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[This is an excerpt.] What is meant by the term “DEI,” and why is it important? One of the most popular acronyms in modern-day society carries with it not only meaning but also charge to action. Diversity, equity, and inclusion (DEI) are most commonly represented as an acronym, but it is much more than three letters or words. It seeks to represent the importance of ensuring that groups of people working toward a common goal are diverse in identity, thought, and experience. Beyond identity, however, operationalizing principles of DEI requires a commitment to justice, safety, and accountability (Fig. 1). [To read more, click View Resource.]

BACKGROUND: Several studies show that intense work schedules make health care professionals particularly vulnerable to emotional exhaustion and burnout. OBJECTIVE: In this scenario, promoting self-compassion and mindfulness may be beneficial for well-being. Notably, scalable, digital app–based methods may have the potential to enhance self-compassion and mindfulness in health care professionals. METHODS: In this study, we designed and implemented a scalable, digital app–based, brief mindfulness and compassion training program called “WellMind” for health care professionals. A total of 22 adult participants completed up to 60 sessions of WellMind training, 5-10 minutes in duration each, over 3 months. Participants completed behavioral assessments measuring self-compassion and mindfulness at baseline (preintervention), 3 months (postintervention), and 6 months (follow-up). In order to control for practice effects on the repeat assessments and calculate effect sizes, we also studied a no-contact control group of 21 health care professionals who only completed the repeated assessments but were not provided any training. Additionally, we evaluated pre- and postintervention neural activity in core brain networks using electroencephalography source imaging as an objective neurophysiological training outcome. RESULTS: Findings showed a post- versus preintervention increase in self-compassion (Cohen d=0.57; P=.007) and state-mindfulness (d=0.52; P=.02) only in the WellMind training group, with improvements in self-compassion sustained at follow-up (d=0.8; P=.01). Additionally, WellMind training durations correlated with the magnitude of improvement in self-compassion across human participants (ρ=0.52; P=.01). Training-related neurophysiological results revealed plasticity specific to the default mode network (DMN) that is implicated in mind-wandering and rumination, with DMN network suppression selectively observed at the postintervention time point in the WellMind group (d=–0.87; P=.03). We also found that improvement in self-compassion was directly related to the extent of DMN suppression (ρ=–0.368; P=.04). CONCLUSIONS: Overall, promising behavioral and neurophysiological findings from this first study demonstrate the benefits of brief digital mindfulness and compassion training for health care professionals and compel the scale-up of the digital intervention. Clinical Trial: Trial Registration:   International Standard Randomized Controlled Trial Number Registry ISRCTN94766568, https://www.isrctn.com/ISRCTN94766568

IMPORTANCE: Creating an inclusive and equitable learning environment is a national priority. Nevertheless, data reflecting medical students’ perception of the climate of equity and inclusion are limited. OBJECTIVE: To develop and validate an instrument to measure students’ perceptions of the climate of equity and inclusion in medical school using data collected annually by the Association of American Medical Colleges (AAMC). DESIGN, SETTING, AND PARTICIPANTS: The Promoting Diversity, Group Inclusion, and Equity tool was developed in 3 stages. A Delphi panel of 9 members identified survey items from preexisting AAMC data sources. Exploratory and confirmatory factor analysis was performed on student responses to AAMC surveys to construct the tool, which underwent rigorous psychometric validation. Participants were undergraduate medical students at Liaison Committee on Medical Education–accredited medical schools in the US who completed the 2015 to 2019 AAMC Year 2 Questionnaire (Y2Q), the administrations of 2016 to 2020 AAMC Graduation Questionnaire (GQ), or both. Data were analyzed from August 2020 to November 2023. EXPOSURES: Student race and ethnicity, sex, sexual orientation, and socioeconomic status. MAIN OUTCOMES AND MEASURES: Development and psychometric validation of the tool, including construct validity, internal consistency, and criterion validity. RESULTS: Delphi panel members identified 146 survey items from the Y2Q and GQ reflecting students’ perception of the climate of equity and inclusion, and responses to these survey items were obtained from 54 906 students for the Y2Q cohort (median [IQR] age, 24 [23-26] years; 29 208 [52.75%] were female, 11 389 [20.57%] were Asian, 4089 [7.39%] were multiracial, and 33 373 [60.28%] were White) and 61 998 for the GQ cohort (median [IQR] age, 27 [26-28] years; 30 793 [49.67%] were female, 13 049 [21.05%] were Asian, 4136 [6.67%] were multiracial, and 38 215 [61.64%] were White). Exploratory and confirmatory factor analyses of student responses identified 8 factors for the Y2Q model (faculty role modeling; student empowerment; student fellowship; cultural humility; faculty support for students; fostering a collaborative and safe environment; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation) and 5 factors for the GQ model (faculty role modeling; student empowerment; faculty support for students; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation). Confirmatory factor analysis indicated acceptable model fit (root mean square error of approximation of 0.05 [Y2Q] and 0.06 [GQ] and comparative fit indices of 0.95 [Y2Q] and 0.94 [GQ]). Cronbach α for individual factors demonstrated internal consistency ranging from 0.69 to 0.92 (Y2Q) and 0.76 to 0.95 (GQ). CONCLUSIONS AND RELEVANCE: This study found that the new tool is a reliable and psychometrically valid measure of medical students’ perceptions of equity and inclusion in the learning environment.

