Full work analysis of resident work hours

BACKGROUND: Resident duty hour restrictions, while intended to improve patient safety and resident well-being, may decrease time available for patient care and education. Our objective was to perform in-depth analysis of how a pediatric surgical resident utilizes his time in hopes of eliminating waste, and in effect, add educationally relevant hours. MATERIALS AND METHODS: Work done by a senior pediatric surgical resident was prospectively collected using three methods. The duty hours logged by the resident for a full academic year were analyzed. A detailed work analysis was performed by an independent observer who videotaped the resident. Finally, the resident recorded and categorized his daily activities during the month in which the videotaping occurred. RESULTS: 18.9 h (1134.9 min) of videotaped data were collected. The total time spent directly related to patient care, including the operating room, was 656 min. One hundred seventy-five min were spent on education, both didactic and teaching on the wards. The resident spent 139.8 min traveling within the hospital; 132.7 min were categorized as communication; only 1.5% of time was deemed pure waste. A total of 344.75 h (20,685 min) were self-reported and categorized. Didactic education comprised 6.7% of total time while less formal teaching is embedded in the clinical activities of consultation, rounds, and clinic. CONCLUSIONS: Increased efficiency in the operating room, where the most time was spent, coupled with workflow redesigns that decrease travel and time spent on the phone would increase time available for education and patient care.     

Introducing new technology into the operating room: measuring the impact on job performance and satisfaction

BACKGROUND: The Massachusetts General Hospital (MGH) Operating Room of the Future (ORF) project is a test site for evaluating new surgical technologies and processes. Here we evaluate the effect on staff satisfaction and burnout of introducing a set of new technologies. METHODS: Staff satisfaction and burnout were measured via sequential surveys based on the Maslach Burnout Inventory during the introduction of a new technology system. Functional behavior of the OR was measured in terms of flow time (time to transit the OR) and wait time (time to access the OR). These data were gathered using time-motion analysis methods. RESULTS: Significant functional improvements were found in the ORF (more than 35% reduction in flow time and wait time, P < .05). During the same period, more exposure to the ORF resulted in greater sense of personal accomplishment among surgeons, a worse sense of personal accomplishment among nurses, more emotional exhaustion among surgeons, and less emotional exhaustion among nurses. However, the responses for emotional exhaustion were reversed the greater the time from exposure to the ORF. Staff with 6 to 10 years' experience were at highest risk for burnout across all categories. General surgeons experienced more emotional exhaustion than other physicians. CONCLUSIONS: Tracking the response of all users and identifying groups at high risk for burnout when exposed to new systems should be a central part of any new technology project.     

Effects of resident duty-hours restrictions on surgical and nonsurgical teaching faculty

OBJECTIVE: To evaluate the effects of resident duty-hours restrictions on teaching faculty, patient care, and the institutional climate at a single center. METHODS: An anonymous questionnaire was provided to all teaching faculty (N = 606) at a single institution from March through October 2006. The questionnaire focused on perceptions of job satisfaction, workload changes, and effects on patient care and the institution. RESULTS: Overall response rate was 41% (n = 248). More than half of faculty (n = 140 [56%]) feel they have less time for teaching, 33% report less time for extracurricular activities, and 42% report increased work hours. Forty-three percent of respondents (n = 106) were less satisfied with their jobs after implementation of resident duty-hours restrictions, while only 2% (n = 5) were more satisfied. Of the respondent faculty, surgeons were more likely than nonsurgeons to report increased work hours (54% vs 34%; P = .002), decreased time for teaching (66% vs 51%; P = .03), lower job satisfaction (55% vs 35%; P = .003), and negative effects on their personal relationships outside of work (24% vs 12%; P = .01). Although most responses suggest that the restrictions on resident duty hours have not adversely affected patient care or the institutional climate, 33% of respondents (n = 82) felt that patient care was worse. CONCLUSIONS: Surgeons reported a particularly negative effect from resident duty-hours reform, especially within the areas of job satisfaction, time for teaching, and workload. Efforts to counteract these effects will be critical to maintain and recruit teaching faculty.     

