"Going through the motions": A qualitative exploration of the impact of emergency medicine resident burnout on patient care.
Ontology highlight
ABSTRACT: Objectives
Burnout occurs frequently in emergency medicine (EM) residents and has been shown to have a negative impact on patient care. The specific effects of burnout on patient care are less well understood. This study qualitatively explores how burnout may change the way EM residents provide patient care.Methods
Qualitative data were obtained from a sample of 29 EM residents in four semistructured focus groups across four institutions in the United States in early 2019. Transcripts were coded and organized into major patient care themes.Results
Residents described many ways in which feelings of burnout negatively impacted patient care. These detrimental effects most often fit into one of four main themes: reduced motivation to care for patients, poor communication with patients, difficult interactions with health care colleagues, and impaired decision making.Conclusions
According to EM residents, burnout negatively impacts several important aspects of patient care. Resident engagement with clinical care, communication with patients and colleagues, and clinical care may suffer as a result of burnout.
SUBMITTER: Akhavan AR
PROVIDER: S-EPMC9513530 | biostudies-literature | 2022 Oct
REPOSITORIES: biostudies-literature
Publications
"Going through the motions": A qualitative exploration of the impact of emergency medicine resident burnout on patient care.
Akhavan Arvin Radfar AR Strout Tania D TD Germann Carl A CA Nelson Sara W SW Jauregui Joshua J Lu Dave W DW
AEM education and training 20220927 5
<h4>Objectives</h4>Burnout occurs frequently in emergency medicine (EM) residents and has been shown to have a negative impact on patient care. The specific effects of burnout on patient care are less well understood. This study qualitatively explores how burnout may change the way EM residents provide patient care.<h4>Methods</h4>Qualitative data were obtained from a sample of 29 EM residents in four semistructured focus groups across four institutions in the United States in early 2019. Transc ...[more]
Similar Datasets
Project description:ObjectiveBurnout is prevalent among resident physicians and has a negative impact on their well-being and effectiveness at work. How burnout shapes residents' educational experiences, attitudes, habits, and practices is not well understood. There is also a lack of research regarding self-identified mitigation strategies for residents. The authors qualitatively explored burnout's role in the educational experiences of resident physicians.MethodsQualitative data were generated from a sample of 29 emergency medicine residents through four semistructured focus groups across four institutions in January and February 2019. The authors employed a constructivist approach to thematic analysis. Transcripts were coded and organized into major and minor themes.ResultsResidents reported that a misalignment of their individual versus institutional priorities and a lack of agency were significant contributors to their burnout. Residents described how burnout affected multiple aspects of their education, including their motivation and curiosity to learn, engagement in scholarly activity, and teaching of others. Residents identified several ways of building a sense of community that they explained was most useful in mitigating their experiences with burnout.ConclusionBurnout had a negative influence on many facets of residents' educational experiences during training. Program directors and educators can take resident-identified steps to moderate its detrimental role on trainee education.
| S-EPMC8019220 | biostudies-literature
Project description:IntroductionEmergency medicine (EM) physicians and trainees report high levels of burnout. Burnout negatively impacts physician well-being and career satisfaction but it remains unclear how burnout may influence patient care. We examined the degree to which EM trainee burnout at one institution was associated with patients' satisfaction with their emergency department (ED) care.MethodsIn this cross-sectional, pilot study conducted at a single institution, we measured EM trainee burnout using the Maslach Burnout Inventory through a confidential, electronic survey. We subsequently linked individual trainee burnout results with their individual Press Ganey (PG) ED patient satisfaction scores. We compared burnout scores across sex and postgraduate year using chi-square tests and PG results via analysis of variance.ResultsTwenty-seven of 53 (50.9%) eligible EM trainees completed the burnout assessment. Trainees reported an overall burnout rate of 77.8% (95% confidence interval = 59.2%-89.4%). There were no significant differences in burnout based on sex (p = 0.888) or postgraduate year (p = 0.671). Trainee burnout was significantly associated with lower trainee-specific PG scores, including patient ratings of resident physician courtesy (p = 0.011), taking the time to listen (p = 0.004), keeping informed of treatment (p = 0.014), and concern for patient comfort (p = 0.006). There was no significant association between trainee burnout and patients' overall likelihood to recommend the ED to others (p = 0.364).ConclusionEmergency medicine trainee burnout is associated with lower trainee-specific PG ED patient satisfaction scores across all four physician domains. In addition to its detrimental impact on physician wellness, burnout may play a significant adverse role in patients' perceptions of their ED providers' interpersonal and communication skills.
