Stress,burnout and job satisfaction among Indian Anaesthesiology residents

Introduction

Anaesthesiology is considered one of the stressful fields in medical practice . Anaesthesiologists work in multiple domains including peri-operative care, intensive care, pain management, emergency and trauma. They are active researchers, teachers, and bear hospital administrative responsibilities.

Burnout syndrome is chronic occupational stress affecting both physical and cognitive function. Small acute stress events occurring every day at work, can gradually lead to long-term, chronic stress. It can cause work exhaustion, sleepiness, decreased interest in work, lack of enthusiasm, low self-esteem, and increase susceptibility to illness leading to decreased work efficiency.

Continuous work in a fast-paced environment can lead to mental and physical exhaustion. Mental wellness is as important as physical well being but is often neglected. Prolonged mental stress and burnout are an important occupational hazard for health professionals. Long working hours and poor recognition can lead to job dissatisfaction .

 Aims and Objective:

To assess the prevalence of burnout, stress and job satisfaction among practicing anaesthesiology residents in India

                    Review of literature

  According to a  blinded, confidential survey by MT Kluger and J Byrant done on anaesthetic technicians in New Zealand1. At total of 154 forms were returned (51% response rate). Respondents worked predominantly in public hospitals and many had duties outside the operating room. Job satisfaction was related to teamwork, practical nature of work and patient contact, while dissatisfaction was related to lack of respect from nurses and limited career pathway. High to moderate levels of emotional exhaustion (48%), depersonalisation (39%) and low levels of personal accomplishment (58%) were indicators of burnout. The

Short Form 12 revealed high levels of physical impairment in 24% and emotional impairment in 35% of respondents. These data suggest that work is needed to evaluate anaesthetic assistants’ job structure and actively manage their important physical and emotional sequelae.

   According to an another study carried out by Annie Sheeba John and Shenthil Kumar to assess burnout in Indian Anaesthesiologists cross-sectional survey study was conducted, wherein a questionnaire was emailed to 5000 anaesthesiologists.2 There were 1238 responders, with a response rate of 24.7%. A total of 864 completed responses were considered for analysis. The prevalence of emotional exhaustion, depersonalisation, and low professional outcome among our responders was 39.5%, 65%, and 50.6%. Senior residents showed a high prevalence of burnout in all subsets compared to other designation (p < 0.001). Increased prevalence was seen in the 26–35 years age group, those working around 12 h/day, doing 7–10 night shifts per month, and perceived poor remuneration.

   According to another study carried out by MT Kluger in Australia looking at aspects of job satisfaction,dissatisfaction and stress in Anaesthesiologist.3 The response rate was 60% (422 / 700) with the majority of respondents being male (83%). Stressful aspects of anaesthesia included time constraints and interference with home life. Experienced assistants and improved work organisation helped to reduce stress. The high standard of practice and practical aspects of the job were deemed satisfying, whereas poor recognition and long hours were the major dissatisfying aspects of the job. With respect to burnout, high emotional exhaustion, high levels of depersonalisation and low levels of personal achievement were seen in20, 20 and 36% of respondents, respectively. Female anaesthetists reported higher stress levels than males (p ¼0.006), but tended to prioritise home / work commitments better than males (p ¼ 0.05). Private practitioners rated time issues of high importance compared with public hospital doctors, whereas public hospital doctors rated communication problems as being more significant than with private specialists. Although burnout levels are high in anaesthetists, they compare favourably with other medical groups. There are, however, aspects of the anaesthetist’s job that warrant further attention to improve job satisfaction and stress.

Materials and Methods:

 After obtaining institutional ethics committee of SGPGIMS approval and informed consent from the subjects, data will be conducted during the period of September 2022 to December 2023.

 Â·         Subjects would be eligible for inclusion in this study if they are:

o   Mentally and physically able to answer the questionnaire

o   Either gender with consent.

o   At least one year of experience in field of Anaesthesiology

EXCLUSION CRITERIA

 Â·         Subjects who are not giving consent for study .

 Â·         Subjects who are not able to understand our instructions.

  All subjects will be asked from a questionnaire and their answers will be recorded.

 Study design and sampling

The present hospital based cross sectional study will be conducted among residents of the anaesthesiology who have had completed at least one year experience in the anaesthesiology department. To develop the questionnaire an in-depth literature search was done. Based on the literature gathered, questions were prepared and after discussion among the experts of the Anaesthesiology, questions related to this study were finalized.

Next, the prepared questions will be evaluated by the senior faculties in the department for content validation. In case any useful suggestions are obtained from the experts, it would be incorporated in the questionnaires. The final questionnaire will be circulated among the eligible participants and the responses would be collected.

Survey tool

The questionnaire is consisted into three sections,

 Part 1: Aims to collect socio-demographic and family data

Part 2:Consists of six questions regarding stress and work satisfaction in anaesthesia.

Part 3 consists of Maslach Burnout Inventory-Human Services Survey (MBI-HSS)4consisting of a set of 22 questions divided into three subsets. The subsets are Emotional Exhaustion (EE), Depersonalization (DP), and Low Professional Outcome (LPO).

Sample size:

Based on a published study, average of the moderate to severe job satisfaction, stress or burnout was 50%. [Kluger M.T.et al,  2003]. At minimum two-sided 95% confidence interval and 6% margin of error in the given burnout, estimated sample size was 267. Finally, 300 residents to be targeted to include in the study. Sample size was estimated using software “Power analysis and sample size, version-16 (PASS-16)”.

Statistical analysis

Mean and standard deviation (SD) or median (interquartile range) will be used for continuous variables depend on normality status. Categorical variables will be presented in number (%). For independent groups, comparison between means or median will be done using independent samples t test / one-way ANOVA or its non-parametric methods. To compare the proportions chi square test / Fisher exact test will be used. Causes /factors of the stress and work satisfaction will be presented in terms of frequency (%) from most common to least common. Burnout responses will be summarised as per standard procedure of the used scale and categories in terms of their severity. Association of the demographic factor with severity of the burnout, to be assessed using multinomial logistic regression analysis. All statistical analyses will be performed using SPSS software / MedCalc with a significance level < 0.05 (two sided).