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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
ORIGINAL ARTICLE  
Year : 2019  |  Volume : 30  |  Issue : 3  |  Page : 581-586
Using single-item survey to study the prevalence of burnout among medical residents-influence of gender and seniority


General Surgery Department, Queen Elizabeth Hospital, Greenwich and Lewisham NHS Trust, Greenwich, London, UK

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Date of Web Publication26-Jun-2019
 

   Abstract 


The objective of this study was to evaluate the prevalence of burnout among medical residents in and assess the influence of certain demographic factors. The residents were asked to classify their level of burnout (according to one out of five levels of burnout) using their own definition of burnout. This survey was undertaken away from any examination time and confidentially ascertained. The frequency of burnout and itself level were calculated and compared between genders and year of training using the Chi-square. Eighty-two residents responded to the survey (100% of attendees and 91.1% of all residents in the department); 74.2% were male and 25.8% of female, 38.7% were in their 1st year of training, 24.2% in their 2nd year, 29.0% in their 3rd year, and 8.1% in their 4th year. The overall burnout frequency was 41.9% (29% with moderate burnout, and 12.9% with severe burnout). Overall twice as many female residents had burnout than males (P = 0.017). The prevalence of “moderate burnout” among males and females was 19.8% and 56.3%, respectively. However, no difference between males and females was seen in the “severe burnout” category (13% and 12.5%, respectively). The overall burnout rate was the lowest in the 1st year of training (33.3%) and the highest in the last (60%) but with no statistical significance (P = 0.4). Whereas 2/3rd of the male residents had no burnout, only 1/3rd one their female counterparts had no burnout (P = 0.017). Conversely, the prevalence of “moderate burnout” among males and females was 19.8% and 56.3%, respectively (P = 0.002). However, no difference between males and females was seen in the “severe burnout” category (13% and 12.5%, respectively. In conclusion, 50% of the residents had burnout which was significantly more prevalent in females. The rate of burnout is the highest in the last year of training and the lowest in the 1st year

How to cite this article:
AlSayari RA. Using single-item survey to study the prevalence of burnout among medical residents-influence of gender and seniority. Saudi J Kidney Dis Transpl 2019;30:581-6

How to cite this URL:
AlSayari RA. Using single-item survey to study the prevalence of burnout among medical residents-influence of gender and seniority. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 Jul 23];30:581-6. Available from: http://www.sjkdt.org/text.asp?2019/30/3/581/261330



   Introduction Top


Burnout a syndrome characterized by deper-sonalization, emotional exhaustion, and sense of low personal accomplishment is common among medical residents.[1] It has been estimated that 50% of doctors suffer from the burnout that reflects the emotional and psychological stress experienced by doctors.[1] National Data from the USA showed that burnout prevalence has increased form 45.8% in 2011 to 54.4% in 2014 and the prevalence of dissatisfaction in with work-life balance among doctors rose from 36.9% to 44.5% over the same time frame.[2] Burnout can lead to reduced work efficiency and commitment and lower job satisfaction.[3]

Doctors affected by the major forms of burnout can become cynical and less empathic to patients.[4] Burnout has been found to associated with increased prevalence in medical errors and make poor decisions.[5],[6],[7]

A previous study from Saudi Arabia revealed that 70% of the residents had burnout with 50% having a “high emotional exhaustion.” Depersonalization score was significantly higher in the emergency medicine residents with the pediatric residents having the lowest.[8]

Physicians with burnout have an increased risk of psychiatric illness with increased prevalence of suicidal ideation. However, it has not been possible to establish which preceded the other, the burnout or psychiatric illness.[9],[10]

In a mega-analytical study, that there are individual-focused strategies and systems or organizational strategies that can be effective in reducing overall burnout (from 54% to 44%). Most studies highlight systemic strategies as being more effective.[11]

The objective of this study was to evaluate the prevalence of burnout among medical residents in major University Hospital in Saudi Arabia and to assess the influence of gender and residency seniority using a “Single-Item Survey.”


   Methods Top


A validated single item developed by Schmoldt et al was used to assess self-defined burnout, with five response options.[12]

The single □ item burnout question used has been shown to correlate well with the results obtained using Maslach Burnout Inventory (MBI) scores and MBI scores.[13]

The respondent was asked to classify her/his level of burnout using his own definition of burnout to one of the following:

  1. I enjoy my work. I have no symptoms of burnout
  2. Occasionally, I am under stress, and I don’t always have as much energy as I once did, but I don’t feel burned out
  3. I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion
  4. The symptoms of burnout that I’m experiencing won’t go away. I think about frustration at work a lot
  5. I feel completely burned out and often wonder if I can go on. I am at the point where I may need some changes or may need to seek some sort of help.


For the purposes of our analysis, response 1 (above) was considered to reflect “no burnout”, responses 2 and 3 to reflect “moderate burnout” and 4 and 5 to reflect “severe burnout”

All the residents in the Medicine Residency Training Program attending one of their regular weekly Academic activity were enrolled the study. The single-item question was displayed on the screen and the residents were asked to choose the appropriate option for them and write it, as well their year of residency and sex on a previously distributed blank piece of paper which was then collected by the investigator. They were instructed not to write their names or anything that would identify them on the piece of paper. They were given 10 min to write their answers.

Prevalences of burnout by gender and year of residency were calculated. The frequency of burnout and itself level were calculated and compared between genders and year of training using the Chi-square. A P < 0.05 was considered statistically significant.


   Results Top


All the 82 residents attending the academic activity during which the survey was done responded to the survey (100% response rate). As nine residents did not attend the academic activity, the overall response rate is 91.1%.

Of the respondents, 38.7% were in their 1st year of training, 24.2% in their 2nd year, 29.0% in their 3rd year, and 8.1% in their 4th year.

There were 74.2 % of males and 25.8% of females (this is true reflection of the gender breakdown in the program).

Of all participants in the study, 41.9% had some degree of burnout (29% with moderate burnout and 12.9% with severe burnout) [Figure 1].
Figure 1: The overall prevalence of burnout and its degrees.

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[Figure 2] shows the rate of burnout among residents at different years of training. Burnout is the lowest in the first year (33.3%) and the highest in the last (fourth) year (60%). However, this did not reach statistical significance (P = 0.4) [Figure 3]. The rates of “severe burnout” is the lowest in the first year (4.2%) and highest in the lasts (fourth) year (40%); however, this did not reach statistical significance (P = 0.6) [Figure 3].
Figure 2: The rate of burnout among residents at different years of training.

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Figure 3: Rates of burnout by year of training subcategorized into “no burnout”, “moderate burnout” and “severe burnout.

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[Figure 4] shows the rates of burnout among males and females subcategorized into “no burnout,” “moderate burnout,” and “severe burnout.” Whereas only third of the male residents had burnout, two-thirds their female counterparts had burnout (P = 0.017). The prevalence of “moderate burnout” among males and females was 19.8% and 56.3%, respectively (P = 0.002). No difference between males and females was seen in the “severe burnout” category (13% and 12.5%, respectively).
Figure 4: Rates of burnout among males and females subcategorized into “no burnout”, “moderate burnout” and “severe burnout.

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   Discussion Top


In “Seeking Solutions to Physician Burnout,” a report by NEJM catalyst, it was found that “Clinician burnout is pervasive and by a large margin, is due to organizations, rather than individuals, as the locus for solutions.” This report suggest four initiatives to reduce/prevent burnout: (a) off-load clerical tasks to scribes, (b) improve electronic medical records, and other IT systems, (c) create/improve an organizational culture of wellness, and (d) change compensation/incentive models.[14]

MBI is widely used as a tool for evaluation turnout. Using this particular tool, three domains of burnout can be identified, emotional exhaustion, depersonalization and personal accomplishment, and burnout is deemed present in the presence of high score on deper-sonalization or emotional exhaustion and/or low score in personal accomplishment.[15]

It has been shown that there is a significant correlation between the single-item self-defined burnout measure (that we used in this study) and burnout as measured using Maslach Inventory (r = 0.64, P < 0.0001) with emotional exhaustion and the ANOVA yielded an R of 0.5 (P <0.0001)[1617] MBI Emotional Exhaustion was significantly correlated with the single-item burnout measure (r = 0.68, P < 0.0001) and an ANOVA yielded an R2 of 0.5 (P <0.0001).[16]

Burnout appears to develop increasingly over a long period.[18],[19],[20]

We found that the highest burnout score in general as well as in “sever burnout “category is seen in the final residents. This may be related to the approach to the final examination and the worry of not finding a position in the increasingly competitive fellowship programs.

