BACKGROUND: Arts-and-humanities-based interventions are commonly implemented in medical education to promote well-being and mitigate the risk of burnout. However, mechanisms for achieving these effects remain uncertain within graduate medical education. The emerging field of the positive humanities offers a lens to examine whether and how arts-based interventions support well-being in internal medicine interns. AIM: Through program evaluation of this visual art workshop, we used a positive humanities framework to elucidate potential mechanisms by which arts-based curricula support well-being in internal medicine interns. SETTING: We launched the re-FRAME workshop at the Philadelphia Museum of Art in winter 2020. PARTICIPANTS: Fifty-six PGY-1 trainees from one internal medicine residency program. PROGRAM DESCRIPTION: The 3-h re-FRAME workshop consisted of an introductory session on emotional processing followed by two previously described arts-based interventions. PROGRAM EVALUATION: Participants completed an immediate post-workshop survey (91% response rate) assessing attitudes towards the session. Analysis of open-ended survey data demonstrated 4 categories for supporting well-being among participants: becoming emotionally aware/expressive through art, pausing for reflection, practicing nonjudgmental observation, and normalizing experiences through socialization. DISCUSSION: Our project substantiated proposed mechanisms from the positive humanities for supporting well-being-including reflectiveness, skill acquisition, socialization, and expressiveness-among medical interns.
Extending Arts-Based Interventions in Graduate Medical Education through the Positive Humanities: the Re-FRAME Workshop
BACKGROUND: Burnout among millennial medical students is an important health issue with a possibility of potential professional dissatisfaction. The reason for burnout is multifactorial. The gender of the medical student may play a significant role when choosing a residency specialty and making a career choice. Gender may also influence while establishing the burnout seen in students. Here we tested the association between burnout in medical students based on gender and residency specialty choice during COVID-19. METHODS: A multicentric cross-sectional study, using a questionnaire-based survey on the items related to gender, educational interest, status, residency aspiration, changes to career aspiration based on gender, and COVID-19 and an indigenous burnout assessment tool that was administered to all the medical students in the study. Reliability and validity of the tool were assessed, and the burnout was calculated for emotional exhaustion, personal achievement, and depersonalization domain. RESULTS: A total of 487 medical students (42.5% males, 57.2% females) completed the survey. A higher number of female participants felt that COVID-19 affected their energy levels (68.9%), interest in education (53.2%), and developed reservations about residency specialty of choice (46%); emotional and physical exhaustion (2.88 ± 0.69 & 2.34 ± 0.76) was higher than the male participants (3.16 ± 0.67 & 2.75 ± 0.85). CONCLUSION: More female participants experienced emotional distress, depersonalization or professional disengagement, and psychological and physical stress and exhaustion due to the COVID-19 pandemic. An important association observed in the study was between residency choice and burnout.
Factors Influencing Burnout in Millennial Medical Students During the COVID-19 Pandemic!
BACKGROUND: There has been considerable research into burnout but much less into how surgeons thrive and find joy. This study, conducted by the SAGES Reimagining the Practice of Surgery Task Force, explored factors influencing surgeon well-being, the eventual goal being translating findings into tangible changes to help restore the joy in surgery. METHODS: This was a qualitative, descriptive study. Purposive sampling ensured representation across ages, genders, ethnicities, practice types, and geographies. Semi-structured interviews were recorded and transcribed. We coded inductively, finalized the codebook by consensus, and then constructed a thematic network. Global themes formed our conclusions; organizing themes gave additional detail. Analysis was facilitated by NVivo. RESULTS: We interviewed 17 surgeons from the US and Canada. Total interview time was 15 hours. Our global and organizing themes were: Stressors (Work–life Integration, Administration-related Concerns, Time and Productivity Pressures, Operating Room Factors, and Lack of Respect). Satisfaction (Service, Challenge, Autonomy, Leadership, and Respect and Recognition). Support (Team, Personal Life, Leaders, and Institutions). Values (Professional and Personal). Suggestions (Individual, Practice, and System level).Values, stressors, and satisfaction influenced perspectives on support. Experiences of support shaped suggestions. All participants reported stressors and satisfiers. Surgeons at all stages enjoyed operating and being of service. Supports and suggestions included compensation and infrastructure, but human resources were most critical. To experience joy, surgeons needed high-functioning clinical teams, good leaders/mentors, and supportive family/social networks. CONCLUSIONS: Our results indicated organizations could (1) better understand surgeons’ values, like autonomy; (2) provide more time for satisfiers, like patient relationship building; (3) minimize stressors, like time and financial pressures; and (4) at all levels focus on (4a) building teams and leaders and (4b) giving surgeons time and space for healthy family/social lives. Next steps include developing an assessment tool for individual institutions to build “joy improvement plans” and to inform surgical associations’ advocacy efforts.
