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The Clinical Teacher Apr 2024Burnout is a complex phenomenon and a major concern in graduate medical education as it directly impacts trainee well-being. Identifying modifiable lifestyle factors...
BACKGROUND
Burnout is a complex phenomenon and a major concern in graduate medical education as it directly impacts trainee well-being. Identifying modifiable lifestyle factors over which trainees have immediate control could support timely, actionable, individual and programme-level interventions to combat it.
OBJECTIVE
The objective of this pilot study is to describe modifiable lifestyle factors that may limit the development of burnout in medical residents and fellows.
METHODS
We performed a cross-sectional survey of residents and fellows at academic medical centre from September 2017 to October 2017. Participants completed the Maslach Burnout Inventory and a questionnaire designed to identify factors hypothesised to be protective against burnout.
FINDINGS
A total of 205/805 (25%) trainees completed the survey with a mean (SD) age of 29.7 (2.6) years. 52% (n = 107) were female. Averaging at least 7 h of sleep per night was found to have a significant association with lower scores for the emotional exhaustion (24.8 [11, p = 0.04]) and depersonalisation (11.1 [6.4, p = 0.02]) dimensions of burnout. Additionally, self-identifying as a healthy eater was found to have a significant association with lower scores for emotional exhaustion (25 [11.5, p = 0.03]) and depersonalisation (11.5 [6.6, p = 0.04]) as well. Workouts, hobbies, identifying with organised religion, praying, meditation and mindfulness activities were not associated with a difference.
CONCLUSIONS
Adequate sleep (7 or more hours per night) and healthy eating are modifiable individual-level lifestyle factors associated with lower burnout scores in trainees. These items could be a target for trainee education and programme level support initiatives.
PubMed: 38664946
DOI: 10.1111/tct.13767 -
Journal of Trauma & Dissociation : the... 2018Depersonalization is defined as persistent or recurrent episodes of feeling detached or estranged from a sense of self and the world. This study addressed the primary...
Depersonalization is defined as persistent or recurrent episodes of feeling detached or estranged from a sense of self and the world. This study addressed the primary question: Do nonclinical individuals who endorse high symptomatic depersonalization have inherently more intense emotional responses, along with more childhood adversity and past trauma? In this IRB approved study, participants who met clinical levels of depersonalization (n = 43, 16.3%) were compared to a group without clinical levels of depersonalization (n = 221, 83.7%). Adverse childhood experiences, adult traumatic events, emotional overexcitability, coping strategies under stress, and anxiety were examined in both groups. The variables to assess depersonalization severity included the Dissociative Experience Scale-II, Cambridge Depersonalization Scale, and Multiscale Dissociation Inventory. The results indicated that clinical levels of depersonalization were identified in 16.3% of the sample. The high depersonalization group had significantly more adverse childhood experiences, in particular, emotional abuse and neglect. They also experienced more adult traumatic events, higher levels of anxiety, more emotional overexcitability, and they employed a less adaptive emotion-oriented coping strategy under stress. It is recommended that treating depersonalization symptoms should include examining childhood adversity, especially emotional abuse and neglect. Based on study findings, emotion regulation skills should be promoted to help individuals with elevated depersonalization manage their emotion-oriented coping strategies, anxiety, and emotional overexcitability.
Topics: Adaptation, Psychological; Adult Survivors of Child Abuse; Case-Control Studies; Depersonalization; Dissociative Disorders; Emotions; Female; Humans; Male; Psychiatric Status Rating Scales; Stress, Psychological; Young Adult
PubMed: 28509616
DOI: 10.1080/15299732.2017.1329770 -
Urology May 2020To identify factors and stress coping mechanisms associated with burnout within the field of urology.
OBJECTIVE
To identify factors and stress coping mechanisms associated with burnout within the field of urology.
METHODS
A survey study was completed using the abbreviated Maslach Burnout Inventory to evaluate emotional exhaustion, depersonalization, and low personal achievement. Demographic information, training status, practice setting, work hours, and mechanisms used to cope with stress were evaluated. Participants were also asked to comment on contributors to burnout in an open-ended question. Univariate analysis and multivariate regression identified factors associated with measures of burnout.
RESULTS
A total of 476 survey responses from 377 practicing urologists and 99 residents/fellows were included. Burnout was identified in 49.6% of all participants. Burnout through high emotional exhaustion was seen in 40.7%, high depersonalization in 30.7%, and low personal achievement in 18.3%. Trainees exhibited higher levels of depersonalization and lower levels of personal achievement. Higher levels of emotional exhaustion were identified in urologists in the middle of their careers and those in private practice. Urologists identified documentation, insurance and reimbursement, government regulations, medical practice expectations, and patient expectations as stressors contributing to burnout. Exercising and socializing were consistently associated with lower measures of burnout whereas stress eating and alcohol use were associated with higher measures of burnout on multivariate analysis.
