The high prevalence of burnout in medical education indicates an urgent need to develop and implement effective interventions at both the individual and organisational levels. Currently, there is a shortage of studies that include perspectives from multiple stakeholders, such as medical students, trainees and university staff. Our objective is to identify and discuss interventions from various stakeholders using a bottom-up approach to guide future implementation. A co-creation methodology was adopted, including workshops and a Delphi session, engaging 96 participants. The study included 12 workshops with medical students and trainees in Flanders (Belgium): first-year bachelor students (n = 12), first-year master students (n = 13), first-year General Practice (GP) trainees (n = 14) and first-year specialist trainees (n = 39). Additionally, one Delphi session was held with 18 other relevant stakeholders, including university staff. All workshops were transcribed verbatim and thematically analysed using NVivo. Our results identified interventions to prevent and mitigate burnout among medical students and trainees. On the individual level, participants discussed personalized coaching, annual health assessments and training sessions. On the organisational level, a distinction was made between interventions intended for universities, and those for hospitals and GPs involved in medical training. Six interventions focused on preventing burnout in all contexts (i.e., onboarding programs); three were meant for universities only (i.e., pass-fail system), and six were tailored for hospitals and GPs (i.e., flexibility in scheduling). Through an iterative multistakeholder co-creation process, this study identified interventions to prevent and mitigate burnout within medical education. These interventions span individual and organisational levels, targeting universities, hospitals and GPs. While organisational interventions are increasingly recognized as crucial to address burnout, individual-focused interventions remain predominant in current research. There is a pressing need to further investigate organisational interventions and their combination with individual-focused strategies.

Abstract Introduction Healthcare organisations are confronted with challenges in retaining physicians and nurses, leading to increased costs and decreased quality of care. This study endeavours to identify interventions aimed at enhancing job satisfaction among healthcare workers, and subsequently translate these findings into policy recommendations. Methods The study was conducted in Belgium, the Netherlands, Poland and Italy, and adopted a co-creation methodology.Eight co-creation workshops were organised for physicians and nurses (n= 53), followed by four Delphi-inspired sessions (n=17) and eight additional interviews with policy makers (n=8). All workshops were transcribed verbatim and thematically analysed using NVIVO. Ethical approval was obtained from the Ethics Committee Research UZ/ KU Leuven (S66009). Results The outcomes derived from the co-creation process were categorized into four main themes: (1) Providing personal and professional support, such as evaluation sessions; (2) Prioritising lifelong learning through different development opportunities; (3) Providing the necessary legislative frameworks to address challenges at the workplace; (4) Improving financial and infrastructural factors, such as transport and accommodation. Discussion The findings underscore the complex and multi-level nature of job retention in healthcare and highlight the need for multifaceted approaches. Comprehensive strategies should take place at both hospital and national level, and should address facilitating career development, promoting work-life balance and reducing administrative burdens. Conclusion No one-size-fits-all solution exists to improve job retention in healthcare. By understanding and addressing the multiple factors involved, hospitals and countries can create a supportive environment that encourages healthcare workers to remain in the profession.

The European healthcare sector faces a significant shortage of healthcare workers. Assessing the prevalence of this issue and understanding its direct and indirect determinants are essential for formulating effective recruitment programs and enhancing job retention strategies for physicians and nurses. A multicentric cross-sectional study was conducted, involving 381 physicians and 1351 nurses recruited from eight European hospitals in Belgium, the Netherlands, Italy, and Poland. The study focused on assessing turnover intentions among healthcare workers based on the Job Demands-Resources model, using an online questionnaire. Structural equation models were employed to test the data collection questionnaires’ construct validity and internal consistency. The turnover intention was assessed by agreement with the intention to leave either the hospital or the profession. Among physicians, 17% expressed an intention to leave the hospital, while 9% intended to leave the profession. For nurses, the figures were 8.9% and 13.6%, respectively. The internal consistency of the questionnaires exceeded 0.90 for both categories of health workers. Depersonalization and job dissatisfaction were identified as direct determinants of turnover intention, with work engagement being particularly relevant for nurses. We found a higher intention to leave the hospital among physicians, while nurses were more prone to leave their profession. To mitigate turnover intentions, it is recommended to focus on improving job satisfaction, work engagement and fostering a positive working climate, thereby addressing depersonalisation and promoting job retention.

