Internal medicine residents at the University of Washington, Seattle were surveyed to assess for evidence of “burnout” and its perceived effect on patient care. Validated questionnaires were utilized to screen for burnout, as well as depression, substance abuse, career satisfaction, coping strategies, and patient care practices. Of 151 eligible residents, 76% responded in February and March, 2001. Participation decreased by residency year, with 90%, 71%, and 62% of first-, second-, and third-year residents responding, respectively. Resident responses were similar when analyzed by year of residency and were combined for analysis.
Of the 115 respondents, 76% met screening criteria for burnout on the Maslach Burnout Inventory (MBI) that is generally considered the gold standard measure of burnout.1 Sixty-four percent of the residents had high scores on the MBI for depersonalization and 53% had high scores for emotional exhaustion. More than 40% of all residents surveyed felt deprived of both sleep and time away from the hospital. Nearly 1/3 of residents who met the burnout criteria had suffered a major depressive episode during residency versus only 11% of their less-stressed counterparts (P=.031). While 89% of residents without evidence of burnout reported satisfaction in their career choice, only 59% of residents suffering burnout responded positively to this question (P=.003). No significant association between substance abuse and burnout was found.
Residents suffering burnout were significantly more likely to report sleep deprivation, frequent shifts greater than 24 hours, and lack of “leisure time” as major stress factors. Burnout also had significant associations with several negative practices and attitudes regarding patient care. Approximately 70% of residents suffering burnout felt they “had little emotional reaction” to a patient death as compared to only 20% of their less-stressed colleagues (P<.05). Fifty-three percent of residents with burnout self-reported suboptimal patient care practices monthly, such as errors in management not due to level of knowledge or training, compared to 21% of residents without burnout (P<.004). Important stress-management strategies included talking with family as well as with colleagues. The residents surveyed identified protected time off on rotations, adequate ancillary services, and night-float systems as effective means of reducing work-related stress.
Burnout, a syndrome of physical, mental, and emotional exhaustion, is well-recognized in both practicing physicians and academicians. The significance of the above study is that it calls attention to the frequency and consequences of burnout in a group of contemporary physicians-in-training, in this case internal medicine residents. While the study has significant strengths in the validated measures used to assess the various emotional components of burnout, just as much power lies in the practicality of stressors and coping mechanisms identified. In the same journal, an accompanying report of a survey of medical residents in all 415 United States internal medicine programs underscores the frequency of stress and depression in trainees despite recent efforts...