mental health of the healthcare workers, which consequently had a direct effect on the quality of medical care given to patients.
... Apprendre aux individus à maintenir leur santé émotionnelle et physique [6] ; Programme d'entraîement à la résilience [41] ; Proposer des ateliers d'auto-soins [60,61] Exercices de relaxation Pratiquer du yoga [62] ; Avoir un passe-temps en dehors du travail [6] ; Pratiquer la pleine conscience (MBSR) [6,51,63] ; Pratiquer la méditation [64] ; Réaliser des programmes de gestion de l'état de stress [51,65,66] centrées sur les individus sont des stratégies qui négligent les facteurs organisationnels qui sont les principaux moteurs du burn-out des soignants en réanimation [44]. Ces interventions confortent également un discours institutionnel interprétant l'épuisement professionnel comment émanant de la responsabilité exclusive de l'individu [44]. ...
... In addition to mitigating mental health disorders, physical activity has been inversely associated with burnout among physicians. [17][18][19]. The purpose of this study was to implement a pilot, resident-led, goal-based physical wellness initiative for resident EPs and to evaluate whether this intervention was useful in promoting well-being and combating burnout. ...
Introduction: The COVID-19 pandemic has taken a significant toll on societal, physical, and psychological health. Emergency physicians (EPs) are susceptible to burnout under ordinary circumstances and may be particularly vulnerable during the pandemic. To reduce pandemic-related burnout, we implemented a residency-led physical wellness initiative and evaluated the effect on burnout among EPs. Methods: In the spring of 2020, we invited all resident and attending EPs in our department to participate in a four-week physical wellness initiative as part of a prospective study. After completing or opting out of this wellness initiative, EPs responded to an online survey comprised of five sections: demographics, participation, opinion on wellness initiative, opinion on the impact of COVID-19, and the Maslach Burnout Index (MBI-HSS). We stratified respondents by initiative participation, described the characteristics of each group, and then compared the perceived impact of COVID-19 and the MBI-HSS results between the two groups. Results: Out of 110 eligible participants, 57 EPs completed the survey (51.8%). Thirty-five respondents completed the wellness initiative. Few (37.1%) documented their progress, though most worked with accountability partners (85.7%). Most enrollees enjoyed participation (Likert Score 3.2-5, CI 2.9-3.5) and would participate again (3.3, CI 3.0-3.6). The reported effect of the COVID-19 pandemic on mental wellbeing was lower for participants, although this was not significant (2.1, CI 1.5-2.1 vs 2.4, CI 2.0-2.7, p=0.312). On the MBI-HSS, participants had a lower emotional exhaustion score (1.4, 95% CI 0.9-1.8) than non-participants (2.2, 95%CI 1.8-2.6, p=0.005).
Introduction
Globally, Resident Doctors face challenges like long work hours, critical decision-making stress, and exposure to death and distress, prompting concern for their well-being. This study addresses the need for interventions to improve their working conditions, vital for enhancing quality of life, patient care, and retaining a skilled workforce.
Methods
Following PRISMA guidelines, a systematic literature review until January 3, 2024, explored interventions for Resident Doctors pre and post-COVID-19. It evaluated intervention effectiveness, metrics, and feasibility, excluding studies with high bias risk.
Results
The review identified diverse interventions, from mentoring to wellness resources, showing significant improvements in job satisfaction, mental health, and professional growth among Resident Doctors. Due to methodological variations, a narrative synthesis was conducted.
Conclusion
Effective interventions addressing Resident Doctors' challenges can notably enhance their well-being and job satisfaction. Scaling such interventions is vital for fostering supportive work environments, sustaining the healthcare workforce, and improving patient care quality.
Keywords
Junior Doctors, Doctors in Training, Resident Doctors, Residents, Well-being Interventions, Work-life balance, Mental Health, Healthcare Workforce Retention, Post-COVID Healthcare
Objective
Examine the impact of a participatory wellness continuing medical education (CME) program on physician burnout, wellness, and well-being.
Methods
Physicians attending a three-day wellness CME program. Self-reported questionnaires at baseline with paired analyses at 26-week follow-up.
Results
Compared to baseline, at 26 weeks there were decreases in burnout ( P < .001, ES -0.68), red meat consumption ( P = .02, ES -0.29), and current stress levels ( P < .001, ES -0.50). There were increases in fruit/vegetable consumption ( P < .001, ES 0.55), energy levels at work ( P < .001, ES 0.60) and at home ( P < .001, ES 0.66), quality of life ( P < .001, ES 0.53), and confidence ( P < .001, ES 0.89) and frequency ( P = .01, ES 0.32) of counseling patients on wellness.
Conclusion
Attendance at this participatory wellness CME program was associated with improved physician burnout, health behaviors in diet, stress, energy, quality of life, and wellness counseling.
The impact of the practice of physical activities on Burnout and its dimensions remains very little documented among students living in subaerial African countries. The present study was to determine the impact of the level of physical activities on Burnout. In a cross-sectional analytical study, students from the Faculty of Medicine of the University of Kinshasa were recruited by convenience in the period from February 1 to August 1, 2023. The parameters of interest included intensity, frequency, duration of the practice of physical activities and the dimensions of Burnout. Analysis of Variance (ANOVA) was used to research the influence between the intensity, frequency and duration of physical activity practice on Emotional Exhaustion, Depersonalization, Lack of Personal Accomplishment and Burnout syndrome. The moderate and high level of physical activity practice significantly reduces Emotional Exhaustion by -14 (30.08±13.04 vs 16.10±10.38), p < 0.001, Depersonalization by -7(12. 45±6.42vs 5.89±5.99), p < 0.001, Burnout of -17 (28.17±10.05 vs 11.00±8.47), p < 0.001 and increases the Personal Accomplishment of students of the Faculty of Medicine of +31(42.00±10.7vs11.00±8.47), p < 0.002. The duration of the practice of physical activities of 30 minutes or more positively influences personalization in 28% (p < 0.001), 75% personal accomplishment (p < 0.003) and 63% burnout (p < 0.004). Furthermore, the frequency of 3 or more times per week of practicing physical activities positively improves Emotional Exhaustion by 56% (p < 0.001), professional accomplishment by 79% (p < 0.002) and 83% by Burnout (p < 0.001). Young medical school students with Burnout are inactive and sedentary. The latter are associated with a decrease in Personal Accomplishment and an increase in Burnout syndrome. The duration of physical activities of 30 to 45 minutes per day practiced three or more times per week positively improves Emotional Exhaustion, personalization, personal accomplishment and Burnout syndrome. The dissemination of information programs, particularly to medical students, seems urgent.
Purpose: The aim of the study was to examine the relationships between physical activity level (PAL), burnout, job satisfaction, quality of life, and some sociodemographic factors in academicians.
Materials and Methods: The study included 214 academicians, including research assistants, lecturers, assistant professors, associate professors, and professors. Computer usage time, tenure of office, age, experience abroad, PAL (with International Physical Activity Questionnaire), burnout level (with Maslach Burnout Inventory), job satisfaction (with Job Satisfaction Scale for Academicians), and quality of life (with Short Form-36 Health Survey) were evaluated.
Results: It was observed that computer usage time, PAL, burnout, job satisfaction, and quality of life varied according to the academic title (p<0.05). Computer usage time and burnout level were the highest among research assistants, while job satisfaction and quality of life were the lowest. This finding was found to be the opposite in professors (p<0.05). Strong negative relationships were observed between burnout and job satisfaction, and quality of life (p<0.05). Those with experience abroad had lower burnout levels, higher job satisfaction, and quality of life (p<0.05). In each academic title group, significant and strong negative relationships were observed between PAL and burnout, while significant strong positive relationships were observed between PAL and job satisfaction and quality of life (p<0.05).
Conclusion: It is thought that the academicians' burnout levels can be decreased and job satisfaction and quality of life can be increased by improving working conditions, enabling them to gain experience abroad, and encouraging adequate and regular physical activity.
Objective:
Physicians of all specialties experienced unprecedented stressors during the COVID-19 pandemic, exacerbating preexisting burnout. We examine burnout's association with perceived and actionable electronic health record (EHR) workload factors and personal, professional, and organizational characteristics with the goal of identifying levers that can be targeted to address burnout.
