Resource Library

The temporal progression and workload-related causal contributors to physician burnout are not well-understood.

Shortage of nurses on the ICU is not a new phenomenon, but has been exacerbated by the COVID-19 pandemic. The underlying reasons are relatively well-recognized, and include excessive workload, moral distress, and perception of inappropriate care, leading to burnout and increased intent to leave, setting up a vicious circle whereby fewer nurses result in increased pressure and stress on those remaining. Nursing shortages impact patient care and quality-of-work life for all ICU staff and efforts should be made by management, nurse leaders, and ICU clinicians to understand and ameliorate the factors that lead nurses to leave. Here, we highlight 10 broad areas that ICU clinicians should be aware of that may improve quality of work-life and thus potentially help with critical care nurse retention.

Sparse attention is paid in the psychoanalytic literature to the management of self-care needs of the analyst. I suggest that pandemic fatigue experienced by psychotherapists during the Covid-19 global crisis has thrown into bold relief the requirement for clinicians to attune to the body, particularly the requirement for rest and creative space. Physical and emotional exhaustion is multidetermined and not unique to this time period; the global crisis appears to have unmasked particular difficulties in sensing and tending to requirements of the body-mind. Changes observed in sleep, dreams, exercise, eating, and somatic states during the pandemic raise additional questions about modifiable risk factors of burnout. Drawing upon contemporary evidence emerging from the fields of cognitive psychology, neuroscience, and psychodynamic practice and theory, suggestions are made to assist the analyst in rendering essential self-care.

BACKGROUND: Before COVID-19, preclinical medical students traditionally attended didactic lectures in inperson settings. Due to social distancing, students were required to switch to online meeting platforms, such as Zoom. For medical students accustomed to in-person interactions, these changes may add more stress to the already stressful medical school experience. Furthermore, it was unclear if students’ stress levels were related to their preference for one learning modality over another. The purpose of this study was thus to explore associations between lecture modality (synchronous Zoom lectures versus live, in-person lectures) and stress in second-year medical students after they transitioned from a face-to-face learning experience to a fully online lecture platform. METHODOLOGY: Cross-sectional data were collected from 112 second-year medical students enrolled in a large U.S. medical school using an anonymous questionnaire delivered electronically via social media and emails. The survey contained items pertaining to students’ attitudes towards different types of lecture modalities and how they relate to personal stress. Descriptive data and Spearman’s rank correlation tests were conducted using IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp. RESULTS: This study examined correlations between preclinical medical school lecture delivery and personality type, stress levels, attendance, and burnout. Overall, no significance was found between mode of delivery and personality type. On the other hand, the mode of delivery significantly affected stress levels, attendance, and burnout. Moderate to strong correlations were found between the item “Zoom lectures have reduced stress compared to in-person lectures” and preference for Zoom, quality of education using Zoom compared to the in-person lectures, belief that Zoom lectures should continue as part of the curriculum delivery method, staying motivated with lectures fully online with Zoom, and liking that Zoom lectures save commute time to campus. CONCLUSIONS: Findings suggest that a fully online curriculum may play a role in reducing stress in medical students without compromising the quality of education.

Clinicians in health professional shortage areas (HPSAs) often work in practices with fewer resources and higher workloads, challenging recruitment and retention efforts. Nurse practitioners (NPs) frequently care for underserved patients in HPSAs. As a result, HPSA NPs may be susceptible to poor workforce outcomes, including burnout and job dissatisfaction. Using multiple logistic regression, our study assessed the relationship between the work environment and the odds of burnout and job dissatisfaction, and whether HPSA status moderated the relationship between a good work environment and lower odds of these negative outcomes. Consistent with prior research, we found that better work environments significantly decreased the odds of burnout and job dissatisfaction. Working in an HPSA was not associated with NP burnout or job dissatisfaction, nor did HPSA moderate the relationship between the work environment and NP job outcomes. Thus, improving work environments holds promise for reducing negative NP workforce outcomes regardless of HPSA designation.

