Burnout In Trainees Research Articles

834 - Trainee burnout in the United States and Europe: A multi-national comparative study

834 - Trainee burnout in the United States and Europe: A multi-national comparative study

The role of relationship reciprocity and self-efficacy on wellbeing and burnout in clinical psychology trainees

This study aimed to extend knowledge of factors which may be linked with clinical psychology trainee resilience by exploring reciprocity in trainee relationships and self-efficacy beliefs and their associations with trainee burnout and wellbeing.

Gender-Based Discrimination Is Prevalent in the Integrated Vascular Trainee Experience and Serves as a Predictor of Burnout

Trainee burnout is on the rise, and negative training environments may contribute. In addition, as the proportion of women entering vascular surgery increases, identifying factors that challenge recruitment and retention is vital as we grow our workforce to meet demand. This study sought to characterize the learning environment of vascular residents and to determine how gender-based discrimination and bias (GBDB) affect the clinical experience. A survey was developed to evaluate the trainee experience; demographics and a two-item burnout index were included. It was sent electronically to all integrated vascular surgery residents in the United States. Univariate analyses were performed and predictors of burnout identified. There were 284 residents who were invited and 208 (73%) who completed the survey. Participants were predominantly male (64%) and white (57%), with a mean age of 30.7 ± 3.2 years. Some form of negative workplace experience was endorsed by 79%, and 29% were at high risk for burnout. Personal experience of GBDB was endorsed by 38%, with a significant difference between men and women (14% vs 81%; P < .000). Whereas men were significantly more likely to witness GBDB than to experience it, women were still more likely to observe these occurrences (77% vs 56%; P = .003). Patients and nurses were the most frequently cited sources of GBDB (80% and 65%, respectively), with vascular surgery attendings cited by 42% of trainees. More than one in four female resident respondents indicated being sexually harassed during the course of training, with a significant gender difference (1% vs 26%; P < .001). Nearly half (46%) of trainees who witnessed or experienced GBDB thought that quality of patient care, job satisfaction, personal well-being, and personal risk of burnout were affected. GBDB was predictive of high risk of burnout (odds ratio, 1.9; 95% confidence interval, 1.1-3.6; P = .035), as were longer work hours (>80 h/wk; odds ratio, 2.6; 95% confidence interval, 1.1-6.7; P = .049). GBDB was experienced by 38% of integrated trainees, with women significantly more affected than men. GBDB is predictive of high risk of burnout, and this has significant implications for our specialty in the recruitment and retention of female physicians. Programs addressing these issues are needed to maintain a diverse workforce and to promote physicians’ well-being.

Occupational Burnout among Otolaryngology-Head and Neck Surgery Trainees in Australia.

Surgical trainee burnout has gained attention recently as a significant factor leading to poorer quality of patient care, decreased productivity, and personal dysfunction. As a result, we aimed to determine the prevalence and associated risk factors for burnout among otolaryngology-head and neck surgery (OHNS) trainees in Australia. Cross-sectional survey. National cohort of accredited OHNS trainees in Australia. Participants completed the Maslach Burnout Inventory (MBI). Trainee burnout was defined if any threshold of the 3 MBI domains-emotional exhaustion, depersonalization, or personal accomplishment-reached an established high threshold. Demographic data on potential predictors of burnout, such as stressors, workload, satisfaction, and support systems, were collected from survey responses. Predictors were compared with the burnout status. Of 67 OHNS trainees, 60 responded (66.7% men). Burnout was common among respondents, with 73.3% suffering from burnout in at least 1 of the 3 MBI domains (70.0%, emotional exhaustion; 46.7%, depersonalization; 18.3%, personal accomplishment). Trainee burnout was significantly influenced by training location (chi-square, P = .05), living geographically apart from social supports (odds ratio [OR], 3.49; chi-square, P = .007), number of years trained rurally or away from social supports (Kendall's tau-B, P = .03), difficulty balancing work and nonwork commitments (OR, 10.0; chi-square, P = .03), training negatively affecting their partner or family (OR, 14.30; chi-square, P = .05), and feeling uncomfortable approaching a supervisor (OR, 2.50; chi-square, P < .0001). Burnout was found to be very common among OHNS trainees in Australia. The statistically significant predictors identified should be addressed to minimize trainee burnout.

