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BACKGROUND: Previous systematic reviews have found high burnout in healthcare professionals is associated with poorer patient care. However, no review or meta-analysis has investigated this association in surgeons specifically. The present study addressed this gap, by examining the association between surgeon burnout and 1) patient safety and 2) surgical professionalism. METHODS: A systematic review was performed in accordance with PRISMA guidelines. We included original empirical studies that measured burnout and patient care or professionalism in surgeons. Six databases were searched (PsycINFO, Ovid MEDLINE(R), EMBASE, Cochrane Database, CINAHL, and Web of Science) from inception to February 2021. An adapted version of the Cochrane Risk of Bias tool was used to assess study quality. Meta-analysis and narrative synthesis were utilised to synthesise results. RESULTS: Fourteen studies were included in the narrative review (including 27,248 participants) and nine studies were included in the meta-analysis. Burnout was associated with a 2.5-fold increased risk of involvement in medical error (OR = 2.51, 95% Cl [1.68-3.72]). The professionalism outcome variables were too diverse for meta-analysis, however, the narrative synthesis indicated a link between high burnout and a higher risk of loss of temper and malpractice suits and lower empathy. No link was found between burnout and patient satisfaction. CONCLUSION: There is a significant association between higher burnout in surgeons and poorer patient safety. The delivery of interventions to reduce surgeon burnout should be prioritised; such interventions should be evaluated for their potential to produce concomitant improvements in patient safety.

[This is an excerpt.] The culture of surgical training has seen a significant shift in recent years to focus more on resident well-being and decreasing burnout. The Flexibility in duty-hour Requirements for Surgical Trainees trial reported an alarming rate of weekly burnout to be 39% among residents surveyed nationally and was also more prevalent among female trainces. Female surgeons face unique challenges including salary inequities, microaggressions, and unconscious bias that can contribute to burnout. Organizations such as the Association of Women Surgeons (AWS) were founded to gather and support female surgeons experiencing these unique challenges and inspire and encourage women surgeons to reach their professional and personal goals. In this isue of Annals of Surgery. Palamara et al' conducted a randomized controlled trial comparing the effectiveness of a virtual coaching program for female residents meant to increase wellbeing and decrease burnout as a collaborative effort with the AWS. Trainees were randomized into 3 professional development 1:1 virtual coaching sessions over a year as the intervention arm compared with emailed wellness resources as a control. The authors found significant improvement in well-being based on numerous standardized scales with excellent validity evidence, as well as a significant difference between the 2 arms on the Positive Emotion. Engagement, Relationship, Meaning, and Accomplishment scale. Coaching was provided by attending surgeons from the AWS after undergoing a 3-hour, in-person coaching training program that focused on the principles of positive psychology. [To read more, click View Resource.]

BACKGROUND: Virtually all surgeons will experience patient death in their practice. Despite this, little is known about how surgeons cope with patient death or its potential adverse impact on surgeons' wellbeing. Education on how to respond to loss is not often incorporated into current wellness curricula in surgical training. In light of the ongoing COVID-19 pandemic and the significant hospital-related mortality, understanding surgical provider response to patient loss takes on unique import. METHODS: A retrospective analysis was performed following administration of a 10-item survey that assessed healthcare provider (HCP) experience with patient death, activities used to cope with patient loss, and symptoms HCPs experienced. Participants included surgical faculty, residents, surgical advance practice providers and medical students on their surgical clerkship. Demographic characteristics were recorded: age, gender, academic level. Chi-squared test or Fisher exact test compared proportionality between those that did and did not experience patient loss. Logistic regression generated odds ratios examining impact of patient loss on symptoms experienced and activities engaged in after patient loss. RESULTS: : Fifty-six (75%) respondents experienced patient death. Common responses were to talk with colleagues (71%) and seek comfort from family/friends/partner (55%). Most respondents did not report symptoms related to patient death (53%); burnout was the most common symptom reported (36%). Respondents were less likely to seek interpersonal support for COVID-19-related death (P<0.008). Only 49% of participants received education on coping with patient death. CONCLUSIONS: Few surgeons receive training related to patient death. Optimal coping strategies are unknown but may mitigate potential negative impacts, including burnout. The data presented here also suggests the need to establish medical education designed to mitigate the distress associated with patient loss.