Healthcare organizations worldwide face challenges in retaining their healthcare workforce, with individual and organizational factors influencing their intentions to leave. This study conducted eight online co-creation workshops and four Delphi sessions to gain qualitative and in-depth insights into job retention interventions, involving healthcare workers, hospital managers, and policymakers. A thematic analysis was conducted, resulting in multiple interventions that were clustered in four pre-defined themes: professional and personal support, education, financial incentives, and regulatory measures. Professional and personal support interventions included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling. Educational interventions encompassed facilitating development opportunities, periodic evaluations, onboarding, mentorship programs, and peer support groups. Financial incentives included the provision of competitive salaries, adequate infrastructure, extra benefits, transport possibilities, and permanent employment contracts. Regulatory measures addressed the need for complementary legislation across various levels, fixed healthcare worker-to-patient ratio, and instruments to monitor workload. To optimize retention strategies, healthcare organizations should tailor these interventions to address the unique factors influencing their workforce's intentions to leave within their specific context. The study concludes that combining personal and professional support, educational opportunities, financial incentives, and regulatory measures is necessary because there is no one-size-fits-all solution.

Background Multiple factors can fuel nurses’ intention to leave their employing hospital or their profession. Job dissatisfaction and burnout are contributors to this decision. Sociodemographic and work context factors can also play a role in explaining nurses’ intention to leave. Objective To investigate the role of sociodemographic and work context factors, including job resources, job demands, job dissatisfaction, depersonalization, and emotional exhaustion, on nurses’ intention to leave their hospital or their profession. Design Multicentre cross-sectional study. Setting(s) Eight European hospitals, two per each country, including Belgium, the Netherlands, Italy, and Poland. Participants From May 16 to September 30, 2022, we collected 1,350 complete responses from nurses working at the selected hospitals (13 % response rate). Methods The intention to leave was assessed through two 5-Likert scale outcomes, agreeing with the intention to leave the profession and the intention to leave the hospital. Logistic regression models were used for statistical analysis. Results At the multivariable analysis, a higher intention to leave the hospital was observed for: younger age, having served on the frontline against COVID-19, lack of quipment, living in the Netherlands, emotional exhaustion, dissatisfaction with work prospects, and dissatisfaction with the use of professional abilities. There was a higher intention to leave the profession for: younger age, living in the Netherlands, having work-related health problems, depersonalization, emotional exhaustion, low possibilities of professional development, dissatisfaction with work prospects, lack of use of professional abilities, overall ob issatisfaction, and dissatisfaction with salary. Nurses living in Italy expressed the lowest intention to leave. Conclusion While confirming the role of job dissatisfaction and burnout, we found higher intention to leave for young nurses, nurses with work-related health problems, and caregivers during the COVID-19 pandemic. Dissatisfaction with work prospects, professional development, and salary also increased the intention to leave. We call for educators, managers, and policymakers to address these factors to retain at-risk nursing categories, implementing strategies to mitigate intentions to leave.

Background GPs are particularly vulnerable to job burnout. Tailored prevention and intervention strategies are needed. Aim To investigate organisational, interpersonal, and individual factors contributing to exhaustion and disengagement at work among GPs. Design & setting We conducted a cross-sectional study in a sample of Belgian GPs. Method A total of 358 doctors (73% females, 301 with complete data) completed an online anonymous questionnaire assessing job burnout, psychosocial characteristics of the work environment, perceived social support in the private domain, emotional competence, and self-compassion. Results GPs reported moderate levels of exhaustion and disengagement. Regression models showed that included factors jointly explained 69% of the variance in exhaustion and 63% in disengagement. Exhaustion was significantly predicted by female sex ( β effect size = −0.1), high perceived emotional demands ( β = 0.19), as well as low self-compassion ( β = −0.14) and low emotional competence ( β = 0.09). Disengagement was significantly predicted by low seniority ( β = −0.12) and limited opportunities for development ( β = −0.16). Both exhaustion and disengagement were predicted by low perceived quality of work ( β = −0.19 and −0.14, respectively), meaning of work ( β = −0.17 and −0.31, respectively), and role clarity ( β = 0.09 and 0.12, respectively), as well as high perceived work–life conflict ( β = 0.46 and 0.21, respectively). Moreover, GPs working in a multidisciplinary group reported lower levels of exhaustion and disengagement than those working in a monodisciplinary group or a solo practice, and this difference was associated with factors such as work–life conflict. Conclusion Organisational, interpersonal, and intrapersonal factors interact to predict a substantial part of burnout in general practice. The most significant risk factors were perceived work–life conflict and poor meaning of work. Policymakers should work to support more sustainable practices based on the specific needs and constraints reported by GPs.

