Global meta-analysis of physicians' experiences of workplace sexual harassment by patients.

The World Health Organization recognises that sexual harassment is an occupational hazard in medicine, but the prevalence of sexual harassment by patients is unknown. This global meta-analysis found that a pooled prevalence of 45.13% of 18 803 physicians from several specialities (e.g. internal medicine and surgery) have ever experienced it. Hospitals should implement protective measures such as panic alarms for night shifts and isolated wards.

Balint groups: an effective tool for improving health professionals' perceived well-being.

BACKGROUND: Physician burnout is a common problem that negatively impacts their well-being and patient care. Balint groups (BGs) deal with doctor-patient relationships. Previous studies that have demonstrated the positive effects of BGs are descriptive and based on small sample sizes. This study aims to evaluate the perceptions of health professionals who participated in BGs, determine the impact of BGs on their personal and professional well-being, and identify the factors related to these positive outcomes. METHODS: On January and February 2023 the authors have distributed a questionnaire to 142 healthcare providers in a conference and internet networks. Most respondents were family physicians. RESULTS: Participation in BGs is seen to have a positive impact on healthcare professionals' perceived well-being and professional development. Respondents who had participated in the BG reported a reduction in burnout, increased empathy, and enhanced professional identity and relationships with patients and colleagues. The study also highlighted the importance of duration of participation in BG, with attendance longer than 5 years linked to significantly more positive outcomes compared to less than 1 year. In a logistic regression analysis two factors were significantly associated with self-reported well-being: attending BGs for more than five years and perceiving BGs as a means of relieving burnout. CONCLUSIONS: The findings suggest that medical organizations should encourage the regular availability of BGs to support physicians' well-being.

Workforce Concerns: Professional Self Care, Personal Readiness, Impact of the Pandemic, and Other Factors that Impact the Workforce.

Physician burnout is pervasive and takes a heavy toll on individuals and the healthcare system. Post-coronavirus disease 2019 the negative impact of organizational culture on physician burnout has been highlighted. Substantial research has accrued identifying steps organizations can take to pivot and develop leaders committed to physician well-being. Physicians can also proactively explore research in sleep, nutrition, physical activity, stress management, and social connections. Positive mindset has a powerful protective effect in medicine, especially in the emerging areas of self-valuation, self-compassion, and positive psychology. Physician coaching can accelerate positive behavior change. Committed physician leaders are needed for sustained culture change to occur.

Graduate medical education well-being directors in the United States: who are they, and what does the role entail?

BACKGROUND: Institutional Graduate Medical Education (GME) Well-being Director (WBD) roles have recently emerged in the United States to support resident and fellow well-being. However, with a standard position description lacking, the current scope and responsibilities of such roles is unknown. This study describes the scope of work, salary support, and opportunities for role definition for those holding institutional leadership positions for GME well-being. METHODS: In November 2021, 43 members of a national network of GME WBDs in the United States were invited to complete a cross-sectional survey that included questions about job responsibilities, percent effort, and dedicated budget, and a free text response question about unique leadership challenges for GME WBDs. The survey was analyzed using descriptive statistics for quantitative data and thematic analysis for qualitative data. RESULTS: 26 members (60%) responded. Most were physicians, and the majority identified as female and White. Median percent effort salary support was 40%. A small minority reported overseeing an allocated budget. Most respondents worked to improve access to mental health services, oversaw institution-wide well-being programs, designed or delivered well-being content, provided consultations to individual programs, met with trainees, and partnered with diversity, equity, and inclusion (DEI) efforts. GME WBDs described unique challenges that had implications for perceived effectiveness related to resources, culture, institutional structure, and regulatory requirements in GME. DISCUSSION: There was high concordance for several key responsibilities, which may represent a set of core priorities for this role. Other reported responsibilities may reflect institution-specific needs or opportunities for role definition. A wide scope of responsibilities, coupled with limited defined budgetary support described by many GME Well-being Directors, could limit effective role execution. Future efforts to better define the role, optimize organizational reporting structures and provide funding commensurate with the scope of work may allow the GME Well-being Director to more effectively develop and execute strategic interventions.

Do physicians need tragic optimism?

