scholarly journals Moral distress and burnout in internal medicine residents

2017 ◽  
Vol 8 (1) ◽  
pp. e36-43 ◽  
Author(s):  
Sharareh Sajjadi ◽  
Monica Norena ◽  
Hubert Wong ◽  
Peter Dodek
Keyword(s):  
Internal Medicine ◽  
Moral Distress ◽  
Clinical Teaching ◽  
Maslach Burnout Inventory ◽  
Intention To Leave ◽  
Internal Medicine Residents ◽  
Distress Score ◽  
Teaching Unit ◽  
High Level ◽  
Distress Scale

Background: Residents frequently encounter situations in their workplace that may induce moral distress or burnout. The objective of this study was to measure overall and rotation-specific moral distress and burnout in medical residents, and the relationship between demographics and moral distress and burnout.Methods: The revised Moral Distress Scale and the Maslach Burnout Inventory (Human Service version) were administered to Internal Medicine residents in the 2013-2014 academic year at the University of British Columbia.Results: Of the 88 residents, 45 completed the surveys. Participants (mean age 30+/-3; 46% male) reported a median moral distress score (interquartile range) of 77 (50-96). Twenty-six percent of residents had considered quitting because of moral distress, 21% had a high level of burnout, and only 5% had a low level of burnout. Moral distress scores were highest during Intensive Care Unit (ICU) and Clinical Teaching Unit (CTU) rotations, and lowest during elective rotations (p<0.0001). Women reported higher emotional exhaustion. Moral distress was associated with depersonalization (p=0.01), and both moral distress and burnout were associated with intention to leave the job.Conclusion: Internal Medicine residents report moral distress that is greatest during ICU and CTU rotations, and is associated with burnout and intention to leave the job.

scholarly journals A collective case study of supervision and competence judgments on the inpatient internal medicine ward

2021 ◽  
Author(s):  
Tristen Gilchrist ◽  
Rose Hatala ◽  
Andrea Gingerich
Keyword(s):  
Internal Medicine ◽  
Clinical Supervision ◽  
Clinical Teaching ◽  
Senior Resident ◽  
Structured Interviews ◽  
Collective Case Study ◽  
Teaching Unit ◽  
Competency Based ◽  
Trainee Competence

Abstract Introduction Workplace-based assessment in competency-based medical education employs entrustment-supervision scales to suggest trainee competence. However, clinical supervision involves many factors and entrustment decision-making likely reflects more than trainee competence. We do not fully understand how a supervisor’s impression of trainee competence is reflected in their provision of clinical support. We must better understand this relationship to know whether documenting level of supervision truly reflects trainee competence. Methods We undertook a collective case study of supervisor-trainee dyads consisting of attending internal medicine physicians and senior residents working on clinical teaching unit inpatient wards. We conducted field observations of typical daily activities and semi-structured interviews. Data was analysed within each dyad and compared across dyads to identify supervisory behaviours, what triggered the behaviours, and how they related to judgments of trainee competence. Results Ten attending physician-senior resident dyads participated in the study. We identified eight distinct supervisory behaviours. The behaviours were enacted in response to trainee and non-trainee factors. Supervisory behaviours corresponded with varying assessments of trainee competence, even within a dyad. A change in the attending’s judgment of the resident’s competence did not always correspond with a change in subsequent observable supervisory behaviours. Discussion There was no consistent relationship between a trigger for supervision, the judgment of trainee competence, and subsequent supervisory behaviour. This has direct implications for entrustment assessments tying competence to supervisory behaviours, because supervision is complex. Workplace-based assessments that capture narrative data including the rationale for supervisory behaviours may lead to deeper insights than numeric entrustment ratings.

scholarly journals Moral distress and Burnout syndrome: are there relationships between these phenomena in nursing workers?