Abstract Background Burnout is a growing problem in medical education, and is usually characterised by three dimensions: emotional exhaustion, cynicism, and reduced professional efficacy. Currently, the majority of burnout studies have been conducted in western high-income countries, overshadowing findings from low- and middle-income countries. Our objective is to investigate burnout and its associated predictive factors in Morocco, aiming to guide intervention strategies, while also assessing differences between the preclinical and clinical years. Methods A cross-sectional, self-administered online survey assessing burnout dimensions and its main determinants was distributed among medical students at Université Mohammed VI des Sciences et de la Santé (UM6SS, Casablanca, Morocco). Descriptive analyses involved computing mean scores, standard deviations and Pearson correlations. Further, t-tests were performed to check for significant differences in burnout dimensions across the preclinical and clinical learning phase, and stepwise linear regression analyses were conducted using a backward elimination method to estimate the effects of the selected variables on the three burnout dimensions. Results A t-test assessing the difference in cynicism found a significant difference between students at the preclinical phase and the clinical phase, t(90) = -2.5, p = 0.01. For emotional exhaustion and reduced professional efficacy no significant difference was observed. A linear regression analysis showed that emotional exhaustion was significantly predicted by workload, work-home conflict, social support from peers and neuroticism. Cynicism was predicted by the learning phase, workload, meaningfulness and neuroticism; and reduced professional efficacy by neuroticism only. Conclusions Our findings suggest a potential gradual increase in cynicism during medical education in Morocco. Conducting this study in a low- and middle income country has enhanced the scientific understanding of burnout in these regions. Given the identified predictive factors for burnout, such as workload, work-home conflict, support from peers, neuroticism, and meaningfulness, it is necessary to focus on these elements when developing burnout interventions.

Objectives: Healthcare systems in European countries, including METEOR partner countries, are faced with the aging population, an increase costs for innovative technologies and medication, a shortage of health professionals, and inequality in access to healthcare. Presented paper aimed to recognize and compare the functioning of healthcare systems between METEOR partner countries and simultaneously check if the current epidemiological situation of COVID-19 has some relationship with the number of medical staff, yearly gross domestic product, or documented percentage of fully vaccinated people. Material and Methods: In the model of descriptive epidemiological study, available demographic, socioeconomic, and healthcare organizational data in the Netherlands, Belgium, Italy, and Poland were compared to the epidemiological situation of the COVID-19 pandemic (percentage of fully vaccinated people, incidence, and mortality) in all mentioned countries. Results: Obtained data confirmed the lowest number of physicians, as well as the life expectancy and gross domestic product per capita, is in Poland. Simultaneously, the lower number of medical staff and lower gross domestic product (GDP) correspond to higher mortality due to COVID-19. The percentage of fully cinated with the last dose of the primary series was also the lowest in Poland. Conclusions: Obtained results confirmed that higher mortality to COVID-19 in METEOR participants' countries is related to a lower number of medical staff and weaker GDP. The worse situation was noted Poland, a country with problems in the functioning healthcare system, including hospital care and a serious shortage of practicing medical staff. Int J Occup Med Environ Health. 2023;36(3):417-27

The shortage of healthcare workers is a growing problem across the globe. Nurses and physicians, in particular, are vulnerable as a result of the COVID-19 pandemic. Understanding why they might leave is imperative for improving retention. This systematic review explores both the prevalence of nurses and physicians who are intent on leaving their position at hospitals in European countries and the main determinants influencing job retention among nurses and physicians of their respective position in a hospital setting in both European and non-European countries. A comprehensive search was fulfilled within 3 electronic databases on June 3rd 2021. In total 345 articles met the inclusion criteria. The determinants were categorized into 6 themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants for job retention were job satisfaction, career development and work-life balance. European and non-European countries showed similarities and differences in determinants influencing retention. Identifying these factors supports the development of multifactorial interventions, which can aid the formulation of medical strategies and help to maximize retention.

