Emergency Medicine Resident Burnout and Examination Performance

Abstract

Objectives Burnout afflicts emergency physicians (EPs) to a significant degree. The impact of burnout spans from decreased clinical efficiency to increased medical errors to heightened risk of physician suicide. This large‐scale study captures responses from emergency medicine (EM) residents regarding two burnout items and examines the correlation between in‐training examination (ITE) scores and burnout risk as well as that between residency year and burnout risk. Methods This was a prospective, mixed‐methods, cross‐sectional cohort study. All residents in U.S. categorical EM residents who took the 2019 ITE were included. At the end of the ITE, residents were invited to complete a voluntary survey that included two items from the Maslach Burnout Inventory (MBI) that have been found to be strongly indicative of burnout: one about self‐perception of being burned out and one about feelings of callousness. Responses were on a 7‐level Likert scale (1–7), ranging from very low frequency (1) to very high frequency (7). Measurements included the number of residents in each year‐level of training (EM1–EM4), the MBI item ratings, and the ABEM ITE score. Performance, as measured by the scaled, equated score, was compared to the MBI item responses. A corrected Spearman’s correlation coefficient (ρ) was used to compare continuous data (score) against a discrete ordinal variable (MBI Likert response). Results There were 2,501 EM1 residents, 2,389 EM2 residents, 2,206 EM3 residents, and 616 EM4 residents in the study group. There were 7,206 (93.4%) physicians who completed the first MBI question about burnout; 7,172 (93%) completed the second MBI question about callousness. There was no statistically significant association between the burnout item response and ITE performance (ρ = –0.03; p = 0.015). There was a positive, statistically significant association between the callousness item response and higher ITE performance (ρ = 0.07; p < 0.001). There was a statistically significant association between the response to the burnout item and training level (ρ = 0.07; p <0.001). There was also a statistically significant association between the response to the callousness item and training level (ρ = 0.15; p < 0.001). The overall prevalence of burnout risk in various training levels were EM1, 28.2%; EM2, 39%; EM3, 41.1%; and EM4, 43.3%. Conclusions Our study found no significant correlation between ITE score and burnout risk. There was a weakly positive correlation between ITE scores and callousness. Based on our study results, ITE scores may not be useful in prognosticating burnout risk for EM residents and, interestingly, higher ITE scores correlated to stronger feelings of callousness. Our study indicates that EM residents at higher levels of training reported stronger self‐perceptions of burnout and callousness. Further investigation into why residents at higher levels of training may experience greater b...

Reliability and validity support for an abbreviated Copenhagen burnout inventory using exploratory and confirmatory factor analysis

“…To determine quantitative thresholds for burnout, the 2‐factor model was compared to a large study of emergency medicine residents using the Maslach Burnout Inventory. 11 Given the 2‐factor model, each factor had to be regarded as an independent indicator of burnout. Therefore, each factor required an individual threshold.…”

“…Given that some residents had both types of burnout (10.1% had both), the overall incidence of a resident having 1 or both types of burnout was 34.1%, which is very similar to prior reports using validated burnout inventories for emergency medicine residents. 11 In addition, the incidence of burnout increased as training progressed. Emergency medicine first‐year residents had a 29.3% incidence that increased to 37.5% for emergency medicine third‐ and fourth‐year residents (Table 6 )…”

“…Rating thresholds used an anticipated frequency between 30% and 40% because of prior studies using items from the Maslach Burnout Inventory and nearly identical resident cohorts (Lu DW, Zhan T, Bilimoria KY, et al unpublished data, 2021). 11 There were several intermediary results needed to determine the primary outcomes. These intermediary outcomes included interitem correlations, determinants of factorability, and several data points needed to derive a final inventory.…”

“… 10 Using criteria applied to an abbreviated Maslach Burnout Inventory, the prevalence is 28% during the first‐year of an emergency medicine residency and increases to more than 40% in the final year of training. 11 Another recent study reported that the overall incidence was 30% (Lu DW, Zhan T, Bilimoria KY, et al unpublished data, 2021). 12 Determining the prevalence of burnout is complicated by the varied definitions that are applied to this enigmatic syndrome, 12 as well as the arduousness and expense in using some burnout inventories.…”

“…Burnout is a frequently reported problem within emergency medicine. 10 , 11 Conducting additional research on emergency physician burnout would provide an opportunity to better characterize the root causes of burnout and to explore more system‐based interventions that could benefit the specialty. More frequent, longitudinal assessments would be easier to conduct using a shorter inventory.…”