Resource Library

[This is an excerpt.] Beyond traditional obstacles associated with providing care in the prehospital setting, EMS clinicians now face a novel series of challenges resulting from the SARS-CoV-2 (COVID-19) pandemic. Resource constraints and concern regarding risks associated with aerosolizing procedures resulted in rapidly changing protocols. Out-of-hospital cardiac arrest (OHCA) activations increased substantially and survival outcomes worsened. Collectively, these new strains on EMS clinicians have led to increased burnout and potential for attrition. Understanding how prehospital care practices and EMS professional well-being have been affected by the COVID-19 pandemic is important to mitigate negative patient outcomes and improve workforce well-being and stability. The objective of this study was to assess how the COVID-19 pandemic affected EMS clinicians in the state of Texas through structural factors (resource availability, operational protocols), process measures (clinical care, prehospital time intervals) and wellness (burnout). [To read more, click View Resource.]

This study applied a hermeneutic phenomenological approach to better understand pharmacy workplace wellbeing and resilience using respondents’ written comments along with a blend of the researchers’ understanding of the phenomenon and the published literature. Our goal was to apply this understanding to recommendations for the pharmacy workforce and corresponding future research. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacy personnel was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Usable responses were from those who wrote an in-depth comment detailing stories and experiences related to pharmacy workplace and resilience. There were 614 respondents who wrote such comments. The findings revealed that business models driven by mechanized assembly line processes, business metrics that supersede patient outcomes, and reduction of pharmacy personnel’s professional judgement have contributed to the decline in the experience of providing patient care in today’s health systems. The portrait of respondents’ lived experiences regarding pharmacy workplace wellbeing and resilience was beyond the individual level and revealed the need for systems change. We propose several areas for expanded inquiry in this domain: (1) shared trauma, (2) professional responsibility and autonomy, (3) learned subjection, (4) moral injury and moral distress, (5) sociocultural effects, and (6) health systems change.

BACKGROUND: Medical students are at risk of burnout and reduced quality of life (QoL). The risk of burnout doubles from third to sixth year of medical school, and medical students have an 8%–11% lower QoL than nonmedical students. It is imperative to prevent this, as burnout and reduced QoL is independently associated with errors in practice. This systematic review aims to examine whether physical activity/exercise is associated with burnout and/or QoL in medical students. METHODS: Articles were identified through database searches of Embase, Medline, PsycINFO, Scopus and Web of Science. Studies were included if both physical activity/exercise and burnout or QoL were measured and limited to those focusing on medical students. Risk of bias was assessed using accredited cohort and cross-sectional checklists. A narrative synthesis was conducted due to heterogeneity in the dataset. FINDINGS: Eighteen studies were included, comprising 11,500 medical students across 13 countries. Physical activity was negatively associated with burnout and positively associated with QoL. Furthermore, the findings were suggestive of a dose–response effect of physical activity on both burnout and QoL; higher intensities and frequencies precipitated greater improvements in outcomes. CONCLUSIONS: This multinational review demonstrates that physical activity is associated with reduced burnout and improved QoL in medical students. It also identifies a paucity of research into the optimal intensity, frequency, volume and mode of physical activity. Further research, building on this review, is likely to inform the long overdue development of evidence-based, well-being curricula. This could involve incorporating physical activity into medical education which may improve well-being and better prepare students for the demands of medical practice.

