OBJECTIVE: To perform a literature review on burnout prevalence, factors that affect burnout and well-being, and solutions to address burnout in otolaryngology-head and neck surgery (OTO-HNS) residents and residents in other surgical specialties.
DATA SOURCES: Ovid Medline, Embase, and article reference lists.
REVIEW METHODS: A literature search was performed to identify articles on resident burnout, distress, wellness, well-being, and quality of life. Articles deemed outside the scope of the current work were excluded. Search was limited to the past 5 years.
CONCLUSIONS: Moderate to high burnout has been reported in 35% to 86% of OTO-HNS residents. Among other surgical specialties, resident burnout ranges between 58% and 66% in plastics, 11% and 67% in neurosurgery, 38% and 68% in urology, and 31% and 56% in orthopedics. Highest burnout rates were seen in postgraduate year 2 residents. Factors significantly associated with burnout included hours worked (>80 h/wk), level of autonomy, exercise, and program support. Reported resident work hours have steadily increased: 8% of OTO-HNS residents in 2005 vs 26% in 2019 reported averaging >80 h/wk. Practical implications of resident burnout include decreased empathy, moral distress and injury, poor health, decreased quality of life, increased attrition, decreased desire to pursue fellowship, and increased likelihood of medical errors. Structured mentorship programs, wellness initiatives, and increased ancillary support have been associated with lower burnout rates and improvements in resident well-being across specialties.
IMPLICATIONS FOR PRACTICE: Addressing burnout, which is prevalent in OTO-HNS residents, is critical to improving patient care and physician well-being. Surgical specialties can share strategies to effectively address resident burnout through institutional interventions, which can be essential quality improvement initiatives, to promote well-being.
BACKGROUND: The mental health of medical students is an issue worthy of attention, especially during COVID-19. Many studies have shown that depression and anxiety are the main problems faced by medical students. To assess the pooled prevalence of depression and anxiety among medical students worldwide, we conducted this meta-analysis.
METHODS: According to PRISMA, we used a computerized strategy to search studies in EMBASE, PubMed, PsycArticles, Web of Science, and China Biology Medicine disc. The pooled prevalence of depression and anxiety was calculated by a random-effects model. Heterogeneity was explored by subgroup analysis. Sensitivity analysis and publication bias were also carried out in this meta-analysis.
RESULTS: Of 1316 studies, 41 studies were selected based on 36608 medical students. The pooled depression prevalence was 37.9% (95% CI: 30.7-45.4%), and pooled anxiety prevalence was 33.7% (95% CI: 26.8-41.1%). The prevalence of depression and anxiety among medical students varied by gender, country, and continent.
CONCLUSION: The data reported that the prevalence of depression and anxiety among medical students during COVID-19 was relatively higher than those of the general population and the healthcare workers. The impact of COVID-19 on medical students and how to protect the mental health of medical students are needed to determine through further research.
SYSTEMATIC REVIEW REGISTRATION: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021274015], identifier [CRD42021274015].
OBJECTIVE: To comprehensively review the recent published literature to characterize current trends of burnout and well-being among otolaryngology trainees.
METHODS: Study design: systematic review and meta-analysis. A comprehensive literature review from 2000 to 2021 of studies related to otolaryngology resident burnout and well-being, as well as the general topic of well-being among surgical residents was completed. All included studies were summarized qualitatively. For the quantitative analysis, only articles reporting a Maslach burnout inventory (MBI), modified MBI or Mini-Z- Burnout assessment were included.
RESULTS: Twenty-five articles were included in the qualitative summary and nine articles in the quantitative analysis. In the qualitative summary, trainees were reported to have increased levels of distress and emotional hardening compared to attending otolaryngologists. Total hours worked per week and female gender were associated with worsened well-being. Residency program strategies to improve trainee well-being include program-sponsored wellness activities, dedicated wellness champions, and assistance with clerical burden. Implementation of protected nonclinical time has been shown to decrease burnout and increase well-being among trainees. Moreover, formal trainee mentorship programs have also been shown to reduce trainee burnout and stress. In the quantitative analysis, rates of trainee burnout ranged from 29.7% to 86% with an overall trend towards reduced rates of burnout from 2006 to 2021. Utilizing a weighted average, the overall burnout among otolaryngology residents was 58.6%.
CONCLUSIONS: Rates of burnout remain high among otolaryngology trainees. Implementing formal mentorship programs and providing protected time during regular work hours appear to be effective tools to improve resident well-being.
