Interpersonal Disengagement Research Articles

The Effect of Ambient Artificial Intelligence Notes on Provider Burnout.

Healthcare provider burnout is a critical issue with significant implications for individual well-being, patient care, and healthcare system efficiency. Addressing burnout is essential for improving both provider well-being and the quality of patient care. Ambient artificial intelligence (AI) offers a novel approach to mitigating burnout by reducing the documentation burden through advanced speech recognition and natural language processing technologies that summarize the patient encounter into a clinical note to be reviewed by clinicians. To assess provider burnout and professional fulfilment associated with Ambient AI technology during a pilot study, assessed using the Stanford Professional Fulfillment Index (PFI). A pre-post observational study was conducted at University of Iowa Health Care with 38 volunteer physicians and advanced practice providers. Participants used a commercial ambient AI tool, over a 5-week trial in ambulatory environments. The AI tool transcribed patient-clinician conversations and generated preliminary clinical notes for review and entry into the electronic medical record. Burnout and professional fulfillment were assessed using the Stanford PFI at baseline and post-intervention. Pre-test and post-test surveys were completed by 35/38 participants (92% survey completion rate). Results showed a significant reduction in burnout scores, with the median burnout score improving from 4.16 to 3.16 (p=0.005), with validated Stanford PFI cutoff for overall burnout 3.33. Burnout rates decreased from 69% to 43%. There was a notable improvement in interpersonal disengagement scores (3.6 vs. 2.5, p<0.001), although work exhaustion scores did not significantly change. Professional fulfillment showed a modest, non-significant upward trend (6.1 vs. 6.5, p=0.10). Ambient AI significantly reduces healthcare provider burnout and may enhance professional fulfillment. By alleviating documentation burdens, ambient AI can improve operational efficiency and provider well-being. These findings suggest that broader implementation of ambient AI could be a strategic intervention to combat burnout in healthcare settings.

Burnout Professional Fulfilment and Sleep Quality in Indian Healthcare Workers in Times of the Covid-19 Pandemic

Aim and Background: With more than 210 nations affected, the SARS-COV-2 became the most widespread worldwide pandemic. As of 14 April 2022, over 500 million cases were confirmed globally Given these numbers, it was hardly surprising that the Covid-19 epidemic significantly strained healthcare systems worldwide. This study aimed to evaluate the degree of Burnout, Professional fulfilment, and Sleep quality across various groups of healthcare professionals working during the Covid-19 pandemic and looked for any correlation between these three variables. Methods: This study employed a cross-sectional observational research design and gathered data from respondents across various regions of India through an anonymous online or paper-based questionnaire tailored to the preferences of each participating Healthcare Worker (HCW). The assessment of professional fulfilment was conducted by employing the Stanford Professional Fulfillment Index and the sleep quality of healthcare workers was determined via the use of the Pittsburgh Sleep Quality Index. The variables were analyzed using statistical tools; Chi-square test, Fisher’s Exact test,Kruskal-Wallis One Way Analysis of Variance and Spearman’s rank correlation Results: Burnout was notably higher among the HCWs with poorer Sleep quality and lower in HCWs with higher Professional Fulfilment. Correlations further revealed that Burnout scores positively correlated with Work exhaustion and Interpersonal Disengagement Conclusion: This illustrates that HCWs with poorer sleep quality and lesser professional fulfilment experienced greater burnout at work during the COVID-19 pandemic Clinical significance: These insights guide healthcare providers and policy markers to optimize the well being of Healthcare Workers and foster informed preparedness in case of future pandemics. Keywords: COVID-19, PSQI, HCW, SPFI, Burnout, Professional Fulfilment, Sleep Quality.

Development and validation of the Moral Injury Symptom Scale – Clinician Version – Short Form (MISS-CV-SF)

Background Moral injury occurs when one witnesses or perpetrates an act that transgresses strongly held moral beliefs and expectations. First documented among active military and veterans, moral injury is increasingly studied in healthcare personnel impacted by the coronavirus pandemic. Measurement of moral injury among this population, particularly nurses, is still in its infancy. Objective To develop the Moral Injury Symptom Scale – Clinician-Short Form and validate it among United States based acute care nurses. Methods The Moral Injury Symptom Scale – Military Version was modified for a healthcare audience. 174 acute care nurses responded to a survey package including the scale and related instruments. Reliability and validity, including convergent and discriminant validities, were assessed, and a cutoff score was calculated using the area under the receiver operating characteristic curve. Results Reliability (Cronbach α = .75) and validity were established and a cutoff score of 41, based on functional impairment caused by moral injury, demonstrated 86.4% sensitivity and 69.6% specificity. Nurses who screened positive for moral injury experienced higher depression, anxiety, work exhaustion, interpersonal disengagement, emotional exhaustion, and depersonalization. Conclusions The Moral Injury Symptom Scale – Clinician Version – Short Form is a valid and reliable instrument with strong psychometric properties that can assess moral injury in acute care nurses, a population at risk due to the challenges of providing care during the pandemic. Appropriate measurement and establishing prevalence should prompt support and intervention from healthcare organizations.

