The Effect of Burnout on Medical Errors and Professionalism in First-Year Internal Medicine Residents

ABSTRACT Background Burnout is a common issue in internal medicine residents, and its impact on medical errors and professionalism is an important subject of investigation. Objective To evaluate differences in medical errors and professionalism in internal medicine residents with and without burnout. Methods A single institution observational cohort study was conducted between June 2011 and July 2012. Burnout was measured using the Maslach Burnout Inventory to generate subscores for the following 3 domains: emotional exhaustion, depersonalization, and sense of personal accomplishment. By convention, burnout was defined as a high emotional exhaustion or depersonalization subscore. Medication prescription error rate was the chosen measure of medical errors. Professionalism was measured cumulatively through examining discharge summaries completed within 48 hours, outpatient charts completed within 72 hours, and the average time to review outpatient laboratory tests. Results Of a total of 54 eligible first-year residents, 53 (98%) and 32 (59%) completed the initial and follow-up surveys, respectively. Residents with year-end burnout had a lower rate of medication prescription errors (0.553 versus 0.780, P = .007). Discharge summaries completed within 48 hours of discharge (83.8% versus 84.0%, P = .93), outpatient charts completed within 72 hours of encounter (93.7% versus 94.3%, P = .31), and time (minutes) to review outpatient laboratory test results (72.3 versus 26.9, P = .28) were similar between residents with and without year-end burnout. Conclusions This study found a small decrease in medical errors in residents with year-end burnout compared to burnout-free residents and no difference in selected measures of professionalism.

Download Full-text

Burnout, Coping, and Spirituality Among Internal Medicine Resident Physicians

Journal of Graduate Medical Education ◽

10.4300/jgme-d-12-00136.1 ◽

2013 ◽

Vol 5 (2) ◽

pp. 257-261 ◽

Cited By ~ 39

Author(s):

Benjamin R. Doolittle ◽

Donna M. Windish ◽

Charles B. Seelig

Keyword(s):

Internal Medicine ◽

Coping Strategies ◽

Emotional Exhaustion ◽

Personal Characteristics ◽

Internal Medicine Resident ◽

Maslach Burnout Inventory ◽

Physician Satisfaction ◽

Personal Accomplishment ◽

Application Domain ◽

Medicine Resident

Abstract Background Burnout in physicians is common, and studies show a prevalence of 30% to 78%. Identifying constructive coping strategies and personal characteristics that protect residents against burnout may be helpful for reducing errors and improving physician satisfaction. Objective We explored the complex relationships between burnout, behaviors, emotional coping, and spirituality among internal medicine and internal medicine-pediatrics residents. Methods We anonymously surveyed 173 internal medicine and medicine-pediatrics residents to explore burnout, coping, and spiritual attitudes. We used 3 validated survey instruments: the Maslach Burnout Inventory, the Carver Coping Orientation to Problems Experienced (COPE) Inventory, and the Hatch Spiritual Involvement and Beliefs Scale (SIBS). Results A total of 108 (63%) residents participated, with 31 (28%) reporting burnout. Residents who employed strategies of acceptance, active coping, and positive reframing had lower emotional exhaustion and depersonalization (all, P < .03). Residents who reported denial or disengagement had higher emotional exhaustion and depersonalization scores. Personal accomplishment was positively correlated with the SIBS total score (r = +.28, P = .003), as well as the internal/fluid domain (r = +.32, P = .001), existential axes (r = +.32, P = .001), and humility/personal application domain (r = +.23, P = .02). The humility/personal application domain also was negatively correlated with emotional exhaustion (r = −.20, P = .04) and depersonalization (r = −.25, P = .009). No activity or demographic factor affected any burnout domain. Conclusions Burnout is a heterogeneous syndrome that affects many residents. We identified a range of emotional and spiritual coping strategies that may have protective benefit.

