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JAMA Sep 2018Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout... (Review)
Review
IMPORTANCE
Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown.
OBJECTIVE
To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout.
DATA SOURCES AND STUDY SELECTION
Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018.
DATA EXTRACTION AND SYNTHESIS
Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively.
MAIN OUTCOMES AND MEASURES
Point or period prevalence of burnout assessed by questionnaire.
RESULTS
Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined.
CONCLUSIONS AND RELEVANCE
In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.
Topics: Burnout, Professional; Compassion Fatigue; Depersonalization; Humans; Job Satisfaction; Physicians; Prevalence; Surveys and Questionnaires
PubMed: 30326495
DOI: 10.1001/jama.2018.12777 -
Plastic and Reconstructive Surgery.... Aug 2018Few studies have demonstrated the prevalence of burnout in the specialty of plastic surgery. Therefore, the objective of this systematic literature review and...
BACKGROUND
Few studies have demonstrated the prevalence of burnout in the specialty of plastic surgery. Therefore, the objective of this systematic literature review and meta-analysis was to analyze the prevalence of burnout among plastic surgeons and residents in plastic surgery.
METHODS
The PRISMA statement for systematic reviews was followed, and the most relevant studies, published originally in any language until January 2018, were analyzed. The searches were conducted by 3 researchers in the following databases: the US National Library of Medicine (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, and Scientific Electronic Library Online.
RESULTS
The final sample consisted of 6 publications, including 2,670 plastic surgeons and 90 residents in plastic surgery. There was a prevalence of male subjects, with mean ages of 47.2 years for plastic surgeons and 28.4 years for residents. The prevalence rates of burnout were 32.32% among plastic surgeons and 36.66% among residents in plastic surgery, and high emotional exhaustion, depersonalization, and low personal accomplishment scores were considerably higher among residents in plastic surgery (37.78%, 35.56%, and 42.22%, respectively) than among plastic surgeons (25.84%, 19.15%, and 7.50%, respectively).
CONCLUSION
Given the high prevalence and fact that burnout syndrome correlates with the impairment of the professional and personal life of surgeons and residents in plastic surgery, and reduces quality in the care of patients, it is necessary to perform an early assessment and to regulate this phenomenon, with a focus on identifying, diagnosing, and providing appropriate treatment.
PubMed: 30324054
DOI: 10.1097/GOX.0000000000001854 -
MedEdPublish (2016) 2018This article was migrated. The article was marked as recommended. To identify and describe interventions designed to affect the learning environment (LE) in health...
This article was migrated. The article was marked as recommended. To identify and describe interventions designed to affect the learning environment (LE) in health professions education, summarize factors that influence the LE, and determine gaps that require additional research. The LE can be thought of as a dynamic and complex construct co-created by people in a particular setting. A positive LE represents a welcoming climate for learning, which enhances satisfaction, well-being, academic performance and collaboration, while a negative LE restricts participation and learning, leading to emotional exhaustion, depersonalization and burnout. A six-step scoping review methodology was followed to identify and report on literature that describes interventions affecting the LE in the health professions education: 1. Identify the research question, 2. Identify relevant studies, 3. Select studies to be included, 4. Chart the data, 5. Collate, summarize and report results, and 6. Consult with stakeholders. 2,201 unique citations were identified and reviewed using titles and abstracts. 240 full-text articles were retained for detailed review, resulting in the inclusion of 68 articles. Study results are reported in relation to essential components of the LE: personal, social, organizational, physical and virtual spaces. Results of four different types to the studies of the LE are described: specific impacting the LE, of perceptions of the LE by two or more different groups, such as well-being with the LE, and studies of the LE. Major influences included accreditation regulations, curricular interventions, faculty/staff development grading practices, instructional interventions, placements, physical and virtual spaces, and support services; and are reported along with specific interventions. These results reflect the complexity of the LE and the need for conceptual clarity. Since the quality of the evidence was not evaluated, the identified influences should be viewed as potential opportunities to improve the LE.
PubMed: 38074598
DOI: 10.15694/mep.2018.0000211.1 -
Gates Open Research 2018Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care...
Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.
PubMed: 29984356
DOI: 10.12688/gatesopenres.12779.3 -
BMC Family Practice May 2018burnout syndrome is a significant problem in nursing professionals. Although, the unit where nurses work may influence burnout development. Nurses that work in primary... (Meta-Analysis)
Meta-Analysis
BACKGROUND
burnout syndrome is a significant problem in nursing professionals. Although, the unit where nurses work may influence burnout development. Nurses that work in primary care units may be at higher risk of burnout. The aim of the study was to estimate the prevalence of emotional exhaustion, depersonalization and low personal accomplishment in primary care nurses.
METHODS
We performed a meta-analysis. We searched Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN and LILACS databases up to September 2017 to identify cross-sectional studies assessing primary care nurses' burnout with the Maslach Burnout Inventory were included. The search was done in September 2017.
