Higher Depersonalization Scores Research Articles

Burnout and depression among medical residents in the United Arab Emirates: A Multicenter study.

Introduction:Persistent imbalance between work demands and resources seems to be a crucial contributor to the development of burnout among medical professionals. Yet, it seems that Middle East is lacking studies analyzing psychological well-being's of medical residents. Hence, we aimed to conduct a nationwide study to understand and address burnout and depression in medical residents in the UAE.Methods:A multicenter, cross-sectional study was designed to evaluate professional burnout and depression among medical residents to address the gap.Results:Our results indicate that 75.5% (216/286) of UAE medical residents had moderate-to-high emotional exhaustion (EE), 84% (249/298) had high depersonalization (DP), and 74% (216/291) had a low sense of personal accomplishment. In aggregate, 70% (212/302) of medical residents were considered to be experiencing at least one symptom of burnout based on a high EE score or a high DP score. Depression ranging from 6% to 22%, depending on the specialty was also noted. Noticeably, 83% (40/48) of medical residents who had high scores for depression also reported burnout.Conclusions:This study shows that burnout and depression are high among medical residents in UAE. There is a crucial need to address burnout through effective interventions at both the individual and institutional levels. Professional counseling services for residents will certainly be a step forward to manage resident burnout provided the social stigma associated with counseling can be eliminated with awareness. The work hour regulations suggested by the Accreditation Council for Graduate Medical Education partly provides a solution to improve patient safety and care quality. There is an urge to reconfigure the approach to medical training for the well-being of the next generation of physicians in the Arab world.

A Multicenter Study Investigating Empathy and Burnout Characteristics in Medical Residents with Various Specialties.

We assessed empathy in medical residents, including factors modifying empathy and the relationship between empathy and burnout. Participants (n = 317 residents, response rate = 42%) from 4 university hospitals completed a socio-demographic questionnaire, the Jefferson Scale of Empathy (Health Professional version, Korean edition), and the Maslach Burnout Inventory (MBI). Participants were classified by medical specialty: “people-oriented specialty” (POS group) or “technology-oriented specialty” (TOS group), with more women in the POS than in the TOS group, χ2 = 14.12, P < 0.001. Being female, married, and having children were factors related to higher empathy (gender, t = -2.129, P = 0.034; marriage, t = -2.078, P = 0.038; children, t = 2.86, P = 0.005). Within specialty group, POS residents showed higher empathy scores in the fourth as compared to the first year, F = 3.166, P = 0.026. Comparing POS and TOS groups by year, fourth year POS residents had significantly higher scores than did fourth year TOS residents, t = 3.349, P = 0.002. There were negative correlations between empathy scores and 2 MBI subscales, emotional exhaustion (EE) and depersonalization (DP). Additionally, first year POS residents had higher DP scores than did first year TOS residents, t = 2.183, P = 0.031. We suggest that factors important for empathy are type of medical specialty, marriage, siblings, and children. Burnout state may be related to decreasing empathy.

Medical Resident's Burnout: About 149 Cases

Background Burnout is a professional psychological chronic stress-induced syndrome defined by three dimensions: emotional exhaustion, depersonalization and low personal accomplishment. It concerns all professions especially healthcare staff. Methods A cross-sectional study conducted among medical residents working in hospitals located in Tunis. Three instruments are used: an anonymous self administered questionnaire, Maslach Burnout Inventory (MBI) to assess burnout, Abstract Beck Depression Inventory to evaluate the intensity of depression. Severe burnout was defined as a severely high level of both emotional exhaustion and depersonalization associated with a severely low level of personal accomplishment. Results A total of 149 residents participated in the survey. 17,4% of participants had a severe Burnout. 42,26% reported a severely high score for emotional exhaustion, 46,92% reported a severely high score for depersonalization and 26,14% had a severely low score of personal accomplishment. Among stress factors significantly correlated to burnout: Lack of hobbies (p Conclusion Medical residents in all specialties are at risk of burnout. Nevertheless, it is shown that some specialties are more exhausting, which is consistent with the results reported in the literature. This syndrome deserves to be studied further in junior doctors to develop appropriate means of preventions.

Professional burnout, stress and job satisfaction of nursing staff at a university hospital.