INTRODUCTION: Advocacy is a perceived social and professional obligation of physicians, yet many feel their training and practice environment don’t support increased engagement in advocacy. The aim of this qualitative project was to delineate the role advocacy plays in physicians’ careers and the factors driving physician engagement in advocacy. METHODS: We identified physicians engaged in health advocacy in Kansas through personal contacts and referrals through snowball sampling. They received an email invitation to participate in a short in-person or phone interview which was recorded using Apple Voice Memos and Google Dictation. Two team members independently identified themes from interview transcripts, while a third member served as a moderator if themes identified were dyssynchronous. RESULTS: Of the 19 physicians invited to participate, 13 were interviewed. The most common reasons for engaging in advocacy included the desire to change policy, obligation to go beyond regular clinic duties, giving patients a voice, and avoiding burnout. Physicians reported passion for patients and past experiences with disparities as the most common inspiration. Most physicians did not have formal advocacy training in school or residency, but identify professional societies and peers as informal guides. Common support for advocacy were professional organizations, community partners, and employers. Time was the most common barrier to conducting advocacy work. CONCLUSIONS: Physicians have a broad number of reasons for the importance of doing advocacy work, but identify key professional barriers to further engagement. Providing accessible opportunities through professional organizations and community partnerships may increase advocacy participation.

PURPOSE: The purpose of this article is to review the causes and consequences of burnout in advanced practice providers (APP), with a special emphasis on burnout in physician assistants (PAs). It serves to identify the causes, prevention, risks, and harms of burnout as well as outlining the definition of burnout. METHOD: An extensive literature search was conducted with search terms burnout, burnout in medicine, burnout in midlevel providers, burn out in physician assistants, burnout and depression, and burnout prevention. Thirteen pertinent articles were retrieved, all of which served as the basis for this clinical literature review. RESULTS: Multiple articles showed a positive correlation between provider burnout with the development of provider depression and decreased job satisfaction. The articles also showed burnout as a cause of increased risk of patient harm, increased medical errors, and malpractice lawsuits. Articles also identified the fields in which burnout is more prevalent, and the way in which management can help mitigate burnout in APPs.

Physicians had a rough year in 2021, with many feeling more burned out and stressed than they ever have before. Here's what more than 13,000 doctors had to say.

[This is an excerpt.] A substantial proportion of healthcare professionals report symptoms of burnout. Research into the negative ramifications of physician burnout is abundant, with key insights already established long before the onset and ongoing burden of the covid-19 pandemic. In a linked paper adding to this work, Hodkinson and colleagues (doi:10.1136/bmj-2022-070442) collate 170 observational studies of 239 246 physicians in a large systematic review and meta-analysis examining associations of physician burnout with career engagement and the quality of care provided to patients. The authors found that burnout was associated with a threefold to almost fourfold increase in the odds of job dissatisfaction and regrets about career choice, that physicians with burnout were three times more likely to consider quitting than staying in their jobs, and that burnout was associated with significantly lower productivity. [To read more, click View Resource.]

INTRODUCTION: High rates of physician burnout are well documented in the USA. Identifying beneficial leadership behaviors as an organizational approach to mitigating burnout can lead to improved wellness in the physicians that they lead; however, few studies have examined which leadership behaviors are beneficial and which may be detrimental. MATERIALS AND METHODS: This survey study of academic medical center physicians and their physician leaders assessed the correlation between burnout and leadership behaviors. Data were analyzed for the strength of correlation between scores for leadership behaviors and self-reported physician burnout with analysis of variance by sex, time from training, specialty, and age. RESULTS: Of 1,145 physicians surveyed, 305 returned surveys. Among the respondents, 45% were female, 25% were 56 years or older, and 57% self-identified as practitioners of medicine or medicine subspecialties. Two transformational leadership categories of behaviors (idealized influence behaviors and individualized consideration) and one transactional leadership behavior category (contingent reward) correlated favorably with all domains of burnout (P < .0001). Conversely, two transactional leadership categories of burnout (management by exception passive and laissez-faire) correlated unfavorably with all burnout domains. CONCLUSIONS: Organizational interventions are needed to improve burnout in physicians. Adopting favorable leadership behaviors while avoiding unfavorable leadership behaviors can improve burnout in those physicians being led. These findings could inform the conceptual basis of future physician leadership training programs as transactional leadership behaviors also have an impact on physician wellness.

‍This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.

