The use of social media as a tool for professional communication and education in healthcare has been increasing; pros and cons of such platforms were extensively debated in recent years with mixed results. During the COVID-19 pandemic, social media use has accelerated to the point of becoming a ubiquitous part of modern healthcare systems. As with any tool in healthcare, its risks and benefits need to be carefully considered. In this article, we review the use of social media in the current pandemic. Importantly, we will illustrate this using experiences from the perspective of large medical organisations and also identify the common pitfalls.

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The term 'burnout' describes the collection of symptoms and signs, both physical and psychological, experienced by individuals due to their work. It is defined as the condition where professionals 'lose all concerns, all emotional feeling for the people they work with, and come to treat them in a detached or even dehumanised way'. 1 Individuals often feel a sense of emotional exhaustion, indifference, depersonalization, and a lack of desire for personal achievement. Stress is related to, but is not the same as burnout (Table 1). Stress occurs when the individual's ability to cope and deal with demands is exceeded. In controlled amounts, stress allows an individual to improve his/her performance, while burnout is an intrinsic response to continued excessive stress without time or space for recovery. Often mentioned and described with burnout, resilience is defined in the Oxford Dictionary as 'the capacity to recover quickly from difficulties'. A true clinical definition of resilience is lacking, although it has considerable overlap with the concepts of wellness and well-being. Rather than simply being the absence of burnout, it is considered a state of being able to thrive in the presence of challenges. 2 Like burnout, resilience is a complex interplay between the individual, environment, and culture. Prevalence among health care professionals Although burnout can affect workers from any field, health care professionals are particularly at risk. With the ever-increasing workload and demands placed on the modern health care system, there is growing concern about burnout among health care professionals due to its potential to negatively affect the workforce and also patient care. Doctors reported substantially higher rates of psychological distress and attempted suicide compared with both the general population and other professionals. 3 Key points • Burnout is a syndrome characterized by depersonalization, emotional exhaustion, and loss of sense of achievement.

In the last 10 years, there has been increasing interest into the psychological wellbeing of healthcare providers. Within critical care, increasing attention is being paid to the concept of ‘burnout’ – a cluster of symptoms that adversely affect the health of critical care providers. Publications and statements from the major critical care societies have all addressed this syndrome and emphasised urgency in tackling it. The current COVID-19 pandemic has fundamentally changed the way we work, communicate and learn. Even before the pandemic, there have been growing concerns and acknowledgement that healthcare practitioners in intensive care are at increased risk of burnout and burnout syndrome. There has never been greater pressure on intensive care or indeed healthcare as a whole to look after so many patients during this pandemic and yet there is global acknowledgement that key to overcoming these challenges is to look after the care providers – both physically and psychologically. In this paper, we review the issue of burnout amongst healthcare practitioners during current pandemic. We present the impact of burnout on the individual and the system as a whole but perhaps most importantly, we provide a review of steps being taken to mitigate against these adverse outcomes in the short and longer term.

BackgroundRecent studies suggest that displays of unacceptable behaviour, including bullying, discrimination and harassment, between healthcare workers (HCWs) may impair job performance, and in turn, increase the frequency of medical errors, adverse events and healthcare-related complications. The objective of this systematic review was to summarise the current evidence of the impact of unacceptable behaviour occurring between HCWs on clinical performance and patient outcomes.MethodsWe searched MEDLINE, Embase, PsycINFO and CINAHL from 1 January 1990 to 31 March 2021. The search results were screened by two independent reviewers and studies were included if they were original research that assessed the effects of unacceptable behaviour on clinical performance, quality of care, workplace productivity or patient outcomes. Risk of bias was assessed using tools relevant to the study design and the data were synthesised without meta-analysis.ResultsFrom the 2559 screened studies, 36 studies were included: 22 survey-based studies, 4 qualitative studies, 3 mixed-methods studies, 4 simulation-based randomised controlled trials (RCTs) and 3 other study designs. Most survey-based studies were low quality and demonstrated that HCWs perceived a relationship between unacceptable behaviour and worse clinical performance and patient outcomes. This was supported by a smaller number of higher quality retrospective studies and RCTs. Two of four RCTs produced negative results, possibly reflecting inadequate power or study design limitations. No study demonstrated any beneficial effect of unacceptable behaviour on the study outcomes.ConclusionsDespite the mixed quality of evidence and some inconsistencies in the strengths of associations reported, the overall weight of evidence shows that unacceptable behaviour negatively affects the clinical performance of HCWs, quality of care, workplace productivity and patient outcomes. Future research should focus on the evaluation and implementation of interventions that reduce the frequency of these behaviours.