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[This is an excerpt.] The diversity of medical school classes has barely budged in recent decades, even with the ability to consider an applicant’s race as one factor in admissions. Now, many medical school leaders fear a looming U.S. Supreme Court decision to restrict or ban race-conscious admissions policies could lead to precipitous declines, imperiling efforts to fight the nation’s stark racial and ethnic health disparities. [To read more, click View Resource.]

OBJECTIVE: To determine whether students’ levels of resilience and self-reported wellness behaviors predicted burnout and grade point average at the end of the first fall semester of the COVID-19 pandemic. METHODS: We measured first-year students’ resilience, burnout (exhaustion and disengagement), and self-reported wellness behaviors (sleep, nutrition, social time, and self-care activities) at the beginning and end of the fall 2020 semester of pharmacy school. We also collected students’ demographic information and end-of-semester grade point average from their academic records. Using multivariable regression, we assessed whether students’ resilience and wellness behaviors predicted burnout and grade point average at the end of the semester. We also assessed for changes in burnout and wellness behaviors over time. RESULTS: Resilience was positively associated with older age and was lower among students of color. Exhaustion and disengagement were high at baseline and continued to worsen over time. Students’ self-reported wellness behaviors also decreased over time, except for ratings of sleep adequacy. Resilience predicted lower levels of disengagement at the end of the semester, but its relationship with exhaustion was inconsistent. The only wellness behaviors associated with lower burnout were nutrition and sleep adequacy. Students’ end-of-semester grade point average was also related to nutrition and sleep adequacy but not resilience or burnout. CONCLUSION: Resilience offered some protection from burnout, but its relationship to immutable factors suggests that individual-focused interventions to improve student well-being (e.g., wellness behaviors such as mindfulness meditation) should be complemented by organizational support, especially for younger students and students of color.

[This is an excerpt.] Interventional radiology physicians display some of the highest levels of mental and physical ailments among physicians. The American College of Radiology (2018) issued a statement noting that radiologists are at a higher risk for burnout than most other physicians. In addition to mental and emotional pain, interventional radiologists also commonly deal with chronic lower back pain. For many decades, physicians have tried everything from drugs and alcohol to psychological and physical therapy in an effort to solve these problems. In recent years, a growing body of evidence paired with an increased interest has led to spiritual approaches to address these mental, emotional, and physical ailments patients and physicians suffer alike. [To read more, click View Resource.]

[This is an excerpt.] Health care is undoubtedly approaching a critical inflection point. Clinicians across the country are questioning whether they can remain in a profession in which so much is expected of them, yet policies, resources, and infrastructure are not aligned to allow them to perform their best work in safe and sustainable ways. Clinicians must constantly adapt to unnecessarily complex information systems and cumbersome workflows to provide the best care for their patients. Instead of this inefficient and ineffective environment, we need systems designed for both human capacity and human limitations. [To read more, click View Resource.]

Physicians are experiencing epidemic levels of work-related stress and burnout. Determine efficacy of mindfulness meditation delivered as a hybrid (in-person and digital) format to reduce perceived stress in pediatric residents. Pediatric residents (n = 66) were block randomized to a hybrid Mindful Awareness Practices (MAPs) intervention, comprised of one in-person 60-min session and 6-week access to a digitally delivered MAPs curriculum (n = 27) or wait-list control (n = 39). Perceived Stress Scale (PSS) was administered at baseline and post-intervention as the primary outcome measure. A priori secondary outcomes were measured using the Abbreviated Maslach Burnout Inventory-9, Beck Depression Inventory, Beck Anxiety Inventory, UCLA Loneliness Scale, and Pittsburgh Sleep Quality Index. After the first session, 58% participated at least one digital session (M = 2.0; SD = 1.3). MAPs participants showed significant decrease in PSS compared to controls, with between-group mean difference of 2.20 (95% CI 0.47-3.93) at post-intervention (effect size 0.91; 0.19-1.62). No secondary outcome group differences were detected. Exposure to a hybrid mindfulness intervention was associated with improvement in perceived stress among pediatric residents.