CONCLUSION
Burnout in urology was associated with trainee status, years in practice, and practice setting. Exercising and socializing were protective against burnout whereas stress eating and alcohol consumption were associated with higher rates of burnout.
Topics: Achievement; Adaptation, Psychological; Adult; Aged; Alcohol Drinking; Burnout, Professional; Depersonalization; Eating; Exercise; Female; Humans; Internship and Residency; Male; Middle Aged; Motivation; Practice Management, Medical; Private Practice; Regression Analysis; Social Participation; Stress, Psychological; Surveys and Questionnaires; Urologists; Urology; Young Adult
PubMed: 32032685
DOI: 10.1016/j.urology.2019.11.072 -
Journal of Clinical Psychology Apr 2022Depersonalization-derealization disorder (DDD) is characterized by diverse symptomatology overlapping with anxiety and dissociative disorders, but the sources of this...
OBJECTIVE
Depersonalization-derealization disorder (DDD) is characterized by diverse symptomatology overlapping with anxiety and dissociative disorders, but the sources of this variability are poorly understood. This study aims to determine whether symptom heterogeneity is attributable to the presence of latent subgroups.
METHOD
We applied latent profile analysis to psychometric measures of anxiety, depersonalization-derealization, and dissociation in 303 DDD patients.
RESULTS
The analysis yielded evidence for five discrete subgroups: three of varying severity levels and two moderate-to-severe classes characterized by differential dissociative symptoms. The five classes reliably differed on several nondissociative symptoms, comorbidities, and factors precipitating their diagnosis but did not significantly differ in other symptoms including anxiety.
CONCLUSION
These results suggest the presence of three distinct DDD subtypes in the upper severity range that are distinguished by differential expression of detachment and compartmentalization symptoms. Further elucidation of these subtypes has potential implications for the etiology, mechanisms, and treatment of DDD.
Topics: Anxiety; Comorbidity; Depersonalization; Dissociative Disorders; Humans; Psychometrics
PubMed: 34487354
DOI: 10.1002/jclp.23241 -
International Emergency Nursing Jul 2018Previous studies showed increased levels of absenteeism, drug abuse, depression, and symptoms allied with burnout in emergency nurses. This meta-analysis aimed to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Previous studies showed increased levels of absenteeism, drug abuse, depression, and symptoms allied with burnout in emergency nurses. This meta-analysis aimed to quantify the three dimensions of burnout in emergency nurses and estimate the proportion of nurses who experience higher than tolerable levels of burnout.
MATERIALS AND METHODS
A systematic search was conducted on PubMed, Scielo, Xueshu Baidu and Informa databases with a cut-off time between 1997 and 2017 to retrieve published papers in any language that had estimated the burnout levels in emergency nurses by using MBI scale.
RESULTS
We identified a total of 11 eligible studies. The total mean estimate was moderate for emotional exhaustion (25.552), but clearly trending towards higher level, whereas depersonalization (10.383) and lack of personal accomplishment (30.652) showed higher burnouts levels. The proportion of emergency nurses suffering from high emotional exhaustion, high depersonalization, and low personal accomplishment was 40.5%, 44.3%, and 42.7%, respectively.
CONCLUSION
Burnout is detrimental to achieving high-quality healthcare services and causes a loss of productivity. It is high time for nursing leader and management personnel to identify appropriate measures to counteract burnout.
Topics: Adult; Burnout, Professional; Depersonalization; Emergency Nursing; Female; Humans; Male; Nurses; Psychometrics
PubMed: 29361420
DOI: 10.1016/j.ienj.2017.12.005 -
Academic Radiology Jun 2017Burnout is a psychological syndrome composed of emotional exhaustion, depersonalization, and sense of lack of personal accomplishment, as a result of prolonged...
RATIONALE AND OBJECTIVES
Burnout is a psychological syndrome composed of emotional exhaustion, depersonalization, and sense of lack of personal accomplishment, as a result of prolonged occupational stress. The purpose of our study was to determine the prevalence of burnout among current musculoskeletal radiology fellows and to explore causes of emotional stress.
MATERIALS AND METHODS
A 24-item survey was constructed on SurveyMonkey using the Maslach Burnout Inventory. We identified 82 musculoskeletal radiology fellowship programs. We recruited subjects indirectly through the program director or equivalent.
