Chiropractic faculty experiences of burnout and the COVID-19 pandemic
The Maslach Burnout Inventory (MBI) is frequently used to assess occupational burnout and the Epidemic-Pandemic Impacts Inventory (EPII) is a new tool for assessing pandemic impacts. This study’s objective is to describe chiropractic faculty members’ experience of the COVID-19 pandemic, their burnout as professional educators, and their strategies for coping with stress. A Qualtrics survey link was emailed to 73 current faculty and 10 previously employed faculty from 1 chiropractic school. The survey included 22 MBI, 31 EPII, and 2 questions about coping strategies. Faculty were given several weeks to complete the survey, were reminded via emails and meeting announcements, and were given paper surveys to increase participation. Responses were analyzed in STATA17. Forty-three faculty completed the survey (response rate = 52%). Of these, 25.8% reported testing positive for COVID-19, 30.23% reported difficulties transitioning to working from home, and 25.5% scored high on the MBI subscale for emotional exhaustion (EE) (mean 15.79, SD 13.68). Higher EE was associated with pandemic-related increases in mental health and sleep problems. Common coping strategies included self-care and social support. The majority of faculty reported neither contracting COVID-19 nor having difficulty transitioning to work from home. Average EE for participating faculty was lower than previous reports although a quarter scored high in EE, which may be associated with pandemic-related mental health and sleep problems. These results suggest chiropractic faculty might need support coming out of the COVID-19 pandemic and indicate the need for future research on burnout among faculty from other chiropractic institutions.ABSTRACT
Objective
Methods
Results
Conclusion
INTRODUCTION
As of November 2023, there have been over 6.5 million hospitalizations and over 1.1 million deaths in the United States due to the SARS-CoV-2 virus.1 In addition to morbidity and mortality from the virus, the COVID-19 pandemic has had other public health consequences, including changes in health behaviors2 and mental health.3
Previous studies have documented pandemic-related anxiety, stress and depression among university faculty.4–6 In 1 study of Washington University employees, 50% of faculty reported increased work-loads due to the pandemic and the majority of faculty reported worse overall, mental and social well-being due to COVID-19 related work or life changes.5 Teachers may be at more risk for anxiety, stress, and depression during the COVID-19 pandemic than the general population.7
According to a Chronicle of Higher Education survey, over 50% of higher education faculty considered leaving their job in 2020 during the first year of the pandemic.8 Burnout is associated with career dissatisfaction in health professional faculty9,10 and is defined by the World Health Organization as an “[occupational] syndrome…resulting from chronic workplace stress that has not been successfully managed.”11 The Maslach Burnout Inventory is commonly used to assess burnout among university teaching staff12 and to the investigators’ knowledge, has not been used previously with faculty at doctor of chiropractic programs (DCPs).
The primary purpose of this study was to document the impacts of the COVID-19 pandemic on DCP faculty physical and emotional well-being using the Epidemic-Pandemic Impacts Inventory (EPII) and to describe faculty burnout using the MBI. The secondary aim was to assess whether MBI scores were associated with EPII responses and faculty characteristics, such as part-time vs full-time status. We were also interested in faculty members’ strategies for coping with work-related stress.
METHODS
This study took place at 1 chiropractic college with a 4 quarter (11-weeks each) academic calendar. In March 2022 (during week 8 of the Winter 2022 quarter), the principal investigator emailed an invitation and Qualtrics (Provo, UT) survey link to currently employed faculty (n = 73) who taught part-time or full-time during 2020–2022 at the institution and who were not on the investigation team. The principal investigator also emailed invitations to 10 former faculty members who had previously left the college during that same timeframe (2020–2022). The investigation team chose an online-survey for the advantages outlined by Helen Ball, including the ability to reach a large number of faculty at 1 time13 and used Draugalis and colleagues’14 best practices as a guide for reporting survey research.14
The email invitation for the survey shared information about the study and offered a $100 gift card to be raffled for every 10 participants. The first page of the survey provided an informed consent including approximate time for taking the survey (15–20 minutes); possible risks of the survey (stress or social discomfort); and steps taken to preserve confidentiality (storing separately any links between emails and responses in a password protected file to be deleted after study completion).
This study was reviewed by the Life Chiropractic College West institutional review board and received a determination of exemption. The investigators protected the identity of respondents by not asking questions about age, gender, race and ethnicity. The study also used the anonymous links in Qualtrics which does not identify participants in the survey responses but keeps a separate log of who opened and completed the survey to aid with follow-up. Faculty had 3.5 weeks to complete the survey and they were reminded via 2 emails and 2 faculty meeting announcements. In June 2022 (week 8 of the Spring 2022 quarter), the research team also delivered paper surveys to currently employed non-responders who had mailboxes on-campus (n = 30) to increase participation.
