How Do Areas of Work Life Drive Burnout in Orthopaedic Attending Surgeons, Fellows, and Residents?
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ABSTRACT:
SUBMITTER: Verret CI
PROVIDER: S-EPMC7899526 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
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How Do Areas of Work Life Drive Burnout in Orthopaedic Attending Surgeons, Fellows, and Residents?
Verret Claire Isabelle CI Nguyen Joseph J Verret Carolyne C Albert Todd J TJ Fufa Duretti T DT
Clinical orthopaedics and related research 20210201 2
<h4>Background</h4>Concerning levels of burnout have been reported among orthopaedic surgeons and residents. Defined as emotional exhaustion and depersonalization, physician burnout is associated with decreased productivity, increased medical errors, and increased risk of suicidal ideation. At the center of burnout research, person-centered approaches focusing on individual characteristics and coping strategies have largely been ineffective in solving this critical issue. They have failed to cap ...[more]
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Project description:BackgroundIn 2019, we assessed rates of burnout in orthopedic surgeons (attendings and trainees) at our institution and found distinct levels and drivers of burnout. Excessive workload had the strongest association with burnout across career stages.PurposesWe sought to re-examine the rates of burnout in orthopedic trainees and faculty in the same institution several years later and to identify the areas of worklife that correlated with burnout at distinct career stages, comparing 2019 and 2023 responses.MethodsFrom November 2022 to February 2023, we invited 190 orthopedic attending surgeons and trainees to participate in a survey by email. The Maslach Burnout Inventory and Areas of Worklife Scale were used to evaluate burnout and areas of worklife, respectively. Respondents were invited to elaborate on their experiences in free-text boxes. Results were compared to those of our 2019 survey.ResultsIn 2023, 76 recipients completed the survey, for a 40% response rate, compared with a 79% response rate in 2019. The response rate among residents fell from 93% in 2019 to 28% in 2023. High levels of depersonalization were found in 38% of residents and 21% of attending surgeons. High levels of emotional exhaustion were found in 31% of residents and 33% of attending surgeons. The proportion of attending surgeons reporting symptoms of burnout doubled between 2019 and 2023, whereas rates remained similar in residents. In 2023, 38% of residents reported low personal accomplishment compared with 5% in 2019. Excessive workload and limited job control were the work life areas most strongly correlated with burnout.ConclusionsThe results of our 2023 survey suggest that burnout rates increased in academic orthopedic attending surgeons at our institution since 2019. The COVID-19 pandemic has highlighted the importance of institutions continuing to prioritize physician well-being.
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Project description:IntroductionIn shared decision-making (SDM), physicians encourage the patient to participate in the care process. The theory of planned behaviour describes that behaviour is dependent on intention. In its turn, intention is explained by attitude, subjective norm and perceived behavioural control. In orthopaedics, little is known about current SDM behaviour and how to promote it.The aim of the present study was to gain insight into the SDM behaviour of orthopaedic residents and supervisors by measuring levels of intention, attitudes, subjective norms and perceived behavioural control. Furthermore, we aimed to determine the predictors of intention for SDM.MethodsA questionnaire survey study was conducted among orthopaedic surgeons and residents working in the care of hip and knee osteoarthritis, to determine their intentions, attitudes, subjective norms and perceived behavioural control regarding SDM.ResultsOf the 385 physicians approached, 71 residents and 64 orthopaedic surgeons participated. Residents and the supervisors alike had positive intentions regarding SDM. Intention for SDM behaviour was explained by attitude, subjective norm and perceived behavioural control, with perceived behavioural control having the strongest association. In residents, the intention to engage in SDM was more hampered by a lower level of perceived behavioural control than in surgeons.ConclusionsPhysicians are willing to perform SDM and consider SDM as favourable in the orthopaedic clinic. The implementation of SDM is mainly hampered by experienced barriers that they cannot control. These findings underline the importance of incorporating SDM in the curriculum of postgraduates. Possibilities for efficient SDM implementation should be explored, to overcome perceived barriers.