Factors Influencing Surgeon Well-Being: Qualitatively Exploring the Joy of Surgery
OBJECTIVES: Describe demographic and professional factors predictive of burnout in academic otolaryngology before and during the COVID-19 pandemic. METHODS: In 2018 and 2020, cross-sectional surveys on physician wellness and burnout were distributed to faculty members of a single academic institution's otolaryngology department. Faculty were dichotomized into low and high burnout groups for 2018 (n = 8 high burnout, 19%) and 2020 (n = 11 high burnout, 37%). To identify protective factors against burnout, three semi-structured interviews were conducted with faculty that reported no burnout. RESULTS: Forty-two participants (59%) in 2018 and 30 out of 49 participants (62%) in 2020 completed the survey. In multivariate analysis of 2018 survey data, full and associate professors had significantly lower odds of high burnout (OR 0.06, 95% CI 0.00–0.53; p = .03). Female gender was associated with increased in odds of high burnout (OR 15.55, 95% CI 1.86–231.74; p = .02). However, academic rank and gender did not remain independent predictors of high burnout in the 2020 survey. We identified significant differences in drivers of burnout brought on by the pandemic, including a shift from a myriad of work-related stressors in 2018 to a focus on patientcare and family obligations in 2020. Interview analysis identified three themes in faculty who reported no burnout: (1) focus on helping others, (2) happiness over compensation as currency, and (3) gratitude for the ability to have an impact. CONCLUSION: Approximately 20% of faculty reported high burnout before the pandemic, and this proportion nearly doubled during the pandemic. The risk factors and themes identified in this study may help academic otolaryngologists prevent burnout.
Factors Related to Wellness and Burnout in Academic Otolaryngology: A Pre- and Post-COVID-19 Analysis
[This is an excerpt.] A literature review exploring factors influencing the intent of nurse managers employed in acute care settings to leave their current positions identifies five major themes: organizational support, job satisfaction, work-life balance, personal characteristics, and burnout. [To read more, click View Resource.]
Factors that Influence Nurse Managers' Intent to Leave: An Integrative Literature Review
Pharmacy faculty commonly report feeling stressed, overwhelmed, exhausted, and burnt out. Women may be disproportionally impacted by personal and professional demands. The purpose of this commentary is to describe one mechanism for creating a suborganization (Circle) that establishes a supportive community to combat burnout and promote professional fulfillment. This commentary is a description of one American Academy of Colleges of Pharmacy (AACP) Women Faculty Special Interest Group (SIG) Circle. The authors describe how one Circle sought to enhance the well-being of its members through the various domains of the Stanford Model of Professional Fulfillment, including personal resilience, workplace efficiency, and creating a culture of well-being. Circles and similar frameworks may be effective tools for combatting burnout, improving fulfillment, and promoting wellness and well-being among women and other groups of faculty.
