West, Colin P.

Abstract Workplace stress is one of the main sources of stress for adults, although physiological and cognitive factors may impact each person's stress response. Numerous studies have shown heart rate, heart rate variability, neural activity, and cognitive performance are affected by stress. Additionally, visual and auditory stimuli in one's environment have been shown to affect individuals' reaction to stressful events. To our knowledge, few studies have examined how each of these physiological and cognitive measures relate to one's perception of stress, the ability to recover from stress, and what environmental factors may help with stress recovery. Here, 80 healthy adults performed a laboratory-controlled stress induction task where they experienced and recovered from an acute psychological stressor (Trier Social Stress Test, TSST, using verbal math skills and a public presentation that was videotaped). Throughout the assessment, heart rate, heart rate variability, and neural activity were measured using wearable devices to assess changes before, during, and after the stressor. Additionally, participants were assessed their perceived stress levels at specific times throughout the assessment. After the psychological stressor, participants were randomly assigned to one of four recovery conditions within a multisensory relaxation room: Control (C), Auditory Only (A), Visual Only (V), or Combined Auditory and Visual (AV). During the stressor, anxiety, heart rate, and beta EEG power increased and high-frequency power and heart rate variability decreased, confirming participants reactivity to the stressor ( P < 0.01 for all vs. baseline). Only the V and AV conditions led to notable reductions in anxiety (15 and 17%, respectively) vs. the C condition, but these did not reach statistical significance. There was no difference between V and AV, suggesting a stronger impact of V. We observed no differences between conditions during recovery for HR and HRV. Overall, these findings suggest the visual features of the relaxation room impacted self-reported anxiety, however physiological and neurological effects did not demonstrate a statistically meaningful response.

Abstract Purpose This study evaluates associations with suicidal ideation (SI) of impact of work on personal relationships (IWPR), self-valuation (SV), and imposter phenomenon and compares the SI point prevalence in physicians vs other workers. Method This study used American Medical Association Physician Professional Data to sample US physicians across different specialties between November 2020-March 2021. Of 7360 survey respondents, 6497 (88.3%) completed the SI question. A probability-based sample included 2508 nonphysician individuals from the US population employed at the time of survey administration, with 2501 workers (99.7%) completing the SI item. Logistic regression was used to evaluate the associations of occupational distress factors, including IWPR, SV, imposter phenomenon, and other factors, with SI before and after adjusting for depression and compare the risk of SI among physicians with other US workers. Results The study included 6497 physicians and 2501 workers in other fields. Adjusting for sex, age, relationship status, parenting status, and depression, each 1-point higher IWPR score (range, 0-10) was associated with 10% increased SI odds (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.05-1.15). Adjusting for the same variables, each 1-point higher SV score (range, 0-10) was associated with 10% lower SI odds (OR, 0.90; 95% CI, 0.85-0.95). The association between imposter phenomenon scores (range, 4-20) and SI was not statistically significant (OR, 1.03; 95% CI, 0.99-1.08). The unadjusted 1-year SI point prevalence was 6.6% (95% CI, 6.0%-7.4%) in physicians vs 5.6% (95% CI, 4.7%-6.6%) among workers in other fields (P = .09). In a multivariable model, workers in other fields with a bachelor’s or master’s degree had lower SI odds compared with physicians (OR, 0.64; 95% CI, 0.46-0.87). Conclusions IWPR and low SV are associated with SI among physicians, independent of depression. Development and evaluation of interventions designed to mitigate these factors in physicians may be warranted.