OBJECTIVE: To determine the effects of a popular opinion leader (POL)-led organizational intervention targeting all physicians and advanced practice providers (APPs) working within clinic groups on professional fulfillment (primary outcome), gratitude, burnout, self-valuation, and turnover intent. PATIENTS AND METHODS: All 20 Stanford University HealthCare Alliance clinics with ≥5 physicians-APPs were matched by size and baseline gratitude scores and randomly assigned to immediate or delayed intervention (control). Between July 10, 2018, and March 15, 2019, trained POLs and a physician-PhD study investigator facilitated 4 interactive breakfast or lunch workshops at intervention clinics, where colleagues were invited to discuss and experience one evidence-based practice (gratitude, mindfulness, cognitive, and behavioral strategies). Participants in both groups completed incentivized annual assessments of professional fulfillment, workplace gratitude, burnout, self-valuation, and intent to leave as part of ongoing organizational program evaluation. RESULTS: Eighty-four (75%) physicians-APPs at intervention clinics attended at least 1 workshop. Of all physicians-APPs, 236 of 251 (94%) completed assessments in 2018 and 254 of 263 (97%) in 2019. Of 264 physicians-APPs with 2018 or 2019 assessment data, 222 (84%) had completed 2017 assessments. Modal characteristics were 60% female, 46% White, 49% aged 40 to 59 years, 44% practicing family-internal medicine, 78% living with partners, and 53% with children. Change in professional fulfillment by 2019 relative to average 2017 to 2018 levels was more favorable (0.63 points; effect size = 0.35; P=.001) as were changes in gratitude and intent to leave among clinicians practicing at intervention clinics. CONCLUSION: Interventions led by respected physicians-APPs can achieve high participation rates and have potential to promote well-being among their colleagues.

BACKGROUND: Engaging frontline clinicians and staff in quality improvement is a promising bottom-up approach to transforming primary-care practices. This may be especially true in federally qualified health centers (FQHCs) and similar safety-net settings where large-scale, top-down transformation efforts are often associated with declining worker morale and increasing burnout. Innovation contests, which decentralize problem-solving, can be used to involve frontline workers in idea generation and selection. OBJECTIVE: We aimed to describe the ideas that frontline clinicians and staff suggested via organizational innovation contests in a national sample of 54 FQHCs. INTERVENTIONS: Innovation contests solicited ideas for improving care from all frontline workers-regardless of professional expertise, job title, and organizational tenure and excluding those in senior management-and offered opportunities to vote on ideas. PARTICIPANTS: A total of 1,417 frontline workers across all participating FQHCs generated 2,271 improvement opportunities. APPROACHES: We performed a content analysis and organized the ideas into codes (e.g., standardization, workplace perks, new service, staff relationships, community development) and categories (e.g., operations, employees, patients). KEY RESULTS: Ideas from frontline workers in participating FQHCs called attention to standardization (n?=?386, 17%), staffing (n?=?244, 11%), patient experience (n?=?223, 10%), staff training (n?=?145, 6%), workplace perks (n?=?142, 6%), compensation (n?=?101, 5%), new service (n?=?92, 4%), management-staff relationships (n?=?82, 4%), and others. Voting results suggested that staffing resources, standardization, and patient communication were key issues among workers. CONCLUSIONS: Innovation contests generated numerous ideas for improvement from the frontline. It is likely that the issues described in this study have become even more salient today, as the COVID-19 pandemic has had devastating impacts on work environments and health/social needs of patients living in low-resourced communities. Continued work is needed to promote learning and information exchange about opportunities to improve and transform practices between policymakers, managers, and providers and staff at the frontlines.

INTRODUCTION: Inpatient Addiction Consultation Services (ACS) fill an important need by connecting hospitalized patients with substance use disorders with resources for treatment; however, providers of these services may be at risk for burnout. In this qualitative study, we aimed to identify factors associated with burnout and, conversely, resilience among multidisciplinary providers working on ACS. METHODS: We completed 26 semi-structured interviews with clinicians working on ACS, including physicians, social workers, and advanced practice providers. Twelve institutions across the country were represented. The study recruited participants via email solicitation to ACS directors and then via snowball sampling. We used an inductive, grounded theory approach to analyze data. RESULTS: Providers described factors contributing to burnout and strategies for promoting resilience, and three main themes arose: (1) Systemic barriers contributed to provider burnout, (2) Engaging in meaningful work increased resilience, and (3) Team dynamics influenced perceptions of burnout and resilience. CONCLUSION: Our results suggest that hospital-based addiction medicine work is intrinsically rewarding for many providers and that engaging with other addiction providers to debrief challenging encounters or engage in advocacy work can be protective against burnout. However, administrative and systemic factors are frequent sources of frustration for providers of ACS. Structured debriefings may help to mitigate burnout. Furthermore, training to enhance providers' ability to engage effectively in advocacy work within and between hospital systems has the potential to promote resilience and protect against burnout among ACS providers.