| S-EPMC6001511 | biostudies-literature
Project description:ObjectivesEmergency departments (EDs) are complex adaptive systems and improving patient flow requires understanding how ED processes work. This study aimed to explore the patient flow process in an ED in Trinidad and Tobago, identifying organisational factors influencing patient flow.MethodsMultiple qualitative methods, including non-participant observations, observational process mapping and informal conversational interviews were used to explore patient flow. The process maps were generated from the observational process mapping. Thematic analysis was used to analyse the data.SettingThe study was conducted at a major tertiary level ED in Trinidad and Tobago.ParticipantsPatient and staff journeys in the ED were directly observed.ResultsSix broad categories were identified: (1) ED organisational work processes, (2) ED design and layout, (3) material resources, (4) nursing staff levels, roles, skill mix and use, (5) non-clinical ED staff and (6) external clinical and non-clinical departments. Within each category there were individual factors that appeared to either facilitate or hinder patient flow. Organisational processes such as streaming, front loading of investigations and the transfer process were pre-existing strategies in the ED while staff actions to compensate for limitations with flow were more intuitive. A conceptual framework of factors influencing ED patient flow is also presented.ConclusionThe knowledge gained may be used to strengthen the emergency care system in the local context. However, the study findings should be validated in other settings.
| S-EPMC7735135 | biostudies-literature
Project description:ObjectiveTo identify physician perspectives on factors associated with physician burnout, protective factors against burnout, and to seek potential solutions for this pervasive problem.DesignA qualitative study with semistructured focus group interviews using a systematic framework analysis.Setting and participantsPhysicians from general internal medicine (GIM) and the emergency department (ED) at two urban tertiary care hospitals in Vancouver, Canada, were recruited. Separate GIM and ED physician focus groups were conducted virtually from July 2021 to December 2022, led by an independent facilitator. Audio recordings from focus group sessions were then transcribed for analysis.Results41 physicians (29 GIM and 12 ED) participated in the focus groups. The dominant themes for organisational factors attributed to burnout that were highlighted by both groups included heavy workload and scheduling, frequent interruptions, interdepartmental conflict and feeling undervalued by leadership. Other contributing factors that were only emphasised by GIM physicians were pressure to work out-of-scope of their practice, pressure to admit and discharge patients quickly, as well as sexism in the workplace. Factors unique to ED physicians included experiencing violence in the workplace and having to assess patients in waiting rooms. Protective organisational factors included time to build rapport with patients, staff collegiality, working within their scope of practice, and feeling rewarded and valued by leadership. Interventions suggested by physicians included improving channels of communication between staff, increasing flexibility in scheduling and strengthening hospitalists' services.ConclusionsMost organisational factors driving burnout were common to both GIM and ED physicians, including heavy workload and scheduling, frequent interruptions, interdepartmental conflict and feeling undervalued by leadership. Leveraging protective factors and intervening on organisational factors attributed to burnout such as improving communication and enhancing support services may be effective in addressing the physician burnout epidemic.
