DOI QR코드

DOI QR Code

A Review of Burnout in Medical School Professors

의과대학 교수의 소진에 대한 이해

  • Hyo Hyun Yoo (Department of Medical Education, Jeonbuk National University Medical School) ;
  • Hyoungtae Kim (Department of Medical Education, Jeonbuk National University Medical School)
  • 유효현 (전북대학교 의과대학 의학교육학교실) ;
  • 김형태 (전북대학교 의과대학 의학교육학교실)
  • Received : 2022.04.25
  • Accepted : 2023.02.01
  • Published : 2023.02.28

Abstract

The purpose of this study was to promote an enhanced understanding of burnout among medical school professors by reviewing the literature on burnout in domestic and international medical professors, and to seek measures to prevent burnout. To this end, the general concept of burnout and the physical, cognitive, psychological, social, and behavioral symptoms that result from burnout were explained. In addition, the causes and results of high burnout among medical school professors were summarized in terms of demographic characteristics and the duties of educators, researchers, and physicians, and measures to prevent burnout in medical school professors were divided into individual and organizational levels. In order to prevent burnout among medical school professors, sensitive interest in themselves and self-reflection are required at the personal level. At the organizational level, it is necessary to regularly monitor burnout among medical school professors, improve systems, encourage participation in the policy-making process, and develop customized education programs. At the social level, it is necessary to recognize that burnout of medical school professors is a social problem, for which further research is needed. Therefore, in order for medical school professors not to burn out, there must be appropriate interactions among the individuals, organizations, and society, and the consistent attention should be paid to this issue.

