Abstract
Objectives
This prospective study explores the prevalence, associated characteristics, and trajectory of burnout over one academic year in a multidisciplinary sample of resident physicians using a relatively new burnout survey instrument.
Methods
All residents from a U.S. academic health center (n = 633) were invited to complete the Copenhagen Burnout Inventory (CBI) three times, with 4-month time lags between invitations. A total of 281 (44%) provided complete CBI survey responses at least once, and 43 (7%) did at all three times. Descriptive statistics, cross-sectional analyses, correlations, and multivariable linear regression analyses were computed, as well as repeated measures ANOVAs and paired t tests, as appropriate, for each CBI domain (personal, work, patient-related burnout).
Results
About half had CBI scores indicating moderate-to-high levels of personal burnout (49–52%) and work-related burnout (45–49%), whereas patient-related burnout was less common (14–24%). However, patient-related burnout increased significantly from the beginning to the end of the year. Regression analyses indicated patient-related burnout was significantly higher for postgraduate year 1–2 residents compared to PGY 4+ residents, but was not significantly different by gender. Personal and work burnout scores were significantly higher for females. Persistently high burnout was observed in only 6% of respondents.
Conclusions
In this study of resident physicians using the CBI, burnout was prevalent and higher levels of burnout were observed for females on the personal and work burnout domains, while junior residents had higher patient-related burnout. Persistently, high burnout was rare. The CBI demonstrated high reliability, was practical to administer, and produced similar results with existing burnout research.
References
West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences, and solutions. J Intern Med. 2018;283(6):516–29. https://doi.org/10.1111/joim.12752.
van der Heijden F, Dillingh G, Bakker A, Prins J. Suicidal thoughts among medical residents with burnout. Arch Suicide Res. 2008;12(4):344–6. https://doi.org/10.1080/13811110802325349.
Weiss KB, Bagian JP, Wagner R. CLER pathways to excellence: expectations for an optimal clinical learning environment (executive summary). J Grad Med Educ. 2014;6(3):610–1. https://doi.org/10.4300/JGME-D-14-00348.1.
Shea JA, Bellini LM. Moving toward evidence-based interventions for trainee and physician wellness. JAMA Intern Med. 2017;177(12):1772–3. https://doi.org/10.1001/jamainternmed.2017.5164.
Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–13. https://doi.org/10.1016/j.mayocp.2015.08.023.
Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132–49. https://doi.org/10.1111/medu.12927.
Ishak WW, Lederer S, Mandili C, et al. Burnout during residency training: a literature review. J Grad Med Educ. 2009;1(2):236–42. https://doi.org/10.4300/JGME-D-09-00054.1.
Campbell J, Prochazka AV, Yamashita T, Gopal R. Predictors of persistent burnout in internal medicine residents: a prospective cohort study. Acad Med. 2010;85(10):1630–4. https://doi.org/10.1097/ACM.0b013e3181f0c4e7.
West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296(9):1071–8. https://doi.org/10.1001/jama.296.9.1071.
Pantaleoni JL, Augustine EM, Sourkes BM, Bachrach LK. Burnout in pediatric residents over a 2-year period: a longitudinal study. Acad Pediatr. 2014;14(2):167–72. https://doi.org/10.1016/j.acap.2013.12.001.
Parr JM, Pinto N, Hanson M, Meehan A, Moore PT. Medical graduates, tertiary hospitals, and burnout: a longitudinal cohort study. Ochsner J. 2016;16(1):22–6 27046399.
Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory: MBI. Palo Alto: Consulting psychologists press; 1981.
Schaufeli WB, Leiter MP, Maslach C. Burnout: 35 years of research and practice. Career Development International. 2009;14(3):204–20. https://doi.org/10.1108/13620430910966406.
Kristensen TS, Borritz M, Villadsen E, Christensen KB. The Copenhagen burnout inventory: a new tool for the assessment of burnout. Work & Stress. 2005;19(3):192–207. https://doi.org/10.1080/02678370500297720.
Schaufeli WB, Greenglass ER. Introduction to special issue on burnout and health. Psychol Health. 2001;16(5):501–10. https://doi.org/10.1080/08870440108405523.
Borritz M, Rugulies R, Christensen KB, Villadsen E, Kristensen TS. Burnout as a predictor of self-reported sickness absence among human service workers: prospective findings from three year follow up of the PUMA study. Occup Environ Med. 2006;63(2):98–106. https://doi.org/10.1136/oem.2004.019364.
Madsen IE, Lange T, Borritz M, Rugulies R. Burnout as a risk factor for antidepressant treatment - a repeated measures time-to-event analysis of 2936 Danish human service workers. J Psychiatr Res. 2015;65:47–52. https://doi.org/10.1016/j.jpsychires.2015.04.004.
Winwood PC, Winefield AH. Comparing two measures of burnout among dentists in Australia. Int J Stress Manag. 2004;11(3):282–9. https://doi.org/10.1037/1072-5245.11.3.282.
Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, et al. Prevalence of burnout among physicians: a systematic review. JAMA. 2018;320(11):1131–50. https://doi.org/10.1001/jama.2018.12777.
Ratnakaran B, Prabhakaran A, Karunakaran V. Prevalence of burnout and its correlates among residents in a tertiary medical center in Kerala, India: a cross-sectional study. J Postgrad Med. 2016;62(3):157–61. https://doi.org/10.4103/0022-3859.184274.