Survey Components
The survey was developed and pilot tested by the research team of 2 full-time faculty members and 3 research staff.
Demographic Questions
The survey asked 3 questions about faculty status: position (full-time or adjunct); department (academic or health center); and years working at the institution (less than 2 years, 2–4 years, 5–9 years, and greater than 10 years). Faculty were queried about the primary format of their class teaching (online-asynchronous, online-synchronous, hybrid, or in-person); and whether or not their course(s) primarily required a hands on component in which students needed to physically touch other students. From the survey responses received, the principal investigator created dichotomous variables for years working at the institution (≤9 years vs 10 years or more) and for online status (online or hybrid vs in-person).
COVID-19 Experience Questions
The survey included 31 questions from the Epidemic-Pandemic Impacts Inventory (EPII). EPII was designed by a team from the University of Connecticut School of Medicine and University of Massachusetts in 2020 to assess how the COVID-19 pandemic changed people’s lives.15 The original EPII tool included 92 questions and asked participants to consider what has changed for themselves and their family since the pandemic began. The research team reviewed the EPII questions and discussed which ones would be most relevant to the faculty based on informal conversation with peers. Consensus was reached after multiple rounds of survey edits. At the time of the survey design, the EPII questions were not yet validated. For data analysis, investigators compared responses for faculty who selected “Yes (me)” to those who responded “Yes, other person in my home,” “No,” and “N/A” as the primary interest was the direct impacts of the pandemic on faculty themselves.
Burnout Questions
The survey also included 22 questions from the Maslach Burnout Inventory Educators Survey (MBI-ES; copyright ©1986 Christina Maslach, Susan E. Jackson, and Richard L. Schwab). The MBI-ES assesses 3 aspects of burnout, each measured on a continuous scale: emotional exhaustion (EE), depersonalization (DP) and personal achievement (PA). Higher EE and DP scores and lower PA scores are indications of burnout. The EE subscale contains 9 questions with a total possible score of 54. The DP subscale has 5 questions with total possible score of 30, and PA subscale has 8 questions and total possible score of 48. For data analysis, the principal investigator created ordinal variables using thresholds for high, moderate and low EE, DP and PA based on other prior research16,17: Low EE (0–16), Moderate EE (17–26), High EE (27 or higher); Low DP (0–6), Moderate DP (7–12), and High DP (13 or higher); and Low PA (0–30); Moderate PA (31–36), and High PA (37 or higher).
Coping Questions
In addition to the multiple choice questions described above, the survey included the following 2 open-ended questions to gather information about faculty members’ coping strategies: “In the text box below, please share how you cope with work-related stress” and “If you adopted new strategies for coping with stress since the beginning of the COVID-19 pandemic, please describe.”
Analysis of Survey Data
Quantitative data were exported from Qualtrics into Microsoft Excel (Microsoft Corp) and then imported into STATA/SE 17.0 (StataCorp) for descriptive and inferential statistical analyses. Associations between the continuous EE subscale, the dichotomous faculty status variables and the dichotomized responses to the EPII questions were assessed using the Mann Whitney U test. To account for multiple testing, Bonferroni correction was set to an alpha level of .001. The analysis excluded missing answers.
To analyze the qualitative data, 2 of the investigators (MP, KW) first reviewed the de-identified responses to the open-ended questions about coping with work-related stress and then conducted thematic analysis. They created a codebook by identifying common codes based on the faculty responses and searched for themes previously reported in the extant literature (thematic analysis).18 The same 2 investigators independently applied the codebook to the survey responses and discussed any discrepancies until reaching 100% agreement for categorizing specific coded responses into final general themes.
RESULTS
Faculty were considered responders if they completed the majority of the survey. The combined response rate of all invited participants was 52% (n = 43). 55% of current faculty responded and 33% of contacted faculty who had left the college responded. Among currently employed faculty, the response rate for the electronic survey (51%) was much higher than for the paper survey (10%). Ninety-three percent of currently employed participating faculty responded via the initial electronic survey. Figure 1 provides additional information on the faculty respondents.
