{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T01:59:24Z","timestamp":1785895164447,"version":"3.56.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T00:00:00Z","timestamp":1647561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>To identify preferred burnout interventions within a resident physician population, utilizing the Nominal Group Technique. The results will be used to design a discrete choice experiment study to inform the development of resident burnout prevention programs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Three resident focus groups met (10\u201314 participants\/group) to prioritize a list of 23 factors for burnout prevention programs. The Nominal Group Technique consisted of three steps: an individual, confidential ranking of the 23 factors by importance from 1 to 23, a group discussion of each attribute, including a group review of the rankings, and an opportunity to alter the original ranking across participants.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The total number of residents (36) were a representative sample of specialty, year of residency, and sex. There was strong agreement about the most highly rated attributes which grouped naturally into themes of autonomy, meaning, competency and relatedness. There was also disagreement on several of the attributes that is likely due to the differences in residency specialty and subsequently rotation requirements.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study identified the need to address multiple organizational factors that may lead to physician burnout. There is a clear need for complex interventions that target systemic and program level factors rather than focus on individual interventions. These results may help residency program directors understand the specific attributes of a burnout prevention program valued by residents. Aligning burnout interventions with resident preferences could improve the efficacy of burnout prevention programs by improving adoption of, and satisfaction with, these programs. Physician burnout is a work-related syndrome characterized by emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment [1]. Burnout is present in epidemic proportions and was estimated to occur in over 50 percent of practicing physicians and in up to 89 percent of resident physicians pre-COVID 19. The burnout epidemic is growing; a recent national survey of US physicians reported an 8.9 percent increase in burnout between 2011 and 2014 [2]. Rates of physician burnout have also increased [3] during the COVID-19 pandemic with a new classification of \u201cpandemic burnout\u201d experienced by over 52 percent of healthcare workers as early as June of 2020 [4]. Physician burnout can lead to depression, suicidal ideation, and relationship problems that may progress to substance abuse, increased interpersonal conflicts, broken relationships, low quality of life, major depression, and suicide [5\u20137]. The estimated rate of physician suicide is 300\u2013400 annually [8\u201310].<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0264921","type":"journal-article","created":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T17:32:34Z","timestamp":1647624754000},"page":"e0264921","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["Using nominal group technique among resident physicians to identify key attributes of a burnout prevention program"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9838-6084","authenticated-orcid":true,"given":"Vicki","family":"Nelson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Dubov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Morton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liana","family":"Fraenkel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,3,18]]},"reference":[{"key":"pone.0264921.ref001","article-title":"Maslach burnout inventory","author":"JS Maslach C","year":"1986","journal-title":"Consult Psychol Press"},{"key":"pone.0264921.ref002","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/j.mayocp.2015.08.023","article-title":"Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014","volume":"90","author":"T Shanafelt","year":"2015","journal-title":"Mayo Clin Proc"},{"issue":"7","key":"pone.0264921.ref003","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1002\/hed.26292","article-title":"Mental health among otolaryngology resident and attending physicians during the COVID-19 pandemic: National study","volume":"42","author":"AM Civantos","year":"2020","journal-title":"Head Neck"},{"issue":"8","key":"pone.0264921.ref004","doi-asserted-by":"crossref","first-page":"664","DOI":"10.5005\/jp-journals-10071-23518","article-title":"Burnout among Healthcare Workers during COVID-19 Pandemic in India: Results of a Questionnaire-based Survey","volume":"24","author":"RW Khasne","year":"2020","journal-title":"Indian J Crit Care Med"},{"issue":"1","key":"pone.0264921.ref005","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/medu.12927","article-title":"A narrative review on burnout experienced by medical students and residents","volume":"50","author":"L Dyrbye","year":"2016","journal-title":"Med