Last updated: 19 September 2023
Sperling EL, Hulett JM, Sherwin LB, Thompson S, Bettencourt BA. Prevalence, characteristics and measurement of somatic symptoms related to mental health in medical students: a scoping review. Ann Med. 2023;55(2):2242781.
Keywords: Medical students; mental health; somatization; stress.
Abstract
Introduction: Somatic symptoms related to mental health in medical students are under-researched, with nothing on the topic being published in the United States in over three decades. This scoping review is the first of its kind to explore the prevalence, type and severity of somatic symptoms induced by stress, anxiety, depression and burnout amongst medical students, with the objective of describing the significance and breadth of this issue.
Methods: PRISMA-ScR guidelines were used to guide this review. A comprehensive search was performed of 22 databases, followed by bibliographic and hand searching. Inclusion criteria were published, peer-reviewed articles with a sample of medical students and at least one measure of somatic symptoms related to mental health, in English or with an English-language translation. Excluded were review, companion and editorial articles. Coding was done by an experienced coder trained in systematic review techniques. Two authors reviewed each article.
Results: Twenty-nine articles met inclusion criteria, representing 16 countries, 31 schools/teaching hospitals and 9,887 medical students. The prevalence of somatic symptoms ranged from 5.7 to 80.1%, and somatic symptoms were overwhelmingly found to be significantly correlated with mental ill-health. Somatic symptoms included back pain, neck pain, headaches, sleep disturbances and functional gastrointestinal disorders. Eleven different outcome measures were used, with varying degrees of validity and reliability, which were compared and assessed.
Conclusions: Somatic symptoms appear strongly correlated with mental ill-health in medical students, and are likely highly prevalent. This review highlights the need for further research on somatic symptoms of mental ill-health in medical students, particularly in the United States, and the addition of larger, multi-institutional cohorts to expand our understanding of prevalence, incidence and inciting factors of somatic symptoms. Longitudinal studies tracking somatic symptoms' effect on career trajectory and professional burnout levels are also needed. Finally, future research should explore interventions for reducing physical symptom burden in medical students.
Chen F, Powers K, Goetzinger AM, et al. Exploring the Impact of Book Club Participation on Clinicians' Empathy and Reflection on Empathetic Practice: A Wake-Up Call. Cureus. 2023;15(5):e39656.
Empathy is associated with desirable outcomes in healthcare, including improved patient-clinician rapport, fewer patient complications, and reduced clinician burnout. Despite these benefits, research suggests empathy declines during professional training. This study aimed to explore the impact of book club participation on clinicians' and trainees' empathy and perspectives on empathetic patient care.
Keywords: anesthesiology; book club; empathy; humanistic medicine; medical education.
McKenna-Plumley PE, Turner RN, Yang K, Groarke JM. Experiences of Loneliness Across the Lifespan: A Systematic Review and Thematic Synthesis of Qualitative Studies. Int J Qual Stud Health Well-being. 2023;18(1):2223868.
Loneliness is a fundamentally subjective experience that is common at various life stages. Studies have qualitatively explored loneliness, but a comprehensive overview is lacking. This research therefore provides a fine-grained review of studies on loneliness experiences across the lifespan.
Keywords: Emotions; Life course perspective; Loneliness; Qualitative research; Systematic review; Thematic synthesis.
Garnett PB, Douglas SG, Riley RH, Roberts LJ. The Bullying in Anaesthesia Registrars Survey (BARS): Does a validated questionnaire improve our understanding of bullying in Australian and New Zealand anaesthesia trainees? [epub ahead of print, 2023 Mar 1]Previous studies have established that bullying is a pervasive problem in healthcare. However, most investigations of bullying in anaesthesia use self-labelled survey questions in which respondents’ subjective perceptions of bullying are central in defining prevalence. This study applied the validated revised Negative Acts Questionnaire (NAQ-r) for a more objective assessment of bullying prevalence and types of negative behaviours experienced by anaesthesia trainees in Australia and New Zealand.
An online questionnaire was distributed by the Australian and New Zealand College of Anaesthetists (ANZCA) Clinical Trials Network to 990 randomly selected ANZCA trainees. Bullying prevalence was assessed using both a self-labelled survey tool and the NAQ-r, which requires respondents to select from a list of negative acts, with validated cut-offs that define bullying. Sources of bullying, impact on recipients and barriers to reporting were also examined. This design allowed comparison of the two methods for evaluating bullying prevalence.
