PONE-D-24-43143Burnout among Intensivists and Critical Care Fellows in South Korea: Current Status and Associated FactorsPLOS ONE

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1. Is the manuscript technically sound, and do the data support the conclusions?

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Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Burnout among Intensivists and Critical Care Fellows in South Korea: Current Status

and Associated Factors

Thank you for the opportunity to review a study. It is a topic widely studied in the nursing panorama but always offers insights into the phenomenon's evolution. My comments are below:

Introduction

The background seems well set, but we should expand the epidemiological part of the phenomenon to strengthen our reasons. For example, how widespread is burnout in nurses? And in critical care nurses? For this reason, I suggest reading this paper (DOI: 10.7429/pi.2022.751028), in which stratification by item is made on a national population. Furthermore, it is unclear what the authors mean by "Intensivists" and "Critical Care Fellows". I think these figures are present in the system where the data were collected, but how do we contextualize them internationally?

The passage on cultural aspects is interesting. It is often underestimated (in the text - For example, values such as collectivism, perseverance, and hard work that are prevalent in many Asian cultures may have dual effects on burnout, potentially mitigating and exacerbating its development [13, 14].)

The study aims to examine the associated factors. It is unclear whether these factors cause burnout or the intensive environment. Clarify this point.

Broadens the meaning of the study, why is it important?

Methods

I would write a separate paragraph titled "Ethical Considerations."

I need more information about data collection. Have response rates been calculated? Emailing the link often does not let us know if the person responding is someone we want to address. Be more explicit about data collection and write a separate paragraph.

Detailed information on the instrument used should be available. Likert scale? How many items per dimension? Psychometric properties? Is the instrument available in the language of the country where it was administered? I recommend using a checklist for reporting, e.g. STROBE in the methods.

Inclusion and exclusion criteria?

Describe the population and the risk factors more accurately. Why do we call them associated factors?

Results

The results are well presented; in Table 2, try inserting the p-value in the column for each factor.

Here, you define "Risk factors for burnout and severe burnout" as risk factors. Are you congruent throughout the manuscript regarding risk factors or associated factors?

Discussion

The discussions begin with the resumption of the objective and the declaration of the key points

the discussion offers a good overview of the phenomenon, but are we sure it is burnout? In the literature, a recent review explains the relationship between different phenomena, such as moral injury; I recommend reading it (DOI: 10.1177/09697330241281376). Furthermore, are there other phenomena that interact with burnout and abandonment? For example, regarding workplace violence, I suggest reading this interesting study (DOI: 10.7429/pi.2020.732089). What are the implications for the profession? For nursing managers? Broaden the discussion on preventive interventions.

Offer a unique perspective of this article to the magazine's readers.

Reviewer #2: I would like to thank the authors for submitting a manuscript titled "Burnout among Intensivists and Critical Care Fellows in South Korea: Current Status and Associated Factors”.

This manuscript is based on a survey by the Korean Society of Critical Care Medicine to hospitals who provide CCM fellowship. Factors associated with burn out as defined by the Maslach Burnout Index are described. Below are specific comments and suggestions for improving the clarity, and educational content of the manuscript:

I would offer the following questions and/or suggestions.

Please adjust the abstract to better reflect that this survey was done by the Korean Society of Critical Care Medicine, who the target was and what the purpose of the survey was. I cant see a response rate.

Background: You write: Internationally, burnout rates among ICU professionals are alarmingly high, with studies reporting prevalence rates ranging from 33% to 47% in Western countries [9-11]. Delete the “however” at the start of the next sentence- it does not make sense. However, a recent cross-sectional survey of 159 ICUs in 16 Asian countries and regions found that the prevalence of burnout syndrome among ICU physicians and nurses in Asia accounts for 50-52% [12].

Background: You write: However, the prevalence and characteristics of burnout among ICU staff in Asian contexts, particularly in South Korea, remain understudied. Then you state: This research gap is significant given the potential impact of cultural, economic, and systemic factors on the experience of burnout. Obviously there is a study in Asian countries. Do you mean there is no data available in Korea and that is the gap? Please specify.

Background: You write: Recognizing the high prevalence of burnout among medical professionals in various specialties, this study specifically aims to address the less explored area of burnout among those at the forefront of critical care in South Korea. However, you just previously mentioned studies looking at critical care clinicians, this is confusing. Please rewrite.

Methods: The study design is unclear. Who sent out the survey. How did you know who to sent it to? Did you sent it to individuals or to institutions? You mention previous surveys. Needs to be rewritten.

Is the study IRB exempt or not. You mention an ethics approval

NownSurvey and Google Forms need to be referenced. I could not find NownSurvey online

Results: Whats the response rate?

This is unclear: The position of the intensivist, especially for those at the level of assistant professor or fellow, was associated with a higher likelihood of burnout (OR, 3.916; 95% CI, 1.485 - 10.327; p = 0.006). All surveyed people were intensivists, right?

Please delete the double brackets [[: Another study in France found the prevalence of burnout among intensivists to be approximately 32% [[16], further highlighting the disparity between regions. A similar survey from Asian ICUs found a burnout rate of 51% within the same professional cohort [[12].

In this study 47.5 % of french intenivists had burnout: Embriaco N, Azoulay E, Barrau K, et al. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med. 2007;175:686–92.

Studies have shown female gender is associated with higher rates of burnout- see study above or (Moll V, Meissen H, Pappas S, Xu K, Rimawi R, Buchman TG, Fisher L, Bakshi V, Zellinger M, Coopersmith CM. The Coronavirus Disease 2019 Pandemic Impacts Burnout Syndrome Differently Among Multiprofessional Critical Care Clinicians-A Longitudinal Survey Study. Crit Care Med. 2022 Mar 1;50(3):440-448.)

The discussion needs to be rewritten in a more concise manner.

How can the highest qualification be only a bachelors degree in 22.5% if all participants were physicians?

How can the Stay-home night calls per month be associated with burnout but not the in house nights?

It is unclear if this survey only went to medical ICUs? There are no surgical, neuro, CVICU, etc?

The major issue though that I see is that the survey was done almost 6 years ago. Much has happened since -COVID! I would encourage the authors to repeat the survey now, in the post COVID world. The results might be different (worse?) now.

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Reviewer #1: No

Reviewer #2: No

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Burnout among Intensivists and Critical Care Fellows in South Korea: Current Status and Associated Factors

PONE-D-24-43143R1

Dear Dr. Hong,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Chinh Quoc Luong, MD., PhD.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear EIC and author,

Thank you for the opportunity to read this paper titled "Burnout among Intensivists and Critical Care Fellows in South Korea: Current Status and Associated Factors." I have read the authors' responses, which I find interesting and make the paper more fluid. I have no other comments. Best

Reviewer #2: (No Response)

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If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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