“Necessary Compromises”: A Qualitative Exploration of the Influence of Burnout on Resident Education

Abstract

Objective: Burnout is prevalent among resident physicians and has a negative impact on their well-being and effectiveness at work. How burnout shapes residents' educational experiences, attitudes, habits, and practices is not well understood. There is also a lack of research regarding self-identified mitigation strategies for residents. The authors qualitatively explored burnout's role in the educational experiences of resident physicians.Methods: Qualitative data were generated from a sample of 29 emergency medicine residents through four semistructured focus groups across four institutions in January and February 2019. The authors employed a constructivist approach to thematic analysis. Transcripts were coded and organized into major and minor themes.Results: Residents reported that a misalignment of their individual versus institutional priorities and a lack of agency were significant contributors to their burnout. Residents described how burnout affected multiple aspects of their education, including their motivation and curiosity to learn, engagement in scholarly activity, and teaching of others. Residents identified several ways of building a sense of community that they explained was most useful in mitigating their experiences with burnout. Conclusion:Burnout had a negative influence on many facets of residents' educational experiences during training. Program directors and educators can take resident-identified steps to moderate its detrimental role on trainee education.B urnout among resident physicians is prevalent 1,2 and has been attributed to high educational demands, long working hours, lack of autonomy, and a poor work-life balance. [3][4][5] Residents with burnout are less effective at work and have increased rates of substance abuse, alcohol consumption, and suicidality. 3,[6][7][8] The significance of burnout on resident education and training was reinforced by the Accreditation Council for Graduate Medical Education's (ACGME) release of new standards that require residency programs to monitor burnout and establish wellness initiatives. 9

“Pulling the Parachute”: A Qualitative Study of Burnout’s Influence on Emergency Medicine Resident Career Choices

“…The proportions of male and female residents in our sample were similar to those in a 2018 to 2019 national sample of active EM residents 28 . Over half of our participants (18, 62.1%) reported high scores on the depersonalization or emotional exhaustion subscales of the MBI as previously reported 20 . The majority (18, 62.1%) disclosed educational debts greater than $100,000, including many (12, 41.3%) with debts greater than $200,000.…”

“…Similar to what we reported previously, 20 there were several limitations to our study. First, our sample consisted of only EM residents, albeit from four geographically diverse sites and from 3‐ and 4‐year programs.…”

“…Twenty‐nine EM residents participated in four focus groups (numbers of participants ranged from seven to eight per group) that lasted 80 to 90 minutes. Characteristics of the participants have been presented elsewhere 20 and are summarized in Table 2. The proportions of male and female residents in our sample were similar to those in a 2018 to 2019 national sample of active EM residents 28 .…”

“…We performed a qualitative study to investigate the role of burnout in multiple aspects of resident education and training. Prior work from the same study examining burnout’s impact on residents’ educational experiences, attitudes, and practices has been previously described 20 . We focused specifically on burnout’s influence on residents’ career decisions in this paper.…”

“…We used the constant comparative approach to conduct thematic analysis of the study data 26,27 . Details of the analytic process have been previously described 20 . Steps taken to increase the trustworthiness of our findings are detailed in Table 1.…”