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The COVID-19 pandemic has imposed substantial burdens on clinicians and there is a need to better understand the impact on mental health and well-being. This scoping review investigates the prevalence of mental health concerns in anaesthetists, risk and protective factors for mental well-being, and anaesthetists' pandemic-related concerns and support. We searched online databases for articles published between January 2020 and May 2022, using search terms related to: anaesthesia; burnout, well-being, mental health or stress; and COVID-19. We identified 20 articles comprising 19 different populations of anaesthetists (n = 8680) from 14 countries. Studies identified the prevalence of the following condition in anaesthetists: burnout (14–59%); stress (50–71%); anxiety (11–74%); depression (12–67%); post-traumatic stress (17–25%); psychological distress (52%); and insomnia (17–61%). Significant risk factors for poorer mental health included: direct COVID-19-related issues (fear of self and family exposure to infection; requirement for quarantine); practitioner health factors (insomnia; comorbidities); psychosocial factors (loneliness; isolation; perceived lack of support at home and work); demographic factors (female gender; non-white ethnicity; LGBTQIA+); and workplace factors (redeployment outside area of clinical practice; increased work effort; personal protective equipment shortages). Protective factors identified included: job satisfaction; perceived organisational justice; older age; and male sex. Anaesthetists' self-reported concerns related to: personal protective equipment; resource allocation; fear of infection; fear of financial loss; increased workload; and effective communication of protocols for patient treatment. Support from family, colleagues and hospital management was identified as an important coping mechanism. Findings from this review may support the design of interventions to enhance anaesthetists' psychological health during pandemic conditions and beyond. Future research should include consistent psychological outcome measures and rigorous experimental design beyond cross-sectional studies.

The APAF Center for Workplace Mental Health (CWMH) provides employers with high-impact tools and resources to effectively address the mental health and well-being of employees and their families and provide actionable steps in creating a mentally healthy workplace. Through the Brave of Heart Fund, the Center was able to create Frontline Connect: Mental Health for the Healthcare Workforce. Frontline Connect is focused on improving access to mental health care for frontline healthcare workers. The high-impact video toolkit highlights effective strategies for healthcare leaders to improve access to timely and effective mental health care and to eradicate stigma and other barriers.

INTRODUCTION: Mentorship is an important aspect of medical education in providing students guidance and connections to new opportunities, ultimately leading to increased productivity and career satisfaction. The purpose of this study was to design and implement a formal mentoring program between medical students participating in their orthopedic surgery rotation and orthopedic residents to determine if this relationship improved students’ experiences during their rotation compared to students who were not mentored. DESIGN: Third- and fourth-year medical students rotating in orthopedic surgery and PGY2-PGY5 orthopedic residents at one institution were eligible to participate in a voluntary mentoring program between the months of July and February during 2016 to 2019. Students were either randomly paired with a resident mentor (experimental group) or not (unmentored control group). Anonymous surveys were distributed to participants at weeks 1 and 4 of their rotation. There were no minimum number of meetings required between mentors and mentees. RESULTS: Twenty-seven students (18 mentored, 9 unmentored) and 12 residents completed surveys during week 1. Fifteen students (11 mentored, 4 unmentored) and 8 residents completed surveys during week 4. While both mentored and unmentored students experienced an increase in enjoyment, satisfaction, and level of comfort at week 4 compared to week 1, the unmentored group demonstrated a greater overall increase. However, from the perspective of the residents, excitement for the mentoring program and the perceived value of mentoring decreased and 1 (12.5%) resident felt that it detracted from their clinical responsibilities. CONCLUSION: While formal mentoring enhanced the experience of medical students on orthopedic surgery rotations, it did not substantially improve medical student perceptions when compared to students who did not receive formal mentoring. The greater satisfaction and enjoyment observed in the unmentored group may be explained by informal mentoring that naturally occurs among students and residents with similar interests and goals.