Physician Coaching by Professionally Trained Peers for Burnout and Well-Being

Physician burnout is problematic despite existing interventions. More evidence-based approaches are needed. To explore the effect of individualized coaching by professionally trained peers on burnout and well-being in physicians. This randomized clinical trial involved Mass General Physician Organization physicians who volunteered for coaching from August 5 through December 1, 2021. The data analysis was performed from February through October 2022. Participants were randomized to 6 coaching sessions facilitated by a peer coach over 3 months or a control condition using standard institutional resources for burnout and wellness. The primary outcome was burnout as measured by the Stanford Professional Fulfillment Index. Secondary outcomes included professional fulfillment, effect of work on personal relationships, quality of life, work engagement, and self-valuation. Analysis was performed on a modified intention-to-treat basis. Of 138 physicians enrolled, 67 were randomly allocated to the coaching intervention and 71 to the control group. Most participants were aged 31 to 60 years (128 [93.0%]), women (109 [79.0%]), married (108 [78.3%]), and in their early to mid career (mean [SD], 12.0 [9.7] years in practice); 39 (28.3%) were Asian, 3 (<0.1%) were Black, 9 (<0.1%) were Hispanic, 93 were (67.4%) White, and 6 (<0.1%) were of other race or ethnicity. In the intervention group, 52 participants underwent coaching and were included in the analysis. Statistically significant improvements in burnout, interpersonal disengagement, professional fulfillment, and work engagement were observed after 3 months of coaching compared with no intervention. Mean scores for interpersonal disengagement decreased by 30.1% in the intervention group and increased by 4.1% in the control group (absolute difference, -0.94 poimys [95% CI, -1.48 to -0.41 points; P = .001), while mean scores for overall burnout decreased by 21.6% in the intervention group and increased by 2.5% in the control group (absolute difference, -0.79 points; 95% CI, -1.27 to -0.32 points; P = .001). Professional fulfillment increased by 10.7% in the intervention group compared with no change in the control group (absolute difference, 0.59 points; 95% CI, 0.01-1.16 points; P = .046). Work engagement increased by 6.3% in the intervention group and decreased by 2.2% in the control group (absolute difference, 0.33 points; 95% CI, 0.02-0.65 points; P = .04). Self-valuation increased in both groups, but not significantly. The findings of this hospital-sponsored program show that individualized coaching by professionally trained peers is an effective strategy for reducing physician burnout and interpersonal disengagement while improving their professional fulfillment and work engagement. ClinicalTrials.gov Identifier: NCT05036993.

Investigating the Feasibility of Using a Wearable Device to Measure Physiologic Health Data in Emergency Nurses and Residents: Observational Cohort Study.

Emergency departments play a pivotal role in the US health care system, with high use rates and inherent stress placed on patients, patient care, and clinicians. The impact of the emergency department environment on the health and well-being of emergency residents and nurses can be seen in worsening rates of burnout and cardiovascular health. Research on clinician health has historically been completed outside of clinical areas and not personalized to the individual. The expansion of digital technology, specifically wearable devices, may enhance the ability to understand how health care environments impact clinicians. The primary objective of this pilot study was to assess the feasibility and acceptability of using wearable devices to measure and record physiologic data from emergency nurses and resident physicians. Understanding strategies that are accepted and used by clinicians is critical prior to launching larger investigations aimed at improving outcomes. This was a longitudinal pilot study conducted at an academic, urban, level 1 trauma center. A total of 20 participants, including emergency medicine resident physicians and nurses, were equipped with a wearable device (WHOOP band) and access to a mobile health platform for 6 weeks. Baseline surveys assessed burnout, mental health, and expectations of the device and experience. Participants provided open-ended feedback on the device and platform, contributing to the assessment of acceptance, adoption, and use of the wearable device. Secondary measures explored early signs and variations in heart rate variability, sleep, recovery, burnout, and mental health assessments. Of the 20 participants, 10 consistently used the wearable device. Feedback highlighted varying experiences with the device, with a preference for more common wearables like the Apple Watch or Fitbit. Resident physicians demonstrated higher engagement with the device and platform as compared with nurses. Baseline mental health assessments indicated mild anxiety and depressive symptoms among participants. The Professional Fulfillment Index revealed low professional fulfillment, moderate workplace exhaustion, and interpersonal disengagement. This pilot study underscores the potential of wearable devices in monitoring emergency clinicians' physiologic data but reveals challenges related to device preferences and engagement. The key takeaway is the necessity to optimize device and platform design for clinician use. Larger, randomized trials are recommended to further explore and refine strategies for leveraging wearable technology to support the well-being of the emergency workforce.