2014 ◽  
Vol 22 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Graziele de Lima Dalmolin ◽  
Valéria Lerch Lunardi ◽  
Guilherme Lerch Lunardi ◽  
Edison Luiz Devos Barlem ◽  
Rosemary Silva da Silveira
Keyword(s):  
Moral Distress ◽  
Maslach Burnout Inventory ◽  
Burnout Syndrome ◽  
Bivariate Analysis ◽  
Rio Grande Do Sul ◽  
Weak Correlation ◽  
Professional Performance ◽  
Moderating Variables ◽  
Professional Fulfillment ◽  
Distress Scale

OBJECTIVE: to identify relationships between moral distress and Burnout in the professional performance from the perceptions of the experiences of nursing workers. METHODS: this is a survey type study with 375 nursing workers working in three different hospitals of southern Rio Grande do Sul, with the application of adaptations of the Moral Distress Scale and the Maslach Burnout Inventory, validated and standardized for use in Brazil. Data validation occurred through factor analysis and Cronbach's alpha. For the data analysis bivariate analysis using Pearson's correlation and multivariate analysis using multiple regression were performed. RESULTS: the existence of a weak correlation between moral distress and Burnout was verified. A possible positive correlation between Burnout and therapeutic obstinacy, and a negative correlation between professional fulfillment and moral distress were identified. CONCLUSION: the need was identified for further studies that include mediating and moderating variables that may explain more clearly the models studied.

scholarly journals Validation of content of clinical cases in obstetric medicine for a shared web-based educational tool

2018 ◽  
Vol 12 (3) ◽  
pp. 129-135
Author(s):  
Annabelle Cumyn ◽  
Paul Gibson
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Web Based ◽  
Clinical Exposure ◽  
General Internal ◽  
Internal Medicine Residents ◽  
Obstetric Medicine ◽  
The Creation ◽  
High Level ◽  
Clinical Cases

Subsequent to the validation of a Canadian Curriculum blueprint for Obstetric Medicine (OM), the Canadian Consensus for a Curriculum in Obstetric Medicine (CanCOM) research group was approached to develop 20 cases to address gaps in clinical exposure during clinical rotations in OM. Forty-nine Obstetric Internists were identified and 43 confirmed their affiliation to the group. Participants (N = 22) reviewed the content of the CanCOM blueprint and identified curriculum content that they considered essential for a rotation for senior General Internal Medicine residents. This survey led to the creation of the CanCOM II essential content blueprint for General Internal Medicine. Following this step, a second subgroup of participants (N = 21) participated in a Delphi survey to identify the content that should be addressed by a teaching case for senior General Internal Medicine residents. A high-level of consensus was obtained for 13 topics and a moderate level for the 7 subsequent topics resulting in the creation of the CanCOM II clinical cases available at http://gemoq.ca/cancom-ii-clinical-case-databank/

Moral distress and burnout in Iranian nurses: The mediating effect of workplace bullying

2018 ◽  
Vol 26 (6) ◽  
pp. 1834-1847 ◽  
Author(s):  
Fardin Ajoudani ◽  
Rahim Baghaei ◽  
Mojgan Lotfi
Keyword(s):  
Workplace Bullying ◽  
Moral Distress ◽  
Maslach Burnout Inventory ◽  
Mediating Effect ◽  
Equation Modeling ◽  
Mediating Role ◽  
Distress Scale ◽  
The Relationship ◽  
Negative Acts

Background: Moral distress and workplace bullying are important issues in the nursing workplace that appear to affect nurse’s burnout. Aim: To investigate the relationship between moral distress and burnout in Iranian nurses, as mediated by their perceptions of workplace bullying. Ethical considerations: The research was approved by the committee of ethics in research of the Urmia University of Medical Sciences. Method: This is a correlation study using a cross-sectional design with anonymous questionnaires as study instruments (i.e. Moral Distress Scale-Revised, Maslach Burnout Inventory and The Negative Acts Questionnaire-Revised). Data were collected from 278 nurses from five teaching hospitals in Urmia, the capital of Western Azerbaijan, northwest of Iran. Structural equation modeling and bootstrapping procedures were employed to recognize the mediating role of their perceptions of workplace bullying. Results: The mean score of moral distress, burnout, and the Negative Acts Questionnaire-Revised Scale among the participants were 91.02 ± 35.26, 79.9 ± 18.27, and 45.4 ± 15.39, respectively. The results confirmed our hypothesized model. All the latent variables of study were significantly correlated in the predicted directions. The moral distress and bullying were significant predictors of burnout. Perception of bullying partially mediated the relationship between moral distress and burnout. The mediating role of the bullying suggests that moral distress increases burnout, directly and indirectly. Conclusion: Nursing administrators should be conscious of the role of moral distress and bullying in the nursing workplace in increasing burnout.

