Associations between job demands, job resources and patient-related burnout among physicians: results from a multicentre observational study

OBJECTIVES: To investigate associations of job demands and resources with patient-related burnout among physicians. DESIGN: Multicentre observational study. SETTING: Fifty medical departments at 14 (academic and non-academic) hospitals in the Netherlands. PARTICIPANTS: Four hundred sixty-five physicians (71.6% response rate), comprising 385 (82.8%) medical specialists and 80 (17.2%) residents. MAIN OUTCOME MEASURES: Job demands (workload and bureaucratic demands), job resources (participation in decision making, development opportunities, leader's inspiration, relationships with colleagues and patients)-measured with the validated Questionnaire of Experience and Evaluation of Work and Physician Worklife Survey-and patient-related burnout, measured using the validated Copenhagen Burnout Inventory. RESULTS: Patient-related burnout was positively associated with workload (b=0.36; 95% CI, 0.25 to 0.48; p<0.001) and negatively associated with development opportunities (b=-0.18; 95% CI, -0.27 to -0.08; p<0.001) and relationships with patients (b=-0.12; 95% CI, -0.22 to -0.03; p=0.01). Relationships with patients moderated the association between bureaucratic demands and patient-related burnout (b=-0.15; 95% CI, -0.27 to -0.04; p=0.01). CONCLUSIONS: Physicians with high workloads and few development opportunities reported higher levels of patient-related burnout. Those with positive patient relationships were less likely to experience patient-related burnout, even in the presence of excessive bureaucracy. Therefore, positive physician-patient relationships may be supported to reduce the likelihood of physicians' patient-related burnout. However, the specific support needed to effectively reduce patient-related burnout may vary per healthcare context and thus requires intensified research across healthcare systems and settings

Trust, professionalism and regulation: a critical comparison of Medicine and Law

Background & Aims: Trust, professionalism and regulation are complex social phenomena, which are contextually dependent and dynamic. This project aims to explore the concept of ‘trust’ in Law and Medicine - questioning what it means to be a ‘trustworthy’ professional and how these understandings relate to ideas of professionalism and regulation. Methods: This study draws on a comprehensive review of the literature and interviews with thirty participants from within, or related to, the UK legal and medical professions. Participants included practitioners, those creating and implementing policy, and public representatives. Data was analysed using the ‘logics approach’ from Political Discourse Theory (PDT). This helped us draw out taken-for-granted ideas and beliefs about trust, professionalism and regulation and expose these to critique. Results: Participants highly valued patient/client trust, seeing it as fundamental to the functioning of their professional ‘service’. Trust was seen as attributed primarily to the individual practitioner and maintained through demonstrating measurable ‘professionalism’. Practitioners were understood to be individually responsible for preserving their image as a ‘good professional’, via evidencing their ‘professionalism’ to the patient/client and the regulator. Discussion: Current ways-of-thinking about trust permitted trust in individuals to be maintained, even when trust in the professions as a whole was challenged. However, for medical professionals particularly, this was predicated on a need to ‘evidence’ that one was a ‘good professional’ through intensive and continual regulation. This created an increased dependency on a ‘trust-industry’ of regulatory bodies and systems. This project critically questions how regulation shapes and impacts trust in the professions. It is a problem-driven approach, which seeks to break with current patterns of thinking and question: ‘what might be possible instead?’ This opens up an ideological space and new viewpoints, whereby audiences are encouraged to consider future change

A national longitudinal cohort study of factors contributing to UK medical students' mental ill-health symptoms

Background The mental health of current medical students is predictive of their mental health as future doctors. The prevalence of anxiety, depression and burnout is high among medical students, but less is known about the occurrence of other mental ill-health symptoms, such as eating or personality disorders, and factors contributing to mental ill-health. Aims (1) To explore the prevalence of various mental ill-health symptoms in medical students and (2) to investigate what medical school factors and students’ attitudes contribute to these mental ill-health symptoms. Methods Between November 2020 and May 2021, medical students from nine geographically spread medical schools in the UK participated by completing online questionnaires at two points in time, approximately 3 months apart. Results Of the 792 participants who filled in the questionnaire at baseline, over half experienced medium to high somatic symptoms (50.8%; 402) and drank alcohol at hazardous levels (62.4%; 494). Adjusted longitudinal data analysis of 407 students who completed the follow-up questionnaire demonstrated that less supportive educational climates that were more competitive and less centralised around the students, lower feelings of belongingness, greater stigma towards mental ill-health and lower intentions to seek help for mental ill-health, all contributed to students’ mental ill-health symptoms. Conclusions Medical students experience a high prevalence of various mental ill-health symptoms. This study suggests that medical school factors and students’ attitudes towards mental ill-health are significantly associated with students’ mental health

The impact of service change on doctors' training (GMC 822)

The aim of this research is to gain a deeper understanding about the direct and indirect impacts of service change on doctors’ training: to understand if specific types of service change pose a risk to the training experience, and to gain insights into the contextual influences that undermine or enhance the education of doctors during service change