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BACKGROUND: The COVID-19 pandemic has challenged the mental health of health care workers, increasing the rates of stress, moral distress (MD), and moral injury (MI). Virtual reality (VR) is a useful tool for studying MD and MI because it can effectively elicit psychophysiological responses, is customizable, and permits the controlled study of participants in real time.

BACKGROUND: Hospital nurse practitioner (NP) turnover is costly and complex. PURPOSE: Provide a pre-COVID-19 pandemic baseline of hospital NP turnover. METHODS: A secondary analysis of NSSRN18 data on 6,558 (67,863 weighted) NPs employed in hospitals on 12/31/2017. We describe rates of turnover, intention to leave, and reasons for leaving or staying. Using multivariate logistic regression, we examine the association between individual and organizational characteristics and turnover. Survey weights and jackknife standard errors were applied to analyses. DISCUSSION: Approximately 10% of NPs left their job the following year, and 53% of NPs that remained considered leaving at some point. The top reasons cited for leaving or staying were largely organizational factors. Regression analysis revealed not practicing to one’s fullest scope, lower income, lack team-based care, and non-white race were associated with an increased likelihood to leave. CONCLUSION: We find several modifiable factors associated with hospital NP turnover that can be used to tailor recruitment and retention strategies.

[This is an excerpt.] The union membership rate--the percent of wage and salary workers who were members of unions--was 10.0 percent in 2023, little changed from the previous year, the U.S. Bureau of Labor Statistics reported today. The number of wage and salary workers belonging to unions, at 14.4 million, also showed little movement over the year. In 1983, the first year for which comparable data are available, the union membership rate was 20.1 percent and there were 17.7 million union workers.These data on union membership are collected as part of the Current Population Survey(CPS), a monthly sample survey of about 60,000 eligible households that obtains information on employment and unemployment among the nation's civilian noninstitutional population age 16 and over. For further information, see the Technical Note in this news release. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Empowering Workers & Strengthening Leadership and Governance (Strengthening Protections to Speak Up)

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BACKGROUND: To examine the effectiveness of interventions to ameliorate burnout, secondary traumatic stress, and emotional exhaustion in nurses and midwives. The systematic review was completed with all available studies that reported data on the effect of interventions that targeted burnout using the outcome measures of the Professional Quality of Life scale (ProQOL), or the Maslach Burnout Inventory (MBI). METHODS: We used a systematic review methodology, which included a meta-analysis. A total of 2103 articles resulted from the systematic search; 688 were removed as duplicates, and 1415 articles were reviewed by the title and abstract, of which 255 were eligible for full-text screening. Only 66 met the inclusion criteria and were included in the analysis. The final meta-analysis consisted of 33 reports divided into 12 studies for ProQOL and 21 studies for the MBI. RESULTS: The results provide an overall effect in studies using the ProQOL measurement was Z = 2.07 (P = 0.04) and a positive improvement mean difference of 9.32. The overall effect in studies using MBI was Z = 3.13 (P = 0.002) and a positive improvement mean difference of 6.58. CONCLUSIONS: Whilst most studies indicated a positive difference, the most effective interventions included clinical supervision or activities that addressed the personal physical and mental well-being of nurses. Less effective interventions were managerial interventions or ones that used a strictly educational approach.

