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James Appleyard


Objectives: To reflect on the present international culture of professional burnout
in health care systems and the need for a radical new approach with an increased
understanding of a person- and people-centered attitudes in the promotion of
training in wellbeing and the prevention and management of burnout among
physicians and health care professionals
Methods: A literature search worldwide was undertaken for significant research
papers on professional education related to burnout with particular reference to
both medical staff resilience and health care system factors.
Findings: Burnout among doctors is a global phenomenon. The incidence of
burnout reported in a selection of studies among pediatric residents and staff are
25% in Argentina, 37% in the United Kingdom, and 70% in Saudi Arabia. In a
national survey in the United States where the overall rate was 59% burned out
residents reported significantly increased stress, poorer mental health, and
decreased empathy, mindfulness, resilience, self-compassion, and confidence in
providing compassionate care Three levels of change that should be the focus of
training in prevention, health promotion, and stress reduction awareness have been
recommended to reduce the risk of burnout: (1) modifying the organizational
structure and work processes; (2) improving the fit between the organization and
the individual doctor through professional development programs so that better
adaption to the work environment occurs; and (3) individual-level actions to reduce
stress and poor health symptoms through effective coping and promoting healthy
Discussion: The history of burnout shows important links with increased work
complexity. Narrow training interventions such as debriefing after an adverse
clinical event have not been found effective. A more comprehensive personcentered
approach with a variety of measurable interventions has resulted in a
reduction of 50% in the pediatric faculty in one study. A person- and
people-centered cybernetic approach is needed with six standards are to establish
and sustain a healthy work environment (1) authentic leadership (2) meaningful
recognition, (3) skilled communication, (4) true collaboration, (5) effective
decision making, and (6) appropriate staffing.
Conclusion: With such high levels of burnout, health systems worldwide can be
viewed as failing their populations on a grand scale. Only an organizational
paradigm change to a person- and people cybernetic centered system that
incorporates complexity is adaptive and integrative will a health system be
effective in preventing and ameliorating the effects of burnout and reduce the
increasingly unaffordable misuse of human resources.

Article Details

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Author Biography

James Appleyard, President, International Association of Medical College

President, International Association of Medical Colleges; Former Consultant Pediatrician, Kent and Canterbury Hospital, Canterbury, Kent CT1, UK