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INTRODUCTION: During the 2020-2021 academic year, the Family Medicine (FM) faculty at David Grant USAF Medical Center (DGMC) incorporated Clinic First principles into the resident educational experience. The faculty hypothesized that these changes could improve symptoms of resident burnout. MATERIALS AND METHODS: The study was conducted at a single United States Air Force (USAF) FM residency program in California and was approved by the DGMC Institutional Review Board. The validated Maslach Burnout Inventory Human Services Survey for Medical Personnel was used to assess (1) emotional exhaustion, (2) depersonalization, and (3) personal achievement both prior to and following implementation of the Clinic First-inspired curriculum. Descriptive and inferential statistics were used to summarize the data. RESULTS: There were 25 eligible FM residents who participated in the study. At baseline, the mean scores on the Maslach Burnout Inventory Human Services Survey for Medical Personnel indicated moderate burnout across all 3 domains. There was a statistically significant difference (P?=?.03) in the mean EE score over time, demonstrating worsening exhaustion. There was no statistically significant difference (P?=?.37 and P?=?.08, respectively) in the mean DP or PA score over time. CONCLUSIONS: Residents in the DGMC FM residency program were experiencing moderate burnout at the beginning of the 2020-2021 AY. Due to unforeseen challenges, the Clinic First initiative was not realized in its full potential, and the curriculum changes did not definitively protect against burnout. Further study is indicated.

High educational debt is prevalent among resident physicians and correlates with adverse well-being outcomes, including symptoms of stress and burnout. Residents also report low financial literacy levels, affecting financial well-being. Understanding resident viewpoints toward financial well-being initiatives is crucial to develop targeted resident financial well-being programs. This study aims to examine residents’ experiences financing their medical education and how these experiences influence well-being and attitudes toward financial education in residency. We recruited residents from a Southern California health system with residency programs in Family Medicine, Internal Medicine, General Surgery, Orthopaedic Surgery, and Psychiatry. We contacted residents by email and text message to participate in semi-structured interviews. We conducted interviews from October 2020 to March 2021 and analyzed 59 resident interviews using reflexive thematic analysis. Among residents, 76% (45/59) had ? $200,000 in student loans. Residents perceived mounting medical education debt as unfairly burdensome for trainees engaged in socially beneficial work, leaving residents feeling undervalued – a feeling heightened by the stressors of the COVID-19 pandemic – and hampering well-being. Compartmentalizing debt attenuated financial stressors but often made financial education seem less pressing. A subset of residents described how financial planning restored some agency and enhanced well-being, noting that protected didactic time for financial education was crucial. Resident interviews provide practical guidance regarding designing financial education sessions. Desired education included managing debt, retirement planning, and the business of medicine. How residents framed educational debt and their degree of financial literacy impacted their well-being and sense of agency. Residents proposed that residency programs can aid in stress mitigation by providing residents with skills to help manage debt and plan for retirement. To reduce clinician indebtedness, this approach needs to occur in tandem with systemic changes to financing medical education.

Medical education is a time wrought with personal and professional stressors, posing serious challenges to maintaining student wellness. Extensive research has thus been conducted to identify these stressors and develop practical solutions to alleviate their harmful effects. This narrative review of quantitative and qualitative literature summarizes trends in student wellness and examines interventions deployed by medical schools to ameliorate student distress. Current trends indicate that mental illness, substance use, and burnout are more prevalent in medical students compared to the general population due to excessive academic, personal, and societal stressors. Pass/fail grading systems and longitudinal, collaborative learning approaches with peer support appear to be protective for student wellness. Additionally, maintaining enjoyable hobbies, cultivating social support networks, and developing resiliency decrease distress in medical students on an individual level. Faculty and administrator development is also a necessary component to ensuring student wellness. The COVID-19 pandemic has posed unique challenges to the medical education system and has stimulated unprecedented innovation in educational technology and adaptability. Particularly, the discontinuation of the clinical skill evaluation components for both osteopathic and allopathic students should be a focus of medical student wellness research in the future.

