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PURPOSE: The Harvard Medical School Pathways curriculum represents a major reform effort. Our goals were to enhance reasoning and clinical skills and improve the learning environment and students’ approach to learning via use of collaborative, case-based pedagogy; early clinical exposure; and enhanced approaches to teaching and evaluating clinical skills. We evaluated the impact of Pathways on key outcomes related to these goals. MATERIALS AND METHODS: In this prospective, mixed-methods study, we compared the last prior-curriculum cohort (2014 matriculation, n = 135) and first new-curriculum cohort (2015 matriculation, n = 135). Measures included Likert-type surveys, focus groups, and test scores to assess outcomes. RESULTS: Compared with prior-curriculum students, new-curriculum students reported higher mean preclerkship learning environment ratings (Educational Climate Inventory, 62.4 versus 51.9, p < 0.0001) and greater satisfaction with the quality of their preclerkship education (88% versus 73%, p = 0.0007). Mean USMLE Step-1 and Step-2 scores did not differ between groups. At graduation, new-curriculum students rated their medical school experience higher in 6 of 7 domains, including ‘fostering a culture of curiosity and inquiry’ (4.3 versus 3.9, p = 0.006) and focus on ‘student-centered learning’ (3.9 versus 3.4, p = 0.002). CONCLUSIONS: The new curriculum outperformed or was equal to the prior one on most measures of learning environment and perceived quality of education, without a decline in medical knowledge or clinical skills. Robust longitudinal evaluation provided important feedback for ongoing curriculum improvement.

The intensive care unit (ICU) is an emotionally taxing environment. Patients and family members are at an increased risk of long-term physical and psychological consequences of critical illness, known collectively as post-intensive care syndrome (PICS). These environmental strains can lead to a high incidence of staff turnover and burnout.

BACKGROUND: Uncertainty is ubiquitous in medicine. Studies link intolerance of uncertainty to burnout, ineffective communication, cognitive bias, and inappropriate resource use. Little is known about how uncertainty manifests in the clinical learning environment. We aimed to explore the perceptions and experiences of uncertainty among residents and attendings. METHODS: We conducted a mixed-methods study including a survey, semi-structured interviews, and ethnographic observations during rounds with residents and attendings at an academic medical center. The survey included three validated instruments: Physicians’ Reaction to Uncertainty Scale; Maslach Burnout Inventory 2-item; and Educational Climate Inventory. RESULTS: 35/60 (58%) of eligible residents and 14/21 (67%) attendings completed the survey. Residents reported higher anxiety due to uncertainty than attendings, higher concern about bad outcomes, and greater reluctance to disclose uncertainty to patients. Residents reported increased symptoms of burnout (p < .05). Perceiving the learning environment as more competitive correlated with reluctance to disclose uncertainty (r ¼ À0.44; p < .01). Qualitative themes included: recognizing and facing uncertainty, and consequences for the learning environment. Observations revealed senior clinicians have greater comfort acknowledging uncertainty. CONCLUSIONS: Medical curricula should be developed to promote recognition and acknowledgement of uncertainty. Greater acknowledgement of uncertainty, specifically by attendings and senior residents, may positively impact the clinical learning environment.

This dissertation sought to ascertain whether or not Crisis Intervention Team (CIT) training could lower burnout in correctional officers (CO) in a Southeastern state prison system. Using an experimental learning theory in a quantitative, quasi-experimental approach, the researcher administered the pre-test and post-test assessments using Maslach Burnout Inventory to CO before CIT and 4-weeks after they completed CIT. The researcher concluded that CIT lowered burnout on CO in all areas of the MBI but was statistically significantly lower for emotional exhaustion and depersonalization.

Physicians, Physician assistants (PAs), and trainees are at significantly increased risk for developing mental health disorders and burnout when compared to the general population. Mental health disorders and burnout can result in significant consequences, not only for the individual, but also for their patients, and the healthcare system. Mindfulness practices have been evaluated as a potential solution to mental health deterioration in this population and have shown promising results. Time commitment is a barrier to practice; however, mindfulness courses are being adapted to suit the demanding schedules of healthcare professionals and trainees, and out­ comes of these adaptions appear favorable. Research on PAs and PA trainees is extremely limited; however, PAs are trained using the medical model, and therefore data on physicians and medical trainees can likely be extrapolated to PAs and PA trainees (Johnson et al., 2020a). Although this article focuses on physicians and PAs it also may shed some light on experiences and the potential value of mindfulness for all health professionals.

