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Quality of Life During Orthopedic Training and Academic Practice Part 1: Orthopedic Surgery Residents and Faculty
Abstract
A pilot study of two academic training programs revealed concerning levels of resident burnout and psychological dysfunction. The purpose of the present study was to determine the quality of life of orthopaedic residents and faculty on a national scale and to identify risk factors for decompensation.
Three hundred and eighty-four orthopaedic residents and 264 full-time orthopaedic faculty members completed a voluntary, anonymous survey consisting of three validated instruments (the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale) and question sets assessing demographic information, relationship issues, stress reactions/management, and work/life balance.
High levels of burnout were seen in 56% of the residents and 28% of the faculty members. Burnout risk was greatest among second-postgraduate-year residents and residents in training programs with six or more residents per postgraduate year. Sixteen percent of residents and 19% of faculty members reported symptoms of psychological distress. Sleep deprivation was common among the residents and correlated positively with every distress measure. Faculty reported greater levels of stress but greater satisfaction with work and work/life balance. A number of factors, such as making time for hobbies and limiting alcohol use, correlated with decreased dysfunction for both residents and faculty.
Despite reporting high levels of job satisfaction, orthopaedic residents and faculty are at risk for burnout and distress. Identification of protective factors and risk factors may provide guidance to improve the quality of life of academic orthopaedic surgeons in training and beyond.
... 2,4,7 Orthopaedic trainees are at higher risk, with reports suggesting work hours, electronic medical records (EMR), lack of sleep and lack of supportive mentors as common predisposing factors. 5,15 Two studies identified female orthopaedic surgeons as being at greater risk of experiencing burnout. 15,16 Despite the paucity of data on physician burnout in low-and middle-income countries (LMICs), much work has been done in South Africa (RSA) to assess the prevalence of burnout among doctors. ...
... 5,15 Two studies identified female orthopaedic surgeons as being at greater risk of experiencing burnout. 15,16 Despite the paucity of data on physician burnout in low-and middle-income countries (LMICs), much work has been done in South Africa (RSA) to assess the prevalence of burnout among doctors. 17 A national study found higher rates of burnout in medical doctors than comparative international figures. ...
... 2,8,32 The majority of associations reported with burnout are health-system related or work environment issues such as: lack of autonomy, too many bureaucratic tasks, administrative responsibilities, high workload, remuneration, working hours and calls (correlated to sleep deprivation). [2][3][4]8,10,11,14,15,[33][34][35][36] The other causes pertain to work-life imbalance including: having dependants and inability to balance work and family responsibilities. 2,5,7,11,32,36 Specific groups shown to be at greater risk for developing burnout comprise: physicians of younger age, female gender and trainees. ...
BACKGROUND: Burnout is epidemic among physicians, with the orthopaedic speciality displaying one of the highest rates of burnout in international studies. The burnout rate of the South African orthopaedic community is unknown. This study aimed to determine the prevalence and causes of burnout, as well as the coping mechanisms and associations with burnout, in South African orthopaedic surgeons and trainees METHODS: We conducted a cross-sectional, secure, online survey of members of the South African Orthopaedic Association. The survey assessed demographic characteristics, workload, professional fulfilment and burnout (utilising the Stanford Professional Fulfilment Index), associated workplace distress conditions, causes of and coping strategies for burnout. A response was not compulsory for any question. Statistical analysis was performed to assess for independent associations with burnout RESULTS: One hundred and fifty-six respondents, with a median age of 46.5 years (interquartile range [IQR] 37-58) participated. Ninety per cent (139 of 155) of respondents were male. Registrars accounted for 17% (27 of 155), while 83% (128 of 155) were qualified specialists. Respondents were in orthopaedic practice for a median of 17 years (IQR 9-28). Sixty per cent (76 of 127) practise in private, 17% (22 of 127) in public and 23% (29 of 127) in both sectors. The overall burnout rate was 72% (113 of 156). Burnout was associated with being the parent of young children and having fewer hours of sleep on call. Registrars were more likely to have burnout than consultants (OR 5.68, 95% CI 1.3-25.2). Gender, practice setting and subspeciality were not associated with burnout. Self-reported causes of burnout that were found to be associated with actual burnout were: 'hours at work', 'lack of free time' and 'work-life imbalance'. No self-reported coping mechanisms were found to be protective in this cohort, but the use of alcohol as a coping mechanism was associated with an increased likelihood of burnout (OR 3.9, 95% CI 1.4-10.7). Respondents felt that the concurrent experience of the COVID pandemic at the time of running the survey reduced their experience of burnout CONCLUSION: The burnout rate in the South African orthopaedic community is 72%. Trainees were found to be particularly vulnerable. There appears to be a need to develop, assess and implement effective system-related initiatives aimed at reducing the burnout rate among orthopaedic surgeons and trainees in South Africa Level of evidence: Level 4
... In a study performed by Faivre et al. on 441 orthopedists in France, burnout was observed in 39% of the participants (9). Another study reported 28% burnout among orthopedic surgeons in the United States (20). In the study conducted by Shanafelt et al. female gender and being married were associated with occupational burnout which was inconsistent with the results of the present study (19). ...
... In another study conducted by Sargent et al. in the United States, it was revealed that 56% of 384 orthopedic residents suffered from burnout. Furthermore, in line with the results of the current study, the rate of burnout was higher in orthopedic residents compared to that in orthopedic surgeons (28% of 264 orthopedic surgeons) (20). The prevalence of burnout among Iranian orthopedic residents was significantly higher than their peers in the two later studies. ...
... The results of the present study indicated an association between burnout with age and working status, similar to the findings of Faivre et al. and Sargent et al. (9,20). According to the findings of this study and similar studies, young people are more prone to burnout due to such reasons as more enthusiasm for higher income through overworking, high level of stress, and fear of making mistakes due to the lack of enough skills and experience (25). ...
Background:
Burnout is an emotional, psychological, and physical exhaustion syndrome with feelings of negativism toward one's job and reduced attention to clients. This complication is caused by the lack of control over work-related stress. Physicians, especially surgeons, are at higher risk for burnout due to critical responsibility and heavy workload. Given the importance and consequences of this dilemma, the present study aimed to investigate the frequency of burnout among orthopedic surgeons and residents.
Methods:
The present cross-sectional, analytical study was conducted in 2019 in the cities of Tehran and Yazd, in Iran. A total of 180 orthopedic surgeons and residents participated in the study. A demographic characteristics form and the Maslach Burnout Inventory (MBI) were employed to assess burnout in the participants.
Results:
The mean age of the participants was 42.8 years, and 94.4%, 23.9%, 52.2%, and 23.9% of the participants were male, residents, general orthopedic specialists, and fellowship-trained orthopedics, respectively. Out of 180 participants, 90 (50%) cases were suffering from burnout, of whom 26.7%, 16.1%, and 7.2% got a pathological score in one, two, and three criteria. No significant relationship was observed between burnout and gender, marital status, years of experience, and the average number of surgeries per week. However, there was a significant association between burnout and younger age, lower academic rank or being a resident, working in the public sector, and spending less time in leisure and sports activities.
Conclusion:
The prevalence of burnout (50%) among orthopedists was remarkable and worrying. The frequency of burnout was higher among residents and the ones working in the public sector. This study demonstrates that the issue of burnout and its related risk factors have to be addressed in Iranian orthopedic surgeons and residents.
... 2,4 About orthopaedic surgery in particular, the rate of burnout among residents has been cited anywhere between 38% and 56%. [5][6][7] This high potential for emotional exhaustion and lack of fulfillment has contributed to diminished clinical and academic performance. For example, a recent study showed that performance on the Orthopaedic In-Training Examination was worse among residents exhibiting burnout symptoms, even when controlling for test-taking ability. ...
... In the 2011 survey by the American Orthopaedic Association, 384 orthopaedic residents reported a 56% burnout rate, with the highest risk being seen in those in their postgraduate (PGY) 2-year, female residents, and larger programs (defined as having six or more residents per year). 7 By focusing on each of the surrounding factors predisposing these groups to higher rates of work dissatisfaction and emotional withdrawal, the hope is to encourage well-being early and effectively. During the PGY-2 year, residents at most programs experience a notable increase in independence through on-call duties and an emphasis on developing orthopaedic knowledge and surgical skills. ...
... With risk factors to physician burnout being well documented and studies illustrating that greater than 50% of residents either in orthopaedics or another specialty meet the criteria for burnout, the onset of a worldwide call to treat a novel pathogen tipped an already delicate balance into a spiral. [5][6][7]17 Studies such as the one undertaken by Kannampallil et al 37 have demonstrated the deleterious effects that exposure to patients with COVID-19 can have on physician trainees' rates of depression, anxiety, stress, burnout, and professional fulfillment. Further exacerbating the situation, the postponement of elective surgical procedures and in-person conferences, as well as the inability to socialize at work and outside the hospital, during the COVID-19 pandemic changed the landscape of what residency programs had access to regarding wellness initiatives. ...
The challenges associated with surgical residency have been well documented and described. Despite implementation of work-hour restrictions, residency remains a balancing act between patient care, surgical and clinical education, medical record documentation, and research endeavors. The added challenge of balancing these duties with life outside of the hospital further complicates the situation. Multiple studies have documented the stress associated with residency training, highlighting the prevalence of emotional exhaustion, detachment from people both in and out of the hospital, and a concerning rate of clinical depression among residents. Moreover, this emotional exhaustion has been shown to directly correlate with residents' clinical performance and abilities to carry out academic duties. More recently, feelings of isolation and detachment have been exacerbated by the necessity of COVID-19 precautions and change in clinical duties. The Accreditation for Graduate Medical Education (ACGM) now requires all residencies to include programming that focuses on resident well-being. Programs have implemented various strategies in an effort to help their trainees cope with the stress associated with residency and beyond. Despite the variety in approaches of programs, these initiatives have the similar objective of teaching resilience and the ability to navigate stressors in a healthy and effective manner. The programming can also serve to promote resident interaction and develop camaraderie in an effort to minimize feelings of emotional exhaustion and isolation. In this article, we discuss the importance of sustained physician wellness and describe approaches from various professions that can be implemented into the wellness curriculum for residency programs across the country. By promoting a culture of wellness and incorporating effective wellness programming, our aim is that residents will be able to succeed not only in their training but also in their personal lives and professional endeavors after graduation.
... 10 Psychological distress in orthopaedic surgery was lower than previously published reports (19%-33%) with no participants scoring for tentative diagnosis of depression. 11,12 Regarding burnout, 20% of individuals endorsed emotional exhaustion (I feel burned out from my work) and 16% reported depersonalization (I have become more callous toward people since I took this job). These are lower rates compared to previous reports which have found 26%-32% burnout among practicing physicians in the United States. ...
... Sargent et al. performed a survey-based study to investigate burnout, quality of life, and mental health in orthopaedic resident and attending physicians. 12 They found that residents worked an average 70.24 ± 20.39 hours per week with faculty working an average 62.8 ± 18.2 hours per week. Sleep hygiene was poor with 46.8% of residents and 31% of faculty reporting "quite a bit" to "a lot" of sleep deprivation. ...
... Sargent et al. found that 69% of orthopaedic residents and 85% of faculty were fairly satisfied or better with their work. 12 Furthermore, 80% of residents and 88% of faculty were satisfied with the personal sacrifices made for their career. ...
Introduction: This study compares rates of depression, suicidal ideation, and burnout among resident/fellow and attending physicians in orthopaedic surgery to other specialties during height/end of the first wave of the coronavirus disease 2019 (COVID-19) pandemic at our institution. Main outcomes and measures included suicidal ideation, Patient Health Questionnaire for Depression (PHQ-9) scores for depression, and 2 single-item measures for emotional exhaustion and depersonalization. This study provides valuable information regarding orthopaedic surgeon mental health during world crises. Methods: This is a cross-sectional survey-based study of resident, fellow, and attending physicians from 26 specialties during and after the first wave of the COVID-19 pandemic at our institution from April 24, 2020 to May 15, 2020. The survey contained 22 items. This includes consent, demographics and general data, 2 single-item questions of emotional exhaustion and depersonalization, and the PHQ-9. Subjects were eligible if they were a resident/fellow or attending physician at our institution. Results: The response rate for the study was 16.31%. Across all specialties rates were 6.2% depression, 19.6% burnout, and 6.6% suicidal ideation. The results for orthopaedic surgeons are as follows: 0% tentative diagnosis of depression, 3.8% suicidal ideation, and 4% burnout. Anesthesiology had the highest rate of depression (14.3%). Internal medicine and other non-surgical specialties had the highest rate of suicidal ideation (10.2%). Orthopaedic surgeons were significantly more likely to achieve work–life balance and experience less burnout than anesthesiologists and pediatricians. Discussion: Depression, suicidal ideation, and burnout continue to affect physicians across all specialties. These issues are amplified in light of crisis. Job satisfaction and rigorous training may be protective factors that allow orthopaedic surgeons to adapt to novel clinical settings under stress when compared to anesthesiologists and pediatricians. Resilience training and stress management strategies should continue to be investigated to better prepare physicians for world crises.
