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5 March 2002 | Volume 136 Issue 5 | Pages 358-367
Background: Burnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Little is known about burnout in residents or its relationship to patient care.
Objective: To determine the prevalence of burnout in medical residents and explore its relationship to self-reported patient care practices.
Design: Cross-sectional study using an anonymous, mailed survey.
Setting: University-based residency program in Seattle, Washington.
Participants: 115 internal medicine residents.
Measurements: Burnout was measured by using the Maslach Burnout Inventory and was defined as scores in the high range for medical professionals on the depersonalization or emotional exhaustion subscales. Five questions developed for this study assessed self-reported patient care practices that suggested suboptimal care (for example, "I did not fully discuss treatment options or answer a patient's questions" or "I made ... errors that were not due to a lack of knowledge or inexperience"). Depression and at-risk alcohol use were assessed by using validated screening questionnaires.
Results: Of 115 (76%) responding residents, 87 (76%) met the criteria for burnout. Compared with non–burned-out residents, burned-out residents were significantly more likely to self-report providing at least one type of suboptimal patient care at least monthly (53% vs. 21%; P = 0.004). In multivariate analyses, burnout—but not sex, depression, or at-risk alcohol use—was strongly associated with self-report of one or more suboptimal patient care practices at least monthly (odds ratio, 8.3 [95% CI, 2.6 to 26.5]). When each domain of burnout was evaluated separately, only a high score for depersonalization was associated with self-reported suboptimal patient care practices (in a dose–response relationship).
Conclusion: Burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.
Editors' Notes
Context
Contribution
Editor's Note
—The Editors
Author and Article Information
From University of Washington, Veterans Affairs Northwest Health Services Research and Development Center of Excellence, and Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
Note: Views expressed in this article are those of the authors and do not necessarily represent the views of the University of Washington, Department of Veterans Affairs, the Robert Wood Johnson Foundation, the National Institute of Alcohol Abuse and Alcoholism, or the Project on Death in America.
Acknowledgments: The authors thank the Internal Medicine residents and the chief medical residents at the University of Washington-affiliated hospitals and Drs. James F. Wallace and William Bremner for their support of this project. They also thank Ms. Amee Epler for assistance with data analysis and manuscript preparation.
Grant Support: By the University of Washington Internal Medicine Residency Program and the Veterans Affairs Northwest Center of Excellence for Health Services Research and Development. Dr. Bradley is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar and is currently supported by U.S. National Institute of Alcohol Abuse and Alcoholism grant K23AA00313. Dr. Back is a Faculty Scholar of the Project on Death in America.
Requests for Single Reprints: Anthony L. Back, MD, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way (S-111), Seattle, WA 98108; e-mail, tonyback{at}u.washington.edu.
Current Author Addresses: Dr. Shanafelt: Department of Hematology, Mayo Clinic, West 10, 200 First Street SW, Rochester, MN 55905.
Drs. Bradley, Wipf, and Back: Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108.
Author Contributions: Conception and design: T.D. Shanafelt, K.A. Bradley, J.E. Wipf, A.L. Back.
Analysis and interpretation of the data: T.D. Shanafelt, K.A. Bradley, J.E. Wipf, A.L. Back.
Drafting of the article: T.D. Shanafelt, K.A. Bradley, J.E. Wipf, A.L. Back.
Critical revision of the article for important intellectual content: T.D. Shanafelt, K.A. Bradley, J.E. Wipf, A.L. Back.
Final approval of the article: T.D. Shanafelt, K.A. Bradley, J.E. Wipf, A.L. Back.
Provision of study materials or patients: T.D. Shanafelt.
Statistical expertise: K.A. Bradley.
Obtaining of funding: J.E. Wipf.
Administrative, technical, or logistic support: T.D. Shanafelt, K.A. Bradley, A.L. Back.
Collection and assembly of data: T.D. Shanafelt, J.E. Wipf. ARTICLE
Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program
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