In 2016, as a trainee doctor, I wrote a paper on changing the culture of medicine. I felt the medical system was broken back then, and it seems even less functional now, with higher rates of burnout, dropout and staff shortages nationally. As a result of a lack of resources, it feels impossible to provide the care to our communities expected of us, making our work challenging and disheartening. Until all stakeholders acknowledge the systemic issues faced by our workforce, service outcomes and physician well-being may not improve. We need to collaborate and innovate to reform the healthcare system taking a multifaceted, evidence-based approach, implementing an appropriate balance of systemic change and interventions to support individual well-being. As we collectively work towards these changes, tragic optimism may spur physicians to develop meaning and purpose despite the inevitable challenges. This may serve as the motivation and fuel required to survive and sustain our practice but also thrive working in careers of value.

Narrative Medicine: The Power of Shared Stories to Enhance Inclusive Clinical Care, Clinician Well-Being, and Medical Education.

The COVID-19 pandemic exacerbated the problem of secondary trauma and moral injury for health care workers. This reality, together with the epidemic of social isolation and loneliness, has brought the mental health of health care practitioners and patients to the forefront of the national conversation. Narrative medicine is an accessible, diversity-honoring, low-cost, underutilized pedagogical framework with potentially revolutionary benefits for enhancing patient care, supporting the underserved, mitigating clinician burnout, and improving team dynamics. Herein, the authors review the literature on these benefits and then discuss methods for integrating narrative medicine into clinical care and medical education at the undergraduate and graduate levels as well as continuing medical education.

Pediatric Faculty Engagement and Associated Areas of Worklife After a COVID19 Surge.

Purpose: Healthcare organizations strive to increase physician engagement and decrease attrition. However, little is known about which specific worklife areas may be targeted to improve physician engagement or retention, especially after stressful events such as a COVID19 surge. Our objective was to identify demographic characteristics and worklife areas most associated with increased physician engagement and decreased intent to leave in pediatric faculty. Patients and Methods: In September 2020, we conducted a cross-sectional survey of faculty at an academic, tertiary-care children's hospital. A convenience and voluntary sampling approach was used. The survey included demographics, Maslach Burnout Index-Human Services Survey (MBI-HSS) and the Areas of Worklife Survey (AWS). The MBI-HSS was used to measure faculty engagement. The AWS measures satisfaction with six worklife areas (workload, control, reward, fairness, community, values). We used bivariate analyses to examine relationships between worklife areas and engagement and between worklife areas and intent to leave. We included multivariate logistic regression models to examine worklife areas most associated with increased work engagement and decreased intent to leave. Results: Our response rate was 41% (113/274 participants). In bivariate analysis, engaged faculty reported higher satisfaction in all worklife areas. In multivariate analyses, positive perceptions of workload (odds ratio (OR) 2.83; 95% confidence interval (CI), 1.2-6.9), control (OR, 3.24; 95% CI 1.4-7.3), and community (OR, 6.07; 95% CI 1.9-18.7) were associated with engagement. Positive perceptions of values (OR, 0.07; 95% CI 0.02-0.32) and community (OR, 0.19; 95% CI 0.05-0.78) were negatively associated with intent to leave. Conclusion: We found that positive perceptions of workload, control, and community were most associated with engagement. Alignment of values and increased sense of community were associated with decreased intent to leave. Our findings suggest specific worklife areas may be targeted to increase faculty engagement and retention.

Survey Highlighting Impostor Phenomenon (SHIP): Evaluating the Prevalence of Impostor Phenomenon Among Physicians in a Military Treatment Facility.

OBJECTIVES: Impostor Phenomenon (IP) describes feelings of distrust in one's own capabilities or accomplishments. This experience exists across many professional settings, affecting men and women across diverse backgrounds. IP has not been studied within a military health system. The purpose of this study was to evaluate the prevalence of IP among physicians at a military hospital. METHODS: An online survey was constructed incorporating the Clance Impostor Phenomenon Scale (CIPS) and demographic data. All physicians at the institution received the survey link via email and the survey remained open for 1 month for completion. Multivariable analysis was performed to identify significant differences among groups as well as characteristics associated with IP. Exploratory factor analysis was used to examine the factor structure of the CIPS. RESULTS: The response rate was 25% (94/376). Forty-one respondents (44.1%) had CIPS scores ranging between 41 and 60, classifying the respondent as having moderate IP experiences. Differences in scores were noted for age and years of experience (both P < .01). No differences were noted based on gender, self-reported race/ethnicity, or surgical versus nonsurgical specialty. Active-duty respondents had a mean IP score of 62 (SD = 16) and civilian respondents had a mean IP score of 49 (SD = 12, P < .01). CONCLUSION: With nearly half (46.3%) of respondents reporting frequent or intense IP experiences, this study underscores the pervasiveness of the issue and indicates concordance with previously published data. IP is not limited to certain subgroups or gender identity but rather is a common issue which may negatively affect a physician's well-being.