BACKGROUND: The burden of clinical documentation in electronic health records (EHRs) has been associated with physician burnout. Numerous tools (e.g., note templates and dictation services) exist to ease documentation burden, but little evidence exists regarding how physicians use these tools in combination and the degree to which these strategies correlate with reduced time spent on documentation. OBJECTIVE: To characterize EHR note composition strategies, how these strategies differ in time spent on notes and the EHR, and their distribution across specialty types. DESIGN: Secondary analysis of physician-level measures of note composition and EHR use derived from Epic Systems' Signal data warehouse. We used k-means clustering to identify documentation strategies, and ordinary least squares regression to analyze the relationship between documentation strategies and physician time spent in the EHR, on notes, and outside scheduled hours. PARTICIPANTS: A total of 215,207 US-based ambulatory physicians using the Epic EHR between September 2020 and May 2021. MAIN MEASURES: Percent of note text derived from each of five documentation tools: SmartTools, copy/paste, manual text, NoteWriter, and voice recognition and transcription; average total and after-hours EHR time per visit; average time on notes per visit. KEY RESULTS: Six distinct note composition strategies emerged in cluster analyses. The most common strategy was predominant SmartTools use (n=89,718). In adjusted analyses, physicians using primarily transcription and dictation (n=15,928) spent less time on notes than physicians with predominant Smart Tool use. (b=-1.30, 95% CI=-1.62, -0.99, p<0.001; average 4.8 min per visit), while those using mostly copy/paste (n=23,426) spent more time on notes (b=2.38, 95% CI=1.92, 2.84, p<0.001; average 13.1 min per visit). CONCLUSIONS: Physicians' note composition strategies have implications for both time in notes and after-hours EHR use, suggesting that how physicians use EHR-based documentation tools can be a key lever for institutions investing in EHR tools and training to reduce documentation time and alleviate EHR-associated burden.

BACKGROUND: Front-line providers working with people who inject drugs (PWID) are at increased risk of experiencing burnout. Few studies have examined protective factors against burnout incurred in the care of PWID, including harm reduction counseling skills. We measured self-efficacy in harm reduction counseling, burnout, and compassion satisfaction among Internal Medicine (IM) trainees caring for PWID. METHODS: In this cross-sectional study, we surveyed IM interns and residents. Self-efficacy was assessed by asking trainees about attitudes, comfort, and knowledge in harm reduction counseling on a five-point Likert scale. Burnout and compassion satisfaction were assessed via an adapted 20-question Professional Quality of Life Scale. We compared self-efficacy in harm reduction counseling, compassion satisfaction, and burnout between interns and residents using ANOVA and Mann–Whitney U tests. We used Spearman’s rho correlational analysis to examine the relationship between these three variables. RESULTS: Seventy-nine IM trainees (36 interns, 43 residents) completed the survey for a 52% response rate. Residents reported higher self-efficacy in harm reduction counseling, similar levels of burnout, and higher compassion satisfaction compared to interns. Across training levels, we found a negative correlation between burnout and compassion satisfaction (r ¼ À0.55, p < 0.01) and a positive correlation between compassion satisfaction and comfort counseling PWID on harm reduction (r ¼ 0.30, p < 0.01). CONCLUSIONS: Among IM trainees at an urban institution serving a large population of PWID, self-efficacy in harm reduction counseling and compassion satisfaction increase with time in training while burnout remains similar. Strengthening trainees’ capacity to counsel PWID on harm reduction may improve their compassion satisfaction in caring for this population, potentially leading to improved care. This relationship should be explored longitudinally in larger cohorts and through evaluations of harm reduction-focused medical education.