Life after 80 hours: the impact of resident work hours mandates on trauma and emergency experience and work effort for senior residents and faculty

BACKGROUND: The purpose of this study was to evaluate the impact of work hours mandates on (1) senior resident patient exposure and operating experience in trauma and emergency surgery and (2) faculty work effort. METHODS: We measured resident and faculty work on the trauma and emergency surgery services at our Level I trauma center during two comparable 6-month periods. Period 1 (July 1-December 31, 2002) had no call restrictions, separate trauma and emergency service resident call, and some overlap of faculty call responsibilities. Period 2 (July 1-December 31, 2003) had resident work hours compliance and complete integration of resident and faculty trauma and emergency call. Work hours were measured by surveys for faculty and residents. All data were collected prospectively. RESULTS: Resident exposure to trauma patients was similar during both time periods. Emergency surgery admissions declined during period 2; however, intensive care unit admissions increased. The number of operations performed by senior residents did not change; however, there was a shift in the median number of emergency surgery cases to more senior residents. Faculty work hours increased slightly despite a decrease in faculty call. CONCLUSION: Work hours compliance resulted in a 50% reduction in senior resident call and a 19% decrease in their work hours with no significant change in trauma/emergency patient care exposure or operative case load. Service call amalgamation reduced faculty call by 21% but did not result in a corresponding change in work hours or productivity.     

Burnout among Plastic Surgery Residents in India: An Observational Study

Introduction  Burnout syndrome can be defined as emotional exhaustion, depersonalization, and perceived lack of personal accomplishment, all of which lead to decreased effectiveness at work. The Medscape burnout and depression report of 2018 suggests that the burnout range across various specialties ranges from 23 to 48%. There are no studies to assess the burnout among plastic surgery residents in India. This study is an attempt to assess the same. Materials and Methods  An online survey was conducted in March and April 2019 for plastic surgery residents across India. Various parameters including those related to gender, year of the curriculum, hobbies, exercise, and marital status were assessed. There were multiple sections in the survey, which included the demographic details, stress-related variables, and the abbreviated Maslach Burnout Inventory. The abbreviated Maslach Burnout Inventory is a validated scale that has been used to assess the burnout among plastic surgery residents in India. The three subscales, emotional exhaustion, depersonalization, and personal accomplishment were measured on a Likert scale. Univariable and multivariable analysis of factors associated with burnout was performed. Results  Of the 185 respondents, 48.4% experienced moderate-to-high burnout. Of these, 25% ( n = 46) were above the 75th centile of the overall burnout score, indicating severe burnout. Insufficient faculty involvement, insufficient time allotted for formalized teaching, conflict with colleagues, and lack of adequate support staff correlated with resident burnout on multivariate analysis. Residents who pursued their hobbies or performed physical activities for exercise had significantly lesser burnout. Conclusion  The incidence of burnout in plastic surgery residents surveyed in our study was 48.4%. The faculty of the departments and the residents themselves, as well as the governing bodies, all have a role to play to address the issue of burnout among residents. Dedicated and persistent efforts toward improving physical and psychological well-being of plastic surgery residents will positively impact not only the well-being of the residents but also the quality of patient care.     

Prevalence of burnout among anesthesiologists at Hospital Universitario Virgen Macarena de Sevilla

Burnout, characterized by emotional exhaustion, depersonalization, and lowered sense of professional accomplishment, is a consequence of chronic stress. Few studies have been published on burnout in anesthesiology even though this specialty is considered particularly stressful. We surveyed members of the department of anesthesiology and postoperative care in our hospital, using an anonymous questionnaire including items on social and personal characteristics and the Spanish language version of the Maslach Burnout Inventory. Forty-valid questionnaires were returned, for a response rate of 69.4%. Mean (SD) scores were 19.5 (9.5) points for emotional exhaustion, 7.4 (5.5) for depersonalization, and 32.5 (9.1) for professional accomplishment. We detected high levels of emotional exhaustion in 19.5% of the anesthesiologists and of depersonalization in 31.7%. Scores reflecting low levels of sense of personal accomplishment were recorded for 41.4%. Scores for concern on at least 1 subscale were noted for 58.3% of the anesthesiologists, on 2 subscales for 21.8%, and on 3 subscales for 12.1%. No significant differences were detected in relation to gender, age, stage in professional life, or employment status. Burnout levels in our department are similar to those reported for anesthesiologists in other countries and detectably lower than those of other specialties in Spain.     

