Modified Maslach Burnout Inventory Research Articles

Burnout during Electronic Medical Record Migration among Healthcare Providers: A Cross-Sectional Study at Mitra Paramedika Hospital, Indonesia

Health Care Professionals (HCPs) are professionals who provide comprehensive care to patients, including medical documentation. During the migration from manual medical records to electronic medical records (EMR), the documentation process can pose additional challenges and induce stress, as HCPs must adapt to a new documentation process and face the risk of errors in documentation. This situation can lead to burnout related to the migration of medical records. This study aimed to identify the factors influencing burnout among HCPs during the migration of medical records at Mitra Paramedika Hospital. A correlational study was conducted involving 67 HCPs in the outpatient unit of Mitra Paramedika Hospital. Burnout data were collected through the distribution of a modified Maslach Burnout Inventory (MBI) questionnaire, and statistical analysis was performed using SPSS version 25 with the Cramer's V & Somer’s D statistical test. The evaluation revealed that the average burnout score among HCPs related to the migration of medical records was 1.86, categorizing it as moderate burnout. Factors such as respondents' age, gender, marital status, years of service, and profession had no significant impact on burnout among HCPs in the outpatient unit of Mitra Paramedika Hospital. Only educational status that significantly correlated to burnout in our study. Further assessment is required to explore another factors of burnout among HCPs during EMR migration.

A Quality Improvement Initiative to Reduce Pediatrician Burnout Led by the American Academy of Pediatrics Section on Internal Medicine and Pediatrics (Med-Peds).

Physician burnout impacts care (of self and patient), productivity, longevity of career, and overall cost to the system. While burnout rates for pediatricians are lower than average, they havenot improved significantly over time. While strategies at the system level have been more successful than those at the individual level, both aspects are vital. This quality improvement study explores physician wellness and burnout trends of a sample population of pediatricians at the 2018 and 2019 AAP National Conference and Exhibition (NCE), using the Physician Health and Wellness Booth (PHWB). A rapid cycle approach with the Plan-Do-Check-Act (PDCA) framework was utilized. The aim was to observe if reported burnout decreased by 20% over six months. Of the pediatricians who interacted with the PHWB, 56 were randomly selected to participate. This included men and women and those in various practice settings, ranging from resident physicians to providers in practice for over 20 years. Baseline surveys included elements from a modified Maslach Burnout Inventory and the Stanford Physician Wellness Survey, focusing on burnout components (emotional exhaustion, depersonalization, and fulfillment) and wellness activities. Individual-based interventions were provided at the PHWB, includingadult preventative health guidelines, resources on sleep, stress mitigation, and complementary medicine.Participants received a movie ticket and Starbucks gift card. Follow-up included six monthly newsletters with strategies from seven wellness domains. Post-intervention surveys at six months assessed all baseline questionsplus the effectiveness of monthly newsletters. A second PDCA cycle was conducted from the 2019 NCE. All individual-based interventions continued with an addedaromatherapy oilstation.Additional system-based resources included sample institutional wellness initiatives and burnout cost analyses, all focusing onadvocating for cultural change at their respective home organizations. Interactive monthly wellness calendars addressing seven wellness domains were emailed for six months follow-up. Results from 10 post-intervention surveys (10/56=18% of respondents) from the initial cohort reported an average of 25% decrease in burnout (p=0.09). This was measured on a scale of 1-10 (from "never" burned out to "very often") and improved from 6.68 ("sometimes" to "often" burned out) to 5.0 ("rarely" to "sometimes" burned out). Results from Cohort 2 reflected a decrease in burnout from 4.94 ("rarely" to "sometimes" burned out) to 2.85 ("never" to "rarely" burned out) in returnfrom 20 post-intervention surveys (20/48=42% of respondents, p=0.003).Participants noted a lack of control over work schedules and a disconnect with organizational values as drivers of burnout. Both the PHWB and monthly newsletters were rated as valuable as reminders about wellness practices. Limitations includedlow response rate, which was notable, and inability to prove causation of improvement from our intervention. Future steps include utilizing subject identification numbers to allow for anonymity in a prospective cohort study with a third PDCA cycle. This would allow anonymous but matched same-subject comparison ofpre- and post-survey results despite the small sample size. Follow-up incentives could be beneficial. Lastly, data from both cohorts revealed the highest level of burnout in early career physicians within 10 years of training, paving an opportunity for future study.