scholarly journals The Effect of Burnout on Medical Errors and Professionalism in First-Year Internal Medicine Residents

2016 ◽  
Vol 8 (4) ◽  
pp. 597-600 ◽  
Author(s):  
Jason Kwah ◽  
Jennifer Weintraub ◽  
Robert Fallar ◽  
Jonathan Ripp
Keyword(s):  
Internal Medicine ◽  
Emotional Exhaustion ◽  
Medical Errors ◽  
Maslach Burnout Inventory ◽  
Personal Accomplishment ◽  
First Year ◽  
Medication Prescription ◽  
Internal Medicine Residents ◽  
Laboratory Test Results ◽  
Discharge Summaries

ABSTRACT Background  Burnout is a common issue in internal medicine residents, and its impact on medical errors and professionalism is an important subject of investigation. Objective  To evaluate differences in medical errors and professionalism in internal medicine residents with and without burnout. Methods  A single institution observational cohort study was conducted between June 2011 and July 2012. Burnout was measured using the Maslach Burnout Inventory to generate subscores for the following 3 domains: emotional exhaustion, depersonalization, and sense of personal accomplishment. By convention, burnout was defined as a high emotional exhaustion or depersonalization subscore. Medication prescription error rate was the chosen measure of medical errors. Professionalism was measured cumulatively through examining discharge summaries completed within 48 hours, outpatient charts completed within 72 hours, and the average time to review outpatient laboratory tests. Results  Of a total of 54 eligible first-year residents, 53 (98%) and 32 (59%) completed the initial and follow-up surveys, respectively. Residents with year-end burnout had a lower rate of medication prescription errors (0.553 versus 0.780, P = .007). Discharge summaries completed within 48 hours of discharge (83.8% versus 84.0%, P = .93), outpatient charts completed within 72 hours of encounter (93.7% versus 94.3%, P = .31), and time (minutes) to review outpatient laboratory test results (72.3 versus 26.9, P = .28) were similar between residents with and without year-end burnout. Conclusions  This study found a small decrease in medical errors in residents with year-end burnout compared to burnout-free residents and no difference in selected measures of professionalism.

scholarly journals Infectious Diseases on a General Internal Medicine Clinical Teaching Unit

1999 ◽  
Vol 10 (1) ◽  
pp. 33-38
Author(s):  
LE Nicolle ◽  
J Uhanova ◽  
P Orr ◽  
A Kraut ◽  
K Van Ameyde ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Length Of Stay ◽  
Infectious Diseases ◽  
General Internal Medicine ◽  
Clinical Teaching ◽  
Cost Of Care ◽  
Therapeutic Interventions ◽  
General Internal ◽  
Teaching Unit ◽  
Time Of Admission

OBJECTIVE: To describe the spectrum of infectious diseases and characteristics of patients admitted with infections on a general internal medicine clinical teaching unit.DESIGN: Retrospective review of patients admitted to one general internal medicine unit at a tertiary care teaching hospital during two three-month periods.METHODS: Data collection through chart review.OUTCOME MEASURES: Descriptive analysis of types of infections: therapeutic interventions; consultations and outcomes, including death; hospital-acquired infection; and length of stay.RESULTS: During the two three-month periods, 76 of 233 (33%) and 52 of 209 (25%) admissions were associated with a primary diagnosis of infection. An additional 23 (10%) and 24 (12%) patients had infection at the time of admission, but this was not the primary admitting diagnosis. Pneumonia, urinary infection, and skin and soft tissue infection were the most frequent diagnosis at the time of admission, but these accounted for only about 50% of admissions with infection. Patients admitted with infection were characterized by a younger age, greater number of therapeutic interventions in the first 24 h, and increased medication costs, entirely attributable to antimicrobial therapy, but patients admitted with infection did not differ in comorbidity, death, nosocomial infection or length of stay compared with patients without infection.CONCLUSIONS: A wide variety of infections contribute to admissions to general internal medical clinical teaching units. Patients with infection have more interventions and an increased cost of care, but do not differ in outcome.

