March 4, 2002
Symptoms of burnout common among medical residents; UW taking steps to help
In the largest study so far of burnout in medical residents, the syndrome of emotional detachment and exhaustion and a sense of low personal accomplishment struck about 76 percent of the internal medicine residents who responded to a February, 2001, University of Washington survey. The study is being published in the March 5 edition of the Annals of Internal Medicine, along with three other articles on the causes and consequences of resident burnout from other institutions. The UW has accelerated efforts to control resident workloads and is taking other measures to further reduce burnout.
Residents are doctors enrolled in postgraduate training after receiving their medical degrees. They frequently put in long hours and work rotating shifts. The study is believed to be the only one so far to evaluate the relationship between physician burnout and residents’ perceptions of patient care.
The study was conceived and conducted by former UW internal medicine resident Dr. Tait D. Shanafelt, now at the Mayo Clinic, Rochester, Minn.; and Dr. Katharine A. Bradley, Dr. Joyce Wipf and Dr. Anthony L. Back of Veterans Affairs Puget Sound Health Care System and the UW School of Medicine. Additionally, Wipf is the associate director of the UW medical residency program. The study was intended as a means of better understanding resident burnout and its effect on these young physicians. Wipf said when the study revealed that internal medicine residents had a high rate of burnout, the program stepped up existing strategies dealing with the problem in a variety of ways and enhanced them.
“When the results were tabulated, we met with residents to discuss them and measures that could help those who were feeling burned out,” Wipf said. “We formed several support groups led by selected faculty in the departments of Medicine and Psychiatry and Behavioral Sciences, and these groups are meeting monthly.”
Additionally, Wipf explained that following the survey, the results were discussed with supervising physicians and medical educators to enlist faculty awareness and support for improving resident training conditions. The program’s annual summer intern retreat and July courses for senior residents included an expanded discussion of burnout, and the School of Medicine has hired a director of counseling specifically to help UW residents in all medical programs to deal with emotional issues.
The study shows that 53 percent of the residents in the burnout group reported at least one incident monthly in which they believed they had provided sub-optimal care for a patient. These incidents ranged from discharging patients early to reduce demands on the healthcare team to ordering medication or other treatment for an agitated patient without evaluating the patient completely. Attitudes toward patients were also affected by burnout. Burned-out residents were more likely to report paying little attention to the social or personal impact of an illness on a patient, for example. No actual events of adverse patient care or patient outcomes were reported from care provided by the residents surveyed for the study.
Back added that this survey measures the residents’ perceptions of the care they were providing, rather than an actual measure of patient care.
“UW internal medicine residents are a dedicated, intelligent, hard-working group,” Back said. “This study suggests that if we can help them deal with burnout, they could become more compassionate, more attuned to patient needs and more competent at all the skills needed to be a physician and healer.”
The study consisted of a 92-item self-administered survey that was mailed to the residents’ homes. All the internal medicine residents in the 3-year program were eligible to participate, except for Shanafelt, the study’s first author. The residents rotate through UW Medical Center, Veterans Affairs Puget Sound Health Care System, Harborview Medical Center and Providence Campus of Swedish Medical Center. Fifty percent of their rotations include in-hospital on-call shifts every fourth night with at least one day off per week.
Residents responded anonymously to questions, and were not aware their answers were being studied for symptoms of burnout.
###