INTRODUCTION: In 2007, the first formal postgraduate nurse practitioner (NP) residency program was launched at Community Health Center, Inc., a large Federally Qualified Health Center in Connecticut, and focused on primary care and community health. There are numerous post-graduate nurse practitioner training programs across the nation, and many more are under development. Although the literature describes the impact of postgraduate residency training programs on new NPs' early practice transition, to date, no studies have examined the long-term impact of postgraduate NP training programs on alumni's career choices, practice, and satisfaction. This study sought to understand the impact over time of Community Health Center Inc.'s postgraduate NP residency program on the subsequent career paths of alumni who completed the program between 2008 and 2019. Additionally, it explored alumni's current reflections on the impact of their postgraduate residency training on their transition to the post-residency year and beyond, as well as their professional development and career choices. Moreover, it sought to identify any previously undocumented elements of impact for further exploration in subsequent studies. METHODS: This was a retrospective cohort study that used an electronic survey and interviews. All 90 of the alumni who had completed Community Health Center Inc.'s residency between 2008 and 2019 were invited to participate. RESULTS: The survey's response rate was 72%. Most (74%) of the participating alumni indicated they were still practicing as primary care providers. Of these, 57% were practicing at FQHCs. Nine subthemes were identified from the interviews, with an overarching theme that the program was foundational to a successful career in community-based primary care and that the impact of the program continues to evolve. CONCLUSION: Community Health Center Inc.'s postgraduate NP residency program had a long-standing impact on alumni's commitment to continuing in primary care practice, as well as their engagement in leadership activities to ensure quality care.

The TILES-2019 data set consists of behavioral and physiological data gathered from 57 medical residents (i.e., trainees) working in an intensive care unit (ICU) in the United States. The data set allows for the exploration of longitudinal changes in well-being, teamwork, and job performance in a demanding environment, as residents worked in the ICU for three weeks. Residents wore a Fitbit, a Bluetooth-based proximity sensor, and an audio-feature recorder. They completed daily surveys and interviews at the beginning and end of their rotation. In addition, we collected data from environmental sensors (i.e., Internet-of-Things Bluetooth data hubs) and obtained hospital records (e.g., patient census) and residents’ job evaluations. This data set may be may be of interest to researchers interested in workplace stress, group dynamics, social support, the physical and psychological effects of witnessing patient deaths, predicting survey data from sensors, and privacy-aware and privacy-preserving machine learning. Notably, a small subset of the data was collected during the first wave of the COVID-19 pandemic.

Burnout, a negative job-related psychological state particularly associated with the health professions, equates to a loss of valuable research in healthcare researchers. Team mindfulness, recognized to enhance personal fulfilment through work engagement, represents one important aspect found effective in reducing burnout. In a specific series of diverse membership academic meetings intended to reduce research burnout—employing writing prompts, doodling and continuous developmental feedback to do so—team mindfulness was demonstrated when conducted in person. Therefore, determining if team mindfulness is evident when holding such academic meetings online is relevant. When COVID-19 limitations required moving these academic meetings online, it was previously noted and reported that team mindfulness was affected in no longer being present during the first eighteen months of restrictions. To discover if this result persisted, question asking, doodles submitted and feedback responses were analyzed of the following year’s academic meetings for the same group, both quantitively and qualitatively. In finding the team mindfulness of these meetings additionally compromised the second full year, online practices actually found successful at creating and supporting team mindfulness—online games—are identified and considered. Concluding implications are noted and recommendations made regarding team mindfulness in reducing burnout for future online academic meetings.

