Burnout in medicine: A novel approach exploring the impact of uncertainty and the use of biomarkers as a measurement tool.

Burnout constitutes a significant challenge for healthcare organisations not only in respect to individual wellbeing but also in terms of the catastrophic downstream implications to patient safety, patient satisfaction, and quality of care. This DPhil, divided into three parts, aims to explore burnout in healthcare professionals, an accelerating phenomenon that is hotly discussed but minimally understood, with a focus on the impact uncertainty has and an exploration into the novel use of neurohormones as potential biomarkers of wellbeing. Part I: Exploration of concepts: burnout and uncertainty. Chapter 1 presents a selective overview of the broad context of burnout in healthcare, reporting existing literature on the impact of burnout—to physicians, to patients, and to healthcare organisations—and considering the challenges that pertain to burnout research, particularly relating to challenges in measurement. Chapter 2 explores the presence of uncertainty in the healthcare environment looking at what impacts an individual’s tolerance of uncertainty and how the reaction affects provider- and patient-centred outcomes. Chapters 3 and 4 present two observational studies exploring drivers of satisfaction at work for faculty in an academic medical centre, with an analysis of the interplay between burnout and uncertainty in the clinical environment. Chapter 5 presents a study that looks at how language used in clinical hand-over affects sense of uncertainty in the receiving clinician, demonstrating how language variation can influence emotional perception of uncertainty. Part II: Exploration of biology: exploration into use of biomarkers to measure burnout. Chapters 6 and 7 explore the novel use of cortisol and oxytocin levels as potential biomarkers of stress and burnout in clinical faculty at a large teaching hospital. Part III: Exploration of interventions to reduce burnout and strategies to embrace uncertainty. Chapter 8 presents an interprofessional intervention study looking to reduce burnout through self-facilitated groups meeting monthly for three months. This study re-affirms the importance of the findings presented in this thesis and points to the need for more interventions aimed at enhancing trainee and faculty wellbeing. Chapter 9 synthesises current literature on tolerance of uncertainty alongside findings of the thesis, self-experience, and experience of colleagues and students in a narrative review to identify strategies to help clinicians thrive in the face of clinical uncertainty. Finally, Chapter 10 presents an overview of the key findings from each study, their methodological strengths and limitations, directions for future research, and implications for clinical training, the measurement of wellbeing initiatives, and patient care.