Keywords

References

  1. Schaufeli WB, Leiter MP, Maslach C. Burnout: 35 years of research and practice. Career Dev Int. 2009;14(3):204-20. https://doi.org/10.1108/13620430910966406 
  2. Campbell DA Jr, Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surgery. 2001;130(4):696-7025. https://doi.org/10.1067/msy.2001.116676 
  3. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114(6):513-9. https://doi.org/10.1016/s0002-9343(03)00117-7 
  4. Association of American Medical Colleges. Medical Schools [Internet]. Washington (DC): Association of American Medical Colleges; 2019 [cited 2021 Mar 12]. Available from: https://www.aamc.org/data-reports/faculty-institutions/report/promising-practices-understanding-and-addressing-salary-equity-us-medical-schools 
  5. Walton M, Murray E, Christian MD. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care. 2020;9(3):241-7. https://doi.org/10.1177/2048872620922795 
  6. Crisford P, Winzenberg T, Venn A, Schultz M, Aitken D, Cleland V. Factors associated with physical activity promotion by allied and other non-medical health professionals: a systematic review. Patient Educ Couns. 2018;101(10):1775-85. https://doi.org/10.1016/j.pec.2018.05.011 
  7. Stanford FC, Durkin MW, Stallworth JR, Powell CK, Poston MB, Blair SN. Factors that influence physicians' and medical students' confidence in counseling patients about physical activity. J Prim Prev. 2014;35(3):193-201. https://doi.org/10.1007/s10935-014-0345-4 
  8. Hall LH, Johnson J, Watt I, Tsipa A, O'Connor DB. Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS One. 2016;11(7):e0159015. https://doi.org/10.1371/journal.pone.0159015 
  9. Hwang MH, Park A, Kim HR. The development and use status of psychological burnout scales in Korea. J Educ Stud. 2022;53(3):209-37. https://doi.org/10.15854/jes.2022.09.53.3.209
  10. Park HH, Ju HJ, Jeong S. Research trend analysis on job stress in the social sciences disciplines: for the papers published in excellent and registered journals of the National Research Foundation of Korea(2017-2021). Korean J Local Gov Stud. 2021;25(2):275-303. https://doi.org/10.20484/klog.25.2.12 
  11. Seo JH, Bae HO, Kim BJ, Huh S, Ahn YJ, Jung SS, et al. Burnout of faculty members of medical schools in Korea. J Korean Med Sci. 2022;37(9):e74. https://doi.org/10.3346/jkms.2022.37.e74 
  12. Freudenberger H. Staff burnout. J Soc Issues. 1974;30(1):159-65. https://doi.org/10.1111/j.1540-4560.1974.tb00706.x 
  13. Maslach C, Jackson SE. The measurement of experienced burnout. J Organ Behav. 1981;2(2):99-113. https://doi.org/10.1002/job.4030020205 
  14. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397-422. https://doi.org/10.1146/annurev.psych.52.1.397 
  15. World Health Organization. Burn-out an "occupational phenomenon": International Classification of Diseases [Internet]. Geneva: World Health Organization; 2019 [cited 2021 Jan 31]. Available from: https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases 
  16. Maslach C, Schaufeli WB. Historical and conceptual development of burnout. In: Schaufeli WB, Maslach C, Marek T, editors. Professional burnout: recent developments in theory and research. London: Routledge; 2017. p. 1-16. 
  17. Kim SC. Burnout syndrome worst at the beginning of the year. J Tradit Med Clin Naturop. 2018;7(1):1000e144. https://doi.org/10.4172/2573-4555.1000e144 
  18. Salvagioni DA, Melanda FN, Mesas AE, Gonzalez AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies. PLoS One. 2017;12(10):e0185781. https://doi.org/10.1371/journal.pone.0185781 
  19. Schaufeli WB, Bakker AB. Job demands, job resources, and their relationship with burnout and engagement: a multi-sample study. J Organ Behav. 2004;25(3):293-315. https://doi.org/10.1002/job.248 
  20. Yu J, Lee S, Kim M, Lim K, Chang K, Chae S. Professional self-concept and burnout among medical school faculty in South Korea: a cross-sectional study. BMC Med Educ. 2019;19(1):248. https://doi.org/10.1186/s12909-019-1682-z 