BACKGROUND: Mentorship during residency training is correlated with improved outcomes. Many residency programs have implemented formal mentorship programs; however, reported data for these programs have not been previously synthesized. Thus, existing programs may fall short on delivering effective mentorship. Objective: To synthesize current literature on formal mentorship programs in residency training in Canada and the United States, including program structure, outcomes, and evaluation. METHODS: In December 2019, the authors performed a scoping review of the literature in Ovid MEDLINE and Embase. The search strategy included keywords relevant to mentorship and residency training. Eligibility criteria included any study describing a formal mentorship program for resident physicians within Canada or the United States. Data from each study were extracted in parallel by 2 team members and reconciled. RESULTS: A total of 6567 articles were identified through the database search, and 55 studies met inclusion criteria and underwent data extraction and analysis. Though reported program characteristics were heterogenous, programs most commonly assigned a staff physician mentor to a resident mentee with meetings occurring every 3 to 6 months. The most common evaluation strategy was a satisfaction survey at a single time point. Few studies performed qualitative evaluations or used evaluation tools appropriate to the stated objectives. Analysis of data from qualitative studies allowed us to identify key barriers and facilitators for successful mentorship programs. CONCLUSIONS: While most programs did not utilize rigorous evaluation strategies, data from qualitative studies provided insights into barriers and facilitators of successful mentorship programs, which can inform program design and improvement.

BACKGROUND: After-hours documentation burden among US clinicians is often uncompensated work and has been associated with burnout, leading health systems to identify root causes and seek interventions to reduce this. A few studies have suggested quality programme participation (e.g., Merit-Based Incentive Payment System [MIPS]) was associated with a higher administrative burden. However, the association between MIPS participation and after-hours documentation has not been fully explored. Thus, this study aims to assess whether participation in the MIPS programme was independently associated with after-hours documentation burden. METHODS: We used 2021 data from the National Electronic Health Records Survey. We used a multivariable ordinal logistic regression model to assess whether MIPS participation was associated with the amount of after-hours documentation burden when controlling for other factors. We controlled for physician age, specialty, sex, number of practice locations, number of physicians, practice ownership, whether team support (e.g., scribes) is used for documentation tasks, and whether the practice accepts Medicaid patients. RESULTS: We included 1801 office-based US physician respondents with complete data for variables of interest. After controlling for other factors, MIPS participation was associated with greater odds of spending a greater number of hours on after-hours documentation (odds ratio?=?1.44, 95% confidence interval 1.06-1.95). CONCLUSIONS: MIPS participation may increase after-hours documentation burden among US office-based physicians, suggesting that physicians may require additional resources to more efficiently report data.

Law enforcement officers are frequently subjected to highly stressful and traumatic situations with increased negative physical and mental health outcomes. Mindfulness is proposed as a means of improving self-reported physical or mental health outcomes, including depression, anxiety, burnout, and sleep disturbances. This meta-analysis aims to pool the results from studies evaluating mindfulness for police officers, providing an overall effect size for each outcome of interest. Through systematic review, four studies were identified for meta-analysis. Fixed and random inverse variance effects were used. Results indicate that mindfulness-based intervention programs likely decrease depression and may result in reductions of anxiety and burnout.

The current systematic review and meta-analysis focused on the effectiveness of mindfulness interventions for the mental resilience of police officers. The aim was to determine whether mindfulness can contribute to the increase of mental resilience of police officers by reducing stress-related complaints and/or psychological problems. Through an extensive literature search 651 potential relevant studies were found on EBSCO-host, PubMed and Web of Science. After selection, nine studies with at least a pre-post-intervention design were included in the systematic review and meta-analysis. Moderate effects were found for the effect of mindfulness interventions for police officers on reducing burnout, stress, depression and anxiety, and enhancing psychological health between pre- and post-measurements. The effects were less clear between pre- and follow-up measurements. For resilience the effects were not significant. In addition, no moderation effects were found for the type of mindfulness intervention, after how many weeks the follow-up measurement took place and the length of the mindfulness intervention. Mindfulness interventions seem effective for reducing burnout, stress, depression and anxiety, and for improving the psychological health of police officers in the short term. Mindfulness interventions do not seem effective in improving resilience due to problems with operationalization of the construct. Follow-up research is required so mindfulness interventions can be used more effectively within the target group.