"You've Got Gratitude!"- A Multispecialty and Multi-institution Program Encouraging Expressions of Gratitude.

OBJECTIVE: Efforts to improve physician well-being have focused on gratitude, which predicts health and happiness. Despite reported benefits, expressions of gratitude in healthcare can seem infrequent. Here, we describe Gratitude-Grams, an intervention to cultivate expressions of gratitude throughout a department. METHODS/APPROACH: Piloted in our Department of Surgery and adopted by others, Gratitude-Grams employs a web-based platform (Qualtrics). Program feedback was solicited during teaching conferences using an anonymous department survey. RESULTS: Gratitude-Grams streamlines and encourages expressions of gratitude while minimizing maintenance, cost, and time. The platform has been highly utilized and well-received in our Department of Surgery. CONCLUSION: Expressing and receiving gratitude has been shown to be critical for well-being. Gratitude-Grams is a highly utilized, simple, and attainable system to support expressions of gratitude and is ready for rapid implementation.

Supporting home-based meal preparation improves lunchtime habits and self-assessed work performance of interns at a tertiary hospital.

There is ample evidence that doctors frequently miss meals at work, which negatively impacts concentration, decision-making and overall patient care. Junior doctors are particularly vulnerable given their heavy workload. We report on the impact of a pilot programme supporting home-based meal preparation on the dietary habits and energy levels of interns at a tertiary hospital and demonstrate this is one strategy healthcare organisations can adopt to promote a healthier workforce.

Lifestyle Medicine Practitioners Implementing a Greater Proportion of Lifestyle Medicine Experience Less Burnout.

PURPOSE: To identify reasons for burnout, characterize the effect of lifestyle medicine (LM) practice on burnout, and assess the risk of burnout in relation to the proportion of LM practice. DESIGN: Analysis of mixed methods data from a large, cross-sectional survey on LM practice. SETTING: Web-based survey platform. PARTICIPANTS: Members of an LM medical professional society at the time of survey administration. METHODS: Practitioner members of a medical professional society were recruited to a cross-sectional, online survey. Data were collected on LM practice and experiences with burnout. Free-text data were thematically grouped and counted, and the association of burnout with the proportion of lifestyle-based medical practice was analyzed using logistic regression. RESULTS: Of 482 respondents, 58% reported currently feeling burned out, 28% used to feel burned out but no longer do, and 90% reported LM had positively impacted their professional satisfaction. Among LM practitioners surveyed, practicing more LM was associated with a 43% decrease (0.569; 95% CI: 0.384, 0.845; P = 0.0051) in the odds of experiencing burnout. Top reasons for positive impact included professional satisfaction, sense of accomplishment, and meaningfulness (44%); improved patient outcomes and patient satisfaction (26%); enjoyment of teaching/coaching and engaging in relationships (22%); and helps me personally: quality of life and stress (22%). CONCLUSION: Implementing LM as a greater proportion of medical practice was associated with lower likelihood of burnout among LM practitioners. Results suggest that increased feelings of accomplishment due to improved patient outcomes and reduced depersonalization contribute to reduced burnout.

Society for Maternal-Fetal Medicine Special Statement: Curriculum outline on patient safety and quality for maternal-fetal medicine fellows.

To help fellows in maternal-fetal medicine gain a well-rounded education in patient safety and quality, we present a curriculum outline that addresses the requirements of the Accreditation Council for Graduate Medical Education and the American Board of Obstetrics and Gynecology. For each month of fellowship, the outline suggests brief video clips, readings, and activities. Emphasis is placed on helping fellows develop and complete a quality improvement project. If desired, the curriculum can be modified to fit program-specific needs and can be adapted for use with residents in obstetrics and gynecology.

Longitudinal Study of Emotional Intelligence, Well-being, and Burnout of Surgical and Medical Residents.