[This is an excerpt.] We read with great interest the educational perspective of Barrett et al. As physicians and more specifically radiology residents in a developing country, your article seems utopian to us. In Colombia, there were 869 radiology specialists nationwide in 2017. Since our population in 2017 was 48 million inhabitants, there is a very low ratio of specialists per capita as compared with developed countries such as the United States. Moreover, since the COVID-19 pandemic began, the workload has increased exponentially due to the number and complexity of the cases). We agree that taking a break from this busy profession is essential to avoid burnout. However, in a developing country, it is not easy. With our 11 hour workday, manda- tory study hours, and time spent commuting there is little time left to engage in leisure activities, much less outdoor activities. [To read more, click View Resource.]

Academic medicine as a practice model provides unique benefits to society. Clinical care remains an important part of the academic mission; however, equally important are the educational and research missions. More specifically, the sustainability of health care in the United States relies on an educated and expertly trained physician workforce directly provided by academic medicine models. Similarly, the research charge to deliver innovation and discovery to improve health care and to cure disease is key to academic missions. Therefore, to support and promote the growth and sustainability of academic medicine, attracting and engaging top talent from fellows in training and early career faculty is of vital importance. However, as the health care needs of the nation have risen, clinicians have experienced unprecedented demand, and individual wellness and burnout have been examined more closely. Here, we provide a close look at the unique drivers of burnout in academic cardiovascular medicine and propose system-level and personal interventions to support individual wellness in this model.

Physician and clinician well-being is an increasingly recognized problem. There is mounting evidence that more caregivers are experiencing the signs and symptoms of burnout, and many individuals are finding the profession of caring for people less rewarding. Multiple factors are conspiring to exacerbate the loss of meaning and purpose. Career dissatisfaction significantly impacts the larger healthcare system in the form of increased physician turnover, increased medical error rate, and decreased patient satisfaction. Early retirement, substance abuse, depression, and in the worst cases, suicide are all real problems in healthcare today. Optimal care cannot be provided by healers who have exhausted their reservoirs of resilience. The global coronavirus pandemic has further frayed the bonds of community that have served to tie doctors, nurses, and other healthcare team members together. Individual and organizational strategies have been described to restore a sense of personal and professional satisfaction. Thoughtful and inclusive institutional leadership has been shown to be valuable and effective in establishing a culture that is compassionate to all participants. Intentional application of these strategies and investment of resources at multiple levels is the challenge before the medical community.

IMPORTANCE: Burnout is common among physicians and is associated with suboptimal patient outcomes. Little is known about how experiences with patients, families, and visitors differ by physician characteristics or contribute to the risk of burnout. OBJECTIVE: To examine the occurrence of mistreatment and discrimination by patients, families, and visitors by physician characteristics and the association between such interactions and experiencing burnout. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey was conducted from November 20, 2020, to March 23, 2021, among US physicians. EXPOSURES: Mistreatment and discrimination were measured using items adapted from the Association of American Medical College's Graduation Questionnaire with an additional item querying respondents about refusal of care because of the physicians' personal attributes; higher score indicated greater exposure to mistreatment and discrimination. MAIN OUTCOMES AND MEASURES: Burnout as measured by the Maslach Burnout Inventory. RESULTS: Of 6512 responding physicians, 2450 (39.4%) were female, and 369 (7.2%) were Hispanic; 681 (13.3%) were non-Hispanic Asian, Native Hawaiian, or Pacific Islander; and 3633 (70.5%) were non-Hispanic White individuals. Being subjected to racially or ethnically offensive remarks (1849 [29.4%]), offensive sexist remarks (1810 [28.7%]), or unwanted sexual advances (1291 [20.5%]) by patients, families, or visitors at least once in the previous year were common experiences. Approximately 1 in 5 physicians (1359 [21.6%]) had experienced a patient or their family refusing to allow them to provide care because of the physician's personal attributes at least once in the previous year. On multivariable analyses, female physicians (OR, 2.33; 95% CI, 2.02-2.69) and ethnic and racial minority physicians (e.g., Black or African American: OR, 1.59; 95% CI, 1.13-2.23) were more likely to report mistreatment or discrimination in the previous year. Experience of mistreatment or discrimination was independently associated with higher odds of burnout (vs score of 0 [no mistreatment], score of 1: OR, 1.27; 95% CI, 1.04-1.55; score of 2: OR, 1.70; 95% CI, 1.38-2.08; score of 3: OR, 2.20; 95% CI, 1.89-2.57). There was no difference in the odds of burnout by gender after controlling for experiencing mistreatment and discrimination score and other demographic factors, specialty, practice setting, work hours, and frequency of overnight call. CONCLUSIONS AND RELEVANCE: In this study, mistreatment and discrimination by patients, families, and visitors were common, especially for female and racial and ethnic minority physicians, and associated with burnout. Efforts to mitigate physician burnout should include attention to patient and visitor conduct.

