Alec Knight

ObjectiveTo estimate the pooled prevalence of burnout among practicing physician assistants/associates (PAs) and identify contributing factors.MethodsWe conducted a systematic review and meta-analysis of observational studies published between January 2018 and January 2026 using CINAHL, PubMed, Embase, ScienceDirect, Cochrane, and Google Scholar. Primary research reporting burnout statistics in practicing PAs was included. Data were pooled using inverse-variance weighted random-effects models.ResultsEighteen studies (N = 47,098) were included. The pooled burnout prevalence was 33.7% (95% CI: 30.3%–37.3%;prediction interval: 21.1%–49.2%; I2 = 97.4%). Heterogeneity was substantial (I2 = 97.4%). Subgroup analysis revealed significantly higher burnout rates in studies using MBI (39.0%) compared with non-MBI measures (29.4%; p = .002). No evidence of small-study effects was detected (p = .98).ConclusionsApproximately one-third of PAs experience burnout. Prevalence estimates are sensitive to the measurement instrument used. Interventions should target systemic factors rather than individual demographics to ensure workforce sustainability.

Background: Burnout is increasingly identified as a factor affecting physician welfare, and subsequently patient care. Surgeons are known to experience higher rates of burnout compared with the general population. No review has focused exclusively on burnout prevalence among paediatric surgeons. This systematic review and meta-analysis aims to determine the prevalence of burnout among paediatric surgeons, alongside identifying and analysing potential influences. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines, following our published PROSPERO protocol (CRD42025640570), 719 records were identified from inception through 13 January 2025. Included studies produced primary data reporting paediatric surgeon burnout prevalence, using validated burnout metrics. Main exclusion criteria were: study or population irrelevance, study type and duplicates. All available data were extracted; authors were contacted for original data. Random-effects meta-analysis with restricted maximum likelihood estimation estimation was conducted to estimate a pooled burnout prevalence, further subgroup analyses and meta-regressions were performed. Results: Meta-analysis of 15 studies (2757 paediatric surgeons) revealed a pooled burnout prevalence of 29.4% (95% CI 20.3% to 40.5%), with substantial heterogeneity (I²=96.4%). Burnout rates ranged from 7.8% to 73.7%. Studies using the Maslach Burnout Inventory (MBI) reported significantly lower burnout (22.4%) compared with non-MBI tools (44.9%; p=0.025). No publication bias was detected. Study quality and measurement tool choice explained 35.3% and 24·5% of heterogeneity, respectively. Conclusions: This study establishes that nearly one in three paediatric surgeons experience burnout, with a pooled prevalence of 29.4% (95% CI 20.3% to 40.5%). This rate, while concerning, is notably lower than other surgical disciplines. Strong personal accomplishment, resulting from emotionally rewarding work with children, appears protective, alongside structurally embedded practices such as family-centred care and multidisciplinary collaboration. Personality traits associated with increased agreeableness, conscientiousness and emotional stability may further reduce susceptibility to burnout. Specialty-specific interventions, supported by structured mentorship, are critical to sustainable well-being throughout paediatric surgical practice.

Background: Fostering a strong professional identity (PI) enhances career fulfillment. In China, therapy education is undergoing development, integrating both Western and traditional health concepts, causing inconsistent PI among therapy students. To date, no validated tools exist to measure and monitor PI of Chinese therapy students. This study aimed to translate and validate the 9-item MacLeod Clark Professional Identity Scale (MCPIS-9) for this purpose. Design: This study involved translation and cultural adaptation of the MCPIS-9, followed by a rigorous assessment of its model fit and psychometric properties using data collected via an online questionnaire. Methods: A forward- and backward- translation process was conducted. Content validity was evaluated using item-level content validity index (I-CVI) and scale level content validity index average method (S-CVI/Ave). Therapy students across all grades at undergraduate and postgraduate levels in China were eligible. Exploratory factor analysis (EFA) examined the underlying factor structure. Model fit was evaluated through confirmatory factor analysis (CFA) using the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Standardized Root Mean Square Residual (SRMR) and Root Mean Square of Error of Approximation (RMSEA). Convergent validity was assessed through Pearson’s correlations coefficient (r) with the Professional Identity Scale for Health Students and Professionals (PISHSP). Internal consistency was examined using Cronbach’s Alpha (Cα) and McDonald’s Omega (ω). Results: A total of 1054 students participated. Content validity was excellent (I-CVI = 0.86–1.0, S-CVI/Ave = 0.98). EFA indicated a two-factor structure with acceptable model fit (CFI = 0.978; TLI = 0.968; SRMR = 0.033; RMSEA = 0.063). Reliability was strong (Cα = 0.835; ω = 0.817). Convergent validity demonstrated a strong correlation (r = 0.75) with the PISHSP. Conclusions: The Chinese MCPIS-9 is a reliable and valid tool for assessing PI among therapy students. Future research could focus on refining item 4 of this tool, potentially through further exploration of therapy students’ perceptions of PI within the unique context of the Chinese healthcare system.