Burnout and job stress of anesthesiologists in the tertiary class A hospitals in Northwest China: A cross-sectional design.

Our purpose was to assess job stress and burnout among anesthesiologists in the tertiary class A hospitals in Northwest China, analyze the possible causes and adverse consequences of increased job stress and burnout of anesthesiologists in this region, and put forward suggestions in combination with the current national policies. We sent 500 electronic questionnaires to all anesthesiologists practicing in the tertiary class A hospitals in Northwest China from 1960 to 2017 on April 2020. A total of 336 (67.2%) questionnaires were returned and could be used for analysis. Burnout and job stress were assessed by using the modified Maslach Burnout Inventory-Human Services Survey and Chinese Perceived Stress Scale, respectively. First, as for emotional exhaustion, the situations of anesthesiologists with different working years and workloads are different with statistical significance (P < 0.05). Second, as for depersonalization, the situations of anesthesiologists with different ages, professional titles, working years, physical health status, and workload are different (P < 0.05). Third, as for personal accomplishment, the situations of anesthesiologists with different physical health status are different (P < 0.05). Finally, the regression results showed that the longer the fatigue working years and the worse the physical health of anesthesiologists in Northwest China, the more likely these two factors were to cause burnout (P < 0.05), as for job stress, there was a negative correlation between job stress and physical health status (P < 0.05). Burnout and high job pressure are common among anesthesiologists in tertiary class A hospitals in Northwest China. We should focus on the allocation of labor intensity, pay attention to the physical and mental health of employees, establish targeted incentive mechanism, and improve the system of promotion and income rises for grassroots doctors. This may be not only conducive to the quality of medical care for patients but also conducive to the development of anesthesiology in China. Identifier: ChiCTR2000031316.

Factors associated with risk of burnout in neurosurgeons: current status and risk factors.

ObjectiveThe study aimed to evaluate burnout and associated risk factors in neurosurgical residents and faculty members.Summary of background dataBurnout is an occupational risk of emotional exhaustion, depersonalization, and reduced perception of personal accomplishment secondary to work stress. It burdens the individual with immense mental stress causing compromised professional performance. Healthcare workers, particularly surgeons, have been documented to be at high risk of developing burnout, considering the stressful routine and serious impact of their profession.MethodsThe modified Maslach Burnout Inventory was filled by fellow neurosurgical residents or consultants. The respondents were classified into burnout and non-burnout groups and then analyzed for the associated risk factors. The data were analyzed using SPSS v26.ResultsOne hundred and thirty-eight neurosurgical healthcare workers, including 62 residents and 76 consultants, responded to the questionnaire. The burnout and non-burnout groups comprised 83 (60%) and 55 (39.9%) respondents. Female gender and few kids were observed as significant risk factors for the development of burnout (p = 0.013 and p = 0.006, respectively). Regardless of its year, residency was a risk factor for overall burnout, as well as in each subsection of the Maslach Inventory (p = 0.002). In consultants, recent qualifications and a high number of weekly calls were also associated with a significant risk of burnout (p = 0.012 and p = 0 .027, respectively). Marital status and national economic status did not reveal any influence on the status of burnout in neurosurgical healthcare workers.ConclusionBurnout syndrome is a prevalent and serious, yet overlooked, condition among neurosurgeons. Adequate assessment and steps should be encouraged to ensure physician and patient safety.

To the Editor: COVID-19 as a Catalyst to Transform Graduate Medical Education.