Engaging in well-being behaviors may promote resilience, which can protect against burnout. This descriptive, correlational analysis utilized baseline data from health care workers enrolled in the Web-based Implementation of the Science for Enhancing Resilience longitudinal study (N?=?2,383). The study aimed to describe the association of (a) types of well-being behaviors (regular exercise, yoga, meditation, spent time with a close friend, vacation) and (b) total number of well-being behaviors with resilience (emotional thriving and emotional recovery), covarying for sociodemographic and professional characteristics. General linear model findings indicated that each well-being behavior was significantly associated with greater emotional thriving, while only exercise and spending time with friends were significantly related to greater emotional recovery. Emotional thriving and emotional recovery were also significantly higher among health care workers reporting more well-being behaviors. Engaging in well-being behaviors may be one part of the solution toward increasing resilience in health care workers that warrants further investigation.

Despite substantial research on medical student mistreatment, there is scant quantitative data on microaggressions in US medical education.

BACKGROUND: Primary care “teamlets” in which a staff member and physician consistently work together might provide a simple, cost-effective way to improve care, with or without insertion within a team.

OBJECTIVE: To determine the prevalence and performance of teamlets and teams.

DESIGN: Cross-sectional observational study linking survey responses to Medicare claims.

PARTICIPANTS: Six hundred eighty-eight general internists and family physicians.

INTERVENTIONS: Based on survey responses, physicians were assigned to one of four teamlet/team categories (e.g., teamlet/no team) and, in secondary analyses, to one of eight teamlet/team categories that classified teamlets into high, medium, and low collaboration as perceived by the physician (e.g., teamlet perceived-high collaboration/no team).

MAIN MEASURES: Descriptive: percentage of physicians in teamlet/team categories. Outcome measures: physician burnout; ambulatory care sensitive emergency department and hospital admissions; Medicare spending.

KEY RESULTS: 77.4% of physicians practiced in teamlets; 36.7% in teams. Of the four categories, 49.1% practiced in the teamlet/no team category; 28.3% in the teamlet/team category; 8.4% in no teamlet/team; 14.1% in no teamlet/no team. 15.7%, 47.4%, and 14.4% of physicians practiced in perceived high-, medium-, and low-collaboration teamlets. Physicians who practiced neither in a teamlet nor in a team had significantly lower rates of burnout compared to the three teamlet/team categories. There were no consistent, significant differences in outcomes or Medicare spending by teamlet/team or teamlet perceived-collaboration/team categories compared to no teamlet/no team, for Medicare beneficiaries in general or for dual-eligible beneficiaries.

CONCLUSIONS: Most general internists and family physicians practice in teamlets, and some practice in teams, but neither practicing in a teamlet, in a team, or in the two together was associated with lower physician burnout, better outcomes for patients, or lower Medicare spending. Further study is indicated to investigate whether certain types of teamlet, teams, or teamlets within teams can achieve higher performance.

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Optimizing Teams).

The Benefits of Self-Compassion in Mental Health Professionals: A Systematic Review of Empirical Research

BACKGROUND: In recent years, there has been increasing focus on the well-being of resident physicians. Considering the persistent problem of burnout and attrition particularly among surgical trainees, this is a well-warranted and laudable area of focus. However, despite the widespread adoption of resources available to residents through individual institutions, there is little understanding of how and why these resources are engaged or not during particularly vulnerable moments, such as following an unwanted patient event including postoperative complications and deaths. METHODS: This qualitative study explored access to and usage of resources to promote well-being following an unwanted patient outcome through semi-structured interviews of 28 general surgery residents from 14 residency programs across the United States, including community, academic, and hybrid programs. A qualitative descriptive approach was used to analyze transcripts. RESULTS: Residents described 3 main types of institutional resources available to them to promote well-being, including counseling services, support from program leadership, and wellness committees. Residents also described important barriers to use for each of these resources, which limited their access and value of these resources. Finally, residents shared their recommendations for future initiatives, including additional protected time off during weekdays and regular usage of structured debrief sessions following adverse patient outcomes. CONCLUSIONS: While institutional resources are commonly available to surgery residents, there remain important limitations and barriers to use, which may limit their effectiveness in supporting resident well-being in times of need. These barriers should be addressed at the program level to improve services and accessibility for residents.