Effect of Reflective Writing on Burnout in Medical Trainees

This article was migrated. The article was not marked as recommended. Introduction: Narrative Perspective and Reflective Writing is a fourth-year elective at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. This is the first study to show through both quantitative and qualitative data that medical students who participated in such a course experienced lower burnout. Preliminary data suggests that the course also fostered increased resilience. Methods: This longitudinal course was offered to all fourth-year medical students as an elective. Assessments were administered electronically to students before starting the course and following the final session. Pre- and post- course questionnaires consisted of items from the Maslach Burnout Inventory (MBI) for both cohorts. The Connor-Davidson Resilience Scale (CD-RISC) was added to the questionnaire for the second cohort only. Results: There were statistically significant reductions in emotional exhaustion and depersonalization from pre- to post-course assessments. There were modest, but not statistically significant, increases in the MBI subscale of personal accomplishment subscale and on the Connor-Davidson Resilience scale. Qualitative student feedback was overwhelmingly positive. Discussion: These findings suggest that engagement with health humanities can reduce burnout and possibly increase resilience in medical trainees. The course is well-aligned with efforts to incorporate communication and empathy training into postgraduate and continuing medical education. It is an enriching and effective intervention that can reduce burnout at a critical point in students' medical training. Limitations: Limitations of our study are discussed, as are strategies to control for confounding variables. The challenges faced in implementing more humanities-based courses into medical education are briefly presented. Conclusion: This is the first study to show both quantitatively and qualitatively that fourth-year medical students participating in a health humanities course experienced reduction in burnout. The positive impact of this humanities-based elective on medical trainees at a crucial juncture of their careers should prompt more widespread implementation of humanities-based electives in medical education.

Burnout, depression, perceived stress, and self-efficacy in vascular surgery trainees

ObjectiveBurnout is a work-related syndrome involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment that has become prevalent in all levels of medical training. We sought to understand factors associated with burnout identified in vascular surgery trainees. MethodsAn anonymous electronic survey consisting of demographic and programmatic information as well as validated scales for burnout, depression, perceived stress, self-efficacy, and social support was given to all vascular surgery trainees in the United States. Univariate and multivariate analyses were used to compare responses. Residents were grouped into quartiles based on burnout level, and predictors of burnout were determined. ResultsOf the 514 invitations sent, 177 (34%) respondents completed the survey. Trainees in the highest quartile of burnout were more likely to have moderate to severe depression (40% vs 4%; P < .01), higher perceived stress score (odds ratio [OR], 1.3; P < .01), lower social support (OR, 0.89; P < .01), and lower self-efficacy (OR, 0.76; P < .01), and they were less likely to reconsider vascular surgery as a career if given the chance to do it over (χ2 = 20; P < .01). Trainees without a self-identified mentor were significantly more likely to report burnout (χ2 = 15; P < .01). In addition, trainees who reported more frequent 80-hour work infractions each month (3.6 vs 2.3; P < .01) and those without access to programmatic social events (χ2 = 11; P < .01) had higher levels of burnout. In contrast, trainees with the lowest quartile of burnout scores reported lower depression (OR, 0.43; P < .01), lower stress (OR, 0.63; P < .01), more social support (OR, 0.1.2; P < .01), higher self-efficacy (OR, 1.2; P < .01), and fewer work week violations each month (2.3 vs 2.9; P = .04). Lower burnout scores were associated with program mentorship (χ2 = 7.3; P < .01), program-sponsored social events (χ2 = 8.7; P < .01), and being more likely to choose vascular surgery again if given the chance (χ2 = 6.3; P < .01). Highest burnout scores did not correlate with sex (χ2 < .01; P = 1), age (32 years vs 32 years; P = .65), marital status (χ2 < .01; P = 1), proximity to family (OR, 1.2; P = .26), alcohol consumption (χ2 = 0.23; P = .63), postgraduate year (OR, 1.1; P = .47), number of prior program graduates (OR, 0.95; P = .73), use of physician extenders in the program (OR, 0.93; P = .74), or total debt (OR, 1.0; P = .63). Similarly, there were no significant associations with these variables among trainees with the lowest quartile of burnout scores. On multivariate analysis, higher depression (OR, 1.6; P < .01) and higher perceived stress (OR, 1.2; P < .01) were associated with higher burnout scores, and lower burnout scores were associated with lower perceived stress (OR, 0.67; P < .01). ConclusionsBurnout in vascular surgery trainees is associated with higher levels of depression and perceived stress and lower levels of social support and self-efficacy. The addition of programmatic social events, limiting 80-hour work week violations, and addition of formal mentoring programs may decrease levels of burnout.

