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Evidence-based approach to intensive care unit management: need for improvement

, 1 , 1

Critical Care

BioMed Central

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      Resident burnout.

      Intense work demands, limited control, and a high degree of work-home interference abound in residency training programs and should strongly predispose resident physicians to burnout as they do other health care professionals. This article reviews studies in the medical literature that address the level of burnout and associated personal and work factors, health and performance issues, and resources and interventions in residents. MEDLINE and PubMed databases were searched for peer-reviewed, English-language studies reporting primary data on burnout or dimensions of burnout among residents, published between 1983 and 2004, using combinations of the Medical Subject Heading terms burnout, professional, emotional exhaustion, cynicism, depersonalization and internship and residency, housestaff, intern, resident, or physicians in training and by examining reference lists of retrieved articles for relevant studies. A total of 15 heterogeneous articles on resident burnout were thus identified. The studies suggest that burnout levels are high among residents and may be associated with depression and problematic patient care. However, currently available data are insufficient to identify causal relationships and do not support using demographic or personality characteristics to identify at-risk residents. Moreover, given the heterogeneous nature and limitations of the available studies, as well as the importance of having rigorous data to understand and prevent resident burnout, large, prospective studies are needed.
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        High level of burnout in intensivists: prevalence and associated factors.

        Professional burnout is a psychological syndrome arising in response to chronic interpersonal stressors on the job. There is the perception that intensivists are particularly exposed to stress because lives are literally in their hands. To evaluate the prevalence and associated factors (patients or organization) of burnout among physicians working in intensive care units (ICUs) (including interns, residents, fellows, and attending physicians). A 1-day national survey was conducted in adult ICUs in French public hospitals. The level of burnout was evaluated on the basis of the Maslach Burnout Inventory (MBI). A total of 189 ICUs participated and 978 surveys were returned (82.3% response rate). A high level of burnout was identified in 46.5% of the respondents. Ordinal logistic regression showed that female sex (odds ratio, 1.58; 95% confidence interval, 1.09 to 2.30) was independently associated with a higher MBI score. Whereas no factor related to the severity of illness of patients was retained by the model, organizational factors were strongly associated with a higher MBI score. Workload (the number of night shifts per month, a long period of time from the last nonworking week, night shift the day before the survey) and impaired relationships (such as conflict with another colleague intensivist, and/or with a nurse) were the variables independently associated with a higher MBI score. In contrast, the quality of the relationships with chief nurses and nurses was associated with a lower MBI score. Approximately one-half of the intensivists presented a high level of burnout. Organizational factors, but not factors related to the patients, appeared to be associated with burnout.
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          The seven habits of highly effective people.

           S Covey (1991)
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            Author and article information

            Affiliations
            [1 ]Department of Intensive Care Medicine, Entrance 42, Level 2, Malmö University Hospital, S-20505 Malmö, Sweden
            Contributors
            Journal
            Crit Care
            Critical Care
            BioMed Central
            1364-8535
            1466-609X
            2008
            25 January 2008
            : 12
            : 1
            : 404
            2374605
            cc6763
            18254936
            10.1186/cc6763
            Copyright © 2008 BioMed Central Ltd
            Categories
            Letter

            Emergency medicine & Trauma

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