INTRODUCTION: Emotional intelligence (EI) as a concept is becoming increasingly relevant in the healthcare industry. In order to examine the relationship between EI, burnout, and wellness, we administered these measures quarterly in resident physicians and analyzed the variables in each subset to gain insights and understanding of their relationship. METHODS: In 2017 and 2018, all residents entering the training programs in year one (PGY-1) were administered The Emotional Intelligence Questionnaire - Short Form (TEIQue-SF), The Maslach Burnout Inventory (MBI), and The Physician Wellness Inventory (PWI). The questionnaires were completed quarterly. Statistical analysis included ANOVA and ANCOVA. RESULTS: The overall combined PGY-1 resident year (n = 80) had an EI global trait mean score of 5.47 (SD: 0.59) at the beginning of their first year. The domains of burnout and physician wellness were examined across four different time points during the resident's first year. Domain scores changed significantly over the four time points during the first year. There was a relative 46% increase in exhaustion (P < .001), 48% increase in depersonalization (P < .001), and an 11% decrease in personal achievement (P < .001). Physician wellness domains also changed significantly between time 1 and the end of the year (time 4). There was a relative 12% decrease in career purpose (P < .001), a 30% increase in distress (P < .001), and 6% decrease in cognitive flexibility (P < .001). Each burnout domain and physician wellness domain were highly correlated with emotional quotient (EQ). Emotional quotient was independently assessed with each domain at baseline and with changes overtime. The lowest EQ group reported their distress increased significantly over time (P = .003) and a decline in career purpose (P < .001) and cognitive flexibility (P = .04). The response rate was 100%. CONCLUSION: Emotional intelligence is associated with well-being and burnout in individual residents; therefore, it is important to identify those who require increased support during residency in order to succeed.

Healthcare Workers' Well-Being: A Systematic Review of Positive Psychology Interventions.

Given persistent occupational stressors and multiple challenges in the delivery of healthcare, there is an increased focus on the well-being of healthcare workers. Responding to these challenges will require a multipronged approach, focusing on system level, organization, and individual actions. Positive psychology interventions (PPIs) represent a promising area for individual action. This systematic review indicates that PPI, delivered via many methods, holds promise for improving the well-being of healthcare workers, although there is a clear need for additional randomized controlled trials utilizing defined and standardized outcome measures. In this review, the most commonly evaluated PPIs were mindfulness-based or gratitude-based interventions. These were delivered via different methods, with many administered in the workplace and commonly in the form of courses ranging from two days to eight weeks. Researchers documented measurable improvements in multiple studied outcomes, noting reductions in symptoms of depression, anxiety, burnout, and stress. Some interventions increased well-being, job and life satisfaction, self-compassion, relaxation, and resilience. Most studies emphasized that these are simple, accessible, low-cost interventions. Limitations included some nonrandomized or quasi-experimental designs, alongside generally small sample sizes and varying methods of intervention delivery. Another concern is the lack of standardized outcome assessments and long-term follow-up data. As almost all studies included were performed before the pandemic, further research will be required post-pandemic. Overall, however, PPI shows promise as one arm of a multipronged approach to improving the well-being of healthcare workers.

Examining Early Career Pediatrician Characteristics, Sacrifices, and Satisfaction.

OBJECTIVE: Explore relationships between pediatrician characteristics, sacrifices made for career, and career and life satisfaction. METHODS: Surveys of early career pediatricians (ECPs) who recently graduated residency (2016-18), as part of the AAP Pediatrician Life and Career Experience Study (PLACES) were administered in 2019. Logistic regression analyzed association of pediatrician characteristics with personal sacrifices (a lot vs some or no sacrifices) made for one's career and whether career was worth the sacrifices made to become a physician, and association of characteristics and sacrifices with overall career and life satisfaction. RESULTS: Of 918 ECPs in the cohort, 90% responded to the 2019 survey. Seventy-seven percent agreed their career was worth the sacrifices and 40% reported they made a lot of personal sacrifices for their career. In multivariable analysis, female sex was associated with lower odds of viewing career as worth the sacrifices made [adjusted odds ratio [aOR] 0.45; 95% confidence interval [CI], 0.28-0.71], a higher odds of delaying starting a family [aOR 2.25; CI, 1.32-3.86] and making sacrifices in having children for career [aOR 2.60; CI, 1.48-4.58]. Those in fellowship training also reported making more sacrifices related to having children for their career [aOR 1.73; CI, 1.08-2.78]. ECPs who reported making a lot of sacrifices for their career were less likely to be satisfied with their overall career and life. CONCLUSIONS: Most ECPs believe their sacrifices to become a pediatrician were worth it. Female pediatricians were less likely to feel personal sacrifices were worth it and reported more sacrifices related to having children.