Download Full-text

Quality of discharge summaries prepared by first year internal medicine residents

BMC Medical Education ◽

10.1186/1472-6920-12-77 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 20

Author(s):

Kimberly Legault ◽

Jacqueline Ostro ◽

Zahira Khalid ◽

Parveen Wasi ◽

John J You

Keyword(s):

Internal Medicine ◽

First Year ◽

Internal Medicine Residents ◽

Discharge Summaries

Download Full-text

Correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns at Yale University, New Haven, USA

Journal of Educational Evaluation for Health Professions ◽

10.3352/jeehp.2015.12.41 ◽

2015 ◽

Vol 12 ◽

pp. 41 ◽

Cited By ~ 18

Author(s):

Benjamin R. Doolittle ◽

Donna M. Windish

Keyword(s):

Internal Medicine ◽

Coping Strategies ◽

Emotional Exhaustion ◽

Maslach Burnout Inventory ◽

Active Coping ◽

Personal Accomplishment ◽

Burnout Syndrome ◽

New Haven ◽

Yale University ◽

Survey Instruments

Purpose: This study aimed to determine the correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns in internal medicine, primary care, and internal medicine/pediatrics residency programs at two institutions. Methods: Intern physicians completed anonymous voluntary surveys prior to starting the internship in June 2009 and in the middle of the internship in February 2010. Three validated survey instruments were used to explore burnout, coping, and spiritual attitudes: the Maslach Burnout Inventory, the COPE Inventory, and the Hatch Spiritual Involvement and Beliefs Scale. The interns were in programs at the Yale University School of Medicine and a Yale-affiliated community hospital, New Haven, Connecticut, USA. Results: The prevalence of self-identified burnout prior to starting the internship was 1/66 (1.5%) in June 2009, increasing to 10/53 (18.9%) in February 2010 (P<0.0001). From June 2009 to February 2010, the prevalence of high emotional exhaustion increased from 30/66 (45.5%) to 45/53 (84.9%) (P<0.0001), and that of high depersonalization increased from 42/66 (63.6%) to 45/53 (84.9%) (P=0.01). Interns who employed the strategies of acceptance and active coping were less likely to experience emotional exhaustion and depersonalization (P<0.05). Perceptions of high personal accomplishment was 75.5% and was positively correlated with total scores on the Hatch Spiritual Involvement and Beliefs Scale, as well as the internal/fluid and existential/meditative domains of that instrument. Specific behaviors did not impact burnout. Conclusion: Burnout increased during the intern year. Acceptance, active coping, and spirituality were correlated with less burnout. Specific behaviors were not correlated with burnout domains.

Download Full-text

The Effect of the Hidden Curriculum on Resident Burnout and Cynicism

Journal of Graduate Medical Education ◽

10.4300/jgme-d-11-00044.1 ◽

2011 ◽

Vol 3 (4) ◽

pp. 503-510 ◽

Cited By ~ 49

Author(s):

Martha E. Billings ◽

Michael E. Lazarus ◽

Marjorie Wenrich ◽

J. Randall Curtis ◽

Ruth A. Engelberg

Keyword(s):

Internal Medicine ◽

Emotional Exhaustion ◽

Hidden Curriculum ◽

Maslach Burnout Inventory ◽

Well Being ◽

Cross Sectional ◽

Unprofessional Behavior ◽

Internal Medicine Residents ◽

Hospital Culture ◽

Resident Burnout

Abstract Introduction Residents learn and participate in care within hospital cultures that may tolerate unprofessional conduct and cynical attitudes, labeled the “hidden curriculum.” We hypothesized that this hidden curriculum may have deleterious effects on residents' professional development and investigated whether witnessing unprofessional behavior during residency was associated with burnout and cynicism. Methods We surveyed internal medicine residents at 2 academic centers for 3 years (2008–2010). Hidden curriculum items assessed exposure to unprofessional conduct. We used regression analyses to examine if hidden curriculum scores were associated with cynicism and the Maslach Burnout Inventory depersonalization and emotional exhaustion domain scores. Results The response rate was 48% (337 of 708). In the 284 surveys analyzed, 45% of respondents met burnout criteria and had significantly higher hidden curriculum scores (26 versus 19, P < .001) than those not meeting criteria. In cross-sectional analyses, the hidden curriculum score was significantly associated with residents' depersonalization, emotional exhaustion, and cynicism scores. Cynicism scores were also associated with burnout. Conclusions Exposure to unprofessional conduct was associated with higher burnout and cynicism scores among internal medicine residents. We also found that cynicism and burnout were significantly associated and may be measures of similar but not necessarily identical responses to the challenges posed by residency. Measuring the hidden curriculum and cynicism may provide direction for educators attempting to reform hospital culture and improve resident well-being.

Download Full-text

Cross-sectional survey on physician burnout during the COVID-19 pandemic in Vancouver, Canada: the role of gender, ethnicity and sexual orientation

BMJ Open ◽

10.1136/bmjopen-2021-050380 ◽

2021 ◽

Vol 11 (5) ◽

pp. e050380

Author(s):

Nadia Khan ◽

Anita Palepu ◽

Peter Dodek ◽

Amy Salmon ◽

Heather Leitch ◽

...

Keyword(s):

Internal Medicine ◽

Sexual Orientation ◽

Ethnic Minority ◽

Emotional Exhaustion ◽

Maslach Burnout Inventory ◽

Personal Accomplishment ◽

Physician Burnout ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Academic Hospitals

ObjectiveTo determine the prevalence of physician burnout during the pandemic and differences by gender, ethnicity or sexual orientation.Design, setting and participantsWe conducted a cross-sectional survey (August–October in 2020) of internal medicine physicians at two academic hospitals in Vancouver, Canada.Primary and secondary outcomesPhysician burnout and its components, emotional exhaustion, depersonalisation and personal accomplishment were measured using the Maslach Burnout Inventory.ResultsThe response rate was 38% (n=302/803 respondents, 49% women,). The prevalence of burnout was 68% (emotional exhaustion 63%, depersonalisation 39%) and feeling low personal accomplishment 22%. In addition, 21% reported that they were considering quitting the profession or had quit a position. Women were more likely to report emotional exhaustion (OR 2.00, 95% CI: 1.07 to 3.73, p=0.03) and feeling low personal accomplishment (OR 2.26, 95% CI: 1.09 to 4.70, p=0.03) than men. Visible ethnic minority physicians were more likely to report feeling lower personal accomplishment than white physicians (OR 1.81, 95% CI: 1.28 to 2.55, p=0.001). There was no difference in emotional exhaustion or depersonalisation by ethnicity or sexual orientation. Physicians who reported that COVID-19 affected their burnout were more likely to report any burnout (OR: 3.74, 95% CI: 1.99 to 7.01, p<0.001) and consideration of quitting or quit (OR: 3.20, 95% CI: 1.34 to 7.66, p=0.009).ConclusionBurnout affects 2 out of 3 internal medicine physicians during the pandemic. Women, ethnic minority physicians and those who feel that COVID-19 affects burnout were more likely to report components of burnout. Further understanding of factors driving feelings of low personal accomplishment in women and ethnic minority physicians is needed.

Download Full-text

Association between Burnout Syndrome and medical training by specialty in first-year residents

Salud Mental ◽

10.17711/sm.0185-3325.2020.031 ◽

2020 ◽

Vol 43 (5) ◽

pp. 227-233

Author(s):

José Manuel Rosas-Navarro ◽

Sergio Armando Covarrubias-Castillo ◽

José Carlos Villalobos-Lizardi ◽

Daniel Alejandro Muñoz-Chacón ◽

Rogelio Bazúa O’Connor

Keyword(s):

Emotional Exhaustion ◽

Analytical Study ◽

Medical Training ◽

Maslach Burnout Inventory ◽

Personal Accomplishment ◽

Burnout Syndrome ◽

First Year ◽

Contributing Factors ◽

Cross Sectional ◽

Group Type

Introduction. Burnout syndrome (BOS) comprises emotional exhaustion, depersonalization, and reduced personal accomplishment in those affected. Instruments such as the Maslach Burnout Inventory (MBI) can help to identify those affected. Physicians in training have been described as an at-risk group for this syndrome. Objective. Describe the association between BOS and medical training by specialty in first-year residents. Method. This is a cross-sectional analytical study of specialty residents at the Hospital Civil de Guadalajara. Sociodemographic data were obtained and the MBI was administered to identify BOS. Samples were compared, and a comparative analysis performed to identify factors associated with BOS. Results. Eighty-eight residents were included, with 21.6% (n = 19) presenting BOS, 53.4% displaying emotional exhaustion (n = 47), 53.7% showing depersonalization (n = 47), and 39.8% reduced personal accomplishment (n = 35). Presenting BOS was not associated with sociodemographic characteristics or type of specialty. Work hours (ro = .229, p = .032), and a higher number of on-call hours/week (ro = .34, p = .001) were associated with higher BOS. Discussion and conclusion. The prevalence of BOS was lower than expected. Over half scored for emotional exhaustion and depersonalization, which could be explained by a self-reporting bias. There was no association between the group/type of specialty and BOS. This study creates new knowledge that works as an institutional situational diagnosis, helps to determine the scope of the problem, and encourages to consider the contributing factors to its origin and maintenance.

