Relationship between the educational climate and the syndrome of professional exhaustion in resident physicians of the Hospital Nacional
Article Sidebar
Main Article Content
Abstract
Introduction: the postgraduate educational climate (CE) in the hospital environment can determine the way in which resident physicians (MRs) adapt to their new stage, during which professional burnout syndrome (PAS) is highly likely to occur at some point.
Objective: to determine the relationship between the educational climate and professional burnout in physicians in the medical residency programs of the National Hospital 2023-2024.
Methodology: cross-sectional observational study of a sample of MR convenience of both sexes from all medical specialties of the National Hospital between November 2023 and January 2024, MR with external rotation and/or vacations were excluded. Sample calculation; 136 MR. An online form from Google was sent to the MR email requesting voluntary participation. The SAP was measured with the standard Maslach Burnout Inventory (MBI) method with subscales; emotional exhaustion (EA), depersonalization (DESP), personal fulfillment (PR), with PAS with high scores of AE, DESP and low RP. The EC was assessed with the measure of the hospital postgraduate educational environment (PHEEM) with subscales; perception of role autonomy (PAR), perception of teaching (PE), perception of social support (PSS), the higher the score, the better the EC. Demographic and academic variables, MBI and PHEEM scores were collected, and the SAP was considered dependent, as the main result was the predictive relationship of the PHEEM on the SAP. Data were compared with χ², t-test or Mann-Whitney U, ANOVA and linear regression (p-significant value = 0.05).
Results: of 233 participants, the mean age was 28.75 (±2.20), 63.94 % (149) women, the general prevalence of PAS; 70.38 % (164/233), PAS in men 75 % (63/84) and women 67.78 % (101/149) p=0.0014, the first 2 years with the highest frequency of PAS; 65 (85.52 %), 59 (86.76 %) respectively p=0.0009, 63 (90 %) p=0.0071 surgical specialties. The subscales of the MBI, the AE; 79.82 % (186) with an average of 35.39 (± 11.61) points. The CE of MRs with SAP; 107.9 (19.6) dots and without PAS; 136.3 (12.1) dots 95 % CI 18.1– 5.0 p= 0.0001. The PHEEM predicted the AE with R2=0.619,
B= -0.18 (±0.009) p=0.001, and the DESP; R2= 0.385, B= -0.001(0.004) p=0.009, PSS being a
significant predictor with inverse correlation in both.
Conclusion: there is an inverse relationship between the educational climate and burnout syndrome
in the population studied, with a high prevalence of burnout in male residents of surgical specialties,
with the social support of the hospital educational environment being a significant predictor for the
development of burnout syndrome.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Paraguay. Ministerio de Salud Pública y Bienestar Social. Resolución S.G. N° 557 por la cual se aprueba el Reglamento General del Concurso para el ingreso a la Residencias Médicas – CONAREM, para el ejercicio fiscal 2023; y se abroga el Reglamento aprobado por la Resolución S.G. N° 013, de fecha 19 de enero de 2022. Disponible en: https://www.ins.gov.py/resolucion-s-g-n-557-22-reglamento-general-del-concurso-para-el-ingresoa-la-residencias-medicas/
Navinés R, Olivé V, Fonseca F, Martín-Santos R. Estrés laboral y burnout en los médicos residentes, antes y durante la pandemia por COVID-19: una puesta al día. Med Clin (Barc). 2021;157(3):130-40. doi: 10.1016/j.medcli.2021.04.003
Sigal AR, Costabel JP, Burgos LM, Alves De Lima A. Burnout y resiliencia en residentes de cardiología y cardiólogos realizando subespecialidades. MEDICINA (Buenos Aires). 2020; 80(2):138-142. Disponible en: https://www.medicinabuenosaires.com/revistas/vol80-20/n2/138.pdf
Llera J, Durante E. Correlación entre el clima educacional y el síndrome de desgaste profesional en los programas de residencia de un hospital universitario. Arch. argent. pediatr. 2014;112(1):6-11. doi.org/10.5546/aap.2014.e6.
Galli A, Brissón ME, Soler C, Lapresa S, Alves De Lima A. Evaluación del ambiente educacional en residencias de cardiología. Rev Argent Cardiol. 2014;82(5):396-401. Disponible en: https://www.scielo.org.ar/pdf/rac/v82n5/v82n5a08.pdf
Soemantri D, Herrera C, Riquelme A. Measuring the educational environment in health professions studies: a systematic review. Med Teach. 2010;32(12):947-52. doi: 10.3109/01421591003686229.