  21. Gomez-Urquiza JL; De la Fuente-Solana EI, Albendin-Garcia L, Vargas-Pecino C, Ortega-Campos EM; Canadas-De la Fuente GA. Prevalence of burnout syndrome in emergency nurses: a meta-analysis. Crit Care Nurse. 2017;37(5):e1-9. https://doi.org/10.4037/ccn2017508 
  22. Kumar S. Burnout and doctors: prevalence, prevention and intervention. Healthcare (Basel). 2016;4(3):37. https://doi.org/10.3390/healthcare4030037 
  23. Davis BH, Hill SE, Fisher P, Nick T, Ward WL. Faculty burnout in a large department of pediatrics. J Hosp Adm. 2015;4(2):74-7. https://doi.org/10.5430/jha.v4n2p74 
  24. Dandar V, Grigsby RK, Bunton S. Burnout among US medical school faculty. Anal Brief. 2019;19(1):1-3. 
  25. Akram Z, Sethi A, Khan AM, Zaidi FZ. Assessment of burnout and associated factors among medical educators. Pak J Med Sci. 2021;37(3):827-32. https://doi.org/10.12669/pjms.37.3.3078 
  26. Abdo SA, El-Sallamy RM, El-Sherbiny AA, Kabbash IA. Burnout among physicians and nursing staff working in the emergency hospital of Tanta University, Egypt. East Mediterr Health J. 2016;21(12):906-15. https://doi.org/10.26719/2015.21.12.906 
  27. Arvandi Z, Emami A, Zarghi N, Alavinia SM, Shirazi M, Parikh SV. Linking medical faculty stress/burnout to willingness to implement medical school curriculum change: a preliminary investigation. J Eval Clin Pract. 2016;22(1):86-92. https://doi.org/10.1111/jep.12439 
  28. Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-49. https://doi.org/10.1111/medu.12927 
  29. Bergus GR, Randall CS, Winniford MD, Mueller CW, Johnson SR. Job satisfaction and workplace characteristics of primary and specialty care physicians at a bimodal medical school. Acad Med. 2001;76(11):1148-52. https://doi.org/10.1097/00001888-200111000-00020 
  30. Tijdink JK, Vergouwen AC, Smulders YM. Publication pressure and burn out among Dutch medical professors: a nationwide survey. PLoS One. 2013;8(9):e73381. https://doi.org/10.1371/journal.pone.0073381 
  31. Fanelli D. Do pressures to publish increase scientists' bias?: an empirical support from US States Data. PLoS One. 2010;5(4):e10271. https://doi.org/10.1371/journal.pone.0010271 
  32. Adler NJ, Harzing AW. When knowledge wins: transcending the sense and nonsense of academic rankings. Acad Manag Learn Educ. 2009;8(1):72-95. https://doi.org/10.5465/amle.2009.37012181 
  33. Miller AN, Taylor SG, Bedeian AG. Publish or perish: academic life as management faculty live it. Career Dev Int. 2011;16(5):422-45. https://doi.org/10.1108/13620431111167751 
  34. Olson K, Sinsky C, Rinne ST, Long T, Vender R, Mukherjee S, et al. Cross-sectional survey of workplace stressors associated with physician burnout measured by the Mini-Z and the Maslach Burnout Inventory. Stress Health. 2019;35(2):157-75. https://doi.org/10.1002/smi.2849 
  35. Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors related to physician burnout and its consequences: a review. Behav Sci (Basel). 2018;8(11):98. https://doi.org/10.3390/bs8110098 
  36. Maslach C, Leiter MP. Early predictors of job burnout and engagement. J Appl Psychol. 2008;93(3):498-512. https://doi.org/10.1037/0021-9010.93.3.498 
  37. Rao SK, Kimball AB, Lehrhoff SR, Hidrue MK, Colton DG, Ferris TG, et al. The impact of administrative burden on academic physicians: results of a hospital-wide physician survey. Acad Med. 2017;92(2):237-43. https://doi.org/10.1097/ACM.0000000000001461 
  38. Shanafelt TD, Gorringe G, Menaker R, Storz KA, Reeves D, Buskirk SJ, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015;90(4):432-40. https://doi.org/10.1016/j.mayocp.2015.01.012 
  39. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136(5):358-67. https://doi.org/10.7326/0003-4819-136-5-200203050-00008 
  40. West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296(9):1071-8. https://doi.org/10.1001/jama.296.9.1071 
  41. Thomas MR, Dyrbye LN, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, et al. How do distress and well-being relate to medical student empathy?: a multicenter study. J Gen Intern Med. 2007;22(2):177-83. https://doi.org/10.1007/s11606-006-0039-6 