Shortages in the nursing, primary-care, and behavioral health workforces are an ongoing and widespread issue in the United States. This report assesses shortages in these health care workforces in the Commonwealth of Virginia and identifies potential interventions to address these shortages. The report is the culmination of the second and third phases of a larger study. In the first phase of the study, the Virginia Health Workforce Development Authority and its partners focused on initial data collection and analysis related to challenges faced by Virginia’s health care workforce. This report extends the first phase to identify specific interventions for (1) retaining existing health care workers, (2) recruiting first-time future health care workers, and (3) maximizing the ability of the Virginia health care workforce to meet the Commonwealth’s needs via structural efficiencies—for example, better geographic distribution of the Commonwealth’s workforce via economic and social policy interventions or telehealth practice. We identified interventions to improve retention, recruitment, and structural efficiency based on an environmental scan of peer-reviewed and grey literature; primary multi-stakeholder conference, interview, focus group, and survey data; and statistical analysis and simulation based on data from the Commonwealth and other relevant sources. Importantly, a wide variety of Virginia health care workforce stakeholders participated in and supported the research by attending the study conference, participating in interviews, focus groups, and serving on the study’s advisory board. The participation of these Virginia stakeholders was critical to identifying solutions that better fit Virginia’s specific health care workforce landscape and population needs. Appendixes A–H to this report, which provide details on the methods and analysis used for this research, are contained a separate annex, available at www.rand.org/t/RRA2093-1. This research was funded by the Virginia Health Workforce Development Authority (VHWDA) and carried out within the Access and Delivery Program in RAND Health Care. The Virginia General Assembly established VHWDA in 2010 in order to identify and address health workforce issues in the Commonwealth. As a public entity, VHWDA exercises public and essential governmental functions to secure the health, welfare, convenience, knowledge, benefit, and prosperity of Virginians. VHWDA’s mission is to “facilitate the development of a statewide health professions pipeline that identifies, educates, recruits, and retains a diverse, geographically distributed and culturally competent quality workforce” (VHWDA, undated-a). VHWDA accomplishes this through core functions outlined in the Code of Virginia (Virginia’s Legislative Information System, undated-c). RAND Health Care, a division of the RAND Corporation, promotes healthier societies by improving health care systems in the United States and other countries. We do this by providing health care decisionmakers, practitioners, and consumers with actionable, rigorous, objective evidence to support their most complex decisions.

BACKGROUND: COVID-19 pandemic introduced significant challenges that may have exacerbated healthcare worker (HCW) burnout. To date, assessments of burnout during COVID-19 pandemic have been cross-sectional, limiting our understanding of changes in burnout. This longitudinal study assessed change across time in pediatric HCW burnout during the COVID-19 pandemic and whether demographic and psychological factors were associated with changes in burnout. METHODS: This longitudinal study included 162 physicians, physician assistants, nurses, and medical technicians within the emergency department (ED), intensive care, perioperative, and inter-hospital transport services in a children’s hospital. HCW demographics, anxiety and personality traits were reported via validated measures. HCWs completed the Maslach Burnout Inventory in April 2020 and March 2021. Data were analyzed using generalized estimating equations. RESULTS: The percentage of HCWs reporting high emotional exhaustion and/or depersonalization burnout increased significantly across time (18.5% to 28.4%, P?=?0.010). Factors associated with increased emotional exhaustion included working in the ED (P?=?0.011) or perioperative department (P?