Feeding the Soul via Creation of a Suborganization to Promote a Sense of Community
PURPOSE: Professional identity formation (PIF) is a dynamic process by which an individual internalizes the core values and beliefs of a specific profession. Within medical education, PIF begins in medical school and continues throughout training and practice. Transitions affect PIF, with a critical transition occurring between medical training and unsupervised practice. This study aims to characterize PIF during the transition from resident to early-career faculty physician and explores the relationship between PIF and burnout during this transition. METHOD: The authors conducted a qualitative study using constructivist grounded theory. They conducted semistructured interviews with early-career faculty physicians (defined as practicing for ≤ 5 years) from the Department of Medicine, Mayo Clinic. Deidentified interview transcripts were processed through open and axial coding. The authors organized themes and identified relationships between themes that were refined through discussion and constant comparison with newly collected data. During data analysis, the authors identified self-determination theory, with the concepts of autonomy, competence, and relatedness, as a framework to support the organization and analysis of the data. RESULTS: Eleven early-career faculty physicians participated in the interviews. Their PIF was characterized by the dual desires to fit in and stand out. Striving for these desires was characterized by imposter syndrome, driving physicians to question their decision making and overall competence. Participants associated imposter syndrome and academic pressures with burnout. Autonomy support by the institution to pursue opportunities important for career development helped mitigate burnout and support PIF. CONCLUSIONS: Early-career faculty physicians face identity challenges when transitioning from training to unsupervised practice, including striving to fit in and stand out. They link this tension to imposter syndrome, which they associated with burnout. Institutional awareness and support, including addressing structural and cultural contributors to imposter syndrome, are paramount as new faculty explore their identities and navigate new challenges.
Fitting In While Standing Out: Professional Identity Formation, Imposter Syndrome, and Burnout in Early-Career Faculty Physicians
[This is an excerpt.] A new bargaining chip appeared on the table as hospital employees in Iowa negotiated a new contract with the University of Iowa Hospitals and Clinics—protection from patient attacks. Iowa’s increase in non-fatal workplace injuries and illnesses among registered nurses echoed national trends with a 32.9 percent increase in violence-related workplace injury and illness in nurses from 2019 to 2020. Across the US, violent assaults in health care are rising; three nurses were killed at work in the fall of 2022. One hospital-based analysis shows two nurses are assaulted every hour. The statistics are alarming and disturbing. The COVID-19 pandemic increased patient violence toward nurses and health care workers; in one survey, 27 percent of nurses reported more incidents during the pandemic than previously. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Government: Ensuring Workers' Physical and Mental Health (Strengthen Occupational Safety and Health Policies).
Five Urgent Steps To Address Violence Against Nurses In The Workplace
[This is an excerpt.] A mental health pandemic exists in nurses, the entire health workforce, health sciences faculty, and students as the nation and world recover from the COVID-19 pandemic. Depression, suicide rates, and burnout have skyrocketed in these populations, resulting in presenteeism, absenteeism, and high job turnover as well as substantial collegiate drop-out rates that are costing both healthcare and educational institutions huge economic losses. Findings from research also have shown strong positive associations among clinician burnout, mental health issues, and preventable medical errors (Melnyk et al., 2021). Promoting the mental health and well-being of the healthcare workforce, as well as health sciences faculty and students is not a nicety; it is a necessity as people's lives are at stake. [To read more, click View Resource.]
Fixing Broken Systems and Unhealthy Cultures in Healthcare and Educational Institutions Is Key to Improving the Mental Health and Well-Being of Nurses, the Healthcare Workforce, Faculty, and Students
[This is an excerpt.] During the COVID-19 pandemic, pharmacists’ roles were expanded. Pharmacists have constantly been on the front line, administering COVID-19 vaccines and providing treatment. With these added responsibilities, there is often a trade-off—especially when adequate support isn’t provided. This can lead to burnout, a workplace phenomenon characterized by emotional exhaustion and lack of personal accomplishment at work. In May 2022, the US surgeon general issued an advisory report to address health worker burnout and resignation. The report emphasizes the importance of protecting the health, safety, and well-being of health workers. Pharmacists should have a variety of tools at their disposal to prevent, identify, and cope with burnout. [To read more, click View Resource.]
