work is devoted to identifying significant changes in the individual and psychological characteristics of medical workers with the initial level of professional burnout according the pathological states professional psychophysiological which implement preventive measures against the professional burnout development.
questionnaire.
28 respondents (emergency medical services staff: doctors, paramedics) took part in the questionnaire to determine the level of professional burnout, as well as testing psychophysiological reactions of the central nervous system for a comprehensive assessment of the respondents’ general condition. The proposed mathematical approach enabled us to determine a group of pre
The dynamic development and intensification of production processes, the increase in the social
component of a person's environment is characterized by an additional psychological burden in
professions of the socionomic type, which activities are based on the "person-to-person" communication
[
The professional burnout syndrome is included in the 11th revised version of the International the state of public health and referrals to health care institutions" (Z00- Z99), which contains the reasons for the population referral to health care institutions, which are not classified as diseases or medical
2022 Copyright for this paper by its authors.
conditions (WHO, 28 May 2019). Specialists of the Center for Disease Control (CDC, Atlanta, USA)
and the Prevention National Institute for Occupational Safety (NIOS) annually review and supplement
the list of professional specialties related to the control of the chronic fatigue syndrome ("burnout") and
its prevention measures (CDC, NIOS, 2019) [
In modern literature there are data characterizing the development of stress at work [
The study of functions that affect professional medical activity is becoming more and more relevant
in the social aspect, which is due to the great practical interest in the effective work of physicians. In
particular, the professional burnout syndrome in emergency medical staff develops as a result of
constantly being in situations related to communication, urgent decision-making, responsibility for the
life and health of the patient, variability in work and other organizational factors [
The general scheme of the problem is shown in Figure No. 1. It provides factors of the labor process that are triggers for the appearance of psycho-emotional stress in medical workers, which subsequently lead to the development of symptoms of professional burnout. It is clear from the given scheme that the task of our research was to develop an approach that will help to identify a complex of early criteria of pre-pathological conditions in order to prevent the occurrence of symptoms of psycho-emotional stress, and therefore to prevent the development of professional burnout.
The relevance of this issue is sufficiently highlighted in the above. The given data indicate the state and relevance of the problem and do not offer measures and algorithms to prevent the professional burnout development, do not determine the criteria for diagnosing pre-pathological states development in such a socially significant category of workers as healthcare workers. Therefore, it is important to search for adequate and informative criteria using modern mathematical tools, which allow to identify with a high degree of objectivity the criteria for the pre-pathological states of the professional burnout syndrome in specialists of the emergency medical care center.
Therefore, the aim of this study is to develop a scheme of a mathematical approach to establishing the information criteria for the early diagnosis of the professional burnout development in healthcare workers, using the example of emergency medical care to form a group of pre-pathological states of professional burnout.
The study of emergency medical care staff was conducted in two stages. At the first stage, a medical and psychological questionnaire was conducted as a means of diagnosing the development of professional burnout and assessing the individual and psychological qualities of respondents using the questionnaire "Maslach Burnout Inventory - General Survey" (MBI-GS) in order to identify the levels of professional burnout based on the three-factor model of the professional burnout syndrome development. The second stage is the study for a comprehensive assessment of the psychophysiological and psychological properties and functions of the respondents’ body based on the results of performing test tasks, namely: a simple visual-motor reaction, a choice reaction, a difference reaction, a critical blinking fusion frequency, memory for images, a visual-motor reaction with a score. For a comprehensive assessment, a computer complex of psychophysiological testing NS-psychotest (certificate of state registration No. 2017618884 dated August 10, 2017) was used. The representative sample included 28 respondents – specialists in emergency medical care (doctor, paramedic) Fig. 2.
The biggest part of Artificial Intelligence (AI) methods for classification tasks can be presented as
black-box-models. It means that special methods should be used for understanding reasons of such
decisions made by classification system. Explainable Artificial Intelligence [
The main idea of Permutation Importance method is how much any score as accuracy, f1, R2 etc.
decreases when a feature is not available. On each step one feature is replaced by random noise (to
make feature column presented in dataset, but it no longer contains useful information), the estimator
re-trains and algorithm checks the score. So, it shows what features are important within a dataset, not
what is important within a concrete trained model. Eli5 in combination with lgbm-model shows high
accuracy for explaining model results for covid-19 data [
Mathematical approach is based on classification method (logistic regression) with explanator Eli5
[
It consists of MBI-GS questionnaire and professional burnout type that was calculated based on special methodology. Classification model training combining with explanator is needed for defining information indicators of MBI-GS questionnaire. Measured psycho-physiological indicators are fed to second classification model as a training vector and results of calculation professional burnout level for the same respondent – as a target vector. After models were trained, explanator analyses trained model and explain result.
At first step professional burnout level have to be defines for each respondent. The methodology of
those calculating was modified in [
Scatter plot of respondents in the space of three principal components is presented in Fig.4.
