Baugh Joshua J, Margolin Justin, Raja Ali S, White Benjamin A
Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.
West J Emerg Med. 2025 Jul 18;26(4):1105-1111. doi: 10.5811/westjem.39651.
Despite prior efforts to improve well-being in emergency medicine, clinician burnout in the specialty is rising. In this study we examined the acceptability and feasibility of using a method called "experience sampling" to explore factors important to clinician experience in emergency departments (ED). Experience sampling enables the measuring of work experience in real time, with more granular detail than in usual burnout surveys. The approach may reveal new opportunities for improving work experience in emergency medicine at a critical time.
We conducted this pilot study in a large, urban, academic, quaternary care ED. Iterative multidisciplinary focus groups were used to generate a brief, experience-sampling tool that was comprised of three different surveys to assess emergency clinician experience before, during, and after shifts. These were deployed using a smartphone application to a convenience sample of 11 clinicians (three attending physicians, two residents, five physician assistants, and one registered nurse) during four shifts each. A post-pilot survey was also sent to all participants to evaluate their experience of using the tool. Our primary outcome measures were feasibility, assessed by the survey response rates during the pilot, and acceptability, assessed by participant sentiment as expressed in the post-pilot surveys. Secondary outcomes were quantitative- and qualitative-experience data collected using the tool.
The overall response rates for pre-shift, on-shift, and post-shift surveys were 79%, 73%, and 91%, respectively. All participants responded to the post-pilot survey and indicated they would be willing to use the experience-sampling tool again in the future. Many participants noted that the simple and open-ended on-shift questions were relatively easy to complete; some also said on-shift survey questions could present added difficulty during busy shifts. Four participants said the exercise of completing surveys itself improved on-shift experience by prompting reflection. Common themes associated with positive experiences included manageable patient volumes, excellent teamwork, interesting cases, adequate staffing, and feeling able to provide adequate care. Common themes associated with negative experiences included crowding, inadequate staffing, feeling overwhelmed, complex patient cases, difficult disposition plans, and feeling unable to provide adequate care.
Experience sampling is an acceptable and feasible method for measuring clinician experience in a busy academic ED. Further studies could potentially use this approach to identify targets for reducing burnout in emergency medicine.
尽管此前一直在努力改善急诊医学领域的工作状态，但该专业的临床医生职业倦怠现象仍在加剧。在本研究中，我们探讨了使用一种名为“经验抽样”的方法来探究对急诊科临床医生工作体验至关重要的因素的可接受性和可行性。经验抽样能够实时测量工作体验，比常规的职业倦怠调查提供更详细的信息。这种方法可能在关键时刻为改善急诊医学工作体验带来新的契机。
我们在一家大型城市学术型四级医疗急诊科开展了这项试点研究。通过多学科迭代焦点小组，开发了一个简短的经验抽样工具，该工具由三项不同的调查组成，用于评估急诊临床医生轮班前、轮班期间和轮班后的工作体验。这些调查通过智能手机应用程序分发给11名临床医生（三名主治医师、两名住院医师、五名医师助理和一名注册护士）的便利样本，每人各参与四个班次。试点结束后还向所有参与者发送了一份调查问卷，以评估他们使用该工具的体验。我们的主要指标包括可行性（通过试点期间的调查回复率评估）和可接受性（通过试点后调查问卷中参与者表达的意见评估）。次要指标是使用该工具收集的定量和定性工作体验数据。
轮班前、轮班期间和轮班后调查的总体回复率分别为79%、73%和91%。所有参与者都回复了试点后的调查问卷，并表示他们未来愿意再次使用经验抽样工具。许多参与者指出，轮班期间简单且开放式的问题相对容易回答；一些人还表示，轮班期间的调查问卷问题在忙碌的班次中可能会增加难度。四名参与者表示，填写调查问卷这一行为通过促使他们反思，改善了轮班体验。与积极体验相关的常见主题包括患者数量可控、团队协作出色、病例有趣、人员配备充足以及感觉能够提供充分的护理。与消极体验相关的常见主题包括拥挤、人员配备不足、不堪重负、患者病例复杂、处置计划困难以及感觉无法提供充分的护理。
经验抽样是一种在繁忙的学术型急诊科测量临床医生工作体验的可接受且可行的方法。进一步的研究可能会利用这种方法来确定减少急诊医学领域职业倦怠的目标。