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Project description:BackgroundPhysician burnout is common and associated with significant consequences for physicians and patients. One mechanism to combat burnout is to enhance meaning in work.ObjectiveTo provide a trainee perspective on how meaning in work can be enhanced in the clinical learning environment through individual, program, and institutional efforts.Methods"Back to Bedside" resulted from an appreciative inquiry exercise by 37 resident and fellow members of the ACGME's Council of Review Committee Residents (CRCR), which was guided by the memoir When Breath Becomes Air by Paul Kalanithi. The exercise was designed to (1) discover current best practices in existing learning environments; (2) dream of ideal ways to enhance meaning in work; (3) design solutions that move toward this optimal environment; and (4) support trainees in operationalizing innovative solutions.ResultsBack to Bedside consists of 5 themes for how the learning environment can enhance meaning in daily work: (1) more time at the bedside, engaged in direct patient care, dialogue with patients and families, and bedside clinical teaching; (2) a shared sense of teamwork and respect among multidisciplinary health professionals and trainees; (3) decreasing the time spent on nonclinical and administrative responsibilities; (4) a supportive, collegial work environment; and (5) a learning environment conducive to developing clinical mastery and progressive autonomy. Participants identified actions to achieve these goals.ConclusionsA national, multispecialty group of trainees developed actionable recommendations for how clinical learning environments can be improved to combat physician burnout by fostering meaning in work. These improvements can be championed by trainees.
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Project description:Background The COVID-19 global pandemic has caused unprecedented levels of strain on the United States healthcare and its workforce. Orthopaedic and neurosurgery residents and fellows, as part of this workforce have also experienced some of the uncertainty and stress caused by this pandemic. Concerns exist regarding the effects of the pandemic on spine surgery education due to the cancellation of all elective surgeries. Current Context We explore how this pandemic is affecting orthopaedic and neurosurgery residents and fellows and their spine surgery education and experience. We also examined measures taken by the residency and fellowship programs to protect their residents and fellows, and measures taken by regulatory agencies like the ACGME and the ABOS to give programs some flexibility during these difficult times. Conclusion Orthopaedic and neurosurgery residents and fellows are often on the front lines of patient care. Programs have to ensure adequate resources and training, supervision, and work hour requirements are met. Residents and fellows need to be ready to assist with management of COVID-19 patients if necessary. Residency programs and spine surgery fellowships need to use objective metrics to assess the impact of the pandemic on the spine surgery education of their residents and fellows in order to address any potential area of weakness caused by the decreased exposure to spine surgery.
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Project description:BackgroundBurnout resulting from long-term and unmanaged workplace stress is high among healthcare professionals, especially surgeons, and affects both individuals and the quality of patient care. The objective of this study was to determine the prevalence and associated factors for burnout among attending general surgeons and to identify possible preventive strategies.MethodsA national cross-sectional survey using a 35-item questionnaire was conducted among members of the Turkish Surgical Society. The survey evaluated demographics, professional and practice characteristics, social participation, and burnout as well as interventions to deal with burnout. Burnout was defined as a high score on the emotional exhaustion (EE) and/or depersonalization (DP) subscales. Surgeons with high scores on both the EE and DP and a low score on personal accomplishment (PA) were considered to have severe burnout.ResultsSix hundred fifteen general surgeons completed the survey. The median EE, DP, and PA scores were 34 (IQR, 20-43), 9 (IQR, 4-16), and 36 (IQR, 30-42), respectively. Overall, the prevalence of burnout and severe burnout were 69.1 and 22.0%, respectively. On multivariable analysis, factors independently associated with burnout were working in a training and research hospital (OR = 3.34; P < 0.001) or state hospital (OR = 2.77; P = 0.001), working ≥ 60 h per week (OR = 1.57; P = 0.046), and less frequent participation in social activities (OR = 3.65; P < 0.001).ConclusionsBurnout is an important problem among general surgeons with impacts and consequences for professionals, patients, and society. Considering that burnout is a preventable condition, systematic efforts to identify at-risk populations and to develop strategies to address burnout in surgeons are needed.