Twenty-six percent of trainees surveyed completed both bullying survey instruments. Thirty percent of these respondents self-labelled as having experienced bullying in the previous six months, with 8% reporting bullying at least monthly. With the NAQ-r, most respondents (96%) reported experiencing at least one negative act in the prior six months, with 54% reporting these on a monthly basis. The most frequent behaviours described were humiliation and intimidation. Using NAQ-r cut-offs, 36% of respondents experienced occasional bullying and 10% were victims of severe workplace bullying.
The NAQ-r provides a more nuanced and objective insight into bullying faced by ANZCA trainees than do self-labelled surveys. The results of the present study provide a valuable baseline for ongoing assessment.
Scholliers A, Cornelis S, Tosi M, et al. Impact of fatigue on anaesthesia providers: a scoping review [epub ahead of print, 2023 Jan 23]. Br J Anaesth. 2023;S0007-0912(22)00736-X (REQUEST VIA LIBRARY).
Keywords: anaesthesia providers; fatigue; fatigue risk management systems; medication error; non-technical skills; scoping review; sleepiness.
Abstract
Background: Recently, fatigue has received more attention as a workplace hazard. This scoping review focuses on fatigue in anaesthesia providers. We explore the prevalence of fatigue in anaesthesia providers, and we examine how fatigue impacts their performance.
Methods: A literature search was independently conducted from December 2019 through March 2020. The following four databases were consulted: MEDLINE, CINAHL, EMBASE, and PubPsych. Only studies discussing fatigue in anaesthesia providers were eligible.
Results: The initial database search identified a total of 118 studies, of which 30 studies were included in the review. Eight articles concerned the prevalence of fatigue in anaesthesia providers, whereas 22 explored the impact of fatigue on the performance of anaesthesia providers. Up to 60.8% of anaesthesia providers suffered from severe excessive daytime sleepiness, and fatigue was denoted as a common workplace problem in up to 73.1% of anaesthesia providers. Fatigue had a negative influence on medication errors and vigilance, and it decreased the performance of anaesthesia providers during laboratory psychomotor testing. There was a decrease in non-technical skills (notably communication and teamwork) and worsening mood when fatigued.
Conclusions: Based on this scoping review, fatigue is a prevalent a phenomenon that anaesthesia providers cannot ignore. A combination of deterioration in non technical skills, increased medication errors, loss of sustained attention, and psychomotor decline can lead to poorer performance and cause patient harm. Concrete strategies to mitigate fatigue should be developed.
Afonso AM, Cadwell JB, Staffa SJ, Zurakowski D, Vinson AE. Burnout Rate and Risk Factors among Anesthesiologists in the United States. Anesthesiology. 2021;134(5):683-696.Abstract
Background: Physician burnout, widespread across medicine, is linked to poorer physician quality of life and reduced quality of care. Data on prevalence of and risk factors for burnout among anesthesiologists are limited. The objective of the current study was to improve understanding of burnout in anesthesiologists, identify workplace and personal factors associated with burnout among anesthesiologists, and quantify their strength of association.
Methods: During March 2020, the authors surveyed member anesthesiologists of the American Society of Anesthesiologists. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey. Additional survey questions queried workplace and personal factors. The primary research question was to assess rates of high risk for burnout (scores of at least 27 on the emotional exhaustion subscale and/or at least 10 on the depersonalization subscale of the Maslach Burnout Inventory Human Services Survey) and burnout syndrome (demonstrating all three burnout dimensions, consistent with the World Health Organization definition). The secondary research question was to identify associated risk factors.
Results: Of 28,677 anesthesiologists contacted, 13.6% (3,898) completed the survey; 59.2% (2,307 of 3,898) were at high risk of burnout, and 13.8% (539 of 3,898) met criteria for burnout syndrome. On multivariable analysis, perceived lack of support at work (odds ratio, 6.7; 95% CI, 5.3 to 8.5); working greater than or equal to 40 h/week (odds ratio, 2.22; 95% CI, 1.80 to 2.75); lesbian, gay, bisexual, transgender/transsexual, queer/questioning, intersex, and asexual status (odds ratio, 2.21; 95% CI, 1.35 to 3.63); and perceived staffing shortages (odds ratio, 2.06; 95% CI, 1.76 to 2.42) were independently associated with high risk for burnout. Perceived lack of support at work (odds ratio, 10.0; 95% CI, 5.4 to 18.3) and home (odds ratio, 2.13; 95% CI, 1.69 to 2.69) were most strongly associated with burnout syndrome.