PURPOSE: The prevalence of physician burnout has risen and negatively impacts patient care, healthcare costs, and physician health. Medical students are heavily influenced by the medical teams they rotate with on the wards. We postulate that faculty well-being influences student perception of clerkships. METHODS: Medical student evaluations core clerkships at one academic institution were compared with results of faculty well-being scores over 2 years (2018–2020). Linear mixed models were used to model each outcome adjusting for year, mean faculty distress score, and the standard deviation (SD) of WBI mean distress scores. Clerkships and students were treated as random effects. RESULTS: Two hundred and eighty Well-Being Index evaluations by faculty in 7 departments (5 with reportable means and standard deviations), and clerkship evaluations by 223 students were completed. Higher faculty distress scores were associated with lower student evaluation scores of the clerkship (??0.18 per unit increase in distress, std. err?=?0.05, p?

[This is an excerpt.] After the COVID-19 pandemic, the expectations for employees and employers have shifted, and the approach to how and where people work has changed. For most organizations, hybrid work models, including virtual meetings and remote work, are likely here to stay. For surgeons, incorporating telehealth and hybrid virtual communications tools was valuable during this period, as it allowed for interaction with patients, trainees, and administration that otherwise would have been threatened. While the world is slowly recovering from this pandemic, workplaces are adjusting to this new normal. In medicine, particularly surgery, this unique ability to perform virtual work coupled with the numerous academic, clinical, and administrative tasks leads to record-breaking physician burnout and dissatisfaction. Physician burnout is characterized by emotional exhaustion, chronic stress, and a decreased sense of satisfaction and personal achievement. Burnout impacts the mental and physical health of physicians and correlates to increased all-cause mortality for patients. Prior studies have demonstrated that medical errors reported by surgeons were strongly related to their self-reported degree of burnout. [To read more, click View Resource.]

Compassion fatigue is a condition in which there is an inability to sympathize or feel compassion. Nurses have struggled with feelings of helplessness when caring for COVID-19 patients as well as dealing with the stress related to the unknowns of the disease and risk of spread. This article offers background information about the concept of compassion fatigue, synthesis of related literature, and describes the methods of a study that considered compassion fatigue, compassion satisfaction, and mindfulness. An intervention using the Headspace meditation application was created to improve compassion satisfaction, compassion fatigue, and mindfulness among hospital-based nurses. The study results and discussion describe how use of this application significantly impacted compassion satisfaction, compassion fatigue, and mindfulness in a small sample. This study was the first known to evaluate the impact of mobile meditation application use by acute care nurses on these concepts. The conclusion notes implications for research and practice, such as studies a larger and more diverse sample and comparisons of different meditation applications.

BACKGROUND: Burnout is a global concern for the healthcare community, especially following a disaster response. It is a major obstacle to providing safe and quality health care. Avoiding burnout is essential to ensuring adequate healthcare delivery and preventing psychological and physical health problems and errors among healthcare staff. AIMS: This study aimed to determine the impact of burnout on healthcare staff working on the frontline in a disaster context, including pandemics, epidemics, natural disasters, and man-made disasters; and to identify interventions used to mitigate burnout among those healthcare professionals before, during, or after the disaster. METHOD: A mixed methods systematic review was used and included a joint analysis and synthesis of data from qualitative and quantitative studies. The was guided by the preferred reporting items for systematic review and meta-analyses (PRISMA) of qualitative and quantitative evidence. Several databases were searched, for example, Medline, Embase, PsycINFO, Web of Science, Scopus, and CINAHL. The quality of included studies was assessed using the Mixed Method Appraisal Tool (MMAT), version 2018. RESULTS: Twenty-seven studies met the inclusion criteria. Thirteen studies addressed the impact of burnout in relation to disasters and highlighted the association between burnout and the physical or mental well-being of healthcare workers, work performance, and workplace attitude and behavior. Fourteen studies focused on different burnout interventions including psychoeducational interventions, reflection and self-care activities, and administering a pharmacological product. LINKING EVIDENCE TO ACTION: Stakeholders should consider reducing risk of burnout among healthcare staff as an approach to improving quality and optimizing patient care. The evidence points to reflective and self-care interventions having a more positive effect on reducing burnout than other interventions. However, most of these interventions did not report on long-term effects. Further research needs to be undertaken to assess not only the feasibility and effectiveness but also the sustainability of interventions targeted to mitigate burnout in healthcare workers.