A majority of primary care physicians in the US and 9 other high-income countries report that they are burned out as a result of increased workloads since the emergence of the COVID-19 pandemic, with many saying it has affected the quality of care they provide, according to a new report from the Commonwealth Fund.In addition, nearly half of older primary care physicians in most of the countries surveyed said they plan to leave the workforce soon. Such an outflow of physicians working in primary care is especially concerning, the report said, because for 2 decades or more, the US and other countries were already “bracing for a shortage of physicians, a problem that has reached crisis proportions in recent years.”

[This is an excerpt.] In healthcare, listening to what employees tell you they need goes a long way. When workers feel like their feedback isn't being heard, they can become disengaged – a problem that can lead to increased turnover, negative patient experience scores and more. For HR teams, a successful engagement strategy begins with listening, a skill that should go beyond routine employee surveys. Listening should be centered on a comprehensive plan that includes both structured and unstructured conversations that consider the needs of all employees and leaders. Cleveland Clinic recently launched a new listening effort as part of the organization's four-part engagement strategy. The program, which is being introduced to employees in phases, begins with a leadership approach focused on three key elements: listening, connecting and developing. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Worker & Learner Engagement).

This guide shares twelve evidence-informed interventions for preventing suicide and improving mental well-being for the health care workforce.

This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Mental Health).

A second victim is a healthcare provider who has been involved in a critical event. A critical event is a clinical situation in which an unforeseen clinical outcome occurs, or the clinical deterioration of the patient takes place for many different reasons. The patient and his/her family are the first victims. The healthcare provider(s) involved in the event are second victims. After such an event, the healthcare provider may experience a constellation of negative emotions, such as guilt, sadness, depression, somatic symptoms, hypervigilance, and fear. Most second victims require support to cope with the adverse clinical situation. Many of the studies addressed in this integrative review, revealed that having a trusted colleague or staff member with whom to discuss the critical event is therapeutic. Some organizations have developed programs to support second victims in which specially trained staff members are deployed to discuss critical events with those involved, if the participant(s) desire the support. Other clinical facilities do not have established support programs; however, healthcare providers have expressed desire to discuss the critical event with supportive colleagues.

With the aging population and increasing number of cancer survivors contributing to a projected provider shortage, one solution is the specialization of nurse practitioners and physician assistants (part of the advanced practice provider [APP] workforce) in oncology. However, a lack of preparation in caring for the patient with cancer has led to burnout and stress in these groups. The authors studied an APP fellowship program to describe resilience, stress, and compassion in a transition-to-practice program and explore the experience of intentional, facilitated conversations. During 2019 and 2020, 18 APP fellows at a large, academic comprehensive cancer center participated in this descriptive study. The fellowship started in-person but changed to a virtual setting due to the COVID-19 pandemic. Resilience was measured through the Connor Davidson Resilience Scale 10, the Perceived Stress Scale, and the Professional Quality of Life Scale at four points in time: baseline, 6 months, 12 months, and 18 months. The experience of intentional, facilitated conversations was captured through simple theme collection as part of a standard program evaluation. Resilience, perceived stress, and compassion showed no statistical significance over the course of the fellowship. Evaluations of an intentional, facilitated conversation program found focal areas that included challenges, fatigue, empathy, relationships, role, self-awareness, and self-care. Despite the challenges of the pandemic on the health-care provider, the retention rate of APPs remained steady during the fellowship. The findings from this study suggested there was a benefit in an oncology fellowship for advanced practice and that intentional, facilitated conversations provide reflection and support during this experience.

[This is an excerpt.] The negative impact of burnout in health care is far-reaching. The direct physical and emotional manifestations in health-care workers are personally experienced and accordingly most widely recognized. However, the magnitude of downstream consequences for colleagues, critical care teams, hospitals, health care in general—and most importantly patients—is substantial and less well appreciated. [To read more, click View Resource.]

Sexual and/or gender minority health-care workers are subject to the heteronormativity and cisnormativity of society and often face open discrimination. Empowering these individuals to bring their full, authentic selves to work so that they can serve their patients and institutions with the totality of their strengths requires institutes and cisgender or straight allies to support LGBTQ+ communities by creating a culture of inclusivity and enacting progressive policies.