Conclusions: The prevalence of burnout among anesthesiologists is high, with workplace factors weighing heavily. The authors identified risk factors for burnout, especially perceived support in the workplace, where focused interventions may be effective in reducing burnout.
Bazargan-Hejazi S, Shirazi A, Wang A, et al. Contribution of a positive psychology-based conceptual framework in reducing physician burnout and improving well-being: a systematic review. BMC Med Educ. 2021;21(1):593.
Keywords: Achievement; Engagement; Meaning; Physician; Positive emotion; Relationship; Well-being; Burnout
Background: The PERMA Model, as a positive psychology conceptual framework, has increased our understanding of the role of Positive emotion, Engagement, Relationships, Meaning, and Achievements in enhancing human potentials, performance and wellbeing. We aimed to assess the utility of PERMA as a multidimensional model of positive psychology in reducing physician burnout and improving their well-being.
Methods: Eligible studies include peer-reviewed English language studies of randomized control trials and non-randomized design. Attending physicians, residents, and fellows of any specialty in the primary, secondary, or intensive care setting comprised the study population. Eligible studies also involved positive psychology interventions designed to enhance physician well-being or reduce physician burnout. Using free text and the medical subject headings we searched CINAHL, Ovid PsychINFO, MEDLINE, and Google Scholar (GS) electronic bibliographic databases from 2000 until March 2020. We use keywords for a combination of three general or block of terms (Health Personnel OR Health Professionals OR Physician OR Internship and Residency OR Medical Staff Or Fellow) AND (Burnout) AND (Positive Psychology OR PERMA OR Wellbeing Intervention OR Well-being Model OR Wellbeing Theory).
Results: Our search retrieved 1886 results (1804 through CINAHL, Ovid PsychINFO, MEDLINE, and 82 through GS) before duplicates were removed and 1723 after duplicates were removed. The final review included 21 studies. Studies represented eight countries, with the majority conducted in Spain (n = 3), followed by the US (n = 8), and Australia (n = 3). Except for one study that used a bio-psychosocial approach to guide the intervention, none of the other interventions in this review were based on a conceptual model, including PERMA. However, retrospectively, ten studies used strategies that resonate with the PERMA components.
Conclusion: Consideration of the utility of PERMA as a multidimensional model of positive psychology to guide interventions to reduce burnout and enhance well-being among physicians is missing in the literature. Nevertheless, the majority of the studies reported some level of positive outcome regarding reducing burnout or improving well-being by using a physician or a system-directed intervention. Albeit, we found more favorable outcomes in the system-directed intervention. Future studies are needed to evaluate if PERMA as a framework can be used to guide system-directed interventions in reducing physician burnout and improving their well-being.
Brazier A, Larson E, Xu Y, et al. 'Dear Doctor': a randomised controlled trial of a text message intervention to reduce burnout in trainee anaesthetists. Anaesthesia. 2022;77(4):405-415.
Keywords: anaesthetist; burnout; text; trainee; well-being
One in four doctors in training in the UK reports feeling 'burnt out' due to their work and similar figures are reported in other countries. This two-group non-blinded randomised controlled trial aimed to determine if a novel text message intervention could reduce burnout and increase well-being in UK trainee anaesthetists. A total of 279 trainee anaesthetists (Core Training Year 2, Specialty Training Years 3 or 4) were included. All participants received one initial message sharing support resources. The intervention group (139 trainees) received 22 fortnightly text messages over approximately 10 months. Messages drew on 11 evidence-based themes including: gratitude; social support; self-efficacy; and self-compassion. Primary outcomes were burnout (Copenhagen Burnout Inventory) and well-being (Short Warwick-Edinburgh Mental Well-being Scale). Secondary outcomes were as follows: meaning in work; professional value; sickness absence; and consideration of career break. Outcomes were measured via online surveys. Measures of factors that may have affected well-being were included post-hoc, including the impact of COVID-19 (the first UK wave of which coincided with the second half of the trial). The final survey was completed by 153 trainees (74 in the intervention and 79 in the control groups). There were no significant group differences in: burnout (β = -1.82, 95%CI -6.54-2.91, p = 0.45); well-being (-0.52, -1.73-0.69, p = 0.40); meaning (-0.09, -0.67-0.50, p = 0.77); value (-0.01, -0.67-0.66, p = 0.99); sick days (0.88, -2.08-3.83, p = 0.56); or consideration of career break (OR = 0.44, -0.30-1.18, p = 0.24). Exploratory post-hoc analysis found the intervention was associated with reduced burnout in participants reporting personal or work-related difficulties during the trial period (-9.56, -17.35 to -1.77, p = 0.02) and in participants reporting that the COVID-19 pandemic had a big negative impact on their well-being (-10.38, -20.57 to -0.19, p = 0.05). Overall, this trial found the intervention had no impact. However, given this intervention is low cost and requires minimal time commitment from recipients, it may warrant adaptation and further evaluation.