Neculpán LA, Bruno MA. Burnout (síndrome de desgaste profesional) en médicos residentes de anestesiología y su relación con la percepción del clima educacional. Rev Argent Anestesiol. 2018;76(2). doi: 10.24875/RAA.18000021
Real Delor RE, Saucedo Ayala A. Maltrato a residentes de medicina del Paraguay en 2022: estudio multicéntrico. Rev Fac Cienc Médicas Córdoba [Internet]. 2023;80(2):112-8. Disponible en: https://revistas.unc.edu.ar/index.php/med/article/view/40440
Ríos-González CM, Ortiz D, Sánchez Romero N, Palacios-González JM. Validación de la Medida de Entorno Educativo Hospitalario de Postgrado (PHEEM) en médicos residentes de Paraguay, 2019. Rev. salud publica Parag. 2023;13(2). doi: 10.18004/rspp.2023.agost.02
Maslach C, Jackson SE. The measurement of experienced burnout. J Organ Behav [Internet]. 1981;2(2):99-113. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/job.4030020205
Roff S, McAleer S, Skinner A. Development and validation of an instrument to measure thep ostgraduate clinical learning and teaching educational environment for hospital-based junior doctors in the UK. Med Teach. 2005;27(4):326-31. doi: 10.1080/01421590500150874
Clapham M, Wall D, Batchelor A. Educational environment in intensive care medicine—use Hospital Educational Environment Measure (PHEEM). Med Teach 2007;29(6):e184-91. doi: 10.1080/01421590701288580.
Riquelme A, Herrera C, Aranis C, Oporto J, Padilla O. Psychometric analyses and internal consistency of the PHEEM questionnaire to measure the clinical learning environment in the clerkship of a Medical School in Chile. Med Teach. 2009 31(6):e221-5. doi: 10.1080/01421590902866226.
Koutsogiannou P, Dimoliatis ID, Mavridis D, Bellos S, Karathanos V, Jelastopulu E. Validation of the Postgraduate Hospital Educational Environment Measure (PHEEM) in a sample of 731 Greek residents. BMC Res Notes. 2015;8:734. doi:
1186/s13104-015-1720-9
Rodríguez H, Cobucci R, Oliveira A, Cabral JV, Medeiros L, Gurgel K, et al. Burnout syndrome among medical residents: a systematic review and meta-analysis. PLoS One. 2018;13(11):e0206840. doi: 10.1371/journal.pone.0206840.
Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443-51. doi: 0.1097/ACM.0000000000000134.
Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 2020;323(21):2133-2134. doi: 10.1001/jama.2020.5893.
West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018;283(6):516-529. doi: 10.1111/joim.12752
Taylor SE. Adjustment to threatening events: a theory of cognitive adaptation. Am Psychol. 1983;38(11):1161-1173. doi: 10.1037/0003-066X.38.11.1161
Pulcrano M, Evans SR, Sosin M. Quality of life and Burnout rates across surgical specialties: a systematic review. JAMA Surg. 2016;151(10):970-978. doi: 10.1001/jamasurg.2016.1647.
Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463-71. doi: 10.1097/SLA.0b013e3181ac4dfd.
Bakker AB, Demerouti E. Job demands-resources theory: taking stock and looking forward. J Occup Health Psychol. 2017;22(3):273-285. doi: 10.1037/ocp0000056.
O'Rourke P, Tackett S, Chacko K, Knaus SJ, Shalaby M, Fluker SA, et al. Factors Influencing. Primary Care Career Choice: A Multi-Institutional Cross-sectional Survey of Internal Medicine Primary Care Residency Graduates. J Gen Intern Med. 2024. doi: 10.1007/s11606-024-08846-z.
Zhang Y, Feng X. The relationship between job satisfaction, burnout, and turnover intention among physicians from urban state-owned medical institutions in Hubei, China: a cross-sectional study. BMC Health Serv Res. 2011;11:235. doi: 10.1186/1472-6963-11-235.
Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98(2):310-57. doi: 10.1037/0033-2909.98.2.310
Swami MK, Mathur DM, Pushp BK. Emotional intelligence, perceived stress and burnout among resident doctors: an assessment of the relationship. Natl Med J India. 2013;26(4):210-3.
Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68-78. doi: 10.1037//0003-066x.55.1.68
Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103-11. doi: 10.1002/wps.20311.
Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E, Chew-Graham C, et al. association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA Intern Med. 2018;178(10):1317-1331. doi: 10.1001/jamainternmed.2018.3713. Retraction in: JAMA Intern Med. 2020;180(7):931. doi:
1001/jamainternmed.2020.1755. Erratum in: JAMA Intern Med. 2019;179(4):596. doi: 10.1001/jamainternmed.2019.0155.
Chopra V, Arora VM, Saint S. Will You Be My Mentor?-Four Archetypes to Help Mentees Succeed in Academic Medicine. JAMA Intern Med. 2018;178(2):175-176. doi: 10.1001/jamainternmed.2017.6537.
Trockel M, Bohman B, Lesure E, Hamidi MS, Welle D, Roberts L, et al. A brief instrument to assess both burnout and professional fulfillment in physicians: reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians. Acad Psychiatry. 2018;42(1):11-24. doi: 10.1007/s40596-017-0849-3.
Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ,…et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284-93. doi: 10.1001/jama.2009.1384