  42. Williams ES, Manwell LB, Konrad TR, Linzer M. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study. Health Care Manage Rev. 2007;32(3):203-12. https://doi.org/10.1097/01.HMR.0000281626.28363.59 
  43. Montgomery A. The inevitability of physician burnout: implications for interventions. Burn Res. 2014;1(1):50-6. https://doi.org/10.1016/j.burn.2014.04.002 
  44. Armutlukuyu M, Marakoglu K, Kargin NC. Evaluation of burnout levels of the academic staff and research assistants working at medical faculties. Euras J Fam Med. 2019;8(1):10-8. https://doi.org/10.33880/ejfm.2019080102 
  45. Tijdink JK, Vergouwen AC, Smulders YM. Emotional exhaustion and burnout among medical professors; a nationwide survey. BMC Med Educ. 2014;14:183. https://doi.org/10.1186/1472-6920-14-183 
  46. Zivin K, Brower KJ, Sen S, Brownlee RM, Gold KJ. Relationship between faculty characteristics and emotional exhaustion in a large academic medical center. J Occup Environ Med. 2020;62(8):611-7. https://doi.org/10.1097/JOM.0000000000001898 
  47. Chichra A, Abhijnhan A, Tharyan P. Job stress and satisfaction in faculty of a teaching hospital in south India: a cross-sectional survey. J Postgrad Med. 2019;65(4):201-6. https://doi.org/10.4103/jpgm.JPGM_489_18 
  48. Dyrbye LN, Varkey P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career stages. Mayo Clin Proc. 2013;88(12):1358-67. https://doi.org/10.1016/j.mayocp.2013.07.016 
  49. Peisah C, Latif E, Wilhelm K, Williams B. Secrets to psychological success: why older doctors might have lower psychological distress and burnout than younger doctors. Aging Ment Health. 2009;13(2):300-7. https://doi.org/10.1080/13607860802459831 
  50. Keeton K, Fenner DE, Johnson TR, Hayward RA. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. 2007;109(4):949-55. https://doi.org/10.1097/01.AOG.0000258299.45979.37 
  51. Lackritz JR. Exploring burnout among university faculty: incidence, performance, and demographic issues. Teach Teach Educ. 2004;20(7):713-29. https://doi.org/10.1016/j.tate.2004.07.002 
  52. Lufler RS, McNulty MA. The glass ceiling thickens: the impact of COVID-19 on academic medicine faculty in the United States. Med Educ Online. 2022;27(1):2058314. https://doi.org/10.1080/10872981.2022.2058314 
  53. Anderson WA, Grayson M, Newton D, Zoeller ED. Why do faculty leave academic medicine? J Gen Intern Med. 2003;18 (Suppl 1):99. 
  54. Sonnad SS, Colletti LM. Issues in the recruitment and success of women in academic surgery. Surgery. 2002;132(2):415-9. https://doi.org/10.1067/msy.2002.127694 
  55. Nonnemaker L. Women physicians in academic medicine: new insights from cohort studies. N Engl J Med. 2000;342(6):399-405. https://doi.org/10.1056/NEJM200002103420606 
  56. Deryugina T, Shurchkov O, Stearns J. COVID-19 disruptions disproportionately affect female academics. AEA Pap Proc. 2021;111:164-8. https://doi.org/10.1257/pandp.20211017 
  57. Hashmi AM. The challenge of Burnout in Public Medical Teachers in Pakistan: a mixed methods study. Pak J Med Sci. 2021;37(5):1268-75. https://doi.org/10.12669/pjms.37.5.4429 
  58. Buckley LM, Sanders K, Shih M, Hampton CL. Attitudes of clinical faculty about career progress, career success and recognition, and commitment to academic medicine: results of a survey. Arch Intern Med. 2000;160(17):2625-9. https://doi.org/10.1001/archinte.160.17.2625 
  59. Khalid T. Faculty perceptions about roles and functions of a department of medical education. J Coll Physicians Surg Pak. 2013;23(1):56-61. 
  60. Kang PS, Kim DS, Lee KY, Hwang TY, Bang JB. The operating status of medical education management units in Korea. Korean J Med Educ. 2006;18(1):13-22. https://doi.org/10.3946/kjme.2006.18.1.13 
  61. Park K, Lee YM. Burnout among medical education specialists in Korean medical colleges. Korean Med Educ Rev. 2014;16(2):92-8. https://doi.org/10.17496/kmer.2014.16.2.092 
  62. Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med. 2013;11(5):412-20. https://doi.org/10.1370/afm.1511 
