The Silent Epidemic: Causes and Consequences of Medical Learner Burnout.

PURPOSE OF REVIEW: Clinician burnout has significant socioeconomic, health, and quality of life implications. However, there has been little attention directed at medical students and house officers (i.e., medical learners). This review provides pertinent evidence regarding burnout as it relates to medical learners including risk factors and potential interventions. We conclude with recommendations on future research directions and potential approaches to address this epidemic of medical learner burnout. RECENT FINDINGS: Burnout is a significant issue among medical learners that is impacted both by interpersonal and environmental factors. There are points of heightened vulnerability for medical learners throughout their training. However, studies are unable to reach consensus regarding effective interventions to mitigate the impact of burnout. Furthermore, some elements of burnout are not readily reversible even after removing risk factors. Burnout is a significant concern for medical learners with wide-ranging physical, emotional, and psychosocial consequences. However, the current body of literature is sparse and does not provide consistent guidance on how to address burnout in medical learners. It is clear additional attention is needed in understanding burnout among learners and establishing proactive approaches to minimize its negative impact.

The effect of race in older adults presenting for chronic pain management: a comparative study of black and white Americans.

In an aging society, chronic pain will increasingly have a significant impact on successful aging. Chronic pain may further differentially affect racial and ethnic minorities while diminishing their health and quality of life. This study addresses the potential differential effects of chronic pain cross-culturally in older Americans. A retrospective analysis of a group of subjects presenting for chronic pain management in a tertiary care multidisciplinary pain center was performed. This comparative study of black and white American adults (N [equals] 2040) was done to determine whether there were differences in (1). psychologic functioning, (2). pain characteristics, (3). pain disability, and (4). comorbidities. The black American population had more depressive symptoms and symptoms of posttraumatic stress disorder when compared with the white Americans. These results suggest that chronic pain adversely affects the quality of life and health status of black Americans to a greater extent than white Americans before initial presentation for treatment at a multidisciplinary pain center. This study of older Americans with chronic pain showed significant differences in pain and health status based on race. It further demonstrates a difference in the chronic pain experience based on race in older Americans.

Race and chronic pain: A comparative study of young black and white Americans presenting for management.

Chronic pain is a debilitating problem for many Americans. It affects physical, social, and emotional health. This study addresses the potential differential effects of chronic pain cross-culturally in younger Americans. A retrospective analysis of persons younger than 50 years of age presenting for chronic pain management in a multidisciplinary pain center was done. White and black American adults aged 18 to 50 years (N = 3669) were compared to determine whether there were differences in (1) psychologic functioning, (2) pain characteristics, (3) pain disability, and (4) comorbidities. Our results suggest that black Americans had more depressive symptoms and symptoms consistent with post-traumatic stress disorder when compared to white Americans. These results showed that on initial assessment, black Americans with chronic pain report significantly more pain and sleep disturbance as well as more symptoms consistent with post-traumatic stress disorder and depression than white Americans. They also experience a higher prevalence of self-identified comorbidities, including dizziness, chest pain, and high blood pressure. In conclusion, considerable diminution in the overall physical and emotional health of black Americans 18 to 50 years of age with chronic pain was noted. These data support the need for further study of the chronic pain experiences of racial and ethnicity minority persons.

Intrarace differences among black and white americans presenting for chronic pain management: the influence of age, physical health, and psychosocial factors.

OBJECTIVE: Emerging comparative literature documents significant racial differences in the chronic pain experience in terms of physical, psychological, and social well-being. However, the intrarace differences of chronic pain among black Americans and white Americans has not been extensively investigated. The purpose of this investigation was to examine the potential within-race-group differential effects and the psychosocial aspects of chronic pain in black and white Americans across age groups. DESIGN: A retrospective study of patients presenting for chronic pain management. SETTING: A tertiary care multidisciplinary pain center. PATIENTS: Patients were younger (<50 years) (mean +/- SD: 36.7 +/- 8.4) and older (> or =50 years) (60 +/- 9.3) black Americans (N = 525), and younger (36.6 +/- 8.1) and older (63 +/- 9.8) white Americans (N = 5,298). OUTCOME MEASURES: Participants were measured on depressive symptoms, social functioning, pain intensity, pain-related disability, and physical comorbidities. RESULTS: Younger black Americans reported more depressive symptoms, pain intensity, and were less successful at coping with pain when compared to older black Americans. Similar within-group differences were also observed for reports of depressive symptoms, pain intensity, and coping abilities among white Americans. Results further showed that younger white Americans also experienced more symptoms related to post-traumatic distress than older white Americans. CONCLUSION: Examining within-race-group variability suggests that chronic pain differentially affects the quality of life and health status of black Americans and white Americans across age groups. This study emphasizes the need for further chronic pain studies examining pain indicators within defined racial and ethnic groups.