Gordon L, Scanlan GM, Tooman TR, et al. Heard, valued, supported? Doctors' wellbeing during transitions triggered by COVID-19 [epub ahead of print, 2021 Nov 18]. Med Educ.
Keywords: COVID-19; Multidimensional transitions; Wellbeing
Context: Supporting doctors' wellbeing is crucial for medical education to help minimise negative long-term impacts on medical workforce retention and ultimately patient care. There is limited study of how doctors' transitions experiences impact wellbeing, particularly socially and culturally. Multiple Multidimensional Transitions (MMT) theory views transitions as dynamic, incorporating multiple contexts and multiple domains. Using MMT as our lens, we report a qualitative analysis of how transitions experienced by doctors during the pandemic impacted on social and cultural aspects of wellbeing.
Methods: Longitudinal narrative inquiry was employed, using interviews and audio-diaries. Data were collected over six months in three phases: (1) interviews with doctors from across the career spectrum (n=98); (2) longitudinal audio-diaries for 2-4 months (n=71); (3) second interviews (n=83). Data were analysed abductively, narrowing focus to factors important to social and cultural wellbeing.
Findings: Doctors described experiencing multiple interacting transitions triggered by the pandemic in multiple contexts (workplace, role, homelife, education). Patterns identifiable across the dataset allowed us to explore social and cultural wellbeing crosscutting beyond individual experience. Three critical factors contributed to social and cultural wellbeing both positively and negatively: being heard (e.g. by colleagues asking how they are); being valued (e.g. removal of rest spaces by organisations showing lack of value); and being supported (e.g. through regular briefing by education bodies).
Conclusions: This study is the first to longitudinally explore the multiple-multidimensional transitions experienced by doctors during the COVID-19 pandemic. Our data analysis helped us move beyond existing perceptions around wellbeing and articulate multiple factors that contribute to social and cultural wellbeing. It is vital that medical educators consider the learning from these experiences to help pinpoint what aspects of support might be beneficial to trainee doctors and their trainers. This study forms the basis for developing evidenced-based interventions that ensure doctors are heard, valued and supported.
Haque OS, et al. Physician, heal thy double stigma - doctors with mental illness and structural barriers to disclosure. N Engl J Med. 2021;384(10):888-891.
Keywords: Wellbeing; Mental illness
Despite calls for greater awareness of high rates of depression and suicide among physicians, estimates suggest that only about 1% of medical students with major depressive disorder disclose it as a disability.
Janosy NR, Anderson CTM. Toward physician well-being and the mitigation of burnout. Curr Opin Anaesthesiol. 2021;34(2):176-179.
Keywords: Wellbeing; Burnout; Suicide
Abstract
Purpose of review: Healthcare provider burnout is a real phenomenon. The rates of burnout are on the rise. Burnout-associated suicide amongst physicians represents a real "public health crisis." This article discusses the drivers of burnout and offers some strategies to mitigate burnout and improve well-being.
Recent findings: Measures of burnout such as stress, micro, and macro-aggression in the workplace have a psychological impact on staff. Additionally, a measurable economic price is exacted when an organization fails to address the lack of well-being burnout represents.
Summary: As healthcare providers struggle to survive and deal with the complex new set of problems and obstacles that the COVID-19 pandemic, the National economic crisis, and the increasing regulatory obligations have summoned forth, professional burnout rates have risen drastically. With good leadership, developing comprehensive programs to identify, track, and treat burnout symptoms and improve well-being in the work environment can result in greater work satisfaction and save resources.
Lorello GR, et al. Impact of the intersection of anaesthesia and gender on burnout and mental health. Anaesthesia. 2021;76 Suppl 4:24-31.
Keywords: COVID-19; Anaesthesia; Burnout; Gender; Gender equity; Mental health; Women.
