Professional Fulfillment Index Research Articles

Association of Physician Burnout With Suicidal Ideation and Medical Errors

Addressing physician suicide requires understanding its association with possible risk factors such as burnout and depression. To assess the association between burnout and suicidal ideation after adjusting for depression and the association of burnout and depression with self-reported medical errors. This cross-sectional study was conducted from November 12, 2018, to February 15, 2019. Attending and postgraduate trainee physicians randomly sampled from the American Medical Association Physician Masterfile were emailed invitations to complete an online survey in waves until a convenience sample of more than 1200 practicing physicians agreed to participate. The primary outcome was the association of burnout with suicidal ideation after adjustment for depression. The secondary outcome was the association of burnout and depression with self-reported medical errors. Burnout, depression, suicidal ideation, and medical errors were measured using subscales of the Stanford Professional Fulfillment Index, Maslach Burnout Inventory-Human Services Survey for Medical Personnel, and Mini-Z burnout survey and the Patient-Reported Outcomes Measurement Information System depression Short Form. Associations were evaluated using multivariable regression models. Of the 1354 respondents, 893 (66.0%) were White, 1268 (93.6%) were non-Hispanic, 762 (56.3%) were men, 912 (67.4%) were non-primary care physicians, 934 (69.0%) were attending physicians, and 824 (60.9%) were younger than 45 years. Each SD-unit increase in burnout was associated with 85% increased odds of suicidal ideation (odds ratio [OR], 1.85; 95% CI, 1.47-2.31). After adjusting for depression, there was no longer an association (OR, 0.85; 95% CI, 0.63-1.17). In the adjusted model, each SD-unit increase in depression was associated with 202% increased odds of suicidal ideation (OR, 3.02; 95% CI, 2.30-3.95). In the adjusted model for self-reported medical errors, each SD-unit increase in burnout was associated with an increase in self-reported medical errors (OR, 1.48; 95% CI, 1.28-1.71), whereas depression was not associated with self-reported medical errors (OR, 1.01; 95% CI, 0.88-1.16). The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.

A National Curriculum to Address Professional Fulfillment and Burnout in OB-GYN Residents.

Physician well-being is a priority in graduate medical education as residents suffer high rates of burnout. With complex stressors affecting the clinical environment, conflicting evidence exists as to whether a formal curriculum improves resident well-being. We assessed the feasibility and impact of a national pilot of a yearlong wellness curriculum for obstetrics and gynecology (OB-GYN) residents. The Council on Resident Education in Obstetrics and Gynecology Wellness Task Force developed a national multicenter pilot group of 25 OB-GYN programs to participate in a prospective cohort study. The curriculum included 6 interactive wellness workshops using uniform teaching materials delivered during didactic time. Prior to and following their participation in the curriculum, residents completed a survey containing demographic information and the Professional Fulfillment Index. Among 592 eligible participants, 429 (72%) responded to the pretest and 387 (65%) to the posttest. Average age of respondents was 29.1 years (range = 24-52 years) and included 350 (82%) women and 79 (18%) men. At baseline, 254 of 540 (47%) respondents met criteria for burnout, and 101 (23%) met criteria for robust professional fulfillment. Residents participated in an average of 3.9 workshops. While aggregate posttest scores did not differ from baseline, residents attending 4 to 6 workshops had improved rates of burnout (40% vs 50%, P = .017) and robust professional fulfillment (28% vs 20%, P < .001) compared with those with lower attendance. A wellness curriculum was a feasible addition to OB-GYN residency program curricula in programs across the country. Residents with higher attendance experienced improved professional fulfillment and less burnout.

Veterinary Technicians and Occupational Burnout.

Burnout and compassion fatigue are common conditions affecting health care providers. Unique occupational conditions in veterinary medicine make technicians especially susceptible to burnout. A total of 1,642 practicing veterinary technicians completed an anonymous online survey comprised of demographic questions, and two tools to assess burnout: the Maslach Burnout Inventory-General Survey (MBI-GS) and the Stanford Professional Fulfillment Index (PFI). Over half of participants (862/1479, 58.3%) had EE scores over the 3.0 threshold for burnout. On the PFI, the total score for the 10 burnout questions was x = 1.54 (SD = 0.75), which is above the 1.33 cutoff for burnout. The mean score of 2.26 (SD = 0.81) on the professional fulfillment scale is also indicative of burnout. The relationship between enabling resources and scores on each MBI-GS scale was analyzed. Schedule control was the most significant predictor of lower EE scores. The perception of adding value to the practice was associated with lower scores on the CY scale and higher scores on the PE scale. Given the correlation between burnout and environmental factors, veterinary practices are encouraged to explore non-monetary mechanisms for enhancing job satisfaction. This includes giving technicians greater control over their schedules, recognizing their contributions to the team, and providing opportunities for professional development. From a morale standpoint, destigmatizing the dirty work done by technicians can also help combat burnout among veterinary technicians.

Reflection rounds to facilitate resilience in hematology/medical oncology fellows.