Materials and methods:
Survey of physicians of all specialties in an academic health center, using a standard measure of burnout, self-reported EHR work stress, and EHR-based work assessed by the number of messages regarding prescription reauthorization and use of a staff pool to triage messages. Descriptive and multivariable regression analyses examined the relationship among burnout, perceived EHR work stress, and actionable EHR work factors.
Results:
Of 1038 eligible physicians, 627 responded (60% response rate), 49.8% reported burnout symptoms. Logistic regression analysis suggests that higher odds of burnout are associated with physicians feeling higher level of EHR stress (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.07-1.25), having more prescription reauthorization messages (OR, 1.23; 95% CI, 1.04-1.47), not feeling valued (OR, 3.38; 95% CI, 1.69-7.22) or aligned in values with clinic leaders (OR, 2.81; 95% CI, 1.87-4.27), in medical practice for ≤15 years (OR, 2.57; 95% CI, 1.63-4.12), and sleeping for <6 h/night (OR, 1.73; 95% CI, 1.12-2.67).
Discussion:
Perceived EHR stress and prescription reauthorization messages are significantly associated with burnout, as are non-EHR factors such as not feeling valued or aligned in values with clinic leaders. Younger physicians need more support.
Conclusion:
A multipronged approach targeting actionable levers and supporting young physicians is needed to implement sustainable improvements in physician well-being.
Introdução: a Síndrome de Burnout se caracteriza como resposta física e psíquica aos estressores emocionais do trabalho envolvendo exaustão emocional; despersonalização e diminuição do envolvimento pessoal. Tem-se notado um avanço no conhecimento sobre o Burnout e as respectivas estratégias terapêuticas utilizadas para diminuir os efeitos deletérios da síndrome na saúde. Objetivos: descrever as principais estratégias terapêuticas utilizadas para o tratamento da SB que acomete os profissionais da saúde, publicaadas no período de 2012 a 2022. Método: trata-se de estudo de revisão sistemática de literatura, realizada nas bases de dados da National Library of Medicine (MEDLINE), via PubMed, com os seguintes descritores: “Therapeutic AND Burnout” OR “Therapeutic AND Burnout AND healthcare professional”. Resultados: a Síndrome de Burnout afeta principalmente profissionais médicos e enfermeiros, em sua maioria mulheres, que enfrentam um cotidiano de dificuldades estruturais e organizacionais, que possuem carga de trabalho exaustiva, com relação próxima às pessoas fragilizadas em sua saúde física e/ou mental e que não possuem preparação emocional para o combate dessa síndrome. As estratégias terapêuticas mais descritas envolvem especialmente ações em grupo. Mindfulness (atenção plena) foi a terapia mais citada e a que ofereceu aos profissionais maior resultado na prevenção e no tratamento da SB, destaca-se também a prática de exercício físico e programas com terapias especificas, além do uso do Canabidiol. Conclusão: esta revisão sistemática trouxe estratégias terapêuticas aplicadas em profissionais da área da saúde diagnosticados com SB. Grande parte dessas intervenções são utilizadas como tratamento preventivo a fim de minimizar os riscos do surgimento da síndrome. Tais estratégias apresentam resultados promissores quanto à prevenção e tratamento do burnout, mas é importante destacar que são necessários mais estudos randomizados controlados (Randomized Controlled Trials) com métodos rigorosos e amostras maiores para obtenção de resultados mais definitivos.
According to Kirk & Rhodes (2011), Nooijen et al. (2018), and Saridi et al. (2019), the motivators and barriers to exercise are influenced by one's occupation, especially among those in the healthcare field. We sought to examine the barriers and motivators to physical activity that are distinctive to clinicians. Community hospital clinicians were surveyed regarding motivators and barriers to exercise that they experience, their burnout levels as described by an adaptation of the Mini-Z single item burnout scale, and average weekly exercise habits. The top barriers and motivators were then correlated to burnout levels, levels of physical activity, and demographics. We received 64 total responses from clinicians. The overall average level of burnout was 2.37 and the median level was 2. Approximately 38% of clinicians reported adhering to American Heart Association (AHA) guidelines of 150 minutes of exercise per week, while 33% of clinicians exercise <75 minutes per week. The top general motivator was for one's own well-being and the top clinician-related motivator was reducing stress. The top two barriers to exercise were COVID-19 concerns at an indoor exercise facility and a lack of time. Higher average levels of burnout were experienced by those who marked being too stressed or too burnt out as barriers to exercise. Because of clinicians' roles in propagating healthy practices in their patients from their own habits, wellness programs should be aimed at capitalizing motivators to combat barriers that this group distinctively experiences. Efforts to improve physical and mental wellness among clinicians will translate into better provider and patient health outcomes.
Medicine is, and to a certain extent always was, washed by or immersed in various kinds of uncertainties that can ultimately affect its constitutive agent’s health and wellbeing.
The COVID-19 pandemic as a public health issue has spread to the rest of the world. Although the well-being and emotional resilience of healthcare professionals are key components of continuing healthcare services during the COVID-19 pandemic, healthcare professionals have been observed in this period to experience serious psychological problems and to be at risk in terms of mental health. Therefore, this study aims to probe the psychological resilience of healthcare workers. Psychological resilience remains a key factor in sustaining healthy emotional functioning during the crisis and facilitating rapid recovery as we move forward to build a better post-pandemic world. Our research, and that of others, suggests that healthy sleep is one of the most powerful aspects of psychological resilience. Psychological resilience levels of healthcare workers in their later years were found to be higher. Doctors constitute the group with the lowest levels of psychological resilience among healthcare workers. The current study is considered to have contributed to the literature in this regard. Primary needs such as sleep which are determinants of quality of life, life satisfaction and psychological resilience should be met.
Public health crises that increase the demand for healthcare professionals (HCPs) often result in increased mental distress in HCPs. The current study investigated the specific mental health ramifications of the COVID-19 pandemic on HCPs and perceived support from their places of work. Data was collected from US-based HCPs ( N = 325) working as physicians (21.8%), nurses (26.8%), mental health professionals (MHPs; 30.5%), and allied healthcare professionals (AHPs; 20.9%) from April 2020 to April 2021 amidst the COVID-19 pandemic, using an online self-report survey. Descriptive and correlational statistical analyses assessed worry, stressors, psychological functioning, and perceived support. A majority of participants expressed worry about the pandemic broadly (93%), and approximately half (50.5%) indicated that their degree of worry was moderate to extreme. Respondents worried most about the risk of infection for family and relatives. HCPs reported not having been able to enjoy daily activities (66.9%), losing sleep (43.1%), and feeling constantly under strain (66.9%), compared to usual. Most HCPs indicated a strong desire for clear communication regarding the pandemic and psychological support from their workplaces. This paper provides recommendations to support HCP mental health by both ameliorating distress caused by the COVID-19 pandemic as well as protecting the health and wellness of HCPs more generally. HCPs and institutions that employ them should seek out or provide access to mental health resources and services, engage with or provide opportunities and activities to actively address mental health, and improve communication regarding COVID-19 or other topics HCPs demonstrate interest in.