Initiatives that promote mental well-being are formally recommended for all British workers, with many practices targeting change in individual workers' resources. While the existing evidence is generally positive about these interventions, disagreement is increasing because of concerns that individual-level interventions do not engage with working conditions. Contributing to the debate, this article uses survey data (N = 46,336 workers in 233 organisations) to compare participants and nonparticipants in a range of common individual-level well-being interventions, including resilience training, mindfulness and well-being apps. Across multiple subjective well-being indicators, participants appear no better off. Results are interpreted through the job demands–resources theory and selection bias in cross-sectional results is interrogated. Overall, results suggest interventions are not providing additional or appropriate resources in response to job demands.

Healthcare literature suggests that leadership behavior has a profound impact on nurse work-related well-being. Yet, more research is needed to better conceptualize, measure, and analyse the concepts of leadership and well-being, and to understand the psychological mechanisms underlying this association. Combining Self-Determination and Job Demands-Resources theory, this study aims to investigate the association between engaging leadership and burnout and work engagement among nurses by focusing on two explanatory mechanisms: perceived job characteristics (job demands and resources) and intrinsic motivation.

Ethics ratings of a diverse list of 23 professions are less positive than they have been in recent years, with eight establishing or tying record lows.

Burnout causes decreased job satisfaction, mental health issues, and leads to poor patient care. A large contributor is the electronic health record. Primary care providers from a medical group completed the Professional Fulfillment and Burnout Index survey showing high rates of burnout, and a scribe program was initiated. This quality improvement project evaluated the scribe program and its effects on burnout, documentation burden, and productivity for primary care physicians and nurse practitioners. Most participants had burnout. After using scribes, most had improved work-life balance. The scribe program was an important resource to prevent burnout related to the electronic health record.

OBJECTIVE: Burnout is a prevalent issue in healthcare. However, investigations into experiences of burnout among mainly administrative health systems’ personnel have not been conducted. Therefore, the purpose of this study is to evaluate burnout experiences among health systems’ personnel in administrative positions who do not medically treat patients as part of their daily work. METHODOLOGY: This is a mixed-methods study measuring burnout using an 18-question burnout scale and by conducting 23 semi-structured interviews. Mean responses and a correlation analysis of the survey results were conducted. Interview transcripts were coded using ATLAS.ti 22. FINDINGS: The quantitative results show low burnout scores. However, the interviews show that all administrative personnel had experienced burnout or stress, particularly during the COVID-19 pandemic. The COVID-19 pandemic, workload, and volatility drove burnout. Recognizing employees, promoting a strong work/life balance, and self-care practices may alleviate burnout. IMPLICATIONS: Similar to nurses and physicians, administrative health systems’ personnel are susceptible to burnout. Therefore, health systems’ leaders should cultivate strategies to mitigate and prevent burnout among administrative personnel. Additionally, this study uses interviews to obtain a context for survey results, unlike previous studies. Leaders should recognize not only clinicians but also administrative employees for their work to alleviate burnout. Additionally, leaders should promote work/life balance, especially among remote workers and attempt to reduce workload to mitigate burnout. ORIGINALITY: This research is unique because it focuses on experiences of burnout among health systems’ employees who do not treat patients as part of their daily work. Previous studies have focused on mainly nurses and physicians. However, this study shows that non-patient-facing health systems’ employees can also suffer from burnout.