We applaud Wietlisbach and colleagues for highlighting the silver lining in the dark clouds of the COVID-19 pandemic.1 Their qualitative study based on 4 internal medicine (IM) residency programs in the Northeast United States suggests that IM residents adjusted quickly to the disruption and changes brought on by COVID-19 and focused on resiliency and well-being during the pandemic. Our own experience at a large IM residency program at Johns Hopkins Bayview Medical Center suggested that, although COVID-19 had a predominantly negative effect on the well-being of the residents, it also presented an incredible learning opportunity. Forty IM residents were contacted as part of a larger survey to monitor the stress and well-being of staff during COVID-19 at Johns Hopkins Bayview Medical Center between October and December 2020, out of which 18 (45%) completed the survey. Survey measures included Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, and modified Maslach Burnout Inventory. In addition, residents were asked about the satisfaction of their educational experience.Survey results showed that 17% of the residents had significant depressive symptoms and sleep disturbances, while 25% endorsed moderate to severe anxiety symptoms. More than 70% residents felt burned out, and 22% indicated that they felt burned out and callous toward their work on a daily basis. Ninety-four percent of residents indicated that their training was significantly impacted by COVID-19. Sixty-seven percent had to miss their didactic training due to work demands. Thirty-three percent had to change their core or elective rotations. On the positive side, 50% of the residents indicated that they learned new skills during COVID-19 that contributed to their professional growth. Some of the comments from residents were: “Now on call as an intern,” “Taking on more shifts on my scheduled days off,” “Type of cases seen are limited by COVID,” “Zoom didactic sessions are not as effective as in person,” and “Less mentorship and teaching from upper residents and faculty.”In contrast to the Wietlisbach study, our survey suggests that the residents were less enthusiastic about the technological innovations in didactics and training and longed to go back to the pre-COVID-19 normal. However, we also found a strong focus of resiliency by the residents, with 61% of the sample scoring &gt;6 on the 2-item Connor-Davidson Resilience Scale. We agree with Wietlisbach and colleagues that COVID-19 can be a catalyst in the transformation of graduate medical education.2

New adaptation of neurosurgical practice and residency programs during the Covid-19 pandemic and their effects on neurosurgery resident satisfaction and welfare at the National General Hospital, Jakarta, Indonesia

IntroductionMany institutions in numerous countries have made changes in their health care services during the COVID-19 pandemic. One change has been to reduce elective neurosurgery cases, which has impacted neurosurgery education. Published literature is lacking about the healthcare services, education, and residents’ well-being during adaptation to the pandemic, especially in national referral hospitals in developing countries. MethodsWe conducted a cross-sectional study on current neurosurgical services during 2020. We evaluated 34 neurosurgery residents in Cipto Mangunkusumo National General Hospital using a self-made questionnaire to determine the effects of the COVID-19 pandemic on their surroundings, education process, and satisfaction with the currently adapted education program. We used the modified Maslach Burnout Inventory to assess burnout in the residents before and during the pandemic. ResultsNeurosurgical residents spent more time studying neurosurgical theory (Mode 1–1.5h/day, p < 0.05) but spent less time learning neurosurgical skills (Mode 30 min–1 h/day, p < 0.05) compared to before the pandemic. The resident satisfaction mean score (scale 0–10) was 7.58 for live surgery and 8.53 for the microsurgical skills lab training program. On a scale of 1–10, the residents’ stress level increased after the pandemic but the change was not statistically significant (6.61 ± 1.87, p > 0.05). The Modified Maslach Burnout inventory score was 3.02 ± 3.74 during the pandemic, and increased from before the pandemic (2.41 ± 3.18), but the difference was not statistically significant. ConclusionThe COVID-19 pandemics have reduced the working hours and the clinical exposure of neurosurgical residents. Fortunately, this pandemic has led to a new opportunity to find many suitable learning methods which may decrease the risk of burnout. The psychological burden of residents is still worrisome, and planned management is necessary to sustain resident performance.

Relationship Distress at Home and Burnout Among 254 Pediatric Intensive Care Nurses.