11019 Background: Given the prevalence of burnout among medical oncologists (40-60% in the literature), education on burnout risk factors, recovery, and prevention are needed urgently in training curricula for medical oncology fellows. Care of patients with cancer is increasingly complex, and often can seem overwhelming to new trainees. Debriefing as a resiliency skill to develop self-reflection and identify coping strategies may provide a durable way to navigate these complexities. Optimization of fellowship Reflection Rounds (RR) was selected as a fellow-led quality improvement (QI) project for the current academic year. Methods: A QI team including the APD and representatives from all levels of fellowship training was assembled. Feedback regarding previously unstructured, monthly, hour long faculty-facilitated RR for first year fellows was reviewed. Topics with associated readings were selected and paired with fellow-nominated faculty based on the most common recurring themes. The QI team administered the Stanford Professional Fulfillment Index (PFI) to all fellows at the midway point of the academic year. RR were re-structured to include a chaplain with trainee communication expertise and a chief fellow to participate the sessions to assess changes in trainee engagement. Repeat assessment of the Stanford PFI is planned for the end of the academic year. Results: Topics identified for discussion included handling bias, futile care, patient communication, end of life care, and work-life balance. 26 fellows completed the Stanford PFI including nine 1st year fellows, 13 2nd year fellows, and 6 3rd year fellows. Survey results revealed emotional and/or physical fatigue as areas of greatest need for improvement in fellow well-being with 27% of fellows reporting “moderate” emotional or physical exhaustion. Conclusions: RR provides a safe and effective forum to develop peer debriefing and self-refection as resiliency skills within hematology/medical oncology fellowship training. Optimization of RR will continue as fellows become more involved in planning and implementation of curricular improvements to promote resiliency and enhance wellness.

Presence, resilience, and compassion training in clinical education (PRACTICE): Evaluation of a mindfulness-based intervention for residents.

Residents’ well-being tends to decline in the course of training, yet research on preventive and restorative interventions for residents is limited. Mindfulness-based interventions have been successfully employed to support well-being in practicing physicians, but their impacts on residents are not well established. This paper describes the structure, content, and evaluation of a pilot mindfulness-based intervention program designated PRACTICE (presence, resilience and compassion training in clinical education) that was designed specifically to support resident well-being. A combined sample of 14 postgraduate year one residents from two residency training programs participated in a four-session (8 h) mindfulness-based intervention in the Fall/Winter of 2018. Participants were surveyed before, after, and at 3 months postintervention, on measures of wellness (Professional Fulfillment Index) and mental health (Patient Health Questionnaire-4), along with measures of program engagement. Participants demonstrated a significant reduction in burnout at the conclusion of the program. Depression and anxiety screening scores also trended toward improvement. However, participants were not able to sustain these gains. Three months after the conclusion of the program wellness measures had returned to preintervention levels. The results of this study support the use of mindfulness-based interventions in resident wellness programs. The lack of an enduring effect indicates the need for a maintenance phase intervention.

7. PROFESSIONAL FULFILLMENT IN PEDIATRIC RESIDENTS

Knowledge about physician burnout is vast, but little is known about professional fulfillment. It is defined as satisfaction and meaningfulness with self-efficacy at work. The purpose of this study was to examine professional fulfillment and burnout among pediatric residents at SUNY Upstate using the Stanford Professional Fulfillment Index (SPFI). It is a 16-item survey that has been previously validated. It has been recognized by the National Academy of Medicine as an important resource for assessing clinician well-being. The survey with additional demographic questions was distributed to residents in November 2018. Data were collected and managed using REDCap electronic data capture tools hosted at SUNY Upstate. Residents received a unique link to the index to maintain confidentiality. This study was determined to be exempt from IRB review. 76% of residents completed the survey. Responses to many questions were similar across training levels. There is a positive sense of professional fulfillment; at least 2/3 selected moderately/very true for these questions. 92% of PL-1s indicated feeling happy at work to be moderately/very true, compared to 81% of senior residents (PL-2/3/4). On feeling in control when dealing with difficult problems at work, 52% of PL-1s said this was moderately/very true vs. 81% of seniors. At least 1/3 indicated responses of on questions about burnout. One-fifth responded they felt a lot of emotional exhaustion at work; 8% of PL-1s vs. 29% of seniors. 40% of all residents indicated they were moderately less empathetic with colleagues - 15% of PL-1s vs. 52% of seniors. This is a small sample at a single site and results may not be generalized to other programs at our institution or other pediatric programs. There are no published reports using the SPFI exclusively in pediatric residents and therefore we lack other data for comparison. We will use these results to develop resources aimed at mitigating burnout, focusing on improving empathy and decreasing emotional exhaustion. We will use the SPFI quarterly to gauge the impact of changes on professional fulfillment.

Assessing Burnout and Professional Fulfillment in Breast Surgery: Results From a National Survey of the American Society of Breast Surgeons.

Physician burnout is a well-recognized problem in health care that has a negative impact on professional well-being and quality of patient care. Rates of burnout in breast surgery are not well-defined. This study sought to understand the degree of burnout among breast surgeons and to identify factors that influence professional fulfillment. All U.S. members of the American Society of Breast Surgeons with a valid email address were surveyed in October 2017. The results were anonymous, and the participants were blinded to the study hypothesis. The survey included 30 questions (16-item Professional Fulfillment Index [PFI] and 14-item demographics/practice patterns). Multivariable linear regressions were performed to assess overall burnout and high professional fulfillment. Of the 2568 surveys delivered, 708 surveys were initiated, and 660 were completed. Among breast surgeons, 270 (41.3%) expressed burnout, whereas 281 (42.5%) reported high professional fulfillment. In the multivariable analysis, years in practice was inversely associated with burnout and positively correlated with professional fulfillment. Working more than 60h per week was positively associated with burnout, and having more than 50% of practice dedicated to breast surgery correlated positively with fulfillment. Approximately 4 of 10 breast surgeons have symptoms of burnout, whereas 4 of 10 surgeons report high professional fulfillment. Specific clinical practice conditions largely influence rates of burnout and professional fulfillment. The contributing factors identified in the study analysis may be useful in identifying breast surgeons at higher risk for burnout. The study findings also help to inform the design of interventions focused on the clinical practice environment to promote professional fulfillment and sustainability.