OBJECTIVES: to describe the social and work characteristics of the nursing staff at a tertiary hospital in the Public Health Service of Andalucía, to assess the degree of professional professional burnout and job satisfaction of those professionals and to study the possible relation between the professional burnout variables and the stress and job satisfaction levels on the one hand and social and employment variables on the other. METHOD: descriptive and cross-sectional study in a sample of 258 baccalaureate and auxiliary nurses. As research instruments, an original and specific questionnaire was used to collect social and employment variables, the Maslach Burnout Inventory, the Nursing Stress Scale and the Font-Roja questionnaire. Descriptive, inferential statistics and multivariate analysis were applied. RESULTS: average scores were found for professional stress and satisfaction, corresponding to 44,23 and 65,46 points, respectively. As regards professional burnout, an average score was found on the emotional exhaustion subscale; a high score for depersonalization and a low score for professional accomplishment. Studies are needed to identify the scores on these subscales in health organizations and to produce knowledge on their interrelations.

Professional Burnout Among US Plastic Surgeons

Little is known about professional burnout among plastic surgeons. Our purpose is to describe its prevalence among a large national sample of plastic surgeons and identify contributing factors. A mailed, self-administered survey was sent to 708 plastic surgeons who were randomly sampled from the American Society of Plastic Surgeons national membership (71% response rate). The dependent variable was professional burnout, measured by 3 subscales from the validated Maslach Burnout Inventory-Human Services Survey. "High" scores in either the emotional exhaustion or depersonalization subscale categories predict professional burnout. The independent variables included surgeon sociodemographic and professional characteristics. χ was used for the bivariate analyses. Nearly one third (29%) of surgeons scored high in subscale categories predictive of professional burnout. Factors associated with high emotional exhaustion scores included surgeon age, 40-50 years (P = 0.03); fair/poor physician health (P < 0.01); ER call (P < 0.01); >60 work hours per week (P = 0.03); primarily reconstructive practice (P < 0.01); private practice (P = 0.01); and group practice (P = 0.02). Factors associated with high depersonalization scores included fair/poor physician health (P= 0.01); ER call (P < 0.01); private practice (P = 0.01); and group practice (P = 0.02). Nearly one third of plastic surgeons have signs of professional burnout. Middle-aged surgeons and those in poor health are most at risk; along with those who have a reconstructive rather than cosmetic practice, long work hours, ER call responsibility, a nonacademic setting. and group as compared to solo practice. These data have important implications for future workforce shortages and health care quality.

Magnitude and risk factors for burnout among primary health care physicians in Asir province, Saudi Arabia

Job-related burnout is an occupational hazard for health care professionals. This study aimed to determine the prevalence of burnout and its associated factors among physicians working at primary health care centres in Asir province, Saudi Arabia. In a cross-sectional survey applying the Maslach Burnout Inventory (MBI) with standard cutoffs, 29.5% of respondents reported high emotional exhaustion, 15.7% high depersonalization and 19.7% low personal accomplishment, with 6.3% scoring high in all 3 dimensions. High emotional exhaustion score was associated with younger age, Saudi nationality and salary 15,000-20,000 SR. Physicians who had more working days and those who had longer duration of annual vacation were less likely to report emotional exhaustion. High depersonalization score was associated with Saudi nationality, working for 5-15 years and salary > 20,000 SR. Low personal accomplishment score was associated with younger age, non-Saudi nationality, working for > or =5 years and more annual vacation.

Determinants of burnout in acute and critical care military nursing personnel: a cross-sectional study from Peru.

BackgroundEvidence on the prevalence and determinants of burnout among military acute and critical care nursing personnel from developing countries is minimal, precluding the development of effective preventive measures for this high-risk occupational group. In this context, we aimed to examine the association between the dimensions of burnout and selected socio-demographic and occupational factors in military acute/critical care nursing personnel from Lima, Peru.Methods and FindingsWe conducted a cross-sectional study in 93 nurses/nurse assistants from the acute and critical care departments of a large, national reference, military hospital in Lima, Peru, using a socio-demographic/occupational questionnaire and a validated Spanish translation of the Maslach Burnout Inventory. Total scores for each of the burnout dimensions were calculated for each participant. Higher emotional exhaustion and depersonalisation scores, and lower personal achievement scores, implied a higher degree of burnout. We used linear regression to evaluate the association between each of the burnout dimensions and selected socio-demographic and occupational characteristics, after adjusting for potential confounders. The associations of the burnout dimensions were heterogeneous for the different socio-demographic and occupational factors. Higher emotional exhaustion scores were independently associated with having children (p<0.05) and inversely associated with the time working in the current department (p<0.05). Higher depersonalization scores were independently associated with being single compared with being divorced, separated or widowed (p<0.01), working in the emergency room/intensive care unit compared with the recovery room (p<0.01), and inversely associated with age (p<0.05). Finally, higher personal achievement scores were independently associated with having children (p<0.05).ConclusionAmong Peruvian military acute and critical care nursing personnel, potential screening and preventive interventions should focus on younger/less experienced nurses/nurse assistants, who are single, have children, or work in the most acute critical care areas (e.g. the emergency room/intensive care unit).