| S-EPMC11781124 | biostudies-literature
Project description:ObjectivesProvider efficiency has been reported in the literature but there is a lack of efficiency analysis among emergency medicine (EM) residents. We aim to compare efficiency of EM residents of different training levels and determine if EM resident efficiency is affected by emergency department (ED) crowding.MethodsWe conducted a single-center retrospective observation study from July 1, 2014, to June 30, 2017. The number of new patients per resident per hour and provider-to-disposition (PTD) time of each patient were used as resident efficiency markers. A crowding score was assigned to each patient upon the patient's arrival to the ED. We compared efficiency among EM residents of different training levels under different ED crowding statuses. Dynamic efficiency changes were compared monthly through the entire academic year (July to next June).ResultsThe study enrolled a total of 150,920 patients. A mean of 1.9 patients/hour was seen by PGY-1 EM residents in comparison to 2.6 patients/hour by PGY-2 and -3 EM residents. Median PTD was 2.8 hours in PGY-1 EM residents versus 2.6 hours in PGY-2 and -3 EM residents. There were no significant differences in acuity across all patients seen by EM residents. When crowded conditions existed, residency efficiency increased, but such changes were minimized when the ED became overcrowded. A linear increase of resident efficiency was observed only in PGY-1 EM residents throughout the entire academic year.ConclusionResident efficiency improved significantly only during their first year of EM training. This efficiency can be affected by ED crowding.
| S-EPMC6637007 | biostudies-literature
Project description:There is a universal shortage of nurses, with a current needs-based shortage of 5.9 million. This is not solely a recruitment issue but one of retention, triggered by high levels of work-induced stress, burnout, and reports of low job satisfaction resulting in poor care delivery. Some of the health repercussions on nurses include anxiety, insomnia, depression, migraines, irritability, absenteeism, and sometimes alcoholism and drug abuse. To tackle some of these costly issues, a qualitative exploration into how inner resources is used by nurses to cope with stress at different points of their careers is proposed. Through the lens of grounded theory, semi-structured interviews will be carried out with two distinct sets of participants: (1) Student nurses registered at the University of the Illes Baleares between 2022-2025. (2) Experienced nurses on the Balearic nursing register. Interviews will be coded and then analysed using Atlas.ti. Expected results will inform curriculum improvements that will benefit the well-being of (student) nurses, from the outset of their training, pre-empting potential psycho-social risks before they arise in the workplace. This is vital as it addresses nurses' mental health as well as chronic issues of retention and absenteeism.
| S-EPMC10801579 | biostudies-literature
Project description:IntroductionConsideration of the cost of care and value in healthcare is now a recognized element of physician training. Despite the urgency to educate trainees in high-value care (HVC), educational curricula and evaluation of these training paths remain limited, especially with respect to emergency medicine (EM) residents. We aimed to complete a needs assessment and evaluate curricular preferences for instruction on HVC among EM residents.MethodsThis was a qualitative, exploratory study using content analysis of two focus groups including a total of eight EM residents from a single Midwestern EM residency training program. Participants also completed a survey questionnaire.ResultsThere were two themes. Within the overall theme of resident experience with and perception of HVC, we found five sub-themes: 1) understanding of HVC focuses on diagnosis and decision-making; 2) concern about patient costs, including the effects on patients' lives and their ability to engage with recommended outpatient care; 3) conflict between internal beliefs and external expectations, including patients' perceptions of value; 4) approach to HVC changes with increasing clinical experience; and 5) slow-moving, political discussion around HVC. Within the overall theme of desired education and curricular design, we identified four sub-themes: 1) limited prior education on HVC and health economics; 2) motivation to receive training on HVC and health economics; 3) desire for discussion-based format for HVC curriculum; and 4) curriculum targeted to level of training. Respondents indicated greatest acceptability of interactive, discussion-based formats.DiscussionWe conducted a targeted needs assessment for HVC among EM residents. We identified broad interest in the topic and limited self-reported baseline knowledge. Curricular content may benefit from incorporating resident concerns about patient costs and conflict between external expectations and internal beliefs about HVC. Curricular design may benefit from a focus on interactive, discussion-based modalities and tailoring to the learner's level of training.
