Abstract
Background/Objective:Burnout is common among resident physicians, which has the potential to translate into diagnostic and management errors. Our study investigates the relationship between sleepiness, depression, anxiety, burnout, and lack of professional fulfillment with clinical performance during a critically ill patient simulation.Methods/Approach:Emergency medicine residents were recruited to participate in a high-fidelity simulation case of a critically ill patient. A survey with validated wellbeing measures (National Institutes of Health Patient-Reported Outcomes Measurement Information System (NIH PROMIS), Linzer burnout measure, and professional fulfillment index) was administered prior to the simulation. Each encounter was video-recorded and analyzed by two blinded raters based on a binary critical-actions checklist. Time-to-intubation, management errors, and misdiagnosis rates were assessed.Results:Twenty residents participated, with most subjects endorsing sleepiness (70%) and less than half reporting depression (40%) and anxiety (45%). Burnout was identified to be in 50% of participants by the Linzer measure and 85% by the professional fulfillment index. No significant difference was found between mean performance scores in sleepy, depressed, and anxious cohorts in comparison to groups without those symptoms. Similarly, burnout and professional fulfillment did not yield any significant difference, nor did comparisons with time to intubation, management errors, and frequency of misdiagnosis.Conclusion:Resident burnout, depression, anxiety, sleepiness, and lack of professional fulfillment did not appear to have a measurable impact on clinical performance in managing a critically ill patient. There is no evidence from this study that the lack of resident physician well-being adversely impacts patient care by increasing errors in management or misdiagnoses during this high-fidelity simulation.
Highlights
Burnout has been defined by Dr Christina Maslach as having three key components: 1) a feeling of overwhelming exhaustion, 2) cynicism and detachment from the job, 3) and a sense of ineffectiveness and lack of accomplishment [1]
Burnout was identified to be in 50% of participants by the Linzer measure and 85% by the professional fulfillment index
With simulation performance as a proxy for clinical performance, our findings suggest that providers may be able to perform adequately when caring for individual critically ill patients even in the context of scoring lower measures on various wellness metrics
Summary
Burnout has been defined by Dr Christina Maslach as having three key components: 1) a feeling of overwhelming exhaustion, 2) cynicism and detachment from the job, 3) and a sense of ineffectiveness and lack of accomplishment [1]. These symptoms often begin manifesting early in medical learners during medical school with increasing depersonalization and emotional exhaustion [2,3]. In simulated medical scenarios, lower cumulative performance scores on high-fidelity simulation scenarios have been associated with emergency medical trainees exhibiting signs of burnout [6]
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