Burnout and Resilience of Internal Medicine Physician Trainees in a Tertiary Government Hospital in the Philippines during the COVID-19 Pandemic: A Mixed-method Study

Abstract

Objectives. Internal Medicine physician trainees faced unique challenges as the primary frontline physicians at a tertiary COVID-19 government referral center during the COVID-19 pandemic. This study examined the prevalence of burnout and resilience of these physician trainees during the early period of the pandemic, the determinants of burnout, and their sources of anxiety and coping mechanisms.
 Methods. Using a mixed-methods approach, we conducted an online cross-sectional survey to measure burnout and resilience among 196 Internal Medicine physician trainees using the Maslach Burnout Index Human Services Survey for Medical Personnel and the Connor-Davidson Resiliency questionnaires, respectively. We then conducted virtual focus group discussions and in-depth key informant interviews to explore the trainees’ sources of anxiety and coping mechanisms until thematic saturation was satisfied.
 Results. Out of 146 respondents (from 196 eligible participants, 74% response rate), four percent of physician trainees fit the frank burnout profile, 40% were engaged, while the majority had intermediate profiles (23% ineffective, 28% overextended, and 4% disengaged). The mean resilience score was 72.9 (SD 12.4). Resilience was a significant negative predictor for burnout (Beta Coefficient = -0.73, p<0.001). Its protective effect decreases in those with more exposure to patient deaths (Beta Coefficient = 6.767, p<0.05). Significant sources of anxiety included changes in the practice of medicine (changes in workflow, working in full personal protective equipment, telemedicine and zoom fatigue, constant threat of acquiring the infection) and having competing demands between service and training. Coping mechanisms included preserving a haven, maintaining social relationships, and self-care.
 Conclusion. In the largest government hospital in the Philippines, four percent of Internal Medicine physician trainees had burnout, 40% were engaged, and the majority were at-risk for burnout a few months into the COVID-19 pandemic in 2020. Resilience reduces the risk for burnout. However, its protective effect decreased with exposure to a higher number of patient deaths per week.

Fatiga digital en estudiantes universitarios como consecuencia de la enseñanza online durante la pandemia Covid-19

“…Otro factor clave fue la rama de conocimiento de los estudios cursados, obteniendo los estudiantes de Artes y Humanidades un mayor grado de fatiga digital. En contraposición, con investigaciones previas que destacan la rama de Ciencias de la Salud como la mayor agravada por este fenómeno (Franco et al, 2022;Oducado et al, 2021). Asimismo, dependiendo de la institución educativa donde se recopilen los datos, la casuística por rama de conocimiento puede variar dependiendo del contexto.…”

“…Generalmente el corpus de estudios recientes ha reportado resultados similares en estudiantes de diversas áreas del conocimiento de la educación superior. Por ejemplo, se ha evidenciado que estudiantes del área de medicina padecían burnout, y se identificó el desarrollo de la resiliencia para reducir los riesgos de la fatiga digital (Franco et al, 2022). Con estudiantes de enfermería se infiere que la fatiga es relativamente frecuente y que puede estar pasando factura a los alumnos (Oducado et al, 2021).…”