The level of burnout in a group of dental research assistants

Working as doctor or dentist may entail higher levels of burnout than experienced by the general population. Maslach Burnout Inventory, evaluates emotional exhaustion, depersonalization and reduced personal accomplishment. This article presents data conserning levels and sources of burnout in dental research assistants taking postgraduate education in two dental schools in Turkey. One, a new school and the other, an established school. In this study we aimed to investigate if there was an association between the level of burnout and sociodemographic factors and to measure the level of burnout in dental research assistants. Seventy‐eight dental research assistants working in two different dental schools participated in the study. Sociodemographic data were obtained. Sociodemographic characteristics were not significantly different between the two dental schools. In addition, there were statistically significant differences between the two schools in personal accomplishment, depersonalization and work related strain, but no significant difference in emotional exhaustion. Copyright © 2004 John Wiley & Sons, Ltd.     

Short communication: Occupational stress and burnout among South African medical practitioners

The aim of this study was to identify job stress and burnout symptoms among randomly selected South African medical practitioners from a national survey. The sample included 402 doctors, 59.5 per cent male and 40.5 per cent female. The majority were Whites (59.3 per cent), followed by African Black (21.3 per cent), and Asians (14 per cent). Results showed that the overall job stress index indicated with 4.9, high job stress levels among the doctors. High severity job stress ratings included (1) fellow workers not doing their job, (2) inadequate salary and (3) covering work for another employee and high frequency of job stress, (4) working overtime, making critical on‐the‐spot decisions and dealing with crisis situations. Female doctors felt significantly more lack of support on job stress severity than male doctors. High levels of burnout (emotional exhaustion and depersonalization) were found among doctors. Job stress predicted emotional exhaustion and depersonalization but not personal accomplishment. Emotional exhaustion was associated with female doctors and personal accomplishment was significantly related to male doctors. White doctors reported more job stress and also burnout symptoms than doctors with colour. Copyright © 2003 John Wiley & Sons, Ltd.     

Burnout and self‐employment: a cross‐cultural empirical study

This study examined the differences between full‐time self‐employed and organizationally employed individuals in Canada (n = 248) and Pakistan (n = 306) in terms of overall burnout and its three dimensions (emotional exhaustion, depersonalization and lack of accomplishment), turnover intentions and non‐work satisfaction. Data were collected by means of a structured questionnaire from Canadian employees in Montreal and Pakistani employees in Lahore. One‐way analysis of variance and multivariate analysis of variance were used to analyse the data. The self‐employed reported significantly higher overall burnout, emotional exhaustion, lack of accomplishment, non‐work satisfaction and turnover intention than the organizationally employed in both countries. No significant differences were found between self‐employed and organizationally employed in terms of depersonalization in both countries. Results are discussed in light of previous empirical evidence on self‐employment and the quality of work and non‐work life from cross‐cultural perspectives. Copyright © 2007 John Wiley & Sons, Ltd.     

A test of carver and scheier's self-control model of stress in exploring burnout among mental health nurses

A sample of Australian psychiatric nurses completed a questionnaire which included operational measures of elements of Carver and Scheier's self-control model of stress including the frequency dimension of the subscales of the Maslach Burnout Inventory — emotional exhaustion, depersonalization, and diminished accomplishment. Other scales completed by participants included independent subscales contained in the Positive and Negative Affectivity Scale and the private and public self-focus and social anxiety subscales of the Self-Consciousness Scale (Revised). Two interpretable canonical variates labelled emotional exhaustion–depersonalization and diminished accomplishment were derived from analysis of the date. Each element of the self-control model showed an expected contribution to an emotional exhaustion–depersonalization canonical variate, whereas reported levels of only positive affectivity and private self-focus made a notable contribution to explanation of variance on the diminished accomplishment canonical variate.     