Looking Back to Move Forward: First-Year Medical Students' Meta-Reflections on Their Narrative Portfolio Writings.

The day-to-day rigors of medical education often preclude learners from gaining a longitudinal perspective on who they are becoming. Furthermore, the current focus on competencies, coupled with concerning rates of trainee burnout and a decline in empathy, have fueled the search for pedagogic tools to foster students' reflective capacity. In response, many scholars have looked to the tradition of narrative medicine to foster "reflective spaces" wherein holistic professional identity construction can be supported. This article focuses on the rationale, content, and early analysis of the reflective space created by the narrative medicine-centered portfolio at the Columbia University Vagelos College of Physicians and Surgeons. In January 2015, the authors investigated learning outcomes derived from students' "Signature Reflections," end-of-semester meta-reflections on their previous portfolio work. The authors analyzed the Signature Reflections of 97 (of 132) first-year medical students using a constant comparative process. This iterative approach allowed researchers to identify themes within students' writings and interpret the data. The authors identified two overarching interpretive themes-recognition and grappling-and six subthemes. Recognition included comments about self-awareness and empathy. Grappling encompassed the subthemes of internal change, dichotomies, wonder and questioning, and anxiety. Based on the authors' analyses, the Signature Reflection seems to provide a structured framework that encourages students' reflective capacity and the construction of holistic professional identity. Other medical educators may adopt meta-reflection, within the reflective space of a writing portfolio, to encourage students' acquisition of a longitudinal perspective on who they are becoming and how they are constructing their professional identity.

VESS13. Burnout, Depression, Perceived Stress, and Self-Efficacy in Vascular Surgery Trainees

VESS13. Burnout, Depression, Perceived Stress, and Self-Efficacy in Vascular Surgery Trainees

Creating Structured Opportunities for Social Engagement to Promote Well-Being and Avoid Burnout in Medical Students and Residents.

Increasing attention is being paid to medical student and resident well-being, as well as to enhancing resilience and avoiding burnout in medical trainees. Medical schools and residency programs are implementing wellness initiatives that often include meditation and other mindfulness activities, self-reflection, journaling, and lectures or workshops on resilience tools such as metacognition and cognitive restructuring. These interventions have in common the creation of opportunities for trainees to become more aware of their experiences, to better recognize stressors, and to regulate their thoughts and feelings so that stressors are less likely to have harmful effects. They often enable trainees to temporarily distance themselves mentally and emotionally from a stressful environment. In this Invited Commentary, the author suggests that medical school leaders and residency program directors should also create structured opportunities for trainees to establish meaningful connections with each other to provide greater social support and thereby reduce the harmful effects of stress. Social connection and engagement, as well as group identification, have potential to promote well-being and reduce burnout during training.

Emergency Medicine Trainee Burnout Is Associated With Lower Patients' Satisfaction With Their Emergency Department Care.