OBJECTIVE: This evidence-based practice project assessed the impact of integrating mindfulness training into an existing nurse residency program. BACKGROUND: Stress and burnout are endemic in healthcare. The transition to practice is associated with stress and anxiety for newly graduated nurses. Evidence supports mindfulness-based interventions to mitigate stress and burnout and improve the workplace environment and patient outcomes. METHODS: This project employed a pre/post design to measure burnout, stress, and mindfulness, comparing means and standard deviations between intervention and comparison nurse residency cohorts. Mindfulness training was integrated at 4 points within the 1st 6 months of the residency program. RESULTS: The intervention cohort reported significantly less burnout and stress and more mindfulness at 6 months than the comparison group. CONCLUSIONS: Mindfulness training can be feasibly integrated into an existing nurse residency program to decrease stress and burnout for new graduate nurses during the transition to practice.

"Workplace stress is a psychological and physical mental disorder that occurs when existing resources cannot fulfill employees"" demands. The problem addressed by this study is the lack of well-disposed management approaches to workplace stress among healthcare workers, which in turn poses devastating impacts on the productivity of these professionals. This exploratory case study aims to understand the approaches management adopts to address workplace stress, reducing productivity impacts on healthcare professionals in public hospitals in the United States. The underlying conceptual framework for this research is founded on the perception that workplace stress (and related anxiety and depression) can be caused by a combination of demographic variables, and psychological and social factors. This research involved using qualitative methodology and an exploratory case study design using telephone interviews, face-to-face interviews, and emails. In relation to the two research questions detailed in this study, the findings revealed that some traits affecting workplace productivity among healthcare professionals include burnout, entry feelings, growth, productivity, teamwork, and team productivity. This study considered the implications of the findings of this research on account of extant literature, which involved a comprehensive discussion of the findings and making of substantiated conclusion in study findings. It was recommended that there is a need for more research to gain an in-depth understanding of the specific differences through the standardization of terminology. Such additional studies could use a different methodology from the one used in this research, including reliance on different sample sizes and even not completing the survey during a pandemic. The researcher could alter the research settings to help decipher how this might differ from or remain similar to the already established findings."

Psychiatric nurses’ work environment factors, including long hours, heavy workloads and leadership issues, can serve as barriers to achieving a healthy work-life balance. However, for both individuals and organizations, that balance is crucial as it is a key determinant of job satisfaction and leaving intentions. To address the limiting evidence to that topic, this study had two objectives: (1) to describe the work-life balance of nurses working in psychiatric inpatient settings; and (2) to examine those nurses’ work-life balance and its associations with individual (i.e., age, gender), psychosocial (i.e., leadership) and structural factors (i.e., employment percentage). To analyze these factors and their impacts, we conducted a cross-sectional study in a sample of 1209 nurses from 116 units in 13 psychiatric hospitals of the German-speaking part of Switzerland and analyzed the resulting data via multilevel analysis. This led to three main results. First, nurses reported a high mean value regarding their work-life balance. Second, multivariable regression results indicated that their work-life balance ratings correlated directly with certain psychosocial work environment factors (leadership and support of nurses, perceived staffing resources) and inversely with structural factors (employment percentage, overtime). And third, we found an interaction between leadership and support of nurses and the patient-to-nurse ratio: the lower the leadership level, the stronger the inverse association between patient load and work-life balance. No individual factors were significantly associated with work-life balance. Overall, though, we found that organizational factors are vital to nurses’ work-life balance. Therefore, interventions to improve nurses’ work-life balance should be institution-level, and should focus on improving either leadership or structural factors, e.g., employment percentage, overtime, and patient-to-nurse ratios.

During medical school and residency, we are taught to always keep boundaries with our patients. I took this lesson to heart and considered my patients merely as "diseases" during training. As I transitioned into the role of an early career attending physician, I realized my lack of meaningful patient relationships, and the concomitant burnout that it had caused. I hence changed my perspective and started listening to patient stories. These stories give me a purpose and gratitude in medicine that I had never felt before. On the flip side, I also gained insight that these stories come with a cost. There is so much joy, but grief exists simultaneously. Bad outcomes and patient losses are more heartbreaking than ever before. In this essay I reflect upon my journey of finding a path to the humanistic side of medicine and highlight my struggle to find the balance between the joy of connecting to patients and the vulnerability to pain and loss that accompanies it.

