Table 1 Description of the Studies
Author(s) | Study Population | Sample Description | Burnout Measure | Quality of Care Outcome Measure |
|---|---|---|---|---|
Beckman et al. (2012) [26] USA | Internal Medicine residents at one institution Jun 2009 – Aug 2010 Response rate: 64.7% No significant difference between responders versus non-responders with respect to year of training, age, sex, program type, or US Medical Licensing Examination Step 1 or 2 Clinical Knowledge scores | n = 202 Internal Medicine residents Male = 57.4% Female = 42.6% Age: 24–30 yrs. = 85.5% ≥ 31 yrs. = 14.5% Year of training: PGY 1 = 72.8% PGY 2 = 13.9% PGY 3 = 13.4% | 22-item Maslach Burnout Inventory Burnout defined as high scores on either DP or EE | 6-items from the Mini-Clinical Evaluation Exercise (CEX) completed by peers, senior residents and non-physician professionals for each resident: • Desirability as a physician for one of your family • Desirability as a future co-worker or team member • Effectiveness and completeness of sign-outs • Coverage of cross-over issues and completeness of tasks while on call • Demonstrates empathy and compassion for patients • Communication skills with patients, family, allied health, and other providers |
Block et al. (2013) [30] USA | 1st year Internal Medicine residents from three Internal Medicine residency programs in Baltimore May – Jun 2011 Response rate: 72% | n = 55 Internal Medicine residents Male = 53% Female = 47% Mean age: 29 yrs. ± 3 | 6 items from the Maslach Burnout Inventory Burnout was scored into 3 categories based on tertiles of the sample scale scores: low, medium, high | Details about the items from the questionnaires used were not given. From the paper, error items included: • Make errors due to fatigue • Make errors due to workload • Forget to order med • Forget to convey info |
de Oliveira et al. (2013) [31] USA | Residents in Anesthesiology departments in the American Society of Anesthesiologists directory Response rate: 54% | n = 1430 Anesthesiology residents Male: 57% Female: 43% Age: ≤ 30 yrs. = 54% > 30 yrs. = 46% Year of training: 1st-2nd yr. = 51% 3rd – 4th yr. = 49% | 12 items from the Maslach Burnout Inventory: 3 from DP domain, 5 from EE domain, and 4 from PA domain High risk of burnout defined as having moderate high or high burnout sub-scale scores in 2 or more sub-scales | 7-items adapted three studies (Prins et al. [32]; West et al. [27]; Shanafelt et al. [33]): • I make mistakes without negative consequences to my patients • I perform procedures without appropriate training • I make mistakes with negative consequences to my patients • I fall short in the quality of care I provide to my patients • I do not have enough time or attention for my patients • I have made medication errors involving the wrong drug or dose in the last year • I do not monitor the patient in the operating room as closely as I should |
Fahrenkopf et al. (2008) [25] USA | Residents in Pediatrics and medicine-pediatrics at three institutions Response rate: 50% No significant difference between responders versus non-responders with respect to year of training, age, and sex | n = 123 Pediatric residents Male = 30% Female = 70% Age: < 30 yrs. = 62% ≥ 30 yrs. = 38% Year of training: PGY 1 = 33% PGY 2 = 34% PGY 3 = 33% | 22-item Maslach Burnout Inventory medical staff version High burnout if combined score for EE (≥ 27) and DP (≥ 10) | Trained reviewers conduct daily review of charts and medication orders for all patients on the survey wards and a review of solicited and voluntary error reports by staff. Intensive care units and ambulatory settings excluded. Abstracted information categorized by trained reviewers as: (1) preventable adverse event, (2) non-preventable adverse event, (3) potential adverse event, (4) error with little potential for harm |
Passalacqua and Segrin (2012) [28] USA | Internal medicine residents in one internal medicine program in the Southwest Response rate: not reported Measures taken pre and post long-call shift | n = 93 internal medicine residents Male: 62 Female: 30 Mean age: 29.6 ± 3.2 yrs | 22-item Maslach Burnout Inventory Scored using a sum of all items | Adaptation of a 13-item patient-centered communication scale (Wanzer et al. [38]). Original scale designed for nurses and patients to evaluate physician-centered communication. Adaptation asked physicians to think of their shift from midnight until end of shift and report on selected behavior using a 5-point scale from 1 (never) to 5 (very often). State empathy assessed using an adaptation of Tsang and Stanford’s [40] 8-item state empathy scale. Adaptation asked statements regarding emotions toward a particular person using a 7-point scale from 1 (strongly disagree) to 7 (strongly agree) |
