An Investigation of the Relationship Between Emergency Medicine Trainee Burnout and Clinical Performance in a High‐fidelity Simulation Environment

Abstract

Objective: Burnout is prevalent among emergency medicine (EM) physicians, with physicians experiencing burnout more likely to report committing medical errors or delivering suboptimal care. The relationship between physician burnout and identifiable differences in clinical care, however, remains unclear. We examined if EM trainee burnout was associated with differences in clinical performance using high-fidelity simulation as a proxy for patient care. Methods:In this cross-sectional study across six institutions, we measured trainee performance over four simulation scenarios based on recognized EM milestones. For each scenario a faculty rater assessed whether the trainee performed predefined critical actions specific to each case. A summation of performed actions across all cases resulted in a cumulative task (CT) score (range = 0-85). Raters also assigned an impression score on a 10-point scale (0 = poor; 10 = outstanding) assessing the trainee's overall performance after each scenario, with the mean of the scores resulting in an overall impression (OI) score. After the simulation assessment, we measured trainees' burnout via the Maslach Burnout Inventory through a confidential, electronic survey. Trainee depression, quality of life (QOL) and daytime sleepiness were also evaluated. Survey results were compared to simulation scores using analysis of variance and covariance.Results: Fifty-eight of 89 (65.2%) eligible participants completed the survey and simulation assessment. Thirtyone of 58 (53.4%, 95% CI = 40.2% to 66.7%) trainees reported burnout. In trainees with burnout compared to those without, mean CT scores (73.4 vs. 75.2, 95% CI of difference = 0.06 to 3.51) and OI scores (6.4 vs 6.8, 95% CI of difference = 0.03 to 0.79) were negatively associated with burnout after controlling for training program. In contrast, QOL were positively associated with CT [F(1,48) = 4.796, p = 0.033] and OI [F(1,48) = 4.561, p = 0.038] scores. There were no significant associations between simulation performance and depression or daytime sleepiness.Conclusion: Emergency medicine trainees with burnout received lower cumulative performance scores over four high-fidelity simulation scenarios than trainees without burnout.

Emergency Medicine Trainee Burnout Is Associated With Lower Patients’ Satisfaction With Their Emergency Department Care

“…Our study's rate of trainee burnout (78%) was higher than prior estimates among EM trainees (55%–65%) . Recent work, however, demonstrates a trend of increasing burnout rates among EPs and trainees, with current estimates between 70 and 75% .…”

“…There are many speculated reasons for this phenomenon among all physicians, not just EPs, and our study did not seek to address this issue . Nevertheless our results add to growing literature that suggests an association between physician burnout and negative patient care experiences . Residency programs may need to identify and address trainee burnout not only to enhance the well‐being of individual residents but also to potentially improve the quality of care they provide to patients.…”

“…Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and a sense of low personal accomplishment . Emergency medicine (EM) physicians and trainees report the highest levels of burnout (55%–65%) among all specialties . Burnout negatively impacts physician health, productivity, and career satisfaction .…”

Emergency Medicine Faculty Are Poor at Predicting Burnout in Individual Trainees: An Exploratory Study

“…7 It is troubling, however, that EM trainees report similarly high levels of burnout as practicing EM attendings. [2][3][4] Coupled with recent evidence demonstrating an association between physician burnout and lower quality of care, 3,8,12 accurate identification and effective methods of addressing physician burnout are paramount.…”

“…7 Recent work demonstrated that burnout is prevalent (55%-65%) among EM trainees as early as the second year of training. 3,4,8 Efforts to ameliorate the impact of burnout on trainees have been suggested, although their effectiveness remains unclear. 9 One reason for the uncertain success of these wellness interventions may be due to their implementation among trainees en masse, without discrimination between those with high versus low levels of burnout.…”