Survival From In-hospital Cardiac Arrest on the Internal Medicine Clinical Teaching Unit

2013 ◽  
Vol 29 (1) ◽  
pp. 117-121 ◽  
Author(s):  
Blair C. Schwartz ◽  
Dev Jayaraman ◽  
Paul J. Warshawsky
Keyword(s):  
Internal Medicine ◽  
Cardiac Arrest ◽  
Clinical Teaching ◽  
Teaching Unit ◽  
Hospital Cardiac Arrest

scholarly journals A survey of moral distress in staff working in intensive care in the UK

2018 ◽  
Vol 20 (3) ◽  
pp. 196-203 ◽  
Author(s):  
GA Colville ◽  
D Dawson ◽  
S Rabinthiran ◽  
Z Chaudry-Daley ◽  
L Perkins-Porras
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Moral Distress ◽  
Female Gender ◽  
Intention To Leave ◽  
Post Traumatic Stress ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Work Related ◽  
Distress Scale

Elevated rates of burnout and post-traumatic stress have been found in staff working in critical care settings, but the aspect of moral distress has been harder to quantify until a recent revision of a scale previously designed for nurses, was adapted for use with a range of health professionals, including physicians. In this cross-sectional survey, n = 171 nurses and physicians working in intensive care in the United Kingdom completed the Moral Distress Scale-Revised in relation to their experiences at work. Mean (SD) Moral Distress Scale-Revised score was 70.2 (39.6). Significant associations were found with female gender (female 74.1 (40.2) vs. male 55.5 (33.8), p = 0.010); depression ( r = 0.165, p = 0.035) and with intention to leave job (considering leaving 85.5 (42.4) vs. not considering leaving 67.2 (38.6), p = 0.040). These results highlight the importance of considering the moral impact of work-related issues when addressing staff wellbeing in critical care settings.

Predictors of Internal Medicine Resident Satisfaction with Teaching by Attendings

2010 ◽  
Vol 13 (2) ◽  
Author(s):  
Cassandra M Guarino ◽  
Chung Pham ◽  
Elaine Quiter ◽  
Jose J Escarce
Keyword(s):  
Internal Medicine ◽  
Clinical Teaching ◽  
Medical Training ◽  
Internal Medicine Resident ◽  
Resident Satisfaction ◽  
Factors Associated ◽  
Medicine Resident ◽  
Internal Medicine Residents ◽  
Number Of Patients ◽  
Negative Factors

This study identifies factors that predict internal medicine resident satisfaction with the quality of teaching by attendings. A key issue facing educators is whether high-quality instruction can be maintained in an environment in which attending physicians have many competing demands placed on their time. A national survey of clinical third-year internal medicine residents in 125 academically affiliated generally medical training programs was conducted. Univariate analyses describe the characteristics of the sample, and multivariate analyses evaluate the factors associated with resident satisfaction with teaching. The response rate was 64.1% (n=1354). Positive factors relating to satisfaction with teaching on inpatient ward rotations included: number of patients seen during rounds, attendings were fulltime, attending did clinical teaching during bedside work rounds, attending gave spontaneous and prepared presentations, and attendings were reached soon when needed. Negative factors included: number of residents in a ward team, number of patients admitted on overnight call, attendings seemed rushed and eager to finish rounds, and attendings were temporarily called away during rounds. Positive factors relating to satisfaction with teaching in continuity clinics included: residents being female and amount of time spent on talking to or examining patients. Negative factors included: amount of time spent on paperwork or routine work, attending changed resident’s decisions, attendings were difficult to reach, and attendings were temporarily called away during teaching. Different clinic settings also affected satisfaction. This study identifies several factors associated with internal medicine residents’ satisfaction with teaching and highlights mutable factors that faculty may consider changing to improve education and satisfaction.

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