IMPORTANCE: Emotional exhaustion (EE) rates in healthcare workers (HCWs) have reached alarming levels and been linked to worse quality of care. Prior research has shown linguistic characteristics of writing samples can predict mental health disorders. Understanding whether linguistic characteristics are associated with EE could help identify and predict EE. OBJECTIVES: To examine whether linguistic characteristics of HCW writing associate with prior, current, and future EE. DESIGN SETTING AND PARTICIPANTS: A large hospital system in the Mid-West had 11,336 HCWs complete annual quality improvement surveys in 2019, and 10,564 HCWs in 2020. Surveys included a measure of EE, an open-ended comment box, and an anonymous identifier enabling HCW responses to be linked across years. Linguistic Inquiry and Word Count (LIWC) software assessed the frequency of one exploratory and eight a priori hypothesized linguistic categories in written comments. Analysis of covariance (ANCOVA) assessed associations between these categories and past, present, and future HCW EE adjusting for the word count of comments. Comments with <20 words were excluded. MAIN OUTCOMES AND MEASURES: The frequency of the linguistic categories (word count, first person singular, first person plural, present focus, past focus, positive emotion, negative emotion, social, power) in HCW comments were examined across EE quartiles. RESULTS: For the 2019 and 2020 surveys, respondents wrote 3,529 and 3,246 comments, respectively, of which 2,101 and 1,418 comments (103,474 and 85,335 words) contained ?20 words. Comments using more negative emotion (p < 0.001), power (i.e., references relevant to status, dominance, and social hierarchies, e.g., own, order, and allow) words (p < 0.0001), and words overall (p < 0.001) were associated with higher current and future EE. Using positive emotion words (p < 0.001) was associated with lower EE in 2019 (but not 2020). Contrary to hypotheses, using more first person singular (p < 0.001) predicted lower current and future EE. Past and present focus, first person plural, and social words did not predict EE. Current EE did not predict future language use. CONCLUSION: Five linguistic categories predicted current and subsequent HCW EE. Notably, EE did not predict future language. These linguistic markers suggest a language of EE, offering insights into EE's etiology, consequences, measurement, and intervention. Future use of these findings could include the ability to identify and support individuals and units at high risk of EE based on their linguistic characteristics.

INTRODUCTION: The purpose of the study was to investigate gender differences in attrition rate between male and female physicians working in academia. METHODS: All physicians who billed Medicare from a teaching hospital in March 2014 were included and were followed up until December 2019. Physicians who retired during the study period were excluded. The primary outcome was leaving academia and was defined as not having billed Medicare from a teaching hospital for more than 1 year. The primary independent variable was physician gender. Multivariate logistic regression was conducted, adjusting for physician experience, medical school ranking, specialty (surgery vs nonsurgery), and region of the country. Stratified subset analyses were also performed for the variables listed above. RESULTS: There were 294,963 physicians included, 30.5% female. The overall attrition rate was 34.2% after 5 years, 38.3% and 32.4% for female and male physicians, respectively. Female physicians had higher attrition rate than their male counterparts across every career stage (Figure). On the adjusted analysis, female physicians were 25% more likely to leave academia than their male counterparts (odds ratio [OR] = 1.25, 95% CI = 1.23, 1.28). The results were qualitatively similar on all subset analyses. CONCLUSION: Female physicians are more likely to leave academia than male physicians at all career stages, in all regions of the country, in both surgical and nonsurgical specialties, and regardless of medical school ranking. Successful diversity, equity, and inclusion efforts should address attrition in addition to pipeline issues.

INTRODUCTION: COVID-19 has led to exacerbated levels of traumatic stress and moral distress experienced by emergency nurses. This study contributes to understanding the perspectives of emergency nurses’ perception of psychological trauma during COVID-19 and protective mechanisms used to build resilience. METHOD: The primary method was qualitative analysis of semistructured interviews, with survey data on general resilience, moral resilience, and traumatic stress used to triangulate and understand qualitative findings. Analyses and theme development were guided by social identity theory and informed by the middle range theory of nurses’ psychological trauma. RESULTS: A total of 14 emergency nurses were interviewed, 11 from one site and 3 from the other. Almost all nurses described working in an emergency department throughout the pandemic as extraordinarily stressful, morally injurious, and exhausting at multiple levels. Although the source of stressors changed throughout the pandemic, the culmination of continued stress, moral injury, and emotional and physical exhaustion almost always exceeded their ability to adapt to the ever-changing landscape in health care created by the pandemic. Two primary themes were identified: losing identity as a nurse and hopelessness and self-preservation. DISCUSSION: The consequences of the pandemic on nurses are likely to be long lasting. Nurses need to mend and rebuild their identity as a nurse. The solutions are not quick fixes but rather will require fundamental changes in the profession, health care organizations, and the society. These changes will require a strategic vision, sustained commitment, and leadership to accomplish.

