Physician Burnout and the Electronic Health Record Leading up to and During The First Year of COVID-19: A Systematic Review (Preprint)

BACKGROUND Physician burnout was first identified in 1974, and it has been particularly prevalent during the first year of the pandemic. OBJECTIVE To objectively analyze the literature over the last five years for empirical evidence of burnout incident to the EHR and to identify barriers, facilitators, associated patient satisfaction to using the EHR to improve symptoms of burnout. METHODS No human subjects were used in this review, however 100% of participants in studies analyzed were adult physicians. Four research databases and one targeted journal were queried for studies commensurate with the objective statement from January 1, 2016 through January 31st 2021 (n=25). RESULTS The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one’s schedule, cognitive fatigue, a general loss of autonomy and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes to alleviate the administrative burden of the EHR and decreased symptoms of burnout. CONCLUSIONS The solutions provided in the literature only addressed two of the three factors, workflow and documentation time, but not the third, usability. Practitioners and administrators should focus on the former two factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify usability features with the greatest impact to improve. Researchers should design experiments to explore solutions that address all three factors of the EHR that contribute to burnout. INTERNATIONAL REGISTERED REPORT RR2-10.2196/15490

Resident Physician and Medical Academic Faculty Burnout

Physician burnout finds its roots in both undergraduate and graduate medical education and has emerged as an important cause of academic faculty turnover. Recognition of the need for resiliency training has led to the development and implementation of wellness programmes throughout the country and world. This chapter examines the causes and potential solutions of combating resident physician and academic faculty burnout in medical education. The authors reviewed current literature on wellness programmes in medical education, including both traditional and curricular approaches and provide a template for creating a well-rounded wellness programme to promote resident physician and academic faculty wellness.

An Assessment of Physician Well-Being and Burnout Among Army Obstetricians and Gynecologists

ABSTRACT Introduction Physician burnout is associated with unsafe patient care and poor patient satisfaction. Civilian studies show burnout rates of 46% among obstetricians/gynecologists (OB/GYNs). Army Active Duty (A-AD) physician burnout rates range from 7.7% to 26% across specialties, but no studies have assessed A-AD OB/GYN burnout. The objective of this study was to quantify well-being of A-AD OB/GYNs by determining rates of professional fulfillment (wellness) and burnout and detect factors of potential protective or risk for wellness and burnout. Methods A cross-sectional survey-based study was designed to determine well-being of A-AD OB/GYNs. This Institutional Review Board–approved study used the validated Professional Fulfillment Index. The survey was shared anonymously via email to 197 A-AD OB/GYNs. Additional questions asked as possible risk factors for burnout include location, training status, fellowship training, and remaining active duty service obligation (ADSO). Wellness and burnout rates were determined using published scales. Mean rates of wellness and burnout were reported, and chi-square tests detected associations between wellness/burnout and other variables. Results Eighty-three A-AD OB/GYNs responded to the survey (42%), with 73 available for full analysis. 26.5% had positive wellness, and 50% reported burnout. Completing fellowship training and shorter ADSO (of 0-2 years compared to >5 years) had higher rates of wellness. There were no differences in burnout among groups. Conclusions Burnout rates in A-AD OB/GYNs appear higher than A-AD physicians of other specialties but are similar to civilian OB/GYNs. Fellowship training may confer higher rates of wellness. Further research is needed regarding improvements in A-AD OB/GYN well-being and burnout.

Contribution of a positive psychology-based conceptual framework in reducing physician burnout and improving well-being: a systematic review

Background The PERMA Model, as a positive psychology conceptual framework, has increased our understanding of the role of Positive emotion, Engagement, Relationships, Meaning, and Achievements in enhancing human potentials, performance and wellbeing. We aimed to assess the utility of PERMA as a multidimensional model of positive psychology in reducing physician burnout and improving their well-being. Methods Eligible studies include peer-reviewed English language studies of randomized control trials and non-randomized design. Attending physicians, residents, and fellows of any specialty in the primary, secondary, or intensive care setting comprised the study population. Eligible studies also involved positive psychology interventions designed to enhance physician well-being or reduce physician burnout. Using free text and the medical subject headings we searched CINAHL, Ovid PsychINFO, MEDLINE, and Google Scholar (GS) electronic bibliographic databases from 2000 until March 2020. We use keywords for a combination of three general or block of terms (Health Personnel OR Health Professionals OR Physician OR Internship and Residency OR Medical Staff Or Fellow) AND (Burnout) AND (Positive Psychology OR PERMA OR Wellbeing Intervention OR Well-being Model OR Wellbeing Theory). Results Our search retrieved 1886 results (1804 through CINAHL, Ovid PsychINFO, MEDLINE, and 82 through GS) before duplicates were removed and 1723 after duplicates were removed. The final review included 21 studies. Studies represented eight countries, with the majority conducted in Spain (n = 3), followed by the US (n = 8), and Australia (n = 3). Except for one study that used a bio-psychosocial approach to guide the intervention, none of the other interventions in this review were based on a conceptual model, including PERMA. However, retrospectively, ten studies used strategies that resonate with the PERMA components. Conclusion Consideration of the utility of PERMA as a multidimensional model of positive psychology to guide interventions to reduce burnout and enhance well-being among physicians is missing in the literature. Nevertheless, the majority of the studies reported some level of positive outcome regarding reducing burnout or improving well-being by using a physician or a system-directed intervention. Albeit, we found more favorable outcomes in the system-directed intervention. Future studies are needed to evaluate if PERMA as a framework can be used to guide system-directed interventions in reducing physician burnout and improving their well-being.