BIOMEDICAL RESEARCH POLICY COMMITTEE REPORT WAS PUBLISHED AS A SUPPLEMENT TO THE AUGUSTJOURNAL OF MEDICAL EDUCATION. A REPRINT IS ENCLOSED. REQUESTS FOR ADDITIONAL COPIES SHOULD BE ADDRESSED TO THISOFFICE. -COPIES ARE BEING SENT TO MEMBERS OF CONGRESS AND THE KEY MEMBERS OF THE ADMINISTRATION. CALLING UPON-YOUR SENATORSAND CONGRESSMEN TO TELL THE STORY OF THE ROLE. OF MEDICAL SCHOOLS IN BIOMEDICAL RESEARCH AND HEALTH CARE IS IMPORTANT.I STRONGLY URGE THAT YOU MAKE AN 411 APPOINTMENT TO SEE YOUR CONGRESSIONAL REPRESENTATIVES WHILE YOU ARE IN WASHINGTON FOR THE COUNCIL MEETINGON OCTOBER 29. UPON REQUEST WE CAN SUPPLY THE NAMES OF APPOINTMENT SECRETARIES AND PHONE NUMBERS OF YOUR SENATORS AND CONGRESSMEN. APPROPRIATIONS COMMITTEE ACTED WITH EXTRAORDINARY ALACRITY THIS YEAR. THE-NIH APPROPRIATION WAS INCREASED BY 242 MILLION DOLLARSOVER 1971, REPRESENTING A 142 MILLION DOLLAR INCREASE OVER. THE ADMINISTRATION BUDGET, THE BLUE SHEET ASCRIBES APPROPRIATIONS OUTCOME TO THE EFFECTIVENESS OF THE COALITION FOR HEALTH FUNDING UNDER THE LEADERSHIP OF JOHN A. D. COOPER.

The Association of American Medical Colleges

Maslach Burnout Inventory Manual

The outbreak of the coronavirus disease 2019 (COVID-19) and its rapid global spread have created unprecedented challenges to health care systems. Significant and sustained efforts have focused on mobilization of personal protective equipment, intensive care beds, and medical equipment, while substantially less attention has focused on preserving the psychological health of the medical workforce tasked with addressing the challenges of the pandemic. And yet, similar to battlefield conditions, health care workers are being confronted with ongoing uncertainty about resources, capacities, and risks; as well as exposure to suffering, death, and threats to their own safety. These conditions are engendering high levels of fear and anxiety in the short term, and place individuals at risk for persistent stress exposure syndromes, subclinical mental health symptoms, and professional burnout in the long term. Given the potentially wide-ranging mental health impact of COVID-19, protecting health care workers from adverse psychological effects of the pandemic is critical. Therefore, we present an overview of the potential psychological stress responses to the COVID-19 crisis in medical providers and describe preemptive resilience-promoting strategies at the organizational and personal level. We then describe a rapidly deployable Psychological Resilience Intervention founded on a peer support model (Battle Buddies) developed by the United States Army. This intervention-the product of a multidisciplinary collaboration between the Departments of Anesthesiology and Psychiatry & Behavioral Sciences at the University of Minnesota Medical Center-also incorporates evidence-informed "stress inoculation" methods developed for managing psychological stress exposure in providers deployed to disasters. Our multilevel, resource-efficient, and scalable approach places 2 key tools directly in the hands of providers: (1) a peer support Battle Buddy; and (2) a designated mental health consultant who can facilitate training in stress inoculation methods, provide additional support, or coordinate referral for external professional consultation. In parallel, we have instituted a voluntary research data-collection component that will enable us to evaluate the intervention's effectiveness while also identifying the most salient resilience factors for future iterations. It is our hope that these elements will provide guidance to other organizations seeking to protect the well-being of their medical workforce during the pandemic. Given the remarkable adaptability of human beings, we believe that, by promoting resilience, our diverse health care workforce can emerge from this monumental challenge with new skills, closer relationships, and greater confidence in the power of community.

Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the COVID-19 Pandemic.

Physician burnout is not new, but the COVID-19 pandemic is accelerating the many negative repercussions of uncertainty and inadequate support, and the consequences are being felt by patients, physicians, and healthcare systems.

https://www.ccjm.org/content/ccjom/early/2020/07/01/ccjm.87a.ccc051.full.pdf

Burnout of healthcare providers during COVID-19.