The Norms and Corporatization of Medicine Influence Physician Moral Distress in the United States.

PhenomenonMoral distress, which occurs when someone's moral integrity is seriously compromised because they feel unable to act in accordance with their core values and obligations, is an increasingly important concern for physicians. Due in part to limited understanding of the root causes of moral distress, little is known about which approaches are most beneficial for mitigating physicians' distress. Our objective was to describe system-level factors in United States (U.S.) healthcare that contribute to moral distress among pediatric hospitalist attendings and pediatric residents.ApproachIn this qualitative study, we conducted one-on-one semi-structured interviews with pediatric hospitalist attendings and pediatric residents from 4 university-affiliated, freestanding children's hospitals in the U.S. between August 2019 and February 2020. Data were coded with an iteratively developed codebook, categorized into themes, and then synthesized.FindingsWe interviewed 22 hospitalists and 18 residents. Participants described in detail how the culture of medicine created a context that cultivated moral distress. Norms of medical education and the practice of medicine created conflicts between residents' strong sense of professional responsibility to serve the best interests of their patients and the expectations of a hierarchical system of decision-making. The corporatization of the U.S. healthcare system created administrative and financial pressures that conflicted with the moral responsibility felt by both residents and hospitalists to provide the care that their patients and families needed.InsightsThese findings highlight the critical role of systemic sources of moral distress. These findings suggest that system-level interventions must supplement existing interventions that target individual health care providers. Preventing and managing moral distress will require a broad approach that addresses systemic drivers, such as the corporatization of medicine, which are entrenched in the culture of medicine.

A Narrative Medicine Pilot Curriculum for Internal Medicine Residents.

Narrative medicine (NM) is the practice of reflecting on patient stories, which can improve physician empathy and has been linked to higher levels of well-being. We implemented a NM curriculum for a large internal medicine residency program and report the curriculum's positive effects.

Decision Fatigue in Emergency Medicine: An Exploration of Its Validity.

Emergency physicians face a relentless stream of complex, high-stakes decisions in a fast-paced and dynamic environment. The concept of decision fatigue, a phenomenon characterized by a decline in the quality of decision-making after a long sequence of choices, has garnered increasing attention within healthcare. Several investigations show that the number and complexity of decisions made during prolonged shifts correlate with increased self-reported fatigue; however, the effect on clinical decision quality is uncertain. Conversely, a subset of studies found no clear relationship between decision fatigue and errors in clinical judgment. Importantly, some researchers argue that decision fatigue may be mitigated by factors such as experience, training, and support systems. This narrative review highlights the existing literature on decision fatigue among emergency physicians and explores whether this concept holds as a valid concern or remains a myth in the context of their practice.

The Wicked Problem of Physician Well-Being.

The collective threat to physician well-being is a complex issue with no clear solution. Even before the coronavirus disease 2019 pandemic, physicians suffered from widespread burnout and moral injury, with negative consequences for patient care, physician health, and the health care system. Initial clinician well-being efforts leaned heavily on individual-focused interventions. However, workplace culture and environment are key factors that affect burnout, and therefore clinician well-being efforts require both individual-focused and systems-level interventions. A sustainable culture of support in medicine is necessary to foster physician well-being.

Moving Past Burnout, Looking Toward Engagement.

Physician engagement is often discussed in the medical literature; yet health care research examining this construct has been disjointed and plagued by conceptual ambiguities. Examining validated organizational evidence, we offer 3 key antecedents of work engagement that show promise as resources for medical professionals and health care organizations: psychological safety, organizational justice, and job crafting. In addition, we outline the nomological network of related, yet distinct, concepts, to demonstrate the relationship between engagement, burnout, and job satisfaction. As health care organizations facilitate engagement, they provide an additional avenue to decrease physician burnout, while also positively impacting provider and organizational outcomes.