Underlying construct of empathy, optimism, and burnout in medical students.

OBJECTIVE: This study was designed to explore the underlying construct of measures of empathy, optimism, and burnout in medical students. METHODS: Three instruments for measuring empathy (Jefferson Scale of Empathy, JSE); Optimism (the Life Orientation Test-Revised, LOT-R); and burnout (the Maslach Burnout Inventory, MBI, which includes three scales of Emotional Exhaustion, Depersonalization, and Personal Accomplishment) were administered to 265 third-year students at Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University. Data were subjected to factor analysis to examine relationships among measures of empathy, optimism, and burnout in a multivariate statistical model. RESULTS: Factor analysis (principal component with oblique rotation) resulted in two underlying constructs, each with an eigenvalue greater than one. The first factor involved positive personality attributes (factor coefficients greater than .58 for measures of empathy, optimism, and personal accomplishment). The second factor involved negative personality attributes (factor coefficients greater than .78 for measures of emotional exhaustion, and depersonalization). CONCLUSIONS: Results confirmed that an association exists between empathy in the context of patient care and personality characteristics that are conducive to relationship building, and considered to be positive personality attributes, as opposed to personality characteristics that are considered as negative personality attributes that are detrimental to interpersonal relationships. Implications for the professional development of physicians-in-training and in-practice are discussed

Dissociation and pain perception : an experimental investigation

textDissociative symptoms and abnormalities in pain perception have been associated with a range of disorders. We tested whether experimentally induced increases in state dissociation would cause an analgesic response, and whether this effect would be moderated by participants' history of trauma and dissociative experiences. Participants (n=120) were classified based on their histories of traumatic and dissociative experiences: No trauma or dissociation (NN), trauma without dissociation (TN), or trauma with dissociation (TD). All participants were randomized to a dissociation induction condition via audiophotic stimulation or a credible control condition and were compared on prepost changes in subjective pain and pain tolerance in response to a standard cold-pressor test. Unexpectedly, dissociation induction did not lead to greater pain tolerance or reduced self-reported pain. However, increases in state dissociation significantly predicted increased immersion time and decreased subjective pain.Psycholog

Negative intrusive thoughts and dissociation as risk factors for self-harm.

Relationships between self-harm and vulnerability factors were studied in a general population of 432 participants, of whom 30% reported some experience of self-harm. This group scored higher on dissociation and childhood trauma, had lower self-worth, and reported more negative intrusive thoughts. Among the non-harming group, 10% scored similarly to the self-harmers on the dissociation and self-worth scales, and engaged in potentially maladaptive behaviors that are not defined as indicating clinical self-harm, but experienced fewer negative intrusive thoughts. This group may be at risk of future self-harm if they begin to experience negative intrusive thoughts. If negative intrusive thoughts are playing a causal role, then therapeutic approaches tackling them may help those who are currently self-harming

Neurovisceral phenotypes in the expression of psychiatric symptoms

This review explores the proposal that vulnerability to psychological symptoms, particularly anxiety, originates in constitutional differences in the control of bodily state, exemplified by a set of conditions that include Joint Hypermobility, Postural Tachycardia Syndrome and Vasovagal Syncope. Research is revealing how brainbody mechanisms underlie individual differences in psychophysiological reactivity that can be important for predicting, stratifying and treating individuals with anxiety disorders and related conditions. One common constitutional difference is Joint Hypermobility, in which there is an increased range of joint movement as a result of a variant of collagen. Joint hypermobility is over-represented in people with anxiety, mood and neurodevelopmental disorders. It is also linked to stress-sensitive medical conditions such as irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia. Structural differences in 'emotional' brain regions are reported in hypermobile individuals, and many people with joint hypermobility manifest autonomic abnormalities, typically Postural Tachycardia Syndrome. Enhanced heart rate reactivity during postural change and as recently recognised factors causing vasodilatation (as noted post prandially, post exertion and with heat) is characteristic of Postural Tachycardia Syndrome, and there is a phenomenological overlap with anxiety disorders, which may be partially accounted for by exaggerated neural reactivity within ventromedial prefrontal cortex. People who experience Vasovagal Syncope, a heritable tendency to fainting induced by emotional challenges (and needle/blood phobia), are also more vulnerable to anxiety disorders. Neuroimaging implicates brainstem differences in vulnerability to faints, yet the structural integrity of the caudate nucleus appears important for the control of fainting frequency in relation to parasympathetic tone and anxiety. Together there is clinical and neuroanatomical evidence to show that common constitutional differences affecting autonomic responsivity are linked to psychiatric symptoms, notably anxiety

Professional Burnout in Social Service Organizations: A Review of Theory, Research and Prevention

This paper provides an overview of research on burnout in human service workers, with an emphasis on findings relevant to social workers and other professionals in child welfare and children’s mental health and the organizations that employ them. It is intended to inform the reader about the developments in burnout research since the phenomenon was initially described, and to identify some issues and questions that need further study. Part one of the paper begins with a discussion of several definitions of burnout and its components. Part two outlines the variables that have been identified by research as antecedent to burnout, and as consequences of burnout. Part three describes several theoretical models that have been used to explain the causes of burnout and its relationship to other forms of stress, coping and organizational processes. Part four reviews and critiques some prevention literature, and offers additional thoughts for consideration when intervention is planned

The Divided Self: The Double Consciousness of Faculty of Color in Community Colleges