Two years into the arrival of COVID, we have witnessed the impact of this virus to our lives. COVID initially created chaos, since our knowledge of the virus was very limited. Health care workers experienced the isolation of everyone else but had the added stress from work. Health care workers were dealing with the unknown, taking care of the ill, often with limited equipment available for protection. Family members of patients were unable to stay with their loved ones and we could see, hear and feel their fear. This created for many a moral injury (a type of psychological distress one feels when unable to deliver the normal type of care). Then we added in our own concern of bringing COVID home to our family. Even as the initial emergency subsided, the environment never returned to ‘normal,’ and it probably will not. Too many nurses are still struggling mentally with fall-out from the pandemic.

Emergency responders (ERs), often termed First Responders, such as police, fire and paramedic roles are exposed to occupational stressors including high workload, and exposure to trauma from critical incidents, both of which can affect their mental health and wellbeing. Little is known about the impact of the ER occupation on the mental health and wellbeing of their families. The aim of the current study was to investigate what mental health and wellbeing outcomes and experiences have been researched internationally in ER families, and to examine the prevalence and associated risk and protective factors of these outcomes. We conducted a systematic review in accordance with an a priori PROSPERO approved protocol (PROSPERO 2019 CRD42019134974). Forty-three studies were identified for inclusion. The majority of studies used a quantitative, cross-sectional design and were conducted in the United States; just over half assessed police/law enforcement families. Themes of topics investigated included: 1) Spousal/partner mental health and wellbeing; 2) Couple relationships; 3) Child mental health and wellbeing; 4) Family support and coping strategies; and 5) Positive outcomes. The review identified limited evidence regarding the prevalence of mental health and wellbeing outcomes. Family experiences and risk factors described were ER work-stress spillover negatively impacting spousal/partner wellbeing, couple relationships, and domestic violence. Traumatic exposure risk factors included concerns family had for the safety of their ER partner, the negative impact of an ER partners' mental health problem on the couples' communication and on family mental health outcomes. Protective factors included social support; however, a lack of organisational support for families was reported in some studies. Study limitations and future research needs are discussed. Progressing this area of research is important to improve knowledge of baseline needs of ER families to be able to target interventions, improve public health, and support ER's operational effectiveness.

The Mini Z is a psychometrically sound measure of worklife and wellness in practicing clinicians. Measures in residents address slightly different issues and are moderately longer, potentially limiting response rates. We adapted the Mini Z for use in residents (the Mini ReZ), using the Mini Z core 10 questions and 5 additional questions reflecting domains identified by Trockel. Validating the new variation on the Mini Z would provide program directors the means to assess well-being within their programs (in collaboration with their residents), and determine actionable steps for improvement. The objective of this report is to demonstrate the validation of the Mini ReZ.

[This is an excerpt.] Stress and burnout among healthcare workers are at alarming levels. The Mini Z (Zero Burnout Program) worklife measure for clinicians was derived from validated instruments with the factor structure published in JGIM in 2016. The 1.0 version included 4 work conditions (work ambience (chaos), work control, teamwork effectiveness, and values alignment), 3 clinician reactions (stress, satisfaction, and burnout), and 3 items related to electronic medical record (EMR) stress (time pressure, home EMR time, and EMR proficiency). This paper investigates the psychometric structure of the 2.0 version which (1) changes EMR proficiency to EMR frustration, (2) aligns positive scores for calculation of a summary (joy) score, and (3) has two 5-item subscales (supportive work environment and work pace/EMR stress). Mini Zs have been adapted for residents, nurses, and administrators, and administered to thousands of healthcare workers in multiple languages across 5 continents. Concurrent validity of the burnout item was assessed with the Maslach Burnout Inventory (MBI) emotional exhaustion (EE) subscale. A subsequent study assessed convergent validity of the remaining items against EE and depersonalization MBI subscales. To provide a brief, valid measure for healthcare organizations to address clinician satisfaction and burnout, we determined the reliability and validity of the Mini Z 2.0’s two-subscale structure. [To read more, click View Resource.]