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

PURPOSE: Clinical pharmacists are recognized as valuable team members in primary care clinics due to the variety of patient care services they provide. This study examined nonpharmacist healthcare providers' perceptions of how embedded clinical pharmacists impact the work environment in ambulatory care clinics. SUMMARY: This was an exploratory mixed methods study consisting of semistructured interviews and a subsequent survey. Participants included attending and resident physicians and advanced practice providers (APPs) practicing in clinics with an embedded clinical pharmacist. Coded interview transcripts were analyzed to identify themes that were used to develop a survey. Interview participants were not asked to complete the survey. Survey responses were analyzed utilizing descriptive statistics. Subgroup analysis assessed for differences in responses based on provider type, gender, clinical practice area, years of practice, and pharmacy services utilization. Fourteen physicians and APPs participated in the semistructured interviews, and 43 other providers completed the survey. In the interviews, participants stated the clinical pharmacist contributed positively in terms of work environment, workload, work-related stress, and burnout. The major themes identified were sharing patient care responsibilities, saving provider time, and being a knowledgeable resource. Survey responses were consistent with interview statements; however, the positive impact differed between nonusers and moderate to high utilizers of clinical pharmacy services. The main barrier to collaborating with clinical pharmacists was their limited availability. CONCLUSION: Embedded clinical pharmacists positively impact the work environment in ambulatory care clinics by reducing provider workload, work-related stress, and burnout. Participants also noted clinical pharmacists are a trusted resource for patient care and drug information questions.

[This is an excerpt.] In July 2016, The American Medical Association conducted a comprehensive study of physician’s motivations and requirements for the adoption of digital clinical tools. The AMA repeated the study to determine the degree to which adoption has occurred in the past 3 years and identify attitudinal shifts among physicians towards their use and adoption. The goals for this research were to update the 2016 and 2019 studies to determine: 1. Any change in overall interest in digital health tools and the degree to which physicians believe they will help or hinder their patient care 2. Current familiarity with 7 specific digital health tools and physician enthusiasm, belief in the relevance to their practice, timeline for incorporating or current use 3. For each tool, the motivators and level of disruption caused or foreseen 4. The ideal level of involvement physicians would like to have in adoption decisions 5. An understanding of enthusiasm, current usage and requirements for emerging technologies. [To read more, click View Resource.]

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

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OBJECTIVES: This prospective cohort study assessed the impact of a 12-hour mindfulness-based wellness curriculum on OB-GYN residents’ burnout, mindfulness, and self-compassion. METHODS: Fourteen 1st year OB-GYN residents at the University of California, Irvine (n = 7 in two separate cohorts) were eligible and participated in a 12-hour, in-person wellness curriculum between January 2017 and May 2018 emphasizing meditation training, present moment emotional awareness, and self-compassion. The curriculum included didactic and experiential components and home-based exercises. Participants were assessed before starting the curriculum (T1), after finishing the curriculum (T2), and 6-9-months later (T3) using the Maslach Burnout Inventory (MBI), the Five Facet Mindfulness Questionnaire (FFMQ), and the Self-Compassion Scale (SCS). RESULTS: Fourteen residents (100%) completed the survey at T1, 13 residents (93%) completed the survey at T2, and 12 residents (86%) completed the survey at T3. Levels of burnout did not change significantly. Overall mindfulness increased from T1 to T3 (p < .05), as did non-judging inner experiences (p < .01). Overall levels of self-compassion increased from T1 to T3 (p < .05), with self-kindness and self-judgment improving from T1 to T3 (both p < .05). The vast majority of improvements were evident at the 6-9-month follow-up. CONCLUSIONS: This study provides preliminary support that a mindfulness-based wellness curriculum may improve overall levels of mindfulness and self-compassion in 1st year OB-GYN residents.

