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Academic Psychiatry

, Volume 42, Issue 1, pp 94–108 | Cite as

What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement

  • Keri J. S. Brady
  • Mickey T. Trockel
  • Christina T. Khan
  • Kristin S. Raj
  • Mary Lou Murphy
  • Bryan Bohman
  • Erica Frank
  • Alan K. Louie
  • Laura Weiss Roberts
In Depth Article: Systematic and Other Reviews

Abstract

Objective

Physician wellness (well-being) is recognized for its intrinsic importance and impact on patient care, but it is a construct that lacks conceptual clarity. The authors conducted a systematic review to characterize the conceptualization of physician wellness in the literature by synthesizing definitions and measures used to operationalize the construct.

Methods

A total of 3057 references identified from PubMed, Web of Science, and a manual reference check were reviewed for studies that quantitatively assessed the “wellness” or “well-being” of physicians. Definitions of physician wellness were thematically synthesized. Measures of physician wellness were classified based on their dimensional, contextual, and valence attributes, and changes in the operationalization of physician wellness were assessed over time (1989–2015).

Results

Only 14% of included papers (11/78) explicitly defined physician wellness. At least one measure of mental, social, physical, and integrated well-being was present in 89, 50, 49, and 37% of papers, respectively. The number of papers operationalizing physician wellness using integrated, general-life well-being measures (e.g., meaning in life) increased [X 2 = 5.08, p = 0.02] over time. Changes in measurement across mental, physical, and social domains remained stable over time.

Conclusions

Conceptualizations of physician wellness varied widely, with greatest emphasis on negative moods/emotions (e.g., burnout). Clarity and consensus regarding the conceptual definition of physician wellness is needed to advance the development of valid and reliable physician wellness measures, improve the consistency by which the construct is operationalized, and increase comparability of findings across studies. To guide future physician wellness assessments and interventions, the authors propose a holistic definition.

Keywords

Physician wellness Physician well-being Physician burnout Conceptualization and measurement Review 

Notes

Acknowledgements

The authors are deeply grateful to Dennis L. Simmons for his assistance with data management, to Gabrielle Termuehlen for her assistance with copyediting, and to Katie Ryan for her assistance with manuscript preparation.

Compliance with Ethical Standards

IRB Information

IRB approval was not needed since all data were obtained from publicly available sources.

Disclosure

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Funding Sources

None.