Abstract
Physician burnout and poor mental health are prevalent and often stigmatised. Anaesthetists may be at particular risk and this is further increased for women anaesthetists due to biases and inequities within the specialty. However, gender-related risk factors for and experiences of burnout and poor mental health remain under-researched and under-reported. This negatively impacts individual practitioners, the anaesthesia workforce and patients and carries significant financial implications. We discuss the impact of anaesthesia and gender on burnout and mental health using the COVID-19 pandemic as an example illustrating how women and men differentially experience stressors and burnout. COVID-19 has further accentuated the gendered effects of burnout and poor mental health on anaesthetists and brought further urgency to the need to address these issues. While both personal and organisational factors contribute to burnout and poor mental health, organisational changes that recognise and acknowledge inequities are pivotal to bolster physician mental health.
Mendelsohn D. Self in medicine: Determinants of physician well-being and future directions in improving wellness. Med Educ. 2022;56(1):48-55.Context: Medicine, a profession dedicated to the wellness of patients, is struggling with a crisis of physician and trainee wellness. Physicians and trainees are burning out at alarming rates. Historically, medicine has been characterised by challenging working conditions and inattention to physician wellness and self-care. Healthy physicians are better at promoting wellness to their patients, and physicians who are suffering from burnout can deliver compromised patient care.
Discussion: In recent years, research has increasingly focused on the causes of unwellness among doctors, and a broad range of health determinants have been identified. Studies of interventions for improving trainee and physician wellness have identified individual-focused and organisational approaches that can address the root causes of burnout. Insights from the corporate workplace may help guide interventions. Strategies for addressing physician burnout and improving wellness will involve innovative and multifaceted approaches. Despite a growing emphasis of physician wellness in the literature, implementation of wellness interventions is lagging, and quality improvement methods can address these challenges.
Conclusion: Physician wellness is a shared responsibility among doctors, health care organisations and governing bodies. Addressing burnout and improving physician wellness will require transformational change and the embracement of a culture of wellness in medicine. Quality improvement methods are the next step in identifying effective wellness interventions and the targeted groups of physicians and trainees who will most benefit.
Sexton JB, Adair KC, Proulx J, et al. Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021. JAMA Netw Open. 2022;5(9):e2232748.Importance: Extraordinary strain from COVID-19 has negatively impacted health care worker (HCW) well-being.
Objective: To determine whether HCW emotional exhaustion has increased during the pandemic, for which roles, and at what point.
Design, setting, and participants: This survey study was conducted in 3 waves, with an electronic survey administered in September 2019, September 2020, and September 2021 through January 2022. Participants included hospital-based HCWs in clinical and nonclinical (eg, administrative support) roles at 76 community hospitals within 2 large health care systems in the US.
Exposures: Safety, Communication, Organizational Reliability, Physician, and Employee Burnout and Engagement (SCORE) survey domains of emotional exhaustion and emotional exhaustion climate.
Main outcomes and measures: The percentage of respondents reporting emotional exhaustion (%EE) in themselves and a climate of emotional exhaustion (%EEclim) in their colleagues. Survey items were answered on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree); neutral or higher scores were counted as "percent concerning" for exhaustion.
Results: Electronic surveys were returned by 37 187 (of 49 936) HCWs in 2019, 38 460 (of 45 268) in 2020, and 31 475 (of 41 224) in 2021 to 2022 for overall response rates of 74.5%, 85.0%, and 76.4%, respectively. The overall sample comprised 107 122 completed surveys. Nursing was the most frequently reported role (n = 43 918 [40.9%]). A total of 17 786 respondents (16.9%) reported less than 1 year at their facility, 59 226 (56.2%) reported 1 to 10 years, and 28 337 (26.9%) reported 11 years or more. From September 2019 to September 2021 through January 2022, overall %EE increased from 31.8% (95% CI, 30.0%-33.7%) to 40.4% (95% CI, 38.1%-42.8%), with a proportional increase in %EE of 26.9% (95% CI, 22.2%-31.8%). Physicians had a decrease in %EE from 31.8% (95% CI, 29.3%-34.5%) in 2019 to 28.3% (95% CI, 25.9%-31.0%) in 2020 but an increase during the second year of the pandemic to 37.8% (95% CI, 34.7%-41.3%). Nurses had an increase in %EE during the pandemic's first year, from 40.6% (95% CI, 38.4%-42.9%) in 2019 to 46.5% (95% CI, 44.0%-49.1%) in 2020 and increasing again during the second year of the pandemic to 49.2% (95% CI, 46.5%-51.9%). All other roles showed a similar pattern to nurses but at lower levels. Intraclass correlation coefficients revealed clustering of exhaustion within work settings across the 3 years, with coefficients of 0.15 to 0.17 for emotional exhaustion and 0.22 to 0.24 for emotional exhaustion climate, higher than the .10 coefficient typical of organizational climate (a medium effect for shared variance), suggestive of a social contagion effect of HCW exhaustion.