For Pharmacists, Building Resilience and Well-Being Is Critical
This chapter explores the evolution of a mindfulness-based program that began as a patient-focused pilot study and developed into a hospital-wide staff-focused program. Initially, a mindfulness-based program was adapted and studied to measure its impact on stress and coping in a group of adolescents with implanted cardiac devices. The positive outcomes of this study led to a larger randomized study in the same patient population. With continued positive outcomes, a larger, train-the-trainer model was designed and implemented. This program trains hospital staff in mindfulness techniques with the goal of decreasing their own stress and burnout while ultimately reaching and benefitting larger groups of patients and nonclinical staff through greater mindful awareness and education of staff. The program has had a hospital-wide impact including tremendous support from hospital administration. In addition to outlining background and specifics of the nurse-led model, this chapter describes the processes that were undertaken to develop and implement the program.
From Patient Studies to a Hospital-Wide Initiative: A Mindfulness Journey
OBJECTIVES: This study explored design solutions that can help clinicians manage work-related stress, pursue mindful work, and practice relaxation and coping strategies. BACKGROUND: Clinicians are experiencing burnout at increasingly higher rates, leading to compromised patient care. While self-care and stress management strategies are shown to be effective in healthcare settings, little is known about how the design of healthcare settings can facilitate these strategies. METHODS: Using findings of a preceding study by the authors, a virtual walk-through video of a design proposal for a free-standing emergency department was built. Feedback data were collected from clinicians in 10 in-depth interviews, and emerging themes were identified using qualitative content analysis. RESULTS: Our findings suggest that work environments that reflect intentional efforts to meet clinicians? needs for stress management can enhance their feeling of being valued and sense of professional worth. Clinicians are more likely to step away from work if there are multiple spaces for bio breaks and rest breaks. Primary break rooms are preferred to be close to patient care areas, but respite/escape spaces are preferred to be distant and private from patient care areas. Participants endorsed the provision of at least one staff bathroom large enough for extra seating and one outdoor respite space. Multiple workspaces should allow the completion of various tasks with adjustable levels of privacy. CONCLUSIONS: We suggest special attention to non-institutional aesthetics, providing choice and control, increasing flexibility, promoting privacy for focused work, maximizing access to daylight and outdoors, and providing opportunities for grief support.
From Stressful to Mindful: Reactions to a Proposed Emergency Department Design for Enhancing Mindfulness and Stress Reduction Among Healthcare Clinical Staff
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Frontline Connect: Mental Health for the Healthcare Workforce
BACKGROUND: Full practice authority (FPA) improves clinical autonomy for nurse practitioners (NPs). Autonomy may reduce burnout. PURPOSE: Estimate the effect of changing from reduced or restricted practice authority to FPA on NP burnout. METHODS: In this quasi-experimental study, we compared NP burnout before (2016) and after (2018) a Veterans Health Administration (VHA) regulation authorized NP FPA. Burnout proportions were estimated for VHA facilities by aggregating responses to the VHA's All Employee Survey from 1,352 primary care NPs. DISCUSSION: Seventy-seven percent of facilities changed to FPA postregulation. Burnout was six points lower among NPs in facilities that changed to FPA compared to facilities that had FPA prior to the regulation; however, this association was not statistically significant. CONCLUSION: NPs are increasingly working under independent practice. While changing to FPA did not reduce NP burnout, this association may vary by health care setting or when burnout is measured for individuals or teams.
Full Practice Authority and Burnout Among Primary Care Nurse Practitioners
Health care is a $4 trillion component of the US economy, and the well-being of the clinician workforce is a major factor determining its effectiveness. Extensive evidence indicates that inefficiency, poorly designed workflows and processes, suboptimal teamwork, work overload, isolation, problems with work-life integration, and a professional culture that expects perfection and discourages help-seeking are currently contributing to high levels of occupational distress among clinicians. Although the problem and its impact on the health care delivery system are well defined, there is minimal evidence regarding effective interventions to drive progress. This knowledge gap is, in large part, due to the near-complete absence of federal funding for research to address one of the critical challenges facing the US health care delivery system.