References

  1. 1.
    Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–13.PubMedCrossRefGoogle Scholar
  2. 2.
    Prins JT, Hoekstra-Weebers JE, Gazendam-Donofrio SM, et al. Burnout and engagement among resident doctors in the Netherlands: a national study. Med Educ. 2010;44(3):236–47.PubMedCrossRefGoogle Scholar
  3. 3.
    Diez-Pinol M, Dolan SL, Sierra V, Cannings K. Personal and organizational determinants of well-being at work: the case of Swedish physicians. Int J Health Care Qual Assur. 2008;21(6):598–610.PubMedCrossRefGoogle Scholar
  4. 4.
    Markwell AL, Wainer Z. The health and wellbeing of junior doctors: insights from a national survey. Med J Aust. 2009;191(8):441–4.PubMedGoogle Scholar
  5. 5.
    van der Heijden F, Dillingh G, Bakker A, Prins J. Suicidal thoughts among medical residents with burnout. Arch Suicide Res. 2008;12(4):344–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Williams ES, Manwell LB, Konrad TR, Linzer M. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study. Health Care Manag Rev. 2007;32(3):203–12.CrossRefGoogle Scholar
  7. 7.
    Welp A, Meier LL, Manser T. Emotional exhaustion and workload predict clinician-rated and objective patient safety. Front Psychol. 2014;5Google Scholar
  8. 8.
    Frank E, Dresner Y, Shani M, Vinker S. The association between physicians’ and patients’ preventive health practices. Can Med Assoc J. 2013;185(8):cmaj. 121028.CrossRefGoogle Scholar
  9. 9.
    Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336(7642):488–91.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Halbesleben JRB, Rathert C. Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Manag Rev. 2008;33(1):29–39.CrossRefGoogle Scholar
  12. 12.
    Scheepers RA, Boerebach BC, Arah OA, Heineman MJ, Lombarts KM. A systematic review of the impact of physicians’ occupational well-being on the quality of patient care. Int J of Behav Med. 2015:1–16.Google Scholar
  13. 13.
    Konrad TR. Measures, methods, and models of doctor satisfaction: future research challenges. Professions and Professionalism. 2015;5(1).Google Scholar
  14. 14.
    West CP. Physician well-being: expanding the triple aim. J Gen Intern Med. 2016;31(5):458–9.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    World Health Organization. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. 1948.Google Scholar
  16. 16.
    Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Schrijver I, Brady KJS, Trockel M. An exploration of key issues and potential solutions that impact physician wellbeing and professional fulfillment at an academic center. Peer J. 2016;4:e1783.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Wallace JE, Lemaire J. On physician well being-you’ll get by with a little help from your friends. Soc Sci Med. 2007;64(12):2565–77.PubMedCrossRefGoogle Scholar
  19. 19.
    Shanafelt TD. Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care. JAMA. 2009;302(12):1338–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Shanafelt TD, Oreskovich MR, Dyrbye LN, et al. Avoiding burnout: the personal health habits and wellness practices of US surgeons. Ann Surg. 2012;255(4):625–33.PubMedCrossRefGoogle Scholar
  21. 21.
    Goldberg R, Boss RW, Chan L, et al. Burnout and its correlates in emergency physicians: four years’ experience with a wellness booth. Acad Emerg Med. 1996;3(12):1156–64.PubMedCrossRefGoogle Scholar
  22. 22.
    Shanafelt TD, West C, Zhao X, et al. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med. 2005;20(7):559–64.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Shanafelt TD, Novotny P, Johnson ME, et al. The well-being and personal wellness promotion strategies of medical oncologists in the north central cancer treatment group. Oncology. 2005;68(1):23–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Uncu Y, Bayram N, Bilgel N. Job related affective well-being among primary health care physicians. Eur J Pub Health. 2007;17(5):514–9.CrossRefGoogle Scholar
  25. 25.
