Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment

Abstract

Background: Burnout is a common problem among physicians and physicians-in-training. The Maslach Burnout Inventory (MBI) is the gold standard for burnout assessment, but the length of this well-validated 22-item instrument can limit its feasibility for survey research.

Objective: To evaluate the concurrent validity of two questions relative to the full MBI for measuring the association of burnout with published outcomes. DESIGN, PARTICIPANTS, AND MAIN MEASURES: The single questions "I feel burned out from my work" and "I have become more callous toward people since I took this job," representing the emotional exhaustion and depersonalization domains of burnout, respectively, were evaluated in published studies of medical students, internal medicine residents, and practicing surgeons. We compared predictive models for the association of each question, versus the full MBI, using longitudinal data on burnout and suicidality from 2006 and 2007 for 858 medical students at five United States medical schools, cross-sectional data on burnout and serious thoughts of dropping out of medical school from 2007 for 2222 medical students at seven United States medical schools, and cross-sectional data on burnout and unprofessional attitudes and behaviors from 2009 for 2566 medical students at seven United States medical schools. We also assessed results for longitudinal data on burnout and perceived major medical errors from 2003 to 2009 for 321 Mayo Clinic Rochester internal medicine residents and cross-sectional data on burnout and both perceived major medical errors and suicidality from 2008 for 7,905 respondents to a national survey of members of the American College of Surgeons.

Key results: Point estimates of effect for models based on the single-item measures were uniformly consistent with those reported for models based on the full MBI. The single-item measures of emotional exhaustion and depersonalization exhibited strong associations with each published outcome (all p ≤ 0.008). No conclusion regarding the relationship between burnout and any outcome variable was altered by the use of the single-item measures rather than the full MBI.

Conclusions: Relative to the full MBI, single-item measures of emotional exhaustion and depersonalization exhibit strong and consistent associations with key outcomes in medical students, internal medicine residents, and practicing surgeons.

Figure 1.

Association of the (A) continuous.^* and (B) dichotomized^† single-item measure of emotional exhaustion with outcomes. *Columns within each outcome indicate rate as emotional exhaustion single-item measure ranges from 0 (Never) to 6 (Daily), read from left to right. ^†Columns within each outcome indicate rate for emotional exhaustion single-item measure categorized in green as “less than once weekly” (not high) and in red as “weekly or more often” (high).

Figure 2.

Association of the (A) continuous^* and (B) dichotomized^† single-item measure of depersonalization with outcomes. *Columns within each outcome indicate rate as depersonalization single-item measure ranges from 0 (Never) to 6 (Daily), read from left to right. ^†Columns within each outcome indicate rate for depersonalization single-item measure categorized in green as “less than once weekly” (not high) and in red as “weekly or more often” (high).