RESULTS
Fifty-eight respondents (48 male, 10 female) identified themselves as current musculoskeletal radiology fellows and completed the survey. Comparison of the weighted subscale means in our data to the Maslach normative subscale thresholds for medical occupations indicates that musculoskeletal radiology fellows report relatively high levels of burnout with regard to lack of personal accomplishment and depersonalization, whereas emotional exhaustion levels in our sample are within the average range reported by Maslach. Although male musculoskeletal radiology fellows experience relatively high levels in two of the three dimensions of burnout (depersonalization and personal accomplishment), female musculoskeletal radiology fellows experience relatively high burnout across all three dimensions. Job market-related stress and the effort required providing care for dependents significantly affect personal accomplishment. Conversely, imbalances in the work-life relationship and feelings of powerlessness are significantly associated with depersonalization and emotional exhaustion.
CONCLUSIONS
Musculoskeletal radiology fellows report relatively high levels of burnout. Because the consequences of burnout can be severe, early identification and appropriate intervention should be a priority.
Topics: Burnout, Professional; Depersonalization; Fellowships and Scholarships; Female; Humans; Male; Physicians; Radiology; Stress, Psychological; Surveys and Questionnaires; United States; Work-Life Balance
PubMed: 28341410
DOI: 10.1016/j.acra.2016.12.024 -
Pediatric Emergency Care Apr 2020Burnout is a syndrome in which a reduced sense of personal accomplishment, depersonalization, and emotional exhaustion develop in response to prolonged stress. It is...
OBJECTIVE
Burnout is a syndrome in which a reduced sense of personal accomplishment, depersonalization, and emotional exhaustion develop in response to prolonged stress. It is well known that physicians suffer high rates of burnout; emergency medicine physicians experience significantly increased rates of burnout, whereas physicians in other specialties, like pediatrics, may be spared. Pediatric emergency medicine physicians are on the frontline of care for the critically ill child, which could put them at high risk for burnout. This study evaluates the rate of burnout in pediatric emergency medicine physicians.
METHODS
We conducted a survey assessing burnout using a sample of pediatric emergency medicine physicians who subscribe to an open Listserv server maintained by Brown University. Burnout was measured using a validated instrument, the Maslach Burnout Inventory-Human Services Survey, which was distributed by e-mail to the study group.
RESULTS
Respondents averaged a score of 9 (95% confidence interval [CI], 8-10), 23 (95% CI, 21-25), and 39 (95% CI, 38-40) in the subscales of depersonalization, emotional exhaustion, and personal accomplishment, respectively. This placed our cohort into the average range for all subscales. The percentage of respondents who scored in the high levels of burnout (moderate to high scores in both depersonalization and emotional exhaustion and low to moderate scores in personal accomplishment) was 25% (95% CI, 18-32).
CONCLUSIONS
Unlike previous literature showing burnout prevalence in excess of 60% in emergency medicine physicians and 38% in pediatricians, our pediatric emergency medicine physicians fared better with only 25% (95% CI, 18-32), showing elevated levels of burnout.
Topics: Adult; Aged; Burnout, Professional; Child; Depersonalization; Emergency Medicine; Emotions; Female; Humans; Male; Middle Aged; Pediatric Emergency Medicine; Pediatricians; Physicians; Prevalence; Stress, Psychological; Surveys and Questionnaires
PubMed: 29200142
DOI: 10.1097/PEC.0000000000001379 -
Psychiatry Research Sep 2022The dissociative disorders and germane conditions are reliably characterized by elevated responsiveness to direct verbal suggestions. However, it remains unclear whether...
The dissociative disorders and germane conditions are reliably characterized by elevated responsiveness to direct verbal suggestions. However, it remains unclear whether atypical responsiveness to suggestion is similarly present in depersonalization-derealization disorder (DDD). 55 DDD patients and 36 healthy controls completed a standardised behavioural measure of direct verbal suggestibility that includes a correction for compliant responding (BSS-C), and psychometric measures of depersonalization-derealization (CDS), mindfulness (FFMQ), imagery vividness (VVIQ), and anxiety (GAD-7). Relative to controls, patients did not exhibit elevated suggestibility (g = 0.26, BF = .11) but displayed significantly lower mindfulness (g = 1.38), and imagery vividness (g = 0.63), and significantly greater anxiety (g = 1.39). Although suggestibility did not correlate with severity of depersonalization-derealization symptoms in controls, r = -.03 [95% CI: -.36, .30], there was a weak tendency for a positive association in patients, r = .25, [95% CI: -.03, .48]. Exploratory analyses revealed that patients with more severe anomalous bodily experiences were also more responsive to suggestion, an effect not seen in controls. This study demonstrates that DDD is not characterized by elevated responsiveness to direct verbal suggestions. These results have implications for the aetiology and treatment of this condition, as well as its classification as a dissociative disorder in psychiatric nosology.