Functional Neuroimaging Correlates of Burnout among Internal Medicine Residents and Faculty Members.

Burnout is prevalent in residency training and practice and is linked to medical error and suboptimal patient care. However, little is known about how burnout affects clinical reasoning, which is essential to safe and effective care. The aim of this study was to examine how burnout modulates brain activity during clinical reasoning in physicians. Using functional Magnetic Resonance Imaging (fMRI), brain activity was assessed in internal medicine residents (n = 10) and board-certified internists (faculty, n = 17) from the Uniformed Services University (USUHS) while they answered and reflected upon United States Medical Licensing Examination and American Board of Internal Medicine multiple-choice questions. Participants also completed a validated two-item burnout scale, which includes an item assessing emotional exhaustion and an item assessing depersonalization. Whole brain covariate analysis was used to examine blood-oxygen-level-dependent (BOLD) signal during answering and reflecting upon clinical problems with respect to burnout scores. Higher depersonalization scores were associated with less BOLD signal in the right dorsolateral prefrontal cortex and middle frontal gyrus during reflecting on clinical problems and less BOLD signal in the bilateral precuneus while answering clinical problems in residents. Higher emotional exhaustion scores were associated with more right posterior cingulate cortex and middle frontal gyrus BOLD signal in residents. Examination of faculty revealed no significant influence of burnout on brain activity. Residents appear to be more susceptible to burnout effects on clinical reasoning, which may indicate that residents may need both cognitive and emotional support to improve quality of life and to optimize performance and learning. These results inform our understanding of mental stress, cognitive control as well as cognitive load theory.

Burnout in the Irish oncology community: Results of a single-institution study.

e19601 Background: Several European studies suggest that healthcare professionals working in oncology display higher levels of professional burnout than their colleagues from non-oncology units. We aimed to identify the level of burnout of professionals working in cancer care at a single institution in Dublin, Ireland. Methods: 143 oncology staff members were emailed a 3 section questionaire. We employed the Maslach Burnout Inventory, a validated, burnout-specific instrument, incorporating a three-dimensional assessment of the syndrome through its subscales: emotional exhaustion (EE), depersonalization (DP) and personal achievment (PA). Sociodemographic, protective and predisposing variables were identified in tandem, while the final section afforded respondents an opportunity to speculate on workplace stressors and their potential remediation. The primary endpoint was overall high burnout. Secondary endpoints were mean scores for each individual category. Wilcoxon rank sum and Kruskal-Wallis tests were performed on SPSS version 18. Results: The overall response rate was 41.3% (59/143) (see table). Three respondents (5.1%) reported high levels of burnout in all 3 categories. In subcategory analysis, men had significantly higher mean DP scores [9, SD: 6.03] than women [5.3,SD: 4.46](p &lt; .05) and residents had significantly higher DP scores [8.11,SD: 4.46] than attendings [4.14,SD: 3.2]( p &lt; .05). Regression analysis, found that being male was a significant predictor for high levels of depersonalization but found no predictor for EE or PA. Conclusions: We identified low levels of burnout among Irish cancer care professional. Protective factors such as age &lt;35yrs (66%), religion (68%), hobbies (86%),working &lt;50 hours (66%) and being in a relationship (74%) were at high levels, which may have biased our results. A national expansion and comparison with international figures is planned and will be presented at ASCO. [Table: see text]

Burnout syndrome, working conditions, and health: a reality among public high school teachers in Brazil

The objective of the study was to evaluate the occurrence of Burnout Syndrome in 100 teachers of six public high schools and its correlation with working conditions in a southeast city of Brazil. Characterization of the sample occurred after application of a socio-demographic questionnaire. Evaluation of the working conditions was done by means of an Ergonomic Working Analysis. The presence of Burnout Syndrome was evaluated by means of the Maslach Burnout Inventory. The sample presented the predominance of women, with an average age of 40.4 and the majority married with children. Roughly 50% had less than 10 years of service, and more than half of the teachers taught more than 18 classes per week. Hoarseness after work was principally reported among women, which required many days off for health treatment. Environmental conditions reflect inadequacy in relation to noise, light, humidity and temperature. Presence of pain in the upper limbs was especially high among women. Risk of musculoskeletal disorders in the upper limbs predominated as moderately important to significant. We also identified an average distance walked by teachers of 1.5 Km and an average of 4.2 Kg of school supplies carried between classes. The Burnout Syndrome presented a high score for depersonalization principally among men, but it has association with both sexes. Emotional exhaustion correlates with noise, depersonalization, and personal fulfillment, in addition to the high number of weekly lessons. It can be concluded that Burnout syndrome is present among teachers, principally in terms of depersonalization, deserving the attention of government officials and the schools, as well as the teachers themselves.