RESULTS
After the search process, n = 8 studies were included in the meta-analysis, representing a total sample of n = 1110 primary care nurses. High emotional exhaustion prevalence was 28% (95% Confidence Interval = 22-34%), high depersonalization was 15% (95% Confidence Interval = 9-23%) and 31% (95% Confidence Interval = 6-66%) for low personal accomplishment.
CONCLUSIONS
Problems such as emotional exhaustion and low personal accomplishment are very common among primary care nurses, while depersonalization is less prevalent. Primary care nurses are a burnout risk group.
Topics: Burnout, Professional; Community Health Nursing; Compassion Fatigue; Humans; Job Satisfaction; Nurses; Prevalence; Primary Care Nursing
PubMed: 29747579
DOI: 10.1186/s12875-018-0748-z -
PloS One 2018Although burnout in paediatric nurses has been addressed in previous research, the heterogeneous nature of the results obtained and of the variables studied highlights... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Although burnout in paediatric nurses has been addressed in previous research, the heterogeneous nature of the results obtained and of the variables studied highlights the need for a detailed analysis of the literature.
OBJECTIVE
The aim of this study was to analyse the literature on burnout characteristics, reported prevalence, severity and risk factors, to achieve a better understanding of the risk of emotional exhaustion, depersonalisation and feelings of low personal accomplishment.
METHOD
For this purpose, we carried out a systematic review and meta-analysis of the literature. The databases consulted were CINAHL, LILACS, PubMed, the Proquest Platform (Proquest Health & Medical Complete), Scielo and Scopus. This study used the search equation "burnout AND "pediatric nurs*"", and was conducted in July 2017.
RESULTS
The search produced 34 studies targeting burnout in paediatric nurses, with no restrictions on the date of publication. Many of these studies detected moderate-high values for the three dimensions of burnout, and highlighted sociodemographic, psychological and job-related variables associated with this syndrome. The sample population for the meta-analysis was composed of 1600 paediatric nurses. The following prevalence values were obtained: (i) emotional exhaustion, 31% (95% CI: 25-37%); (ii) depersonalisation, 21% (95% CI: 11-33%); (iii) low personal accomplishment, 39% (95% CI: 28-50%).
CONCLUSIONS
A significant number of paediatric nurses were found to have moderate-high levels of emotional exhaustion and depersonalisation, and low levels of personal accomplishment. These nurses, therefore, were either experiencing burnout or at high risk of suffering it in the future. These results support the need for further study of the risk factors for burnout in paediatric nurses. They also highlight the importance of developing interventions or therapies to help prevent or attenuate the above symptoms, thus helping nurses cope with the workplace environment and with situations that may lead to burnout.
Topics: Burnout, Professional; Depersonalization; Female; Humans; Male; Nurses, Pediatric; Prevalence; Risk Factors; Workplace
PubMed: 29694375
DOI: 10.1371/journal.pone.0195039 -
Journal of Surgical Education 2018Surgeon burnout compromises the quality of life of physicians and the delivery of care to patients. Burnout rates and interpretation of the Maslach Burnout Inventory... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
Surgeon burnout compromises the quality of life of physicians and the delivery of care to patients. Burnout rates and interpretation of the Maslach Burnout Inventory (MBI) complicates the interpretation of surgeon burnout. The purpose of this study is to apply a standardized interpretation of severe surgeon burnout termed, "burnout syndrome" to analyze inherent variation within surgical specialties.
DESIGN
A systematic literature search was performed using MEDLINE, PsycINFO, and EMBASE to identify studies reporting MBI data by surgical specialty. Data extraction was performed to isolate surgeon specific data.
SETTING
A meta-analysis was performed.
RESULTS
A total of 16 cross-sectional studies were included in this meta-analysis, totaling 3581 subjects. A random effects model approximated burnout syndrome at 3.0% (95% CI: 2.0%-5.0%; I = 78.1%). Subscale analysis of emotional exhaustion, depersonalization, and personal accomplishment indicated subscale burnout in 30.0% (CI: 25.0%-36.0%; I = 93.2%), 34.0% (CI: 25.0%-43.0%; I = 96.9%), and 25.0% (CI: 18.0%-32.0%; I = 96.5%) of surgeons, respectively. Significant differences (p < 0.001) in MBI subscale scoring existed among surgical specialties.
CONCLUSIONS
Approximately 3% of surgeons suffer from extreme forms of burnout termed "burnout syndrome," although surgeon burnout may occur in up to 34% of surgeons, characterized by high burnout in 1 of 3 subscales. Surgical specialties have significantly different rates of burnout subscales. Future burnout studies should target the specialty-specific level to understand inherent differences in an effort to better understand methods of improving surgeon burnout.