... This pattern has been reported both within original studies directly comparing residents and consultant or attending surgeons and in systematic reviews comparing results between studies. In a survey of US Orthopaedic Surgery Residents and Faculty, it was found that 56% of residents reported burnout compared with 28% of faculty members [32]. In a systematic review of 41 studies across surgical specialties, high levels of depersonalisation were found in 46-53% of residents compared with 7-26% of attending surgeons and high levels of emotional exhaustion were found in 17-42% of residents compared with 9-31% of attendings [33]. ...
... Similarly, a survey of US general surgery residents found no links between burnout and gender or relationship status, but did report that burnout was higher in residents reporting fewer programmatic social events and lower in residents receiving programme mentorship [30]. Links between receiving mentorship and reporting lower burnout have also been reported in other studies of surgical trainees [32,39,40]. However, there is no evidence to suggest that burnout varies consistently according to training stage, with studies showing mixed and variable findings in burnout rates across training years [32,36,39,41]. ...
... Links between receiving mentorship and reporting lower burnout have also been reported in other studies of surgical trainees [32,39,40]. However, there is no evidence to suggest that burnout varies consistently according to training stage, with studies showing mixed and variable findings in burnout rates across training years [32,36,39,41]. ...
Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.
... Physician burnout can occur early during medical training [1,7] and often affects residents. Residents have higher odds of developing burnout compared with medical students [1] and, on average, report higher EE, higher DP, and/or lower PA scores than attending physicians across multiple specialties [1,8,9]. Not only must trainees balance daily clinical and administrative tasks, but they must also consistently study after hours in order to safely provide patient care when at work and to obtain board certification. ...
... This, along with the timing of board examinations, may contribute to fluctuating burnout symptoms during training, which vary among specialties [10][11][12]. Increases in EE or DP and decreases in PA have been documented as early as intern year among pediatric residents during their training [10], while intern or postgraduate year (PGY) 2 orthopedic residents reported increased EE or DP without a statistically significant decrease in PA [9,13]. In contrast, PGY 2 to PGY 4 status has been associated with increased burnout symptoms during the 5year otolaryngology residency [14]. ...
... Four hundred eighty-eight residents (61.8%) remained in our analytical sample. This response rate is lower than in international studies evaluating radiology residents in Saudi Arabia [7] and Canada [8], which yielded 40% and 50% response rates, respectively, but is similar to the 20% response rate in Guenette et al's [9] Q7 study of burnout in Northeast radiology residents. Tables 1 and 2 highlight the study's resident demographics and physician training experience, respectively. ...
Purpose
The aim of this study was to investigate the relationship between the subcomponents of burnout and year of training among radiology residents.
Methods
In this cross-sectional analysis, the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS [MP]) was distributed to eligible radiology residents. Primary outcomes included the MBI-HSS (MP) subcomponents: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Multivariate analysis of variance, tests of between-subjects effects, and Tukey post hoc analysis with 95% confidence interval were conducted.
Results
Seven hundred seventy of 2,823 residents (27.3%) responded, with 488 of 770 completing the MBI-HSS (MP). There was a statistically significant difference in subcomponent scores between cohorts based on year of training (P < .005) and a statistically significant effect between year of training and EE (P < .05) and DP (P < .005), but not PA. Third-year (R3) residents reported a higher frequency of EE than first-year (R1) residents and a higher frequency of DP than R1 and second-year (R2) residents. Fourth-year (R4) residents reported more DP than R1 residents.
Conclusions
This analysis shows variation in burnout subcomponents during training, with the highest recorded EE and DP means and lowest recorded PA means among R3 residents. Although these findings demonstrate evidence of burnout among radiology residents, mean subcomponent scores for EE (21.3) and DP (8.4) were lower and for PA (35.1) was higher for all trainees than in previous studies assessing radiology residents, which correlates with less burnout. DP was the only subcomponent that remained statistically elevated between matriculating R1 and graduating R4 residents.
... They identified risk factors as well as protective factors against burnout for orthopaedic residents and faculty. Many of the protective factors focused on self-care, including dedicating time for exercise, hobbies, vacations, and spouses as well as having mentors in which to confide (Sargent et al. 2009). Additionally, Arora et al. found that subjective factors such as the perception of an unrewarding career or perceived lack of autonomy showed a stronger correlation to level of burnout than objective factors of caseload, practice setting, or proportion of patients insured (Arora, Diwan, and Harris 2013). ...
... While orthopaedic surgeons are known to have high reported rates of burnout, limited studies have focused on EHR usage amongst residents and faculty in this specialty (Sargent et al. 2009;Arora, Diwan, and Harris 2013;Barrack et al. 2006). The current study found that approximately half of each surgeon's time was spent entering information into the EHR or waiting for it to load during a typical day in clinic. ...
Background
While the relationship between electronic health record usage and physician burnout has been investigated in other specialties, no reports exist for orthopaedic surgery. The purpose of this study was to determine the amount of time spent on the electronic health record compared to actual patient interaction in four busy orthopaedic outpatient clinics.
Hypothesis
We hypothesized that surgeons would spend as much time on the electronic health record as they do interacting with patients on a typical clinic day.
Methods
Four busy academic orthopaedic surgeons (Surgeon 1, 2, 3, and 4) at a tertiary academic institution were each followed on clinic days to determine their total time spent on Epic Hyperspace electronic health record as compared to face-to-face interactions with patients. A research assistant recorded the amount of time each surgeon spent dictating notes, writing orders, or replying to clinical inbox messages (electronic health record time) and how much time was spent on loading screens or electronic health record buffering (loading time) during which no actions could be completed.
Results
Surgeon 1 spent an average of 63% of their clinic days using the electronic health record. Surgeon 2 spent 50% of their time on the computer. Surgeon 3 spent 35% of his days on the computer. Surgeon 4 spent 46% of his days on the computer.
Conclusion
Approximately half of each surgeon’s clinic time was spent using the electronic health record. Given the known influence of electronic health record usage on orthopaedic surgeon burnout, this is an issue that needs to be addressed. The solution likely involves a multifactorial approach, including changes to electronic health records, widespread use of scribes or advanced care teams, work hour limitations, and mindfulness training for residents and faculty. Information technology quality improvements can be made to EHRs that include reducing or eliminating unnecessary information displayed on screen, providing more abundant and accessible EHR training and on-site technical support, and a more streamlined software interface that eliminates unnecessary typing and clicks to improve charting flow and efficiency.
Level of Evidence
Level IV Descriptive Study
... Based on the weight results in the previous section, from the perspective of local weight, the weight value of personal and family factors is 0.467, which is close to 0.5, indicating that personal and family factors are the key factors causing burnout of orthopedic surgeons and have a high degree of influence (44). From the perspective of global weight, the top four sub-criteria are C 11 , C 31 , C 12 , and C 22 , these factors are little time for family, anxiety about clinical competence, work-family conflict, and heavy work load. ...
... The general burnout rate among physicians is approximately 40% (44,54) and the burnout rate of orthopedic surgeons is nearly 55% higher than this general level (55). Furthermore, a study has shown that the burnout rate among Chinese orthopedic surgeons is as high as 85% (24). ...
Objectives: To develop an evaluation model for, and identify key factors contributing to, burnout in orthopedic surgeons, providing a reference for the management of burnout among orthopedic surgeons in hospitals.
Methods: We developed an analytic hierarchy process (AHP) model with 3 dimensions and 10 sub-criteria based on an extensive literature review and expert assessment. We used expert and purposive sampling and 17 orthopedic surgeons were selected as research subjects. The AHP process was then used to obtain the weights and to prioritize the dimensions and criteria for burnout in orthopedic surgeons.
Results: The dimension of C 1 (personal/family) was the key factor affecting burnout in orthopedic surgeons, and in the sub-criteria, the top four sub-criteria were C 11 (little time for family), C 31 (anxiety about clinical competence), C 12 (work-family conflict), and C 22 (heavy work load).
Conclusion: This model was effective in analyzing the key factors contributing to job burnout risk, and the results can inform improved management of the levels of burnout affecting orthopedic surgeons in hospitals.
... 5 En ambientes docentes, el burnout es más frecuente en residentes que en especialistas clínicos y/o académicos. 6,7 El cansancio emocional y la despersonalización son los síntomas más comunes en la especialidad, siendo además mayor su ocurrencia en comparación a otras especialidades quirúrgicas. 5 Factores como ansiedad en relación con la competencia clínica, preocupación por el creciente número de cirujanos ortopédicos, obligaciones financieras y desbalance entre el trabajo y la vida personal contribuyen con la aparición del burnout 7,8 Es importante conocer la prevalencia de burnout por la posibilidad de intervenir en factores relacionados modificables. ...
... 6,7 El cansancio emocional y la despersonalización son los síntomas más comunes en la especialidad, siendo además mayor su ocurrencia en comparación a otras especialidades quirúrgicas. 5 Factores como ansiedad en relación con la competencia clínica, preocupación por el creciente número de cirujanos ortopédicos, obligaciones financieras y desbalance entre el trabajo y la vida personal contribuyen con la aparición del burnout 7,8 Es importante conocer la prevalencia de burnout por la posibilidad de intervenir en factores relacionados modificables. En Chile, se ha reportado un 53,7% de burnout en la especialidad mediante el autorreporte con herramientas no estandarizadas. ...
Resumen
Introducción El síndrome de burnout fue descrito como un conjunto de síntomas relacionados a cansancio emocional, despersonalización y falta de realización personal. En especialistas de Ortopedia y Traumatología, se ha descrito una prevalencia entre 4% y 59,4%. El objetivo de este estudio es evaluar, en especialistas de Ortopedia y Traumatología en Chile, la prevalencia de burnout en sus dimensiones y sus factores asociados.
Materiales y Métodos Se invitó a participar a los especialistas inscritos al Congreso Chileno el año 2016. Se evaluó el síndrome de burnout con el cuestionario Maslach Burnout Inventory. Se describieron las variables numéricas y categóricas, y se analizó el burnout según sus dimensiones y variables asociadas. Se consideró la significancia estadística con valores de p < 0,05. Este proyecto fue aprobado por el Comité de Ética Científica Institucional.
Resultados Se obtuvo la respuesta de la encuesta completa de 99 traumatólogos. La mediana de edad fue de 45 (rango: 29–76) años, y el 92% (n = 85) era del sexo masculino. Un 21% presentó un alto puntaje en la dimensión cansancio emocional, 20%, en despersonalización, y un 6% tenía alteración en la dimensión de realización personal. En la muestra total, un 35% presentó burnout. Las variables que se asociaron significativamente con la presencia de burnout fueron dormir menos de 5 horas y el consumo de modafinilo.
Conclusión En este estudio se encontró una prevalencia de 35% de burnout, definido como la alteración de al menos una de las dimensiones. Futuros estudios deberán indagar en la prevención a partir de los factores de riesgo modificables.
... This difficulty can lead to burnout and a subsequent cascade into a series of detrimental conditions that put the health and well-being of the resident or attending physician, their family and friends, and their patients at risk. 31 Sargent et al conducted a national survey of orthopedic residents, faculty members, and resident and faculty spouses to assess coping mechanisms, job satisfaction, demographic information, stress, and perceptions of harassment. 32 Published in 2009, the study reported high levels of burnout in more than half of the resident respondents, almost 30% of the faculty, and 13% and 30% of the faculty and resident spouses, respectively. In a followup paper published in 2011, Sargent et al reported that female residents in their second year of postgraduate training were at the greatest risk of burnout. ...
... Resilience, the ability to persevere through times of change or uncertainty, is a critical component of successfully coping with burnout. The importance of family and emotional and social outlets is reinforced in both papers by Sargent et al. 31,32 The provision of essential public health services is dependent on a resilient and sustainable health care workforce. If left unaddressed, the impact of burnout on physician attrition will be more severe in the future, as a Medical Group Management Association Stat poll showed that 41% of physicians who unexpectedly retired in the prior year stated their reason was related to the COVID-19 pandemic (burnout, health risks, loss of reimbursement). ...
Background: Louisiana is historically one of the lowest-performing states in terms of health outcomes in the United States. Hurricane Katrina led to a decrease in available health care resources, with a larger impact on resources for those living below the poverty line. Subsequently, the coronavirus disease 2019 (COVID-19) pandemic has been shown to have had disproportionately large impacts on minority communities, uninsured populations, and rural communities-all of which are found in Louisiana. Methods: This review focuses on the unique challenges of health care in Louisiana, the influence of COVID-19 on physician burnout, and methods of reducing work exhaustion for those in the health care field. Results: A national survey showed that physician satisfaction decreased from June 29, 2021, through September 26, 2021, compared to before the pandemic. A critical component in the provision of the essential services of public health is the ability to build and sustain a clinically skilled and diverse physician workforce. Maintaining well-being and retaining the physician workforce are prerequisites to the equitable provision of access to health care services. Conclusion: Maintaining one's own wellness is critical to occupational sustainability, particularly when unique stressors such as those encountered during the COVID-19 pandemic are present. The future of a vital health care system depends on physicians maintaining healthy habits and seeking help when burnout symptoms are recognized, both at the individual and institutional level.
... The 5-year OT residency is a challenging process and requires thorough education and research training, along with learning about complex surgical techniques. 2 Various surveys have documented that rates of psychiatric problems such as stress disorder, burnout syndrome, and suicidal ideation are particularly high among OT residents. [3][4][5] In a survey from the USA (2009), high levels of burnout were reported in 56% of 384 OT residents. 3 In another survey from France (2018), burnout was observed at a rate of 40% among the orthopedic residents, with a 10% rate of experiencing suicidal ideation within the last 12 months. ...