IMPORTANCE: The murder of George Floyd in 2020 spurred an outpouring of calls for racial justice in the United States, including within academic medicine. In response, academic health centers announced new antiracism initiatives and expanded their administrative positions related to diversity, equity, and/or inclusion (DEI). OBJECTIVE: To understand the experiences of DEI leaders at US allopathic medical schools and academic health centers, ie, the structure of their role, official and unofficial responsibilities, access to resources, institutional support, and challenges. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used key informant interviews with participants who held formal DEI positions in their school of medicine, health system, or department. Interviews were conducted from December 2020 to September 2021. Transcripts were coded using a phenomenographic approach, with iterative concurrent analysis to identify thematic categories across participants. Data were analyzed from January to December 2021. EXPOSURE: Formal DEI role. MAIN OUTCOMES AND MEASURES: Questions elicited reflection on the responsibilities of the role and the strengths and challenges of the unit or office. RESULTS: A total of 32 participants (18 of 30 [56%] cisgender women; 16 [50%] Black or African American, 6 [19%] Latinx or Hispanic, and 8 [25%] White) from 27 institutions with a mean (range) of 14 (3-43) years of experience in medical education were interviewed. More than half held a dean position (17 [53%]), and multiple participants held 2 or more titled DEI roles (4 [13%]). Two-thirds self-identified as underrepresented in medicine (20 [63%]) and one-third as first generation to attend college (11 [34%]). Key themes reflected ongoing challenges for DEI leaders, including (1) variability in roles, responsibilities, and access to resources, both across participants and institutions as well as within the same position over time; (2) mismatch between institutional investments and directives, including insufficient authority, support staff, and/or funding, and reduced efficacy due to lack of integration with other units within the school or health system; (3) lack of evidence-based practices, theories of change, or standards to guide their work; and (4) work experiences that drive and exhaust leaders. Multiple participants described burnout due to increasing demands that are not met with equivalent increase in institutional support. CONCLUSIONS AND RELEVANCE: In this qualitative study, DEI leaders described multiple institutional challenges to their work. To effectively address stated goals of DEI, medical schools and academic centers need to provide leaders with concomitant resources and authority that facilitate change. Institutions need to acknowledge and implement strategies that integrate across units, beyond one leader and office. Policymakers, including professional organizations and accrediting bodies, should provide guidance, accountability mechanisms, and support for research to identify and disseminate evidence for best practices. Creating statements and positions, without mechanisms for change, perpetuates stagnation and injustice.

Between 2020-2023, many health systems and organizations created formal positions to improve diversity, equity, and inclusion (DEI) and health equity in response to social and health injustices and public demands for diversity and equity among executive level leadership. The National Academies Roundtable on the Promotion of Health Equity hosted an October 2023 public hybrid workshop to explore the successes and challenges of DEI and health equity C-suites, dimensions of DEI and health equity commitments, strategies for achieving internal and external goals, and potential metrics for measuring success.

GOAL: Clinician stress and resilience have been the subjects of significant research and interest in the past several decades. We aimed to understand the factors that contribute to clinician stress and resilience in order to appropriately guide potential interventions. METHODS: We conducted a scoping review (n = 42) of published reviews of research on clinician distress and resilience using the methodology of Peters and colleagues (2020). Our team examined these reviews using the National Academy of Medicine's framework for clinician well-being and resilience. PRINCIPAL FINDINGS: We found that organizational factors, learning/practice environment, and healthcare responsibilities were three of the top four factors identified in the reviews as contributing to clinician distress. Learning/practice environment and organizational factors were two of the top four factors identified in the reviews as contributing to their resilience. PRACTICAL APPLICATIONS: Clinicians continue to face numerous external challenges that complicate their work. Further research, practice, and policy changes are indicated to improve practice environments for healthcare clinicians. Healthcare leaders need to promote resources for organizational and system-level changes to improve clinician well-being.

Healthcare professionals, including occupational therapy practitioners, are experiencing epidemic levels of burnout. Professional organizations have prioritized research and programming to address burnout. This study evaluated the feasibility of an evidence-based virtual mindfulness continuing education program, Mindfulness at Work, and the mindfulness strategies participants learned and embedded into their workday. This program was developed and facilitated by an occupational therapist who is also a registered advanced yoga teacher. A total of 11 occupational therapy practitioners experiencing burnout met with the facilitator for once-weekly synchronous sessions over three weeks. OT practitioners were taught mindfulness strategies to use throughout their workday. Participants practiced the strategies at work between sessions and discussed their experiences during subsequent sessions. Aspects of the feasibility of both the program and the mindfulness strategies were measured post-only. Participant burnout was measured pre and post. Participants rated the virtual mindfulness continuing education program and mindfulness strategies as acceptable, appropriate, and feasible. There were significant decreases in pre- and post-test burnout scores during this preliminary evaluation. Attendance and retention rates were high. Eligibility criteria challenged recruitment capability.