The focus of this rapid response brief is on the birth doula workforce, which is the dominant type of doula discussed in the literature (other types of doulas not covered in this brief serve their clients through abortion or infant loss, death, and adoption among many others). Based on literature from January 2021, we found that: • The literature that has been published from January 2021-August 2022 on the birth doula workforce is limited, with many more studies focused on the association between doula services and perinatal outcomes. • The literature focused on the doula workforce identifies challenges that individual doulas face as part of their work, particularly doulas who identify as Black, Indigenous, and other People of Color (BIPOC)and/or Lesbian, Gay, Bisexual, Transgender, Queer, Intersex or Asexual (LGBTQIA). Until recently, a majority of those served by birth doulas, and doulas themselves, identified as White and cis-gendered. A growing number of doulas identifying as community-based doulas – who identify with and are often from the communities they serve – are working to expand access to services for underserved communities and are increasing racial and ethnic diversity within the doula field. • Challenges experienced by the doula workforce include witnessing and/or experiencing discrimination while working with their clients in a variety of healthcare settings, struggling with ineffective or inadequate payment models, meeting resistance when collaborating with other perinatal providers, feeling alienated from mainstream doula groups, and experiencing burnout.

The SARS-CoV-2 pandemic (COVID-19) dramatically increased the number of stressors on healthcare workers, including palliative care practitioners. Restrictions and increased demands on time made it difficult for the UMass Memorial Health palliative care team to utilize preexisting wellness strategies. In response to team members’ stress reactions, a buddy system intervention was conceived and implemented to restore a sense of connection and self-efficacy (Phase 1). Our objective with this quality improvement project was to assess the feasibility and effectiveness of the buddy system and evaluate staff attitudes toward this intervention. After four months, feedback from team members informed redesign to a more structured buddy system (Phase 2). A mixed-methods design of this project included a qualitative online survey along with quantitative data collection with the Professional Quality of Life Scale V (ProQOL V) and the Brief Resilience Scale (BRS) during Phase 1. Phase 2 was also evaluated quantitatively with ProQOL V and BRS. Semi-structured interviews were conducted at the end of this project to enhance qualitative data on staff attitudes and beliefs. Of the 12 study participants, 10 completed all phases of the study. Participants reported the buddy system was a useful, easy-to-implement intervention for mitigating personal distress and compassion fatigue (CF) by providing a strong sense of support and connection to team members.

The objectives of this study were to examine the prevalence of burnout, specify contributors to and protective factors against burnout, and gather suggestions to improve well-being in psychiatry Program Directors.

[This is an excerpt.] Early career (EC) cardiologists within the first 7 years of graduation represent a unique professional group. Faced with the task of building a practice on the professional front and raising a family on the personal front, many EC cardiologists encounter several simultaneous challenges. Entering independent practice, defining a clinical niche, meeting clinical productivity targets,1 launching a research career, obtaining research funding, and potential lack of mentorship2 are some of the professional challenges EC cardiologists face. EC cardiologists may have to navigate numerous personal challenges such as sustaining a successful marriage,3 supporting a family, raising children, paying student debt, and planning for a strong financial future. Although each of these challenges is unique in its own way, striking a balance between busy professional schedules and parental responsibilities remains pivotal to ensuring success on both fronts. These parenting challenges have been further amplified for physician parents during the COVID-19 pandemic, given the disruption to daycare routines, with subsequent parental anxiety.4,5 Although some previous studies evaluated the challenges of pregnancy during residency and fellowship training,6-8 these studies did not explore the parenting challenges beyond childbirth and are not uniformly applicable to physicians in practice. A paucity of literature addresses parenting challenges of EC physicians, and data are even more sparse in the field of cardiology. [To read more, click View Resource.]

Nurse burnout is a threat to safe, efficient health care delivery, yet estimated rates of nurse burnout are above 40 %. A critical step in reducing burnout is identifying phenomena that are amenable to intervention. Loneliness may be one such factor, yet the relationship between loneliness and burnout is not clearly described. This review aims to summarize existing literature documenting this connection. A systematic search was performed to identify studies reporting a relationship between burnout and loneliness with social support serving as a proxy construct. Twenty-four articles met inclusion criteria: 18 quantitative, two mixed-methods, and four qualitative studies. These studies identified a relationship between burnout and social support, with social support explaining approximately a third of the variability in burnout. Qualitative data suggest that social support is critical to coping with work stressors and is likely related to burnout. This review provides evidence that reducing nurse loneliness is a promising strategy for improving nurse wellbeing.