Borritz M, Rugulies R, Bjorner JB, Villadsen E, Mikkelsen OA, Kristensen TS. Burnout among employees in human service work: design and baseline findings of the PUMA study. Scand J Public Health. 2006;34(1):49–58. https://doi.org/10.1080/14034940510032275.
Wright JG, Khetani N, Stephens D. Burnout among faculty physicians in an academic health science centre. Paediatr Child Health. 2011;16(7):409–13 PMID: 22851895.
Messias E, Gathright MM, Freeman ES, Flynn V, Atkinson T, Thrush CR, et al. Differences in burnout prevalence between clinical professionals and biomedical scientists in an academic medical centre: a cross-sectional survey. BMJ Open. 2019;9:bmjopen-2018-023506. https://doi.org/10.1136/bmjopen-2018-023506.
Hurst C, Kahan D, Ruetalo M, Edwards S. A year in transition: a qualitative study examining the trajectory of first year residents’ well-being. BMC Med Educ. 2013;13:96. https://doi.org/10.1186/1472-6920-13-96.
Hannan E, Breslin N, Doherty E, McGreal M, Moneley D, Offiah G. Burnout and stress amongst interns in Irish hospitals: contributing factors and potential solutions. Ir J Med Sci. 2018;187(2):301–7. https://doi.org/10.1007/s11845-017-1688-7.
O’Brien BC. What to do about the transition to residency? Exploring problems and solutions from three perspectives. Acad Med. 2018;93(5):681–4. https://doi.org/10.1097/ACM.0000000000002150.
Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373–83. https://doi.org/10.1001/jama.2015.15845.
Messias E, Flynn V. The tired, retired, and recovered physician: professional burnout versus major depressive disorder. Am J Psychiatry. 2018;175(8):716–9. https://doi.org/10.1176/appi.ajp.2018.17121325.
Guille C, Frank E, Zhao Z, Kalmbach D, Nietert PJ, Mata DA, et al. Work-family conflict and the sex difference in depression among training physicians. JAMA Intern Med. 2017;177(12):1766–72. https://doi.org/10.1001/jamainternmed.2017.5138.
Aaronson AL, Backes K, Agarwal G, Goldstein JL, Anzia J. Mental health during residency training: Assessing the barriers to seeking care. Acad Psychiatry. 2018;42(4):469–72. https://doi.org/10.1007/s40596-017-0881-3.
Kolarik RC, O’Neal RL, Ewing JA. Resident preferences for program director role in wellness management. J Gen Intern Med. 2018;33(5):705–9. https://doi.org/10.1007/s11606-018-4367-0.9.
Dyrbye LN, West CP, Sinsky CA, Goeders LE, Satele DV, Shanafelt TD. Medical licensure questions and physician reluctance to seek care for mental health conditions. Mayo Clin Proc. 2017;92(10):1486–93. https://doi.org/10.1016/j.mayocp.2017.06.020.
Holmes EG, Connolly A, Putnam KT, Penaskovic KM, Denniston CR, Clark LH, et al. Taking care of our own: a multispecialty study of resident and program director perspectives on contributors to burnout and potential interventions. Acad Psychiatry. 2017;41(2):159–66. https://doi.org/10.1007/s40596-016-0590-3.
Dyrbye LN, Satele D, Shanafelt TD. Healthy exercise habits are associated with lower risk of burnout and higher quality of life among U.S. medical students. Acad Med. 2017;92(7):1006–11. https://doi.org/10.1097/ACM.0000000000001540.
McManus IC, Keeling A, Paice E. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Med. 2004;2(1):29. https://doi.org/10.1186/1741-7015-2-29.
Tyssen R, Dolatowski FC, Røvik JO, Thorkildsen RF, Ekeberg Ø, Hem E, et al. Personality traits and types predict medical school stress: a six-year longitudinal and nationwide study. Med Educ. 2007;41(8):781–7. https://doi.org/10.1111/j.1365-2923.2007.02802.x.
Piedmont RL. A longitudinal analysis of burnout in the health care setting: the role of personal dispositions. J Pers Assess. 1993;61(3):457–73. https://doi.org/10.1207/s15327752jpa6103_3.
Lue BH, Chen HJ, Wang CW, Cheng Y, Chen MC. Stress, personal characteristics and burnout among first postgraduate year residents: a nationwide study in Taiwan. Med Teach. 2010;32(5):400–7. https://doi.org/10.3109/01421590903437188.
Dunford BB, Shipp AJ, Boss RW, Angermeier I, Boss AD. Is burnout static or dynamic? A career transition perspective of employee burnout trajectories. J Appl Psychol. 2012;97(3):637–50. https://doi.org/10.1037/a0027060.
Shanafelt TD, Kaups KL, Nelson H, Satele DV, Sloan JA, Oreskovich MR, et al. An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons. Ann Surg. 2014;259(1):82–8. https://doi.org/10.1097/SLA.0b013e3182a58fa4.
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Thrush, C.R., Guise, J.B., Gathright, M.M. et al. A One-Year Institutional View of Resident Physician Burnout. Acad Psychiatry 43, 361–368 (2019). https://doi.org/10.1007/s40596-019-01043-9
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DOI: https://doi.org/10.1007/s40596-019-01043-9