A Mixed-Methods Cohort Study Evaluating the Impact of a One-Day Well-Being Course for Anesthesia Providers Working in Low-Resource Settings.

Burnout, depression, and anxiety are increasingly recognized as common among health care providers. Risks for these conditions are exacerbated in low-resource settings by excessive workload, high disease burden, resource shortage, and stigma against mental health issues. Based on discussions and requests to learn more about burnout during the Vital Anaesthesia Simulation Training (VAST), our team developed VAST Wellbeing, a 1-day course for health care providers in low-resource settings to recognize and mitigate burnout and to promote personal and professional well-being. This mixed-methods study used quantitative pre- and postcourse surveys using validated mental health measures and qualitative semistructured interviews to explore participants' experience of VAST Wellbeing during and after the course. Quantitative outcomes included burnout and professional fulfillment as measured by the Professional Fulfillment Index and general well-being as measured by the Warwick-Edinburgh Mental Wellbeing Scale. Twenty-six participants from 9 countries completed the study. In the immediate postcourse survey, study participants rated the course overall as "very good" (60.7%) and "excellent" (28.6%). Quantitative analysis showed no statistical differences in levels of work exhaustion, interpersonal disengagement, burnout, professional fulfillment, or general mental well-being 2 months after the course. Five themes on the impact of VAST Wellbeing were identified during qualitative analysis: (1) raising awareness, breaking taboos; (2) not feeling alone; (3) permission and capacity for personal well-being; (4) workplace empowerment; and (5) VAST Wellbeing was relevant, authentic, and needed. Causes of burnout are complex and multidimensional. VAST Wellbeing did not change measures of burnout and fulfillment 2 months postcourse but did have a meaningful impact by raising awareness, reducing stigma, fostering connection, providing skills to prioritize personal well-being, and empowering people to seek workplace change.

Sudarshan Kriya Yoga Breathing and a Meditation Program for Burnout Among Physicians

Physicians are exposed to high stress and strain that results in burnout, which affects them, their families, their patients, and the entire health care system; thus, there is an urgent need to develop methods to increase the resiliency of physicians. Sudarshan Kriya Yoga (SKY) is a comprehensive yoga breathing and meditation-based program that is a potential approach to mitigate physician burnout. To determine whether SKY can reduce psychological distress and improve wellness in physicians. This randomized clinical trial assessed the potential efficacy of SKY compared with a stress management education (SME) training as control. This study was conducted online from November 11, 2021, to March 14, 2022, and included physicians from Turkey, Germany, and Dubai. Both the SKY and the SME control groups received 1.5 hours of training for 3 consecutive days via a group video conference call. Participants were physicians willing to do some form of relaxation exercise everyday for 2 months. Exclusion criteria included presence of major illness and maintaining a regular mind-body program practice. Statistical analysis took place from March to November 2023. Participants were randomly assigned 1:1 into 2 groups-the SKY group or the SME (control) group-using a computer algorithm. After the 3-day instruction period, the participants in the SKY group practiced for approximately 30 minutes per day on their own and participated in a weekly 1-hour, group-based online follow-up practice. After the 3-day instruction period, participants in the SME group reviewed and applied the notes from stress management education training at their initiative and had a weekly 1-hour group-based online follow-up session. The primary outcomes were stress and depression (measured by the 42-item Depression, Anxiety, and Stress Scale [DASS-42]) and insomnia measured by the Regensburg Insomnia Scale (RIS) with primary end point at 8 weeks. Secondary outcomes included anxiety (DASS-42); optimism (Life Orientation Test-Revised [LOT-R]); professional fulfillment, work exhaustion, interpersonal disengagement, and overall burnout (Professional Fulfillment Index [PFI]); and self-reported professional errors (Self-Reported Professional Error Questionnaire). This study included 129 participants (SME, 63 participants [48.9%]; SKY, 66 participants [51.1%]; 115 females [89.2%]; 14 males [10.8%]; mean [SD] age, 46.2 [9.0] years). Compared with the SME control group, participants in the SKY group had significantly decreased stress on the DASS-42 at posttraining (difference, -6.8 points; 95% CI, -9.6 to -4.1 points; P = .006) and at postintervention (difference, -6.0 points; 95% CI, -8.8 to -3.3 points; P = .03), significantly decreased depression at posttraining (difference, -5.7 points; 95% CI, -8.6 to -2.8 points; P < .001) and postintervention (difference, -5.4 points; 95% CI, -8.3 to -2.5 points; P < .001), and significantly decreased anxiety at postintervention. In addition, there was a significant decrease in insomnia from baseline to postintervention in the SKY group (difference, -0.3 points; 95% CI, -2.3 to 1.7 points; P = .01). The SKY group also showed significantly increased professional fulfillment as well as significant decreases in work exhaustion, interpersonal disengagement, and burnout. There was no effect on self-reported medical errors. In this randomized clinical trial, physicians who regularly practiced SKY throughout a 2-month period experienced improvements in wellness and decreased burnout. These data suggest that SKY may be an effective, practical, and safe strategy to increase wellness and mitigate burnout in physicians. ClinicalTrials.gov Identifier: NCT05956470.

