Understanding Burnout in General Practice Registrars
Files
(Thesis)
Date
2023
Authors
Prentice, Shaun Mark Lawrence
Editors
Advisors
Dorstyn, Diana
Benson, Jill
Elliott, Taryn (Royal Australian College of General Practitioners)
Benson, Jill
Elliott, Taryn (Royal Australian College of General Practitioners)
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Thesis
Citation
Statement of Responsibility
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Abstract
Burnout in postgraduate medical trainees is prevalent, producing immense personal, professional, and societal costs. Yet, trainees’ experiences of burnout and wellbeing remain underexplored, as are the contextual circumstances contributing to burnout (e.g., specialty training). General Practice (GP) trainees, specifically, face unique work-related stressors from high clinical independence and ambiguity. The present thesis sought to clarify the constructs of burnout and wellbeing within GP trainees. A secondary aim was to use this understanding to guide burnout management and prevention interventions for this cohort. Four studies were undertaken. Study 1 comprised a systematic review and metaanalysis of 89 studies (Npooled = 18,509 postgraduate medical trainees) based on the Maslach Burnout Inventory. Trainees’ depersonalisation and personal accomplishment levels deviated more drastically from normative data compared to their emotional exhaustion levels. Subgroup analyses and meta-regressions confirmed that burnout presentation differed according to trainee specialty. Study 2 entailed a hermeneutic literature review, involving iterative qualitative analysis of 36 publications concerning Family Medicine and GP trainees. A model of trainee wellbeing was synthesised, highlighting the multifaceted, interacting personal and professional domains of wellbeing. Study 2’s analysis of proposed and implemented intervention strategies yielded insights into interpersonal (e.g., comradery) and intrapersonal intervention change mechanisms (e.g., normalising and accepting feelings of insecurity). The findings inform intervention delivery, including the importance of ingraining wellness into daily life. Studies 1 and 2 informed the design and analysis of Study 3, which involved interviews and focus groups with 47 trainees, supervisors, medical educators, and program coordinators from an Australian training organisation. Study 3 proposed a novel conceptualisation of burnout for GP trainees, describing seven dimensions: altered emotion, compromised performance, disengagement, dissatisfaction, exhaustion, feeling overwhelmed, and overexertion. Study 2’s wellbeing model was extended to acknowledge an underlying ‘wellbeing reservoir’ that fuelled personal and professional domains. This addition connected burnout and wellbeing, positing that burnout arises as a function of value unfulfillment. Study 3 also identified practical strategies for trainees, practices, and training organisations to implement, alongside broader system changes to support trainee wellbeing. Study 4 triangulated the findings from Studies 1-3 into guidelines for burnout prevention and management, and wellbeing promotion, amongst registrars. These guidelines were subjected to two rounds of stakeholder consultation within an Australian training organisation to enhance their acceptability, feasibility, and usefulness. Ultimately, 30 practical guidelines were produced for individuals, practices training services, and the broader medical system. The collective findings of these four studies offer an integrated conceptualisation of burnout and wellbeing that emphasises value fulfilment. The findings also inform the design and delivery of interventions to address GP trainee burnout. Implications for practice are discussed in the final chapter, including the formulation of burnout as a psychological presentation, and psychological strategies to enhance individual coping with work-related stressors. Future research directions are also highlighted, particularly the need to further refine and empirically test the present thesis’ findings and hypotheses. Contemporary efforts to translate these findings into practice in an Australian training organisation are described, and the strengths and limitations of the overarching thesis considered.
School/Discipline
School of Psychology
Dissertation Note
Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2023
Provenance
This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals.