Teacher Emotion Inventory: validación en una muestra de profesorado español / Teacher Emotion Inventory: validation in a sample of Spanish teachers

Antecedentes: La escala Teacher Emotion Inventory (TEI) es un instrumento que evalúa emociones discretas experimentadas por el profesorado en el proceso de enseñanza-aprendizaje. El objetivo de este estudio es examinar las propiedades psicométricas de la versión breve española de la escala Teacher Emotion Inventory (TEI-BSV) en una muestra de 567 profesores (65.5% son mujeres), con edades comprendidas entre 25 y 65 años (M = 46.04; DT = 9.09). Método: Tras su adaptación mediante traducción inversa, el profesorado completó una batería que incluía el TEI-BSV, un cuestionario de inteligencia emocional, dos escalas de bienestar subjetivo, una escala sobre burnout y una escala sobre engagement. Resultados: Los resultados mostraron una consistencia interna adecuada de las subescalas del TEI-BSV. Los análisis factoriales (exploratorio y confirmatorio) proporcionaron pruebas de que el TEI-BSV tiene una estructura de cuatro factores con un buen ajuste, frente a la estructura de cinco factores original. Se han hallado evidencias de validez convergente, así como de validez criterial e incremental del TEI-BSV. Conclusiones: el TEI-BSV podría ser una herramienta útil para la evaluación ecológica de las emociones discretas del profesorado en su contexto laboral.(AU)

Background: The Teacher Emotion Inventory (TEI) scale is an instrument that evaluates discrete emotions experienced by teachers in the teaching-learning process. The aim of this study was to examine the psychometric properties of the brief Spanish version of the Teacher Emotion Inventory scale (TEI-BSV) using a sample of 567 teachers (65.5% women), aged between 25 and 65 years (M= 46.04; SD= 9.09). Methods: After adaptation through back-translation, the teachers com-pleted a battery of tests included in the TEI-BSV: an emotional intelli-gence questionnaire, two subjective well-being scales, a burnout scale and a scale on engagement. Results: The data revealed adequate internal consistency of the TEI-BSV subscales, and exploratory and confirma-tory factor analyses provided evidence that the TEI-BSV has a four-factor structure with good adjustment, as opposed to the original five-factor structure proposed. There was evidence of convergent validity of the TEI-BSV, as well as criterion and incremental validity. Conclusions: The TEI-BSV could be a useful instrument for the ecological assess-ment of teachers' discrete emotions in the context of their workplace.(AU)

Investigating food retail workers' experiences during the COVID-19 pandemic: A case of effort-reward imbalance.

Food retail businesses experienced a pronounced increase in sales when food hospitality outlets closed in the early stages of the COVID-19 pandemic in Canada. This study investigates how pandemic-related modifications to food retail businesses in Ontario, Canada affected the well-being of workers. Semi-structured interviews were conducted with 17 food retail employees between June 2020 and May 2021 as part of the Food Retail Environment Study for Health and Economic Resiliency (FRESHER). Transcripts were analyzed inductively, and themes were refined using the Effort Reward Imbalance Model. Themes were connected to the main components of this model: extrinsic effort, intrinsic effort, money, esteem, status control, and burnout. Results indicate that, for food retail employees, the presence of an imbalance between efforts and rewards threatens well-being via symptoms of burnout. Further study is needed to examine how this inequality and burnout among this population might be measured and addressed.

How School Burnout Affects Depression Symptoms Among Chinese Adolescents: Evidence from Individual and Peer Clique Level.

The impact of peer clique school burnout norms on adolescents' emotional adaptation is becoming increasingly prominent, but its underlying mechanisms remain unclear, especially in China where academic achievement is highly valued. The present study examined how clique burnout norms impact the relationship between school burnout, negative cognitive bias, and depressive symptoms. A total of 904 Chinese adolescents (57% boys; Mage = 12.73, SD = 0.43) participated in a two-wave longitudinal study (initiated in 2015, with approximately a 2-year interval). The results of multilevel models indicated that only in low clique burnout norms, adolescents with high school burnout at T1 would exhibit more negative cognitive bias and suffer from more depressive symptoms at T2, whereas the moderating effect was only observed in all-boys cliques. These findings reflect that a decrease in the overall level of burnout within a peer clique does not necessarily benefit every student, and the adaptation issues of students experiencing burnout still require attention even in a relatively healthy context.