BACKGROUND: Burnout among postgraduate medical trainees (PMTs) is increasingly being recognized as a crisis in the medical profession. We aimed to establish the prevalence of burnout among PMTs, identify risk and protective factors, and assess whether burnout varied by country of training, year of study and specialty of practice.
METHODS: We systematically searched MEDLINE, Embase, PsycINFO, the Cochrane Database of Systematic Reviews, Web of Science and Education Resources Information Center from their inception to Aug. 21, 2018, for studies of burnout among PMTs. The primary objective was to identify the global prevalence of burnout among PMTs. Our secondary objective was to evaluate the association between burnout and country of training, year of study, specialty of training and other sociodemographic factors commonly thought to be related to burnout. We employed random-effects meta-analysis and meta-regression techniques to estimate a pooled prevalence and conduct secondary analyses.
RESULTS: In total, 8505 published studies were screened, 196 met eligibility and 114 were included in the meta-analysis. The pooled prevalence of burnout was 47.3% (95% confidence interval 43.1% to 51.5%), based on studies published over 20 years involving 31 210 PMTs from 47 countries. The prevalence of burnout remained unchanged over the past 2 decades. Burnout varied by region, with PMTs of European countries experiencing the lowest level. Burnout rates among medical and surgical PMTs were similar.
INTERPRETATION: Current wellness efforts and policies have not changed the prevalence of burnout worldwide. Future research should focus on understanding systemic factors and leveraging these findings to design interventions to combat burnout.
STUDY REGISTRATION: PROSPERO no. CRD42018108774.
ABSTRACT Background: Medical students frequently have depressive symptoms. Thus, the psychological impact of COVID-19 on them should be high. AIM: To conduct a systematic review and meta-analysis on the prevalence of depression in medical students during the COVID-19 pandemic. MATERIAL AND METHODS: MEDLINE via PubMed, Embase and Web of Science were searched for studies reporting the prevalence of depression in medical students, published from December 1, 2019 to December 27, 2020. RESULTS: Eleven studies were included, most of them from Asia. The estimated overall prevalence of depression in medical students was 31% (95% CI: 23%-40%), with lower prevalence rates reported in studies from Asia in general, and China in particular. CONCLUSIONS: Our findings indicate that the proportion of medical students with depression during the pandemic was high, and comparable with that reported in other university students.
ABSTRACT: This meta-analysis aimed to estimate the prevalence of burnout among medical students in China.A systematic search from the following electronic databases: China National Knowledge Infrastructure, Wangfang database, VIP database, Chinese biomedical literature database, PubMed, Embase, Web of Science, and Google Scholar was independently conducted by 2 reviewers from inception to September 2019. The data were analyzed using stata software Version 11. Heterogeneity was assessed using I2 tests, and publication bias was evaluated using funnel plots and Egger's test. The source of heterogeneity among subgroups was determined by subgroup analysis of different parameters.A total of 48 articles with a sample size of 29,020 met the inclusion criteria. The aggregate prevalence of learning burnout was 45.9% (95% confidence interval [CI] = 38.1%-53.8%). The prevalence rate of high emotional exhaustion was 37.5% (95% CI: 21.4%-53.7%). The percentage was 44.0% (95% CI: 29.2%-58.8%) for low personal accomplishment. The prevalence rate was 36.0% (95% CI: 23.0%-48.9%) in depersonalization dimension. In the subgroup analysis by specialty, the prevalence of burnout was 30.3% (95% CI: 28.6%-32.0%) for clinical medicine and 43.8% (95% CI: 41.8%-45.8%) for other medical specialties. The total prevalence of burnout between men and women was 46.4% (95% CI: 44.8%-47.9%) and 46.6% (95% CI: 45.5%-47.6%), respectively. The prevalence of burnout with Rong Lian's scale was 43.7% (42.1%-45.2%), and that with the other scales was 51.4% (50.4%-52.4%). The prevalence rates were 62.9% (61.3%-64.6%), 58.7% (56.3%-61.1%), 46.5% (42.9%-50.2%), and 56.0% (51.6%-60.4%) from Grades 1 to 4, respectively. There was a statistically significant difference among the different grades (P = .000).Our findings suggest a high prevalence of burnout among medical students. Society, universities, and families should take appropriate measures and allot more care to prevent burnout among medical students.