Educ"},{"issue":"6","key":"pone.0264921.ref006","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1097\/DCR.0000000000000844","article-title":"Physician Burnout and Well-Being: A Systematic Review and Framework for Action","volume":"60","author":"DA Rothenberger","year":"2017","journal-title":"Dis Colon Rectum"},{"issue":"6","key":"pone.0264921.ref007","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1111\/joim.12752","article-title":"Physician burnout: contributors, consequences and solutions","volume":"283","author":"CP West","year":"2018","journal-title":"J Intern Med"},{"issue":"39","key":"pone.0264921.ref008","doi-asserted-by":"crossref","first-page":"E1240","DOI":"10.1503\/cmaj.1095498","article-title":"Physician suicide too often \"brushed under the rug\"","volume":"189","author":"R. Collier","year":"2017","journal-title":"CMAJ"},{"issue":"3","key":"pone.0264921.ref009","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1080\/10401334.2015.1044751","article-title":"Physician Depression and Suicide: A Shared Responsibility","volume":"27","author":"J Eckleberry-Hunt","year":"2015","journal-title":"Teach Learn Med"},{"key":"pone.0264921.ref010","article-title":"Burnout should not e a silent epidemic","author":"M.D. Harvey EJ","year":"2019","journal-title":"Can J Surg"},{"issue":"9","key":"pone.0264921.ref011","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1097\/ACM.0000000000001226","article-title":"Finding the Why, Changing the How: Improving the Mental Health of Medical Students, Residents, and Physicians","volume":"91","author":"SJ Slavin","year":"2016","journal-title":"Acad Med"},{"issue":"7","key":"pone.0264921.ref012","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1097\/ACM.0000000000001736","article-title":"Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment","volume":"92","author":"NA Yaghmour","year":"2017","journal-title":"Acad Med"},{"issue":"11","key":"pone.0264921.ref013","doi-asserted-by":"crossref","first-page":"784","DOI":"10.7326\/M18-1422","article-title":"Estimating the Attributable Cost of Physician Burnout in the United States","volume":"170","author":"S Han","year":"2019","journal-title":"Ann Intern Med"},{"issue":"2","key":"pone.0264921.ref014","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1080\/0142159X.2017.1279278","article-title":"Strategies to promote resilience, empathy and well-being in the health professions: Insights from the 2015 CENTILE Conference","volume":"39","author":"A Haramati","year":"2017","journal-title":"Med Teach"},{"issue":"12","key":"pone.0264921.ref015","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1001\/jama.2009.1385","article-title":"Enhancing meaning in work: A prescription for preventing physician burnout and promoting patient-centered care","volume":"302","author":"TD Shanafelt","year":"2009","journal-title":"JAMA"},{"issue":"2","key":"pone.0264921.ref016","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1001\/jamainternmed.2016.7674","article-title":"Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis","volume":"177","author":"M Panagioti","year":"2017","journal-title":"JAMA Intern Med"},{"issue":"3","key":"pone.0264921.ref017","doi-asserted-by":"crossref","first-page":"294","DOI":"10.4300\/JGME-D-16-00372.1","article-title":"Efficacy of Interventions to Reduce Resident Physician Burnout: A Systematic Review","volume":"9","author":"KR Busireddy","year":"2017","journal-title":"J Grad Med Educ"},{"issue":"1","key":"pone.0264921.ref018","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1093\/intqhc\/mzv098","article-title":"Participating physician preferences regarding a pay-for-performance incentive design: a discrete choice experiment","volume":"28","author":"T-T Chen","year":"2016","journal-title":"Int J Qual Health Care"},{"key":"pone.0264921.ref019","first-page":"14","article-title":"How to Implement Adherence-Promoting Programs in Clinical Practice? A Discrete Choice Experiment on Physicians\u2019 Preferences","author":"S M\u00fclle","year":"2020","journal-title":"Patient Prefer Adherence"},{"key":"pone.0264921.ref020","first-page":"11","article-title":"Factors affecting residency rank-listing: a Maxdiff survey of graduating Canadian medical students","author":"T Wang","year":"2011","journal-title":"BMC Med Educ"},{"issue":"6","key":"pone.0264921.ref021","first-page":"245","article-title":"Using Nominal Group Technique (NGT) to reach consensus on Graduate Attributes for nurses undertaking Postgraduate Certification in Neonatal Intensive Care in Australia","volume":"20","author":"P. Bromley","year":"2014","journal-title":"JNN"},{"key":"pone.0264921.ref022","year":"2020","journal-title":"Nominal Group Technique [Internet]."