BACKGROUND: The COVID-19 pandemic resulted in significant system strain, requiring rapid redeployment of nurses to intensive care units. Little is known about the impact of the COVID-19 pandemic and surge models on nurses. OBJECTIVE: To identify the impact of the COVID-19 pandemic on nurses working in intensive care units. METHODS: A scoping review was performed. Articles were excluded if they concerned nurses who were not caring for critically ill adult patients with COVID-19, did not describe impact on nurses, or solely examined workload or expansion of pediatric intensive care units. RESULTS: This search identified 417 unique records, of which 55 met inclusion criteria (37 peer-reviewed and 18 grey literature sources). Within the peer-reviewed literature, 42.7% of participants were identified as intensive care unit nurses, 0.65% as redeployed nurses, and 72.4% as women. The predominant finding was the prevalence of negative psychological impacts on nurses, including stress, distress, anxiety, depression, fear, posttraumatic stress disorder, and burnout. Women and members of ethnic minority groups were at higher risk of experiencing negative consequences. Common qualitative themes included the presence of novel changes, negative impacts, and mitigators of harm during the pandemic. CONCLUSIONS: Nurses working in intensive care units during the COVID-19 pandemic experienced adverse psychological outcomes, with unique stressors and challenges observed among both permanent intensive care unit and redeployed nurses. Further research is required to understand the impact of these outcomes over the full duration of the pandemic, among at-risk groups, and within the context of redeployment roles. ©2023 American Association of Critical-Care Nurses.

INTRODUCTION: The COVID-19 pandemic presented unpredicted challenges to Emergency Medicine (EM) education. The rapid onset of the pandemic created clinical, operational, administrative, and home-life challenges for virtually every member of the medical education community, demanding an educational and professional response at all levels including undergraduate medical education (UME), graduate medical education (GME), and faculty. The Council of Residency Directors in Emergency Medicine (CORD) COVID-19 Educational Impact Task Force was established in 2021 to examine these effects and the response of the EM educational community. METHODS: The Task Force utilized consensus methodology to develop the survey instruments, which were revised using a modified Delphi process. Both open- and closed-answer questions were included in the survey, which was initially distributed electronically to attendees of the 2021 Virtual Academic Assembly. Results were analyzed quantitatively and qualitatively. RESULTS: Sixty-three individuals responded to the first part of the survey (which addressed issues related to UME and GME) and 41 individuals responded to the second part of the survey (which addressed faculty and wellness). The pandemic’s influence on EM education was viewed in both a positive and negative light. The transition to virtual platforms had various impacts, including innovation and engagement via technology. Remote technology improved participation in didactics and allowed individuals to more easily participate in departmental meetings. However, this also led to a decreased sense of connection with peers and colleagues resulting in a mixed picture for overall engagement and effectiveness. The Task Force has developed a list of recommendations for best practices for EM programs and for EM organizations. CONCLUSION: The survey results articulated the educational benefits and challenges faced by EM educators during the COVID-19 pandemic. Through the challenging times of the pandemic, many institutional and program-based innovations were developed and implemented to address the new educational environment. These approaches will provide invaluable educational tools for future training. This will also prepare the EM academic community to respond to future educational disruptions.

The COVID-19 pandemic, and the responses to it that were required from frontline healthcare providers and others working in healthcare settings including environmental, clerical, and security staff, has challenged our healthcare systems in unprecedented ways. The threats to the financial, physical, and psychological well-being of healthcare professionals – many of whom entered the field due at least in part to a deep commitment to caring for and helping others – will have profound and long-lasting personal and professional impacts. Early in the pandemic response, healthcare professionals knew little about the risks they, their patients, and their loved ones faced from COVID-19 as they operated under crisis standards of care and without adequate supplies of personal protective equipment. As the pandemic response progressed, the lack of clear, science-based guidance, and the politicization of the pandemic presented new medical, ethical, and moral dilemmas. New psychological support mechanisms, including crisis counseling and evidence-based interventions, are needed for all workers in healthcare settings, regardless of their job role.

