Reducing Stress and Burnout in Junior Doctors
Background Internship and residency are difficult times with novice practitioners facing new challenges and stressors. Junior doctors may experience burnout, a syndrome that encompasses three dimensions: emotional exhaustion, depersonalisation and reduced personal accomplishment. While there is some existing literature on the prevalence of burnout in junior doctors, there are few studies on interventional strategies.
Aims This study aimed to examine the prevalence of burnout in a cohort of junior doctors and whether debriefing sessions reduced levels of burnout.
Methods A prospective randomised controlled study of a convenience sample of postgraduate year 1 doctors in a single hospital was undertaken during a rotation term in 2011. All participants completed a questionnaire using a validated tool, the Maslach Burnout Inventory, to determine the prevalence of burnout. They were then randomly assigned to a group who were to receive four debriefing sessions over 2 months, or, to the control group, who had no debriefing sessions. Quantitative and qualitative analyses were conducted.
Results Thirty-one postgraduate year 1 doctors participated in the study, with 13 being assigned to the group receiving debriefing sessions and 18 assigned to the control group. At baseline, 21/31 (68%) participants displayed evidence of burnout in at least one domain as measured by the Maslach Burnout Inventory. Burnout was significantly higher in women. There was no significant difference in burnout scores with debriefing. The intervention was well received with 11/18 (61%) suggesting they would recommend the strategy to future junior doctors and 16/18 (89%) found that the sessions were a source of emotional and social support.
Conclusions Burnout is prevalent among postgraduate year 1 doctors, and they value the emotional and social support from attending debriefing sessions. A larger study is required to determine if debriefing can reduce the incidence of burnout in junior doctors.
Many medical graduates feel unprepared for clinical practice when confronted with the realities of the wide breadth of duties that the job entails. They are required to manage acutely ill patients and stressful workloads. It is not surprising, therefore, that some of them will suffer psychological stress that reduces their functioning, experience increased psychiatric morbidity along with job and life dissatisfaction. Doctors who are emotionally exhausted, cynical about the importance or value of one's occupation or show diminished interest in their work are experiencing features of burnout. Burnout encompasses three dimensions; emotional exhaustion, depersonalisation and reduced personal accomplishment. It is a response to chronic emotional and interpersonal stressors and has been known to affect professions requiring significant and intense involvement with people, such as doctors and nurses.
The consequences of burnout to the individual are significant. Personal health is often neglected, with one study indicating that 65% of medical practitioners felt unable to take time off work when ill, and 92% had self-prescribed medication. Burnout, depression and sleep deprivation have also been shown to significantly increase the odds of a motor vehicle accident.
Medical staff are not the only ones affected; patient care can also be impeded. Burnout has been linked to deferred clinical decision making and increased perceived medical errors. It has long been recognised that stress levels affect intellect, judgement and technical ability. Fatigue, distress and depression have been separately shown to be associated with medical errors. Addressing burnout is critical, as it not only has an impact on the quality of life of junior doctors, but also patient safety and health outcomes.
Burnout is common in junior doctors. It has been reported to occur in 18–82% of junior doctors and increases towards the end of the intern year. One Australian study on junior doctor well-being found that 71% of doctors were concerned about their own health and the majority had low job satisfaction (71%), burnout (69%) and compassion fatigue (54%).
There have been few studies investigating strategies to prevent or reduce burnout in junior doctors in comparison with the literature on its prevalence. Previous interventions have aimed to implement change at either the organisational or individual level.
Long working hours, poor work–life balance and the inability to commit to personal and social activities outside of work has been associated with burnout. However, there is conflicting opinion on the implementation of work hour limits at an organisational level reducing the prevalence of burnout.
The work of a junior doctor is inherently stressful. High levels of responsibility coupled with role ambiguity and low levels of decision latitude are common and are associated with an increased risk of burnout. The developing pressures associated with job prospects and career trajectories also contribute to stress on the junior doctor. Given that it is unlikely that these factors change, most strategies to reduce burnout have concentrated on modifying individuals' response to work stress.
Approaches that have addressed stress reduction in junior doctors' work have included educational workshops on recognising signs of stress. A 9-weekly team training session, led by a psychotherapist, for resident physicians and nurses, focused on improved communication and role conflict, and was well received by its participants. Meditation based techniques have also been effective. Shapiro demonstrated that a meditation based stress reduction intervention reduced anxiety and depression, and increased empathy levels in medical students. Another form of meditation (using a breathing technique) has also been shown to improve emotional exhaustion levels in family physicians. However, these methods do not address each of the dimensions of burnout or the underlying contributory chronic emotional and interpersonal stressors.
The establishment of debriefing strategies to reduce burnout in junior doctors has been recommended with varying success. Debriefing, in the context of chronic work-related emotional and interpersonal stressors, can be described as an opportunity to meet with peers and have a facilitated discussion with a senior and trusted health professional. It essentially involves peer support, feedback, mentoring and problem solving. Increased support and feedback has been shown to reduce work-related psychological stress. Sharing experiences is a possible antidote to burnout, with peer -support groups helpful in prevention. However, the efficacy of debriefing to reduce burnout in junior doctors has not been evaluated.
The objective of the study is to determine the prevalence of burnout in a cohort of junior doctors and to evaluate the effectiveness of debriefing sessions in reducing burnout.