... [3][4][5] In a survey from the USA (2009), high levels of burnout were reported in 56% of 384 OT residents. 3 In another survey from France (2018), burnout was observed at a rate of 40% among the orthopedic residents, with a 10% rate of experiencing suicidal ideation within the last 12 months. 5 Furthermore, a most recent survey from Canada (2020) showed that 40% of OT residents suffered from stress disorder (distress). ...
Objective:
The aim of this study was to analyse the factors that led to resignations from Orthopaedics and Traumatology Residency pro- grammes in Turkey, and to determine the overall rate of resignation among residents from Orthopaedics and Traumatology programmes.
Methods:
In this cross-sectional survey,120 residents who either resigned or transferred to other OT clinics between autumn of 2013 and spring of 2020 were included. They were asked to complete a questionnare which was sent via Whatssapp application or e-mail. The ques- tionnare was comprised of 2 sections; Section A, which adressed resignation, consisted of 15 questions and Section B, which adressed transfer to another OT programme, consisted of 12 questions. Both sections had open ended and multiple choice questions.
Results:
Of 120 residents, 96 (6.6%) resigned and then transferred to another specialty, and 24 (1.6%) transferred to another orthopedics and traumatology clinic based on our review. The overall resignation rate as per the total quotas for orthopedics and traumatology residency from 2013 to 2020 was 8.2%. Of the 120 orthopedics and traumatology residents who were eligible for the survey, 83 (70%) completed the questionnaire. Sixty-one (60 males, 1 female; median age = 26 years; age range = 25-35) of 96 residents who resigned from the orthopedics and traumatology residency completed section A (the response rate was 63.5%); 22 (22 males; median age=27.6 years; age range=25-34) out of 24 residents who transferred to another orthopedics and traumatology clinic completed section B (the response rate was 91.6%). In section A, 40 out of 61 individuals (65.5%) preferred orthopedics and traumatology specialty as the first choice in TUS, and 34 residents (55.7%) reported not to have had enough information regarding the residency program before starting their clinics. In section B, out of the 22 residents, 13 (59%) stated that orthopedics and traumatology residency was not their first choice in TUS, and 18 (81.8%) reported not to have had sufficient knowledge about the preferred clinic. The most common reason for resignation or transfer to another specialty was heavy workload (n=46, 74.19%), followed by excessive hours of work (n=45, 72.58%). The most common reason for transfer to another orthopedics and traumatology clinic was drudgery (n=10, 45.5%), followed by problems with the hierarchy in orthopedics and traumatology residency (n = 9, 40.9%).
Conclusion:
The results of this survey have shown us, with an overall resignation rate of 8.2% as per the total quotas for OT residency from 2013 to 2020, that resignation from OT residency represents an important problem in Turkey. Workload and excessive hours of work were the most common reasons for resignation from orthopaedic residency programmes. Furthermore, extra work that diverted residents from their actual job responsibilities, as well as academic and educational concerns, were the main factors leading to transfer to another OT residency programme.
... Trainee exercise frequency was also positively associated with well-being and lower levels of loneliness, depression, and stress. While this is not surprising given the many studies linking exercise with well-being [95], rates of exercise among the trainees in our study were remarkably low. Trainees reported exercising on average fewer than seven times per month, with residents exercising fewer than six times per month. ...
... Trainees reported exercising on average fewer than seven times per month, with residents exercising fewer than six times per month. A previous study that compared faculty physicians and residents on a number of quality-of-life measures found that residents exercise less than faculty, with 41% of residents reporting that they exercised three to five times per week as compared to 54% of faculty physicians [95]. Identifying ways to facilitate exercise among healthcare trainees is a promising approach to increase well-being and prevent deleterious mental health outcomes [96,97]. ...
While much attention has been paid to healthcare provider and trainee burnout, less is known about provider well-being (i.e., flourishing) or about the effects of well-being on immune function. This study examined the demographic and psycho-social correlates of well-being among healthcare trainees (resident physicians and physician assistant (PA) trainees) and evaluated the association of well-being with the “conserved transcriptional response to adversity” (CTRA) characterized by up-regulated expression of pro-inflammatory genes and down-regulated expression of innate antiviral genes. Participants (n = 58) completed self-reported assessments of sleep disturbance, loneliness, depressive symptoms, anxiety, stress, and well-being (flourishing). Blood sample RNA profiles were analyzed by RNA sequencing to assess the CTRA. Slightly over half (n = 32; 55.2%) of healthcare trainees were categorized as flourishing. Flourishing was less prevalent among primary caregivers, and more prevalent among trainees who exercised more frequently and those with fewest days sick. Loneliness (AOR = 0.75; 95% CI = 0.61, 0.91; p = 0.003) and stress (AOR = 0.65; 95% CI = 0.45, 0.94; p = 0.02) were associated with decreased odds of flourishing when controlling for other variables. Flourishing was associated with down-regulated CTRA gene expression, whereas loneliness was associated with up-regulated CTRA gene expression (both p < 0.05). Assessing these relationships in a larger, multi-site study is of critical importance to inform policy, curricula, and interventions to bolster sustainable trainee well-being.
... [2][3][4]10,17 Within orthopaedic surgery, burnout has been reported to occur at alarming rates in multiple practice settings (40% to 60%), and has been found to be more prevalent in trainees and early career surgeons than in older surgeons. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Several personal risk factors (e.g. age, sex, sleep, relationships, finances, substance abuse, stress contributors, etc.) and occupational risk factors (e.g. ...
... Several prior studies have examined physician burnout in orthopaedic surgeons from different healthcare systems around the world. 22,24,25,28,32,47,48 However, no study to date has used newer wellness instruments (Mayo and Stanford) to examine trends and compare physician wellness among orthopaedic surgeons living and practicing in different countries. ...
Aims
Physician burnout and its consequences have been recognized as increasingly prevalent and important issues for both organizations and individuals involved in healthcare delivery. The purpose of this study was to describe and compare the patterns of self-reported wellness in orthopaedic surgeons and trainees from multiple nations with varying health systems.
Methods
A cross-sectional survey of 774 orthopaedic surgeons and trainees in five countries (Australia, Canada, New Zealand, UK, and USA) was conducted in 2019. Respondents were asked to complete the Mayo Clinic Well-Being Index and the Stanford Professional Fulfillment Index in addition to 31 personal/demographic questions and 27 employment-related questions via an anonymous online survey.
Results
A total of 684 participants from five countries (Australia (n = 74), Canada (n = 90), New Zealand (n = 69), UK (n = 105), and USA (n = 346)) completed both of the risk assessment questionnaires (Mayo and Stanford). Of these, 42.8% (n = 293) were trainees and 57.2% (n = 391) were attending surgeons. On the Mayo Clinic Well-Being Index, 58.6% of the overall sample reported feeling burned out (n = 401). Significant differences were found between nations with regards to the proportion categorized as being at risk for poor outcomes (27.5% for New Zealand (19/69) vs 54.4% for Canada (49/90) ; p = 0.001). On the Stanford Professional Fulfillment Index, 38.9% of the respondents were classified as being burned out (266/684). Prevalence of burnout ranged from 27% for Australia (20/74 up to 47.8% for Canadian respondents (43/90; p = 0.010). Younger age groups (20 to 29: RR 2.52 (95% confidence interval (CI) 1.39 to 4.58; p = 0.002); 30 to 39: RR 2.40 (95% CI 1.36 to 4.24; p = 0.003); 40 to 49: RR 2.30 (95% CI 1.35 to 3.9; p = 0.002)) and trainee status (RR 1.53 (95% CI 1.15 to 2.03 p = 0.004)) were independently associated with increased relative risk of having a ‘at-risk’ or ‘burnout’ score.
Conclusions
The rate of self-reported burnout and risk for poor outcomes among orthopaedic surgeons and trainees varies between countries but remains unacceptably high throughout. Both individual and health system characteristics contribute to physician wellness and should be considered in the development of strategies to improve surgeon wellbeing. Level of Evidence: III Cite this article: Bone Jt Open 2021;2(11):932–939.
... Sua prática geralmente envolve carga de trabalho pesada, turnos noturnos e cirurgias longas. 2 Como resultado, o programa de treinamento em ortopedia é notoriamente difícil. 3,4 O surgimento de um vírus altamente contagioso em dezembro de 2019 alterou drasticamente as interações sociais em todo o mundo. 5 À medida que o COVID-19 se espalhou rapidamente, foi declarada uma pandemia, o que causou profundas mudanças nos sistemas de saúde, alterando drasticamente os programas de treinamento médico. ...
... 1,16,17 A prevalência de burnout é maior no início da carreira dos cirurgiões ortopédicos. 1,4 Sargent et al. 4 mostraram que estes estão mais exaustos emocionalmente, mais despersonalizados e têm menos realização pessoal do que seus docentes. Resultados semelhantes foram relatados em outros estudos. ...
Resumo
Objetivo O objetivo principal do presente estudo é avaliar o impacto da pandemia de COVID-19 na prevalência da síndrome de burnout entre residentes de ortopedia Como objetivo secundário, foram avaliadas características associadas ao risco de desenvolver a forma grave da síndrome.
Método No presente estudo transversal, foram avaliados residentes antes e durante a pandemia de COVID-19. Estudantes de medicina formaram um grupo de controle. Os participantes responderam a um questionário sociodemográfico, ao Inventário Maslach Burnout, e à versão validada brasileira do Short Form Health Survey 36 (SF-36). Cinquenta e dois residentes foram avaliados antes da pandemia e 19 durante a pandemia.
Resultados Quarenta e quatro (84,6%) residentes tinham critérios para síndrome de burnout, e a forma grave da síndrome estava presente em 16 (30,7%). Não houve alteração significativa nos escores avaliados após o início da pandemia de COVID-19. Também não houve aumento na prevalência da síndrome de burnout ou da forma grave da síndrome. Observou-se correlação negativa entre os itens SF-36 e o desenvolvimento da forma grave da síndrome de burnout.
Conclusão A prevalência da síndrome de burnout e da forma grave da doença foi muito alta entre os residentes em cirurgia ortopédica. A pandemia de COVID-19 não aumentou o burnout nos residentes.
... Residents reported substantial burnout, with a high level of emotional exhaustion and depersonalization and an average level of personal achievement, whereas faculty reported minimal burnout, showing a low level of emotional exhaustion, an average level of depersonalization, and a high level of personal achievement [9]. A different study in 2009 by Sargent et al. revealed a similar trend, with high levels of burnout in 56% of residents and 28% of faculty [10]. ...
... Our finding that residents work the most time in the hospital is consistent with the historical norms of a surgical residency. Of note this number is lower than the 88 hours a similar burnout survey study reported fifteen years earlier [10]. Recent literature draws attention to the possible increase in hours spent working with electronic medical records and the detrimental effect they have on the productivity of orthopaedic practitioners in the clinic [22,23]. ...
Background
Burnout is an important and timely topic in medicine as a whole and spine orthopaedics as a specialty. Prior studies analyzing burnout in orthopaedics generally assess for the prevalence of burnout, without using a targeted analysis on possible causes and/or the potential association with work hours. In addition, burnout has not been assessed along the spectrum of the orthopaedist's career.
Methods
An anonymous survey was given to 24 medical students on surgical rotations, 20 orthopaedic residents, and 20 orthopaedic surgeons between June 2019 and August 2019 at a single academic institution. The survey inquired about demographics, general attributes, work hours, and included the aMBI (abbreviated Maslach Burnout Inventory [aMBI]).
Results
Residents worked the most hours per week (p <0.0001). Job satisfaction and home support were not significantly different between students, residents, and attendings. Control over life/schedule was greatest for attendings (p= 0.0036).
In terms of the aMBI scores, depersonalization was highest for residents (p= 0.0020), and personal accomplishment was highest for attendings (p=0.0095).
Taking all survey participants together, increased work hours correlated with greater depersonalization (p=0.015), greater sense of personal accomplishment (p=0.049), but was not correlated with emotional exhaustion. Higher job satisfaction correlated with lower emotional exhaustion and higher personal accomplishment.
Conclusion
With work hours correlating with depersonalization and personal accomplishment, continuing to focus on these factors seems important. With higher job satisfaction correlating with lower emotional exhaustion and higher personal accomplishment, burnout is a topic that will need to continue to be addressed for the well-being of our profession.
... For trainees, several factors were found to be protective, including perceived support from other medical institutions, working with an in-program mentor, leaving personal concerns outside work, personal time focused on exercise and hobbies, taking vacations, limiting alcohol use, and drawing on religion or faith. 18 Many studies have proposed treatment options for employees affected by burnout. Those include: mindfulness-based interventions, 36,37 counseling sessions, and workshops. ...
... For trainees, several factors were found to be protective, including perceived support from other medical institutions, working with an in-program mentor, leaving personal concerns outside work, personal time focused on exercise and hobbies, taking vacations, limiting alcohol use, and drawing on religion or faith. 18 Daniels et al 27 found that implementation of changes at the organizational or institutional level was the most effective means of reducing the burden of burnout. Institutions should also optimize infrastructure and support for surgeons, create a system of rewards for surgeon contributions, and create mentorship opportunities for younger surgeons. ...
Study design:
Cross-sectional survey study.