Psycho-emotional impact of the COVID-19 pandemic on nursing professionals in Ecuador: a cross-sectional study.

AIM AND OBJECTIVES: To analyse the levels of anxiety, depression, post-traumatic stress, and burnout among nursing professionals working in the Imbabura region of Ecuador during the COVID-19 pandemic and identify the contributing socio-occupational factors. BACKGROUND: The high demand for care of COVID-19 patients led to increased work pressure on nurses, owing to increased demands for care and shortages of medical supplies and protective equipment. DESIGN: A cross-sectional study was conducted from September to December 2022 using a self-administered questionnaire addressed to nursing professionals who cared for COVID-19 patients. METHODS: The questionnaire included socio-demographic characteristics, the Spanish adaptation of Hospital Anxiety and Depression Scale (HADS-Spanish), Impact of Event Scale-Revised (IES-R) for the evaluation of post-traumatic stress disorder (PTSD), and the Spanish adaptation of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS-Spanish) for burnout assessment. Univariate and multivariate analyses were performed. RESULTS: Of the 782 participants, 88.6% had a high level of burnout (MBI-HSS-Spanish scale score > 27). Female nurses, nurses with eight-hour work shifts, and older professionals exhibited high levels of anxiety and depression. Prolonged working hours in COVID-19 patient care services were found to be a risk factor for burnout and post-traumatic stress. CONCLUSIONS: Participating nurses presented with a high level of chronic work stress and exhibited signs of anxiety and depression during the period under consideration. Providing nurses with psychological support measures and performing liaison consultations will alleviate the psychological burden on nurses. RELEVANCE TO CLINICAL PRACTICE: The study has shown that accounting for the environments where the emotional impact is greatest and how to reduce it would not only reduce anxiety, depression, and burnout in nurses but also improve the quality of care, not only in pandemic. PATIENT OR PUBLIC CONTRIBUTION: Nurses contributed to the conduct of the study by participating in the data collection via questionaries.

Resilience in the face of pandemic: exploring the influence of psychological flexibility on turnover intentions and burnout among critical care nurses in COVID-19 hospitals.

AIM: Assess the levels of psychological flexibility, burnout, and turnover intention among critical care nurses and assess the impact of psychological flexibility on burnout, and turnover intention among critical care nurses. BACKGROUND: Burnout and turnover intentions among critical care nurses are rapidly increasing because of the challenges of COVID-19. There is a need for evidence-based interventions like psychological flexibility to be addressed in research to overcome those challenges. METHODS: A descriptive correlational research. A convenient sample of 200 critical care nurses working in COVID-19 hospitals from two governorates in Egypt. The sociodemographic and clinical data sheet, the work-related acceptance and action questionnaire, the Copenhagen burnout inventory, and the adopted version of the staff nurses' intention to leave the nursing profession questionnaire were used. RESULTS: The majority of critical care nurses reported a moderate level of psychological flexibility (75.5%, Mean = 31.23), a moderate level of burnout (65.5%, Mean = 59.61), and low to moderate levels of intention to leave (73%, Mean = 5.95). Psychological flexibility has a statistically significant negative correlation with burnout (PC = -0.304, Sig = 0.000) and the intention to leave (PC = -0.258, Sig = 0.000). In addition, psychological flexibility has a predictable effect on decreasing burnout (R2 = 0.232) and intention to leave (R2 = 0.127) among critical care nurses. CONCLUSION: critical care nurses in COVID-19 hospitals reported varied levels of burnout and an intention to leave that must be considered. The effect of psychological flexibility on burnout and intention to turnover highlighted the importance of improving it among critical care nurses by applying acceptance and commitment therapy as a management intervention.

A Nation-Wide Survey of Program Directors at a Large Health Care Organization: Prevalence and Perceptions of Resident Wellness Activities.

