Burnout Levels and Patterns in Postgraduate Medical Trainees: A Systematic Review and Meta-Analysis

Abstract

Purpose Postgraduate medical trainees experience high rates of burnout; however, inconsistencies in definitions of burnout characterize this literature. The authors conducted a systematic review and meta-analysis examining burnout levels and patterns in postgraduate medical trainees, using a continuous conceptualization of burnout, consistent with the Maslach Burnout Inventory (MBI) framework. Method The authors searched 5 electronic databases (Cochrane Library, Embase, ERIC, Ovid MEDLINE, Ovid PsycINFO) between January 1981 and July 2019 for studies reporting postgraduate medical trainees’ burnout levels using the MBI-Human Services Survey. They examined study reporting quality using the QualSyst quality appraisal tool and calculated standardized mean differences (Hedges’ g), comparing trainees’ data with MBI norms for medicine and the overall population using a random effects model. They explored between-study heterogeneity using subgroup analyses (i.e., by training level and specialty). Finally, they studied the combined contribution of these 2 variables (and year of study publication) to burnout levels, using meta-regression. Results The authors identified 2,978 citations and included 89 independent studies in their review. They pooled the data for the 18,509 postgraduate trainees included in these studies for the meta-analyses. Reporting quality was generally high across the included studies. The meta-analyses revealed higher burnout levels among trainees compared with medicine and overall population norms, particularly for the depersonalization subscale. The authors also identified statistically significant differences between nonsurgical and surgical registrars (specialty trainees), with trainees from 12 individual specialties exhibiting unique burnout patterns. Conclusions There is a need to reduce and prevent burnout early in medical training. Given the differences in burnout levels and patterns across specialties, interventions must focus on the unique patterns exhibited by each specialty in the target population using a multidimensional approach. Standardizing the definition of burnout in accordance with the MBI framework will facilitate progression of this work.

Burnout in Surgical Trainees: a Narrative Review of Trends, Contributors, Consequences and Possible Interventions

“…However, specialising in surgery is also associated with high levels of burnout, the psychological syndrome characterised by feelings of emotional exhaustion and disengagement or ‘depersonalisation’ [ 7 ]. Evidence from a recent systematic review and meta-analysis of 89 independent studies indicates that surgical trainees report higher levels of burnout than their non-surgical peers [ 8 ]. This has also been found in a study in India, where surgical residents scored significantly higher than anaesthesia residents on several burnout indicators relating to neglect of personal needs [ 9 ].…”

Shifting Focus from Burnout and Wellness toward Individual and Organizational Resilience

“…Within the marked heterogeneity of assessment instruments, even the most commonly used Maslach Burnout Inventory (MBI) yields frequencies of burnout ranging from 0% to 85% depending on which of the three major subscales are used to define this multi-dimensional construct. 17 Such dramatic ranges of reported burnout-dependent on the measurement tool used-challenge understanding of what being "burned out" might mean as well as the benefit of any specific intervention.…”

“…As illustrated in a recent meta-analysis of nearly 3000 citations, involving over 18,000 residents in 12 individual specialties, the combined subscales of emotional exhaustion and depersonalization were more important for surgical specialties, depersonalization and personal accomplishment were more important for non-surgical residencies, and low personal accomplishment-often omitted from studies using the MBI-was particularly important to the specialties of anesthesiology and psychiatry. 17 The inconsistency of reporting all three subscales creates difficulty for those who are trying to gauge differences across time, studies, and specialties. It also creates challenges to understanding the relationship between burnout and other mental health concerns such as depression, suicidality, and suicide.…”

Does teaching Optimism lower Burnout in residency training– a pilot study

“…Over the past decade, U.S. physician burnout rates have ranged from 40–54%[ 1 ], with rates greater than 50% documented among residents[ 2 ]. Trainee burnout exceeds other medical professionals, as well as the overall population [ 1 , 3 ]. Burnout is insidious and once established tends to be persistent and possibly even contagious to peers[ 4 ].…”