OBJECTIVES: The potential usefulness of mindfulness-based interventions (MBIs) is being investigated for healthcare staff burnout and associated problems, but empirical research on MBI's for end-of-life (EOL) professionals is still in its infancy. The aim of this review is to describe and evaluate the body of evidence-based research on the use of MBIs to support the psychological wellbeing of professional staff in EOL care settings. METHODS: A systematic review of the literature was conducted. Database records were extracted from ERIC, PsycInfo, EBSCO, PubMed Central (PMC) and Web of Science, using search terms to locate peer-reviewed studies on professional (not volunteer) staff in dedicated end-of-life settings, administering MBIs not embedded in more general therapeutic modalities (such as ACT or DBT). After removing duplicates, 8701 potential studies were identified: eliminating those that did not fit the eligibility criteria reduced the number of eligible studies to six. RESULTS: A total of six empirical studies were identified and further evaluated. Interventions primarily focussed on reducing burnout symptoms, increasing self-care and self-compassion, and fostering mindfulness. Studies demonstrated very little overlap in treatment, methodology and measures. Only one study was a randomised control trial, which on application of the 3-item Jadad quality scoring, (evidence of randomisation, blinding of researcher to participants’ identity and accounts provided of all participants), achieved 1 out of 5 possible points. Furthermore, other concerns were identified as to the study's methodology. CONCLUSIONS: Results of this review point to significant gaps in the research on the potential of MBIs to improve the wellbeing of EOL professionals.

BACKGROUND: Female and racial/ethnic minority representation in surgical programs continues to trail behind other medical specialties. Various structural and perceived obstacles which contribute to a difficult path for underrepresented minority (URM) trainees have been identified, and efforts to reduce these hurdles are underway. Gaining perspective and insight from current surgical minority trainees may add valuable insight to aid with improving and innovating strategies to recruit and retain URM surgeons. OBJECTIVE: To characterize how race/ethnicity, cultural background, and gender affect the surgical training experience of URM surgical residents in all areas of surgery a focus on the field of Orthopedic Surgery, given its particularly poor rates of diversity. METHODS: Authors conducted semi-structured video interviews on current surgical residents or fellows who were members of underrepresented populations including Female, African-American/Black, Latino, Asian, Native American, and First or Second-generation immigrant status. Recruitment was achieved through a combination of voluntary, convenience, and snowball sampling procedures. Interview transcripts were then coded using conventional thematic analysis. Themes were iteratively expanded into subthemes and subsequently categorized utilizing a pile-sorting methodology. RESULTS: Among 23 surgical trainees 12 self-identified as Black (60.9%), 5 as Asian (17.4%), 1 as Hispanic (4.4%), and 5 as Caucasian (17.4%). Twelve residents identified as male (52%) and 11 as female (48%). Six surgical specialties were represented with the majority of participants (83%) being trainees in surgical subspecialties, among those orthopedic surgery was most strongly represented (57%). Analysis of their responses revealed 4 major themes: positive experiences, problems related to minority status, coping strategies, and participant suggested interventions. Themes were distilled further to sub-themes. Positive experiences' sub-themes included finding a supportive community, pride in minority status, and being able to better relate to patients. Negative experiences related to minority status' subthemes included perceived microaggressions and additional pressures, such as greater scrutiny and harsher punishments relative to their nonminority counterparts, which negatively impacted their surgical training. Most respondents did not feel there were dedicated resources to help alleviate these additional burdens, so some sought help outside of their training programs while others tried to assimilate, and others felt isolated. Recommended proposed interventions included validating the URM resident experience, providing education/training, and creating opportunities for mentorship. IMPLICATIONS/CONCLUSIONS: URM surgical trainees face numerous challenges related to their minority status. Recruitment and retention of URM in medicine would benefit from individual early and longitudinal mentorship, mitigating imposter syndrome, acknowledging the challenges faced by residents, and seeking feedback from both past and current residents.

This resource is found in our Actionable Strategies for Health Organizations: Promoting Diversity, Equity, & Inclusion.

International medical graduates (IMGs) represent 16% of general surgery residents.1 Mistreatment is common in general surgical training, particularly for non-White or Hispanic residents, and is associated with burnout.2 We assessed whether mistreatment and wellness differ between IMGs and US medical graduates in a national sample of general surgery residents.

In recent years, social workers have paid increased attention to ethical issues. The profession’s literature has burgeoned on topics such as ethical dilemmas in social work practice, ethical decision making, boundary issues and dual relationships, ethics-related risk management, and moral injury. This noteworthy trend builds on social work’s rich and long-standing commitment to the development of core values and ethical standards evident throughout its history. Unlike allied human service and behavioral health professions, social work’s ethics-related literature has not focused on the critically important issue of moral disengagement. Moral disengagement is typically defined as the process whereby individuals convince themselves that ethical standards do not apply to them. In social work, moral disengagement can lead to ethics violations and practitioner liability, particularly when social workers believe that they are not beholden to widely embraced ethical standards in the profession. The purpose of this article is to explore the nature of moral disengagement in social work, identify possible causes and consequences, and present meaningful strategies designed to prevent and respond to moral disengagement in the profession.