Defining Burnout as a Dichotomous Variable

To the Editor:—In the July 2008 issue, Legassie et al.1 define burnout as having a high score in all three burnout domains of the Maslach burnout inventory (MBI): emotional exhaustion, depersonalization, and low personal accomplishment. Although the MBI is the gold standard tool for measuring burnout, there is considerable variability in how researchers studying physicians and medical students have defined burnout. For example, others have considered those with either high emotional exhaustion or high depersonalization as experiencing burnout.2 The effect of these differing definitions is significant. Legassie et al. report an overall burnout rate of 12.5%. This grossly underestimates the burnout rate under alternative definitions, since at least 29% of participants experienced high levels of either emotional exhaustion or depersonalization in the Legassie study. Ultimately, burnout is a complex, continuous, and heterogeneous construct3 that manifests itself differently in different individuals. Emotional exhaustion, depersonalization, and inefficacy are symptoms of the syndrome. These symptoms can manifest in differing degrees resulting in burnout being best considered a continuum rather than a dichotomous variable. As advocated by Maslach,3 when evaluating the relationship between symptoms of burnout and other outcomes the ideal approach is to use the individual domain scores as continuous data. The second best option is to report categorized results separately using established definitions of low, average, and high cut-off scores3 for each domain. Using an overall burnout assessment (i.e. a dichotomous variable) is practical in research studies but problematic as there is no accepted standard definition. High scores on either the emotional exhaustion or depersonalization scales but not a low score on the personal accomplishment scale can distinguish the clinically burned out from the non-burned out,4 supporting the high emotional exhaustion and/or high depersonalization definition cited above.2 Another approach, supported by Maslach, is that an individual may be considered clinically burned out when a high emotional exhaustion score is present in combination with either a high depersonalization score or a low personal accomplishment score (Maslach, personal communication, September 24, 2008). Either approach is associated with trade-offs with respect to sensitivity and specificity. We note, however, that requiring high scores in all three domains is unsubstantiated by existing literature on the MBI. We applaud Legassie et al.’s efforts to better understand physician well-being. Future research should incorporate consistent approaches for defining burnout using the MBI, rather than use variable definitions of burnout that prevent comparison across studies and slow efforts to identify, understand, and reduce burnout.

Burnout in Medical School Deans

In Reply: We greatly appreciate the letter from Drs. West, Dyrbye, and Shanafelt about our report on burnout in medical school deans. They note that we state that only 2% of medical school deans exhibited high levels of burnout utilizing the Maslach Burnout Inventory (MBI). They emphasize that each subscale of the MBI, depersonalization, emotional exhaustion, and low personal accomplishment, should be considered separately. The MBI states, “A high degree of burnout is reflected in high scores on the emotional exhaustion and depersonalization subscales and in low scores on the personal accomplishment subscale”1. In the conclusions of our article, we emphasize that “only 2% of deans who participated in the study exhibited high levels of burnout in all three subcomponents.” We agree that the subscales should also be considered separately and that our finding that 40% of deans had high emotional exhaustion scores and that 24% had high depersonalization scores is cause for concern. For that reason, the final section of our article describes approaches the deans have taken to reduce stress and the risk for burnout. Finally, we emphasized that the pattern we observed in deans is similar to that described by Hewlett and Luce2 in their assessment of individuals with “extreme jobs.” In our study, 82% of deans had moderate to high personal accomplishment; Hewlett and Luce found that most extreme-job holders say they love their jobs. Steven G. Gabbe, MD Senior vice president for health sciences, chief executive officer, The Ohio State University Medical Center, 370 West Tenth Avenue, Columbus, Ohio; ([email protected]). Lynn Webb, PhD Chief of staff, Vanderbilt University School of Medicine, Nashville, Tennessee.