PURPOSE OF REVIEW: Although financial wellness is a predictor of physician burnout, we are yet to optimize financial education or wellness of Urology trainees. We assessed existing studies, compared them to those of other specialties, and discussed resources and methods to address this deficiency. RECENT FINDINGS: Urology residents tend to be less fiscally savvy (carry significant debt, and lack retirement savings or disability insurance), and 90% of trainees and young Urologists do not feel comfortable with the business of practice, including skills like coding and billing, contract negotiation, and self-value assessment. SUMMARY: Financial and business literacy are deficiencies of Urology training, as in other specialties. Eventually, the goal should be universal adoption of a formal curriculum that is graded in nature. In the interim, we need to propose and endorse adoption of a formal curriculum, and we should support trainees by promoting a space for easily accessible and transparent information regarding best practices in personal finance and the business of healthcare.

[This is an excerpt.] Studies of physician well-being commonly use narrow measures like happiness, life satisfaction, mental health, or burnout. However, well-being is a complex and multifaceted construct. Flourishing offers promise as a holistic conceptualization of well-being, as it integrates eudaimonic, hedonic, psychological, social, and physical aspects of well-being. [To read more, click View Resource.]

Recent literature has explored the psychological well-being of physicians, addressing conditions like perfectionism, imposter phenomenon/syndrome (IP), depression, burnout, and, less frequently, magical thinking. But recognizing the connections among these psychological factors is vital for developing targeted interventions to prevent or alleviate their impact. This article examines the often-sequential emergence of these five conditions within a physician's career, with a specific emphasis on their prevalence among emergency physicians (EPs), who must manage a diverse array of acute illnesses and injuries. The descent into psychological distress initiates with magical thinking—in this case, the belief that perfection is possible despite evidence to the contrary—leading to the pursuit of maladaptive perfectionism. If unaddressed, this trajectory may lead to depression, burnout, and in some cases, suicide. Understanding this continuum lays the groundwork for devising a systematic approach to enhance physicians' mental health. The article delves into detailed descriptions of these psychological conditions, encompassing their prevalence, individual impact, how they are integrated into this continuum and potential preventive or corrective methods. Recognizing unrealistic expectations as a major contributor to burnout, depression, and even suicide within the medical profession, the article advocates for the development of targeted interventions and support structures to assist medical students and professionals in managing IP. Practical strategies involve acknowledging unrealistic expectations, setting attainable goals, seeking support, taking breaks, and prioritizing self-care. Addressing this pervasive issue aims to cultivate a culture where medical professionals can thrive, ensuring optimal care for patients.

COVID-19 put unprecedented strain on the health and care workforce (HCWF). Yet, it also brought the HCWF to the forefront of the policy agenda and revealed many innovative solutions that can be built upon to overcome persistent workforce challenges. In this perspective, which draws on a Policy Brief prepared for the WHO Fifth Global Forum on Human Resources for Health, we present findings from a scoping review of global emergency workforce strategies implemented during the pandemic and consider what we can learn from them for the long-term sustainability of the HCWF. Our review shows that strategies to strengthen HCWF capacity during COVID-19 fell into three categories: (1) surging supply of health and care workers (HCWs); (2) optimizing the use of the workforce in terms of setting, skills and roles; and (3) providing HCWs with support and protection. While some initiatives were only short-term strategies, others have potential to be continued. COVID-19 demonstrated that changes to scope-of-practice and the introduction of team-based roles are possible and central to an effective, sustainable workforce. Additionally, the use of technology and digital tools increased rapidly during COVID-19 and can be built on to enhance access and efficiency. The pandemic also highlighted the importance of prioritizing the security, safety, and physical and mental health of workers, implementing measures that are gender and equity-focused, and ensuring the centrality of the worker perspective in efforts to improve HCWF retention. Flexibility of regulatory, financial, technical measures and quality assurance was critical in facilitating the implementation of HCWF strategies and needs to be continued. The lessons learned from COVID-19 can help countries strengthen the HCWF, health systems, and the health and well-being of all, now and in the future.