BACKGROUND: There is growing concern about moral distress and injury associated with the COVID-19 pandemic in healthcare professions. This study aimed to quantify the nature, frequency, severity and duration of the problem in the public health professional workforce. METHODS: Between 14 December 2021 and 23 February 2022, Faculty of Public Health (FPH) members were surveyed about their experiences of moral distress before and during the pandemic. RESULTS: In total, 629 FPH members responded, of which, 405 (64%; 95% confidence interval [95%CI] = 61–68%) reported one or more experience of moral distress associated with their own action (or inaction), and 163 (26%; 95%CI = 23–29%) reported experiencing moral distress associated with a colleague’s or organization’s action (or inaction) since the start of the pandemic. The majority reported moral distress being more frequent during the pandemic and that the effects endured for over a week. In total, 56 respondents (9% of total sample, 14% of those with moral distress), reported moral injury severe enough to require time off work and/or therapeutic help. CONCLUSIONS: Moral distress and injury are significant problems in the UK public health professional workforce, exacerbated by the COVID-19 pandemic. There is urgent need to understand the causes and potential options for its prevention, amelioration and care.

Pharmacists and other pharmacy personnel are experiencing job stress and burnout, and in some instances, suicidal ideation and death by suicide. However, the described lived experiences of pharmacists and other pharmacy personnel are not defined by burnout. Thus, consideration of and research about whether pharmacy personnel are possibly experiencing moral distress or moral injury is necessary and urgent. The pharmacy academy is served by considering workplace conditions and lived experiences of pharmacists because of the potential, negative impact on prospective student recruitment, quality of experiential sites and preceptors, sites for clinical faculty placement, and the well-being of alumni. Understanding phenomena occurring for pharmacy personnel and determining how they impact the pharmacy academy can lend itself to the future development of solutions.

[This is an excerpt.] Kolbe and de Melo-Martin (2023) describe fatal problems in current definitions and measurement of moral distress and injury (MD/I) in medical professionals, which impede development of genuine attempts at its prevention and treatment. We agree, and note that these problems are of particular consideration and concern for military medicine given the complementarity of professional duties borne by military healthcare professionals. [To read more, click View Resource.]

BACKGROUND: Emergency medical technicians (EMTs) or paramedics may not be able to do according to their moral standards during the COVID-19 pandemic, which can cause burnout and job dissatisfaction. 0BJECTIVES: This study aimed to evaluate moral distress (MD), job satisfaction, and burnout among EMTs during the COVID-19 pandemic. METHODS: This cross-sectional study was conducted in Bam, Iran in 2020. In total, 134 EMTs completed the online survey that included demographic information, a MD scale, the Maslach Burnout Inventory, and an item for assessing job satisfaction. Descriptive statistics along with independent samples t-test, one-way analysis of variance, Mann–Whitney U, and Kruskal–Wallis tests, as well as multiple linear regression analysis were used to analyze data. RESULTS: The mean scores of MD and job satisfaction were 25.44 ± 12.78 and 3.63 ± 1.07, respectively. Concerning severity, the mean scores of emotional exhaustion, depersonalization, and personal accomplishment (PA) were 35.45 ± 5.04, 20.61 ± 3.40, and 33.04 ± 4.07, respectively. All three burnout subscales were significantly correlated with job satisfaction (P < 0.05) and MD (P < 0.05). Access to personal protective equipment and education level significantly predicted MD (P < 0.05). CONCLUSION: Despite high burnout and moderate MD, EMTs reported high job satisfaction, possibly because of increased social respect and salary. EMTs can avoid MD and burnout by learning how to handle ethical challenges during the COVID-19 pandemic.