O objetivo do estudo é verificar a associação entre a prevalência da Síndrome de Burnout e o nível de atividade física de estudantes de uma universidade pública do sul do Brasil. O estudo transversal, com amostragem probabilística e intencional, incluiu 584 universitários. Para avaliar o nível de atividade física, foi aplicado o International Physical Activity Questionnaire (IPAQ) - versão longa. A Síndrome de Burnout foi avaliada por meio do Maslach Burnout Inventory Student Survey - (MBI-SS), sendo utilizado também um questionário sociodemográfico. Para a análise dos dados foram adotados testes de associação e análise de regressão logística multinomial bruta e ajustada para estimar as razões de chance (RC) . Os resultados indicaram que estudantes inativos no trabalho apresentaram maiores chances de média eficácia profissional e estudantes inativos no lazer apresentaram maiores chances de alta exaustão emocional e média descrença. Abstract. The aim of the study was to verify the association between the prevalence of Burnout Syndrome and the level of physical activity of students at a public university in southern Brazil. The cross-sectional study with probabilistic and intentional sampling included 584 university students. To assess the level of physical activity, the International Physical Activity Questionnaire (IPAQ) - long version was applied. Burnout syndrome was assessed using the Maslach Burnout Inventory Student Survey - (MBISS) and a sociodemographic questionnaire was also used. For data analysis, association tests and crude and adjusted multinomial logistic regression analyzes were used to estimate the odds ratios (OR) . The results indicated that students inactive at work had higher chances of average professional effectiveness and students inactive at leisure had higher chances of high emotional exhaustion and average disbelief. Resumen. El objetivo del estudio es verificar la asociación entre la prevalencia del Síndrome de Burnout y el nivel de actividad física de los estudiantes de una universidad pública del sur de Brasil. El estudio transversal, con muestreo probabilístico e intencional, incluyó a 584 estudiantes universitarios. Para evaluar el nivel de actividad física se aplicó el Cuestionario Internacional de Actividad Física (IPAQ) - versión larga. El Síndrome de Burnout se evaluó mediante el Maslach Burnout Inventory Student Survey - (MBI-SS), y también se utilizó un cuestionario sociodemográfico. Para el análisis de los datos, se utilizaron pruebas de asociación y análisis de regresión logística multinomial cruda y ajustada para estimar las razones de probabilidad (OR) . Los resultados indicaron que los estudiantes inactivos en el trabajo tenían mayores posibilidades de efectividad profesional promedio y los estudiantes inactivos en el tiempo libre tenían mayores probabilidades de agotamiento emocional alto e incredulidad promedio.
The issue of physician wellness has received increasing attention in recent years for multiple reasons, including issues ranging from physician attrition and suicide to patient outcomes. Multiple factors have been identified as contributing to high levels of burnout, including individual as well as systemic and institutional factors. A number of tools for detecting and monitoring burnout and physician wellness have been developed and have been increasingly deployed in healthcare and professional organizational settings. Strategies for individuals and institutions to employ to mitigate and prevent burnout have been recognized and studied. This chapter will review the current status of our understanding of surgeon burnout and wellness and its measurement, including contributory factors. Mitigation strategies will also be reviewed, with a particular emphasis on looking beyond coping and defensive strategies into the area of promoting and celebrating joy, fulfillment, and meaning in our work.KeywordsBurnoutWellnessPositive psychologyMotivationResilienceOrganizational culture
Recently, the work-life conflicts and burnout of doctors have been reported as important problems worldwide. In addition, physician burnout such as overall burnout, emotional exhaustion score, and depersonalization score has reached epidemic levels in both physicians in training and practising physicians. The burnout is rather serious not only for surgeons but also for the gastroenterologists. Furthermore, the burden of young woman doctors is the most serious group in this pandemic state of COVID-19. The consequences are negative effects on patient care, professionalism, physicians’ own care and safety, and the viability of health-care systems. Several reports including Korean Gastroenterologists survey showed that work-life imbalance and burnout were most severe in young woman doctors due to their domestic demands among physicians’ burnout. Systemic review showed that intervention could decrease overall burnout from 54% to 44% (difference 10% [95% CI, 5–14]), suggesting that both individual-focused and structural or organisational strategies can contribute to improve the burnout among physicians.KeywordsWork-life balanceGastroenterologistsSexGenderBurnoutPhysician
Background:
Surgical culture has shifted to recognize the importance of resident wellbeing. This is the first study to longitudinally track regional surgical resident wellbeing over 5 years.
Study design:
An anonymous cross-sectional, multi-institutional survey of New England general surgery residents using novel and published instruments to create three domains: health maintenance, burnout, and work environment.
Results:
Overall, 75% (15/20) of programs participated. The response rate was 44% (250/570) and 53% (133/250) were female, 94% (234/250) were 25-34 years old, and 71% (178/250) were in a relationship. For health maintenance, 57% (143/250) reported having a primary care provider, 26% (64/250) had not seen a primary care provider in 2 years, 59% (147/250) endorsed being up to date with age-appropriate health screening, however, only 44% (109/250) were found to actually be up to date. Only 14% (35/250) reported exercising greater than 150 minutes/week. The burnout rate was 19% (47/250), with 32% (81/250) and 25% (63/250) reporting high levels of emotional exhaustion and depersonalization, respectively. For both program directors and attendings, 90% of residents reported they cared about resident wellbeing. 87% of residents believe it was acceptable to take time off during the workday for a personal appointment, while only 49% reported they would personally take the time.
Conclusions:
The personal health maintenance of general surgery residents has changed little over the past five years, despite an overwhelming majority of residents reporting attendings and program directors care about their wellbeing. Further study is needed to understand the barriers to improvement of resident wellbeing.
OBJECTIVE
To describe veterinary house officers’ perceptions of dimensions of well-being during postgraduate training and to identify potential areas for targeted intervention.
SAMPLE
303 house officers.
PROCEDURES
A 62-item questionnaire was generated by use of an online platform and sent to house officers at participating institutions in October 2020. Responses were analyzed for trends and associations between selected variables.
RESULTS
239 residents, 45 rotating interns, and 19 specialty interns responded to the survey. The majority of house officers felt that their training program negatively interfered with their exercise habits, diet, and social engagement. House officers reported engaging in exercise significantly less during times of clinical responsibility, averaging 1.6 exercise sessions/wk (SD ± 0.8) on clinical duty and 2.4 exercise sessions/wk (SD ± 0.9) when not on clinical duty ( P < 0.001). Ninety-four percent of respondents reported experiencing some degree of anxiety regarding their physical health, and 95% of house officers reported feeling some degree of anxiety regarding their current financial situation. Overall, 47% reported that their work-life balance was unsustainable for > 1 year; there was no association between specialty and sustainability of work-life balance. Most house officers were satisfied with their current training program, level of clinical responsibility, and mentorship.
CLINICAL RELEVANCE
Veterinary house officers demonstrated a poor balance between the demands of postgraduate training and maintenance of personal health. Thoughtful interventions are needed to support the well-being of veterinary house officers.
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Physician burnout is a barrier to the patient-centered approach to health care.
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One of the driving factors of resident burnout is the decreased level of control that residents have over their everyday lives.
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Providing residents with a sense of control over their lives and their jobs increases job satisfaction and leads to a decrease in reports of negative effects on health, rest, participation in extracurricular activities, and time with family.
Given the high prevalences of burnout, more so in medical students, residents, and junior doctors than experienced physicians, prevention is paramount for a healthier future. The workplace culture needs to be based on respect and civility. Such an ethos is built on competence and compassion, recognition and rewards, teamwork and collegiality, and the use of initiative and personal control while also normalizing a work-life balance that is equitable, respectful, and free of role ambiguity. Medical student selection is wisely based on traits of openness to new experience, agreeableness, conscientiousness, and determination – characteristics that are linked to resilience. Training programs need to nurture self-efficacy and robustness, foster social support, promote mentoring, and ensure sensible rostering of work hours. Individuals ought to choose their specialty based on what is fulfilling and meaningful, build stress management into their lives, and include regular exercise, self-reflection, and debriefing. Organizations require formal wellness systems such as Balint groups, Schwartz Center Rounds, near-peer mentoring, and zero tolerance programs about bullying and sexual harassment. The physician can be blessed with a life of creativity, accomplishment, and success if this is inspired by virtue and generosity yet balanced with common sense.
We compared the amount of exercise undertaken by medical students, clinicians, and sport scientists with the National Australian Physical Activity (NAPA) Guidelines. A second aim was to compare attitudes to exercise counseling as preventive medicine between university- and clinic-based professionals. The research setting was a university medical school and a sports science sports medicine centre. A 20-item questionnaire was completed by 216 individuals (131 medical students, 43 clinicians and 37 sports scientists). Self-reported physical activity habits, exercise counseling practices and attitudes towards preventive medicine were assessed. The physical activity undertaken by most respondents (70%) met NAPA Guidelines. General practitioners had significantly lower compliance rates with NAPA Guidelines than other professionals. More than half of clinicians and medical students (54%) were less active now compared with levels of activity undertaken prior to graduate training. Most physicians (68%) reported they sometimes discuss physical activity with patients. In contrast, the majority of non-medically qualified respondents (60%) said they never discuss physical activity with their doctor. Most respondents (70%) had positive attitudes to exercise counseling. Sports scientists and respondents who were highly active in childhood had more positive attitudes to exercise counseling than others. Health professionals in this study were more active than the general population; however healthy exercise habits tend to deteriorate after the commencement of medical training. Despite the important role of doctors in health promotion, the degree of exercise counseling to patients is low.