Objective:
To evaluate the prevalence of burnout, assess the personal and professional characteristics associated with burnout in spine surgeons and determine their quality of life.
Summary of background data:
Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and decreased sense of accomplishment that leads to decreased effectiveness at work. To date, there has been a lack of information on the prevalence of burnout among spine surgeons worldwide and the risk factors associated with this condition.
Methods:
An electronic survey with members of AO Spine was performed in May 2018. The survey evaluated demographic variables, practice characteristics, burnout, and quality of life. Maslach Burnout Inventory (MBI) and EuroQol 5-dimensions (EQ5D) were used to evaluate burnout and quality of life, respectively.
Results:
A total of 818 surgeons from 86 countries completed the survey. The prevalence of burnout was 30.6%. In the multiple linear model, emotional fatigue was independently associated with younger age (B = -0.17, CI95% = -0.26 to -0.07, P < 0.0001), and longer working hours per week (B = -2.71, CI95% = -4.34 to -1.07, P = 0.001); depersonalization was independently associated with younger age (B = -0.13, CI95% = -0.19 to -0.07, P < 0.0001), practicing outside Latin America (LA) (B = 0.71, CI95% = 0.41-1.01, P < 0.0001) and currently being a fellow (B = 0.54, CI95% = 0.06-1.02, P = 0.02); and higher scores of personal fulfilment was associated with practicing in LA (B = -1.27, CI95% = -1.69 to -0.85, P < 0.0001).
Conclusion:
Burnout is a common condition among spine surgeons worldwide. There is a significant association between burnout scores and decreased general quality of life. These results highlight the need to develop interventional programs to better identify, prevent, and manage this condition among practicing spine surgeons.Level of Evidence: 4.
... While the majority of burnout research and proposals is devoted to systemic change, some investigators have also written about development of hobbies and interests for mitigating burnout and enhancing engagement [2,[22][23][24][25][26][27][28][29][30][31]]-yet most have not focused on this potential form of relief. Sargent et al. [32], found that 58% of their respondents reported that devoting time at least weekly or more to hobbies and leisure activities resulted in less psychiatric morbidity, better marital relations, and, for faculty, less emotional exhaustion and improved levels of personal achievement. Oskrochi et al. [4] placed making time for hobbies on a list of "protective factors" for surgical residents. ...
... In the medical profession as there are several specialties available, students perform a thorough analytical survey regarding the size of the practice, economic advantages, happiness quotient of a particular specialty before embracing one as their lifelong career. Despite many virtues, a career in orthopaedics and its associated fields occasionally demands high degrees of hard work and dedication, making it a stressful path [3]. The challenges in training and practice that a surgeon may face lead to personal distress and significant burnout, affecting their eventual degree of success. ...
Introduction- Ewing sarcoma (ES) is a malignant and aggressive bony tumor affecting the most common age group of 5-20 years. It constitutes 10%-15% of all bone sarcomas and is the second most common primary malignant bone tumor after osteosarcoma. Methods- We undertook a review of the literature on Ewing’s Sarcoma of the spine to evaluate its etiology, clinical presentations, differential diagnosis, imaging modalities, and management with chemotherapy, radiotherapy, and surgical management. PubMed, EMBASE, Google Scholar, and Cochrane key articles were searched. Keywords like ‘Ewing’s Sarcoma’, ‘Spine’, ‘etiology’, ‘treatment’, ‘surgical management’, and ‘en bloc resection’ were used Discussion- The current management of Ewing’s sarcoma of the spine usually involves three main modalities: combination chemotherapy, surgery, and/or radiotherapy. Recent improvements in combination chemotherapy (vincristine, doxorubicin, cyclophosphamide +/- Ifosfamide, and etoposide) are one of the most significant factors for improving survival. Also, recent advancements in radiotherapy and instrumentation, and fusion techniques in surgical management have also been demonstrated to improve local disease control and overall survival. Conclusion- Primary Ewing sarcoma of the spine is a rare condition affecting the most common age group of 5-20 years and accounting for 1-3 cases/million/year. About 5 % of cases have spine involvement. Recent improvements in combination chemotherapy have improved the overall survival rates. En block resection and/or radiotherapy have improved local control of the disease. Keywords: Ewing’s Sarcoma, Spine, etiology, Treatment, Surgical management, En-bloc resection
... For one, it matters because it affects the job performance of surgical trainees and, ultimately, their patients. Burnout, a combination of emotional exhaustion, depersonalization, and sense of reduced accomplishment, is associated with worse patient outcomes, increased medical malpractice suits and major medical errors among surgeons, and decreased patient compliance and patient satisfaction [9][10][11][12][13]. Secondly, from an academic perspective, surgical residents who perceive adequate support to succeed and have less burnout are also more likely to have high performance on the in-service examination [14]. ...
Purpose of Review
To describe the unique stressors of surgical training and fellowship and how grit and resilience influence trainee wellness
Recent Findings
Surgical training is an intense, high-stress experience. For fellows-in-training, unique stressors are associated with this chapter of training, from financial pressors to the stress of job acquisition. Wellness is essential for surgical fellows, not just for the critical need for quality mental health of providers, but also for the patients who are also affected by provider burnout. There are various wellness programs that can be instituted nationally and institutionally to optimize fellow wellness, but one of the most high-yield foci for fellow wellness is focused mentorship, the key to assuring wellness and harnessing grit.
Summary
Surgical residency and fellowship are prodigiously demanding experiences, which mandate grit and resilience. It is imperative that widespread cultural and institutional changes take place to best support surgical trainees.
... 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.
... 2,5,21 In addition, surgical trainees have been found to be at a higher risk of burnout than consultants or attending surgeons. 5,22 A systematic review carried out by Galaiya, Kinross and Arulampalam showed that burnout levels are higher in people who are less experienced. 23 Therefore, there is clearly a need for more and higherquality studies investigating burnout treatments in surgeons and surgical trainees. ...
Background and Aims
Poor well-being affects the performance of all kinds of workers, including surgeons. This study aimed to answer two questions: (1) how does burnout affect surgeons personally, and what is their burnout experience like? (2) How does burnout affect the care that surgeons provide in the United Kingdom (UK)?
Method
This study conducted thematic analysis of semi-structured interviews with 14 surgeons recruited from the UK National Health Service (NHS).
Result
The study found three themes in surgeons’ experiences of burnout: first, burnout is common but frequently not recognised nor understood; second, burnout is a personal crisis; and third, burnout creates vulnerability at work. The study also revealed four themes related to burnout's effect on patient care: first, burnout reduces the quality of surgeon-patient relationships; second, burnout affects patient safety; third, burnout impairs staff relationships; and fourth, burnout makes surgeons less motivated to improve.
Conclusion
Burnout is common but not well recognised in surgeons. Improving understanding and treatment of burnout could have benefits for both surgeons themselves and the care they provide to patients.
... Previous studies have confirmed that orthopaedic surgeons are susceptible to emotional exhaustion and depersonalization (Ames et al. 2017;Daniels, DePasse, and Kamal 2016;van Wulfften Palthe et al. 2016;Travers 2020;Arora, Diwan, and Harris 2013). In 2009, Sargent et al. found that 28.4% of faculty members exhibited burnout as defined by high scores on emotional exhaustion and/or depersonalization scales (Sargent et al. 2009). Verret et al. surveyed orthopaedic surgeons at their institution and found that burnout was most strongly associated with increasing workload and decreasing job control in orthopaedic residents and attending surgeons and with a decreasing sense of fairness and poorer sense of community among fellows (Verret et al. 2021). ...
Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment in the work environment. Limited data are available to assess how orthopaedic surgeons have been affected by the COVID-19 pandemic, especially in regard to symptoms of burnout. A 28-question multiple-choice anonymous online survey was distributed via email to 2,002 orthopaedic surgeons practicing at academic institutions in the United States. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to evaluate burnout. 2,025 emails were distributed; 227 valid questionnaires were analyzed. 155 participants (68%) showed burnout. Emotional exhaustion and depersonalization correlated with age, gender, years of practice, and whether participants had children (all p < 0.05). Female surgeons (especially single and childless surgeons) had significantly higher emotional exhaustion and depersonalization. COVID-19 had a negative impact on surgeons’ personal well-being (79%, p < 0.001). Significantly more surgeons who indicated that, because of the COVID-19 pandemic, they were under financial distress (17 of 18, p = 0.015), mental/emotional distress (123 of 154, p < 0.001), had deteriorating home situations (37 of 39, p < 0.001), and had to change their practice dynamics (52 of 62, p = 0.002) had burnout. Orthopaedic surgeons experienced high levels of burnout during the COVID-19 pandemic. Younger orthopaedic surgeons or those in early stages of practice were more susceptible to burnout. Female orthopaedic surgeons, especially childless and unmarried female surgeons, experienced more emotional exhaustion and depersonalization.
... In interviews from 200 physicians, Zwack et al. found that physicians with more effective coping strategies had improved resiliency; in concert with this, they found that resiliency was central to the concept of physician well-being [33]. Sargent et al. surveyed a large cohort of Orthopedic residents and attendings and identified several protective factors for building resiliency and preventing burnout [34]. For residents, protective factors included having control over one's time, taking mental breaks, mentorship and support. ...
Background:
Burnout and professional satisfaction is an often an overlooked component for healthcare outcomes; the COVID-19 pandemic represents an unprecedented stressor that could contribute to higher levels of burnout.
Objectives:
Our primary objective was to evaluate the association of a battery of fulfillment, job satisfaction change, COVID-19 concerns, and coping measures. Our secondary objective was to determine whether the fulfillment and coping measures differed by gender and by experience levels among a battery of physician specialties.
Methods:
The study was a purposive sample of convenience. Study participants included all trainees and attending orthopedic surgeons from our academic institution; all participants were invited to complete a survey built around a validated measure of professional fulfillment aimed at assessing response to acute change and stressors. We performed univariate statistics and a matrix correlational analysis to correlate different survey domains with variables of interest.
Results:
The survey was sent electronically to 138 individuals; 63 surveys were completed (response rate = 45.7%). Twenty-seven (42.8%) individuals met the threshold criteria for fulfillment whereas 10 (15.9%) met the threshold for burnout. We found that surgeon perspectives on COVID-19 were not associated with burnout or professional fulfillment. Burnout was inversely associated with professional fulfillment (R = -0.35). Support seeking was noted to be correlated with professional fulfillment (R = 0.37).
Conclusions:
Stressors related to COVID-19 pandemic were not correlated with physician burnout and fulfillment. This held true even when stratifying by gender and by attending vs. trainee. Continued efforts should be implemented to protect against physician burnout and ensure professional fulfillment for Orthopedic surgeons.
... This is encouraging as several studies to date paint a negative picture of job satisfaction and burnout among surgical residents. 7,[9][10][11]21,[31][32][33][34][35][36] The domain that residents are least satisfied with is "feedback given to residents," with respondents commenting on the need for more frequent, formal, and mandatory feedback sessions. Previous studies have shown that enhancing the frequency and quality of resident feedback enhances both teacher and learner satisfaction. ...
Objective
Resident wellness is a focus of medical training and is prioritized in both Canadian and American accreditation processes. Job satisfaction is an important component of wellness that is not examined in the literature. The purpose of this study was to analyze job satisfaction in a national sample of plastic surgery residents, and identify factors that influence satisfaction.
Methods
We designed a cross-sectional survey adapted from existing instruments, with attention to thorough item generation and reduction as well as pilot and clinical sensibility testing. All plastic surgery residents at Canadian institutions were surveyed regarding overall job satisfaction as well as personal- and program-specific factors that may affect satisfaction. Predictors of satisfaction were identified using multivariable regression models.
Results
The response rate was 40%. Median overall job satisfaction was 4.0 on a 5-point Likert scale. Operative experience was considered both the most important element of a training program, and the area in most need of improvement. Senior training year ( P < .01), shorter commute time ( P = .04), fewer duty hours ( P = .02), fewer residents ( P < .01), and more fellows ( P < .01) were associated with significantly greater job satisfaction.
Conclusions
This is the first study to gather cross-sectional data on job satisfaction from a national sample of plastic surgery residents. The results from this study can inform programs in making tangible changes tailored to their trainees’ needs. Moreover, our findings may be used to inform a prospectively studied targeted intervention to increase job satisfaction and resident wellness to address North American accreditation standards.
... Available evidence has suggested a relationship between burnout and impaired cognitive function or propensity to physical illness, which can affect others and translate to poorer patient care [2][3][4]. Surveyed residents have reported higher degree of burnout compared with medical students and attending physicians in several specialties [5][6][7]. Residents are required to juggle several clinical, administrative, and scholarly responsibilities during the workday that may seep into their personal lives outside of work. Residents are susceptible to burnout at any point throughout their training, and peak rates can occur as early as internship year through to later years in training [8][9][10]. ...
Objective:
The aim of this study was to investigate the effect of various predictors on burnout among radiology residents during their training.
Methods:
In this cross-sectional analysis, we distributed the Maslach Burnout Index for Medical Personnel (MBI-HSS [MP]) to eligible United States (US) radiology residents. Covariates of interest included age, child status, debt burden, partner status, and self-identified gender. Primary outcomes include MBI-HSS (MP) subcomponent scores - emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Mann-Whitney tests were used to compare averages between groups.