OBJECTIVE: We examined the relationship of team and leadership attributes with clinician feelings of burnout over time during the corona virus disease 2019 (COVID-19) pandemic. METHODS: We surveyed emergency medicine personnel at 2 California hospitals at 3 time points: July 2020, December 2020, and November 2021. We assessed 3 team and leadership attributes using previously validated psychological scales (joint problem-solving, process clarity, and leader inclusiveness) and burnout using a validated scale. Using logistic regression models we determined the associations between team and leadership attributes and burnout, controlling for covariates. RESULTS: We obtained responses from 328, 356, and 260 respondents in waves 1, 2, and 3, respectively (mean response rate = 49.52%). The median response for feelings of burnout increased over time (2.0, interquartile range [IQR] = 2.0–3.0 in wave 1 to 3.0, IQR = 2.0–3.0 in wave 3). At all time points, greater process clarity was associated with lower odds of feeling burnout (odds ratio [OR] [95% confidence interval (CI) = 0.36 [0.19, 0.66] in wave 1 to 0.24 [0.10, 0.61] in wave 3). In waves 2 and 3, greater joint problem-solving was associated with lower odds of feeling burnout (OR [95% CI] = 0.61 [0.42, 0.89], 0.54 [0.33, 0.88]). Leader inclusiveness was also associated with lower odds of feeling burnout (OR [95% CI] = 0.45 [0.27, 0.74] in wave 1 to 0.41 [0.24, 0.69] in wave 3). CONCLUSIONS: Process clarity, joint problem-solving, and leader inclusiveness are associated with less clinician burnout during the COVID-19 pandemic, pointing to potential benefits of focusing on team and leadership factors during crisis. Leader inclusiveness may wane over time, requiring effort to sustain.

[This is an excerpt.] Has the routine physician’s office visit been permanently disrupted by telehealth? According to the J.D. Power 2022 U.S. Telehealth Satisfaction Study,^SM released today, a growing majority of consumers now say they prefer telehealth over in-person visits for a wide range of routine care, including prescription refills, reviews of medication options and to discuss medical results. Additionally, almost all—94%—of telehealth users say they would use the technology to receive medical services in the future. “Telehealth and digital technologies are transforming how patients seek and receive healthcare,” said Christopher Lis, managing director of global healthcare intelligence at J.D. Power. “Telehealth has the potential to increase access, convenience, care coordination and continuity, improve outcomes, and fill in gaps in provider coverage, particularly in underserved areas. As technology adoption and consumer demand continue to increase, it will be important to keep evaluating what’s working well and which areas need improvement, with the aim being to improve equitable access, quality of care and patient outcomes that complement in-person care.” [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/GOALS: The objective of this study is to examine the associated changes in the EHR use patterns after the widespread implementation of telehealth in the ambulatory care setting after the COVID pandemic. METHODS/STUDY POPULATION: The study sample will be all attending ambulatory care physicians at UCSF Health. Signal measures captured by Epic Systems are markers of EHR use pattern that characterize EHR use at the individual provider level in terms of time spent performing certain activities, time spent at particular times of the day, and the number of EHR tools being used. We will use the Single Interrupted Time Series framework to analyze the changes in Signal measures that occur after the widespread implementation of telehealth with pre-telehealth time period defined as Jan 2018 – Feb 2020 and post-telehealth time period defined as March 2020 – present. RESULTS/ANTICIPATED RESULTS: The outcomes of this study will reveal how the increased use of telehealth following the COVID pandemic has changed the way providers utilize various functions within EHR (e.g. time in EHR at particular time of day, documentation, medication and non-medication orders, chart review, etc). These results can, in turn, inform us potential impacts of increased telehealth use on physician burnout given that a number of markers of EHR use pattern (i.e. Signal measures) in previous studies have been associated with burnout. In addition, a stratified version of Interrupted Time Series by specialty and clinical work volume may inform us how different subgroups of providers exhibit varying EHR use patterns in response to the increased use of telehealth. DISCUSSION/SIGNIFICANCE: The use of telehealth will likely remain a strong presence in health care delivery in the post-COVID era. This study can serve as a baseline study on the influence of telehealth on EHR use. Future studies may focus on potential targeted interventions to best support the usage of telehealth.

Healthcare workers, especially female employees, have historically been at an increased risk for occupational stress. During the early stages of the COVID-19 pandemic, many healthcare workers shifted to a telework model of care and started working from home (WFH). It is unclear how WFH impacted female healthcare employees’ job satisfaction and stress levels.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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