Citation: Journal of Chiropractic Education 38, 1; 10.7899/JCE-22-30
EPII Responses for Experiences During the COVID-19 Pandemic
The majority of faculty reported that since the COVID-19 pandemic began, they have worked in close contact with people who might be infected (76.74%) and experienced increased workload (76.74%); increased mental health problems/symptoms (51.16%); increased screen time (76.74%) and increased sedentary behavior (69.77%). The majority also reported decreased participation in social clubs, sports or volunteer activities (76.74%) and physical activity (53.49%). Other notable findings were 48.84% reported increased sleep problems, 37.21% reported increased unhealthy eating; 25.58% reported increased use of alcohol or substances, and 23.26% reported increased health problems not related to COVID-19. Twenty-six percent reported testing positive for SARS-CoV-2 and no respondents reported medical treatment or hospital stay for COVID-19 (although 18.6% reported death of a close friend or family member due to COVID-19). Over 1/3 of faculty reported the following positive changes since the coronavirus disease pandemic: more time in nature (39.53%); more time doing enjoyable activities (44.19%); greater meaning in work (37.21%); more efficient at work (37.21%); and more appreciative of things (74.42%). A summary of the responses to the EPII questions are in Table 1.
MBI-ES Responses for Feelings of Burnout
The average scores and standard deviations (SD) for the 3 aspects of burnout were 15.79 (SD = 13.68) for Emotional Exhaustion (EE); 5.23 (SD 4.73) for Depersonalization (DP) and 38.43 (SD 7.39) for Personal Achievement (PA). The majority of faculty scored low on EE and DP and high on PA however 25.58% scored high on EE, 11.63% scored high on DP; and 9.30% scored low on PA.
Associations Between EPII Responses and EE and Between Faculty Status and EE:
The difference in mean ranks of EE scores were significantly different for faculty who responded “yes” to increases in mental health symptoms (p < .001), sleep difficulty (p < .001) and alcohol use (p = .001) since the beginning of the pandemic, compared to faculty who responded “no.” Median EE scores by EPII responses are available in Table 2. There were no statistically significant differences in EE scores in any of the faculty status variables with alpha level = .001. Adjunct faculty had lower median EE scores compared to full-time faculty (8.0 vs 17.5) (p = .007) (Table 3).
Qualitative Findings for Coping Questions
The first coping question queried faculty on their strategies for coping with work-related stress. Applying the codebook, the investigators categorized responses into 4 main identified themes of self-care, social support, mental attitude, and leisure activities. Within the self-care theme, faculty specifically reported that they would “do physical work outside,” “[take] a nice long walk,” “[play] golf,” “[do] yoga,” “exercise daily,” “[get] adjusted,” and “sleep deeply and enough.” For the social support theme, faculty reported spending time with “family” and also receiving “emotional support from [their] pet.” Under mental attitude, faculty responded that they were able to “focus on aspects [they are] grateful for” and “see the positive in [their] life.” For leisure activity, faculty would watch “Netflix,” spend “a day at the beach” and simply “do activities that have nothing to do with work.”
The study’s other coping question queried whether faculty adopted new strategies for coping with stress since the beginning of the COVID-19 pandemic, and the 2 themes of self-care and mental attitude were prominently mentioned again. Self-care post pandemic included “improved diet to lose weight gained over past 2 years” and mental attitude included, “Just kept focusing on what I could do to make the world better” and “did not allow myself to be sucked into the extremely fear-based political and media machine.” Responses to the second coping question also frequently included time management as a common theme, in that faculty reported that “focus[ing] on productivity,” “creating a home office” and “[finishing tasks] before too late in the day” helped them cope with stress during the COVID-19 pandemic. One faculty wrote, “I mostly lost touch with my coping mechanisms [until I made changes to my work responsibilities].”
DISCUSSION
This study had over a 50% response rate and highlighted faculty experiences during the COVID-19 pandemic at 1 chiropractic college in the United States. At the time of the study (Spring 2022) the United States Centers for Disease Control and Prevention reported a 57.7% seroprevalence for SARS-COV-2,19 yet only 25.58% of faculty participants reported testing positive. It is not known if this is due to a lower rate of infection or to a lower rate of testing or unwillingness to disclose, or other possible reason. The majority of participating faculty reported increases in workload, mental health problems, screen-time, and sedentary behavior since the onset of the pandemic. These findings are not unique to this DCP.4–6,20
A strength of this study was the use of the validated 22 item MBI-ES to assess 3 dimensions of burnout in chiropractic faculty. Participating faculty on average scored lower on the EE and DP subscales and higher on the PA subscale compared to health professional faculty from several other studies using a 22 item MBI to assess burnout in health professional faculty.16,21–23 The investigators did not find statistically significant differences between faculty status variables and the EE subscale in the current study; however prior studies have found associations between EE and full vs part-time status,21,24,25 type of classes/department,24,26 and hours working from home.26 While participating faculty scored relatively low on EE and DP subscales and high on the PA subscale, about a quarter of the faculty members were flagged as having high emotional exhaustion. To decrease selection bias in this study, the investigators invited faculty who recently departed the institution and provided a paper survey to current faculty non-responders. While the responses to these outreach efforts were too limited for robust statistical testing, EE levels were 4 times higher among faculty who had recently departed the college compared to current faculty.