One study showed that 4.3% of internal medicine residents had burnout at the beginning of their first year of training which increased to 55.3%, at the end of the year. On the hand, another study of internal medicine found that 76% met criteria for burnout as measured by the MBI, regardless of postgraduate year.[21]

We also found that the highest burnout score in general as well as in “sever burnout” category is seen in female than male medical residents. Ina previous study from Saudi Arabia, female residents had significantly lower mean scores on the accomplishment burnout scale.[8] Some studies have shown that female physicians to have 20%–60% increased chance of developing burnout.[22],[23]

McMurray et al reports that female doctors have 1.6 times chance of having burnout compared with men which increase increasing by 12% to 15% for each additional 5 h worked/week. Lack of control over working conditions is major factor in this.[22]



 
   References Top

1.
Ishak WW, Lederer S, Mandili C, et al. Burnout during residency training: A literature review. J Grad Med Educ 2009;1:236-42.  Back to cited text no. 1
    
2.
Shanafelt TD, Hasan O, Dyrbye LN, 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;90:1600-13.  Back to cited text no. 2
    
3.
Williams ES, Konrad TR, Scheckler WE, et al. Understanding physicians’ intentions to withdraw from practice: The role of job satisfaction, job stress, mental and physical health. Health Care Manage Rev 2001;26:7-19.  Back to cited text no. 3
    
4.
Steel C, Macdonald J, Schröder T, Mellor-Clark J. Exhausted but not cynical: Burnout in therapists working within improving access to psychological therapy services. J Ment Health 2015;24:33-7.  Back to cited text no. 4
    
5.
West CP, Dyrbye LN, Shanafelt TD. Physician burnout: Contributors, consequences and solutions. J Intern Med 2018;283:516-29.  Back to cited text no. 5
    
6.
Kumar S. Burnout and doctors: Prevalence, prevention and intervention. Healthcare (Basel) 2016;4. pii: E37.  Back to cited text no. 6
    
7.
West CP, Huschka MM, Novotny PJ, et al. Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. JAMA 2006;296:1071-8.  Back to cited text no. 7
    
8.
Abdulaziz S, Baharoon S, Al Sayyari A. Medical residents’ burnout and its impact on quality of care. Clin Teach 2009;6:218-24.  Back to cited text no. 8
    
9.
Willcock SM, Daly MG, Tennant CC, Allard BJ. Burnout and psychiatric morbidity in new medical graduates. Med J Aust 2004;181:357-60.  Back to cited text no. 9
    
10.
Ramirez AJ, Graham J, Richards MA, et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer 1995;71:1263-9.  Back to cited text no. 10
    
11.
West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. Lancet 2016;388:2272-81.  Back to cited text no. 11
    
12.
Schmoldt RA, Freeborn DK, Klevit HD. Physician burnout: Recommendations for HMO managers. HMO Pract 1994;8:58-63.  Back to cited text no. 12
    
13.
West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med 2009;24:1318-21.  Back to cited text no. 13
    
14.
NEJM Catalyst Roundtable Report: Seeking Solutions to Physician Burnout. Available from https://catalyst.nejm.org/roundtable-solutions-to-physician-burnout/. [Last accessed on 2018 Dec 28].  Back to cited text no. 14
    
15.
Maslach C, Jackson SE, Leiter MP, Schaufeli WB, Schwab RL. Maslach Burnout Inventory. Palo Alto, CA: Consulting Psychologists Press; 1986.  Back to cited text no. 15
    
16.
Hansen V, Girgis A. Can a single question effectively screen for burnout in Australian cancer care workers? BMC Health Serv Res 2010;10:341.  Back to cited text no. 16
    
17.
Rohland BM, Kruse GR, Rohrer JE. Validation of a single-item measure of burnout against the Maslach Burnout inventory among physicians. Stress and Health 2004;20:75-9.  Back to cited text no. 17
    
18.
Dyrbye LN, Thomas MR, Huntington JL, et al. Personal life events and medical student burnout: A multicenter study. Acad Med 2006; 81:374-84.  Back to cited text no. 18
    
19.
Dahlin ME, Runeson B. Burnout and psychiatric morbidity among medical students entering clinical training: A three year prospective questionnaire and interview-based study. BMC Med Educ 2007;7:6.  Back to cited text no. 19
    
20.
Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinal study of students’ depression at one medical school. Acad Med 1997;72:542-6.  Back to cited text no. 20
    
21.
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.  Back to cited text no. 21
    
22.
McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians results from the physician work life study. The SGIM career satisfaction study group. J Gen Intern Med 2000;15:372-80.  Back to cited text no. 22
    
23.
Shanafelt TD, Hasan O, Dyrbye LN, 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;90:1600-13  Back to cited text no. 23
    

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Correspondence Address:
Rehab A AlSayari
Queen Elizabeth Hospital, Greenwich and Lewisham NHS Trust, Greenwich, London, SE18 6AJ
UK
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DOI: 10.4103/1319-2442.261330

PMID: 31249221

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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