BACKGROUND: Previous systematic reviews have found high burnout in healthcare professionals is associated with poorer patient care. However, no review or meta-analysis has investigated this association in surgeons specifically. The present study addressed this gap, by examining the association between surgeon burnout and 1) patient safety and 2) surgical professionalism. METHODS: A systematic review was performed in accordance with PRISMA guidelines. We included original empirical studies that measured burnout and patient care or professionalism in surgeons. Six databases were searched (PsycINFO, Ovid MEDLINE(R), EMBASE, Cochrane Database, CINAHL, and Web of Science) from inception to February 2021. An adapted version of the Cochrane Risk of Bias tool was used to assess study quality. Meta-analysis and narrative synthesis were utilised to synthesise results. RESULTS: Fourteen studies were included in the narrative review (including 27,248 participants) and nine studies were included in the meta-analysis. Burnout was associated with a 2.5-fold increased risk of involvement in medical error (OR = 2.51, 95% Cl [1.68-3.72]). The professionalism outcome variables were too diverse for meta-analysis, however, the narrative synthesis indicated a link between high burnout and a higher risk of loss of temper and malpractice suits and lower empathy. No link was found between burnout and patient satisfaction. CONCLUSION: There is a significant association between higher burnout in surgeons and poorer patient safety. The delivery of interventions to reduce surgeon burnout should be prioritised; such interventions should be evaluated for their potential to produce concomitant improvements in patient safety.

[This is an excerpt.] The culture of surgical training has seen a significant shift in recent years to focus more on resident well-being and decreasing burnout. The Flexibility in duty-hour Requirements for Surgical Trainees trial reported an alarming rate of weekly burnout to be 39% among residents surveyed nationally and was also more prevalent among female trainces. Female surgeons face unique challenges including salary inequities, microaggressions, and unconscious bias that can contribute to burnout. Organizations such as the Association of Women Surgeons (AWS) were founded to gather and support female surgeons experiencing these unique challenges and inspire and encourage women surgeons to reach their professional and personal goals. In this isue of Annals of Surgery. Palamara et al' conducted a randomized controlled trial comparing the effectiveness of a virtual coaching program for female residents meant to increase wellbeing and decrease burnout as a collaborative effort with the AWS. Trainees were randomized into 3 professional development 1:1 virtual coaching sessions over a year as the intervention arm compared with emailed wellness resources as a control. The authors found significant improvement in well-being based on numerous standardized scales with excellent validity evidence, as well as a significant difference between the 2 arms on the Positive Emotion. Engagement, Relationship, Meaning, and Accomplishment scale. Coaching was provided by attending surgeons from the AWS after undergoing a 3-hour, in-person coaching training program that focused on the principles of positive psychology. [To read more, click View Resource.]

BACKGROUND: Virtually all surgeons will experience patient death in their practice. Despite this, little is known about how surgeons cope with patient death or its potential adverse impact on surgeons' wellbeing. Education on how to respond to loss is not often incorporated into current wellness curricula in surgical training. In light of the ongoing COVID-19 pandemic and the significant hospital-related mortality, understanding surgical provider response to patient loss takes on unique import. METHODS: A retrospective analysis was performed following administration of a 10-item survey that assessed healthcare provider (HCP) experience with patient death, activities used to cope with patient loss, and symptoms HCPs experienced. Participants included surgical faculty, residents, surgical advance practice providers and medical students on their surgical clerkship. Demographic characteristics were recorded: age, gender, academic level. Chi-squared test or Fisher exact test compared proportionality between those that did and did not experience patient loss. Logistic regression generated odds ratios examining impact of patient loss on symptoms experienced and activities engaged in after patient loss. RESULTS: : Fifty-six (75%) respondents experienced patient death. Common responses were to talk with colleagues (71%) and seek comfort from family/friends/partner (55%). Most respondents did not report symptoms related to patient death (53%); burnout was the most common symptom reported (36%). Respondents were less likely to seek interpersonal support for COVID-19-related death (P<0.008). Only 49% of participants received education on coping with patient death. CONCLUSIONS: Few surgeons receive training related to patient death. Optimal coping strategies are unknown but may mitigate potential negative impacts, including burnout. The data presented here also suggests the need to establish medical education designed to mitigate the distress associated with patient loss.