Conclusions and relevance: This large-scale survey study of HCWs spanning 3 years offers substantial evidence that emotional exhaustion trajectories varied by role but have increased overall and among most HCW roles since the onset of the pandemic. These results suggest that current HCW well-being resources and programs may be inadequate and even more difficult to use owing to lower workforce capacity and motivation to initiate and complete well-being interventions.
Ungar P, Schindler AK, Polujanski S, Rotthoff T. Online programs to strengthen the mental health of medical students: A systematic review of the literature. Med Educ Online. 2022;27(1):2082909.
Keywords: Medical students; mental health; online programs; prevention; promotion
Medical students have been shown to be vulnerable to mental stress. Strengthening individual protective characteristics can be one cornerstone for promoting medical students' mental health and thereby preventing mental disorders. Online programs are an opportunity to provide appropriate options that have the advantage of being accessible from anywhere, at any time, and with a low entry threshold. This review provides a literature overview of current online programs for medical students. The findings can serve as a point of reference for designing effective online programs for mental health-promotion and mental disorder-prevention in medical curricula. We applied a systematic literature search in PubMed, ERIC, Cochrane, and Web of Science. Programs offered had to be web-based, and the addressed group had to be medical students. Protective individual characteristics for mental health and information on the programs' effectiveness were included in the search. As outcomes, we included mental health, burnout, symptoms of depression, anxiety, and well-being. The search yielded 723 articles; of them, 11 met the inclusion criteria. Programs found were grouped according to their focus: mental health literacy, mindfulness, based on Cognitive Behavioral Therapy, or peer support. Two studies showed significant reductions in perceived stress; one study indicated reduced burnout levels. One program had significant immediate effects on mindfulness, empathy, and resilience; two studies indicated strengthening coping strategies. Two programs were qualitatively assessed as helpful; two studies are ongoing. Nine studies lacked control groups; two randomized controlled trials were ongoing. Only a few online programs with limited evidence of effectiveness were found. They addressed protective individual characteristics, highlighting their importance for mental health. Thus, more health-promoting and mental disorder-preventing programs with high-quality effectiveness studies are necessary. An integration of such programs into curricula would allow for greater utilization and could give greater emphasis to and prioritize mental health in medical education.
van der Wal RAB, Bijleveld E, Herwaarden AEV, Bucx MJL, Prins JB, Scheffer G. Chronic stress indicated by hair cortisol concentration in anaesthesiologists and its relationship to work experience and emotional intelligence: A cross-sectional biomarker andAbstract
Background: Anaesthesia is a stressful medical specialty. The reaction to stress is constituted by behavioural, psychological and physiological components. Chronic physiological stress can have negative consequences for health.
Objectives: First, we hypothesised that chronic physiological stress is higher for both beginning and late-career consultant anaesthesiologists. Second, we hypothesised that individuals high in emotional intelligence endure lower physiological stress.
Design: Cross-sectional biomarker and survey study.
Setting: Participants were recruited during the May 2019 annual meeting of the Dutch Anaesthesia Society.
Participants: Of the 1348 colleagues who attended the meeting, 184 (70 male/114 female) participated in the study. Of the study participants, 123 (67%) were consultant anaesthesiologists (52 male/71 female) and 61 (33%) were resident anaesthesiologists (18 male/43 female). Exclusion criteria were endocrine disorders and not having enough hair. Also, experience of a recent major life event led to exclusion from analysis of our hypotheses.
Main outcome measures: Chronic physiological stress was measured by hair cortisol concentration. Emotional intelligence was assessed using a validated Dutch version of the Trait Emotional Intelligence Questionnaire. As secondary measures, psychological sources of stress were assessed using validated Dutch versions of the home-work interference (SWING) and the effort-reward imbalance questionnaires.
Results: In support of Hypothesis 1, hair cortisol concentration was highest among early and late-career consultant anaesthesiologists (quadratic effect: b = 45.5, SE = 16.1, t = 2.8, P = 0.006, R2 = 0.14). This nonlinear pattern was not mirrored by self-reported sources of psychological stress. Our results did not support Hypothesis 2; we found no evidence for a relationship between emotional intelligence and physiological stress.
