Advertisement

Academic Psychiatry

, Volume 39, Issue 1, pp 47–54 | Cite as

Efficacy of Burnout Interventions in the Medical Education Pipeline

  • Daniel WilliamsEmail author
  • Gian Tricomi
  • Jay Gupta
  • Annie Janise
In Depth Article: Systematic Review

Abstract

Objective

Little is known about the efficacy of current interventions to mitigate burnout among medical students and residents, despite its association with mood disorders, absenteeism, low job satisfaction, and medical errors. This review summarizes the efficacy data of burnout interventions and how each modality is used.

Method

OVID-SP Medline, Google Scholar and PsychINFO were searched for combinations of medical subject headings (MeSH) terms: premedical students, medical students, internships, intern, medical graduate, clinical clerkship, and residents in combination with a keyword group of burnout, professional burnout, suicide, attempted suicide, and prevention. Studies with data on the efficacy from burnout prevention programs were included for review.

Results

Nineteen studies were selected for inclusion in this review. Eleven different types of interventions and combinations of interventions were used. There were six studies on the impact of the 2003 duty-hour restrictions by the Accreditation Council for Graduate Medical Education on burnout. Other approaches included self-development groups, conversion to a pass-fail grading system and training in mindfulness, communication, and stress management. Half of the intervention approaches had at least one study demonstrating benefit in reducing burnout. Self-development groups, the Respiratory One Method for relaxation, and conversion to a pass-fail grading system appear to reduce burnout. The burnout data on mindfulness training and the 2003 resident duty-hour restrictions are mixed. There were no studies available on burnout among premedical students or suicide prevention among medical students or residents.

Conclusions

There is a growing body of evidence-based interventions to mitigate burnout which can be used in the development of future programs. More research is needed to identify and intervene against burnout earlier in the medical education pipeline, including at the undergraduate level.