Through qualitative field methods research addressing faculty of color in four California community colleges, this investigation examines and explains faculty experiences and professional sense making. By combining critical race theory with social identity theory, our perspective underlines the potential social and ethnic identity conflicts inherent in the daily lives of faculty of color. The professional and social identities of faculty of color are not necessarily compatible, leading to a condition of "double consciousness," or what we refer to as "the divided self." © The Author(s) 2013

A 2-Question Summative Score Correlates with the Maslach Burnout Inventory

Introduction: There is a high prevalence of burnout among emergency medicine (EM) residents. The Maslach Burnout Inventory - Human Services Survey (MBI-HSS) is a widely used tool to measure burnout. The objective of this study was to compare the MBI-HSS and a two-question tool to determine burnout in the EM resident population.Methods: Based on data from the 2017 National Emergency Medicine Resident Wellness Survey study, we determined the correlation between two single-item questions with their respective MBI subscales and the full MBI-HSS. We then compared a 2-Question Summative Score to the full MBI-HSS with respect to primary, more restrictive, and more inclusive definitions of burnout previously reported in the literature.Results: Of 1,522 residents who completed the survey 37.0% reported “I feel burned out from my work,” and 47.1% reported “I have become more callous toward people since I took this job” once a week or more (each item >3 on a scale of 0-6). A 2-Question Summative Score totaling >3 correlated most closely with the primary definition of burnout (Spearman’s rho 0.65 [95% confidence interval 0.62-0.68]). Using the summative score, 77.7% of residents were identified as burned out, compared to 76.1% using the full MBI-HSS, with a sensitivity and specificity of 93.6% and 73.0%, respectively.Conclusion: An abbreviated 2-Question Summative Score correlates well with the full MBI-HSS tool in assessing EM resident physician burnout and could be considered a rapid screening tool to identify at-risk residents experiencing burnout

An interoceptive predictive coding model of conscious presence

We describe a theoretical model of the neurocognitive mechanisms underlying conscious presence and its disturbances. The model is based on interoceptive prediction error and is informed by predictive models of agency, general models of hierarchical predictive coding and dopaminergic signaling in cortex, the role of the anterior insular cortex (AIC) in interoception and emotion, and cognitive neuroscience evidence from studies of virtual reality and of psychiatric disorders of presence, specifically depersonalization/derealization disorder. The model associates presence with successful suppression by top-down predictions of informative interoceptive signals evoked by autonomic control signals and, indirectly, by visceral responses to afferent sensory signals. The model connects presence to agency by allowing that predicted interoceptive signals will depend on whether afferent sensory signals are determined, by a parallel predictive-coding mechanism, to be self-generated or externally caused. Anatomically, we identify the AIC as the likely locus of key neural comparator mechanisms. Our model integrates a broad range of previously disparate evidence, makes predictions for conjoint manipulations of agency and presence, offers a new view of emotion as interoceptive inference, and represents a step toward a mechanistic account of a fundamental phenomenological property of consciousness

A Workplace Study of Three Children’s Mental Health Centres in Southern Ontario

Rationale Recent cuts to resources for children and families requiring children’s mental health services coupled with an increase in the number of children needing these services have left staff in many agencies feeling extremely challenged in providing positive service environments for children and families. In this context, agencies are faced with the challenge of providing working environments that attract and retain staff, particularly in children’s residential mental health services. The purpose of this study was to explore sources of job satisfaction and stress, and why employees stay with and leave these organizations, in an effort to understand what contributes to a positive work environment in children’s mental health services. Research Design A survey was distributed to employees of three children’s mental health services agencies. Completion of the survey was voluntary and all individual responses were kept confidential. Completed surveys were returned directly to researchers. Survey Results Ninety-eight surveys were completed (for a return rate of 44.3%). Forty-eight percent of employees reported low levels of intention to leave, and 18% reported strong intention to leave their organization. However, strong intention to leave ranged from 13.5% to 35.3% across the three participating children’s mental health agencies. Over 55% of all employees who responded to the survey indicated high levels of overall job satisfaction. Across the three participating agencies overall job satisfaction ranged from 43.2% to 70.6%. The majority of respondents, however, were only moderately satisfied with salary and benefits, as well as with promotion availability and process. Twenty-three percent of all employees responding to the survey reported high levels of emotional exhaustion, suggesting that high levels of stress are affecting almost a quarter of survey respondents. However, the majority of respondents reported low to moderate levels of emotional exhaustion. Over 70% of children’s mental health employees who responded to the survey reported high levels of personal accomplishment, or a feeling of competence and successful achievement in their work with people. Discussion & Implications The majority of employees in all three organizations are only moderately satisfied with the financial rewards and benefits, and in all of the organizations it seems that the front-line staff are the group least satisfied with this aspect. Front-line staff and clinicians are more likely to be high on intention to leave, and less likely to be highly satisfied with their jobs overall. They are less likely to feel that their jobs are highly “doable” and more likely to be unsatisfied with promotional opportunities. Clinicians, along with front-line staff, are also less likely than employees in other positions to be highly satisfied with their pay. Overall job satisfaction, while in the high range for 55% of children’s mental health employees as a whole, varies considerably across the three organizations. Employees with low job satisfaction are 4 more likely to have high levels of emotional exhaustion and depersonalization, to perceive a lack of fit between their personal values and goals and those of the organization (image violation), and to see the employment relationship as inequitable. The scales that are statistically associated with high intention to leave for all three organizations include “perceived inequitable employment relationship” and “image violation”. It may be that those employees who are feeling most strongly about pay levels and limited promotional opportunities perceive that they are giving more than they are receiving from the organization