Emergency medicine (EM) physicians and trainees report high levels of burnout. Burnout negatively impacts physician well-being and career satisfaction but it remains unclear how burnout may influence patient care. We examined the degree to which EM trainee burnout at one institution was associated with patients' satisfaction with their emergency department (ED) care. In this cross-sectional, pilot study conducted at a single institution, we measured EM trainee burnout using the Maslach Burnout Inventory through a confidential, electronic survey. We subsequently linked individual trainee burnout results with their individual Press Ganey (PG) ED patient satisfaction scores. We compared burnout scores across sex and postgraduate year using chi-square tests and PG results via analysis of variance. Twenty-seven of 53 (50.9%) eligible EM trainees completed the burnout assessment. Trainees reported an overall burnout rate of 77.8% (95% confidence interval = 59.2%-89.4%). There were no significant differences in burnout based on sex (p = 0.888) or postgraduate year (p = 0.671). Trainee burnout was significantly associated with lower trainee-specific PG scores, including patient ratings of resident physician courtesy (p = 0.011), taking the time to listen (p = 0.004), keeping informed of treatment (p = 0.014), and concern for patient comfort (p = 0.006). There was no significant association between trainee burnout and patients' overall likelihood to recommend the ED to others (p = 0.364). Emergency medicine trainee burnout is associated with lower trainee-specific PG ED patient satisfaction scores across all four physician domains. In addition to its detrimental impact on physician wellness, burnout may play a significant adverse role in patients' perceptions of their ED providers' interpersonal and communication skills.

Re: "Emergency Medicine Faculty Are Poor at Predicting Burnout in Individual Trainees: An Exploratory Study".

Re: "Emergency Medicine Faculty Are Poor at Predicting Burnout in Individual Trainees: An Exploratory Study".

Resident Wellness: An Intervention to Decrease Burnout and Increase Resiliency and Happiness.

Despite the national focus on trainee burnout, effective wellness programs that can easily be incorporated into training curriculums are lacking. Strategies such as mindfulness and positive psychology, linked with deep breathing, have been shown to increase resiliency. We hypothesized that education about the neuroscience literature, coupled with teaching about well-being using short, easy-to-practice evidence-based exercises, would increase acceptance of this curriculum among residents and that providing protected time to practice these exercises would help trainees incorporate them into their daily lives. Residents were asked to attend a 60-minute didactic featuring both the concepts and science behind well-being. Residents then attended 15-minute booster sessions during protected didactic time each week for a 12-week curriculum. The booster sessions were peer-led by wellness champions. Additionally, there were monthly competitions using free phone apps to promote physical fitness through steps and flights challenges. The 12-week curriculum was offered to 272 residents across five subspecialties of internal medicine, general surgery, anesthesiology, psychiatry, and physical medicine and rehabilitation. A total of 188 residents (69%) participated in the initial didactic component. The curriculum was positively received, with four of the five residency programs participating in weekly sessions. Residents in four participating departments then chose to continue the weekly sessions on a voluntary basis after the initial 12-week curriculum. It is feasible to implement a low-cost, peer-led wellness curriculum to educate residents and foster an environment during residency training where mindfulness, optimism, gratitude, and social connectedness are the norm.

X + Y Scheduling Models in Internal Medicine Residency Programs: A National Survey of Program Directors' Perspectives

Perspectives Viewpoint • The X+Y scheduling model is utilized by many internal medicine residency programs. • 44% of programs utilize an X+Y scheduling model. • X+Y programs are often larger with 53% of them having more than 75 residents. • Most program directors perceive that X+Y models reduce trainee burnout and tension between patient care responsibilities. • 90% of programs utilizing an X+Y scheduling model are somewhat satisfied or very satisfied with their system.

Impact of Resident Burnout on Medical Students (Descriptive Abstract)

Burnout in medical trainees may impact factors including professionalism, medical knowledge, medical errors, career choice, and mental health. In teaching hospitals, residents are responsible for a significant portion of medical student education. The interaction between resident and student could affect student well-being, burnout, and career choices. To date, no study has examined relationships between resident burnout and their teaching skills.

Professional Burnout, Early Maladaptive Schemas, and Physical Health in Clinical and Counselling Psychology Trainees.