Protective and risk factors associated with substance use coping among healthcare workers during the COVID-19 pandemic.

Healthcare workers (HCWs) experienced high levels of stress and mental health consequences associated with the COVID-19 pandemic, which may have contributed to unhealthy coping behaviors, such as substance use coping (SUC). This study aimed to understand the extent of and predictors of SUC. The sample consisted of 263 HCWs in North Central Florida. Univariable and multivariable logistic regression analyses investigated whether moral injury and other work risk factors, protective factors, and clinically relevant symptoms (i.e., work exhaustion, interpersonal disengagement, depression, anxiety, and/or PTSD) were associated with likelihood of SUC. Clinically relevant levels of interpersonal disengagement and anxiety increased the likelihood of SUC. Mediational analyses found that interpersonal disengagement and anxiety explained 54.3% of the relationship between Self Moral Injury and SUC and explained 80.4% of the relationship between professional fulfillment and SUC. Healthcare supervisors should be aware that providers who are experiencing moral injury and less professional fulfillment may be experiencing significant interpersonal disengagement and anxiety, which could lead to SUC. Future studies should examine the effects of implementing targeted prevention and treatment interventions, along with longitudinal outcomes related to SUC behaviors.

Intrapersonal and Interpersonal Disengagement Coping: Associations with Emotions of Youth At-Risk for Huntington's Disease.

Families in which a parent has Huntington's disease (HD) are faced with significant stressors that can contribute to difficulties in communicating together about illness-related concerns. Family members who use more disengagement coping strategies, including denial and avoidance, to deal with illness-related stressors may have the greatest challenges to effective communication. The current study examined the associations of intrapersonal and interpersonal disengagement coping responses with observed and reported emotions of adolescents and young adults (AYA) at genetic risk for HD. Families included 42 AYA (n = 26 females) ages 10 to 34 (M = 19 years, 11 months; SD = 7 years, 6 months) and their parent with HD (n = 22 females, M age = 46 years, 10 months; SD = 9 years, 2 months). Dyads participated in observations of communication and completed questionnaires about disengagement coping and internalizing symptoms. Disengagement coping of AYA was unrelated to their observed and reported emotional difficulties (intrapersonal coping). However, there was evidence for the importance of interpersonal disengagement coping, as AYA's negative affect was observed and reported to be highest when both AYA and their parents reported using high levels of avoidance, denial, and wishful thinking to cope with HD-related stress. The findings underscore the importance of a family-oriented approach to coping and communication in families affected by HD.

Paper 06: Is There a Home-Field Advantage in Sports Medicine Clinic? Comparing Well-Being Outcomes of Two Staffing Models