Evidence suggests that the level of physical activity of physicians can be correlated directly with physician counselling patterns about this behaviour. Our objective was to determine if medical students, resident and fellow physicians and attending physicians meet the physical activity guidelines set forth by the US Department of Health and Human Services.
A representative cross-sectional web-based survey was conducted in June 2009-January 2010 throughout the USA (N=1949). Using the short form of the International Physical Activity Questionnaire, the authors gathered demographical data and information related to physical activity, the level of training, the number of work hours per week, body mass index (BMI), confidence about counselling about physical activity and frequency with which the physical activity is encouraged to his/her patients.
Based on the 1949 respondents, attending physicians (84.8%) and medical students (84%) were more likely than resident (73.2%) and fellow physicians (67.9%) to meet physical activity guidelines.
Physicians and medical students engage in more physical activity and tend to have a lower BMI than the general population. Resident and fellow physicians engage in less physical activity than attending physicians and medical students.
Physician distress is common and has been associated with negative effects on patient care. However, factors associated with resident distress and well-being have not been well described at a national level.
To measure well-being in a national sample of internal medicine residents and to evaluate relationships with demographics, educational debt, and medical knowledge.
Study of internal medicine residents using data collected on 2008 and 2009 Internal Medicine In-Training Examination (IM-ITE) scores and the 2008 IM-ITE survey. Participants were 16,394 residents, representing 74.1% of all eligible US internal medicine residents in the 2008-2009 academic year. This total included 7743 US medical graduates and 8571 international medical graduates.
Quality of life (QOL) and symptoms of burnout were assessed, as were year of training, sex, medical school location, educational debt, and IM-ITE score reported as percentage of correct responses.
Quality of life was rated "as bad as it can be" or "somewhat bad" by 2402 of 16,187 responding residents (14.8%). Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8343 of 16,192 (51.5%), 7394 of 16,154 (45.8%), and 4541 of 15,737 (28.9%) responding residents, respectively. In multivariable models, burnout was less common among international medical graduates than among US medical graduates (45.1% vs 58.7%; odds ratio, 0.70 [99% CI, 0.63-0.77]; P < .001). Greater educational debt was associated with the presence of at least 1 symptom of burnout (61.5% vs 43.7%; odds ratio, 1.72 [99% CI, 1.49-1.99]; P < .001 for debt >200,000 had mean IM-ITE scores 5.0 points (99% CI, 4.4-5.6; P < .001) lower than those with no debt. These differences were similar in magnitude to the 4.1-point (99% CI, 3.9-4.3) and 2.6-point (99% CI, 2.4-2.8) mean differences associated with progressing from first to second and second to third years of training, respectively.
In this national study of internal medicine residents, suboptimal QOL and symptoms of burnout were common. Symptoms of burnout were associated with higher debt and were less frequent among international medical graduates. Low QOL, emotional exhaustion, and educational debt were associated with lower IM-ITE scores.
Presenteeism is highly prevalent and costly to employers. It is defined as being present at work, but limited in some aspect of job performance by a health problem.Workplace health promotion (WHP) is a common strategy used to enhance on-the-job productivity. The primary objective is to determine if WHP programs are effective in improving presenteeism. The secondary objectives are to identify characteristics of successful programs and potential risk factors for presenteeism.
The Cochrane Library, Medline, and other electronic databases were searched from 1990 to 2010. Reference lists were examined, key journals were hand-searched and experts were contacted. Included studies were original research that contained data on at least 20 participants (≥ 18 years of age), and examined the impacts of WHP programs implemented at the workplace. The Effective Public Health Practice Project Tool for Quantitative Studies was used to rate studies. 'Strong' and 'moderate' studies were abstracted into evidence tables, and a best evidence synthesis was performed. Interventions were deemed successful if they improved the outcome of interest. Their program components were identified, as were possible risk factors contributing to presenteeism.
After 2,032 titles and abstracts were screened, 47 articles were reviewed, and 14 were accepted (4 strong and 10 moderate studies). These studies contained preliminary evidence for a positive effect of some WHP programs. Successful programs offered organizational leadership, health risk screening, individually tailored programs, and a supportive workplace culture. Potential risk factors contributing to presenteeism included being overweight, a poor diet, a lack of exercise, high stress, and poor relations with co-workers and management. Limitations: This review is limited to English publications. A large number of reviewed studies (70%) were inadmissible due to issues of bias, thus limiting the amount of primary evidence. The uncertainties surrounding presenteeism measurement is of significant concern as a source of bias.
The presenteeism literature is young and heterogeneous. There is preliminary evidence that some WHP programs can positively affect presenteeism and that certain risk factors are of importance. Future research would benefit from standard presenteeism metrics and studies conducted across a broad range of workplace settings.
The health and economic burden of physical inactivity is well documented. A wide range of primary care and community-based interventions are available to increase physical activity. It is important to identify which components of these interventions provide the best value for money.
To assess the cost-effectiveness of physical activity interventions in primary care and the community.
Systematic review of cost-effectiveness studies based on randomised controlled trials of interventions to increase adult physical activity that were based in primary health care or the community, completed between 2002 and 2009.
Electronic databases were searched to identify relevant literature. Results and study quality were assessed by two researchers, using Drummond's checklist for economic evaluations. Cost-effectiveness ratios for moving one person from inactive to active, and cost-utility ratios (cost per quality-adjusted life-year [QALY]) were compared between interventions.
Thirteen studies fulfilled the inclusion criteria. Eight studies were of good or excellent quality. Interventions, study populations, and study designs were heterogeneous, making comparisons difficult. The cost to move one person to the 'active' category at 12 months was estimated for four interventions ranging from €331 to €3673. The cost-utility was estimated in nine studies, and varied from €348 to €86,877 per QALY.
Most interventions to increase physical activity were cost-effective, especially where direct supervision or instruction was not required. Walking, exercise groups, or brief exercise advice on prescription delivered in person, or by phone or mail appeared to be more cost-effective than supervised gym-based exercise classes or instructor-led walking programmes. Many physical activity interventions had similar cost-utility estimates to funded pharmaceutical interventions and should be considered for funding at a similar level.
As people lead longer and generally healthier lives, aspirations and expectations of health care extend to include well-being and enhanced quality of life. Several measurement scales exist to evaluate how well health care reaches these goals. However, the definitions of well-being or quality of life remain open to considerable debate, which complicates the design, validation, and subsequent choice of an appropriate measurement.
This article reviews nine measures of psychological well-being, tracing their origins in alternative conceptual approaches to defining well-being. It compares their psychometric properties and suggests how they may be used.
The review covers the Life Satisfaction Index, the Bradburn Affect Balance Scale, single-item measures, the Philadelphia Morale scale, the General Well-Being Schedule, the Satisfaction With Life scale, the Positive and Negative Affect Scale, the World Health Organization 5-item well-being index, and the Ryff's scales of psychological well-being.
Scales range in size from a single item to 22; levels of reliability and validity range from good to excellent, although for some of the newer scales we lack information on some forms of validity.
Measures exist to assess several conceptions of psychological well-being. Most instruments perform adequately for survey research, but we know less about their adequacy for use in evaluating health care interventions. There remains active debate over how adequately the questions included portray the theoretical definition of well-being on which they are based.
Burnout has negative effects on work performance and patient care. The current standard for burnout assessment is the Maslach Burnout Inventory (MBI), a well-validated instrument consisting of 22 items answered on a 7-point Likert scale. However, the length of the MBI can limit its utility in physician surveys.
To evaluate the performance of two questions relative to the full MBI for measuring burnout.
Cross-sectional data from 2,248 medical students, 333 internal medicine residents, 465 internal medicine faculty, and 7,905 practicing surgeons.