The culture of modern surgical training is difficult to quantify in absolute terms. We aim to provide context by examining the origin of surgical residency in the early twentieth century and how it evolved over time. In order to understand the culture underlying surgical training, three main stakeholders are identified including patients, surgeons, and residents. The relationships between these parties are explored, and common value systems are discussed. We examine modern barriers that residents face in the work environment and highlight the ways in which they contribute to burnout and attrition among surgical trainees. Positive and negative aspects of the hierarchical training structure and work dynamics inherent in surgical residency are analyzed. Mentorship is identified as a key component of the modern surgical education framework, though limitations exist in the scope of mentorship offered to trainees by attending surgeons. We discuss important realities of worldwide heterogeneity in surgical training culture and specifically utilize case examples highlighting differing surgical educational experiences in regions with limited resources. Limitations are highlighted acknowledging significant contributions from North American, European, and Australian groups to the body of literature cited in this chapter. Herein, we provide a snapshot of modern surgical culture. This chapter spans the inception of surgical residency programs, followed by key stakeholders and interprofessional relationships that are central to surgical training, and finally discusses surgical resident working conditions, power dynamics, and mentorship.

The lingering COVID pandemic has left the nursing profession in a particularly vulnerable state. Nursing burnout, turnover, increased workload, and the lack of professional development opportunities have become workplace dissatisfiers. The “Great Resignation Era” created large turnover and vacancy rates within inpatient hospital units. To mitigate staffing shortages, nurse leaders were challenged to balance large cohorts of new graduate orientees while also motivating and engaging seasoned nurses with leadership opportunities. Traditional orientation pathways proved to be unsuccessful during this unique climate and warranted more creative measures to balance the needs of both new graduates and seasoned nurses.

Challenges among trainees can impact their surgical education, their ability to provide quality patient care, and the training program as a whole. The extent to which trainees in difficulty are identified and addressed can serve as a barometer for the culture of a program. As such, it is incumbent upon residency and fellowship program directors to take interest in better understanding their trainees at an individual level, and the collective fabric of their training program at a systems level. This chapter explores the dimensions of difficulties in training, focusing both on trainees who present with difficulties through their interactions and behavior, and contrasting this with residents who may also find themselves in difficulty by virtue of external stressors. The overall goal of this chapter is to examine and identify an approach to ensuring the wellbeing of individual trainees, and that of a training program collectively. Educators must ensure that trainees meet their clinical and professional competencies, as well as the goals of the surgical training program. To train a generation of thoughtful and adept surgeons, it is essential to address difficult trainees and focus on cultivating professional behaviours within a positive training environment.

[This is an excerpt.] Burnout is pervasive in the medical community. Like most U.S. medical students, I went straight from university to medical school without a break. As a third-year medical student, I reached my breaking point. Academically, things were fine, but behind that façade, my life had become so scholastically slanted that I could no longer recognize myself. I stopped exercising, quit my favorite hobbies, and neglected my family and friends. I had become caught in the “academic current”—a collective group ambition that, when appropriately harnessed, spurs scientific breakthroughs and drives clinical mastery, but when left unchecked, can pull trainees under. At a proverbial fork in the river, I decided to get out of the water. [To read more, click View Resource.]

BACKGROUND: Physician burnout is a major problem in the United States. Small studies suggest scribes can improve clinician satisfaction, but scribe programs have not been evaluated using separate control groups or structured measures of electronic health record (EHR) use. METHODS: We conducted a pre-post, non-randomized controlled evaluation of a remote scribe pilot program introduced in September 2019 in an academic primary care practice. Scribes were paired with physicians via an audio-only cellphone connection to hear and document in real-time. Physician wellness was measured with the 10-item Mini-Z and 16-item Professional Fulfillment Index. EHR use was measured using vendor-derived platforms that provide routine EHR-related data. RESULTS: 37 of 38 scribe users (97.4%) and 68 of 160 potential control physicians (42.5%) completed both pre and post intervention questionnaires. Compared with controls, scribe users had improvements in Mini-Z wellness metrics including Joyful Workplace (mean improvement 2.83, 95%CI 0.60, 5.06) and a single-item dichotomized burnout measure (OR 0.15, 95%CI 0.03, 0.71). There were significant reductions among scribe users compared to controls in total EHR time per 8 scheduled hours (?1.14 h, 95%CI -1.55, ?0.72), and an increase in the percentage of orders with team contribution (10.4%, 95%CI 5.2, 15.6). These findings remained significant in adjusted analyses. CONCLUSIONS/IMPLICATIONS: A remote scribe program was associated with improvements in physician wellness and reduced EHR use. Healthcare organizations can consider scribe programs to help improve wellness among their physician workforce.