Conclusion: In the early and later phases of an anaesthesiologist's career, physiological chronic stress is higher than in the middle of the career. However, this physiological response could not be explained from known sources of psychological stress. We discuss these findings against the background of key differences between physiological and psychological stress.
Wang J, Song B, Shao Y, Zhu J. Effect of Online Psychological Intervention on Burnout in Medical Residents From Different Majors: An Exploratory Study. Front Psychol. 2021;12:632134.
Keywords: anxiety; burnout; depression; medical residents; psychological intervention; stress
Background: Work-related stress among healthcare professionals poses a serious economic and healthcare burden. This study aimed to investigate the prevalence of burnout as well as anxiety, depression, and stress in medical residents from different majors, and assess the effects of an online psychological intervention on the mental health status of medical residents with a high degree of burnout. Methods: We conducted an online survey that collected information on the demographics, mental health, and burnout conditions of medical residents from Shengjing Hospital. The mental health condition was assessed by the Depression, Anxiety, and Stress Scale (DASS)-21. Further, burnout was assessed by the Maslach Burnout Inventory (MBI). Medical residents with a total MBI score between 50 and 75 were selected to receive online psychological intervention for 3 months. Results: Two-hundred and ten medical residents completed the questionnaire, of whom, 63 residents with an MBI score between 50 and 75 received the 3-month online psychological intervention. Anesthesia residents showed the highest level of depression, anxiety, and stress, and presented with a lower sense of personal accomplishment, higher emotional exhaustion, and higher depersonalization. Furthermore, pediatric residents had the second highest DASS and MBI scores following anesthesia residents. Following the online psychological intervention, negative emotional states and burnout levels were significantly lower among anesthesia and pediatric residents. There were no differences in the level of stress and sense of personal accomplishment pre- and post-online psychological intervention among the different majors. Conclusion: Our findings revealed high levels of burnout, as well as depression, anxiety, and stress symptoms in medical residents, with marked differences among different majors. The online psychological intervention effectively improved emotional exhaustion, and depersonalization, and relieved the psychological problems such as anxiety and depression in medical residents.
Yetneberk T et al. The prevalence of burnout syndrome and its association with adherence to safety and practice standards among anesthetists working in Ethiopia. Ann Med Surg (Lond). 2021;69:102777.
Keywords: Anesthetist; Burnout; COR Crude Odds Ratio, MBI-HSS Maslach Burnout Inventory; Emotional exhaustion; Ethiopia; Human Service Survey
Background: Burnout amongst healthcare professionals is a serious challenge affecting health care practice and quality of care. The ongoing pandemic has highlighted this on a global level. This study aimed to determine the prevalence of burnout syndrome and its association with adherence to safety and practice standards among non-physician anesthetists in Ethiopia.
Methods: A cross-sectional survey was conducted amongst non-physician anesthetists throughout Ethiopia in January 2020 utilizing an online validated questionnaire containing sociodemographic characteristics, symptoms of burnout using the 22 items of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scale, 10 questions designed to evaluate the best practice of providers, and 7 questions evaluating self-reported errors. The MBI-HSS questions assessed depersonalization, emotional exhaustion, and personal accomplishment. A high level of burnout was defined as a respondent with an emotional exhaustion score ≥27, a depersonalization score ≥10, and a personal accomplishment score ≤33 in the MBI-HSS subscales. Bi-variable and multivariable logistic regression were used to identify factors associated with burnout.
Results: Out of a total of 650 anesthetists approached, 400 responded, a response rate of 61.5%. High levels of burnout were identified in 17.3% of Ethiopian anesthesia providers. Significant burnout scores were found in academic anesthetists (p = 0.01), and were associated with less years of anesthesia experience (p < 0.001), consuming >5 alcoholic drinks per week (p = 0.02), and parenthood (p = 0.01).
Conclusion: We found that non physician anesthetists working in Ethiopia is suffering by high levels of burnout. The problem is alarming in those working at academic environments and less experienced.
Rasmussen JM, Najarian MM, Ties JS, Borgert AJ, Kallies KJ, Jarman BT. Career satisfaction, gender bias, and work-life balance: a contemporary assessment of general surgeons. Journal of Surgical Education. 2021 Jan-Feb;78(1):119-125. doi: 10.1016/j.jsurg.2020.06.012.
Kaur B. Burnout recognition and mitigation in the context of a global pandemic. Paediatric Anaesthesia. 2021 Jan;31(1):8-9. doi: 10.1111/pan.14065.
