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      The global level of harm among surgical professionals during the COVID-19 pandemic: A multinational cross-sectional cohort study

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          Abstract

          Background

          Health care workers, including surgical professionals, experienced psychological burnout and physical harm during the coronavirus 2019 pandemic. This global survey investigated the coronavirus 2019 pandemic impact on psychological and physical health.

          Methods

          We conducted a global cross-sectional survey between February 18, 2021 and March 13, 2021. The primary outcome was to assess the psychological burnout, fulfillment, and self-reported physical level of harm. A validated Stanford Professional Fulfilment Index score with a self-reported physical level of harm was employed. We used a practical overall composite level of harm score to calculate the level of harm gradient 1–4, combining psychological burnout with self-reported physical level of harm score.

          Results

          A total of 545 participants from 66 countries participated. The final analysis included 520 (95.4%) surgical professionals barring medical students. Most of the participants (81.3%) were professionally unfulfilled. The psychological burnout was evident in 57.7% and was significantly common in those <50 years ( P = .002) and those working in the public sector ( P = .005). Approximately 41.7% of respondents showed changes in the physical health with self-remedy and no impact on work, whereas 14.9% reported changes to their physical health with <2 weeks off work, and 10.1% reported changes in physical health requiring >2 weeks off work. Severe harm (level of harm 4) was detected in 10.6%, whereas moderate harm (level of harm 3) affected 40.2% of the participants. Low and no harm (level of harm 2 and level of harm 1) represented 27.5% and 21.7%, respectively.

          Conclusion

          Our study showed that high levels of psychological burnout, professional unfulfillment, work exhaustion, and severe level of harm was more frequent in younger professionals working in the public sector. The findings correlated with a high level of harm in surgical professionals impacting surgical services.

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          Most cited references10

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          Burnout and career satisfaction among American surgeons.

          To determine the incidence of burnout among American surgeons and evaluate personal and professional characteristics associated with surgeon burnout. : Burnout is a syndrome of emotional exhaustion and depersonalization that leads to decreased effectiveness at work. A limited amount of information exists about the relationship between specific demographic and practice characteristics with burnout among American surgeons. Members of the American College of Surgeons (ACS) were sent an anonymous, cross-sectional survey in June 2008. The survey evaluated demographic variables, practice characteristics, career satisfaction, burnout, and quality of life (QOL). Burnout and QOL were measured using validated instruments. Of the approximately 24,922 surgeons sampled, 7905 (32%) returned surveys. Responders had been in practice 18 years, worked 60 hours per week, and were on call 2 nights/wk (median values). Overall, 40% of responding surgeons were burned out, 30% screened positive for symptoms of depression, and 28% had a mental QOL score >1/2 standard deviation below the population norm. Factors independently associated with burnout included younger age, having children, area of specialization, number of nights on call per week, hours worked per week, and having compensation determined entirely based on billing. Only 36% of surgeons felt their work schedule left enough time for personal/family life and only 51% would recommend their children pursue a career as a physician/surgeon. Burnout is common among American surgeons and is the single greatest predictor of surgeons' satisfaction with career and specialty choice. Additional research is needed to identify individual, organizational, and societal interventions that preserve and promote the mental health of American surgeons.
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            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

            Objective The objective of this study was to evaluate the performance of the Professional Fulfillment Index (PFI), a 16-item instrument to assess physicians’ professional fulfillment and burnout, designed for sensitivity to change attributable to interventions or other factors affecting physician well-being. Methods A sample of 250 physicians completed the PFI, a measure of self-reported medical errors, and previously validated measures including the Maslach Burnout Inventory (MBI), a one-item burnout measure, the World Health Organization’s abbreviated quality of life assessment (WHOQOL-BREF), and PROMIS short-form depression, anxiety, and sleep-related impairment scales. Between 2 and 3 weeks later, 227 (91%) repeated the PFI and the sleep-related impairment scale. Results Principal components analysis justified PFI subscales for professional fulfillment, work exhaustion, and interpersonal disengagement. Test-retest reliability estimates were 0.82 for professional fulfillment (α = 0.91), 0.80 for work exhaustion (α = 0.86), 0.71 for interpersonal disengagement (α = 0.92), and 0.80 for overall burnout (α = 0.92). PFI burnout measures correlated highly (r ≥ 0.50) with their closest related MBI equivalents. Cohen’s d effect size differences in self-reported medical errors for high versus low burnout classified using the PFI and the MBI were 0.55 and 0.44, respectively. PFI scales correlated in expected directions with sleep-related impairment, depression, anxiety, and WHOQOL-BREF scores. PFI scales demonstrated sufficient sensitivity to detect expected effects of a two-point (range 8–40) change in sleep-related impairment. Conclusions PFI scales have good performance characteristics including sensitivity to change and offer a novel contribution by assessing professional fulfillment in addition to burnout.
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              Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences.

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                Author and article information

                Journal
                Surgery
                Surgery
                Surgery
                Elsevier Inc.
                0039-6060
                1532-7361
                11 March 2022
                11 March 2022
                Affiliations
                [a ]Department of Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
                [b ]Department of Surgery, National Cancer Institute, Cairo University, Egypt
                [c ]Department of Surgery, The James Cook University Hospital, Middlesbrough, UK
                [d ]STMU Shifa College of Medicine, Islamabad, Pakistan
                [e ]Department of General and Digestive Surgery, Complejo Asistencial Universitario de León, Spain
                [f ]Department of Surgery, University Hospital North Midlands, Stoke-on-Trent, UK
                [g ]Department of Surgery, Whittington Health NHS Trust, London, UK
                [h ]Department of Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
                [i ]Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
                [j ]Department of Surgery, University Hospital Bielefeld, Germany
                [k ]Department of Surgery, Barking Havering and Redbridge University Hospital NHS Trust, Romford, UK
                [l ]Department of Surgery, Istanbul Medeniyet University, Turkey
                [m ]Department of Surgery, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
                Author notes
                []Reprint requests: Yirupaiahgari K.S Viswanath, MS, FRCS, South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Marton Road, Middlesbrough, Cleveland TS43BW, UK.
                Article
                S0039-6060(22)00071-X
                10.1016/j.surg.2022.01.039
                8916612
                35287957
                e0abf274-67af-4a1f-b6f0-ab0a1bf9c58a
                © 2022 Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 27 January 2022
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