Little is known about the personal factors that increase vulnerability to job-related stress and burnout among psychologists in training. This study was based on a large international sample and aimed to explore the role of early maladaptive schemas (EMS) in predicting vulnerability to burnout, as well as attendant effects on short-term physical health, in clinical and counseling postgraduate psychology trainees. An online, quantitative, cross-sectional survey method design was used to collect self-report data that measured burnout, EMS, and physical health from 1,297 trainees. Only the unrelenting standards (US) schema predicted high burnout among trainees. The most commonly endorsed physical health symptoms were back and neck pain and tiredness, and were more severe for those experiencing high burnout. The current study contributes to our understanding of the role of the US EMS in the evolution of burnout in trainees and has implications for the development of self-awareness training programs for this population.

Working hours of United Kingdom psychiatric trainees: Findings from the BoSS study

IntroductionThe international burnout syndrome study (BoSS) examined burnout in psychiatry trainees and associated factors. Long working hours were significantly associated with burnout.AimsA high rate of severe burnout in UK psychiatric trainees (38%) was found in the BoSS study. This paper looks at the working hours of UK trainees.MethodsData collected during the BoSS study included information related to working hours, looking in particular at the working time directive rules. A total of 3964 UK psychiatric trainees were invited to take part, of which 1187 (30%) responded, and 811 (20%) provided complete responses for working hours questions.ResultsThe mean age was 33 years, with 49.1% males and equal gender distribution of participants and non-participants. The mean hours of contracted work per week were 42.7 (42.2–43.2) for men, versus 41.1 (40.4–42.0) for women. Actual hours worked were significantly higher at 46.2 (45.0–47.4) for men and 46.0 (44.9–47.1) for women. Forty-six percent of trainees breached one or more working time directive (WTD) safety limits.ConclusionActual hours worked among psychiatric trainees in the United Kingdom are about 10% higher than contracted hours. Female trainees also work more uncontracted hours than male trainees. This is significant when considering the association between hours of work and burnout, and also adds to the perception that women have to work harder for the same recognition as men. Forty-six percent of trainees breached WTD limits.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Trainee Wellness: Why It Matters, and How to Promote It

Wellness is critical to physicians in training and the general physician workforce. At present, physicians in general and especially intensive care unit physicians are experiencing high rates of depression and burnout. The prevalence of burnout is greatest in resident and fellow trainees. The Accreditation Council for Graduate Medical Education has recognized the importance of physician wellness by proposing Common Program Requirements that pertain to trainee and faculty well-being. Several individual-focused, organizational, and structural strategies have been described in the literature as helpful in decreasing burnout. Successful implementation of a trainee wellness program requires institutional resources and collaborative efforts between the institution, leadership, faculty, and trainees. To ensure the greatest effect in reducing burnout, training programs and institutions should create programs that intervene at both the organizational and individual levels. Additional steps to implement a trainee wellness program include the following: (1) establish support from institutional and divisional leadership; (2) create a wellness committee; (3) perform a needs assessment; (4) assess trainee wellness and burnout; (5) perform targeted interventions; and (6) routinely reassess trainee wellness and burnout. More research is needed to identify and refine strategies that improve wellness and decrease burnout among physicians and trainees. As a community, we must take on the challenge of improving wellness among physicians for the benefit of our trainees, ourselves, and our patients.

Prevalence of depression in psychiatry trainees in 22 countries: Findings from the international burnout syndrome study (BoSS)

AimsThe Burnout Syndrome Study screened for burnout in psychiatric trainees in 22 countries, along with associated factors. This paper reports the results of the PHQ-9 depression screen that formed part of the study.BackgroundIt is well documented that physicians have higher rates of mental illness compared to the general population. Post-graduate medical trainees may work long hours and be exposed to stressful or saddening situations regularly. Their environment and workload means they may not exhibit appropriate help-seeking behaviours and be at significant risk of depression.MethodsThe study used a cross sectional, multi-country online survey. Participants were asked to participate via an email invitation. The participants were asked to complete the PHQ-9 questionnaire, which is validated as a primary care self-administered screen for depression. Mixed methodology was used when recruiting trainees to obtain the most representative sample possible from each country. Statistical analysis was performed using SPSS.ResultsComplete data was obtained from 1980 trainees with an average age of 31.9 years and with 2.8 years of training. The prevalence of depression in psychiatric trainees varied by country from 50% in Latvia to 7.1% in Belarus. The average rate of depression was 20.8%.ConclusionsPrevalence of depression in the US general population is estimated at 6.7%, making the prevalence of depression in trainees of 20.8% a sign that action needs to be taken to reduce depression rates in trainees.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatry trainee burnout in the United Kingdom: The BoSS study