A síndrome da estafa profissional em médicos cancerologistas brasileiros

The Burnout syndrome can be characterized by abnormalities in three domains: emotional exhaustion (EE), depersonalization (DP) and lack of personal realization (PR). In the medical profession, oncologists are especially prone to this syndrome. This study evaluates its prevalence among cancer physicians in Brazil correlating it to their demographic, work related variables and seeks possible solutions to prevent burnout. We mailed three questionnaires (Maslach burnout inventory, general and opinion questionnaires) to all 645 members of the Brazilian Cancer Society and received 136 responses after 10 weeks. The response rate was of 21%. The burnout syndrome was present at moderate or severe levels in all three domains analyzed in 15.7% of the physicians. For each of these the frequency of moderate or severe dysfunction was analyzed and found to be present in 55.8% for EE, 96.1% for DP and 23.4% for RP. Practicing physical activity or having a hobby correlated significantly with lower levels of EE (p = 0.008) while working only for the private sector correlated with higher DP scores (p = 0.021). Cancer physicians pointed out that less paper work (73.5%) and a lower patient load (72.7%) were the most important factors for prevention of this syndrome. Burnout syndrome is frequent among Brazilian cancer physicians and further studies should be conducted to evaluate its prevalence and prevention among other sub specialists.

Incidence of and factors associated with the burnout syndrome among Brazilian cancer physicians

8143 Background: The burnout syndrome can be characterized by abnormalities in three domains: emotional exhaustion (EE), depersonalization (DP) and lack of personal realization (RP). In the medical profession, oncologists are especially prone to this syndrome. This study aims at evaluating its prevalence among cancer physicians in Brazil and correlate it to their demographic, work related variables as well as search for possible solutions to prevent it. Methods: In this prospective study we sent 3 questionnaires (Maslach burnout inventory, general and opinion questionnaires) by mail to all 645 members of the Brazilian Cancer Society. We defined burnout as proposed by Grunfeld as moderate or severe dysfunction in all three aforementioned domains. We evaluated correlations between the presence of burnout and the other variables by univariate and multiple logistic regression. Results: We received 136 responses (21%) after 10 weeks. The burnout syndrome was present at moderate or severe levels in all 3 analyzed dimensions in 15,7% (95% CI: 9,62 to 21,78%) of the surveyed physicians. For each domain, we analyzed the frequency of moderate or severe dysfunction and they were present in 55,8% for EE, 96,1% for DP and 23,4% for PR. Physical activity or having a hobby correlated significantly with lower levels of EE (p=0,008), and work restricted only to the private sector correlated with higher DP scores (p=0,021). By univariate logistic regression younger age (p = 0.002), female sex (p=0,004), number of patients seen per day (p = 0.013) and lack of family support (p=0,025) correlated significantly with burnout. By multiple logistic regression only lack of family support correlated significantly (p = 0.05) with the presence of burnout. Cancer physicians pointed out that less paper work (73,5%) and a lower patient load (72,7%) were the most important factors to prevent this syndrome. Conclusions: Burnout syndrome is frequent among brazilian cancer physicians and further studies should be conducted to try to decrease its occurrence by attempting to modify variables that may predispose physicians to it. No significant financial relationships to disclose.

Burnout and self-reported patient care in an internal medicine residency program.

Burnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Little is known about burnout in residents or its relationship to patient care. To determine the prevalence of burnout in medical residents and explore its relationship to self-reported patient care practices. Cross-sectional study using an anonymous, mailed survey. University-based residency program in Seattle, Washington. 115 internal medicine residents. Burnout was measured by using the Maslach Burnout Inventory and was defined as scores in the high range for medical professionals on the depersonalization or emotional exhaustion subscales. Five questions developed for this study assessed self-reported patient care practices that suggested suboptimal care (for example, "I did not fully discuss treatment options or answer a patient's questions" or "I made...errors that were not due to a lack of knowledge or inexperience"). Depression and at-risk alcohol use were assessed by using validated screening questionnaires. Of 115 (76%) responding residents, 87 (76%) met the criteria for burnout. Compared with non-burned-out residents, burned-out residents were significantly more likely to self-report providing at least one type of suboptimal patient care at least monthly (53% vs. 21%; P = 0.004). In multivariate analyses, burnout--but not sex, depression, or at-risk alcohol use--was strongly associated with self-report of one or more suboptimal patient care practices at least monthly (odds ratio, 8.3 [95% CI, 2.6 to 26.5]). When each domain of burnout was evaluated separately, only a high score for depersonalization was associated with self-reported suboptimal patient care practices (in a dose-response relationship). Burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.