Efficacy of Interventions to Reduce Resident Physician Burnout: A Systematic Review

Busireddy, Kiran R.; Miller, Jonathan; Ellison, Kathleen; Ren, Vicky; Qayyum, Rehan; Panda, Mukta

doi:10.4300/jgme-d-16-00372.1

Cited by 236 publications

(244 citation statements)

References 29 publications

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“…Burnout is a syndrome of emotional exhaustion (feeling overwhelmed by job demands and depletion of emotional resources), depersonalization (feelings of cynicism and detachment toward patients), and decreased perceived personal accomplishment (decrease in feelings of work competence and achievement) [2,3]. It develops in response to long-term emotional and interpersonal occupational stressors [3].…”

Section: Introductionmentioning

confidence: 99%

Burnout in Diplomates of the American Board of Physical Medicine and Rehabilitation—Prevalence and Potential Drivers: A Prospective Cross‐Sectional Survey

Sliwa

Clark

Chiodo

et al. 2019

PM&R

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BackgroundPhysician burnout is of growing concern. Burnout among physical medicine and rehabilitation (PM&R) physicians has shown a significant increase, positioning PM&R as one of the most “burned out” of specialties. Little has been written about potential factors contributing to physiatrist burnout or potential interventions.ObjectiveTo determine the prevalence of burnout among physiatrists and identify risk factors for burnout and potential strategies to decrease burnout among physiatrists.DesignProspective cross‐sectional survey.SettingNational survey of board certified physiatrists. Participants: One thousand five hundred thirty‐six physiatrists certified by the American Board of PM&R.OutcomeThe Mini‐Z Burnout Survey, 1 question from the Maslach Burnout Scale on callousness toward patients, and several potential drivers of burnout. The probability of burnout, identified by question 3 on the Mini‐Z, was the dependent variable. Other questions on the Mini‐Z were explored as independent variables using logistic regression.ResultsSeven hundred seventy physiatrists (50.7%) fulfilled the definition of burnout. Only 38% of physiatrists reported not becoming more callous toward patients. The top 3 causes of burnout identified by physiatrists were increasing regulatory demands, workload and job demands, and practice inefficiency and lack of resources. Higher burnout rate was associated with high levels of job stress and working more hours per week. Lower burnout rates were associated with higher job satisfaction, control over workload, professional values aligned with those of department leaders, and sufficient time for documentation. There was no significant association between burnout and sex, years in practice, practice focus, or practice area.ConclusionBurnout is a significant problem among PM&R physicians and is pervasive throughout the specialty. Opportunities exist to address major contributing drivers of burnout relating to practice patterns and efficiency of care within PM&R. These opportunities are, to varying degrees, under the control of hospital leaders, practice administrators, and practitioners.

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Section: Introductionmentioning

confidence: 99%

Burnout in Diplomates of the American Board of Physical Medicine and Rehabilitation—Prevalence and Potential Drivers: A Prospective Cross‐Sectional Survey

Sliwa

Clark

Chiodo

et al. 2019

PM&R

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show abstract

“…3,4 Apart from the implementation of the 80-hour work week, educators have made little progress in combating resident burnout. 5 One potential contributing factor that has received less attention is the learning environment itself. 4 A meta-analysis from JAMA Surgery that looked at resident attrition showed that women are more likely to leave surgical residency than men are, which suggests that there may indeed be sex-related differences in the training experience.…”

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confidence: 99%

Gender-based discrimination is prevalent in the integrated vascular trainee experience and serves as a predictor of burnout

Wang

Tanious

et al. 2020

Journal of Vascular Surgery

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Objective: 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.Methods: A survey was developed to evaluate the trainee experience; demographics and a two-item burnout index were also included. The instrument was sent electronically to all integrated (0 þ 5) vascular surgery residents in the United States. Univariate analyses were performed and predictors of burnout identified.Results: A total of 284 integrated vascular residents were invited to participate and 212 (75%) completed the survey. Participants were predominantly male (64%) and white (56%), with a median age of 30 years (interquartile range, 28-32 years). Seventy-nine percent of respondents endorsed some form of negative workplace experience and 30% met high-risk criteria for burnout. More than a third (38%) of residents endorsed personally experiencing GBDB, with a significant difference between men and women (14% vs 80%; P < .001). Women were more likely than men to report witnessing GBDB (76% vs 56%; P ¼ .003). Patients and nurses were the most frequently cited sources of GBDB (80% and 64%, respectively), with vascular surgery attendings cited by 41% of trainees. One in four female resident respondents indicated being sexually harassed during the course of training; this was significantly higher than for male residents (25% vs 1%; 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 directly affected as a result of GBDB. GBDB was predictive of burnout (odds ratio, 1.9; 95% confidence interval, 1.1-3.5; P ¼ .04), as were longer work hours (>80 h/wk; odds ratio, 2.8; 95% confidence interval, 1.1-7.1; P ¼ .03).Conclusions: GBDB was experienced by 38% of integrated trainees, with women significantly more affected than men. GBDB is predictive of burnout, and this has significant implications for our specialty in the recruitment and retention of female physicians. Resources addressing these issues are needed to maintain a diverse workforce and to promote physician well-being. (J Vasc Surg 2020;71:220-7.)

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“…W e read the review of burnout interventions by Busireddy and colleagues 1 with interest and applaud the authors' efforts to synthesize evidence around interventions to reduce burnout among trainees. We published a study that examined the impact of a formal narrative medicine curriculum among obstetrics and gynecology residents at 3 training programs, which demonstrated a significant improvement in emotional exhaustion (measured by the Maslach Burnout Inventory) for residents who attended more of the reflective writing workshops, with a moderate effect size as measured by Cohen's d. While the authors 1 did not indicate in their methods when they performed their query of the literature, the review includes studies from 1991 to 2015, 1 year before our study was in print.…”

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confidence: 99%

“…We would agree with Busireddy and colleagues' conclusion that adding required activities in the name of improving wellness may miss the mark with residents who are already chronically overburdened. 1 For this reason, our curriculum takes place during protected time and does not include any preparatory reading or other homework. It will be challenging to explore whether this and other interventions aimed at improving the learning environment for residents are effective across sites and specialties.…”

mentioning

confidence: 99%

Work Hour Limits Versus Wellness Interventions in Reducing Resident Burnout

Winkel

Feldman

2017

Journal of Graduate Medical Education

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Efficacy of Interventions to Reduce Resident Physician Burnout: A Systematic Review

Abstract: Background Studies report high burnout prevalence among resident physicians, with little consensus on methods to effectively reduce it.

Cited by 236 publications

References 29 publications

Burnout in Diplomates of the American Board of Physical Medicine and Rehabilitation—Prevalence and Potential Drivers: A Prospective Cross‐Sectional Survey

Burnout in Diplomates of the American Board of Physical Medicine and Rehabilitation—Prevalence and Potential Drivers: A Prospective Cross‐Sectional Survey

Gender-based discrimination is prevalent in the integrated vascular trainee experience and serves as a predictor of burnout

Work Hour Limits Versus Wellness Interventions in Reducing Resident Burnout

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