Petrini LA, Thottathil P, Shih G, Henderson A, Pasquariello C, Black SA. Ask the question, be the solution: fostering wellbeing through contextualized assessment and strategy development.Paediatric Anaesthesia. 2020 Nov 20. doi: 10.1111/pan.14087.
Rodrigues H, Cobucci R, Oliveira A, Cabral JV, Medeiros L, Gurgel K, Souza T, Gonçalves AK. Burnout syndrome among medical residents: A systematic review and meta-analysis. PLoS One. 2018 Nov 12;13(11):e0206840. doi: 10.1371/journal.pone.0206840.
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Wilson G, Larkin V, Redfern N, Stewart J, Steven A. Exploring the relationship between mentoring and doctors' health and wellbeing: a narrative review.Journal of the Royal Society of Medicine. 2017;110(5):188-197. doi:10.1177/0141076817700848
Unadkat S, Farquhar M. Doctors' wellbeing: self-care during the covid-19 pandemic. British Medical Journal. 2020;368:m1150. Published 2020 Mar 24. doi:10.1136/bmj.m1150
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Llewellyn, A.Asking difficult questions in supervision, think RUOK? On the wards; Feb 9, 2017.
Rimmer A. I've noticed a change in my colleague's behaviour. what should I do? BMJ(Online). 2019;365. Request from Library
Mufarrih SH, Naseer A, Qureshi NQ, et al. Burnout, job dissatisfaction, and mental health outcomes among medical students and health care professionals at a tertiary care hospital in Pakistan: protocol for a multi-center cross-sectional study. Frontiers in Psychology. 2019;10:2552-2552.
Lawson ND. It is time to stop linking burnout, depression, and medical errors. Academic Medicine. 2020;95(1):11-11.
Physician burnout: the need to rehumanise health systems. The Lancet. 2019;394(10209):1591-1591.
Karp JF. Resident mental health: time for action. Anesthesiology. 2019;131(3):464-466.
Talbot SG. Physicians aren’t ‘burning out.’ They’re suffering from moral injury. STAT, First Opinion, July 26, 2018.
Kim DD, Kimura A Jr, Pontes DKL, Oliveira MLS, Cumino DO. Evaluation of anesthesiologists' knowledge about occupational health: pilot study. BMC Anesthesiology. 2018;18(1):193-193.
Canadian Anesthesiologists' Society. Healthy Anesthesiologist [Internet]. 2019. From: https://www.cas.ca/English/Healthy-Anesthesiologist. Accessed 6 March 2019.
Schäfer SK, Lass-Hennemann J, Groesdonk H, Volk T, Bomberg H, Staginnus M, et al. Mental health in anesthesiology and ICU staff: sense of coherence matters. Front. Psychiatry, 19 September 2018.
Prins DJ, van Vendeloo SN, Brand PLP, Van der Velpen I, de Jong K, van den Heijkant F, et al.The relationship between burnout, personality traits, and medical specialty. A national study among Dutch residents.Med Teach. 2018 Nov 3:1-7.
Dyrbye L, Shanafelt T.A narrative review on burnout experienced by medical students and residents.Med Educ. 2016;50(1):132-49.
Westbrook, J., Sunderland, N. Bullying and harassment of health workers endangers patient safety. The Conversation,Medical Observer, 5 November 2018, .
Robson, S.I was a young doctor, about to kill myself, when I heard a knock at my door.Sydney Morning Herald; 2 November 2018.
Victorian Institute of Forensic Medicine.Clinical Communique. 2018;5(3):10.
Special issue on clinician suicides.
Marr, J.#39;I needed it to look like an accident. A tired doctor falls asleep at the wheel and hits a tree' [article post]. Medical observer. Posted 24 August, 2017.
In this article GP Dr Jane Marr tells how one night, during a shift on a labour ward, she came close to suicide.
Murray R, Crotty B.What needs to happen to build resilience and improve mental health among junior doctors [article post]. The Conversation. Posted May 25, 2017.
Doctors experience higher levels of suicide and mental distress than their non-medical peers. A review of studies in the area found male doctors had a 26% higher risk of suicide, while female doctors had a 146% higher risk (more than double) than the general population...
Wiedersehn, Sarah.Anaesthetists conference: Medical professionals encouraged to speak up on mental health [article post]. Brisbane Times. Posted May 14, 2017.
A healthy anaesthetist means a healthier patient, which is why the topic of mental health among this "high-risk" group of doctors is being brought out in the open...
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