The single questions with the highest factor loading on the emotional exhaustion (EE) ("I feel burned out from my work") and depersonalization (DP) ("I have become more callous toward people since I took this job") domains of burnout were evaluated in four large samples of medical students, internal medicine residents, internal medicine faculty, and practicing surgeons. Spearman correlations between the single EE question and the full EE domain score minus that question ranged from 0.76-0.83. Spearman correlations between the single DP question and the full DP domain score minus that question ranged from 0.61-0.72. Responses to the single item measures of emotional exhaustion and depersonalization stratified risk of high burnout in the relevant domain on the full MBI, with consistent patterns across the four sampled groups.
Single item measures of emotional exhaustion and depersonalization provide meaningful information on burnout in medical professionals.
Fatigue and distress have been separately shown to be associated with medical errors. The contribution of each factor when assessed simultaneously is unknown.
To determine the association of fatigue and distress with self-perceived major medical errors among resident physicians using validated metrics.
Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic, Rochester, Minnesota. Data were provided by 380 of 430 eligible residents (88.3%). Participants began training from 2003 to 2008 and completed surveys quarterly through February 2009. Surveys included self-assessment of medical errors, linear analog self-assessment of overall quality of life (QOL) and fatigue, the Maslach Burnout Inventory, the PRIME-MD depression screening instrument, and the Epworth Sleepiness Scale.
Frequency of self-perceived, self-defined major medical errors was recorded. Associations of fatigue, QOL, burnout, and symptoms of depression with a subsequently reported major medical error were determined using generalized estimating equations for repeated measures.
The mean response rate to individual surveys was 67.5%. Of the 356 participants providing error data (93.7%), 139 (39%) reported making at least 1 major medical error during the study period. In univariate analyses, there was an association of subsequent self-reported error with the Epworth Sleepiness Scale score (odds ratio [OR], 1.10 per unit increase; 95% confidence interval [CI], 1.03-1.16; P = .002) and fatigue score (OR, 1.14 per unit increase; 95% CI, 1.08-1.21; P < .001). Subsequent error was also associated with burnout (ORs per 1-unit change: depersonalization OR, 1.09; 95% CI, 1.05-1.12; P < .001; emotional exhaustion OR, 1.06; 95% CI, 1.04-1.08; P < .001; lower personal accomplishment OR, 0.94; 95% CI, 0.92-0.97; P < .001), a positive depression screen (OR, 2.56; 95% CI, 1.76-3.72; P < .001), and overall QOL (OR, 0.84 per unit increase; 95% CI, 0.79-0.91; P < .001). Fatigue and distress variables remained statistically significant when modeled together with little change in the point estimates of effect. Sleepiness and distress, when modeled together, showed little change in point estimates of effect, but sleepiness no longer had a statistically significant association with errors when adjusted for burnout or depression.
Among internal medicine residents, higher levels of fatigue and distress are independently associated with self-perceived medical errors.
OBJECTIVE: To evaluate how Doctors compared to the UK average, in terms of Department-of-Health recommended thirty-minutes of moderate-exercise, at least five times-per-week. Further hypotheses tested include whether those with on-site gym facilities are more likely to meet the recommendations, than those without, and whether those meeting DOH-recommendations at medical school, continue as Doctors. DESIGN: Each candidate answered 21 questions including demographics, exercise-habits and general-health. Data were analysed statistically using Student's t-test, Fisher's, McNemara's test. SETTING: Bedford Hospital, West Middlesex University Hospital. PARTICIPANTS: 61 foundation and specialty trainees were randomly recruited. INTERVENTIONS: Independent variable was the presence of exercise facilities. MAIN OUTCOME MEASURES: The number of participants currently meeting DOH-recommendations. We recorded the reason each participant gave, if they did not do so. RESULTS: 32 female, 29 male, median BMI 23.5, 6% smokers; 11% ex-smokers, ~10% drank excess alcohol, (n=61). Only 21% met DOH-exercise-recommendations, significantly lower than national average (p<0.001). Of the 79% who did not, 58% blamed no time, 29% lacked motivation and 13% no facilities. Conversely, more doctors without on-site gym facilities met DOH-recommendations, than those with (p<0.05). 64% met DOH-exercise-recommendations as medical-students, of whom, only 23% do now (p<0.0001). CONCLUSION: The Doctors in this study exercise less than average. However, those with on-site facilities did not meet DOH-recommendations more than those without. Few of those who met the DOH recommendations as medical students, continued as Doctors. This is especially worrying. The combination of a heavy work-load, lack of time and poor motivation contributes to the lack of exercise.
Doctors are well positioned to provide physical activity (PA) counselling to patients. They are a respected source of health-related information and can provide continuing preventive counselling feedback and follow-up; they may have ethical obligations to prescribe PA. Several barriers to PA counselling exist, including insufficient training and motivation of doctors and improvable, personal PA habits. Rates of exercise counselling by doctors remain low; only 34% of US adults report exercise counselling at their last medical visit. In view of this gap, one of the US health objectives for 2010 is increasing the proportion of patients appropriately counselled about health behaviours, including exercise/PA. Research shows that clinical providers who themselves act on the advice they give provide better counselling and motivation of their patients to adopt such health advice.
In summary, there is compelling evidence that the health of doctors matters and that doctors’ own PA practices influence their clinical attitudes towards PA. Medical schools need to increase the proportion of students adopting and maintaining regular PA habits to increase the rates and quality of future PA counselling delivered by doctors.
To compare the validity, reliability and responsiveness of a single, global quality of life question to multi-item scales.
Data were obtained from 83 consecutive patients with oesophageal adenocarcinoma undergoing either transhiatal or transthoracic oesophagectomy. Quality of life was measured at baseline, 5 weeks, 3 and 12 months post-operatively with a single-item Visual Analogue Scale (VAS) ranging from 0 to 100, the multi-item Medical Outcomes Study Short Form-20 (MOS SF-20) and Rotterdam Symptom Check-List (RSCL). Convergent and discriminant validity, test-retest reliability and both distribution-based and anchor-based responsiveness were evaluated.
At baseline and at 5 weeks, the VAS showed high correlations with the MOS SF-20 health perceptions scale (r = 0.70 and 0.72) and moderate to high correlations with all other subscales of the MOS SF-20 and RSCL (r = 0.29-0.70). The test-retest reliability intra-class correlation for the VAS was 0.87. At 5 weeks post-operatively, the distribution-based responsiveness was moderate for the VAS (standardised response mean: -0.47; effect size: -0.56), high for the physical subscales of the MOS SF-20 and RSCL (-1.08 to -1.51) and low for the psychological subscales (0.11 to -0.25). Five weeks post-operatively, anchor-based responsiveness was highest for the VAS (r = 0.54).
The VAS is an instrument with good validity, excellent reliability, moderate distribution-based responsiveness and good anchor-based responsiveness compared to multi-item questionnaires. Its use is recommended in clinical trials to assess global quality of life.
The Accreditation Council for Graduate Medical Education implemented mandatory work hour limitations in July 2003, partly out of concern for residents' well-being in the setting of sleep deprivation. These limitations are likely to also have an impact on other aspects of the lives of residents.
To summarize the literature regarding the effect of interventions to reduce resident work hours on residents' education and quality of life.
We searched the English-language literature about resident work hours from 1966 through April 2005 using MEDLINE, EMBASE, and Current Contents, supplemented with hand-search of additional journals, reference list review, and review of abstracts from national meetings.
Studies were included that assessed a system change designed to counteract the effects of resident work hours, fatigue, or sleep deprivation; included an outcome directly related to residents; and were conducted in the United States.
For each included study, 2 investigators independently abstracted data related to study quality, subjects, interventions, and findings using a standard data abstraction form.
Fifty-four articles met inclusion criteria. The interventions used to decrease resident work hours varied but included night and day float teams, extra cross-coverage, and physician extenders. Outcomes included measures of resident education (operative experience, test scores, satisfaction) and quality of residents' lives (amount of sleep, well-being). Interventions to reduce resident work hours resulted in mixed effects on both operative experience and on perceived educational quality but generally improved residents' quality of life. Many studies had major limitations in their design or conduct.