INTRODUCTION: In 2007, the first formal postgraduate nurse practitioner (NP) residency program was launched at Community Health Center, Inc., a large Federally Qualified Health Center in Connecticut, and focused on primary care and community health. There are numerous post-graduate nurse practitioner training programs across the nation, and many more are under development. Although the literature describes the impact of postgraduate residency training programs on new NPs' early practice transition, to date, no studies have examined the long-term impact of postgraduate NP training programs on alumni's career choices, practice, and satisfaction. This study sought to understand the impact over time of Community Health Center Inc.'s postgraduate NP residency program on the subsequent career paths of alumni who completed the program between 2008 and 2019. Additionally, it explored alumni's current reflections on the impact of their postgraduate residency training on their transition to the post-residency year and beyond, as well as their professional development and career choices. Moreover, it sought to identify any previously undocumented elements of impact for further exploration in subsequent studies. METHODS: This was a retrospective cohort study that used an electronic survey and interviews. All 90 of the alumni who had completed Community Health Center Inc.'s residency between 2008 and 2019 were invited to participate. RESULTS: The survey's response rate was 72%. Most (74%) of the participating alumni indicated they were still practicing as primary care providers. Of these, 57% were practicing at FQHCs. Nine subthemes were identified from the interviews, with an overarching theme that the program was foundational to a successful career in community-based primary care and that the impact of the program continues to evolve. CONCLUSION: Community Health Center Inc.'s postgraduate NP residency program had a long-standing impact on alumni's commitment to continuing in primary care practice, as well as their engagement in leadership activities to ensure quality care.

The TILES-2019 data set consists of behavioral and physiological data gathered from 57 medical residents (i.e., trainees) working in an intensive care unit (ICU) in the United States. The data set allows for the exploration of longitudinal changes in well-being, teamwork, and job performance in a demanding environment, as residents worked in the ICU for three weeks. Residents wore a Fitbit, a Bluetooth-based proximity sensor, and an audio-feature recorder. They completed daily surveys and interviews at the beginning and end of their rotation. In addition, we collected data from environmental sensors (i.e., Internet-of-Things Bluetooth data hubs) and obtained hospital records (e.g., patient census) and residents’ job evaluations. This data set may be may be of interest to researchers interested in workplace stress, group dynamics, social support, the physical and psychological effects of witnessing patient deaths, predicting survey data from sensors, and privacy-aware and privacy-preserving machine learning. Notably, a small subset of the data was collected during the first wave of the COVID-19 pandemic.

Burnout, a negative job-related psychological state particularly associated with the health professions, equates to a loss of valuable research in healthcare researchers. Team mindfulness, recognized to enhance personal fulfilment through work engagement, represents one important aspect found effective in reducing burnout. In a specific series of diverse membership academic meetings intended to reduce research burnout—employing writing prompts, doodling and continuous developmental feedback to do so—team mindfulness was demonstrated when conducted in person. Therefore, determining if team mindfulness is evident when holding such academic meetings online is relevant. When COVID-19 limitations required moving these academic meetings online, it was previously noted and reported that team mindfulness was affected in no longer being present during the first eighteen months of restrictions. To discover if this result persisted, question asking, doodles submitted and feedback responses were analyzed of the following year’s academic meetings for the same group, both quantitively and qualitatively. In finding the team mindfulness of these meetings additionally compromised the second full year, online practices actually found successful at creating and supporting team mindfulness—online games—are identified and considered. Concluding implications are noted and recommendations made regarding team mindfulness in reducing burnout for future online academic meetings.