Burn-out of urologists in the county of Schleswig-Holstein, Germany: a comparison of hospital and private practice urologists

PURPOSE: Mental and physical burden of physicians, especially surgeons, is high. The degree of burn-out was estimated among urologists in the German federal county of Schleswig-Holstein, with special emphasis on differences related to age, qualification and hospital versus private practice. MATERIALS AND METHODS: The Maslach Burnout Inventory was mailed to all urologists and urologists in training registered in the county of Schleswig-Holstein to determine the frequency and intensity of the 3 burn-out subscales of emotional exhaustion, depersonalization and low personal accomplishment, together with a questionnaire covering demographic data. RESULTS: Of 128 urologists 75 (58.6%) replied. Levels of burn-out in the subscales of emotional exhaustion and depersonalization were increased among hospital urologists, urologists in training and urologists younger than 45 years. Urologists in private practices, fully trained urological specialists and urologists older than 45 years showed a low degree of burn-out, corresponding to normal values, whereas young urologists in training and working in hospitals had the highest risk of burn-out. The personal accomplishment level was generally high in all groups. CONCLUSIONS: The constellation of being a urologist in private practice and older than 45 years appears to provide some protection against burn-out that might be due to a more personal relationship to the patients, lesser hierarchical situation and workload related income. In times of increasing pressure on the health care system, the personal situation of physicians in training should not be overlooked.     

Burnout in health care providers of dialysis service in Northern Italy--a multicentre study.

BACKGROUND: Few data are available regarding the prevalence of burnout among dialysis health care workers. Aims of the present study were to assess and compare burnout levels in a sample of nurses and physicians working in dialysis units, and to investigate their relationships with quality of life, in a cross-sectional observational study. METHODS: A total of 344 workers from 10 dialysis centres in Northern Italy completed a battery of questionnaires including the Maslach Burnout Inventory, the MOS-36 Item Short Form Health Survey [SF36: physical (PCS) and mental (MCS) component scores] and the 30-item General Health Questionnaire (GHQ30). Data on social and demographic characteristics and working conditions were also collected. General Estimating Equations models were used for the analysis. RESULTS: Overall, burnout scores were lower than the Italian normative sample, with no significant differences between physicians and nurses. However, 30% of nurses had high emotional exhaustion vs 18% of physicians (adjusted OR 2.38, P = 0.003). Emotional exhaustion was also predicted by number of worked hours and months worked in dialysis in the previous 2 years. Depersonalisation was predicted by male gender and bad relationship with coworkers. Having no children and having a permanent hospital position predicted low personal accomplishment. PCS was lower in nurses (50.0 vs 53.3, P < 0.001), while no significant difference was found for MCS and GHQ30. Lower PCS was associated with emotional exhaustion (P = 0.007) and GHQ30 > 5 with depersonalization (P = 0.032). CONCLUSIONS: Although burnout is not a general problem in dialysis health care providers, a subgroup of them may be identified, who would benefit from supportive measures to prevent this condition. Nurses appeared more burned-out in the emotional exhaustion scale than physicians.     

Has the 80-hour work week increased faculty hours?