Objectives: Learning objectives: Define differences between integrated versus rotating team-based models of care Identify tools to assess professional fulfillment, burnout, and clinical efficiency Understand the impact of integrated versus rotating team-based care models on care team members well-being Project objective/background: Team-based healthcare improves patient access, billable services, and recruitment/retention (1). The staff roles and tasks impacts working to top of license (2) which likely contribute to professional fulfillment and well-being at work. However, well-being measures comparing team-staffing models have not been described. We compare well-being measures of an Integrated Consistent Care-Team Model (ICCM) with Rotating Care-Team Model (RTM) in pediatric sports medicine clinics. Our hypothesis is that ICCM providers and staff would consistently demonstrate greater professional fulfillment, less burnout, greater clinical efficiency, and more advanced team development compared to RTM providers and staff. Methods: We identified an ICCM and RTM model within one healthcare system. The ICCM group includes one core team of pediatric sports medicine providers and staff (n=6), consistently located in the same outpatient practice setting. The RTM includes varying provider and staff team members at varying locations (n=7). All care team members from both models completed three assessments (at 0 and 7 months) of professional fulfillment, burnout, and perception of team development. Metrics used included the Professional Fulfillment Index (PFI), a 16-item survey measuring professional fulfillment and burnout, the Mini-Z_2.0, a 10-item survey measuring burnout via Supportive Work Environment and Practice Efficiency subscales, and the Team Development Measure (TDM), a 31-item survey measuring team development. EMR Data was also analyzed to determine trends in efficiency and practice across the RTM and ICCM groups. Results: PFI results taken at both time periods indicated higher rates of Professional Fulfillment in the ICCM group than the RTM Group. A cutoff point of 3.00 or greater is indicative of professional fulfillment and was demonstrated by the ICCM group at both time points (M=3.31, SD=0.33; M=3.37, SD=0.30). RTM team members scored significantly higher (unfavorable) than ICCM team members on PFI Overall Burnout Scale and showed higher scores in Work Exhaustion and Interpersonal Disengagement subscales. Mini-Z_2.0 results were favorable for ICCM team members on the Supportive Work Environment and Practice Efficiency subscales at both time periods. Overall scaled scores for the ICCM team were greater than the cutoff point of 40 at both time periods, indicating a joyful workplace, in contrast to RTM scores which were below the cutoff points on subscale scores and overall scores at both time periods. ICCM members also trended higher in team development scores on the TDM survey at both time periods. A Welch’s t-test was performed for the Mini-Z and PFI data collection and determined results were statistically significant across both samples and time periods. Furthermore, ICCM providers yielded better EMR efficiency metrics than their RTM colleagues, including less in basket management, PJ time, clinical review and EMR time on unscheduled days at both time periods. Both groups averaged a similar number of appointments per day at each time point (M=9.51 in January; M=11.61 in August). Conclusions: This study describes differences in well-being measures for providers and staff within a pediatric sports medicine ambulatory clinic setting when comparing two different care team models across a 7-month period, suggesting that consistent care-team with core providers and less variability has advantages to provider and staff well-being.

Resilient, but for how long? The relationships between temperament, burnout, and mental health in healthcare workers during the Covid-19 pandemic.

Dispositional traits of wellbeing and stress-reaction are strong predictors of mood symptoms following stressful life events, and the COVID-19 pandemic introduced many life stressors, especially for healthcare workers. We longitudinally investigated the relationships among positive and negative temperament group status (created according to wellbeing and stress-reaction personality measures), burnout (exhaustion, interpersonal disengagement), COVID concern (e.g., health, money worries), and moral injury (personal acts, others' acts) as predictors of generalized anxiety, depression, and post-traumatic stress symptoms in 435 healthcare workers. Participants were employees in healthcare settings in North Central Florida who completed online surveys monthly for 8 months starting in October/November 2020. Multidimensional Personality Questionnaire subscale scores for stress-reaction and wellbeing were subjected to K-means cluster analyses that identified two groups of individuals, those with high stress-reaction and low wellbeing (negative temperament) and those with the opposite pattern defined as positive temperament (low stress-reaction and high wellbeing). Repeated measures ANOVAs assessed all time points and ANCOVAs assessed the biggest change at timepoint 2 while controlling for baseline symptoms. The negative temperament group reported greater mood symptoms, burnout, and COVID concern, than positive temperament participants overall, and negative participants' scores decreased over time while positive participants' scores increased over time. Burnout appeared to most strongly mediate this group-by-time interaction, with the burnout exhaustion scale driving anxiety and depression symptoms. PTSD symptoms were also related to COVID-19 health worry and negative temperament. Overall, results suggest that individuals with higher stress-reactions and more negative outlooks on life were at risk for anxiety, depression, and PTSD early in the COVID-19 pandemic, whereas individuals with positive temperament traits became more exhausted and thus more symptomatic over time. Targeting interventions to reduce mood symptoms in negative temperament individuals and prevent burnout/exhaustion in positive temperament individuals early in an extended crisis may be an efficient and effective approach to reduce the mental health burden on essential workers.

Veterinarians and moral distress.

Assess veterinarians' reported levels of moral distress and professional well-being. Determine the predictive value of moral distress, controlling for demographic factors, on veterinarians' levels of Professional Fulfillment, Work Exhaustion, Disengagement, and Burnout. Members of the Veterinary Information Network. An electronic survey distributed via the Veterinary Information Network data collection portal. A total of 1,919 veterinarians completed the survey. For both associates and owners, gender and age were significant predictors of moral distress with younger female veterinarians reporting higher levels of distress than older male veterinarians. For associates, age was a positive predictor and moral distress score was a negative predictor of Professional Fulfillment. Age was a negative predictor, and female gender and moral distress score were both positive predictors for Work Exhaustion. For Interpersonal Disengagement and Burnout, age was a negative predictor and moral distress score was a positive predictor. For owners, age was a positive predictor and moral distress score was a negative predictor for Professional Fulfillment. Age was a negative predictor, and female gender and moral distress score were both positive predictors of Work Exhaustion, Interpersonal Disengagement, and Burnout. We found that, controlling for age and gender, higher levels of moral distress predicted lower levels of Professional Fulfillment and higher levels of Work Exhaustion, Interpersonal Disengagement, and Burnout. Given the prevalence of moral distress and its impact on mental health, it is imperative that the veterinary field provide training and education on how to recognize and navigate ethical conflicts.

Presence, Resilience, and Compassion Training in Clinical Education (PRACTICE): A Follow-Up Evaluation of a Resident-Focused Wellness Program.

Graduate medical education is demanding, and many residents eventually experience a reduced sense of well-being. Interventions are in development, but knowledge gaps remain in terms of time commitment and efficacy. To evaluate a mindfulness-based wellness program for residents-PRACTICE (Presence, Resilience, and Compassion Training in Clinical Education). PRACTICE was delivered virtually by the first author in the winter and spring of 2020-2021. The intervention totaled 7 hours delivered over 16 weeks. An intervention group of 43 residents (19 primary care and 24 surgical) participated in PRACTICE. Program directors electively enrolled their programs, and PRACTICE was integrated into residents' regular educational curriculum. The intervention group was compared to a non-intervention group of 147 residents whose programs did not participate. Repeated measure analyses were conducted before and after the intervention using the Professional Fulfillment Index (PFI) and Patient Health Questionnaire (PHQ)-4. The PFI measured professional fulfillment, work exhaustion, interpersonal disengagement, and burnout; the PHQ-4 measured depression and anxiety symptoms. A mixed model was used to compare scores between the intervention and non-intervention groups. Evaluation data were available from 31 of 43 (72%) residents in the intervention group, and from 101 of 147 (69%) residents in the non-intervention group. Significant and sustained improvements were demonstrated in professional fulfillment, work exhaustion, interpersonal disengagement, and anxiety in the intervention group versus the non-intervention group. Participation in PRACTICE resulted in improvements in measures of resident well-being that were sustained over the 16-week duration of the program.

Professional Fulfillment, Burnout, and Turnover Intention Among US Dialysis Patient Care Technicians: A National Survey

High professional fulfillment and low burnout and staff turnover are necessary for a stable dialysis workforce. We explored professional fulfillment, burnout, and turnover intention among US dialysis patient care technicians (PCTs). Cross-sectional national survey. National Association of Nephrology Technicians/Technologists (NANT) members in March-May 2022 (N=228; 42.6% aged 35-49 years, 83.9% female, 64.6% White, 85.3% non-Hispanic). Likert-scale items (range, 0-4) related to professional fulfillment and 2 domains of burnout (work exhaustion and interpersonal disengagement) and dichotomous items related to turnover intention. Summary statistics (percentages, means, medians) were calculated for individual items and average domain scores. Burnout was defined by combined work exhaustion and interpersonal disengagement scores of≥1.3 and professional fulfillment by a score≥3.0. Most respondents (72.8%) worked≥40 hours per week. Overall scores for work exhaustion, interpersonal disengagement, and professional fulfillment (median [IQR]) were 2.3 (1.3-3.0), 1.0 (0.3-1.8), and 2.6 (2.0-3.2), respectively; 57.5% reported burnout, and 37.3% reported professional fulfillment. Important contributors to burnout and professional fulfillment included salary (66.5%), supervisor support (64.0%), respect from other dialysis staff (57.8%), sense of purpose about work (54.5%), and hours worked per week (52.9%). Only 52.6% reported that they plan to be working as a dialysis PCT in 3 years. Free text responses reinforced perceived excessive work burden and lack of respect. Limited generalizability to all US dialysis PCTs. More than half of dialysis PCTs reported burnout, driven by work exhaustion; only about one-third reported professional fulfillment. Even among this relatively engaged group of dialysis PCTs, only half intended to continue working as PCTs. Because of the critical, frontline role of dialysis PCTs in the care of patient receiving in-center hemodialysis, strategies to improve morale and reduce turnover are imperative.