Past interventions suggest that residents' quality of life may improve with work hour limitations, but interpretation of the outcomes of these studies is hampered by suboptimal study design and the use of nonvalidated instruments. The long-term impact of reducing resident work hours on education remains unknown. Current and future interventions should be evaluated with more rigorous methods and should investigate links between residents' quality of life and quality of patient care.
The primary goal of this study was to evaluate the feasibility and effectiveness of a structured, multidisciplinary intervention targeted to maintain the overall quality of life (QOL), which is more comprehensive than psychosocial distress, of patients undergoing radiation therapy for advanced-stage cancer.
Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0% to 50% were randomly assigned to either an eight-session structured multidisciplinary intervention arm or a standard care arm. The eight 90-minute sessions addressed the five domains of QOL including cognitive, physical, emotional, spiritual, and social functioning. The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale (Linear Analog Scale of Assessment or modified Spitzer Uniscale). QOL was assessed at baseline, week 4 (end of multidisciplinary intervention), week 8, and week 27.
Of the 103 participants, overall QOL at week 4 was maintained by the patients in the intervention (n = 49), whereas QOL at week 4 significantly decreased for patients in the control group (n = 54). This change reflected a 3-point increase from baseline in the intervention group and a 9-point decrease from baseline in the control group (P = .009). Intervention participants maintained their QOL, and controls gradually returned to baseline by the end of the 6-month follow-up period.
Although intervention participants maintained and actually improved their QOL during radiation therapy, control participants experienced a significant decrease in their QOL. Thus, a structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment.
Medical errors are associated with feelings of distress in physicians, but little is known about the magnitude and direction of these associations.
To assess the frequency of self-perceived medical errors among resident physicians and to determine the association of self-perceived medical errors with resident quality of life, burnout, depression, and empathy using validated metrics.
Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic Rochester. Data were provided by 184 (84%) of 219 eligible residents. Participants began training in the 2003-2004, 2004-2005, and 2005-2006 academic years and completed surveys quarterly through May 2006. Surveys included self-assessment of medical errors and linear analog scale assessment of quality of life every 3 months, and the Maslach Burnout Inventory (depersonalization, emotional exhaustion, and personal accomplishment), Interpersonal Reactivity Index, and a validated depression screening tool every 6 months.
Frequency of self-perceived medical errors was recorded. Associations of an error with quality of life, burnout, empathy, and symptoms of depression were determined using generalized estimating equations for repeated measures.
Thirty-four percent of participants reported making at least 1 major medical error during the study period. Making a medical error in the previous 3 months was reported by a mean of 14.7% of participants at each quarter. Self-perceived medical errors were associated with a subsequent decrease in quality of life (P = .02) and worsened measures in all domains of burnout (P = .002 for each). Self-perceived errors were associated with an odds ratio of screening positive for depression at the subsequent time point of 3.29 (95% confidence interval, 1.90-5.64). In addition, increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months (P=.001, P<.001, and P=.02 for depersonalization, emotional exhaustion, and lower personal accomplishment, respectively; P=.02 and P=.01 for emotive and cognitive empathy, respectively).
Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress. Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors, suggesting that perceived errors and distress may be related in a reciprocal cycle.
Background: Burnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Little is known about burnout in residents or its relationship to patient care. Objective: To determine the prevalence of burnout in medical residents and explore its relationship to self-reported patient care practices. Design: Cross-sectional study using an anonymous, mailed survey. Setting: University-based residency program in Seattle, Washington. Participants: 115 internal medicine residents. Measurements: Burnout was measured by using the Maslach Burnout Inventory and was defined as scores in the high range for medical professionals on the depersonalization or emotional exhaustion subscales. Five questions developed for this study assessed self-reported patient care practices that suggested suboptimal care (for example, I did not fully discuss treatment options or answer a patient's questions or I made … errors that were not due to a lack of knowledge or inexperience). Depression and at-risk alcohol use were assessed by using validated screening questionnaires. Results: Of 115 (76%) responding residents, 87 (76%) met the criteria for burnout. Compared with non-bumed-out residents, burned-out residents were significantly more likely to self-report providing at least one type of suboptimal patient care at least monthly (53% vs. 21%; P = 0.004). In multivariate analyses, burnout-but not sex, depression, or at-risk alcohol use-was strongly associated with self-report of one or more suboptimal patient care practices at least monthly (odds ratio, 8.3 [95% Cl, 2.6 to 26.5]). When each domain of burnout was evaluated separately, only a high score for depersonalization was associated with self-reported suboptimal patient care practices (in a dose-response relationship). Conclusion: Burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.
Aims
This study aimed to investigate burnout among physiotherapists in hospitals within four health districts in South Tyrol (the German and Italian speaking area of Italy).
Method
Data were collected anonymously by envelope. The German version of the Maslach Burnout Inventory (MBI-D) ( Büssing and Perrar, 1992 ; Büssing and Glaser, 1998 ), socio-demographic, occupational data, the use of clinical supervision or support and the desire for emotional distance and closeness to clients were recorded. Questionnaires were sent to 191 physiotherapists in South Tyrol; and 132 participated in the study (return rate 69.63%).
Results
In the MBI-D, which contains three scales: ‘emotional exhaustion’, ‘depersonalisation’ and ‘personal accomplishment’; the risk of burnout is reflected in high values in the emotional exhaustion and the depersonalisation scales and low values in personal accomplishment. The present study found that about 35% of the physiotherapists who responded to the questionnaire showed burnout risk in emotional exhaustion, 18% in depersonalisation and 14% in personal accomplishment. This is in agreement with many other studies conducted among health professionals. Gender differences were observed only on the depersonalisation scale, with men scoring higher than women. No differences were found regarding length of stay in the profession. Only one third of physiotherapists are offered clinical supervision or support by their employer but about 50% of physiotherapists sought psychological support. The use of supervision or support was 2.72 times more likely when available at work than not. Contrary to expectations, the impact of supervision or support did not reach significance in the burnout scales. The desire for more closeness is predicted by gender (male), higher emotional exhaustion and depersonalisation, and the desire for more distance is predicted by higher emotional exhaustion.
Conclusions
More attention to mental hygiene and support in the workplace and during training would help to prevent burnout among physiotherapists, and benefit the profession, patients and organisations.
Purpose:
There is limited documentation regarding the potential quality of life (QOL) benefits associated with use of a worksite wellness center. Therefore, the aim of this study was to examine the relationship between potential QOL change and use of a worksite wellness center during a 12-month period.
Design:
Analysis of an annual QOL wellness center member survey and wellness center use during a 12-month time period.
Setting:
A worksite wellness center.
Participants:
A total of 1151 employee wellness center members, average age of 39.5 years, 69.7% female, and 43.5% reported being overweight.
Intervention:
Members of the worksite wellness center have access to a range of fitness options, including exercise classes, water aerobics, an indoor track, strength training, and aerobic conditioning equipment. Additionally, nutritional classes are offered, and there is a wellness café. For resiliency, members can participate in wellness coaching or a stress-reduction group program.
Method:
Participants completed a baseline QOL survey and a second QOL survey 1 year later. An electronic entry system tracked use of the wellness center.
Results:
Participants were divided into four wellness center use quartiles: low users (less than once every 2 weeks), below-average users, above-average users, and high users (two to three visits per week). High users reported experiencing improvements in their physical QOL (p < .0001) compared with the low users. Additionally, low users experienced a greater decline in their mental QOL (p = .05) compared with high users.
Conclusion:
In a large sample of employees, use of a wellness center during a 12-month period was associated with benefits for physical QOL. QOL is an important domain of wellness; therefore, in addition to measuring physiologic changes, examining potential QOL changes may be another important outcome measure for wellness centers.
Background:
Despite extensive data about physician burnout, to our knowledge, no national study has evaluated rates of burnout among US physicians, explored differences by specialty, or compared physicians with US workers in other fields.
Methods:
We conducted a national study of burnout in a large sample of US physicians from all specialty disciplines using the American Medical Association Physician Masterfile and surveyed a probability-based sample of the general US population for comparison. Burnout was measured using validated instruments. Satisfaction with work-life balance was explored.