Funding Research on Health Workforce Well-being to Optimize the Work Environment
INTRODUCTION: Burnout among physicians has reached an epidemic level, with substantially higher rates among women. In this brief report, the authors evaluate recent literature to identify major factors leading to gender differences in physician burnout. METHODS: The authors review data on gender within each of the key drivers of burnout, including workload and job demands, efficiency and resources, control and flexibility, organizational culture and values, social support and community at work, work-life integration, and meaning at work. RESULTS: Women physicians face a higher workload, spending more time in electronic health records, and more time per patient. Women physicians also receive fewer resources and report less control over their workload and schedules. Organizational culture factors, such as a lack of women in leadership roles, compensation disparities, lower rates of career advancement and academic promotion, as well as gender bias, microaggressions, and harassment, also play a key role in gender disparities in burnout. Disproportionate responsibilities outside of work, including childcare and elder care, contribute to less satisfaction with work-life integration. Additionally, women physicians report lower self-compassion and perceived appreciation. These factors ultimately lead to decreased professional fulfillment and higher burnout rates among women physicians. Finally, the authors present proposals to address each of these factors at an organizational level, to effectively address the high burnout rate among women physicians. CONCLUSION: Burnout among women physicians is substantially higher compared to men and stems from multiple factors. It is crucial for organizations to evaluate the gender differences within each burnout driver and develop sustainable strategies to reduce disparities.
Gender Differences in Physician Burnout: Driving Factors and Potential Solutions
IMPORTANCE: The COVID-19 pandemic stressed the healthcare field, resulting in a worker exodus at the onset and throughout the pandemic and straining healthcare systems. Female healthcare workers face unique challenges that may impact job satisfaction and retention. It is important to understand factors related to healthcare workers' intent to leave their current field. OBJECTIVE: To test the hypothesis that female healthcare workers were more likely than male counterparts to report intention to leave. DESIGN: Observational study of healthcare workers enrolled in the Healthcare Worker Exposure Response and Outcomes (HERO) registry. After baseline enrollment, two HERO 'hot topic' survey waves, in May 2021 and December 2021, ascertained intent to leave. Unique participants were included if they responded to at least one of these survey waves. SETTING: HERO registry, a large national registry that captures healthcare worker and community member experiences during the COVID-19 pandemic. PARTICIPANTS: Registry participants self-enrolled online and represent a convenience sample predominantly composed of adult healthcare workers. EXPOSURE(S): Self-reported gender (male, female). MAIN OUTCOME: Primary outcome was intention to leave (ITL), defined as having already left, actively making plans, or considering leaving healthcare or changing current healthcare field but with no active plans. Multivariable logistic regression models were performed to examine the odds of intention to leave with adjustment for key covariates. RESULTS: Among 4165 responses to either May or December surveys, female gender was associated with increased odds of ITL (42.2% males versus 51.4% females reported intent to leave; aOR 1.36 [1.13, 1.63]). Nurses had 74% higher odds of ITL compared to most other health professionals. Among those who expressed ITL, three quarters reported job-related burnout as a contributor, and one third reported experience of moral injury. CONCLUSIONS AND RELEVANCE: Female healthcare workers had higher odds of intent to leave their healthcare field than males. Additional research is needed to examine the role of family-related stressors.
