Date Published: December 1, 2017
Publisher: Springer International Publishing
Author(s): Mickey Trockel, Bryan Bohman, Emi Lesure, Maryam S. Hamidi, Dana Welle, Laura Roberts, Tait Shanafelt.
The objective of this study was to evaluate the performance of the Professional Fulfillment Index (PFI), a 16-item instrument to assess physicians’ professional fulfillment and burnout, designed for sensitivity to change attributable to interventions or other factors affecting physician well-being.
A sample of 250 physicians completed the PFI, a measure of self-reported medical errors, and previously validated measures including the Maslach Burnout Inventory (MBI), a one-item burnout measure, the World Health Organization’s abbreviated quality of life assessment (WHOQOL-BREF), and PROMIS short-form depression, anxiety, and sleep-related impairment scales. Between 2 and 3 weeks later, 227 (91%) repeated the PFI and the sleep-related impairment scale.
Principal components analysis justified PFI subscales for professional fulfillment, work exhaustion, and interpersonal disengagement. Test-retest reliability estimates were 0.82 for professional fulfillment (α = 0.91), 0.80 for work exhaustion (α = 0.86), 0.71 for interpersonal disengagement (α = 0.92), and 0.80 for overall burnout (α = 0.92). PFI burnout measures correlated highly (r ≥ 0.50) with their closest related MBI equivalents. Cohen’s d effect size differences in self-reported medical errors for high versus low burnout classified using the PFI and the MBI were 0.55 and 0.44, respectively. PFI scales correlated in expected directions with sleep-related impairment, depression, anxiety, and WHOQOL-BREF scores. PFI scales demonstrated sufficient sensitivity to detect expected effects of a two-point (range 8–40) change in sleep-related impairment.
PFI scales have good performance characteristics including sensitivity to change and offer a novel contribution by assessing professional fulfillment in addition to burnout.
In our evaluation of reliability, sensitivity to change, and construct validity of the PFI measurement tool, we use previously published definitions of these terms and their related components [35, 36]. The construct validity of a survey measure is its ability to measure what it is intended to measure. Reliability of a measure refers to its ability to consistently measure the variable it is intended to measure. Sensitivity to change refers to the ability of an instrument to detect changes over time. Face validity refers to a subjective assessment of whether a survey instrument appears to measure the construct it purports to measure. Content validity of a survey instrument refers to the degree to which the survey items assess the breadth of the variable it is intended to measure. Criterion validity refers to the relationships between scores on a measurement tool and other variables that should correlate with the variable these scores quantify. Evaluation of criterion validity includes assessment of convergent validity, discriminant validity, concurrent validity, and predictive validity. Convergent validity is the convergence or correlation between measures that are intended to assess the same variable. Discriminant validity is the divergence or lack of correlation between measures that are intended to assess distinct variables. Concurrent validity refers to the correlation between scores on a measurement tool and other theoretically associated variables measured at the same time. Predictive validity is not assessed in the current study and refers to the correlation between scores on a measurement tool and other theoretically associated variables measured later. Factor validity refers to the degree to which hypothesized structure of a measurement scale is observed in a data set of responses to survey items .
The Physician Fulfillment Index (PFI) was developed to meet the need for a more robust and balanced approach to assessing wellness variables that (1) are relevant to physicians and are relatively short and easy to use, (2) are well suited to assessment of changes that occur across time in relation to interventions, and (3) include a focus on positive aspects of the role and work of physicians, i.e., professional fulfillment, as well as negative aspects, i.e., burnout. This study involving 250 physicians based at a major academic center demonstrates that the PFI has good internal consistency and test-retest reliability. The PFI correlates well with other widely used measurement tools, while, compared with other tools currently used to assess physicians’ work-related wellness, it is broader and more balanced in its scope. For instance, the PFI work exhaustion scale had a high correlation with the emotional exhaustion scale of the MBI, which is widely used to evaluate burnout variables. Similarly, the PFI interpersonal disengagement also had a high correlation with the related MBI depersonalization scale. Perhaps most importantly, the PFI scales demonstrated sufficient sensitivity to detect the expected burnout and professional fulfillment effects of a two-point or greater (scale range 8 to 40) change in sleep-related impairment, a risk factor for lower physician well-being—particularly among resident physicians , who comprised more than two thirds of the current study sample. This psychometric property of the PFI is particularly important because a significant motivator for the development of the PFI was to create a measure sufficiently sensitive to detect recent changes, a measurement property needed when evaluating the effects of an intervention lasting weeks or months rather than years. This finding suggests the PFI is a suitable tool for assessing physician well-being pre- and post-intervention efforts to prevent or ameliorate physician burnout.