Results:
Out of the 770 of 2823 residents (27.3%) who responded, 488 of 770 completed the MBI-HSS (MP). During the R1 year, male sex was associated with marginally higher PA scores (36.5 versus 33.5; P = .029). Having children or a partner was associated with lower EE scores (18.7 versus 26.8, P = .012; 22 versus 28.9, P = .022, respectively) and higher PA scores (37 vs 32.7, P = .024; 35 versus 31.3, P = .039, respectively) among the R3 cohort. Reporting debt < $200,000 was associated with lower EE scores among the R3 (21.2 versus 27.3, P = .028) and R4 (16.4 versus 21.9, P = .033) cohort.
Discussion:
There are several predictors of burnout that transiently impact residents at different years of training and primarily impact EE or PA, but not DP scores. R3 residents' scores are most sensitive to these covariates.
Objective:
The present study examined among orthopedic residents the relationship between the presence of depressive or anxious symptoms and the degree of perfectionism, perceived work-related distress, and involvement in the care of patient(s) who died.
Method:
A cross-sectional online survey based on self-reported measures was used to collect the data from October 2019 to April 2021.
Results:
The sample consisted of 642 orthopedic residents (50.6% response rate; 70.9% male; average age 29.8 years old). A total of 12.5 and 18.4% reported depressive or anxious symptoms, respectively. On a scale of 0-100, the mean score of perceived work-related distress was 51.9. A third (33.6%) reported being involved in the care of patient(s) who had died. Higher levels of perceived work-related distress and higher scores on the indecision of action/perfectionism dimension were associated with depressive and anxious symptoms. Being involved in the care of patient(s) who had died was associated with having anxious symptoms (OR = 1.79; 95%CI = 1.18-2.72).
Conclusions:
These results highlight the need for the systematic monitoring of the mental health status of orthopedic residents in Mexico, particularly those who report a high level of work-related distress or perfectionism or who have recently experienced the death of a patient.
Orthopaedic surgeons may, at times, derive less enjoyment from their work. Limited engagement can arise, on the one hand, from limited autonomy, burdens of care, and reduced reimbursement. On the other hand, surgeons may enjoy their work less if they feel less able to help people. For instance, people with pressing medical, mental, and social health opportunities may place inordinate hope on what an orthopaedic surgeon can do to improve their lives. Pressure to provide tests and treatment with more potential for harm than benefit can, at times, contribute to a sense of futility and emotional exhaustion. There may, at times, be small and large pressures that can induce surgeons to compromise respect for evidence and lapse in adherence to ethical principles, placing them at risk for moral injury. These aspects of orthopaedic practice seem important given the association between limited joy in practice and self-harm, abandoning medical practice, and errors and patient harm. There are things to consider when working on joy in practice, including recognizing and naming the unsavory parts of practice; making improvement in the area for creativity, innovation, and personal growth; and developing strategies to limit and alleviate stress.
Background:
Burnout is a well-known consequence of chronic stress. Orthopedic surgery is among the most desired specialty among Iranian medical students. The nature of the job, the income, and the ability to deal with stress can all be stressful factors for orthopedic surgeons. Nonetheless, little is known about how these medical doctors work and live in Iran. The present study aimed to assess job satisfaction, engagement, and burnout among Iranian orthopedists.
Methods:
A nationwide online survey was conducted in Iran. Job satisfaction, engagement, and burnout were evaluated using the job description index (JDI), Utrecht Work Engagement Scale, and Maslach Burnout Scale. They were also asked some additional questions related to career choice.
Results:
A total of 456 questionnaires (41% response rate) were retrieved. Overall, 56.8% of the participants experienced burnout. The burnout levels significantly differed based on age, years from graduation, working in public hospitals, operating more than 10 patients in a week, monthly income, having less than two children, and being single (P<0.05). They scored higher on work questions on the present job and jobs in general but lower scores on pay and opportunities for promotion.
Conclusion:
In a national study of orthopedic surgeons, their primary concern in JDI was "pay and promotion." Burnout was substantially associated with respondents' characteristics, such as younger age and having fewer children. This will lead to impaired performance, increased patient complaints, and the tendency to immigrate.
Introduction:
Orthopaedic surgery is one of the most cited specialties among legal claims. Malpractice lawsuits are financially burdensome, increase defensive practices, and incur a notable emotional toll on defendants. We sought to determine the effect of malpractice lawsuits on professional well-being and self-reported medical errors among orthopaedic surgeons.
Methods:
We surveyed 305 members of the American Orthopaedic Association to collect information on experiences with medical malpractice lawsuits, demographic and practice characteristics, professional well-being on the Professional Fulfillment Index, and self-reported medical errors. Multivariable logistic regression identified predictors of malpractice lawsuits, professional well-being, and self-reported medical errors.
Results:
Seventy-three percent (224 of 305) respondents had been involved in a medical malpractice lawsuit. The odds of experiencing a malpractice lawsuit increased by seven percent with each year in practice (OR = 1.07, 95% CI: 1.04 to 1.10, P < 0.001) and with specialization in spine surgery. Respondents with a lawsuit in 2 years before the survey reported comparable professional well-being and medical error rates with those without a lawsuit. However, compared with respondents without a lawsuit, respondents with a lawsuit more than 2 years in the past were less likely to report burnout (OR = 0.43, 95% CI: 0.20 to 0.90, P = 0.03) and more likely to report a medical error in the past year, which resulted in patient harm (OR = 3.51, 95% CI: 1.39 to 8.91, P = 0.008).
Discussion:
While malpractice lawsuits negatively affect professional well-being, this effect resolves with time. The effect on medical errors may be more permanent; orthopaedic surgeons who have experienced a lawsuit reported greater rates of medical errors even after these legal issues have been settled. Among orthopaedic surgeons dealing with lawsuits, supportive interventions to protect professional well-being and mitigate the factors which lead to greater medical errors are needed.
Level of evidence:
Prognostic Level III.
Introduction:
The personality traits of those who become orthopaedic surgeons may also lead to overwork, work-life balance issues, and burnout. Health and wellness practices of orthopaedic surgeons have not been widely explored. This study evaluated the personal health habits, wellness, and burnout of practicing orthopaedic surgeons in the United States.
Methods:
An anonymous self-assessment survey was completed by 234 practicing orthopaedic surgeon alumni from two large residency programs. The survey assessed exercise habits according to Centers for Disease Control and Prevention recommendations, compliance with preventive medical care practices according to the United States Preventive Services Task Force, prioritization of occupational wellness strategies, and the presence of burnout via an adapted Maslach Burnout Inventory. Survey responders' mean age was 52 years, 88% were male, and 93% had a body mass index <30 kg/m2. Surgeons were stratified according to practice type, years in practice, and subspecialty.
Results:
Among orthopaedic surgeons, compliance with aerobic and strength exercise recommendations was 31%. Surgeons in academic practice were significantly (P = 0.007) less compliant with exercise recommendations (18%) compared with private (34%) or employed (43%) practicing surgeons. Most (71%) had seen their primary care provider within 2 years and were up to date on age-appropriate health care screening including a cholesterol check within 5 years (79%), colonoscopy (89%), and mammogram (92%). Protecting time away from work for family/friends and finding meaning in work were the most important wellness strategies. The overall burnout rate was 15% and remained not significantly different (P > 0.3) regardless of years in practice, practice type, or subspecialty.
Conclusion:
This survey study identifies practicing orthopaedic surgeons' health habits and wellness strategies, including limited compliance with aerobic and strength exercise recommendations. Orthopaedic surgeons should be aware of areas of diminished personal wellness to improve quality of life and avoid burnout.
Background:
Female and racial/ethnic minority representation in surgical programs continues to trail behind other medical specialties. Various structural and perceived obstacles which contribute to a difficult path for underrepresented minority (URM) trainees have been identified, and efforts to reduce these hurdles are underway. Gaining perspective and insight from current surgical minority trainees may add valuable insight to aid with improving and innovating strategies to recruit and retain URM surgeons.
Objective:
To characterize how race/ethnicity, cultural background, and gender affect the surgical training experience of URM surgical residents in all areas of surgery a focus on the field of Orthopedic Surgery, given its particularly poor rates of diversity.
Methods:
Authors conducted semi-structured video interviews on current surgical residents or fellows who were members of underrepresented populations including Female, African-American/Black, Latino, Asian, Native American, and First or Second-generation immigrant status. Recruitment was achieved through a combination of voluntary, convenience, and snowball sampling procedures. Interview transcripts were then coded using conventional thematic analysis. Themes were iteratively expanded into subthemes and subsequently categorized utilizing a pile-sorting methodology.
Results:
Among 23 surgical trainees 12 self-identified as Black (60.9%), 5 as Asian (17.4%), 1 as Hispanic (4.4%), and 5 as Caucasian (17.4%). Twelve residents identified as male (52%) and 11 as female (48%). Six surgical specialties were represented with the majority of participants (83%) being trainees in surgical subspecialties, among those orthopedic surgery was most strongly represented (57%). Analysis of their responses revealed 4 major themes: positive experiences, problems related to minority status, coping strategies, and participant suggested interventions. Themes were distilled further to sub-themes. Positive experiences' sub-themes included finding a supportive community, pride in minority status, and being able to better relate to patients. Negative experiences related to minority status' subthemes included perceived microaggressions and additional pressures, such as greater scrutiny and harsher punishments relative to their nonminority counterparts, which negatively impacted their surgical training. Most respondents did not feel there were dedicated resources to help alleviate these additional burdens, so some sought help outside of their training programs while others tried to assimilate, and others felt isolated. Recommended proposed interventions included validating the URM resident experience, providing education/training, and creating opportunities for mentorship.
Implications/conclusions:
URM surgical trainees face numerous challenges related to their minority status. Recruitment and retention of URM in medicine would benefit from individual early and longitudinal mentorship, mitigating imposter syndrome, acknowledging the challenges faced by residents, and seeking feedback from both past and current residents.
Introduction:
Burnout is a syndrome that adversely affects those who work in roles designed to assist and aid others, such as healthcare professionals. There is a paucity of data available on this topic among French pediatric orthopedic surgeons, registrars and interns. Therefore, we conducted a national survey to 1) assess the prevalence of burnout syndrome among French pediatric orthopedic surgeons 2) determine the risks and protective factors associated with this syndrome.
Hypothesis:
The prevalence of burnout among French pediatric orthopedic surgeons is at least as high as in other medical and surgical specialties.
Materials and methods:
We conducted a nationwide survey during the months of June and July 2022 by distributing a digitized questionnaire by e-mail. The burnout syndrome was assessed by the MBI (Maslach Burnout Inventory) score. Demographic and professional practice data were also collected.
Results:
Thirty-eight interns and 65 pediatric orthopedic registrars took part in the survey, i.e. a participation rate estimated at 65.5% and 44.4% respectively. Twenty-six percent (n=10) of interns and 13.9% (n=9) of registrars had MBI scores suggestive of moderate or severe burnout. Respectively 20.8% (n=9) and 9.2% (n=6) of interns and registrars reported suicidal thoughts in the past year. After statistical analysis, medical errors (OR: 3.4336; 95% CI: 1.7164 - 6.869; p <0.001) and suicidal ideation (OR: 2.3075; 95% CI: 1.0480 - 5.081; p=0.038) were associated with severe burnout. Having children (OR: 0.495; 95% CI: 0.2491 - 0.983; p=0.044) emerged as a protective factor.
Discussion:
With a high participation rate, this study reveals a high burnout rate among French pediatric orthopedic interns and registrars, even if slightly lower than those found in other surgical specialties. Interns seem more exposed to this risk than their seniors. The consequences of burnout are diverse but can be significant. These results necessitate a vigilant approach to the occurrence of burnout among health professionals, and the appropriate management of it.
Level of evidence:
III; descriptive cross-sectional study without a control group.
Introduction:
Improving psychological wellbeing in healthcare professionals has demonstrable links with improvements in system-performance and patient outcomes. The aims of this study were to determine the prevalence of burnout among orthopaedic surgeons within the United Kingdom (UK) and to identify any influencing factors.
Methods:
This prospective, cross-sectional nationwide study used the Oldenburg Burnout Inventory to assess burnout among orthopaedic registrars, middle grades and consultants from across the UK. In total, 369 participants completed an anonymised online survey. Reasons for burnout were assessed using a list of 20 stressors followed by a white-space box for elaboration.
Results:
Respondents included 204 (55.3%) consultants, 100 (27.1%) registrars and 65 (17.6%) who were an associate specialist, trust grade or fellow. Some 252 (68.3%) participants experienced moderate-level burnout and 81 (22.0%) high-level burnout. There was no significant association between burnout and grade (p = 0.283), gender (p = 0.433), marital status (p = 0.932), years since graduation (p = 0.397), overseas training (p = 0.642), hours worked (p = 0.601), region (p = 0.699) or hospital type (p = 0.813). A high level of disengagement and exhaustion were identified, with the latter being a greater contributory factor. The most common reasons for burnout were insufficient staff numbers, an overload of administrative work and limited time to see patients.
Conclusion:
There was a moderate to high level of burnout among orthopaedic surgeons within the UK. Clinical and management teams should focus on improving staff numbers, reducing administrative work and increasing clinic consultation times to limit any further disengagement and exhaustion from surgeons. Reducing burnout may help to improve mental wellbeing, work satisfaction and workforce productivity.