Importance Little is known about how factors external to the workplace, such as spousal support, influence physician attrition. Objectives To explore associations of spousal support among married/partnered physicians with both ‘hard’ attrition ((HA), considering leaving academic medicine within 2 years) and ‘soft’ attrition ((SA), having ever considered part-time work), before and after adjusting for demographic variables, burnout and satisfaction with work-life integration (WLI). Design This cross-sectional survey study was conducted among faculty physicians employed at Mayo Clinic. Outcomes and measures Survey items measured demographics, spousal support (five items), HA, SA, satisfaction with WLI (single-item measure) and burnout (two-item measure). Check-all-that-apply questions explored reasons for considering attrition. We investigated associations of spousal career support with attrition consideration using logistic regression analyses, adjusting for demographic variables then for WLI satisfaction and burnout. Results 739/2103 physicians responded (response rate 35.1%); 666 (90.1%) were married or partnered and responded to the HA question. 42.5% (283/666) reported considering HA and 60.9% of full-time employees (288/473) had ever considered SA. 65.5% (437/666) considered any attrition (AA). Respondents reporting more frequent spousal career support had lower odds of HA (OR 0.80, 95% CI 0.68 to 0.94, p=0.006), though this was not significant when considering AA (OR 0.85, 95% CI 0.71 to 1.01, p=0.07). Neither association was significant after adjusting for WLI satisfaction and burnout (OR 1.01, 95% CI 0.80 to 1.29, p=0.91 (HA), OR 1.10, 95% CI 0.86 to 1.37, p=0.45 (any attrition)). Conclusions While spousal support was no longer significantly associated with attrition after adjusting for WLI satisfaction and burnout, it may mitigate attrition.

Abstract Purpose Crisis periods—defined as sustained disruptions to the clinical environment resulting in increased workload, exposure to high-acuity patient care, or limited access to coping resources—can lead to posttraumatic stress disorder (PTSD) among residents and fellows (trainees). By examining self-reported pandemic-related PTSD symptoms, associated risk factors, and their consequences, this study aims to identify vulnerable groups and inform institutional strategies to support trainee well-being during and after crisis events. Method A multi-institutional cross-sectional survey was conducted at 3 U.S. academic medical centers between April and May 2022. Measures included the Primary Care PTSD Screen for DSM-5 (range 0 to 5, scores ≥4 indicate probable PTSD), 4-item PROMIS Social Isolation scale (normed T-score range 0 to 100 scale with higher scores indicating greater isolation), items exploring intent to stay at one’s institution, and demographics. Multivariable analysis adjusted for demographics, specialty, and postgraduate year. Results Of 6,057 eligible trainees, 3,185 (53%) participated in the survey, with 3,109 completing the PTSD screening. A total of 190 (6%) trainees screened positive for self-reported PTSD symptoms. Multivariable analysis revealed that female trainees had a higher odds of screening positive for self-reported PTSD symptoms compared to males (odds ratio [OR] 1.45; 95% confidence interval [CI], 1.03-2.04; P = .03). Greater social isolation was independently associated with increased PTSD risk (OR 1.09; 95% CI, 1.07-1.11; P &lt; .001). Additionally, trainees who did not intend to remain at their institution after training were more likely to screen positive for PTSD (OR 1.74; 95% CI, 1.17-2.58; P = .01). Conclusions Female gender, greater social isolation, and reduced intention to remain at one’s institution are independently associated with self-reported PTSD symptoms in trainees. Recognizing these relationships may enable health care leaders to proactively identify trainees at higher risk during crisis periods and to implement targeted, evidence-based interventions that promote well-being and workforce retention.