Burnout among physicians: Prevalence and predictors of depersonalization, emotional exhaustion and professional unfulfillment among resident doctors in Canada

IntroductionBurnout in the medical profession has garnered a lot of attention over the recent years. While it is reported across all specialties and all stages of medical education; resident physicians in particular are at high risk for burnout throughout their years of training.ObjectivesThis study aimed at evaluating the prevalence and correlates of burnout among resident physicians in Alberta.MethodsThrough a descriptive cross-sectional study design, a self-administered questionnaire was used to gather data from resident physicians at two medical schools in Alberta, Canada. Maslach Burnout Inventory was used as an assessment tool. Chi-squared and multivariate binary logistic regression analyses were used.ResultsOverall burnout prevalence among residents was 58.2%. Working more than 80 hours/week (OR= 16.437; 95% CI: 2.059 – 131.225), being dissatisfied (OR= 22.28; 95% CI: 1.75– 283.278) or being neither satisfied nor dissatisfied with a career in medicine [(OR= 23.81; 95% CI: 4.89 – 115.86) were significantly associated with high depersonalization. Dissatisfaction with efficiency and resources (OR= 10.83; CI: 1.66- 70.32) or being neither satisfied nor dissatisfied with a career in medicine (OR= 5.14; CI: 1.33- 19.94)] were significantly associated with high emotional exhaustion. Working more than 80 hours/week (OR= 5.36; CI: 1.08- 26.42) and feeling that the residency program is somewhat having enough strategies aimed at resident well-being in place (OR= 3.70; CI: 1.10- 12.46) were significantly associated with high work exhaustion and interpersonal disengagement. Young age of the residents (≤ 30 years) (OR= 0.044; CI: 0.004- 0.445) was significantly associated with low professional fulfillment.ConclusionsBurnout is a serious occupational phenomenon that can degenerate to other conditions or disrupts one’s professional performance. Significant correlates were associated with high rates of burnout. Leaders of medical schools and policy makers need to acknowledge, design, and implement various strategies capable of providing continuous effective mental health support to improve the psychological health of the medical resident across Canada.Disclosure of InterestNone Declared

Burnout among Residents: Prevalence and Predictors of Depersonalization, Emotional Exhaustion and Professional Unfulfillment among Resident Doctors in Canada.

Burnout in the medical profession has garnered a lot of attention over recent years. It has been reported across all specialties and all stages of medical education; however, resident doctors in particular are at risk for burnout throughout their years of training. This study was aimed at evaluating the prevalence and correlates of burnout among resident doctors in Alberta. Through a descriptive cross-sectional study design, a self-administered questionnaire was used to gather data from resident doctors at two medical schools in Alberta, Canada. The Maslach Burnout Inventory was used as the assessment tool. Chi-squared and multivariate binary logistic regression analyses were used. Overall burnout prevalence among residents was 58.2%, and for professional fulfilment index, it was 56.7% for work exhaustion and interpersonal disengagement and 83.5% for lack of professional fulfillment. Working more than 80 h/week (OR = 16.437; 95% CI: 2.059-131.225), being dissatisfied (OR = 22.28; 95% CI: 1.75-283.278) or being neither satisfied nor dissatisfied with a career in medicine (OR = 23.81; 95% CI: 4.89-115.86) were significantly associated with high depersonalization. Dissatisfaction with efficiency and resources (OR = 10.83; CI: 1.66-70.32) or being neither satisfied nor dissatisfied with a career in medicine (OR = 5.14; CI: 1.33-19.94) were significantly associated with high emotional exhaustion. Working more than 80 h/week (OR = 5.36; CI: 1.08-26.42) and somewhat agreeing that the residency program has enough strategies aimed at resident well-being in place (OR = 3.70; CI: 1.10-12.46) were significantly associated factors with high work exhaustion and interpersonal disengagement. A young age of residents (≤30 years) (OR = 0.044; CI: 0.004-0.445) was significantly associated with low professional fulfillment. Burnout is a serious occupational phenomenon that can degenerate into other conditions or disrupt one's professional performance. Significant correlates were associated with high rates of burnout. Leaders of medical schools and policymakers need to acknowledge, design, and implement various strategies capable of providing continuous effective mental health support to improve the psychological health of medical residents across Canada.

Reliability and validity of the Japanese version of the Professional Fulfillment Index among healthcare professionals: A validation study.

Translation of the Professional Fulfillment Index (PFI) into Japanese would be more useful than the currently developed scales for appropriately measuring burnout and professional fulfillment in healthcare professionals. This study aimed to develop the Japanese version of the PFI and examine its internal consistency, structural validity, and convergent validity in healthcare professionals. Healthcare professionals in Japan were recruited online. The survey was conducted from October to November 2022. Internal consistency was tested using Cronbach's α. Structural validity was tested using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Convergent validity was tested using Pearson's correlation coefficients, which were calculated between each score of the PFI scale and burnout (the Japanese Burnout Scale: JBS), depressive symptoms (the Patient Health Questionnaire-9), and QOL (the General Health Questionnaire-12). The Cronbach's alpha was .91 in professional fulfillment, .80 in burnout: work exhaustion, .90 in burnout: interpersonal disengagement, and .89 in burnout: total score. Confirmatory factor analysis demonstrated a modest fit, and EFA yielded a three-factor structure the same as the original PFI. The all three subscales and total score of burnout were significantly correlated with the scores of all the scales (p < .001; e.g., burnout: work exhaustion correlated emotional exhaustion in JBS, r = .71). The Japanese version of the PFI demonstrated acceptable high internal consistency, structural validity, and convergent validity of the scale with a three-factor structure the same as in the original PFI. The Japanese version of PFI proved to be reliable and valid for use in healthcare professionals.