| S-EPMC10777185 | biostudies-literature
Project description:BackgroundEmergency departments (EDs) are important venues for the distribution of naloxone to patients at high risk of opioid overdose, but less is known about patient perceptions on naloxone or best practices for patient education and communication. Our aim was to conduct an in-depth exploration of knowledge and attitudes toward ED naloxone distribution among patients who received a naloxone prescription.MethodsWe conducted semi-structured telephone interviews with 25 adult participants seen and discharged from three urban, academic EDs in Philadelphia, PA, with a naloxone prescription between November 2020 and February 2021. Interviews focused on awareness of naloxone as well as attitudes and experiences receiving naloxone in the ED. We used thematic content analysis to identify key themes reflecting patient attitudes and experiences.ResultsOf the 25 participants, 72% had previously witnessed an overdose and 48% had personally experienced a non-fatal overdose. Nineteen participants (76%) self-disclosed a history of substance use or overdose, and one reported receiving an opioid prescription during their ED visit and no history of substance use. In interviews, we identified wide variability in participant levels of knowledge about overdose risk, the role of naloxone in reducing risk, and naloxone access. A subset of participants was highly engaged with community harm reduction resources and well versed in naloxone access and use. A second subset was familiar with naloxone, but largely obtained it through healthcare settings such as the ED, while a final group was largely unfamiliar with naloxone. While most participants expressed positive attitudes about receiving naloxone from the ED, the quality of discussions with ED providers was variable, with some participants not even aware they were receiving a naloxone prescription until discharge.ConclusionsNaloxone prescribing in the ED was acceptable and valued by most participants, but there are missed opportunities for communication and education. These findings underscore the critical role that EDs play in mitigating risks for patients who are not engaged with other healthcare or community health providers and can inform future work about the effective implementation of harm reduction strategies in ED settings.
| S-EPMC9412772 | biostudies-literature
Project description:ObjectivesAbout half of all resident physicians report symptoms of burnout. Burnout negatively influences multiple aspects of their education and training. How burnout may impact residents' career choices remains unclear. The authors explored the role burnout played in residents' career decisions.MethodsThis was a qualitative study among a sample of 29 emergency medicine residents from four institutions. Qualitative data were generated through four semistructured focus groups. The authors employed a constructivist approach to thematic analysis. Transcripts were coded and organized into major themes.ResultsFive major themes connecting burnout with residents' career choices emerged: 1) residents' current burnout and the prevention of future burnout figured prominently in their career considerations, 2) residents aimed to mitigate sources of burnout through their career choices, 3) residents' view of clinical work as a burden and a burnout contributor spurred the pursuit of other interests, 4) faculty advice and role modeling in relation to burnout shaped residents' career perspectives, and 5) residents weighed long-term burnout concerns with short-term financial needs.ConclusionBurnout played an important role in multiple aspects of residents' career considerations. Educators, program directors, and organization leaders can focus on identified target areas to address burnout's influence on residents' career decisions.
| S-EPMC8166306 | biostudies-literature
Project description:ObjectivesPostresidency career choices are complex decisions that involve personal, professional, and financial preferences and may be influenced by training programs. It is unknown how residents navigate these decisions during emergency medicine (EM) residency. We explored EM residents' perspectives on career decision making and how residency programs can support career planning.MethodsWe conducted semistructured interviews at seven accredited EM residency programs from diverse locations and training formats. We used purposive sampling to reflect the diversity of trainees with regard to gender, level of training, and career plans. Two researchers independently coded the transcripts. We used a constructivist-interpretivist paradigm to guide our thematic analysis.ResultsWe interviewed 11 residents and identified major themes in three categories. Residents described being exposed to career options through formalized curricula such as required rotations, career fairs, and subspeciality tracks, highlighting the importance of access to faculty with diverse areas of clinical and academic expertise. Many noted that exposure was often self-driven. We identified three major themes regarding career decisions: instrumental factors, people involved, and processes of decision making. Instrumental factors included personal interests, goals, and values as well as practice characteristics, financial considerations, timing, and opportunity costs. Mentors and family were highly involved in resident career decisions. Residents often utilized reflection and conversations with mentors and peers in their decision-making process. Participants recommended that programs provide exposure to diverse career options early in training, protect time for career education, and ensure adequate mentorship and a supportive community. Participants suggested specific curricular content and strategies to support career decisions.ConclusionsThis study illuminates important factors involved in resident career decision making and how programs can support their trainees. Essential components include diverse experiences and building a reflective mentorship environment.
| S-EPMC10951628 | biostudies-literature