INTRODUCTION: To date, studies have shown a high prevalence of burnout in surgeons. Various factors have been found to be associated with burnout, and it has significant consequences personally and systemically. Junior doctors are increasingly placing their own health and wellbeing as the most important factor in their decisions about training. Finding ways to reduce and prevent burnout is imperative to promote surgical specialties as attractive training pathways.
METHODS: The MEDLINE, PsychInfo and EMBASE databases were searched using the subject headings related to surgery and burnout. All full text articles that reported data related to burnout were eligible for inclusion. Articles which did not use the Maslach Burnout Inventory or included non-surgical groups were excluded; 62 articles fulfilled the criteria for inclusion.
FINDINGS: Younger age and female sex tended to be associated with higher levels of burnout. Those further in training had lower levels of burnout, while residents suffered more than their seniors. Burnout is associated with a lower personal quality of life, depression and alcohol misuse. Academic work and emotional intelligence may be protective of burnout. Certain personality types are less likely to be burnt out. Mentorship may reduce levels of burnout.
CONCLUSIONS: Workload and work environment are areas that could be looked at to reduce job demands that lead to burnout. Intervening in certain psychological factors such as emotional intelligence, resilience and mindfulness may help to reduce burnout. Promoting physical and mental health is important in alleviating burnout, and these factors likely have a complex interplay.
Key Points: Question: What factors are associated with burnout/stress in trainee physicians? FINDINGS: This systematic review and meta-analysis of 48 studies included 36 266 trainee physicians. The odds ratios for the associations between workplace factors and burnout/stress were found to be higher compared with nonmodifiable and non–work-related factors such as age and grade. Meaning: The findings of this study highlight the importance of improving training and work environments to possibly prevent burnout among trainee physicians and suggest that implementing multicomponent interventions to target major stressors uncovered in this study could be promising. Importance: Evidence suggests that physicians experience high levels of burnout and stress and that trainee physicians are a particularly high-risk group. Multiple workplace- and non–workplace-related factors have been identified in trainee physicians, but it is unclear which factors are most important in association with burnout and stress. Better understanding of the most critical factors could help inform the development of targeted interventions to reduce burnout and stress. OBJECTIVE: To estimate the association between different stressors and burnout/stress among physicians engaged in standard postgraduate training (ie, trainee physicians). DATA SOURCES: Medline, Embase, PsycINFO, and Cochrane Database of Systematic reviews from inception until April 30, 2019. Search terms included trainee, foundation year, registrar, resident, and intern. STUDY SELECTION: Studies that reported associations between stressors and burnout/stress in trainee physicians. Data Extraction and Synthesis: Two independent reviewers extracted the data and assessed the quality of the evidence. The main meta-analysis was followed by sensitivity analyses. All analyses were performed using random-effects models, and heterogeneity was quantified using the I2 statistic. Main Outcome and Measures: The main outcome was the association between burnout/stress and workplace- or non–workplace-related factors reported as odds ratios (ORs) and their 95% CIs. RESULTS: Forty-eight studies were included in the meta-analysis (n = 36 266, median age, 29 years [range, 24.6-35.7 years]). One study did not specify participants' sex; of the total population, 18 781 participants (52%) were men. In particular, work demands of a trainee physician were associated with a nearly 3-fold increased odds for burnout/stress (OR, 2.84; 95% CI, 2.26-3.59), followed by concerns about patient care (OR, 2.35; 95% CI, 1.58-3.50), poor work environment (OR, 2.06; 95% CI, 1.57-2.70), and poor work-life balance (OR, 1.93; 95% CI, 1.53-2.44). Perceived/reported poor mental or physical health (OR, 2.41; 95% CI, 1.76-3.31), female sex (OR, 1.34; 95% CI, 1.20-1.50), financial worries (OR, 1.35; 95% CI, 1.07-1.72), and low self-efficacy (OR, 2.13; 95% CI, 1.31-3.46) were associated with increased odds for burnout/stress, whereas younger age and a more junior grade were not significantly associated. Conclusions and Relevance: The findings of this study suggest that the odds ratios for burnout and stress in trainee physicians are higher than those for work-related factors compared with nonmodifiable and non–work-related factors, such as age and grade. These findings support the need for organizational interventions to mitigate burnout in trainee physicians. This systematic review and meta-analysis examines the factors associated with burnout and stress among physicians receiving standard postgraduate training.
