january 2022

Burnout in European Paediatric Training   

THE SITUATION

Despite the opportunities afforded by a career in paediatrics, there are significant problems around recruitment to, and retention in the specialty. Across the UK and Europe, paediatric trainees have identified difficulties of increased workload, poor working conditions and burnout. The Royal College of Paediatrics and Child Health (RCPCH) Workforce Census (2019) showed that 12.5% of new ST1 (first year trainee) posts went unfilled in 2018 and showed a vacancy rate of 11.1% on junior rotas and 14.6% on middle grade rotas. 84% of respondents said that rota gaps and training posts posed a risk to patients or the service (RCPCH, 2019b). These difficulties may have been compounded further through COVID-19.

Burnout refers to a syndrome of chronic workplace stress, resulting in exhaustion, cynicism towards the job and reduced professional efficacy (WHO, 2019).

Burnout has been associated with physician ill-health (Salvagioni et al., 2017) and dissatisfaction at work (Demir et al., 2003), as well as negative impacts on patient safety and on a systems level (Wise, 2018), (Shanafelt et al., 2002). Covid-19 may have increased physician burnout (Morgantini et al., 2020), (Duarte et al., 2020), (GMC, 2020). Hence, a better understanding of factors influencing burnout among paediatric trainees may inform ways of better supporting the wellbeing of these doctors and maintaining a sustainable paediatric workforce.

STUDY AIMS

The aims of this study were to establish the prevalence of burnout in European paediatric trainees, to identify associated and contributing factors and to review the impact of COVID-19 on burnout.

METHODS

Survey methodology was used. A survey was disseminated via the Young European Academy of Paediatrics (YEAP) network to paediatric trainees across 25 European countries using SurveyMonkey. Demographic data was collected, and burnout was assessed using the Copenhagen Burnout Inventory (CBI). Trainees were asked what factors they felt were associated with burnout, whether they felt burnt-out pre COVID-19, whether COVID-19 increased their burnout, and whether it impacted training. Prevalence of burnout was calculated. A regression analysis was performed on potential factors associated with burnout . A content analysis was performed on the free text responses around factors identified by trainees and the impact of COVID-19 on burnout and training.

RESULTS

Trainees responded from 11 countries (205). The prevalence of burnout was as follows: 60% (124/205) of respondents scored as burnt-out in the personal burnout category, 43% (88/205) in the work-related category and 15% (30/205) in the patient related category. 39% of trainees had considered quitting paediatric training since entering the programme. Feeling burnt-out was associated with scoring as burnt-out in one or more CBI categories. Associations were found between lack of flexibility in the training programme, working more than 40 hours per week and 24-hour oncall. Content analysis highlighted excessive administrative work, need for additional work outside of the training programme and bullying and harassment, all of which contributed to burnout. COVID-19 increased trainees’ feelings of burnout and had impacted on training for 73% of trainees.

Discussion and Recommendations

Burnout remains a significant issue within paediatric training. COVID-19 has exacerbated this. This study found significant associations between burnout and lack of flexibility in training, working more than 40 hours per week and 24-hour oncalls. Themes also centred around excessive administrative work, need for additional work outside of working hours and bullying and harassment. Limitations of the study included variable responses from countries and therefore being unable to compare burnout rates and associated factors, and self-selection sampling may have led to bias as only respondents with strong feelings may have responded. Targets for intervention include the structure of training, content of work and work environment. Limiting hours to 40 hours or fewer per week and moving from 24 hour oncall to a shift system may help to reduce burnout. However, there has been an increase in burnout and stress related issues despite a move towards hours compliant with the European Working Time Directive and shift systems rather than 24 hour oncalls. One explanation may be that the content of the work drives burnout rather than the number of hours worked – working more hours may be associated with burnout due to increased exposure to difficult working conditions. Increasing flexibility in training may protect against burnout. A further study specifically exploring where flexibility is lacking and how trainees would like flexibility to improve may be beneficial. Addressing these factors may mitigate risks and promote a sustainable and healthy workforce.

REFERENCES

1. Demir, A., Ulusoy, M. and Ulusoy, M.F. (2003) ‘Investigation of factors influencing burnout levels in the professional and private lives of nurses’, International Journal of Nursing Studies, 40(8), pp. 807-827.
2. Duarte, I., Teixeira, A., Castro, L., Marina, S., Ribeiro, C., Jácome, C., Martins, V., Ribeiro-Vaz, I., Pinheiro, H.C., Silva, A.R., Ricou, M., Sousa, B., Alves, C., Oliveira, A., Silva, P., Nunes, R. and Serrão, C. (2020) ‘Burnout among Portuguese healthcare workers during the COVID-19 pandemic’, BMC Public Health, 20(1), p. 1885.
3. GMC (2020) National Training Survey Summary Report.
4. Morgantini, L.A., Naha, U., Wang, H., Francavilla, S., Acar, Ö., Flores, J.M., Crivellaro, S., Moreira, D., Abern, M., Eklund, M., Vigneswaran, H.T. and Weine, S.M. (2020) ‘Factors contributing to healthcare professional burnout during the COVID-19 pandemic: A rapid turnaround global survey’, PLOS ONE, 15(9), p. e0238217.
5. RCPCH (2019b) Workforce census: UK overview report (2019). [Online]. Available at: https://www.rcpch.ac.uk/resources/workforce-census-uk-overview-report-2019#_-recruit-and-train-more-paediatricians. 
6. Salvagioni, D.A.J., Melanda, F.N., Mesas, A.E., González, A.D., Gabani, F.L. and Andrade, S.M.d. (2017) ‘Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies’, PloS one, 12(10), pp. e0185781-e0185781.
7. Shanafelt, T.D., Bradley, K.A., Wipf, J.E. and Back, A.L. (2002) ‘Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program’, Annals of Internal Medicine, 136(5), pp. 358-367
8. WHO (2019) Burn-out an “occupational phenomenon”: International Classification of Diseases. Available at: https://www.who.int/mental_health/evidence/burn-out/en/. 
9. Wise, J. (2018) ‘Burnout linked to suboptimal patient care, study finds’, BMJ, 362, p. k3771.

About the authors:

Sian Copley is the Young EAP Secretary and UK representative and a 7th year paediatric resident

Reviewed by:

Rob Ross Russell is the Director of Medical Studies at Peterhouse, University of Cambrigde. He is also the current Chair of the European Board of Paediatrics. Rob works at Addenbrooke’s Hospital in Cambridge, where he has been a consultant in Paediatric Intensive Care and Paediatric Respiratory Medicine.