Background:
Orthopedic oncology surgeons commonly engage in prolonged and complex surgical procedures. These types of surgeries increase the risk of physical and psychological stressors, which may in turn make these physicians prone to work-related occupational injuries.
Aim:
The aim of this study was to explore in orthopedic oncologists, the prevalence of work-related physical injuries and psychological disturbances.
Methods:
A modified version of the physical discomfort survey was developed to assess occupational injuries among orthopedic oncology surgeon members of the Musculoskeletal Tumor Society, the Canadian Orthopedic Oncology Society and European Musculoskeletal Oncology Societies. The survey was sent by email, and it explored musculoskeletal complaints, psychological disturbances, treatment required for these complaints and the requirement of time off work.
Results:
A total of 67 surgeon responses were collected. A high number of orthopedic oncologists (84%) reported an occupational injury. Low back pain (39%) was the most prevalent musculoskeletal condition, followed by lumbar disk herniation (16%), shoulder tendinitis (15%) and lateral epicondylitis (13%). Of the cohort, 46% required surgery and 31% required time off work due to their injury. Thirty-three respondents reported a psychological disorder. Burnout (27%), anxiety (20%) and insomnia (20%) were the most commonly reported. Time required off work due to injury was associated with old age and years in practice.
Conclusion:
Orthopedic oncology surgeons report a high prevalence of work-related disorders. Lower back related injury and burnout were the most reported disorders. Improving operative room ergonomics and prevention of stress related to the work environment should be areas to explore in upcoming research.
Background:
Burnout among surgeons is increasingly recognized as a crisis. However, little is known about changes in burnout prevalence over time. We evaluated temporal trends in burnout among surgeons and surgical trainees of all specialties in the US and Canada.
Study design:
We systematically reviewed MEDLINE, Embase, and PsycINFO for studies assessing surgeon burnout from January 1981 through September 2021. Changes in dichotomized Maslach Burnout Inventory scores and mean subscale scores over time were assessed using multivariable random-effects meta-regression.
Results:
Of 3,575 studies screened, 103 studies representing 63,587 individuals met inclusion criteria. Publication dates ranged from 1996 through 2021. Overall, 41% of surgeons met criteria for burnout. Trainees were more affected than attending surgeons (46% vs 36%, p = 0.012). Prevalence remained stable over the study period (-4.8% per decade, 95% CI -13.2% to 3.5%). Mean scores for emotional exhaustion declined and depersonalization declined over time (-4.1 per decade, 95% CI -7.4 to -0.8 and -1.4 per decade, 95% CI -3.0 to -0.2). Personal accomplishment scores remained unchanged. A high degree of heterogeneity was noted in all analyses despite adjustment for training status, specialty, practice setting, and study quality.
Conclusions:
Contrary to popular perceptions, we found no evidence of rising surgeon burnout in published literature. Rather, emotional exhaustion and depersonalization may be decreasing. Nonetheless, burnout levels remain unacceptably high, indicating a need for meaningful interventions across training levels and specialties. Future research should be deliberately designed to support longitudinal integration through prospective meta-regression to facilitate monitoring of trends in surgeon burnout.
Physician wellness and burnout have been an increasing source of debate, while physician depression and suicide continue to be on the rise. The Pediatric Orthopedic Society of North American has been on the forefront of addressing these issues throughout the creation of a Physician Wellness Task Force, membership surveys, and a pre-course at the annual meeting directly addressing this topic. However, physician members of POSNA still report a burnout rate of almost forty percent. Despite hard questions being asked, there continues to be significant debate about how best to address physician burnout and focus on physician wellness. Key Concepts: Occupational burnout is the constellation of emotional exhaustion, depersonalization, and a perceived lack of personal accomplishment. Physician burnout can lead to increased complications and medical errors. Physician burnout requires a multi-faceted approach to prevent and treat, including both personal and institutional strategies. POSNA continues to develop and implement strategies to help their members prevent burnout and focus on wellness.
Burnout among physicians is a syndrome of emotional exhaustion, de-personalization, and reduced sense of personal accomplishment that can negatively affect personal relationships, physician well-being, and patient outcomes. Although burnout rates of up to 50% to 60% among orthopedic surgeons have been reported, no studies have evaluated burnout among orthopedic generalists and subspecialists. The primary goal of this study was to examine the prevalence of burnout among orthopedic disciplines. We conducted a multicenter study from March 2019 through December 2019 involving 149 orthopedists. An abbreviated Maslach Burnout Inventory-Human Services Survey was used to measure burnout. Demographic information, personal characteristics, professional characteristics, family life and spousal support, and depression were also assessed. The mean rate of burnout among all respondents was 62%, whereas 16.77% screened positive for depression. Subspecialties with the highest rates of burnout were oncology (100%), sports medicine (68%), and trauma (63%). Similarly, trauma (50.00%), oncology (40.00%), and general orthopedics (20.00%) had the highest positive depression screening rates. In contrast, shoulder and elbow (50%), pediatric (52%), and foot and ankle (54%) specialists had the lowest rates of burnout, whereas shoulder and elbow (0.00%), spine (0.00%), and sports medicine (6.50%) specialists had the lowest rates of positive depression screening. Older age, higher debt load, and oncology subspecialty were associated with increased burnout risk. This study sought to determine burnout rates within each orthopedic discipline, with a secondary aim of disclosing contributing factors. Trauma and oncology had the highest rates of burnout and positive depression screening. Because this study represents a small orthopedic cohort, larger studies are needed to appropriately manage burnout in the future. [Orthopedics. 20XX;XX(X):xx-xx.].
Physician and clinician well-being is an increasingly recognized problem. There is mounting evidence that more caregivers are experiencing the signs and symptoms of burnout, and many individuals are finding the profession of caring for people less rewarding. Multiple factors are conspiring to exacerbate the loss of meaning and purpose. Career dissatisfaction significantly impacts the larger healthcare system in the form of increased physician turnover, increased medical error rate, and decreased patient satisfaction. Early retirement, substance abuse, depression, and in the worst cases, suicide are all real problems in healthcare today. Optimal care cannot be provided by healers who have exhausted their reservoirs of resilience. The global coronavirus pandemic has further frayed the bonds of community that have served to tie doctors, nurses, and other healthcare team members together. Individual and organizational strategies have been described to restore a sense of personal and professional satisfaction. Thoughtful and inclusive institutional leadership has been shown to be valuable and effective in establishing a culture that is compassionate to all participants. Intentional application of these strategies and investment of resources at multiple levels is the challenge before the medical community.KeywordsWellnessWell-beingBurnoutPatient safetyPatient careMoral injurySecond victim syndromeOrganizational wellness
Introduction:
Trauma and orthopaedics is renowned for being a challenging yet rewarding career. The value of mentorship in medical and surgical training is known to be beneficial; however, the prevalence and quality of mentorship opportunities in orthopaedics are less well studied. Identifying the strengths and weaknesses of mentoring programmes in orthopaedic training and recognising barriers to effective mentorship are key to unlocking the full potential of future orthopaedic surgeons.
Methods:
A comprehensive search of PubMed, Medline, EMBASE and the Cochrane Library was performed. All studies published in the English language that reported data on mentorship programmes in orthopaedic training were included.
Findings:
A total of 23 studies met the inclusion criteria. These studies demonstrated that formal mentorship programmes in orthopaedics are lacking but are sought after, with a positive influence on satisfaction and future career choice/subspecialty selection identified. Several barriers to mentoring in the field were recognised including the difficulty faced by female trainees, the availability of mentors and time constraints. The opportunity to choose a mentor, a mentor with the same interests, regular meetings and the option of gender congruent mentorship were all identified as crucial requirements for effective mentorship.
Conclusion:
Mentorship opportunities must be more accessible to all orthopaedic trainees alike and should aim to incorporate the attributes identified to provide the highest calibre of training to prospective orthopaedic surgeons.
Objective
To perform a literature review on burnout prevalence, factors that affect burnout and well-being, and solutions to address burnout in otolaryngology–head and neck surgery (OTO-HNS) residents and residents in other surgical specialties.
Data Sources
Ovid Medline, Embase, and article reference lists.
Review Methods
A literature search was performed to identify articles on resident burnout, distress, wellness, well-being, and quality of life. Articles deemed outside the scope of the current work were excluded. Search was limited to the past 5 years.
Conclusions
Moderate to high burnout has been reported in 35% to 86% of OTO-HNS residents. Among other surgical specialties, resident burnout ranges between 58% and 66% in plastics, 11% and 67% in neurosurgery, 38% and 68% in urology, and 31% and 56% in orthopedics. Highest burnout rates were seen in postgraduate year 2 residents. Factors significantly associated with burnout included hours worked (>80 h/wk), level of autonomy, exercise, and program support. Reported resident work hours have steadily increased: 8% of OTO-HNS residents in 2005 vs 26% in 2019 reported averaging >80 h/wk. Practical implications of resident burnout include decreased empathy, moral distress and injury, poor health, decreased quality of life, increased attrition, decreased desire to pursue fellowship, and increased likelihood of medical errors. Structured mentorship programs, wellness initiatives, and increased ancillary support have been associated with lower burnout rates and improvements in resident well-being across specialties.
Implications for Practice
Addressing burnout, which is prevalent in OTO-HNS residents, is critical to improving patient care and physician well-being. Surgical specialties can share strategies to effectively address resident burnout through institutional interventions, which can be essential quality improvement initiatives, to promote well-being.
Background:
It has been postulated that the process of-and stresses associated with-medical training may cause a loss of empathy among trainees. Because empathy is considered an important value for clinicians and may even be associated with better patient outcomes, we assessed the empathy of orthopaedic surgery trainees and identified factors associated with empathy.
Methods:
Between June and September 2020, an anonymous survey was distributed electronically to trainees in 23 Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs via the Collaborative Orthopaedic Educational Research Group. The survey comprised the validated Short-Form 8-Item Empathy Quotient (EQ-8) questionnaire-scored on a scale of 0, least empathetic, to 16, most empathetic-and single-item measure of emotional exhaustion and depersonalization derived from the Maslach Burnout Index-scored using a frequency scale. In total, 438 of 605 (72%) trainees completed the survey. The scores were compared via one-way analysis of variance, with Bonferroni correction and Tukey post-hoc testing, α = 0.05.
Results:
The mean (±SD) EQ-8 score among respondents was 11.3 ± 3.3. Women scored significantly higher (mean, 12.2 ± 2.8) than men (mean, 11.2 ± 3.3) (p = 0.02). Mean scores were significantly higher for trainees planning on a career in academic medicine (12.0 ± 2.9) than those intending to pursue private practice (10.9 ± 3.3) or those with a military commitment (10.4 ± 3.4) (p = 0.01). An inverse relationship was found between EQ-8 scores and single-item Maslach Burnout Index measures in depersonalization and emotional exhaustion (both, p < 0.01). No significant differences were found in EQ-8 scores across postgraduate year, program location, primary training setting, intended fellowship, relationship status, or whether they reported having children.
Conclusions:
We found no association between postgraduate year and EQ-8 score. Women and those intending to pursue a career in academic medicine had significantly higher levels of empathy. A significant inverse relationship was found between burnout and empathy. Respondents with higher levels of emotional exhaustion and depersonalization had lower levels of empathy.
The aim was to identify and compare the presence of emotional difficulties during the orthopedic residency period of professional medical training. This prospective study included 13 male residents, with a mean age of 26 years. The Rorschach (SC) instrument was applied in the 1st month of R1 (T0), after 12 months of R1 (T2) and after 9 months of R3 (T3). There were high amounts of MOR responses at T0, which decreased markedly over time (T3). The FD and S variables showed a minimal decrease from T0 to T3, however, increased significantly at T2. The residents began R1 presenting self-deprecating components, which dissipated over time, with the maintenance of self-inspection and self-burdening as traits. The medical residency program does not appear to be harmful, however, it may be a source of emotional vulnerability, especially during the first year due to the inexperience and the pace and intensity of the medical tasks.
Objectives:
To assess the prevalence of relationship distress and burnout among PICU nurses.
Design:
Cross-sectional, web-based survey.
Setting:
Pediatric intensive care nursing practices in the United States.
Subjects:
Pediatric intensive care nurses.
Interventions:
None.
Measurements and main results:
A total of 254 pediatric intensive care nurses in the United States completed the survey consisting of demographic data, practice, and personal characteristics, Revised Dyadic Adjustment Scale, and modified Maslach Burnout Inventory. Relationship distress in consensus was noted in 45.6% of participants, and 26.3% reported distress in relationship satisfaction. Moderate to high burnout was reported by 65% nurses in the emotional exhaustion domain, 43% in depersonalization, and 27% of nurses reported low personal accomplishment. A significant difference in relationship satisfaction was found among nurses identified in different domains of burnout, showing that nurses who scored higher in depersonalization also reported higher distress in relationship satisfaction (p = 0.045). Interestingly, nurses who reported high personal accomplishment (thereby less burnout) reported higher distress in relationship consensus (p = 0.015). The difference in the satisfaction subscale between different age groups was significant, suggesting distress in satisfaction among nurses over the age of 40 (p = 0.004). Comparison of nurses actively involved in marriage counseling with those not actively involved in marriage counseling demonstrated a significant difference in relationship consensus (p = 0.046; odds ratio = 2.46; 95% CI, 0.99-6.06) and satisfaction (p = 0.004; odds ratio = 3.26; 95% CI, 1.42-7.47), suggesting an association between higher relationship distress and counseling.