},{"key":"pone.0264921.ref023","doi-asserted-by":"crossref","first-page":"133","DOI":"10.2147\/PPA.S38408","article-title":"Nominal group technique to select attributes for discrete choice experiments: an example for drug treatment choice in osteoporosis","volume":"7","author":"M Hiligsmann","year":"2013","journal-title":"Patient Prefer Adherence"},{"key":"pone.0264921.ref024","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1186\/1471-2296-15-139","article-title":"Identifying competencies required for medication prescribing for general practice residents: a nominal group technique study","volume":"15","author":"JP Fournier","year":"2014","journal-title":"BMC Fam Pract"},{"issue":"10","key":"pone.0264921.ref025","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S0160-3450(16)33610-8","article-title":"Tapping employee insights with the Nominal Group Technique","volume":"NS30","author":"J Justice","year":"1990","journal-title":"Am Pharm"},{"issue":"3","key":"pone.0264921.ref026","first-page":"655","article-title":"How to use the nominal group and Delphi techniques","volume":"38","author":"SS McMillan","year":"2016","journal-title":"Int J Clin Pharm"},{"key":"pone.0264921.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13643-017-0526-3","article-title":"Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review","volume":"6","author":"B Clough","year":"2017","journal-title":"Syst Rev"},{"issue":"4","key":"pone.0264921.ref028","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.mayocpiqo.2019.07.006","article-title":"Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review","volume":"3","author":"PF DeChant","year":"2019","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"issue":"1","key":"pone.0264921.ref029","doi-asserted-by":"crossref","first-page":"81","DOI":"10.4103\/ijpvm.IJPVM_255_18","article-title":"Interventions for physician burnout: A systematic review of systematic reviews","volume":"9","author":"S Kalani","year":"2018","journal-title":"Int J Prev Med"},{"issue":"6","key":"pone.0264921.ref030","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/sjop.12398","article-title":"A systematic review and meta-analysis of tertiary interventions in clinical burnout","volume":"58","author":"O Perski","year":"2017","journal-title":"Scand J Psychol"},{"issue":"10057","key":"pone.0264921.ref031","doi-asserted-by":"crossref","first-page":"2272","DOI":"10.1016\/S0140-6736(16)31279-X","article-title":"Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis","volume":"388","author":"CP West","year":"2016","journal-title":"Lancet (London, England)"},{"issue":"4","key":"pone.0264921.ref032","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1007\/s40596-019-01023-z","article-title":"Interventions to Prevent and Reduce Burnout Among Undergraduate and Graduate Medical Education Trainees: a Systematic Review","volume":"43","author":"AL Walsh","year":"2019","journal-title":"Acad Psychiatry"},{"issue":"8","key":"pone.0264921.ref033","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.4314\/jasem.v23i8.7","article-title":"Weighting methods for multi-criteria decision making technique","volume":"23","author":"GO Odu","year":"2019","journal-title":"JASEM"},{"issue":"11","key":"pone.0264921.ref034","first-page":"e","article-title":"Identification and Prioritization of Important Attributes of Disease-Modifying Drugs in Decision Making among Patients with Multiple Sclerosis: A Nominal Group Technique and Best-Worst Scaling","volume":"11","author":"IEH Kremer","year":"2016","journal-title":"PloS One"},{"issue":"8","key":"pone.0264921.ref035","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.1056\/NEJMp1008305","article-title":"ACGME duty-hour recommendations\u2013a national survey of residency program directors","volume":"363","author":"TS Antiel RM","year":"2010","journal-title":"N Engl J Med"},{"issue":"5","key":"pone.0264921.ref036","first-page":"352","article-title":"PRACTITIONER APPLICATION: An Organizational Intervention to Reduce Physician Burnout","volume":"63","author":"WJ Oetgen","year":"2018","journal-title":"J Healthc Manag"},{"issue":"5","key":"pone.0264921.ref037","first-page":"338","article-title":"An Organizational Intervention to Reduce Physician Burnout","volume":"63","author":"ST Gregory","year":"2018","journal-title":"J Healthc Manag"},{"issue":"6","key":"pone.0264921.ref038","doi-asserted-by":"crossref","first-page":"E174","DOI":"10.1503\/cmaj.109-5556","article-title":"Addressing physician burnout at the systems level","volume":"190","author":"R. Collier","year":"2018","journal-title":"CMAJ"},{"key":"pone.0264921.ref039","doi-asserted-by":"crossref","first-page":"1-N.PAG","DOI":"10.3402\/ljm.v9.23556","article-title":"Burnout among physicians","volume":"9","author":"M Romani","year":"2014","journal-title":"Libyan J Med"},{"issue":"4","key":"pone.0264921.ref040","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1056\/NEJMp1715127","article-title":"To Care Is Human\u2014Collectively Confronting the Clinician-Burnout Crisis","volume":"378","author":"VJ Dzau","year":"2018","journal-title":"N Engl J Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264921","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T17:33:22Z","timestamp":1647624802000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264921"}},"subtitle":[],"editor":[{"given":"Sergio A.","family":"Useche","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,18]]},"references-count":40,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0264921","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,18]]}}}