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#KeyLIMEpodcast 130: It’s NEVER better to burnout, than to fade away…

The Key Literature In Medical Education podcast covers one of the biggest issues health professions educators must tackle – physician burnout.

The numbers are concerning.  Here’s a Medscape report.  Check out Figure 1, to see where your specialty ranks.  Here’s a link to a recent virtual journal club that I hosted on how to promote wellness in HPE (aka the antidote to burnout.)

So, how are you preparing your learners, yourself, to mitigate the risk and effect of burnout in your professional life?  Intrigued?  Read more below.  Better yet, check out the podcast here.

– Jonathan

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KeyLIME Session 130 – Article under review:

Listen to the podcast

View/download the abstract here.

Panagioti M, Efharis Panagopoulou E, Peter Bower P, Lewith G, Kontopantelis E, Chew-Graham C, Dawson S, van Marwijk H, Geraghty K, Esmail A. Controlled Interventions to Reduce Burnout in Physicians A Systematic Review and Meta-analysis. JAMA Internal Medicine. 2016 Dec. [ePub ahead of print]

Reviewer: Jonathan Sherbino (@sherbino)

Background

Training and practice in the health professions is extremely challenging.  I’m particularly concerned about a series of national self-report studies that suggest critical levels of burnout in all medical specialties. Of most concern, emergency medicine (my specialty) consistently ranks near the top.  Burnout is defined as a syndrome of emotional exhaustion, depersonalization and a diminished sense of personal accomplishment that results from workplace stressors.

Healthcare and Education organizations are attempting to respond to the personal and professional challenges of healthcare delivery.  For example, the CanMEDS 2015 Framework explicitly incorporates physician wellness as a competency for incorporation into training and practice for all Canadian specialists.

“Demonstrate a commitment to physician health and well-being to foster optimal patient care.

Exhibit self-awareness and manage influences on personal well-being and professional performance

Manage personal and professional demands for a sustainable practice throughout the physician life cycle

Promote a culture that recognizes, supports, and responds effectively to colleagues in need”

Yet, the question remains.  What are the effective solutions to prevent burnout and promote wellness for clinicians?  This systematic review attempts to answer that problem.

Purpose

To evaluate the effectiveness of interventions to reduce burnout in physicians and whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience), and health care setting characteristics (primary or secondary care) were associated with improved effects.”

Type of Paper

Systematic review

Meta-analysis

Key Points on Methods

Exemplary PRISMA standards were followed.

  • A search of MEDLINE, Embase, PsychINFO, CINAHL and Cochrane were search from inception to May, 2016.
  • RCT and controlled before/after studies targeting burnout in physicians included.
  • Two independent reviewers extracted data and assessed for bias.
  • A random-effects model was used for all analyses.

Key Outcomes

Initial search identified 2322 articles. 19 studies (with 20 comparisons) were included.

  • n = 1550 physicians
  • mean age = 40.3
  • 49% male
  • 42% conducted in the USA
  • 37% primary care
  • moderate control for bias
    • (subgroup analysis of studies at low risk for bias matched main analysis)
  • no publication bias for main analysis (no funnel plot asymmetry)

Main analysis

  • Standardized mean difference (SMD) = -0.29; 95%CI -0.42 to -0.16
  • ~3 point reduction on emotional exhaustion domain of Maslach Burnout Inventory
  • Only 5 of 20 comparisons individually significant
  • Interventions ranged from 2 weeks to 9 months

Physician-directed Interventions

  • mindfulness
  • education targeting physician self-confidence and communication skills
  • exercise
  • combinations of the above
  • SMD = -0.18; 95%CI -0.32 to -0.03

Organization-directed Interventions

  • workload reduction
  • shift rescheduling
  • teamwork/leadership interventions
  • SMD = -0.45; 95%CI -0.62 to -0.28

Interventions with Experience Level of Physician

  • Experienced SMD = -0.37; 95%CI -0.58 to -0.16
  • Inexperienced SMD = -0.27; 95%CI -0.40 to -0.14

Interventions on Type of Practice

  • Primary care SMD = -0.39; 95%CI -0.59 to -0.19
  • Specialty care SMD = -0.24; 95%CI -0.41 to -0.07

Key Conclusions

The authors conclude…

“Evidence from this meta-analysis suggests that recent intervention programs for burnout in physicians were associated with small benefits that may be boosted by adoption of organization-directed approaches. This finding provides support for the view that burnout is a problem of the whole health care organization, rather than individuals.”

Shout out

Check out the Academic Life in Emergency Medicine (ALiEM.com) and Journal of Graduate Medical Education Hot Topics in #MedEd virtual journal club on a systematic review of physician wellness.

Access KeyLIME podcast archives here

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