BACKGROUND: The first goal of this study was to assess longitudinal changes in burnout among psychotherapists prior to (T1) and during the COVID-19 pandemic (T2). The second objective was to assess the effects of job demands, job resources (including organizational support for evidence-based psychotherapies, or EBPs) and pandemic-related stress (T2 only) on burnout. METHOD: Psychotherapists providing EBPs for posttraumatic stress disorder in U.S. Department of Veterans Affairs (VA) facilities completed surveys assessing burnout, job resources, and job demands prior to (T1; n = 346) and during (T2; n = 193) the COVID-19 pandemic. RESULTS: Burnout prevalence increased from 40 % at T1 to 56 % at T2 (p < .001). At T1, stronger implementation climate and implementation leadership (p < .001) and provision of only cognitive processing therapy (rather than use of prolonged exposure therapy or both treatments; p < .05) reduced burnout risk. Risk factors for burnout at T2 included T1 burnout, pandemic-related stress, less control over when and how to deliver EBPs, being female, and being a psychologist rather than social worker (p < .02). Implementation leadership did not reduce risk of burnout at T2. LIMITATIONS: This study involved staff not directly involved in treating COVID-19, in a healthcare system poised to transition to telehealth delivery. CONCLUSION: Organizational support for using EBPs reduced burnout risk prior to but not during the pandemic. Pandemic related stress rather than increased work demands contributed to elevated burnout during the pandemic. A comprehensive approach to reducing burnout must address the effects of both work demands and personal stressors.

BACKGROUND: This clinical pharmacy on-call program (CPOP) is a 24-hour, in-house service provided by pharmacy residents. During shifts, challenging situations may arise, which may correlate with depression, anxiety, and stress. OBJECTIVE: This pilot study aims to describe the implementation of a debriefing program and characterize mental-health patterns of residents in the CPOP. METHODS: A structured debriefing process was developed to provide support to residents in the CPOP. Over a 1-year period, twelve outgoing pharmacy residents and ten incoming pharmacy residents completed a modified Depression Anxiety Stress Scale (mDASS-21) questionnaire and received a stress perception score (SPS) during debriefing. Data from first and final on-call shifts were compared via a paired Wilcoxon signed-rank test. Residents were referred to an Employee Assistance Program (EAP) based on mDASS-21 and SPS results. Scores from final on-call shifts were compared between residency classes via a Wilcoxon rank sum test. RESULTS: Following successful implementation, 106 debriefing sessions were completed. Pharmacy residents responded to a median number of 38 events per shift. Significant reductions in anxiety and stress scores were observed from the first and final on-call shifts. Six residents were referred to EAP. A lower incidence of depression, anxiety, and stress was observed in pharmacy residents who received debriefing compared to previous residents. CONCLUSION: The debriefing program provided emotional support to pharmacy residents participating in the CPOP. Implementation of debriefing demonstrated a reduction of anxiety and stress from the beginning to the end of the academic year and in comparison to the previous year.

Emergency medicine training is associated with high levels of stress and burnout, which were exacerbated by the COVID‐19 pandemic. The pandemic further exposed a mismatch between trainees' mental health needs and timely support services; therefore, the objective of our innovation was to create an opportunity for residents to access a social worker who could provide consistent coaching. The residency leadership team partnered with our graduate medical education (GME) office to identify a clinical social worker and professionally‐trained coach to lead sessions. The project was budgeted at an initial cost of $15,000 over 1 year. Residents participated in 49 group and 73 individual sessions. Post implementation in 2021, we compared this intervention to all other wellness initiatives. Resident response rate was 80.88% (n = 55/68) and median interquartile range (IQR) score of the initiative was 2 (1 = detrimental and 4 = beneficial) versus 3.79 (3.69–3.88) the median IQR of all wellness initiatives. A notable number, 22%, rated the program as detrimental, which could be related to summary comments regarding ability to attend sessions, lack of session structure, loss of personal/educational time, and capacity of the social worker to relate with them. Summary comments also revealed the innovation was useful, with individual sessions preferred to group sessions. Application of a social worker coaching program in an emergency medicine residency program appears to be a feasible novel intervention. Lessons learned after implementation include the importance of recruiting someone with emergency department/GME experience, orienting them to culture before implementation and framing coaching as an integrated residency resource.