Interventions to Prevent and Reduce Burnout Among Undergraduate and Graduate Medical Education Trainees: a Systematic Review

Walsh, Anne L.; Lehmann, Susan W.; Zabinski, J.S.; Truskey, Maria; Purvis, Taylor E.; Gould, Neda F; Stagno, Susan J.; Chisolm, Margaret S.

doi:10.1007/s40596-019-01023-z

Cited by 43 publications

(42 citation statements)

References 47 publications

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“…One systematic review showed that students required to stay for overnight call were more likely to experience burnout, and this was attributed to the long hours [28]. Restricting duty hours reduced levels of emotional exhaustion and burnout in a systematic review of surgical residents [29]. Our study suggests a reduction, or greater flexibility of contact hours could improve wellbeing.…”

Section: Contact Hours and Attendancementioning

confidence: 59%

Medical student perceptions of curricular influences on their wellbeing: a qualitative study

et al. 2020

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Background: Medical student mental health and wellbeing is highly topical and the subject of much research. While theoretically informed definitions of wellbeing abound, how do medical students themselves understand and perceive wellbeing? What aspects of the curriculum do they regard as affecting their wellbeing and mental health? This study explored these questions, and aimed to identify factors associated with student acceptability of wellbeing programs and interventions. Methods: All students at an Australian undergraduate medical school (n = 619) were invited to complete a qualitative online questionnaire between 2017 and 2018 following the introduction of several wellbeing initiatives, including "Wellbeing Days" (WBD). WBD allow students to take single absence days for self-care. Open-ended questions were asked about perceptions and experience of mental health and wellbeing, and views on interventions to improve wellbeing such as WBD. Thematic analysis was conducted across all responses. Three authors developed preliminary themes, which were then refined and confirmed by all researchers. Thematic saturation was achieved within data from the 68 respondents, which included participants from all cohorts. Results: Participants described wellbeing as positively experienced work/life balance, impacted by four factors; contact hours, peer relationships, staff relationships, and trust in how wellbeing initiatives were used. Long contact hours were deemed incompatible with self-care activities, maintaining employment, and seeking professional medical/psychological help. Peers could promote wellbeing by offering social and academic support, but also undermine wellbeing by being competitors. Degree of trust, engagement and communication with staff influenced acceptability of interventions. Participants viewed initiatives such as WBD favourably, but distrust of peers, and of staff, led to perceptions that WBD could be prone to misuse, or used for surveillance rather than support. Conclusion: Our findings suggest that wellbeing days which allow self-care, reduction in contact hours, and peer support may promote student wellbeing, but the acceptability of any interventions is influenced by relationships between staff and students, and in particular, trust in these relationships. We suggest strategies to strengthen trust and further research to investigate the relationship between trust and perceptions of wellbeing in self and peers.

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Section: Contact Hours and Attendancementioning

confidence: 59%

Medical student perceptions of curricular influences on their wellbeing: a qualitative study

et al. 2020

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“…Burnout is a substantial problem among ICU clinicians and interventions to prevent or reduce burnout are sparse. 6,16,30 Identi cation of interventions that can prevent burnout in physicians and staff caring for critically ill patients is vital. STOPTHEBURN is the rst study to evaluate the e cacy of the hospital-based Death Café to prevent burnout in ICU clinicians.…”

Section: Discussion: Implicationsmentioning

confidence: 99%

“…6 In spite of the growing awareness of the consequences of burnout, interventions to prevent or address burnout are sparse in the literature. 6,16,30 Most interventions to date have focused on reduction in work hours, development of wellness curricula, and mindfulness promotion. [30][31][32][33] Preliminary studies suggest that debrie ng opportunities may reduce burnout through enhancement of social support and interprofessional collaboration.…”

Section: Introduction Background and Rationale {6a}mentioning

confidence: 99%

“…6,16,30 Most interventions to date have focused on reduction in work hours, development of wellness curricula, and mindfulness promotion. [30][31][32][33] Preliminary studies suggest that debrie ng opportunities may reduce burnout through enhancement of social support and interprofessional collaboration. [34][35][36][37][38] Death Cafés are a speci c form of debrie ng which have emerged internationally for the general public using informal discussion on topics of death, dying, loss, and illness to mitigate distress.…”

Section: Introduction Background and Rationale {6a}mentioning

confidence: 99%

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Death Cafes for Prevention of Burnout in Intensive Care Unit Employees: Study Protocol for a Randomized Controlled Trial (STOPTHEBURN)

Bateman

Hammer

Byrne

et al. 2020

Preprint

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Background: Burnout is an occupational syndrome that leads to mental health problems, job turnover, and patient safety events. Those caring for critically ill patients are especially susceptible due to high patient mortality, long hours, and regular encounters with trauma and ethical issues. Interventions to prevent burnout in this population are needed. Preliminary studies suggest debriefing sessions may reduce burnout. This study aims to assess whether participation in regular debriefing can prevent burnout in intensive care unit (ICU) clinicians.Methods: A randomized controlled trial will be conducted in two large academic medical centers. 200 ICU clinicians will be recruited with target enrollment of 100 physicians and 100 non-physicians (nurses, pharmacists, therapists). Participants must have worked in the ICU for the equivalent of at least 1 full time work week in the preceding 4 weeks. Enrolled subjects will be randomized to virtually attend biweekly debriefing sessions facilitated by a psychotherapist for 3 months or to a control arm without sessions. Our debriefs are modelled after Death Cafés, which are informal discussions focusing on death, dying, loss, grief and illness. These sessions allow for reflection on distressing events and offer community and collaboration among hospital employees outside of work. The primary outcome is clinician burnout as measured by the Maslach Burnout Inventory (MBI) Score. Secondary outcomes include depression and anxiety, as measured by the patient health questionnaire 8 (PHQ-8) and generalized anxiety disorder 7-item scale (GAD-7), respectively. Questionnaires will be administered prior to the intervention, at 1 month, at 3 months, and at 6 months after enrollment. These values will be compared between groups temporally. Qualitative feedback will also be collected and analyzed. This trial was registered prospectively with clinicaltrials.gov on April 15, 2020 (NCT04347811).Discussion: With ICU clinician burnout rates exceeding 50%, Death Café debriefing sessions may prove to be an effective tool to avert this debilitating syndrome. With COVID-19 limiting social interactions and overloading ICUs worldwide, the virtual administration of the Death Café for ICU clinicians provides an innovative strategy to potentially mitigate burnout in this vulnerable population.

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“…Turning now to the question of what can be done, Walsh et al [9] provide a valuable contribution with a systematic review of the evidence for burnout prevention and intervention in trainees. Although they initially set out to review only prevention of burnout in medical students and residents, they found no studies that targeted prevention specifically, so they broadened their search to include burnout interventions in general.…”

Section: Constructive Approachesmentioning

confidence: 99%

An Update on Trainee Wellness: Some Progress and a Long Way to Go

et al. 2019

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Interventions to Prevent and Reduce Burnout Among Undergraduate and Graduate Medical Education Trainees: a Systematic Review

Cited by 43 publications

References 47 publications

Medical student perceptions of curricular influences on their wellbeing: a qualitative study

Medical student perceptions of curricular influences on their wellbeing: a qualitative study

Death Cafes for Prevention of Burnout in Intensive Care Unit Employees: Study Protocol for a Randomized Controlled Trial (STOPTHEBURN)

An Update on Trainee Wellness: Some Progress and a Long Way to Go

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