Is there an elephant in the Room? Burnout in orthopaedic training: A scoping review

Abstract

Background: Burnout is a growing concern among orthopaedic residents, with numerous studies reporting high prevalence rates. It impacts both mental and physical well-being and typically manifests as emotional exhaustion, depersonalisation, and a reduced sense of personal accomplishment. The medical culture of perseverance often obscures recognition of these issues, leading to underreporting and insufficient support. Burnout not only affects the health of residents but also poses significant risks to patient safety and care quality. This review explores the contributing factors to burnout among orthopaedic residents and evaluates strategies for its prevention and management.

Methods: comprehensive search was conducted across PubMed, Scopus, Medline and Web of Science from 2015 to 2025, using a combination of keywords, including 'Orthopaedic', 'Orthopaedic surgeon', 'Orthopaedic resident', 'Burnout', and 'Burnout prevention'. Studies were selected based on specific inclusion criteria. This included peer-reviewed articles addressing burnout prevalence, causes, and prevention strategies in orthopaedic residents. Systematic reviews, randomized controlled trials (RCT), cross-sectional studies, and pilot studies were included. Narrative reviews and commentaries were also incorporated due to the limited availability of studies to provide context and synthesise broader perspectives on burnout and resilience. Studies that showed no relevance to orthopaedics were removed. Two independent reviewers assessed the studies. A thematic analysis was performed on the identified studies to synthesise common management strategies.

Results: The review identified 69 studies that met the search criteria discussing burnout in orthopaedic residents. These studies highlighted key factors influencing burnout, which were categorized into three domains: work life, personal aspects and home life. There were limited studies on strategies to prevent burnout in orthopaedic residents, specifically with only 2 studies. Individual-level strategies, such as resilience and mindfulness training, show promise in reducing burnout. Organisational changes were also emphasized; however, there were no studies specifically addressing this.

Conclusion: To address burnout, individual-level strategies such as mindfulness and resilience training show promise; however, sustainable change requires structural reforms including workload redistribution and supportive leadership. Future research should prioritise high-quality, orthopaedic-specific studies, particularly multicentre RCTs to evaluate the feasibility and effectiveness of these strategies. A comprehensive approach addressing both individual and organisational factors is essential to improve resident well-being and maintain high standards in orthopaedic training and care.

Keywords: Burnout; Medical education; Medical students; Orthopaedics; Professional-level training; Wellbeing.