PURPOSE: Moral distress (MD) is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care. This study was initiated to explore associations between MD, burnout, and the organizational climate (OC) for oncology physician assistants (PAs). METHODS: A national survey of oncology PAs was conducted to explore the associations between MD, OC, and burnout. The Nurse Practitioner-Primary Care OC Questionnaire was revised for oncology PAs to assess OC for PA practice. MD and burnout were assessed using the Measure of MD-Healthcare Professionals (MMD-HP) and the Maslach Burnout Inventory. RESULTS: One hundred forty-six oncology PAs are included in the analysis. PAs were mostly female (90%), White/Caucasian (84%), married/partnered (78%), and in medical oncology (73%), with mean age 41.0 years. The mean MMD-HP score for oncology PAs was 71.5 and there was no difference in MD scores on the basis of oncology subspecialty, practice setting, practice type, or hours worked per week. PAs currently considering leaving their position because of MD had significantly higher mean scores on the MMD-HP compared with those not considering leaving their position (108.2 v 64.8; P = .001). PAs with burnout also had significantly higher mean scores for MD compared with PAs without burnout (97.6 v 54.3; P < .001). A negative relationship between OC for PA practice and MD was only found for the PA-administration relations subscale, whereas all subscales were negatively associated with burnout. CONCLUSION: This study demonstrates that the risk of professional burnout increases significantly with increasing levels of MD. Additional research exploring the relationship between MD and burnout is needed.

Moral Injury is a concept developing in psychology literature to review the impact of war on veterans and has especially focused on individual symptoms and finding clear diagnosis tools. This paper explores the connection between moral injury and the context in which they occur, a relationship that provides valuable understanding about the experience, but also the systemic factors that increase the vulnerability. The article begins by setting the groundwork for the discussion and introducing moral injury and its associate concepts. Part two explores the institutional dimension of moral injury and how an individual's professions can contribute to the injury. Part three proposes how moral injury insights can be implemented as guiding principles within peace and security, and particularly in peacekeeping missions. The final conclusion points to the context and the institutional system as the frame where personal reaction, values and systemic influences combine to produce moral injury. Therefore, looking for solutions to prevent and treat moral injury must acknowledge the true roots causes of distress that is not part of individualistic pathologizing mental health diagnosis.

[This is an excerpt.] Moral injury has been defined as the combined psychological, social, and spiritual impact of events involving violation of personal moral beliefs and values, especially in high-stress situations. 1 For centuries, this phenomenon has been experienced by military service members who perpetrated, witnessed, or failed to prevent acts that transgressed their own moral values or code of conduct. Examples include causing the deaths of civilians, following illegal or immoral orders, or failing to provide needed medical assistance. General mechanisms of moral injury include acts of commission, acts of omission, and betrayal. [To read more, click View Resource.]

INTRODUCTION: Ethical issues are pervasive in healthcare, but few specialties rival the moral complexity of transplant medicine. Transplant providers must regularly inform patients that they are no longer eligible to receive a potentially life-saving operation and the stress of these conversations poses a high risk of moral injury. Training in end of life counseling (EOLC) has been shown to significantly reduce provider stress and burnout. We hypothesized that training in EOLC reduces levels of moral injury among transplant providers. METHODS: This was a mixed methods study. A survey was administered to staff in the solid organ transplant department at the University of Kansas health-system. Providers indicated whether they had received training in EOLC and completed the standardized Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP). A two-sample, one-sided t-test compared levels of moral injury between trained and untrained staff. Subsequently, semi-structured interviews were conducted with transplant providers, and inductive coding followed by thematic network analysis was performed. RESULTS: Thirty-seven percent of respondents reported a moral injury score at or above the threshold for psychosocial dysfunctioning associated with moral injury. Analysis revealed no difference in moral injury scores between the trained and untrained groups (p=0.362, power=0.842). Ten participants were interviewed. Thematic network analysis demonstrated high-level themes of “challenges”, “training” and “stress relief”. CONCLUSIONS: Our study demonstrated a concerning prevalence of moral injury among transplant providers and suggested that EOLC training does not significantly mitigate the threat of moral injury.

[This is an excerpt.] Physicians make a promise, when joining this profession, to care for ill and injured patients, to the best of their ability, absent self-interest. Throughout training that obligation is ingrained in our every decision. Mentors and colleagues demand that we live up to the same exceptionally high standards they have maintained, or risk rebuke, shunning, and serious sanctions. Our patients believe our oath—that we will put their best interests ahead of personal or professional gain—and, as one author said, they “offer their trust as a gift.”2 In accepting the honor of such freely given vulnerability, most physicians strive, in every encounter, to be worthy of it. However, over the last three decades reimbursement and regulatory pressures have corporatized medicine. Physicians, small business/private practice owners in decades past, are now mostly employed and increasingly torn between their covenant with patients and the allegiance they owe to employers. When that rift is irreconcilable, the result can be moral injury. [To read more, click View Resource.]