OBJECTIVE: The 80-hour work week has affected not only surgical residents but also faculty. The aim of this study was to determine the effect of resident hour restrictions on faculty hours and attitudes. DESIGN: Anonymous survey. SETTING: A single, large academic medical center. PARTICIPANTS: All faculty in the Departments of Surgery, Neurosurgery, Orthopedics, and Otolaryngology. METHODS: Faculty were surveyed 6 months before and 6 months after the institution of the resident 80-hour work week. Surgeons detailed hours worked over 1 week and answered yes/no questions about changes in patient care and resident education. P values were determined by Chi-square tests or Student t-tests as appropriate. RESULTS: Of the 118 surveys distributed, 88 were returned (75%). Respondents were evenly divided between general surgeons (GS) and subspecialists (SS). Initially, 70% of faculty predicted that resident work-hour restrictions would increase faculty hours; however, only 47% of faculty felt that this had occurred. When current faculty work hours were compared with previously collected data, no differences were found. Faculty reported working an average of 69.9 +/- 12.2 hours per week this year, compared with 70.4 +/- 12.5 hours last year. When asked about the global impact of the 80-hour work week on faculty, 46% viewed the changes as harmful to the faculty. More concerning, 50% of all faculty felt the care their patients received was worse than previously, with only 2% feeling patient care had improved. This perception was significantly more common among GS faculty (70% GS vs 37% SS; p < 0.01), 94% of whom felt that the current lack of continuity compromises patient care. When the data were stratified by faculty work hours, interesting differences are seen. Of those faculty with work weeks less than 60 hours, only 6% thought the changes were harmful to patients and 64% thought resident training had suffered. In contrast, of those faculty who worked greater than 80 hours per week, 56% thought patients were harmed (p = 0.03) and 100% thought training had suffered (p < 0.01). CONCLUSIONS: Faculty work hours have not increased in the 6 months after the institution of the 80-hour resident work week. However, the majority of the faculty feels that both patient care and resident education have deteriorated.     

Factor structure and psychometric properties of the Maslach Burnout Inventory‐Educators Survey among elementary and secondary school teachers in Cyprus

Burnout is described as a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that can occur among individuals who work with other people in some capacity. The present research examines the psychometric properties and factor structure of Maslach, Jackson and Leiter's (1996) educators' burnout measure, the Maslach Burnout Inventory‐Educators Survey (MBI‐ES), in a sample of 771 Greek Cypriot teachers. Results, using exploratory and confirmatory factor analytic techniques, support the three factor structure of the construct which was tested against alternative models. Other psychometric qualities are also very satisfactory. Findings are compared to the published normative data for the MBI. Female teachers appear more emotionally exhausted than their male counterparts. Primary school teachers scored higher on emotional exhaustion, but depersonalization was higher among secondary school teachers. Overall, the results suggest that the Greek MBI represents a valid and reliable adaptation of the instrument, which can be confidently used to measure burnout. Copyright © 2006 John Wiley & Sons, Ltd.     

Burnout levels of hemodialysis nurses

Background: Previous studies have found significant stressors experienced by nurses working in hemodialysis units. The purpose of this study was to determine the burnout levels of hemodialysis nurses working in hemodialysis units and their relation with some sociodemographic variables. Methods: The study was conducted between July 2012 and Sept 2012 in hemodialysis units of four hospitals, including one university, one public and two private hospitals, in the province of Erzurum. The population of the study consisted of 32 nurses rendering service in hemodialysis units of the related hospitals. Information forms, which were prepared by researchers in accordance with the literature, and aimed at determining the personal characteristics of nurses and Maslach Burnout Inventory were used for the data collection. Results: Examining mean scores obtained by nurses from the Maslach Burnout Inventory, it is observed that they scored 17.07?±?8.29 from subscale of emotional exhaustion, 5.89?±?4.13 from subscale of depersonalization and 20.64?±?4.10 from subscale of personal accomplishment. Conclusion: The results of the study revealed that nurses working in hemodialysis units experience a medium-level burnout in terms of subscales of emotional exhaustion, depersonalization, and a high-level burnout in terms of the subscale of personal accomplishment.     

Burnout and depressive symptoms in teachers: Factor structure and construct validity of the Maslach Burnout inventory‐educators survey among elementary and secondary school teachers in Hungary

This study validated the Hungarian version of the Maslach Burnout Inventory–Educators Survey on a sample of n = 211 elementary and secondary teachers. To test factorial validity, we ran a series of confirmatory analysis with eight models. The best fitting model was the bifactor model with general burnout and three specific factors: emotional exhaustion, depersonalization, and personal accomplishment. Analyzing the covariates revealed that gender and age were not associated with burnout, but depressive symptoms and overcommitment had a significant relationship with general burnout, and overcommitment was related to emotional exhaustion as well.     