Results:
Of 27 276 physicians who received an invitation to participate, 7288 (26.7%) completed surveys. When assessed using the Maslach Burnout Inventory, 45.8% of physicians reported at least 1 symptom of burnout. Substantial differences in burnout were observed by specialty, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine, and emergency medicine). Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both). Highest level of education completed also related to burnout in a pooled multivariate analysis adjusted for age, sex, relationship status, and hours worked per week. Compared with high school graduates, individuals with an MD or DO degree were at increased risk for burnout (odds ratio [OR], 1.36; P < .001), whereas individuals with a bachelor's degree (OR, 0.80; P = .048), master's degree (OR, 0.71; P = .01), or professional or doctoral degree other than an MD or DO degree (OR, 0.64; P = .04) were at lower risk for burnout.
Conclusions:
Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.
Background:
The debate on the quality of health care provided in the United States has continued to be waged as concerns have grown over the years. Stress, sleep deprivation, poor diet, and lack of exercise may lead to inadequate work performance by physicians.
Objective:
This study was undertaken to determine whether Emergency Medicine (EM) residents satisfy daily recommendations for total number of steps taken per day set forth by the Centers for Disease Control and Prevention and Surgeon General in a 12-h shift.
Methods:
An observational prospective cohort study was conducted between August 2009 and November 2009 at an urban Level I trauma center with an annual census of over 165,000 Emergency Department (ED) visits per year. The mean number of steps taken by EM residents during 12-h shifts was measured.
Results:
Mean steps taken during a shift were 7333 (95% confidence interval 6901-7764). Only nine (9.9%) pedometer readings reached the target level of 10,000 (10 K) steps or above. A t-test was used to compare steps with the hypothesized 10 K steps target. Recordings of 10K steps or greater were not correlated with ED sections (p=0.60) shift (medical vs. surgical, p=0.65) or ED census (r(2)<0.0017).
Conclusion:
A majority of residents (90%) did not meet the target number of steps for shifts. More rigorous charting needs, overcrowding, or even spatial limitations may explain this. This warrants further investigation to determine if some daily physical activity regimens may help improve the overall well-being of EM residents.
To complement the hard variables generally used in the assessment of different treatments for cancer and other chronic diseases we developed a ‘hardened’, succinct quantitative index to measure the quality of life (QL-Index) of survivors. It was designed for use by physicians. It has five items and its range of scores is 0–10. It was used in pretests and validation tests by more than 150 physicians to rate 879 patients; median completion time was one minute. Fifty-nine percent of physicians reported that they were at least ‘very confident’ of the accuracy of their scores. We established predetermined criteria for validity before field work commenced and evaluated the index using convergent and discriminant approaches of construct validity, as well as content validity. The QL-Index has convergent discriminant and content validity among cancer patients and patients with other chronic physical diseases. Assessment of internal consistency demonstrated a high coefficient (Cronbach's α = 0.775) and the interrater Spearman rank correlation was high and statistically significant (rho = 0.81, P < 0.001) when independent scores of two physicians were compared, or doctors ratings were compared to self-ratings of patients (rho = 0.61, P < 0.001) Our aim has been to provide a new measure that can help physicians assess the relative benefits and risks of various treatments for serious illness and of supportive programs such as palliative care or hospice service. The QL-Index is not, however, suitable for measuring or classifying the quality of life of ostensibly healthy people.
To evaluate the health habits, routine medical care practices, and personal wellness strategies of American surgeons and explore associations with burnout and quality of life (QOL).
Burnout and low mental QOL are common among US surgeons and seem to adversely affect quality of care, job satisfaction, career longevity, and risk of suicide. The self-care strategies and personal wellness promotion practices used by surgeons to deal with the stress of practice are not well explored.
Members of the American College of Surgeons were sent an anonymous, cross-sectional survey in October 2010. The survey included self-assessment of health habits, routine medical care practices, and personal wellness strategies and standardized assessments of burnout and QOL.
Of 7197 participating surgeons, 3911 (55.0%) participated in aerobic exercise and 2611 (36.3%) in muscle strengthening activities, in a pattern consistent with the Centers for Disease Control and Prevention recommendations. The overall and physical QOL scores were superior for surgeons' following the Centers for Disease Control and Prevention recommendations (all P < 0.0001). A total of 3311 (46.2%) participating surgeons had seen their primary care provider in the last 12 months. Surgeons who had seen their primary care provider in the last 12 months were more likely to be up to date with all age-appropriate health care screening and had superior overall and physical QOL scores (all P < 0.0001). Ratings of the importance of 16 personal wellness promotion strategies differed for surgeons without burnout (all P < 0.0001). On multivariate analysis, surgeons placing greater emphasis on finding meaning in work, focusing on what is important in life, maintaining a positive outlook, and embracing a philosophy that stresses work/life balance were less likely to be burned out (all P < 0.0001). Although many factors associated with lower risk of burnout were also associated with achieving a high overall QOL, notable differences were observed, indicating surgeons' need to employ a broader repertoire of wellness promotion practices if they desire to move beyond neutral and achieve high well-being.
This study identifies specific measures surgeons can take to decrease burnout and improve their personal and professional QOL.
Burnout is a common problem among physicians and physicians-in-training. The Maslach Burnout Inventory (MBI) is the gold standard for burnout assessment, but the length of this well-validated 22-item instrument can limit its feasibility for survey research.
To evaluate the concurrent validity of two questions relative to the full MBI for measuring the association of burnout with published outcomes. DESIGN, PARTICIPANTS, AND MAIN MEASURES: The single questions "I feel burned out from my work" and "I have become more callous toward people since I took this job," representing the emotional exhaustion and depersonalization domains of burnout, respectively, were evaluated in published studies of medical students, internal medicine residents, and practicing surgeons. We compared predictive models for the association of each question, versus the full MBI, using longitudinal data on burnout and suicidality from 2006 and 2007 for 858 medical students at five United States medical schools, cross-sectional data on burnout and serious thoughts of dropping out of medical school from 2007 for 2222 medical students at seven United States medical schools, and cross-sectional data on burnout and unprofessional attitudes and behaviors from 2009 for 2566 medical students at seven United States medical schools. We also assessed results for longitudinal data on burnout and perceived major medical errors from 2003 to 2009 for 321 Mayo Clinic Rochester internal medicine residents and cross-sectional data on burnout and both perceived major medical errors and suicidality from 2008 for 7,905 respondents to a national survey of members of the American College of Surgeons.
Point estimates of effect for models based on the single-item measures were uniformly consistent with those reported for models based on the full MBI. The single-item measures of emotional exhaustion and depersonalization exhibited strong associations with each published outcome (all p ≤0.008). No conclusion regarding the relationship between burnout and any outcome variable was altered by the use of the single-item measures rather than the full MBI.
Relative to the full MBI, single-item measures of emotional exhaustion and depersonalization exhibit strong and consistent associations with key outcomes in medical students, internal medicine residents, and practicing surgeons.
Using a national cross-sectional survey of 500 primary care physicians conducted between 9 February and 1 March 2011, the objective of this study was to assess the impact of physician BMI on obesity care, physician self-efficacy, perceptions of role-modeling weight-related health behaviors, and perceptions of patient trust in weight loss advice. We found that physicians with normal BMI were more likely to engage their obese patients in weight loss discussions as compared to overweight/obese physicians (30% vs. 18%, P = 0.010). Physicians with normal BMI had greater confidence in their ability to provide diet (53% vs. 37%, P = 0.002) and exercise counseling (56% vs. 38%, P = 0.001) to their obese patients. A higher percentage of normal BMI physicians believed that overweight/obese patients would be less likely to trust weight loss advice from overweight/obese doctors (80% vs. 69%, P = 0.02). Physicians in the normal BMI category were more likely to believe that physicians should model healthy weight-related behaviors-maintaining a healthy weight (72% vs. 56%, P = 0.002) and exercising regularly (73% vs. 57%, P = 0.001). The probability of a physician recording an obesity diagnosis (93% vs. 7%, P < 0.001) or initiating a weight loss conversation (89% vs. 11%, P ≤ 0.001) with their obese patients was higher when the physicians' perception of the patients' body weight met or exceeded their own personal body weight. These results suggest that more normal weight physicians provided recommended obesity care to their patients and felt confident doing so.