Abstract Background To contrast effectively the shortage of healthcare workers in the EU, it is essential to find the determinants of the intention to leave the hospital (ITL) by analyzing the role of burnout (BO), job satisfaction (JS), and other individual characteristics and working-related variables. This study aims to estimate the prevalence of ITL for physicians and nurses in Europe, to investigate the determinants of ITL, and to suggest possible job retention policies. Methods The METEOR survey is a cross-sectional study on 8 hospitals of Belgium, The Netherlands, Italy, and Poland. Data collection was from May to September 2022. The theoretical model was the Job demands-resources model and validated questionnaires were used. ITL was assessed as agreement with the sentence “I intend to leave my current hospital for another one in the near future” and the response items were scored on a 5-point Likert scale. Two multivariable logistic models for ITL were estimated for both physicians and nurses, including JS, BO, and workers’ individual and hospital characteristics as covariates. Results The study included 381 physicians, and 1351 nurses. Physicians and nurses who agreed with ITL were 17% and 9%, respectively. Logistic models for physicians showed that by increasing JS (OR = 0.31, p < 0.001) as well as age (OR = 0.91, p < 0.001), and living with partner (vs alone) (OR = 0.56, p < 0.039), the odds of ITL decreased. For nurses, the model revealed that by increasing JS (OR = 0.27, p < 0.001), as well as age (OR = 0.97, p < 0.001), and equipment (OR = 0.56, p < 0.039), the odds of ITL decreased. Conclusions Our survey showed high prevalence of ITL for both nurses and physicians. Recruitment and retention policies, at the micro/meso/macro-levels are needed. It is strategic to support healthcare workers’ categories at higher risk of ITL, such as the younger physicians and nurses. Key messages • Our survey found significant individual and work environment characteristics playing a role to explain ITL. • We provide an estimate of ITL prevalence of hospital physicians and nurses in EU.

Introduction: Co-creation is becoming increasingly popular to develop interventions that can achieve results beyond scientific findings. Workshops are one of the main ways to collect data and generate ideas in co-creation, which traditionally have been conducted at a fixed, physical location. However, organising face-to-face workshops is considered challenging, due to the transportation time, low flexibility and high costs. This study aims to investigate the online format of co-creation workshops and to discuss methodological considerations. Methods: Co-creation workshops were organised with 78 medical students, general practitioner (GP) trainees and specialist trainees from five Belgian universities. The study included four different cohorts, namely first-year bachelors ( n = 12), first-year masters ( n = 13), first-year GP trainees ( n = 14) and first-year specialist trainees ( n = 39). Three consequential online workshops were organised for each cohort, resulting in 12 workshops in total. The collected data included qualitative data (video-and audio recordings, notes from interdisciplinary team discussions, Miro boards) and quantitative data (registrations and actual attendance rates). All workshops were transcribed verbatim and thematically analysed using NVivo. Results: The participants reported increased flexibility and reduced costs as main benefits of the online format. In addition, the online platforms Miro and Microsoft Teams were considered dynamic and inspiring, facilitating high levels of engagement and interactivity. However, the online format also showed some challenges, such as the need for a digitally educated population and a stable internet connection. Conclusion: This study has shown that online workshops, also in the highly interactive method of co-creation, provide a viable alternative to collect data and generate ideas. This is particularly the case, when the target population is geographically dispersed, has a high workload and is digitally educated. Online workshops, however, also face limitations and challenges that need to be considered when choosing this format.

The shortage of healthcare workers is a growing concern. The COVID-19 pandemic and retirement wave have accelerated turnover rates. This systematic review aimed to identify and analyse the existing interventions for job retention of healthcare workers, in terms of nurses and physicians, in a hospital setting. A comprehensive search was conducted within three electronic databases, guided by the preferred reporting items for systematic review and meta-analyses (PRISMA) and synthesis without meta-analysis (SWiM) guidelines, this resulted in 55 records that met the inclusion criteria. The intervention outcomes are categorized into substantial themes: onboarding, transition program to a different unit, stress coping, social support, extra staffing, coping with the demands of patient care, work relationships, development opportunities and department resources, job environment, work organization, recruitment approach, and technological innovations. Considering the literature, onboarding programs and mentoring for nurses and physicians are recommended. Additionally, other interventions described in this review could positively affect the retention of nurses and physicians. When selecting an intervention for implementation, managers and human resources should consider the intervention that matches the determinant of intention to leave of their healthcare workers and the hospital's mission, vision, and values. Sharing the success stories of implemented interventions may benefit healthcare organizations.