    West CP, Shanafelt TD, Cook DA. Lack of association between resident doctors’ well-being and medical knowledge. Med Educ. 2010;44(12):1224–31.PubMedCrossRefGoogle Scholar
  26. 26.
    Fang CK, Li PY, Lai ML, Lin MH, Bridge DT, Chen HW. Establishing a ‘Physician’s Spiritual Well-being Scale’ and testing its reliability and validity. J Med Ethics. 2011;37(1):6–12.PubMedCrossRefGoogle Scholar
  27. 27.
    Lebensohn P, Dodds S, Benn R, et al. Resident wellness behaviors: relationship to stress, depression, and burnout. Fam Med. 2013;45(8):541–9.PubMedGoogle Scholar
  28. 28.
    Colon-de Marti LN, Martinez A, Gomez Y, Rivera-Colon I. Perceptions of a group of surgical and non-surgical residents at a Hispanic academic medical center of the impact of the night-float system. P R Health Sci J. 2014;33(2):45–50.PubMedGoogle Scholar
  29. 29.
    Thorndike AN, Mills S, Sonnenberg L, et al. Activity monitor intervention to promote physical activity of physicians-in-training: randomized controlled trial. PLoS One. 2014;9(6):e100251.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    von Vultee PJ, Axelsson R, Arnetz B. Individual and organizational well-being of female physicians—an assessment of three different management programs. Med Gen Med. 2004;6(1):4.CrossRefGoogle Scholar
  31. 31.
    von Vultée PJ, Arnetz B. The impact of management programs on physicians’ work environment and health: a prospective, controlled study comparing different interventions. J Health Organ Manage. 2004;18(1):25–37.CrossRefGoogle Scholar
  32. 32.
    Grunfeld E, Zitzelsberger L, Coristine M, Whelan TJ, Aspelund F, Evans WK. Job stress and job satisfaction of cancer care workers. Psychooncology. 2005;14(1):61–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well-being: assessment of an innovative program. J Gen Intern Med. 2007;22(11):1544–52.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Schaufeli WB, Bakker AB, van der Heijden F, Prins JT. Workaholism, burnout and well-being among junior doctors: the mediating role of role conflict. Work Stress. 2009;23(2):155–72.CrossRefGoogle Scholar
  35. 35.
    Grieve S. Measuring morale—does practice area deprivation affect doctors’ well-being? Br J Gen Pract. 1997;47(422):547–52.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med. 2005;165(22):2601–6.PubMedCrossRefGoogle Scholar
  37. 37.
    von Vultée PJ, Axelsson R, Arnetz B. The impact of organisational settings on physician wellbeing. Int J Health Care Qual Assur. 2007;20(6):506–15.CrossRefGoogle Scholar
  38. 38.
    Gardiner M, Lovell G, Williamson P. Physician you can heal yourself! Cognitive behavioural training reduces stress in GPs. J Fam Pract. 2004;21(5):545–51.CrossRefGoogle Scholar
  39. 39.
    Gardiner M, Sexton R, Durbridge M, Garrard K. The role of psychological well-being in retaining rural general practitioners. Aust J Rural Health. 2005;13(3):149–55.PubMedCrossRefGoogle Scholar
  40. 40.
    Gardiner M, Sexton R, Kearns H, Marshall K. Impact of support initiatives on retaining rural general practitioners. Aust J Rural Health. 2006;14(5):196–201.PubMedCrossRefGoogle Scholar
  41. 41.
    Keim SM, Mays MZ, Williams JM, Serido J, Harris RB. Measuring wellness among resident physicians. Med Teach. 2006;28(4):370–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Aalto AM, Heponiemi T, Keskimaki I, et al. Employment, psychosocial work environment and well-being among migrant and native physicians in Finnish health care. Eur J Pub Health. 2014;24(3):445–51.CrossRefGoogle Scholar
  43. 43.
    Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. Eur J Pub Health. 2011;21(4):520–5.CrossRefGoogle Scholar
  44. 44.
    Heponiemi T, Puttonen S, Elovainio M. On-call work and physicians’ well-being: testing the potential mediators. Occup Med. 2014;64(5):352–7.CrossRefGoogle Scholar
  45. 45.
    Kuusio H, Heponiemi T, Aalto AM, Sinervo T, Elovainio M. Differences in well-being between GPs, medical specialists, and private physicians: the role of psychosocial factors. Health Serv Res. 2012;47(1 Pt 1):68–85.PubMedCrossRefGoogle Scholar
