Occupational burnout levels in emergency medicine--a nationwide study and analysis.

INTRODUCTION: The specificity of the emergency medical act strongly manifests itself on account of a wide series of psycho-traumatizing factors augmented both by the vulnerable situation of the patient and the paroxysmal state of the act. Also, it has been recognized that the physical solicitation and distress levels are the highest among all medical specialties, this being a valuable marker for establishing the quality of the medical act. MATERIAL AND METHODS: We have surveyed a total of 4725 emergency medical workers with the MBI-HSS instrument, receiving 4693 valid surveys (99.32% response rate). Professional categories included Emergency Department doctors (M-EMD), ambulance doctors (M-AMB), ED doctors with field work in emergency and resuscitation (including mobile intensive care units and airborne intensive care units) (D-SMU), medical nurses in Emergency Departments (N-EMD), medical nurses in the ambulance service (N-AMB), ED medical nurses with field activity in emergency and resuscitation (N-SMU), ambulance drivers (DRV) and paramedic (EMT). The n values for every category of subjects and percentage of system coverage (table 3) shows that we have covered an estimated total of 29.94% of the Romanian emergency medical field workers. RESULTS: MBI-HSS results show a moderate to high level of occupational stress for the surveyed subjects. The average values for the three parameters, corresponding to the entire Romanian emergency medical field were 1.41 for EE, 0.99 for DP and 4.47 for PA (95% CI). Average results stratified by professional category show higher EE average values (v) for the M-SMU (v=2.01, 95%CI) and M-EMD (v=2.21, 95% CI) groups corresponding to higher DP values for the same groups (vM-EMD=1.41 and vM-SMU=1.22, 95% CI). PA values for these groups are below average, corresponding to an increased risk factor for high degrees of burnout. Calculated PA values are 4.30 for the M-EMD group and 4.20 for the M-SMU group. CONCLUSIONS: Of all surveyed groups, our study shows a high risk of burnout consisting of high emotional exhaustion (EE) and high depersonalization (DP) values for Emergency Department doctors, Emergency, and Resuscitation Service doctors (M-SMU). Possible explanations for this might be linked to high patient flow, Emergency Department crowding, long work hours and individual parameters such as coping mechanisms, social development and work environment.

Importance of basic life support training for first and second year medical students--a personal statement.

INTRODUCTION: Current studies show that there is a significant lack of knowledge regarding the typical signs and risk factors associated with serious medical conditions among medical students and laypersons. Basic life support consists of a number of medical procedures provided to patients with life threatening conditions of the body that cause pain or dysfunction to the person. FURTHER DEVELOPMENTS: In spite of the fact that this programme is not included in the curricula, students might receive this information from various persons, even though these persons are not specialized in the domain of giving first aid. Learning medicine without placing patients at an increased risk of complications is of utmost importance in the medical profession. High-fidelity patient simulators can potentially achieve this, and, therefore they are increasingly used in the training of medical students. Recent studies regarding simulation training show that the simulation-based intervention offers a positively evaluated possibility to enhance students' skills in recognizing and handling emergencies improving the ability to manage medical emergencies. CONCLUSION: Understanding BLS courses and more than that, practicing these techniques is by far the most challenging task confronting first aid. Taking everything into consideration, we believe that an adequate education in first aid and basic life support should be considered an essential aspect of the medical curriculum.

Occupational burnout levels in emergency medicine--a stage 2 nationwide study and analysis.

INTRODUCTION: The first stage of this nationwide study and analysis of the occupational burnout and psychological risk parameters showed a high consistency of emotional exhaustion, depersonalization and low personal accomplishment for doctors working in Emergency Departments and Emergency and Resuscitation Services. These workers were then set in the highest risk group for burnout syndrome and depression. This stage II of our research will focus on those two groups analyzing causal factors, coping mechanisms and possible repercussions of these findings. DEMOGRAPHICS: We have issued a total of 272 surveys from which we have received a total of 263 complete and valid ones (n = 263, response rate = 96, 69%). INSTRUMENTS: The Maslach Burnout Inventory--Human Services Survey MBI-HSS is an instrument designed to assess the three components of the burnout syndrome: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). The COPE questionnaire is a 52 item addressing different ways of coping with stress. The Center for Epidemiologic Studies Depression Scale (CES-D) has been shown to be a reliable measure in assessing the number, types, and duration of depressive symptoms across racial, gender, and age categories. RESULTS AND DISCUSSION: Results were not correlated with gender, age or marital status, but an important correlation was found with professional experience in the Emergency Departments. We have shown that during the first 4 years of experience, the EE factor has been at a satisfying average of 2.4, this variable rising to an average of 2.85 after another 3 years of work. The same type of correlation was found with the CES-D results. CONCLUSIONS: Of the two surveyed groups, the EMD group showed higher values for all risk parameters and low personal accomplishment on the MBI-HSS survey. Also, emotional exhaustion and depression were found to have a powerful correlation with work experience. Coping mechanisms were found to be invariable to the general population, with a slight incline towards active coping and behavioral disengagement.