Keywords

Medical student Resident Burnout prevention Suicide 

Notes

Disclosures

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Shiralkar MT, Harris TB, Eddins-Folensbee FF, Coverdale JH. A systematic review of stress-management programs for medical students. Acad Psychiatry. 2013;37:158–64.PubMedCrossRefGoogle Scholar
  2. 2.
    Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149:334–41.PubMedCrossRefGoogle Scholar
  3. 3.
    Netterstrøm B, Conrad N, Bech P, et al. The relation between work-related psychosocial factors and the development of depression. Epidemiol Rev. 2008;30:118–32.PubMedCrossRefGoogle Scholar
  4. 4.
    Ahola K, Hakanen J. Job strain, burnout, and depressive symptoms: a prospective study among dentists. J Affect Disord. 2007;104:103–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Ahola K, Honkonen T, Kivimäki M, et al. Contribution of burnout to the association between job strain and depression: the health 2000 study. J Occup Environ Med. 2006;48:1023–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Siegrist J. Chronic psychosocial stress at work and risk of depression: evidence from prospective studies. Eur Arch Psychiatry Clin Neurosci. 2008;258:115–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Ghetti C, Chang J, Gosman G. Burnout, psychological skills, and empathy: balint training in obstetrics and gynecology residents. J Grad Med Educ. 2009;1:231–5.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Martini S, Arfken CL, Churchill A, Balon R. Burnout comparison among residents in different medical specialties. Acad Psychiatry. 2004;28:240–2.PubMedCrossRefGoogle Scholar
  9. 9.
    Gelfand DV, Podnos YD, Carmichael JC, Saltzman DJ, Wilson SE, Williams RA. Effect of the 80-hour workweek on resident burnout. Arch Surg. 2004;139:933–8. discussion 8–40.PubMedCrossRefGoogle Scholar
  10. 10.
    McCue JD, Sachs CL. A stress management workshop improves residents' coping skills. Arch Intern Med. 1991;151:2273–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Dyrbye LN, Thomas MR, Huntington JL, et al. Personal life events and medical student burnout: a multicenter study. Acad Med. 2006;81:374–84.PubMedCrossRefGoogle Scholar
  12. 12.
    Dyrbye LN, Thomas MR, Huschka MM, et al. A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students. Mayo Clin Proc. 2006;81:1435–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358–67.PubMedCrossRefGoogle Scholar
  14. 14.
    Ramirez AJ, Graham J, Richards MA, et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer. 1995;71:1263–9.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA. 2002;287:3143–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Lemkau JP, Purdy RR, Rafferty JP, Rudisill JR. Correlates of burnout among family practice residents. J Med Educ. 1988;63:682–91.PubMedGoogle Scholar
  17. 17.
    Chang E, Eddins-Folensbee F, Coverdale J. Survey of the prevalence of burnout, stress, depression, and the use of supports by medical students at one school. Acad Psychiatry. 2012;36:177–82.PubMedCrossRefGoogle Scholar
  18. 18.
    Woodside JR, Miller MN, Floyd MR, McGowen KR, Pfortmiller DT. Observations on burnout in family medicine and psychiatry residents. Acad Psychiatry. 2008;32:13–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory manual. 3 ed. Consulting Psychologists; 1996Google Scholar
  20. 20.
    Rafferty JP, Lemkau JP, Purdy RR, Rudisill JR. Validity of the Maslach Burnout Inventory for family practice physicians. J Clin Psychol. 1986;42:488–92.PubMedCrossRefGoogle Scholar
  21. 21.
    Terry PC, Lane AM, Fogarty GJ. Construct validity of the profile of mood states—adolescents for use with adults. Psychol Sport Exerc. 2003;4:125–39.CrossRefGoogle Scholar
  22. 22.
    Dyrbye LN, Szydlo DW, Downing SM, Sloan JA, Shanafelt TD. Development and preliminary psychometric properties of a well-being index for medical students. BMC Med Educ. 2010;10:8.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Westerman M, Fokkema JP, Teunissen PW. The need for a uniform use of the construct of burnout. Acad Med. 2011;86:661.PubMedCrossRefGoogle Scholar
  24. 24.
    Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81:354–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Thompson D, Goebert D, Takeshita J. A program for reducing depressive symptoms and suicidal ideation in medical students. Acad Med. 2010;85:1635–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Holm M, Tyssen R, Stordal KI, Haver B. Self-development groups reduce medical school stress: a controlled intervention study. BMC Med Educ. 2010;10:23.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165:2595–600.PubMedCrossRefGoogle Scholar
  28. 28.
    Barrack RL, Miller LS, Sotile WM, Sotile MO, Rubash HE. Effect of duty hour standards on burnout among orthopaedic surgery residents. Clin Orthop Relat Res. 2006;449:134–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M. Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med. 2003;15:88–92.PubMedCrossRefGoogle Scholar
  30. 30.
    Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg. 2006;243:864–71. discussion 71–5.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med. 2005;165:2601–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Lieberman III JA, Stuart MR. The BATHE method: incorporating counseling and psychotherapy into the everyday management of patients. Prim Care Companion J Clin Psychiatry. 1999;1:35–8.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Rohe DE, Barrier PA, Clark MM, Cook DA, Vickers KS, Decker PA. The benefits of pass-fail grading on stress, mood, and group cohesion in medical students. Mayo Clin Proc. 2006;81:1443–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Clara IP, Cox BJ, Enns MW. Confirmatory factor analysis of the Depression–Anxiety–Stress Scales in depressed and anxious patients. J Psychopathol Behav Assess. 2001;23:61–7.CrossRefGoogle Scholar
  35. 35.
    Reed DA, Shanafelt TD, Satele DW, et al. Relationship of pass/fail grading and curriculum structure with well-being among preclinical medical students: a multi-institutional study. Acad Med. 2011;86:1367–73.PubMedCrossRefGoogle Scholar
  36. 36.
    Bandura A. Self-efficacy. In: Ramachaudran VS, editor. Encyclopedia of human behavior. New York: Academic; 1994. p. 71–81.Google Scholar
  37. 37.
    Ospina-Kammerer V, Figley CR. An evaluation of the Respiratory One Method (ROM) in reducing emotional exhaustion among family physician residents. Int J Emerg Ment Health. 2003;5:29–32.PubMedGoogle Scholar
  38. 38.
    Milstein JM, Gerstenberger AE, Barton S. Healing the caregiver. J Altern Complement Med. 2002;8:917–20.PubMedCrossRefGoogle Scholar
  39. 39.
    Finkelstein C, Brownstein A, Scott C, Lan YL. Anxiety and stress reduction in medical education: an intervention. Med Educ. 2007;41:258–64.PubMedCrossRefGoogle Scholar
  40. 40.
    Bragard I, Etienne AM, Merckaert I, Libert Y, Razavi D. Efficacy of a communication and stress management training on medical residents' self-efficacy, stress to communicate and burnout: a randomized controlled study. J Health Psychol. 2010;15:1075–81.PubMedCrossRefGoogle Scholar
  41. 41.
    Warnecke E, Quinn S, Ogden K, Towle N, Nelson MR. A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Med Educ. 2011;45:381–8.PubMedCrossRefGoogle Scholar
  42. 42.
    About The Center for Mind-Body Medicine. Center for Mind-Body Medicine, 2012. http://cmbm.org . Accessed 26 Apr 2012.
  43. 43.
    Sikora R, Mongold B, Sedgeman J, Davis SM. 122: Burnout in Emergency Medicine residents and faculty: an attempt to modify stress response by journaling. Ann Emerg Med. 2008;51:508.CrossRefGoogle Scholar

Copyright information

© Academic Psychiatry 2014

Authors and Affiliations

  • Daniel Williams
    • 1
    Email author
  • Gian Tricomi
    • 1
  • Jay Gupta
    • 1
  • Annie Janise
    • 2
  1. 1.Baylor Scott & White HealthTempleUSA
  2. 2.Baylor UniversityWacoUSA

Personalised recommendations