To assess the prevalence of relationship distress and burnout among PICU nurses. Cross-sectional, web-based survey. Pediatric intensive care nursing practices in the United States. Pediatric intensive care nurses. None. A total of 254 pediatric intensive care nurses in the United States completed the survey consisting of demographic data, practice, and personal characteristics, Revised Dyadic Adjustment Scale, and modified Maslach Burnout Inventory. Relationship distress in consensus was noted in 45.6% of participants, and 26.3% reported distress in relationship satisfaction. Moderate to high burnout was reported by 65% nurses in the emotional exhaustion domain, 43% in depersonalization, and 27% of nurses reported low personal accomplishment. A significant difference in relationship satisfaction was found among nurses identified in different domains of burnout, showing that nurses who scored higher in depersonalization also reported higher distress in relationship satisfaction (p = 0.045). Interestingly, nurses who reported high personal accomplishment (thereby less burnout) reported higher distress in relationship consensus (p = 0.015). The difference in the satisfaction subscale between different age groups was significant, suggesting distress in satisfaction among nurses over the age of 40 (p = 0.004). Comparison of nurses actively involved in marriage counseling with those not actively involved in marriage counseling demonstrated a significant difference in relationship consensus (p = 0.046; odds ratio = 2.46; 95% CI, 0.99-6.06) and satisfaction (p = 0.004; odds ratio = 3.26; 95% CI, 1.42-7.47), suggesting an association between higher relationship distress and counseling. This study reflects the prevalence of relationship distress and its association with burnout and other practice and personal factors among PICU nurses. Nurses with high depersonalization experienced significantly higher distress in relationship satisfaction, and nurses who reported high personal satisfaction had significantly higher distress in relationship consensus.

Impact of COVID-19 on surgical residency programs in Pakistan; A residents' perspective. Do programs need formal restructuring to adjust with the "new normal"? A cross-sectional survey study.

BackgroundDue to high-risk exposure of surgical residents to coronavirus, surgical residency programs have changed their training methods and working hours drastically. The purpose of this study is to find out the positive and negative impacts of the pandemic on surgical residency programs and on the lives of surgical residents.Materials and methodsA cross-sectional study was conducted on 112 surgical residents of a tertiary care hospital in Pakistan, with a mean age of 30.5 years from all the departments of surgery using a self-made, validated 40-point questionnaire comprising three sections. The last section also included modified Maslach Burnout inventory.ResultsOf all the residents, 97 (86.6%) stated that their surgical hands-on duration is adversely affected by the pandemic. As for clinical exposure, 92 (82.1%) trainees responded that their clinical exposure is affected too. Among all the subjects, 69 (61%) were concerned about transmitting it to their family members and 43 (38.4%) affirmed on being afraid of dying because of their direct exposure.On the brighter side, the average number of working hours per week for surgical residents were reduced from 81.10 ± 6.21 to 49.16 ± 6.25 (p < 0.001) due to the outbreak. Modified Maslach Burnout inventory score was 8.33 ± 2.34 after the outbreak, showing statistically significant reduction in burnout among the surgical residents (p < 0.001).ConclusionThe changes in the surgical residency programs amidst the pandemic has reduced the working hours, hands-on and clinical exposure of the surgical residents. Moreover, the situation has provided an opportunity to explore efficient methods of learning that can lead to lesser burnout. However, psychological burdens of surgical residents like fear of acquiring the infection should be appropriately addressed.

Higher Grit Scores Associated With Less Burnout in a Cohort of Internal Medicine Residents

BackgroundThe association between grit, defined as perseverance and passion for long-term goals, and professional burnout has not been studied in internal medicine residents. Our objective was to examine whether internal medicine residents’ scores on a grit scale were associated with various measures of burnout. MethodsAll residents from a single internal medicine program were invited to participate in a study of grit and burnout. Grit and burnout were measured using the Short Grit Scale and modified Maslach Burnout Inventory, respectively. In addition, demographics, last In-Training Examination (ITE) score, and interest in a subspecialty were captured. ResultsA total of 139 of 168 eligible residents (83%) participated. Emotional exhaustion and depersonalization (i.e., burn out) were identified in 63% and 42% of residents, respectively. Endorsement of emotional exhaustion was higher for residents living with family members, postgraduate year (PGY)1 and PGY2 compared with PGY3 residents, and residents scoring above the 50th percentile on the last ITE. Grit scores were higher for residents not reporting emotional exhaustion. As grit score increases, the odds of reporting emotional exhaustion significantly decreased, after adjustments for demographics, ITE scores, type of medical school, PGY level, and interest in a subspecialty (odds ratio = 0.36, 95% CI 0.15-0.84). ConclusionsGrit appeared to be an independent predictor of burnout in internal medicine residents in this sample, with lower grit scores associated with higher burnout scores. By measuring grit early in residency, programs can potentially identify residents at risk for symptoms of burnout, specifically emotional exhaustion, and implement targeted interventions.