The novel coronavirus disease (COVID-19) pandemic has brought a great deal of pressure for medical students, who typically show elevated anxiety rates. Our aim is to investigate the prevalence of anxiety in medical students during this pandemic. This systematic review and mini meta-analysis has been conducted following the PRISMA guidelines. Two researchers independently searched PubMed on 26 August 2020 for cross-sectional studies on medical students during the COVID-19 outbreak, with no language restrictions applied. We then performed a manual search to detect other potentially eligible investigations. To the 1361 records retrieved in the initial search, 4 more were added by manual search on medRxiv. Finally, eight studies were finally included for qualitative and quantitative analysis, which yielded an estimated prevalence of anxiety of 28% (95% CI: 22-34%), with significant heterogeneity between studies. The prevalence of anxiety in medical students is similar to that prior to the pandemic but correlates with several specific COVID-related stressors. While some preventive and risk factors have been previously identified in a non-pandemic context, knowledge and cognitions on COVID-19 transmission, treatment, prognosis and prevention negatively correlate with anxiety, emerging as a key preventive factor that may provide a rationale for why the levels of anxiety have remained stable in medical students during the pandemic while increasing in their non-medical peers and the general population. Other reasons for the invariability of anxiety rates in this population are discussed. A major limitation of our review is that Chinese students comprised 89% the total sample, which could compromise the external validity of our work.
BACKGROUND: Applying the concept of burnout to medical students before residency is relatively recent. Its estimated prevalence varies significantly between studies. Our objective was to estimate the prevalence of burnout in medical students worldwide.
METHODS: We systematically searched Medline for English-language articles published between January 1, 2010 and December 31, 2017. We selected all the original studies about the prevalence of burnout in medical students before residency, using validated questionnaires for burnout. Statistical analyses were conducted using the OpenMetaAnalyst software.
RESULTS: Prevalence of current burnout was extracted from 24 studies encompassing 17,431 medical students. Among them, 8060 suffered from burnout and we estimated the prevalence to be 44.2% [33.4%-55.0%]. The information about the prevalence of each subset of burnout dimensions was given in nine studies including 7588 students. Current prevalence was estimated to be 40.8% for 'emotional exhaustion' [32.8%-48.9%], 35.1% [27.2%-43.0%] for 'depersonalization' and 27.4% [20.5%-34.3%] for 'personal accomplishment'. There is no significant gender difference in burnout. The prevalence of burnout is slightly different across countries with a higher prevalence in Oceania and the Middle East than in other continents.
CONCLUSIONS: The results of this meta-analysis suggest that one student out of two is suffering from burnout, even before residency. Again, our findings highlight the high level of distress in the medical population. These results should encourage the development of preventive strategies.
To perform a literature review on burnout prevalence, factors that affect burnout and well-being, and solutions to address burnout in otolaryngology-head and neck surgery (OTO-HNS) residents and residents in other surgical specialties.
DATA SOURCES:
Ovid Medline, Embase, and article reference lists.
REVIEW METHODS:
A literature search was performed to identify articles on resident burnout, distress, wellness, well-being, and quality of life. Articles deemed outside the scope of the current work were excluded. Search was limited to the past 5 years.
CONCLUSIONS:
Moderate to high burnout has been reported in 35% to 86% of OTO-HNS residents. Among other surgical specialties, resident burnout ranges between 58% and 66% in plastics, 11% and 67% in neurosurgery, 38% and 68% in urology, and 31% and 56% in orthopedics. Highest burnout rates were seen in postgraduate year 2 residents. Factors significantly associated with burnout included hours worked (>80 h/wk), level of autonomy, exercise, and program support. Reported resident work hours have steadily increased: 8% of OTO-HNS residents in 2005 vs 26% in 2019 reported averaging >80 h/wk. Practical implications of resident burnout include decreased empathy, moral distress and injury, poor health, decreased quality of life, increased attrition, decreased desire to pursue fellowship, and increased likelihood of medical errors. Structured mentorship programs, wellness initiatives, and increased ancillary support have been associated with lower burnout rates and improvements in resident well-being across specialties.
IMPLICATIONS FOR PRACTICE:
Addressing burnout, which is prevalent in OTO-HNS residents, is critical to improving patient care and physician well-being. Surgical specialties can share strategies to effectively address resident burnout through institutional interventions, which can be essential quality improvement initiatives, to promote well-being.
