Assessment of burnout prevention and wellness programs for US-based neurosurgical faculty and residents: a systematic review of the literature

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  • 1 School of Medicine, University of Texas at San Antonio, Texas;
  • 2 School of Medicine, Case Western Reserve University, Cleveland, Ohio;
  • 3 Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio;
  • 4 Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;
  • 5 Department of Neurosurgery, UT Health San Antonio, Texas; and
  • 6 Department of Neurosurgery, Rochester Regional Health and University of Rochester Medical Center, Rochester, New York
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OBJECTIVE

Neurosurgeon burnout is a serious and prevalent issue that has been shown to impact professionalism, physician health, and patient outcomes. Interventions targeting physician burnout primarily focus on improving physician wellness. Many academic neurosurgery programs have established wellness curricula to combat burnout and improve wellness. No official recommendations exist for establishing a wellness program that effectively targets sources of burnout. The aim of this review was to examine measures of burnout and report objective results of wellness interventions for neurosurgical faculty and residents.

METHODS

Two systematic literature reviews were performed in parallel, in accordance with PRISMA 2009 guidelines. Following removal of duplicates, a query of PubMed/MEDLINE, Scopus, Ovid, Cochrane, and EMBASE databases yielded 134 resident-related articles and 208 faculty-related articles for abstract screening. After abstract screening, 17 articles with a primary focus of resident wellness and 10 with a focus on faculty wellness met criteria for full-text screening. Of the total 27 screened articles, 9 (6 resident, 2 faculty, 1 both resident and faculty) met criteria and were included in the final analysis. Article quality was assessed using the Joanna Briggs Institute critical appraisal tools for cohort studies.

RESULTS

Included studies reported burnout rates for neurosurgery residents of 30%–67%. Work-life imbalance, imbalance of duties, inadequate operative exposure, and hostile faculty were contributors to burnout. The 2 included studies reported burnout rates for neurosurgery faculty members of 27% and 56.7%. Psychosocial stressors, relational stressors, and financial uncertainty were generally associated with increased feelings of burnout. Of the 4 studies reporting on outcomes of wellness initiatives included in this review, 3 reported a positive impact of the wellness interventions and 1 study reported no significant improvement after implementing a wellness initiative.

CONCLUSIONS

Burnout among neurosurgical faculty and residents is prevalent and permeates the daily lives of neurosurgeons, negatively affecting patient outcomes, career satisfaction, and quality of life. Many neurosurgery programs have instituted wellness programs to combat burnout, but few have published evidence of improvement after implementation. While studies have shown that residents and faculty recognize the importance of wellness and look favorably on such initiatives, very few studies have reported objective outcomes.

ABBREVIATIONS ACS = American College of Surgeons; GAD-7 = Generalized Anxiety Disorder 7-Item scale; JBI = Joanna Briggs Institute; MBI = Maslach Burnout Inventory; MSPSS = Multidimensional Scale of Perceived Social Support; PCP = primary care physician; PGY = postgraduate year; PHQ-8 = Personal Health Questionnaire depression scale.

Supplementary Materials

    • Supplemental Table 1 (PDF 444 KB)

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Contributor Notes

Correspondence James Wright: University Hospitals Cleveland Medical Center, Cleveland, OH. jmonroewright@gmail.com.

L.B. and C.G. contributed equally to this work.

INCLUDE WHEN CITING Published online October 30, 2020; DOI: 10.3171/2020.6.JNS201531.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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