Objective: We aimed to determine the prevalence of burnout among hospital healthcare workers in Libya during the coronavirus disease (COVID-19) pandemic and civil war. Methods: A cross-sectional study was conducted from April 18 to May 2, 2020 among Libyan healthcare workers. Data on participant characteristics were collected with a specifically designed questionnaire. Burnout was assessed with the abbreviated Maslach Burnout Inventory (aMBI) comprising three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), with each sub-scale score range from 0 to 18. For EE and DP, scores of 10 to 18 were regarded as "moderate to severe burnout." PA was scored inversely, where a score ≤ 10 indicated severe burnout. Results: The study yielded a sample size of 532 participants. Of these, 357 (67.1%) reported emotional exhaustion (EE Score ≥ 10), 252 (47.4%) reported depersonalization (DP score ≥ 10), and 121 (22.7%) reported a lower sense of personal accomplishment (PA score ≤ 10). Verbal abuse was experienced by 304 participants (57.1%) and physical abuse in 93 (17.5). Gender was associated with high emotional exhaustion and high depersonalization. Being 35 years or older was associated with high depersonalization. Professional specialty was significantly associated with high emotional exhaustion and depersonalization. Fear of COVID-19 infection was associated with high emotional exhaustion and high depersonalization. Conclusion: The rising prevalence of mental disorders and inadequate availability of health services facilities during the COVID-19 pandemic and civil war demonstrated the need for healthcare policies to address the well-being of healthcare workers to decrease the risk of loss, suicide, and medical negligence.

/pdf/burnout-syndrome-among-hospital-healthcare-workers-during-4ogb9wfpmy.pdf

Burnout Syndrome Among Hospital Healthcare Workers During the COVID-19 Pandemic and Civil War: A Cross-Sectional Study

Each year more than 400 physicians take their lives, likely related to increasing depression and burnout. Burnout-a psychological syndrome featuring emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment-is a disturbingly and increasingly prevalent phenomenon in healthcare, and emergency medicine (EM) in particular. As self-care based solutions have proven unsuccessful, more system-based causes, beyond the control of the individual physicians, have been identified. Such system-based causes include limitations of the electronic health record, long work hours and substantial educational debt, all in a culture of "no mistakes allowed." Blame and isolation in the face of medical errors and poor outcomes may lead to physician emotional injury, the so-called "second victim" syndrome, which is both a contributor to and consequence of burnout. In addition, emergency physicians (EP) are also particularly affected by the intensity of clinical practice, the higher risk of litigation, and the chronic fatigue of circadian rhythm disruption. Burnout has widespread consequences, including poor quality of care, increased medical errors, patient and provider dissatisfaction, and attrition from medical practice, exacerbating the shortage and maldistribution of EPs. Burned-out physicians are unlikely to seek professional treatment and may attempt to deal with substance abuse, depression and suicidal thoughts alone. This paper reviews the scope of burnout, contributors, and consequences both for medicine in general and for EM in particular.

/pdf/burnout-drop-out-suicide-physician-loss-in-emergency-2rc912s62h.pdf

Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part I.

“Burnout” evokes images of harried, sleep-deprived, hungry physicians, overwhelmed with “paperwork,” administrative complaints of missed metrics, and pending tasks for family and patients. For the physician suffering from burnout, recovery can seem daunting or even impossible. For healthcare, burnout has been branded an epidemic, with societal and human economic and personal costs.1 This article, the first of two parts, synthesizes information on burnout—the scope of the problem, its causes and consequences—from the perspective of the emergency physician (EP). Part II will focus on wellness and seek to make recovery less daunting. 
 
Burnout: Definition and Measurement 
Burnout is a complex condition with a history in many disciplines. Based on his experiences, Freudenberger described the phenomenon of “burn-out”, subsequently defined by Maslach as a psychological syndrome with three dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment.2,3 Those who score high in “exhaustion” feel over-extended, their emotional and physical resources depleted.3 High scorers in “cynicism” (depersonalization) appear more callous or detached than would be expected for normal “coping.”3 Those lacking confidence or feeling they have achieved little work success score high in the “inefficacy” (reduced personal accomplishment) dimension.3 Overall, sufferers from burnout are frequently exhausted, diminished in their ability to care, and feel as though their work makes little difference. 
 
Maslach used these definitions to create the most frequently used assessment tool for identifying burnout, the Maslach Burnout Inventory (MBI). This tool contains 22 questions addressing the three dimensions and provides scores in each. The higher the score, the higher the burnout in that dimension.4 Rather than a dichotomous cutoff score of burnout as a diagnosis, the MBI describes a spectrum with higher scores equating to more severe symptoms and consequences.5 While the MBI has been modified and abbreviated for specific populations and ease of use, it remains proprietary. The next most common tool used in healthcare burnout research, the Oldenburg Burnout Inventory, focuses on emotional exhaustion and depersonalization/disengagement, while leaving out personal accomplishment.6 A list of burnout assessment tools appears in Appendix 1; however, readers may consider simply asking physicians if they are burned out: In one study, self-reported burnout accurately predicted meeting MBI burnout criteria 72% of the time.7

Rachel S. Gershaw

Papers

Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part I.

Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part I.

Erratum: This Article Corrects: "Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part 1"