Building resilient oncologists: A feasibility study of a resiliency curriculum for hematology oncology fellows.

TPS11043 Background: Rates of burnout and career dissatisfaction have declined slightly, but remain high among oncologists (Berg, AMA 2020). As hematology oncology fellows prepare to join this workforce, the ACGME now mandates wellness be a part of their training curriculum. Yet, there are few, if any, structured and effective programs specifically for these trainees. Based on feedback from our prior mindfulness-based wellness curriculum, we created a more varied and comprehensive resiliency program with the use of our institutional resources to incorporate and evaluate as part of our fellowship curriculum (ASCO, Abstract 10508), and potentially expand to other fellowships. Methods: This is a single-center, non-randomized, pilot project to assess the feasibility, acceptability, and impact of a resiliency training program. All hematology oncology fellows at our institution were eligible for enrollment, and participation was voluntary. A total of seven monthly, 1 hour sessions were conducted through the academic year. Each session focused on a particular topic - alternative forms of wellness through art and music, self care, mindfulness and stretching, reflective writing, and healthy boundaries and work life integration - which have all been studied individually in wellness and burnout with positive results. Sessions were co-led by a peer and “expert” guest speakers from our training institution. Participants completed questionnaires pre and post-program, and feedback evaluations after each session. Questionnaires included the Perceived Stress Scale (PSS), Five Facet Mindfulness Questionnaire (FFMQ), Connor Davidson Resiliency Scale (CDRS-10), and modified Maslach Burnout Inventory (MBI), as well as demographics and open response questions. The primary aim was feasibility (enrollment, completion, and compliance rates), and the secondary aim was acceptability (usefulness of the intervention). Examination of stress, mindfulness, resiliency, and burnout were exploratory. Enrollment and data collection are complete, with 18 of 29 (62%) eligible participants consented. Data analysis is in process.

P046: Physicians experience with the Epic electronic health record system: findings from an academic emergency department implementation

Introduction: In June 2019, The Ottawa Hospital launched the Epic EHR system, which transitioned all departments from a primarily paper-based system to an exclusively electronic system using a one-day “big bang” approach. All Emergency Physicians (EP) received online module training, personalization sessions, and at-the-elbow support during the transition. We sought to evaluate EP satisfaction with the implementation process and the system's impact on clinical practice in a tertiary care academic emergency medicine setting. Methods: Email surveys were distributed during the pre-implementation and go-live phases. Questions were developed by the research team and piloted for face validity and clarity. Surveys were sent to staff EPs, residents and fellows. Likert scales were used to evaluate agreement with statements and the modified Maslach Burnout Inventory was used to assess burnout. Pre-post groups were compared using chi-squared tests to assess for significant differences. Future surveys will be distributed in 2020 for continued implementation evaluation. Results: Response rates were 49% (78/160) in the pre and 48% (76/160) in the post period. The majority of respondents were staff (66% pre; 75% post) working 8-15 shifts/month. Prior to launch, 52% of EPs felt the pre-training modules provided sufficient preparation, however only 32% felt this way after go-live (p = 0.02). Providers did not feel there were enough personalization (21% pre vs. 24% post, p = 0.66) or hands-on sessions offered (51% pre vs. 39% post, p = 0.15) and this opinion did not change after go-live. Before Epic, EPs were most concerned with productivity/efficiency, documentation time, and lack of support/training. Although documentation was reported to be easier after go-live by 69% of EPs, reviewing documents, using standardized workups/protocols, patient monitoring/follow-up, efficiency and billing were reported by &gt;50% of EPs to be more difficult. Overall, there was a 22% increase in feeling confident to use Epic (28% pre vs. 50% post, p &lt; 0.01); however, only 38% of providers were satisfied with the system. Notably, 82% of EPs reported experiencing moderate or high burnout in the post implementation period. Conclusion: Despite receiving standard EHR training and support, the majority of clinicians did not feel adequately trained or confident using Epic and reported moderate to high burnout. These findings will inform optimization efforts and they represent key considerations for other EDs planning future implementations.