Topics: Adult; Age Factors; Burnout, Professional; Cross-Sectional Studies; Female; Humans; Incidence; Male; Middle Aged; Quality of Life; Risk Assessment; Sex Factors; Specialties, Surgical; Surgeons; United States
PubMed: 29500145
DOI: 10.1016/j.jsurg.2018.02.003 -
BMC Medical Education Nov 2017To identify the: extent to which medical students in China experience burnout; factors contributing to this; potential solutions to reduce and prevent burnout in this... (Review)
Review
BACKGROUND
To identify the: extent to which medical students in China experience burnout; factors contributing to this; potential solutions to reduce and prevent burnout in this group; and the extent to which the experiences of Chinese students reflect the international literature.
METHODS
Systematic review and narrative synthesis. Key words, synonyms and subject headings were used to search five electronic databases in addition to manual searching of relevant journals. Titles and abstracts of publications between 1st January 1989-31st July 2016 were screened by two reviewers and checked by a third. Full text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted and synthesised.
RESULTS
Thirty-three studies were eligible and included in the review. Greater levels of burnout were generally identified in males, more senior medical students, and those who already experienced poorer psychological functioning. Few studies explored social or contextual factors influencing burnout, but those that did suggest that factors such as the degree of social support or the living environment surrounding a student may be a determinant of burnout.
CONCLUSIONS
Greater understanding of the social and contextual determinants of burnout amongst medical students in China is essential towards identifying solutions to reduce and prevent burnout in this group.
Topics: Burnout, Professional; China; Education, Medical, Graduate; Education, Medical, Undergraduate; Female; Humans; Male; Schools, Medical; Sex Factors; Social Support; Students, Medical
PubMed: 29145854
DOI: 10.1186/s12909-017-1064-3 -
BJPsych Bulletin Aug 2017To systematically review the prevalence and associated factors of burnout and stress-related psychiatric disorders among UK doctors. An extensive search was conducted... (Review)
Review
To systematically review the prevalence and associated factors of burnout and stress-related psychiatric disorders among UK doctors. An extensive search was conducted of PubMed, EBSCOhost and British medical journals for studies published over a 20-year span measuring the prevalence of psychiatric morbidity (using the General Health Questionnaire) and burnout (using the Maslach Burnout Inventory). Prevalence of psychiatric morbidity ranged from 17 to 52%. Burnout scores for emotional exhaustion ranged from 31 to 54.3%, depersonalisation 17.4 to 44.5% and low personal accomplishment 6 to 39.6%. General practitioners and consultants had the highest scores. Factors significantly associated with increase in the prevalence of burnout and psychiatric morbidity include low job satisfaction, overload, increased hours worked and neuroticism. The results indicate a worryingly high rate of burnout and psychiatric morbidity among UK doctors, which could have a huge negative impact on healthcare provision in general. Factors at personal and organisational levels contribute to burnout and psychiatric morbidity, and so efforts made to counter these problems should target both levels.
PubMed: 28811913
DOI: 10.1192/pb.bp.116.054247 -
BMC Health Services Research Jul 2017Burnout among healthcare professionals is one of the key challenges affecting health care practice and quality of care. This systematic review aims to (1) estimate the... (Review)
Review
BACKGROUND
Burnout among healthcare professionals is one of the key challenges affecting health care practice and quality of care. This systematic review aims to (1) estimate the prevalence of burnout among health care professionals (HCP) in Arab countries; and (2) explore individual and work-related factors associated with burnout in this population.
METHODS
Multiple electronic databases were searched for studies published in English or Arabic from January 1980 to November 2014 assessing burnout (using the Maslach Burnout Inventory; MBI) amongst health care professionals (HCP) in Arab countries.
RESULTS
Nineteen studies (N = 4108; 49.3% females) conducted on HCP in Bahrain, Egypt, Jordan, Lebanon, Palestine, Saudi Arabia and Yemen were included in this review. There was a wide range of prevalence estimates for the three MBI subscales, high Emotional Exhaustion (20.0-81.0%), high Depersonalization (9.2-80.0%), and low Personal Accomplishment (13.3-85.8%). Gender, nationality, service duration, working hours, and shift patterns were all significantly associated with burnout.
CONCLUSIONS
Within the constraints of the study and the range of quality papers available, our review revealed moderate-to-high estimates of self-reported burnout among HCP in Arab countries that are similar to prevalence estimates in non-Arabic speaking westernized developed countries. In order to develop culturally appropriate interventions, further research using longitudinal designs is needed to confirm the risk factors for burnout in specific HCP settings and specialties in Arab countries.
Topics: Arabs; Burnout, Professional; Depersonalization; Fatigue; Female; Health Personnel; Humans; Male; Middle East; Prevalence; Risk Factors; Self Report
PubMed: 28716142
DOI: 10.1186/s12913-017-2319-8