IntroductionBurnout is a growing problem among young researchers, affecting individuals, organizations and society. Our study aims to identify burnout profiles and highlight the corresponding job demands and resources, resulting in recommendations to reduce burnout risk in the academic context.MethodsThis cross-sectional study collected data from young researchers (n = 1,123) at five Flemish universities through an online survey measuring burnout risk, work engagement, sleeping behavior, and the most prominent job demands (e.g., publication pressure) and resources (e.g., social support). We conducted Latent Profile Analysis (LPA) to identify burnout profiles in young researchers and subsequently compared these groups on job demands and resources patterns.ResultsFive burnout profiles were identified: (1) High Burnout Risk (9.3%), (2) Cynical (30.1%), (3) Overextended (2.3%), (4) Low Burnout Risk (34.8%), and (5) No Burnout Risk (23.6%). Each burnout profile was associated with a different pattern of job demands and resources. For instance, high levels of meaningfulness (OR = −1.96) decreased the odds to being classified in the Cynical profile.ConclusionOur findings show that the Cynical profile corresponds to a relatively high number of young researchers, which may imply that they are particularly vulnerable to the cynicism dimension of burnout. Additionally, work-life interference and perceived publication pressure seemed the most significant predictors of burnout risk, while meaningfulness, social support from supervisor and learning opportunities played an important protective role.

Introduction. Despite the increasing importance of teamwork in healthcare, medical education still puts great emphasis on individual achievements. The purpose of this study is to examine medical students’ team role preferences, including the association with gender and specialty; and to provide implications for policy makers and medical educators. Methods. We used an exploratory methodology, following a repeated cross-sectional design. Data was collected from first year master students in medicine (n=2293) during five consecutive years (2016 – 2020). The Belbin Team Role Self Perception Inventory (BTRSPI) was used to measure medical students’ self-perceptions of their team role. Results. The Team Worker was the most preferred team role among medical students (35.8%), regardless of study year, gender or specialty. Female and male students had similar team role patterns, although female students scored higher on Team Worker (40.4% vs. 29.1%, p < 0.001) and Completer-Finisher (14.0% vs. 8.0%, p < 0.001). Conclusions. Our findings are encouraging due to the increased importance of interdisciplinary collaborations in healthcare. Nevertheless, policy makers and medical educators should prioritize teamwork skills at all stages (i.e. admission to residency) and levels (i.e. in the explicit and implicit curriculum) to ensure their continued development throughout the educational process.

Despite the increasing importance of teamwork in healthcare, medical education still puts great emphasis on individual achievements. The purpose of this study is to examine medical students’ team role preferences, including the association with gender and specialty; and to provide implications for policy makers and medical educators. We used an exploratory methodology, following a cross-sectional design. Data was collected from first year master students in medicine (n = 2293) during five consecutive years (2016–2020). The Belbin Team Role Self Perception Inventory (BTRSPI) was used to measure medical students’ self-perceptions of their team role. The Team Worker was the most preferred team role among medical students (35.8%), regardless of gender or specialty. Female and male students had similar team role patterns, although female students scored higher on Team Worker (40.4% vs. 29.1%, P < .001) and Completer-Finisher (14.0% vs. 8.0%, P < .001). With regard to specialties, the Team Worker role was more often chosen by general practitioners than by person-centered and technique-oriented specialties (47.1% vs. 41.8% vs. 29.1%, P < .001). Our findings contribute to an increased scientific understanding of how medical students perceive their own team role, and how this is related to gender and specialty. This is valuable due to the increased importance of interdisciplinary teamwork in healthcare. Medical schools should prioritize stimulating teamwork skills through the implementation of different interventions at all stages (i.e. from the admission process to curricula to residency) and all levels (i.e. explicit and implicit curricula). • Team worker is the most frequently preferred team role among medical students, regardless of gender or specialty. • Female students scored higher on the Team Worker role compared to male students. • Team Workers were more present in future general practitioners and lower in technique-oriented specialties, with students who chose a person-centered specialty in the middle. • Medical education should stimulate teamwork skills throughout the entire educational career, from the admission process to curricula to residency .