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Project description:IntroductionThe Work-Related Quality of Life (WRQoL) is a complex, multidimensional concept, and its assessment is challenging due to a lack of consensus on the factors involved. While the WRQoL Scale has been validated in various countries, no translation into Brazilian Portuguese existed until this study. The primary aim was to validate the Brazilian Portuguese version of the WRQoL Scale, using psychologists as the target population, and to measure burnout and life satisfaction in this group.MethodsA backtranslation process was followed, involving bilingual translators and a focus group of psychology professionals to refine the final version. A total of 610 psychologists participated, completing the Maslach Burnout Inventory, the Life Satisfaction Scale, and the WRQoL Scale via an online platform (SurveyMonkey®). Exploratory and confirmatory factor analyses were conducted to test and refine the factor structure of the WRQoL Scale. Spearman's correlations and group comparison analyses were also performed.ResultsSeventy-six percentage of participants reported adequate life satisfaction, while 60.2% exhibited burnout symptoms, particularly in emotional exhaustion and depersonalization. Protective factors for the mental health of psychologists were identified. The final version of the WRQoL Scale included 23 items across three factors, with good internal consistency (Cronbach's alpha = 0.89 ICC = 0.96).DiscussionThe WRQoL Scale - Brazilian version, demonstrated adequate psychometric properties, as evidenced by its construct validity and internal consistency. This provides evidence that the WRQoL Scale is a adequate tool that can measure work-related quality of life in psychologists.
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Project description: Not available
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Project description:PurposeTo evaluate the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete description of gender diversity within this subspecialty.MethodsOfficial program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America fellowship directory were examined. Data collected for analysis included the gender of program directors, fellowship faculty, orthopaedic surgery department faculty, current sports medicine fellows, and fellows who graduated within the last 5 years.ResultsOf the 132 orthopaedic sports medicine fellows in training in the United States in the 2021 to 2022 academic year, 113 (85.6%) were men and 19 (14.4%) were women (P < .001). Within the past 5 years, 419 fellows were listed as completing a sports medicine fellowship, with 375 (89.5%) being men, and 44 (10.5%) being women (P < .001). There was no significant difference in the gender composition of current fellows compared with the composition of fellows within the last 5 years (P = .74). When we examined gender trends in sports medicine faculty, 639 (86.6%) were men and 99 (13.4%) were women (P < .001). There were 14 women (14.4%) orthopaedic sports medicine faculty in leadership positions (i.e., program director or assistant program director) compared with 83 men in such positions (85.6%) (P < .001).ConclusionsOrthopaedic sports medicine fellowships remain heavily male-dominated on all levels, including fellows, faculty, and leadership. There were no differences in the gender composition of current fellows when compared with those who graduated in the last 5 years, suggesting persistent gender disparity and the need for novel initiatives to enhance gender diversity in sports medicine.Level of evidenceIV, descriptive study.
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Project description:BackgroundGeneral surgery residents may be underprepared for practice, due in part to declining operative autonomy during training. The factors that influence entrustment of autonomy in the operating room are unclear.ObjectiveTo identify and compare the factors that residents and faculty consider influential in entrustment of operative autonomy.MethodsAn anonymous survey of 29-item Likert-type scale (1-7, 1 = strongly disagree, 7 = strongly agree), 9 multiple-choice, and 4 open-ended questions was sent to 70 faculty and 45 residents in a large ACGME-approved general surgery residency program comprised of university, county, and VA hospitals in 2018.ResultsSixty (86%) faculty and 38 (84%) residents responded. Faculty were more likely to identify resident-specific factors such as better resident reputation and higher skill level as important in fostering entrustment. Residents were more likely to identify environmental factors such as a focus on efficiency and a litigious malpractice environment as impeding entrustment. Both groups agreed that work hour restrictions do not decrease autonomy and entrustment does not increase risk to patients. More residents considered low faculty confidence level as a barrier to operative autonomy, while more faculty considered lower resident clinical skill as a barrier. Improvement in resident preparation for cases was cited as an important intervention that could enhance entrustment.ConclusionsDifferences in perspectives exist between general surgery residents and faculty regarding entrustment of autonomy. Residents cite environmental and attending-related factors, while faculty cite resident-specific factors as most influential. Residents and faculty both agree that entrustment is integral to surgical training.
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