Conclusions:
This study reflects the prevalence of relationship distress and its association with burnout and other practice and personal factors among PICU nurses. Nurses with high depersonalization experienced significantly higher distress in relationship satisfaction, and nurses who reported high personal satisfaction had significantly higher distress in relationship consensus.
Introduction:
Symptoms of stress, depression, and burnout are prevalent in medicine, adversely affecting physician performance. We investigated real-time measurements of physiological strain in orthopaedic resident and faculty surgeon volunteers and identified potential daily stressors.
Methods:
We performed a prospective blinded cohort pilot study in our academic orthopaedic department. Physicians used a wearable fitness device for 12 weeks to objectively measure heart rate variability (HRV), a documented parameter of overall well-being. Baseline burnout levels were assessed using the Maslach Burnout Inventory questionnaire. Daily surveys inquiring on work responsibilities (clinic, operating room [OR], or "other") were correlated with physiological parameters of strain. Descriptive statistics and linear mixed effects modeling were used to evaluate bivariate relationships.
Results:
Of the 21 participating surgeons, 9 faculty and 12 residents, there was a response rate of 95.2% for the initial burnout survey. Daily surveys were completed for 63.8% (54.9 ± 22.3 days) of the total collection window, and surgeons wore the device for 83.2% of the study (71.6 ± 25.0 days). Residents trended toward lower personal accomplishment and greater psychological detachment on the Maslach Burnout Inventory, with 5 surgeons including 1 faculty surgeon (11.1%) and 4 resident surgeons (33.3%) found to have negatively trending HRV throughout the study period demonstrating higher physiological strain. Time in the OR led to increased next-day HRV (y-intercept = 47.39; B = 4.90; 95% confidence interval, 2.14-7.66; P < 0.001), indicative of lower physiological strain. An increase in device-reported sleep from a surgeon's baseline resulted in a significant increase in next-day HRV (y-intercept = 50.46; B = 0.64; 95% confidence interval, 0.11-1.17; P = 0.02).
Discussion:
Orthopaedic residents, more than faculty, had physiologic findings suggestive of burnout. Time in the OR and increased sleep improved physiological strain parameters. Real-time biometric measurements can identify those at risk of burnout and in need of well-being interventions.
Level of evidence:
Level III.
Background:
Emotional intelligence (EI) has been associated with decreased burnout in surgical residents but has not been extensively studied in medical students. We hypothesized that higher EI would lead to decreased levels of burnout among medical students at a US medical school.
Methods:
The authors administered three separate EI measures and compiled an EI score by adding the normalized score on each test. These measures were the DRS-15, the Grit Scale, and the Reading the Mind Between the Eyes Quiz. The Professional Fulfillment Index (PFI) was used to determine levels of burnout experienced two weeks before survey completion.
Results:
The population included 68 medical students. PFI and EI scores were positively correlated (R = 0.55, p < .001). The separate EI measures indicated that both Grit (R = 0.43, p < .001) and DRS-15 (R = 0.56, p < .001) were correlated with PFI. The Eyes Quiz did not show a significant correlation with PFI (p = .2).
Conclusions:
The results confirmed our hypothesis that EI would be correlated with decreased levels of burnout among this group of students. Some areas of potential future study include whether these same results hold true at other medical schools and if improving EI has a benefit of decreasing burnout.
Objective:
To obtain insights into the effects of surgical training on the well-being of support persons.
Summary background data:
Surgical trainee wellness is a critical priority among surgical educators and leaders. The impact of surgical training on the wellness of loved ones who support trainees has not been previously studied.
Methods:
This qualitative study employs semi-structured interviews of 32 support persons of surgical trainees at a single tertiary care center with multiple surgical specialty training programs. Interviews focused on perceptions about supporting a surgical trainee. Transcripts underwent thematic analysis with semantic and conceptual coding. Key themes regarding the effects that caring for a trainee has on support persons are reported.
Results:
Three key themes were identified: (1) Sacrifices-support persons report significant tangible and intangible sacrifices, (2) Delaying life-life is placed on hold to prioritize training, and (3) A disconnect-there is a disconnect and a lack of recognition of support person needs that require greater awareness and targeted interventions.
Conclusions:
The impact of surgical training can extend beyond trainees and can affect the wellness of their support persons who endure the effects of training alongside trainees. Programs should be aware of these effects and develop meaningful strategies to aid trainees and their support persons.
The existing research on the Dyadic Adjustment Scale (DAS) indicated that there were problems with some of the subscales and individual items. This study was designed to improve the instrument by following the standards of construct hierarchy. Through previous research and the analyses in this study, the subscales were found to contain some items that were homogeneous and others that were more heterogeneous. This problem was corrected by selecting out items that were homogeneous; 7 first-order scales were created which were combined to creat the 3 second-order concepts of consensus, satisfaction, and cohesion. With a sample of distressed and nondistressed couples, a series of confirmatory factor analyses was conducted. The factor analyses provided evidence for the construct validity of the new structure of the Revised DAS (RDAS) with the distressed, nondistressed, and total samples of this study, as well as with the sample from Spanier and Thompson's (1982) study. Additional analyses correlating the RDAS with another popular marital instrument provided more evidence for the construct validity of the RDAS. Criterion validity was demonstrated by discriminant analyses results. Both internal consistency and split-half reliability estimates demonstrated that the RDAS was reliable. The result also supported dividing the RDAS into two alternative forms for use in pre- and posttest studies. Summary statistics for the RDAS are presented as are implications for the field of marriage and family therapy.
Concerns about the working and learning environment of residency training continue to surface. Previous surveys of residents have focused on work hours and income, but have shed little light on how residents view their training experience.
To provide a description of the internship year as seen by a large cross section of second-year residents.
Mail survey conducted in 1991.
Residency programs in the United States.
Random 10% sample (N=1773) of all second-year residents listed in the American Medical Association's medical research and information database.
What and who contributes most to residents' learning during internships, degree of satisfaction with the internship experience, on-call and sleep schedules, incidents of perceived mistreatment or abuse, observations of unethical behavior, and experiences of harassment or discrimination.
A total of 1277 surveys (72%) of 1773 mailed were returned. Overall, respondents reported a moderate level of satisfaction with their first year of residency. On a scale of 0 to 3, residents rated other residents as contributing most (score of 2.3) to their learning, with special patients ranked second (2.1). During a typical work week, residents reported that they spent an average of 56.9 hours on call in the hospital. A total of 1185 (93%) residents reported experiencing at least 1 incident of perceived mistreatment, with 53% reporting being belittled or humiliated by more senior residents. Among women residents, 63% reported having experienced at least 1 episode of sexual harassment or discrimination. A total of 45% of residents reported having observed another individual falsifying medical records, and 70% saw a colleague working in an impaired condition, most often lack of sleep. Regression analyses suggest that satisfaction with the residency experience was associated with the presence of factors that enhanced learning, and fewer experiences of perceived mistreatment.
Residents report significant problems during their internship experience. Satisfaction with internship is enhanced by positive learning experiences and lack of mistreatment.
To encourage treatment of depression and prevention of suicide in physicians by calling for a shift in professional attitudes and institutional policies to support physicians seeking help.
An American Foundation for Suicide Prevention planning group invited 15 experts on the subject to evaluate the state of knowledge about physician depression and suicide and barriers to treatment. The group assembled for a workshop held October 6-7, 2002, in Philadelphia, Pa.
The planning group worked with each participant on a preworkshop literature review in an assigned area. Abstracts of presentations and key publications were distributed to participants before the workshop. After workshop presentations, participants were assigned to 1 of 2 breakout groups: (1) physicians in their role as patients and (2) medical institutions and professional organizations. The groups identified areas that required further research, barriers to treatment, and recommendations for reform.
This consensus statement emerged from a plenary session during which each work group presented its recommendations. The consensus statement was circulated to and approved by all participants.
The culture of medicine accords low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide. Barriers to physicians' seeking help are often punitive, including discrimination in medical licensing, hospital privileges, and professional advancement. This consensus statement recommends transforming professional attitudes and changing institutional policies to encourage physicians to seek help. As barriers are removed and physicians confront depression and suicidality in their peers, they are more likely to recognize and treat these conditions in patients, including colleagues and medical students.
To investigate resident burnout in relation to work and home-related factors.
Maslach Burnout Inventory was mailed to residents in eight different medical specialties, with a response rate of 35%.
Overall, 50% of residents met burnout criteria, ranging from 75% (obstetrics/gynecology) to 27% (family medicine). The first year of residency, being single, personal stress, and dissatisfaction with faculty were independently associated with burnout.
Efforts to reduce resident burnout nationally would benefit from expanding beyond the work-hours regulation.
It has been hypothesized that previous research on physician suicide has neglected a possible suppressor effect on suicide from a low risk of divorce among physicians. The present article addresses this question using data on 143,885 deaths from the 1990 National Mortality Detail Files. The results of a multivariate logistic regression analysis indicated that when controls are introduced for marital status, gender, race, and other covariates of social status, physicians were 2.45 times more likely to die of suicide than the rest of the working age population. The results suggested that previous work, which had not controlled for the protective effect of marital status, might have underestimated the incidence of physician suicide.
The Accreditation Council for Graduate Medical Education work-hour limitations (WHLs) were implemented in July 2003. Effects on resident well-being, patient care, and education are not well understood. We investigated these effects of WHLs.
Self-administered survey of internal medicine residents in a university-based residency program in Seattle, Wash. Part of this survey was identical to one completed at our institution in 2001, permitting comparison of burnout, career satisfaction, and depression before and after WHLs. We surveyed 161 internal medicine residents, with 118 respondents (response rate, 73%). We measured resident well-being using the Maslach Burnout Inventory, a validated screening questionnaire for depression, and a previously described questionnaire for career satisfaction. We developed questions about overall agreement with implementation of WHLs and effects on resident well-being, patient care, and education.
Comparison with the 2001 survey demonstrated an increase in the proportion of residents satisfied with their career (66% to 80%; P = .02) and a decrease in the proportion meeting criteria for emotional exhaustion (53% to 40%; P = .05). Slightly more residents reported a negative effect of WHLs on patient care (37%) than they did a positive (29%) or a neutral (34%) effect, and more reported a negative effect on their education (47%) than they did a positive (32%) or a neutral (21%) effect. Overall, most residents (65%) approved of WHLs.
Internal medicine residents approve of WHLs overall and report benefits to their well-being. However, they also report negative effects on patient care and resident education.
Burnout is characterized by emotional exhaustion, physical fatigue, and cognitive weariness, resulting from prolonged exposure to work-related stress. The authors review the accumulated evidence suggesting that burnout and the related concept of vital exhaustion are associated with increased risk of cardiovascular disease and cardiovascular-related events. The authors present evidence supporting several potential mechanisms linking burnout with ill health, including the metabolic syndrome, dysregulation of the hypothalamic-pituitary-adrenal axis along with sympathetic nervous system activation, sleep disturbances, systemic inflammation, impaired immunity functions, blood coagulation and fibrinolysis, and poor health behaviors. The association of burnout and vital exhaustion with these disease mediators suggests that their impact on health may be more extensive than currently indicated.
Background: Although curricular reforms have attempted to address sources of stress in medical residency, no recent studies have examined the financial or emotional situations of current medicine residents. Objective: To question medicine residents about financial status, educational debt, moonlighting, and psychological issues. Design: Survey distributed in a nonrandomized fashion to medicine residents. Setting: All 415 U.S. medicine residency programs. Results: According to the questionnaire responses submitted by the 4128 (18%) participating residents, a substantial number of residents had financial and emotional distress that could have interfered with training. The reported educational debt was at least $50 000 for 1657 (42%) of the respondents and at least $100000 for 737 (19%). The monthly disposable income was $100 or less for 1620 (43%) of the residents, and 637 residents (16%) could not afford safe housing. Among respondents in their 2nd through 5th year of postgraduate training, 2187 (52%) had insufficient funds to purchase books and equipment, and 678 (29%) could not afford the required fees for the American Board of Internal Medicine certifying examination; 2659 (33%) worked as moonlighters, and this percentage increased progressively with increasing educational debt. Four or five depressive symptoms during residency were reported by 1461 (35%) residents. Eight hundred ninety-nine residents (23%) thought they had become less humanistic over the course of their residency training; 2347 (61%) reported becoming more cynical. Female residents were more likely than male residents to report increased cynicism and multiple depressive symptoms. Increased cynicism and depressive symptoms were associated with increasing educational debt. Conclusions: Despite recent curricular reforms, an alarming number of current medicine residents report depressive symptoms, increasing cynicism, and decreasing humanism, which were associated with increasing educational debt and a need to moonlight for financial survival. Ongoing curricular reform, legislative relief from early loan repayment, and salary increases may be necessary to address these problems.
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.
The purpose of the study was to investigate the level of stress and the relationship between job-related stress and sources of stress for teachers in the United States in comparison to their counterparts in England. Self-report questionnaires from 773 middle school teachers served as the sample. Teachers in the survey reported a higher level of job-related stress than teachers surveyed in England in a previous study. A standard multiple regression analysis was used to determine the degree of association between levels of stress and sources of stress for teachers in urban, suburban, and rural middle schools. The multiple R's for cases in American urban, suburban, and rural schools were .56, 41, and .47, respectively. The standardized beta weights from the multiple regression procedures were analyzed and significant sources of teacher stress were identified. The results of the current study supported the previously reported findings of research based on a sample of teachers in the United Kingdom.