OBJECTIVE: We examined the relationship of team and leadership attributes with clinician feelings of burnout over time during the corona virus disease 2019 (COVID-19) pandemic. METHODS: We surveyed emergency medicine personnel at 2 California hospitals at 3 time points: July 2020, December 2020, and November 2021. We assessed 3 team and leadership attributes using previously validated psychological scales (joint problem-solving, process clarity, and leader inclusiveness) and burnout using a validated scale. Using logistic regression models we determined the associations between team and leadership attributes and burnout, controlling for covariates. RESULTS: We obtained responses from 328, 356, and 260 respondents in waves 1, 2, and 3, respectively (mean response rate = 49.52%). The median response for feelings of burnout increased over time (2.0, interquartile range [IQR] = 2.0–3.0 in wave 1 to 3.0, IQR = 2.0–3.0 in wave 3). At all time points, greater process clarity was associated with lower odds of feeling burnout (odds ratio [OR] [95% confidence interval (CI) = 0.36 [0.19, 0.66] in wave 1 to 0.24 [0.10, 0.61] in wave 3). In waves 2 and 3, greater joint problem-solving was associated with lower odds of feeling burnout (OR [95% CI] = 0.61 [0.42, 0.89], 0.54 [0.33, 0.88]). Leader inclusiveness was also associated with lower odds of feeling burnout (OR [95% CI] = 0.45 [0.27, 0.74] in wave 1 to 0.41 [0.24, 0.69] in wave 3). CONCLUSIONS: Process clarity, joint problem-solving, and leader inclusiveness are associated with less clinician burnout during the COVID-19 pandemic, pointing to potential benefits of focusing on team and leadership factors during crisis. Leader inclusiveness may wane over time, requiring effort to sustain.

[This is an excerpt.] Has the routine physician’s office visit been permanently disrupted by telehealth? According to the J.D. Power 2022 U.S. Telehealth Satisfaction Study,^SM released today, a growing majority of consumers now say they prefer telehealth over in-person visits for a wide range of routine care, including prescription refills, reviews of medication options and to discuss medical results. Additionally, almost all—94%—of telehealth users say they would use the technology to receive medical services in the future. “Telehealth and digital technologies are transforming how patients seek and receive healthcare,” said Christopher Lis, managing director of global healthcare intelligence at J.D. Power. “Telehealth has the potential to increase access, convenience, care coordination and continuity, improve outcomes, and fill in gaps in provider coverage, particularly in underserved areas. As technology adoption and consumer demand continue to increase, it will be important to keep evaluating what’s working well and which areas need improvement, with the aim being to improve equitable access, quality of care and patient outcomes that complement in-person care.” [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Using Technology to Improve Workflows) 

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OBJECTIVES/GOALS: The objective of this study is to examine the associated changes in the EHR use patterns after the widespread implementation of telehealth in the ambulatory care setting after the COVID pandemic. METHODS/STUDY POPULATION: The study sample will be all attending ambulatory care physicians at UCSF Health. Signal measures captured by Epic Systems are markers of EHR use pattern that characterize EHR use at the individual provider level in terms of time spent performing certain activities, time spent at particular times of the day, and the number of EHR tools being used. We will use the Single Interrupted Time Series framework to analyze the changes in Signal measures that occur after the widespread implementation of telehealth with pre-telehealth time period defined as Jan 2018 – Feb 2020 and post-telehealth time period defined as March 2020 – present. RESULTS/ANTICIPATED RESULTS: The outcomes of this study will reveal how the increased use of telehealth following the COVID pandemic has changed the way providers utilize various functions within EHR (e.g. time in EHR at particular time of day, documentation, medication and non-medication orders, chart review, etc). These results can, in turn, inform us potential impacts of increased telehealth use on physician burnout given that a number of markers of EHR use pattern (i.e. Signal measures) in previous studies have been associated with burnout. In addition, a stratified version of Interrupted Time Series by specialty and clinical work volume may inform us how different subgroups of providers exhibit varying EHR use patterns in response to the increased use of telehealth. DISCUSSION/SIGNIFICANCE: The use of telehealth will likely remain a strong presence in health care delivery in the post-COVID era. This study can serve as a baseline study on the influence of telehealth on EHR use. Future studies may focus on potential targeted interventions to best support the usage of telehealth.

Healthcare workers, especially female employees, have historically been at an increased risk for occupational stress. During the early stages of the COVID-19 pandemic, many healthcare workers shifted to a telework model of care and started working from home (WFH). It is unclear how WFH impacted female healthcare employees’ job satisfaction and stress levels.