Background: The United Kingdom (UK) population is experiencing high levels of economic inactivity due to long‐term sickness absence. Concurrently, the occupational health (OH) workforce, which plays an important role in assisting people back to work and maintaining their health and well‐being at work, is declining in numbers and struggling to recruit. The study aim was to explore the role that experienced OH professionals (OHPs) can play in encouraging recruitment to the field—from the perspective of non‐OH doctors and nurses (pre‐ and postqualification) as groups who could potentially join the field. Methods: In 2023, we undertook a study where we explored the awareness and attractiveness of the OH field based on the perspectives of 58 medical and nursing students, practitioners, and career leavers working within and outside OH. The role of experienced professionals was identified as an important element in OH recruitment. We therefore reinterrogated data (i.e., reanalysed codes) collected in 25 interviews and 3 focus groups (total = 43 participants) with non‐OH medical and nursing students and practitioners about the factors that influenced participants’ career choices, factors that influenced levels of awareness and attractiveness of OH, and strategies and channels to increase both and to promote OH career. Data were analysed thematically using NVivo 14 to manage the process. Findings: Two themes about the role of experienced OHPs in recruitment were identified: developing opportunities to build interactions with OHPs, sharing knowledge about OH occupational features and providing insights about career choices in mentoring relationships. Conclusions: The potential for experienced OHPs as specialism advocates and ambassadors could be leveraged more purposefully and systematically. Employers, professional and educational bodies, and policy makers could encourage and incentivise experienced OHPs to host more placements and to provide other opportunities for quality interactions between OHPs and potential recruits.

Background and aims: Psychedelics show promise for treatment of mental health conditions (MHCs). But there is relatively little research on indigenous psychedelics conducted in the Global South (GS). Much research is carried out in the Global North, where there are different cultural perceptions of mental health and psychedelics. Therefore, this paper appraises research on psychedelics for treatment or therapy where research was carried out in the GS.Method: A systematic review of research literature was conducted from 1st January 2010 to 31st July 2023. Medline, PsychINFO and Global Health databases were searched for studies of patients undergoing treatment for MHCs with psychedelics.Results: Data from 27 papers were extracted and narratively synthesized. A total of 984 participants were included suffering from depression, obsessive-compulsive disorder, substance use disorder, post-traumatic stress disorder and eating disorders. The studies investigated the feasibility of psychedelic treatments and presented evidence for their safety. There was preliminary efficacy data for ayahuasca, iboga, 5-MeO-DMT, psylocibin, and MDMA in the treatment of some MHCs. All studies were conducted in line with ethical and medical guidelines, and no serious adverse events were reported.Conclusion: A renaissance of clinical psychedelic research on substances that have been used as traditional medicines in the GS presents promising evidence for treatment efficacy and safety across a range of MHCs. Psychedelics present an exciting new treatment approach for people in the GS, in a health area with considerable unmet need. Moreover, research demonstrated cost-effectiveness, while results suggested no significant safety concerns or side effects.

Background: Acquired brain injury (ABI) and other chronic conditions are placing unprecedented pressure on healthcare systems. In the UK, 1.3 million people live with the effects of brain injury, costing the UK economy approximately £15 billion per year. As a result, there is an urgent need to adapt existing healthcare delivery to meet increasing current and future demands. A focus on wellbeing may provide an innovative opportunity to reduce the pressure on healthcare services while also supporting patients to live more meaningful lives. The overarching aims of the study are as follows: (1) evaluate the feasibility of conducting a positive psychotherapy intervention for individuals with ABI and (2) ascertain under what conditions such an intervention would merit a fully powered randomised controlled trial (RCT) compared to a standard control group (TAU). Methods and analysis: A randomised, two-arm feasibility trial involving allocation of patients to either a treatment group (positive psychotherapy) or control group (treatment as usual) group, according to a 1:1 ratio. A total of 60 participants at three sites will be recruited including 20 participants at each site. Assessments will be conducted at baseline, on completion of the 8-week intervention and 3 months following completion. These will include a range of questionnaire-based measures, psychophysiology and qualitative outcomes focusing on feasibility outcomes and participant experience. This study has been approved by the Wales Research Ethics Committee (IRAS project ID: 271,251, REC reference: 19/WA/0336). Discussion: This study will be the first to examine the feasibility of an innovative, holistic positive psychotherapy intervention for people living with ABI, focused on individual, collective and planetary wellbeing, and will enable us to determine whether to proceed to a full randomised controlled trial. Trial registration: ISRCTN12690685, registered 11th November 2020.

BackgroundThe COVID-19 pandemic presented significant challenges to healthcare workers worldwide, including the effect on the psychological wellbeing of dentists.AimsTo evaluate the impact of the early phases of the pandemic on the psychological health, long-term wellbeing and clinical service provision of dentists, as well as the identification of the key risk and protective factors for adverse mental health outcomes (MHOs) in this group.MethodsA systematic review of cross-sectional studies (n = 53) from public and private dentistry sectors was employed to delineate the risk and protective factors for adverse MHOs.ResultsSelf-reports from these studies (1 December 2019 to 31 December 2021), involving 45,671 dentists worldwide were analysed. Study findings were classified according to their psychological impact (as risk or protective factors), categorised as 'operational' or 'organisational' and subdivided into 'psychosocial', 'occupational', 'sociodemographic' and 'environmental' elements. A GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) certainty of evidence score was calculated for all the identified factors.ConclusionsThis review confirmed the negative impact of the pandemic on the MHOs of dentists worldwide. Pivotal risk factors included fear of infection, transmission to families, lack of personal protective equipment and possible direct contact with infected patients. Enhanced infection control protocols, individual resilience and organisational support were identified as important protective factors.