Prins et al. (2009) [32] The Netherlands | All residents in training on October 1, 2005 Response rate: 41.1% | n = 2115 residents Specialties: General surgery: 8.0% Surgical specialties: 12.8% Internal medicine: 13.8% Medical specialties: 23.5% Obstetrics/gynecology: 5.9% Pediatrics: 7.7% Psychiatry: 11.5% Supportive specialties: 16.8% Male: 39% Female: 61% Mean age: 31.5 ± 3.5 yrs. Mean years in training: 3.1 ± 1.5 yrs. | 20-item Utrecht Burn-Out Scale (UBOS)/Maslach Burnout Inventory for Health and Social Services Scored using UBOS manual cut-offs to diagnose moderate and severe burnout | Based on six-items from a previous study (Shanafelt et al. [33]) with a two factor solution: Action/experience error: • I make mistakes without negative consequences for the patient • I perform procedures for which I am not properly trained • I make mistakes that have negative consequences for the patient Errors due to lack of time: • I discharge patients later because my workload is too heavy • I fall short in the quality of care I provide • I do not have enough time for my patients |
Shanafelt et al. (2002) [33] USA | All internal medicine residents in hospitals affiliated with one University Feb 2001 Response rate: 76% There was a decreasing response rate by residency year | n = 115 internal medicine residents Male: 47% Female: 53% Year of training: PGY 1 = 48% PGY 2 = 30% PGY 3 = 23% | 22-item Maslach Burnout Inventory Scored each of the three domains based on terciles of a published study of 1104 medical professionals: low, medium, high Burnout defined as high score on DP or EE | Self-reported frequency of suboptimal patient care practices: • I found myself discharging patients to make the service ‘manageable’ because the team was so busy • I did not fully discuss treatment options or answer a patient’s questions • I made treatment or medication errors that were not due to a lack of knowledge or inexperience • I ordered restraints or medication for an agitated patient without evaluating him or her • I did not perform a diagnostic test because of desire to discharge a patient Self-reported frequency of suboptimal patient care attitudes: • I paid little attention to the social or personal impact of an illness on a patient • I had little emotional reaction to the death of one of my patients • I felt guilty about how I treated one of my patients from a humanitarian standpoint Frequency: never, once, several times per year, monthly, weekly Summary measures: • Suboptimal patient care practices at least monthly • Suboptimal patient care practices at least weekly |
Toral-Villanueva et al. (2009) [34] Mexico | Junior doctors at three hospitals in the Mexican Health System Sep 2003 – Jan 2004 Response rate: 65% | n = 312 junior doctors On-the-job seniority: 28 ± 17.6 mths Male: 57% Female: 42% Mean age: 28 ± 2.5 yrs | 22-item Maslach Burnout Inventory validated in Spanish. Scored using low, moderate, high cutoffs Burnout defined as high scores for either DP(≥ 10) or EE (≥ 27) | Used Shanafelt et al. [33] items and scoring methods (see above) |
West et al. (2006) [27] USA | Internal medicine residents at one institution in academic years 2003–2004, 2004–2005, and 2005–2006 Data collected up to May 2006 Residents surveyed every 3-months throughout training Response rate: 84% No significant difference between responders versus non-responders with respect to age, sex and program type | n = 184 internal medicine residents Male: 51.1% Female: 35.9% Age: ≤ 30 yrs. = 70.1% > 30 yrs. = 16.3% | 22-item Maslach Burnout Inventory Burnout defined as high DP, high EE, and low PA scores | Single question asked every 3 months, “Are you concerned that you have made any major medical errors in the last 3 months?” |
West et al. (2009) [29] USA | Internal medicine residents at one institution in academic years in the residency program from July 2003 – Feb 2009 Residents surveyed every 3 months throughout their training beginning in 2003 Response rate: 88.3% No significant difference between responders versus non-responders with respect to age, sex and program type | n = 380 internal medicine residents Male: 62.1% Female: 37.9% Age: ≤ 30 yrs. = 63.2% > 30 yrs. = 14.7% | Maslach Burnout Inventory Burnout defined as high DP, high EE, and low PA scores | Single question asked every 3 months, “Are you concerned that you have made any major medical errors in the last 3 months?” |