Self-care, social support, mental attitude, and leisure activities were common themes in this study for how current faculty cope with work-related stress. Similar to the findings in this investigation, social support, maintaining/improving physical health, and leisure activity were reported to be coping mechanisms in other educators following the COVID-19 pandemic.27 While the investigators did not find statistically significant differences in EE between faculty answering “Yes” or “No” to EPII questions that relate to these themes at p < .001, faculty who reported that the pandemic afforded them more quality time and improved relationships with family or friends had lower median EE scores than their peers. The study also noted non-statistically significant lower EE in faculty who answered “Yes” to EPII questions about increasing physical exercise and spending time doing enjoyable activities as well as mental attitude questions for being more appreciative and finding greater meaning (Table 2).
Limitations and Recommendations for Future Studies
The years 2020–2022 brought many challenges to DCP faculty, including shifting between on-line and in-person instruction as a result of the COVID-19 pandemic. For the 25% of faculty who scored high on the MBI Emotional Exhaustion subscale in this study, it is unknown if emotional exhaustion was due to the pandemic, institutional changes that occurred during 2020–2022, or due to other variables. Over 50% of faculty responded to the survey, a relatively strong turnout for surveys of busy professionals. The investigators could not statistically test for selection bias by comparing demographic or other characteristics of respondents to nonrespondents because the survey did not collect demographic data. This study is also limited to only 1 institution. The need to better understand burnout amongst the larger population of DCP faculty would justify replicating the survey across multiple chiropractic schools and also including other institutional variables that could impact burnout such as number of students per class, administrative management style of institutions and departments, and faculty reationships with their colleagues.22,25,28,29
CONCLUSION
This study provided information about faculty experiences during the COVID-19 pandemic at 1 United States chiropractic college and measured 3 dimensions of burnout. While average scores corresponded to less burnout than previous studies with other health profession faculty, about ¼ of faculty were at risk for high emotional exhaustion. Associations between EE and pandemic-related increases in mental health and sleep problems indicate DCP faculty may need additional support following the COVID-19 pandemic.
Faculty positions, time teaching at the college, and types of classes taught for the 43 survey participants.
Contributor Notes
Krista Ward (corresponding author) is research specialist in the Research Department at Life Chiropractic College West (25001 Industrial Blvd Hayward, CA 94545; kward@lifewest.edu). At the time the research was conducted, Melinda Pham was a research assistant in the Research Department at Life Chiropractic College West (25001 Industrial Blvd Hayward, CA 94545; mpham@lifewest.edu). At the time the research was conducted, Ricky Wong was a professor in the Departments of Basic Sciences and Radiology at Life Chiropractic College West (25001 Industrial Blvd Hayward, CA 94545; rickywongdc@gmail.com). Bradley Francis is an associate professor in the Technique Department at Life Chiropractic College West (25001 Industrial Blvd Hayward, CA 94545; bfrancis@lifewest.edu). Monica Smith is the director of research at Life Chiropractic College West (25001 Industrial Blvd Hayward, CA 94545; msmith@lifewest.edu).
Concept development: KW, MP, RW, BF, MS. Design: KW, MP, RW, BF, MS. Supervision: KW. Data collection/processing: KW, MP, RW. Analysis/interpretation: KW, MP. Literature search: KW, MP. Writing: KW, MP, MS. Critical review: KW, MP, RW, BF, MS.
This paper received an Honorable Mention Award for the Chiropractic Educators Research Forum/World Federation of Chiropractic Alan Adams Education Research Award presented at the World Federation of Chiropractic/Association of Chiropractic Colleges Global Education Conference, November 2–5, 2022. The award is funded in part by sponsorships from NCMIC, ChiroHealth USA, Activator Methods, Clinical Compass, World Federation of Chiropractic, and Brighthall. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by these sponsors.