Topics: Anxiety; Depersonalization; Dissociative Disorders; Humans; Suggestion
PubMed: 35870293
DOI: 10.1016/j.psychres.2022.114730 -
Cognitive Neuropsychiatry Sep 2016Hallucinations that involve shifts in the subjectively experienced location of the self, have been termed "out-of-body experiences" (OBEs). Early psychiatric accounts... (Review)
Review
INTRODUCTION
Hallucinations that involve shifts in the subjectively experienced location of the self, have been termed "out-of-body experiences" (OBEs). Early psychiatric accounts cast OBEs as a specific instance of depersonalisation and derealisation disorder (DPD-DR). However, during feelings of alienation and lack of body realism in DPD-DR the self is experienced within the physical body. Deliberate forms of "disembodiment" enable humans to imagine another's visuo-spatial perspective taking (VPT), thus, if a strong relationship between deliberate and spontaneous forms of disembodiment could be revealed, then uncontrolled OBEs could be "the other side of the coin" of a uniquely human capacity.
METHODS
We present a narrative review of behavioural and neuroimaging work emphasising methodological and theoretical aspects of OBE and VPT research and a potential relationship.
RESULTS
Results regarding a direct behavioural relationship between VPT and OBE are mixed and we discuss reasons by pointing out the importance of using realistic tasks and recruiting genuine OBEers instead of general DPD-DR patients. Furthermore, we review neuroimaging evidence showing overlapping neural substrates between VPT and OBE, providing a strong argument for a relationship between the two processes.
CONCLUSIONS
We conclude that OBE should be regarded as a necessary implication of VPT ability in humans, or even as a necessary and potentially sufficient condition for the evolution of VPT.
Topics: Body Image; Depersonalization; Emotions; Female; Hallucinations; Humans; Imagination; Male; Neuroimaging; Self Concept; Sensation; Social Alienation
PubMed: 27684304
DOI: 10.1080/13546805.2016.1203769 -
The Journal of the American Academy of... Nov 2020Burnout is an occupational hazard for physicians at all stages of training and medical practice. The purpose of the current study was to determine whether residency...
INTRODUCTION
Burnout is an occupational hazard for physicians at all stages of training and medical practice. The purpose of the current study was to determine whether residency factors, with the use of an activity monitor, including the amount of exercise, have any impact on burnout among orthopaedic surgery residents in varying years of training.
METHODS
Orthopaedic residents at a single institution were recruited immediately before beginning a new clinical rotation and followed for four weeks. On enrollment, the participants were given a wrist-worn activity monitor (Fitbit Flex) and instructed on its use for tracking physical activity. REDCap was used to collect burnout levels (as assessed by using the Maslach Burnout Inventory and the Patient Health Questionnaire-9), which were completed a total of five times, once at enrollment and weekly during the study period.
RESULTS
Twenty-seven residents were enrolled, including 13 junior residents (interns and second years) and 14 senior residents (third, fourth, and fifth years). Seven residents were on fracture rotations, whereas 20 were not. As measured by using the Maslach Burnout Inventory, juniors were more emotionally exhausted (P = 0.01) and depersonalized (P = 0.027). No difference in the objective physical activity data as measured by using the Fitbit Flex and no difference in the self-reported hours of sleep were observed. Residents on orthopaedic trauma rotations also reported significantly higher rates of emotional exhaustion and depersonalization (P < 0.001) than other residents and were more physically active on average (P < 0.030).
DISCUSSION
Although depersonalization and depression are common symptoms seen among orthopaedic surgery residents, this study demonstrated that quality of life improves markedly as they progress through their residency training. Residents on orthopedic trauma rotations have greater levels of emotional exhaustion and depersonalization. This pilot study suggests that burnout prevention programs should begin at the start of training to provide residents with strategies to combat and then reinforced while on orthopaedic trauma rotations.
LEVEL OF EVIDENCE
Level III Diagnostic Study.
Topics: Adult; Burnout, Professional; Depersonalization; Depression; Education, Medical; Exercise; Female; Humans; Internship and Residency; Male; Orthopedic Procedures; Pilot Projects; Quality of Life; Students, Medical; Surveys and Questionnaires
PubMed: 32039922
DOI: 10.5435/JAAOS-D-19-00648