Abstract and Introduction
Abstract
Background Internship and residency are difficult times with novice practitioners facing new challenges and stressors. Junior doctors may experience burnout, a syndrome that encompasses three dimensions: emotional exhaustion, depersonalisation and reduced personal accomplishment. While there is some existing literature on the prevalence of burnout in junior doctors, there are few studies on interventional strategies.
Aims This study aimed to examine the prevalence of burnout in a cohort of junior doctors and whether debriefing sessions reduced levels of burnout.
Methods A prospective randomised controlled study of a convenience sample of postgraduate year 1 doctors in a single hospital was undertaken during a rotation term in 2011. All participants completed a questionnaire using a validated tool, the Maslach Burnout Inventory, to determine the prevalence of burnout. They were then randomly assigned to a group who were to receive four debriefing sessions over 2 months, or, to the control group, who had no debriefing sessions. Quantitative and qualitative analyses were conducted.
Results Thirty-one postgraduate year 1 doctors participated in the study, with 13 being assigned to the group receiving debriefing sessions and 18 assigned to the control group. At baseline, 21/31 (68%) participants displayed evidence of burnout in at least one domain as measured by the Maslach Burnout Inventory. Burnout was significantly higher in women. There was no significant difference in burnout scores with debriefing. The intervention was well received with 11/18 (61%) suggesting they would recommend the strategy to future junior doctors and 16/18 (89%) found that the sessions were a source of emotional and social support.
Conclusions Burnout is prevalent among postgraduate year 1 doctors, and they value the emotional and social support from attending debriefing sessions. A larger study is required to determine if debriefing can reduce the incidence of burnout in junior doctors.
Introduction
Many medical graduates feel unprepared for clinical practice when confronted with the realities of the wide breadth of duties that the job entails. They are required to manage acutely ill patients and stressful workloads. It is not surprising, therefore, that some of them will suffer psychological stress that reduces their functioning, experience increased psychiatric morbidity along with job and life dissatisfaction. Doctors who are emotionally exhausted, cynical about the importance or value of one's occupation or show diminished interest in their work are experiencing features of burnout. Burnout encompasses three dimensions; emotional exhaustion, depersonalisation and reduced personal accomplishment. It is a response to chronic emotional and interpersonal stressors and has been known to affect professions requiring significant and intense involvement with people, such as doctors and nurses.
The consequences of burnout to the individual are significant. Personal health is often neglected, with one study indicating that 65% of medical practitioners felt unable to take time off work when ill, and 92% had self-prescribed medication. Burnout, depression and sleep deprivation have also been shown to significantly increase the odds of a motor vehicle accident.
Medical staff are not the only ones affected; patient care can also be impeded. Burnout has been linked to deferred clinical decision making and increased perceived medical errors. It has long been recognised that stress levels affect intellect, judgement and technical ability. Fatigue, distress and depression have been separately shown to be associated with medical errors. Addressing burnout is critical, as it not only has an impact on the quality of life of junior doctors, but also patient safety and health outcomes.
Burnout is common in junior doctors. It has been reported to occur in 18–82% of junior doctors and increases towards the end of the intern year. One Australian study on junior doctor well-being found that 71% of doctors were concerned about their own health and the majority had low job satisfaction (71%), burnout (69%) and compassion fatigue (54%).
There have been few studies investigating strategies to prevent or reduce burnout in junior doctors in comparison with the literature on its prevalence. Previous interventions have aimed to implement change at either the organisational or individual level.
Long working hours, poor work–life balance and the inability to commit to personal and social activities outside of work has been associated with burnout. However, there is conflicting opinion on the implementation of work hour limits at an organisational level reducing the prevalence of burnout.
The work of a junior doctor is inherently stressful. High levels of responsibility coupled with role ambiguity and low levels of decision latitude are common and are associated with an increased risk of burnout. The developing pressures associated with job prospects and career trajectories also contribute to stress on the junior doctor. Given that it is unlikely that these factors change, most strategies to reduce burnout have concentrated on modifying individuals' response to work stress.
Approaches that have addressed stress reduction in junior doctors' work have included educational workshops on recognising signs of stress. A 9-weekly team training session, led by a psychotherapist, for resident physicians and nurses, focused on improved communication and role conflict, and was well received by its participants. Meditation based techniques have also been effective. Shapiro demonstrated that a meditation based stress reduction intervention reduced anxiety and depression, and increased empathy levels in medical students. Another form of meditation (using a breathing technique) has also been shown to improve emotional exhaustion levels in family physicians. However, these methods do not address each of the dimensions of burnout or the underlying contributory chronic emotional and interpersonal stressors.
The establishment of debriefing strategies to reduce burnout in junior doctors has been recommended with varying success. Debriefing, in the context of chronic work-related emotional and interpersonal stressors, can be described as an opportunity to meet with peers and have a facilitated discussion with a senior and trusted health professional. It essentially involves peer support, feedback, mentoring and problem solving. Increased support and feedback has been shown to reduce work-related psychological stress. Sharing experiences is a possible antidote to burnout, with peer -support groups helpful in prevention. However, the efficacy of debriefing to reduce burnout in junior doctors has not been evaluated.
The objective of the study is to determine the prevalence of burnout in a cohort of junior doctors and to evaluate the effectiveness of debriefing sessions in reducing burnout.
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