This study examined the relationship between age or years of experience and employee burnout by performing a meta-analysis on research studies that present findings on relationships between employee burnout and age or years of experience. The problem has practical significance in that the appropriateness of approaches to addressing employee burnout may depend on whether age or years of experience is a factor related to burnout. Results indicated that there was a small negative correlation between employee age and emotional exhaustion, one of the components of burnout, at least for employees in some fields in the United States, and possibly a small negative correlation between years of experience in a field and emotional exhaustion.
Sources of stress and symptoms of burnout were examined in 51 rural and 46 urban secondary school teachers from 11 school systems in Georgia and North Carolina. Urban school teachers experienced significantly more stress from poor working conditions and poor staff relations than did rural school teachers. Stress from pupil misbehavior and time pressures was significantly greater than stress from poor working conditions and poor staff relations for both rural and urban school teachers. Poor working conditions and time pressures predicted burnout for rural school teachers; pupil misbehavior and poor working conditions predicted burnout for urban school teachers. Results were discussed in relation to designing effective programs to prevent negative effects of stress and burnout.
Background:
Burnout can be characterized by a low degree of personal accomplishment and a high degree of emotional exhaustion and depersonalization using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). With increasing demands and constraints placed on academic department chairs, the risk of developing burnout may be increasing. The prevalence of burnout in chairs of academic departments of otolaryngology and the factors associated with it have not been previously described.
Objectives/hypothesis:
The purpose of this study was to determine the prevalence of burnout in otolaryngology chairs and to identify the factors that are associated with burnout development. Understanding these elements can lead to improved prevention, recognition, and treatment of professional burnout.
Study design:
A cross-sectional questionnaire-based study of 120 academic chairs of otolaryngology in the United States was performed.
Methods:
A confidential questionnaire was mailed to U.S. otolaryngology chairs. The questionnaire consisted of six parts assessing the following elements: 1) demographic information, 2) professional stressors, 3) personal and professional life satisfaction, 4) a self efficacy survey, 5) a spousal support survey, and 6) the MBI-HSS. Statistical analyses were performed using Pearson correlation and analysis of variance, and burnout data were compared with previously reported data from other department chairs and physicians.
Results:
Questionnaires were returned from 107 department chairs for a response rate of 89%. Chairs were on average 56 years of age, serving as chair for a mean of 11 years. Average work week was 68 hours and did not vary significantly with increasing duration as chair. Sixty-six percent of time was spent delivering patient care, 8% in research, and 26% performing administrative duties. MBI-HSS scores demonstrate 3% of chairs experiencing high burnout, 81% of chairs with moderate burnout, and 16% of chairs with low burnout. On average, chairs have low depersonalization scores, low-moderate emotional exhaustion scores, and low-moderate personal accomplishment scores. High emotional exhaustion or depersonalization was correlated with low self-efficacy, low spousal support, disputes with the dean, department budget deficits, working nights and weekends, Medicare audits, loss of key faculty, and being a malpractice defendant. High personal accomplishment was correlated with increased time spent performing administrative duties. When compared with other physician specialties, otolaryngology chairs demonstrate less sense of emotional exhaustion and depersonalization but also slightly less sense of personal accomplishment. Duration as chair, age, and hours worked per week were not associated with increased burnout.
Conclusions:
Most otolaryngology chairs experience moderate levels of burnout. The biggest risk factors for burnout include low self-efficacy, low spousal support, disputes with the medical school dean, department budget deficits, and nights/weekends worked. These findings may help department chairs identify and prevent burnout and may help in developing programs to minimize burnout in our field's academic leaders.
OBJECTIVE: To evaluate personal and professional factors associated with marital and parental satisfaction of physicians.
STUDY DESING: Cross-sectional study.
PARTICIPANTS: A survey was sent to equal numbers of licensed male and female physicians in a Southern California county. Of 964 delivered questionnaires, 656 (68%) were returned completed. Our sample includes 415 currently married physicians with children, 64% male and 36% female.
MEASUREMENTS AND MAIN RESULTS: Ratings of marital and parental satisfaction were measured on a 5-point Likert scale, 5 being extremely satisfied. Prevalence of work and home life factors was also evaluated. The mean score for marital satisfaction was 3.92 (range 1.75–5.0). Approximately half of the physicians reported high levels of marital satisfaction (63% of male physicians and 45% of female physicians). The gender difference disappeared after adjusting for age differences. Two factors were associated with high marital satisfaction: a supportive spouse (odds ratio [OR] 10.37; 95% confidence interval [CI] 2.66, 40.08) and role conflict (OR 0.61; 95% CI 0.42, 0.88). The mean score for parental satisfaction was 3.43 (range 1.0–5.0), and approximately two thirds of both male and female physicians reported at least moderate levels of parental satisfaction. The major factors associated with parental satisfaction were a supportive spouse (OR 2.24; 95% CI 1.32, 3.80), role conflict (OR 0.35; 95% CI 0.23, 0.53), salaried practice setting (OR 2.14; 95% CI 1.21, 3.81), marriage to a spouse working in a profession (OR 2.14; 95% CI 1.21, 3.81), and marriage to a spouse working as a homemaker (OR 2.33; 95% CI 1.20, 4.56). Number of hours worked was not found to be related to either satisfaction score, but rather to an intervening variable, role conflict.
CONCLUSIONS: For physicians with children, our study indicates that minimizing the level of role conflict and having a supportive spouse are associated with higher levels of marital and parental satisfaction. Working in salaried positions and marriage to a spouse who is either working in a profession or who is a stay-at-home parent are also related to high parental satisfaction.
To evaluate whether the negative emotions and attitudes that residents develop during internship continue throughout the remaining years of their residency, the authors undertook a four-year prospective study of two classes of internal medicine residents who completed their training in 1985 and 1986 in a residency program based at the Oregon Health Sciences University. Every two to three months over all three years of training, the residents indicated on Likert-type scales their levels of agreement with questions about their career satisfaction and emotional states, and the satisfying and dissatisfying aspects of their residency experiences. Between the internship and the end of their residencies, the physicians indicated significant improvements in their emotions and attitudes. Those experiences identified as satisfying continued to be so, whereas those considered dissatisfying became less so. Although more research of other classes of residents is needed, the findings suggest that while internal medicine internships may be dysphoric, the residents' emotional states and attitudes tend to normalize during the remainder of the residency.
Three alternative models of the role of workplace social support in ameliorating the effect of occupational stress on burnout symptoms were tested. Correctional officers (N = 166) completed a variety of questionnaire measures of job stress, the Inventory of Socially Supportive Behaviors, and the Maslach Burnout Inventory. Analyses showed no support for either the direct or buffering models of social support. Rather, the data were consistent with the indirect model of social support in the workplace. Among the job stress indices, role ambiguity, work load, and direct contact with inmates were found to be independent predictors of burnout symptomatology. The findings suggest a preventive rather than remedial effect of workplace social support in reducing occupational stress and burnout.
The ultimate effects of residency training on the personal and professional lives of physicians are largely unknown. We do not know, for example, whether young physicians are influenced by their training to be compassionate and concerned or instead to learn behaviors that insulate them emotionally from their patients' needs. We do know, however, that during the years of residency training a young physician must face, simultaneously, many intense and stressful experiences, which are likely to change future behaviors and his or her self-image as a physician.
Stresses of medical practice, recognized as severe, do not increase morbidity and mortality of physicians due to physical illness; the rates of substance dependence, divorces, and mental illness, however, exceed those in the general population. This study was undertaken to explore the effect of stress on physicians and to determine its role in the personal and occupational parameters of adaptation. 100 physicians of various specialties were randomly chosen and their responses to a standard questionnaire were computer analyzed. The previous hypothesis of the motivation of the choice of medicine as a vocation was explored from the point of view of personality features and responses to stress. All physicians reported considerable compulsivity. Its continuous utilization leads to failure of adaptation apparently responsible for further emotional and mental maladaptation. On the whole, the group under study did not show severe psychopathology equal to what has been reported in many other studies. Theoretical and practical aspects of this study are elucidated in the paper.
The author describes a stress response syndrome prevalent among physicians in training, the house officer stress syndrome. Episodic cognitive impairment, chronic anger, pervasive cynicism, and family discord occur in nearly all cases, usually in a benign form. Severely affected house officers, however, may also suffer from major depression, suicidal ideation, and substance abuse. Possible contributing stresses include sleep deprivation, excessive work load, patient care responsibility, perpetually changing work conditions, and competition. Approaches to prevention and management of the malignant form of the syn drome include improved work conditions, increased group responsibility, and psychiatric referral.
Burnout and psychiatric morbidity among gastroenterologists, surgeons, radiologists, and oncologists in the UK have been estimated by means of a questionnaire-based survey. The relationship between consultants' mental health and their job stress and satisfaction, as well as their job and demographic characteristics, were also examined.
Psychiatric morbidity was estimated using the 12-item General Health Questionnaire. The three components of burnout-emotional exhaustion, depersonalization, and low personal accomplishment-were assessed using the Maslach Burnout Inventory. Job stress and satisfaction were measured using study-specific questions.
Of 1133 consultants, 882 (78%) returned questionnaires. The estimated prevalence of psychiatric morbidity was 27%, with no significant differences between the four specialist groups. Radiologists reported the highest level of burnout in terms of low personal accomplishment. Job satisfaction significantly protected consultants' mental health against job stress. Three sources of stress were associated with both burnout and psychiatric morbidity; feeling overloaded, and its effect on home life; feeling poorly managed and resourced; and dealing with patients' suffering. Burnout was also associated with low satisfaction in three domains: relationships with patients, relatives and staff; professional status/esteem; intellectual stimulation. In addition, being aged 55 years or less and being single were independent risk factors for burnout. Burnout was also more prevalent among consultants who felt insufficiently trained in communication and management skills.
Consultants' mental health is likely to be protected against the high demands of medical practice by maintaining or enhancing job satisfaction, and by providing training in communication and management skills.
The purpose of this study was to characterize response rates for mail surveys published in medical journals; to determine how the response rate among subjects who are typical targets of mail surveys varies; and to evaluate the contribution of several techniques used by investigators to enhance response rates.
One hundred seventy-eight manuscripts published in 1991, representing 321 distinct mail surveys, were abstracted to determine response rates and survey techniques. In a follow-up mail survey, 113 authors of these manuscripts provided supplementary information.
The mean response rate among mail surveys published in medical journals is approximately 60%. However, response rates vary according to subject studied and techniques used. Published surveys of physicians have a mean response rate of only 54%, and those of non-physicians have a mean response rate of 68%. In addition, multivariable models suggest that written reminders provided with a copy of the instrument and telephone reminders are each associated with response rates about 13% higher than surveys that do not use these techniques. Other techniques, such as anonymity and financial incentives, are not associated with higher response rates.
Although several mail survey techniques are associated with higher response rates, response rates to published mail surveys tend to be moderate. However, a survey's response rate is at best an indirect indication of the extent of non-respondent bias. Investigators, journal editors, and readers should devote more attention to assessments of bias, and less to specific response rate thresholds.
Women surgeons are becoming increasingly prevalent. Despite this, there have been few studies of personal or professional characteristics of US surgeons of either gender.
Data were taken from the Women Physicians' Health Study, a nationally representative random sample (n = 4,501 respondents) of US women physicians, and data were analyzed in SUDAAN.
Surgeons were younger, and more likely to be US born, white, unmarried, and childless than were other women physicians; their personal health behaviors were similar to those of others. They worked significantly more clinical hours and call nights, but were not more likely to report feeling that they worked too much, had too much work stress, or had less control of their work environment. Their career satisfaction was similar to that of other women physicians, and satisfaction with their specialty was greater. They were less avid preventionists than were primary care practitioners, and somewhat less avid than other specialists.
Women surgeons differ in interesting and important ways from other women physicians.
Different versions of the General Health Questionnaire (GHQ), including the GHQ-12 and GHQ-28 have been subjected to factor analysis in a variety of countries. The World Health Organization study of psychological disorders in general health care offered the opportunity to investigate the factor structure of both GHQ versions in 15 different centres.
The factor structures of the GHQ-12 and GHQ-28 extracted by principal component analysis were compared in participating centres. The GHQ-12 was completed by 26,120 patients and 5,273 patients completed the GHQ-28. The factor structure of the GHQ-28 found in Manchester in this study was compared with that found in the earlier study in 1979.
For the GHQ-12, substantial factor variation between centres was found. After rotation, two factors expressing depression and social dysfunction could be identified. For the GHQ-28, factor variance was less. In general, the original C (social dysfunction) and D (depression) scales of the GHQ-28 were more stable than the A (somatic symptoms) and B (anxiety) scales. Multiple cross-loadings occurred in both versions of the GHQ suggesting correlation of the extracted factors. In Manchester, the factor structure of the GHQ had changed since its development. Validity as a case detector was not affected by factor variance.
These findings confirm that despite factor variation for the GHQ-12, two domains, depression and social dysfunction, appear across the 15 centres. In the scaled GHQ-28, two of the scales were remarkably robust between the centres. The cross-correlation between the other two subscales, probably reflects the strength of the relationship between anxiety and somatic symptoms existing in different locations.