Background: This study evaluated wellness programs in a large hospital network to determine residency program directors' (PDs) perspectives on their wellness programs' state, including wellness prioritization, frequency of wellness activities, and wellness' influence on decision-making across organizational levels. Methods: In 2021, 211 PDs were sent surveys on program policies, program implementation frequency, perceptions of the administration's ability to prioritize wellness, funding sources, and perceptions of resident wellness' impact on decision-making. Results: Among 211 contacted programs, 148 surveys were completed (70.1%). The majority reported having wellness programs, committees, and funding. Fewer than 25% reported having a chief wellness officer. PDs perceived that fellow colleagues in their institution linked wellness to markers of institutional success to a greater extent than other available options (ie, Accreditation Council for Graduate Medical Education [ACGME] requirements, budgetary concerns, resident input, core faculty priorities, and education quality). Financial well-being was perceived as least connected to wellness. Perceptions of wellness were rated across 3 organizational levels: program, institution, and organization. Across all levels, ACGME requirements (31.0%-32.8%) and budgetary/financial concerns (21.9%-37.0%) were perceived as having the most significant influence on overall decision-making, whereas resident wellness was rated lower in influence (8.0%-12.2%). Most programs allowed residents to attend mental health appointments without using paid time off (87.9%) and while on duty (83.1%). Conclusion: The frequency of wellness activities varied greatly across programs. PDs reported challenges making resident self-care and personal development a priority and perceived resident wellness as having limited importance to decision-making at higher levels.

The Impact of a 4-Domain Wellness-Initiative Curriculum on Internal Medicine Resident Physicians.

Background: There is a trend toward fostering well-being, or the state of being happy and healthy, within the medical community. Historically, resident physicians have faced high rates of distress during training. A structured well-being curriculum in residency programs may shift residents' mindsets from survival and resilience to one centered on purpose, engagement, and joy. Methods: An original well-being curriculum was administered to residents in person at a single institution every 5 weeks for approximately 10 well-being workshops, totaling around 20 hours of curriculum exposure during every academic year. The well-being curriculum was divided into 4 domains: cognitive distortions and problematic mindsets, mindfulness and meditation, creative outlets, and self-compassion.Residents exposed to at least 1 year of the well-being curriculum were asked to answer an anonymous survey. Four questions were asked for each of the 4 domains. The first and second questions asked how familiar they were with the topic before and after the workshops on a scale of 1-5 of familiarity. The third and fourth questions asked how much the knowledge acquired influenced their professional and personal life on a scale of 1-5 of influence. Results: Before curriculum exposure, the average for moderate or higher levels of knowledge across all domains was 22.7%, which improved to 77.3% after curriculum completion. Overall, 58.6% of participants felt the knowledge of the domains was moderately or extremely influential in their professional lives and 83.6% in their personal lives. There were no significant differences between post-graduate year 2 and post-graduate year 3 residents for any domains examined before and after the wellness workshops. Conclusion: A 4-domain well-being curriculum practiced in a group setting positively impacted participating residents in their personal and professional lives. Further studies need to be performed on a larger scale to assess if the curriculum fits the needs of the broader medical community.

A Multi-Wave Study of Factors Associated With Resident Engagement, Depression, Burnout, and Stay Intent.

Background: Many studies have documented the epidemic of mental ill-being among resident physicians, but fewer have focused on mental well-being or on guiding intervention design to make progress toward positive change in residency programs to support resident thriving. Informed by the job demands-resources model (JD-R) and positive psychology, the current study examines 4 potential predictors of residents' ill-being (burnout, depression) and well-being (engagement, stay intent) that are malleable and thus capable of change through intervention: psychological capital (PsyCap), supervising physicians' autonomy-supportive leadership style (ASL), social support, and meaningful work. Methods: Three waves of data were collected between November 2017 and September 2018 at a large hospital system in the United States. Due to participant response rates, we were unable to conduct a planned longitudinal analysis. Therefore, for each wave, Bayesian regression analyses were used to examine cross-sectional relationships between the 4 predictors and each outcome. Results: Although findings varied across the study's 3 waves, the outcomes were largely as expected. With only 1 exception (depressive symptoms in Wave 2), meaningful work significantly predicted all outcome variables in the expected direction across all 3 waves. PsyCap significantly predicted burnout, depressive symptoms, and engagement in the expected direction across all 3 waves. ASL significantly predicted engagement in the expected direction across all 3 waves, as well as depressive symptoms and stay intent in 2 waves, and burnout in 1 wave. Social support significantly negatively predicted depressive symptoms in all 3 waves and burnout in 1 wave. Conclusion: Applying the JD-R framework and a positive psychology lens can open new pathways for developing programming to support resident thriving. Meaningful work, PsyCap, ASL, and social support all significantly predicted 1 or more outcomes related to resident thriving (burnout, depression, engagement, stay intent) across all 3 waves. Thus, this study provides theoretical and practical implications for future intervention studies and designing current programming for resident thriving.