Gender and Intention to Leave Healthcare During the COVID-19 Pandemic Among U.S. Healthcare Workers: A Cross Sectional Analysis of the HERO Registry
AIMS AND OBJECTIVES: To determine the global prevalence of nursing burnout syndrome and time trends for the last 10 years. BACKGROUND: The prevalence of burnout syndrome varied greatly in different regions in the last 10 years, so the average prevalence and time trends of nursing burnout syndrome for the last 10 years were not completely clear. DESIGN: A meta-analysis conducted in the PRISMA guidelines. METHODS: CINAHL, Web of Science, and PubMed were searched for trials on the prevalence of nursing burnout syndrome from 2012 to 2022 systematically. Hoy's quality assessment tool was used to evaluate the risk of bias. The global prevalence of nursing burnout syndrome was estimated, and subgroup analysis was used to explore what caused heterogeneity. Time trends for the last 10 years were evaluated by meta-regression using Stata 11.0. RESULTS: Ninety-four studies reporting the prevalence of nursing burnout were included. The global prevalence of nursing burnout was 30.0% [95% CI: 26.0%-34.0%]. Subgroup analysis indicated that the specialty (p < .001) and the region (p < .001) and the year (p < .001) were sources of the high heterogeneity. Meta-regression indicated that it tended to increase gradually for the last 10 years (t = 3.71, p = .006). The trends increased in Europe (t = 4.23, p = .006), Africa (t = 3.75, p = .006) and obstetrics (t = 3.66, p = .015). However, no statistical significance was found in ICU (t = -.14, p = .893), oncology (t = -0.44, p = .691) and emergency department (t = -0.30, p = .783). CONCLUSIONS: A significant number of nurses were found to have moderate-high levels of burnout syndrome for the last 10 years. The meta-analysis also indicated an increased trend over time. Therefore, more attention to the prevalence of nursing burnout syndrome is urgently required. Relevance to clinical practice: High prevalence of nursing burnout may attract more attention from the public. This analysis may serve as an impetus for relevant policy to change nurses' working conditions and reduce the occurrence of burnout.
Global Prevalence of Nursing Burnout Syndrome and Temporal Trends for the Last 10 years: A Meta-Analysis of 94 Studies Covering Over 30 Countries
BACKGROUND: Burnout has earned notoriety in medicine. It affects medical students, residents and surgeons, causing a decrease in career satisfaction, quality of life, and increased risk of depression and suicide. The effect of resilience against burnout is yet unknown in plastic surgery trainees. METHODS: A survey was sent via email to the members of plastic surgery societies (ICOPLAST) and the trainees from (ASPS) Resident Council from November 2021 through January 2022. The data included: demographics, training program characteristics, physician wellness resources, and single item Maslach-Burnout Inventory and Connor-Davidson Resilience Scale questionnaire. RESULTS: One-hundred seventy-five plastic surgery trainees responded to the survey. Of these, 119 (68%) trainees from 24 countries completed the full survey. Most respondents 110 (92%) had heard of physician burnout, and almost half of respondents (45%) had burnout. The average Connor-Davidson Resilience Scale score varied significantly amongst trainees self-reporting burnout and those who did not (28.6 versus 31.3, P = 0.008). Multivariate logistic regression demonstrated that increased work hours per week were associated with an increased risk of burnout (OR = 1.03, P = 0.04). Higher resilience score (OR = 0.92; P = 0.04) and access to wellness programs (OR = 0.60, P = 0.0004) were associated with lower risk of burnout. CONCLUSIONS: Burnout is prevalent across plastic surgery trainees from diverse countries. Increased work hours were associated with burnout, whereas access to wellness programs and higher resilience scores were “protective.” Our data suggest that efforts to build resilience may mitigate burnout in plastic surgery trainees.
Global Resilience in Plastic Surgery Study (GRIPS): Resilience is Associated with Lower Burnout Rates
Burnout is one of the most insidious challenges for healthcare professionals, and has been exacerbated by the COVID-19 pandemic. Gratitude is emerging as an intervention to reduce burnout. However, to the authors' best knowledge, no systematic review has previously been carried out to explore the impact of gratitude on burnout among healthcare professionals. The present study aimed to address this gap. A total of 95 publications were identified, of which 13 were included in the review. These studies provide preliminary evidence for the inverse association between gratitude and burnout, and the effectiveness of gratitude interventions in reducing burnout among healthcare professionals. Limitations of the current research and future directions are discussed, along with the implications for practice.