Download Full-text

Job Satisfaction and Burnout Levels of Home Care Nurses in Turkey

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4325 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Nilgun Yurtsever ◽

Medine Yilmaz

Keyword(s):

Job Satisfaction ◽

Home Care ◽

Emotional Exhaustion ◽

Maslach Burnout Inventory ◽

Personal Accomplishment ◽

Home Healthcare ◽

Satisfaction Scale ◽

Work Related ◽

Related Stress ◽

Home Care Nurses

Owing to the nature of their jobs, nurses all over the world experience burnout. The aim of this descriptive and correlational study was to describe the job characteristics, job satisfaction and burnout levels of home care nurses, and to predict what factors contributed to their job satisfaction and burnout levels. The study population consisted of 80 nurses working in home care units. Of them, 71 participated in the study. A socio-demographic questionnaire, the Minnesota Satisfaction Scale and the Maslach Burnout Inventory were used. Of the participants, 85.9 per cent were female, 56.4 per cent had a bachelor’s degree, and 46.5 per cent were employed in the public sector, 36.6 per cent in municipalities and 16.9 per cent in the private sector. The results revealed that their burnout levels for emotional exhaustion and personal accomplishment were high, and moderate for depersonalisation. Perceived work-related stress was more associated with emotional exhaustion and depersonalisation than with work satisfaction. Home healthcare nurses were suffering from high levels of burnout. Interventions are needed to improve job satisfaction, to reduce the burden of burnout among nurses, and to prevent them from leaving their jobs and retiring earlier.

Download Full-text

Burnout and Its Relationship with Demographic and Job-Related Variables among Dentists in Lithuania: A Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083968 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3968

Author(s):

Eglė Slabšinskienė ◽

Andrej Gorelik ◽

Aistė Kavaliauskienė ◽

Apolinaras Zaborskis

Keyword(s):

Job Satisfaction ◽

Emotional Exhaustion ◽

Maslach Burnout Inventory ◽

Cross Sectional Study ◽

Personal Accomplishment ◽

Cross Sectional ◽

Satisfaction Index ◽

Sum Score ◽

Sum Scores ◽

High Level

Although burnout has been described as a serious hazard for personal and professional lives and has been surveyed among dentists in many countries, no study has been published regarding burnout among dentists in Lithuania. This study aimed to evaluate the burnout level among Lithuanian dentists and its association with demographic variables, job satisfaction, and other job-related variables. The data were collected among dentists online or during professional conferences while using an anonymous questionnaire (n = 380). The Maslach Burnout Inventory (MBI) was used to evaluate the burnout level. A Poisson regression was applied for the analysis of relationships between variables. We observed that 42.3% of the respondents had a high emotional exhaustion (EE) (95% confidence interval (CI): 37.4–42.3%), while 18.7% (95% CI: 15.0–22.9%) and 28,2% (95% CI: 23.4–32.6%) had high depersonalization (DP) and low personal accomplishment (PA), respectively. Nonetheless, 15.3% (95% CI: 11.8–18.9%) of the study population experienced a high level of overall burnout. An original job satisfaction index was elaborated. It was significantly associated with sum scores of all burnout dimensions: with the EE sum score (Ratio of Sum Score Means (RSSM) 1.54; 95% CI: 1.46–1.62), DP sum score (RSSM 1.59; 95% CI: 1.45–1.74), and PA sum score (RSSM 0.88; 95% CI: 0.84–0.92). It was concluded that Lithuanian dentists can be characterised by high burnout intensity and high prevalence of burnout, being especially evident in emotional exhaustion. The dentist with low job satisfaction appeared to be the most vulnerable to all burnout dimensions.