Structural equation modelling analysis on relationships of job demands and resources with work engagement, burnout and work ability: an observational study among physicians in Dutch hospitals

Objective: To investigate to what extent work engagement mediates the relationships of job resources with work ability, and to what extent burnout mediates the relationships of job demands and resources with work ability. Design: Multicentre observational study. Setting: Academic and non-academic hospitals in the Netherlands. Participants: Physicians (n=385) participated in this study. Primary and secondary outcome measures: We measured work ability with selected items from the validated Questionnaire of Experience and Evaluation of Work 2.0 (QEEW V.2.0), work engagement with the Utrecht Work Engagement Scale and burnout with the exhaustion subscale of the Oldenburg Burnout Inventory. The job demand ‘workload’ and job resources ‘development opportunities’, ‘participation in decision-making’, ‘inspirational leadership’ and ‘relationships with colleagues’ were measured using the QEEW V.2.0. The job demand ‘bureaucratic burden’ was measured with the Three Item Red Tape scale. A structural equation model was built to answer our research question. Results: Work engagement mediated relationships of job resources with physicians’ work ability, and burnout mediated relationships of job resources and demands with work ability. Development opportunities (β=0.39, SE=0.12, p<0.001), participation in decision-making (β=0.18, SE=0.08, p=0.028) and relationships with colleagues (β=0.19, SE=0.19, p=0.002) were positively related to work engagement. Development opportunities (β=−0.20, SE=0.08, p=0.004) were negatively related and workload (β=0.51, SE=0.19, p<0.001) was positively related to burnout. Work engagement (β=0.22, SE=0.04, p<0.001) was positively related and burnout (β=−0.56, SE=0.06, p<0.001) was negatively related to work ability. Conclusions: Physicians’ work engagement and burnout mediated the relationships of various job demands and resources with their work ability. More work-engaged and less burned-out physicians reported better work ability. Hospitals may attenuate excessive workloads and facilitate development opportunities, participation in decision-making and good collegial relationships to enhance physicians’ occupational well-being and performance

A national qualitative investigation of the impact of service change on doctors' training during Covid-19

Background The Covid-19 crisis sparked service reconfigurations in healthcare systems worldwide. With postgraduate medical education sitting within these systems, service reconfigurations substantially impact trainees and their training environment. This study aims to provide an in-depth qualitative understanding of the impact of service reconfiguration on doctors’ training during the pandemic, identifying opportunities for the future as well as factors that pose risks to education and training and how these might be mitigated. Methods Qualitative parallel multi-centre case studies examined three Trusts/Health Boards in two countries in the United Kingdom. Data were collected from online focus groups and interviews with trainees and supervisors using semi-structured interview guides (September to December 2020). A socio-cultural model of workplace learning, the expansive-restrictive continuum, informed data gathering, analysis of focus groups and coding. Results Sixty-six doctors participated, representing 25 specialties/subspecialties. Thirty-four participants were male, 26 were supervisors, 17 were specialty trainees and 23 were foundation doctors. Four themes described the impact of pandemic-related service reconfigurations on training: (1) Development of skills and job design, (2) Supervision and assessments, (3) Teamwork and communication, and (4) Workload and wellbeing. Service changes were found to both facilitate and hinder education and training, varying across sites, specialties, and trainees’ grades. Trainees’ jobs were redesigned extensively, and many trainees were redeployed to specialties requiring extra workforce during the pandemic. Conclusions The rapid and unplanned service reconfigurations during the pandemic caused unique challenges and opportunities to doctors’ training. This impaired trainees’ development in their specialty of interest, but also presented new opportunities such as cross-boundary working and networking

Work-Related Well-Being Among Dutch Cardiologists - A National Survey

This is the first study to provide a holistic examination of cardiologists' well-being, investigating positive and negative dimensions, and its determinants. We conducted a national, multicenter, self-administered web-based questionnaire. We used frequencies to depict scores on three well-being indicators (professional fulfillment, work exhaustion and interpersonal disengagement) and performed three multiple regression analyses to elucidate their determinants. Cardiologists' mean scores (scale 1 to 5) were 3.85 (SD = 0.62) for professional fulfillment, 2.25 (SD = 0.97) for work exhaustion and 2.04 (SD = 0.80) for interpersonal disengagement. Workload, work-home interference and team atmosphere predicted the negative dimensions of well-being. Autonomy predicted cardiologists' professional fulfillment. Physician-patient interactions, person-job fit and individual resilience affected both dimensions. Dutch cardiologists score relatively high on professional fulfillment and average on work exhaustion and interpersonal disengagement. In order to foster cardiologists' well-being it is critical to increase energy providing work- and individual aspects

Exploring Nurses' Role in Guiding Residents' Workplace Learning: a Mixed-Method Study