BACKGROUND: Burnout and medical resident well-being has become an increasingly studied topic in medical degree (MD) and doctor of osteopathic medicine (DO) fields and specialties, which has led to systemic changes in postgraduate education and training. Although an important topic to address for physicians of all experience levels and fields of practice, there is little research on this topic as it pertains specifically to the podiatric medical community. METHODS: A wellness needs assessment was developed and distributed to podiatric medical residents via electronic survey to assess overall wellness levels of residents and to highlight several subdomains of well-being in the training programs of the podiatric medical profession. RESULTS: A total of 121 residents completed the wellness needs assessment. Survey respondents indicated that they experienced high levels of professional burnout, with large numbers of them experiencing depression and anxiety. When analyzing the different subdomains of wellness, levels of intellectual and environmental wellness were high, and levels of financial and physical wellness were reported as low. In addition, free response answers were recorded in the survey regarding well-being initiatives that have been implemented in residency programs, and in many cases no such programs are reported to exist. CONCLUSIONS: Podiatric medical residents experience compromised well-being similar to their MD/DO counterparts. These exploratory survey group results are concerning and warrant further investigation as well as organizational introspection. Analyzing well-being and implementing changes that can support podiatric physicians at all levels of training could decrease the deleterious effects of burnout in all its forms.

Although the police have been identified as a key service provider when responding to domestic violence and abuse (DVA), very few studies have investigated their response in relation to children. This review aims to examine children’s experiences of police response in the context of DVA and to explore how the police understand and respond to children living with DVA. A rapid review of the empirical literature on the police response to DVA involving children was undertaken. PsycINFO, Web of Science and ProQuest were searched. Studies with a qualitative element, concerning children under 18 with experience of police involvement, or police experiences of children, in the context of DVA were included. The final sample comprised of six studies. Using reflexive thematic analysis, four key themes emerged in relation to children: children’s experiences of DVA; fear, uncertainty, and mistrust of police; confronting “childism”: a matter of children’s rights; and going beyond empathy: equality and justice. Regarding the police, three key themes emerged: variability in police response; limited view of police role; lack of professional competence. The findings underscore the need for awareness raising and an urgent review of the training officers receive regarding the impact of DVA on children. They also highlight the pivotal role of police when responding to DVA where children are present, as well as to advance the frontiers of research by including not only adults and professionals but also the most vulnerable DVA victim: the child.

[This is an excerpt.] Prior research, practical experience, and clinical practice in the field of law enforcement support the fact that police work is challenging, stressful, and that exposure to potentially traumatic events is endemic to police work. Over the last couple of decades, research, policy, and clinical practice have also focused on police resilience and wellness. Exploring the impact, for instance, of gruesome crime scenes (e.g., decomposed dead bodies) on officers' health from a psychopathological perspective is one aspect of the phenomenon. On the other hand, many researchers and professionals have also placed emphasis on studying what makes police officers resilient and what strategies can help police officers maintain resilience and promote wellness. This is an intriguing topic allowing us to explore what helps officers thrive despite exposure to hundreds or even thousands of potentially traumatic events over the course of their career. In contrast, the average civilian would probably be exposed to a small number, if any, of potentially traumatic incidents over the course of their lives. [To read more, click View Resource.]