Download Full-text

Addressing the relationship between perceived fear of COVID-19 virus infection and emergence of burnout symptoms in a sample of Egyptian physicians during COVID-19 pandemic: a cross-sectional study

Middle East Current Psychiatry ◽

10.1186/s43045-020-00079-0 ◽

2020 ◽

Vol 27 (1) ◽

Author(s):

Mohamed Abdelghani ◽

Hayam M. El-Gohary ◽

Eman Fouad ◽

Mervat S. Hassan

Keyword(s):

Quality Of Life ◽

Depressive Symptoms ◽

Virus Infection ◽

Emotional Exhaustion ◽

Maslach Burnout Inventory ◽

Cross Sectional Study ◽

Personal Accomplishment ◽

Sectional Study ◽

Cross Sectional

Abstract Background Physicians during the COVID-19 pandemic are working under relentless stress. This study aimed to identify the impact of the perceived fears of COVID-19 virus infection on the quality of life and the emergence of burnout syndrome among physicians in Egypt during the COVID-19 outbreak. This cross-sectional study was conducted between May 10th and June 9th, 2020, and included 320 Egyptian physicians who were working during the outbreak of the COVID-19 pandemic. The participants were interviewed using the Fear of COVID-19 scale (FCV-19S), Hospital Anxiety and Depression Scale (HADS), Maslach Burnout Inventory, and World Health Organization Quality of Life Scale (WHOQOL-BREF) for assessment of the perceived fears of COVID-19 virus infection, associated anxiety and depressive symptoms, burnout symptoms, and quality of life, respectively. Results Overall, most physicians were females (63%). Ideas about death, moderate-to-severe anxiety, and depressive symptoms were reported by 11, 28, and 29% of physicians, respectively. For burnout symptoms, high emotional exhaustion, high depersonalization, and low personal accomplishment were reported by 20, 71, and 39% of physicians, respectively. The perceived fear of COVID-19 virus infection was positively correlated with anxiety, depression, and burnout emotional exhaustion, and depersonalization symptoms, and negatively correlated with personal accomplishment and all quality of life domains. Conclusions Egyptian physicians experienced higher levels of COVID-19-related fears, anxiety, and depressive and burnout symptoms. There was a robust correlation between these perceived fears, and higher burnout symptoms, and poor quality of life among physicians. Specific interventions should be tailored to minimize the physical and mental burdens on the physicians during the COVID-19 pandemic.

Download Full-text

Burnout Impact of COVID-19 Pandemic on Health-Care Professionals at Assiut University Hospitals, 2020

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105368 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5368

Author(s):

Shimaa A. Elghazally ◽

Atef F. Alkarn ◽

Hussein Elkhayat ◽

Ahmed K. Ibrahim ◽

Mariam Roshdy Elkhayat

Keyword(s):

Health Care ◽

Health Care Providers ◽

Emotional Exhaustion ◽

Health Care Professionals ◽

Maslach Burnout Inventory ◽

Adverse Outcomes ◽

Personal Accomplishment ◽

Burnout Syndrome ◽

Care Providers ◽

University Hospitals

Background: burnout syndrome is a serious and growing problem among medical staff. Its adverse outcomes not only affect health-care providers’ health, but also extend to their patients, resulting in bad-quality care. The COVID-19 pandemic puts frontline health-care providers at greater risk of psychological stress and burnout syndrome. Objectives: this study aimed to identify the levels of burnout among health-care professionals currently working at Assiut University hospitals during the COVID-19 pandemic. Methods: the current study adopted an online cross-sectional design using the SurveyMonkey® website for data collection. A total of 201 physicians were included and the Maslach Burnout Inventory (MBI) scale was used to assess the three burnout syndrome dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. Results: about one-third, two-thirds, and one-quarter of the respondents had high emotional exhaustion, high depersonalization, and low personal accomplishment, respectively. Younger, resident, and single physicians reported higher burnout scores. The personal accomplishment score was significantly higher among males. Those working more than eight hours/day and dealing with COVID-19 patients had significantly higher scores. Conclusion: during the COVID-19 pandemic, a high prevalence of burnout was recorded among physicians. Age, job title, working duration, and working hours/day were significant predictors for burnout syndrome subscale results. Preventive and interventive programs should be applied in health-care organizations during pandemics.

Download Full-text