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Table 1 Description of the Studies

From: The relationship between resident burnout and safety-related and acceptability-related quality of healthcare: a systematic literature review

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?”