Learning from Health Care Counselors' Perspectives on Health Care Worker Distress: A Qualitative Analysis.

Background: Health care provider stress and emotional distress were well documented long before the COVID-19 pandemic, and there is growing data suggesting these have increased in response to the pandemic. The goal of this study was to take advantage of the unique experiences of licensed mental health (MH) clinicians working with health care trainees and clinicians before and during the pandemic to identify how this crisis affected both ongoing as well as new sources of stress. The Healer Education, Assessment and Referral Program (HEAR) provides MH screening, support, and MH referrals to ~19 000 health care students, trainees, staff, and faculty. Since its inception in 2009, the program has been staffed by 4 licensed counseling professionals who have worked both before and since the COVID-19 pandemic. Methods: Qualitative data obtained from semi-structured, 1-hour interviews and a follow-up 1-hour focus group with 4 HEAR counselors was analyzed using reflexive thematic analysis. Results: Several preexisting stressors were amplified during the pandemic: financial concerns; long work hours; exposure to the suffering of illness, death, and dying; bullying; discordant values and moral distress; social inequities; individuals' lack of adaptive coping; and individuals' self-concept as a victim. New stressors included: health care demand greater than the workforce numbers and resources; caretaking for ill family/friends; homeschooling of children; social isolation; experiencing the COVID-19 crisis as a war, fire, or storm; fear of personal illness and death, especially before vaccines; and hopes of a cure with vaccines; followed by perceived opportunities for improvement in leadership response to staff concerns. Conclusion: Authentically responding to staff concerns/ideas, a patient and provider-centered health care culture, grief education and support, and attention to actionable stressors affecting providers' well-being are indicated to meet the amplified and new stressors triggered by the COVID-19 pandemic and sequelae.

Exercise Is a Vital Sign.

Description In this review, we argue that exercise (physical activity) be monitored as a vital sign since no other basic sign or symptom provides as much information about a patient's health status. The influence of regular exercise on patient health is indisputable, with strong evidence to show the power of exercise to mitigate chronic disease and improve overall health. Several simple tools, such as Physical Activity as a Vital Sign and Exercise as a Vital Sign are available to assess patient physical activity. When properly applied, there is evidence to support the efficacy of these tools, but there are barriers that prevent broad inclusion in primary care, among which are time and provider knowledge. In our review, we also discussed the value of physician-led lifestyle discussions with patients and found they view these discussions favorably. There is also evidence that physicians who exercise are more likely to have these lifestyle discussions with their patients, but the proportion of physicians who exercise regularly is fairly low. We believe physicians' awareness of their patients' sedentary lifestyles should prompt a prescription to increase physical activity, but additional in-clinic support and community resources need to be in place for patients to get a regular dose.

Addressing Burnout and Enhancing Well-Being Among Academic Physicians: A Call for Future Research and Organizational Support.

Description Burnout among academic physicians, who navigate multiple roles beyond the clinical environment, is a pressing issue. However, the factors driving burnout among academic physicians are not fully understood. Prior research has revealed differences in burnout dimensions between clinical and basic science faculty, but the impact of balancing research, education, and clinical demands on academic physicians is still unclear. This knowledge gap negatively affects the clinical, translational science, research, and medical education workforces and has particular implications for minoritized and marginalized groups working in academic medical centers. Creating a culture of well-being has been vital in addressing burnout. Further research is needed to explore the unique experiences and demands of academic physicians- particularly those from minoritized and marginalized backgrounds-and to develop effective strategies to promote well-being as they balance diverse roles and contexts. This commentary highlights gaps in understanding burnout among academic physicians and proposes guidelines for future research as well as strategies to improve well-being at academic medical centers.

Burnout in Graduate Medical Education: Uncovering Resident Burnout Profiles Using Cluster Analysis.