It is easy to see that density of group without professional burnout (0 group) is higher than density of group of high professional burnout level (2 group). It can be explained by the fact that professional burnout process can be occurred on one of three scales (“emotional exhaustion” (ee), “cynicism/depersonalization” (zy) and “reduction of personal achievements” (ef)). The most interesting for diagnostic is 1 group – the group of probands with initial manifestation of professional burnout process.
MBI-GS questionnaire
(information indicators of
Eli5 explainer helps to determine the information indices that demonstrate the development of depersonalization phenomena according to the answers to questions 13, 14, 15 (MBI_14_zy, MBI_13_zy, MBI_15_zy) (Fig. 5).
These indicators are most informative ones for the presented division into groups. The accuracy of the logistic regression model is 0,96 0,13 (based on 10-fold cross-validation).
professional burnout on the level of
The next part of research is based on defining the dependencies between psycho-physiological indicators and level of professional burnout. Psycho-physiological indicators consist of six subgroups: Simple visual-motor reaction (SVMR), Choice reaction (CR), Discrimination reaction (DR), Visualmotor reaction with counting (VMRC), Critical flicker fusion frequency (CFFF) and Memory for images (MI). Psycho-physiological indicators for each of subgroups are presented in Table 1 and Table 2. It should be noted that the number of psycho-physiological indicators is close to the number of respondents. That’s why each type of psycho-physiological indicators was processed separately. Results presented in Fig. 6. The most important features have higher value of weight.
Visual-motor reaction with
counting (VMRC)
Average reaction time Root mean square deviation of
the reaction time Number of correct reactions Number of mistakes made Number of passes made Number of false reactions Number of premature clicks Attention span and working memory
Critical flicker fusion frequency
(CFFF)
Average frequency with increasing flicker frequency
Average frequency with decreasing flicker frequency
Memory for images
(MI) Number of correct answers
Number of mistakes
Memory capacity
According to the results of the medical and psychological survey, a group of workers with prepathological conditions was identified, for which significant criteria questions from the MBI questionnaire were determined. The analysis of the obtained data proved that the workers from the prepathology group feel exhausted at the end of the working day (emotional exhaustion), strive to fulfill only their direct duties, have manifestations of cynicism (depersonalization), doubts about the significance of their work, but at the same time have confidence that the work is performed effectively (reduced personal accomplishment).
During the study of psychophysiological changes in the body using the "simple visual-motor reaction" method among the emergency medical staff, it was established that the significant criteria indicators are an increase in the "visual-motor reaction rate" indicator; an increase in the "performance evaluation by reaction rate" indicator; an increase in the "functional level of the system" with a simultaneous decrease in the "level of functional capabilities" indicators.
According to the "visual-motor reaction with counting" method, the criterion-significant indicators are an increase in the "number of errors", "attention span and working memory" and decrease in "root mean square deviation of the sensorimotor reaction rate". According to the method of "difference reaction", all indicators had the same low level of informativeness. According to the "choice reaction" method, only a decrease in the "number of clicks" indicator is informative.
Indicators of the "critical frequency of flicker fusion" method are sufficiently informative compared to the indicators of the "memory for images" method.
The general characteristic of the comparison of methods and the dynamics of changes in indicators shows that the establishment of the most significant changes from the CNS was determined using the "simple visual-motor reaction" method. Therefore, the decrease in the efficiency of visual-motor reactions is provoked by the formation of inertia of the nervous processes due to the decrease in the sensorimotor reaction rate, which is probably related to the branching of neural connections between the frontal parts of the cerebral cortex and the motor areas of the cortex, subcortical structures responsible for the motor reaction formation. These changes can be considered as the instability of the visual-motor response to external stimuli against the background of the suppression of the functional stability of the brain structures work, their reduced strength, balance, which is caused by a high level of work intensity. The above-mentioned changes are the triggers for declining performance levels, developing fatigue, and reducing sensory memory capacity.
1. The establishment of early diagnostic criteria for the prenosological state of the professional burnout development in healthcare workers (on the example of the emergency care staff) should be considered a necessary stage in the preventive measures development.
2. According to the results of selection of the cluster of the pre-pathological state group based on the MBI-GS questionnaire using a mathematical model based on artificial intelligence, it was established that the phenomena of emotional exhaustion and state of reduced personal accomplishment were observed in the group of pre-pathology, while the most informative indicators were the development of depersonalization.
3. The use of an original mathematical approach made it possible to establish objective psychophysiological indicators by which it is possible to determine the pre-pathological state from the CNS functioning, namely: a simple visual-motor reaction (according to the criteria of "visual-motor reaction rate", "performance evaluation by reaction rate", "functional level of the system", "level of functional capabilities"), visual-motor reaction with counting (according to the criteria "number of errors", "root mean square deviation of the sensorimotor reaction rate").
The study was conducted as a part of the scientific research work "Justification of criteria for prepathological states of professional burnout in healthcare workers", state registration number 0121U110914, financed by the Ministry of Health of Ukraine at the expense of the state budget.