Abstract:

Recent research on burnout shows high levels of emotional exhaustion in emergency medicine among physicians and nurses; in one study, Turkey had the highest prevalence, next the United States with France the lowest. The Maslach Burnout Inventory MBI-HSS is validated for assessing burnout Emotional Exhaustion (EE), Depersonalization (DP), and Personal Achievement (PA) in healthcare workers. The study goal was to examine a model of burnout related to various stressors, happiness measures, and demographic characteristics. Research question was: for PGME trainees in one Canadian province, how does High Stress On Call, Lack of Control, Expectations, Financial Worry, Number Clinical Hours, Number Social Supports, Happiness With Career, Happiness with Residency, and Work-Life Balance predict Burnout (EE, DP, and PA) levels, controlling for Gender, Age, Specialty-type, and Post-Graduate Year (PGY)?

Study was approved by both universities' ethics boards. Anonymous surveys were emailed to residents at 2 medical Faculties in Alberta twice. EE, DP, and PA items were summed (Sum EE, Sum DP, Sum PA). Frequencies were calculated for demographic variables. Burnout indices were calculated using cut-off values from Dyrbye (2014) with High EE > 26, High DP >9, and Low PA <33. Regression analyses with each dependent variable (Sum EE, Sum DP, Sum PA) were run with the following variables: High Stress On Call, Lack of Control, Expectations, Financial Worry, Numbers Clinical Hours, Number Social Supports, Happiness With Career, Happiness with Residency, Work-Life Balance, Gender, Age, Specialty-type, and PGY. Proportion of variance accounted for and Beta coefficients were calculated. Significance level p< .05 was set a priori.

Total number of surveys returned=479. Two-thirds of respondents were females and most (58%) were 25-30 years old; year of residency was 25% PGY1, 29% PGY2, 38% PGY3-5; and specialty-type was 26% Family Medicine, 25% Medicine, 13% Pediatrics, 16% Surgery, and 20% other.

There was a decrease in Sum EE and Sum DP and an increase in Sum PA for the independent variables: Work-life Balance, Career Happiness, Happiness with Residency, and Age. Sum DP was lower for women and Sum PA was higher with more Social Supports.

There was an increase in Sum EE with Higher Stress On Call, with Lack of Control, and Financial Worry; Sum DP was only higher with Higher Stress On Call. There was no relationship to Sum EE, Sum DP, or Sum PA for: Specialty-type; PGY; Expectations; or Number Clinical Hours. Total variance accounted for by the independent variables was: Sum EE=.55; Sum DP= .27; and Sum PA=.36. Burnout levels were: High EE= 61%; High DP=65%; and Low PA=35%.

The percentage of residents with burnout is alarming; however, burnout could be ameliorated if one is happy with their career and residency, while having work-life balance. Older residents had less burnout, even though year in residency was not related. Not surprising was that financial worries, feeling a lack of control, and greater stress on call were associated with greater burnout. Interesting, was women felt less Depersonalization than men. How and why some residents are happier with their residency, careers, and feel greater work-life balance is unknown, especially when not related to specialty type. Given negative effects from a perceived lack of control in residency, perhaps allowing residents more control over things, such as their schedules and their decision making may help.

Keywords:

Burnout, Maslach, Post graduate medical education.