  63. Lamothe M, Rondeau E; Malboeuf-Hurtubise C, Duval M, Sultan S. Outcomes of MBSR or MBSR-based interventions in health care providers: a systematic review with a focus on empathy and emotional competencies. Complement Ther Med. 2016;24:19-28. https://doi.org/10.1016/j.ctim.2015.11.001 
  64. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272-81. https://doi.org/10.1016/S0140-6736(16)31279-X 
  65. Howie EK, Cannady N, Messias EL, McNatt A, Walter CS. Associations between physical activity, sleep, and self-reported health with burnout of medical students, faculty and staff in an academic health center. Sport Sci Health. 2022;18(4):1311-9. https://doi.org/10.1007/s11332-022-00902-7 
  66. McKinley T. Toward useful interventions for burnout in academic medical faculty: the case for unit-specific approaches. J Contin Educ Health Prof. 2022;42(1):e69-74. https://doi.org/10.1097/CEH.0000000000000389 
  67. Pololi L, Conrad P, Knight S, Carr P. A study of the relational aspects of the culture of academic medicine. Acad Med. 2009;84(1):106-14. https://doi.org/10.1097/ACM.0b013e3181900efc 
  68. Hitchcock MA, Bland CJ, Hekelman FP, Blumenthal MG. Professional networks: the influence of colleagues on the academic success of faculty. Acad Med. 1995;70(12):1108-16. https://doi.org/10.1097/00001888-199512000-00013 
  69. Rowe MM. Four-year longitudinal study of behavioral changes in coping with stress. Am J Health Behav. 2006;30(6):602-12. https://doi.org/10.5555/ajhb.2006.30.6.602 
  70. Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. JAMA Intern Med. 2019;179(10):1406-14. https://doi.org/10.1001/jamainternmed.2019.2425 
  71. Pololi LH, Knight SM, Dennis K, Frankel RM. Helping medical school faculty realize their dreams: an innovative, collaborative mentoring program. Acad Med. 2002;77(5):377-84. https://doi.org/10.1097/00001888-200205000-00005 
  72. Morzinski JA, Fisher JC. A nationwide study of the influence of faculty development programs on colleague relationships. Acad Med. 2002;77(5):402-6. https://doi.org/10.1097/00001888-200205000-00010 
  73. Oh YI. The mediating effect of job burnout on the relationship between job stressors and job turnover in salaried doctors: focusing on a moderated mediation effect of medical professionalism. [dissertation]. Seoul: Kyung Hee University; 2022. 
  74. Pipas CF, Damianos JA, Montalbano L, Matous AL, Hua J, Shoop GH. A curriculum to promote a culture of wellness among medical students and faculty. PRiMER. 2020;4:13. https://doi.org/10.22454/PRiMER.2020.930805 
  75. Dillon EC, Tai-Seale M, Meehan A, Martin V, Nordgren R, Lee T, et al. Frontline perspectives on physician burnout and strategies to improve well-being: interviews with physicians and health system leaders. J Gen Intern Med. 2020;35(1):261-7. https://doi.org/10.1007/s11606-019-05381-0 
  76. Guthier C, Dormann C, Voelkle MC. Reciprocal effects between job stressors and burnout: a continuous time meta-analysis of longitudinal studies. Psychol Bull. 2020; 146(12):1146-73. https://doi.org/10.1037/bul0000304 
  77. Forbes DL. Toward a unified model of human motivation. Rev Gen Psychol. 2011;15(2):85-98. https://doi.org/10.1037/a00234 
  78. Swensen S, Kabcenell A, Shanafelt T. Physician-organization collaboration reduces physician burnout and promotes engagement: the Mayo Clinic experience. J Healthc Manag. 2016;61(2):105-27. https://doi.org/10.1097/00115514-201603000-00008 
  79. Halliday L, Walker A, Vig S, Hines J, Brecknell J. Grit and burnout in UK doctors: a cross-sectional study across specialties and stages of training. Postgrad Med J. 2017;93(1101):389-94. https://doi.org/10.1136/postgradmedj-2015-133919 
  80. Schrijver I, Brady KJ, Trockel M. An exploration of key issues and potential solutions that impact physician wellbeing and professional fulfillment at an academic center. PeerJ. 2016;4:e1783. https://doi.org/10.7717/peerj.1783 
  81. Callahan K, Christman G, Maltby L. Battling burnout: strategies for promoting physician wellness. Adv Pediatr. 2018;65(1):1-17. https://doi.org/10.1016/j.yapd.2018.03.001