A Prospective Intervention to Reduce Burnout Among Academic Radiologists

Few studies have examined what constitutes effective interventions to reduce burnout among radiologists. We compared self-reported burnout among academic medical center radiologists before and after a series of departmental initiatives intended to increase wellbeing and professional satisfaction. This Institutional Review Board-approved, prospective study took place 2017-2019 in a tertiary academic medical center. In pre- (2017) and post-intervention (2019) periods, we administered the previously-validated Stanford Physician Wellness Survey to faculty in our 11-division radiology department. Faculty rated their burnout level across 8 domains (professional fulfillment, emotional exhaustion, interpersonal disengagement, sleep difficulties, self-compassion, negative work impact on personal relations, organizational/personal values alignment, perceived quality of supervisory leadership). Between the two surveys, departmental initiatives focusing on culture, team building, work-life balance, and personal well-being were implemented (e.g., electronic medical record training, shorter work hours). Pre- and post-survey results were compared, using Whitney-Mann U test to calculate Z scores. Faculty members rated lower professional fulfillment (Z-3.04, p=0.002), higher emotional exhaustion (Z=2.52, p=0.012), increased sleep-related impairment (Z=2.38, p=0.012), and reduced organizational/personal values alignment (Z=-4.10, p<0.0001) between the two surveys. No significant differences were identified associated with interpersonal disengagement (Z=1.82, p=0.069), self-compassion (Z=1.39, p=0.164), negative impact of work on personal relationship (Z=0.89, p=0.372) and perceived supervisory leadership quality (Z=0.07, p=0.942). Despite numerous departmental initiatives intended to improve culture, workplace efficiency, work-life balance, and personal wellness, self-reported burnout was unchanged or worsened over time.Physician and employee wellness embedded into institutional culture maybe more effective than departmental improvement initiatives.

Why and When Overqualified Employees Do (Not) Help Coworkers? A Resource-Based Perspective

Previous studies have theorized overqualification as a state of underutilization of qualifications, suggesting that overqualification creates deleterious consequences for employees’ extra-role performance. However, the existing literature has largely ignored the potential positive aspects of overqualification that it may serve as an indicator of possessing superior capabilities. This paper takes the negative and the positive aspects of overqualification into account simultaneously. Building upon a resource-based perspective, this paper suggests that overqualification generates paradoxical effects on overqualified employees’ helping behavior through two opposing pathways: A resource exchange pathway (i.e., workplace status) and a resource preservation pathway (i.e., interpersonal disengagement). Based on a multi-wave and multi-source study, we found that overqualification exhibited a positive indirect effect on helping via workplace status and a negative indirect effect on helping via interpersonal disengagement. Furthermore, the positive effect of overqualification on workplace status was stronger for overqualified employees holding highly task-interdependent jobs. Theoretical and practical implications are also discussed.

Validity Evidence of Brazilian Portuguese Version of the Professional Fulfillment Index.

The questionnaire "Professional Fulfillment Index" (PFI) was validated to assess emotional exhaustion, interpersonal disengagement, and professional achievement among physicians. This study presents the process of cross-cultural adaptation of the PFI to the Brazilian context. Analytical cross-sectional study carried out between July and October 2020. Settings: For conceptual equivalence, a panel of experts was constituted who conducted analyzes on the translation and back-translation processes from English to Brazilian Portuguese. For the operational equivalence, 432 physicians in the field of Occupational Medicine were invited. They answered the PFI in an online platform. Analysis: Both exploratory and confirmatory factor analysis were performed to seek evidence of the hypothesized structure of PFI item responses. Reliability was assessed using three indicators. The Brazilian version can be considered similar to the original. Most of participants were female (57.6%) and mean age 49.6years-SD 14.0. The mean time since graduation was 18.5years-SD 9.67. Most of them had a full-time job (88.0%) and were trained through post-graduation courses 83.8%. The most frequent job task was to perform worker´s clinical evaluations (84.9%). Exploratory and confirmatory analyzes showed the adequacy of the items in measuring the instrument's construct, with stability for use in other populations and samples. The PFI was developed to evaluate positive and negative aspects of physicians' role and performance. The process described in this article was the first cross-cultural adaptation of the questionnaire. The PFI can help in mapping potential risk situations for negative impacts on physicians' occupational well-being and performance at work, in order to propose interventions that reduce exhaustion and expand professional fulfillment.