Abstract Purpose To evaluate the correlation between occupational burnout and depression, frequency with which they coexist, how often 1 condition may be present in the absence of the other, and their association with suicidal ideation. Method The authors conducted a secondary analysis of cross-sectional national surveys of practicing U.S. physicians (conducted October 19, 2023, to March 3, 2024) and residents/fellows (“trainees”; conducted November 30, 2023, to January 2, 2024). They measured correlation between emotional exhaustion (EE) and depersonalization (DP) scores using the Maslach Burnout Inventory and depression T-scores using the National Institutes of Health Patient Reported Outcomes Measurement Information System Depression scale. Results A total of 5993 practicing physicians and 2676 trainees were included in the analysis. The pooled R2 value between EE and depression scores for physicians and trainees was 0.42 (P &lt; .001) and between DP and depression scores was 0.28 (P &lt; .001). Among the 4087 practicing physicians with normal depression scores, 1201 (29.4%) had high EE and/or high DP. Among the 1601 trainees with normal depression scores, 485 (30.3%) had high EE and/or high DP. On multivariable logistic regression adjusting for age, gender, relationship status, and work hours, each 1-point increase in depression T-score was associated with 15% higher odds of suicidal ideation among practicing physicians (OR 1.15; 95% CI, 1.13–1.17; P &lt; .001) and trainees (OR 1.15, 95% CI, 1.13–1.17; P &lt; .001). No statistically significant association between EE or DP scores and suicidal ideation was observed. Conclusions Occupational burnout and depression are correlated but distinct constructs with distinct outcomes. Less than half the variation in burnout is explained by depression (and vice versa). Population health approaches to improve physician well-being should address both conditions. Organizational efforts should go beyond providing support for individuals experiencing distress and also address the work environment factors that contribute to it.

Introduction Sleep is routinely assessed in the management of mental health conditions. Wearable technologies like smartwatches offer a non-intrusive method to quantitatively measure sleep. However, there are limited empirical benchmarks for sleep duration and sleep quality measured by wearables against user reports. This study aims to evaluate the concordance between user-reported and smartwatch-measured hours of sleep and sleep quality. Methods Participants were recruited from two decentralized digital health well-being studies and completed a 7-day sleep diary while simultaneously wearing their smartwatch to sleep (November 7, 2023 - June 30, 2024). Participants self-reported sleep timestamps and perceived sleep quality using the Sleep Quality Scale. Sleep timestamps and quality were also derived from their smartwatches (Garmin Vívoactive 4 2019, Garmin Venu 2 Plus 2022, and Garmin Venu 3/3S 2023). Statistical analyses included paired t-tests, equipercentile linking, and chi-square tests to assess agreement between smartwatch and self-reported sleep parameters. Exploratory analyses established the difference between reported and recorded sleep duration in healthcare shift workers. Results From 841 sleep instances reported by 130 participants wearing three different generation smartwatches, the mean difference in sleep duration between smartwatch-recorded and participant-reported was 21.22 (Garmin Vívoactive), 11.67 (Garmin Venu 2 Plus), and 6.58 (Garmin Venu 3/3S) minutes, respectively. There were statistically significant between-group differences in mean sleep durations assessed by participant self-report vs. Vívoactive 4 smartwatches, but not self-report vs. Venu 2 Plus or Venu 3/3S smartwatches. Equipercentile linking revealed concordance between smartwatch sleep scores and self-reported sleep quality using the Sleep Quality Scale (SQS) between 4 and 7, with disagreements observed at the SQS ranges from 0–4 and 7-10. Conclusions These results suggest that wearables can reliably measure sleep duration, and future research warrants improvements in algorithms that estimate sleep quality with validations across different wearable vendors.

Abstract Different types of health care worker distress are often conflated. Understanding their distinctions helps customize support and encourages more exact terminology in academic discourse. While it is not necessary to diagnose a colleague to support them, it helps to have an awareness of unique struggles. This targeted support can be provided alongside universally caring approaches such as empathetic listening, encouraging professional support, maintaining confidentiality, seeking specialist advice, and destigmatizing mental health issues.