Zjawisko wypalenia zawodowego personelu pielęgniarskiego zatrudnionego na wybranych oddziałach psychiatrycznych w Polsce

Background. Professional burnout occurs under circumstances of chronic stress and applies mostly to occupational groups whose work entails direct contact and close interpersonal involvement with people. Professional burnout is a consequence of dissonance between the person and the work environment. It is a multidimensional and remote response to chronic interpersonal stress at work. It is a process that usually builds up gradually and is difficult to reverse. Nurses working with mentally ill patients are a high-risk group for developing professional burnout.Objectives. The aims of the study were to evaluate the level of professional burnout in mental health nurses working in the Masovian voivodeship in Poland, and to identify stress-inducing factors.Material and Methods. The research, which was conducted in January and February 2017 using the diagnostic survey method, involved 107 mental health nurses employed in healthcare facilities located in the Masovian voivodeship. The research tool was a survey comprising of 2 questionnaires. The 1st was a modified Maslach Burnout Inventory (MBI), the 2nd − Goldberg’s General Health Questionnaire (GHQ-28) for mental health evaluation. The statistical analysis was conducted using the STATISTICA v. 13.1 program and the MBI questionnaires were evaluated with χ2 test, Kruskal−Wallis ANOVA and Mann–Whitney U test. Values of p < 0.05 were regarded as statistically significant.Results. The statistical analysis of both questionnaires showed that the selected group of nurses is at risk of professional burnout. The research results showed that 51% of the interviewees were emotionally exhausted, while 46% admitted they are more or much more overtired than usual. Education level, age and job seniority also affected the mental health status of the respondents.Conclusion. These findings show that the study group is prone to professional burnout. Younger nurses with higher education and shorter overall employment histories are significantly at risk of professional burnout.

Taking care of healthcare workers during COVID-19 pandemic: does plastic surgery have a role?

Background:The massive use of personal protective equipment is required by the medical and paramedical staff of the COVID-19 dedicated departments. This often causes painful pressure injuries. The aim of this study is to value the use of anesthetic cream and collagen veil masks for the treatment of pain. We also evaluated the possible psychological impact on healthcare workers involved in the emergency, which is currently a hot topic in the worldwide literature.Materials and Methods:We applied lidocaine idrochloride 5% cream and a collagen veil mask respectively before and after each work shift. We evaluated the improvement of pain symptoms through VAS assessments. We used a modified Maslach burnout inventory as well to evaluate the psychological impact of our treatments on healthcare workers.Results:A significant reduction of pain was detected within the first 3 days, but this was not significant over the long period (10 days). Otherwise, we saw a significant improvement of the psychological assessment (p<0,05).Conclusions:Parameters such as pain or psychological stress are not objective, but, anyway, our data show a reduction of pain due to continuative PPE wearing and a significant improvement of psychological wellness of healthcare workers from two different countries, a finding which should not be undervalued by all the health caregivers not directly involved in COVID-19 pandemic. (www.actabiomedica.it)

The Slippery Slope: Can Motivation and Perfectionism Lead to Burnout in Coaches?

The purpose of the study was to investigate the relationships between perfectionism, motivation, burnout, and coaching satisfaction in high school and collegiate coaches (n = 311). Coaches completed the modified Maslach Burnout Inventory, the Behavioral Regulation in Sport Questionnaire, the Multidimensional Perfectionism Scale, and an investigator-designed survey to assess satisfaction. As predicted, perfectionism was related to both motivation and burnout. In particular, socially-prescribed perfectionism emerged as the most significant type of perfectionism, showing positive relationships with controlled forms of motivation and burnout and negative relationships with autonomous forms of motivation and feelings of personal accomplishment. Self-oriented perfectionism was related to motivation, but not directly related to burnout, and other-oriented perfectionism was not significantly related to motivation or burnout. Autonomous motivation was strongly associated with coaches’ satisfaction. The influence of socially-prescribed perfectionism on coaches is discussed in relation to the high expectations placed on coaches by programs and communities, perhaps contributing to feelings of low autonomy and external regulation. Controlling forms of social expectations and external regulation may act as a “slippery slope” in which the initial motivation of coaches may move toward burnout.

Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training

BackgroundPhysicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts.MethodsA cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender.ResultsAmong 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients’ families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00).ConclusionsMistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.

Targeted Interventions to Improve Resident Well-Being

PURPOSE: To quantify and compare physician well-being and incidence of burnout across residency programs at our institution, emphasizing program-specific and resident-driven interventions. BACKGROUND: As the national conversation regarding physician well-being evolves, the importance of addressing physician burnout has come to the forefront. Our institution identified moderate levels of burnout across all residency programs, and thus initiated institution-wide efforts. Literature suggests utilizing organization-wide and targeted interventions together has the most significant impact on improving well-being and reducing burnout. METHODS: A Modified Maslach Burnout Inventory (MBI) survey is distributed annually to all residents at our institution. Results from 2015-2018 were analyzed to track changes in burnout scores. All residents participated in institution-wide interventions. Some departments initiated additional resident-determined program-specific interventions. RESULTS: Mean MBI scores qualified for moderate burnout for all programs across all years. Most programs utilizing institution-wide interventions demonstrated no change in burnout scores; while some, specifically OB/GYN, saw a statistically significant increase in burnout scores (p&lt;0.001). Departments with program-specific interventions demonstrated decreased scores during the same time period. DISCUSSION: Residency programs utilizing targeted interventions demonstrated marked improvement in burnout scores. Amongst those without targeted interventions, OB/GYN demonstrated the largest increase in burnout, suggesting differing etiologies of burnout for individual programs, with OB/GYN being uniquely susceptible. We plan to combat this by utilizing a guided focus group of OB/GYN residents to identify drivers of burnout and specific interventions addressing these factors, using the Mayo Well-Being Index to track anticipated improvement. Continued work in evidence-based strategies addressing the challenge of burnout will ultimately produce more engaged physicians.

Assessing Burnout Among Advanced Practice Providers (APPs) Compared with APP Trainees.

This study explored the prevalence of burnout syndrome among advanced practice providers (APPs = physician assistants (PAs) and advanced practice nurses (APNs)) and physician assistant students in training to become APPs. While previous research has focused on understanding burnout in a myriad of health professions, burnout among APPs and APP trainees has been underexplored. As such, this work serves as a primer for establishing benchmark levels of burnout in these specific healthcare provider/trainee populations. This study distributed a modified Maslach Burnout Inventory (MBI) to a sample of 297 APPs and 1200 PA students. Mean differences in burnout scores were compared against a national reference sample of healthcare professionals using one sample t tests and linear regression explored relationships among demographics and burnout dimension scores. APPs (n = 124) and APP trainees (n = 230) who responded to the survey displayed average levels of burnout, though both populations expressed significantly lower personal accomplishment scores than the national reference sample. No significant differences were detected between APNs and practicing PAs (p = 0.761). Increased age was negatively associated with depersonalization scores suggesting that APP trainees and younger APPs are at higher risk of developing severe burnout and may need additional support in their training and early careers. Furthermore, the prevalence of burnout between APPs and APP trainees was found to be comparable, suggesting that burnout from training may persist into practice. A small proportion of APPs and APP trainees may be at risk of developing severe burnout. Individuals in these "at risk" populations may need additional support during training and perhaps later on in practice.

