Burn-out and relationship with the learning environment among psychiatry residents: a longitudinal study

Abstract

ObjectivesRecent research suggests that burn-out is high and appears to be rooted in system-level factors including the local learning environment (LE). While most studies on this topic have been cross-sectional, our aim was to explore the relationship between burn-out and the LE over time within psychiatry residents. We hypothesised that burn-out is a significant predictor of learner perception of overall and all subdomains of LE within residents.DesignThis was a repeated measures questionnaire study.SettingWe surveyed psychiatry residents in Singapore between January 2016 and December 2019.Primary and secondary outcome measuresThe Oldenburg Burnout Inventory and the Postgraduate Hospital Education Environment Measure (PHEEM) were used to assess burn-out and resident perception of the LE, respectively. Linear mixed modelling was used to examine changes in PHEEM scores over time while taking into account burn-out status.ParticipantsOverall, 93 residents (response rate 89.4%) took part.ResultsThe average difference between initial PHEEM total scores for residents with and without burn-out was significant (p<0.001). Burn-out status was a significant predictor of lower overall and all subdomain PHEEM scores at baseline (all p<0.001). PHEEM Teaching scores showed a significant increase over time for all residents regardless of burn-out status (p<0.05). However, PHEEM Total, Role Autonomy, Social Support scores did not change significantly over time or change significantly between residents with or without burn-out.ConclusionsPerceptions of LE among psychiatry residents at baseline are inversely associated with burn-out status. That only the Teaching subdomain score increased over time could be accounted for by the fact that it is a more tangible and visible aspect of the LE compared with perceived role autonomy or social support subdomains. Our findings underscore the importance of attending to the well-being and improving the LE of our residents so as to optimise learning during training.

Revisão de escopo da aplicação do Postgraduate Hospital Educational Environment Measure (PHEEM) na residência médica

“…Os estudos excluídos e os motivos da exclusão estão demonstrados no Quadro 1. Dessa forma, incluíram-se 36 estudos nesta revisão [6][7][8] Quando se analisaram as respostas do PHEEM, observaram-se os principais problemas: alimentação durante o plantão (20 estudos), falta de um manual informativo para os residentes (12 estudos), acomodação no plantão (dez estudos), carga horária excessiva (nove estudos), além de falta de tempo protegido para estudo, falta de feedback por parte dos preceptores e cultura de culpar o residente. Embora, em vários estudos, a baixa discriminação sexual e racial tenha sido citada como fator positivo, outros estudos realizados na Arábia Saudita 31 , em Marrocos 28 , no Paquistão 24 e na Grécia 41 revelaram a discriminação sexual e racial como um problema importante nesses países.…”

“…Papaefstathiou et al 48 demonstraram que o escore total do PHEEM se correlacionou negativamente com burnout. A percepção do ambiente educacional foi inversamente proporcional ao status de burnout em residentes de psiquiatria, no estudo de Chew et al 8 . Outros estudos revelaram correlação positiva entre bem-estar do residente e o ambiente educacional 50 , e correlação entre exaustão emocional e ambiente educacional com qualidade de vida no trabalho 51 .…”

“…O questionário PHEEM foi traduzido e validado para o português por Vieira 7 e, portanto, pode ser utilizado como método de avaliação das residências médicas no Brasil. Além disso, a monitorização longitudinal do PHEEM após alterações no ambiente da residência médica pode ser utilizada para comprovar melhorias no ambiente educacional 4,8 .…”

Scoping review of the application of the Postgraduate Hospital Educational Environment Measure (PHEEM) in medical residency

“…A scoping review was carried out in accordance with the Joanna Briggs Institute methodology for scoping reviews 8 .…”

“…The PHEEM questionnaire was translated and validated into Portuguese by Vieira 7 and, therefore, can be used as a method to evaluate medical residencies in Brazil. Furthermore, longitudinal monitoring of PHEEM after changes in the medical residency environment can be used to demonstrate improvements in the educational environment 4,8 .…”