Context The Accreditation Council for Graduate Medical Education implemented mandatory work hour limitations in July 2003, partly out of concern for residents' well-being in the setting of sleep deprivation. These limitations are likely to also have an impact on other aspects of the lives of residents. Objective To summarize the literature regarding the effect of interventions to reduce resident work hours on residents' education and quality of life. Data Sources We searched the English-language literature about resident work hours from 1966 through April 2005 using MEDLINE, EMBASE, and Current Contents, supplemented with hand-search of additional journals, reference list review, and review of abstracts from national meetings. Study Selection Studies were included that assessed a system change designed to counteract the effects of resident work hours, fatigue, or sleep deprivation; included an outcome directly related to residents; and were conducted in the United States. Data Extraction For each included study, 2 investigators independently abstracted data related to study quality, subjects, interventions, and findings using a standard data abstraction form. Data Synthesis Fifty-four articles met inclusion criteria. The interventions used to decrease resident work hours varied but included night and day float teams, extra cross-coverage, and physician extenders. Outcomes included measures of resident education (operative experience, test scores, satisfaction) and quality of residents' lives (amount of sleep, well-being). Interventions to reduce resident work hours resulted in mixed effects on both operative experience and on perceived educational quality but generally improved residents' quality of life. Many studies had major limitations in their design or conduct. Conclusions Past interventions suggest that residents' quality of life may improve with work hour limitations, but interpretation of the outcomes of these studies is hampered by suboptimal study design and the use of nonvalidated instruments. The long-term impact of reducing resident work hours on education remains unknown. Current and future interventions should be evaluated with more rigorous methods and should investigate links between residents' quality of life and quality of patient care.
Burnout has damaging effects on physicians. This research reveals how outstanding doctors avoid burnout. Winners of the American Medical Association Foundation's Pride in the Professions Award were interviewed to learn how they manage burnout. Information was collected through telephone interviews. The data were categorized through content analysis. The results showed that techniques for avoiding burnout varied and included setting limits, sharing issues with family and friends, physical exercise, cultivating relaxation, and humor. These doctors have become skilled at recognizing the signs of burnout and countering its effects while maintaining the highest standard of care and demonstrating leadership in their vocation.
Resident burnout continues to be a major problem despite work hours restrictions. The authors conducted a longitudinal study to determine whether burnout in internal medicine residents is persistent and what factors predispose residents to persistent burnout.
The authors mailed a survey to internal medicine residents at the University of Colorado Denver Health Science Center each May, from 2003 through 2008. The survey measures included the Maslach Burnout Inventory organized into three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment. The authors defined burned-out residents as having a high EE or DP score and persistent burnout as being burned out during all three years of residency.
Of the 179 eligible residents, 86 (48%) responded to the survey during all three years of their residency. Sixty-seven residents (78%) were burned out at least once: 58 residents (67%) were burned out during their internship, 58 (67%) during their second year, and 50 (58%) during their third year (P < .08). Of the 58 burned-out interns, 42 (72%) continued to be burned out through their three years of training. Persistent burnout was more likely to occur in men (OR = 3.31, P < .01) and was associated with screening positive for depression as an intern (OR = 4.4, P < .002).
Once present, burnout tends to persist through residency. Men and residents who screened positive for depression as interns are at the highest risk for persistent burnout. Interventions to prevent burnout during internship may significantly decrease burnout throughout residency.
To determine the incidence of burnout among American surgeons and evaluate personal and professional characteristics associated with surgeon burnout.
: Burnout is a syndrome of emotional exhaustion and depersonalization that leads to decreased effectiveness at work. A limited amount of information exists about the relationship between specific demographic and practice characteristics with burnout among American surgeons.
Members of the American College of Surgeons (ACS) were sent an anonymous, cross-sectional survey in June 2008. The survey evaluated demographic variables, practice characteristics, career satisfaction, burnout, and quality of life (QOL). Burnout and QOL were measured using validated instruments.
Of the approximately 24,922 surgeons sampled, 7905 (32%) returned surveys. Responders had been in practice 18 years, worked 60 hours per week, and were on call 2 nights/wk (median values). Overall, 40% of responding surgeons were burned out, 30% screened positive for symptoms of depression, and 28% had a mental QOL score >1/2 standard deviation below the population norm. Factors independently associated with burnout included younger age, having children, area of specialization, number of nights on call per week, hours worked per week, and having compensation determined entirely based on billing. Only 36% of surgeons felt their work schedule left enough time for personal/family life and only 51% would recommend their children pursue a career as a physician/surgeon.
Burnout is common among American surgeons and is the single greatest predictor of surgeons' satisfaction with career and specialty choice. Additional research is needed to identify individual, organizational, and societal interventions that preserve and promote the mental health of American surgeons.
Evidence is accumulating that exercise has profound benefits for brain function. Physical activity improves learning and memory in humans and animals. Moreover, an active lifestyle might prevent or delay loss of cognitive function with aging or neurodegenerative disease. Recent research indicates that the effects of exercise on the brain can be enhanced by concurrent consumption of natural products such as omega fatty acids or plant polyphenols. The potential synergy between diet and exercise could involve common cellular pathways important for neurogenesis, cell survival, synaptic plasticity and vascular function. Optimal maintenance of brain health might depend on exercise and intake of natural products.
Prevalent among resident physicians, burnout has been associated with absenteeism, low job satisfaction, and medical errors. Little is known about the number and quality of interventions used to combat burnout.
We performed a systematic review of the literature using MEDLINE and PubMed databases. We included English-language articles published between 1966 and 2007 identified using combinations of the following medical subject heading terms: burnout, intervention studies, program evaluation, internship and residency, graduate medical education, medical student, health personnel, physician, resident physician, resident work hours, and work hour limitations. Additional articles were also identified from the reference lists of manuscripts. The quality of research was graded with the Strength of Evidence Taxonomy (SORT) from highest (level A) to lowest (level C).
Out of 190 identified articles, 129 were reviewed. Nine studies met inclusion criteria, only two of which were randomized, controlled trials. Interventions included workshops, a resident assistance program, a self-care intervention, support groups, didactic sessions, or stress-management/coping training either alone or in various combinations. None of the studied interventions achieved an A-level SORT rating.
Despite the potentially serious personal and professional consequences of burnout, few interventions exist to combat this problem. Prospective, controlled studies are needed to examine the effect of interventions to manage burnout among resident physicians.
Two common formats for grading quality of life parameters are descriptive choices (mild, moderate, severe) and visual analogue scales. However the quantitative relationship between descriptive terminology and visual analogue scale scores has not been determined. A content neutral questionnaire was administered to 213 evaluable subjects who were asked to place the descriptors 'mildly', 'moderately', and 'severely' (presented in random order) on 100mm visual analogue scales. Visual analogue scales were presented without and then with hashmarks at 25mm, 50mm, and 75mm. Median visual analogue scale values for the descriptive terms differed significantly without hashmarks ('mildly' = 24mm', moderately' = 43mm, 'severely' = 84mm; p < 0.001) and also with hashmarks ('mildly' = 31mm, 'moderately' = 49mm, 'severely' = 85mm; p < 0.001). Comparison of interquartile range values (25th-75th percentile) revealed a distinct meaning for 'severely' (68-93mm) but marked overlap between 'mildly' (10-45mm) and 'moderately' (22-53mm). Errors of order (order other than 'mildly' < 'moderately' < 'severely') were made by 91 subjects. The discrepancy 'moderately' < 'mildly' accounted for most of these errors (72 subjects). Median values for 'mildly', 'moderately', and 'severely' are distinct and approximately linear on a visual analogue scale for large populations. However there is significant confusion between the terms 'mildly' and 'moderately' for individual subjects. Visual analogue scales can reveal finer quantitative differences than descriptive terms but require a significant time commitment for instruction and administration. Descriptive terms on a word-graphic scale or descriptive terms with numerical values to reenforce order of severity (0 = absent, 1 = 'mildly', 2 = 'moderately', 3 = 'severely') may be reasonable alternatives.