Medical student depression and its correlates across three international medical schools

BACKGROUNDMedical students have high rates of depression, anxiety, and burnout that have been found to affect their empathy, professional behaviors, and performance as a physician. While studies have examined predictors for burnout and depression in the United States (US), no study, to our knowledge, has compared depression in medical students cross-culturally, or has attempted to examine the effect of factors influencing rates including burnout, exercise, stress, unmet mental health needs, and region.AIMTo examine rates of depression in three international cohorts of medical students, and determine variables that may explain these differences.METHODSConvenience samples of medical students from three countries (US, China, and a Middle Eastern country whose name remains anonymous per request from the school) were surveyed in this observational study. Using the Patient Health Questionnaire-2 (PHQ-2) and a modified Maslach Burnout Inventory, depression and burnout were examined among medical students from the three cohorts (n = 473). Chi-square test and analysis of variance were used to examine differences in demographics, behavioral, and psychological variables across these three schools to identify potentially confounding descriptive characteristics. Analysis of covariance compared depression and the emotional exhaustion component of burnout identified through Principal Component Analysis across countries. Multiple linear regression was used to analyze the impact of demographic, behavioral, and psychological variables on screening positive for depression.RESULTSMedical students from the Middle Eastern country had the highest rates of positive depression screens (41.1%), defined as a PHQ-2 score of ≥ 3, followed by China (14.1 %), and then the US (3.8%). More students in the Middle Eastern school had unmet mental health needs (50.8%) than at the medical school in China (34.8%) or the school in the US (32.8%) (Pearson chi-square significance < 0.05). Thus, PHQ-2 scores were adjusted for unmet mental health needs; however, the Middle Eastern country continued to have the highest depression. Adjusting for PHQ-2 score, medical students from the US scored the highest on emotional exhaustion (a measure of burnout). Demographic variables did not significantly predict medical student depression; however, lack of exercise, unmet mental health needs, stress, and emotional exhaustion predicted nearly half of depression in these cohorts. In comparison to the US, coming from the Middle Eastern country and China predicted higher levels of depression.CONCLUSIONDepression rates differ in three international cohorts of medical students. Measured factors contributed to some observed differences. Identifying site-specific prevention and intervention strategies in medical student mental health is warranted.

Burnout among nurses and teachers in Jordan: a comparative study

Aim of the studyThis study was conducted to evaluate burnout among nurses and teachers in Jordan, and to explore the differences between them. Several demographic factors were examined to evaluate their effect on burnout levels in both professionsSubject or material and methodsThis study adopts the descriptive cross sectional design and was performed on 240 total participants; 120 nurses and 120 teachers. A modified Maslach Burnout Inventory (Modified-MBI) was used to assess the three dimensions of burnout.ResultsThe results of this study showed moderate levels of burnout among both nurses and teachers; however statistical analysis indicated that nurses had significantly higher level of burnout than teachers. Moreover, this study showed that sex, marital status and experience significantly affected the level of burnout in teachers but not in nurses. Educational level did not affect the level of burnout in either groupDiscussionThe results will be discussed according to the study questions.ConclusionsThis study should help in setting proper intervention plans and psychological programs to tackle this important problem

Surgeon Burnout among American Pediatric Urologists

IntroductionBurnout is a syndrome characterized by exhaustion, depersonalization and low personal achievement that leads to decreased effectiveness at work. Little to no information is known about the surgeon burnout rate of pediatric urologists. MethodsAn online survey containing a modified Maslach Burnout Inventory and additional demographic information was emailed to practicing pediatric urologists in the United States. The dependent variable was professional burnout measured by 3 subscales from the Maslach Burnout Inventory of 1) emotional exhaustion, 2) depersonalization and 3) low personal achievement. The independent variables included surgeon demographics and practice characteristics. ResultsThe survey response rate was 66.7%. Of the 41 subjects most were male (82.9%), approximately three-quarters worked at academic centers, more than half had a rank of division chief or full professor and more than half worked more than 60 hours per week. Six (14.6%) pediatric urologists met the criteria for burnout, defined as high scores in emotional exhaustion plus high scores in depersonalization or low personal achievement. When comparing demographic and practice characteristics between pediatric urologists who were burned out to those who were not burned out, there were no statistically significant differences between the 2 groups. Only American Urological Association North Central and Western sections had surgeons with burnout. ConclusionsPediatric urologists have a low burnout rate compared to adult urologists and other surgical specialties.