  46. 46.
    Balch CM, Oreskovich MR, Dyrbye LN, et al. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. 2011;213(5):657–67.PubMedCrossRefGoogle Scholar
  47. 47.
    Shanafelt TD, Raymond M, Horn L, et al. Oncology fellows’ career plans, expectations, and well-being: do fellows know what they are getting into? J Clin Oncol. 2014;32(27):2991–7.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Chen DF, Tsai TC, Lei SM. Career satisfaction, commitment, and well-being among Taiwanese pediatricians. Pediatr Neonatol. 2013;54(3):173–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Lemaire JB, Wallace JE. How physicians identify with predetermined personalities and links to perceived performance and wellness outcomes: a cross-sectional study. BMC Health Serv Res. 2014;14Google Scholar
  50. 50.
    West CP, Dyrbye LN, Rabatin JT, et al. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med. 2014;174(4):527–33.PubMedCrossRefGoogle Scholar
  51. 51.
    Gleichgerrcht E, Decety J. Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PLoS One. 2013;8(4):e61526.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Frey R, Decker K, Reinfried L, et al. Effect of rest on physicians’ performance in an emergency department, objectified by electroencephalographic analyses and psychometric tests. Crit Care Med. 2002;30(10):2322–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Lederer W, Kinzl JF, Trefalt E, Traweger C, Benzer A. Significance of working conditions on burnout in anesthetists. Acta Anaesthesiol Scand. 2006;50(1):58–63.PubMedCrossRefGoogle Scholar
  54. 54.
    von Vultee PJ, Axelsson R, Arnetz B. The impact of organisational settings on physician wellbeing. Int J Health Care Qual Assur. 2007;20(6):506–15.CrossRefGoogle Scholar
  55. 55.
    Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;02(12):1284–93.CrossRefGoogle Scholar
  56. 56.
    Eisenach JH, Sprung J, Clark MM, et al. The psychological and physiological effects of acute occupational stress in new anesthesiology residents: a pilot trial. Anesthesiology. 2014;121(4):878–93.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Hoonpongsimanont W, Murphy M, Kim CH, Nasir D, Compton S. Emergency medicine resident well-being: stress and satisfaction. Occup Med. 2014;64(1):45–8.CrossRefGoogle Scholar
  58. 58.
    Saadat H, Snow DL, Ottenheimer S, Dai F, Kain ZN. Wellness program for anesthesiology residents: a randomized, controlled trial. Acta anaesthesiologica Scand. 2012;56(9):1130–8.CrossRefGoogle Scholar
  59. 59.
    Eley DS, Cloninger CR, Walters L, Laurence C, Synnott R, Wilkinson D. The relationship between resilience and personality traits in doctors: implications for enhancing well being. PeerJ. 2013;1Google Scholar
  60. 60.
    Salles A, Cohen GL, Mueller CM. The relationship between grit and resident well-being. Am J Surg. 2014;207(2):251–4.PubMedCrossRefGoogle Scholar
  61. 61.
    Legassie J, Zibrowski EM, Goldszmidt MA. Measuring resident well-being: impostorism and burnout syndrome in residency. J Gen Intern Med. 2008;23(7):1090–4.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Hill JD, Smith RJ. Monitoring stress levels in postgraduate medical training. Laryngoscope. 2009;119(1):75–8.PubMedCrossRefGoogle Scholar
  63. 63.
    Gardiner M, Sexton R, Durbridge M, Garrard K. The role of psychological well-being in retaining rural general practitioners. Austr J Rural Health. 2005;13(3):149–55.CrossRefGoogle Scholar
  64. 64.
    Dyrbye LN, Satele D, Sloan J, Shanafelt TD. Utility of a brief screening tool to identify physicians in distress. J Gen Intern Med. 2013;28(3):421–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Walsh J. Gender, the work-life interface and wellbeing: a study of hospital doctors. Gend Work Organ. 2013;20(4):439–53.CrossRefGoogle Scholar
  66. 66.
    Beckman TJ, Reed DA, Shanafelt TD, West CP. Impact of resident well-being and empathy on assessments of faculty physicians. J Gen Intern Med. 2010;25(1):52–6.PubMedCrossRefGoogle Scholar
