Resident Burnout on the Internal Medicine Ward

Abstract

Background: Burnout is common among medical trainees. Whether brief periods of training on the internal medicine ward leads to resident burnout is unknown.

Methods: A survey-based study was conducted at a single academic institution. Medical residents undertaking four-week rotations on the internal medicine ward were included. Burnout was measured at the beginning and end of each rotation using the Maslach Burnout Inventory - Human Services Survey. Burnout was defined as either an emotional exhaustion score of ≥ 27 or a depersonalization score of ≥ 10. Self-reported workplace conditions, behaviors and attitudes were recorded.

Results: The survey response rate was 71% and included 148 participants. The overall prevalence of burnout was 17% higher at the end of the rotation compared to the beginning of the rotation (71% vs. 54%; P < 0.001). Forty-three percent of residents without pre-rotation burnout developed post-rotation burnout. Residents with post-rotation burnout were more likely to report at least one suboptimal behavior or attitude related to patient care or professionalism (84% vs. 35%; P < 0.001). Respondents with new onset burnout were less likely to report being appreciated for their work, having their role as a learner emphasized, and receiving satisfactory support from allied healthcare professionals. New onset burnout was inversely associated with completing a second consecutive internal medicine ward rotation (adjusted OR 0.19; 95% CI, 0.04-0.90; P = 0.04).

Conclusion: Seven in ten residents are in a state of burnout after completing internal medicine ward rotations. Interventions to mitigate burnout development during periods of high intensity clinical training are needed.

Figure 1

Change in burnout status between pre- and post-rotation surveys, in respondents with paired pre- and post-rotation Maslach Burnout Inventory (MBI) scores.

Figure 2

Frequency of suboptimal self-reported patient care-related behaviors and professional attitudes, in respondents with versus without post-rotation burnout (N = 172); p ≤ 0.05*, p ≤ 0.01**, p ≤ 0.001***.