PURPOSE: Understanding residents' workplace learning could be optimized by not only considering attending physicians' role but also the role of nurses. While previous studies described nurses' role during discrete activities (e.g., feedback), a more profound understanding of how nurses contribute to residents' learning remains warranted. Therefore, we used the educational concept of guidance and explored the extent to which residents' and nurses' perceptions align regarding nurses' guiding role and which reasons they provide for their perceptions. METHOD: This mixed-method study was conducted at four Dutch University Medical Centers in 2021. We simultaneously collected quantitative and qualitative data from 103 residents and 401 nurses through a theory-informed questionnaire with a Likert-scale and open-ended questions. We analyzed quantitative data to explore respondents' perceptions of nurses' guiding role by using ANOVA. The thematically analyzed qualitative open-comments explored respondents' reasons for their perceptions. RESULTS: Nurses indicated to provide significantly more support (p = .01) and guidance on learning from patient care (p < .01) than perceived by residents. Moreover, nurses indicated that attending physicians did not always involve them in guiding residents, whereas residents perceived nurses were being involved (p <.001). Themes suggest that nurses and residents could be divided into two groups: (1) respondents who felt that guiding was inextricably linked to good interprofessional collaboration and patient care, and (2) respondents who saw the guiding role as limited and emphasized the distinct fields of expertise between nurses and physicians. CONCLUSIONS: Residents and nurses felt that nurses played an important role in guiding residents' workplace learning. However, some residents did not always perceive to be guided. To further capitalize on nurses' guiding role, we suggest that residents can be encouraged to engage in the learning opportunities nurses provide to achieve optimal team-based patient care

Doctors' alertness, contentedness and calmness before and after night shifts: a latent profile analysis

Background While night shifts are crucial for patient care, they threaten doctors’ well-being and performance. Knowledge of how the impact of night shifts differs for doctors is needed to attenuate the adverse effects of night shifts. This study aimed to obtain more precise insight into doctors’ feelings surrounding night shift by: identifying profiles based on doctors’ alertness, contentedness and calmness scores before and after night shifts (research question (RQ) 1); assessing how doctors’ pre- and post-shift profiles change (RQ2); and determining associations of doctors’ demographics and shift circumstances with alertness, contentedness and calmness change (RQ3). Methods Latent Profile Analysis using doctors’ pre- and post-shift self-rated alertness, contentedness and calmness scores was employed to identify pre- and post-shift profiles (RQ1). A cross-tabulation revealed pre- and post-shift profile changes (RQ2). Multiple regressions determined associations of demographics (i.e. age, sex, specialty) and night shift circumstances (i.e. hours worked pre-call, hours awake pre-call, shift duration, number of consecutive shifts, total hours of sleep) with alertness, contentedness and calmness change (RQ3). Results In total, 211 doctors participated with a mean age of 39.8 ± 10 years; 47.4% was male. The participants included consultants (46.4%) and trainees (53.6%) of the specialties surgery (64.5%) and obstetrics/gynaecology (35.5%). Three pre-shift (Indifferent, Ready, Engaged) and four post-shift profiles (Lethargic, Tired but satisfied, Excited, Mindful) were found. Most doctors changed from Ready to Tired but satisfied, with alertness reducing most. Age, specialty, sleep, shift duration and the number of consecutive shifts associated with alertness, contentedness and calmness changes. Conclusions The results provided nuanced insight into doctors’ feelings before and after night shifts. Future research may assess whether specific subgroups benefit from tailored interventions

Uncovering trends in training progression for a national cohort of psychiatry trainees: discrete-time survival analysis

BACKGROUND: The global rise in mental health issues calls for a strong psychiatry workforce. Yet, psychiatry training worldwide is facing recruitment challenges, causing unfilled consultant posts and possibly threatening the quality of patient care. An in-depth understanding of trainees' progression through training is warranted to explore what happens to recruited trainees during training. AIMS: To uncover current trends in psychiatry trainees' progression through training in the UK. METHOD: This national retrospective cohort study with data from the UK Medical Education Database used discrete-time survival analysis to analyse training progression for those trainees who started their core psychiatry post in 2012-2017 (2820 trainees; 59.6% female, 67.6% UK graduates (UKGs)). The impact of sociodemographic characteristics on training progression were also investigated. RESULTS: The overall probability of completing training in 6 years (minimum years required to complete psychiatry training in the UK) was 17.2% (ranging from 4.8% for non-UKG females to 29% for UKG males). The probability to not progress was highest (57.1%) from core to specialty training. For UKGs, trainees from ethnicities other than White, trainees with a disability, and trainees who had experienced childhood social deprivation (measured as entitlement to free school meals) had a significantly (P ≤ 0.02) lower probability of completing training in 6 years. CONCLUSIONS: Less than one in five psychiatry trainees are likely to complete training in 6 years and this probability varies across groups of doctors. Completing psychiatry training in 6 years is, therefore, the exception rather than the norm and this has important implications for trainees, those planning psychiatry workforces or responsible for psychiatry training