  67. 67.
    West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA. 2011;306(9):952–60.PubMedCrossRefGoogle Scholar
  68. 68.
    Lovseth LT, Aasland OG, Fridner A, Jonsdottir LS, Marini M, Linaker OM. Confidentiality and physicians’ health. A cross-sectional study of University Hospital Physicians in four European cities (the HOUPE-study). J Occup Health. 2010;52(5):263–71.PubMedCrossRefGoogle Scholar
  69. 69.
    Beckman HB, Wendland M, Mooney C, et al. The impact of a program in mindful communication on primary care physicians. Acad Med. 2012;87(6):815–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Shanafelt TD, Kaups KL, Nelson H, et al. An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons. Ann Surg. 2014;259(1):82–8.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Aldrees TM, Aleissa S, Zamakhshary M, Badri M, Sadat-Ali M. Physician well-being: prevalence of burnout and associated risk factors in a tertiary hospital, Riyadh. Saudi Arabia Ann Saudi Med. 2013;33(5):451–6.PubMedCrossRefGoogle Scholar
  72. 72.
    van Vendeloo SN, Brand PL, Verheyen CC. Burnout and quality of life among orthopaedic trainees in a modern educational programme: importance of the learning climate. Bone Joint J. 2014;96-b(8):1133–1138.Google Scholar
  73. 73.
    Parshuram CS, Amaral A, Ferguson ND, et al. Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial. CMAJ. 2015;187(5):321–9.PubMedPubMedCentralCrossRefGoogle Scholar
  74. 74.
    Tucker P, Bejerot E, Kecklund G, Aronsson G, Akerstedt T. The impact of work time control on physicians’ sleep and well-being. Appl Ergon. 2015;47:109–16.PubMedCrossRefGoogle Scholar
  75. 75.
    Beckman TJ, Reed DA, Shanafelt TD, West CP. Resident physician well-being and assessments of their knowledge and clinical performance. J Gen Intern Med. 2012;27(3):325–30.PubMedCrossRefGoogle Scholar
  76. 76.
    DiLalla LF, Hull SK, Dorsey JK. Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teach Learn Med. 2004;16(2):165–70.PubMedCrossRefGoogle Scholar
  77. 77.
    Zare SM, Galanko JA, Behrns KE, et al. Psychologic well-being of surgery residents after inception of the 80-hour workweek: a multi-institutional study. Surgery. 2005;138(2):150–7.PubMedCrossRefGoogle Scholar
  78. 78.
    Cooper CL, Rout U, Faragher B. Mental health, job satisfaction, and job stress among general practitioners. BMJ. 1989;298(6670):366–70.PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Perry MY, Osborne WE. Health and wellness in residents who matriculate into physician training programs. American J Obstet Gynecol. 2003;189(3):679–83.CrossRefGoogle Scholar
  80. 80.
    Stamp T, Termuhlen P, Miller S, et al. Before and after resident work hour limitations: an objective assessment of the well-being of surgical residents. Curr Surg. 2005;62(1):117–21.PubMedCrossRefGoogle Scholar
  81. 81.
    Virtanen P, Rantalaiho L, Koivisto AM. Employment status passages and psychosocial well-being. J Occup Health Psychol. 2003;8(2):123–30.PubMedCrossRefGoogle Scholar
  82. 82.
    Heponiemi T, Kouvonen A, Vanska J, et al. Effects of active on-call hours on physicians’ turnover intentions and well-being. Scand J Work Environ Health. 2008;34(5):356–63.PubMedCrossRefGoogle Scholar
  83. 83.
    Lam TP, Wong JG, Ip MS, Lam KF, Pang SL. Psychological well-being of interns in Hong Kong: what causes them stress and what helps them. Med Teach. 2010;32(3):e120–6.PubMedCrossRefGoogle Scholar
  84. 84.
    Tucker P, Brown M, Dahlgren A, et al. The impact of junior doctors’ worktime arrangements on their fatigue and well-being. Scand J Work Environ Health. 2010;36(6):458–65.PubMedCrossRefGoogle Scholar
  85. 85.
    Heijstra TM, Rafnsdottir GL, Jonsdottir LS. Autonomy and well-being among Nordic male and female hospital physicians. Work. 2011;40(4):437–43.PubMedGoogle Scholar
  86. 86.
    Elovainio M, Salo P, Jokela M, et al. Psychosocial factors and well-being among Finnish GPs and specialists: a 10-year follow-up. Occup Environ Med. 2013;70(4):246–51.PubMedCrossRefGoogle Scholar