Research suggests that Canadian police officers are exposed to trauma at a greater frequency than the general population. This, combined with other operational stressors, such as risk of physical injury, high consequence of error, and strained resources, can leave officers less resilient to organizational stressors. In my experience, a significant and impactful organizational stressor is ineffective leadership, which include leaders who are non-supportive, inconsistent, egocentric, and morally ambiguous. Ineffective leadership in the context of paramilitary police culture has been recognized as psychologically distressing. Further, moral injury may result when leadership fails to meet officers’ needs, expectations, and values. Ineffective leadership and resulting moral injuries are an understudied area in the literature. This review will help provide a comprehensive context of policing and the impact of ineffective leadership on police mental health.

[This is an excerpt.] The National Health Service Corps (NHSC) is a clinician recruitment and retention program that aims to reduce health workforce shortages in underserved areas. The NHSC has three components: (1) a federal scholarships program, (2) a federal loan repayment program, and (3) astate-operated loan repayment program. Under each of these programs, health providers receive either scholarships or loan repayments in exchange for a service commitment at an NHSC-approved facility located in a federally designated health professional shortage area (HPSA, see text box).1 Participants in the state loan repayment programs may also serve in state-designated shortage areas; federal program participants may not. NHSC-approved facilities are generally nonprofit or government-operated (federal, state, local, or tribal) organizations that provide care to patients without regard for the patient’s ability to pay. The program’s clinicians provided careto an estimated 23.6 million patients in calendar year 2021. This is an increase from FY 2019,when the program estimated that its clinicians provided care to 13.7 million patients.2 [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Strengthen Worker Compensation and Benefits).

OBJECTIVE Burnout and work-life balance have been noted to be problems for residents across all fields of medicine, including neurosurgery. No studies to date have evaluated how these factors may contribute to issues outside of the hospital, specifically residents’ home lives. This study aimed to evaluate the interplay between home life and work life of neurosurgical residents, specifically from the point of view of residents’ significant others. METHODS Online surveys were distributed to the significant others of neurosurgical residents at 12 US neurosurgery residencies. Residents’ partners were asked about relationship dynamics, their views on neurosurgery residency (work-life balance and burnout), and their views of neurosurgery as a career. RESULTS The majority of residents’ significant others (84%) reported being satisfied with their relationship. Significant others who reported dissatisfaction with their relationship were more likely to report frustration with work-life balance and more likely to report their resident partner as having higher levels of burnout. CONCLUSIONS From the perspective of neurosurgery residents’ significant others, higher perceived levels of burnout and lower satisfaction with work-life balance are correlated with lower levels of relationship satisfaction. These findings speak to the complex interplay of work life and home life and can be used to inform future interventions into improving the quality of life for both the resident and the significant other.

BACKGROUND: Newly licensed registered nurses (NLRNs) are a vital health human resource necessary for the sustainability of the nursing workforce. There are challenges associated with the transition of NLRNs into practice; yet, new nurses continue to leave their positions within the first year. To compound the situation, a global pandemic hit in 2020. To leverage a sustainable future for our nursing workforce we must examine workforce data of NLRNs. PURPOSE: The purpose of this descriptive study was to review the most recent national source of workforce data to determine if the data reveals insight to help renew the focus on the NLRN workforce. METHODS: This descriptive study was a secondary analysis of demographic, education, employment, and work environment variables from the 2018 National Sample Survey of Registered Nurses. FINDINGS: The NLRN workforce is slightly more diverse, seeking a BSN as the first degree, and funding their initial education with federal loans. NLRNs cite inadequate staffing, stressful work environments, burnout, and salary as the reasons for leaving the first job. NLRNs cite a balanced schedule, experience in the job, and a sense of community with peers as reasons why they stay. DISCUSSION: This study joins the decades of literature that points to a small group of problems that account for the overwhelming majority or nursing turnover and attrition. After analyzing the data, the authors pose several questions to readers for consideration about the NLRN workforce. The authors' hope is to garner renewed attention to the issues facing NLRNs.