Abstract Purpose Consensus recommendations and guidelines for reporting quantitative research in health professions education (HPE) research are lacking. This study synthesizes available quantitative reporting recommendations and guidelines to present a harmonized framework and derive quantitative standards for reporting HPE research. Method The authors identified existing standards, recommendations, and guidelines from peer-reviewed scientific journals in medicine, education, and social sciences by searching PubMed, Web of Science, and Google from August 2006 through April 2025. The authors also requested input from experts in HPE (scholars and journal editors) via electronic communication over 6 months (November 2024 to April 2025). The articles identified were then used to synthesize and generate an initial list of standards for reporting quantitative research in HPE. Two authors reviewed each article to rate its alignment with HPE research. All authors independently evaluated the full list of standards and discussed them as a group for their relevance and alignment for reporting in HPE; all authors also made recommendations for each standard (to report as is, report but modify, or drop). The group subsequently reviewed and collectively reached consensus on the final set of quantitative reporting standards. Results The authors reviewed a total of 34 articles, with 19 identified as having alignment with HPE quantitative research standards. Mean interrater agreement among author pairs was 98% (kappa = .96). Authors initially generated 40 reporting standards, of which 18 (45%) were modified and 1 (3%) was identified to be dropped. The final set of quantitative guidelines consisted of 39 standards, with each standard nested in one of 28 topic areas. Conclusions The quantitative reporting standards identified in this study provide guidance to ensure rigor in reporting expectations for HPE research. These standards may also facilitate critical appraisal of articles and enhance the quality and impact of quantitative HPE research.

Importance Exploring the relationship between moral distress and occupational burnout is necessary to understand the association between these constructs. Objective To evaluate moral distress among physicians and US workers, and to explore the association of moral distress with burnout, intent to leave (ITL) current position, and intent to reduce clinical work hours (ITR). Design, Setting, and Participants This cross-sectional national survey study included physicians from all specialties and a probability-based sample of employed nonphysicians. Participants were aged 29 to 65 years. Data were collected between October 19, 2023, and March 5, 2024. Data were analyzed from June 30 to October 20, 2025. Main Outcomes and Measures Moral distress was measured using the Moral Distress Thermometer (MDT, range 0-10), with a high level of moral distress defined by a score of 4 or higher. Burnout was measured using the complete Maslach Burnout Inventory (MBI). Professional fulfillment was measured using the Stanford Professional Fulfillment Index. ITL and ITR were measured using a standardized item with response options of none, slight, moderate, likely, and definitely. Results This survey study included 5741 physicians and 3501 nonphysician US workers. The median (IQR) age of physicians was 53 (44-62), and included 3262 men (58.0%), 2255 women (40.1%), and 107 individuals who responded other (1.9%). The mean (SD) moral distress score for physicians was 3.29 (2.81), with 2243 (39.1%) reporting a high level of moral distress (4 or more considered high). On multivariable analysis, women physicians had higher odds of moral distress (OR, 1.29; 95% CI, 1.12-1.48). Compared with internal medicine subspecialists, emergency medicine physicians (OR, 3.16; 95% CI, 2.27-4.4) and general internal medicine physicians (OR, 1.92; 95% CI, 1.42-2.59) were more likely to report high levels of moral distress. Mean emotional exhaustion and depersonalization scores, as well as the proportion of physicians with burnout, were higher with each 1-point increase in moral distress score. The overall correlation between the emotional exhaustion score and moral distress score was R = 0.55 ( P &amp;lt; .001) while the correlation between the depersonalization score and moral distress score was R = 0.50 ( P &amp;lt; .001). Additionally, 1068 of 3477 physicians (30.7%) with a moral distress score less than 4 had burnout symptoms compared with 1675 of 2231 physicians (75.1%) with scores of 4 or more ( P &amp;lt; .001). The prevalence of ITL and ITR was higher for each 1-point increase in moral distress score. For example, 619 of 3404 physicians (18.2%) with low moral distress reported ITL within 24 months compared with 748 of 2171 (34.5%) among those with high moral distress ( P &amp;lt; .001). Compared with other US workers, physicians had markedly higher odds of experiencing moral distress (OR, 4.40; 95% CI, 3.84-5.06). Conclusion and Relevance In this survey study, moral distress was common among physicians and experienced at higher rates than the general US working population. Understanding the differences between moral distress and burnout may allow organizations to more effectively implement interventions to address both concerns among clinicians.