Background: Burnout is common among residents and negatively impacts patient care and professional development. Residents vary in terms of their experience of burnout. Our objective was to employ cluster analysis, a statistical method of separating participants into discrete groups based on response patterns, to uncover resident burnout profiles using the exhaustion and engagement sub-scales of the Oldenburg Burnout Inventory (OLBI) in a cross-sectional, multispecialty survey of United States medical residents. Methods: The 2017 ACGME resident survey provided residents with an optional, anonymous addendum containing 3 engagement and 3 exhaustion items from the OBLI, a 2-item depression screen (PHQ-2), general queries about health and satisfaction, and whether respondents would still choose medicine as a career. Gaussian finite mixture models were fit to exhaustion and disengagement scores, with the resultant clusters compared across PHQ-2 depression screen results. Other variables were used to demonstrate evidence for the validity and utility of this approach. Results: From 14 088 responses, 4 clusters were identified as statistically and theoretically distinct: Highly Engaged (25.8% of respondents), Engaged (55.2%), Disengaged (9.4%), and Highly Exhausted (9.5%). Only 2% of Highly Engaged respondents screened positive for depression, compared with 8% of Engaged respondents, 29% of Disengaged respondents, and 53% of Highly Exhausted respondents. Similar patterns emerged for the general query about health, satisfaction, and whether respondents would choose medicine as a career again. Conclusion: Clustering based on exhaustion and disengagement scores differentiated residents into 4 meaningful groups. Interventions that mitigate resident burnout should account for differences among clusters.

Burnout and Health Scores Among Residency Programs as an Indicator of Wellness.

Background: With long hours, significant responsibilities, and a heavy workload, residency can be an incredibly stressful experience. The aim of our study was to assess the impact of residency on mental health and wellness. A secondary aim was to determine if the post-graduate year (PGY) of the different residents impacted their mental health or ability to cope with the stressors of residency. Methods: Residents in anesthesiology, family medicine, internal medicine, and surgery were invited to complete a survey. The first portion of the survey had residents rank their mental health on a scale from 1 to 5. There was also a short-form answer portion, which collected suggestions on how to improve wellness. An analysis of variance was used to compare the means of 2 continuous outcome variables-Patient Health Questionnaire (PHQ) and burnout scores compared across specialties and post-graduate years. Burnout scores were measured using the Oldenburg Burnout Inventory. This survey was created and validated by psychology researchers to assess burnout based on the strongest indicators of burnout-emotional exhaustion and disengagement from work. The PHQ9 survey was chosen as it has a specificity of 91-94% and is a reliable method to screen for depression, a common companion to burnout. Results: PHQ9 scores were highest among surgery residents (7.2 ± 7.07), followed by anesthesia (6.59 ± 6.64), emergency medicine (5.57 ± 4.09), and internal medicine (4.82 ± 3.68). Scoring was also higher among PGY4-6 residents. Burnout scores were highest among surgery (37.8 ± 8.69) and anesthesia (38.17 ± 7.09) residents and among PGY4-6 residents. PGY4-6 residents had a mean burnout score of 38.55 ± 7.67 compared to 36.17 ± 8.69 among first-year residents. Similarly, the P value noted no significant difference among burnout scores across either specialty or year: .5930 and .8061. Conclusion: There was no significant difference among specialties or years in training among their subjective ratings of depression.

The Feasibility and Impact of an Asynchronous Interprofessional Well-Being Course on Burnout in Health Care Professionals.

Background: Well-being initiatives are essential components in fostering an engaged workforce and creating an effective health care ecosystem. Health care professional (HCP) burnout is widespread and has worsened since the COVID-19 pandemic. In 2014, with Health Resources and Services Administration funding support, the Andrew Weil Center for Integrative Medicine created an online course for HCP well-being. It was subsequently studied in medical residents and revised in 2020. In this study, we explore the impact of the course across larger systems, as well as the long-term impact on HCPs. Methods: The Health Care Professional Well-Being course is 4.5 hours of interactive online education that explores personal well-being, promoters and detractors of well-being, and systemic factors that influence the overall impact of well-being in health care systems. Participants were recruited through institutional members of the Academic Consortium for Integrative Medicine and Health and were randomized to either active or waitlist control groups. Assessments were taken pre-course, 1-month post-course, and 6-months post-course in the areas of burnout, compassion, resiliency, and lifestyle behaviors. Results: Burnout measures of depersonalization and emotional exhaustion showed a significant improvement amongst active participants, sustained for 6 months after the course. However, no significant improvement in either the resiliency or the compassion measurements was noted for the active group. Initially, the active group showed improvement in personal accomplishment; however, both groups showed a decline overall. Most noteworthy, a large number of active participants demonstrated adoption of new health-promoting behavior; 95% incorporated at least 1 new lifestyle behavior learned from the course. Conclusion: This study of a brief, asynchronous, online well-being course with interprofessional HCPs, demonstrates that the course is associated with improvement in individual burnout measures and can educate HCPs about healthy behaviors and a framework for professional engagement.

The Effects of the COVID-19 Pandemic on Resident Education and Burnout.

Background: The COVID-19 pandemic has impacted the residency experience for physicians across all specialties. There have been studies examining resident perspectives on changes in curriculum and clinical experiences due to the pandemic; however, little research has been conducted on how residents in different specialties interpreted their educational experience and rates of burnout during the pandemic. Methods: We extended surveys to 281 residents across 15 separate residency programs between November 17, 2020, and December 20, 2020. The questions pertained to burnout and the effects of the pandemic on their careers. Differences between general and specialty medicine resident responses were analyzed using descriptive statistics and the Mann-Whitney U test. Results: The final analysis included 105 responses (40% response rate). We received 62 surveys (59%) from general medicine residents and 43 surveys (41%) from specialty medicine residents, with a higher response rate from junior level trainees in both groups. We found no significant differences between general and specialty residents on the level of burnout, impact on clinical experience, or future career due to COVID-19, though there was a significant difference between resident groups on the perceived impact of COVID-19 on learning. Conclusion: Specialty medicine residents reported a negative perception of the pandemic's impact on their learning during residency suggesting a greater impact on training than was perceived by the general medicine residents. Residents from general and specialty medicine programs reported similar levels of burnout and similar perceptions of the pandemic's impact on their clinical experience and future career prospects. Understanding the impacts of the COVID-19 pandemic on resident education and well-being should serve graduate medical education administrators well and prepare them for future interruptions in the traditional learning process.

Creating and Supporting Well-Being in Graduate Medical Education.

Description Graduate medical education strives to create the next generation of skillful and compassionate physicians for our nation. Yet, research shows a high degree of depression, anxiety, workplace burnout, lack of engagement, and general dissatisfaction with the work and learning environment for many of these dedicated individuals. We present this special issue related to creating and supporting well-being in the graduate medical education community.

Resident Feedback on Incorporating Reflection Rounds Into a Family Medicine Residency Wellness Curriculum: A Brief Report.

Background: We sought to understand well-being from the perspectives of residents in a family medicine residency program and to assess the residents' opinions on implementing "Reflection Rounds" (RR) to promote wellness and combat burnout through self-reflection. These aims were achieved through descriptive qualitative analysis of a focus group of family medicine residents. Methods: Participation was voluntary and open to all 45 residents in the program. The final participant sample consisted of 14 residents who shared similar characteristics, including level of training and being exposed to similar training stressors. Both a priori and open coding were used for this analysis. Results: An iterative process identified themes based on focus group responses. The residents were in favor of initiating RR and recommended discussion topics unique to family medicine residency. They also identified logistical preferences for this intervention, such as conducting confidential and unrecorded groups, splitting rounds by training year, offering RRs led by a trained facilitator, providing snacks if feasible, and making the RRs available on a regular basis during protected didactic time. Conclusion: This project elucidates how residents are identifying and managing wellness and burnout as well as informs effective ways that family medicine residency programs can incorporate RR into their wellness curriculum.

Mitigating Workplace Burnout Through Transformational Leadership and Employee Participation in Recovery Experiences.

Description Burnout is a complex organizational phenomenon that diminishes employee well-being and overall organizational productivity. Researchers propose that leadership style contributes to employees' well-being, which impacts employee productivity. Organizations and leaders must address the causes of burnout and promote techniques employees can use to mitigate burnout, such as employee participation in recovery experiences. Recovery experiences are non-work activities that create positive outlooks and restore the energy needed to focus on one's work. This literature review examines current research in employee recovery experiences, conservation of resource theory (COR), burnout, and transformational leadership theory. Studying burnout through the lens of COR shows how important resource gain and recovery activities are to healthy employees and their job performance within the organization. The research reviewed suggests that transformational and transactional leadership styles have higher probabilities of promoting employee participation in recovery experiences than passive avoidant leadership style. The literature consistently showed burnout as a significant organizational phenomenon negatively affecting productivity, employee well-being, and turnover rates. The literature revealed that mitigating burnout happens through participation in recovery experiences. The literature on leadership styles supports the assumption that leaders play a significant role in employee well-being, group identity, and organizational climate. Leaders who desire to mitigate employee burnout will benefit from research that links transformational leadership style behaviors and employee participation in recovery activities.