  87. 87.
    Cohen JS, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ. 2005;5(1):21.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Guest RS, Baser R, Li Y, Scardino PT, Brown AE, Kissane DW. Cancer surgeons’ distress and well-being, II: modifiable factors and the potential for organizational interventions. Ann Surg Oncol. 2011;18(5):1236–42.PubMedCrossRefGoogle Scholar
  89. 89.
    Guest RS, Baser R, Li Y, Scardino PT, Brown AE, Kissane DW. Cancer surgeons’ distress and well-being, I: the tension between a culture of productivity and the need for self-care. Ann Surg Oncol. 2011;18(5):1229–35.PubMedCrossRefGoogle Scholar
  90. 90.
    Fabreau G, Elliott M, Khanna S, et al. Shifting perceptions: a pre-post study to assess the impact of a senior resident rotation bundle. BMC Med Educ. 2013;13:115.PubMedPubMedCentralCrossRefGoogle Scholar
  91. 91.
    Chen I, Vorona R, Chiu R, Ware JC. A survey of subjective sleepiness and consequences in attending physicians. Behav Sleep Med. 2008;6(1):1–15.PubMedCrossRefGoogle Scholar
  92. 92.
    Lin GA, Beck DC, Stewart AL, Garbutt JM. Resident perceptions of the impact of work hour limitations. J Gen Intern Med. 2007;22(7):969–75.PubMedPubMedCentralCrossRefGoogle Scholar
  93. 93.
    Sangi-Haghpeykar H, Ambani DS, Carson SA. Stress, workload, sexual well-being and quality of life among physician residents in training. Int J Clin Pract. 2009;63(3):462–7.PubMedCrossRefGoogle Scholar
  94. 94.
    Foster E, Biery N, Dostal J, Larson D. RAFT (Resident Assessment Facilitation Team): supporting resident well-being through an integrated advising and assessment process. Fam Med. 2012;44(10):731–4.PubMedGoogle Scholar
  95. 95.
    Wen LS, Baca JT, O’Malley P, Bhatia K, Peak D, Takayesu JK. Implementation of small-group reflection rounds at an emergency medicine residency program. CJEM. 2013;15(3):175–7.PubMedCrossRefGoogle Scholar
  96. 96.
    Waterman AS. Reconsidering happiness: a eudaimonist’s perspective. J Posit Psychol. 2008;3(4):234–52.CrossRefGoogle Scholar
  97. 97.
    Huta V, Waterman AS. Eudaimonia and its distinction from hedonia: developing a classification and terminology for understanding conceptual and operational definitions. J Happiness Stud. 2014;15(6):1425–56.CrossRefGoogle Scholar
  98. 98.
    Shadish WR, Cook TD, Campbell DT. Experimental and quasi-experimental designs for generalized causal inference. Wadsworth Cengage Learning; 2002.Google Scholar
  99. 99.
    Ryan RM, Huta V, Deci EL. Living well: a self-determination theory perspective on eudaimonia. J Happiness Stud. 2008;9(1):139–70.CrossRefGoogle Scholar
  100. 100.
    Feeney BC, Collins NL. A new look at social support: a theoretical perspective on thriving through relationships. Personal Soc Psychol Rev. 2015;19(2):113–47.CrossRefGoogle Scholar
  101. 101.
    Frank E, McMurray JE, Linzer M, Elon L. Career satisfaction of US women physicians: results from the Women Physicians’ Health Study. Arch Intern Med. 1999;159(13):1417–26.PubMedCrossRefGoogle Scholar
  102. 102.
    Frank E, Bhat SK, Elon L. Exercise counseling and personal exercise habits of US women physicians. J Am Med Women’s Assoc (1972). 2002, 58(3):178–84.Google Scholar
  103. 103.
    Linzer M, Manwell LB, Williams ES, Bobula JA, Brown RL, Varkey AB, et al. Working conditions in primary care: physician reactions and care quality. Ann Intern Med. 2009;151(1):28–36.PubMedCrossRefGoogle Scholar

Copyright information

© Academic Psychiatry 2017

Authors and Affiliations

  • Keri J. S. Brady
    • 1
  • Mickey T. Trockel
    • 2
  • Christina T. Khan
    • 2
  • Kristin S. Raj
    • 2
  • Mary Lou Murphy
    • 2
  • Bryan Bohman
    • 2
  • Erica Frank
    • 3
  • Alan K. Louie
    • 2
  • Laura Weiss Roberts
    • 2
  1. 1.Boston University School of Public HealthBostonUSA
  2. 2.Stanford University School of MedicineStanfordUSA
  3. 3.University of British ColumbiaVancouverCanada

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