IntroductionBurnout syndrome is defined by three domains: emotional exhaustion, cynicism and reduced professional efficacy. Junior doctors have a high susceptibility to burnout reflected in the high prevalence identified in previous work. This is a significant issue as burnout has measurable effects on work performance. There has been limited research conducted on burnout in psychiatry trainees in the United Kingdom.AimThis paper takes a step towards addressing this gap by extracting the data concerning UK psychiatric trainees collected in the international burnout syndrome study (BoSS), which aimed to assess the prevalence and contributing factors of burnout among psychiatric trainees from over 20 countries, and presenting the findings concerning UK trainees.MethodData collected included demographic data and information related to working hours, bullying, harassment and stalking, supervision, suicidal ideation, depression (PHQ−9), and a personality trait assessment. Burnout syndrome was measured using the Maslach burnout inventory (MBI-GS). A total of 3964 psychiatry trainees in the UK were invited, of which 1187 (30%) responded including 811 (20%) providing complete responses for MBI-GS.ResultsThe mean age was 33 years, and 49.1% of respondents were male. Gender distribution of participants was the same as non-participants. Mean scores were 2.6 for exhaustion, 2.1 for cynicism and 4.5 for professional efficacy; and severe burnout was found in 309 (38%).ConclusionThree factors were positively associated with severe burnout: long working hours, lack of clinical supervision and not having regular time to rest.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Emergency Medicine Faculty Are Poor at Predicting Burnout in Individual Trainees: An Exploratory Study.

Burnout is common among emergency medicine (EM) physicians, and it is prevalent even among EM trainees. Recently proposed Accreditation Council for Graduate Medical Education requirements encourage faculty to alert residency leadership when trainees display signs of burnout. It remains uncertain how trainees experiencing burnout can be reliably identified. We examined if EM faculty advisers at one institution can accurately predict burnout in their EM resident advisees. In this cross-sectional, exploratory study at a single institution, we measured EM trainee burnout using the Maslach Burnout Inventory through a confidential, electronic survey. We subsequently asked EM faculty to predict if their designated advisees were experiencing burnout through a separate confidential, electronic survey. Burnout results were dichotomized from each survey and compared using a 2 × 2 contingency table and Fisher's exact test. Thirty-six of 54 (66.7%) eligible EM trainees completed the burnout assessment. Eleven of 19 (57.9%) eligible faculty advisers completed trainee burnout predictions, resulting in 30 of 54 (55.6%) trainees who completed the burnout assessment and had a faculty burnout prediction. Trainees reported an overall burnout rate of 70.0% (95% confidence interval [CI] = 53.6% to 86.4%). Cumulative faculty predictions of trainee burnout resulted in an overall burnout rate of 16.7% (95% CI = -5.3% to 38.7%). The sensitivity and specificity of faculty predictions of trainee burnout were 19.1% (95% CI = 5.5% to 41.9%) and 88.9% (95% CI = 51.8% to 99.7%), respectively. Faculty prediction of trainee burnout had a positive predictive value of 80.0% (95% CI = 28.4% to 99.5%) and a negative predictive value of 32.0% (95% CI = 15.0% to 53.5). The difference between trainees' reported rate of burnout and faculty predictions of trainee burnout was significant (p < 0.001). Emergency medicine faculty prediction of trainee burnout was poor. Education on recognizing burnout and other methods of identifying trainee burnout may be necessary.