Burnout, Exhaustion, Experiences of Discrimination, and Stress among Underrepresented and First-Generation College Students in Graduate Health Profession Education.

OBJECTIVES: Mental health disorders are increasing among health profession students. Compounding this, students from underrepresented backgrounds may face additional stressors and challenges. The aims of this study were to: 1) assess the extent to which burnout, exhaustion, experiences of discrimination, and stress exist among students in dentistry, nursing, occupational therapy, pharmacy, and physical therapist professional education programs; 2) determine if there are significant differences by key demographic characteristics (those who are first-generation college students [FGCS], a member of an underrepresented minority [URM] group), or both); and 3) highlight strategies and solutions to alleviate these challenges identified by students. METHODS: Cross-sectional survey using a mix of question types of a sample of graduate students from dentistry, nursing, occupational therapy, pharmacy, and physical therapy programs from February to June 2020. Utilizing the Maslach Burnout Inventory Student Survey (MBI-SS) and campus climate and stress survey, mean subscale scores were calculated for the following outcomes of interest: MBI-SS burnout, dimensions of stress, and observed racism. Logistic regressions examined student factors that may help explain these outcomes. Content analysis examined participants' responses to open-ended questions. RESULTS: There were 611 individuals who completed all survey questions. FGCS were significantly more likely than non-FGCS to report exhaustion (adjusted odds ratio [AOR]: 1.50; 95% CI: 1.04-2.16), family stress (AOR: 3.11; 95% CI: 2.13-4.55), and financial stress (AOR: 1.74; 95% CI: 1.21-2.50). URM students reported not feeling supported in their program and mentioned needing additional support, particularly for well-being, from staff and faculty. CONCLUSION: Findings from this study are consistent with literature that FGCS students experience additional stressors that may lead to burnout and exhaustion. URM students reported not feeling supported in their programs. This study's findings point to the need for leadership and faculty of health professional schools to implement or strengthen current policies, practices, and strategies that support URM students and FGCS. IMPACT: Research demonstrates that a diverse student body and faculty enhances the educational experience for health professional students, and that diversity strengthens the learning environment and improves learning outcomes, preparing students to care for an increasingly diverse population. However, this study finds that students from underrepresented backgrounds may still experience more burnout, exhaustion, discrimination, and stress than their peers. Programs and policies to support URM students and FGCS throughout their academic careers can help improve graduation and retention rates, leading to improved workforce diversity.

Accounting for taste: preferences mediate the relationship between documentation time and ambulatory physician burnout.

OBJECTIVES: Physician burnout in the US has reached crisis levels, with one source identified as extensive after-hours documentation work in the electronic health record (EHR). Evidence has illustrated that physician preferences for after-hours work vary, such that after-hours work may not be universally burdensome. Our objectives were to analyze variation in preferences for after-hours documentation and assess if preferences mediate the relationship between after-hours documentation time and burnout. MATERIALS AND METHODS: We combined EHR active use data capturing physicians' hourly documentation work with survey data capturing documentation preferences and burnout. Our sample included 318 ambulatory physicians at MedStar Health. We conducted a mediation analysis to estimate if and how preferences mediated the relationship between after-hours documentation time and burnout. Our primary outcome was physician-reported burnout. We measured preferences for after-hours documentation work via a novel survey instrument (Burden Scenarios Assessment). We measured after-hours documentation time in the EHR as the total active time respondents spent documenting between 7 pm and 3 am. RESULTS: Physician preferences varied, with completing clinical documentation after clinic hours while at home the scenario rated most burdensome (52.8% of physicians), followed by dealing with prior authorization (49.5% of physicians). In mediation analyses, preferences partially mediated the relationship between after-hours documentation time and burnout. DISCUSSION: Physician preferences regarding EHR-based work play an important role in the relationship between after-hours documentation time and burnout. CONCLUSION: Studies of EHR work and burnout should incorporate preferences, and operational leaders should assess preferences to better target interventions aimed at EHR-based contributors to burnout.