Summary thesis
Medical residency is a demanding and
challenging period, and burnout is highly prevalent in medical residents. In
the Netherlands, approximately one fifth of medical residents have moderate to
severe burnout symptoms. Although burnout has significant effects on the health
of the individual and on his or her job performance, research on interventions
to prevent or reduce burnout in medical residents is limited. Over the last few
years, mindfulness-based interventions (MBIs), such as Mindfulness-Based Stress
Reduction (MBSR) have been reported to be helpful in decreasing burnout and
promoting wellbeing in healthcare professionals. However, hardly any evidence
is available on the effectiveness of MBSR in medical residents. The primary aim
of this thesis was to examine the effectiveness of MBSR in reducing burnout in
medical residents. The following four research questions were addressed:
1)
What
are potential contributing factors of burnout and work engagement in medical
residents?
In chapter 2 we focused on the potential
predictors of burnout in medical residents. We examined the associations of job
demands and resources, home demands and resources, and work–home interferences
with burnout in male and female medical residents. The study population
consisted of a nation-wide sample of medical residents. Path analysis was used
to examine the associations between job and home characteristics and work–home
interference and burnout in both males and females. In total, 2115 (41.1%)
residents completed the questionnaire. In both sexes emotional demands at work
and the interference between work and home were important contributing factors
of burnout. Opportunities for job development appeared to be an important
protective factor. Other contributing and protective factors were different for
male and female residents. In females, social support from family or partner
seemed protective against burnout. In males, social support from colleagues and participation in decision-making at
work seemed important. This study implied that effectively handling emotional
demands at work, dealing with the interference between work and home, and having
opportunities for job development are essential factors that should be
addressed when developing interventions to prevent or reduce burnout in medical
residents. However, it is important to take gender differences into
consideration when implementing preventive or therapeutic interventions for
burnout in medical residents.
While chapter 2 focused on burnout, chapter 3
focused on work engagement in medical residents. In this chapter, the results
of a study on the potential predictors of work engagement in the same
cross-sectional sample are described. Path analysis was used to examine the
associations between the potential predictors and work engagement. Important
positive contributing factors of work engagement were opportunities for job
development, mental demands at work, positive work[1]home
interference and positive home-work interference. Emotional demands at work and
negative home-work interference were negatively associated with work engagement
and seem to hinder work engagement. The influence of these factors on work
engagement was similar in male and female residents. This study implied that
opportunities for job development, having challenging work, dealing effectively
with emotional demands and home-work interference are of high relevance in
enhancing work engagement.
2)
What
is the feasibility and effectiveness of MBSR in physicians?
Chapter 4 described the results of a mixed
methods pilot study of MBSR in general practitioners (GPs). MBSR is an 8-week
group-based intervention, including mindfulness practices and teachings on
stress. This study was conducted in order to gain insight into the feasibility
and effects of MBSR on burnout, empathy, and (work-related) wellbeing in GPs. A
waiting list-controlled pre-/post-study and a qualitative study were conducted.
Fifty Dutch GPs participated in this study. The MBSR group reported greater
improvements in depersonalization (burnout), dedication (work engagement) and
mindfulness skills compared with the control group. There was no change in
empathy. The qualitative data indicated that the MBSR course increased their
wellbeing and compassion towards themselves and others, including their
patients. The study indicated that MBSR for GPs is feasible and might result in
fewer burnout symptoms and increased work engagement and wellbeing. However, an
adequately powered randomized controlled trial is needed to confirm these
findings. 128
3)
What
is the effectiveness of MBSR in reducing burnout in medical residents?
In Chapter 5 the outcomes of the randomized
controlled trial (RCT) of Mindfulness-Based Stress Reduction (MBSR) in medical
residents are reported. In total, 148 medical residents participated in the RCT
comparing MBSR with a waitlist-control group. In contrast to our expectations,
no significant difference was found between the two groups on the primary
outcome, emotional exhaustion (burnout). However, exploratory moderation
analysis showed that the intervention outcome was moderated by baseline
severity of emotional exhaustion; those with more emotional exhaustion at
baseline did seem to benefit. Furthermore, the MBSR group did report
significantly greater improvements compared to the control group in reduced
personal accomplishment, worry, mindfulness skills, self-compassion and
perspective taking (empathy). To conclude, this RCT suggested that although
MBSR did not result in a significant reduction of emotional exhaustion in the
whole group, residents with high baseline levels of emotional exhaustion seemed
to benefit from the intervention. This indicates the potential of MBSR as a
burnout intervention for residents. Our findings also indicate that MBSR might
be beneficial for medical residents in terms of wellbeing more generally and
therefore could have a valuable place in medical residency programs. However,
our findings are preliminary and should be interpreted with care. More research
is needed in order to confirm these findings. 4) How does MBSR influence the
professional development of medical residents?
Chapter 6 described the results of a
qualitative study in which we explored how MBSR influences medical residents’
professional development. In-depth, face-to-face interviews were conducted with
19 medical residents. The constant comparison method was used to analyze the
data. The analysis of the data resulted in five themes: (1) awareness of
thoughts, emotions, bodily sensations and behavior; (2) increased
self-reflection; (3) acceptance and non-judgment; (4) increased resilience; and
(5) relating to others. Medical residents indicated that the MBSR training
increased their awareness and self-reflection at work and that they were more
accepting towards themselves and towards their limitations. Furthermore, they
mentioned that they were more resilient (the competence to cope and adapt in
the face of adversity and to bounce back when stressors become overwhelming) and better at setting priorities and
limits. They improved their self-care and work-life balance. In addition,
residents indicated that the training made them more aware of how they
communicated. They asked for help more often and they seemed to be more open
towards feedback. Finally, they indicated an increased sense of compassion for
others. This study indicated that mindfulness training can serve as a tool to cultivate
important professional competencies for medical residents.
Click on this link to access the thesis.