Surgeon workhours in the era of limited resident workhours

BACKGROUND: Resident workhours have received much attention, yet there is little information concerning faculty workhours. In addition, the perspectives of surgical faculty on the anticipated effects of reducing resident hours have not been studied. STUDY DESIGN: An anonymous survey was distributed to all clinical faculty in the Departments of Surgery, Neurosurgery, Orthopaedics, and Otolaryngology at a single, large academic institution. Surgeons completed a detailed retrospective report of hours worked during a 1-week period. Opinions regarding resident workhour restrictions were also elicited. Chi-square or Student's t-tests were used to determine p values as appropriate, with p 相似文献   

The impact of work hour restrictions on surgical resident education

OBJECTIVE: Resident work-hour restrictions were instituted in July 2003 based on ACGME mandates. The American Board of Surgery In-Training Examination (ABSITE), American Board of Surgery Qualifying Examination (ABSQE), and operative volume traditionally have been measures of surgical resident education and competency. The objective of this study was to determine the effect of reduced work hours on resident standardized test scores and operative volume at our institution. DESIGN: We reviewed ABSITE scores, ABSQE scores, and operative logs from 1997 to 2005 of all general surgery residents. Linear mixed-effects models were fitted for each component ABSITE score (total, basic science, and clinical management), and they were compared using a chi-squared likelihood ratio. Operative logs of graduating residents were compared before and after the work restrictions and were evaluated for association with ABSITE score. p-values less than 0.05 were considered significant. RESULTS: The program was compliant with ACGME mandates within 6 months of institution. ABSITE scores improved significantly after the restriction of work hours in both basic science (p = 0.003) and total score (p = 0.008). Clinical management scores were not affected. The number of major cases recorded by graduating residents did not change. A positive correlation was found between number of cases performed during residency and clinical management ABSITE scores (p = 0.045). ABSQE scores were not impacted by operative volume during residency. CONCLUSIONS: ABSITE scores improved significantly after the restriction of resident work hours. Resident operative experience was not affected. An unexpected consequence of work-hour restrictions may be an improvement in surgical resident education.     

The impact of the 80-hour resident workweek on surgical residents and attending surgeons

OBJECTIVE: To assess the impact of the 80-hour resident workweek restrictions on surgical residents and attending surgeons. SUMMARY BACKGROUND DATA: The ACGME mandated resident duty hour restrictions have required a major workforce restructuring. The impact of these changes needs to be critically evaluated for both the resident and attending surgeons, specifically with regards to the impact on motivation, job satisfaction, the quality of surgeon training, the quality of the surgeon's life, and the quality of patient care. METHODS: Four prospective studies were performed at a single academic surgical program with data collected both before the necessary workforce restructuring and 1 year after, including: 1) time cards to assess changes in components of daily activity; 2) Web-based surveys using validated instruments to assess burnout and motivation to work; 3) structured, taped, one-on-one interviews with an external PhD investigator; and 4) statistical analyses of objective, quantitative data. RESULTS: After the work-hour changes, surgical residents have decreased "burnout" scores, with significantly less "emotional exhaustion" (Maslach Burnout Inventory: 29.1 "high" vs. 23.1 "medium," P = 0.02). Residents have better quality of life both in and out of the hospital. They felt they got more sleep, have a lighter workload, and have increased motivation to work (Herzberg Motivation Dimensions). We found no measurable, statistically significant difference in the quality of patient care (NSQIP data). Resident training and education objectively were not statistically diminished (ACGME case logs, ABSITE scores). Attending surgeons perceived that their quality of their life inside and outside of the hospital was "somewhat worse" because of the work-hour changes, as they had anticipated. Many concerns were identified with regards to the professional development of future surgeons, including a change toward a shift-worker mentality that is not patient-focused, less continuity of care with a loss of critical information with each handoff, and a decrease in the patient/doctor relationship. CONCLUSION: Although the mandated restriction of resident duty hours has had no measurable impact on the quality of patient care and has led to improvements for the current quality of life of residents, there are many concerns with regards to the training of professional, responsible surgeons for the future.